On its second-quarter earnings call, company leaders touted Carelon, Elevance’s health care services division.

“In our health services businesses, we are making progress on our key strategic priority to scale our enterprise flywheel for growth,” Elevance CEO Gail Boudreaux said on the earnings call. “Carelon Services delivered robust growth in operating revenue and earnings in the quarter as we gained traction with external clients both through new business wins and the expansion of risk-based services to existing customers.”

Elevance’s Medicaid woes are derived from the “attrition” of healthier members, according to the company, which has led to higher utilization of care services.

“We are also seeing signs of increased utilization across the broader Medicaid population, including in outpatient home health, radiology, durable medical equipment, as well as some elective procedures,” Elevance CFO Mark Kaye said on the call.

Carelon has helped offset some of those woes, however. Its operating revenue grew by over 26% year over year, and operating earnings increased by more than 30%.

Elevance also agreed to acquire Paragon Healthcare, a major infusion therapy provider, earlier this year.

Paragon provides a significant amount of home-based infusion services, which Elevance leaders highlighted on the call.

“As it relates to Paragon, again, just to reiterate the opportunity there, we feel very, very good about that,” Carelon President Pete Haytaian said on the call. “We’re talking about $16 billion of infusion spend as it relates to Elevance Health with about 50% of that being in the hospital setting. So again, a great opportunity for us to have care be provided in a more appropriate setting, be it in an ambulatory site or in the home, and we feel very good about our positioning and the density that we have in our markets as it relates to that.”

Overall Elevance Health operating revenue checked in at $43.2 billion in the second quarter, which represented a year-over-year decrease of $200 million.

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The company has partnered with the private equity firm Clayton, Dubilier & Rice (CD&R) on a primary care initiative that will bring together Carelon Health – Elevance Health’s provider arm – and apree health and Millennium Physician group, two CD&R-backed companies.

“CD&R’s collaboration with Elevance Health is an important step in our ongoing investment focus to accelerate innovation in care delivery across the country,” Clay Richards, a CD&R operating partner, said in a press release Monday. “We are excited to enter into this strategic partnership with Elevance Health and for what this effort can accomplish, drawing out the strengths of each of the three companies to improve the patient and physician experience for the communities they serve.”

The initiative specifically is aimed at taking a “whole health approach” to primary care, focused on patients’ physical, social and behavioral health needs.

Elevance Health Gail Boudreaux expanded on the partnership in her company’s first-quarter earnings call Thursday.

“We’re excited to collaborate with CD&R and a broad range of care provider partners to accelerate innovation, enhance healthcare experiences and improve health outcomes for consumers,” Boudreaux said. “The collaborative development of the business will advance our enterprise strategy by accelerating the provision of value-based care for our members and consumers more broadly, with our Carelon businesses providing capabilities to integrate and personalize the care delivered.”

Eventually, Elevance Health plans to fully own what comes of the partnership, and Boudreaux expects it to be a “leading platform for value-based care” across payer groups.

In the first quarter, Elevance Health posted operating revenue of $42.3 billion, which was a 0.9% year-over-year increase.

Carelon, on the other hand, brought in $12.1 billion in operating revenue in the first quarter, a $600 million or about a 5% year-over-year increase.

Elevance Health also recently bolstered its provider capabilities through the acquisition of Paragon Healthcare, an infusion provider that also delivers care in the home.

“In the first quarter, we made tangible progress on our strategic initiatives, notably in Carelon, where we continue to scale our flywheel for enterprise growth,” Boudreaux said. “Carelon closed its acquisition of Paragon Healthcare, a leading provider of infusion services. We are looking forward to expanding its geographic reach and therapeutic coverage to serve more consumers and Elevance Health members for years to come.”

Elevance Health certainly has its hands in home-based care across its portfolio, but has not yet fully dived in. 

Recent acquisitions and launched initiatives, however, could be a sign of things to come.

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“Carelon has, and will continue to add, attractive capabilities that we can scale rapidly and sustainably over the long term,” Elevance CEO Gail Boudreaux said during the company’s fourth quarter earnings call on Wednesday.

Based in Indianapolis, Elevance Health is a large managed care company and provider.

Boudreaux noted that Carelon Services is poised for strong growth in 2024 due to the onboarding of new clients, and continued expansion of services. This expansion of services includes the launch of Carelon Insights, and the rollout of comprehensive Carelon behavioral health management services.

The company also believes that the growth of its health benefits businesses will drive revenue for Carelon Services.

Value-based care, and streamlining processes to ensure better outcomes, also remains top of mind.

“We have multiple-year arrangements with our value-based providers,” Boudreaux said. “We’re always looking at a couple of things. One, make sure that it’s a win-win, and we’re aligned on cost quality outcomes, and stars. We spent a lot of time focusing on some of the ways that we can get data back and forth more simply. We’ve integrated the way we share data back and forth, and that’s really around closing gaps in care, and simplifying the process under which we work with those providers.”

Elevance Health’s goal is for this to become ubiquitous across all of the company’s value-based care providers.

“We made a lot of progress there, and dramatically improved the time to action with those providers, and I think that’s important, because it gives them data to act on and that improves their outcomes,” Boudreaux said. “We have seen our value-based providers perform better in this circumstance.”

During the call, Elevance Health also touched on its recent acquisition of the infusions services company Paragon Healthcare.

“The acquisition expands our capabilities, catering to consumers with complex and chronic needs, who could benefit the most from our approach to whole-person health,” Boudreaux said.

The purchase of Paragon Healthcare will complement Elevance Health’s suite of pharmacy services, which includes the company’s advanced home delivery service.

Overall, Elevance Health’s operating revenue for Q4 2023 was $42.5 billion, a 7% increase from Q4 2022.

The full year operating revenue for 2023 was $170 billion, a 9.3% increase from $155.7 billion in 2022.

Carelon Services’ operating revenue for Q4 2023 was $12.4 billion, a 14.1% increase from $10.9 billion in 2022.

“We delivered strong results every quarter of 2023, including in the fourth quarter, which is marked by solid top- and bottom-line growth and significant progress in the execution of our enterprise strategy to accelerate capabilities and services, invest in high-growth opportunities and optimize our businesses,” Mark Kaye, executive vice president and CFO at Elevance Health, said during the call.

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Elevance Health to acquire infusion provider Paragon Healthcare

Elevance Health (NYSE: ELV) announced that it has plans to acquire the infusions services company Paragon Healthcare.

The acquisition opens up the opportunity for Elevance members to receive more in-home care.

“The acquisition of Paragon Healthcare will deepen our capabilities around providing affordable, convenient access to specialty medications and best-in-class services for our members living with chronic and complex illnesses,” Elevance EVP Pete Haytaian said in a statement. “Together, Elevance Health and Paragon Healthcare will have the ability to provide members with greater choice on the most appropriate site of care options — such as ambulatory or in-home locations — which will remove barriers to care and better support members’ whole health.”

Based in Indianapolis, Elevance Health is a large managed care company. It also is part provider, however, and has made in-home care a priority.

Based in Plano, Texas, Paragon Healthcare is an infusion services provider that caters to patients with chronic and acute conditions through ambulatory infusion centers and home infusion pharmacies.

Elevance plans to expand Paragon Healthcare’s reach and operations and hopes to enhance therapeutic coverage beyond the eight states Paragon operates in now.

Post-acquisition, Paragon Healthcare will become part of CarelonRx, Elevance Health’s pharmacy services segment within Carelon, its health services division.

The deal is expected to close in the first half of 2024.

New Day Healthcare buys Texas-based Compassion Hospice

New Day Healthcare, a home health and hospice provider, has acquired Compassion Hospice, a Texas-based hospice provider.

The specific value of the deal was not disclosed.

New Day now has 29 locations across Texas, Missouri, Kansas and Illinois. The company serves over 100,000 patients annually and has been growing rapidly over the past few years – this is the company’s ninth completed acquisition since 2020.

“New Day Healthcare is pleased to welcome Compassion Hospice to our platform,” New Day Chief Development Officer Matthew Griffin said in a statement. “Compassion provides us with a high-quality hospice operation in East Texas, where New Day currently has significant market share in both personal care and skilled care services. This latest acquisition continues to prove New Day’s commitment to bringing together multiple home health service lines within markets to improve patient care coordination and outcomes.”

Last fall, New Day acquired Pathfinder Home Health and AdvantageCare Home Health in September. Both of those companies are headquartered in Texas.

Despite the acquisition, Compassion Hospice will maintain its current brand and leadership structure.

Assisted Living Services buys Day Kimball Homemakers

Assisted Living Services Inc. — a non-medical home care agency — has acquired Day Kimball Health’s Day Kimball Homemakers Inc. The terms of the transaction were not disclosed.

As part of the deal, Day Kimball Homemakers employees have been offered positions with Assisted Living Services.

“It’s our mission to build upon and grow the strong tradition that Day Kimball Homemakers has established among the senior population in the area, while bringing some enhanced services to the community such as live-in companion, adult family living, foster care, and technology solutions for aging-in-place,” Mario D’Aquila, chief operating officer at Assisted Living Services, said in a press statement. “Further, we are excited to provide the community with additional jobs and work opportunities.”

Assisted Living Services provides care for seniors in a number of settings, including their homes, retirement communities and senior living communities.

Loma Linda University Health launches PACE program

Loma Linda University Health has launched a Program of All-inclusive Care for the Elderly model — better known as PACE — at its Park Avenue location in Redlands, California.

“This is concierge planned care with a plan,” Leslie Von Esch, director of Loma’s PACE program, said in a statement. “PACE creates a community for our local seniors and keeps them active — all in addition to providing services and support for their regular medical needs.”

PACE programs help dual-eligible beneficiaries remain in the broader community through an interdisciplinary approach.

Loma’s new PACE program will offer a wide variety of services, including clinical outpatient care, food service, primary care exams, physical therapy, cardiology specialties and much more.

The program is starting with about 20 participants and is expected to grow to 350. California now has over 19,000 participants in PACE programs throughout the state, according to CalPACE.

Axxess announces partnership with Stacy Olinger Consulting

Axxess — a home-based care technology company that provides agencies with cloud-based software solutions — has announced a partnership with Stacy Olinger Consulting.

Stacy Olinger Consulting is a tech and health care consulting firm with a focus on home care, post-acute throughput and chronic illness services.

“Our partnership with Axxess highlights our shared ethos of putting people first,” Stacy Olinger, founder and CEO of the company, said in a statement. “By combining our focus on human-centered strategies with innovative technology, we are able to give care teams more time at the bedside, improve satisfaction, optimize organizational efficiency and create sustainable and scalable growth solutions.”

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In light of those sentiments and expected constraints, some believed MA plans could begin trimming their supplemental-benefits packages, which could lead to fewer home-based care offerings delivered under the Expanded Primarily Health-Related Benefits (EPHRB) and Special Supplemental Benefits for the Chronically Ill (SSBCI) options.

MA plans began touting their benefits to Medicare beneficiaries at the beginning of October – and early signs suggest a pullback is, indeed, taking place.

“Fewer plans are using SSBCI to offer benefits, with decreases in Social Needs Benefits (128 fewer plans than in 2023) and Meals (99 fewer plans),” Washington, D.C.-based research and advisory firm ATI Advisory wrote in a LinkedIn post.

Specifically, across EPHRB, SSBCI and VBID authorities in 2024, 867 plans will offer in-home support services (IHSS) as a supplemental benefit, according to ATI. This is a decrease from the 1,308 plans offering this benefit in 2023.

It’s not exclusively due to the brighter spotlight on plans, however.

“We suspect the main reason behind the decrease is that IHSS is a more administratively complex benefit to offer, especially compared to something like a grocery card,” Bill Winfrey, director of Medicare innovation at ATI Advisory, told Home Health Care News in an email. “To offer the benefit, plans must identify providers in a crowded marketplace, build a provider network to ensure market coverage and manage increasing labor costs that are driving up the cost of the benefit itself.”

Before heading into the 2024 plan year, IHSS had been one of the most popular benefits. There was a 364% increase in plans offering the benefit since 2020.

Dr. Sachin Jain, CEO of the Medicare Advantage organization The SCAN Group, recently discussed how MA plans may operate in this different environment with HHCN sister publication Palliative Care News.

“The way Medicare Advantage works is that we receive a risk adjusted, per member, per month payment in addition to revenue bonuses for [star ratings], which then fuels our ability to purchase services on behalf of our members,” Jain told Palliative Care News. “It just goes to reason that if we start getting paid less in aggregate, then our downstream entities are likely going to either see smaller increases or lower payments.”

CMS moved forward with changes to its risk-adjustment process earlier this year via its 2024 final rule for Medicare Advantage plans. The agency is implementing a 3.3% base-rate increase for MA plans while beginning a three-year phase-in of an updated approach to risk adjustment.

On top of that, the agency is transitioning its code system from Internal Classification of Diseases (ICD)-9 to ICD-19. It removed more than 2,000 of the diagnosis codes that MA plans use, with the affected codes “focused on conditions that are subject to more coding variation,” according to CMS.

“Paying Medicare Advantage plans more accurately for the care they provide is how we ensure that people enrolled in Medicare Advantage, especially populations with the highest health disparities and people in underserved communities, can continue to access the care they deserve,” CMS Administrator Chiquita Brooks-LaSure said in a statement.

An HHCN review of benefit announcements from some of the largest insurers reinforces the notion that fewer are touting home-based care offerings for 2024.

In recent years, many highlighted benefits for a certain number of hours of in-home support from in-home care technicians who can assist with light housekeeping and activities of daily living (ADLs). In-home companionship services and programs designed to ensure smooth hospital-to-home transitions were also common.

Few of the big insurers are touting the same degree of home-based care benefits for 2024 in their announcements.

Elevance Health (NYSE: ELV) highlighted supplemental benefits such as “dental, vision and hearing, transportation to medical appointments, assistive devices, utilities such as gas and electric bills, and groceries,” for example. UnitedHealthcare touted similar benefits, plus home delivery prescriptions.

Aetna – whose parent company, CVS Health (NYSE: CVS), acquired both Oak Street health and Signify Health – will offer an annual “healthy home visit” to members and access to primary care clinics.

Oak Street Health’s innovative care model provides comprehensive primary care with a focus on prevention and wellness. Aetna MA members will have access to all Oak Street Health primary care clinic locations across the country as part of the extensive Aetna provider network.

“[A health home visit] includes a comprehensive health risk assessment and non-invasive physical exam from the comfort of the member’s home,” Aetna wrote in an announcement. “The clinician will also evaluate the home environment to identify social support needs and risks that could result in early detection of health problems.”

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Geoff Abraskin has been named the new president of the hospice division at Amedisys (Nasdaq: AMED). 

He has been with the company for nearly 15 years.

“Geoffrey Abraskin has been promoted to President of the Hospice Division!” Amedisys wrote in a LinkedIn post last week. “Geoff is a doctor of physical therapy and a certified wound specialist who joined Amedisys 14 years ago as an administrator and rehabilitation specialty director. He most recently served as SVP of the home health northeast region, and brings strong operational, clinical, integration, engagement and overall strategy expertise to the hospice team.”

Based in Baton Rouge, Louisiana, Amedisys is a provider of home health, hospice and high-acuity care services in the home. It has about 16,500 employees that deliver care through over 520 care centers in 37 states and the District of Columbia.

Abraskin recently sat down with Home Health Care News to chat about some of Amedisys’ recent successes.

“We’re seeing some green shoots from people applying for jobs,” he said. “We actually just had our best two months in terms of fills. We’re seeing contractor costs coming down, so that’s a big positive for us. But overall, there’s so many people that need home health today, and there’s just X number of capacity. We’re hiring more people. We just can’t hire fast enough.”

UnitedHealth Group’s (NYSE: UNH) Optum agreed to acquire Amedisys earlier this year.

Elevance Health’s Next CFO

Earlier this month, Elevance Health (NYSE: ELV) announced that CFO John Gallina would be retiring from his role as executive vice president and CFO later this year. In tandem with that news, the company announced that Mark Kaye would be taking over those positions.

Kaye was formerly the CFO at Moody’s Corporation. He will report directly to Gail Boudreaux, the president and CEO of Elevance Health. From September 6 to November 1, Kaye will serve as CFO Designate. After that, he will officially become the executive vice president and CFO of Elevance Health.

Gallina will also remain with the company as a special advisor to the CEO following his retirement. He has been at Elevance Health for nearly three decades, and was named CFO in 2016.

“On behalf of the entire Elevance Health team, I want to thank John for his contributions to our company over the last three decades,” Boudreaux said in a statement. “John has been a valued member of our organization who has successfully led our finance organization, navigated an ever-changing and dynamic health care landscape, and played an important role in our transformation to become a lifetime trusted health partner.”

Based in Indianapolis, Elevance Health is a large managed care company. It also is part provider, however, and has made in-home care a priority.

It most recently teased big plans to get more involved with at-home acute care.

“Mark is a well-respected leader with an extensive global finance background, who has significant experience in leveraging data-driven financial insight to support the execution of superior operational and strategic decisions, including growing and scaling businesses to drive success,” Boudreaux said in a statement. “With an innovative and customer first mindset coupled with his passion for fostering a high- performance culture, Mark will be a tremendous asset as we work to deliver on our purpose to improve the health of humanity.”

The Helper Bees’ Daniel Murphy joins the Family Caregiving Advisory Council

The Helper Bees announced last week that Daniel Murphy will join the federal Family Caregiving Advisory Council, which “makes recommendations to the administrator of ACL/Assistant Secretary for Aging on how to support and improve the lives of family caregivers.”

Murphy is the general manager of SaaS solutions at The Helper Bees. He previously was the co-founder and chief product officer of healthAlign, which was acquired by The Helper Bees in 2021. Before that, he served as national director of population health product and strategy for Maxim, a home health care provider.

“My experiences in the military led me to the home health care industry when I transitioned to the private sector, where I continue to serve others,” Murphy said in a statement. “I’ve spent the past decade in the aging services industry, helping families, insurance companies and policymakers deliver better care for veterans and older Americans who deserve quality care. I look forward to working with other members of the Council, advising on solutions to improve caregiving.”

Based in Austin, Texas, the Helper Bees is an insurtech company that partners with payers and home-based care providers to help coordinate care in the home.

Murphy will serve on the Family Advisory Council through 2026.

DUOS appoints chief strategy and growth officer

The home-based care startup DUOS has named Jenn Kerfoot as chief strategy and growth officer.

Kerfoot previously served as the chief experience officer at FarmboxRx.

“Coming off a stellar Series A funding close earlier this year, DUOS brings on Kerfoot at a critical time of expansion to lead all things growth, including business development, B2B sales, brand marketing and more,” the company said in a statement.

Indeed, DUOS announced in June that it raised $10 million, bringing its funding total to over $33 million. The round was led by Primetime Partners and SJF Ventures.

Based in New York, the company places personal care assistants into seniors’ homes. It also has proprietary software, which has become a larger part of its business model.

DUOS hired Tom Shankle as the company’s new VP of health solutions earlier this month.

AlayaCare brings on new SVP of customer success

AlayaCare announced that Rhonda Bosch is joining its executive leadership team as SVP of customer success.

In the her role, she will “spearhead customer success strategies and initiatives, driving unparalleled value and satisfaction for clients across the home care sector,” according to the company.

“We are delighted to welcome Rhonda to our executive team,” AlayaCare Founder and CEO Adrian Schauer said in a statement. “Her proven expertise in fostering customer relationships and driving growth aligns seamlessly with our mission to provide innovative solutions that exceed our client’s expectations.”

Previously, Bosch served as the COO of Mercatus Technologies Inc.

“I am honored to join AlayaCare and lead the customer success efforts,” Bosch said in a statement. “What drew me to AlayaCare is that our people really care. And when you care about making a difference, you really own it. AlayaCare works hard to make it easier for caregivers to be able to execute a high level of care, and I’m excited to help nurture and foster their customers to achieve better outcomes.”

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Those were two main takeaways from the Indianapolis-based company’s second quarter earnings call Wednesday.

Elevance CEO Gail Boudreaux noted that Carelon Services — the company’s provider services arm — delivered solid organic growth led by the expansion of post-acute care management solutions within the company’s Medicare health plans.

“New business awards and successful execution in these fast-growing high-cost areas of trends underscore the value Carelon provides to health plans and the expanding earnings power and attractive growth profile of the Carelon Services business,” she said during the call.

Elevance’s myNEXUS – now called Carelon post-acute care solutions – is gaining a lot of visibility through its home solutions, too, according to Peter Haytaian. Haytaian is the executive vice president of Elevance Health and president of Carelon.

Achieving value-based care throughout the Elevance network remains a priority, a priority that can be accelerated through home-based care, company leaders acknowledged.

“We’re also working with care provider partners to enable acute care in the home, a patient centered care alternative to traditional care in the hospital that improves cost, quality and patient experiences,” Boudreaux said. “For select patients, acute care at home is safe, improves patient satisfaction, and provides high value care, resulting in approximately a 20% reduction in cost, a 25% decrease in readmissions and a 50% reduction in time spent in bed.”

Currently, Elevance has partnerships with a number of major health systems in its markets. The company has also seen major interest from other health systems looking to expand hospital-level care in the home.

“Connectivity with care provider partners is crucial to supporting our value-based care strategy,” Boudreaux said.

With this in mind, Boudreaux also touched on Elevance’s efforts to expand bi-directional data exchanges between the company’s systems and care providers EMRs.

To date, Elevance is connected with over 1,700 hospitals across 24 markets.

“In addition to enabling physicians to practice value-based care more effectively, these arrangements have simplified common business practices, resulting in more than 60% fewer requests for clinical information and more than 80% less provider appeals,” Boudreaux said. “This has not only enhanced operating efficiency for our clinicians and care provider partners, it has also accelerated care approval processes for consumers.”

Overall, in Q2, Elevance saw double-digit growth in revenue, operating income and adjusted earnings per share.

“[This was] driven by the focused execution of our strategy,” Elevance CFO John Gallina said.

Operating revenue for Elevance was $43.4 billion in Q2 of 2023, an increase of $4.9 billion, or 12.7%, year over year.

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Home-based care providers — both big and small — are struggling at the negotiating table with Medicare Advantage (MA) plans. But they’re also struggling in negotiations with managed Medicaid plans.

While MA plans and managed Medicaid plans operate a bit differently, providers are having similar issues with both. Proving value to health plan leaders is central to those issues.

“There’s more data readily available to them when it comes to Medicare Advantage, and I think payers are a little bit more well-trained and comfortable with how certified home health is connected to the rest of the health care system,” Care Advantage CEO Tim Hanold told Home Health Care News. “That’s versus Medicaid, which feels exploratory to them. In one way, I think there is a bigger hurdle there because you’re probably doing more credibility work upfront.”

The Richmond, Virginia-based Care Advantage is a home-based care company that has 38 locations throughout Virginia, Maryland, Delaware, Washington, D.C., and North Carolina. The company offers both personal care and home health care services.

Showing value

One of the things that will always hurt providers at the negotiating table is a lack of density in a market. They need to prove that they can make an impact on spend for managed Medicaid plans to listen.

Though selling home care to Medicaid payers might include more legwork at the beginning, there tends to be less “noise” past initial conversations, Hanold said.

However, those initial conversations – which include that “value” topic – tend to be the biggest part of negotiations.

“Whenever it comes to personal care, LTSS, HCBS, big payers and providers are still figuring out the overall core value,” Hanold said. “The first part of this is developing credibility and understanding that this is a real part of the health care system and it’s not just a staff, bill and pay shop. I feel like a lot of my initial conversations with payers are about the care we provide in the home and how it can have real positive outcomes on things they care about.”

The things they care about, according to Hanold: keeping members out of the ER, out of the hospital, and reducing costs overall.

“There’s also value in just the information that can be captured for the MCO in the home,” he said. “Medicaid sees that and, [from my experience], is truly interested in the consumer and member experience.”

One of the biggest value-adds that Care Advantage leans on when in conversation with managed care organizations is the consistency that comes with having one caregiver for a member over an extended period of time.

A member having a consistent caregiver has been shown to improve patient outcomes and satisfaction.

“The satisfaction — both from a member and the MCO — can often be tied to the individual who is providing the most face time with a member or a patient,” Hanold said. “Something we’re still getting our arms around with the MCOs is that with caregiver consistency — there’s a really long-term bond and trust that is coming together. We haven’t really tapped into those positive behaviors and habits that we can enable with that caregiver in the home over a period of time. Because trust really matters. Trust scales.”

Getting beyond the friction

Perception also plays a big role in the success of a provider-payer relationship in the managed Medicaid world.

“Payers in the provider space are seen as the bad guys,” Jamie Swann, director of GBD Special Programs at Anthem, told HHCN. “They’re seen as the people that don’t want to give you what you want, what you need and the ones who are going to hold up your pay. So it can be really difficult sometimes to form those relationships because — almost out of the gate — it’s seen as this contentious relationship.”

Swann’s role is within Anthem Health Keepers, which is a part of Elevance Health (NYSE: ELV).

Keeping the patient at the center of negotiations is a good start, she said. But there also needs to be give and take on both sides. Anthem and Care Advantage, for instance, have had a harmonious relationship.

“The individual that we’re all caring for should be at the center of everything,” she said. “Here at Elevance, we have quality incentive programs for our agencies so that we can make some quality payments when they’re providing quality care. There is an opportunity for us to work together to put a little more money in the agency’s pockets, especially working with those Medicaid individuals. And to improve outcomes for the sickest individuals. But it takes both sides. It takes us coming to the table and it takes the agencies coming to the table.”

In 2021, Swann helped seal a risk-based deal with Care Advantage to better support Anthem’s Medicaid long-term support services members in Virginia.

“I know that when I have a member that can’t seem to find an agency, I can usually reach out to Care Advantage and we can work something out,” Swann said. “So, that’s really helpful for us.”

Companies like Elevance Health see the value of personal home care in the larger health care space, but working with those providers is a less simple equation.

“What makes it difficult now is if you talk about traditional home health, you go in, change a wound vac and go out — it’s very cut and dry,” Swann said. “But when you talk about personal care providers, or even private duty nursing, those individuals are not providing a traditional medical service, so it gets more difficult to enter into a value-based arrangement.”

The ability to deliver valuable data as a provider makes the equation more clear, however.

“Sharing data is an incredibly important component of building trusting credibility with the MCO,” Hanold said. “To them, they need to be able to look and say, ‘This is a willing provider and here they are tracking this information.’ Our job is obviously to continue to build credibility and show the sophistication of our care delivery system.”

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To achieve both of those, the company is likely to leverage home-based care.

Elevance’s myNEXUS – a post-acute care convener – remains one of the company’s emerging assets within the Carelon health care services platform, Carelon President Peter Haytaian said on the company’s earnings call Wednesday.

“What we’re trying to really do here is create a differentiated experience for post-acute care providers,” Haytaian said. “When they are in need of services or approval of services, they’re dealing with technology and a portal that is differentiated and is a streamlined service so that they can get the approvals they need in the most appropriate fashion.”

So far, Elevance has seen positive results.

“As we’re looking at the different levels of post-acute care, we’re seeing our performance play through and meeting our original objectives,” Haytaian said. “That is, going to the appropriate levels of care — and sites of care — and then ultimately into the home where cost and quality is most effective.”

Elevance is working closely with provider partners within its own EMR systems to make data exchanges, prior authorization processes and clinical decision-making more seamless, its leaders explained.

“In addition to accelerating care approval processes for consumers, this is resulting in substantially fewer requests for additional clinical information and significantly lower provider appeal rates,” Elevance CEO Gail Boudreaux said. “We expect to provide annual updates on our progress towards achieving our 2027 target of having at least 80% of our consolidated benefit expense in value-based care with at least 40% in downside risk.”

A commitment to expanding the scope of Carelon has already paid dividends.

“We’ve grown membership 19% year to date, compared with 5% growth for the market across our geographic footprint,” Boudreaux said. “We are well positioned for additional growth when Medicaid beneficiaries begin to transition coverage later this year — whether they’re members of our own Medicaid health plans or with coverage elsewhere.”

Operating revenue for Elevance was $41.9 billion in the first quarter of 2023, an increase of $4 billion, or 10.6%, year over year.

“As we look to the rest of 2023, our focus will remain on the execution of our strategy and demonstrating that we have the best catcher’s mitt in the industry,” Elevance CFO John Gallina said. “We will continue to optimize our mature businesses, invest in high growth opportunities and accelerate the growth of our organization through Carelon.”

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Starting this year, the company will separate its business reports for its provider services wing, Carelon, as a way to adapt to the company’s evolving infrastructure.

“Carelon offers a diverse suite of services across behavioral health, advanced analytics, complex care, pharmacy services and digital assets,” Elevance CFO John Gallina said during Wednesday’s quarterly earnings call. “We remain committed to expanding the scale and scope of services Carelon provides to our own and third-party health plans.”

Elevance has touted its own at-home care offerings in the past, too. Today, it is reaping some of the benefits that have come from its investments in home-based care and other health care services.

Carelon RX and Carelon health services grew revenue by 12% and 27% in 2022 compared to 2021, respectively.

Gallina said that separating its business divisions and keeping Carelon’s earnings and operations as its own entity is an indication of “how we will grow our enterprise for years to come.”

Elevenace also touted its recent purchase of Blue Cross and Blue Shield of Louisiana, which will expand its portfolio of Anthem brand health plans.

The deal will bring 1.9 million health plan customers to Elevance’s insurance plans and makes Louisiana the 15th state where the Anthem Blue Cross brand of health insurance will be sold once the deal is finalized.

While Elevance is not ruling out more acquisitions in the near-term future, it is bullish on Carelon’s ability to continue to grow without inorganic growth.

“We expect Carelon services to grow revenue in the low double-digit range organically, excluding all pending or unannounced M&A,” Gallina said. “That growth will be driven by revenue per consumer served.”

Partnering with health plans has also proven to be financially beneficial.

Of Carelon’s nearly $41 billion of revenue in 2022, about 60% came from partnering with Elevance’s health plans.

Growing internally is something Elevance will continue to focus on in 2023 and beyond.

“A core part of our strategy is focused on internal growth and serving Elevance’s affiliated health plans,” Peter Haytaian, executive vice president of Elevance Health and president of Carelon, said. “We built infrastructure to engage to a much better degree with our associates and partners internally and we’re seeing really good progress there. We remain keenly focused on whole health and improving the patient experience.”

Elevance is also still exploring and refining its strategy when it comes to value-based care.

“We continue, quite frankly, to refine and improve our strategy,” Elevance CEO Gail Boudreaux said. “We feel like we’re making really good progress on it. What we’re seeing is a lot more interest in sharing up and downside risk. Historically, value-based care was more upside risk. I think one of the biggest differences is the sharing of data bilaterally and much more timely so that action can be taken in a much more integrated way.”

That could potentially open the door for more home-based care providers to partner with the company in the future. CareAdvantage Inc., for instance, works with the company on a risk-sharing model in Virginia.

Elevance Health’s profits dipped 16.5% to $949 million in the fourth quarter of 2022, compared to $1.1 billion last year during the same time period. Revenue jumped 9% to $39.9 billion compared to $36.6 billion a year ago.

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