ST. LOUIS – HMO Louisiana, Inc., a subsidiary of Blue Cross and Blue Shield of Louisiana, the largest nonprofit health insurer in the state, has chosen Lumeris, a pioneer in population health management solutions headquartered in St. Louis, to manage its entry into the Medicare Advantage (MA) market in Louisiana.
Utilizing its near decade of experience operating Essence Healthcare, a 4.5-Star rated Medicare Advantage Prescription Drug (MAPD) plan, Lumeris will assist HMO Louisiana to develop and launch a new MAPD plan based on Lumeris’ successful operating model. The partnership extends through 2020 and will enable Lumeris to help HMO Louisiana establish a robust Population Health Services Organization (PHSO), which will empower healthcare organizations and providers to successfully make the journey from volume to value-based care. The MAPD business model behind the PHSO focuses on better, healthier outcomes by engaging physicians and patients to keep them well instead of the more traditional, costly practices of merely treating the sick, and when they are sick, coordinating their care more effectively.
“We’re delighted HMO Louisiana has decided to partner with Lumeris. And, we’re eager to design, build and manage an outcome-based healthcare plan for them,” said Richard Jones, Chief Business Development Officer for Lumeris.
HMO Louisiana and the physicians in its network will work collaboratively and proactively to share information on the cost and quality of services via an integrated population health platform. This data will help physicians attain more statistical information on their patients and their care needs, and the platform will interact with patients and members to provide reminders, alerts, coaching advice and treatment information. Under the new federal health law, physician reimbursement is focused in-part upon outcomes, which shifts the emphasis to preventative care to avoid costly and unnecessary procedures and hospital visits. Physicians are incented to see all their patients and provide comprehensive assessments that improve patient satisfaction and promote quality care.
Under the arrangement, Lumeris will assist in the creation of the MAPD plan, operate the plan and provide oversight. These services will help HMO Louisiana meet the industry’s goals of the Triple Aim and Lumeris’ mission of the Triple Aim plus One: improved quality, cost, and patient plus physician satisfaction.
“By leveraging our experience and proven playbooks, processes and systems, we are actively partnering with HMO Louisiana to lower the cost of healthcare and increase operational efficiencies,” said Michael Long, chairman and CEO of Lumeris. “Our value-based health plan solutions will also position their membership to experience improved care coordination and quality of care.”
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 Lumeris.com.