These services qualify for reimbursement through Principal Care Management codes, which were added by Medicare in and 2020 and are due to the success of the Chronic Care Management codes introduced in 2015. These codes, which saw a reimbursement increase of over 50% in 2022, are billed separately from office visits on the date that all criteria for billing have been satisfied. As a result, we guarantee meaningful revenue to practices who offer our services with no startup fees or cumbersome EMR integration required. 

Care coordinators can do anything that helps the patient better manage their disease. At-home care, medication adherence, and visit attendance are major areas of focus, but we also spend significant time helping patients with things like financial assistance programs, prescriptions and refills, insurance issues, transportation, social services, disease education, and coordinating care with other providers. In all interactions, we counsel the patient using proven behavioral science tools like Motivational Interviewing. Our care coordinators are a trusted, always-available partner in the patient’s care journey. We take great pride in our ability to build deep, long-lasting relationships with patients.

For non-emergent and non-clinical issues, the primary medium of communication is through the EMR, following the process that in-clinic technicians use to communicate about patient care. If emergent issues arise, the Care Coordinator will transfer the patient directly to the phone number provided by the practice for medical issues (including a “warm” hand-off to clinic staff to bring them up to speed on the patient and the issue). 

A dedicated Clinical Operations / Account Manager and Lead Care Coordinator are assigned to each practice, and are reachable at any time via phone or email.

No, Lumata Health does not charge any startup costs. There is no penalty to cancel the program. The practice can terminate the agreement at any time.

For  most practices, offering this service in-house is not financially viable due to the staffing, technology, and oversight required.

Staffing

A typical Care Coordinator requires about 500 patients “under management” to offset the salary and overhead costs associated with providing the service. Fewer patients under management means the practice is operating at a loss. Likewise, 600 patients under management means 100 patients either cannot be helped, or the practice has to hire another person (at a loss) to accommodate those patients. A practice may elect to split a technician’s time between care management and normal duties. This can be ineffective largely because patients require assistance at unpredictable times, or are unreachable when the Care Coordinator is free to contact them. The result is an inefficient process that is difficult to justify financially, frustrating for patients, and likely detrimental to the quality of care. 

Lumata Health makes this work by managing patients for practices all over the country, keeping our Care Coordinators operating at close to 100% capacity across multiple locations and having a team of Care Coordinators available to answer patient calls at any time. Also, our Care Coordinators have a unique skill set – combining their eye care knowledge as a COA or COT with social work and behavioral science knowledge through our training programs. 

Technology

Most practice EMRs are not equipped for care management. They lack specific functionality such as detailed and integrated time-tracking, automated call scheduling, embedded text messaging, automated care plan creation and many more features necessary to operate a successful care management program that satisfies CMS requirements.  Lumata Health has invested heavily in building a custom, HIPAA-compliant platform specifically tailored for care management.

Lastly, our proprietary AI-driven engagement algorithms, built with NEI support, provide a level of efficiency and effectiveness that is difficult to replicate in-house.

No, we are willing and able to provide this service to patients of any number of physicians that would like to participate. At some practices, we have started the service with one or two physicians prior to expanding practice-wide.

Lumata adheres to the highest standards of data privacy and security for all of our customers, from large insurance providers to individual practices. We are HIPAA compliant, but also operate in HI-TRUST certified environments when appropriate. Our data privacy and security processes and protocols have been rigorously vetted and approved by each of our customers, including Health Care Service Corporation – the largest customer-owned health insurance company in the United States.

Our primary outcome measures are clinical; we expect better clinical outcomes derived from our focus on promoting compliance with the doctor’s recommendations. To date, we have demonstrated statistically significant reduction in intraocular pressure for patients in our program versus a control group. Lumata also uses validated survey instruments to assess the effectiveness of the program at improving self-reported medication adherence. We also track patient experience of their chronic care management, patient satisfaction with their physician/practice, patient satisfaction with Lumata’s service, and patient perceptions related to their unique barriers to care. The validated instruments used are the ASK-12, PACIC, NPS, OSDI, and ABQ-IVT surveys.

No. Our focus is on solving non-clinical problems that prevent patients from adhering to their doctor’s recommendations, such as financial issues, transportation, prescription refills, insurance issues, and general health coaching to promote compliance. We do provide the patient with information related to their doctor’s instructions, such as reminders about which medications they should be taking, and when. This information is based on what is in the patient’s chart. We are happy to share our policies and procedures for dealing with medical issues over the phone. These policies mirror typical in-house clinical staff guidance and are based on JCAHPO training modules.

A requirement from Medicare is that every patient must be aware that they are able to leave the program at any time. Should a patient decide to cease participation, their disenrollment is documented in the EMR along with the primary reason for unenrollment. Reasons for disenrollment may be a lack of perceived value, patient perception that they are now “in control” of their care, resolution or stability of the chronic condition, or moving or transferring to another physician. If a patient’s care is transferred to another physician, Lumata will assist the patient in making that transition prior to closing the patient’s account.