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A conversation with Luminare Health CEO Craig Julien

Third-party administrator Luminare Health has more than doubled its membership to 1.5 million since the company was acquired by Health Care Service Corporation in 2022. In this interview, Luminare Health CEO Craig Julien discusses how the company’s focus on service excellence and operational expertise, combined with HCSC’s scale, are making the health care experience simpler, more accessible and more affordable for its clients and their health plan members.

How do you explain Luminare Health to someone who isn’t familiar with the industry?

People understand the concept of group health insurance as provided by their employer. But when you ask, “Who's your insurance?” they will typically look at the ID card and it says Blue Cross Blue Shield or another carrier. Most of the time that’s the provider network they’re accessing. The employer holds the financial risk of paying the claims that are covered under the medical benefit plan, but they don't take phone calls and print ID cards and process claims. That's our job.

We act as the front-office call center and the back office providing all of the services of a typical fully insured type of plan.

How does Luminare Health add value beyond those basic functions?

One of the things that overlays everything that we do is service excellence, whether for the client itself, the member, brokers or any other stakeholder.

For the employer, we can tailor specific services to their needs based on their employee population, their risk profile and what they want their benefits to look like. Our goal, underneath providing the best service to the client and the member, is how do we make that process simpler, more affordable and easier to use.

If you look at the ways the health care dollar can be stretched, one of them is the price of the services. So we help employers find the best network.

And then we think about the whole system that goes behind that, all of the ways to find savings throughout the experience, whether it’s utilization management, redirection of care or wellness tools.

Clients with us for four years see a 4.2% cost trend versus 8.3% nationally.

What’s an example of how this plays out for a specific type of client?

The fastest growing part of our business is hospitals and health systems because they have a unique characteristic: They can service their own employees, so they are a domestic network in and of themselves.

Their goal is usually to try to contain 90% of their service utilization within their domestic network. And then we need to wrap that with another network to fill in the gaps, either from a geographic perspective or services that they may not have. We’ve gotten really good at that. That’s 30% of our membership and growing.

Another major vertical for Luminare Health is tribal nations, which must be very different from servicing health systems.

They're both trying to stretch their health care dollar, right? They're trying to be efficient, provide quality care, access to care.

The tribal population, though, is unique. Their life expectancy is 6.5 years lower than the national average. Access to care is an issue, particularly if you're on a reservation, the sovereign land. They may have a clinic, but it doesn't have all the regular services. If you're a tribal member and you're not on the reservation, you still have access to a number of federal programs.

If a member has a chronic condition that has a treatment protocol that's going to be expensive, a tribe can take that member off of their group plan and subsidize their premium for an individual marketplace plan.

We coordinate all of that to help them stretch their health care dollar — but in particular, tailor wellness and care services to the populations and their specific needs.

How has Luminare Health accomplished and managed its growth since the acquisition?

As I look back to when I started in April of 2023, this kind of tsunami of growth was just starting to hit us, and there was a little bit of uneasiness — like, how are we going to do this? So we had to figure out how to become more efficient.

We've made investments in people in terms of process, methodology and training, and we've been utilizing HCSC’s expertise for that. We've also been looking at all of our vendor contracts. We are now using Medecision (another wholly owned HCSC subsidiary) to modernize utilization management and case management, which went live in June.  

Our collaboration model is evolving as our national presence expands. We’re embracing a team-of-teams approach — leveraging HCSC’s clinical and network strengths while maintaining the agility that makes TPAs attractive.

What aspects of HCSC’s culture have been a good fit?

HCSC’s culture of caring and collegial nature — we didn't have to earn anybody's trust or respect. What we share is a commitment to providing the best service we can to our members and our customers.

I spend time every month listening to phone calls across the organization — inbound for customer service, inbound for utilization management, outbound for case management — to see what that experience is like.

I'm always impressed with our ability to help members and providers through complex situations. A lot of times they're stressful. And underlying that is technology and people. So many things have to go well behind the scenes for that call to go well. The systems have to work. The data has to be available. The people have to have confidence on the phone.

And I tell my teams, across the company, when I listen to those calls and those events where we're truly touching a member, we're making a difference in their day or their care.