To address the lack of affordable health care coverage alternatives in many state and regional markets, the Affordable Care Act includes provisions that facilitate the development of nonprofit, member-run insurance companies known as Consumer Operated and Oriented Plans (CO-OPs). Under the law, CO-OPs must operate with a strong consumer focus, and profits must be used to further their mission through lower premiums, improved benefits, or improved quality of care. A new Commonwealth Fund issue brief examines strategies that CO-OP organizers can use to build sufficient market share, create integrated provider networks, and achieve cost savings through provider payment reform.