Health Plans

Dual Focus on Administrative and Medical Loss Performance

Health Plan Performance Requires a Balanced Approach

Evolent Health partners with health plans delegating risk to their provider networks, by supporting them across all the key medical and administrative functions that drive performance—claims management, network management, medical management, risk adjustment, pharmacy benefits management, quality and member services. 

"Being able to bring what Evolent has in their focus and in their technology to supplement what we already know and do in the market? That's 1+1=3."

Dr. Martin Hickey
CEO, True Health New Mexico

Efficient, Scaled and Proven Capabilities

Health Plan Services

Grow your health plan, drive down administrative costs and provide a superior experience to your network and members. We deliver efficient third-party administration and medical management services to health plans and providers with delegated risk. Learn More

Network Performance

Support your network physicians with education and actionable data while reducing administrative overhead. Our proven strategies, tactics and tools motivate physicians to embrace change within their practices and find a greater sense of purpose in their work. Learn More

Risk Adjustment

Ensure that you accurately document and code your patients’ severity of illness. With Evolent, you won’t need to stitch together services and tools from multiple vendors. Our team works with your physician practices and leverages leading-edge machine learning, natural language processing and electronic medical record integration technologies to more easily identify, document and code conditions. Learn More

Pharmacy Benefit Management (PBM)

Our comprehensive PBM capabilities focus on driving value through pharmacy benefits. In addition to offering a highly cost-effective PBM, we integrate pharmacy data and clinical data with your model of care to streamline prior-authorizations, bring better pharmacy data to the care team and provide a unified experience for patients. Learn More

Performance Analytics

Follow your progress, see where your value-based care efforts are succeeding and discover where you need to adjust. As part of our continuous improvement cycle, actuaries and clinical informaticists regularly analyze your performance data, offering scorecards, interim cost and quality forecasts and process improvement actions. Learn More