Instead it got more than 40,000.
Today, the health insurance co-op has over 72,000 members, operates in two states and is considered one of the most successful insurance co-ops in the country.
And it did it by being different: Offering free care to people with chronic disease, providing case management and free or low-cost mental health care and maintaining relationships with doctors and hospitals throughout the state at a time when the insurer’s closest competitor was telling its clients they were limited in the doctors they could see.
“We took a risk in this approach of having a broad network that would accommodate the entire service area, allow people throughout the state to go to any hospital in network,” Lewis told more than a dozen audience members during Thursday’s Great Falls Forum at the Lewiston Public Library. “It’s been one of the hallmarks of our success.”
Lewis, CEO of Community Health Options, spent an hour speaking about the co-op’s approach to health insurance and its mission to improve health and provide benefits that are both high-quality and affordable.
“We’re going to fall apart at the seams in terms of our health care economy,” he said. “It’s not sustainable. It’s not sustainable for employers, it’s not sustainable for families and individuals. I bring this up because that is the impetus for our start.”
Lewiston-based Community Health Options, formerly Maine Community Health Options, formed in 2011 and began selling health insurance plans in fall 2013. It was a novel concept created by the Affordable Care Act. The nonprofit health insurance company is run by and for members.
With its low prices and statewide network of doctors and hospitals, Community Health Options immediately ruled the Affordable Care Act’s health insurance marketplace in Maine.
Community Health Options grew profitable while other co-ops around the country struggled to survive. It also lowered prices while other co-ops, and many traditional insurance companies, raised theirs.
With 25 percent of its members hovering close to the poverty line, it worked to educate members about their plan options and the government subsidies available to them so they didn’t pay more than they had to.
And with a number of its members dealing with chronic disease, such as diabetes, it worked to get people healthy by providing free care, testing and generic medications for a handful of chronic diseases.
“The advantage to us is increased medication adherence, because some of the worst health outcomes can occur when someone can’t afford medication and so they have an acute crisis and wind up in the hospital or are readmitted to the hospital,” Lewis said.
This fall marks Community Health Options’ third open enrollment period, the season when anyone can buy health insurance. The co-op will experience some changes, including premiums that will increase about half a percent and a greater number of plans that will include dental coverage for children.
It will also have new competition. Aetna will join the ACA marketplace in Maine for 2016.
Open enrollment starts Nov. 1. Lewis said he’d like to see people use that period to gauge their insurance needs and shop around, even if that means they decide Community Health Options isn’t their best option.
“We’d rather have people that are into coverage that is right for them,” he said.
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