AI @ HLTH : Navigating Financial Sustainability in Healthcare with Lumeris

In this conversation, Dr. David Carmouche discusses the critical transition from fee-for-service to value-based care in the healthcare industry, emphasizing the role of AI in enhancing primary care and improving patient outcomes. He highlights the financial pressures on health systems and the importance of aligning incentives to achieve sustainability. The discussion also covers the innovative solutions offered by Lumeris and the transformative potential of AI in automating care processes and improving patient engagement. Finally, Dr. Carmouche addresses the need for regulatory guardrails as AI becomes more integrated into healthcare delivery.

In this episode , they discuss:

• The shift from fee-for-service to value-based care is essential for financial sustainability.
• AI is poised to transform primary care delivery and patient engagement.
• Healthcare costs have been deemed unsustainable for decades, necessitating change.
• Aligning incentives is crucial for improving patient outcomes in healthcare.
• Lumeris has a decade-long history of partnering with health systems for value-based care.
• AI can automate and standardize care processes, enhancing efficiency.
• Data availability and interoperability are key to successful value-based care models.
• Generative AI can proactively engage patients and improve care delivery.
• Training clinicians to effectively use AI is vital for its successful integration.
• Regulatory guardrails will be necessary as AI becomes more prevalent in healthcare.

A little about Dr David Carmouche: 

David Carmouche, MD, is the Executive Vice President & Chief Clinical Transformation Officer at Lumeris. Dr. Carmouche is a visionary leader in transformational healthcare delivery, with a unique blend of provider, payer, retail, and integrated delivery network leadership experience.

Prior to joining Lumeris, Dr. Carmouche served as Walmart’s Senior Vice President of Healthcare Delivery, where he led the fleet of Walmart Health centers, Walmart Health Virtual Care, a value-based care partnership with Optum, and Walmart’s work to address Social Determinants of Health. Dr. Carmouche has also held significant leadership roles with Ochsner Health, the largest nonprofit academic healthcare system in the Gulf South, and Blue Cross Blue Shield of Louisiana, where he introduced the company’s first value-based care contracts. Earlier in his career, he built and led a multidisciplinary internal medicine and preventive cardiology practice.

Dr. Carmouche attended Tulane University and LSU Medical School in New Orleans. Board-certified in Internal Medicine, he completed his residency at the University of Alabama at Birmingham, where he later served as Chief Resident. He serves as President of the Board of the Consortium for Southeastern Healthcare Quality and on the advisory board at Stellar Health. He has served on the board of the National Association of Accountable Care Organizations.