Luminare Health Clinical Health Solutions

The Right Care at the Right Time

With healthcare costs on the rise, maintaining the health and wellbeing of member populations more important than ever. Our Clinical Health Solutions program helps to individually assess and address each members health concerns, allowing clients foster a healthier member population overall.

Healthcare Management

Our in-house, fully-integrated healthcare management team is there to help advocate for, guide, and support members when they need it most, all while delivering substantial savings for our clients.

Our team of intake coordinators, support staff, utilization review nurses, and case managers work together to effectively help manage each patient’s care, prevent unnecessary services, and facilitate communication among providers. When a patient’s care is in question, issues are reviewed and, if necessary, the course of treatment may be transitioned by their provider to an alternative method of care. 


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Case Management

Our member-centered case management program delivers compassionate support and clinical expertise to members with complex health issues to help improve patient outcomes. 

Trust our team of clinical experts to provide:
• Focused Case Management Programs
• Experienced Case Managers
• Population-Specific Resources
• Integration with Specialty Services
• Member Education, Advocacy,  Care Coordination and Treatment Plans
• And more

Quality Care with Utilization Management

Utilization management enhances the quality of care by evaluating medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities under the provisions of a client’s health benefit plan.

Our utilization management program provides a top to-bottom suite of services including pre-service review, concurrent review, retrospective review and appeals. 

Base-level Utilization Management Includes all inpatient admission pre-certification for:
  • Acute and Long-term Acute Care
  • Skilled Nursing Facilities Residential  
  • Treatment Centers

Best-in-class Vended Solutions

To help match members with the right care, we’ve developed a suite of best-in-class vended solutions that provide personalized support for an array of health conditions and concerns.

Engage members, encourage healthy change. The Well onTarget program for population health management features a low-cost, high-value set of personalized digital support programs and services like wellness coaching, online tools and resources, fitness programs, wellness consulting services, premium communication packages, and more. 
With increased demand for mental healthcare and a limited pool of providers who will accept a member’s health benefit plan, it can be challenging for members to access the mental and behavioral healthcare that they need. Our solution, powered by Headway, connects members with affordable, quality mental health care through an  asset-free national network of therapists that will  accept the member’s health benefit plan. 

Supported conditions include:
• Anxiety
• Chronic Condition Comorbidity
• Depression
• Substance-Use
• And more
Powered by Ovia Health's suite of digital apps, members can receive support for a full spectrum of women’s and family health needs including:

• Preventive & preconception health
• Fertility & family building
• Prenatal, pregnancy, & postpartum
• Return to work & parenting
• Surrogacy and adoption
• Menopause & midlife
• Symptom management and alerts when medical concerns are detected
 
This comprehensive digital physical therapy solution helps to reduce spend and improve members’ quality of life with muscle and joint pain management. Personalized to their specific needs and areas of concern, participants receive complete clinical joint and muscle care with mind, body, and behavioral support from expert clinicians. 

Deliver expert care from head to toe that can target pain in the:
• Neck and upper back
• Shoulders
•  Elbows, forearms, wrists, and hands
• Lower back and hips
• Pelvic region
• Thighs and knees
• Shins and calves
• Ankles and feet
Powered by Teladoc Health, CCM+ offers an integrated approach to managing multiple chronic conditions.  CCM+ offers tailored, multi-condition support by:
•  Calling members to action using personalized health signals
•  Connecting with technology and devices including  a digital scale, blood glucose meter, and unlimited  test strips, all at no additional cost
•  Offering 1:1 live and digital coaching with a  dedicated coach
•  Incorporating weight management and mental  health support to foster lasting change

Together, this offers an effective way to manage multiple health challenges and delivers up to $180 PPPM in cost savings3.
Our URAC- accredited MyNurse 24/7 support line is a member’s first resource for immediate clinical guidance on everyday health issues.  By providing vital health information and assisting members in their healthcare decision-making, our team may even identify emerging conditions  before they become expensive acute medical events.     

MyNurse 24/7 Offers:
  • 24/7 clinical guidance via telephone    
  • Support in English, Spanish and 240 other languages
  • Increased productivity, improved attendance, and reduced healthcare costs
Empower members to get active and achieve their fitness goals with discounted access to thousands of gyms nationwide.

Program membership includes:
  • Access to 12,700+ standard gyms nationwide and/or 8,800+ premium exercise studios  with 20% – 70% discounts on most
  • 12,000+ on-demand workout videos so members can work out at home or on-the-go
  • The ability to enroll a spouse/domestic partner4
  • A variety of workout classes available anytime on YouTube and Facebook
  • Activity tracking through the Active&Fit Direct Connected!™ tool, which aggregates data from 250+ wearable fitness trackers and apps
  • One-on-one well-being coaching in areas such as fitness, nutrition, stress, and sleep
  • Digital resources and classes
  • No long-term contracts. Switch gyms or cancel anytime.

A Good Fit for Clients Seeking:

Arrows pointing various directions

Flexibility & design control

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Variety of vendor options and integrations

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Ability to bring or substitute their own vendors or solutions

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Quick implementation

Connect with a Luminare Health sales executive to learn more.

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1Not all data points may be available for all clients.
2 Oliver Wyman, 2014. Adjusted to compress health status categories. Acute episodic care costs excluded from analysis.
3 Savings based on diabetes anchor condition using multi-condition ROI methodology, white paper available upon request, Teladoc Health, 2022.
4 Add a spouse/domestic partner to a primary membership for additional monthly fees. Spouses/domestic partners must be 18 years or older. Fees may vary based on fitness center selection.

Vended solutions are independent companies that have contracted with Luminare Health Benefits, Inc. to provide programs for members of self-funded medical benefit plans administered by Luminare Health Benefits, Inc. (Luminare Health). Luminare Health make no endorsements, representations or warranties regarding third-party vendors and their products and services offered by them.