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Helping health systems navigate the ever-evolving healthcare landscape is Lumeris, a technology-powered value-based care services operator. The company enables health systems to deliver exceptional value-based care successfully through its market-leading population health solution, the Population Health Services Organization (PHSO). “We are leveraging technology to optimize population health management under value-based care models. Our company is transforming the payer-provider-patient space and optimizing the contract management processes to operate with efficiency, align to value, and engage physicians to produce better patient outcomes,” states Richard Jones, Essence President and Board Member at Lumeris.
In conversation with CIO Applications, Jones and Jean- Claude Saghbini, the CTO at Lumeris, mention how the company is helping health systems and physicians achieve value-based care utilizing one of the industry’s most advanced technology backbones, coupled with proven playbooks and processes to operate at scale.
What were the factors that led to the genesis of Lumeris?
Jones: Several years ago, Essence Healthcare, a Lumeris-operated Medicare Advantage plan, was the first stepping stone for making Lumeris what it is today. Lumeris offers a holistic and scaled solution to manage outcomes for Medicare, Medicaid, and commercial populations. We developed the Lumeris model in 2007 to enable a new partnership founded on data sharing and the creation of new processes around a collaborative payer-provider contract. We have created shared goals for both insurance companies and physicians to facilitate better outcomes, higher quality, more transparency, and interactive relationships with the patients. Since then, we have scaled up the model and operated it at a consistently high-performance level, which, in turn, helped us receive the coveted CMS 5-STAR rating in terms of quality and outcomes for our Medicare Advantage plan.
In doing so, we have essentially developed and executed a robust collaborative process of sharing information. For example, rather than having either siloed data or a dearth of unusable data between payers and providers, our model synthesizes all data into a crisp set of actionable insights that can be expressed at the right point in the workflow and that inform and guide the physician-patient interactions towards the best outcome and quality, while reducing the underlying costs of service. Over 15 years, we have expanded the footprint of our PHSO solution from a single location and partnered with multiple health systems across the country. Once our model took off, we started developing it further and refining it to align with various market particulars and evolving needs and help our health system partners achieve positive outcomes.
Please elaborate on the solution you have in place.
Saghbini: What we put forth is a three-part solution that we refer to as our PHSO offering — the population health management playbook, a services offerings powered by technology, and a world-class technology stack.
Our population health management playbook has continued evolving over the course of a decade and has been tuned and optimized with consistently proven results.
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.
Our company is transforming the payer-provider-patient space and optimizing the contract management processes to operate with efficiency, align to value, and engage physicians to produce better patient outcomes
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.