Commercial Population

Commercial health plans serve a range of customers — from individuals to large, multinational, self-insured employers. In the U.S., employers have a long history as the predominant buyer of health insurance, covering approximately 45% of the population.1

Our Commercial health plan affiliates serve more than 27 million consumers in 14 states.2, 3 Through our local density and national scale, we have been well-positioned to advance the shift to value on behalf of employers. Our health plan affiliates designed networks that offer choice and incentivize value over volume to deliver employee coverage that leads to better health outcomes at lower costs.

Care providers of all types — from primary care to specialty to hospital and post-acute care — participate in and perform well in our value-based care arrangements.

A Conversation on Value-Based Care

Listen to Tich Changamire, MD, Vice President and Chief Medical Officer, Commercial Health Benefits, Elevance Health; and Kevin Wang, MD, Chief Medical Officer, apree health, discuss the benefits they have seen from value-based care for the commercially insured population, including how it helps drive quality and affordability.

There are close to 1,800 care provider organizations, representing over 100,000 healthcare professionals, participating in our value-based payment arrangements.4 Through these solutions, we've driven measurable improvements in the quality and affordability of care for our Commercial population.

Enhanced Personal Health Care

Enhanced Personal Health Care (EPHC) is our health plan affiliates' main value-based payment arrangement for the Commercial population and is the nation's largest value-based solution tailored to meet local market needs.5

EPHC is designed to improve quality outcomes and control cost-of-care trends in local markets. Care providers participating in EPHC are incentivized to deliver quality, efficient care by focusing on prevention and wellness, offering personalized plans, and coordinating treatment across the care spectrum.

When comparing critical health indicators among our Commercial consumers in value-based arrangements to those who are not, we've seen an impact on that population's health.

Our decade-long experience with Enhanced Personal Health Care has facilitated our understanding of what helps care providers succeed in value-based care arrangements. Now, we are bringing that experience to bear as we expand our value-based care work in medical specialties, including oncology.

Commercial: Value-Based Care Versus Non-Value-Based Care6

  • Medication Adherence for Cholesterol: 2.9% higher
  • Breast Cancer Screenings: 6.5% higher
  • Colorectal Cancer Screening: 7.1% higher
  • Well-Child Visits in the First 30 Months of Life: 7.7% higher

Oncology Medical Home Plus

While much of the conversation around value-based care focuses on investing in primary care, we are working to enable specialists, too, particularly to drive outcomes for consumers with more chronic and complex conditions. Launched in 2022, the Oncology Medical Home Plus (OMH+) program incentivizes high-value care by leveraging digital resources, population health analytics, and practice transformation tools to support improved care provider decision-making and access to equitable, quality, and more affordable cancer care for our consumers.

With close to 100 care provider practices participating in 14 markets across the country, OMH+ was designed to accelerate momentum, shifting medical oncologists in all practice settings to value-based care.7 The program leverages our collaborating vendor's broader network of existing relationships with smaller oncology care providers.

OMH+ features financial incentives for care providers who prioritize patient-centric oncology care and drive better outcomes for their patients in an upside-risk arrangement that introduces accountability for quality and cost performance.

With projected cost-of-care savings of 2.2% in the Commercial line of business, the program's success will help us build value-based care arrangements for other medical specialties, including programs that will be managed with support from our subsidiary, Carelon.8

1 Kaiser Family Foundation, Health Insurance Coverage of Nonelderly 0-64 (2022): 2 Elevance Health press release, Elevance Health Reports Q3 2023 Earnings (October 18, 2023): 3 Elevance Health, Q3 2023 Corporate Fact Sheet (2023). 4 Elevance Health, internal reporting (December 2023). 5 Elevance Health, EPHC Longitudinal Impact on Cost and Quality: Health Affairs Publication (February 2023). 6 Elevance Health, internal reporting (2022). 7 Elevance Health, internal reporting (2023). 8 Elevance Health, internal reporting (2023).