Evolent Health Details Deepening Payer Partnerships

Evolent Health’s business model involves partnering with payers and providers to reduce the total cost of care, improve clinical quality and simplify administration. During the company’s Feb. 23 fourth-quarter earnings call, Evolent executives revealed details about new customer relationships, including Blue Cross Blue Shield of North Carolina and Bright HealthCare, which has health plans in 17 states.

Describing the work in North Carolina, Seth Blackley, Evolent chief executive officer, said that starting in January 2022, Evolent Care Partners and its network of independent primary care physicians began managing over 10,000 Blue Premera members. “Evolent Care Partners will leverage our proprietary Identifi platform, proven care management, and patient engagement programs to improve quality and reduce unnecessary costs,” he said. “Blue Cross and Blue Shield of North Carolina is a leading payer in the value-based care space, and we look forward to collaborating with them to improve the health of communities across North Carolina.”

Beginning Jan. 1, 2022, Evolent went live with a multiyear operational partnership, whereby Minneapolis-based Bright HealthCare will leverage Evolent's health plan administrative services to initially support an estimated 350,000 commercial and Medicare Advantage members. “We're delighted to work with Bright as they integrate vendor relationships and seek to expand their unique patient-centered integrated payer/provider model to the health plan market,” Blackley said.

Other new partnerships are for Evolent’s New Century Health. Payers fully delegate oncology and cardiology risk to New Century Health for the guaranteed cost savings, and providers team with New Century Health to manage two-sided specialty care risk to help oncologists and cardiologists succeed in advanced alternative payment models.

Blackley called Molina Healthcare an important and growing partner. “We have signed an agreement to bring our cardiology performance suite to Molina Nevada,” he said.

In addition, Molina Healthcare in Kentucky and Washington State will migrate from Evolent’s Technology and Services suite to its Cardiology Performance Suite. “With these three expansions, in addition to the previously announced Performance Suite relationship with Molina Ohio, we anticipate Molina will contribute more than $75 million of revenue in 2022, with the opportunity to continue to grow in future years,” Blackley said. “Further, we feel that the conversion from New Century Technology and Services to our Performance Suite is further evidence of the value we provide to our partners and to the expansion opportunity we see within our existing partner base.”

In deploying the Performance Suite, Blackley explained, payers and risk-bearing providers are seeking a partner who can guarantee cost reduction and quality improvements in high-cost specialties. “We believe we offer a compelling value proposition, whereby a health plan partner transfers responsibility for a scope of medical cost to Evolent. We, in turn, drive our margin by capturing the clinical savings we create from that capitation rate using our advanced technology platform, scaled services, and our proprietary clinical intellectual property.”

He also noted that within Evolent Health Services, the company is “leveraging artificial intelligence and other technology investments to scale high-volume transaction processing activity more efficiently for our provider and health plan partners.”

In the fourth quarter, Evolent reported revenue of $248.4 million, up 0.7 percent from the fourth quarter of 2020. Adjusted earnings before interest, taxes, depreciation and amortization (EBITDA) were $24.3 million. Evolent’s guidance for the first quarter of 2022 was for $280 to $295 million of revenue and adjusted EBITDA of between $20 million and $25 million.