Evolent Health at William Blair Conference: Strategic Growth Amid Challenges

On Tuesday, 03 June 2025, Evolent Health (NYSE:EVH) participated in the 45th Annual William Blair Growth Stock Conference. The company highlighted its strategic initiatives to manage complex conditions like oncology, cardiology, and musculoskeletal issues. Despite facing market headwinds such as Medicare Advantage plan exits and rising oncology costs, Evolent remains optimistic about its growth potential and increased demand for its solutions.

Key Takeaways

• Evolent Health aims to improve adherence to evidence-based medicine from 65% to 85%.
• The company identifies a $50 billion cross-sell opportunity with existing clients.
• Evolent focuses on margin expansion through automation and AI.
• The company is committed to 15% plus organic top-line growth.
• Evolent’s performance suite guarantees savings for health plans.

Financial Results

• Evolent Health currently generates $2 billion in revenue.
• The company reiterated its financial outlook and emphasized the importance of deleveraging.
• Evolent has a total addressable market (TAM) of $150 billion, with a $50 billion opportunity for cross-selling.

Operational Updates

• Evolent employs 4,500 people, including 1,500 clinical professionals and 350 physicians.
• The company reviews approximately 8 million cases annually.
• Evolent’s product consists of clinical decision support, provider alignment, and member navigation.

Future Outlook

• Evolent aims to drive a 20% improvement in clinical outcomes.
• The company plans to expand its market share, currently less than 5%.
• Margin expansion is targeted through the performance suite, automation, and AI.

Q&A Highlights

• Evolent ensures physicians are not financially penalized for recommending lower-cost treatments.
• The company addresses the impact of generic drugs and biosimilars on oncology costs.

In conclusion, for a comprehensive understanding, readers are encouraged to refer to the full transcript below.

Full transcript - 45th Annual William Blair Growth Stock Conference:

Ryan Daniels, HCIT and Health Care Services Analyst, William Blair: Good afternoon, everyone. Let’s go ahead and get started. Thanks for coming to the Evolent Health presentation. For those of you whom I’ve not yet met, my name is Ryan Daniels. I’m the HCIT and health care services analyst here that covers the company.

I’m joined on the stage by Seth Blackley. Seth is one of the company’s cofounders and the CEO. And John Johnson, the CFO, is in the front row. He’ll be in the breakout session as well, which will take place up on the Second Floor in Adler. Just a reminder, our disclosures are on our website at WilliamBlair.com, and, again, we’ll go for the q and a up in Adler.

Great time to have Evelyn here. It’s been, I would say, a tumultuous year. A lot of end market headwinds, which creates a really interesting dynamic because we’ve seen MA plans exit markets, so through no fault of the owns. Customers have dissipated. We’ve seen things like Medicaid redetermination pulling lives out of the system.

So through no fault of Evolent, kind of seeing customers, again, lose coverage, and more recently, some oncology cost trends that have spiked up. But the other side of the dynamic is that it really creates a great selling environment, a lot of pipeline activity, and probably demand for the solutions, need for the solutions, value from the solutions has never been higher. So from a longer term perspective, although there’s been some noise in the story, we think a great long term growth outlook, really sophisticated product offering that is meeting these market demands, and we think there’s a lot to come in the future. So I think this is a great time to be looking at the stock and a really great time to have the company here. So we appreciate you attending, and we appreciate all of you in the audience.

So with that, I’ll turn it over to Seth, and then, again, we’ll go upstairs in Adler for the q and a. Thanks.

Seth Blackley, CEO and Co-founder, Evolent Health: Alright. Nice to see everybody. Thank you, Ryan. I was joking with Ryan before the presentation. I feel like I’m meeting a lot more value investors today than I’m used to, which I don’t necessarily like, but it is an interesting time for the story.

Before we start, what I thought I would do is briefly do a very layperson’s description because I know this is a growth conference. So, Evolent’s work is managing complex conditions across oncology, cardiology, and MSK. So take we’re gonna focus a lot on oncology today because it’s Evolent’s core business, our largest specialty and and one of our biggest growth areas. But just to frame the issue that we’re helping solve, four out of ten people will be diagnosed with cancer in their lifetime. Four out of ten people in this room of us will be diagnosed, which means that everybody in the room either has a personal experience with cancer or a family member.

We’ve all had it. We’ve had the experience of a diagnosis and then wondering, where do I go to get the care? Am I going to the right place? Am I getting the right diagnosis and the right treatment plan? Right?

And we’ve all probably dealt with that with extended family members. Evolent’s work fundamentally is to help make sure that that patient is getting the right diagnosis and the right treatment plan. If you go walk into an oncologist today off the street across America, on average, you’re getting the right diagnosis, the right treatment plan sixty five percent of the time, which is an amazing, scary statistic when you think about it. Meaning thirty five percent of the time, there’s something with either the diagnosis or the treatment plan that isn’t right. We try to get that number from 65 up to close to eighty five percent on average.

That is the work we do, improving adherence to evidence based medicine. I’ll explain how we do that, the way we make money off it, who we sell it to, and and and the like as I go through. But that fundamentally is the value proposition of the business. Just a little bit on the the the profile of the organization as I start, and I’ll hit a couple of these metrics that I’ll preview, and then I’ll take you into more detail. So Evolent’s primary customer base are are the insurance companies.

Our largest com our largest customers, Humana, Centene, Molina, the Blue plans, and the like, are our customers. We help them manage the quality and adherence to the evidence that I described a moment ago across oncology, cardiology, and MSK. Ultimately, we do that work through the treating oncologist. I’ll explain how we do that. And at the end of the day, our motivation is the patient, getting the right care for the patient.

We do this through a staff, as you can see here, at 4,500 people on the team at Evolent, highly mission oriented, 1,500 are clinical, 350 physicians on staff who are reviewing these cases case by case. 8,000,000 times a year, we’re reviewing a case in oncology and cardiology and MSK and the like. And I mentioned the 20% improvement that we seek to drive. That, on average, drives lower cost for the patient. Sometimes it’s higher.

Sometimes we’re recommending something for the patient that is more expensive. But on average, we’re helping drive down the cost, and we’re doing it in a way that physicians are satisfied and patients are satisfied. So this is what I’m gonna walk you through today as we go through it. I’ll skip past this slide briefly because I wanna focus today on oncology, which is our biggest specialty. But just to be clear, as I mentioned, oncology, musculoskeletal conditions, and cardiology, those are the three big conditions that we manage, through the work at Evolent.

So let me dive into oncology as I mentioned. This is the basic value proposition. So if you’re a health plan and you work with Evolent, there are a couple things that we’re gonna be doing to help drive value into your network and in your system. Number one, in the top left, is get that 65% adherence to best practice medicine up to 85 on average in a market. You guys may know this.

In cancer care, there are 300 journal articles published every month. Imagine trying to keep up with that if you’re an oncologist. The average oncologist is reading about four of those 300 articles. So the pace of scientific innovation is hard to keep up with, and that’s one of the reasons you see this huge problem, which only 65% of the time is the right care being delivered. And we’re able to make those changes case by case, as I’ll describe in a minute, while having the treating oncologist satisfied with the work we do.

You can imagine if I’m an oncologist, do I like somebody looking over my shoulder, you know, to say, hey, I think there’s a different care plan that’s possible? Can imagine that could create tension, but really proud of the fact that we’re able to do that with a high satisfaction rate. Primarily, I believe we’re able to do this because the evidence is so complicated and the changes are happening so frequently that we’re able to bring value to the treating oncologist. And then the last thing that we’re doing, increasingly new product that we just announced in May, is an app and a product and a set of navigators wrapped around the patient and the family. So imagine there’s a diagnosis.

You’re in care now. You’re at home, and you have a fever, and you’re wondering, should I go into the hospital? Should I call my oncologist? If you had a family member deal with this, these things happen all the time. We have an app that allows the member to track these symptoms at home.

They can push a button to be connected to one of the Evolent nurse, oncologists who can have a conversation with them and help them triage. On the other side of the equation, the things that we are driving down are the cost. On average, about 20% reduction in the total cost of these conditions across a three year period. Doesn’t happen in year one. Some of it happens in year one, but across three years through educating the oncologist or the cardiologist or the orthopods, being able to drive down that cost over time.

Again, certain cases, may be driving up the cost, so these are average numbers. Decreased use of what we call low value regimens. Low value regimens are, you know, therapeutic choices, and most of the cost in oncology is the cost of the drug. Folks may have heard of a drug called Keytruda. It’s $35,000,000,000 for one drug.

It’s bigger than McDonald’s. One drug, one brand. It’s a checkpoint inhibitor for immuno oncology. And then the last thing that we drive down, people were aware after the tragedy in December at United, with Brian Thompson being murdered that physicians and patients don’t like care being denied, right, particularly in a life threatening area. And I think the work we do, the way we do this, the 8,000,000 interventions we make a year with dissatisfied physicians, I’m really proud of the fact that we’re able to do this kind of work, and the denial rates typically go down.

Meaning, the the the speed with which we’re approving care and getting the patient what they need, that is better than the status quo in the market, which to me is a really important factor. Okay? So I know it took a little while on that slide, but I think it’s important. What that has led to for the business, we’ll talk about the EBITDA and the headwinds that we’ve had with the market over the last few years in managed care, but the sales opportunity in the market right now is incredible across all three conditions, but particularly in oncology. Today, we’re about $2,000,000,000 of revenue.

We have a direct cross sell opportunity, meaning an existing client, an opportunity, a population, a line of business that we don’t yet have. If we cross sell all of our customers, our products, that is a $50,000,000,000 cross sell opportunity, which is about a third of the TAM. So the total opportunity is a hundred and 50,000,000,000. A third of it we can get at with our existing customer relationships, those logos you saw on the first page. That to me is a big time opportunity.

If we do a good job for our clients, we have an opportunity to earn more business. And the reasons for all this, again, on the right, if you go talk to any health plan right now, ask them what their number one problem is, it’s gonna be the cost of oncology. And I think that’s a big opportunity for us, again, to continue addressing that, and you can see some of the reasons why. It goes back to the rapid pace of scientific innovation, the cost of the therapeutic, and the like. So big time opportunity in the market, that’s driving big demand.

I mentioned on the last earnings call in May that the weighted pipeline for Evolent from a year ago has more than doubled, which, again, is driven by these factors. Very briefly, what do we do? How do we do the work that I mentioned? There are three components to our product. One is clinical decision support.

That means I’m a physician. I’m getting ready to treat a patient. Could be with cardiology. Could be a musculoskeletal surgery. It could be cancer.

And right as I’m getting ready to make the decision on what treatment plan to put in place, Evelyn’s team, through our technology, our AI, but most importantly, our teams, are reviewing that case and going back with recommended changes on some subset of the cases. We don’t recommend changes on most, but on the ones where we think there’s a big opportunity through clinical decision support in real time right before the treatment starts, we are making those recommendations. The payer requires the physician to come to us with their care plan through their EMR or through extracting their clinical data. We receive it. Our algorithms look at it.

We flag the cases that need an intervention of some kind. And then the biggest and the best interventions are through one of our physicians calling the treating physician. That’s that’s the biggest opportunity where there are more complex cases, and it needs what I would call a peer to peer consult. Second part of our value proposition is the provider alignment. So for the oncologist, the cardiologist, or the orthopod, do they the studies, the benchmarks, and the incentives to do the right thing?

So I said 65% of the time, the right care is being delivered. How do I get that number to eighty five? One of the ways you do it is you make sure the physician is able to benchmark their data, look at their cases not one at a time, but across maybe a quarter or across six months. And we do that work. We send people into the offices with the data and the information to sit down with the physicians.

We also create financial incentive programs, adhere to the best evidence, and the most latest evidence will pay you a bonus. Those are the sorts of things we do as part of our product in column two. Column three is the member navigation that I mentioned earlier, which is, again, an app and a wraparound set of services for the patient and the family member in the home twenty four hours a day. We’ve launched that so far for oncology, and we’ll do so over time for the other two products. Alright.

So let me click into these three areas, give you a little bit more detail. Number one, which is the clinical decision support. How do we do this work? The first thing we do on the left side of the page is we develop a view on what is the best evidence. We collect that from the categories of of work listed on the left side.

Anybody know what ASCO is? It is the largest association for oncology. They’re meeting right down the street here in the convention center this week. Incredible innovation going on. We take the ASCO guidelines as a for instance, but also all of these other categories of information, including real world data, to develop what we think of as our level one pathways.

Level one pathway means, hey. If you follow this evidence, this is the best thing for the patient from a quality perspective first and from a cost perspective second. Take that to the middle. Okay. Now take it down to an individual case.

There’s a patient diagnosed with, let’s make it up, non small cell lung cancer. That’s the diagnosis. How can I treat that patient? As you can see on this page at the top, compendia means that is what CMS will pay for. That is what is approvable.

In this case, there’s, I don’t know, nine different regimens, 10 regimens that you could follow, all of which are approvable, all of which the evidence and literature says these are fine. We review all 10 of those and say, okay. Which ones are really the best for the patient? We identify the next five. We then look at toxicity.

Toxicity means am I gonna get a hospitalization or an adverse event because of the treatment? And we take out the ones that are not efficacious and have high toxicity. And then at the very end, we look at what the cost looks like. And at the end, our level one pathways are either b or e. And so if the physician’s not prescribing b or e, that would be one of those thirty five percent of the cases where we’re gonna make a phone call or send a message electronically to the patient to try to get that shift.

Again, quality first, but we do think about cost. You can see the effect of the on the cost on the right hand side, which is when a patient is on level one versus level two, average cost per case is significantly lower. Again, these are average. Sometimes it’ll be higher. But on average, it’s significantly lower, akin to what you might see in manufacturing where high quality you know, the Deming principle of high quality actually is lower cost, and that’s the case in these high cost conditions.

Let’s move second to the provider alignment, that second column. I mentioned the peer to peer engagement, the education, and the alternative payment models. Those are the three things we do to help drive the right outcomes. As you can see in the middle of the page, only about 3% of the time are we going to the physician and say, hey. This is really a bad idea.

You can’t do it or you shouldn’t do it, a denial. But we will sometimes say that. If you’re doing something really dangerous for the patient, we’ll flag it. But ninety seven percent of the time, either electronically or through the peer to peer process, we’re convincing them that, like, hey. There’s a better path here for the patient, quality first, toxicity second, and cost third.

And in those cases, we’re able to make those changes. Then you look at the data on the right, look at the look at the percentage of the time the peer to peer changes. They have no requirement to change, but eighty one percent of the time, we pick up the phone, a change gets made, which is fantastic. And then I think importantly, the satisfaction rate that I mentioned earlier, I think, is really important because it tells you that the oncologist thinks that we’re credible, and I think that’s really important. Third and finally, I’ll just touch briefly that we have with Careology, which is a leading, consumer application developed in The UK originally for the NHS.

We have the exclusive US license to distribute the product, and we integrate that fully with our nurse oncologic nurse care team and triage the patients so that they can get twenty four seven access. These services that we’ve just introduced are in place for a couple hundred thousand of our lives today, so it’s not hugely penetrated, but we believe it’ll be a growth category for us. And the savings in this is really about avoided emergency room visits and avoided hospitalization. So this is a slightly different value proposition than, hey. Are you on the right drug?

Which is a part b cost and is more about, can we keep the patient at home and healthy, rather than running off to the hospital. Real quick, we thought we’d put in one quick case study. Does anybody know what a checkpoint inhibitor is? There’s probably a few health care investors in here. In in cancer care, there’s a couple broad types of treatment.

Historically, everybody hears about chemo. Chemo is poisoning the body to kill the cancer cells, but you’re also poisoning the body. And it’s difficult on people. It’s a blunt instrument. Right?

Checkpoint inhibitors are a newer category of of oncology care called immunotherapy. It switches on the immune system to attack the cancer cell. Checkpoint inhibitors specifically work by switching on a specific mechanism for attacking the cancer cell. It has been a massive growth opportunity. Keytruda is a checkpoint inhibitor.

Optivo is a checkpoint inhibitor. Tecentriq is one. You’ve heard these brand names perhaps. This is gonna be 200,000,000,000 industry in in in a handful of years, the checkpoint inhibitor space. Been growing at 15 to 20%.

And we’re able, through the work that we do, identifying the right patient, the right right disease base, and the right evidence, and one of our clients decreased the the cost of these checkpoint inhibitors by 4%. When the market’s been going up at 15 to 20, and we’re going negative four while getting better quality for the patient, that’s what we do, and that’s the value proposition that we bring to our patients. We can get in more detail in q and a about how exactly we do that. Alright. Let me turn a little bit to the business, now that you understand the product.

You know, I’d say we have a couple elements to the growth algorithm. The first is we’ve committed to what we call 15% plus plus top line growth organically over time. We feel like we’ll continue to be able to drive this number for many years to come. We have less than 5% market share. I mean, you look think about our TAM.

We have a 80,000 of the two million cancer cases in The United States we take care of, so there’s ninety plus percent of the cases we don’t yet take care of and manage. And then we think we have the best product to do it. So I think we’re gonna be able to continue growing business aggressively over time, including with the performance suite, which if you’re new to the business, the performance suite is our product where we will actually guarantee the savings to the plan. And the ability to make that guarantee has been a big part of our ability to continue to sell the product. And that part of our business in particular has been, I’d say, very strong over the last year in terms of pipeline.

The second part of our formula is around margin expansion. And so that that covers it. Growth and margin expansion gets most of what you need in life. The margin expansion side is driven by two components. One is automation and AI.

So we’re never gonna use AI to make a clinical determination, but we will use AI to make our process more efficient. So if something in the past required manual review, maybe AI can say, hey. This is gonna get approved anyway. Let’s not spend time on it with a manual cost, and let’s automatically make it sure that it’s going through for the for the plan and for the patient. Another way to use AI is say, hey.

It used to take us twenty minutes to do this review. Now we can do it in twelve minutes because of AI. So there’s a bunch of savings that we see on the AI front that are about efficiency that, again, don’t use AI to actually make clinical decisions. And then the second really important part around margin expansion is our performance suite. Our risk side today, this year, our kind of rough margin is about 7% on that line of business.

The mature margin in that business is about 10%. So we’re under earning, I’d call it, our performance sweep margins based on the issues Ryan talked about. There’s been a ton of headwinds in managed care. It’s been probably the hardest underwriting cycle for any managed care organization for the last couple years that it’s been in a few decades. And so our ability to get back to our sort of more mature margins is the second big piece.

That translates into our outlook, which obviously we reiterate today, and we feel really good about that outlook, as John said. Alright. So just in wrapping up, the biggest place we get questions in our one on ones and we’ll probably have in the q and a is sort of comparing the two two business models we have within the company. One is our tech and services model, which is a fee based think of it like a tech and services product, right, with 50 type margins. The other product, as I mentioned, is our risk product, which is called the performance suite, which is a majority of our revenue dollars but has a lower margin percentage because of the model that I described.

So what you’ll notice, couple things I call out, while the margin percentage for tech and services is higher, look at the, target mature flow through margin PMPM dollars. So 20¢, right, on the tech and services side and, you know, a buck 50 to $4 plus on the performance suite side. So what that tells us, and I think many of our investors who know us well, is that growing that part of our business is the best outcome for us, but it’s also best for our partners. You’re gonna get most savings for them, the best clinical outcomes for them. So a lot of the questions that we’ve had around our ability to grow that product and continue to manage the margin in that product.

We feel really good about that. And as I mentioned, the pipeline will indicate that. There are a few things that we change coming into this year based on the kind of managed care market that we’ve seen, which is really high cost in 2023 and 2024. We basically took the bell curve on the way we take risk and narrowed it on both sides. Meaning, historically, we would take risk above a % MLR and below 90% MLR.

If you know the MLR statistics, meaning we could make a lot of money when things are going well, and we could lose a lot of money when things were not going well. We’ve taken that and tightened the curve around that with what we call corridors along with some other contractual adjustments that we made, and we think that is a better product a public company and going forward in this market. One question we’ve had is, hey. Well, you better sell that product. And we’ve had very good success thus far, I mentioned, by the pipeline earlier, people attaching to this product.

So we feel very good about where that performance suite product sits and, the ability to drive it into the marketplace. Last thing, just briefly, we’re very focused on the balance sheet as well. And I think there’s a couple priorities that we have. The main priority in addition to some basic product investments, organic product investments, which I think of as software investment, largely capitalized software, is gonna be around delevering, right, and just taking the free cash flow of the business over time to have our leverage ratio fall. You can see some of the targets that we’ve listed here over time, and want everybody to hear that loud and clear that that is a huge priority for us.

The leverage will come down over time, and, the team and I are very focused on making that happen. I’ll just close on this statement, which you go to our website. You’ll see it. We guide everything we do with a mindset, which is what if this were a family member? And I sort of made it a little bit personal at the beginning if four of ten people in this room will get cancer.

You know? Some of us will. Whether it’s that or one of these other conditions, we think if we make sure that we are taking care of our patients like family members, that will drive the right trust in the marketplace, but also ultimately is the thing that also benefits the system on affordability. So that’s our true north. And with that, I’ll wrap up, and we’ll we’ll take some q and a.

Unidentified speaker: We’ve got a couple minutes. So if there’s any questions from the audience, we can get that.

Seth Blackley, CEO and Co-founder, Evolent Health: Yeah. So the question was, how do the alternative payment models work and what are some specific examples? So for those who aren’t close to the market, let’s use oncology as an example. The oncologist receives 6% of the cost of the injectable drug. So if you have to go in and get an infusion for your cancer care, which many patients do, the oncologist is getting 6%.

So if you’re on a checkpoint inhibitor that costs hundred and $80,000 a year, the treating oncologist is getting 6% of that in the form of a payment. ASP plus six is how it’s known in the market. So I don’t think most oncologists, Jay, to your question, they’re they’re not doing things that are untoward. I think vast majority are trying to do the right thing. But if we’re going to them and saying, hey.

The cost was $200,000 a year. You were gonna make $12,000 of income from your 6% payment. We’re asking you to do something that cost $10,000, and that that’s a real example. Unfortunately, those huge discrepancies exist. That loss of close to $12,000 of income is a real issue.

And so what we’ll typically do is say, hey. Look. We’ll make you whole in the 12,000. So we’ll make sure that your, in this example, income stays at $12,000. The cost of the therapeutic is gonna fall from, you know, in that example, 200,000 to 10,000.

Again, hundred $90,000 of savings offset by 12,000 of the increased payments. It’s obviously a win win for the payer. The patient, as you guys probably know this, often pay up to 20% of these costs. So you can imagine what it means to get a co pay for, you know, a hundred thousand or $200,000 injectable. You guys may know this.

The number one cause of bankruptcy in America is health care costs, and, oncology is the number one driver of that. It’s these expensive drugs. So I think it, you know, it also is the right incentive for the patient, which is if it’s the right answer, let’s make sure we don’t dang the physician for doing the right thing, and it’s good for quality, good for the system’s cost, and then good for the patient’s pocketbook. Like, that combination, is how we do it. There are other mechanisms, where we will pay, an incentive just around overall adherence rates to the evidence, which is more of a comprehensive program versus a one off on high cost drugs.

So there’s a couple different ways we do it, but, it’s fundamentally around adherence to evidence. Yeah. Question was what happens when one of these big ones like Keytruda goes generic. So a couple things, Chris, I’d say on that. One is biosimilars, which is the, you know, generic version of these part B injectables, often are only fifteen, twenty, 30 percent cheaper, which is, I think, an interesting point.

It’s not like they go to, you know, 90% reduced cost. The, you know, the cost will come down a little bit. Number two, through a bunch of legal appeals and mechanisms, usually, that time frame gets extended a couple years. So our view is that’s probably more like twenty, thirty before it really affects. And then the last two points, they’re pharma smart.

Right? They they are very thoughtful about how to do this. They have a new product coming out, which is a subcutaneous version, meaning you don’t have to sit in a chair and get the drip IV. You just get a shot. That will be considered a new product.

And it’s better for the patient. Right? I don’t wanna sit in the chair for an hour, two hours. Just get the shot and be on my way, but that’s gonna have a patent extension attached to it. And then the last point, of course, is that, you know, a lot of these things, as you probably know better than me, Chris, like, there are so many different innovations coming that, you know, as as always happens, one will go down a little bit through biosimilar, even with the things I mentioned of subcutaneous and with, you know, the extensions, the next thing will be coming.

And I think gene and cell therapies are gonna be explose. AI is gonna make these gene and cell therapies explode, I think, because they’re gonna be more and more tailored over time. And the ability for computers to basically run trials and crunch the data around what works and what doesn’t, I think, is gonna have a whole new class of things over time. So, you know, our belief is that the specialty pharma market is gonna be a huge market for a long time.

Unidentified speaker: We’ll go ahead and move up to Ambler for the breakout session. If you turn back to the team, I appreciate it. Thanks.

Ryan Daniels, HCIT and Health Care Services Analyst, William Blair: This presentation has now finished. Please check back shortly for the archive.

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