NorthShore—Edward-Elmhurst Health (NS-EEH) is teaming up with value-based care company Lumeris to improve care for nearly half a million lives.
Working together, the partners hope to enable care coordination while improving clinical outcomes, the patient and provider experience and managing healthcare costs. The long-term partnership is payer-agnostic, covering 440,000 patients across all populations.
NS-EEH, the result of a 9-hospital merger in 2022, has already been engaged in value-based care, participating in the Medicare Shared Savings Program and commercial and government value-based agreements. “This is really an acceleration of their desire to lean into those models and drive transformation at the practice level,” John Fryer, Lumeris’ chief revenue officer, said.
“Relationships like this can move markets and we really are bullish on the opportunity to move Chicago towards a more value-oriented model of care,” Fryer said.
NS-EEH hopes to strengthen its clinically integrated network, which comprises more than 3,000 doctors and advanced practice providers, by incorporating Lumeris’ population health data platform into its strategy. The two organizations plan to deliver joint services, supporting the network’s providers in care management, pharmacy management, patient engagement and other key areas. Lumeris will also deploy its accountable risk organization, a vehicle for taking more advanced risk-sharing and managed care relationships from payers.
According to Lakshmi Halasyamani, M.D., chief clinical officer for NS-EEH, Lumeris offers capabilities that clinicians otherwise don’t have. Doctors need actionable data to better engage with and treat patients.
“It’s really hard for physicians and their teams to improve if they don’t have information,” Halasyamani told Fierce Healthcare. The partnership will offer that and will be critical to addressing some of the burnout challenges plaguing the industry, she added.
Initially, the partners will focus on the ACO REACH model, which seeks to streamline care coordination and improve outcomes for traditional Medicare patients. Eventually, they hope to expand their focus to include other types of accountable care and population health models to reduce disparities for underserved communities.
Lumeris, founded by physicians, seeks to align payers and providers in a model that “allows for investment in key clinical delivery of services to really keep populations healthy,” Fryer said. Lumeris has 1.5 million lives on its platform, managing more than $12 billion in medical spend across its partners.
While competitors tend to focus only on one population like Medicare Advantage, Fryer said, Lumeris prides itself on being multi-payer, multi-population, Fryer said. Similarly, NS-EEH is interested in serving everyone from the Medicaid population to uninsured communities and others.
Clinicians have mixed panels of patients, Fryer noted, and they cannot be expected to think differently about certain sets of people in a value-based context and not others. “It’s not about carving out populations, it’s about delivering these healthcare models in their totality across all populations that we collectively serve,” Fryer said.
“Our goal is to serve everyone and to ensure every patient no matter what door they come through has their equal chance for the best outcome,” Halasyamani echoed.
As life expectancy and chronic disease in the U.S. gets worse, “we’re going to have to change the models of care if we want those outcomes to change,” she said. “No one part of this on its own is really transformative. It’s really bringing all the pieces together that creates the value.”