What You Should Know:
– Edward-Elmhurst Health (NS-EEH) has announced a significant, long-term partnership with Lumeris, a pioneer in value-based care (VBC). This partnership is a major development in the healthcare industry, representing the largest VBC provider deal since 2018.
– With rising expenses outpacing reimbursement rates, health systems and physician organizations are increasingly turning to value-based care to avoid layoffs and service cuts. NS-EEH, the third largest healthcare delivery system in Illinois, comprises nine hospitals, 25,000 team members, and 300 local offices, serving over 4.2 million residents.
Collaboration aims to drive coordinated care and improve quality while reducing costs
NS-EEH will strengthen its clinically integrated network (CIN) by incorporating Lumeris’ population health data platform into its value-based care strategy. The two organizations also plan to deliver joint services, supporting the CIN’s healthcare providers in care management, pharmacy management, patient engagement and other key areas. NS-EEH’s CIN includes more than 3,000 system-employed physicians, affiliated physicians and advanced practice providers, and nine hospitals across Chicagoland.
In collaboration with Lumeris, the organizations will manage joint risk arrangements, leveraging AI as a central component of their technology and approach. Lumeris stands out as the only value-based care enablement company with experience working across various patient populations, including those covered by Medicare Advantage, CMMI programs, commercial insurance, and Medicaid. This partnership aims to enhance collaboration among patients, physicians, and care teams, ultimately leading to improved clinical outcomes, a better experience for both patients and providers, and more efficient management of healthcare costs.
Formation of New ACO Models
Furthermore, NS-EEH and Lumeris will work together to address healthcare disparities in underserved communities by establishing new models of care under the accountable care organization (ACO) framework. Initially, NS-EEH and Lumeris will focus on the opportunity to participate in the Centers for Medicare & Medicaid Services’ (CMS) ACO Realizing Equity, Access, and Community Health (ACO REACH) model. This advanced value-based care model seeks to streamline care coordination and improve health outcomes for traditional Medicare patients. In the future, the partner organizations will expand their focus to include other types of accountable care and population health models to serve our diverse communities.
