A core administration operating partner for Medicaid plans and risk-bearing providers
Evolent Administrative Services simplifies administrative and clinical operations through a comprehensive set of back-, middle- and front-office services that are powered by a modern core administrative platform and a unique strategic partnership model.
We don’t consider ourselves a vendor. We’re experienced partners who work alongside your organizations’ team to meet your goals — and share accountability for outcomes.
We bring a GSD — Get Stuff Done — mentality to our work. We’re flexible and nimble, ready to jump in to help partners meet challenges, whether it’s new Medicaid requirements or state readiness.
We leverage our experience across U.S. markets to drive innovation and develop best practices in areas such as health equity, community engagement and creating a more tailored member experience.
Administrative automation, innovation and simplification for health plans
Evolent’s Administrative Services team partners with Medicaid Managed Care Organizations and risk-bearing provider organizations to simplify administrative and clinical operations. We offer a comprehensive yet flexible set of services for our partners, and work side by side with them to achieve shared goals.
Among our key Medicaid capabilities:
Core administration
Our next-generation core administration capabilities and services drive operational efficiency through higher levels of automation. We do it all — claims processing, enrollment and eligibility, encounters management, provider credentialing and data management.
Contact center
We have extensive experience serving as our partners’ front line for members and provider interactions. Evolent maintains in-house, full-service, U.S.-based and global customer service contact centers to support members and providers. Customer service representatives are trained to understand the nuances of our partner markets, and 85% are bilingual.
Evolent promotes a whole-person approach to member care that seeks to meet members’ physical and behavioral health.
Risk adjustment and quality
We offer a robust set of technologies and services to deliver financial results, effectively engage providers, and develop proper coding practices at the source. Unlike traditional resource-intensive chart review, which relies on evaluating documentation after the patient encounter, our prospective approach alerts physicians to evaluate coding gaps during the patient encounter. More accurate and thorough coding enables improved coordination of care for the member, better referral practices amongst your network, and maximized overall program efficiency.
Clinical services
Evolent promotes a whole-person approach to member care that seeks to meet members’ physical and behavioral health. Accredited by the National Committee for Quality Assurance in care management, population health management, utilization management and behavioral health, we bring an integrated model and interdisciplinary approach focus on reducing handoffs and enabling better health outcomes for members. These programs complement Evolent’s specialty care management solutions to support high-quality, coordinated care across the member experience.
Pharmacy benefit management
We combine all the benefits, claims-processing expertise and network discounts of a large-scale, market-leading PBM with unmatched oversight by pharmacy experts, and a focus on what works best for your health plan’s local market. In our aligned partnership model, we have a shared goal of managing total cost of care across both the pharmacy and medical benefit — all while enhancing member and provider experiences.
Analytics and medical economics
Our experienced and dedicated team conducts detailed medical economics studies to identify actionable opportunities to improve performance. In addition, all our partners gain access to a comprehensive reporting suite. A collection of dashboards and reports help plans track their progress across multiple domains — financial, clinical, pharmacy and provider performance.
Actuarial services
We bring expertise in identifying and assessing risk exposure and then implementing strategies for mitigation.
Management Services Organization for delegated provider services
We serve as an MSO to progressive providers looking to thrive in value-based payment models, including primary care capitation, professional risk and global total cost-of-care risk. Evolent ensures operational success for the contracts our partners have in place today and provides a seamless “turning on” of additional services/capabilities as their contracts evolve.