ACCOUNTABLE CARE’S MOST EXPERIENCED LEADER

Lumeris is an accountable care delivery innovation company offering health systems, payers, and providers operational support, technology, and consulting services. Our innovative solutions help health care organizations design, build, operate, measure, and optimize any accountable care model to accomplish the Triple Aim Plus One: improved quality, cost, and patient and physician satisfaction.

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Who We Are

Our History

A decade ago, a team of health care executives who had grown frustrated with the nation’s dysfunctional health care system asked themselves a question:

What are the most pressing issues in health care, and how do we fix them?

In the current system, it seemed that for someone to win, someone else always had to lose. For the health care system to thrive, the classic adversarial relationship among payers and providers had to end. After much deliberation, these executives distilled their solution to a single word: share. They believed we needed to relearn this childhood lesson and apply it to our broken health care system. This called for an innovative approach, with economics and data shared freely across the continuum of care. It meant incentives—not punishments—offered to encourage optimal behaviors, then supported with the right information and tools.

Our History

These executives set out to fulfill their mission with the generous assistance of many who believed positive, disruptive innovations can change the world. They established the first collaborative payer, Essence Healthcare. Under this model, Essence did not own the continuum of care but instead worked collaboratively with providers in a virtual integrated delivery system. It established new value-based reimbursement models to align incentives, affording providers the time to more proactively manage and coordinate patient care. It developed cloud-based technology to deliver actionable clinical and financial data to providers, along with the tools to leverage that information.

The task was not always easy, but from growing pains came promise. The results were nothing short of remarkable. Costs dropped. Quality improved. Patient satisfaction increased, and provider engagement grew. Through sharing, Essence had united the continuum of care in a common purpose: Ensuring every patient receives the right care in the right setting and at the right cost, with clear accountability for clinical and financial outcomes.

Today, with the nation’s health care industry still struggling and the concept of value-based accountability on the rise, Lumeris shares these transformative technologies, programs, and methods with health plans, hospitals, and other organizations seeking to establish their own high-performing accountable delivery systems.

Solutions

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

  • FEE FOR SERVICE
  • GAIN SHARING
  • SHARED SAVINGS
  • SHARED RISK
  • GLOBAL CAPITATION

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. 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. 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

Risk Adjustment/Enhanced Encounter for Medicare Advantage Prescription Drug (MAPD) Plans offers payers a prospective health assessment to support accurate documentation and coding and ensure maximum reimbursement. Payers

Risk Adjustment/
Enhanced Encounter for MAPD

MAPD Operations

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

MAPD
Operations

Managed Service Offering (MSO)

Managed Service Offering (MSO) allows providers to outsource key business process and technology functions for effective and efficient practice operations in full-risk contracts. Providers

MSO

Key Benefits

Key Benefits

Purpose-built from the ground up

expressly for population health management, and proven successful not only in the Lumeris-operated Medicare Advantage plan, but with health system, payer and provider clients across the country, too.

Helps manage complex operational needs for accountable care

including design, implementation, operation, measurement, and optimization — to drive greater clinical and financial value at speed.

Provides transparency of data across the care continuum

including claims, EMR/encounter data, pharmacy, labs, and other disparate data — and creates a comprehensive view of individual patients and populations.

Delivers meaningful, actionable quality, cost, and utilization intelligence

to physicians, health plan and health system executives, and their staffs.

Offers the industry’s most robust provider-focused care management solution

for accountable care, with support for disease management, transitions of care, ER utilization reduction, medication management, and end-of-life care.

Provides sophisticated clinical and financial reporting

with ability to view from an enterprise or population level down to individual patients and claims detail.

Interfaces

with ambulatory and acute EMRs, claims systems, lab, pharmacy and other role-based systems to provide a unified patient record across the care continuum.

Offers a multi-payer platform

that enables accountable care for a health care organization’s entire population from a single portal.

Designed with an innovative cloud-based infrastructure

to drive rapid deployment and scalability, with no additional infrastructure cost for clients.

Includes optional strategic consulting services

designed to help address a health care organization’s current challenges and design a roadmap for the transformational journey to a value-based care model.

Delivered by a veteran and highly motivated team

with health system, payer, and provider experience and nearly a decade practicing accountable care.

W. Michael Long

Chairman and Chief Executive Officer, Essence Group Holdings Corporation and Lumeris Corporation

An entrepreneur in health care, financial services and energy, Mike has led teams that built Continuum, a multi-billion dollar global leader in insurance software; Healtheon/WebMD, the largest consumer health information and transaction clearinghouse (chronicled in Michael Lewis’ best-seller, The New, New Thing); and NEOS, a solutions-oriented geosciences company that is leading the field in multi-measurement interpretation (of geo-datasets) and imaging of the earth’s subsurface. Today Mike is leading Essence Healthcare and Lumeris. Essence operates health care’s most effective virtual integrated delivery network (vIDN) for accountable care. Lumeris delivers technologies, methodologies and learnings to hospitals, payers and physicians committed to delivering high-quality, low-cost and high-satisfaction accountable health care services. Essence/Lumeris’ purpose is to slow the growth of health care’s $2.6 trillion in expenses while simultaneously improving clinical outcomes and patient satisfaction. Mike and his wife, Betty, are equestrians and their three children are rapidly progressing their entrepreneurial careers in food distribution, energy and health care.

James Starr

Chief Financial Officer

James Starr is an established financial executive with extensive experience in the health care payer and information technology space. He has a strong track record of collaborating to deliver significant value to shareholders in emerging, midsize, and large companies. Before joining Lumeris, he served as the Chief Financial Officer of National Segments and Products at Aetna, providing financial leadership to Aetna’s national accounts, state and local governments, Medicaid, and global benefits businesses. Prior to Aetna, Mr. Starr worked as Chief Financial Officer at Active Health Management, a venture-backed health care technology services company that was acquired by Aetna. He also served as Chief Financial Officer of Sierra Health Services, a NYSE-traded managed care company based in Nevada. Mr. Starr is a certified public accountant and a member of the American Institute of CPAs and the Nevada Society of CPAs.

Lou Anne Gilmore

Senior Vice President Technology and Client Services

Lou Anne Gilmore is a technology executive and certified public accountant with extensive experience delivering software and services in the health care and financial services industries. Before joining Lumeris, Ms. Gilmore worked at Computer Sciences Corporation for 30 years. During her tenure there, she led a $4 billion division that delivers consulting services, software, and outsourcing services to large multinational corporations and government agencies.

Gail Halterman

Vice President and General Counsel

Gail Halterman is a seasoned legal professional with demonstrated expertise in health care regulatory and compliance issues. She joined Lumeris after a distinguished career in the health care group at Lathrop & Gage, LLP, a full-service national law firm. In her role as General Counsel, Ms. Halterman is responsible for legal strategy and operations, helping ensure the company’s proactive adherence with the spirit and letter of all applicable laws and regulations.

Carol Murdock

Chief of Marketing

Carol Murdock joins Lumeris with 25 years of experience in strategic marketing, management and business development in health care. In her current role, Ms. Murdock is responsible for Lumeris’ go-to-market strategy and leads the Accountable Delivery System Institute (ADSI), the premier resource for health systems, payers and provider groups seeking proven solutions and practical guidance on their journey to value-based care. She most recently worked at HealthTech Holdings, where she served as Chief Marketing Officer for its three companies, Healthcare Management Systems, Sentry Healthcare, and MEDHOST. Earlier in her career, Ms. Murdock founded, ran and later sold Coactive Systems Corporation, a health care technology and services company focused on nurse triage and disease management for payers and hospital systems. She has also held executive positions at Healthways, a population health and wellbeing company, and at three large hospital systems: OrNda Healthcorp, Summit Health and National Medical Enterprises.

Subbarao Siddabattula

Chief Technology Officer

Subbarao Siddabattula brings to Lumeris more than 20 years of experience in the computer software industry, including complete lifecycle development of products ranging from enterprise applications to state-of-the-art health care systems. Immediately before joining Lumeris, he was Founder, President, and General Manager of India Operations for Physician Advantage, Inc., which later became part of Lumeris. Mr. Siddabattula has also held various senior management positions in technology and product management at companies including Hewlett Packard, Blue Star Infotech, Rockwell Automation, LoginClinic, and Purkinje.

Jeff Smith

President, Mid-Atlantic Initiative and Strategic Business Development

Jeff Smith is an established health care executive, with 18 years of health care technology and pharmaceutical services experience in sales and account management, operations, product development and management, business development, and corporate strategy. Earlier in his career, Mr. Smith started a point-of-care software business that grew to a market leader. Immediately before joining Lumeris, he was Vice President of Accountable Care and Population Health Management at CVS Caremark, the nation’s leading integrated pharmacy services company. Mr. Smith also served six years on the board of directors of RxHub and Surescripts.

Terry Snyder

Senior Vice President, Worldwide Sales & Operations

Terry Snyder is an experienced health care executive, with more than 25 years in health information technology, consulting, medical systems, managed care, government affairs, and pharmaceutical/biotechnology. Prior to joining Lumeris, he served in leadership roles at CareFusion, McKesson Provider Technologies, Ernst & Young, and Schering-Plough. In his current role, Mr. Snyder has global responsibility for Lumeris sales, client management, and operations, including driving business development, key customer partnerships, revenue growth, and enterprise sales and support.

Deborah Zimmerman, M.D.

Chief Medical Officer, Lumeris and Essence Healthcare

Debbie Zimmerman, MD, has a long and distinguished history of medical leadership at health plans such as CIGNA, Group Health Plan and Health Partners of the Midwest. Before joining Essence Healthcare, she most recently served as chief medical officer of Mercy Health Plans, a provider-sponsored plan owned by Sisters of Mercy. She is also an accomplished entrepreneur, having co-founded a successful disease and complex case management firm. Dr. Zimmerman practiced internal medicine for 15 years, and is licensed to practice in Missouri and Illinois. In her current role for Lumeris, she is responsible for clinical content in the Lumeris Accountable Delivery System Platform, as well as supporting clients’ clinical initiatives. In her current role for the health plan, she is responsible for clinical quality, medical and pharmacy management, and physician practice transformation.

Susie Robinson

VP of Human Resources

Susie Robinson is a results-driven business leader with an eye for talent and a skill for transforming large and emerging organizations. Before joining Lumeris, Ms. Robinson served as Executive Vice President and Chief Human Resources Officer at Infogroup, a data and marketing services company. In that role, she was responsible for global human resources strategy and operations in North America, United Kingdom and Asia-Pacific regions. Under her leadership, Ms. Robinson spearheaded a human resources transformation, which included technology improvements, redesigned compensation and benefits programs and a new recruitment team responsible for hiring 500 people in one year. Her previous work experience includes human resources leadership roles at Dow Jones, Wyeth (now Pfizer), and B.Braun Medical.

W. Michael Long

Chairman and Chief Executive Officer, Essence Group Holdings Corporation and Lumeris Corporation
An entrepreneur in health care, financial services and energy, Mike has led teams that built Continuum, multi-billion dollar global leader in insurance software; Healtheon/WebMD, largest consumer health information and transaction clearinghouse (chronicled in Michael Lewis’ best-seller, The New, New Thing); and NEOS, geophysical sciences software data fusion and ultra-high resolution instrumentation for imaging earth’s subsurface. Today Mike is leading Essence/Lumeris. Essence operates health care’s most effective virtual integrated healthcare delivery system (v-IDN) for accountable care. Lumeris delivers technologies, methodologies and learnings to hospitals, payers and physicians committed to delivering high-quality, low-cost, high-satisfaction accountable health care services. Essence/Lumeris’ purpose is to slow growth of healthcare’s $2.6 trillion expenses while simultaneously improving clinical outcomes and patient satisfaction. Mike and his wife, Betty, are equestrians and their three children are rapidly progressing their entrepreneurial careers in food distribution, energy and health care.

John Burbank

Managing Member and Chief Investment Officer, Passport Capital

John Burbank is the chief investment officer of Passport Capital, LLC, a San Francisco-based global investment firm managing approximately $4.6 billion in assets. The firm’s investment process uses a combination of macroeconomic analysis to develop major themes and rigorous fundamental research on individual companies to create global portfolios. Under Mr. Burbank’s leadership, Passport’s investment team focuses on the following areas: agriculture, basic materials, consumer, energy, financial services, health care, India, capital markets, internet/technology, and Middle East/North Africa.

Mr. Burbank has more than a decade of experience investing in global equity markets. Prior to founding the firm in 2000, he was a consultant to JMG Triton Offshore, Ltd. From 1996 to 1998, he was the director of research at ValueVest management. Mr. Burbank earned his bachelor’s degree from Duke University and his MBA from the Stanford Graduate School of Business.

Denis A. Cortese, M.D.

President and Chief Executive Officer Emeritus, Mayo Clinic
Director, Health Care Delivery and Policy Program, Arizona State University

Denis Cortese is a champion of high-quality and patient-centered health care. He is currently Director of the Health Care Delivery and Policy Program at Arizona State University (ASU); Foundation Professor at ASU; and President of the Healthcare Transformation Institute, a non-profit organization dedicated to improving health care delivery and lowering health care costs. Dr. Cortese is also Chair of the Institute of Medicine’s Roundtable on Value and Science Driven Healthcare, and serves on the boards of Pinnacle West and RAND Health. From 2003 until his retirement in November 2009, he was President and Chief Executive Officer of Mayo Clinic. Prior to that, Dr. Cortese served in other administrative positions at Mayo, and worked in the organization’s pulmonary and critical care areas for nearly 30 years.

L. John Doerr

Partner, Kleiner Perkins Caufield & Byers

John Doerr joined Intel in 1974, just as the company had invented the legendary “8080” 8-bit microprocessor, where he went on to hold various engineering, marketing, and management assignments. In 1980, Mr. Doerr joined Kleiner Perkins Caufield & Byers and soon thereafter started Silicon Compilers, a VLSI CAD software company, and @Home, the nation’s first broadband cable Internet service. Together with KPCB’s partners, he has backed many of America’s best entrepreneurial leaders, including:

  • Larry Page, Sergey Brin, and Eric Schmidt at Google
  • Jeff Bezos at Amazon.com
  • Scott Cook and Bill Campbell at Intuit
  • Andy Bechtolsheim, Scott McNealy, Bill Joy, and Vinod Khosla at Sun Microsystems
  • The founders of Compaq, Cypress, Macromedia, and Symantec

In addition to serving on the EGHC board of directors, Mr. Doerr is a board member at Google and other companies.

Matt Downs

Managing Director, Sandbox Industries

Matt Downs is Managing Director of Sandbox Industries, and a member of the board of directors of Marbles, Bloom Health, and Myca. Prior to joining Sandbox, Mr. Downs was a venture investor with Highland Capital Partners and worked for Morgan Stanley in their mergers and acquisitions group. He earned his bachelor’s degree from Brigham Young University and his MBA from the Stanford Graduate School of Business.

Frank Ingari

President and Chief Executive Officer, NaviNet

Frank Ingari is an accomplished leader with more than 30 years of experience as an entrepreneur and senior information technology executive. Before joining NaviNet, he was president of the Medicare Advantage health plan Essence Healthcare. He previously served as Chairman and Chief Executive Officer of Shiva Corporation, Vice President and General Manager of the spreadsheet division at Lotus Development Corporation, and as Senior Vice President at Atex, Inc., a division of Kodak. He was also founder and Chairman of Wheelhouse Corporation, an early application service provider in the customer relationship market.

Christopher W. Kersey, M.D., MBA

Managing Member, Camden Partners

Christopher W. Kersey serves as a Managing Member of Camden Partners, one of the largest growth equity and investment management funds in the United States, with more than $700 million under management.

Dr. Kersey serves on the board of trustees of Johns Hopkins Medicine and The Johns Hopkins Hospital. He also serves on the board of directors of The Johns Hopkins Hospital Endowment Fund, and is the Chairman of the Board of Johns Hopkins Medicine International, the global development arm of Johns Hopkins Medicine, with hospital management and clinical education services in the Middle East, North America, South America, Europe, and Asia.

Additionally, Dr. Kersey is a director of LipoScience, Inc.; Medivance, Inc.; MinSec Corrections Corporation; PatientSafe Solutions, Inc.; Santa Rosa Consulting, Inc.; and Webmedx, Inc. Eight of his previous portfolio companies have either been acquired or become publicly traded companies.

Dr. Kersey earned his bachelor’s degree from Stanford University, his MBA from the Harvard Business School, and his doctor of medicine from the Emory University School of Medicine.

John H. Rice, M.D.

Executive Vice President and Chief Medical Officer, Esse Health

John Rice is a practicing internist, Executive Vice President, and Internal Medicine Department Chair at Esse Health, one of the nation’s largest independent physician groups. Dr. Rice is also a member of the Esse Health Board of Directors and its executive committee.

Our Sister Organizations

Accountable Delivery System Institute logo

Transformation

• Premier educational resource for accountable care

• Provides proven solutions and practical advice to health care organizations seeking the benefits of a more connected and aligned health care model

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Essence Healthcare logo

Proof of concept

• Lumeris operated Medicare Advantage plan, with 4.5-star CMS rating*

• Offers Medicare beneficiaries comprehensive, affordable insurance that focuses on wellness, care coordination, and personal service

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* Plan performance star ratings are assessed each year and may change from one year to the next.

NaviNet logo

Connectivity

• Nation’s largest real-time health care communication network

• Speeds and simplifies administrative, financial, and clinical transactions among providers and payers

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