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.