Employers and their health plans have a unique stake in today’s transformation of the healthcare industry. Approximately half of the nation’s population receives healthcare coverage through an employer-sponsored health plan, putting employers in a position to leverage their buying power in the marketplace.
Despite countless incremental solutions, such as consumer driven healthcare, cost-shifting and provider payment reform, many employers would agree the impact on healthcare quality and costs has not been enough to substantially address the challenges.
Lighting the Path to Better Health
- Innovative employers are actively seeking new solutions to influence how employees and their families seek high-quality, accessible healthcare and transform those interactions to more closely resemble the experiences consumers expect.
- iluminus™ puts employers and their health plan members at the center of customized healthcare delivery solutions that optimize healthcare investment while improving health outcomes and providing valuable consumer experiences for employees.
- Our holistic approach to health plan creation and management focuses on well-care rather than the fragmented and episodic approach of traditional health plans.
iluminusTM Model for Value-Based Care
Eight Foundational Elements
Focusing on eight Foundational Elements, our approach creates value for the next generation of employer-sponsored health plans through a comprehensive suite of integrated solutions.
Exclusive Provider Network Development
With decades of healthcare industry experience, the iluminus™ team works to ensure health plan members have access to high-quality primary care providers, specialists and facilities across multiple care settings.
- A high-performing physician network across the full continuum of healthcare
- Primary care as the key driver of health and prevention
- Convenient access and enhanced availability of appointments
Network Management & Provider Engagement
Engaging high-value providers in the health management of the employer’s population can improve workforce health.
- Creating dashboards that accurately and succinctly update physicians on their performance around certain quality metrics, such as preventive screenings
- Educating network providers to better manage health outcomes and expenses of attributed lives
Health Plan Management
Accurate and timely claims management, in combination with high-touch customer service, creates a better consumer experience for employees and their families.
- Flexible, customized services to meet the unique needs of your workforce
- User-friendly and engaging employee portals
- Personalized approach to help members navigate the healthcare system and their benefits plan
Population Health Analytics
Actionable data analytics and dashboards drive a comprehensive understanding of the unique needs of your workforce, identify at-risk populations that may benefit from enhanced services and help guide healthcare investment.
Enhanced Clinical Services
In tandem with a high-value primary care network, supportive clinical services such as care management and health coaching can enhance employee experience, increase engagement and improve member health.
Effective care management and coordination drives improved health status for the overall population by:
- Reducing unnecessary utilization of healthcare services
- Increasing self-management, prevention and early detection of disease
- Guiding members to the appropriate site of care
A multi-faceted approach that includes plan design, consumer education and a thoughtfully-designed wellness program can motivate employees to take an active role in their own personal health journey.
As the healthcare industry shifts to value-based care models, where hospitals and physicians are rewarded for managing the cost and quality of care rather than the volume of services provided, there is significant opportunity for strategic contracting between employers and providers. High-value providers of care are implementing programs to manage the health of defined populations, increase access and availability of care, coordinate care across multiple settings and report actionable data on health outcomes. By strategically aligning with these hospitals and physician groups, employers can ensure their plan members are receiving the highest-value care. Some examples of strategic contracting include:
- Bundled payments, where episodes of care, such as prenatal care and delivery, are paid for at a pre-negotiated rate
- Local centers of excellence, where plan members are incentivized to utilize the highest-value facility in their market for certain high-cost, planned procedures
Through a phased approach, the iluminus™ model achieves responsible innovation that moderates risk while maintaining a commitment to each employer’s unique organizational culture.