LEADING HEALTH CARE’S TRANSFORMATION

Lumeris’ technology-enabled solutions support health systems, payers and providers in their journey to value-based care. From Fee for Service, Pay for Performance and Shared Savings to Shared Risk and Global Payment models, Lumeris enables the business and care delivery transformation required to manage quality, cost and utilization for patients and populations. Through incentives, tools and information, we empower providers and administrators to make better-informed, value-based decisions. With our near-decade of experience, unique approach and proven results, we advance health care organizations in their pursuit to become population health managers.

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What We Do

Solutions

TECHNOLOGY-ENABLED SOLUTIONS FOR YOUR JOURNEY TO VALUE-BASED CARE

  • FEE FOR
    SERVICE
  • PAY FOR
    PERFORMANCE
  • SHARED
    SAVINGS
  • SHARED
    RISK
  • GLOBAL
    PAYMENT

Risk Adjustment/Enhanced Encounter for the Health Insurance Marketplace

Risk Adjustment/Enhanced Encounter for the Health Insurance Marketplace offers commercial payers a prospective health assessment to support accurate documentation and coding and ensure maximum reimbursement. In addition, Lumeris offers Retrospective Chart Reviews and Risk Adjustment Data Validation Audit Support to avoid revenue risks and ensure a smooth auditing process. Payers

Risk Adjustment/
Enhanced Encounter for the Health Insurance Marketplace

Clinical Data Integration

Clinical Data Integration allows health systems to collect clinical data from multiple EMRs for purposes of data aggregation and integration into a provider's workflow via the ADSP. Health Systems

Clinical Data Integration

Quality Management

Quality Management offers payers outreach programs and technology tools and reports to enable performance on more than 150 quality measures, including HEDIS metrics and Star ratings. Payers | Health Systems

Quality
Management

Utilization Optimization

Utilization Optimization helps payers through an Opportunity Analysis at the Population Level to uncover opportunities to improve quality, reduce cost and ensure appropriate utilization of health care services. Payers | Health Systems

Utilization
Optimization

Care Management

Care Management offers physicians and their care teams workflows, assessments and automated care plans that enable better care at lower cost for patients with multiple health and social needs. Providers

Care
Management

Accountable Primary Care ModelSM

Lumeris' Accountable Primary Care ModelSM gives providers a proven framework for re-architecting their practice for value-based care. Our Nine C's® Playbook offers a step-by-step guide on the workflows and behaviors that deliver better quality, lower cost and enhance patient plus physician satisfaction.­­ Providers

Nine C's®

Automated Reporting

Automated Reporting provides payers with the analytics and custom reports they need to make timely, value-based decisions. Payers | Health Systems

Automated
Reporting

Risk Adjustment/Enhanced Encounter for MAPD

Offers payers a prospective health assessment to support accurate documentation and coding and ensure maximum reimbursement. In addition, Lumeris gives MA plans Retrospective Chart Reviews and Risk Adjustment Data Validation Audit Support to avoid revenue risks and ensure a smooth auditing process. Payers

Risk Adjustment/
Enhanced Encounter for MAPD

Health Plan Operations

Health plan operations offers payers full turn-key business process outsourcing and management services to design, build, operate, measure, and optimize a highly-rated health plan. Payers | Health Systems

Health Plan
Operations

Managed Service Offering (MSO)

Managed Service Offering (MSO) allows providers to outsource EMR, Practice Management, Revenue Management, Quality Reporting, and other key business process and technology functions for effective and efficient practice operations in full-risk contracts. Providers

MSO

Operations, Technology, Consulting

What-We-Do-Operations

OPERATIONS

Lumeris designs, builds, operates, measures, and optimizes value-based care models by leveraging our near-decade of experience operating a 4.5 Star-rated* Medicare Advantage plan.
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What-We-Do-Technology

TECHNOLOGY

Our technology-enabled solutions are supported by our cloud-based Accountable Delivery System Platform (ADSP)®. Purpose-built for accountable care, the ADSP integrates claims, EMR, lab, and pharmacy data and turns that data into actionable information by seamlessly incorporating it into a provider’s workflow. ADSP Tools and Reports help providers meet metrics in value-based contracts and deliver quality care in the right place, at the right time.
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What-We-Do-Consulting

CONSULTING

Lumeris’ expert team of consultants provides the guidance to ensure success in any value-based care model. From incentive contract design to education on practice redesign, our transformative consulting services offer support to health systems, payers and providers interested in moving toward population health management.
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