How Elevance Health offers added support for leading providers who take on downside risk.
In 2022, HealthLeaders published an exclusive view into a specialized Elevance Health value-based care (VBC) strategy: steering members toward top providers who have taken on downside risk and supporting them with tailored resources.
“We'll use benefit design, marketing, referral steerage—multiple tactics for these providers,” noted Chris Day, president of Value-Based Solutions at Elevance.
For Payer Week, we explored this strategy further and its four key steps:
- Assume downside risk
- Perform and keep performing
- Receive specialized support
- Link to innovative benefit design
Step 1: Assume downside risk
Taking on downside risk isn’t for all providers. But as Day noted, Elevance offers a "multi-year glidepath" based on achievable targets that help providers take increased accountability for managing population health over time. If providers are not making progress, next steps range from corrective action plans to "turning it off" and sending members to higher performers.
A willingness to take on downside risk is where performance-based provider segmentation begins but not where it ends.
Step 2: Perform and keep performing
In the 2022 article, Day notes that it doesn't take long to identify who the high-performing providers are. A focus on cost savings and lower-hanging quality targets (e.g., more primary care, fewer ER visits) provide the fastest indicators. Performance incentives, or financial losses, follow.
At Elevance, VBC consistently outperforms non-VBC models. Among MA plans in 2022, for example, all-cause readmissions were 0.6% lower in VBC models and 1.2% lower in models that included downside risk. This from the Elevance Impact Report 2022, published last month and featuring additional better outcomes from VBC.
Step 3: Receive specialized support
Describing how Elevance contracts for outcomes, president of Health Solutions Bryony Winn writes: “Ours is a capital-light, flexible approach rooted in achieving mutual success. We invest in empowering practices, paying differently for outcomes, and working more deeply with the highest-performing care providers.”
These deeper partnerships include:
- Provider enablement;
- Specialized support and resources; and
- Quality improvement incentives.
Provider enablement, per Elevance Health Public Policy Institute (EHPPI) VP Jennifer Kowalski, means that Elevance will be the easiest payer for providers to work with.
Examples of specialized provider support, per Kowalski, include dedicated clinical liaisons who convey the newest evidence-based interventions, assist with equity-related care delivery obstacles, and help physicians interpret and act on program data.
While these examples are related to the plan’s Obstetric Quality Incentive Program (OBQIP) for Medicaid members, they're likely applicable to other Elevance VBC programs.
OBQIP—one of two VBC maternal health programs highlighted in a May 2023 EHPPI report—has generated more than $5 million in savings. A companion program, Obstetrics Practice Consultant, generated the same for a total savings of more than $10 million across these two initiatives.
"These outcomes offer insights for commercially insured populations as well,” says Kowalski. “Regardless of a member's plan, [our VBC approach] demonstrates lessons learned for others including: promote the ongoing review of quality measures, apply continuous quality improvement to program design, support provider enablement, and promote provider use of digital tools for bi-directional communications."
Step 4: Link to innovative benefit design
A final Elevance strategy to support VBC and downside risk uptake is to steer members toward plans associated with top-performing providers and even richer benefits.
“Within our provider search platform, a provider performance sorting option based on quality and efficiency criteria is available to help members make more informed choices about their medical care,” says Day, adding to his comments from 2022.
“Provider performance can vary widely in relation to efficiency, and member experience. Our goal as a health plan is to make sure our valued members receive the highest quality of care.”
Dr. Omar Latif, Medicare CMO at Elevance, adds that the company’s VBC provider support “is coupled with benefit designs that enable patients, and their care providers, to address whole health. For example, simplified supplemental benefits to help those who have a Medicare plan get over-the-counter meds and even groceries.”
Future features and wrapping up Payer Week
Next week, HealthLeaders will take a deeper dive into Elevance’s VBC maternal health programs, including more from our interview with Kowalski.
In the meantime, view all our coverage for Payer Week—five days of in-depth coverage spotlighting the significant roles and contributions of health insurers. Click below to link to all the coverage.
- MA’s continued growth and expansion
- The harms of MA prior authorization and misleading marketing
- The unknown around supplemental benefits
- The high cost of lower Medicare drug prices
- The state of MA Value-Based Insurance Design, including an exclusive interview with Healthfirst’s Jen Cohen-Smith
- Star Ratings winners and losers
Laura Beerman is a contributing writer for HealthLeaders.
As part of Payer Week, HealthLeaders promised to highlight health plan operational diversity across the industry.
In this brief, we spotlight operational diversity within key health plan activity, specifically Elevance Health and its value-based care programs.
The brief builds on one of HealthLeaders’ most popular articles from 2022, adds Elevance VBC strategy details, and includes excerpts from an exclusive interview from Elevance Health Public Policy Institute VP, Jennifer Kowalski.