Evolent Health Collaborates with Nicklaus Children’s Health System and Baptist Health Care to Launch Provider-Sponsored Medicaid Plans in the State of Florida
Jun 06, 2018

Along with the recently announced partnership with Lee Health, Evolent is providing its Population Health and Health Plan Services Platform across five Medicaid regions in Florida

WASHINGTON, D.C., June 6, 2018 – Evolent Health announced today that its partners, Nicklaus Children’s Health System and Baptist Health Care, have been notified by the Florida Agency for Health Care Administration (AHCA) of its intent to award a contract to Miami Children’s Health Plan (an affiliate of Nicklaus Children’s Health System) and Lighthouse Health Plan (an affiliate of Baptist Health Care) to provide physical and behavioral health care services through Florida’s Statewide Medicaid Managed Care (SMMC) program.

With AHCA’s recent state Medicaid contract award to Best Care Assurance, LLC (an affiliate of another Evolent partner, Lee Health), Evolent expects to provide health plan administration and operational services for three health plans and five regions across Florida:

  • Miami Children’s Health Plan (an affiliate of Nicklaus Children’s Health System) intends to offer a Managed Medical Assistance (MMA) plan to Medicaid beneficiaries living in Region 9 and Region 11, which include Miami-Dade and Palm Beach counties. These regions cover more than 700,000 beneficiaries in Florida’s MMA program.
  • Lighthouse Health Plan (an affiliate of Baptist Health Care) intends to offer a Managed Medical Assistance plan to Medicaid beneficiaries living in Region 1, and it will also have the right to enroll and serve members in Region 2. These regions comprise the northwest Florida Panhandle and cover more than 200,000 beneficiaries in Florida’s MMA program.
  • Best Care Assurance, LLC (an affiliate of Lee Health) intends to offer a Managed Medical Assistance plan to Medicaid beneficiaries living in Region 8, which includes seven counties in southwest Florida covering approximately 200,000 eligible beneficiaries in Florida’s MMA program.

“Launching a Medicaid plan focused on supporting the most vulnerable members of our community is a mission near and dear to our hearts,” said Nicklaus Children’s Health System Chief Executive Officer M. Narendra Kini, M.D., MHA. “Together with our strategic value-based care partner, Evolent Health, we have an exceptional opportunity to make a far-reaching, positive impact in the greater Miami area. We look forward to leveraging Evolent’s robust health plan services, value-based care platform and population health programs to serve the needs of our community and drive better care at a lower cost.”

“We are thrilled to launch Lighthouse Health Plan, a critical component of our value-based care strategy and mission to support the full spectrum of health care needs in northwest Florida,” said Baptist Health Care Chief Financial Officer Michael Gleason. “Evolent’s proven Medicaid expertise and comprehensive platform will be essential to proactively addressing health care needs and providing Medicaid beneficiaries with high-quality health care and services.”

“By partnering with three leading systems in major markets, including Miami-Dade, Palm Beach, Fort Myers, Pensacola and Tallahassee, we are well-positioned to help drive transformative health care change in Florida—the fourth largest Medicaid population in the United States,” said Evolent Health Chief Executive Officer Frank Williams. “We are excited and honored to work closely with our partners, state regulators and other key stakeholders to launch and support health plans that will help meet the unique needs of Medicaid beneficiaries across the region.”

Evolent’s Medicaid Center of Excellence (MCOE) will provide Evolent’s partners with Identifi℠, Evolent's population health performance management platform, clinical and operational capabilities and health plan administrative support—including claims management, member and call center services. The Medicaid Center of Excellence offers a model for states across the nation to implement provider-sponsored, community-based Medicaid health plans in their communities.

Each of the five-year health plan awards with AHCA are subject to regulatory approval and successful completion of a readiness review. Evolent’s partnership agreements are commensurate with the term of the AHCA contract awards and are comprised of an implementation component and a per member per month fee based on plan enrollment. Evolent will also own a minority stake in Lighthouse and Miami Children’s Health Plans as part of this arrangement. Implementation work is anticipated to commence immediately with the formal health plan launch expected to commence in late 2018 or early 2019.

Certain statements made in this press release and in other written or oral statements made by us or on our behalf are "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995 ("PSLRA"). A forward-looking statement is a statement that is not a historical fact and, without limitation, includes any statement that may predict, forecast, indicate or imply future results, performance or achievements, and may contain words like: "believe," "anticipate," "expect," "estimate," "aim," "predict," "potential," "continue," "plan," "project," "will," "should," "shall," "may," "might" and other words or phrases with similar meaning in connection with a discussion of future operating or financial performance. In particular, these include statements relating to services we expect to provide across Medicaid regions in Florida, future actions, trends in our businesses, prospective services, future performance or financial results and the outcome of contingencies, such as legal proceedings. We claim the protection afforded by the safe harbor for forward-looking statements provided by the PSLRA. These statements are only predictions based on our current expectations and projections about future events. Forward-looking statements involve risks and uncertainties that may cause actual results, level of activity, performance or achievements to differ materially from the results contained or described in the forward-looking statements, including that the awards are subject to regulatory approval and readiness review, and may not be awarded as expected. Although we believe the expectations reflected in the forward-looking statements are reasonable, we cannot guarantee future results, level of activity, performance or achievements. Our Annual Report on Form 10-K for the fiscal year ended December 31, 2017, Quarterly Report on Form 10-Q for the quarter ended March 31, 2018 and other documents filed with the SEC include factors that could affect our businesses and financial performance. Moreover, we operate in a rapidly changing and competitive environment. New risk factors emerge from time to time, and it is not possible for management to predict all such risk factors. Further, it is not possible to assess the effect of all risk factors on our businesses or the extent to which any factor, or combination of factors, may cause actual results to differ materially from those contained in any forward-looking statements. Given these risks and uncertainties, investors should not place undue reliance on forward-looking statements as a prediction of actual results. In addition, we disclaim any obligation to update any forward-looking statements to reflect events or circumstances that occur after the date of this press release.