Evolent Health Services

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Evolent Health Services offers a comprehensive suite of administrative and clinical solutions designed to streamline operations for health plans and risk-bearing organizations. By integrating advanced technology with managed services, Evolent enhances operational efficiency, automates workflows, and leverages AI to transform data into actionable insights. Key Features and Functionality: - Core Administration: Provides modern administrative capabilities to drive operational efficiency through automation. - Medical Management: Offers services such as care management, population health management, utilization management, and appeals and grievances. - Analytics and Reporting: Delivers powerful reporting insights to inform operations and business strategy. - Customer Service: Ensures high-quality member engagement and satisfaction. - Pharmacy Benefit Management: Manages pharmacy benefits to optimize therapeutic outcomes. - Risk Adjustment and Quality: Supports risk adjustment processes and quality improvement initiatives. - Provider Data and Network Management: Maintains accurate provider data and efficient network management. - Behavioral Health: Integrates behavioral health services into the overall care model. - Billing and Finance: Manages billing processes and financial operations. - Payment Integrity: Ensures accurate and efficient payment processes. - Actuarial Services: Provides actuarial analysis and support. Primary Value and Solutions: Evolent Health Services addresses the challenges faced by health plans and risk-bearing organizations by offering a flexible and comprehensive set of services from a single partner. Their unique hybrid model allows partners to retain essential functions while driving business transformation. By leveraging AI-enabled capabilities and integrated workflows, Evolent reduces medical and administrative costs, improves quality, and enhances member satisfaction.

New Century Health

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New Century Health, a subsidiary of Evolent Health, specializes in managing specialty care, particularly in oncology and cardiology. Established in 2002, the company partners with payers and providers to enhance the quality and cost-effectiveness of care for complex and high-cost specialties. By integrating evidence-based clinical pathways, real-time decision support, and collaborative provider engagement, New Century Health aims to transform specialty care delivery, ensuring patients receive appropriate treatments while optimizing healthcare expenditures. Key Features and Functionality: - Evidence-Based Clinical Pathways: Develops standardized treatment plans grounded in scientific data to guide physicians in delivering optimal care. - Real-Time Decision Support: Offers electronic portals and EHR integrations that provide immediate feedback on treatment plans, facilitating adherence to best practices. - Provider Collaboration: Engages in peer-to-peer discussions with treating physicians to align on care plans, enhancing provider satisfaction and patient outcomes. - Population Health Analytics: Utilizes advanced analytics and AI to identify high-risk patients, predict outcomes, and inform care decisions. - Risk-Based Contracting: Supports value-based payment models, including shared savings and capitation, aligning financial incentives with quality care delivery. Primary Value and Solutions Provided: New Century Health addresses the challenges of managing high-cost, complex specialties by offering a comprehensive solution that combines clinical expertise, technology, and data analytics. This approach leads to significant cost savings—over 7% immediate savings and 50% ongoing trend reduction—while maintaining high levels of quality and physician satisfaction. By simplifying the path to specialty care success, New Century Health empowers payers and providers to deliver superior patient care efficiently.