Value-Based Models
Lumeris provides flexible partnership options to mitigate provider risk and ensure that all value-based populations are represented by the best-fit CMS Program and payer relationship.
Facilitating the Adoption of Value-Based Care
Empowering the seamless integration of new care models so providers can focus more on patient-centric care.
- Expanding the reach of the delivery of high quality care
- Shifting economic incentives back to those responsible for providing care
- Unlocking the infinite potential of the increasing amount of data to impact health
- Sharing operational and financial risk
Fostering Mutually Beneficial Relationships with Payers
In healthcare, there persists a misconception of a singular solution for payer relationships. Through our extensive industry expertise, we recognize the flaws in this notion.
To us, the best value-based program is the one that best serves your unique provider and beneficiary mix. Leveraging our national payer network, alongside advanced analytics and nuanced localized insights, we negotiate the payer contracts specific to your health system that will drive results.
MLR Target
*Representative Health System
OUR NATIONAL PAYER NETWORK APPROACH
Identifying the best match value-based model for the right population
1
EVALUATE VALUE-BASED
CARE STATUS
Analyze your current position on the value-based care spectrum and population health capabilities
2
DEFINE JOINT
GOALS
Determine our joint ability to achieve defined quality goals and outcomes metrics
3
CONDUCT ACTUARIAL
ASSESSMENT
Assess national, regional, and local benchmarks and cost trends leveraging proprietary, highly accurate models
4
NEGOTIATE PAYER
CONTRACTS
Navigate the intricate process of negotiating payer contracts, ensuring balanced and collaborative terms and maximizing value for your organization
5
PRIORITIZE BEST-FIT
SOLUTIONS
Identify the best opportunities to improve quality, outcomes, and total cost of care through the deployment of our tech-driven solutions
Comprehensive Value-Based Enablement
to Support All Patient Lives
COMMERCIAL PAYERS
As a result of our extensive experience working alongside health system partners, Lumeris understands the importance of balancing value-based and fee-for-service business models. A critical component of managing total cost of care for value-based patients is optimizing in-network utilization of high-value providers and facilities. Through targeted physician education, we empower healthcare professionals to improve coordination across the continuum of care for their full patient panels. By leveraging our expertise, physicians and patients can benefit from improved care coordination and achieve better overall healthcare outcomes.
MEDICAID
Lumeris is committed to ensuring that patients with the greatest need have access to the same population health infrastructure regardless of payer type. We deploy our predictive analytics and patient engagement tools to support our partners in maximizing performance and improve quality outcomes and gaps in care closure for patients, including addressing health equity and SDoH needs.
TRADITIONAL MEDICARE
Lumeris offers our partners the opportunity to participate in various programs such as the Medicare Shared Savings Program (MSSP) and ACO REACH or a curated combination of both. This approach offers our partners flexibility to choose the model that best aligns with their risk tolerance and performance readiness. We work closely with our partners through targeted clinical programs to overcome common barriers associated with managing a traditional Medicare population, including appropriate documentation of health risk status and appropriate utilization.
MEDICARE ADVANTAGE
Lumeris offers our partners the opportunity to participate in risk-based Medicare Advantage arrangements through our Accountable Risk Organization, a joint risk-sharing entity, which leverages our collaborative payer relationships and allows for the mitigation of downside risk to providers. We provide deep expertise in managing value-based populations and payer contracting derived from twenty years of experience operating our highly successful Medicare Advantage plan, Essence Healthcare. Essence Healthcare has consistently achieved a 5-Star CMS rating, showcasing our commitment to exceptional healthcare delivery. Our Accountable Risk Organization negotiates and contracts risk-based arrangements directly with payers with performance supported through the deployment of a comprehensive team of in-market and centralized population health resources, advanced technology, and analytics. This holistic approach ensures that our partners have the necessary tools and expertise to effectively manage and improve outcomes for their population.