There is “a massive opportunity for healthcare systems to reshape their economics as they see declining reimbursement on the inpatient side” Frank Williams, CEO Evolent Health
Frank Williams is the CEO of Evolent Health, a fast growing company that helps health systems make the transformation from volume-based care (aka fee-for-service) to value-based care (payments that incentivize improved clinical and financial outcomes). According to their website, “Evolent Health helps progressive health care systems lead, build and own the path to value-based care.” This means developing and implementing strategies for both clinical and financial transformation.
Transforming healthcare is complex & costly
But getting the job done can be daunting—it means new revenue models, new ways of working with physicians and delivering care, expertise and technology to manage populations, and more. Evolent provides consulting, their proprietary technology and feet on the ground (they have more than 650 employees) to do the work (together with the systems’ own staff) needed to manage patients (or members if the organization wants to set up its own health plan) in the new environment.
Frank says the premium opportunity for health systems, including from Medicare Advantage, Commercial, and the Exchanges (aka Marketplaces) is in the range of $500 million to over a billion dollars. But it will require a lot of work and a big investment. He notes:
“If you think about launching a business of that magnitude, it takes tens of millions of dollars in investment to set up the business for long term success. It means everything from putting in the right technology platforms, setting up physicians organizations, and thinking through how you will have the people, processes and technology to support all the things you want to do. It is not an easy journey, it is actually quite a complex one and one that is going to happen over multiple years. But it is a massive opportunity for these systems to reshape their economics as they see declining reimbursement on the inpatient side.”
When asked if any of the organizations Evolent has been working with are far enough along to have results, Frank points to MedStar in the MidAtlantic region. They have been working with their employee population and were able to see trend go from a 7% to a negative trend. He also points to Indiana University where 90 Evolent employees have been working with their physicians to transform clinical management via care management and leveraging technology. He says they have seen a “massive improvement” in some of the larger outcome metrics that you would look for in a population. They have also worked with Wake Med on getting delegated cap on a significant number of lives.