Guest Blog: Lumeris’ Population Health Effectiveness: Essence Healthcare Achieves 4.5-Star Rating

Since our formation more than a decade ago by a group of local doctors, Essence Healthcare has worked side by side with doctors to provide comprehensive and affordable health insurance to over 40,000 people with Medicare in Missouri and southern Illinois. We are honored to receive the 4.5 star rating for a fourth year in a row. The Medicare Five-Star Quality Rating system rated our plan on a scale of one to five stars, which is based on more than 50 care and service-quality measures including staying healthy, managing chronic conditions, customer services, pharmacy services and member satisfaction from CMS.

Essence Healthcare’s trusted collaborator Lumeris, the leader in creating population health services organizations, has been there to help us through our care-coordination journey helping our organization achieve high-rated operational success by optimizing operations for population health and shared risk-adjusted services.

Together, Essence Healthcare and Lumeris, along with the physicians have designed, built and operated a value-based health plan that continues to achieve risk-adjusted outcomes through proven population health services that drive clinical and financial excellence. Today, we work with the healthcare network of PCPs to make improved, value-based care decisions through actionable patient and population health data to recognize opportunities to close gaps in care.

Lumeris’ health plan operations and population health services models have significantly decreased potentially preventable readmissions, and reduced overall costs 30 percent when compared to fee-for-service Medicare. In addition, more than 97 percent of Essence Healthcare patients are seen annually and more than 80 percent of the network providers consistently rate they are satisfied with their collaborative payer partner.

Staying true to those principles every day, we are committed to protecting the health and wellness of people with Medicare by providing all-in-one coverage that includes hospital, medical and prescription drug coverage as well as valuable extra benefits and financial protection not offered by traditional Medicare plans. We look forward to helping many more providers optimize clinical and financial outcomes.