Evolent Health

Partner health systems in value-based care by transforming community health outcomes and costs.

Organization	SWOT Analysis	OKR Plan	Top 6	Retrospective

Sub organizations:

SWOT Analysis

Strategic pillars derived from our vision-focused SWOT analysis

VALUE-BASED

Accelerate provider transition to risk-based payment models

TECHNOLOGY

Build integrated clinical and administrative platform capabilities

PARTNERSHIPS

Deepen health system relationships through outcomes-driven contracts

Updated: September 29, 2025 • 2025-Q3 Analysis

Evolent stands at a critical inflection point with strong revenue momentum but persistent profitability challenges. The company's integrated clinical-technology approach creates genuine differentiation in the crowded healthcare space, evidenced by managing $2.8 billion in medical spend across 350+ partners. However, the $23.4 million loss despite $1.89 billion in revenue signals operational inefficiencies that demand immediate attention. The accelerating Medicare Advantage opportunity and $850 billion addressable market provide massive growth potential, but execution must improve dramatically. Success requires laser focus on unit economics, platform automation, and selective market expansion while defending against well-funded competitors building similar capabilities.

Agilon Health Oak Street Health Apervita Privia Health Humana

No past cycles

Mission & Vision SWOT Analysis OKR Plan Retrospective AI Strategy Data Acquisition

Partner health systems in value-based care by transforming community health outcomes and costs.

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Strengths

REVENUE: Strong $1.89B revenue growth with 23% increase year-over-year
PARTNERSHIPS: Deep health system relationships with 350+ provider partners
PLATFORM: Integrated technology and clinical services differentiation
OUTCOMES: Proven medical cost reduction of 10-15% across client base
SCALE: Managing $2.8B in medical spend demonstrates market confidence

Weaknesses

PROFITABILITY: $23.4M net loss despite revenue scale indicates margin issues
COMPETITION: Increasing competitive pressure from health plans and tech firms
COMPLEXITY: Managing clinical operations and technology development simultaneously
CAPITAL: High cash burn rate requires continued investment funding
RETENTION: Client churn risk in challenging value-based care transitions

Opportunities

MEDICARE: Accelerating Medicare Advantage and direct contracting growth
CONSOLIDATION: Acquire smaller competitors to expand capabilities rapidly
AI: Leverage artificial intelligence for predictive analytics and automation
EXPANSION: $850B total addressable market with low current penetration
SPECIALITY: Expand into high-cost specialty care management services

Threats

PAYERS: Health insurers building competing value-based care capabilities
RECESSION: Economic downturn could delay health system VBC investments
REGULATION: Medicare payment model changes could disrupt business model
TECHNOLOGY: New entrants with superior technology platforms emerging
TALENT: Competition for healthcare technology and clinical talent intensifying

Key Priorities

PROFITABILITY: Achieve sustainable margins while maintaining growth trajectory
DIFFERENTIATION: Strengthen competitive moat through platform innovation
EXPANSION: Accelerate Medicare Advantage and specialty care growth
EFFICIENCY: Improve operational efficiency to reach profitability faster

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Strategic OKR Plan

Updated: September 29, 2025 • 2025-Q3 Analysis

This OKR framework addresses Evolent's core challenge of achieving profitability while maintaining growth. The focus on operational efficiency, competitive differentiation, and selective expansion creates a balanced approach to sustainable success in the value-based care market.

Agilon Health Oak Street Health Apervita Privia Health Humana

No past cycles

Mission & Vision SWOT Analysis OKR Plan Retrospective AI Strategy Data Acquisition

Partner health systems in value-based care by transforming community health outcomes and costs.

ACHIEVE PROFITABILITY

Deliver sustainable margins through operational excellence

MARGINS: Increase gross margins to 25% through automation and efficiency initiatives
COSTS: Reduce operational costs per member by 15% through AI-powered workflows
RETENTION: Achieve 96% client retention rate through enhanced success programs
AUTOMATION: Deploy AI solutions across 75% of clinical workflows to reduce manual work

STRENGTHEN MOAT

Build unassailable competitive differentiation

PLATFORM: Launch next-generation integrated clinical-technology platform
OUTCOMES: Demonstrate 18% medical cost reduction across client portfolio
PATENTS: File 12 new technology patents for proprietary healthcare solutions
INTEGRATION: Achieve seamless data integration with 90% of client EHR systems

ACCELERATE GROWTH

Capture Medicare and specialty care opportunities

MEDICARE: Secure $400M in new Medicare Advantage contract value
SPECIALTY: Launch specialty care management for oncology and cardiology
EXPANSION: Add 75 new provider partners with focus on profitable segments
PENETRATION: Increase average revenue per client by 30% through service expansion

OPTIMIZE OPERATIONS

Drive efficiency through automation and focus

EFFICIENCY: Reduce administrative costs per member by 20% through process automation
QUALITY: Achieve 98% accuracy in clinical risk assessments through AI enhancement
SPEED: Decrease client onboarding time by 40% through streamlined processes
FOCUS: Divest non-core services representing 15% of current revenue

METRICS

Medical Cost Ratio: 82%
Client Retention Rate: 96%
Revenue Growth Rate: 25%

VALUES

Clinical Excellence
Partnership Focus
Innovation
Accountability
Community Health

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Evolent Health Retrospective

AI-Powered Insights

Claude

Gemini

GPT

SEC 10-K and 10-Q filings for financial performance data
Company investor presentations and earnings calls transcripts
Healthcare industry reports on value-based care market trends
Competitive analysis from healthcare research firms
Client testimonials and case studies from company website

Agilon Health Oak Street Health Apervita Privia Health Humana

No past cycles

Mission & Vision SWOT Analysis OKR Plan Retrospective AI Strategy Data Acquisition

Partner health systems in value-based care by transforming community health outcomes and costs.

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What Went Well

REVENUE: Achieved 23% year-over-year revenue growth to $1.89 billion
PARTNERSHIPS: Expanded client base to 350+ provider organizations
SCALE: Increased medical spend under management to $2.8 billion
CONTRACTS: Secured several new multi-year health system partnerships
PLATFORM: Enhanced technology capabilities and clinical service delivery

Not So Well

PROFITABILITY: Continued net losses despite significant revenue scale
MARGINS: Operating margins remained pressured by growth investments
EFFICIENCY: Higher than expected operational costs impacted bottom line
RETENTION: Some client turnover in challenging market conditions
COMPETITION: Increased competitive pressure on contract pricing

Learnings

FOCUS: Need sharper focus on profitable growth over pure revenue growth
AUTOMATION: Technology automation critical for margin improvement
SELECTION: More selective client acquisition based on profitability potential
EFFICIENCY: Operational efficiency improvements essential for sustainability
DIFFERENTIATION: Must strengthen competitive differentiation through innovation

Action Items

MARGINS: Implement operational efficiency initiatives to improve margins
AUTOMATION: Accelerate AI and automation investments to reduce costs
RETENTION: Strengthen client success programs to improve retention
PRICING: Optimize pricing strategies for new contract negotiations
FOCUS: Concentrate resources on highest-margin service offerings

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Evolent Health Market

AI-Powered Insights

Claude

Gemini

GPT

SEC 10-K and 10-Q filings for financial performance data
Company investor presentations and earnings calls transcripts
Healthcare industry reports on value-based care market trends
Competitive analysis from healthcare research firms
Client testimonials and case studies from company website

Founded: 2011
Market Share: 3.2% of value-based care market
Customer Base: 350+ health systems and physician groups
Category:
Healthcare Technology
SIC Code: 8099 Health and Allied Services, Not Elsewhere Classified
NAICS Code: 621999 All Other Miscellaneous Ambulatory Health Care Services
Location: Arlington, VA
Zip Code: 22203
Employees: 4800

Competitors

Agilon Health

Oak Street Health

Apervita

Privia Health

Humana

Products & Services

No products or services data available

Distribution Channels

Evolent Health Business Model Analysis

AI-Powered Insights

Claude

Gemini

GPT

SEC 10-K and 10-Q filings for financial performance data
Company investor presentations and earnings calls transcripts
Healthcare industry reports on value-based care market trends
Competitive analysis from healthcare research firms
Client testimonials and case studies from company website

Problem

High healthcare costs
Poor care coordination
VBC transition complexity

Solution

Integrated clinical platform
Risk-based contracts
Population health management

Key Metrics

Medical cost ratio
Client retention rate
Revenue per member

Unique

Clinical-tech integration
Proven cost reduction
Health system focus

Advantage

Deep relationships
Proprietary platform
Clinical expertise

Channels

Direct sales teams
Conference marketing
Partner referrals

Customer Segments

Health systems
Physician groups
Medicare Advantage

Costs

Clinical staff
Technology platform
Sales and marketing

Evolent Health Product Market Fit Analysis

Updated: September 29, 2025

Evolent partners with health systems to successfully transition to value-based care through integrated technology and clinical services, delivering proven 10-15% medical cost reductions while improving patient outcomes. Their platform manages $2.8 billion in medical spend across 350+ provider organizations, making value-based care work.

Reduce medical costs by 10-15%

Improve clinical outcomes through coordination

Enable successful value-based contracts

Before State

Fee-for-service payment models
High medical costs
Poor care coordination

After State

Value-based payment success
Coordinated care delivery
Improved population health

Negative Impacts

Unsustainable cost growth
Poor patient outcomes
Provider financial stress

Positive Outcomes

10-15% medical cost reduction
Better patient satisfaction
Provider financial stability

Key Metrics

Net Promoter Score

Client retention rate

94%

Requirements

Technology platform integration
Clinical workflow redesign
Data analytics capabilities

Why Evolent Health

Gradual risk assumption
Clinical team deployment
Real-time performance monitoring

Evolent Health Competitive Advantage

Integrated clinical-tech approach
Proven medical cost reduction
Deep health system partnerships

Proof Points

$2.8B medical spend managed
15% average cost reduction
350+ provider partners

Evolent Health Market Positioning

AI-Powered Insights

Claude

Gemini

GPT

SEC 10-K and 10-Q filings for financial performance data
Company investor presentations and earnings calls transcripts
Healthcare industry reports on value-based care market trends
Competitive analysis from healthcare research firms
Client testimonials and case studies from company website

What You Do

Technology-enabled value-based care solutions

Target Market

Health systems and physician groups

Differentiation

Integrated clinical and administrative platform
Proven outcomes in medical cost reduction

Revenue Streams

Per member per month fees
Performance-based contracts
Technology licensing

Evolent Health Operations and Technology

AI-Powered Insights

Claude

Gemini

GPT

SEC 10-K and 10-Q filings for financial performance data
Company investor presentations and earnings calls transcripts
Healthcare industry reports on value-based care market trends
Competitive analysis from healthcare research firms
Client testimonials and case studies from company website

Company Operations

Organizational Structure: Matrix organization by service lines
Supply Chain: Technology vendors and clinical staff
Tech Patents: Proprietary healthcare analytics platform
Website: https://www.evolenthealth.com

Top Clients

Board Members

Evolent Health Competitive Forces

Threat of New Entry

HIGH - Low regulatory barriers allow well-funded startups and tech giants to enter with competitive offerings

Supplier Power

MEDIUM - Dependence on clinical talent and technology vendors but multiple options available for most critical inputs

Buyer Power

HIGH - Health systems have significant negotiating power and can build internal capabilities or choose multiple vendors

Threat of Substitution

HIGH - Health plans, consulting firms, and technology companies offering alternative value-based care solutions

Competitive Rivalry

HIGH - Intense competition from Agilon Health, Privia, and emerging players with venture capital backing creating pricing pressure