Maryland Heights, Mo.-based Essence Healthcare is celebrating its 20th anniversary this year. Looking ahead to another two decades, Mr. Reigel is “very bullish that Medicare Advantage is here to stay.”
“As we look at the competitive landscape, and at those entities that have come in and tried to play in the Medicare space — we recognize there have been those with true, deep capabilities in managing patient care, producing consistent outcomes,” Mr. Reigel said. “We’ll continue to see those who lack substance falling out of the industry, falling out of the market.”
Essence Healthcare, which has around 60,000 Medicare Advantage members, has earned a 5-star rating from CMS three years in a row.
Essence Healthcare is part of Lumeris, which creates software and analytics to support value-based care. Essence was “achieving results in value-based care before value-based care was really a thing,” Mr. Reigel said.
“We quickly recognized the importance of technology and data to help our physicians make informed, real-time decisions and focus their energy on care delivery, and less on bureaucracy and administrative functions. Lumeris is an intrinsic part of who Essence is, and it’s central to our ability to achieve results in partnership with our physicians.”
Essence’s relationship with physicians and its technology have been key to its 5-star ratings, Mr. Reigel said.
“Without those relationships, without very strong, personal working relationships at the physician-level, we would never achieve the results that we would have been able to achieve,” he said.
Essence Healthcare was founded by St. Louis-area physicians in 2003. The service provider has expanded beyond its original market, offering plans in Illinois, Missouri, Arkansas, Ohio, Kentucky, and Indiana.
The company plans to expand into the Chicago-area market in 2025, Mr. Reigel said.
Decisions to grow are a balance between scale and margin, he said.
“Our ability to generate margin really is central to our value proposition to our members, because it allows us to invest in the benefits that make Medicare Advantage attractive,” Mr. Reigel said. “When we contemplate growth, we always have to consider scalability, but doing so with partners where we know we can succeed and preserve our brand in an enduring and sustainable way.”
