For Elevance Health Inc. (NYSE: ELV), the focuses remain clear: Medicare Advantage (MA) member growth and value-based care growth.
To achieve both of those, the company is likely to leverage home-based care.
Elevance’s myNEXUS – a post-acute care convener – remains one of the company’s emerging assets within the Carelon health care services platform, Carelon President Peter Haytaian said on the company’s earnings call Wednesday.
“What we’re trying to really do here is create a differentiated experience for post-acute care providers,” Haytaian said. “When they are in need of services or approval of services, they’re dealing with technology and a portal that is differentiated and is a streamlined service so that they can get the approvals they need in the most appropriate fashion.”
So far, Elevance has seen positive results.
“As we’re looking at the different levels of post-acute care, we’re seeing our performance play through and meeting our original objectives,” Haytaian said. “That is, going to the appropriate levels of care — and sites of care — and then ultimately into the home where cost and quality is most effective.”
Elevance is working closely with provider partners within its own EMR systems to make data exchanges, prior authorization processes and clinical decision-making more seamless, its leaders explained.
“In addition to accelerating care approval processes for consumers, this is resulting in substantially fewer requests for additional clinical information and significantly lower provider appeal rates,” Elevance CEO Gail Boudreaux said. “We expect to provide annual updates on our progress towards achieving our 2027 target of having at least 80% of our consolidated benefit expense in value-based care with at least 40% in downside risk.”
A commitment to expanding the scope of Carelon has already paid dividends.
“We’ve grown membership 19% year to date, compared with 5% growth for the market across our geographic footprint,” Boudreaux said. “We are well positioned for additional growth when Medicaid beneficiaries begin to transition coverage later this year — whether they’re members of our own Medicaid health plans or with coverage elsewhere.”
Operating revenue for Elevance was $41.9 billion in the first quarter of 2023, an increase of $4 billion, or 10.6%, year over year.
“As we look to the rest of 2023, our focus will remain on the execution of our strategy and demonstrating that we have the best catcher’s mitt in the industry,” Elevance CFO John Gallina said. “We will continue to optimize our mature businesses, invest in high growth opportunities and accelerate the growth of our organization through Carelon.”
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