What Evolent Health does

Evolent Health (NYSE: EVH), founded in 2011 and headquartered in Arlington, Virginia, is a publicly traded specialty care management company serving health plans and providers across the United States, with operational support in India and the Philippines and approximately 4,000 employees globally including 1,300+ clinicians (nearly 400 physicians and 750 nurses). The company delivers a platform-plus-modules architecture anchored by its Performance Suite (covering approximately 6.1 million lives at a Q1 2026 average PMPM of $17.73) and a Specialty Technology and Services Suite (approximately 76,000 lives at a $0.35 PMPM), supplemented by clinical modules for oncology, cardiology, musculoskeletal, radiology, genetic testing, physical medicine, surgical management, advanced imaging, and administrative services. Underlying technology includes evidence-based clinical pathways validated by Scientific Advisory Boards (typically yielding ~30% adherence improvement), AI-powered utilization management acquired from Machinify in 2024, a Careology partnership for patient-facing cancer navigation, and provider portals (RadMD, CarePro, Availity Essentials) that embed prior authorization, eligibility verification, and claims tracking into daily workflows.

Evolent generates revenue primarily through recurring PMPM subscription fees for its Performance Suite and Administrative Services offerings, supplemented by case-based fees averaging $3,772 per case for surgical management and advanced care planning, and performance-based risk-sharing arrangements with health plan partners. Q1 2026 revenue reached $496.2 million, with FY2026 guidance of $2.4B-$2.6B (~30% growth) supported by over $500 million in newly-contracted annualized revenue including 13 new contracts signed in 2025. The customer base spans 60+ health plans and 1,000+ hospitals, with named enterprise clients including Highmark, Aetna, and an unnamed national payer whose Oncology and Cardiology expansion is expected to generate over $200 million of annual revenue beginning Q3 2026.

The company's go-to-market is enterprise field sales targeting payer and provider leadership, complemented by inside sales for smaller accounts, scientific advisory engagement to build clinical trust, and thought leadership through investor conferences and digital content. Following a difficult FY2025 in which revenue declined to $1.88B from $2.55B in FY2024 and the company recorded a $579.4M net loss including a $398M goodwill impairment, Evolent has executed a strategic reset: divesting its non-core ACO business (Evolent Care Partners) to Privia Health for up to $113M in December 2025, restructuring its balance sheet with $145M of convertible senior notes due 2031, and installing new CFO (Mario Ramos, January 2026) and CPO (Archie Mayani, March 2026) executives to refocus the business on specialty condition management and accelerate AI-led product development.

Name

Evolent Health

Legal name

Evolent Health LLC

Website

https://evolent.com

Company type

Public

Founded year

2012

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

Evolent Health is a publicly traded specialty care management company serving 60+ health plans and 1,000+ hospitals with clinical pathways, value-based care orchestration, and AI-powered utilization management across oncology, cardiology, musculoskeletal, and other complex conditions, generating revenue primarily through PMPM and case-based fees.

Ownership category

akta.pro rank

Product category

Specialty Care Management

NAICS

Offices of Physicians (6211), Direct Life, Health, and Medical Insurance Carriers (52411)

SIC

Services-Health Services (8000)

akta.pro primary industry

Patient Engagement, Education & Messaging Platforms (portal/CRM integrated) (HLALABAJ)

Keywords

• Specialty care management
• Value-based care
• Clinical pathways
• Utilization management
• Population health

Headquarters

HQ city

Arlington

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Others

Revenue model

1. Performance Suite: Specialty care management services with per member per month (PMPM) fees. Includes oncology, cardiology, musculoskeletal, advanced imaging and other diagnostic specialty care services. Average PMPM fee of $17.73 in Q1 2026.
2. Specialty Technology and Services Suite: Technology-enabled services for ASO (Administrative Services Only) arrangements with PMPM fees. Average PMPM fee of $0.35 in Q1 2026.
3. Administrative Services: Implementation and core performance services for health plans with PMPM fees. Average PMPM fee of $14.78 in Q1 2026.
4. Case-based Services: Surgery management and advanced care planning programs billed per case. Revenue per case of $3,772 in Q1 2026.
5. Performance-based Arrangements: Risk-sharing arrangements with health plan partners where company shares in medical cost savings or quality outcomes.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels6 records

Core offering

Evolent Health provides technology-enabled specialty care management services to health plans and healthcare providers, covering oncology, cardiology, musculoskeletal, radiology, genetic testing, physical medicine, surgical management, advanced illness, advanced imaging, and administrative services. Its offerings are delivered through the Performance Suite (specialty care management with performance-based contracts covering ~6.1 million lives) and the Specialty Technology and Services Suite (technology-enabled services for ASO arrangements covering ~76,000 lives), supported by AI-powered utilization management, evidence-based clinical pathways, provider portals for prior authorization, and care navigation programs.

Product overview

Evolent Health operates as a specialty care management company offering a platform-plus-modules architecture. The core offerings include the Performance Suite (specialty care management with performance-based contracts covering ~6.1M lives) and Specialty Technology and Services Suite (~76K lives). These are supplemented by specialized clinical modules for Oncology, Cardiology, Musculoskeletal, Radiology, Genetic Testing, Physical Medicine, Surgical Management, and Administrative Services. The company also offers Cancer Care Member Navigation combining personalized support with digital tools, and recently launched an Advanced Imaging Solution. Provider access is facilitated through RadMD and CarePro portals. The platform serves payers and providers transitioning to value-based care, with a focus on improving outcomes for patients with complex conditions including cancer and cardiovascular diseases.

Differentiator

Problem solved

Functional benefit

Brands

• Evolent Care Partners (ECP): Value-based primary care business offering ACO services for independent providers.
• Evolent Surgical Management (ESM)
• Evolent Specialty Services (ESS)

Products and services

• Performance Suite Comprehensive specialty care management platform providing oncology, cardiology, musculoskeletal, advanced imaging, and other specialty services with performance-based contracting for health plans. Covers approximately 6.1 million lives at an average PMPM fee of $17.73 (Q1 2026), serving payers with PMPM subscriptions and risk-sharing arrangements.
• Specialty Technology and Services Suite Technology-enabled specialty care services for ASO (Administrative Services Only) arrangements with health plans, covering approximately 76,101 lives at an average PMPM fee of $0.35 (Q1 2026). For health plan clients operating under ASO models.
• Oncology Solutions Clinical pathways, decision support, and provider/patient engagement solutions designed to achieve better cancer care outcomes. For health plans and providers managing cancer care populations.
• Cardiology Solutions Identifies appropriate cardiac services and ensures alignment with treatment and testing guidelines for cardiovascular conditions. For health plans managing cardiology populations.
• Musculoskeletal Solutions High-value pain management and surgery procedures management in appropriate care settings. For health plans managing musculoskeletal populations.
• Radiology Solutions Imaging studies providing patient care insights while minimizing radiation safety risks. For health plans managing radiology benefit utilization.
• Genetic Testing Solutions Ensures health plan members receive the most appropriate tests to guide clinical decision-making. For health plans managing genetic testing utilization.
• Physical Medicine Solutions Management of chiropractic, physical therapy, occupational therapy, and speech therapy services. For health plans managing physical medicine benefits.
• Surgical Management Optimizes surgical procedures by increasing the value equation through device selection and site of care optimization, delivered through the Evolent Surgical Management (ESM) subsidiary. For health plans seeking to manage surgical costs and quality.
• Administrative Services Streamlines health plan operations and improves member experience through an aligned partnership. PMPM fees averaging $14.78 in Q1 2026. For health plans needing operational support and implementation services.
• Cancer Care Member Navigation Comprehensive end-to-end program combining personalized support and a digital platform to deliver a more connected, empowered experience for health plan members living with cancer, supporting patients from diagnosis to survivorship or end of life. For health plans seeking oncology member experience solutions.
• Advanced Imaging Solution Advanced imaging management solution for specialty care, recently contracted with a new Performance Suite client covering approximately 4.5 million lives across Commercial, Medicaid, and Medicare lines of business. For health plans managing advanced imaging utilization.
• Advanced Illness Solution Empowers people nearing the end of life so their care respects their goals and preferences. For health plans and providers supporting advanced illness populations.

Quantifiable outcome

• Typically 30% increase in adherence to high-value clinical pathways
• +4 more outcomes

Named customers5 records

Segments3 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

AI capability7 records

Feature4 records

Partnerships

Four partnerships are on record, tiered strategic and core.

• Privia Health GroupstrategicGTM or Marketing Partner · 23 September 2025Privia Health acquired Evolent's Accountable Care Organization (ACO) business caring for over 120,000 attributed lives. Transaction valued at up to $113 million including performance-based payouts. Expected to close Q4 2025 and contribute positively to EBITDA in 2026. Divestiture allows Evolent to refocus on core specialty condition management.
• MachinifycoreTechnology or Integration · 4 June 2024Acquisition of artificial intelligence utilization management products and team from Machinify. Enhances Evolent's prior authorization capabilities and enables more efficient utilization review processes for both providers and payers.
• CareologycoreStrategic or Co-development Partner · 9 May 2024Strategic care navigation partnership to enhance cancer care in the U.S. Combines Evolent's clinical expertise with Careology's patient-facing digital application to support cancer patients from diagnosis through treatment and survivorship. The partnership aims to offload administrative burden for PCPs and specialists while ensuring patients have necessary pathology and imaging reports to prevent delays in care.
• Scientific Advisory BoardscoreStrategic or Co-development PartnerPanels of noted academic and community-based specialist physicians that review and validate clinical pathways. They ensure high-value clinical pathways reflect latest evidence and frontline perspectives, building trust with providers and health plans.

Scale indicators12 records

Recent moves8 records

Expansion highlights6 records

Direct peers

• eviCore healthcare (Evernorth/Cigna): eviCore is Evernorth's (Cigna) specialty care management subsidiary providing utilization management and clinical decision support across radiology, cardiology, oncology, MSK, and advanced imaging. It is the closest direct competitor to Evolent's Performance Suite in terms of product scope, customer segment (health plans), and delivery model (clinical pathways + prior authorization).
• New Century Health: New Century Health was a specialty care management company focused on oncology and cardiology clinical pathway management for health plans before being acquired by Evolent in 2018. It remains a relevant comparable for Evolent's specialty care management business model and product architecture.
• AIM Specialty Health (Elevance Health): AIM Specialty Health is Elevance Health's specialty health management subsidiary providing clinical appropriateness review, prior authorization, and care management across radiology, cardiology, oncology, sleep, and genetic testing. It directly competes with Evolent in the specialty care management space and benefits from captive demand within Elevance's affiliated health plans.

Broad incumbents

• Magellan Health: Magellan Health is a managed care company providing specialty health management, behavioral health, and pharmacy benefits management that was acquired by Evolent in 2022 (with the MagellanRx PBM later divested). It is a comparable in specialty health services delivery to health plans and government clients.
• Optum (UnitedHealth Group): Optum is UnitedHealth Group's health services arm, providing utilization management, care management, and specialty care management across oncology, cardiology, MSK, and other specialties through its Optum Health and OptumInsight divisions. It is a broad incumbent in the same payer-facing specialty care management market as Evolent but with substantially greater scale and captive payer demand.
• Health Catalyst: Health Catalyst provides healthcare data and analytics infrastructure including value-based care performance measurement, population health analytics, and outcomes improvement tools. It overlaps with Evolent's analytics and value-based care enablement capabilities for providers and payers, although its focus is more on data infrastructure than end-to-end care management delivery.

Others

• Privia Health Group: Privia Health is a physician enablement and value-based care company that recently acquired Evolent's ACO business (Evolent Care Partners) for up to $113M. While not a direct competitor to Evolent's specialty care management business, it is a closely adjacent value-based care platform serving providers and shared customers.

Emerging players

• Cohere Health: Cohere Health is an intelligent prior authorization and specialty care management platform serving health plans with AI-augmented clinical review and provider collaboration workflows. It overlaps directly with Evolent's prior authorization and utilization management capabilities but is at an earlier commercial stage.
• Phreesia: Phreesia provides patient intake, engagement, and care navigation solutions to providers, payers, and life sciences companies. Its patient-facing digital workflows overlap thematically with Evolent's oncology member navigation offering and broader care navigation capabilities.

Regional players

• Aledade: Aledade operates a value-based care network for independent primary care providers, including ACOs and Medicare Advantage contracts. It does not directly compete with Evolent's specialty care management platform but is a comparable value-based care enabler that addresses the payer-provider interface.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/evolent-health
• Xx.com/EvolentHealth

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles15 records

Subsidiaries3 records

Funding overview

Funding rounds10 records

Investors4 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A8 records

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Evolent Health