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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.
PHOENIX, Ariz. (June 3, 2022) — Vālenz® announced today it is the Title Sponsor of the 42nd annual Self-Insurance Institute of America (SIIA) National Conference & Expo this fall – an event that will be even more special because the conference will be held in the Valenz hometown of Phoenix and is fully in-person for the first time in three years.
Scheduled for Oct. 9-11 at the JW Marriott Phoenix Desert Ridge Resort & Spa, the SIIA National Conference & Expo is the world’s largest self-insurance event, offering educational programs, meaningful insights and game-changing solutions on the latest industry topics.
“Our sponsorship of the SIIA National Conference this year will bring Valenz full circle,” said Rob Gelb, Chief Executive Officer of Valenz. “We launched the Valenz ecosystem at the national conference in October 2019, which was the last time it was held in person before the pandemic. Three years later, we are celebrating being together again and unveiling the fully integrated Healthcare Ecosystem Optimization Platform. It is a tremendous honor to now say thank you to the SIIA community through the Title Sponsorship in our hometown. We can’t wait for October.”
Valenz has been a Diamond Member of SIIA since 2020, which signifies the highest level of support for SIIA’s mission and demonstrates a leadership position in serving the needs of the self-insurance community.
“We were very excited to announce Valenz as the Title Sponsor for this year’s conference,” said SIIA President & CEO Mike Ferguson. “Not only have they been a great supporter of the organization, but they also are an industry innovator in healthcare cost containment solutions for so many of our members involved with self-insured health plans and captives. With Valenz’s support, we expect Phoenix to be a wonderful host city for our biggest event of the year.”
Gelb will facilitate an “Engagement Accelerator” session at the conference called “Selling in the Self-Insurance Market,” which will address the acceleration of change, the challenges of staffing and other industry developments that may shift the mind of the buyer in the self-insurance value chain. Participants will share their experiences and strategies on how to work most effectively to support the self-insurance industry buyers while achieving corporate growth objectives.
Registration for the conference – along with links to the daily schedule, session topics, speakers, FAQs and more – is available at https://www.siiaconferences.org/2022/register_now.cfm.
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 is backed by Great Point Partners. More information is available at valenzhealth.com.
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
The COVID-19 pandemic has had unprecedented impact on healthcare’s delivery, consumption and expense. While the use of virtual care has skyrocketed, 20 percent of U.S. households reported delaying care for serious problems during the pandemic, which can lead to major complications and catastrophic claims.
It is more important than ever for self-insured employers to have strategies in place that ensure their members are getting the right care, at the right time, from the right providers.
Vālenz® hosted a roundtable discussion focused on how the next generation of reference-based pricing programs focus on active collaboration between all parties to improve health outcomes while ensuring transparency.
Watch as Valenz CEO Rob Gelb and Adam V. Russo, Esq., Co-Founder and CEO of The Phia Group, discuss how innovative reimbursement strategies can bring balance to the quality-utilization-cost equation.
You will learn how the next generation RBP model integrates deep analytical insights with member-centric services to:
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