Market Overview

Essence Healthcare, powered by Lumeris technologies, earns 4.5-star rating


Lumeris announced today that one of its health plan customers, Essence Healthcare, was once again awarded a 4.5-star rating from the Centers for Medicare and Medicaid Services, making it the highest-rated Medicare Advantage plan in the St. Louis area for the second year in a row. The Medicare Five-Star Quality Rating system, developed by CMS, rates Medicare Part C and Part D plans on a scale of one to five stars. The overall rating is based on more than 50 care and service quality measures across five categories: staying healthy, managing chronic conditions, customer services, pharmacy services and member satisfaction.

Essence was an early adopter of Lumeris' cloud-based Accountable Delivery System Platform (ADSP), which helps the plan integrate claims and patient data from across the continuum of care to create a holistic and accurate view of plan performance against various cost, quality and utilization metrics. Via the ADSP, Essence pinpoints opportunities for improvement in these areas and then engages primary care physicians in the network to address them via a host of web-based platform applications and tools. Essence's commitment to collaboration and information transparency, supported by the ADSP, has enabled the plan to achieve significant reductions in overall costs while improving quality performance, as well as member and physician satisfaction.

“Essence is always innovating to ensure our members have ready access to the highest quality, most affordable care,” said Richard Jones, President and CEO of Essence Healthcare. “The technology and guidance provided by Lumeris has been fundamental to our success and a major factor in making Essence a 4.5-star plan.”

Lumeris' ADSP was purpose-built to facilitate the big-data analytics, care coordination and population health management necessary for accountable care. The technology, guidance and methods provided by Lumeris are critical for any health care organization looking to implement more value-based, accountable models of care — whether a health plan looking to support patient-centered medical homes among their provider networks or provider organizations and IDNs establishing their own accountable care organizations.

“Essence is one of a very few Medicare Advantage plans to achieve a 4.5-star rating, and Lumeris is proud to partner with the team at Essence to achieve this extraordinary success,” said Mike Long, Chairman and CEO of Lumeris. “Lumeris is rapidly becoming the strategy and implementation partner of choice for payers and providers committed to transforming their business models and behaviors to deliver truly collaborative accountable care.”


Lumeris provides the information technology, guidance and operational services necessary for hospitals and health plans to transform their organizations into high-performing accountable delivery systems. Our revolutionary technology platform for accountable care integrates data from disparate systems across the continuum of care, provides complete visibility into the clinical and financial performance of an enterprise and delivers applications and information to key stakeholders at the point of thought. This improves coordination and enables timely value-based health care decisions that lead to optimal health and cost outcomes. The depth and breadth of our solutions — combined with the company's extensive real-world experience in accountable care — make Lumeris the ideal partner for any health care organization seeking the significant benefits of a better connected, aligned and informed accountable delivery system.


Essence Healthcare offers people with Medicare comprehensive and affordable health insurance that focuses on wellness, care coordination and personal service. Essence's Medicare Advantage HMOs bundle hospital, medical and prescription drug coverage together into one plan with one affordable monthly premium, and include additional benefits not covered under the Original Medicare program. Essence's Medicare Advantage plans are designed and directed in partnership with local doctors, and are among the nation's highest rated according to the federal agency that administers Medicare.

Essence Healthcare is a Medicare Advantage organization with a Medicare contract. The star rating referenced in this announcement is specific to Essence contract H2610 for plan year 2013. The superlatives “top-rated” and “highly rated” are substantiated by this star rating. Plan performance star ratings are assessed each year and may change from one year to the next. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments or coinsurance may change each year.

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Julie Adelsberger, 314-770-3756

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