Kevin Lewis is CEO of Maine Community Health Options, a not-for-profit, consumer-governed health insurer established through loans authorized by the Affordable Care Act. The Maine plan was the only co-op plan in the country that recorded a positive margin through the first nine months of 2014. Lewis previously served as CEO at the Maine Primary Care Association, representing community health centers, and as director of continuing care at the Maine Hospital Association. Modern Healthcare reporter Bob Herman recently spoke with Lewis about why his plan has been in the black while other co-op plans have lost money, building a provider network, and what will happen if the U.S. Supreme Court strikes down the ACA premium subsidies. This is an edited transcript.
Modern Healthcare: How has the 2015 open enrollment gone compared with 2014?
Kevin Lewis: It has been a lot smoother. We saw significant growth in our membership. We are up above 71,000 now, spread across our two states, Maine and New Hampshire.
MH: How did your plan do financially through all of 2014?
Lewis: We were in the black in all four quarters. We ended the year with a net surplus position, and we're looking at 2015 in the same manner.
MH: What has your plan done differently from other co-op plans?
Lewis: One thing we found to be crucial to our first year was being as close to the members as we could in terms of having the call center in-house. We found it essential to have that call center within our four walls so we could be close to the friction points where there were service issues and address them quickly.
We built our own proprietary provider network. That allows us better rates as well as direct relationships with the providers. And we didn't price with the ACA risk corridors or risk adjustment in mind. We priced according to what we thought was a sufficient amount of premium to cover claims and our administrative load.
MH: What is it like working with a consumer-governed board?
Lewis: We have roughly eight member directors and seven nonmember directors. It has been wonderful because of the caliber of the candidates who stepped forward to be directors. They have a passion for the mission, and they drive a discussion that yields the best results. So we as senior management are accountable in a very direct way to the membership, not only in terms of what we offer in our benefits and the results in terms of enrollment, but on a month-to-month, even day-to-day discussion with our board.
MH: Do you get a lot of feedback from them in terms of benefit design and provider networks? Has that been helpful?
Lewis: Absolutely, it has been helpful. It builds our strength and challenges us to ensure that we have all of the considerations in hand before making decisions.
MH: How were you able to bargain with hospitals and doctors over rates without having size or brand recognition?
Lewis: We didn't look at it as bargaining. We went out to the field to have the conversations with hospitals, community health centers and providers as to what the relationship from their viewpoint would look like in a successful payer-provider-patient triangle. And that was well-received. Providers better understood our mission and why we were coming to the market. Providers also value the additional choice we are offering the market.