From Rob Gelb, Vālenz® Health CEO
During the COVID-19 pandemic, many patients paused their doctor visits or let their medications lapse, leading to health issues going unchecked for months or years. The resulting increase in late-stage diagnoses for serious conditions like cancer and heart disease means patient acuity is higher and treatment is more extensive – all key contributors to the ongoing escalation of healthcare costs. And we are all beginning to see the impact of inflation on the healthcare system.
To battle this growing crisis, self-insured employers can advocate for members by deploying medical cost-containment solutions to connect them to necessary quality care while also minimizing expenses for both the member and the employer.
I believe members will benefit from engagement early and often throughout the patient journey, receiving proactive support from navigators who make them aware of all their care options and provide guidance to the right resources that meet not only their health needs, but their financial needs as well.
Case in point: Of the more than 100 million Americans living at or below 400 percent of the Federal Poverty Level (e.g., a family of four with a household income of $106,000 or less), many might not realize they may qualify for low- or no-cost medical care. Most likely, their employer and health plan sponsor are unaware of this opportunity as well. Although about 60 percent of U.S. hospitals receive billions in tax breaks to offer charity care, the lack of promotion of this option – and the resulting low consumer awareness – has become a significant national issue.
As part of the federal requirements of Section 501(r), members who do qualify for low- or no-cost care may receive medical treatment at one of more than 4,000 facilities across the country with fiduciary responsibilities to offer charity care. For members who are above 400 percent FPL, they may be eligible for more than 1,000 pre-negotiated care bundles or other high-quality in-network care.
The impact of healthcare’s rising costs – and the lack of transparency for patients – has become unsustainable. The key to a solution is the creation and adoption of tools that support navigators in collecting members’ financial and demographic information at the onset of navigation and providing education, support and guidance about their care options – a true model of member/patient advocacy. We need to simplify the healthcare journey for members, making it easy for them to receive the best possible care at the lowest cost while staying in network.
To address this need, Vālenz® Health created Care Value Optimizer (CVO) as a unique enhancement to its NaVcare solution for member navigation and advocacy. Leveraging the power of the Valenz Healthcare Ecosystem Optimization Platform to engage data and empower better decision-making, CVO advocates for members by triaging them to charity care, Centers of Excellence care bundles, or high-performance network offerings based on their finances, location, benefits and health profile.
Because every member is different and their needs may change over time, Valenz navigators and nurses conduct ongoing engagement to gain a comprehensive, data-supported view of members’ current needs. Navigators provide insight to the right care options depending on members’ income, health needs and ability to travel for care; and in alignment with the Valenz “Yes, And” culture, navigators also support patients with scheduling, paperwork and other requirements before they see a provider.
CVO enables effective management of the most expensive and complex treatments and procedures, benefiting the member with lower costs, better access to high-quality care, and improved health outcomes. While the member receives advocacy, employers become more empowered to balance quality, utilization and cost of care, reducing claim expense and the overall plan spend. Ultimately, CVO drives smarter, better, faster healthcare for everyone involved.
The “new normal” of a post-pandemic world has had a serious impact on the lives of many members who may find themselves deciding between putting food on the table and getting the healthcare they need. With CVO, the NaVcare Enhanced solution, and all options within the Valenz Healthcare Ecosystem Optimization Platform, self-insured employers and those who support them and their plans can take a significant step toward ensuring members won’t have to face that choice.
About Rob Gelb
Rob Gelb is Chief Executive Officer of Vālenz® Health, which simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.
About Vālenz® Health
Valenz Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.
Vālenz® Health Promotes Kevin O’Donnell to Senior Vice President, Product & Marketing
/in Announcements, Featured, Press/by kamryn cainPHOENIX, Ariz. (Jan. 9, 2023) — Vālenz® Health is pleased to announce that Kevin O’Donnell, MPA, has been promoted to Senior Vice President, Product & Marketing.
In his new role, O’Donnell will lead Valenz marketing initiatives to fuel growth and visibility for the organization. He also will continue to work with Chief Product Officer Maurice Steenland in driving innovations and further advancing the Valenz Healthcare Ecosystem Optimization Platform suite of integrated, interactive solutions.
“Kevin has brought a tremendous vision and creative mindset to Valenz, and we are thrilled that his role is expanding,” Steenland said. “Through his ongoing leadership efforts, we look forward to developing new strategies and further underscoring our ability to change the trajectory of rising plan costs, enhance member experiences, and drive better health outcomes.”
O’Donnell, who lives in Newark, Del., joined Valenz in 2022 as Vice President, Enterprise Solutions. He has been 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.
Previously, O’Donnell was Managing Director of Operations for Evolent Health and held other leadership positions there in operations, claims quality and payment integrity. He 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.
About Vālenz® Health
Vālenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in the validation, integrity and accuracy of claims, and a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for employers and their 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® Health Launches Next Generation of EPStaffCheckTM for Compliance Monitoring
/in Announcements, Featured, Press/by Tori KleinPHOENIX, Ariz. (Dec. 1, 2022) — Vālenz® Health announces the launch of next-generation software for EPStaffCheck™, a comprehensive compliance monitoring solution, complete with an e-commerce application. This new release helps providers easily purchase and quickly use advanced exclusion monitoring — yet another example of how Valenz supports providers with the very best compliance management solutions.
As part of the Valenz Validation, Integrity and Accuracy (VIA) suite of solutions for providers, EPStaffCheck simplifies the complexity of exclusion monitoring with updated service tiers and easy-to-administer tools that address the full range of challenges facing compliance teams. Its services protect healthcare organizations from unnecessary fines and lawsuits associated with non-compliance, while also optimizing reimbursement revenue and ensuring high-quality care for members.
“Now offering four tiers of service – Basic, Professional, Enterprise and Enhanced – this fully functional e-commerce experience allows customers to conveniently find, research and purchase their appropriate EPStaffCheck service tier,” said Maurice Steenland, Chief Product Officer of Valenz. “For customers who prefer full-service support and white-glove rapid onboarding, Valenz compliance teams are readily accessible via the Enhanced tier.”
The key features of EPStaffCheck services include:
With EPStaffCheck, compliance teams are just a few clicks away from quickly and easily searching the millions of sanction records, often found in disparate databases, to avoid the costs and dangers of employing troubled providers. Whether there is a need for permission-based users, a need for single or batch searches, special state-specific licensure search needs, or the need for complete account oversight from Valenz, customers can find the exclusion monitoring solution that is the perfect fit for them.
Learn more about EPStaffCheck and the VIA Provider Solutions: valenzhealth.com/epstaffcheck-compliance-management
Stefani Voorhees Joins Vālenz® Health as Senior Vice President, People
/in Announcements, Featured, Press/by Maris PanjadaPHOENIX, Ariz. (Nov. 18, 2022) — Vālenz® Health is pleased to announce that Stefani Voorhees, SHRM-SCP, has joined the leadership team as Senior Vice President, People.
Having served in leadership positions in human resources since 2015, Voorhees brings extensive experience in developing organizational strategy, building and implementing people-focused programs, overseeing performance management, compensation and benefits strategy, compliance, and employee engagement. She also has a strong background in recruitment and talent acquisition.
“Stefani considers human resources to be the nucleus of the business and the catalyst to driving an exceptional employee experience and highly effective talent strategy. That makes her an excellent fit for the Valenz Health culture,” said Rob Gelb, Chief Executive Officer. “Stefani will play a lead role in supporting our growth strategy and optimizing our talent to help us continue to thrive through future acquisitions and expansion. She is a terrific addition to the Valenz team.”
Most recently, Voorhees served as Head of Human Resources for Companion Protect. She also held leadership roles in human resources and talent management for BranchPattern, PeopleAdmin and Modis after working in client management and financial advisory services. She received her bachelor’s degree in human resource management.
“I’m thrilled to become part of an innovative company that places a high priority on relationships, alignment, communication and employee engagement,” Voorhees said. “People are every company’s greatest asset, and you can’t separate the people decisions from the business decisions. As I strive to foster a ‘love where you work’ mentality, I’m looking forward to the opportunity to support, develop and engage with all the great talent at Valenz.”
For more information about the Valenz executive team, visit valenzhealth.com/about/leadership.
About Vālenz® Health
Vālenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.
Vālenz® Health Promotes Shannah Montgomery to Client Services Executive
/in Announcements, Featured, Press/by Maris PanjadaPHOENIX, Ariz. (Nov. 11, 2022) — Vālenz® Health is pleased to announce Shannah Montgomery has been promoted to Client Services Executive. Montgomery brings expertise with account management to her new role, along with client-centered service.
Montgomery held the position of Client Services Representative at Valenz for nearly two years before her promotion. Under the leadership of Brian Campbell, Vice President of Client Services, she will assist clients with new opportunities and solutions across the Healthcare Ecosystem Optimization Platform, engaging early and often to ensure strong, vigorous and healthy client relationships.
“Over the past two years, Shannah has developed great rapport with Valenz clients through her commitment to excellence and her determination to deliver on the promise of smarter, better, faster healthcare,” said Campbell. “She has a tremendous work ethic and will continue to be even more of an asset to our clients in her new position.”
Montgomery joined Valenz in 2020 with a background in account management and operations. She has a bachelor’s degree from the University of North Florida in Jacksonville. Before Valenz, she was a National Account Manager with One Call, where she was regularly promoted over the course of nearly a decade with the company.
“I’ve always been customer-service driven, and there’s nothing I value more than collaborating with my team at Valenz to enhance customer experience,” said Montgomery. “Here at Valenz, we all share that client-first approach, and it shows in everything we do. Because we get to know our clients, we understand what they need to succeed and achieve their goals – and that’s why Valenz has become one of the fastest growing private companies in the U.S.”
For more information about Valenz and its leadership team, visit valenzhealth.com.
About Valenz Health
Vālenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.
As healthcare costs reach unsustainable levels, care navigators and members need better tools to guide the right care options
/in Announcements, Featured, Press/by kamryn cainFrom Rob Gelb, Vālenz® Health CEO
During the COVID-19 pandemic, many patients paused their doctor visits or let their medications lapse, leading to health issues going unchecked for months or years. The resulting increase in late-stage diagnoses for serious conditions like cancer and heart disease means patient acuity is higher and treatment is more extensive – all key contributors to the ongoing escalation of healthcare costs. And we are all beginning to see the impact of inflation on the healthcare system.
To battle this growing crisis, self-insured employers can advocate for members by deploying medical cost-containment solutions to connect them to necessary quality care while also minimizing expenses for both the member and the employer.
I believe members will benefit from engagement early and often throughout the patient journey, receiving proactive support from navigators who make them aware of all their care options and provide guidance to the right resources that meet not only their health needs, but their financial needs as well.
Case in point: Of the more than 100 million Americans living at or below 400 percent of the Federal Poverty Level (e.g., a family of four with a household income of $106,000 or less), many might not realize they may qualify for low- or no-cost medical care. Most likely, their employer and health plan sponsor are unaware of this opportunity as well. Although about 60 percent of U.S. hospitals receive billions in tax breaks to offer charity care, the lack of promotion of this option – and the resulting low consumer awareness – has become a significant national issue.
As part of the federal requirements of Section 501(r), members who do qualify for low- or no-cost care may receive medical treatment at one of more than 4,000 facilities across the country with fiduciary responsibilities to offer charity care. For members who are above 400 percent FPL, they may be eligible for more than 1,000 pre-negotiated care bundles or other high-quality in-network care.
The impact of healthcare’s rising costs – and the lack of transparency for patients – has become unsustainable. The key to a solution is the creation and adoption of tools that support navigators in collecting members’ financial and demographic information at the onset of navigation and providing education, support and guidance about their care options – a true model of member/patient advocacy. We need to simplify the healthcare journey for members, making it easy for them to receive the best possible care at the lowest cost while staying in network.
To address this need, Vālenz® Health created Care Value Optimizer (CVO) as a unique enhancement to its NaVcare solution for member navigation and advocacy. Leveraging the power of the Valenz Healthcare Ecosystem Optimization Platform to engage data and empower better decision-making, CVO advocates for members by triaging them to charity care, Centers of Excellence care bundles, or high-performance network offerings based on their finances, location, benefits and health profile.
Because every member is different and their needs may change over time, Valenz navigators and nurses conduct ongoing engagement to gain a comprehensive, data-supported view of members’ current needs. Navigators provide insight to the right care options depending on members’ income, health needs and ability to travel for care; and in alignment with the Valenz “Yes, And” culture, navigators also support patients with scheduling, paperwork and other requirements before they see a provider.
CVO enables effective management of the most expensive and complex treatments and procedures, benefiting the member with lower costs, better access to high-quality care, and improved health outcomes. While the member receives advocacy, employers become more empowered to balance quality, utilization and cost of care, reducing claim expense and the overall plan spend. Ultimately, CVO drives smarter, better, faster healthcare for everyone involved.
The “new normal” of a post-pandemic world has had a serious impact on the lives of many members who may find themselves deciding between putting food on the table and getting the healthcare they need. With CVO, the NaVcare Enhanced solution, and all options within the Valenz Healthcare Ecosystem Optimization Platform, self-insured employers and those who support them and their plans can take a significant step toward ensuring members won’t have to face that choice.
About Rob Gelb
Rob Gelb is Chief Executive Officer of Vālenz® Health, which simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.
About Vālenz® Health
Valenz Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.
Vālenz® Health CEO Shares Member-Centric Strategies to Drive Improved Cost Containment and Risk Mitigation
/in Announcements, Featured, Misc./by Maris PanjadaPHOENIX, Ariz. (Oct. 28, 2022) — Self-insured employers looking for cost containment strategies should be open to solutions that prioritize the member first– a shift in thinking that can have a big payoff for both the member and the employer, according to Vālenz® Health CEO Rob Gelb.
As part of a recent HCAA-sponsored “Voices of Self-Funding” podcast with host Ramesh Kumar and Imagine360 CEO Jeff Bak, Gelb addressed key trends in driving lower costs and managing risk for self-funded plans, including the roles played by enhanced transparency, data and technology.
“It starts with the employer being willing to get comfortable being uncomfortable, accepting that they may not have all the answers, and making changes in the spirit of the member to do what’s right,” Gelb said. “More than just cutting the cost of an individual claim, the conversation has to evolve around the total cost of care and placing the member first in the equation while you measure quality of care, reasonable cost and reasonable reimbursement.”
An important first step, Gelb said, is to establish transparency from the start among the provider, payer, plan and member – aligning all parties in achieving a balance of cost, quality and utilization of care.
“There’s a misalignment of incentives with the way that traditional plans design their networks, and an expectation from employers that any provider network that has broad coverage is good for their employees,” Gelb said. “When you have full alignment upfront, all parties understand throughout the process what their role is in balancing the equation of quality, advocacy and cost. That’s how we arrive at cost containment options that benefit everyone involved in the claim.”
“We’ve designed a solution as a platform that becomes a full BUCAH replacement option,” Gelb said, referring to the Valenz Healthcare Ecosystem Optimization Platform. “Economics are a big part of that. We use local and national data sets to feed UCR, paid claim data, other forms of data, and Medicare into an algorithm to determine what we call market sensitive repricing. In addition to determining what services and the price point for those services, we determine what shouldn’t even be on the claim. Then, we typically get provider signoff 50 percent of the time on all of those factors to eliminate any friction. That’s part of our methodology to contain costs and serve the member.”
Hear more from Rob in the full podcast.
About Vālenz® Health
Vālenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.
Title Sponsor Vālenz® Will Introduce Latest Solutions at 2022 SIIA National Conference & Expo
/in Announcements, Featured, Press/by kamryn cainPHOENIX, Ariz. (Sept. 30, 2022) — As Title Sponsor of the Self-Insurance Institute of America (SIIA) National Conference & Expo in October, Vālenz® will introduce several game-changing solutions that will favorably alter the trajectory of healthcare costs for self-insured employers.
Through the power of the Healthcare Ecosystem Optimization Platform, Valenz has expanded its ability to engage data and empower better decision-making to drive outcomes and lower costs, starting long before care is provided and continuing long after a claim is paid. The company’s member navigation and advocacy product, NaVcare is now enhanced with Care Value Optimizer (CVO). In addition to traditional NaVcare member navigation and advocacy services, CVO triages members to charity care, care bundles or high-performance network offerings based on their financial and health profile to drive the least costly, highest quality outcomes for plan sponsors.
“CVO is a game changer in terms of enhancing our ecosystem and ability to drive the lowest cost, highest quality care for members before going to traditional network providers. When you couple this with our care management suite, specialty pharmacy and aggressive bill review and claim repricing programs, it is a strong cost and quality control program that will ultimately bend the trajectory of health plan spend,” said Rob Gelb, CEO of Valenz. “The ultimate goal of the Valenz Healthcare Ecosystem Optimization Platform is to help self-insured employers lower plan spend and mitigate risk.”
To this end, the Valenz V-Rated Solution, will be unveiled at SIIA. The V-Rated Solution leverages the cost reduction value of the full ecosystem to capture optimal stop loss ratings. By utilizing enhanced analytics to assess financial risk, engaging proactively with medical stop loss underwriting which accounts for the positive effects of the ecosystem at the start of the sales process, and employing a continuous loop of information to all parties, plan sponsors can be assured that their premiums are fully representative of the value of cost containment.
“We’re fundamentally changing the way employers look at stop loss insurance. It should no longer be managed as a commodity. By engaging early in assessing risk and having insight into what is possible from integrated cost containment initiatives, employers can mitigate fiduciary risk by enabling Stop Loss to accurately align underwriting with the summary plan description, realize cost savings, and be better positioned to predict costs year after year,” said Gelb. “The journey for transformative and meaningful change in our industry is just beginning and we’re here to bring those ready for that trip forward with us.”
“We’re thrilled to share our fully integrated solution at the industry’s largest self-insurance event,” Gelb said. “We first launched the Valenz ecosystem at the SIIA conference in 2019, the last time it was held fully in person before the pandemic. Three years later, we’ll come together with a great network of companies and people, in our own city of Phoenix, as a rapidly expanding company with several strategic transactions and a fully optimized ecosystem of interactive, data-driven solutions. We are anticipating and curating a very special event for our clients, partners, prospects and industry colleagues.”
Scheduled for Oct. 9-11 at the JW Marriott Phoenix Desert Ridge Resort & Spa, the SIIA annual conference will offer educational programs, meaningful insights and game-changing solutions on the latest industry topics. Gelb will facilitate an “Engagement Accelerator” session called “Selling in the Self-Insurance Market,” which will address the acceleration of change, the challenges of staffing, and other industry developments that should drive thought leadership and likely will shift the mind of the buyer in the self-insurance value chain. Participants will share their experiences and strategies on how to effectively support self-insurance industry buyers while achieving corporate growth objectives. An approach Valenz describes as ‘getting comfortable being uncomfortable’ which is a Core 4 tenet to the Valenz culture driving meaningful change in an industry hungry for innovation and transformation.
Valenz has been a Diamond Member of SIIA since 2020, which signifies the highest level of support for SIIA’s mission and demonstrates a leadership position in serving the needs of the self-insurance community.
About Valenz
Vālenz® simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality and outcomes for employers and their 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® Acquires Fourth Company: Health Cost Control Enhances Medical Cost Savings Solutions for Employers
/in Announcements, Featured, Integrations, Press/by Maris PanjadaPHOENIX, Ariz. (Sept. 9, 2022) —Vālenz® announced today it has acquired Health Cost Control Inc., a national provider of medical cost containment solutions with more than 25 years’ experience. With specialization in claim and cost review services for high-dollar claims, including dialysis, air ambulance and behavioral health billing, Health Cost Control offers custom-designed programs for health plans, third-party administrators, insurance companies and employers.
The fourth company acquired by Valenz since May 2022, Health Cost Control ensures provider adherence to the national guidelines that govern inpatient and outpatient billing, identifying significant savings from inaccurate billing and incomplete documentation. Health Cost Control registered nurses conduct thorough claim reviews for duplication, unbundling, data entry errors and other discrepancies that often go unnoticed and result in higher costs for employer groups. With deep experience covering most clinical settings and understanding related operational costs, Health Cost Control also has expertise in repricing claims to usual, customary and reasonable levels, often garnering 70%+ savings off billed charges.
“We are very excited to welcome Health Cost Control, their clients and their members to the Valenz family,” said Rob Gelb, Chief Executive Officer of Valenz. “In exploring new opportunities to deliver on our core promise to drive smarter, better, faster healthcare, it was clear that the company is an outstanding fit for Valenz. We have partnered with Health Cost Control since 2021 and know we can seamlessly integrate their offerings into our claim management solutions, providing the transparency necessary to lower total health plan spend, improve claim outcomes, and enhance the member experience.”
The Health Cost Control acquisition further fortifies the Valenz Healthcare Ecosystem Optimization Platform, a fully integrated suite of solutions that simplifies the complexities of self-insurance. To balance the relationship between healthcare quality, advocacy and cost, Valenz aligns the member, provider, health plan and payer, supported by a steadfast commitment to data transparency and decision enablement. Ultimately, Valenz drives value across clinical and member advocacy, network development, and the validation, integrity and accuracy of claims.
“Our two companies are truly aligned in our cost containment approach and our dedication to innovation, advocacy and quality,” said Carl Papp, CLU, Principal and President of Health Cost Control. “As we continue to serve our clients with customized, flexible programs for reducing healthcare costs, we look forward to becoming an integral part of the Valenz ecosystem.”
About Valenz
Vālenz® simplifies the complexities of self-insurance by offering an end-to-end Healthcare Ecosystem Optimization Platform that manages the cost and quality of care for employers and their members. To balance the relationship between healthcare quality, advocacy and cost, the Valenz enterprise-level solution suite aligns the member, provider, health plan and payer. Supported by a dynamic, innovation-first culture and a steadfast commitment to data transparency and decision enablement, Valenz leverages its technology infrastructure and enterprise data warehouse to drive value across clinical and member advocacy, network development, and the validation, integrity and accuracy (VIA) of claims. Learn more about how Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.
About Health Cost Control
Health Cost Control, based in Texas City, TX, is a leading national provider of cost containment solutions with over 25 years’ experience. The company was founded with the mission that still holds true today: to reduce healthcare costs for clients and ensure that the national billing guidelines that govern inpatient and outpatient billing are adhered to by providers. With specialization in group health claim review, and drawing from a large range of services, Health Cost Control creates a program tailored to fit your needs and deliver optimum results for lower healthcare costs. Learn more at healthcostcontrol.com.
Vālenz® Promotes Kaylee Davis to Client Services Executive
/in Announcements, Featured, Press/by Maris PanjadaVālenz® is pleased to announce Kaylee Davis has been promoted to Client Services Executive. Davis brings expertise with Valenz ProteKHt™ and account management with client-centered service to this new role.
Davis was previously Supervisor of Claim Operations with Valenz ProteKHt. In her new role under the leadership of Brian Campbell, Vice President of Client Services, she will assist clients with new opportunities and solutions from Valenz, ensuring strong, vigorous and healthy client relationships.
“Kaylee showed an aptitude for exceptional client service when she first started with Valenz,” said Campbell. “Her rapport with clients is just one of the many reasons she’s been promoted twice since her relatively recent arrival at Valenz. We’ve consistently witnessed her work ethic and seen her commitment to delivering on the promise of smarter, better, faster healthcare.”
Davis joined Valenz in 2019 with a background in community healthcare. She has a degree from the Brooks College of Health at the University of North Florida in Health Administration. Before Valenz, she worked with healthcare volunteers and engaged the community at a charitable healthcare clinic in Florida.
For more information about Valenz and its leadership and client services teams, visit valenzhealth.com.
Vālenz® Announces Acquisition of Certus Management Group and Launch of Medical Stop Loss Insurance Solution
/in Announcements, Featured, Integrations, Press/by Maris PanjadaPHOENIX, Ariz. (Aug. 12, 2022) — Vālenz® announced today it has acquired Certus Management Group Stop Loss, Inc. (CMG), a managing general underwriter providing certainty of stop loss protection to self-funded employee benefit plans since 1998.
CMG will become a Valenz Affinity Company and part of the Valenz Healthcare Ecosystem Optimization Platform, a fully integrated suite of solutions that simplifies the complexities of self-insurance through data transparency and decision enablement throughout the life of a claim. Additionally, the acquisition creates a new private label medical stop loss insurance solution, launching in market as a Valenz V-Rated solution. This solution enables the more efficient delivery of medical underwriting and risk mitigation services tailored to the needs of Valenz clients. All other CMG underwriting services will continue to be offered under the CMG trade name.
The Valenz V-Rated solution is an additive benefit for self-insured employers who engage with Valenz for a full ecosystem solution, including care management, member navigation enhanced with Care Value Optimizer (charity care and centers of excellence bundles), specialty drug solutions, contracted and open access success networks, and high-cost claim cost containment programs. When partnering with Valenz during the presale process, clients realize the full value of the ecosystem which allows them to contain medical costs more aggressively than less innovative offerings, while also potentially resulting in more competitive stop loss costs.
“We’re thrilled to welcome CMG to the Valenz family,” said Rob Gelb, Chief Executive Officer of Valenz. “Our companies are a great match for each other in their commitment to transparency, risk management, and financial protection from high-cost claims and escalating pharmaceutical and treatment costs. As Valenz continues to evolve and expand, we are excited to begin this new collaboration in delivering on our core promise: engaging early and often for smarter, better, faster healthcare.”
CMG will retain its trade name and adopt a new tagline: “A Valenz Affinity Company,” with a slightly updated logo to facilitate a more rapid association with Valenz. The core team of 18 will continue to remotely support CMG-integrated products and services at its current headquarters in Indianapolis.
“CMG and Valenz share a deep commitment to financial assurance for the self-insured industry, while also advocating for plan members and ensuring high-quality, cost-effective care,” said Brad Lewis, President and Chief Executive Officer of CMG. “As we join the Valenz team, we look forward to protecting and serving our clients as an integral part of their innovative, data-driven ecosystem.”
CMG’s line of stop loss products limits liability and eliminates the pitfalls that many employers view as obstacles to self-funding. It offers plan design and risk analysis, stop loss underwriting, firm renewals, and a guaranteed “no laser” contract for groups of all sizes – for plans of 11 participating employees and larger with specific retention levels from $10,000. CMG’s claim procedures also protect self-funded employers from cash flow issues that can result from unpredictable claim activity.
About Valenz
Vālenz® simplifies the complexities of self-insurance by offering an end-to-end Healthcare Ecosystem Optimization Platform that manages the cost and quality of care for employers and their members. To balance the relationship between healthcare quality, advocacy and cost, the Valenz enterprise-level solution suite aligns the member, provider and payer. Supported by a dynamic, innovation-first culture and a steadfast commitment to data transparency and decision enablement, Valenz leverages its technology infrastructure and enterprise data warehouse to drive value across clinical and member advocacy, network development and the validation, integrity and accuracy (VIA) of claims. Learn more about how Valenz engages early and often for smarter, better, faster healthcare. Valenz is backed by Great Point Partners.
About CMG
Certus Management Group has developed a line of stop loss products that limit the liability of a self-funded employer and eliminate the pitfalls that many employers view as obstacles of self-funding. With more than 350 years of combined experience in the stop loss business, the CMG staff is among the most qualified in the industry. This experience enables CMG to provide employers with stop loss solutions that bring certainty to their self-funded plan. CMG maintains a strong relationship with two carrier partners, SiriusPoint America Insurance Company (Rated A- (Excellent) by A.M. Best), and Gerber Life Insurance Company (Rated A (Excellent) by A. M. Best). Each carrier shares CMG’s vision of the stop loss marketplace and offers the stability of a well-established insurance company.
Learn more at certusmg.com.