How Working Together Elevates Health Outcomes

While contracting for outcomes with advanced value-based care models is vital to help improve health outcomes, it isn’t enough to truly improve the whole health of our communities. We need to go beyond contractual agreements with our care provider partners to make a real impact on health, together.

This means:

Becoming exceptional business partners by advancing data connectivity, automating processes, accelerating claims processing, and reducing administrative tasks.
Becoming exceptional clinical partners by developing leading digital programs, offering direct clinical support, sharing more actionable data, and supporting patient access to care.

Becoming Exceptional Business Partners

Contributing experts: Tich Changamire, MD, and Beth Weis

By using digital solutions to streamline interactions, from contracting to payment, we’re creating a pathway for collaborative partnerships with care providers and better health outcomes for the people we both serve.

Dr. Omar Latif:

One of the things we talk about in Advancing Health Together is this concept of whole health. I see it as the combination of physical, behavioral, and social drivers and how all of these come together to maximize health at the individual and the population level. How have you observed that in your time as a practicing physician at a leading institution like the Cleveland Clinic?

Dr. Ahmad Kilani:

That’s a great question. As you know, I mean, most of the time when we treat a patient, we tend to focus on the clinical scenario or the condition of the patient. What we’re learning more and more: This is not enough. So, I will give you a very simple example, a case of COPD. And we always talk about COPD readmission. And we always wonder why the patient keeps coming back in a hospital. And when they’re in the hospital, we treat them. We give them the steroid. We give them the breathing treatment. They do fine and they go home. They come back. That would be a good example of how it’s important to know our patients as a whole. It’s not enough just to focus on the treatment. I mean, it’s not enough to say, well, let’s change the inhalers and hopefully the patient will do better. We need to understand why the patient is coming back, keeps coming back and get readmitted because there’s so many times there might be something in the environment which is triggering this recurrence of COPD. Unless we understand all these factors, the social factors, all these things, we will not be able to sustain the success sometimes we might see when we treat an episode. Another example comes to my mind. There are so many times, you know, we have patient they don’t come for the annual visit, which is a key to get their health maintenance and preventive medicine. We need to recognize that. We need to understand why the patient is unable to come for something that was highly beneficial for them. Again, unless we dig in and find out what’s limiting the patient from doing something as high value as this, we definitely were missing opportunities.

Dr. Omar Latif:

Thank you so much for sharing. I know, in our value-based agreements, trying to maximize those annual visits are one of the, one of the things that we look at and we partner together on. I really appreciated your perspective as a provider in the delivery system, because I do think providers are so central to driving and maximizing whole health. As a player on the healthcare benefits side, you know, we’ve invested a lot in terms of, aggregating data from different sources in the healthcare delivery system and then actually taking an opportunity to share that data with providers like the Cleveland Clinic. And it’s so exciting when you look at the innovation that the clinic is doing related to maximizing patient outcomes, whether it’s related to reducing readmissions or closing care gaps, and doing it via these touchpoints that the delivery system owns, like an annual plan visit.

Advancing the Conversation

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The strongest point of our collaboration with Elevance Health is the ability to be open for innovation and new ideas. And I noticed that right from the beginning.

Ahmad Kilani, MD,

Medical Director, Enterprise Physician Advisors | Revenue Cycle Management, Cleveland Clinic, Ohio

Our Provider Success Team Partners With Care Providers for Better Quality Outcomes

Care providers, by the nature of their profession, are inherently driven to deliver the best care possible for their patients. To help achieve optimal outcomes, payers and care providers have developed collaborative partnerships, such as value-based payment models, that recognize and reward high-quality care, better outcomes, and positive patient experiences.

One way we collaborate directly with care provider teams is through our Provider Success Team.

Learn how this collaboration transforms the healthcare experience

Administrative Tasks Made Easier With Digital Support

Physicians, clinicians, and care support teams spend considerable time collecting and tracking patient health plan information, verifying benefits, and handling pre-service authorizations and payments. These tasks add significant administrative burdens, especially when they involve manual, paper-based processes or phone calls. Enhancing digital capabilities reduces these tasks, enabling care providers to concentrate more on patient needs and priorities.

Explore how digital support tools help improve care

How Responsible Artificial Intelligence Could Simplify Healthcare

Artificial intelligence (AI) has the potential to simplify healthcare for consumers, care providers, and payers, while streamlining evidence-based, high-quality care. This is an exciting opportunity to enhance the care experience for providers and the 112 million people we serve as an enterprise.¹

Learn more about how responsible AI is transforming healthcare

Becoming Exceptional Clinical Partners

Contributing experts: Adrienne McFadden, MD, JD, and Jeff Plante

By collaborating with care providers and sharing resources and expertise, we can advance whole health together. To that end, we continue to develop strategies and programs to make us better clinical partners.

Dr. Adrienne McFadden:

You have such an amazing background and, it sounds like, real exposure to the system. If you were queen for a day and you could build the ideal healthcare system, how do you envision the delivery side, like where Yale sits, and the health benefits and administration side, where Elevance sits, would work together to maximize benefits for patients? And what, in your mind, what are the next steps that we need to achieve that?

Dr. Anita Arora:

Ultimately, I mean, you said queen for a day, right? So, I think ultimately, I really view the goal of our work together to provide these robust wraparound services to patients and clinicians with the goal of supporting joy for work, joy of work for clinicians and excellent health outcomes for patients. So, if you think about, if I think about my work in caring for an individual patient or even at the, at a population level, unfortunately we still are living in somewhat of an information silo and I think the joint operating committees meetings that we have with you and other payers really allow us to make those connections. And then the other part is that there are these amazing resources available to patients through payers that sometimes we, we don’t know that are available. And so I think the, the strong touchpoints and communication between us and payers can, can really again, break down those information silos and allow us to understand that, oh, these patients are engaged and your resource and how will that affect their engagement with our, you know, care management, disease management programs, and how do we kind of share notes on those patients. So I think that would be, you know, as we continue to build our ability to transfer information back and forth, would be like a free, free flow of that kind of data where we can really see, like, wow, that was really effective, that the patient was engaged in that care program, and it’s really teeing them up for this program that we have over here at Yale.

Dr. Adrienne McFadden:

I love that, particularly today, the joy of work for clinicians is extremely important. As you hear some more and more about, you know, physician and clinician burnout. And certainly the outcomes of patients is always going to be extremely important. So that’s great. Thank you so much. From your perspective, though, where do you think the strongest points of collaboration are between our two organizations?

Dr. Anita Arora:

I think, Doctor McFadden, I think the strongest point of collaboration is really in using data to drive interventions. So, it’s, it, we’ve found it so helpful to review data on the calls and see and discuss areas for improvement. And we always come off of our calls with Elevance Health with key takeaways related to patient outreach or the way the data is flowing from our system to Elevance Health.

Dr. Adrienne McFadden:

That is so great. I think that just brings home the point that actionable data is just so important. So I’m so happy that our organizations can collaborate in that way.

Advancing the Conversation

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The goal of our work together is to provide robust wraparound services to patients and clinicians in order to support both joy of work for our clinicians and excellent health outcomes for patients.

Anita Arora, MD,

Primary Care Physician, Associate Professor in General Internal Medicine, Associate Chief Population Health Officer, Yale School of Medicine, Connecticut

How Streamlined Data Leads to a More Seamless Healthcare Experience

Building a reliable, secure digital platform is vital to creating exceptional experiences for care providers and their patients. To enhance efficiency and streamline care provider workflows, we’re focused on sharing data, aligning care management, and offering automated solutions — from prior authorizations to roster updates and claims processing.

Health OS, our digital interoperability platform, connects care providers, payers, and consumers to reduce administrative tasks and drive improved health outcomes.

Learn how we design technology to improve the healthcare experience

How Simplifying Prior Authorization Protects Patient Safety, Controls Costs

Prior authorizations help ensure people receive the right care safely, at the right time, and in the right setting.

Most of the prior authorization requests we receive come via phone, fax, or paper. We have invested in digital solutions that enable and encourage care providers to use real-time prior authorization submission and workflow services.

Find out how we’ve made administrative processes easier

Maternal Care Outcomes Improved by Elevance Health Programs and Partnerships

Elevance Health’s affiliated health plans support 1 in 8 babies born in the U.S.² This presents a significant opportunity to work with care providers to improve the lives of their pregnant patients.

To positively influence maternal care outcomes, reduce gaps in care, and lower costs, we've developed new programs in all lines of business and expanded partnerships with virtual care providers.

Discover the impact we’ve made on maternal health

Dr. Catherine Gaffigan:

As a physician and someone who is dedicated to improving whole health by strengthening payer-provider relationships, I've seen firsthand the impact care providers make on the health and well-being of their patients and communities.

When primary care physicians see their patients regularly, those patients have lower emergency department use and fewer hospitalizations. When care providers conduct cancer screening tests, they help save thousands of lives each year through the early detection of cancers.

And when nurses contact a patient post-discharge, hospital readmission rates are 41% lower than without that nurse contact. For those reasons and many more, we're honoring care providers who have gone above and beyond to create a real impact on their patients with our new Care Provider Recognition Program award. This program showcases our top performing care providers who continually strive for excellence.

Join us in celebrating the inspiring impact that these care providers and their teams make in the lives of others.

Congratulations to our winners, and thank you for everything you do, and for the meaningful impact that you make to drive whole health.

Better Health Through Active Partnerships

In collaboration with care providers, we’re dedicated to making a real impact on health. To honor their outstanding patient care, our health plan affiliates launched the Care Provider Recognition Program in fall 2024.

This annual program recognizes care providers who deliver excellence in care to their Medicare patients, our affiliates’ members — which makes it uniquely centered on patient outcomes.

Award winners represent the top 5% of care providers, based on quality measured through internal performance data for Medicare Advantage members. They’re in-network with an affiliated health plan and have contracts in good standing.

See the inaugural winners at elevancehealth.com.

Driving toward better health outcomes is a critical shared goal with our care provider partners, and results like these are worthy of the spotlight.

Supporting Care Providers

Discover how being active partners that go beyond the contract can have a real impact on health. By working closely together with our care provider partners, we can make a meaningful difference.

Committing to Whole Health

Together with care providers, we’re working to address people’s physical, behavioral, and social needs — and improve healthcare quality, outcomes, and experience.

Committing to Whole Health

Contracting for Outcomes

Value-based care arrangements aim to enhance preventive care, reward quality outcomes, promote evidence-based practices, and improve patient experiences within the care system.

Contracting for Outcomes

Connecting for Health

The right tools and solutions can connect the dots between care providers, health plans, employer groups, and consumers to deliver whole health more affordably.

Connecting for Health

Download the Executive Summary of This Report

Executive Summary (PDF)

Collaborating for Success

How Working Together Elevates Health Outcomes

Becoming Exceptional Business Partners

Advancing the Conversation

Our Provider Success Team Partners With Care Providers for Better Quality Outcomes

Administrative Tasks Made Easier With Digital Support

How Responsible Artificial Intelligence Could Simplify Healthcare

Becoming Exceptional Clinical Partners

Advancing the Conversation

How Streamlined Data Leads to a More Seamless Healthcare Experience

How Simplifying Prior Authorization Protects Patient Safety, Controls Costs

Maternal Care Outcomes Improved by Elevance Health Programs and Partnerships

Better Health Through Active Partnerships

Supporting Care Providers

Committing to Whole Health

Contracting for Outcomes

Connecting for Health

Download the Executive Summary of This Report

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