Contracting for Outcomes

Contributing expert: Paul Eisenstat

At Elevance Health, our commitment to accelerating value-based care — particularly through shared-risk arrangements — is fueled by data that shows it leads to better and more equitable health outcomes, increased patient and care provider satisfaction, better access, and more affordable care.

By incentivizing our care provider partners through appropriate value-based arrangements, we're seeing those positive results come to fruition across all populations and across our continuum of businesses. Importantly, value-based care is helping care providers thrive financially; in 2023 alone, more than $1 billion in additional payments from our affiliated health plans were earned by value-based care providers.1 At the same time, these arrangements are driving better health outcomes and helping to curb overall healthcare costs.

Value-Based Care Spend Penetration

We are committed to meeting care providers where they are and helping them manage populations better and move across the risk continuum toward higher value and, ultimately, to appropriate levels of shared risk. Of our total medical spend, 63% is in value-based care and 33% in shared risk — triple what it was two years earlier. These arrangements drive positive health outcomes across all our lines of business.

  • 2019: Value-Based Care Spend: 60%, Shared-Risk Spend: 8.6%
  • 2021: Value-Based Care Spend: 60%, Shared-Risk Spend: 11%
  • 2023: Value-Based Care Spend: 63%, Shared-Risk Spend: 33%

Source: Elevance Health, internal reporting (2023).

Our Results by The Numbers

~198,500

care providers participating in value-based payment arrangements2

6.5%

higher rate of breast cancer screenings for Commercial consumers whose doctors participate in our value-based care programs3

19.2%

consumers with diabetes in our affiliated health plans' Medicare population who show better control of their blood sugar when their doctors participate in value-based care3

91%

National Value Partner Medicare membership that assumes shared risk, which accelerates progress toward better quality and cost outcomes4

13.1%

better rate of weight assessment and nutrition counseling for children and adolescents with Medicaid coverage when their physicians participate in our value-based care programs3

$1B

estimated additional payments earned by care providers in 2023, above base fee schedule payments, in recognition of participation and performance in value-based care arrangements5

These outcomes are the result of a steadfast commitment to changing our country's payment paradigm away from volume of patients seen and toward paying for the value of care delivered. Our approach is built to be scaled while addressing local market needs.

Through our affiliates' Commercial health plans, we are well-positioned to advance this shift to value on behalf of employers locally and nationally by delivering employee coverage that leads to better health outcomes at lower costs. One way we're doing that is through our health plan affiliates' flagship value-based solution, Enhanced Personal Health Care — with over 91,000 participating care providers across Commercial markets.6

Among our affiliated health plans' Medicare population, our data shows a significant difference in health measures for people in value-based programs versus those who aren't. Our affiliates have developed programs to ensure that care providers' payment arrangements support a path to maintaining and managing wellness for Medicare consumers.

We're helping our care provider partners address the unique resources, requirements, and barriers to care experienced by our health plan affiliates' Medicaid population through comprehensive care management and coordination. When care providers can connect with community resources for their patients, it helps improve health outcomes, reduce health disparities and emergency room utilization, and lower overall healthcare costs.

1 Elevance Health, internal analysis (December 2023). 2 Elevance Health, internal reporting (December 2023). 3 Elevance Health, internal reporting (2022). 4 Elevance Health, internal reporting (December 2023). 5 Elevance Health, internal analysis (December 2023). 6 Elevance Health, internal analysis (February 2023).