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CAPG & Lumeris Expert Panel

Following the CAPG Colloquium, Lumeris hosted a discussion about the changing healthcare landscape, the importance of collaboration, and enabling technology. An exciting dialog followed focusing on topics such as John Doerr’s top three future healthcare technology trends to watch for, infrastructures for independent accountable physicians, challenges and opportunities in healthcare data, and providing meaningful incentives for physicians as the model changes.

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Consumer Engagement

Point Of View

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.

Health Plan Operations

Health Plan Operations and Population Health Services

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.

Quality Management Point of View

Empowering Payers, Health Systems and Providers
to Achieve Optimal Clinical Outcomes

Organizations need a strategic and tactical approach to quality management if they are to achieve remarkably improved clinical outcomes. Successful quality management grows from fostering greater collaboration between payers and providers, engaging physicians and patients in healthy behavior change and driving optimization of quality measures within value-based care models. Lumeris offers five quality management lessons for payers, health systems and physician practices seeking to deliver high-quality, value-based care and achieve better clinical outcomes.

Enhanced Encounter Point of View

Enhancing the Provider/Patient Encounter
to Optimize Payer Revenue

Health plan sponsors need the right tools to manage risk and adjust revenue from their network of providers. Prospective health assessments empower providers to conduct comprehensive patient visits that include consideration of care access issues, gaps in care, conditions not currently coded, diagnoses suggested by lab or prescription values that have not been submitted, and codes that may be incomplete. By enhancing patient encounters, providers can ensure patient care plan compliance, improve quality metrics, achieve better health outcomes for patients, and payers can manage risk and optimize revenue available to treat chronic conditions otherwise not captured.

A Lumeris Point of View

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

When EMR data is combined with claims/cost data, a physician gains a complete view of a patient's medical history. In this point of view, 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.

The Lumeris Model

Nine C's of Accountable Care Delivery

The Lumeris Accountable Primary Care ModelSM — or the Nine C'sSM for short — is a powerful, proven framework for delivering the Triple Aim Plus One: quality, cost, and patient and physician satisfaction. The Nine C's help providers understand their risk and the fundamental process, workflow, and behavioral approaches that should be adopted as health care moves from a volume- to a value-based model.

The Collaborative Payer® Model

5 keys to success

Accountable care offers the nation's ailing health care system new hope — but it isn't a new idea. For the past decade, health systems, payers, and providers across the country have been practicing accountable care principles through initiatives such as the Collaborative Payer Model, a care delivery innovation jointly developed by a payer and provider that approximates an accountable care organization.

The full 2008 paper can be viewed here.