Healthcare Innovators

Essence Group Holdings Corp. said it recently raised $61 million in private funding to help commercialize and sell cloud-based technology offerings to emerging accountable healthcare organizations and delivery systems.

The technology products and services offered by EGHC's subsidiary Lumeris include decision support and other cloud-based tools that help clinicians pick the best and most cost effective treatments for patients, said Mike Long, chairman and CEO of EGHC.

Essence Healthcare, another subsidiary of EGHC, was started about five years ago as an accountable healthcare delivery system "experiment" in the St. Louis area. The organization currently serves about 50,000 Medicare Advantage patients and has about 600 participating clinicians, said Long in an interview with InformationWeek Healthcare.

Essence Healthcare's aim was to deliver "better outcomes as lower prices," he said. After several years, the organization found that its use of technology combined with best practices was helping Essence clinicians "make better clinical decisions with better outcomes while reducing costs," including reducing 30-day hospital readmissions of Essence heart failure patients to 4% to 7% compared with the national average of 20%, and reducing by several percent its medical loss ratios, which is the fraction of a health plans premiums that are used to pay for services.

EGHC, through its Lumeris subsidiary, has packaged what sister subsidiary Essence Health has learned about accountable healthcare delivery.

"Lumeris was set up to commercialize all the technology and know-how" Essence Healthcare developed to run accountable care delivery systems, said Long.

Among tools offered by Lumeris are clinical decision support applications that help doctors select from multiple choices the best treatment and tests for patients based on outcome data as well as price, he said.

The $61 million in recent funding from private investors, including Camden Partners and Kleiner Perkins Caufield & Byers, will be used to "to scale nationwide" for other healthcare players what Essence achieved in the St. Louis market, said Long.

Already, Lumeris has signed several clients that are using the company's products and services to transform their organizations to accountable care delivery systems or accountable care organizations, he said. Those clients include 18 various physicians groups, Blue Cross Blue Shield Florida, Network Health Plan in Wisconsin, and WellMed in Austin, he said.

Lumeris' 22 core competency products are delivered via a cloud computing model and are "plug and play," meaning they'll work with existing e-medical record systems. "We're agnostic to EMRs," said Long. The company has "tiger teams" that provide "turn-key integration" and custom APIs to interface Lumeris software with a customer's existing systems, he said.

Among the products and services offered by Lumeris is TackleBox, a package aimed at healthcare providers and payers to help manage the clinical and financial outcomes of coordinated, collaborative patient care.

TackleBox provides tools to help handle 22 competencies that Essence Healthcare has identified as being key in running an accountable healthcare delivery system, including compliance, risk and regulatory management programs, disease management programs, and claims processing and customer services.

TackleBox also includes Maestro, an evidence-based decision support engine "that powers" better clinical and business decision-making, Long said.

EGHC's recent infusion of funding follows other private investments received in the recent past, bringing outside investments to EGHC totaling $151 million so far, said Long.

In addition to Lumeris, other Essence Group Holdings subsidiaries include ClearPractice, which provides an e-health record for the Apple iPad platform.

Accountable care delivery networks and accountable care organizations aim to have clinicians and health plans become more responsible for the outcome of care provided to patients, as well as the cost savings and value of quality services offered.

Under healthcare reform signed into law last year, many healthcare providers across the country are expected to form or join new accountable care organizations to more effectively and efficiently coordinate patient care, meet quality of care and performance measures, and share in financial rewards and cost savings.

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