Vālenz® Acquires Fourth Company: Health Cost Control Enhances Medical Cost Savings Solutions for Employers

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PHOENIX, Ariz. (Sept. 9, 2022) —Vālenz® announced today it has acquired Health Cost Control Inc., a national provider of medical cost containment solutions with more than 25 years’ experience. With specialization in claim and cost review services for high-dollar claims, including dialysis, air ambulance and behavioral health billing, Health Cost Control offers custom-designed programs for health plans, third-party administrators, insurance companies and employers.

The fourth company acquired by Valenz since May 2022, Health Cost Control ensures provider adherence to the national guidelines that govern inpatient and outpatient billing, identifying significant savings from inaccurate billing and incomplete documentation. Health Cost Control registered nurses conduct thorough claim reviews for duplication, unbundling, data entry errors and other discrepancies that often go unnoticed and result in higher costs for employer groups. With deep experience covering most clinical settings and understanding related operational costs, Health Cost Control also has expertise in repricing claims to usual, customary and reasonable levels, often garnering 70%+ savings off billed charges.

“We are very excited to welcome Health Cost Control, their clients and their members to the Valenz family,” said Rob Gelb, Chief Executive Officer of Valenz. “In exploring new opportunities to deliver on our core promise to drive smarter, better, faster healthcare, it was clear that the company is an outstanding fit for Valenz. We have partnered with Health Cost Control since 2021 and know we can seamlessly integrate their offerings into our claim management solutions, providing the transparency necessary to lower total health plan spend, improve claim outcomes, and enhance the member experience.”

The Health Cost Control acquisition further fortifies the Valenz Healthcare Ecosystem Optimization Platform, a fully integrated suite of solutions that simplifies the complexities of self-insurance. To balance the relationship between healthcare quality, advocacy and cost, Valenz aligns the member, provider, health plan and payer, supported by a steadfast commitment to data transparency and decision enablement. Ultimately, Valenz drives value across clinical and member advocacy, network development, and the validation, integrity and accuracy of claims.

“Our two companies are truly aligned in our cost containment approach and our dedication to innovation, advocacy and quality,” said Carl Papp, CLU, Principal and President of Health Cost Control. “As we continue to serve our clients with customized, flexible programs for reducing healthcare costs, we look forward to becoming an integral part of the Valenz ecosystem.”

 

About Valenz

Vālenz® simplifies the complexities of self-insurance by offering an end-to-end Healthcare Ecosystem Optimization Platform that manages the cost and quality of care for employers and their members. To balance the relationship between healthcare quality, advocacy and cost, the Valenz enterprise-level solution suite aligns the member, provider, health plan and payer. Supported by a dynamic, innovation-first culture and a steadfast commitment to data transparency and decision enablement, Valenz leverages its technology infrastructure and enterprise data warehouse to drive value across clinical and member advocacy, network development, and the validation, integrity and accuracy (VIA) of claims. Learn more about how Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.

About Health Cost Control

Health Cost Control, based in Texas City, TX, is a leading national provider of cost containment solutions with over 25 years’ experience. The company was founded with the mission that still holds true today: to reduce healthcare costs for clients and ensure that the national billing guidelines that govern inpatient and outpatient billing are adhered to by providers. With specialization in group health claim review, and drawing from a large range of services, Health Cost Control creates a program tailored to fit your needs and deliver optimum results for lower healthcare costs. Learn more at healthcostcontrol.com.

Vālenz® Announces Acquisition of Certus Management Group and Launch of Medical Stop Loss Insurance Solution

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PHOENIX, Ariz. (Aug. 12, 2022) — Vālenz® announced today it has acquired Certus Management Group Stop Loss, Inc. (CMG), a managing general underwriter providing certainty of stop loss protection to self-funded employee benefit plans since 1998.

CMG will become a Valenz Affinity Company and 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. Additionally, the acquisition creates a new private label medical stop loss insurance solution, launching in market as a Valenz V-Rated solution. This solution enables the more efficient delivery of medical underwriting and risk mitigation services tailored to the needs of Valenz clients. All other CMG underwriting services will continue to be offered under the CMG trade name.

The Valenz V-Rated solution is an additive benefit for self-insured employers who engage with Valenz for a full ecosystem solution, including care management, member navigation enhanced with Care Value Optimizer (charity care and centers of excellence bundles), specialty drug solutions, contracted and open access success networks, and high-cost claim cost containment programs. When partnering with Valenz during the presale process, clients realize the full value of the ecosystem which allows them to contain medical costs more aggressively than less innovative offerings, while also potentially resulting in more competitive stop loss costs.

“We’re thrilled to welcome CMG to the Valenz family,” said Rob Gelb, Chief Executive Officer of Valenz. “Our companies are a great match for each other in their commitment to transparency, risk management, and financial protection from high-cost claims and escalating pharmaceutical and treatment costs. As Valenz continues to evolve and expand, we are excited to begin this new collaboration in delivering on our core promise: engaging early and often for smarter, better, faster healthcare.”

CMG will retain its trade name and adopt a new tagline: “A Valenz Affinity Company,” with a slightly updated logo to facilitate a more rapid association with Valenz. The core team of 18 will continue to remotely support CMG-integrated products and services at its current headquarters in Indianapolis.

“CMG and Valenz share a deep commitment to financial assurance for the self-insured industry, while also advocating for plan members and ensuring high-quality, cost-effective care,” said Brad Lewis, President and Chief Executive Officer of CMG. “As we join the Valenz team, we look forward to protecting and serving our clients as an integral part of their innovative, data-driven ecosystem.”

CMG’s line of stop loss products limits liability and eliminates the pitfalls that many employers view as obstacles to self-funding. It offers plan design and risk analysis, stop loss underwriting, firm renewals, and a guaranteed “no laser” contract for groups of all sizes – for plans of 11 participating employees and larger with specific retention levels from $10,000. CMG’s claim procedures also protect self-funded employers from cash flow issues that can result from unpredictable claim activity.

 

About Valenz

Vālenz® simplifies the complexities of self-insurance by offering an end-to-end Healthcare Ecosystem Optimization Platform that manages the cost and quality of care for employers and their members. To balance the relationship between healthcare quality, advocacy and cost, the Valenz enterprise-level solution suite aligns the member, provider and payer. Supported by a dynamic, innovation-first culture and a steadfast commitment to data transparency and decision enablement, Valenz leverages its technology infrastructure and enterprise data warehouse to drive value across clinical and member advocacy, network development and the validation, integrity and accuracy (VIA) of claims.  Learn more about how Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.

About CMG

Certus Management Group has developed a line of stop loss products that limit the liability of a self-funded employer and eliminate the pitfalls that many employers view as obstacles of self-funding.  With more than 350 years of combined experience in the stop loss business, the CMG staff is among the most qualified in the industry. This experience enables CMG to provide employers with stop loss solutions that bring certainty to their self-funded plan. CMG maintains a strong relationship with two carrier partners, SiriusPoint America Insurance Company (Rated A- (Excellent) by A.M. Best), and Gerber Life Insurance Company (Rated A (Excellent) by A. M. Best). Each carrier shares CMG’s vision of the stop loss marketplace and offers the stability of a well-established insurance company.

Learn more at certusmg.com.

Vālenz® Health Announces the Acquisition of MCM, Expands Care Management and Population Health Solutions

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PHOENIX, Ariz. (July 27, 2022) — Vālenz® Health announced today it has acquired Medical Cost Management Corporation, d.b.a. MCM Solutions for Better Health and its subsidiary, Med-Care Management, Inc, (MCM), a leading provider of managed care and population health management programs spanning the entire continuum of care for self-funded plans. In May, Valenz announced the acquisition of VerifPoint, a credential verification organization today recognized as VPoint™.

As a Valenz company, the combined MCM and Med-Care subsidiary which have served the multi-employer labor space for more than 35 years, will adopt the trade name Valenz Care. Valenz Care offers member and clinical advocacy through concierge navigation and triple URAC-accredited services for care management, disease management and utilization review. The acquisition accelerates the collective ability to deliver data-driven medical cost management and population health management to labor and public entities, as well as commercial customers.

“Valenz continually explores new ways to deliver on our core promise to engage early and often for smarter, better, faster healthcare, and we are thrilled to now deliver that promise to MCM customers and their members,” said Rob Gelb, Chief Executive Officer of Valenz. “The addition of MCM solutions clearly aligns with the Valenz commitment to deliver care optimized solutions that influence member choices prior to costly healthcare decisions being made. Together, we will prospectively – and continually – address member care needs for improved outcomes and cost containment throughout the member’s healthcare journey.”

The partnership with MCM further fortifies the Valenz Healthcare Ecosystem Optimization Platform, an end-to-end, fully integrated suite of solutions that drives value and assures alignment of the member, payer and provider to enable better decision-making, starting long before care is provided and continuing long after a claim is paid.

“We look forward to introducing our customers to the highly innovative Valenz ecosystem and expanding opportunities to provide cost-efficient and comprehensive care management across the health continuum,” said Thomas J. O’Connor, President of MCM. “Our companies share a dedication to serving the self-insured industry, advocating for plan members, and ensuring high quality, cost-effective care, making our partnership a natural fit.”

MCM, a physician-directed company, is URAC accredited in health utilization management and is licensed in all states with requirements. Its solution portfolio also includes chronic disease management, catastrophic care management, a comprehensive health and wellness program, health risk assessments, predictive modeling, and data reporting.

About Vālenz® Health

Vālenz® Health simplifies the complexities of self-insurance by offering an end-to-end Healthcare Ecosystem Optimization Platform that manages the cost and quality of care for employers and their members. To balance the relationship between healthcare quality, advocacy and cost, the Valenz enterprise-level solution suite aligns the member, provider and payer. Supported by a dynamic, innovation-first culture and a steadfast commitment to data transparency and decision enablement, Valenz leverages its technology infrastructure and enterprise data warehouse to drive value across clinical and member advocacy, network development and the validation, integrity and accuracy (VIA) of claims. Learn more about how Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.

About MCM

A pioneer in medical management, Medical Cost Management Corporation, dba MCM Solutions for Better Health, was founded by Michael O’Connor in 1986 to meet the population health management needs of self-funded plans, Taft-Hartley Trusts, associations and claim payers. MCM and its subsidiary Med-Care Management, Inc., provided services to more than 550 plans representing over 600,000 members nationwide. MCM is now part of the Valenz Health family.

Vālenz®, VerifPoint Announce Integration and Launch of Comprehensive Provider Credentialing Solution

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PHOENIX, Ariz. (May 24, 2022) — Vālenz® announced today it has integrated with VerifPoint, an industry-leading Credentialing Verification Organization for health systems, hospitals, providers and health plans. 

The integration of the two companies creates a new solution called Valenz VPoint™, a provider credentialing and continuous monitoring solution that offers effective, diligent credential verification to ensure quality of care for patients and members. As a critical component of the Valenz strategy to assure Validation, Integrity and Accuracy (VIA) for providers, VPoint offers NCQA-certified and URAC-compliant credentialing and re-credentialing solutions. 

In addition, VPoint and Valenz Assurance will combine to enhance VIA Provider Solutions, a comprehensive compliance management solution to improve medical coding efficiency, reimbursement assurance, auditing toolsets, claims accuracy, credentialing, medical staff licensing and exclusion monitoring. 

“We are thrilled to partner with VerifPoint in accelerating our collective ability to deliver data-driven, analytical solutions for credentialing and continuous monitoring,” said Rob Gelb, Chief Executive Officer of Valenz. “With the launch of VPoint, we are poised to support our clients with reduced exposure and facilitate higher-quality care. This is a clear example of how Valenz continually delivers on our promise to engage early and often for smarter, better, faster healthcare.” 

The integration of VerifPoint further fortifies the Valenz Healthcare Ecosystem Optimization Platform, a fully integrated suite of solutions that drives value and assures alignment of the member, payer and provider across all phases of the claim life continuum. While minimizing the opportunity for fraud, waste and abuse, VPoint’s credentialing and monitoring services protect clients from denials, appeals, unpaid claims and penalties associated with employing or paying providers with improper licenses or disciplinary issues. 

“As we join the highly innovative Valenz ecosystem, we are well positioned to accelerate growth and value for clients together,” said Asim Ashary, CEO and President of VerifPoint. “The two companies share a deep commitment to meeting client-specific needs while proactively anticipating the constant changes in technology and the healthcare industry. We look forward to the next steps toward an exciting future as one united company.” 

About Valenz 

Vālenz® 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. To balance the relationship between healthcare quality, advocacy and cost, the Valenz approach aligns the member, provider and payer. We deliver this synergy through a strong foundation with deep roots in clinical and member advocacy, alongside decades-long expertise in claim reimbursement and payment validity, integrity and accuracy. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for you and your members, Valenz engages early and often for smarter, better, faster healthcare. Valenz, ranked two years in a row on Inc. 5000, is backed by Great Point Partners.

About VerifPoint 

A Credentials Verification Organization based in Lake Forest, Calif., VerifPoint offers easy and customizable medical credentialing solutions and provides highly affordable, timely and accurate healthcare practitioner information. Our vision is to be the leading service provider for medical credentialing by providing optimum and best system solutions that are fully adaptable to meet the special needs of clients while keeping pace with the ever-changing needs of technology and the healthcare industry. Fully certified by NCQA, VerifPoint provides primary source verification that meets industry and regulatory standards such as NCQA, TJC, URAC, CMS and AAAHC. 

Vālenz Announces Acquisition of Kozani Health

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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 and bill review sign-off 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

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