Maine Community Health Options (MCHO) has licensed solutions and care guidelines from MCG to support member care management. MCG (part of theHearst Health network) is a leading provider of care guidance to health plan and provider markets.
Built on a foundation of evidence-based, globally sourced medical literature, MCG clinical content provides consistent guidance for medical necessity review across our broad healthcare network,” said Dr. John Yindra, MCHO’s Chief Medical Officer. “At the same time, MCG care guidelines account for the unique circumstances of our individual members – especially with regard to comorbid conditions and psychosocial barriers.”
With $68 million in recent Centers for Medicare and Medicaid Services (CMS) financing, MCHO continues to expand its healthcare network and membership. The MCHO medical services team will use MCG CareWebQI® decision support software and care guidelines to improve communication with its growing network of providers, leading to a streamlined prior authorization process and improved care management for an increasingly diverse membership.
“When conversations between health plan and provider start with the same evidence,” Yindra said, “clinical decision-making improves and the whole system benefits: Provider satisfaction increases, patient outcomes improve and administrative costs are held in check.”
MCHO began providing coverage in Maine in 2014 and now offers plans in New Hampshire, as well. Created under the Affordable Care Act’s Consumer Operated and Oriented Plan (CO-OP) Program, the health plan offers health insurance in the individual and group markets in Maine and New Hampshire.
“In a highly competitive industry, MCHO’s focus on high-value care has led to sustained growth as well as recognition by CMS and the National Committee for Quality Assurance,” said Jon Shreve, president of MCG. “I believe that CO-OPs have become an important element in the country’s healthcare landscape. We are pleased to join with them in the effort to improve healthcare quality MCHO licenses MCG CareWebQI and care guidelines for ambulatory care, National Committee for Quality Assuranceand chronic care. MCHO also licenses MCG patient information to support member self-care.evidence-based, globally sourced medical literature
