• GUEST BLOG

    Guest Blog: Improving Quality through Patient and Provider Outreach

    // posted by Lea Craig

    Providers can become true managers of quality—and earn bonuses as part of value-based contracts—by making full use of data to close gaps in care as well as data transparency to benchmark their performance against their provider group and national peers. At Lumeris, our powerful technology solutions provide market differentiation for health systems and payers, especially in equipping their network of providers with the ability to stratify patients and populations for improved quality performance.

  • GUEST BLOG

    Guest Blog: Integrating Quality Management in Value-Based Contracts

    // posted by S. Troy McMullin

    How does an investment in quality deliver value for health systems, payers, providers, and patients? From government-led ACOs to commercial contracts, successful quality management begins with strategic assessments that pinpoint where to focus improvement efforts. At Lumeris, our proven approach optimizes quality metrics in any value-based care model.

  • GUEST BLOG

    Guest Blog: Advancing Clinical Performance with Strategic Quality Management

    // posted by John Khoury

    Delivering high-quality care is essential to succeeding in today’s evolving market. Well-chosen quality metrics and effective incentives in value-based contracts can lead to healthier populations by generating better clinical, operational and patient outcomes. Lumeris simplifies quality management for health systems, payers and providers.

  • GUEST BLOG

    Guest Blog: Success Managing Risk and Revenue with Prospective Health Assessments

    // posted by Terri Bellmore

    As the October 1, 2014 date for the conversion of the medical coding system from ICD-9 to ICD-10 grows closer, pressure is increasing for coders and physicians to quickly understand, implement and use the system.

  • GUEST BLOG

    Guest Blog: Sophomore to Freshman MSSPs: “Ready…Fire…Aim” Not a Good ACO Data Strategy

    // posted by Jim Hansen

    “The early lesson is that data is what makes [accountable care] possible.” Elliot Fisher, M.D., Dartmouth Institute for Health Policy and Clinical Practice As we begin to absorb the public results announcements and comments for CMS MSSP entities that have been operating for over a year, and for ...

  • GUEST BLOG

    Guest Blog: Automated Reporting: Helping Make Timely and Critical Decisions

    // posted by Eric Mueller

    Reports, dashboards, analytics, and workflow all serve as essential parts in achieving the Triple Aim Plus One: better health outcomes, lower costs and improved patient plus physician satisfaction.

  • GUEST BLOG

    Guest Blog: Better Care at Lower Cost for People with Multiple Health and Social Needs

    // posted by Dr. Deborah Robin

    In my role at Lumeris I often get asked by our clients, “What does care management really mean?” For me, having spent decades practicing geriatric medicine and teaching the principles of post-acute care coordination at a private research university and medical center, care management can be defined, most completely, as better care at lower cost for people with multiple health and social needs.

  • GUEST BLOG

    Guest Blog: Clinical Data Integration: The First Step Toward Value-Based Care and Achieving the Triple Aim Plus One

    // posted by Keith Blankenship

    “Big data” has become a big, intimidating buzz phrase in health care. Health systems and provider groups are all trying to collect large amounts of clinical data, make it meaningful, and according to the American Hospital Association, use it to “facilitate the coordination of patient care across conditions, providers, settings, and time.” While collecting clinical data is a natural first step on the road to value-based care, the integration of that data is often complex, costly and time consuming.

  • GUEST BLOG

    Guest Blog: Managing Risk and Revenue in the Health Insurance Marketplace

    // posted by Terri Bellmore

    In the coming months, payers will assume risk as a predicted seven million previously uninsured Americans enter the health care system. Because of this, I’m pleased to offer guest commentary on Mike Long’s blog about the important and timely topic of Risk Adjustment and Revenue Management in the Health Insurance Marketplace.

  • GUEST BLOG

    ADSI Blog: Accountable Care 2.0: It’s a Journey, Not a Program

    // posted by Jim Hansen

    CMS released a long-awaited checkpoint status on its Pioneer ACO program. Of the 32 entities enrolled in the program, according to CMS...

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    Blog: Health Information Exchange Revisited

    // posted by W. Michael Long

    Next week I’ll be traveling to D.C. to speak at the Fourth National Accountable Care Organization Summit sponsored by the Engelberg Center for Health Care Reform at Brookings and The Dartmouth Institute for Health Policy & Clinical Practice. The topic is Health Information Exchange (HIE). This is a ...

  • GUEST BLOG

    ADSI Blog: What is the Future State Vision for Health Care Delivery System Transformation?

    // posted by Jim Hansen

    The country is in the midst of an unprecedented transformation of the health care system and may even be at a ‘tipping point’, yet many of us find it astounding that we have no official (or unofficial for that matter) collective vision of where we are headed, thus how the heck do we know if we are on the right path to get there?

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    Blog: Are Happier Physicians the Answer to Our Health Care Dilemma?

    // posted by W. Michael Long

    I have used the last two blog posts to introduce the Accountable Primary CareSM Model*, or the NineSM C’s* for short. To illustrate the power of the model, I used examples of some incredibly passionate and committed primary care physicians to demonstrate the first six C’s. I am ...

  • Blog Post

    Blog: Accountable Care Doesn’t Require Changing Physician Behavior!

    // posted by W. Michael Long

    How can that be? Isn’t accountable care all about driving physician behavior change? Not really. Instead, accountable care is unlocking the behaviors that physicians have always had, but were constrained to demonstrate. There is a big difference. Behavioral scientists say that changing fundamental human behaviors is extremely difficult ...

  • GUEST BLOG

    ADSI Blog: The Key to Getting Real Results from Accountable Care Initiatives: Do it Right or Don’t Do it at All

    // posted by Jim Hansen

    The rumors are starting to be heard and the rumblings are starting to be felt. Will there be major financial fallout under accountable care and specifically CMS’s regulatory ACO programs?

  • Blog Post

    Blog: Accountable Primary Care: What Can We Learn From Golf?

    // posted by W. Michael Long

    In last week’s blog, I talked about how a primary care physician, Dr. Smith, changed his behavior, and subsequently his patient’s behavior, maintaining the patient’s health while saving the system $70,000/year. This behavior change was made possible in part by the availability of new tools, information and incentives. ...

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    Blog: What Does a Practicing Accountable Physician Look Like? Do They Behave Differently?

    // posted by W. Michael Long

    Our country is blessed with the finest physicians in the world. They are the best trained and have access to the best medical technology and services. You would think we would have a running dialogue around the country celebrating and promoting this collective national asset. Instead, there is ...

  • Blog Post

    Blog: Keeping Doctors at the Center of Health Care

    // posted by W. Michael Long

    The growing reality of health care reform and the cauldron of conflict it creates between the creaking legacy of volume-based reimbursement and new, largely unproven methods of shifting more financial risk to physicians is upon us. A side effect is unprecedented uncertainty and anxiety among American physicians. Decades ...

  • Blog Post

    Blog: It’s Time!

    // posted by W. Michael Long

    Last week’s Time feature “Bitter Pill” raised U.S. health care costs to a new level of public awareness. Regardless of the assertions made in the article, hospitals are an essential component in the health care delivery system in our country. The historical multi-mission role hospitals play in clinical ...

  • GUEST BLOG

    ADSI Blog: Accountable care 2.0 offers promise of success beyond today’s accountable care 1.0 maturity level approach

    // posted by Jim Hansen

    The ominous declaration of “The Coming Failure of Accountable Care” is creating quite the buzz in accountable care and health policy circles, particularly given that the declaration was made by the highly respected Harvard Business School professor and innovation researcher Clayton Christensen and colleagues in an article that was posted recently in The Wall Street Journal.

  • Blog Post

    Blog: Accountable Care: A Cost-Control Experiment?

    // posted by W. Michael Long

    A lot of people are talking about accountable care as a cost-control experiment. That assertion misses the triple aim of accountable care: cost, quality, and satisfaction. Further, satisfaction must include both the provider and recipient of health care services. Focusing on just patient satisfaction is a fool’s errand ...

  • GUEST BLOG

    ADSI Blog: Nine C’s of Successful Accountable Primary Care Delivery

    // posted by Tom Doerr

    The Accountable Primary Care Model: New Hope for Medicare and Primary Care

  • GUEST BLOG

    ADSI Blog: Has Health Care Industry Transformation Reached its Tipping Point?

    // posted by Jim Hansen

    Quickly out of the gate for 2013, Health Affairs featured the theme of Transforming the Delivery of Health Care in its January edition, Arnold Milstein MD’s Code Red & Blue – Safely Limiting Health Care’s GDP Footprint headlined the New England Journal of Medicine, and CMS announced a new wave of 106 additional ACOs to their program.

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    Point of View: Consumer Engagement

    // posted by Lumeris

    As providers assume greater risk from payers, they are requesting accountability from consumers. But, how do providers engage and empower consumers to make educated health choices and become partners in their own health care? In this point of view, Lumeris offers five, interrelated strategies, based on 10 years of value-based care experience, to help guide accountable providers to successfully engage patients for better clinical and financial outcomes.

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    Point of View: Health Plan Operations and Population Health Services

    // posted by Lumeris

    A definitive blueprint for value-based health plan operations and population health services revealed. Using 10 years of health plan, multi-payer and value-based care experience, Lumeris developed a four-part framework to significantly improve value-based health plan operations. The model includes identifying improvement opportunities to address business transformation, structuring the organization and implementing change, offering value-based care services that support office management and population health, and optimizing business processes. This essential guidance supports business and care delivery transformation in pursuit of the Triple Aim Plus One: better health outcomes, lower costs and improved patient plus physician satisfaction.

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    Point of View: Quality Management

    // posted by Lumeris

    Quality Management: Empowering Payers, Health Systems and Providers to Achieve Optimal Health Outcomes.

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    Point of View: Enhancing The Provider/Patient Encounter To Optimize Payer Revenue

    // posted by Lumeris

    To optimize risk-adjusted revenue for payers, and increase the quality of care each patient receives, Lumeris offers the Enhanced Encounter® Solution, built upon its expertise in meeting the goals of Triple Aim Plus One: better health outcomes, lower costs and improved patient –and our plus one – physician satisfaction.

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    Point of View: The Value of Integrating EMR and Claims/Cost Data in the Transition to Population Health Management

    // posted by Lumeris

    The Value of Integrating EMR and Claims/Cost Data in the Transition to Population Health Management

  • WHITE PAPER_200x200

    White Paper: The Value of Integrating EMR and Claims/Cost Data in the Transition to Population Health Management

    // posted by ADSI

    When EMR data is combined with claims/cost data, a physician gains a complete view of a patient’s medical history. In this white paper, we discuss the importance of combining claims, EMR, admission, lab, and pharmacy data, and how information supported by tools and workflows — helps health systems, payers and providers make value-based decisions and achieve population health management.

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    White Paper: Navigating the Rise of Value-Based Care

    // posted by ADSI

    The transition to accountable care presents hospitals with real and significant financial opportunities, as well as risks. But the risks become manageable when hospital leaders deploy solid strategic planning. Planning that must include an understanding of the unique challenges and opportunities that come with value-based payment arrangements.

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    White Paper: Clinical Data Integration

    // posted by ADSI

    Clinical integration is a vital component to transforming the U.S. health care system. The challenges are complex, but emerging payment models are helping fulfill technology’s promise to improve information-sharing among payers and providers. An important step in increasing collaboration, lowering costs, improving quality, and boosting patient and physician satisfaction.

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    White Paper: Business Process Partnering for Value-Based Care Delivery

    // posted by ADSI

    To establish and execute high performance business process partnering, 22 core competencies must be accounted for and addressed within the accountable care ecosystem.

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    Point of View: How the Nine C’s Help Accomplish the Goals of the Triple Aim Plus One

    // posted by Lumeris

    Lumeris developed the Nine C’s℠ to ensure a powerful, proven framework for delivering the Triple Aim Plus One: quality, cost, plus patient and physician satisfaction. The Nine C’s offer providers a roadmap for making a successful transition from a volume-based to a value-based model.

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    Point of View: The Collaborative Payer Model

    // posted by Lumeris

    The Collaborative Payer Model achieves proven results against the Triple Aim Plus One: better health outcomes, lower costs, and improved patient, as well as physician, satisfaction. And it offers valuable lessons for today’s government-sponsored and private-sector accountable care organizations.