Blueprint

As the market transitions towards value-based care, healthcare executives are faced with the key challenge of how to optimize their value strategy while sustaining performance of their current health care delivery enterprise. The Blueprint lays out a step-by-step plan to build a sustainable value business, defines the required clinical and operational capabilities, drives physician and broader organizational alignment, grows network and details the resulting integrated financial business case.

Market Facing Solutions

  • Employer Value Advantage

  • Payer Value Alliance

  • Health Plan Value Edge

Employer Value Advantage

Employers, including health systems themselves, are looking for innovative approaches to improve the health and productivity of their workforce. We help our partners engage directly with regional and national employers by building customized networks, layering in tailored clinical programs, and creating value-based benefit plan designs which promote a culture of health for all employees.

Payer Value Alliance

Systems and payers often face challenges creating sustainable financial and clinical frameworks to care for and manage defined populations. We support all parties in this endeavor — health systems, physician groups and payers — by designing and operationalizing long-term mutually beneficial partnerships through our network of established national and regional payers and providers, proven value-based contract templates, and specialized negotiation teams.

Health Plan Value Edge

The shift to consumerism creates a disruptive market opportunity, requiring health plans to differentiate around retail value, product design, and the end-to-end member experience. We help health plans enhance their market value proposition and create healthier communities by developing high performance products that attract, engage, and retain members.

Value Based Services Organization

Population Health Performance

Delivery Network Alignment

Financial & Administrative Management

Clinical Programs Specialized Care Program Patient Engagement Quality & Risk Coding

As systems shift to value-based care, they become responsible for not only providing quality care for each individual, but also for improving the overall health of the entire attributed population. 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 patients and their caregivers. Our proven clinical programs and care delivery models enable systems to blend clinical, quality, and social interventions to markedly improve patient health status and wellbeing.

Specialized Care Team

Caring for patients holistically requires teams which 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

At the heart of population health is patient engagement. All of our clinical strategies as well as our suite of patient engagement tools are designed to enhance the patient-provider relationship and foster a more productive interaction.

Patient Engagement

Closing gaps in care and documenting clinical quality are essential capabilities in a value-based environment. We have a toolkit of technology-enabled processes that both identify risk coding and quality improvement opportunities and are automated and seamlessly integrated with workflow.

High Performance Network Value Compensation Models Integrated Specialty Partnerships

In an increasingly retail healthcare landscape, a delivery network aligned around value is a powerful competitive differentiator. We help optimize and maintain high performance networks, which are supported by proven value-based compensation models and enabled by integrated primary and specialty care partnerships.

High Performance Network

Network competitiveness is no longer defined by share, footprint, or even technology integration; delivering on improved quality, access, and price are new critical success factors. We develop high performance networks that expand reach and community impact by focusing on a superior clinical and financial value proposition for patients.

Value Compensation Models

Meaningful change in healthcare is accelerated by well-designed incentive structures. Our value compensation models are customized to reward primary care physicians and specialists for clinical efficiency such that they want to change the way they practice medicine, while being balanced with the broader organizational strategy.

Integrated Specialty Partnerships

Quality and experience are enhanced when primary care and specialists work in close coordination. Our clinical programs and technology platform help build care management and communications bridges across providers to improve care delivered to patients.

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 experienced management whose competencies are often distinct from the care delivery enterprise. We can provide local leadership, scaled back-office infrastructure, and analytics and reporting teams required to manage the operational aspects of a value-based business.

Leadership & Management

Value-based businesses thrive best under passionate leaders who are also well-seasoned in population health. We can identify and bring experienced executives with a track record of success to lead the value-based business operation.

Health Plan

Successful health plans benefit from highly scaled back-office operations as well as ongoing capital investments. Evolent’s end-to-end health plan capabilities are powered by UPMC’s proven infrastructure and our national scale — and are specifically designed to leverage the local advantages unique to providers in their home markets.

Payer Risk

Sustainable risk-sharing requires trust amongst parties, an alignment of interests, and the capabilities to manage the risk that is downloaded. Our sustainable value contracting strategies, team of negotiators and actuaries, and clinical and financial infrastructure enable our network of payers and providers to enter into long-term, mutually beneficial partnerships.

Pharmacy Benefit Manager

Many traditional pharmacy benefits management models were designed without a total medical effectiveness perspective, and are misaligned in their economic incentives. Our approach is simple — to deliver integrated pharmacy services that enable higher value at lower costs for members and plans.

Reporting & Analytics

High performing organizations are fueled by up-to-date and accurate information on how their key metrics are performing. Our analytics team produce ongoing reports and ad hoc insights that pinpoint areas to improve value based performance across the clinical, financial, and network domains.

System Transformation

Organizational Design and Alignment Physician-Led Practice Transformation Communication and Change Management
  • We believe that in order for healthcare transformation to occur, change must come from the inside out. Core to our work is identifying and aligning stakeholders through sound and representative governance, engaging physicians to lead their practices in clinical transformation, and effective change management to communicate with key constituents and the local community.

  • Organizational Design & Alignment

    The right organizational vehicles and governance structure can foster accountability across the organization, engage physician leadership, and help balance strategic priorities. By leveraging successful examples from around the country, we bring models that can be customized to build trust and ownership across local stakeholders.

  • Physician-Led Practice Transformation

    An activated physician community aligned around population health is core to 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 physicians to always do what’s best for their patients.

  • Communication & Change Management

    Effectively articulating change to an entire organization must be well thought out and executed flawlessly. We provide a team of communication experts to act as the internal communication or an extension of the existing team guide internal stakeholders with the proper communication strategies, channels and tactics.

Identifi Technology Platform

Data and Integration Clinical and Business Content EMR Optimization Applications
  • Successful value-based businesses are powered by solid technology foundations. Point technology solutions are often implemented to address certain aspects, but are challenged in supporting the full spectrum of value-based clinical and business activities across multiple payer and provider environments. Identifi was purpose-built to solve for these issues through four capabilities: data integration, clinical and business content, EMR optimization, and an application suite specifically designed for value-based businesses.

  • Data & Integration

    In order to manage quality and the total cost of care of a population, risk-bearers must have an updated, 360 degree view of all of their patients. This requires integrating and normalizing data from any entity who touches their patients, whether in care delivery, financing, or administration. Identifi has been built – from the ground up – to intake and aggregate disparate data sources from both inside and outside health systems, enabling a complete view of the patient population.

  • Clinical & Business Content

    Once data has been aggregated and normalized across disparate systems, clinical and business insights must be extracted. Identifi is equipped with 1000+ pre-built rules to target the most impactable patients within the high-risk population, and can be easily customized for specific payer policies and contracts.

  • EMR Optimization

    Turning data and insights into clinical action at the point-of-care is key to realizing value. Identifi’s EMR Optimization practice pushes insights to physicians within their core EMR, enabling them to take appropriate actions for their patients while also enhancing their workflow.

  • Applications

    Value businesses are complex and require management of many core competencies, including clinical, network, health plan, analytics, and data. Identifi brings a suite of applications that arms executives, administrators, clinicians, and analysts with user-friendly tools to manage their responsibilities within the value-based organization and enables them to understand their impact on the broader initiatives.

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