Thursday, September 28, 2017
Evolent Health, a company providing an integrated value-based care platform to the nation's leading health systems and physician organizations, today announced it expects to significantly expand relationships with partners in Illinois and New Mexico.
"These opportunities in Illinois and New Mexico demonstrate the breadth of our capabilities and confidence we have established with partners in multiple segments of the market," said Evolent Chief Executive Officer Frank Williams. "In Illinois, we expect to extend our health plan services platform to serve an additional 160,000 Medicaid enrollees on behalf of CountyCare Health Plan, a subsidiary of Cook County Health & Hospitals System. In New Mexico, we are acquiring selected assets of New Mexico Health Connections, a legacy Valence partner, to establish a new health plan managed services organization that will leverage Evolent's operational, clinical and technology services to support a provider-centric, value-based model of care throughout the state of New Mexico."
In Illinois, CountyCare announced it expects to expand to 300,000 covered lives as a part of the state's overhaul of Medicaid. As a part of this growth, CountyCare expects to more than double the membership scope of its current agreement with Evolent.
Today, Evolent provides a full suite of health plan operational and clinical services to CountyCare's members and providers. As CountyCare becomes one of the largest Medicaid managed care plans in Illinois, Evolent expects to increase services to support a broader network, expanding on the existing 800 primary care providers and 2,600 specialists across the platform.
"We are thrilled to have the confidence of CountyCare and to be a partner in the expansion efforts. This is an exciting opportunity to build on our existing infrastructure and scale our services to reach more Medicaid members in Cook County and deepen the impact we are having in these communities," said Williams.
In New Mexico, Evolent has entered into a unique agreement to acquire assets related to the commercial business from New Mexico Health Connections (NMHC) for $10.25 million in cash. The assets include a health plan management services organization with a tenured leadership team and employee base with extensive experience working locally with providers to run NMHC's suite of preventive, disease and care management programs. The assets will be contributed to a new entity, True Health New Mexico, Inc., a wholly-owned subsidiary of Evolent Health.
The legacy NMHC will continue to operate as an independent non-profit health care organization operating throughout the state of New Mexico, offering individual health insurance products. True Health New Mexico expects to enter into a managed services agreement with NMHC to support this ongoing individual business. Evolent's combined administrative services revenue for contracting with both entities is expected to be approximately $20 million in 2018. True Health New Mexico may also extend the platform to other provider organizations in New Mexico that require clinical and administrative infrastructure to support value-based care arrangements.
"The ability to combine Evolent's industry leading platform with a statewide organization that has a reputation for an integrated provider and consumer-centric approach represents an exciting growth opportunity," said Williams. "Building upon the success of our financially aligned partnerships in other states, we have the ability to leverage relationships with community providers and a world-class clinical and administrative infrastructure to deliver lower cost, higher quality health care for the residents of New Mexico."
"This relationship with Evolent positions our organization for dynamic growth and the chance to extend our mission to more New Mexicans. We expect that providers, employers and members will all benefit from the scale and infrastructure of a national partnership while ensuring leadership and clinical decision-making are still driven locally," said NMHC Chief Executive Officer Martin Hickey, MD. "Evolent's investment supports the sustainability of a statewide, provider-centric model. This should translate into more choice and lower costs by empowering the local physician community."
Both transactions are subject to customary closing conditions which includes certain regulatory approvals, including approval by the New Mexico Office of Superintendent of Insurance (OSI).
