Lumeris, a leading provider of the technology, insurance capabilities and expertise to support value-based care models, recently appointed Umar Farooq as president of its 5 Star Medicare Advantage Plan, Essence Healthcare. Under Farooq’s direction, Essence just announced a major expansion into five new states and 44 counties in the United States, as Lumeris continues its journey away from the fee-for-service model in realizing the promise of value-based care. A joint-operating partner in both value and risk, Lumeris serves more than one million patients and 7,000 physicians throughout the U.S. As president, Umar is responsible for Essence’s short and long-range strategic plans, P&L, nationally scalable growth, and delivering an industry-leading experience for all members, providers and stakeholders.
You were confirmed as president of Essence Healthcare by the Board of Directors in September. Before that, you were general manager and market president for Commonwealth Care Alliance of Boston where you held P&L responsibility for the $2B payer-provider managed care plan. What made you want to join Lumeris?
Lumeris has been leading the charge in value-based care, and still, the healthcare industry has only scratched the surface in terms of realizing that dream. That’s one of the key reasons why I am here. The Essence Healthcare plan has always been a pioneer dating back to the collaborative payer model, demonstrating that health plans can catalyze a fully engaged doctor/patient relationship to co-produce better healthcare outcomes.
Essence has achieved the highest Overall Plan Rating of 5 stars by the Centers for Medicare & Medicaid Services for the Essence Medicare Advantage Plan. Why is this important and what does it mean for physicians and your patients?
The raw score of 5.115 shows the sustainable model for value-based care that Lumeris envisioned is possible while lowering medical spend. This is the culmination of many years of hard work. Essence is the only 5-star plan in the U.S. that was 5 stars last year and also received 5 stars on the health plan quality plan improvement measure this year, making Essence one of the highest scoring plans in the country.. The plan also received 5-star member experience scores, which include both health plan operations and their experience with the care delivery system, a testament to our model of collaborating with physicians. We’re delivering the highest care possible, and we’re just getting started.
How is Essence continuing to build on its success and show year over year improvement?
Last year we scored 88% on diabetes care/blood sugar control. This year we improved to 94%, one of only four plans to get that high score. Our Part D Medication Adherence for Hypertension (RAS Antagonists) score improved from a 4-star rating to a 5-star rating. We’re also thinking long-term with the launch of our osteoporosis program in 2020, which is already showing improvements in managing chronic conditions.
You recently announced seven new health systems as part of your 5-state expansion. What can you tell us about the expansion?
Beginning January 1, 2023, Essence will enter the Indiana, Kentucky, Arkansas, Georgia and Ohio state Medicare Advantage marketplaces, opening up eligibility to one of the nation’s highest-performing government-sponsored health plans to a growing senior population. The expansion is a 223% increase in county coverage in just one year, marking our explosive growth due to customer and provider satisfaction with Essence’s distinctive plan and benefits. That includes the opportunity to enroll in a $0 monthly premium plan, which we are very proud to offer.
We’re also thrilled to welcome seven new health systems as partners including Northeast Georgia Health System. Having providers at the table when we are co-designing managed care solutions is fundamental to our progress. Together, we’re creating a new standard for how healthcare can be delivered and financed through deep-rooted partnerships.
What’s the greatest opportunity for Essence as you look to the future?
Essence already provides more than 68,000 people with comprehensive and affordable health insurance that focuses on wellness, care coordination and personal service. We’re built around comprehensive partnerships that produce high-quality clinical outcomes and high-rated consumer satisfaction while driving market-leading reductions of in-patient utilization and overall medical costs. That will continue. More importantly on an individual level, we’re creating a system of care that every doctor wants for their own family. That is at the heart of everything we do and drives every single decision. We’re going to build on our success as we continue to scale and deliver an industry-leading experience for all of our members, providers and stakeholders.
