1. Based on more than 10 years’ experience providing population health
management services for Essence Healthcare, a 5-Star (2016 plan
year)* MA plan with over 50,000 members, Lumeris understands
that it takes more than technology to manage accountable care and
achieve remarkably improved outcomes. At Lumeris, we help clients
work collaboratively with providers in value-based arrangements,
and we have identified 22 core competencies in four main areas of
concentration: Consumer & Provider Engagement; Enhanced Care
Delivery; Operational Excellence; and Business Model Alignment.
Mastering these four areas is critical to building and operating
what we call Population Health Services Organizations (PHSOs).
Lumeris’ model focuses on the wellness of patients and fosters
stewardship of healthcare resources in pursuit of the Triple Aim Plus
One: better health outcomes, lower costs and improved patient
experience plus physician satisfaction.
• Health Systems: We help health systems create PHSOs and
define populations for risk. We help them build the foundation
to become their own payer, establish risk-bearing arrangements,
and share in the value created by these contracts.
• Provider Groups: We empower providers and their Accountable
Care Teams (ACTs) with process improvement strategies,
technology and clinical workflows so they can achieve better
contract performance, share in maximum incentives and deliver
high-quality care.
• Payers: We work collaboratively with payers to ensure the right
contracts, measures and incentives are in place to influence
physician behavior and drive quality, cost and utilization
performance.
Lumeris engages and trains providers in appropriate strategies and
tactics for delivering better care, improving the health of populations
We enable PHSOs by helping clients adapt their business
and care delivery models to improve financial and clinical
outcomes:
Value-based Expertise
• Over a decade of experience successfully managing
population health and value-based contracts for
healthcare organizations;
• Results-driven as evidenced by achieving 5 Stars
for the 2016 plan year (and 4.5 Stars the previous four
years) for our client, Essence Healthcare; and
• Solutions are payer agnostic and payer neutral.
Proven Methodology
• Identified 22 core competencies needed to manage
high-performing PHSOs;
• Prescriptive approach to developing/cultivating
physician and Accountable Care Team behaviors
and workflows to manage risk-based contracts; and
• Local, in-market support to drive adoption and
value-based performance.
Flexible Business Model
• Customized solutions and pricing that align with
our clients’ goals and outcomes; and
• Multi-payer, multi-population solution platform.
Enabling Technology
• Cloud-based technology purpose-built to manage
population health;
• Integrates clinical and financial data from
disparate systems; and
• Provides complete visibility to patient care and
actionable insights to manage performance.
WhatMakesLumerisDifferent
and reducing per-capita costs. To do this, we have created our own proprietary model, based on Essence Healthcare’s success, that
helps providers understand their risk and behaviors that should be adopted for healthcare to move from a volume- to value-based model.
This model also incorporates a consumer-centric solution that engages patients so they can become more active participants in their own
care; make better, more informed decisions; interact innovatively with their ACT; improve care-plan compliance; and close gaps in care.
To provide a 360-degree view of patients at the point of care, the Lumeris Accountable Delivery System Platform (ADSP)®
was purpose-built
for population health management. The cloud based system allows providers, payers and executives to provide actionable intelligence on
clinical and financial data to enable timely, value-based healthcare decisions. Some features of the ADSP are:
• Aggregates and analyzes data from across the continuum of care (EMR encounter data, claims, pharmacy, lab and other data)
• Rationalizes data to establish a unified, accurate view of patient care and population health
• Mines data for clinical and financial improvement opportunities
• Sends actionable clinical and financial intelligence.
1.888.586.3747 • Lumeris.com©2016 Lumeris Confidential and Proprietary
*Plan performance Star ratings are assessed each year and may change from one year to the next.

2. To learn more, call 1.888.586.3747 or visit Lumeris.com
Lumeris’ Board of Directors
• Mike Long, Chairman and Chief Executive Officer, Essence Group Holdings Corporation and Lumeris Corporation
• John Burbank, Managing Member and Chief Investment Officer, Passport Capital
• Denis A. Cortese, MD, President and Chief Executive Officer Emeritus, Mayo Clinic Director, Health Care Delivery
and Policy Program, Arizona State University
• L. John Doerr, Partner, Kleiner Perkins Caufield & Byers
• Matt Downs, Managing Director, Sandbox Industries
• Christopher W. Kersey, MD, MBA, Managing Member, Camden Partners
• John H. Rice, MD, Executive Vice President and Chief Medical Officer, Esse Health
Value-Based
Populations
Medicare Advantage
• Roughly 200,000 lives
under mgmt.
Commercial
• Roughly 500,000 lives
under mgmt.
Self-Insured Employee
• Roughly 55,000 lives
under mgmt.
MSSP ACO
• Two successful MSSP
applications
• Roughly 20k lives
Health Systems
Built a PHSO for a $500M
community health system
managing full risk and SS
contracts
Designed and deployed Care
Management and technology
for $800M health system to
support P4Q and SS contracts
Clinically integrating a seven
hospital, 200 site, 2,100
physician health system to
perform on value-based
contracts
Provider Alliances
Built a PHSO for an alliance
with 3 health systems and
over 200 independent
physicians
Delivered PHSO services for
large regional IPA to improve
performance on value-based
contracts
Built a PHSO for 300+
independent PCPs managing
full-risk Medicare Advantage
contracts
Payers
Delivering PHSO services
for multiple health plans
starting Medicare Advantage
offerings
Providing technology and
services to support a large
regional payer’s accountable
provider strategy
Providing EMR integration
and Risk Adjustment services
for large regional payer
Current Client Engagements
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Proven Outcomes
As a result of our outstanding solutions, we have been able to achieve:
• 5 Stars for the 2016 plan year, and 4.5 Stars the previous four years;
• Nearly 70 percent MCR before surplus distribution of physician quality-based compensation;
• 30 percent reduction in costs and 18 percent reduction in readmission rate compared to FFS Medicare;
• Largest, in-region market share for four years; and
• Over 80 percent of providers consistently rate that they are satisfied with their collaborative payer partner.