David Pike

Lumeris – Company Overview

Lumeris offers extensive experience in accountable care services, having helped establish one of the country’s first successful accountable delivery systems, Essence Healthcare. Under this model, we worked collaboratively with providers to establish new value-based reimbursement models to align incentives, affording our providers the time to more proactively manage populations of patients and coordinate patient care. To support this mission, we also developed an innovative cloud-based technology platform to aggregate and rationalize data from across the continuum of care, deliver actionable clinical and financial information to providers and organizational stakeholders, and furnish them with care management applications to leverage that information.

Essence Healthcare developed a significant set of informatics technology, accountable care methodologies, and clinical content to nurture continuous improvement capabilities across our provider network while reducing the cost of care and adhering to national regulations. These capabilities were capitalized on in 2010, when Lumeris, a software-as-a-service (SaaS) company, was established.

In early 2012, Lumeris became an investor and managing partner in NaviNet. NaviNet’s well-established provider portal functionality, utilized by 75% of the nation’s physicians, is well-positioned to support future clients:

  • We understand the strengths and limitations of standard Health Insurance Portability and Accountability Act (HIPAA) transactions and regulatory compliance to support the full range of provider, patient, and payer needs across multiple insurance products, provider organization types, and care delivery models.

  • We know how to extend the capabilities of standard transactions to meet the real-world needs of all users who must interact with portal capabilities.

  • We have integrated with hundreds of systems of every type using many approaches, ranging from the use of standard electronic data interchange (EDI) protocols to highly customized real-time mainframe interfaces.

  • We have implemented numerous hybrid transactions that cross the traditional clinical/administrative boundaries, such as in-context delivery of care guidance in response to the submission of an EDI health care eligibility/benefit inquiry (E&B) transaction.

  • We have the ability to plan, predict, stimulate, and ensure the use of portal capabilities by all users.

  • We have extensive experience transitioning users to new methods of communication and ensuring superior adoption.

Lumeris’ Accountable Delivery System Platform (ADSP) is the core technology behind our accountable care solution. This platform functions as an integrated control system for accountable care by providing executives, staff, and physicians access to real-time clinical and financial information. Rather than replace or compete with existing systems, the ADSP is an open, vendor-agnostic, cloud-based system that integrates disparate health information systems and aggregates claims and visit data from silos across the continuum of care. The ADSP then rationalizes this data to establish a unified, accurate view of individual and organizational performance, and mines the data for clinical and financial opportunities. The ADSP sends findings to key stakeholders and physicians to provide complete visibility into patterns and behaviors that drive costs and impact outcomes. Through a series of application services residing on the platform, our clients can address opportunities and engage physicians to drive and support optimal clinical and financial outcomes.

Lumeris’ ADSP has proven its ability to support high-performing accountable delivery systems, realizing Dr. Berwick’s renowned Triple Aim of improving care quality, cost, and outcomes. As an organization, we have adopted the Triple Aim as the basis and driver of our solutions. Further, we call our model the Triple Aim Plus One, adding physician satisfaction as a key focus and benefit of our solutions.


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