News Release: Lumeris Helps Essence Healthcare Achieve 4.5-Star Rating for Four Years in a Row

Lumeris, a leader in population health management solutions, announced today that Essence Healthcare, one of its pioneer health plan customers, was awarded a 4.5-Star rating from the Centers for Medicare & Medicaid Services (CMS) for a fourth year in a row. Powered by Lumeris, the St. Louis-based Medicare Advantage Prescription Drug plan has achieved high-rated success by optimizing operations for population health and shared risk-adjusted services.

Essence Healthcare has delivered value-based care for more than a decade, and from the beginning of the collaboration, Lumeris led the healthcare network by working closely with physicians to make improved, value-based decisions through actionable patient and population health data to recognize opportunities to close gaps in care for more than 40,000 Medicare Advantage Prescription Drug (MAPD) plan members. The partnership between Lumeris and Essence is strategic and collaborative, focusing on quality of care delivered to plan members, at managed costs, and based on Lumeris’ success in operating other health and MAPD plans. 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.

“It is an honor to receive the coveted 4.5-Star rating from the Centers for Medicare & Medicaid Services for the fourth year in a row,” said Richard Jones, president and CEO of Essence Healthcare. “The rating is a testament to our expert support and collaboration with Lumeris that has helped our organization design, build and operate a value-based health plan that continues to achieve risk-adjusted outcomes through proven population health services that drive clinical and financial excellence.”

The Medicare Five-Star Quality Rating system, developed by CMS, rates Medicare Part C and Part D plans on a scale of one to five stars. The overall rating is based on more than 50 care and service-quality measures across several categories: staying healthy; managing chronic conditions; member experience with the health plan; member complaints and changes in the health plan’s performance; customer service; and drug safety and accuracy of drug pricing.

Lumeris’ Health Plan Operations and Population Health Services solution offers payers and at-risk providers turn-key outsourcing to design, build, operate, measure and optimize value-based health plans. Lumeris partners with clients to share fee risk and is compensated based on the financial success of the health plan. In return, the services help healthcare organizations meet the goals of the Triple Aim plus One, better health outcomes, lower costs and improved patient plus physician satisfaction.

“Our goal with every partnership is to help deliver actionable information, risk and coordinated care management services, powerful tools and effective incentives that physicians, hospitals, payers and patients need to make better-informed, value-based decisions, and with the latest 4.5 Star rating we’ve succeeded to accomplish that,” said W. Michael Long, chairman and CEO of Lumeris. “Lumeris takes the learnings and successes we have had with Essence Healthcare and parlays them into operations, technology and consulting services that we now offer to other health systems, payers and providers across the United States.”

About Lumeris

Lumeris is a pioneer in population health management solutions. Through our operations, technology and consulting services, we enable healthcare organizations to successfully make the journey from volume- to value-based care. We help health systems create Population Health Services Organizations and define populations for risk. We empower providers and their accountable care teams with process improvement strategies, technology tools and clinical workflows to manage their patients and populations effectively. 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. The depth and breadth of Lumeris’ solutions — combined with its decade of experience in value-based care — make the company an ideal partner for any healthcare organization seeking to transform its business and care-delivery model and remarkably improve its clinical and financial outcomes. For more information, call 1.888.586.3747 or visit

About Essence Healthcare

Essence Healthcare offers people with Medicare comprehensive and affordable health insurance that focuses on wellness, care coordination and personal service. Essence’s Medicare Advantage HMOs bundle hospital, medical and prescription drug coverage together into one plan with one affordable monthly premium, and include additional benefits not covered under the Original Medicare program. Essence’s Medicare Advantage Prescription Drug plans are designed and directed in partnership with local doctors, and are among the nation’s highest rated according to the federal agency that administers Medicare.

Essence Healthcare is a Medicare Advantage organization with a Medicare contract. The star rating referenced in this announcement is specific to Essence contract H2610 for plan year 2014. The superlatives “top-rated” and “highly rated” are substantiated by this star rating. Plan performance star ratings are assessed each year and may change from one year to the next. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments or coinsurance may change each year.