Value-Based Care: The smarter path forward for healthcare.

America’s healthcare system is at a breaking point. The traditional fee-for-service (FFS) model is no longer sustainable. It rewards volume over value, leading to rising costs, fragmented care, and physician burnout.

It’s a model that no longer works—for providers, for payers, or for the people we serve.

Together, we turn partnership into progress.

We believe that every individual deserves proactive, personalized care—the kind of care we’d want for those we love. And we know health systems need a sustainable model that aligns economics with outcomes. That’s what value-based care delivers.

We offer comprehensive solutions that combine people, process, and technology to make value-based care operational - and successful.

AI-powered support for care teams

Tom extends primary care by automating routine tasks that strain practices. From patient outreach and chronic condition monitoring to providing an AI-driven alternative for some in-office visits, Tom reduces manual encounters—creating capacity for physicians to focus on complex care and improving outcomes across the panel.

Care quality & access

Help ensure the right care happens at the right time, with solutions designed to increase preventive screenings, close gaps in care, and improve patient access. We provide guideline-driven workflows and automated patient outreach for proactive screenings, management of chronic disease, pharmacy performance optimization, and tailored support to remove barriers that limit access to care.

Documentation & coding

Accurate documentation and coding is the backbone of value-based care. We deliver real-time data, visit-note analysis, and home visits to capture every condition—ensuring precise coding, fair reimbursement, and improved risk adjustment accuracy.

Acute & post-acute orchestration

We help hospitalists, case managers, and therapists employ strategies that maximize resource utilization and enhance care transitions. Our combination of technology, analytics, and strategic partnerships support —lowering readmissions, improving transitions, and enhancing outcomes for medically complex patients.

High-risk patient management

High-risk patients drive the majority of spend. Our AI-powered solutions identify rising-risk populations early and deliver personalized support at home, virtually, and in-office—reducing unnecessary utilization while building trust and continuity of care.

Foundational services

We offer expert teams and proven frameworks to support payer contracting, funds flow, governance, and provider education—aligning incentives and simplifying complexity so health systems thrive in risk-based models. These core services are customized to your structure, market dynamics, and performance goals.

Your strategy. Our value-based care enablement. Shared success.

Built by physicians and proven in practice, Lumeris partners with leading health systems to navigate the complexities of value-based care—aligning payers, providers, and patients to achieve sustainable growth, reduce total cost of care, and drive lasting patient outcomes.

Care that works for everyone

Value-based care rewards outcomes, not encounters. That means healthier populations, fewer avoidable admissions, and incentives that finally align providers, payers, and patients. With Lumeris, health systems reduce unnecessary hospitalizations, improve chronic disease management, and achieve 20–30% total cost of care reductions. Powered by Tom, our AI-enabled Primary Care as a Service platform, we make those results scalable—turning billions of data points into actionable insights that support patients, physicians, and health systems alike.

Built by physicians, proven in practice

Lumeris was founded by physicians who knew care works best when health systems work with doctors—not around them. With 15+ years of experience, $9.3B+ in medical spend under management, and 1.2M lives supported in risk-based models, we’ve proven value-based care can work in the real world. From Medicare Advantage to ACO REACH, MSSP, Medicaid, and Commercial programs, our partners have achieved $100+ PMPM savings and 94% average quality scores—evidence that physician-led transformation drives results at scale.

More than advice, a partner in Value-Based Care transformation

We don’t drop off playbooks and walk away. Our teams embed with yours, aligning incentives, sharing risk, and staying accountable for results. Healthcare transformation isn’t outsourced, it’s built together. Our partners have achieved 3.8X more favorable economics through risk-sharing payer contracting—proof that value-based care can be both sustainable and financially rewarding.

From data exhaust to clinical clarity

Our care orchestration platform, Tom™, ingests 30B+ clinical data points and 219+ payer/EHR pipelines to deliver Best Next Action insights in real time. Care gaps close faster, documentation is simplified, and physicians get to practice at the top of their license.

Results that redefine what’s possible

$100+

PMPM savings in Medicare Advantage

3.8x

Our partners achieve more favorable economics through risk-sharing payer contracting

94%

Average quality scores across ACO partner

20-30%

Reduction in total cost of care

A platform and a partnership for change in healthcare.

Technology powers Value-Based Care. Expertise enables it. Partnership sustains it. With Lumeris, health systems can move faster, scale smarter, and thrive in value-based care.

Let’s build your path to sustainable value together.

Frequently asked questions

What is Value-Based Care—and why does it matter to clinicians?
Value-Based Care (VBC) is a healthcare delivery model that rewards outcomes over volume. Instead of billing for each service or visit (fee-for-service), you’re compensated based on how well your patients are cared for over time—with a focus on preventive care, chronic disease management, and care coordination.
At its best, VBC enables you to deliver smarter, more personalized care—while building financial sustainability and protecting your time.
Who defines ‘value’ in Value-Based Care—and what does it mean for my practice?
Too often, “value” is defined by payers, not practitioners. At Lumeris, we believe physician-led quality metrics are essential to making VBC work. That means using measures tied to clinical relevance: preventive screenings, chronic condition control, avoidable ER visits—not administrative checkboxes.
This helps ensure you’re measured and compensated based on what matters clinically—not what’s convenient for insurers.
Does Value-Based Care mean cutting costs by denying care?
No. It means delivering the right care, at the right time, to the right patients.
With advanced analytics and population health tools, your team can identify:
- Rising-risk patients who need more support
- Stable patients who need check-ins—not office visits
- Social drivers of health that impact outcomes
This isn’t about withholding care—it’s about proactive, efficient delivery that improves outcomes and preserves resources.
Can this really work—or is it just another unproven healthcare reform?
Unlike past “pilot programs,” VBC has proven results. With Lumeris, our partners have achieved:
- $100 PMPM savings in Medicare Advantage
- 90% chronic disease reassessment rates
- 139% increase in upside-sharing within 3 years
This isn’t theory—it’s real-world performance. And when done right, VBC models improve physician compensation, reduce administrative waste, and increase care team satisfaction.
How does Value-Based Care impact operational performance—and is it financially sustainable?
Value-Based Care (VBC) isn’t just a clinical model—it’s a strategic transformation lever that can drive measurable impact across your organization.
Health systems partnering with Lumeris have achieved:
- 20–30% reductions in total cost of care
- $100 PMPM savings in Medicare Advantage at maturity
- 139% growth in negotiated upside share payouts over 3 years
- Improved STAR ratings, risk-adjusted revenue, and care gap closure
But financial outcomes are only half the story.
Our approach aligns clinical, financial, and operational strategies to:
- Support team-based care delivery
- Improve physician engagement and retention
- Drive speed to value across lines of business (MA, MSSP, Commercial)
And we do it through an enablement model—not a one-size-fits-all platform. Our technology, services, and strategic support flex around your infrastructure, risk readiness, and growth goals.