PHOENIX, Ariz. (April 14, 2023) — Certus Management Group (CMG), a Vālenz® Health Affinity Company, details the role of enhanced transparency in helping self-insured health plans deliver member care with greater cost savings and improved health outcomes in its recently released white paper, “Transparency and Fiduciary Responsibility.”
The Transparency in Coverage rule and No Surprises Act, which took effect in 2022, aim to protect consumers from surprise medical bills by requiring providers and plans to make certain information publicly available so consumers realize total costs of care from the start of the healthcare journey.
While many members still struggle to understand costs before services are rendered, health plans are committed to making full transparency possible, according to Steve Butz, Senior Vice President of Business Development for CMG. In fact, the plan’s fiduciary responsibility is to act in the best financial interest of whom it serves. Because a self-funded plan must pay only reasonable plan expenses, transparency in healthcare illuminates the data and financial information plans need to effectively evaluate all claims received.
“Transparency is essential to everything a health plan does – expanding networks, selecting high-quality and low-cost providers, navigating members across the healthcare journey, and the appropriate payment of claims,” Butz said. “With as many as 80 percent of hospital bills containing errors, it is critical for the plan sponsor to mitigate these errors and understand how its fiduciary responsibility prohibits the reimbursement of claims resulting from errors or abusive charges. That’s how we arrive at the right decisions for lowering overall medical costs, improving health outcomes, and driving better member experiences.”
CMG, a managing general underwriter providing certainty of stop loss protection to self-funded employee benefit plans, was acquired by Valenz Health in 2022 and is part of the Valenz Healthcare Ecosystem Optimization Platform, a fully integrated suite of solutions that simplifies the complexities of self-insurance through data transparency and decision enablement throughout the life of a claim.
Read the full white paper here.
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 the validation, integrity and accuracy of claims, and a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan and member. By leveraging data transparency and delivering an omnichannel approach across the healthcare journey, Valenz improves cost, quality and outcomes for employers and their members – engaging early and often for smarter, better, faster healthcare.