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W W W. M A I N E B I Z . B I Z 21 O C T O B E R 5 , 2 0 1 5 customers and which uses its profi ts to lower future premium prices, enrich benefi ts and improve the health of its members by removing the fi nancial barriers — could off er more choice for consumers and greater competition in the marketplace. "Apart from achieving some of our goals on the macro-level, what continues to drive us are the pow- erful anecdotes we hear each and every day of the many ways we're improving the lives of our mem- bers," says Lewis, who previously served as CEO of the nonprofi t Maine Primary Care Association. A graduate of the master of public policy program at the University of Michigan and the Johnson & Johnson Health Care Executive Program at UCLA, Lewis embraces the value-based insurance design approach to health care. Instead of a "one size fi ts all" approach to health insurance copayments, which makes no distinction between high-value and low-value prescriptions or health care procedures, VBID uses no, or low, copayments to encourage the use of medi- cines or procedures with proven health benefi ts. In eff ect, a health insurer following the VBID approach creates incentives that encourage people to become more savvy and engaged in their own health care. Lewis found a ready ally in Hillman, who brings 23 years of health care experience to his position as Community Health Options' COO. As the former CEO of Medical Network Inc. (MedNet), Maine's largest independent, physician-owned-and-directed preferred provider organization, Hillman had directed and supported "third-party administra- tor" services to self-funded employers. Like Lewis, he had become frustrated by what he saw as a "lack of trust between payers and providers" that was coupled with rising costs and less-than-optimum health for the insured customers. Hillman says the opportunity provided by the ACA to create a consumer-operated and -oriented health insurance company was serendipitous for him. "Everything aligned at the right time," he says. "It gave us the opportunity to create what already was the answer in both of our minds to the ques- tion, 'How can we do [health care] diff erently?'" ey have complementary skills. Lewis describes himself as a "pretty decent writer and conveyor of ideas" whose instinctive response to barriers is to ask himself, "What can I do to overcome the barrier?" Hillman sees himself as being "very good at opera- tions" and having "the ability to see the solution while we're talking about the problem." eir combined skills, knowledge of Maine's health care challenges and established relationships with key stakeholders were key to Community Health Options' quick start out of the gate after being named in March 2012 as one of the ACA's fi rst CO-OP recipients, receiving a $62.1 million loan from the federal Centers for Medicare & Medicaid Services to start the company. When approval came through, they'd already received commitments from physicians and hospitals giving them a statewide network of providers — an essential element of their early success in the fi rst year of the ACA's marketplace in Maine. "When you put together the wealth of relationships both of us already had in Maine, it allowed us to engage the people at the highest levels that we needed to speak with in order to build our network," Hillman says. " e quality of your network is a huge part of any insurance company's success." Located on the third fl oor of Storehouse No. 2 within Lewiston's historic Bates Mill complex, Community Health Options has become a $168 million company with 182 employees in less than fi ve years. It's adding choice, competition and price stability in a vari- ety of health insurance plans to individuals and groups, both on and off the ACA marketplace. In the current year, its premium prices for individuals dropped 0.8% and by 10% for small groups. Going into the 2016 open enrollment period, Lewis says its individual rates will increase by 0.5% and for small groups by just under 4%. "We're smack dab in the middle of insurance reform," says Hillman. " at's what keeps me going: It's really exciting stuff ." JameS MCCartHY, Mainebiz senior writer, can be reached at JmCCartHY @ mainebiz.biz and @ JameSMainebiz Community Health Options (formerly Maine Community Health Options) 150 Mill St., Lewiston Founded: 2011 Services: A nonprofit, member-led health insurance company providing comprehensive health insurance benefits to individuals, families and businesses in Maine and New Hampshire. CEO: Kevin Lewis COO: Robert Hillman Employees: 182 Revenues: $168 million (2014) Contact: 855-624-6463 www.healthoptions.org 800.777.5244 www.TalkWithNorton.com Specialists in business insurance and employee benefits. Talk with Norton. MAXIMIZE THE REWARDS. Minimize The Risk. Cyber Liability Workers' Compensation Property & Casualty

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