From where you sit in the organization, you probably realize health care is more complicated than it should be. 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.
Healthfirst
Considering your focus on delivering extraordinary care for your members and on being true partners in the health system, I’m eager to engage and work with Healthfirst to ensure you deliver on your promise of affordable care that fits every life stage. Our missions are very similar and I’m all in to collaborate and help co-design solutions that further your team’s commitments and strengthen your key role in the communities you serve.
I am excited to dive in with the Healthfirst team to find opportunities for us to grow together and work toward improved health care for all. With the recent formation of our new health services portfolio, Evernorth, we are better positioned than ever to support you and your clients to create a better experience for your team, members and providers.
I appreciate the close collaboration and long-term partnership between Healthfirst and eviCore, and I’m excited about the expanded opportunities we can bring via Evernorth. I look forward to continuing our conversation on how we can drive additional value for Healthfirst and its members.
Meet your team
Our team looks forward to getting to know you and exploring opportunities to improve affordability for your plan and care for your members. Hear from Neel Chopdekar, Vice President, Technology Portfolio & Operations.
Meet your team
Our team looks forward to getting to know you and exploring opportunities to improve affordability for your plan and care for your members. Hear from Jim Engler, Senior Director, Health Plan Division.
Meet your team
Our team looks forward to getting to know you and exploring opportunities to improve affordability for your plan and care for your members. Hear from Sam Patel, Vice President, Account Management, Health Plan Division.
Meet your team
Our team looks forward to getting to know you and exploring opportunities to improve affordability for your plan and care for your members. Hear from Tricia Pool, Senior Director, Specialty Solutions.
Meet your team
Our team looks forward to getting to know you and exploring opportunities to improve affordability for your plan and care for your members. Hear from Michael Testa, Operations Director, Health Plan Division.
Diversity, equity and inclusion
We’ve long had a commitment to diversity, equity, and inclusion, but realize there is more work to do. We are excited about the opportunity to partner with Healthfirst, an established leader in diversity and health equity, in serving New Yorkers. We believe combining the knowledge and best practices of our organizations will lead to improved health and reduced socioeconomic healthcare disparities in care to the members you serve.
Strategic guidance and audit support
In 2019, the last full year of audits, Center for Medicare and Medicaid Services (CMS) audited 13 plans and all but one had findings of non-compliance, with an average audit scored of 0.77 and imposed civil monetary penalties totaling over $1.6 million. For 2021, the CMS redoubled their audit efforts following the 2020 moratorium due to COVID-19, placing an industry-wide strain on health plan support staff. One of our health plan clients was selected for a program audit. See the results we were able to help them achieve.
Protecting your plan against fraud, waste and abuse
Fraud, waste and abuse is a significant, and sometimes hidden driver of plan costs, which can occur at both the provider and member level, and impacts payers dramatically. To prevent cases of fraud, waste and abuse, our analytics team monitors patient and prescriber patterns to reduce waste, identifies situations of abnormal utilization or fraud, and intervenes to prevent or stop the misuse. In 2019 and 2020 alone, our solution yielded significant savings to our clients.
substantiated cases presented to plans
referrals resulted
Avoided up to $262M in related prescription costs
Government affairs and the impact on health care
As the political debate around health care continues, we remain committed to addressing the dynamic environment through active, principle-based, nonpartisan engagement with policy markers in Washington D.C. as well as at the state and local levels. Whether it's critically important topics such as broadening approaches to drug pricing and transparency, addressing the underlying drivers of health care costs, or expanding the bring spots within our current system, there has never been a more important time for us to be a powerful and reliable voice in the dialogue.
Evernorth insights: Health Care in Focus
COVID-19 has challenged our health care system like no other. But we’re always looking ahead, identifying ways to redefine what’s possible. We polled consumers and plan sponsors across the U.S. to assess the state of health care in the years ahead.
The results are in
The changes we’ve all had to navigate and the way consumers have responded in the wake of COVID-19 have shaped the future of health care as we know it. Our research yielded insights that offer an opportunity for business leaders and health care decision makers to work together to evaluate health for every member, for every employer, for all.
Health care comes home
As COVID-19 has normalized virtual health and digital care solutions in an environment where advancements in technology and consumers’ demand for digital both grow seemingly at the speed of light, how can health care decision makers and health plan leaders keep up in terms of offering members the tools they need to stay healthy, in a way that is safe and fits into their day-to-day routine?
The mind-body connection
COVID-19 has underscored the connection between physical, mental and social health. While many consumers are engaged in some sort of wellness activities, the focus on health has inspired many to take a more proactive approach to their whole well-being.
The cost-care conundrum
Keeping health care costs down remains a consistent priority for both consumers and decision makers. In fact, it’s a dilemma that affects nearly every plan: How is it possible to do more with less, and still provide high quality, low cost and high touch care.
Evernorth insights: Drug Trend Report
In the face of the COVID-19 crisis, we worked together with clients to solve urgent and emerging needs with innovation, agility and focus while delivering results. See a snapshot of what we were able to help our clients achieve.
Your trusted partner in regulated markets
We're squarely focused on the quality metrics that are important to you and know that our support will help you move the needle on becoming market-leading – today and in the future. Through our clinical programs, network strategy, formulary management and levers designed specifically for regulated markets, we want to be your partner of choice.
Hear from our clients
Drawing on extensive knowledge and experience, our teams are equipped to help you grow and retain your regulated markets business. Hear from Yusuf Rashid from Community Health Plan of Washington about his experience working with us to improve the plan's quality outcomes and Star ratings.
Hear from our clients
Hear from Janae McAfee of Highmark Blue Cross Blue Shield about her experience working with us and our commitment to help their plan grow and retain commercial business.
Health Connect 360
The fix for fragmented care with outcomes aligned to your goals and Stars metrics
InMynd
behavioral health care solution to help your members access mental health support and treatment on their terms
A deeper dive into Health Connect 360: Med D Case Study
Our first-of-its-kind clinical model, Health Connect 360SM, is an outcomes-based approach that leverages industry-wide best-in-class services and allows you to place financial guarantees on the Stars metrics of your choice.
Exploring America's State of Mind
Mental health conditions are the costliest health conditions in the U.S., costing the health care system more than $200 billion annually, and more than $193 billion in lost earnings per year.1 They’re the most common cause of hospitalizations for people ages 45 and younger, and 13% of mental health discharges are readmitted to the hospital within a month.2
America is in the grip of a mental health crisis. Nearly 1 in 5 U.S. adults experienced a mental health condition in 20183
From 2008-2018, the overall prevalence of mental illness increased 8%4
Nearly 17.3 million American adults experienced a major depressive disorder in 20175
Affordable, predictable and simple health care
Aligned with Healthfirst, we'll deliver world-class health services with a singular focus: To make health care more affordable, predictable and simple.
Affordable
We build on our leading, differentiated position to lower the total cost of care
Predictable
We take surprise out of the system and help people make informed health care choices
Simple
We make it easier for the people we serve to get the care they need
References
1. National Alliance on Mental Illness. What’s At Stake. https://www.nami.org/ About-NAMI/NAMI-News/2017/What-s-At-Stake. Accessed March 31, 2020.
2. Loch, A. Discharged from a mental health admission ward: Is it safe to go home? A review on the negative outcomes of psychiatric hospitalization. Psychol Res Behav Manag. 2014; 7: 134-145.
3. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. https://www.samhsa.gov/data/
sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf. Published 2018. Accessed March 17, 2020.
4. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. Available at https://www.samhsa.gov/ data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf. Accessed March, 22, 2020.
5. National Institute of Mental Health. Major Depression. https://www.nimh.nih.gov/health/statistics/major-depression.shtml. Accessed March 17, 2020.
1. National Alliance on Mental Illness. What’s At Stake. https://www.nami.org/ About-NAMI/NAMI-News/2017/What-s-At-Stake. Accessed March 31, 2020.
2. Loch, A. Discharged from a mental health admission ward: Is it safe to go home? A review on the negative outcomes of psychiatric hospitalization. Psychol Res Behav Manag. 2014; 7: 134-145.
3. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. https://www.samhsa.gov/data/
sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf. Published 2018. Accessed March 17, 2020.
4. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. Available at https://www.samhsa.gov/ data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf. Accessed March, 22, 2020.
5. National Institute of Mental Health. Major Depression. https://www.nimh.nih.gov/health/statistics/major-depression.shtml. Accessed March 17, 2020.