Blueprint

As the market transitions toward value-based care, so comes the challenge of pursuing a value strategy while sustaining your enterprise’s overall performance. The Blueprint lays out a step-by-step plan that balances your short-term and long-term objectives. It defines the needed clinical, network and operational capabilities, outlines governance models for organizational and physician alignment, and details the integrated financial business case.

Market Facing Solutions

  • Employer Value Advantage

  • Payer Value Alliance

  • Health Plan Value Edge

Employer Value Advantage

Employers, including you, are searching for innovative approaches to improve workforce health and productivity. We help you engage directly with employers in your community to build customized networks, implement tailored clinical programs, and create value-based benefit plans that achieve savings and promote a culture of health.

Payer Value Alliance

It’s often challenging to work collaboratively with physician groups and payers to create sustainable population health partnerships. We support all parties in this endeavor by leveraging our network of national and regional payers and providers, proven value-based contract strategies, and specialized negotiation teams.

Health Plan Value Edge

The shift to consumerism is creating a disruptive market opportunity. To capitalize, the health plans you bring to market must differentiate themselves based on retail value, product design, and the end-to-end member experience. We work with you to develop and modify health plan products so they attract members and improve health.

Value-Based Services Organization

Population Health Performance

Delivery Network Alignment

Financial & Administrative Management

Clinical Programs Specialized Care Teams Patient Engagement Quality & Risk Coding
The shift to value-based care requires you to not only provide quality care for each individual, but to also focus on improving the health of targeted populations. We offer proven clinical and quality programs, extended care advising teams, and patient engagement tools to improve outcomes across the care continuum.

Clinical Programs

Effective clinical programs must not only be evidence-based, but must also be flexible to meet the changing needs of your patients and caregivers. Our proven clinical programs and care delivery models blend clinical, quality, and social interventions to markedly improve patient health and wellbeing.

Specialized Care Teams

Delivering holistic patient care requires that you integrate multiple disciplines beyond primary and specialty care such as pharmacists, behavioral therapists, nutritionists, and social workers. We offer remote and embedded specialized care team members to support patients throughout their journey.

Quality & Risk Coding

Patient engagement is at the heart of population health management efforts. All of our clinical strategies, as well as our suite of patient engagement tools, are designed to enhance your relationships with patients and foster more productive interactions.

Patient Engagement

In a value-based environment, it is essential that you consistently document clinical quality and underlying patient health status to assure appropriate reimbursement. We bring a toolkit that identifies risk coding and quality improvement opportunities and integrates interventions seamlessly within workflow.
High Performance Network Value Compensation Models Integrated Specialty Partnerships
In an increasingly consumer-driven healthcare market, a delivery network focused on patient value is a powerful competitive differentiator. We will work with you to build and maintain high performance networks, customize value-based compensation models, and strengthen primary and specialty referral partnerships.

High Performance Network

The competitiveness of your network is no longer defined by market share, footprint, or even technology integration. Instead quality, access, and price are the new critical success factors. We develop high performance networks that expand reach and community impact by focusing on a superior clinical, experiential, and financial value proposition for patients.

Value Compensation Models

Meaningful change in healthcare is accelerated by well-designed incentive structures. Our value compensation models help you reward primary care physicians and specialists for clinical efficiency to change the way they practice medicine.

Integrated Specialty Partnerships

To enhance quality and patient satisfaction, you must ensure that primary care and specialists work in close coordination. Our clinical programs and technology platform build care management and communication bridges across providers.
Leadership & Management Health Plan Payer Risk Pharmacy Benefit Manager Reporting & Analytics
Building a successful value-based business requires dedicated administration and operations, as well as leadership experienced in managing risk. We can provide local management, back-office infrastructure, analytics, and reporting teams to manage all of the operational aspects of a value-based business.

Leadership & Management

Value-based businesses thrive under passionate leaders who are experienced in population health. We offer experienced executives with a track record of success to lead and manage your value-based business operations.

Health Plan

Evolent’s end-to-end health plan capabilities are powered by UPMC’s proven infrastructure and leverage our national scale. We design innovative products and customize market strategies to capitalize on your inherent local advantages, including your status as a trusted community provider.

Payer Risk

Sustainable risk-sharing requires trust, alignment of interests, and the capabilities to manage downloaded risk. Our proven value contracting strategies, team of negotiators and actuaries, and technology-enabled infrastructure allow you to form and manage mutually beneficial partnerships with your payers.

Pharmacy Benefit Manager

Traditional pharmacy benefit management models were designed for the fee-for-service world, and are often misaligned with value-based economics. We deliver integrated pharmacy services that enable higher clinical value at lower costs for your members and plans.

Reporting & Analytics

High performing organizations are fueled by up-to-date and accurate metrics. Our analytics team provides reports and insights that pinpoint your improvement opportunities across clinical, financial, and network domains.

System Transformation

Organizational Design & Alignment Physician-Led Practice Transformation Communication & Change Management
  • The imperative to change must come from within your organization. Assisting with change management is core to our work. We help identify and align your stakeholders, put sound governance in place, drive physician-led practice transformation, and communicate with key constituents, including the local community.
  • Organizational Design & Alignment

    The right organizational vehicles and governance structure can foster accountability across your organization, engage physician leadership, and help balance strategic priorities. We bring successful models from around the country that can be customized to build trust and ownership across your stakeholders.
  • Physician-Led Practice Transformation

    Activating your physician community is critical to your success in value-based care. Our goal in practice transformation is to bring joy back to medicine by improving workflow efficiency, providing team-based support, leadership training, and the right incentives to enable your physicians to always do what’s best for patients.
  • Communication & Change Management

    Effectively communicating change to your entire organization must be well planned and executed. We provide a team of change management experts to guide your internal stakeholders with proven communications strategies, channels, and tactics.

Identifi Technology Solution

Data & Integration Clinical & Business Content EMR Optimization Applications
  • To succeed, you need a total population health management platform purpose-built to holistically operate, accelerate, and de-risk your value-based business. Identifi integrates disparate data sources, layers-on evidence-based clinical rules and analytics, and provides a suite of integrated end-user applications that coordinate value-based healthcare.
  • Data & Integration

    In order to manage quality and the total cost of care of a population, you must have a real-time, 360-degree view of all patients. This requires integrating and normalizing data from across your ecosystem, whether in care delivery, finance, or administration.
  • Clinical & Business Content

    Once your data has been aggregated and normalized, insights must be extracted. Identifi is equipped with 1,000+ pre-built clinical and business rules to target patients, and can be easily customized for specific payer policies and contracts.
  • EMR Optimization

    Turning data and insights into discrete clinical actions at the point-of-care is key to realizing value. Identifi’s EMR Optimization practice works to drive insights directly to your providers within their core EMR, enabling them to take appropriate actions for their patients while also enhancing their workflow.
  • Applications

    Managing value-based care businesses requires new core competencies, including care management, network, health plan, and clinical analytics. Identifi offers a suite of user-friendly, web-based applications enabling your executives, administrators, clinicians, care managers, and analysts to manage their responsibilities in a single, fully integrated platform.

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