Lumeris is a pioneer in population
health management solutions.

We engage as an operating partner to provide the people, processes and enabling technology essential for payers and health systems to deliver Population Health Services Organization capabilities. The depth and breadth of our solutions—combined with our decade of experience in value-based care—make Lumeris an ideal partner for any health care organization seeking to transform its business and care-delivery model and remarkably improve its clinical and financial outcomes.

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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 Population Health Services Organization (PHSO).

Key Benefits

Purpose-built from the ground up

Expressly for value-based care, and proven successful not only in the Lumeris-operated 5 Star Medicare Advantage plan, but with health system, payer, and provider clients across the country, too.

Operational partner for value-based care

We engage as an operating partner to provide the people, processes and enabling technology essential for payers and health systems to deliver Population Health Services Organization capabilities in current and new lines of business.

Strategic Advisory

Includes pro forma financial modeling, capability assessment and gap analysis, and opportunity assessments around managing specific populations like Medicare, Medicaid, exchange, commercial and employee.

Accountable Primary Care Model

A new model of care, largely primary care led, with superior coordination of care across the healthcare supply chain and continuum of care to keep a population as healthy as possible while clinically and economically optimizing interventions.

Population Health Service Organization

Provider Engagement, Enhanced Care Delivery, Operational Excellence and Business Model Alignment.

Technology

The cloud-based Accountable Delivery System Platform (ADSP) enables population health by delivering the right data at the right time and the right place across the continuum of care.

Delivered by a veteran and highly motivated team

With health system, payer, and provider experience and nearly a decade successfully practicing value-based care.

Proven Results

Our track-record speaks for itself: Health systems partners are achieving 40% fewer readmissions compared to an unmanaged population. Payer partners are experiencing 30% lower medical costs compared to an unmanaged population. Provider partners are closing gaps and improving care quality by seeing 97% of their patients annually.

W. Michael Long

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

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.

Art Glasgow

President and Chief Operating Officer

A key player in setting Lumeris’ strategy for continued growth, Art Glasgow has more than 20 years of healthcare leadership experience in organizations ranging from start-up ventures to Fortune 15 companies; including senior executive roles at healthcare leaders such as Optum/UnitedHealth Group, Allscripts and the Duke University Health System. Leading sales, marketing, product, technology and operations, Art drives operational excellence, strategic prioritization and accountability throughout Lumeris. Art is a graduate of the United States Naval Academy and a veteran of the United States Marine Corps.

Richard Jones

CEO of Essence Healthcare & Chief Corporate Development Officer

Richard Jones is the president and CEO of Essence Healthcare, one of the nation’s first accountable delivery systems and a consistently high-rated Medicare Advantage Prescription Drug (MAPD) health plan. In addition, he leads Lumeris Healthcare Outcomes, which offers full turn-key business process outsourcing and management services to support MA and commercial health plans. Mr. Jones is an experienced health care business executive and certified public accountant and founding president of Lumeris. He previously served as chief financial officer of Essence Group Holdings Corporation (including Essence Healthcare), national president of United Healthcare Medicare and Medicaid lines of business, president and CEO of Coventry Healthcare of the Midwest, and chief financial officer of Coventry Corporation.

J. Patrick Foley

Senior Vice President of Delivery and Operations

Patrick Foley leads business and strategy development for Lumeris Healthcare Outcomes. An engineer by training, Patrick spent the first part of his career with Texas Instruments (TI) in the San Francisco Bay Area before making the switch to healthcare. After leaving TI, Patrick joined HealthSpring (now part of Cigna) where he spent 8 years building risk-bearing accountable provider organizations and operating Medicare health plans. Immediately prior to joining Lumeris, Patrick served as President for Cigna’s $1 billion Medicare Advantage division in the Mid-Atlantic and Pennsylvania markets. This division provided for the health care needs of more than 90,000 Medicare beneficiaries, nearly half of whom were dual eligibles enrolled in both Medicare and Medicaid.

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.

Gail Halterman

Vice President and General Counsel

Gail Halterman is an experienced legal professional and health care executive.  She joined Lumeris after a distinguished career in private practice at Lathrop & Gage, LLP, a full-service national law firm. At Lathrop & Gage, Ms. Halterman focused in the areas of health care transactional, regulatory and compliance law with particular emphasis on data exchange and privacy issues. In her role as General Counsel, she is responsible for legal strategy and operations, corporate governance matters and government affairs helping ensure the company’s proactive adherence with the spirit and letter of all applicable laws and regulations. In addition to her Juris Doctor, Ms. Halterman holds a master’s degree in health services administration, and prior to her entry into law school, was licensed as a long-term care administrator.

Debbie Zimmerman, MD

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 consulting services and clients’ clinical initiatives as well as clinical content and analytics in the Lumeris Accountable Delivery System Platform (ADSP)®. In her current role for the health plan, she is responsible for clinical quality, medical and pharmacy management and physician practice transformation.

Andrew Cole

Chief Human Resource and Organizational Development Officer

Andrew Cole is leading the strategic human resources program at Lumeris as Chief Human Resource and Organizational Development Officer. As the unprecedented demand for our comprehensive, integrated Population Health Services Organization (PHSO) solution drives tremendous growth at Lumeris, Andrew plays a key role in aligning our human resource functions by attracting and retaining top talent, facilitating team transitions and fostering individual employee development to continue to deliver on key business objectives. A native of Ireland, Andrew has a proven track record of success, after more than two decades with dynamic, high growth global leaders where he has been responsible for the oversight of organizational development programs, corporate talent strategy, leadership development and change management for teams up to 8,000 employees. Prior to Lumeris, Cole was the Senior Vice President of Human Resources at Goldstein Group Management. He’s also worked with high-tech companies such as A123 Systems and Schneider Electric, and held a global position in the Vegetable Seed division of Monsanto. Cole is co-author of a book entitled, “Executing Your Business Transformation.”

Brian LeDuc

Senior Vice President of Technology, Products & Services

Brian LeDuc has a wealth of healthcare and technology experience and shares the Lumeris passion for improving the healthcare delivery system.  Mr. LeDuc joins Lumeris from Express Scripts, where for the last seven years he has managed their core technology products for 3,500 clients and 100 million members for Medicare, Medicaid and commercial populations, as well as managing their $100 billion merger with Medco. Previously, he started his career at Accenture and has served as chief information officer and chief operating officer of multiple startup companies. In his current role he is responsible for leadership of all technology resources to help Lumeris achieve the mission of improving healthcare.

Gaurov Dayal, MD

Senior Vice President of Health Systems and Strategy

Gaurov Dayal, M.D., is a versatile leader responsible for the nationwide adoption of Lumeris’ Population Health Services Organization (PHSO) solutions by the industry’s leading health systems. He offers a deep knowledge and unique perspective on health systems, the largest and fastest growing segment of the population health market, through his executive experience at top healthcare organizations, such as SSM Health and Adventist Healthcare. In his current role, Dr. Dayal oversees business development, key partnerships and revenue growth within health systems, while continually improving the reliability and effectiveness of Lumeris’ PHSO solutions for this emerging segment.

Jeff Smith

Senior Vice President, Head of US Markets

Jeff Smith is an established health care executive with 20 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 Strategy, Acquisitions, and Population Health Management at CVS Caremark, one of the nation’s leading integrated pharmacy services companies. Mr. Smith also served six years on the board of directors of RxHub and Surescripts.  In his current role, Mr. Smith is responsible for the national oversight of Lumeris sales, marketing, and accountable delivery solutions.

Carol Murdock

Senior Vice President and Head of Market

Carol Murdock joined Lumeris with more than 25 years of experience in strategic marketing, management and business development in health 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. In her current role, Ms. Murdock is responsible for sales, client management and operations, including driving business development, key customer partnerships and revenue growth.

Nigel Ohrenstein

Senior Vice President and Head of Market

Nigel Ohrenstein is responsible for Lumeris’ business development and operations in the North and Northeast region of the United States. He brings extensive operational, business development and consultative sales experience to his role at Lumeris. He previously ran the Medicare business for Express Scripts, building a new Part D business from the ground up to a $500 million business unit. Mr. Ohrenstein has held a variety of roles leading sales, account management and operations teams. He began his career as a corporate attorney working for Hebert Smith in London and Hogan & Hartson in Washington, DC. In his current role, Mr. Ohrenstein is responsible for Lumeris sales, client management and operations, including driving business development, key customer partnerships and revenue growth.

Jeff Studenka

Chief Marketing Officer

Jeff Studenka is a healthcare industry veteran with over two decades of global business experience, who plays a key role in developing and deploying an integrated marketing strategy for Lumeris. He offers a proven track record in working across the sales and marketing functions at dynamic and rapidly changing organizations, such as Philips Healthcare, a division of Royal Philips; Stryker Endoscopy; and STERIS Corporation. Further strengthening Lumeris’ position in the population health service organization marketplace, Jeff leads a high-energy team dedicated to making an impact on the country’s healthcare industry as it transitions to value-based care.

Peter Kinhan

Senior Vice President and Head of Market

Peter Kinhan is responsible for Lumeris’ business development and operations in the West region of the United States. Mr. Kinhan is a proven leader in market penetration with a specialty in the development of high performance teams. Most recently at GE Healthcare, he led the organization’s ambulatory practice solutions business, a more than $150M software and services unit supporting 50,000 physicians across the US.  Peter was also instrumental in building the organization’s position in value-based care and population health strategy. Prior to GE he held positions as Ernst & Young and Eclipsys Corporation. In his current role he is responsible for driving business development, key customer partnerships and revenue growth.

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, MD

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 a Managing Director of Sandbox Industries.  He is a member of the Sandbox Healthcare team and is passionate about helping Sandbox portfolio companies grow. Prior to joining Sandbox, he worked at Highland Capital Partners and Morgan Stanley.  He received a bachelor of arts degree from Brigham Young University and an MBA from Stanford. Sandbox Industries provides investment management services for the BCBS Venture Funds.

Richard Jones

CEO of Essence Healthcare & Chief Corporate Development Officer

Richard Jones is the president and CEO of Essence Healthcare, one of the nation’s first accountable delivery systems and a consistently high-rated Medicare Advantage Prescription Drug (MAPD) health plan. In addition, he leads Lumeris Healthcare Outcomes, which offers full turn-key business process outsourcing and management services to support MA and commercial health plans.

Mr. Jones is an experienced health care business executive and certified public accountant and founding president of Lumeris. He previously served as chief financial officer of Essence Group Holdings Corporation (including Essence Healthcare), national president of United Healthcare Medicare and Medicaid lines of business, president and CEO of Coventry Healthcare of the Midwest, and chief financial officer of Coventry Corporation.

Christopher W. Kersey, MD, 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, MD

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

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.