NeueHealth, Inc. and subsidiaries (NeueHealth) is a value-driven, consumer-centric healthcare company.
NeueHealth consists of two reportable segments:
NeueCare — The company’s value-driven care delivery business that manages risk in partnership with external payors and serves all populations across The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (‘ACA’) Marketplace, Medicare, and Medicaid.
NeueSolutions — The company’s provider enabl...
NeueHealth, Inc. and subsidiaries (NeueHealth) is a value-driven, consumer-centric healthcare company.
NeueHealth consists of two reportable segments:
NeueCare — The company’s value-driven care delivery business that manages risk in partnership with external payors and serves all populations across The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (‘ACA’) Marketplace, Medicare, and Medicaid.
NeueSolutions — The company’s provider enablement business that includes a suite of technology, services, and clinical care solutions that empower providers to thrive in performance-based arrangements.
The company can significantly reduce the current friction and lack of coordination in healthcare system by aligning the interests of payors and providers to enable a seamless, consumer-centric healthcare experience that drives value for all.
At the end of 2022, the company exited the ACA Marketplace as an insurer, and as of January 1, 2024, the company ceased offering Medicare Advantage products with the sale of the company’s California Medicare Advantage business. After exiting the health insurance business, the company adopted NeueHealth as its corporate brand name.
The company is focused on delivering value-driven, consumer-centric healthcare through the company’s owned and affiliated clinics, as well as enabling independent providers and medical groups to thrive in performance-based arrangements through deep financial alignment, customized population health tools, and strong partnerships with leading health plans and government programs.
Approach
At NeueHealth, the company is delivering the future of integrated healthcare by deploying a differentiated, value-driven approach that is built on alignment and focused on the consumer.
Built on Alignment
NeueHealth has created a differentiated alignment model built upon three core principles applied consistently but flexed accordingly to meet the company’s provider and payor partners where they are to deliver a more personalized care experience for consumers:
Clinical Alignment — Alignment in healthcare starts with those responsible for delivering care locally. As each of the company’s provider partners has a unique set of clinical tools and capabilities to manage population health risk, the company’s adaptable model lends them the support necessary to enhance local healthcare delivery. Clinical alignment ensures coordination between providers and payors to deliver high-quality care that is affordable and tailored to meet each consumer’s individual needs.
Financial Alignment — The company has developed performance-based payment structures that enable the company to take a staged approach to financial alignment with the company’s provider partners. The company first carefully considers each provider’s ability and interest to take varying levels of population health risk and work with each partner over time to prepare them for success under more advanced models of value-based care. The company’s owned clinics align with payor partners, forming strategic relationships to manage all populations along the continuum of need across the ACA Marketplace, Medicare, and Medicaid primarily through performance-based arrangements.
Data and Technology Alignment — The company’s clinical and financial alignment with the company’s provider and payor partners is designed to incentivize maximum platform interoperability, data transparency and data sharing, affording everyone a more holistic view of the consumers the company serves. The company’s data-driven clinical tools support care teams by streamlining patient information, simplifying administrative processes, and presenting actionable insights to support informed decisions.
Focused on the Consumer
The company’s approach to healthcare remains centered around the belief that there is an ongoing shift from broad, employer-driven, one-size-fits-all offerings to a model built on individual choice. This has driven the company to implement a novel approach to consumer empowerment that focuses on developing true relationships with the company’s patients early in their healthcare journey to understand their specific needs so the company can deliver a personalized, consumer-centric healthcare experience.
Powered by Technology
NeueHealth’s aligned and consumer-focused model enables the company to transform the way technology can affect meaningful change in healthcare. Historically, key stakeholders with misaligned incentives have generally been unwilling to share critical information, thereby limiting the effectiveness of healthcare technology. In addition, data has been transactional, serving the needs of payors and care providers, but not the individual. By aligning stakeholders across the financing and delivery of care and putting consumers in control of their healthcare data, NeueHealth can capture a holistic view of the consumer and empower everyone – the health consumer, provider, and payor – to drive better coordination.
Business
The company deploys its capabilities across its NeueHealth business, which is consisted of two segments – NeueCare and NeueSolutions – each focused on leveraging the company’s value-driven, consumer-centric care model to optimize the healthcare experience for health consumers, providers, and payors.
NeueCare
NeueCare delivers accessible, affordable healthcare to all populations across the ACA Marketplace, Medicare, and Medicaid through owned and affiliated clinics. NeueCare is committed to supporting all patients across the continuum of need with inclusive, proactive, and informed care. Leveraging its patient engagement strategies, NeueCare develops a true relationship with patients early in their healthcare journey to understand their specific needs and deliver the right care at the right time, in a setting the patients trust.
As of December 31, 2024, NeueCare operated 66 risk-bearing clinics, under the Centrum Health and Premier Medical Associates brand names, delivering payor-agnostic care to approximately 318,000 value-based care consumers across the ACA Marketplace, Medicare, and Medicaid. NeueCare engages in local, personalized care delivery through its integrated care model:
Integrated Care Delivery — The company aligns the interests of providers, payors, and consumers to create a better healthcare experience for all. The company’s integrated system of care includes embedded pharmacy, laboratory, radiology, and population health focused specialty services. The company takes a consumer-centric approach to care, engaging each individual and offering expansive preventive care services to proactively meet the needs of each consumer, reduce hospitalizations and other unnecessary utilization of the healthcare system. The company’s clinics leverage NeueHealth’s data and technology capabilities, as well as NeueSolutions’ provider enablement tools to ensure comprehensive care for the company’s at-risk patients, including chronic care management, transitions of care and referral management. NeueCare is tightly aligned with the company’s third-party payor partners, increasing access to high-performing, clinically integrated networks and driving differentiated performance by delivering higher quality care at lower cost.
The company’s care delivery approach focuses on three primary components:
Simplicity, Convenience and Coordination — The company offers a one-stop-shop for consumers providing primary care, behavioral health, rotating specialties, pharmacy, radiology, and laboratory services, many times at a single location. For services not provided, the company can refer to high quality, in-network providers and ensure continuity of care.
Community Connectivity — The company’s clinics are designed to foster a sense of local community, bring consumers together to build true relationships and support their non-medical needs.
Proactive Engagement — Leveraging the company’s technology, the company keeps its local consumers highly engaged in their healthcare. The company proactively communicates with its consumers to close care gaps, and when appropriate, arrange for medical transportation to and from appointments, all while making the company’s care teams available 24/7 through call centers and virtual connectivity, maximizing adherence to a consumer’s care plan.
NeueCare Customer Segments
NeueCare serves customers through its value-driven, consumer-centric care model, including:
External Payors — NeueCare owned and affiliated clinics contract with various third-party payors primarily through value-based arrangements.
Health Consumers — NeueCare provides high-quality, affordable healthcare to health consumers across the ACA Marketplace, Medicare, and Medicaid.
NeueSolutions
NeueSolutions enables providers and medical groups to succeed in performance-based arrangements. NeueSolutions also participates in the Centers for Medicaid and Medicare Innovation’s (‘CMMI’) ACO REACH program, providing high-quality healthcare access to Medicare beneficiaries.
As of December 31, 2024, NeueSolutions served approximately 42,000 value-based care consumers. NeueSolutions takes a comprehensive approach to provider enablement:
Provider Enablement Solutions: Through deep financial alignment, customized population health tools, and strong partnerships with leading health plans and government programs, NeueSolutions enables independent providers and medical groups to enter value-based arrangements designed around their needs, while simultaneously empowering them with the tools and capabilities necessary to maximize their success.
Organizing and Aligning Providers — Building, managing, and delivering high-performing, aligned delivery systems in local markets.
Transforming Practices — Redesigning practice workflows and facilitating culture change with care providers so that they understand and embrace value-based care.
Driving Outcomes — Empowering consumers to access care in the way they desire and providing tools that empower providers to effectively manage risk and deliver outcomes.
Enabling Frictionless Transactions — Reducing administrative complexity for consumers and care providers, while supporting transitions of care across the ecosystem.
Assessing and Improving Performance — Evaluating financial, clinical, and quality performance under risk-based contracts, empowering providers to improve and succeed.
NeueSolutions Customer Segments
NeueSolutions serves a diverse set of customers across the healthcare ecosystem, including:
NeueCare and Affiliated Providers (e.g., Integrated Delivery Networks (‘IDNs’), Independent Physician Associations (‘IPAs’), Medical Groups) — NeueSolutions supports these care providers with a suite of services, including technology, payor contracting, risk management, and administrative support to accelerate the transition to value-based care.
Federal and State Governments — NeueSolutions participates in the ACO REACH program, managing traditional Medicare beneficiaries through value-based relationships in partnership with its owned and affiliated providers.
Growth Strategies
NeueHealth’s alignment model allows the company to pursue additional growth through the following avenues:
Increase Membership in Existing Markets. The company plans to continue to drive membership growth in the core markets the company serves through capacity and service expansions, accretive tuck-in clinic acquisitions, membership growth initiatives and new partnerships.
Expand The company’s Care Delivery Footprint. The company plans to build on longstanding relationships with existing payor partners, as well as prioritize growth with new payors to serve more consumers at the company’s existing clinics, while integrating additional services. The company’s exportable model also affords the company valuable opportunities for de novo growth through the addition of new clinics across both existing and future markets.
Enable Providers in the Management of Population Health Risk. The company leverages its actuarial expertise and population health management infrastructure to take population health risk under total cost of care arrangements in close collaboration with the company’s provider partners. In addition, the company helps its provider partners maximize the benefit of value-based arrangements through tools and capabilities that enable high-touch, high-quality care for consumers at a lower total cost.
Participate in Emerging Direct-to-Government Programs. The company was one of the first participants in these innovative new programs and in 2024, approximately 42,000 of the company’s value-based consumers are attributable to the company’s ACO REACH business.
Competition
The company’s competitors include managed service organizations (‘MSOs’), IPAs, and other organizational providers of primary care services, such as Agilon Health, Inc. (‘Agilon Health’), Privia Health (‘Privia’), ChenMed LLC (‘ChenMed’), 1Life Healthcare, Inc. (‘One Medical’), OptumHealth of UnitedHealth Group Incorporated (‘OptumHealth’), and Village Practice Management Company, LLC (‘VillageMD’).
Government Regulation
The company is subject to federal and state laws and regulations that protect the use and disclosure of patient and other personal, sensitive or regulated data. These include the Health Insurance Portability and Accountability Act of 1996 and the Health Information Technology for Economic and Clinical Health Act, each as amended, and the regulations that implement these laws (collectively ‘HIPAA’), which created privacy and security standards that limit the use and disclosure of protected health information (‘PHI’).
In addition to state requirements, the company and/or its care providers are in some cases subject to federal licensing and certification requirements, such as certification or waiver under the Clinical Laboratory Improvement Amendments of 1988 for performing limited laboratory testing and Drug Enforcement Administration registration requirements for writing prescriptions for controlled substances.
The company’s services are subject to federal and state anti-kickback laws, false claims acts (‘FCA’), and other laws related to reimbursement by government programs.
The company’s operations comply with the Anti-Kickback Statute, the FCA, the Stark Law, and similar federal or state laws addressing fraud and abuse. These laws are subject to modification and changes in interpretation and are enforced by authorities vested with broad discretion. The company continually monitors developments in these regulatory areas, and the company must operate its business within the requirements of these laws.
The states of domicile of the company’s remaining health insurance subsidiaries have statutory risk-based capital requirements for insurance companies based on the Risk-Based Capital For Health Organizations Model Act.
The company’s business exposes the company to potential liability including but not limited to, potential liability for (i) breach of contract or negligence claims by the company’s consumers, (ii) medical malpractice and professional negligence, (iii) non-compliance with applicable laws and regulations, including SEC rules and regulations, and (iv) employment-related claims.
History
The company was founded in 2015. It was incorporated in 2015. The company was formerly known as Bright Health Inc. and changed its name to Bright Health Group, Inc. in 2021. Further, the company changed its name to NeueHealth, Inc. in January 2024.
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