Health Plan Administration
Achieve National Scale without Losing Independence
A New Option for Provider-Sponsored Health Plans
Provider-sponsored health plans (PSHPs) no longer need to choose between a payer-controlled joint-venture and building their own plan from scratch. A partnership with us offers you the best of both options; the reliability and efficiency of a payer joint-venture without compromising local ownership and control of the health plan asset.
We offer comprehensive services and technology to launch, optimize, grow and operate provider-sponsored health plans for employees, Medicaid, Medicare and commercial beneficiaries.
- Health plan launch services
- Health plan growth and scale services
- Health plan joint ventures
- Scaled capabilities including third party administration (TPA), pharmacy benefits management (PBM), population health and network management
- Veteran health plan expertise and leadership
- Differentiated brand and member experience
CASE STUDY: Evolent partnered with the largest health system in southwestern Ohio to grow their Medicare Advantage and Commercial plans quickly. Read this case study to learn how our support in product price and benefit design, network development, and sales and marketing helped them quickly generate critical mass in membership for their plans.
A full set of health plan capabilities, built to complement yours.
Ensure administrative efficiency
Through effective third party administration services covering enrollment, claims processing, premium payment, member services, provider data management and more
Offer innovative benefits that attract members
With a highly experienced actuarial services and benefit design team
Go to market with a truly differentiated brand
By extending your trusted community brand into the local health insurance market, creating a new option that feels more genuine to constituents
Manage costs while improving quality
Through population health management that is tightly integrated with utilization management
Manage and measure the performance of your network
Using clinical and administrative data aggregation and analytics at the physician, practice, group and plan level
Use pharmacy as a strategic lever to improve care and lower costs
Through pharmacy services that are integrated with population health to optimize formularies and automate pre-authorizations
Expand your confidence in a satisfying bottom line
With the potential for our capital investment within select joint-venture health plans
Tap into highly experienced health plan executives
Collaborating with our team who has run major health plans, PBMs and TPAs and have led operational, financial and actuarial, and clinical departments of plans
Innovation toward a Holistic Patient Experience
We deliver the integrated health care experience that patients want, combining their clinical, pharmacy and financial information and actions into a single application that makes care delivery seamless.
Inform your patients and providers
Through apps, portals, EMRs and telephonically—at home or the office—with a single experience encompassing personal and financial health
Increase ownership over health outcomes
By ensuring comprehensive and actionable information is easily accessible for patients and providers