With a new year underway, we’re celebrating long-overdue legislative advancements that help protect healthcare consumers and support their ability to make better, more informed decisions about their health and healthcare coverage. By working to prevent unexpected medical bills and requiring greater visibility into the costs of healthcare services, the No Surprises Act (NSA) and the Transparency in Coverage (TiC) Rule enable self-insured employers to better serve their members for the benefit of all.
As a longtime champion of transparency, advocacy and engagement to drive improved member experiences and outcomes, our team at Vālenz® sees exciting possibilities ahead for real transformation in self-insurance. Here are six opportunities for self-insured employers to focus on in 2022:
1. Increase Transparency with Members
Compared with other industries, the lack of insight into costs prior to paying for health services has been unparalleled. The new NSA and TiC legislation ensures cost transparency and finally puts more control in the hands of the healthcare consumer.
Health plan members will now have full visibility into their medical costs and coverage options, so helping them find true clarity is vital. When members receive quality and cost information that’s delivered in a meaningful way, they can recognize the differences, understand what they’re paying for and make the right buying choices. These smarter decisions made by well-informed members are key to the health of the plan as well, keeping costs low and quality high.
Member advocacy is central to this legislation, and it’s a good reminder that the member is central to everything we do. Whether you are a TPA adjudicating claims in making payments, a health system serving its community, or a partner like Valenz offering improved access points to care, navigation and cost savings, the benefits to the member are shared across the board at every step.
2. Improve Collaboration
When it comes to quality, utilization and cost, a lack of alignment among the patient, provider and payer typically results in friction and a diminished experience for everyone. This is where transparency takes the form of better communication and collaboration among all parties.
Provider collaboration helps secure a fair and reasonable reimbursement for high-quality healthcare services. The plan can better identify the goals regarding medical outcomes and alignment of costs, and care navigation helps members traverse a complex system, so they receive the right care at the right place and right time – ensuring the best chance of a positive result. Strong, vigorous and healthy plan members translate to a healthier plan with fewer expenses for everyone involved.
3. Respond to Legislation
Even before the NSA and TiC legislation, a movement was building toward self-funded plans offering improved transparency and cost savings. Slowly but surely, it has become very clear that the average healthcare cost of around $17,000 annually per employee – for access to a healthcare system that is difficult to navigate and comprehend, with no consistent measure of quality – is not sustainable for the plan or the member.
These major legislative shifts that occur every 10 years or so – such as HIPAA and the Affordable Care Act – offer a transformative opportunity to change the landscape of healthcare. It’s likely that many members don’t have full understanding of what it means for them. Clear and consistent communication with members must take place to drive the improved outcomes intended by the new legislation.
With the latest changes, we will see much greater visibility into the process of health coverage and service delivery, including data transparency and oversight of how business gets placed to carriers. This shift will create opportunities to examine all options and drive decisions on the best fit for each member’s unique needs.
4. Make Data-Driven Decisions
Data for the sake of data is not useful. It must tell a story that a plan and its members can act upon and understand. Tech-enabled solutions include a tremendous number of data points, but data engagement is what leads the story to fully unfold.
Turning numbers into usable information presented in a clear format can guide employers in the right direction to achieve the best results for their plan members. Data analysis and assessments present the information and actions needed for self-insured employers to unlock greater network potential, predict and save costs, and influence the model of a quality health plan.
5. Embrace Change
The self-insured industry sees shifts every year in the 5-15 percent of claims that drive 70-80 percent of the plan spend – from stop-loss renewals and rate increases to high-dollar COVID-19 claims and new therapies. Employers must keep up with the changes and fluctuations in the types of claims that drive their greatest spending and act accordingly.
As information from the clinical arm of the business (medical intelligence) coalesces with the data/technology side (tying to the claim, provider and payment), it’s possible to pinpoint that 5-15 percent in real time. Doing so provides insight into actionable steps to identify it and solve it quickly and proactively.
6. Create an Agile, Respectful Culture
The healthcare industry is evolving at a breakneck pace, accelerating through legislation and a call for change. This results in myriad healthcare management decisions new to many employer groups, including those that self-insure. A plan’s success in serving members hinges on the ability to predict and proactively manage the needs of the unique population and every individual within.
At Valenz, we have built an agile culture where we know how to be comfortable being uncomfortable. As we work to simplify the complexities of healthcare, we are not afraid to take chances that go beyond traditional norms. That’s how we grow as an organization and how we offer unique value to our partners.
We believe a culture of inclusivity and agility is the right way to address improvements to the system our members navigate. The Valenz culture is also about how we work together and how we treat the people who work with us. If you are partnering with an enterprise to help you make benefit and coverage decisions, you need to understand how they operate and know if they live out the values required for meaningful, positive and all-encompassing change.
Partnerships must be respectful and collaborative enough to refrain from a quick negative response and, in its place, say “Yes, and…” instead. That positions us to capitalize on shared resources and data, so we can uncover new solutions together. When we listen without judgment, build upon each other’s expertise, redirect when necessary and get it right together, that’s how we create healthier plans and ensure that members will be strong, vigorous and healthy in 2022 and beyond.
***
Rob Gelb is Chief Executive Officer of Vālenz®, the industry-leading ecosystem offering self-insured employers unrivaled data transparency to pinpoint members at highest risk, address gaps in network designs, ensure appropriate and accurate charges, and expertly navigate members to optimal care solutions for substantial cost savings and improved health outcomes.
Vālenz® Hires John Paolacci as Chief Claims Officer
/in Announcements, Featured, Press/by Maris PanjadaPHOENIX, Ariz. (May 13, 2022) — Vālenz® is pleased to announce John Paolacci, MBA, has joined the company as Chief Claims Officer. With more than 20 years’ experience in managed care and claims, Paolacci has served in leadership roles in client services, operations, strategic planning, managed care product design, pricing, strategic partner contracting, business development strategy and M&A integrations. At Valenz, he will lead the Validation, Integrity and Accuracy (VIA) of claims and payments, implementing tech-enabled solutions that support a robust claim infrastructure for accelerated and streamlined claim operations.
As Chief Claims Officer, Paolacci will partner with Amy Gasbarro, Chief Operations Officer, who ensures early engagement and continuous clinical, member and provider advocacy across the entire healthcare ecosystem. Together, Gasbarro and Paolacci will facilitate a seamless entry for self-insured employers and members into the Valenz Healthcare Ecosystem Optimization Platform, a fully integrated suite of solutions that drives value and assures alignment of the member, payer and provider across the Claim Cost ArcSM.
“John is widely recognized as a results-driven, solutions-oriented leader with deep expertise in claim management and cost containment,” said Rob Gelb, Chief Executive Officer of Valenz. “His superior capabilities position us well to continue building a strong foundation in claim operations as our member base grows, and his philosophy of servant leadership aligns perfectly with the collaborative Valenz culture. We are thrilled he is joining the team.”
Most recently, Paolacci was Senior Vice President, Managed Care for Sedgwick, with responsibility for standalone managed care cost containment divisions including medical bill review, provider networks and client services. He also has held senior leadership positions with York Risk, Avizent Risk, and the Frank Gates Service Company.
Paolacci earned his master’s degree in Business Administration at Franklin University in Columbus, Ohio, He lives in Granville, Ohio.
“I’m honored to have the opportunity to be part of such an energetic, collaborative company that is driving true innovation in the market,” Paolacci said. “As we anticipate the needs of our self-funded customers and continue building the next generation claim organization to serve an ever-evolving healthcare industry, I look forward to advancing the business operations and Valenz vision for smarter, better, faster healthcare.”
About Valenz
Vālenz® simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement. To balance the relationship between healthcare quality, advocacy and cost, the Valenz approach aligns the member, provider and payer. We deliver this synergy through a strong foundation with deep roots in clinical and member advocacy, alongside decades-long expertise in claim reimbursement and payment validity, integrity and accuracy. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for you and your members, Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.
Vālenz® Hires Kevin O’Donnell as Vice President, Enterprise Solutions
/in Announcements, Featured, Press/by Maris PanjadaPHOENIX, Ariz. (March 25, 2022) — Vālenz® is pleased to announce Kevin O’Donnell, MPA, has joined the company as Vice President, Enterprise Solutions.
O’Donnell brings extensive experience in providing advisory and strategic services, project management and implementation support to healthcare organizations. He will be highly involved in expanding and integrating how Valenz delivers solutions for providers and payers that assure the validation, integrity and accuracy of reimbursement and claims, as well as care and member advocacy program enhancements. Other key responsibilities include driving product growth, supporting client-facing sales function, and fulfilling roles within operations and technology.
“We are thrilled to have Kevin’s entrepreneurial spirit and proven success in operations, consulting and change management on the Valenz leadership team,” said Maurice Steenland, Senior Vice President, Product & Delivery. “His superior skills in implementation of care management and value-based care, as well as operational assessments and restructuring, has delivered significant results in improved care, streamlined operations and increased revenues.”
Most recently, O’Donnell was Managing Director of Operations for Evolent Health and held several other leadership positions there in operations, claims quality and payment integrity. He also served as managing consultant for Navigant.
O’Donnell earned a master’s degree in Public Administration with an emphasis in health and human services from the University of Arizona’s Eller College of Management, He lives in Newark, Del.
“I’m a firm believer in living out the culture of strong, vigorous and healthy, which Valenz has fully incorporated into the way it serves its employees, its partners, and their members,” O’Donnell said. “I’m looking forward to building upon that foundation through the proactive, sustainable solutions and customer love that have set Valenz apart as healthcare continues to evolve.”
About Valenz
Vālenz® simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement. To balance the relationship between healthcare quality, advocacy and cost, the Valenz approach aligns the member, provider and payer. We deliver this synergy through a strong foundation with deep roots in clinical and member advocacy, alongside decades-long expertise in claim reimbursement and payment validity, integrity and accuracy. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for you and your members, Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.
Vālenz® CEO Shares Power of Positive Culture in Podcast for Self-funded Employers
/in Announcements, Featured/by Maris PanjadaRob Gelb, Chief Executive Officer of Vālenz®, is spotlighted in a new podcast and video from host Spencer Smith, CSFS®, as he shares how the company’s collaborative culture forges a path to creative solutions for self-insured employers.
In Smith’s video from the recent True Captive “Future of Benefits and Business” conference in Oklahoma City, Gelb discusses how the “Yes, and …” mentality fosters a positive connection among teammates, partners and leaders, facilitating meaningful solutions to industry challenges through the power of the Valenz ecosystem.
Valenz has long been a champion of inclusivity and agility to support its partners in making better decisions as they navigate the complicated nature of health insurance. Replacing an initial negative response with a respectful, team-oriented answer of “Yes, and …” positions all parties to capitalize on shared resources and data to uncover new solutions together.
“When we listen without judgment, build upon each other’s expertise, redirect when necessary and get it right together, that’s how we create healthier plans and strong, vigorous and healthy members,” Gelb said. You can watch the full video below.
The weekly “Self-Funded with Spencer” podcast focuses on healthcare and health insurance in the United States, with a special emphasis on the value of self-funded plans.
Vālenz® Hires Suzann Chesek as Vice President of Care
/in Announcements, Featured/by Holly LawtonPHOENIX, Ariz. (Feb. 25, 2022) — Vālenz® announced today that Suzann Chesek, BSN, RN, MBA, CCM, joined the team as Vice President of Care on February 21.
Chesek, who has more than 20 years’ experience with managed care and healthcare organizations, will lead care management operations for Valenz following the retirement of Janet Koch. Over the next three months, Chesek and Koch will work closely to assure a seamless transition before Koch’s retirement begins on June 1.
Most recently, Chesek was Director of Clinical Operations, Healthcare Management for Trustmark Health Benefits. She also served as Clinical Operations Manager with Holy Spirit Health System and as Hospital Administrator and Clinical Manager Employee Health & Safety with Wellspan Health.
Chesek’s background in clinical operations for managed care is fortified by her strong foundation as an ICU nurse, including roles such as ICU Bedside & Charge Nurse, House Supervisor & ICU Flex Nurse, and PRN ICU RN. With a bachelor’s degree in Nursing from Eastern Mennonite University and an MBA in Healthcare Management from Western Governors University, Suzann is working toward a second master’s degree in Management & Leadership from WGU.
“By leveraging a rich blend of leadership skills and technical expertise throughout her impressive career, Suzann has established herself as a proven leader who thrives in a fast-paced, complex environment,” said Rob Gelb, Chief Executive Officer of Valenz. “She welcomes a challenge and is highly recognized for her superior planning, decision-making and change management capabilities.”
Chesek pointed to her experience in managed care organizations as well as her studies in healthcare management and leadership as great preparation for her new role with Valenz.
“The teamwork, collaboration and leadership model at Valenz clearly align with my vision for the continuous growth and innovation of care management operations,” Chesek said. “As a strong believer in asking “why” to discover what is best for patients, clients and the company, I look forward to further enhancing our culture of partnership and accelerating our ability to deliver smarter, better, faster healthcare for the people we serve.”
Learn more about the Valenz leadership team.
About Valenz
Vālenz® simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement. To balance the relationship between healthcare quality, advocacy and cost, the Valenz approach aligns the patient, payer and provider. We deliver this synergy through a strong foundation with deep roots in clinical and member advocacy, alongside decades-long expertise in claim reimbursement and payment validity, integrity and accuracy. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for you and your members, Valenz engages early and often for smarter, better, faster healthcare. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.
Vālenz® Promotes Jordan Hersh, MBA, to Senior Vice President, Channel Distribution
/in Announcements, Featured/by Diane MorganHersh brings 15+ years’ experience solving cost-related healthcare challenges for employers and companies of all sizes
PHOENIX, Ariz. (Feb. 18, 2022) — In response to continued expansion of the Vālenz® ecosystem and rapidly increasing demand for its solutions, Valenz leaders have announced a new position on their executive tram: Jordan Hersh, MBA, has been appointed to Senior Vice President, Channel Distribution.
This appointment marks a promotion for Hersh, who initially joined Valenz in 2007 and has served as Vice President, Business Development since early 2019. Hersh is known as an excellent cross-functional leader, bringing the organization together to meet business goals through client-focused solutions and services.
“Since joining Valenz at the very beginning of our ecosystem journey, Jordan has been a catalyst for ensuring our vision, organizational strategies and new product development are delivered to the market,” said Nathan Nelson, Chief Revenue Officer. “His passion for success, combined with his proven track record of delivering results, make him the ideal fit to head up channel distribution for our company.”
Hersh’s career spans 15 years at the intersection of healthcare and technology, focused on solving client and member challenges in the employer-sponsored healthcare domain. He has an MBA from the University of San Francisco School of Management and extensive experience in business development, strategic partnerships, product marketing, account management and sales strategy.
“I believe deeply in the Valenz mission, vision and promise, and I’m excited to take on this new opportunity,” said Hersh. “I have a lot of ideas and an incredible team here to further enhance our distribution strategy for the benefit of our clients and their members, as well as our own company and ecosystem partners.”
Learn more about the Valenz leadership team.
About Valenz
Vālenz® simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement. To balance the relationship between healthcare quality, advocacy and cost, the Valenz approach aligns the patient, payer and provider. We deliver this synergy through a strong foundation with deep roots in clinical and member advocacy, alongside decades-long expertise in claim reimbursement and payment validity, integrity and accuracy. By establishing ‘true transparency’ and offering data-driven solutions that improve cost, quality and outcomes for you and your members, Valenz engages early and often for smarter, better, faster healthcare. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.
Janet Koch, Vālenz® Vice President of Care, Announces June 1 Retirement
/in Announcements, Featured/by Diane MorganPHOENIX, Ariz. (Feb. 18, 2022) — After more than 10 years in care management leadership roles with Vālenz®, Janet Koch, RN, BSN, CCM, has announced her retirement beginning June 1.
Janet became Vice President of Care in 2017 after joining Valenz in 2011. Her many accomplishments include transforming the business through clinical platform migrations, leading multiple URAC accreditation certifications for the three core clinical businesses, designing and deploying quality incentive programs for team members, and building the company brand through consistent quality and outcomes for Valenz customers and their members.
“Janet has made such a tremendous impact on Valenz, the Care team and our customers,” said Rob Gelb, Chief Executive Officer of Valenz. “She has been the bedrock of our Care business for 10 years and left her mark on every aspect of our care management operations and team.”
“Although her announcement is bittersweet, we are thrilled for her and her family to embark on the next chapter of her life journey, and we wish her the greatest happiness in the future,” added Amy Gasbarro, Chief Operating Officer of Valenz.
Before joining Valenz, Janet’s career in nursing spanned over 25 years after she served as an air traffic controller in the U.S. Navy for 17 years.
“I have absolutely loved every single day of working side by side with such a talented Care team and the entire extended Valenz family,” Janet said. “I have especially valued my time working with our customers and their members. I’m very grateful to our leadership and my team for the once-in-a-lifetime opportunity I’ve had to make a difference in the lives of so many.”
Janet will continue to work closely with the Valenz team to support a smooth transition. In addition, she has been highly involved in the hiring process for her successor, who soon will be announced.
About Valenz
Vālenz® simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement. To balance the relationship between healthcare quality, advocacy and cost, the Valenz approach aligns the patient, payer and provider. We deliver this synergy through a strong foundation with deep roots in clinical and member advocacy, alongside decades-long expertise in claim reimbursement and payment validity, integrity and accuracy. By establishing ‘true transparency’ and offering data-driven solutions that improve cost, quality and outcomes for you and your members, Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners. More information is available at valenzhealth.com.
Vālenz® Hires Jeff Smith as Director of Project Management
/in Announcements, Featured/by Diane MorganPHOENIX, Ariz. (Feb. 18, 2022) — Vālenz® announced today that Jeff Smith has joined the team as Director, Project Management. Smith, a 33-year industry veteran, will lead all project management initiatives, including but not limited to IT projects, new client implementations, and projects involving mergers and acquisitions.
As a senior-level managed care leader with extensive experience in operations management, product development and sales, Smith has conducted more than 100 implementation projects involving complex products and services. This experience has made him an expert in project planning, process and systems integration, product development, data transfer, and implementation.
“I’ve known Jeff for many years, and several of us at Valenz have worked with him the past. There is no doubt Jeff will be an outstanding catalyst for growth and expansion, and successful delivery of solutions for our clients,” said Rob Gelb, Chief Executive Officer. “His expertise and exceptional project management skills will accelerate success for all stakeholders, and we are thrilled to have him on board.”
Smith’s career spans three decades in the managed care and payer domains, including 10 years as Senior Project Manager at Coventry Health Care, where he led client implementation projects.
“When you have an in-depth understanding of the needs, objectives and environment at the core of every project, then you can ensure implementation will be successful and results will be optimal,” said Smith. “Results-driven project management is a collaborative process that engages early and often, just like all things Valenz. I’m honored to be on the team and feel this is a perfect fit.”
About Valenz
Vālenz® simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement. To balance the relationship between healthcare quality, advocacy and cost, the Valenz approach aligns the patient, payer and provider. We deliver this synergy through a strong foundation with deep roots in clinical and member advocacy, alongside decades-long expertise in claim reimbursement and payment validity, integrity and accuracy. By establishing ‘true transparency’ and offering data-driven solutions that improve cost, quality and outcomes for you and your members, Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners. More information is available at valenzhealth.com.
Vālenz® to Attend HCAA Executive Forum as Corporate Sponsor
/in Announcements, Events, Featured, Press/by Maris PanjadaEvent scheduled for Feb. 21-23 in Las Vegas
PHOENIX, Ariz. (February 11, 2022) — As Corporate Sponsors of the HCAA Executive Forum, Vālenz® leaders have announced they are attending the key networking event for the self-funded industry in Las Vegas this year.
The HCAA Executive Forum, which addresses timely industry topics while providing opportunities to connect with colleagues, returns to an in-person format for the first time in two years. A real-time, live-streaming option is available for registrants unable to attend on site. Valenz also will be featured in the B-to-B Marketplace where attendees can find rich information about how the health data technology firm improves cost, quality and outcomes for self-funded plans and their members.
“This year’s conference theme, Unstoppable Spirit, is very fitting when you consider the new challenges the self-insured industry has had to solve and overcome during the pandemic,” said Rob Gelb, Chief Executive Officer at Valenz. “As we become more agile and adaptable in a dramatically changed world, we look forward to sharing data-driven solutions that simplify the complexities of self-insurance through true transparency and decision enablement.”
The HCAA Executive Forum will be held Feb. 21-23 at the Bellagio, with live-streaming of presentations occurring at Pacific Time. Attendees are encouraged to connect with Valenz to explore the benefits to their business and plan members through the unique integration of services across the care and claim continuum. The Valenz team attending the event includes Brian Campbell, Brittney Parrish, Greg Shelley and Steve Illions.
About Vālenz
Vālenz® simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement. To balance the relationship between healthcare quality, advocacy and cost, the Vālenz® approach aligns the patient, payer and provider. We deliver this synergy through a strong foundation with deep roots in clinical and member advocacy, alongside decades-long expertise in claim reimbursement and payment validity, integrity and accuracy. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for you and your members, Valenz engages early and often for smarter, better, faster healthcare. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.
Vālenz® CEO Outlines Six Areas of Focus for Self-Insured Employers in 2022
/in Featured, Press/by Maris PanjadaWith a new year underway, we’re celebrating long-overdue legislative advancements that help protect healthcare consumers and support their ability to make better, more informed decisions about their health and healthcare coverage. By working to prevent unexpected medical bills and requiring greater visibility into the costs of healthcare services, the No Surprises Act (NSA) and the Transparency in Coverage (TiC) Rule enable self-insured employers to better serve their members for the benefit of all.
As a longtime champion of transparency, advocacy and engagement to drive improved member experiences and outcomes, our team at Vālenz® sees exciting possibilities ahead for real transformation in self-insurance. Here are six opportunities for self-insured employers to focus on in 2022:
1. Increase Transparency with Members
Compared with other industries, the lack of insight into costs prior to paying for health services has been unparalleled. The new NSA and TiC legislation ensures cost transparency and finally puts more control in the hands of the healthcare consumer.
Health plan members will now have full visibility into their medical costs and coverage options, so helping them find true clarity is vital. When members receive quality and cost information that’s delivered in a meaningful way, they can recognize the differences, understand what they’re paying for and make the right buying choices. These smarter decisions made by well-informed members are key to the health of the plan as well, keeping costs low and quality high.
Member advocacy is central to this legislation, and it’s a good reminder that the member is central to everything we do. Whether you are a TPA adjudicating claims in making payments, a health system serving its community, or a partner like Valenz offering improved access points to care, navigation and cost savings, the benefits to the member are shared across the board at every step.
2. Improve Collaboration
When it comes to quality, utilization and cost, a lack of alignment among the patient, provider and payer typically results in friction and a diminished experience for everyone. This is where transparency takes the form of better communication and collaboration among all parties.
Provider collaboration helps secure a fair and reasonable reimbursement for high-quality healthcare services. The plan can better identify the goals regarding medical outcomes and alignment of costs, and care navigation helps members traverse a complex system, so they receive the right care at the right place and right time – ensuring the best chance of a positive result. Strong, vigorous and healthy plan members translate to a healthier plan with fewer expenses for everyone involved.
3. Respond to Legislation
Even before the NSA and TiC legislation, a movement was building toward self-funded plans offering improved transparency and cost savings. Slowly but surely, it has become very clear that the average healthcare cost of around $17,000 annually per employee – for access to a healthcare system that is difficult to navigate and comprehend, with no consistent measure of quality – is not sustainable for the plan or the member.
These major legislative shifts that occur every 10 years or so – such as HIPAA and the Affordable Care Act – offer a transformative opportunity to change the landscape of healthcare. It’s likely that many members don’t have full understanding of what it means for them. Clear and consistent communication with members must take place to drive the improved outcomes intended by the new legislation.
With the latest changes, we will see much greater visibility into the process of health coverage and service delivery, including data transparency and oversight of how business gets placed to carriers. This shift will create opportunities to examine all options and drive decisions on the best fit for each member’s unique needs.
4. Make Data-Driven Decisions
Data for the sake of data is not useful. It must tell a story that a plan and its members can act upon and understand. Tech-enabled solutions include a tremendous number of data points, but data engagement is what leads the story to fully unfold.
Turning numbers into usable information presented in a clear format can guide employers in the right direction to achieve the best results for their plan members. Data analysis and assessments present the information and actions needed for self-insured employers to unlock greater network potential, predict and save costs, and influence the model of a quality health plan.
5. Embrace Change
The self-insured industry sees shifts every year in the 5-15 percent of claims that drive 70-80 percent of the plan spend – from stop-loss renewals and rate increases to high-dollar COVID-19 claims and new therapies. Employers must keep up with the changes and fluctuations in the types of claims that drive their greatest spending and act accordingly.
As information from the clinical arm of the business (medical intelligence) coalesces with the data/technology side (tying to the claim, provider and payment), it’s possible to pinpoint that 5-15 percent in real time. Doing so provides insight into actionable steps to identify it and solve it quickly and proactively.
6. Create an Agile, Respectful Culture
The healthcare industry is evolving at a breakneck pace, accelerating through legislation and a call for change. This results in myriad healthcare management decisions new to many employer groups, including those that self-insure. A plan’s success in serving members hinges on the ability to predict and proactively manage the needs of the unique population and every individual within.
At Valenz, we have built an agile culture where we know how to be comfortable being uncomfortable. As we work to simplify the complexities of healthcare, we are not afraid to take chances that go beyond traditional norms. That’s how we grow as an organization and how we offer unique value to our partners.
We believe a culture of inclusivity and agility is the right way to address improvements to the system our members navigate. The Valenz culture is also about how we work together and how we treat the people who work with us. If you are partnering with an enterprise to help you make benefit and coverage decisions, you need to understand how they operate and know if they live out the values required for meaningful, positive and all-encompassing change.
Partnerships must be respectful and collaborative enough to refrain from a quick negative response and, in its place, say “Yes, and…” instead. That positions us to capitalize on shared resources and data, so we can uncover new solutions together. When we listen without judgment, build upon each other’s expertise, redirect when necessary and get it right together, that’s how we create healthier plans and ensure that members will be strong, vigorous and healthy in 2022 and beyond.
***
Rob Gelb is Chief Executive Officer of Vālenz®, the industry-leading ecosystem offering self-insured employers unrivaled data transparency to pinpoint members at highest risk, address gaps in network designs, ensure appropriate and accurate charges, and expertly navigate members to optimal care solutions for substantial cost savings and improved health outcomes.
Vālenz® to Present at Oklahoma City Event Hosted by True Captive Insurance
/in Announcements, Events, Featured, Press/by Maris PanjadaJan. 26 gathering of business leaders will focus on the future of business and benefits
PHOENIX, Ariz. (January 14, 2022) — Focused on self-funded health plans and how businesses can gain control of healthcare spend, Vālenz® announced today that its chief executive officer Rob Gelb will be a featured presenter at an Oklahoma City event hosted by True Captive Insurance and sponsored by Valenz. The event is Jan. 26 from 1:00-4:00 p.m. at the Petroleum Club in downtown Oklahoma City.
At the executive-level event, Gelb will discuss changes in the self-insured industry, including recent legislation, employer shifts to self-insurance, and the role of data in balancing quality, utilization and cost for better decisions about health coverage.
“Every day, I see employers face challenges as they make decisions about the financial impact of health coverage while also balancing employee health and wellbeing,” said Gelb. “Given current market conditions and the extreme competition for talent, medical benefits packages are becoming more crucial in whether or not a business becomes a preferred workplace. That’s why firms like Valenz and True Captive, as well as transformational industry leaders from EHIM, Simpara, NavMD, Benefit Management, Proactive MD, Plansight and Medxoom are doing everything possible to simplify self-insurance for employers, while helping them deliver benefits that improve health outcomes and reduce costs for the member and the plan.”
As employers seek greater control of their medical plan spend, many are turning to self-insurance. The number of U.S. employers in a self-funded structure is expected to increase from 63 percent to 70 percent this year. Gelb’s presentation will address why it is important for business leaders to develop the right partnerships for self-insurance and feel comfortable during this transformational moment in healthcare.
Space is limited, and early registration is encouraged: truecaptive.com/okc-registration
About Valenz
Vālenz® simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement. To balance the relationship between healthcare quality, advocacy and cost, the Valenz approach aligns the patient, payer and provider. We deliver this synergy through a strong foundation with deep roots in clinical and member advocacy, alongside decades-long expertise in claim reimbursement and payment validity, integrity and accuracy. By establishing ‘true transparency’ and offering data-driven solutions that improve cost, quality and outcomes for you and your members, Valenz engages early and often for smarter, better, faster healthcare. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.
About True Captive Insurance
True Captive is transforming the health insurance industry by giving employers the control and stability they deserve. True Captive Insurance allows small to medium sized companies to band together to create buying power that lowers healthcare costs. Coupled with true care navigation and consumer empowerment, the True Captive Model drives costs down and creates an improved, more personalized experience for members. True Captive Insurance believes in healthcare that is personal and insurance that isn’t complicated. More information is available at truecaptive.com.