As the Centers for Medicare & Medicaid Services (CMS) award fewer 5-Star ratings in 2024, Essence Healthcare receives top scores
St. Louis, MO, Oct. 17, 2023 — Essence Healthcare, Lumeris’ wholly-owned, 5-Star Medicare Advantage (MAPD) plan, has received an overall plan rating of 5 stars from the Centers for Medicare & Medicaid Services (CMS). This is the fourth time and third consecutive year that Essence Healthcare has received a 5-Star rating — a testament to the organization’s consistent high performance and operational excellence, enabled by Lumeris’ strong strategic guidance and technology solutions.
“We rely on the Lumeris model and technology to support the dedicated team at Essence Healthcare, our providers and their efforts to produce the highest quality of care and improve the member experience,” said Ben Grabski, President and CEO of Essence Healthcare. “This recognition reaffirms the collaborative success we’ve achieved together.”
The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). In 2022 15.7% of contracts received 5 stars, while in 2023 the number of contracts awarded 5 stars dropped to 11.24%. For 2024 only 5.69% received a 5-Star rating.
“Receiving our third consecutive 5-Star rating demonstrates the power of our model, our team members, and our provider partners who embody our value-based care model each and every day,” shared Dr. Debbie Zimmerman, Corporate Chief Medical Officer for Lumeris. “We are rooted in a clinical model based on an approach to quality that optimizes outcomes throughout the year, partnering with providers to address critical needs such as care coordination, the management of chronic conditions and patient access.”
Lumeris’ technology-driven solutions, coupled with its extensive experience in value-based care enablement, have played a pivotal role in enhancing Essence Healthcare’s performance and capabilities. By leveraging Lumeris’ model, Essence Healthcare has consistently delivered affordable, comprehensive Medicare Advantage plans with a focus on wellness, care coordination, and exceptional member service.
“The Lumeris model used by Essence Healthcare leverages our breakthrough technology suite and extensive experience in value-based care enablement to assure that doctors can take an active role in caring for their patients, throughout their entire healthcare journey,” stated Jean-Claude Saghbini, President, Lumeris Value-based Care Enablement. “We are pleased to bring this approach to 5-Star quality to health systems across the country.”
Using the same model that powers 5-Star results for Essence Healthcare, Lumeris’ patient-centric model accelerates providers’ transitions to value-based care and enables health systems across the country to supply high quality care to original Medicare, Medicare Advantage, Medicaid, and Commercial populations while managing the total cost of care.
“Fulfilling the promise of value-based care requires a deep dedication to the members we serve, as well as operational expertise,” said Mike Long, chairman and CEO of Lumeris. “The consistent 5-Star ratings for Essence Healthcare serve as an extraordinary affirmation that our technology and approach drive organizations to achieve and sustain the highest quality care and the best consumer experience.”
Lumeris is the market leading value-based care enablement company bringing more than 10 years of experience as a pioneering force helping health systems and physician practices succeed in value-based care. A joint-operating partner in both value and risk, Lumeris delivers market-leading technology, insurance capabilities and on-the-ground expertise. Our partners are able to achieve superior quality metrics, patient experience, physician satisfaction and improvements in the total cost of care for Medicare Advantage, Original Medicare, Medicaid. and Commercial populations. With more than $12 billion of medical spend under management across more than 12 markets, we are creating a system of care that every doctor wants for their family.
Essence Healthcare, Lumeris’ wholly owned health plan, has received a 5-star rating from CMS for the past three years. To learn more about Lumeris, please visit www.lumeris.com.
ABOUT ESSENCE HEALTHCARE
Essence Healthcare provides over 62,000 people with affordable, comprehensive Medicare Advantage plans that focus on wellness, care coordination and personal service. Essence Medicare Advantage plans offer complete hospital, medical and prescription drug coverage and include extra benefits not covered under traditional Medicare. Powered by Lumeris, the nation’s leading population health services and technology company, Essence is earning national recognition for its commitment to service and quality. For three years (2022–2024) in a row, Essence has received Medicare’s highest Overall Plan Rating of 5-out-of-5-stars. Essence HMO and PPO plan options are available in Missouri, Illinois, Arkansas, Ohio, Kentucky, and Indiana for the 2024 plan year. To learn more about Essence Healthcare, please visit EssenceHealthcare.com.
Every year, Medicare evaluates plans based on a 5-star rating system. Star ratings may vary by contract or market. For plan years 2022–2024, plans under Essence Healthcare’s H2610 (HMO) contract achieved a 5-star Overall Plan Rating. Plans under other Essence contracts are too new to be measured for a Star rating.