Maine Community Health Options Partners with Valence Health to Support CO-OP Health Insurance Plan

Valence Health Contact:Brittany Cusick, 617-986-5833Media RelationsorMaine Community Health Options Contact:Robert Hillman, 207-402-3330

, a leading provider of clinical integration, population health and financial risk management solutions, today announced it was selected by the (MCHO) to provide operational support services and population health technology. MCHO was among the first (CO-OPs) approved for loans by the (CMS).

Created by the Affordable Care Act, are designed to give consumers and small businesses more health insurance choices, and will participate in states’ (or Exchanges). Today there are 24 CO-OP plans across the country, bringing innovative ideas, platforms, and business approaches to the traditional health insurance market.

“We’re very excited to partner with Valence Health to bring more insurance choices and better healthcare access to Maine,” said Robert Hillman, MCHO’s Chief Operating Officer. “We went through an extensive RFP and selection process, and chose Valence Health because they have a history of providing innovative organizations with operational and administrative services.”

CO-OPs will receive repayable loans to help them establish private, non-profit, consumer-governed health insurance companies. As consumer-directed organizations, CO-OPs are designed to be accountable to members and responsive to the specific healthcare needs of plan members by using profits to lower premiums, improve quality and expand benefits or enrollment.

“We’ve been providing risk analysis and operational services to leading healthcare organizations since 1996,” said Valence Health CEO Phil Kamp. “MCHO is a leading example for other innovative stakeholders in the market. Working together with clients like MCHO, we see a very real opportunity to help redefine and expand health insurance to better serve consumers across the nation.”

Under the agreement, Valence will provide MCHO with complete operational services including: medical management, medical-claims administration and customer service and data analytics. Additionally, MCHO will fully employ Valence Health’s population analytics platform, Vision. These solutions, used by dozens of Valence Health clients and several provider-sponsored health plans, will integrate health information for all MCHO members and identify clinical areas of opportunity to increase the quality of care. The cost and utilization module, which will also be deployed by MCHO, will provide clear understanding of the economic impact of providing better care – both for the patient member and the health plan.

The partnership between Valence Health and MCHO helps ensure that MCHO will be able to operationally comply with the deadlines established under the CMS CO-OP program. All CO-OP awardees are required to begin fielding inquiries from potential plan members by October 2013 and to begin servicing members by January 2014.

provides healthcare organization solutions for value-based care, helping them better manage their patient populations and accept financial responsibility for the quality of the care they provide. With unique data collection and analysis solutions, Valence Health has emerged as a leader in population management and clinical integration, serving dozens of clients from physician groups to standalone hospitals to large IDNs such as Cleveland Clinic. In-depth actuarial analysis combined with operational excellence allows Valence to not only advise but also provide ongoing services to provider organizations operating under various value-based reimbursement models. From risk-based contracting to accountable care organizations (ACOs) to administering provider-sponsored health plans, Valence has been helping providers appropriately accept and manage financial responsibility while improving clinical quality since 1996. Headquartered in Chicago, with three other office locations, Valence Health serves more than 30,000 physicians and 100 hospitals, helping them manage the health of over 15 million patients nationwide. Follow Valence Health on and .

Established under the Affordable Care Act, and funded in part by a loan from the Centers for Medicare and Medicaid Services, Maine Community Health Options (MCHO) is Maine’s first nonprofit, consumer operated and oriented health insurance plan (CO-OP). With an innovative culture and a goal to improve healthcare for all, MCHO is a member directed health insurance plan that partners with Maine residents, healthcare providers, and small businesses. Maine Community Health Options is a private, nonprofit entity governed by a member-based board of directors, which gives members a strong voice in the management and development of the plan. More information is available at .


Fuel Top Line Growth and Increase Membership

In this webinar, payers can learn how to accelerate the sales pipeline and grow membership across all health insurance market segments using comprehensive sales technologies.