Our Partner - Lumeris

Lumeris serves as a long-term operating partner for organizations that are committed to the transition from volume- to value-based care and delivering extraordinary clinical and financial outcomes.

More than a decade ago, a team of healthcare executives and physicians decided to disrupt the prevailing economic and care delivery model—the same one that dominates today. Their solution was to establish the first collaborative payer, Essence Healthcare, which is a Medicare Advantage plan. Under this model, Essence Healthcare 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.

Essence Healthcare was Lumeris’ pioneer client and has been leveraging Lumeris for more than ten years to operate its Medicare Advantage plans, which serve more than 52,000 Medicare beneficiaries in various counties throughout Missouri and southern Illinois. Essence Healthcare has been awarded the highest rating available from the Centers for Medicare and Medicaid Services, 5-Stars, for the quality of services it delivers to its Medicare Advantage members. The 5-Star award was given to only 3 percent of all the plans in the U.S.

With the nation’s health care industry still struggling and the concept of value-based accountability on the rise, Lumeris shares Essence Healthcare’s transformative technologies, programs, and methods with health plans, health systems, and other organizations seeking to establish their own high-performing accountable delivery systems. Currently, Lumeris is engaged with health systems, provider alliances, and payers representing tens of millions of lives moving to value-based care. Lumeris has nearly 800 employees.

In July 2015, UMMS executed an operating agreement with Lumeris to support the system’s journey into value-based care and establish its Population Health Services Organization.