Vālenz™ NaVcare Delivers Data-Driven Care Navigation, Improves Network Utilization, Member Satisfaction and Health Outcomes

PHOENIX, Ariz. (Sept. 25, 2020) – As part of its triple-URAC-accredited Vālenz Care suite, Valenz has announced the launch of NaVcare, a concierge-level care navigation program that combines data with service delivery to improve utilization, member satisfaction and health outcomes. Based on intelligence from multiple sources within the Valenz ecosystem – including claim, pharmaceutical and demographic data – NaVcare is tailored to each employer with personalized services for each health plan member.

“We place the patient at the center of care, starting with high-touch member onboarding to empower individuals in making better healthcare decisions, improving outcomes and enhancing their experience,” said Amy Gasbarro, Chief Operating Officer. “Working one-on-one with plan members, our care navigators provide expert knowledge of the health plan, care plan and provider network to guide members toward high-quality, low-cost care and medication.”

NaVcare brings member-centric services and data-driven insights into the patient journey, connecting the dots for smarter, better, faster healthcare. NaVcare navigators serve as a central hub for care coordination, providing personalized education, collaboration and communication.

“When integrated with the full Valenz ecosystem, real-time intelligence allows us to target the 5-15 percent of claims that drive 70 percent of an employer’s health spend,” explained Rob Gelb, Chief Executive Officer. “By integrating the high value network design of Vālenz Access with care navigation, Valenz is helping our clients achieve up to 85 percent in-network participation within 12 months, resulting in significant plan and member savings.”

For more information, call (602) 792-5371.

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.

V3 Repricing Engine: Fueled by Big Data to Ensure Fair, Market-Supported Reimbursements

PHOENIX, Ariz. (Sept. 14, 2020) – To accelerate fair and accurate claim repricing and ensure market-supported reimbursements, Vālenz™ has introduced the V3 Repricing Engine. Fueled by the volume, variety and velocity of data within the Valenz ecosystem, V3 supports strategic decision-making and creates value for the payer, the provider and the patient.

The V3 Repricing Engine can identify patterns and pinpoint high-performing providers with optimal cost structures, along with delivering greater efficiency and reduced turnaround times for processing and payments. Ultimately, it ensures savings on professional claims, which account for up to 85% of claim volume for self-funded insurers.

Aggregating years of robust claims data with industry-leading sources, the V3 Repricing Engine uses the proprietary, data-rich VMSSM Repricing Methodology to determine fair, defensible claim reimbursements. Its detailed analysis goes further to identify potential program pain points and opportunities for additional savings. For integrity and timeliness, VMSSM continuously scrubs and adjusts the data as needed to ensure a fair market price for all services rendered, while identifying potential fraud, waste and abuse.

“As we continue to identify solutions that control costs while serving the member and helping the employer, the V3 Repricing Engine is one more way we fulfill our promise of better, smarter, faster healthcare,” said Rob Gelb, Chief Executive Officer of Valenz. “The proprietary algorithms of our VMSSM Repricing Methodology provide actionable insights to support a consistent and substantiated reimbursement model, reducing friction among the payer, provider and patient.”

Curating from multiple data sets to offer up-to-date, regionally specific reimbursement recommendations, the V3 Repricing Engine is fueled by the three Vs of big data:

  • Volume: Years of historical paid claims data
  • Variety: Numerous geographical, medical and claim data elements
  • Velocity: Up-to-date information using real-time insight

“While the V3 Repricing Engine applies to all medical claims, it maximizes discounts for high-volume, low-dollar claims – an overlooked segment in the market to increase value for self-funded plans,” said Amy Gasbarro, Chief Operating Officer of Valenz. “This approach to repricing reduces the cost of healthcare for all parties involved.”

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.

New Front Door to Care: Telehealth is Here to Stay

This article is first in a series examining the long-term impact of COVID-19 on health and healthcare issues for the self-insured industry.

As the COVID-19 pandemic has restricted patients’ access to their physicians, the use of telehealth has grown exponentially in 2020 – and we may be only scratching the surface of its role in the future.

So far this year, virtual care visits have reached more than 1 billion, with 500,000 for COVID-19 – an increase of 64.3 percent, according to a recent analysis by Frost & Sullivan. Telehealth’s $3 billion revenue market has the potential to grow to $250 billion, according to McKinsey & Company. Consumers have been 1.6 times more likely to use telehealth after their first experience, so an increasing number of providers are offering it – 53 percent more than before the pandemic began.

Telehealth’s unprecedented rise has captured the attention of public policymakers as well. On August 3, President Trump signed the Executive Order on Improving Rural and Telehealth Access, which extends the availability of virtual care benefits for Medicare beneficiaries during the pandemic. The order, which calls for permanent expansion, accentuates that telehealth may become a lifeline in rural areas with more limited access to in-person care. With multiple telemedicine bills brought to the House and Senate this year, there is broad bipartisan support for Congress to pass legislation that would keep coverage in place.

For self-insured employers, brokers and third-party administrators, the growing emphasis on telehealth facilitates early engagement with members in diagnosing and treating conditions, as well as disease management for chronic care patients. The convenience of telehealth allows members to take charge of their health and promotes care continuity for long-term wellness. Additionally, the surge in telehealth adoption will open up opportunities to better serve members with other virtual care models, such as remote patient monitoring, texting, digital symptom checkers, and online health coaches.

Member demand for virtual care is undeniable. Frost & Sullivan estimates that the U.S. telehealth market will display staggering seven-fold growth by 2025. Surveys this year by McKinsey & Company indicated that providers are seeing 50 to 175 times the number of patients via telehealth than before COVID-19. Of the survey respondents, 76 percent were highly or moderately likely to use telehealth going forward, and 74 percent of telehealth users reported high satisfaction.

Although in-person doctor visits are unlikely to become a thing of the past, telehealth is here to stay. Signs point to its continued growth as a key healthcare delivery tool for the next 12-18 months – until a vaccine becomes widely available – and beyond. For members, telehealth services can offer the benefits of more accessible care, minimized exposure and health risks, ease of use, and improved patient outcomes – the fruits of our labor to reimagine care.

***

Rob Gelb is Chief Executive Officer of Vālenz™, one of the nation’s leading medical cost reduction and claims flow management organizations offering expanded solutions to support the self-insured industry.

Vālenz Ranks No. 2065 on Inc. 5000 List of Fastest-Growing Private Companies

PHOENIX, Ariz. — Inc. magazine today announced that Vālenz™ ranks No. 2065 on the annual Inc. 5000 list, the most prestigious ranking of America’s fastest-growing private companies. The Inc. 5000 list represents a unique look at America’s most successful independent small businesses. Over the years it has included such leading-edge organizations as Microsoft, Vizio, Intuit, Oracle, Zappos.com and many others.

“We are honored to be recognized as one of the fastest-growing companies in America, and it reinforces what our clients already know – that controlling health plan costs, serving the plan member and helping the employer group are all connected,” said Rob Gelb, Chief Executive Officer at Valenz. “Our rapid growth is a function of everything we do to control costs, deliver quality, and create new paths of opportunity for employers, TPAs, and brokers to improve plan design, reduce plan spend, and enhance member lives.”

Moving forward, the company is poised for future growth. As the innovators behind an ecosystem that combines health data analytics with healthcare service delivery across the entire lifecycle of every claim, Valenz is laser-focused on changing the trajectory of healthcare costs – which they call lowering the Claim Cost Arc℠ – for the self-insured industry. Data and information flow through the Valenz ecosystem from the company’s core products, clients, platform partners and industry sources, and in doing so, it fuels ever-expanding analytic and predictive capabilities. That data-driven decision enablement, coupled with member- and client-centric service delivery, creates continuous value for every individual and organization within the ecosystem.

“If you are excited about what Valenz has accomplished for your business in the three years since we first envisioned our ecosystem, you will be very pleased with what the future holds,” said Gelb. “By engaging early and often for smarter, better, faster healthcare, we are continuously creating new opportunities for self-insurers to target the small percentage of claims that drive their majority of health plan costs.”

“From health and software to media and hospitality, the 2020 list proves that no matter the sector, incredible growth is based on the foundations of tenacity and opportunism,” said Inc. editor-in-chief Scott Omelianuk. Together, the companies in the 2020 Inc. 5000 achieved three-year average growth of more than 500 percent and a median rate of 165 percent, with aggregate revenue accounting for more than 1 million jobs in the same time frame. Complete results of the Inc. 5000 can be found at www.inc.com/inc5000.

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.

About Inc. Media
The world’s most trusted business-media brand, Inc. offers entrepreneurs the knowledge, tools, connections, and community to build great companies. Its award-winning multiplatform content reaches more than 50 million people each month across a variety of channels including websites, newsletters, social media, podcasts, and print. Its prestigious Inc. 5000 list, produced every year since 1982, analyzes company data to recognize the fastest-growing privately held businesses in the United States. For more information, visit www.inc.com.

v-Rx Powered by ScoutRx: Significant Savings and Enhanced Services

PHOENIX, Ariz. (June 30, 2020) – Costs of prescription drugs continue to rise exponentially, with total spending in the United States predicted to reach $610 billion in 2021. As pharmacy benefits represent a significant expense for self-insured employers, Vālenz™ is changing the approach to prescription drug coverage with its latest solution.

v-Rx, powered by ScoutRx, offers innovative cost-reduction and containment strategies that significantly enhance the benefits and services traditionally offered by a pharmacy benefits manager.

“While PBMs focus on getting the best discounts and the biggest rebates, we believe those should be considered short-term solutions. The real opportunity is to deliver long-term strategies that contain costs perpetually and help self-insured employers regain control of their pharmacy spend,” said Rob Gelb, Chief Executive Officer for Valenz.

With a suite of services comprising three core offerings, v-Rx creates long-term reductions in pharmacy benefit spend with average annual savings of 43 percent, while also delivering a concierge-style experience for members.

“Traditional PBM solutions base their savings on discounts without taking pharmaceutical inflation into account. The V-Rx solution gives the group the ability to dramatically reduce their spend and maintain that reduction year-over-year,” said Jordan Hersh, Vice President, Enterprise Solutions for Valenz. “At the same time, members receive highly personalized service and advocacy to assure that they never have to go without their medication.”

The three tiers of v-Rx services include:

  • Specialty Pharmacy: Alternative funding is used to reduce specialty drug costs by up to 100%.
  • Co-Pay Optimization: The full-service co-pay card optimization program enhances group savings without changes or disruption for individual members.
  • International Pharmacy: Dramatic savings for many brand-name, domestically equivalent medications, including temperature-sensitive items.

The v-Rx solution further expands the Valenz ecosystem, offering seamless pharmacy benefits delivery and a superior platform for healthier and more satisfied members.

Learn more about v-Rx powered by ScoutRx here.

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.

About ScoutRx

ScoutRx is a dedicated collection of pharmacy benefit professionals delivering revolutionary solutions to drastically reduce the pharmacy benefit costs for our plan sponsors and their members. Focused on servicing self-funded organizations, ScoutRx offers a fresh approach to maximizing savings and minimizing pharmacy benefit spend. Learn more at scoutrxconsulting.com.

 

Vālenz VzReturn Offers Employers Safe Return-to-Work Solution During COVID-19 Pandemic

PHOENIX, Ariz. (May 22, 2020) – As America turns its attention to re-opening the economy and employers plan for their employees’ return to work, Vālenz™ is introducing VzReturn, a solution for protecting  workforce health and safety during the COVID-19 pandemic. A Valenz Care solution, this comprehensive client-centric set of services further expands the Valenz ecosystem and offers immediate value to self-insured employers.

Valenz VzReturn helps employers meet their legal obligations while also limiting potential health risks for their workforce by providing onsite temperature checks, personal protective equipment and antibody testing where available, prior to and upon their employees’ return to work. The solution also includes a variety of management tools and educational resources for Human Resources leaders and employees to improve emotional fitness and physical well-being.

According to Amy Gasbarro, Chief Operating Officer for Valenz, employers may also access Valenz Care’s personalized health coaching via multiple channels, including telephone, in-person and web chat, as well as Textcoach,™ a secure messaging platform for employees to connect with a licensed mental health counselor to address concerns such as coping, stress, depression or anxiety.

“COVID-19 has presented unprecedented economic and operational challenges for employers, especially now given the lack of consistent guidance related to safe return-to-work policies and procedures,” said Rob Gelb, Chief Executive Officer for Valenz. Gelb added that Valenz is dedicated to offering client-centric solutions like VzReturn to help clients engage early and often to mitigate employer risk while meeting employee health and safety needs during the pandemic response.

“Providing this safe return-to-work onsite solution offers a clearly defined path for employers as they reopen their businesses and resume normal operations. Additionally, with VzReturn, our clients have the tools to continually protect the workforce should employees encounter virus exposure outside the workplace, requiring additional stays of quarantine,” Gelb said. “The Valenz VzReturn solution is just one more component of our promise to support our clients in achieving smarter, better, faster healthcare.”

Click here to learn more about Valenz VzReturn.

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.

The Vālenz Payment Solution: Electronic Solutions for Timely and Efficient Claim Payments

PHOENIX, Ariz. (May 12, 2020) – In response to surging demand for electronic claim payments, leaders at Vālenz™ today announced the rollout of the Valenz payment solution. This development further expands the Valenz ecosystem to include fully automated solutions for electronic provider payments.

With the Valenz payment solution, payers and third-party administrators can automate and streamline payment processes for health, dental and workers’ compensation claims – eliminating the delays of manual payment processes and ensuring payments arrive on time. While the need for electronic payment solutions was already on the rise, the widespread shift to working from home has led to rapid acceleration of the Valenz payment solution, now being released ahead of its original late 2020 schedule.

“COVID-19 has presented many unforeseen operational challenges, especially for organizations with manual processes that raise barriers to conducting business as usual right now,” said Jordan Hersh, Vice President, Enterprise Solutions at Valenz, adding that Valenz is dedicated to meeting client needs even as those needs change day by day during the pandemic response. “The current situation called for us to provide electronic payment solutions as soon as possible for our clients, and we were very happy to make that happen.”

The Valenz payment solution enables clients to send provider payments on time and according to their providers’ own preferences, including virtual card payments. Timely, accurate payments are an important part of maintaining healthy relationships with hospitals and providers, and electronic claim payments eliminate manual steps to streamline operations and reduce expenses. With the Valenz payment solution, all payments are processed on a single system of record, regardless of payment type. And, because security is paramount, the platform is HIPAA and NACHA compliant, and it meets all federal and state requirements for electronic payments.

“Simplified payment processes, operational efficiency and clearer communications benefit all health plan partners, especially while working through significant changes in the work environment,” said Rob Gelb, Valenz Chief Executive Offer. “The Valenz payment solution is an important part of our promise to support our clients in achieving smarter, better, faster healthcare.”

Learn more here.

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.

A picture of a workplace meeting

Vālenz Partners on Joint Economic Recovery Venture for Self-Funded Groups

PHOENIX, Ariz. (May 11, 2020) – In response to the economic impact of COVID-19, Vālenz™ has joined Benefit Plan Administrators, Inc. (BPA) and six other top U.S. health vendors to jointly deploy a self-funded healthcare and benefits solution for new groups that are currently fully-insured. Known as the Stimulus For Business Initiative (SFBI), this program marks a new, unprecedented opportunity for employer savings in the health benefits market.

Through deferred or waived service fees for up to three months following the new business anniversary date for eligible member groups, the SFBI plan offers a unique self-funded adoption opportunity to increase cash-flow and stimulate economic growth. The eight founding organizations, which include Valenz, BPA, 6 Degrees Health, HealthWallet, ScoutRx, The Phia Group, CieloStar and PHCS, collectively rolled out the program on May 8.

SFBI will operate as an LLC formed by some of the nation’s top health plan advisors: DC Advisory LLC, Stautberg Benefit Advisors, Prosperity Benefits and AMR Benefits, who are partnering with leading stop-loss providers East Coast Underwriters to ensure the viability and success of this novel program.

With fully-insured groups expecting significant rate increases on renewals in 2020 and 2021, SFBI’s founders point to this approach as a potential solution for all fully-insured groups as an added stimulus and optional recovery opportunity.

“The SFBI partners are pleased to announce this innovative program,” said Morris Masinter, President of BPA and SFBI co-founder. “With projections showing upcoming high rates for fully-insured renewals, our plan is a smart move for employers to retain control of their benefit spend, even in the face of hardships caused by the devastating coronavirus pandemic.”

Fully-insured groups of 5-5,000 lives in all industries, single or multi-state, public or private entities, will have the option to work in co-advisory arrangement with their current broker and SFBI. Participants can expect customized solutions for their benefit needs and should speak with their broker to learn more about the opportunity. More information on eligibility criteria, including webinars and educational seminars around the program, are coming soon.

“We are thrilled to offer this innovative solution jointly with our co-founders, a highly esteemed group of organizations that share our dedication to supporting self-funded employer groups,” said Rob Gelb, Chief Executive Officer at Valenz. “SFBI is one of many ways we are continuously expanding our ecosystem and engaging early and often for smarter, better, faster healthcare.”

Portrait of Ed Zwicker, MBA, Vice President, Information Technology

Ed Zwicker Joins Vālenz as Vice President, Information Technology

PHOENIX, Ariz. (April 13, 2020) – Vālenz™ is pleased to announce that Ed Zwicker, MBA, has joined the team as Vice President, Information Technology.

Based in Philadelphia, Zwicker brings 35 years’ experience in design, development, and implementation of highly robust data systems and business intelligence applications. He carries out innovative IT initiatives that add value to his company’s primary business, creating and executing data strategies that align with business goals.

“We are thrilled to have Ed join the senior leadership team,” said Rob Gelb, Chief Executive Officer of Valenz, a leading innovator for data-driven solutions that reduce medical claim costs and promote quality healthcare. “Ed is a highly accomplished IT professional who has deep experience in achieving exceptional business results for his clients. He is well positioned to provide the vision for our technology teams and foster partnerships between IT and business.”

Most recently, Zwicker served as Vice President, Client Delivery for Integress, Inc. A mentor and trusted leader who proactively drives projects and programs, he also has held IT leadership roles at such organizations as Philadelphia Insurance Companies, Cigna and Penn Mutual.

“Valenz is an amazing company, and I’m honored to become part of the team,” Zwicker said. “I look forward to working alongside my team members and our platform partners as we continuously innovate to meet the diverse needs of every client. Together, we will accomplish great things through the Valenz ecosystem and our shared promise of 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 health care 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 gppfunds.com.

Right Care, Right Time: Three Ways Nurse Case Managers Deliver Integrated, Patient-Centered Care

Through attentive care, dedicated service and comprehensive guidance, nurse case managers make a tremendous impact on patient outcomes. As an integral part of Vālenz Care, a triple-URAC accredited solution within the complete Vālenz™ ecosystem, Valenz nurse case managers work closely with patients, providers, employers and payers to ensure the right care at the right place and time, paving a more cost-effective path to healthy outcomes.

As we recognize World Health Day on April 7 – and because 2020 has been named the International Year of the Nurse by the World Health Organization – we are celebrating the vital role nurses play in keeping the world healthy. How do nurse case managers accomplish this?

Valenz Care Management Senior Manger Sylvia Robinson, RN, COHN, says their most significant role in today’s healthcare is coordinating and managing patient care. “Care coordination is a collaborative process that involves navigating treatment with physicians, social workers, patient families and other providers, such as home health and physical therapists,” she says. “Ultimately, our goal is aimed at determining the care that plan members need and guiding them on improving health while also minimizing healthcare expenses.”

For patients, nurse case managers are the central point of contact and advocates for high-quality, lower-cost care. For self-insured employers and other professional stakeholders, they help manage health administrative costs and quality by reducing unnecessary and/or preventable emergency room visits, hospitalizations, tests and other high-dollar claim events.

“The Valenz promise is to engage early and often for smarter, better, faster healthcare, and our nurse case managers are essential to that promise,” said Amy Gasbarro, Chief Operating Officer. “Their work improves quality and outcomes while empowering our clients to move from reactive plan models to proactive population health management.”

This level of care and service results in healthier outcomes for all involved. Here are three primary ways our nurse case managers positively impact care quality and healthy outcomes:

 Patient Education and Support

By providing continuous, evidence-based guidance and education, nurse case managers fulfill a key responsibility in helping patients and families fully comprehend health conditions and treatment options, so they can stay on the path to better long-term health.

“When patients have greater awareness and understanding of the treatment plan – and when they receive support from nurse case managers – we tend to see a much better likelihood of compliance,” says Valenz Nurse Case Manager Jessica Mangum, RN, OCN, CCM.

Nurse case managers also provide guidance to patients on effectively self-managing chronic conditions, so patients can take charge of their health and be their own catalysts in making positive lifestyle changes.

“A key component of the education process is to also evaluate the patient’s understanding of that education and his or her ability to take action on it,” Robinson says. “That includes setting short-term goals that they can achieve and celebrating those successes with positive feedback.”

Avoiding Unnecessary Costs

While providing comprehensive care that is appropriate for the patient’s needs, nurse case managers strive to minimize out-of-pocket costs.

When our Nurse Utilization Managers are notified of a new diagnosis or treatment recommendation, they conduct a clinical review to determine that the criteria are met for medical necessity and ensure alignment with the most appropriate level of care, according to evidence-based guidelines for that diagnosis. This helps eliminate expenses tied to unnecessary or excessive treatments.

“When we can manage the length of stay and promote case management, we can achieve effective cost containment while providing excellent service to the members and the plan,” says Valenz Nurse Utilization Manager Staci Cunningham, LPN.

In addition, the shift in focus to proactive health management – getting regular medical care before serious illness strikes – enables nurse case managers to help reduce or eliminate the need for costly medications and physician or emergency visits. That’s a benefit for both members and payers.

Navigating the Health System

For many people, the complexities of the healthcare system can feel so overwhelming, they don’t know where to start.

“Some of the biggest challenges patients face in navigating their care is lack of understanding of the healthcare industry,” Robinson says. “The average patient does not grasp how insurance and healthcare work. They often become frustrated and give up, and then they lose trust in anyone in the healthcare field.”

That’s where a nurse case manager comes in: providing guidance and information on what is covered by a patient’s insurance, managing co-pays, controlling out-of-pocket expenses, and accessibility to care, among many other issues.

“Patients need an advocate to get them through this journey,” says Nurse Utilization Manager Nichole Barone, LPN. “We can research insurance plan documents to give patients the clarity they need; help them understand what benefits they are entitled to; determine whether they need pre-certification before treatment; and assist them in securing all those things.”

Also, people with serious diagnoses like cancer may need a wide range of procedures and tests, which can quickly become confusing for a stressed patient. “By tackling these procedures one by one, we ensure the patient gets the proper, necessary care at the correct time,” Barone says. “We support patients by guiding them through the process so they can focus on getting back to the best possible health.”

Celebrating Nurses on World Health Day

As we celebrate World Health Day in 2020, which is also the International Year of the Nurse, the recognition of our nurse case managers and the amazing work they do takes the spotlight – and it is well deserved. We are proud to acknowledge nurses’ contributions on the front lines of patient care all across the globe, and we share our deep appreciation for the critical role they play in keeping people and communities healthy everywhere.

 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.