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Health Plan Operations and Population Health Services: The Elements for Care Delivery Excellence

White Paper Published By: Lumeris
Published:  Aug 04, 2014
Type:  White Paper
Length:  4 pages

Lumeris offers a definitive formula for value-based health plan operations in shared-risk or global-payment models. Strategic investments in business transformation consulting, structure and implementation, value-based care services, and collaborative payer operations offer health plans and at-risk health systems opportunities to dramatically improve efficiencies and effectiveness. Return on this investment is evident through an organizationís ability to meet the goals of the Triple Aim Plus One: better health outcomes, lower costs and improved patient plus physician satisfaction.

Transitioning risk from payers to providers and evolving payment models from volume to value requires a monumental shift. Providers taking on risk contracts and health plan operations need differentiated capabilities to manage traditional health plan functions. From the payer side, health plan operations must be redesigned to support remarkably improved business and care delivery outcomes. For health plans, health systems with delegated payer operations, or health systems wanting to become their own payer, turn key outsourcing offers expert support to design, build, operate, measure, and optimize value-based health plan operations that can drive clinical and financial excellence, as evidenced by:

  • Higher revenue
  • Lower costs
  • Higher market share
  • Meeting mandates for medical cost ratio (MCR) contained in the Patient Protection and Affordable Care Act

Lumeris offers a four-part framework to health plans and health systems looking to achieve high-rated operational success and as much as 30 percent lower medical costs compared to an unmanaged population.


Tags : 
lumeris, health plan delivery, health plan operations, population health services, value based health plan operations, health plan outsourcing, operating a health plan