Making accountable care work for you — no ifs, ands, or buts
Outcomes are everything. That’s why more health systems, payers and providers are working with Lumeris, a leader in population health. Lumeris’ operations, technology and consulting services are helping organizations achieve remarkably improved clinical and financial performance.
Health systems are achieving 40% fewer readmissions compared to an unmanaged population. Payers are experiencing 30% lower medical costs compared to an unmanaged population. Providers are closing gaps and improving care quality by seeing 97% of their patients annually.
Lumeris is the only population health solutions provider to have results validated by actuarial experts at AON Hewitt, and for two years has been named Best in KLAS for value-based care managed services, 2015/2016-2017. Read more about our proven outcomes below, or download our case study summary here.
Population health management works, and the latest case study from Lumeris demonstrates how working collaboratively with Aria Health achieved the monumental shift from fee-for-service to value-based health care. Not only was this shift accomplished with Lumeris' technology-enabled solutions, but a third-party—IDC Health Insights—interviewed members of Aria's executive team about its successful transformation from volume-based to value-based, collaborative care.
Client: Essence Healthcare – Lumeris used the Collaborative Payer Model between payers and providers. A mentorship program to align physician behaviors around accountability to achieve the Triple Aim Plus One was also incorporated to achieve the desired outcomes. The Accountable Delivery System Platform (ADSP)® was deployed to enable the financial and clinical management of the defined population, resulting in nearly 65% MCR (2013 before physician compensation distribution), a 30% reduction in costs and 40% reduction in readmission rate compared to an unmanaged population.
Client: Hospital-Employed Medical Group – Lumeris conducted a qualitative and quantitative analysis to identify areas for population health management improvement. Data was aggregated and rationalized, and the ADSP was used to provide tools and information to enable the providers to make better, value-based decision. Patients were also engaged in their own care. As a result, over 98% of patients are seen annually, the group has 66% MCR (before physician compensation distribution) and doctors followed up with 67% of patients after high-risk discharge.
Client: Loosely-Affiliated Independent Physician Association – Lumeris used a three-year phased approach to improve a poorly performing group lacking strong leadership. High-risk members weren’t being managed for better population health (to increase care at reduced cost). Lumeris worked with the physician group to reduce acute admissions by 30%; ER visits by 4%; acute days by 27%; and SNF days by 27%. MCR was 63% (before surplus distribution) as a result of the population health management solution offered.
“Our partnership with Lumeris will help us evaluate our performance on key metrics such as reducing hospital readmission rates and increasing life-saving health screenings. This level of data transparency will allow our providers to more proactively address the preventive, socioeconomic and disease-specific needs of our population, and respond with the appropriate care, in the appropriate place, at the appropriate cost that is critical to our mission.”
Kathleen Kinslow, CRNA, EdD, MBA
President and Chief Executive Officer (CEO)
“This initiative will enable Baptist Health South Florida to support the health and wellness of our employees, while assuming greater risk for managing our commercial and Medicare population as health care moves to value-based models of care.”
Ralph E. Lawson
Executive Vice President and Chief Financial Officer
Baptist Health South Florida
“We look forward to being able to improve our patients’ adherence to recommendations for screenings like mammograms and colonoscopies and identify gaps in patient compliance. This comprehensive information will also assist a doctor who is caring for a patient with a chronic disease to ensure the patient receives the preventive care they need by tracking their medical appointments, no matter where they occur, their medicines, and the routine tests they need.”
Keith Sweigard, MD
Medical Director of Abington Health Physicians and Chief of Internal Medicine at Abington Memorial Hospital
“Our partnership with Lumeris gives us the tools necessary to take better care of our health plan members — especially those lacking a strong relationship with a primary care physician.”
Edward Scanlan, MD
Chief Medical Officer
“Lumeris really understands our group practice and our unique way of caring for patients. Our physicians count on Lumeris’ software and accountable care expertise to practice higher quality, cost-effective medicine.”
Chief Executive Officer
Managing Population Health
One important key to accountability through emerging health networks is the ability to identify and manage the health needs of very specific populations. Population health management is defined as providing for the particular healthcare needs of a targeted group of individuals. Examples of distinct populations might be specific ethnic groups, disabled persons, prisoners, seniors, high-school students, our own SCL Health associates, or any other defined group.
The goal is to prevent health problems in these groups before they start, or manage them better once they do. To manage population health, we need to understand the demographics of each group, know their historic patterns of using services and healthcare resources, then anticipate their future preventive and interventional needs. This requires special technology to capture clinical and financial data at the individual and group level.
SCL Health selected the Lumeris Accountable Delivery System Platform (ADSP), specifically built for population health management. ADSP integrates data from systems across the full range of care — including claims, EMR, pharmacy and lab — to provide the information needed to better identify the specific needs of our patient populations.
Once clear patterns emerge, we can help people manage their health better with targeted prevention strategies, optimized access to services, and coordinated care. A key focus is management of chronic conditions such as diabetes, obesity and congestive heart failure.
Independence Blue Cross (IBC), Abington Health, and Lumeris announced today the creation of an accountable care initiative using Lumeris’ transformative technology and services to improve the coordination of patient care, lower overall health care costs, and increase patient and physician satisfaction.
SCL Health System, a faith-based, not-for-profit health care organization, announced today the launch of an accountable care strategy designed to improve the quality of patient care and lower costs at SCL Health System hospitals and clinics.
Lumeris today announced that Network Health Plan, a part of the Affinity Health System, has licensed the company’s popular Accountable Delivery System Platform® to improve the quality and lower the cost of health care delivered to more than 42,000 members in northeast Wisconsin.