How Carelon Global Solutions and Elsevier help nurses look beyond the chart, lifting decision readiness to 72%
Executive summary
As Carelon moves towards integrated, value-based care, a continuous learning program is helping its nurses build the clinical judgment to keep the patient at the center of every review.
For Dr Salin Kataria, the real test of a clinical decision comes days after it has been made.
A nurse reviewing a patient in hospital might recommend moving them to a different level of care, such as from a specialist hospital to a skilled nursing facility. The review can follow every rule and still leave the important question open. “If I had taken a decision, then what happened to the patient 10 days down?” Dr Kataria asks.
That question is at the center of how Carelon Global Solutions is changing: from a “process-centric” organization to a “knowledge-centric” one, where learning is linked directly to quality, affordability, member outcomes and career growth.
72%
share of decision-ready cases reaching medical directors, up from 55%
3,200
estimated hours saved through faster case handling, quality improvements and less reliance on senior clinical experts to answer questions
52%
positive feedback on case quality, up from 30%
The Challenge
A different view on outcomes
Carelon Global Solutions supports health plans and health systems with clinical, operational and technology services. Having built up its global clinical capabilities, it is now focused on redefining value-based care, in which health organizations are rewarded for keeping people well rather than for the volume of treatment they provide.
That means moving from fragmented care, where each hospital stay or appointment is handled on its own, towards care that follows the whole person over time: in person, virtually and through digital tools such as wearables and telehealth. Carelon’s nurses sit where that information comes together, and they need to make sense of it to make good decisions.
For years, quality was judged one review at a time: whether the nurse followed the process and closed the case on time. “If we discharge the patient early, the patient is seen back in the ER as a readmission,” Dr Kataria explains. On paper, the review looked correct. For the patient, the decision came too soon.
Dr Kataria calls the alternative “end-to-end quality”: judging decisions by what follows them. That means measures such as readmissions, length of hospital stay and how often nurses’ recommendations match the final decisions of medical directors, the senior doctors who sign off complex cases.
The workforce model had to change too. Nurses were hired on their credentials, trained on processes and systems, and measured on how many cases they cleared. “We hired for a credential,” Dr Kataria says. Nobody went back to check how strong a nurse was on cardiovascular or musculoskeletal cases.
The Solution
Building capability for more complex work
“The conversation shifted from how we train our nurses to how we build a culture of continuous learning that strengthens clinical judgment and improves outcomes,” Dr Kataria says.
Carelon built that culture for its more than 400 nurses on three Elsevier platforms, each with a different job. Osmosis broadens and refreshes nurses’ clinical knowledge. Clinical Learning Hub sets out learning pathways for specific roles and career paths. Clinical Skills helps nurses apply what they learn and demonstrate the competencies that more complex work requires. “We realized that no single learning platform could address all our needs,” Dr Kataria says.
Access alone was never going to be enough. “It is not like a flash in the pan that we will just take licenses, we will give access to our people, and magic will happen,” he says.
Carelon gave nurses paid time to learn and added extra staff to cover it, accepting that people would work more slowly while they studied. It grouped nurses into four broad specialty cohorts and began routing cases to the cohort with the right expertise, so that nurses deepen their knowledge in the areas they see most. Knowledge became a requirement for incentive pay and promotion.
To cover what a screen cannot teach, Carelon also partnered with leading hospitals so its nurses can spend paid time at the bedside.
The Impact
Early signs beyond the classroom
The clearest change is in the cases nurses send to medical directors. Dr Kataria says they now arrive “more prepared”, with stronger clinical reasoning, better documentation and more consistent recommendations. The share of cases reaching medical directors ready for a decision rose from about 55% to 72%, and positive feedback on case quality rose from 30% to 52%.
Nurses are also working more independently. In the first half of 2026, Carelon estimates the Elsevier partnership saved more than 3,200 hours and around $102,000. The savings came from faster case handling, quality improvements and less reliance on senior clinical experts to answer questions.
The effect on people has been just as important. Learning is now seen as a route to professional growth, not a compliance task. Carelon’s clinical teams recorded the organization’s highest score in a recent Great Place to Work survey, with 87% of nurses taking part, and 94% of nurses stay three years or more. Dr Kataria is careful not to credit Elsevier alone. He also points to nurses seeing their work as a stable profession in which the organization is investing.
What comes next
Making learning part of the job
As their expertise has grown, nurses have started contributing ideas, joining research discussions and helping shape new solutions. Carelon has formed a Clinical Research Council to support that work. Dr Kataria sees it as an “evolution from knowledge consumption to knowledge creation” and expects it to lift clinical capability further over the next 12 to 18 months.
For Carelon, the aim is learning that is “continuously developed, applied and reinforced” in everyday work, so that each review reflects not just the case on the screen but the person behind it.
“It is not like a flash in the pan that we will just take licenses, we will give access to our people, and magic will happen.”