Elevance Health Reflects On The Evolving Role Of Health Plans
By simplifying the healthcare experience, strengthening care coordination, and applying data-driven insights, Elevance Health and its affiliated health plans are redefining how members engage with healthcare helping individuals and families navigate complex health journeys with greater clarity, confidence, and personalized support.
INDIANAPOLIS—As 2025 comes to a close, Elevance Health is reflecting on the changing role of health plans in today’s healthcare landscape. No longer limited to helping people access and pay for medical services, health plans are increasingly expected to support members through a wide range of deeply personal and often complex situations. From cancer diagnoses and mental health crises to pregnancy-related concerns and chronic disease management, health plans are evolving to meet members where they are—both medically and emotionally.
Across employer-sponsored coverage, Medicare Advantage, Medicaid, and other government-sponsored programs, Elevance Health highlights how health plans are broadening their approach to care. By working closely with healthcare providers and community organizations, today’s plans aim to simplify the healthcare experience, personalize care, improve quality, and address the social and behavioral factors that influence overall well-being.
It’s highly personal, our health,” said Dr. Shantanu Agrawal, chief health officer for Elevance Health. “Historically, many of those personal aspects weren’t addressed by the healthcare system. Today, we have the ability to understand and support health at a more individual level, and to help members in ways that work best for them
Taking a Broader View of Health
For decades, healthcare in the United States largely centered on physical and clinical measures. Metrics such as weight, blood pressure, lab values, and diagnostic results guided decision-making. Health plans primarily focused on facilitating access to care, covering costs, and advocating for affordability, safety, and quality. While that foundation remains critical, Elevance Health notes that it is no longer sufficient on its own.
Today’s health challenges are more complex and interconnected. Physical health, behavioral health, and social factors influence one another in powerful ways. Stress, housing instability, access to nutritious food, transportation barriers, and mental health conditions can all shape health outcomes just as much as medical care itself.
“Decades of research show that helping people get and stay healthy requires more than focusing on physical factors alone,” Agrawal said. “Physical health affects behavioral health, behavioral health affects physical health, and social factors influence both. To truly support people, we need to consider all of these elements together—that’s the essence of a whole-health approach.”
Elevance Health and its affiliated plans have embraced this broader view by expanding benefits, programs, and partnerships that address the full spectrum of health needs. One example is the expansion of access to doula care services. Research indicates that women who receive doula support—such as education, coaching, and emotional reassurance—often experience better outcomes during pregnancy, labor, and delivery. Doulas can help expectant parents communicate with healthcare providers, reduce stress, and navigate what can be a physically and emotionally demanding life transition.
This whole-health philosophy also extends across many Medicare Advantage and Medicaid offerings. Members may receive support for nutritious food, over-the-counter medications, and transportation services—benefits that may not traditionally be associated with health insurance, yet play a critical role in improving outcomes and quality of life. By addressing these practical needs, health plans help remove barriers that can prevent members from following care plans or accessing timely treatment.
Simplifying the Healthcare Experience
Healthcare is often described as complex, fragmented, and difficult to navigate. For many members, understanding benefits, finding the right provider, coordinating appointments, and managing medications can feel overwhelming—especially during periods of illness or stress.
Elevance Health-affiliated plans are working to reduce that complexity by delivering clearer, more accessible, and more comprehensive resources. Digital tools such as the Sydney app provide members with easy-to-understand information about benefits, coverage, and available services, all in one place. By meeting members through channels that fit their daily lives, health plans help individuals better understand their options and make informed decisions.
Simplification also benefits healthcare providers. Streamlined processes, better data sharing, and coordinated care models reduce administrative burden and support more seamless collaboration. When providers and plans work together more effectively, members experience fewer delays, clearer communication, and more consistent care.
For members with complex or chronic conditions, personalization and care coordination are especially important. One example is the Community Pharmacy Total Care (CPTC) program, which connects eligible members with independent community pharmacists who provide individualized support. Through collaboration with CPESN USA, the program includes more than 500 pharmacies across 10 states and Washington, D.C.
Advanced analytics help identify members who may benefit most from the program, with a focus on individuals managing diabetes, chronic respiratory or cardiovascular conditions, or behavioral health needs. These pharmacists offer medication counseling, monitor adherence, and provide a personal, community-based touch that complements clinical care.
Helping Members Navigate Healthcare with Confidence
Beyond tools and benefits, human connection remains central to a positive healthcare experience. Elevance Health emphasizes the role of care managers—experienced clinical professionals who work directly with members to answer questions, address challenges, and coordinate services.
“Members don’t always expect their health plan to help them navigate the healthcare system,” Agrawal said. “But that’s exactly what our care managers do. They help members understand their care options, weigh alternatives, and choose what makes the most sense for their individual needs.”
Care managers act as advocates and guides, helping members overcome barriers such as scheduling challenges, benefit questions, or gaps between providers. Their work is particularly valuable for individuals facing serious illness, complex pregnancies, or long-term care needs.
This person-centered approach has earned recognition for Elevance Health-affiliated Medicaid plans in 12 states that offer long-term services and supports (LTSS). These plans received a Person-Centered Organization designation, reflecting a care model that prioritizes individual goals, data-driven decision-making, and coordinated strategies designed to maximize independence, value, and quality of life.
The impact of this approach is best illustrated through real member experiences. When Lilliana was pregnant with her son, Xavier, she discovered a lump on her neck. Concerned and unsure of what steps to take, she contacted her Elevance Health-affiliated plan. A care manager helped her understand her benefits, coordinated with her doctors to arrange a biopsy, and ensured timely follow-up.
The support didn’t stop there. Recognizing additional needs, the care manager connected Lilliana with community organizations that could help provide nutritious food, diapers, and other baby supplies. This holistic support eased stress during a critical period and allowed Lilliana to focus on her health and her growing family.
Expanding Partnerships Into New Areas
Elevance Health and its affiliated plans recognize that health is shaped not only in clinics and hospitals, but also in homes, schools, workplaces, and neighborhoods. As a result, the organization continues to invest in community partnerships that extend beyond traditional healthcare settings.
Using data and local insights, health plans can identify the factors most affecting health in a given community. In some areas, that may involve collaborating with schools to establish on-site food pantries for students and families. In others, it may mean supporting local markets with equipment to stock nutritious food options that reflect cultural preferences and dietary needs.
Actions like these help both the community and the individual,” Agrawal said. “They complement the dedication of care providers and community leaders, and they address root causes that influence long-term health.”
Elevance Health’s community engagement efforts span the country and include hundreds of thousands of volunteer hours, as well as funding and support for local initiatives. Examples range from building community gardens that serve as hands-on nutrition education opportunities, to revitalizing school facilities such as weight rooms that encourage physical activity and wellness.
Looking Ahead: A More Integrated Future for Health Plans
As health plans continue to evolve, Elevance Health’s experience highlights the potential of a more integrated, whole-health approach. By combining data-driven insights, personalized support, digital tools, and deep partnerships with providers and community organizations, health plans can help simplify a historically complex system.
This evolution keeps the focus squarely on members—recognizing their individual circumstances, respecting their goals, and supporting them through every stage of life. In doing so, health plans not only help people navigate care with greater confidence, but also contribute to measurable improvements in health outcomes, affordability, and overall well-being.
Through continued innovation and collaboration, Elevance Health and its affiliated plans are demonstrating how the role of health plans is changing—and how those changes can create a more responsive, compassionate, and effective healthcare experience for all.
About Elevance Health
Elevance Health is a lifetime, trusted health partner whose purpose is to improve the health of humanity. The company supports consumers, families, and communities across the entire healthcare journey – connecting them to the care, support, and resources they need to lead better lives. Elevance Health’s companies serve over 109 million consumers through a diverse portfolio of industry-leading medical, pharmacy, behavioral, clinical, home health, and complex care solutions
