As healthcare costs reach unsustainable levels, care navigators and members need better tools to guide the right care options
From Rob Gelb, Vālenz® Health CEO
During the COVID-19 pandemic, many patients paused their doctor visits or let their medications lapse, leading to health issues going unchecked for months or years. The resulting increase in late-stage diagnoses for serious conditions like cancer and heart disease means patient acuity is higher and treatment is more extensive – all key contributors to the ongoing escalation of healthcare costs. And we are all beginning to see the impact of inflation on the healthcare system.
To battle this growing crisis, self-insured employers can advocate for members by deploying medical cost-containment solutions to connect them to necessary quality care while also minimizing expenses for both the member and the employer.
I believe members will benefit from engagement early and often throughout the patient journey, receiving proactive support from navigators who make them aware of all their care options and provide guidance to the right resources that meet not only their health needs, but their financial needs as well.
Case in point: Of the more than 100 million Americans living at or below 400 percent of the Federal Poverty Level (e.g., a family of four with a household income of $106,000 or less), many might not realize they may qualify for low- or no-cost medical care. Most likely, their employer and health plan sponsor are unaware of this opportunity as well. Although about 60 percent of U.S. hospitals receive billions in tax breaks to offer charity care, the lack of promotion of this option – and the resulting low consumer awareness – has become a significant national issue.
As part of the federal requirements of Section 501(r), members who do qualify for low- or no-cost care may receive medical treatment at one of more than 4,000 facilities across the country with fiduciary responsibilities to offer charity care. For members who are above 400 percent FPL, they may be eligible for more than 1,000 pre-negotiated care bundles or other high-quality in-network care.
The impact of healthcare’s rising costs – and the lack of transparency for patients – has become unsustainable. The key to a solution is the creation and adoption of tools that support navigators in collecting members’ financial and demographic information at the onset of navigation and providing education, support and guidance about their care options – a true model of member/patient advocacy. We need to simplify the healthcare journey for members, making it easy for them to receive the best possible care at the lowest cost while staying in network.
To address this need, Vālenz® Health created Care Value Optimizer (CVO) as a unique enhancement to its NaVcare solution for member navigation and advocacy. Leveraging the power of the Valenz Healthcare Ecosystem Optimization Platform to engage data and empower better decision-making, CVO advocates for members by triaging them to charity care, Centers of Excellence care bundles, or high-performance network offerings based on their finances, location, benefits and health profile.
Because every member is different and their needs may change over time, Valenz navigators and nurses conduct ongoing engagement to gain a comprehensive, data-supported view of members’ current needs. Navigators provide insight to the right care options depending on members’ income, health needs and ability to travel for care; and in alignment with the Valenz “Yes, And” culture, navigators also support patients with scheduling, paperwork and other requirements before they see a provider.
CVO enables effective management of the most expensive and complex treatments and procedures, benefiting the member with lower costs, better access to high-quality care, and improved health outcomes. While the member receives advocacy, employers become more empowered to balance quality, utilization and cost of care, reducing claim expense and the overall plan spend. Ultimately, CVO drives smarter, better, faster healthcare for everyone involved.
The “new normal” of a post-pandemic world has had a serious impact on the lives of many members who may find themselves deciding between putting food on the table and getting the healthcare they need. With CVO, the NaVcare Enhanced solution, and all options within the Valenz Healthcare Ecosystem Optimization Platform, self-insured employers and those who support them and their plans can take a significant step toward ensuring members won’t have to face that choice.
About Rob Gelb
Rob Gelb is Chief Executive Officer of Vālenz® Health, which 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.
About Vālenz® Health
Valenz 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.