Strengthening Payer-Provider Collaboration for Success in Value-Based Care: Catherine Gaffigan, MD

Elevance Health is reshaping its payer-provider relationships to drive meaningful health outcomes across its vast network, Catherine Gaffigan, MD, president of health solutions at Elevance Health, explained in this interview with The American Journal of Managed Care^®.

Gaffigan began by outlining Elevance's organizational scope. The company serves approximately 109 million customers across every stage of life, offering health insurance plans alongside clinical, behavioral, pharmacy, and complex care services. Its health plan arm operates under the Anthem Blue Cross Blue Shield brand in 14 states and serves Medicaid populations through WellPoint, while its Carelon subsidiary delivers health care services through partnerships with health plans, government agencies, and care providers.

At the core of Elevance's provider strategy, Gaffigan emphasized 4 priorities shared by both members and providers: affordability, quality, outcomes, and experience. Rather than treating payer-provider collaboration as a contractual obligation, Elevance focuses on equipping providers with the data and insights they need to succeed in value-based arrangements while also addressing their day-to-day operational needs as health plan partners.

On the value-based care front, the numbers are substantial. In 2024, 66% of Elevance's total medical spending was tied to value-based arrangements, with 37% involving some form of shared risk. Gaffigan was clear that value-based care is no longer a pilot program—it is the operating model. She acknowledged the entrenched nature of fee-for-service, noting that the transition requires sustained commitment and innovation on both sides.

The results, she said, are encouraging. Members treated by providers in value-based arrangements show fewer unresolved care gaps and higher preventive screening rates. For Gaffigan, this reflects the core promise of value-based care: aligning incentives so providers are rewarded not for volume, but for value.