MaineSense, an innovative group health option

By George Lincoln | Apr 26, 2014

Did you realize that there can be a 20 times cost differential in something as basic as a lipid panel (blood workup) when you have a routine physical? How about something fairly common such as an MRI? The cost can swing as much as 2 to 4 times based on something as simple as the time of day that you have it performed!  Did you realize that the majority of health claims that get submitted to your insurance company are auto adjudicated (processed by computers), and 80% of medicals bills contain errors?


The simple reality is that health care costs are extremely high, vary dramatically, and are paid through a complex and inefficient billing system that translates to all of us paying more for health insurance.


If you are a business owner,  you might feel a sense of frustration over the cost increases that you face each year combined with the inability to play any part in improving your work forces overall health and well-being. MaineSense is breathing some fresh air into this dilemma and has proven to be an innovative alternative to traditional health insurance options.


MaineSense is an employer-owned captive group health insurance program. What that means, is that you own a stake and your costs for the program are covered by you and the other employers who belong to the captive. The benefit of this ownership is that you and other like-minded business owners now have a say in how your groups health plan performs.  It presents an opportunity to leverage the collective buying power of many employers to bring rationality and value into the health care equation.


MaineSense is also an opportunity for participating employers to share best practices to help improve employee health and lower overall medical costs.  MaineSense stresses prevention and wellness and fosters a “member helping member” environment with member committees working collaboratively to improve the program.


Realizing that MaineSense isn’t a perfect fit for every business, I am often asked why choose MaineSense over a traditional insurance plan. My response is typically “do you want to change the existing health care system and are you ready to stand with like-minded employers and put your shoulder against the wheel?” This is a progressive employer’s option to have more control over your group’s health plan and also engage employees in improving their health and make them better consumers of health care. This is also a program based in Maine and run by Maine people, so when you call the advocacy hotline with a question or urgent issue, there is a local person ready to help.


Currently there are roughly 50 diverse businesses in MaineSense which translates into close to 4,700 covered employees and dependents. That number is growing as more and more businesses of all sizes are hearing about this alternative.


An ownership model will not be a fit for every company but in this challenging health insurance environment, you should certainly have the benefit of knowing about an innovative program like MaineSense.


George Lincoln

National Worksite Benefit Group


Comments (1)
Posted by: Victoria Bucklin | May 05, 2014 10:07

Mr. Lincoln, congratulations on being part of the solution to affordable medical care in Maine. It is not health insurance that needs fixing, it is the cost of medical care itself. Until there is more transparency in what is being charged by various health providers and a free-market approach, we will be at the mercy of opaque organizations and institutions whether they be large insurance companies or the federal government's Affordable Care Act. If our government spent it energies ensuring truly free markets, rather than controlling us, we could again return to a vibrant, expanding economy where each of us would have an opportunity to realize the "American dream".

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