When gazing on a macro level, costs associated with the US healthcare system are growing at an unsustainable pace, close to 2x GDP and with almost a Trillion dollars of waste and inefficiencies annually. This is influenced by various factors such as poor care coordination, ineffective care, fraud and abuse, and the absence of widespread and consistent preventative care. Meanwhile, Value-based Care (VBC) models are increasing in prevalence, in an attempt to flatten the cost curve. If we zoom in and look at health systems, we see them in the middle of this shift to VBC, facing the pressures to transition from Fee for Service models into this new paradigm. However, these pressures also come with an opportunity, and the new paradigm, if managed well, could actually be more advantageous to health systems while reducing the overall cost of care with better outcomes. VBC models are inherently difficult to navigate and present a lot of risks if not managed well especially when health systems are already operating with thin and sometimes negative margins. The key is to be able to manage care not only at the n of 1 patient but also at the population level. This requires the type of sophisticated capabilities that Lumeris—a value-based care managed services operator—brings to fruition: advanced data operations capabilities and actionable analytics coupled with proven technology-enabled processes to manage the health of populations towards a higher quality of care at lower costs. “A Lumeris core strength is our ability to develop models that can predict the health risks in patients and guide to the next best action,” begins, Jean-Claude Saghbini, Chief Technology Officer, Lumeris.
From Volume Based to Value Based Care
Today, Lumeris empowers health systems to unlock their full enterprise value through population health services, advanced analytics, and technologies aimed at effectively engaging providers and patients in the care journey. The company provides organizations with the infrastructure to help
build a foundation for their transition from volume to value; and more importantly the portfolio of capabilities is tailored to meet health systems wherever they are on the maturity scale in their transition journey. Lumeris enables managing patients in value-based-care arrangements, effectively and more efficiently, so provider-led organizations can deliver care within their high-value network, improve on today’s contracts, and prepare for tomorrow’s contracts. “Through our data-driven technology solutions, organizations can gain actionable insights from the population level down to the individual level, and even further down to the individual service cost of care. In addition to contributing to the overall transformation of healthcare, the technology we develop positively impacts the lives of individual patients, which is what matters most,” says Saghbini.
Lumeris has built its portfolio of solutions from the ground up with a unique focus on value-based care. It is comprised of an industry-leading technology stack coupled with a standardized playbook that can be adapted to fit at any level of a Health System’s maturity and experience in VBC. “We call that our Population Health Services Organization (PHSO) offering,” he adds. In addition to table stakes of large-scale data ingestion and processing capabilities from various sources such as claims data, EHR data, pharmacy data, patient generated data, and social determinants of health (SDoH) for example, Lumeris has built advanced capabilities in predictive risk analytics using Machine Learning models, decision support, and care coordination, as well as patient engagement capabilities. All with the objective of enabling customers to navigate the complexities and get to the insights that matter and that drive the actions that matter. “What also makes us unique in the marketplace is that we are also consumers of our own solutions. We have our own Medicare Advantage (MA) health plan, Essence Health, which is one of the premier MA plans in the country, averaging a 4.5 STAR rating over the past decade. Our PHSO offering is the technology that powers our MA plan. As such, we get a much closer view of insights and processes that work and ones that don’t work. We can adjust and pivot fast as we continue to build on our playbook, and at the end of the day, our customers leverage the same deployed solution that we leverage, with the same advanced analytics and tools,” explains Saghbini.
The Trusted Partner for Health Systems
Under the technical leadership and guidance of Jean-Claude Saghbini, Lumeris today is redefining the healthcare space by enabling the effective delivery of value-based care to the benefit of patients, health systems, and the overall US healthcare system. As the trusted partner for next-generation health systems, Lumeris helps providers deliver extraordinary clinical and financial outcomes. They do so with their unique combination of a decade-long experience in the domain; mature population health playbooks and services; and three key technology pillars: scaled data operations capabilities, advanced data science and AI, and engagement platforms that integrate into clinical workflows to effectively guide patients and providers to the next best action in a consumer-like experience.
An instance that portrays Lumeris’s value proposition is when the company assisted TriHealth—a health system based in Cincinnati, Ohio—to advance its value-based care strategy and capabilities. Having demonstrated strong leadership commitment, cultural alignment, and investment toward population health, TriHealth was preparing to manage over 250,000 value-based lives across its commercial, Medicare, and Medicaid contracts. To coordinate clinical and operational efforts, the system needed a comprehensive approach to develop value-based care capabilities and prepare for downside risk. TriHealth partnered with Lumeris to expand and optimize existing population health initiatives and ultimately prepare for managing downside risk contracts. TriHealth and Lumeris established the PHSO to integrate the necessary programs, tools, and resources to support the provider network. With the support of Lumeris and with the foundation in place, TriHealth is now in a strong position to leverage the synergies and resources of the PHSO to deliver higher quality, cost-effective care across all patient populations.
A Mission to Transform Healthcare
Being at the forefront of innovation is not just about building software, it’s also about fostering a dynamic, collaborative, and innovative team ethos with an adaptable work culture. By innovating at the leading edge of value-based payment models with advanced data science, and provider and consumer engagement, Lumeris fosters cross-organizational collaboration and one team approach that brings together expert in various disciplines such as clinical, finance, technology, and operations. “Fixing healthcare is a team sport,” says Saghbini. Lumeris recently opened the Dr. Tom Doerr Innovation Center, a multi-million dollar state-of-the-art facility that showcases Lumeris’s technology, capabilities, and team-oriented approach to improving patient outcomes. They embrace technology as an enabler to exponential change and are passionate about their mission to transform healthcare. “We believe in iterative innovation in which we deliver value, learn, and adjust in a high-speed cyclical approach. Our roadmap is aligned with some key strategic drivers: expanding our catalog of clinical and operational insights through the continuous acquisition of new data sources and the development of novel predictive models; and broadening our outreach capabilities beyond the clinical settings to streamline patient-provider engagement through interweaved technology and AI enabled experiences,” concludes Saghbini.