Portrait of Maurice Steenland, Vice President, Strategic Enablement at Vālenz

Maurice Steenland Joins Vālenz Leadership Team

As Vice President, Strategic Enablement, Steenland appointed to accelerate value for Valenz clients

PHOENIX, Ariz. (April 9, 2021) — Vālenz® is pleased to announce the appointment of Maurice Steenland as Vice President, Strategic Enablement.

In his new role, Steenland will be responsible for synchronizing departments to accelerate strategic initiatives that bring greater value to Valenz clients, fulfilling the company’s strategic vision and mission. He will continue to drive the expansion of the firm’s data engagement solution, v-Lens, to advance predictive modeling, data-driven decision enablement and transparency across the ecosystem.

“We are excited to welcome Maurice to this key strategic role on our senior leadership team,” said Rob Gelb, Chief Executive Officer of Valenz. “With deep expertise in uncovering operational efficiencies and enabling data and analytics to inform better decisions, Maurice is an excellent fit for the Valenz team. His highly strategic and analytical approach will no doubt add higher levels of transparency across our data-driven ecosystem to deliver smarter, better, faster healthcare.”

Steenland brings 20-plus years in executive roles for health-related organizations. Most recently, he was principal consultant for SISIX, LLC after serving as Vice President, Informatics for Optum, where he managed the Informatics and advanced analytics and data science teams that developed client outcomes reporting, predictive tools and methods to identify emerging risk and cost containment programs.

Steenland also has held leadership positions at CIGNA Healthcare, Coventry Health Care and Intracorp, with specialization in operations, utilization management, strategy and business development. He earned his master’s in business administration from the prestigious Wharton School of the University of Pennsylvania.

“I’m thrilled to join such a future-focused team at Valenz and have the opportunity to pave the way toward quality, utilization and cost transformation through transparency, efficiency and data-driven solutions,” Steenland said. “As we combine analytics-driven approaches with influencing skills to drive change and efficiencies, I look forward to providing greater savings and solutions for our clients in the self-insured industry.”

 

About Valenz

Vālenz® 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 connects cost and quality data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim), complete bill review (Valenz ProteKHt), and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) for smarter, better, faster healthcare. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

Vālenz Announces Acquisition of Kozani Health

Kozani Health integrates as ValenzProteKHt™ for complete and comprehensive bill review solution

PHOENIX, Ariz. (April 1, 2021) — Vālenz® announced today it has acquired Kozani Health, integrating a new and innovative means for self-funded employers and the self-insured community to control costs across the life of a claim.

Kozani Health, which provides customized solutions to meet the challenges of paying medical claims appropriately, joins the ever-expanding Valenz ecosystem of data and solutions as Valenz ProteKHt™. The new solution offers detailed line-by-line bill reviews performed by nurses, certified coders and practicing specialists to uncover inappropriate billing and care provided.

With success rates averaging 70 percent, Valenz ProteKHt is the industry’s recognized comprehensive and complete bill review solution. Valenz ProteKHt offers clear, defensible, transparent and plan-specific reviews that deliver savings of 10-30 percent above the PPO allowable with a signed contract, agreed upon and authorized by the provider.

“We are excited to welcome Kozani Health as part of our data-driven Valenz ecosystem,” said Rob Gelb, Chief Executive Officer. “By bringing our teams together, we are providing self-funded employers and the self-insured community improved cost savings at each step in the life cycle of a claim, strengthening their ability to realize every opportunity to balance cost, quality and utilization under the Claim Cost ArcSM. Our solutions aside, which clearly align value for all, our cultures and the commitment to customer service and ‘customer love’ will be a continuing defining characteristic of our now, collective success.”

Valenz is focused on changing the trajectory of healthcare expenses, creating new opportunities for self-insured employers to control costs while empowering members to lead strong, vigorous and healthy lives. Valenz delivers a 20-40 percent improvement in savings from traditional health plan approaches by bridging the divide between robust analytics, care management, high-value provider networks, payment integrity and claim management.

“We are energized to begin our company’s next chapter as Valenz ProteKHt,” said Michael Scott, Chief Executive Officer and Co-Founder of Kozani Health. “Integrating our claim management solutions into the Valenz ecosystem will accelerate the growth and evolution of our services and bring value to our customers.”

“With this integration, we assure clients they will experience the same close partnership and personal attention as they have with Kozani Health,” said Heather Wilson, Chief Operating Officer and Co-Founder of Kozani Health. “Now, we can also offer the benefit of being part of the Valenz ecosystem. Together, we are committed to nurturing the same ‘customer love’ that has made Kozani Health a symbol of success in the market.”

 

About Valenz

Vālenz® 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 connects cost and quality data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim), complete bill review (Valenz ProteKHt), and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) for smarter, better, faster healthcare. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

About Kozani Health

Kozani Health, headquartered in Mesa, Ariz., provides customized bill review sign-off and bill audit solutions to analyze pricing, coding and care provided to ensure appropriate payment. Since its inception in 2015, Kozani Health has forged long-term customer relationships and continuously improved solutions to solve customer challenges.

About Great Point Partners

Great Point Partners, founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm with approximately $1.3 billion of equity capital currently under management and 28 professionals, investing in the United States, Canada, and Western Europe. GPP is currently making new private equity investments from GPP III, which has $307 million of committed capital. Great Point manages capital in private (GPP I, $156 million and GPP II, $215 million of committed capital, and GPP III) and public equity funds. Great Point Partners has provided growth equity, growth recapitalization, and management buyout financing to more than 200 growing healthcare companies. The private equity funds invest across all sectors of the healthcare industry with a particular emphasis on biopharmaceutical services and supplies, pharmaceutical infrastructure, alternate site care, medical device and information technology enabled businesses. The firm pursues a proactive and proprietary approach to sourcing investments and tuck-in acquisitions for its portfolio companies. Reach Great Point at 203-971-3300 or www.gppfunds.com

Vālenz CaptiV: Reduce Risk, Gain More Control of Your Health Plan Spend

As health care costs rise exponentially, self-insured employers are facing greater risks of high-dollar claims. Recognizing the significant risk-reduction advantages and cost-effectiveness of combining employer plans in a medical stop loss (MSL) group captive program, Vālenz® has launched CaptiV to solve the challenges market volatility can pose for small to medium-sized employers.

Valenz CaptiV goes beyond risk sharing to provide a fully integrated, data-driven model for cost and risk reduction. By bringing together employers that are committed to managing their medical costs while improving health outcomes – and equipping them to engage early and often via its end-to-end analytics platform – Valenz CaptiV represents the next generation of MSL group captives.

“We operate at the center of the MSL group captive, actively engaging the group of employers and their employees in our proprietary ecosystem of data and service solutions,” said Rob Gelb, Chief Executive Officer of Valenz. “Our analytic and predictive capabilities uncover new strategies to drive a 20-40 percent improvement in savings by targeting the high-dollar claims that drive the majority of health plan spending. We continually integrate those learnings among Valenz CaptiV members to reduce the potential for catastrophic claims and create value for everyone.”

For self-insured employers with fewer than 1,000 employees, Valenz CaptiV leverages a larger and more diverse population to reduce plan level and catastrophic risk, while delivering exceptional cost-reduction strategies, increased underwriting credibility, and long-term rate stability.

“For captive members, our ecosystem offers unparalleled data-driven collaboration. from pre-claim loss to post-claim resolution,” said Gelb, explaining, “Valenz solutions build on one another, providing actionable information at each step in the life cycle of a claim.”

To accelerate its captive offerings, Valenz partnered with MSL Captive Solutions, the industry’s only platform dedicated to the development and delivery of comprehensive services exclusively for MSL captives. MSL Captive Solutions works with top insurance carriers and claims administrators to deliver market-leading results for Valenz CaptiV members.

“Properly structured group captives have proved to reduce costs and increase plan stability by effectively managing, diversifying and broadly diffusing risk,” said Phil Giles, Managing Director of MSL Captive Solutions. “By taking a discerning approach to membership and enabling more active, data-driven risk management, Valenz CaptiV promises superior performance.”

Together, the firms offer more strategic, proactive risk control and cost-reduction decision-making. And, as costs are contained, Valenz CaptiV members share in the profitability of the program.

For more information on Valenz CaptiV, call (866) 762-4455.

 

About Valenz

Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

 

About Great Point Partners

Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds.com.

 

About MSL Captive Solutions, Inc.

MSL Captive Solutions is the industry’s only platform devoted exclusively to the development of comprehensive (re)insurance solutions for group and single-parent medical stop loss captives.

MSL Captive Solutions provides consultative underwriting support to some of the industry’s leading stop loss carriers and operates independently to work with all qualified brokers, consultants, and captive managers. For more information visit www.mslcaptives.com.

 

Portrait of Randy Dorshorst, Vice President, Ecosystem Success at Vālenz Portrait of Patty Onion, Vice President, Claims Operations at Vālenz

Vālenz Appoints Dorshorst, Onion to Leadership Team

New Vice Presidents Poised to Enhance Data-Driven Solutions, Cost Savings and Operational Excellence

PHOENIX, Ariz. (December 4, 2020) — Vālenz™ is pleased to announce the appointments of Randy Dorshorst and Patty Onion to the leadership team.

Dorshorst has joined Valenz as Vice President, Ecosystem Success, to advance the innovation behind the company’s health administrative ecosystem, combining data analytics with care service delivery to minimize claims costs for the self-insured industry and promote quality care.

“We are thrilled to welcome Randy to our senior team to oversee the continuing success of our product, data and client program solutions,” said Rob Gelb, Chief Executive Officer. “Randy offers 30 years of expertise in driving growth, technology and value through custom solutions, which makes him an outstanding fit to lead Valenz in the purposeful expansion of our ecosystem.”

Most recently, Dorshorst served as Vice President for AViDEL Medical Management in Irving, Texas. With his comprehensive leadership and management skills, he directed the successful launch of AViDEL as a sister company to Service Lloyds Insurance Company, where he was Vice President for Medical Management Service. Dorshorst also has held executive positions at HealthSmart Casualty Claims Solutions, Web TPA and CorVel Corporation.

Onion, who has more than 30 years’ experience in workers’ compensation, medical cost containment and managed care, joins Valenz as Vice President, Claim Operations.

“Patty’s proven success in setting strategic direction and implementing managed-care platforms and services makes her uniquely well-positioned for this role,” said Amy Gasbarro, Chief Operating Officer of Valenz. “She brings tremendous expertise in claim operations and process improvements that will help us go even farther to drive results for our clients and offer the highest possible level of service.”

Onion most recently served as principal for Milana Health Systems in Kansas City, Mo., specializing in workers’ compensation managed-care consulting. She was CEO of Berkley Medical Management Solutions and has held executive roles with numerous health-related companies including Coventry Health Care, Premera Blue Cross and Mercy Health Plan.

“I have been fortunate to know Patty and Randy for years, and most recently we have benefited from their guidance and counsel as consultants to Valenz,” Gelb said. “Today, I couldn’t be happier to have them on board full time, as they both bring outstanding leadership and deep expertise that will empower us to further deliver on our promise of smarter, better, faster healthcare.”

 

About Valenz

Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim), and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

 

About Great Point Partners

Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds.com.

The Effects of COVID-19 on Chronic Disease Management – and Five Solutions Insurers Should Embrace

This article is second in our series examining the long-term impact of COVID-19 on health and healthcare issues for the self-insured industry.

Chronic conditions are the leading cause of death in the United States, as well as the primary driver of our $3.5 trillion annual healthcare costs. Long before COVID-19 hit, providers, payers and self-insured employers grappled with the challenge of ensuring that patients with chronic illnesses receive effective care.

Recent surveys indicate many patients have put their chronic care needs on hold during the pandemic, potentially leading to more expensive scenarios in the future. Consider these findings from a recent survey:

  • Seven in 10 patients reported a negative impact on their ability to manage their high-risk conditions due to COVID-19, with one in four expressing a high impact.
  • One in three patients reported a reluctance to leave their homes for treatments, with 70 percent sharing they were more worried than usual about their health at this time.
  • Less than 40 percent of respondents felt prepared to manage their health during COVID-19, with more than half expressing concern they would lose access to essential care.
  • More than one in 10 patients reported they were unable to receive their medication.

Even with heightened safety precautions that have made office visits and routine care widely available again, many patients have been slow to return – especially for people with long-term conditions like asthma, heart disease and diabetes, who are at significantly higher risk of severe illness from COVID-19.

As the health industry adapts to consumerism by adapting care deliver to meet the evolving needs of consumers, so too must payers and self-insured employers. Here are five solutions that take significant steps towards improving service and care for chronic disease patients during the pandemic and potentially beyond:

1: Telehealth and virtual care

Expanded telehealth access has been the key component of the rise of virtual care utilization, allowing care continuity while all parties maintain physical distancing. Combined efforts by the federal government, individual states, private insurance companies and self-funded groups have facilitated telehealth as a viable care option during the pandemic, lowering regulatory barriers that had limited its use and the reimbursement of services. According to the American Medical Association, physician telehealth adoption is now estimated at 60-90 percent.

In addition, a survey by Accenture in July 2020 reported that providers were largely able to maintain or even improve on the patient experience with virtual care technology, which also includes live video, audio and instant messaging. With 41 percent of respondents taking advantage of virtual tools – the majority of them for the first time ever – patients reported more personal interactions, faster response times, and the convenience of managing care from home. Virtual care and telehealth are proving especially useful for chronic disease patients in rural and remote areas.

2: Patient-centric care navigation

For self-insured employers, brokers and third-party administrators, care-coordination solutions like NaVcare help members navigate their health journey more effectively, delivering personalized service and guidance for high-quality care and improved outcomes. Real-time data-driven insights, combined with in-depth health plan knowledge, are critical for identifying patients with complex, chronic conditions. Providing those patients with comprehensive care management helps avoid more serious and costly health events.

Informed by data – including claim, pharmaceutical and demographic data –NaVcare tailors services to each employer and illuminates individual care needs for members. Care navigators facilitate virtual care when available for enhanced patient convenience and engagement as well.

3: Behavioral health integration

People with chronic diseases are more likely to experience depression or behavioral issues as they often face impaired mobility and loss of independence. According to the Center for Medicare Advocacy, 43.8 million U.S. adults struggle with mental illness each year, and 26 percent of those are Medicare beneficiaries – a population that is highly vulnerable to the effects of isolation, increased stress and more limited access to regular care, even before the pandemic.

Traditionally, the care delivery models to address physical and behavioral health have been independent  of each other. More and more, providers and health organizations are acknowledging the significant correlations between physical and mental health, turning to integrated care solutions that treat the whole person and deliver improved outcomes with lower costs  – up to 10 percent savings in the nation’s overall healthcare expenses, according to the American Psychiatric Association.

4: Prescription cost management

Following a national trend that has continued for the past decade, costs have risen for chronic disease medications and depression/anxiety drugs during the pandemic, with total prescription spend predicted to reach $610 billion in 2021. Before COVID-19, one in three Americans did not take their medications as prescribed because of high costs, but during a global pandemic, forgoing medications involves even more risks for chronic care patients and incurs even higher costs in the long run.

Cost-containment solutions for self-insured employers, brokers and third-party administrators include a range of PBM solutions and specialty medication case management services. Such solutions create long-term reductions in medication spend while passing on lower costs to members and delivering highly personalized case management services and advocacy.

5: Remote patient monitoring

Recent studies connecting COVID-19 to long-term heart and lung damage, among other serious conditions, accentuate the benefits of remote monitoring technologies for high-risk patients. As it tracks and transmits vital signs in real time, remote patient monitoring allows providers to regularly check pulmonary function, blood pressure, body temperature and other physiology for proactive management of changes in disease progression.

A joint report from AHIP, the national association of America’s Health Insurance Plans, and C-TAC, the Coalition to Transform Advanced Care, concludes that remote patient monitoring is among the most efficient and effective tools available to manage chronic disease — particularly in older patients with diabetes, heart failure, and chronic obstructive pulmonary disease.

Solutions for today and tomorrow

Patients with chronic illnesses are more vulnerable to some of COVID-19’s most significant threats. As the global health crisis continues to present new challenges in treating patients with long-term conditions, it also has opened up new opportunities. It is exciting to be part of the evolution of solutions that will serve patients well beyond the pandemic – showing us all the next level of smarter, better, faster healthcare.

***

Rob Gelb is Chief Executive Officer of Vālenz™, one of the nation’s leading data-driven, medical cost containment and care management organizations offering expanded solutions to support the self-insured industry.

About Valenz

Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

About Great Point Partners

Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds.com.

Vālenz™ Access Assured: An Integrated, Dynamic Approach to Reference Based Pricing

PHOENIX, Ariz. (Oct. 15, 2020) – Employers and private health plans pay hospitals nearly 2.5 times more than Medicare, according to a recent study by the RAND Corporation. And while employers and their members pay more each year, researchers found no strong link between hospital pricing and healthcare quality or safety ratings. To manage rising medical costs while improving health outcomes, self-insured employers need solutions which definitively balance the cost-quality equation.

To answer that growing need, Valenz Assured Access provides an integrated, dynamic approach to reference based pricing. As the innovators behind a comprehensive ecosystem designed to effectively bend the Claim Cost Arc℠ for payers and improve patient experiences for members, Vālenz™ has established a next generation RBP model that integrates deep analytical insights with member-centric services while collaborating with providers and payers to ensure transparency.

Using the proprietary VMS℠ Repricing Methodology, Valenz Access Assured blends payment, cost and charge data sets to produce reimbursement recommendations that are fair, defensible, transparent and consistent for everyone.

“VMS recognizes that not all Current Procedural Terminology (CPT) codes or services delivered in healthcare have a Medicare rate, so we incorporate two additional data sources – paid claim data and Usual, Customary, Reasonable (UCR) data – to provide a more structured and defensible reimbursement recommendation,” said Rob Gelb, Chief Executive Officer. “When leveraging these sources of data, we offer our customers a more robust and well-rounded view of reasonable reimbursement levels.” Supporting a consistent and substantiated reimbursement model not only reduces costs, Gelb explained, it reduces friction among the payer, provider and patient.”

With Valenz Access Assured, member-centric coordination begins at the outset of care, where dedicated care navigators serve as the central point of contact for all stakeholders. Through NaVcare, members receive concierge-level guidance as well as the URAC-accredited care management services of Valenz Care. As a result, members are guided toward high-quality care and empowered to make better health decisions that control costs, improve health outcomes and elevate the member experience.

Provider collaboration also starts before care delivery. The Valenz Assured Access team engages providers and facilities in pre-service negotiation to procure contractual agreements before services are rendered, creating transparency of cost and eliminating the risk of balance billing. From there, a Valenz contracting expert works to secure a long-term agreement, continually supporting the plan and members through high-value network development and expansion, direction of care and high-quality provider utilization.

When contracting is not an option and a provider appeals reimbursement levels, Valenz Assured Access protects the member and the plan with comprehensive support, including negotiations with the provider and legal advocacy.

“We designed all program components with the member in mind, following our guiding philosophy that everyone who engages with the Valenz ecosystem should be strong, vigorous and healthy,” said Amy Gasbarro, Chief Operating Officer. “Ease of access to high-quality providers, appeal support, development of new provider agreements and next-generation pricing models – these approaches integrate seamlessly to deliver on our core promise: engaging early and often for smarter, better, faster healthcare.”

About Valenz

Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

About Great Point Partners

Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds.com.

Vālenz™ NaVcare Delivers Data-Driven Care Navigation, Improves Network Utilization, Member Satisfaction and Health Outcomes

PHOENIX, Ariz. (Sept. 25, 2020) – As part of its triple-URAC-accredited Vālenz Care suite, Valenz has announced the launch of NaVcare, a concierge-level care navigation program that combines data with service delivery to improve utilization, member satisfaction and health outcomes. Based on intelligence from multiple sources within the Valenz ecosystem – including claim, pharmaceutical and demographic data – NaVcare is tailored to each employer with personalized services for each health plan member.

“We place the patient at the center of care, starting with high-touch member onboarding to empower individuals in making better healthcare decisions, improving outcomes and enhancing their experience,” said Amy Gasbarro, Chief Operating Officer. “Working one-on-one with plan members, our care navigators provide expert knowledge of the health plan, care plan and provider network to guide members toward high-quality, low-cost care and medication.”

NaVcare brings member-centric services and data-driven insights into the patient journey, connecting the dots for smarter, better, faster healthcare. NaVcare navigators serve as a central hub for care coordination, providing personalized education, collaboration and communication.

“When integrated with the full Valenz ecosystem, real-time intelligence allows us to target the 5-15 percent of claims that drive 70 percent of an employer’s health spend,” explained Rob Gelb, Chief Executive Officer. “By integrating the high value network design of Vālenz Access with care navigation, Valenz is helping our clients achieve up to 85 percent in-network participation within 12 months, resulting in significant plan and member savings.”

For more information, call (602) 792-5371.

About Valenz

Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

About Great Point Partners

Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds.com.

V3 Repricing Engine: Fueled by Big Data to Ensure Fair, Market-Supported Reimbursements

PHOENIX, Ariz. (Sept. 14, 2020) – To accelerate fair and accurate claim repricing and ensure market-supported reimbursements, Vālenz™ has introduced the V3 Repricing Engine. Fueled by the volume, variety and velocity of data within the Valenz ecosystem, V3 supports strategic decision-making and creates value for the payer, the provider and the patient.

The V3 Repricing Engine can identify patterns and pinpoint high-performing providers with optimal cost structures, along with delivering greater efficiency and reduced turnaround times for processing and payments. Ultimately, it ensures savings on professional claims, which account for up to 85% of claim volume for self-funded insurers.

Aggregating years of robust claims data with industry-leading sources, the V3 Repricing Engine uses the proprietary, data-rich VMSSM Repricing Methodology to determine fair, defensible claim reimbursements. Its detailed analysis goes further to identify potential program pain points and opportunities for additional savings. For integrity and timeliness, VMSSM continuously scrubs and adjusts the data as needed to ensure a fair market price for all services rendered, while identifying potential fraud, waste and abuse.

“As we continue to identify solutions that control costs while serving the member and helping the employer, the V3 Repricing Engine is one more way we fulfill our promise of better, smarter, faster healthcare,” said Rob Gelb, Chief Executive Officer of Valenz. “The proprietary algorithms of our VMSSM Repricing Methodology provide actionable insights to support a consistent and substantiated reimbursement model, reducing friction among the payer, provider and patient.”

Curating from multiple data sets to offer up-to-date, regionally specific reimbursement recommendations, the V3 Repricing Engine is fueled by the three Vs of big data:

  • Volume: Years of historical paid claims data
  • Variety: Numerous geographical, medical and claim data elements
  • Velocity: Up-to-date information using real-time insight

“While the V3 Repricing Engine applies to all medical claims, it maximizes discounts for high-volume, low-dollar claims – an overlooked segment in the market to increase value for self-funded plans,” said Amy Gasbarro, Chief Operating Officer of Valenz. “This approach to repricing reduces the cost of healthcare for all parties involved.”

About Valenz

Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

About Great Point Partners

Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds.com.

New Front Door to Care: Telehealth is Here to Stay

This article is first in a series examining the long-term impact of COVID-19 on health and healthcare issues for the self-insured industry.

As the COVID-19 pandemic has restricted patients’ access to their physicians, the use of telehealth has grown exponentially in 2020 – and we may be only scratching the surface of its role in the future.

So far this year, virtual care visits have reached more than 1 billion, with 500,000 for COVID-19 – an increase of 64.3 percent, according to a recent analysis by Frost & Sullivan. Telehealth’s $3 billion revenue market has the potential to grow to $250 billion, according to McKinsey & Company. Consumers have been 1.6 times more likely to use telehealth after their first experience, so an increasing number of providers are offering it – 53 percent more than before the pandemic began.

Telehealth’s unprecedented rise has captured the attention of public policymakers as well. On August 3, President Trump signed the Executive Order on Improving Rural and Telehealth Access, which extends the availability of virtual care benefits for Medicare beneficiaries during the pandemic. The order, which calls for permanent expansion, accentuates that telehealth may become a lifeline in rural areas with more limited access to in-person care. With multiple telemedicine bills brought to the House and Senate this year, there is broad bipartisan support for Congress to pass legislation that would keep coverage in place.

For self-insured employers, brokers and third-party administrators, the growing emphasis on telehealth facilitates early engagement with members in diagnosing and treating conditions, as well as disease management for chronic care patients. The convenience of telehealth allows members to take charge of their health and promotes care continuity for long-term wellness. Additionally, the surge in telehealth adoption will open up opportunities to better serve members with other virtual care models, such as remote patient monitoring, texting, digital symptom checkers, and online health coaches.

Member demand for virtual care is undeniable. Frost & Sullivan estimates that the U.S. telehealth market will display staggering seven-fold growth by 2025. Surveys this year by McKinsey & Company indicated that providers are seeing 50 to 175 times the number of patients via telehealth than before COVID-19. Of the survey respondents, 76 percent were highly or moderately likely to use telehealth going forward, and 74 percent of telehealth users reported high satisfaction.

Although in-person doctor visits are unlikely to become a thing of the past, telehealth is here to stay. Signs point to its continued growth as a key healthcare delivery tool for the next 12-18 months – until a vaccine becomes widely available – and beyond. For members, telehealth services can offer the benefits of more accessible care, minimized exposure and health risks, ease of use, and improved patient outcomes – the fruits of our labor to reimagine care.

***

Rob Gelb is Chief Executive Officer of Vālenz™, one of the nation’s leading medical cost reduction and claims flow management organizations offering expanded solutions to support the self-insured industry.

Vālenz Ranks No. 2065 on Inc. 5000 List of Fastest-Growing Private Companies

PHOENIX, Ariz. — Inc. magazine today announced that Vālenz™ ranks No. 2065 on the annual Inc. 5000 list, the most prestigious ranking of America’s fastest-growing private companies. The Inc. 5000 list represents a unique look at America’s most successful independent small businesses. Over the years it has included such leading-edge organizations as Microsoft, Vizio, Intuit, Oracle, Zappos.com and many others.

“We are honored to be recognized as one of the fastest-growing companies in America, and it reinforces what our clients already know – that controlling health plan costs, serving the plan member and helping the employer group are all connected,” said Rob Gelb, Chief Executive Officer at Valenz. “Our rapid growth is a function of everything we do to control costs, deliver quality, and create new paths of opportunity for employers, TPAs, and brokers to improve plan design, reduce plan spend, and enhance member lives.”

Moving forward, the company is poised for future growth. As the innovators behind an ecosystem that combines health data analytics with healthcare service delivery across the entire lifecycle of every claim, Valenz is laser-focused on changing the trajectory of healthcare costs – which they call lowering the Claim Cost Arc℠ – for the self-insured industry. Data and information flow through the Valenz ecosystem from the company’s core products, clients, platform partners and industry sources, and in doing so, it fuels ever-expanding analytic and predictive capabilities. That data-driven decision enablement, coupled with member- and client-centric service delivery, creates continuous value for every individual and organization within the ecosystem.

“If you are excited about what Valenz has accomplished for your business in the three years since we first envisioned our ecosystem, you will be very pleased with what the future holds,” said Gelb. “By engaging early and often for smarter, better, faster healthcare, we are continuously creating new opportunities for self-insurers to target the small percentage of claims that drive their majority of health plan costs.”

“From health and software to media and hospitality, the 2020 list proves that no matter the sector, incredible growth is based on the foundations of tenacity and opportunism,” said Inc. editor-in-chief Scott Omelianuk. Together, the companies in the 2020 Inc. 5000 achieved three-year average growth of more than 500 percent and a median rate of 165 percent, with aggregate revenue accounting for more than 1 million jobs in the same time frame. Complete results of the Inc. 5000 can be found at www.inc.com/inc5000.

About Valenz

Through a complete health administrative ecosystem, Valenz connects cost and quality data on a single-source, end-to-end analytics platform for smarter, better, faster healthcare. Valenz solutions integrate data from comprehensive care management services (Valenz Care), high-value provider networks (Valenz Access), claim flow management (Valenz Claim) and solutions for payment integrity, revenue cycle management and eligibility compliance (Valenz Assurance) into the ecosystem. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

About Great Point Partners

Great Point Partners (“GPP”), founded in 2003 and based in Greenwich, CT, is a leading healthcare investment firm, currently with approximately $1.8 billion of equity capital under management and 28 professionals, investing in the United States, Canada and Western Europe. Learn more at www.gppfunds.com.

About Inc. Media
The world’s most trusted business-media brand, Inc. offers entrepreneurs the knowledge, tools, connections, and community to build great companies. Its award-winning multiplatform content reaches more than 50 million people each month across a variety of channels including websites, newsletters, social media, podcasts, and print. Its prestigious Inc. 5000 list, produced every year since 1982, analyzes company data to recognize the fastest-growing privately held businesses in the United States. For more information, visit www.inc.com.