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At Community Health Options, we’re Members and patients, too

Nov 03, 2023
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We recently sat down with David Stuart, senior vice president and chief operations officer at Community Health Options, to talk about why it’s important for companies to find health insurance partners that can facilitate access to health and wellness resources to help their employees thrive. Here’s what he had to say.

Q: What should a Maine-based company look for in a health insurance carrier?

A: Employers need health and wellness benefits that help employees and their families through each stage of life so they can get the care they need when and where they need it. The best partner shares a dedication to well-being and removes barriers to care, particularly for complex issues. Employers should expect that an insurer always has their best interest in mind, providing flexible, nimble world-class service, alongside specialized care teams who excel at finding providers and resources to help overcome the challenges of getting care throughout Maine, especially in rural areas.  

Q: How should an employer evaluate the trade-off between the cost of premiums and coverage benefits?  

A: It's important to provide high-quality benefits backed with excellent service as part of a total compensation package for current and future employees. Attracting and retaining talented people is a challenge felt everywhere, and it often means foregoing the lowest-cost, bargain benefits. Employees can thrive when they have access to wellness resources, along with caring and meaningful help through life's challenges from people who are right here in Maine. That's where Community Health Options comes in—as a long-term partner committed to managing the overall costs of benefits and lowering out-of-pocket costs for Members.

Q: Why are collaborative insurer-provider relationships important? Isn’t it most important that insurers just make sure claims are paid? 

A: Providers are truly our partners as we seek to lower our Members’ healthcare costs without creating hurdles that make it harder to deliver the best patient care experience and improved health outcomes. Our care managers, for instance, can help ease a mother’s mind by finding behavioral health resources for a teenage son in crisis, or work with a cancer patient’s provider to coordinate chemotherapy treatments, often saving thousands on medications. And sometimes our teams find ways to provide more care—not less. We know how important this is because we're Members and patients, too.

Q: What’s the value in forming a long-term partnership with a health insurer?

A: A long-term partnership with an insurer that is invested in the well-being of a company’s employees and understands the resources available in their neighborhoods gives employers the opportunity to truly support their employees through life's journey. That begins with wellness, along with preventive and routine care, and continues with easy access to urgent care options when "life happens," and ongoing care to manage chronic conditions. Community Health Options offers great examples of that value through its infusion therapy support and Chronic Illness Support Program, along with a top-tier wellness platform.

Q: Why should a company consider working with Community Health Options?

A: Simply put, we put our Members at the center of everything we do. That’s a fundamental tenet of our business as a nonprofit. All our effort is focused on making things better for our business clients and Members. We truly are a Maine company—100 percent of our service team lives here—and when businesses partner with us, they are investing in Maine just like we do every day.

David Stuart, vice president and chief operations officer, has more than two decades of experience in the healthcare industry, holding roles in payer and provider organizations across Northern New England. His operations experience spans across enrollment and eligibility, quality audit, claims and configuration, service centers (Member, provider, broker, group administrator), payer and patient billing, and practice management, all with a strong focus on developing and leading teams. He holds an MBA and a Master of Science in Organizational Leadership from Southern New Hampshire University, and a BS in Business Administration from the University of Maine at Augusta.

*This article also appeared as sponsored content in Mainebiz on Oct. 30.

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You think you’re all set, but then the doctor says, “We’ll call you to set up an appointment after we get prior approval from your insurance company.”

Wait. What? You think, “I can barely stand up and now I have to go through this red tape?”

Yes, you probably do.