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

  • Staff fully trained on CMS guidance and State program-specific requirements, including specialized populations like IDD.​
  • Consistent, reliable performance against mandated SLAs that typically exceed state Medicaid program requirements.​
  • Experienced support for regulatory readiness reviews to ensure success.​


Health Equity Focus 

  • Evolent’s equity-centered supplier diversity program targets contracts with diverse vendors to support state equity requirements.​
  • Advanced risk stratification incorporates social determinants of health (SDoH) that disproportionately affect people of color​
  • Racial Disparities Dashboard evaluates key membership attributes to identify and correct health disparities.


Whole Person Approach to Care

  • Proven, evidence-based programs and care models blend clinical and community-based interventions to improve member outcomes. ​
  • Whole person care goes beyond clinical support to meet the member where they are, providing localized, community-based supportive care such as housing and transportation.​
  • Community health workers provide in-person outreach and coordination of clinical, social and community services to help address social determinants of health (SDoH).​



Quality-Focused MCO Program Support 

  • Performance focus prioritizes member, provider and plan-level interventions targeted toward achieving top-quality scores and ongoing growth​

  • NCQA® Certified for HEDIS Measures​

  • Health Plan Performance measurements assess plan resource allocation, member redetermination and outreach, impact of pilot interventions, and member incentives


Actionable Opportunities

  • Medical economic studies analyze data against benchmarks to identify clinical and financial opportunities and highlight variances and trends to propel our partners to improved quality and performance.​
  • Timely, accurate and actionable reporting provides insights to enable partners to expand access to care and identify where best to reinvest in the community. This tailored reporting allows partners to view progress against state program requirements.


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.

Core Administration

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

Clinical Services

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

Quality management including care gap closure, physician support, CMS & state reporting, HEDIS and records review. Industry leading prospective approach to Risk Adjustment. Learn more

Data-Driven Insights

Actionable analytics and reporting data that serves as an extension to your organization. Tailored reporting that meets state regulatory requirements. Learn more

Compliance Support

Audit-ready organization closely manages regulatory development and guidance that impact Evolent business and partners to achieve compliance with new requirements.

Provider Engagement

Provider engagement and management including provider relations, provider communications, incentive development, and provider data management support your network.

Payment Management

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. 

Learn More About How Evolent Can Power Your Medicaid Plan


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