PHOENIX, Ariz. (Oct. 28, 2022) — Self-insured employers looking for cost containment strategies should be open to solutions that prioritize the member first– a shift in thinking that can have a big payoff for both the member and the employer, according to Vālenz® Health CEO Rob Gelb.
As part of a recent HCAA-sponsored “Voices of Self-Funding” podcast with host Ramesh Kumar and Imagine360 CEO Jeff Bak, Gelb addressed key trends in driving lower costs and managing risk for self-funded plans, including the roles played by enhanced transparency, data and technology.
“It starts with the employer being willing to get comfortable being uncomfortable, accepting that they may not have all the answers, and making changes in the spirit of the member to do what’s right,” Gelb said. “More than just cutting the cost of an individual claim, the conversation has to evolve around the total cost of care and placing the member first in the equation while you measure quality of care, reasonable cost and reasonable reimbursement.”
An important first step, Gelb said, is to establish transparency from the start among the provider, payer, plan and member – aligning all parties in achieving a balance of cost, quality and utilization of care.
“There’s a misalignment of incentives with the way that traditional plans design their networks, and an expectation from employers that any provider network that has broad coverage is good for their employees,” Gelb said. “When you have full alignment upfront, all parties understand throughout the process what their role is in balancing the equation of quality, advocacy and cost. That’s how we arrive at cost containment options that benefit everyone involved in the claim.”
“We’ve designed a solution as a platform that becomes a full BUCAH replacement option,” Gelb said, referring to the Valenz Healthcare Ecosystem Optimization Platform. “Economics are a big part of that. We use local and national data sets to feed UCR, paid claim data, other forms of data, and Medicare into an algorithm to determine what we call market sensitive repricing. In addition to determining what services and the price point for those services, we determine what shouldn’t even be on the claim. Then, we typically get provider signoff 50 percent of the time on all of those factors to eliminate any friction. That’s part of our methodology to contain costs and serve the member.”
Hear more from Rob in the full podcast.
About Vālenz® Health
Vālenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.