Enable more affordable, high-quality surgical care   

Removing the barriers to high-value surgical procedures for all stakeholders 

Surgical procedure costs are rising, with limited transparency or ability to manage them. The price of a procedure can be 200% to 400% higher than necessary, depending upon device selection and cost and where the procedure is performed.  

One approach to manage this cost is to perform clinically appropriate cases at lower-cost facilities, such as ambulatory surgery centers (ASC's). Unfortunately, reimbursement structures often make this difficult, due to high device costs. That’s where we come in. 

Our answer 

Evolent partners with health plans, facilities and device manufacturers to provide surgical cost management solutions that bring improved affordability of care to the patients they serve. For surgical procedures using implants, such as a knee replacement, rotator cuff repair or spinal fusion, we align stakeholders to ensure the use of the optimal device and the best site of care.  

In brief, here’s how our program works:  

• We carve out the device from the reimbursement, eliminating facilities’ cost outlay for the device while managing authorizations and collections for it.
• We work with surgeons on clinically appropriate selection of devices.  
• Using our purchasing power, we save on device costs via our contracts with manufacturers.

How stakeholders benefit   

Health plans 

We deliver lower surgical costs to our health plan partners through device management and site-of-care solutions that complement their existing programs. Health plans work with us to benefit from:

• Immediate cost savings with multi-year device trend mitigation
• Aligned incentives that drive lower episodic costs through physician and facility engagement
• A device selection platform that identifies high-quality, lower-cost alternatives  
• Identification of cost-efficient, high-quality providers to support plans’ network strategy
• Analytics to help identify facilities, procedures and surgeons with the greatest opportunity to shift site of care and monitor implant utilization

Facilities 

With a large national footprint, we align incentives and remove barriers to enable facilities to perform higher acuity cases in more cost-effective settings. Evolent supports ambulatory surgery centers and other facilities by:

• Making it easier to expand case mix and increase profitability through appropriate reimbursement rates
• Alleviating the risks and managing the uncertainty around the device, including patient authorization and collections
• Assuming the full cost of devices, reducing cost outlay for facilities and making cash flow more predictable  
• Enhancing surgeon recruitment efforts by offering increased volume and new procedures 

Surgeons 

We enable surgeons to engage with our health plan partners so they can help to reduce costs while supporting value-based care delivery. Surgeons benefit from:

• Mitigation of the risk of coverage and reimbursement of devices, allowing them to focus on patient care
• More rapid access to new cost-effective, high-quality devices, as Evolent works with health plans to establish coverage for them
• Help introducing them to facilities with the infrastructure and capacity to handle higher acuity cases while maintaining device choice
• Lower out-of-pocket costs and higher satisfaction for their patients  

Manufacturers 

Device manufacturers work closely with Evolent to gain greater access to our clients, increase market share and position themselves as part of the solution for high-value care. Collaborating with Evolent enables manufacturers to:

• Create highly efficient new distribution channels
• Differentiate themselves from competitors by being identified as part of the physician-health plan partnership, rather than purely a cost driver
• Raise the visibility of their products within our surgeon and facility networks