Elevating Whole Health, Advancing Health Beyond Healthcare

Integrated Healthcare to Address Complex Needs

People often experience multiple healthcare needs at the same time. A person leaving the hospital after surgery may need physical therapy and a course of prescribed medicines, while a person with a chronic health condition may need treatment for depression. Elevance Health is reimagining the healthcare system with our new brand Carelon, a broad portfolio of healthcare services focused on solving the most complex challenges through integrated services including Care Delivery and Enablement, Behavioral Health, Pharmacy, and Analytics.

CarelonRx Brings Pharmacy Services into Whole Health Care

Receiving a diagnosis is only the beginning of a person’s healthcare journey. Accessing prescribed medication and taking it as required is essential for treatment and recovery, especially for those living with a chronic condition. Many people find it challenging to keep to a medication plan, especially those with social barriers to care.

Elevance Health is redefining pharmacy care to be part of a person’s whole-health, moving it beyond the simple act of filling prescriptions. We made the following enhancements to our benefits:

• We acquired BioPlus Specialty Pharmacy, increasing our ability to provide a complete range of specialty pharmacy services for complex and chronic conditions.
• We launched a program embedding clinical pharmacists into targeted value-based care provider offices helping them meet Medicare quality goals and improve medication fill rates.
• Through ZipDrug, we are using data and artificial intelligence (AI) to connect members with community and independent pharmacies, allowing us to reach those in rural areas and others with environmental or economic barriers to care. Our ZipDrug program has reduced medical costs for high-risk Medicaid members by approximately $800 per member, per year, by lowering inpatient admissions by 28% and emergency room utilization by 4%.
• We launched a cost-relief program for specialty medications that helps significantly reduce costs for members and employers, with fee-based employers saving up to 25% in their total pharmacy benefit specialty drug spend.

The CarelonRx Clinical Pharmacy Care Center: A Person-Centered Pharmacist on Call

Members can need support navigating prescriptions, especially if they are living with complex health conditions. To help members stay on track, CarelonRx offers the Clinical Pharmacy Care Center, a call-in resource staffed by a team of more than 400 pharmacists and pharmacy technicians who are available to speak directly to members and medical providers with questions or concerns about prescription medicines.

Our Call Center Pharmacists:

• Pay special attention to member safety and barriers to health during calls, with specialist teams focused on historically marginalized communities such as those with chronic conditions or older members.
• Advocate for members, connecting them to needed resources. For example, if a person has diabetes, the pharmacist may ask about the member’s daily nutrition to identify any barriers to healthy food. Or, if transportation is a barrier to accessing medication, they may connect the member to home delivery pharmacy services or Medicaid transportation options.
• Are able to view all of a member’s current prescriptions and can advise on drug interactions and adverse side effects.

In 2022, the CarelonRx Clinical Pharmacy Care Center engaged with more than 94,000 care providers and nearly 443,000 members across our Medicare, Medicaid, and commercial affiliated health plans.

Pharmacists Calls Reveals Housing Need

When asked to verify their address, the member revealed they did not have secure housing or transportation, which prevented them from picking up their medications.

“Everybody has a story to tell and it’s my job to listen and then help,” Tia said. Following the call, Tia quickly mobilized her colleagues and a few hours later, the team successfully secured temporary housing for the member. Today, the member is back on their medications and better able to manage their chronic conditions. “I feel very proud that our team shared my urgency to help this member,” Tia said. “I can definitely sleep better at night knowing they are cared for and heard. You just never know what someone is going through.”

Carelon Behavioral Health Reaches More People in Need

Elevance Health Plays a Key Role in the 988 Suicide and Crisis Lifeline

The 988 Suicide and Crisis Lifeline is a national network of more than 200 crisis centers supported by local and state sources and administered by Vibrant Emotional Health, a non-profit organization providing mental health services. The 988 dial code is the behavioral health version of 911, and can be accessed 24/7 via phone call, text or on-line chat by anyone experiencing mental health distress or by someone with concerns about another person.

In 2022, Carelon Behavioral Health began supporting the program with nationwide text and chat center operations in both English and Spanish.

Carelon Behavioral Health uses coordinated system technology, trained intake specialists, and licensed clinicians to work with people contacting the 988 line— first to manage the crisis and then to quickly connect them to the services they need.

Depending on the crisis level, a specialist might:

• Connect the person to social services
• Provide them with referrals to outpatient and inpatient services
• Deploy a regional response team managed by a local community mental health center
• Collaborate with emergency services
• Use peer specialists to help engage the person in ongoing care and services

A Lifesaving Exchange: A Carelon Behavioral Health Specialist Makes a Difference

Marla Vose had been a Carelon crisis specialist for less than 6 weeks when a text came through from a distressed young person. They had called the crisis line to let someone know what they were about to do. “They said that they had made the decision to end their life. And they didn't think anyone could stop them. They just didn't feel like anyone heard them anymore,” Marla recalled.

“I did a lot of listening, a lot of empathizing, and I shared a little bit of me to get a lot of them. I spent an hour and a half letting them speak their piece. They made the comment that it was the first time that they felt heard in years,” said Marla.

Finally, Marla asked them, "Would you consider walking away from the situation for me?" And they said, "Yeah, I think I can do that." And then added, "Well, I'm still alive for today. Thank you."

While I may say that I feel honored to be part of this, the real heroes are the ones that actually make the effort to call us. Because that means that there's some part of them that's not willing to give up yet. And that's a noble fight,” said Marla.

Elevance Health Suicide Prevention Program Responds to a Public Health Crisis

Using the power of data analytics, the Suicide Prevention Program examines health insurance claims for hundreds of potential risk factors going back as far as two years. These can include substance use, certain behavioral health diagnoses, inpatient mental health stays, and prior suicide attempts. The program uses predictive modeling of this data to identify members with at least a 10% risk of a suicide event or attempt in the next 12 months. The program then alerts a specially trained care management team to proactively contact these members by telephone to support their mental health and well-being. The team offers:

• Clinical case management
• Family support
• Access to wellness and recovery specialists
• Connection to community resources
• Peer support services
• After-hours support

Early results in 2022 were encouraging, finding a nearly 50% reduction in suicide attempts for the cohort of people enrolled and participating in the program compared with the control group. The results were so promising, Elevance Health has expanded the initiative in California, Georgia, and New York, and to select membership groups ages 10 and older within its commercial, Medicare, and Medicaid plans.