Community Health Choice: Health is the starting point of progress and potential

Health plans partner with us because we have the scale, passion and commitment to help them grow in a rapidly changing and increasingly competitive environment. Our experts provide innovative, strategic solutions that align with your plan's unique priorities. We believe health is what makes progress possible. Let's embrace our relentless passion and define the future of health care – together.

Let's continue the conversation

You need – and deserve – a strategic partner who is just as invested in the success and strategic growth of Community Health Choice as you are. We look forward to digging in further with you, to take on your toughest health care challenges together.

Review a sample implementation timeline for Medicaid, for illustrative purposes only. Please note that each Implementation is unique. Following the project launch, Community Health Choice will receive a tailored version of this timeline.

Review a sample implementation timeline for HIX and DSNP, for illustrative purposes only. Please note that each Implementation is unique. Following the project launch, Community Health Choice will receive a tailored version of this timeline.

Amy Bricker
Amy Bricker
President, Express Scripts
Health care is more complicated, more fragmented and more costly than it needs to be. We're changing all of that. Being part of the solution to transform health care as we know it – is a vision we can all get behind. Working together, we can take on your toughest challenges, expose opportunities to reduce costs and increase profitability and help you prepare for what's next.

Diversity, equity and inclusion

Our diversity, equity and inclusion (DEI) strategy fosters a culture of belonging and equity that advances our mission to positively impact the well-being of our people and the communities we serve.
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79% of employees agree that there is great DEI at our organization, outperforming other companies by more than 13%
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Committed to doubling diverse supplier spend to $1B by 2025
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Launched COVID-19 disparities project to slow the spread in three target markets with large Black and Hispanic populations

Eliminating health disparities

Families in communities across Texas and the country are faced with social, linguistic, economic and environmental circumstances that directly impact their health. Like Community Health Choice, we are committed to eliminating disparities in health and ensuring that all people have access to care. Which is why we believe in continuing to expand our data intake and learnings relative to the populations we serve and their overall experience. We are currently in review stages of a study that dives more deeply into specific disease states, paired with our geographic Social Determinant Index data, to correlate member adherence to these pieces of member data and will share the findings with you as soon as they are finalized.
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Food security and access
Community and social context
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Neighborhood and physical environment
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Health care and literary access
Susan Stith
Susan Stith
Vice President, DEI, Civic Affairs, and Foundation
Bringing together a diverse workforce means we're better able to meet the needs of our 180 million member and client relationships. And when we address broader societal needs through a diversity and inclusion lens, we can solve business problems critical to our mission.
Three key insights for driving action and change

Health Care in Focus
Explore our newsletter on federal guidance governing regulated markets plans. Every other month, this newsletter will provide an overview of recent happenings in this space, highlighting items important to a variety of plan types.

Explore the Regulated Times Newsletter

Market analysis: Key insights and findings

We operate on a belief that insights can lead to better action, and our regulated markets strategists will equip you with market analyses for growth planning and insight-driven conversations focused on enrollment trends, Star Ratings trends, competitive market benefits and other aspects. These analyses can be done at the state level, service area level, or county level to meet your needs. An initial look generated some insights for conversation.
The bar continues to get higher when it comes to diabetes care management. Currently, Community Health Choice is scoring lower than our health plan book of business on HbA1c and eye exam metrics.
Compared to our health plan book of business, Community Health Choice is scoring lower on follow-up care for children prescribed ADHD medication. Our clinical solutions could help improve critical metrics for this class.
There has been an increased focus on immunizations recently due to the COVID-19 pandemic. Community Health Choice’s immunization rates for children and adolescents trails our health plan book of business average.

Achieving savings and growth through effective utilization management

eviCore healthcare currently provides utilization management for more than 100 health plans with over 100,000,000 members. When one client came to our team, experiencing financial and growth challenges, we were able to do a thorough analysis of the claims file, to identify significant savings opportunities made possible by initiating prior authorization programs supported by the industry's most comprehensive sets of evidence-based clinical criteria. eviCore healthcare took on risk and guaranteed savings as programs went live. Within one year, significant improvements were reported by the client.
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$3.6 million savings in first year
Growing membership across multiple states and markets
Continued collaboration through quarterly performance meetings

Fragmented drug management strategies may be costing you

Medical drug spending is expected to increase by 33% by 2023. With specialty costs rising rapidly, you may be seeking new ways to manage spend and optimize administrative efficiencies. See how our approach to integrating medical drug management optimizes drug savings across pharmacy and medical benefits, enabling better efficiency, greater savings and improved safety.
20% 20%
of claims in the highest specialty spend categories are duplicating work within plans
50% 50%
higher specialty drug approvals vs. traditional approvals within the last 4 years1
$128B $128B
projected medical spend in 2023 – a 33% increase from $96B in 20182

Aligned with Community Health Choice, we'll deliver world-class health services with a singular focus: To make health care more affordable, predictable and simple

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We build on our leading, differentiated position to lower the total cost of care
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We take surprise out of the system and help people make informed health care choices
We make it easier for the people we serve to get the care they need
Thank you
If you have questions or need further information, I am here to help!
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