Independence Blue Cross and regional provider Abington Health announced in late February they would leverage Lumeris' consulting and technology services to enhance their two-year-old accountable care initiative.
Under the arrangement, IBC will feed claims data, pre-authorizations and lab results into Lumeris' cloud-based data and analytics platform, while Abington will feed information from its electronic health records in order to provide Abington care teams with close-to-real-time actionable data that can be used to manage patient care.
"This technology assistance is something we have sought and desired for some time now in our accountable care arrangements," said Doug Chaet, senior vice president of contracting network providers with IBC. "When you incent providers in an arrangement like this, they need data. Because if one of the things you are looking to do is refer them to high-quality providers and refer to the more efficient providers, you need to tell them who they are. In most markets, that information isn't available."
Using the Lumeris technology and delivering it to the desktop of those on the care team is further enabled by the acquisition last year by Lumeris, IBC and two other health plans of administrative platform provider NaviNet, which enjoys a high market penetration in doctors' offices.
"NaviNet makes all this easier, because it already has the pipes and they are already plugged into the providers' offices," Chaet said.
From Abington's perspective, the use of the Lumeris technology and its ongoing consulting services will help it derive the full value of incentives it can earn under its accountable care contract with IBC.
"What Lumeris will be giving us is the missing gaps of what needs to be done (for each patient), along with some coding strategies and risk stratification and that is where the value is," said Keith Sweigard, MD, medical director of Abington Health Physicians and chief of internal medicine at Abington Memorial Hospital.
Sweigard notes that even though IBC and Abington have been engaged for the past two years in creating an accountable care environment, it is still early in the development process in terms of affecting the kind of clinical and practice transformation that needs to occur among the doctors in its system.
"We are still early in this to transform as well as to implement it," he said. "The key here is you have to start to create the culture and have everyone buying in."
But Lumeris understands that the process is not an easy one and that the answer to accountable care is not found solely in its - or any other - technology solution.
"To succeed in accountable care, not only do you need an excellent technology platform, but you need the consulting services that will help drive change," said Eric Olmsted, director of analytic consulting with Lumeris.
Chaet agrees.
"You need to have provider engagement. It is one thing for us to provide the incentives, but the providers have to embrace this," Chaet said. "Lumeris is not only providing the technology, but (is) also providing on-site consultative services to ensure that the users of technology embed this into their routine, fully understand the technology and then use it. That will be a huge piece of the success."