Evolent Health Services
Medicaid Experience to Help Your Plan Thrive
Evolent Can Help Your Managed Care Organization Deliver Cost-Effective, High-Quality Whole Person Care to Vulnerable Medicaid Populations
Whether you’re an established managed care organization (MCO) looking to transform your operations, or a health plan considering entering the Medicaid arena, Evolent Health Services has rich and diverse Medicaid experience – from launching new plans, responding to RFPs, state readiness, implementation capabilities and ongoing operations, we’ve done it all!
Today we support 1M+ lives across multiple markets, including specialized and complex populations like intellectual and developmental disabilities (IDD).
Agile Solution Flexibly Supports Medicaid Program Nuances
CMS & State Program Compliance
Health Equity Focus
Whole Person Approach to Care
Quality-Focused MCO Program Support
Delivering Impact Where It Counts
Partner Reduction of ED Usage:
Evolent was able to reduce inappropriate emergency department (ED) use in one partner’s large Medicaid membership through innovative population health care management programs and a value-based payment (VBP) framework. Our program encouraged the appropriate use of place of service, enhanced integration of behavioral health pre-ED use, improved access to health services to avoid necessity of an ED visit and engaged providers to reduce ambulatory care sensitive condition ED use through VBP.
Reduction in ED visits among members with serious mental illness (SMI)
Reduction in ED visits for members enrolled in Complex Care programs
Reduction in ED visits with VBP providers
Turnkey Business Process as a Service (BPaaS) Solution Set For Your Medicaid Plan
We provide comprehensive services and technology to optimize your Medicaid plan. This support can include full service back-office infrastructure, analytics, and reporting to manage all operational aspects of a managed Medicaid plan, as well as state readiness and procurements.
Modern suite of back-office capabilities and services including enrollment, claims administration, appeals and grievances, complaint tracking module, contact center, premium billing, encounters, and payment integrity to drive operational efficiency through higher levels of automation. Learn more
Whole person approach to managing a member’s needs through an integrated model of medical and behavioral health that incorporates SDoH and leverages local resources, built upon NCQA-accredited Care Management, Population Health Management, and Utilization Management Services. Learn more
Risk Adjustment & Quality
Audit-ready organization closely manages regulatory development and guidance that impact Evolent business and partners to achieve compliance with new requirements.
Provider engagement and management including provider relations, provider communications, incentive development, and provider data management support your network.
Expertise and systematic support for all payment models, including fee for service, capitation, incentive, and value-based payment programs.
Proven Implementation Model
Mature and proven model focused on partner success, transparency, quality and speed that results in on-time implementations.
Want True Transparency from a Core Administration Partner? Three Questions to Ask.
From cherry-picked data to major problems swept under the rug, your core administration partner’s lack of transparency can undermine health plan operations. Learn how to tell which partners truly embrace transparency and accountability.
Some Of Our Partners
Learn More About How Evolent Can Power Your Medicaid Plan