Essence Healthcare, MAPD receives a raw score of 5.115 from CMS, bucking the national downward trend in Star ratings and achieving an average of more than 4.5 stars for 13 straight years.
St. Louis, MO, Oct. 19, 2022 — Essence Healthcare, using the population health technology, tools and expertise of Lumeris, the industry’s leading value-based care solution, once again achieved the highest Overall Plan Rating of 5 stars by the Centers for Medicare & Medicaid Services (CMS). Their raw score of 5.115 is indicative of consistent high performance along with continued year over year improvement. Lumeris’ commitment to quality has enabled Essence to perform in the top tier of Medicare Advantage plans for the last 13 years, showing the power of Lumeris to produce over time.
“The performance of Essence Healthcare demonstrates that a sustainable model for value-based care is possible,” said Mike Long, chairman and CEO of Lumeris. “These ratings serve as an extraordinary affirmation that it is possible to bring the highest quality of care and the best consumer experience while lowering medical spend. We celebrate the extraordinary efforts of all our team members and provider partners who demonstrate our commitment to quality and to delivering the care every doctor wants for their own family.”
Annually, CMS releases Star Ratings to reflect the experiences of people enrolled in Medicare Advantage plans. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. CMS adds a “reward factor” that’s worth up to 0.4 points for plans that are consistently high performing across all the measures they assess. Essence Healthcare was in the very top percentile on both overall score and variability this year, resulting is a rating that exceeds 5 stars.
Essence received perfect member experience scores which include both health plan operations and their experience with the care delivery system—a testament to the Lumeris model of collaborating with physicians. In addition to receiving a perfect 5-star rating in the member experience domain, Essence also received 5 stars in the following domains:
- Staying Healthy (Screenings, Tests and Vaccines)
- Managing Chronic (Long Term) Conditions
- Health Plan Customer Service
“Another 5-star rating this year demonstrates our continued commitment to quality outcomes, exceptional patient experience and superior financial results,” said Dr. Zimmerman, Corporate Chief Medical Officer for Lumeris. “We are pleased with not only the consistency of outstanding results but with our success in the constant quest to improve performance. Notably this year, we achieved a 5-out-of-5-star rating on the member experience survey questions, which is a testament to everyone at Lumeris and the great physicians and their teams that have partnered with us.”
Lumeris brings the industry’s most comprehensive, market-leading technology and enablement capabilities to health system and provider partners looking to perform in value-based care. Those capabilities include supporting 5-star Medicare Advantage plans, like Essence, which is expanding into five new states for 2023. With the start of the 2023 Medicare Annual Enrollment period on October 15, the Star ratings system supports CMS’ efforts to empower people to make healthcare decisions that are best for them.