Complementary Clinical Programs

Achieving whole health requires a genuine commitment to collaboration between payers and care providers. By sharing resources and expertise, together we can deliver exceptional, more affordable care to those who need it most. One way in which Elevance Health and its health plan affiliates are working to that end is through the development of complementary clinical programs focused on making impactful improvements in the way we support, connect, and collaborate with our care provider partners.

Employing thousands of medical doctors, nurses, dietitians, health coaches, and pharmacists, these teams connect annually with over 450,000 patients, our consumers.1 We also see each interaction as an opportunity to help care providers deliver on an integrated whole-health approach that prioritizes the patient experience. Together, we are advancing health outcomes, improving access to care, and bettering the consumer experience through evidence-based practices that address patients' whole-health needs.

In addition to working directly with our consumers, our clinicians work hand in hand with our care provider partners. For example, we operate two specialty practice consultant programs — for obstetrics and oncology — that serve thousands of care provider practices across the country.2 These programs, run by clinicians with maternal, child, and oncology expertise, are rooted in collaboration to enable better care while sharing robust, real-time data with care providers.

Maternity Solutions

Insuring roughly 12% of the nation's births,3 our health plan affiliates have a profound opportunity — and responsibility — to impact the lives of pregnant people, babies, and families. It's why we are committed to improving maternal outcomes by partnering to deliver comprehensive, timely, and affordable obstetric solutions that advance whole health and address our commitment to reducing health disparities. To underscore this responsibility, we partner with care providers to advance maternal health equity through policy and practice, and converse with key stakeholders to envision pathways to meaningfully improve birth outcomes for all. To learn more about how we're advancing maternal health equity, listen to a presentation by Dr. Darrell Gray II, our Chief Health Equity Officer, discussing our research, best practices, and areas of opportunity.

Fundamental to this approach of collaborating with care providers in this specialized arena is building trust with them, given their role as the primary drivers of the maternal consumer experience. To better enable obstetric specialty care providers in our collective goal of improving maternal outcomes, our health plan affiliates deploy consultants to care provider practices across 22 Medicaid markets, with 10 of those markets having a joint commercial footprint.4

Practice consultants are licensed clinicians with obstetric specialty practice expertise, focused on collaboration with care providers and their office administration. They are equipped with the background to serve as clinical liaisons, discussing pathways to high-quality, evidence-based care with practitioners.

These practice consultants visit care providers in our health plan affiliate networks several times per month through virtual and in-person meetings and serve as one-to-one, practice-level support, linking the care provider, patient, and payer. These interactions serve to improve proactive communication, facilitate timely data sharing, and enhance the ongoing delivery of evidence-based care.

They also support care providers in improving health outcomes by:

Facilitating enrollment and engagement in our value-based care programs.

Sharing timely and relevant data that is actionable to closing care gaps locally, such as our Quality Incentive Program scorecards and delivery reports.

Serving as a one-stop coordinator of referrals to applicable patient solutions, including Case Management, Disease Management, and Cancer Care Quality Program.

Improving Maternity Outcomes

It's notable to point out that the program is showing great results. When care providers participating in value-based programs are paired with practice consultants, maternal health outcomes are substantially improved, and they yield savings with the added promise of impacting health disparities:5

Value-based health care programs impact health disparities with 5% savings in total birth costs, 5% savings in maternal first-year costs, 9% reduction in primary C-section rates, 91% increase in postpartum visit compliance and 22% increase in vaginal birth after cesarean (VBAC) rates

Doula Care

In obstetrics, it's particularly important to take a broad view to meet the needs of all pregnant people and babies. To expand and evolve how our health plan affiliates engage with care providers, we have recognized doula care as a critical solution for improving birth outcomes while addressing health disparities. Doulas provide whole-person care to pregnant and postpartum people through education and physical, social, and emotional support.

Despite a varied regulatory landscape, we support increasing access to doula services through a comprehensive approach by:

  • Deploying programs in markets with a doula benefit.
  • Funding pilots and grants to increase access.
  • Advocating for access and coverage of doula services.

This work is underscored by prioritizing care provider engagement as critical to the uptake and utilization of doula services. Where applicable, our obstetrics practice consultants partner with care providers to reinforce doula education and assess barriers to care.

Our doula pilots in California, Florida, and New York revealed that pregnant people receiving doula services have superior outcomes, including being less likely to have babies of low-birth weight or requiring admission to the neonatal intensive care unit. They also experienced higher odds of having a term or post-term birth, a decrease in behavioral health diagnoses, and an increase in postpartum visit compliance. Findings from our analysis suggest that doulas offer a personalized and effective solution that improve the health outcomes of pregnant people and babies while mitigating birth inequities.

Oncology Solutions

The United States is experiencing a growth in the number of patients requiring cancer treatment. The American Cancer Society estimated that nearly 2 million new cases would be diagnosed and over 600,000 people would die from cancer in 2022, the highest estimates made by the society since 2007.6 Our health plan affiliates had an annual oncology spend over $18 billion in 2021.7 To meet this rising trend, we are working hard to improve and expand oncology solutions and supports — for our consumers, their caregivers, and our care provider partners.

To this end, we launched the Oncology Practice Consultant and Cancer Care Navigator programs (OPCCCN), which aim to improve data transparency for care providers, expand palliative care and navigation options, incentivize quality, evidence-based care, and ultimately improve health outcomes.

Our oncology practice consultants are highly skilled oncology experts who interface locally with oncology practices through in-person or virtual touchpoints. Supporting more than 4,000 oncology practices nationwide,7 their primary objective is to ensure care providers are supported in delivering the highest quality care as part of the value-based Cancer Care Quality Program. They achieve this objective by:

  • Proactively discussing actionable data insights to set practice priorities.
  • Collaborating on how to advance health outcomes and prevent potentially avoidable admissions.
  • Communicating and sharing information on early palliative care solutions that aid practices to enhance end-of-life care, when it's needed.

Oncology practice consultants are paired with cancer care navigators who provide end-to-end, high-touch, individualized assistance tailored to address patients' unique life circumstances, while connecting them to the right resources at the right time. Cancer care navigators are certified oncology health educators who utilize our care management digital platform to interact directly with patients to develop a personalized care plan. Among their services, they coordinate benefits, coordinate with our dietitians and pharmacists, and work to address social drivers of health that may create barriers to treatment.

Since the launch of the Oncology Practice Consultant and Cancer Care Navigator programs, cancer care navigators have connected with more than 3,000 consumers and have demonstrated a significant return on initial investments for consumers and care providers. Overall, the program has driven $10 million in consumer program savings, and the oncology practice consultants contributed to $8.3 million in savings derived from the oncology value-based programs. Most importantly, they are making a difference in the lives of people facing one of life's great challenges.

It's partnership-oriented relationships like these that build trust and lead to meaningful improvements in the way we support, connect, and collaborate with clinicians.

Forward Together

We are addressing challenges care providers face by reducing the mismatch that may exist between patient needs and the resources and data available. It's about enabling and supporting our care provider partners to focus on care delivery, including beyond traditional healthcare services, to help improve the whole health of our consumers.

1 Internal data, June 2021-May 2022. 2 Internal data (2022). 3 Internal maternity data (2022). 4 Internal data (2022). 5 Internal 2021 program evaluation. 6 American Cancer Society, Cancer Facts & Figures 2022: cancer.org. 7 Internal Oncology Strategy Presentation (September 2022).