LUMERIS_GEN.WMLD.01-16v1

LUMERIS_GEN.WMLD.01-16v1

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  Based on morethan 10 years’ experience providing population health management services for Essence Healthcare, a 5-Star (2016 plan year)* MA plan with over 50,000 members, Lumeris understands that it takes more than technology to manage accountable care and achieve remarkably improved outcomes. At Lumeris, we help clients work collaboratively with providers in value-based arrangements, and we have identified 22 core competencies in four main areas of concentration: Consumer & Provider Engagement; Enhanced Care Delivery; Operational Excellence; and Business Model Alignment. Mastering these four areas is critical to building and operating what we call Population Health Services Organizations (PHSOs). Lumeris’ model focuses on the wellness of patients and fosters stewardship of healthcare resources in pursuit of the Triple Aim Plus One: better health outcomes, lower costs and improved patient experience plus physician satisfaction. • Health Systems: We help health systems create PHSOs and define populations for risk. We help them build the foundation to become their own payer, establish risk-bearing arrangements, and share in the value created by these contracts. • Provider Groups: We empower providers and their Accountable Care Teams (ACTs) with process improvement strategies, technology and clinical workflows so they can achieve better contract performance, share in maximum incentives and deliver high-quality care. • Payers: We work collaboratively with payers to ensure the right contracts, measures and incentives are in place to influence physician behavior and drive quality, cost and utilization performance. Lumeris engages and trains providers in appropriate strategies and tactics for delivering better care, improving the health of populations We enable PHSOs by helping clients adapt their business and care delivery models to improve financial and clinical outcomes: Value-based Expertise • Over a decade of experience successfully managing population health and value-based contracts for healthcare organizations; • Results-driven as evidenced by achieving 5 Stars for the 2016 plan year (and 4.5 Stars the previous four years) for our client, Essence Healthcare; and • Solutions are payer agnostic and payer neutral. Proven Methodology • Identified 22 core competencies needed to manage high-performing PHSOs; • Prescriptive approach to developing/cultivating physician and Accountable Care Team behaviors and workflows to manage risk-based contracts; and • Local, in-market support to drive adoption and value-based performance. Flexible Business Model • Customized solutions and pricing that align with our clients’ goals and outcomes; and • Multi-payer, multi-population solution platform. Enabling Technology • Cloud-based technology purpose-built to manage population health; • Integrates clinical and financial data from disparate systems; and • Provides complete visibility to patient care and actionable insights to manage performance. WhatMakesLumerisDifferent and reducing per-capita costs. To do this, we have created our own proprietary model, based on Essence Healthcare’s success, that helps providers understand their risk and behaviors that should be adopted for healthcare to move from a volume- to value-based model. This model also incorporates a consumer-centric solution that engages patients so they can become more active participants in their own care; make better, more informed decisions; interact innovatively with their ACT; improve care-plan compliance; and close gaps in care. To provide a 360-degree view of patients at the point of care, the Lumeris Accountable Delivery System Platform (ADSP)® was purpose-built for population health management. The cloud based system allows providers, payers and executives to provide actionable intelligence on clinical and financial data to enable timely, value-based healthcare decisions. Some features of the ADSP are: • Aggregates and analyzes data from across the continuum of care (EMR encounter data, claims, pharmacy, lab and other data) • Rationalizes data to establish a unified, accurate view of patient care and population health • Mines data for clinical and financial improvement opportunities • Sends actionable clinical and financial intelligence. 1.888.586.3747 • Lumeris.com©2016 Lumeris Confidential and Proprietary *Plan performance Star ratings are assessed each year and may change from one year to the next.
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  To learn more,call 1.888.586.3747 or visit Lumeris.com Lumeris’ Board of Directors • Mike Long, Chairman and Chief Executive Officer, Essence Group Holdings Corporation and Lumeris Corporation • John Burbank, Managing Member and Chief Investment Officer, Passport Capital • Denis A. Cortese, MD, President and Chief Executive Officer Emeritus, Mayo Clinic Director, Health Care Delivery and Policy Program, Arizona State University • L. John Doerr, Partner, Kleiner Perkins Caufield & Byers • Matt Downs, Managing Director, Sandbox Industries • Christopher W. Kersey, MD, MBA, Managing Member, Camden Partners • John H. Rice, MD, Executive Vice President and Chief Medical Officer, Esse Health Value-Based Populations Medicare Advantage • Roughly 200,000 lives under mgmt. Commercial • Roughly 500,000 lives under mgmt. Self-Insured Employee • Roughly 55,000 lives under mgmt. MSSP ACO • Two successful MSSP applications • Roughly 20k lives Health Systems Built a PHSO for a $500M community health system managing full risk and SS contracts Designed and deployed Care Management and technology for $800M health system to support P4Q and SS contracts Clinically integrating a seven hospital, 200 site, 2,100 physician health system to perform on value-based contracts Provider Alliances Built a PHSO for an alliance with 3 health systems and over 200 independent physicians Delivered PHSO services for large regional IPA to improve performance on value-based contracts Built a PHSO for 300+ independent PCPs managing full-risk Medicare Advantage contracts Payers Delivering PHSO services for multiple health plans starting Medicare Advantage offerings Providing technology and services to support a large regional payer’s accountable provider strategy Providing EMR integration and Risk Adjustment services for large regional payer Current Client Engagements GEN.WMLD.01-16.v1 Proven Outcomes As a result of our outstanding solutions, we have been able to achieve: • 5 Stars for the 2016 plan year, and 4.5 Stars the previous four years; • Nearly 70 percent MCR before surplus distribution of physician quality-based compensation; • 30 percent reduction in costs and 18 percent reduction in readmission rate compared to FFS Medicare; • Largest, in-region market share for four years; and • Over 80 percent of providers consistently rate that they are satisfied with their collaborative payer partner.