Valenz uses proven, proprietary repricing methodology to protect from surprise out-of-network billing

PHOENIX, Ariz. (December 23, 2021) — To help self-insured employers comply with requirements of the No Surprises Act (NSA) – and to protect plan members from sky-high surprise medical bills for out-of-network emergency air transport – Vālenz^® has rolled out a new VMS™-validated solution within its ever-expanding ecosystem. The air ambulance solution creates a defensible qualified payment amount (QPA) for air ambulance services using Valenz’ proprietary repricing methodology. The result is fair pricing that assures a uniform level of protection for out-of-network air ambulance services.

“Recognizing that the January 1 requirements of NSA have a lot of employers chasing new solutions popping up in the market, we want Valenz clients to rest assured that the repricing methodology behind the Valenz air ambulance solution is completely tried and true,” said Rob Gelb, Chief Executive Officer. “In keeping with our long-standing commitment to transparency and balance billing protections, we are thrilled to apply our proven repricing methodology to combat runaway costs for emergency care, including air transport.”

The need is real – and dire. Over the last decade, the median billed charges for air ambulance services have doubled and even tripled (depending on the provider), with a staggering 71% of all air ambulance rides involving an out-of-network charge. As a result, the average cost for an air ambulance has soared to $50,000-$75,000 for helicopter and fixed wing transports, respectively.

By embedding its market-sensitive repricing methodology into air ambulance claim and cost review, Valenz is well ahead of the curve, said Gelb. “While others are working to develop new solutions, Valenz has always used this innovative repricing methodology to lower costs, enhance care and improve outcomes through quality-first care delivery – now we’ve just extended it to air ambulance. It’s all part of our promise to engage early and often for smarter, better, faster and more transparent healthcare.”

For more information about Valenz and how the Valenz ecosystem supports NSA compliance and balance billing protections, visit valenzhealth.com/nsa.

About Valenz

Valenz 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 offers transparency through data to pinpoint members at highest risk, address gaps in network designs, ensure appropriate and accurate charges, and expertly navigate employees to optimal care solutions for substantial cost savings and improved health outcomes. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

Valenz repricing methodology mitigates risk of payment disputes

PHOENIX, Ariz. (December 10, 2021) — In response to “growing and unnecessary concern” about Independent Dispute Resolution (IDR) requirements that begin Jan. 1, 2022, under the No Surprises Act (NSA), leaders at Vālenz^® are reaching out with assurance to clients that they already have proven tools to mitigate and even eliminate the need for IDRs.

Under the NSA, if there is a payment dispute from a provider, the health plan is required to participate in a third-party, unbiased arbitration process to establish a qualifying payment amount (QPA) for similar services in a geographic area. The health plan may need outside resources to fulfill claim settlement support for the IDR process, a stipulation that has created a rush of new IDR support solutions in market.

However, according to Rob Gelb, Valenz Chief Executive Officer, there is no need for Valenz clients to engage with new pop-up IDR solutions. For years, Valenz has used its proprietary VMS™ repricing methodology to circumvent payment disputes by ensuring fair, defensible, market-sensitive QPAs that both parties agree to. QPAs are based on years of real-world data from Valenz Access contracted networks, as well as additional layers of data from the broader Valenz ecosystem. Valenz has always negotiated with providers in the rare instances where they appeal a QPA. The IDR process only comes into play when an agreement isn’t reached through the normal appeal process and a provider decides to risk paying the cost of going to an independent arbiter.

“As a health data tech company with deep roots in member advocacy, our business model is built on a framework of clinical care management with a decades-long commitment to validation, integrity and accuracy (VIA). We’ve been delivering agile, data-driven solutions to pricing and reimbursement for years, always engaging early and often for smarter, better, faster healthcare,” said Gelb. “For us, this is not new at all – our repricing methodology is tried and true.”

Gelb advises all self-insured employers to embrace the power of transparency and data for improving the high costs of healthcare coverage today – and be cautious of solutions that don’t address root causes. “While others are fueling fear that IDRs will now be commonplace, we’re here to say the opposite – IDRs are not inevitable features of NSA compliance, not when you partner with Valenz.”

For more information about VMS™ visit valenzhealth.com/vms. To discuss how Valenz ensures fair and defensible pricing, call (866) 762-4455.

About Valenz

Valenz 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 offers transparency through data to pinpoint members at highest risk, address gaps in network designs, ensure appropriate and accurate charges, and expertly navigate employees to optimal care solutions for substantial cost savings and improved health outcomes. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.

Risk Bearing Provider Organization Assessment Can Help Minimize Risk, Drive Savings for Value-Based Care

PHOENIX, Ariz. (July 12, 2021) — Vālenz^® has announced a strategic partnership with Beecher Carlson, an insurance brokerage firm that leverages advanced analytics for optimal risk management. Through this partnership, Valenz and Beecher Carlson collaboratively offer the industry’s most in-depth Risk Bearing Provider Organization (RBPO) Assessment for thorough, data-driven analysis of whether an organization is positioned successfully for two-sided risk contracts in a value-based payment model.

Value-based payment models offer significant opportunities to reduce costs, enhance quality and improve outcomes. However, the pay-for-performance reimbursement structure might not be right for every health system or provider group. This RBPO Assessment identifies areas that need assistance and offers solutions to address potential deficiencies. It also helps determine if the program goals and incentives are aligned with the organization’s expected results and endorsed by all stakeholders.

“While there is a high level of interest and enthusiasm for value-based care, the clinical and financial risks need to be carefully considered – and in a two-sided contract, cultural and operational requirements must be in place to ensure success,” said Rob Gelb, Chief Executive Officer of Valenz. “Through this partnership with Beecher Carlson, we are excited to provide actionable insights and proven solutions to guide our clients’ approach to value-based care.”

As noted by Brad Lawson, Senior Vice President-Provider Risk Solutions of Beecher Carlson, the RBPO Assessment financial models assess risk-reward ratios, quantifying maximum probable gains as well as the maximum probable losses. “The 360-degree data and trend analyses account for real-world conditions, allowing organizations to stay nimble, proactively manage risk, and prepare for developing situations – such as an influx of more serious cases following the COVID-19 pandemic as a result of delayed care,” he said.

About Valenz

Valenz 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 offers transparency through data to pinpoint members at highest risk, address gaps in network designs, ensure appropriate and accurate charges, and expertly navigate employees to optimal care solutions for substantial cost savings and improved health outcomes. Valenz is backed by Great Point Partners.

About Beecher Carlson

Beecher Carlson is a large account risk management broker that values depth of industry and product knowledge. Operating as a single profit center organized by specialization, we align our service teams to be structured based on what is best for clients’ business rather than geographic convenience. We go beyond one-off transactions and utilize advanced analytics on every program. By quantifying the effects each decision will have on a company’s risk profile, we take the mystery out of buying insurance. Execution on analytical findings is our true differentiator in mitigating losses and affecting process changes. Our collective success is earned by creating the ideal risk management solution for our clients. To learn more, visit beechercarlson.com.