Medicare

A Delicate Balance of Opportunity and Risk

Medicare Expertise Grounded in Experience

Health systems and physician groups face a bevy of options when it comes to taking on Medicare risk. Our experience launching, optimizing and operating Medicare risk businesses across more than 10 provider-led organizations and over 500k Medicare lives allows us to confidently deliver results for our partners.   

Evolent jointly operates the following Medicare programs:

  • CMS Medicare Shared Savings Program Track 1-3 Accountable Care Organization (ACO)
  • CMS Next Generation ACO
  • Medicare Advantage (MA) Health Plans
  • Delegated MA Contracts with Commercial Payers
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MACRA, MIPS and the Myth of Physician Choice in the New Medicare Payment System

Medicare reimbursement legislation laid out by CMS offers physicians two paths to migrating to a value-based care model, but regardless of the journey the destination is lower costs and improved quality for patients. Discover what these options are and which is right for your organization.

Capabilities That Complement Yours

Population Health Management

Success in value-based care begins with improving quality while lowering the total cost of care delivered. Our multi-disciplinary team of population health management veterans bring proven care management, innovative clinical thinking and leading-edge predicative technology to our population health partnerships. Learn More

Risk Adjustment

For Medicare Advantage and Next Generation ACO participants, your risk adjustment program can make the difference between profit and loss. The goal is accurate documentation and HCC coding, and the ultimate key to success is physician engagement. Our approach, team and technology was purpose-built for provider organizations to succeed. Learn More

Health Plan Administration and Third Party Administration

We offer an attractive alternative to partnering with a commercial payer to launch a Medicare Advantage plan. We can help you stand up and operate a plan that you ultimately own and control, with the support of our team of health plan experts spanning functions including benefit design, actuarial analysis, member services, regulatory and compliance, and sales and marketing. Learn More

Network Performance Management

The physicians in your network will determine how well you perform on cost and quality. Performance measurement and management is essential. Our team of data specialists and informaticists, along with our suite of analytic tools, ensure you have reliable information to drive and sustain improvement among physicians. Learn More

Technology and Electronic Medical Records Integration

Our unified, end-to-end software platform drives population health management, medical management, core health plan administration, reporting and analytics. Electronic medical record (EMR) integration leverages the host EMR’s data and user interface to act as the perfect complement to fully manage your value-based business. Learn More