Innovative reimbursement strategies maximize plan dollars, improve provider relationships and drive significant savings

PHOENIX, Ariz. (November 19, 2021) — At a recent customer event, Vālenz^® leaders unveiled a package of solutions that offer innovative alternatives to traditional reference-based pricing (RBP) agreements, designed to give self-insured employers more leverage in their local markets.

According to Rob Gelb, CEO of Valenz, the market needs to move away from traditional RBP approaches, which continue to be focused on basic payment reductions. “Now is the time to change the way you look at a reference-based approach to reimbursement that is defensible and allows customers to position in the market without contracts,” Gelb said. “The new Valenz package is designed to do this, plus it offers options to share risk with our customers.”

Each solution is fueled by data-driven insights and supported via the proprietary Valenz VMS™ Repricing Methodology yield fair, market-sensitive reimbursements that deliver improvement in savings as high as 75 percent, according to Gelb.

Valenz solutions offer options for self-insured employers to choose the path to smarter, better, faster healthcare that is best for their markets:

• Access Open Solution maximizes plan dollars with a non-network reimbursement strategy that fosters equitable provider relationships. With integrated care navigation that lowers costs, this solution provides transparent quality and outcomes data for fair, defensible and consistent reimbursement recommendations.
• Access Assured Payment builds on Access Open Solution to eliminate the risk of balance billing, member disruption and provider friction by offering assured payments for up to 91 percent of claim volume. The remaining claims undergo comprehensive, line-by-line bill review with provider sign-off for secured savings.
• Access Amplified offers an out-of-network wrap solution – complete with care navigation, bill review and assured payment – to replace wrap networks. This solution directs members to high-quality care at fair, reasonable costs and secures appropriate, accurate charges for every out-of-network claim, resulting in significant savings.
• Providing an alternative reimbursement approach for non-Medicare-based pricing – one that, like the other solutions, embeds VMS for fair, equitable, market-sensitive reimbursement rates.

“These solutions help maximize savings opportunities, reduce risk to the health plan, and put leverage back in the self-insured employer’s favor,” Gelb said. “That’s the power of the Valenz ecosystem. It lets us do what we do best, which is creating partnerships through contracts with providers.

“When we engage early and often to ensure active collaboration among the patient, providers and employer plans, we can ensure transparency and ultimately improve health outcomes.”

 

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.

Database of negotiated hospital rates elevates consumer transparency and choice

PHOENIX, Ariz. (April 26, 2021) — Vālenz^® announced today a partnership with Turquoise Health, a software solutions company that facilitates consumer transparency through its newly launched platform listing payer-negotiated hospital rates.

With new price transparency regulations requiring hospitals to share previously undisclosed rates for many services, Turquoise Health has created the first comparison engine for consumers to make cost-effective decisions about their care.

With full access to Turquoise Health’s database of hospital rates, Valenz will incorporate the comparison information into its concierge-level navigation program and self-service member portal. Valenz also will utilize the data to build highly efficient networks that drive quality care and customer satisfaction alongside cost savings.

“Our partnership with Turquoise Health aligns with our data-driven ecosystem and helps us take a significant step toward providing the transparency our clients and their members need,” said Rob Gelb, CEO of Valenz. “Not only can we share the cost structure of hospital services to help guide members’ decisions, but we can also help them gauge the quality of the service. It’s a key component of the Valenz promise to assure smarter, better, faster healthcare.”

As of Jan. 1, 2021, the federal rule requires hospitals to publish a machine-readable file listing their negotiated payment rates for hundreds of medical procedures, as well as a website where consumers can search for services and prices. Initial compliance has been mixed, with reports of some hospitals blocking their pricing from showing up on web searches – making the Turquoise Health platform all the more valuable in elevating transparency.

CEO Chris Severn says its database currently has more than 2,000 verified rates, and the list continues to grow as Turquoise painstakingly combs through and verifies hospital pricing data.

“This is just the beginning of making hospital billing more clear and patient-friendly,” Severn said. “Using both public price rates data and Turquoise participating provider data, we are showing there is a market for transparency in healthcare. We help put negotiating power where it belongs — in the hands of the consumer.”

 

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 Turquoise Health

Turquoise Health launched in 2020 with a vision to simplify healthcare reimbursement through price transparency. CTO Adam Geitgey, formerly a Director of Engineering at Groupon, brings deep consumer marketplace experience to the healthcare sector. Turquoise invites providers and payers to become Turquoise Verified partners. Using the software suite, organizations create “price certainty” for patients while easing claims adjudication on the back end. Turquoise already counts major revenue cycle partners and hospital systems as satisfied clients. To learn more, visit turquoise.health or email info@turquoise.health.