Big data analytics tools, paired with buy-in from primary care providers, are enhancing population health management at Mount Sinai Health System. While the majority of healthcare organizations have at least recognized the importance of population health management, large integrated delivery systems with hundreds of locations and thousands of providers often find it difficult to drive (…)

CMS recently released the 2018 Star Ratings for Medicare Advantage plans across the country. CMS created the Star Rating System to reward clinical quality, member satisfaction and service, as well as regulatory compliance. For consumers, Star Ratings provide an easy way to shop for and compare plans during enrollment periods. The difference in one star (…)

Using such data as a source of social determinants of health information can boost the accuracy of population risk predictions. It’s no surprise when your mailbox is full of credit card offers or coupons and catalogues from your favorite stores. After all, it’s fairly common knowledge that credit reporting agencies like Experian and Equifax (which (…)

By Ben Kline, Business Development and Joel Andersen, Vice President, Marketing After considerable due diligence, your organization has decided to launch a Medicare Advantage (MA) plan. You evaluated the market and current MA enrollment. You examined market competitors, such as provider-sponsored organizations, regional insurance firms, and large national organizations. You gauged potential competitor responses, trying to figure (…)

By Mitu Ramgopal, Business Development As health systems define their future state vision and how they will achieve the transition to value-based care, one approach that has emerged is to join a provider collaborative. Health systems are coming together to start sharing best practices and work toward common goals. However, it is critical to determine how (…)

In a perfect world, a well-functioning healthcare delivery system should provide the right care at the right time in the right place, while being accountable for clinical and financial outcomes. But the current method of paying for healthcare is broken. Since the inception of Medicare more than 50 years ago, the system has been designed (…)

In this paper, Reinvent & Reimagine Population Health: Interconnected Care Delivery, Lumeris author Kamesh Somanchi discusses the steps required for developing an interconnected platform to support value-based care delivery. While various population health management technology solutions have enabled healthcare organizations to start their transition to value, full transformation requires a comprehensive strategic and operational platform-based (…)

In their paper entitled, Moving to Value with a Population Health Services Organization, Lumeris authors Jeff Smith and Jay Shah provide an overview of the current healthcare market landscape and explore the economic, political, and social drivers influencing the move toward value-based care. This transformation, which requires a change in both the care delivery and (…)

A New Business Model for Provider Organizations Authors: Greg Scrine, Senior Vice President, Lumeris Advisory Services Ricky Garcia, Vice President, Lumeris Advisory Services   Ever-growing healthcare costs and the recognition that one-third or more of US healthcare spending is unnecessary, wasteful, or inappropriate have resulted in pressure on healthcare organizations to cut costs without harming (…)