Depends on what you are doing. If you are starting from scratch, just go with elm-reactor to learn the language.
Once you need an actual website, webpack is still as great as ever, and elm-webpack-loader gives you the excellent live reloading. (That’s what “elm-create-app” is as far as I can tell.) I use this setup on greenfield projects, but webpack configuration does become a bit onerous at times.
I mostly use Elm to enhance existing Rails applications, so I just include the output of elm-make in the Rails asset pipeline.