Provider-Sponsored Health Plan

AN INTEGRATED SOLUTION WITH THE POWER TO CHANGE AN ENTIRE INDUSTRY

Evolent's Provider-Sponsored Health Plan service offering was built by and for providers. In addition to the core capabilities and infrastructure needed to run any successful health plan, we bring tools and experience that help providers leverage their unique advantages to drive rapid member growth, clinical improvement and profitability. 

CREATE A BETTER HEALTH PLAN

Deliver Superior Care

Using an integrated care approach that leverages the unique advantages of a provider-sponsored health plan, with particular focus on integrated technology, clinical programs and risk management

Build Trusted Relationships

With best-in-class operations solutions and vendor arrangements that provide your health plan with capabilities and pricing scale that is on par with national payers

Execute Flawlessly

By leveraging expertise from embedded senior leadership across sales, operations, clinical and network functions to ensure skilled roll-out and oversight of health plan administration

Grow Plan Membership

By retaining control of your own plan without ceding to commercial payer demands and preserving the focus on holistic patient care and health longevity

OUR OFFERING

PRODUCT

Create highly attractive health plan products with rich benefits that are competitively priced to increase health system presence and market share, informed by local market landscape and in-depth analysis

SALES AND MARKETING

Grow membership with a thoughtful and strategic sales and marketing campaign aimed at accelerating initial enrollment, paired with the right Client Relationship Management (CRM) process and platform for continued retention of beneficiaries 

NETWORK

Build a high performance network comprised of both employed and high-value affiliate providers that allows for ongoing evaluation of clinical and cost performance to adequately address beneficiary needs year-over-year 

TPA OPERATIONS

Enhance your operational efficiency by optimizing existing TPA functions or fully delegating to Evolent’s best-in-class platform to keep your TPA operations running smoothly

A COMPREHENSIVE RANGE OF SUPPORT

We've thought through all the factors and have the experience it takes to stand up a successful health plan that can flex to support all members, including at-risk populations.

Locally-Informed Product Design

We help with the initial competitive landscape analysis, product and benefit design, product application and filing, and accompanying business strategy to fit the competitive contours of your local market. We also partner with you on the ongoing management of your health plan to ensure continued success.

Go-to-Market and Retention Strategies

We provide support on requirements for licensure and filing, comprehensive program and process design, direct-to-consumer strategy and website development with the help of our experienced network and marketing teams to ensure that your campaigns hit enrollment targets and membership is retained through utilization of ongoing CRM best practices.

Network Adequacy and Excellence

We assist in both the strategic targeting of physicians through network adequacy analysis to fill gaps in care, as well as conduct contracting on behalf of the network. More than just a network, we design a comprehensive support system to keep your members happy and healthy.

Administrative Operations

We conduct gap analyses coupled with vendor assessment to produce strategic recommendations that best fit your system’s need – from a customized playbook to support TPA and operational workflows, to full delegation and management of operations by Evolent staff and systems, we reduce your administrative burden.

"As we're able to engage more effectively with our patients, that will have a catalytic effect on our community."
Jim Parker
President and CEO
IU Health Plans

Ready to learn more?