Lumeris: Optimizing the Medicare Advantage/payer Space

This technology-driven playbook enables health systems with the execution tactics to optimize their move to value-based care, reducing costs through better patient outcomes driven by higher quality care and strengthening their market advantage. It provides the detailed processes and the structures that are needed to execute on them. But it is not a one-size-fits-all, and our years of experience in this space have given us the know-how and tools to help our health system partners fine tune the processes and adjust them to match their objectives and fit within the uniqueness of their constructs.

On the services side, we have an engagement model that enables the implementation of the Lumeris model playbook. We work hand-in-hand with our customers to derive and execute on mutually aligned objectives. We empower the patient-provider relationship so that it aligns closely with value-based care delivery. Our company works toward continuous improvements and integration of clinical and administrative functions into cohesive plans. We also enable scalability and efficiency in the provider-payer relationship through aligned incentives, data transparency, and continuous innovation.

The last vital component of our solution is our world-class tech stack. Our cloud-based technology is purpose-built to manage population health and risk-based contracts, including Medicare Advantage. It allows us to operate at scale. There are three technical pillars that are core to what we do. The first one is our data and operations platform that is foundational to ingesting and normalizing vast amounts of data from various sources and enabling key health system and health plan operations. The second pillar is our analytics and insights platform, Maestro. It is powered by advanced data science and A.I. capabilities and provides actionable insights to both administration as well as clinical users. Our insights, for example, include risk scores as well as classification and predictive models for patients’ clinical conditions that would guide them to the optimal care pathways. The third pillar is our patient-provider platform, MyPCP. It was built with the objective of activating patients and care providers towards a higher level of coordinated engagement. It includes an advanced orchestration engine that helps streamline the communication and activities between patients and care providers towards better health outcomes through more effective collaboration.

What are some of the unique aspects of Lumeris?

Saghbini: Our uniqueness comes from our approach to value-based care. We are empowering health systems with the tools they need to create the optimal patient-provider-payer relationship and enabling what is referred to as Quadruple Aim: Improving the health of populations through better outcomes, enhancing the experience of patients in their care journey, reducing the total cost of care, and improving the experience of the care providers. It goes to what I mentioned earlier, a combination of proven playbooks, services, and a tech-first approach in which we work side by side with our health system partners; this is our PHSO offering. Our technology profile is also key to our uniqueness. This interconnection of data and operational technology, data science and A.I.-based insights, and action-driving technology embedded in workflows and Electronic Health Records (EHRs) is a foundation to our services and to delivering rapid and measurable results to our customers.

Jones: Added to what Jean-Claude mentioned, we have our own Medicare Advantage (M.A.) plan, Essence Healthcare, which is one of the premier M.A. plans in the country, averaging a 4.5-STAR rating over the past decade. CMS recently announced the new star ratings, and Essence Healthcare achieved the highest rating of 5-STARS. Our PHSO offering is the technology that powers our M.A. plans, enabling us to better view the insights and processes that work and those that don’t. This provides us with the flexibility to quickly adjust and pivot as we continue to build on our playbook. At the same time, customers leverage the same deployed solution that we have successfully leveraged ourselves for our own M.A. plan, with the same advanced analytics and insights.

What do the future years look like for Lumeris?

Saghbini: From a technology standpoint, our key objective has always been to enable a higher quality of care at lower costs. To continue on this path, we will improve access to data sources and continue building more novel models for better insights. For example, we are looking to continue expanding on non-clinical data such as social determinants of health in our insights. Another major expansion angle for us is investing in our patient-provider digital connectivity with our MyPCP solution. Our goal is to create better connectivity between patients and providers through digital means, whether via text messaging, telehealth, emails, or phones, and meeting patients where they are in terms of communication modality preferences. We believe that technology investments sit at the forefront of what we are doing to continue advancing to the True North Star for our company.

Jones: We are also looking to expand the breadth of our solutions, reaching multiple populations and becoming more ubiquitous in working with health systems. Transforming and advancing healthcare in the United States is imperative and is core to our mission and to decisions and future investments we make.