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Vālenz® Unveils Solutions to Replace Traditional Reference-Based Pricing

November 19, 2021/in Announcements, Featured, Press, Valenz Access/by Maris Panjada

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.

https://www.valenzhealth.com/wp-content/uploads/2021/11/Valenz_RBP-Alternatives-600x432-1.jpg 432 600 Maris Panjada https://www.valenzhealth.com/wp-content/uploads/2023/01/valenz-logo-1-23-3.png Maris Panjada2021-11-19 20:33:322021-11-19 20:33:32Vālenz® Unveils Solutions to Replace Traditional Reference-Based Pricing

Vālenz® Releases New Provider Locator for Members

October 29, 2021/in Announcements, Featured, Press, Valenz Access/by Maris Panjada

New search capabilities bring more transparency into access, cost and quality

PHOENIX, Ariz. (October 29, 2021) — In keeping with their commitment to innovation that fuels strong, vigorous and healthy lives, Vālenz® has announced the release its new Provider Locator tool. Available online for plan members and administrators to access anytime, the new and improved Provider Locator is uniquely designed to bring more information and transparency to the process of choosing a provider for healthcare services.

In addition to an array of filters for members to refine searches according to their individual needs and preferences, the new Provider Locator also includes star-ratings and cost data, as well as an interactive map that pins provider locations within the defined geography. Search results include providers currently under contract within each member’s Valenz Access provider network, as well as “Valenz-Friendly” providers who have previously accepted reimbursement from Valenz.

“Engaging early and often for smarter, better, faster healthcare can take many forms, but in most cases, it begins with connecting people to quality providers who will deliver the right care at the right time and at the right cost according to plan coverage,” said Maurice Steenland, Senior Vice President of Product and Delivery. “We are very excited about this initial release and look forward to continuously expanding the data available to plan members in support of their healthcare decisions.”

With future updates, says Steenland, the Provider Locator tool will become more robust with expanded cost and quality data for providers in Valenz networks.

 

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.

https://www.valenzhealth.com/wp-content/uploads/2021/10/Valenz_Blog-Provider-Locator-600x432-1.jpg 432 600 Maris Panjada https://www.valenzhealth.com/wp-content/uploads/2023/01/valenz-logo-1-23-3.png Maris Panjada2021-10-29 20:28:032021-10-29 20:28:03Vālenz® Releases New Provider Locator for Members
Vālenz® Announces Strategic Partnership with Turquoise Health

Vālenz Announces Strategic Partnership with Turquoise Health

April 26, 2021/in Announcements, Featured, Press, Valenz Access/by Maris Panjada

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.

https://www.valenzhealth.com/wp-content/uploads/2021/04/Valenz_Turquoise-Annc-601x433-1.jpg 433 601 Maris Panjada https://www.valenzhealth.com/wp-content/uploads/2023/01/valenz-logo-1-23-3.png Maris Panjada2021-04-26 17:19:492021-04-26 17:19:49Vālenz Announces Strategic Partnership with Turquoise Health

Vālenz™ Access Assured: An Integrated, Dynamic Approach to Reference Based Pricing

October 15, 2020/in Announcements, Featured, Valenz Access/by Maris Panjada

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.

https://www.valenzhealth.com/wp-content/uploads/2020/10/Valenz-Access-Assured_600x432.jpg 432 600 Maris Panjada https://www.valenzhealth.com/wp-content/uploads/2023/01/valenz-logo-1-23-3.png Maris Panjada2020-10-15 13:55:432020-10-27 15:09:51Vālenz™ Access Assured: An Integrated, Dynamic Approach to Reference Based Pricing

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