Evolent Health Exceeds Quality Standards and Saves Medicare $21 Million through its Medicare Shared Savings Program ACO

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Aug 30, 2021, 09:00 ET

WASHINGTON, Aug. 30, 2021 /PRNewswire/ -- Evolent Health, Inc. (NYSE: EVH), a health care company that delivers proven clinical and administrative solutions to payers and providers, announced today that its Evolent Care Partners (ECP) business unit saved Medicare more than $21 million in 2020, its inaugural year as the owner of an accountable care organization (ACO). ECP and the independent physician participants in its ACO network will receive $15.8 million in shared savings for exceeding quality and cost targets in 2020, according to recently released performance data from the Medicare Shared Savings Program (MSSP).

The total cost of care for beneficiaries in ECP's ACO, The Accountable Care Organization, Ltd., was 3.8% below benchmark, putting it in the top 10% of performance of at-scale first year ACOs in the history of the program. In addition, the ACO achieved a quality score of 94.4% on performance measures ranging from preventive health checks to the use of computerized health records and preventing avoidable hospitalizations. The ACO achieved these results during its inaugural year despite the disruption caused by the COVID-19 pandemic, a testament to the power of the partnership between ECP and its physician partners, and the dedication of these physicians to the care of their patients.

CMS data also showed that ECP's ACO drove a 30% drop in ambulatory-care sensitive admissions over traditional Medicare. This translates to 500 fewer hospitalizations among ECP's Medicare population in 2020 than otherwise would have been expected—particularly important given the capacity issues many hospitals are facing during the ongoing pandemic.

"These impressive results reaffirm what physicians can accomplish when they have the right tools, technologies and resources to truly manage their patients' health, inside and outside of the clinic," said Evolent Care Partners CEO Asit Gosar. "I'm gratified that we can help providers be rewarded for delivering better care, not more care."

Evolent Care Partners is Evolent Health's total-cost-of-care management business, focused on improving health outcomes and reducing avoidable hospital admissions and readmissions through the partnership and empowerment of the trusted, respected physician leaders on the ground in each of their markets. While these independent providers are highly committed to their patients, many do not have the tools or resources to manage populations in risk arrangements, and they work largely within a fee-for-service payment system that does not reward preventive care and other activities that reduce costs and keep patients healthier. Through its ACO, ECP fills these gaps, providing industry-leading care management programs Evolent's proprietary Identifi Panel Insight^SM tool to help practices know which patients to target for which interventions, and support for those practices in patient engagement and other critical areas. In addition, ECP aligns financial incentives to help ensure that independent physician organizations are rewarded for the value they generate and can thrive in value-based care. Evolent Care Partners has significantly expanded its physician network over the past year and now supports approximately 90,000 lives, $900 million in medical expense under management, and 1,000 providers across six states, prior to newly announced physician additions for 2022.

In 2020, the average primary care physician participant in the ACO network earned more than $25,000 of additional income through their participation in the ACO. Increased compensation, access to ECP's technology and services, and improved patient quality outcomes are among the factors contributing to ECP maintaining a 98% physician retention rate.

"I would certainly recommend Evolent Care Partners to practices that want to get involved in an ACO," said Michael Margolis, MD, Rochester Medical Group. "It's a true partnership. Physicians can manage a population of patients in a far better way. We are routinely notified of things going on, whether it's a hospitalization or a patient who needs an intervention, via the Identifi Panel Insight^SM tool. I couldn't be in private practice and go to Medicare and take on significant performance-based risk. But, by joining ECP, I have the ability to be fully engaged."

In 2020 nationally, 513 ACOs caring for 10.6 million beneficiaries participated in MSSP, generating gross savings of $4.1 billion, according to the Centers for Medicare & Medicaid Services. After accounting for shared savings earned by ACOs in 2020, estimated net Medicare savings were $1.9 billion. Two-sided risk ACOs again outperformed ACOs in upside-only shared savings tracks, with 97% of two-sided risk ACOs generating gross savings and 88% earning shared savings, versus 75% and 55% respectively for upside-only ACOs.

Contacts

Chelsea Griffin
Investor Relations
919.817.8045
[email protected]

Dan Paladino
Media Relations
571.306.3470
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About Evolent Health

Evolent Health (NYSE: EVH) delivers proven clinical and administrative solutions that improve whole-person health while making health care simpler and more affordable. Our solutions encompass total cost of care management, specialty care management, and administrative simplification. Evolent serves a national base of leading payers and providers, is the first company to receive the National Committee for Quality Assurance's Population Health Program Accreditation and is consistently recognized as a top place to work in health care nationally. Learn more about how Evolent is changing the way health care is delivered by visiting evolenthealth.com.

About Evolent Care Partners

Evolent Care Partners' MSSP ACO empowers independent primary care physicians with the resources needed to participate and succeed within two-sided performance-based contracts. By working with Evolent Care Partners, physicians gain access to population health tools and proven care coordination resources. These resources also help ensure they're managing administrative requirements most efficiently, which enables them to spend more time on patient care. Currently, Evolent Care Partners' ACO has more than 1,000 providers in its network who care for over 90,000 lives across California, Indiana, Michigan, North Carolina, Texas and Utah. Evolent Care Partners operates The Accountable Care Organization, Ltd. (TACO) and is a solution for total cost of care management offered by Evolent Health. TACO is governed by a representative Board of its participating providers.

SOURCE Evolent Health