Care Value Optimizer
Delivering navigated access to high quality, lower cost care
Self-insured plans finally have a solution that triages network selection, care and treatment based on both the financial and health needs of the member: NaVcare Enhanced with Care Value Optimizer, a data-enabled tool used by Vālenz® Health navigators and nurses to swiftly identify the best available care options based on members’ income, location and healthcare needs. The Care Value Optimizer tailors care to each member, offering provider networks that range from low-cost and no-cost options to Centers of Excellence (COE) pre-negotiated care bundles for those who don’t qualify for charity care. Our care guidance balances quality, utilization and cost with an emphasis on keeping members in-network at the highest possible level of quality care for the lowest cost.
Here’s how it works:
- When members have a care need, they call in to our NaVcare Enhanced phone line to engage with a NaVcare team member who will advocate for the best care value.
- If the member is a match for a low-cost/no-cost opportunity, the navigator provides guidance through the necessary paperwork, scheduling, and selection of a provider prior to care. This can eliminate some or all of the member’s costs while reducing overall plan spend and lowering future stop loss premiums for the employer.
- If the member is not a match, the navigator evaluates alignment to one of our COE care bundles, covering thousands of procedures from high-quality providers nationwide.
- If neither of the above is a good match, the CVO provides insight into the member’s in-network options. As a last resort, the navigator will select an out-of-network solution.
- All levels are wrapped with our Care Management services to ensure best value and continuity of care.
Surgery and Imaging Simplified
KISx Card is now Vālenz® Health!
Members who are eligible for surgical and imaging care now have access to care navigators who will facilitate care and treatment with substantially more high-quality providers nationwide for general surgery, major imaging, colonoscopies and orthopedics.