Innovative reimbursement strategies maximize plan dollars, improve provider relationships and drive significant savings
PHOENIX, Ariz. (November 19, 2021) — At a recent customer event, Vālenz® leaders unveiled a package of solutions that offer innovative alternatives to traditional reference-based pricing (RBP) agreements, designed to give self-insured employers more leverage in their local markets.
According to Rob Gelb, CEO of Valenz, the market needs to move away from traditional RBP approaches, which continue to be focused on basic payment reductions. “Now is the time to change the way you look at a reference-based approach to reimbursement that is defensible and allows customers to position in the market without contracts,” Gelb said. “The new Valenz package is designed to do this, plus it offers options to share risk with our customers.”
Each solution is fueled by data-driven insights and supported via the proprietary Valenz VMS™ Repricing Methodology yield fair, market-sensitive reimbursements that deliver improvement in savings as high as 75 percent, according to Gelb.
Valenz solutions offer options for self-insured employers to choose the path to smarter, better, faster healthcare that is best for their markets:
- Access Open Solution maximizes plan dollars with a non-network reimbursement strategy that fosters equitable provider relationships. With integrated care navigation that lowers costs, this solution provides transparent quality and outcomes data for fair, defensible and consistent reimbursement recommendations.
- Access Assured Payment builds on Access Open Solution to eliminate the risk of balance billing, member disruption and provider friction by offering assured payments for up to 91 percent of claim volume. The remaining claims undergo comprehensive, line-by-line bill review with provider sign-off for secured savings.
- Access Amplified offers an out-of-network wrap solution – complete with care navigation, bill review and assured payment – to replace wrap networks. This solution directs members to high-quality care at fair, reasonable costs and secures appropriate, accurate charges for every out-of-network claim, resulting in significant savings.
- Providing an alternative reimbursement approach for non-Medicare-based pricing – one that, like the other solutions, embeds VMS for fair, equitable, market-sensitive reimbursement rates.
“These solutions help maximize savings opportunities, reduce risk to the health plan, and put leverage back in the self-insured employer’s favor,” Gelb said. “That’s the power of the Valenz ecosystem. It lets us do what we do best, which is creating partnerships through contracts with providers.
“When we engage early and often to ensure active collaboration among the patient, providers and employer plans, we can ensure transparency and ultimately improve health outcomes.”
Valenz enables self-insured employers to make better decisions that control costs across the life of a claim while empowering their members to lead strong, vigorous and healthy lives. Valenz offers transparency through data to pinpoint members at highest risk, address gaps in network designs, ensure appropriate and accurate charges, and expertly navigate employees to optimal care solutions for substantial cost savings and improved health outcomes. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.