LUMERIS MaStERIng thE StEpSto popULatIon hEaLth SUccESS

1.888.586.3747 • Lumeris.com

Lumeris Creates Population Health Services Organizations (PHSOs) that Deliver Value for Payers, Providers and Patients

© 2014 Lumeris

As a technology-enabled organization, Lumeris understands the importance of aligning the business model and the technology that makes it work.

•Healthdeliveryorganizationsinrisk-bearing arrangements need differentiated health plan operations and functions. •Forpayers,healthplanoperationsmustsupport remarkablyimprovedbusinessandcaredelivery outcomes. •Healthsystemswithpayeroperationsinvalue- based arrangements—as well as those wanting to become their own payer— need to align both the business model and the technology-enabled servicestomanageoperationsaswellasthehealth of their populations.

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Provider & consumer engagement

Themovementfromvolumetovalueismonumentalforallparticipantsinthehealthcareindustry.Thetransitionofriskfrompayerstoprovidersandevolvingpaymentmodelsrequiresredesign,rethinkingandretoolingtoachievetheleveloftransformationthatwilldeliveronthepromiseofbetteroutcomes.

Whiletheneedsofeachplayerareunique,Lumerishasidentifiedcommonandessentialareasofexpertisethatarecrucialtomasteringpopulationhealthanddeliveringbetteroutcomesandreducedcosts.LumerisPopulationHealthServicesOrganizations(PHSOs)arebuiltonfour,largeareasofknowledge.

Withmorethan10years’experienceoperating high performing MA plans, Lumeris knows one of the steps on theroadtoaPHSOistocreatecollaborativerelationshipsbetweenprovidersandpayers,andthebestwaytodothatisbyaligningincentives.Acollaborativephysicianengagementprogramwillhavealastingimpactonclinicalqualitymetricsandpatienteducation.

Lumeristrainsanddevelopsteamsof healthcare professionals led by physicians who together manage and

coordinatetheprimarycaredeliveredtoapopulation.Tomanageeffectively,mostteamsrequirebothcentralizedandpoint-of-servicesupport.

In addition, best-in-class engagement techniquesputpatientsatthecenterofcare, which is a key strategy to meet the promise of better health outcomes. To help people make the right healthcare andfinancialchoicesforthemselvesandtheirfamilies,theyneedtheadvocates,physician support information and tools. Lumeris’expertscansharetheirexperienceon how to design engagement strategies

thatencouragehealthybehaviorchangeandimproveadherencetotreatment and medication plans.

To learn more, call 1.888.586.3747 or visit Lumeris.com

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Business model AlignmentTodevelopabusinessmodelthatdrivesproviderstowardbetteraccountablecare, Lumeris recommends aligning boththevalue-basedcontractsandtheappropriateincentives.Theexpertswillevaluateaprovider’scurrentinfrastructure and historic performance to understand its capabilities to take on value-basedcontracts.Then,Lumeriswill design contracts with performance metricsthatincludeclinical,quality,costand utilization as well as physician engagement. Together these metrics willcreatebalancedincentivesthat

helpdrivesuccessfulperformanceandpracticechangeamongproviders.

InthiscoreareaLumerisprovidesacomprehensivesolutionthatincludesthe enabling technology and trans-formationalsupporttodriveriskadjustmentandrevenuemanagement.The tools promote accurate coding and help close gaps in care. The platform also contains reports that track risk scores, premiums, high-risk diagnoses and patient conditions.

enhanced care DeliveryAnother key area to master is care delivery.LumerishelpsAccountableCare Teams and physicians gain accesstoessentialclinicalandfinancialdataso they can make better informed value-basedhealthcaredecisions.Careteamsneedamodelthatdevelopsinterventionopportunitiesandenablesseamless workflow integration at the providerleveltoprioritizedailyworkflows. Lumeris also helps optimize patientcarebyprovidinginsightintothe proper balance between cost and efficacy.

TobeasuccessfulPHSO,ahealthdeliveryorganizationneedstounderstandhowafocusonqualitycanhelpachievegreater,sustainableresults.TheLumerisqualitymanagementprogramleveragestechnologytosupport patient outreach to increase compliance and performance in qualitymetrics,andtoclosegapsincare.Astrategyforqualitycareshouldalignwithphysicianincentivesandthedesignofthebenefitplan.Datatiedtothecontractmeasuresdrivesinterventions,whichthendrivesquality

and offers the potential for reducedcosts and increased physician incentives.

operational excellenceOperationalexpertiseisessentialforPHSOstomanagepopulationsefficientlyandeffectively,andtokeep patients healthy. Lumeris’ business operation components improvequality,reducecostandensure appropriate utilization of healthcareserviceswhilemeetingclinical,operationalandfinancialmeasures.

Lumeris helps clients with medical claims processing, medical manage-ment, data warehousing and reporting capabilities, enrollment, eligibility and capitation reconciliation, member servicesandprovidercontracting/relations.EssenceHealthcarebenefitsfromLumeris’expertiseintheseareas, and has earned 5-Stars* from CMS for the 2016 plan year, and 4.5Starsthepreviousfouryears.

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