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® 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.
Vālenz® Unveils Solution to High Air Ambulance Costs
/in Announcements, Featured, Press/by Maris PanjadaValenz uses proven, proprietary repricing methodology to protect from surprise out-of-network billing
PHOENIX, Ariz. (December 23, 2021) — To help self-insured employers comply with requirements of the No Surprises Act (NSA) – and to protect plan members from sky-high surprise medical bills for out-of-network emergency air transport – Vālenz® has rolled out a new VMS™-validated solution within its ever-expanding ecosystem. The air ambulance solution creates a defensible qualified payment amount (QPA) for air ambulance services using Valenz’ proprietary repricing methodology. The result is fair pricing that assures a uniform level of protection for out-of-network air ambulance services.
“Recognizing that the January 1 requirements of NSA have a lot of employers chasing new solutions popping up in the market, we want Valenz clients to rest assured that the repricing methodology behind the Valenz air ambulance solution is completely tried and true,” said Rob Gelb, Chief Executive Officer. “In keeping with our long-standing commitment to transparency and balance billing protections, we are thrilled to apply our proven repricing methodology to combat runaway costs for emergency care, including air transport.”
The need is real – and dire. Over the last decade, the median billed charges for air ambulance services have doubled and even tripled (depending on the provider), with a staggering 71% of all air ambulance rides involving an out-of-network charge. As a result, the average cost for an air ambulance has soared to $50,000-$75,000 for helicopter and fixed wing transports, respectively.
By embedding its market-sensitive repricing methodology into air ambulance claim and cost review, Valenz is well ahead of the curve, said Gelb. “While others are working to develop new solutions, Valenz has always used this innovative repricing methodology to lower costs, enhance care and improve outcomes through quality-first care delivery – now we’ve just extended it to air ambulance. It’s all part of our promise to engage early and often for smarter, better, faster and more transparent healthcare.”
For more information about Valenz and how the Valenz ecosystem supports NSA compliance and balance billing protections, visit valenzhealth.com/nsa.
About Valenz
Valenz enables self-insured employers to make better decisions that control costs across the life of a claim while empowering their members to lead strong, vigorous and healthy lives. Valenz offers transparency through data to pinpoint members at highest risk, address gaps in network designs, ensure appropriate and accurate charges, and expertly navigate employees to optimal care solutions for substantial cost savings and improved health outcomes. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.
Vālenz® Chief Operating Officer Amy Gasbarro Joins SIIA Board of Directors
/in Announcements, Featured, Press/by Maris PanjadaPHOENIX, Ariz. (December 17, 2021) — Amy Gasbarro, Chief Operating Officer for Vālenz®, has been elected to the Board of Directors for the Self-Insurance Institute of America, Inc. (SIIA).
Gasbarro has worked with SIIA in various capacities since 2014, most recently as a trustee for Self-Insurance Political Action Committee (SIPAC), the advocacy and fundraising arm of SIIA. Her three-year term on the board will begin in January 2022.
“It is truly a privilege to become part of SIIA’s outstanding leadership group,” Gasbarro said. “The importance of self-insured health plans in the market is escalating, so this is a great opportunity to continue to advance self-insurance initiatives across the country. I am looking forward to making a strong impact on the SIIA board.”
SIIA works to protect and promote the business interests of companies involved in the self-insurance and captive insurance marketplace. As a single, member-based association, it is dedicated to meeting all the information, educational, networking and legislative/regulatory representation that a company needs.
“Amy has dedicated years of service to SIIA, and we are so proud to see her join the Board of Directors,” said Rob Gelb, Chief Executive Officer at Valenz. “It’s an honor for us as well to have one of our own guiding thought leadership within SIIA to support the evolving needs of the self-insured community and keep it strong, vigorous and healthy.”
About Valenz
Valenz enables self-insured employers to make better decisions that control costs across the life of a claim while empowering their members to lead strong, vigorous and healthy lives. Valenz offers transparency through data to pinpoint members at highest risk, address gaps in network designs, ensure appropriate and accurate charges, and expertly navigate employees to optimal care solutions for substantial cost savings and improved health outcomes. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.
Vālenz® CEO: “Independent Dispute Resolutions Are Not Inevitable” Under No Surprises Act
/in Announcements, Featured, Press/by Maris PanjadaValenz repricing methodology mitigates risk of payment disputes
PHOENIX, Ariz. (December 10, 2021) — In response to “growing and unnecessary concern” about Independent Dispute Resolution (IDR) requirements that begin Jan. 1, 2022, under the No Surprises Act (NSA), leaders at Vālenz® are reaching out with assurance to clients that they already have proven tools to mitigate and even eliminate the need for IDRs.
Under the NSA, if there is a payment dispute from a provider, the health plan is required to participate in a third-party, unbiased arbitration process to establish a qualifying payment amount (QPA) for similar services in a geographic area. The health plan may need outside resources to fulfill claim settlement support for the IDR process, a stipulation that has created a rush of new IDR support solutions in market.
However, according to Rob Gelb, Valenz Chief Executive Officer, there is no need for Valenz clients to engage with new pop-up IDR solutions. For years, Valenz has used its proprietary VMS™ repricing methodology to circumvent payment disputes by ensuring fair, defensible, market-sensitive QPAs that both parties agree to. QPAs are based on years of real-world data from Valenz Access contracted networks, as well as additional layers of data from the broader Valenz ecosystem. Valenz has always negotiated with providers in the rare instances where they appeal a QPA. The IDR process only comes into play when an agreement isn’t reached through the normal appeal process and a provider decides to risk paying the cost of going to an independent arbiter.
“As a health data tech company with deep roots in member advocacy, our business model is built on a framework of clinical care management with a decades-long commitment to validation, integrity and accuracy (VIA). We’ve been delivering agile, data-driven solutions to pricing and reimbursement for years, always engaging early and often for smarter, better, faster healthcare,” said Gelb. “For us, this is not new at all – our repricing methodology is tried and true.”
Gelb advises all self-insured employers to embrace the power of transparency and data for improving the high costs of healthcare coverage today – and be cautious of solutions that don’t address root causes. “While others are fueling fear that IDRs will now be commonplace, we’re here to say the opposite – IDRs are not inevitable features of NSA compliance, not when you partner with Valenz.”
For more information about VMS™ visit valenzhealth.com/vms. To discuss how Valenz ensures fair and defensible pricing, call (866) 762-4455.
About Valenz
Valenz enables self-insured employers to make better decisions that control costs across the life of a claim while empowering their members to lead strong, vigorous and healthy lives. Valenz offers transparency through data to pinpoint members at highest risk, address gaps in network designs, ensure appropriate and accurate charges, and expertly navigate employees to optimal care solutions for substantial cost savings and improved health outcomes. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.
Vālenz® Renews Triple URAC Accreditation
/in Announcements, Featured, Press, Valenz Care/by Maris PanjadaContinues legacy of excellence in clinical care combined with claim validity, integrity and accuracy
PHOENIX, Ariz. (December 3, 2021) — Vālenz® is proud to announce the renewal of its three URAC accreditations in Health Utilization Management, Case Management and Disease Management. URAC is the independent leader in promoting healthcare quality through leadership, accreditation, measurement and innovation. By achieving this status, Valenz has demonstrated a comprehensive commitment to quality care, improved processes and better patient outcomes.
“Because it underscores our staunch commitment to meeting rigorous standards in quality and accountability for clinical care management, we are very proud to renew our URAC accreditation,” said Janet Koch, RN, BSN, CCM, Vice President of Care Management at Valenz.
Rob Gelb, Chief Executive Officer, explains how clinical quality is integral to optimization within the entire claim-cost continuum – and pinpointing quality-first, cost-saving solutions for self-funded health plans requires the ability to see all intricacies and connections between clinical care and reimbursement.
“Valenz is unique in the way we combine clinical care management, advocacy and navigation for every member with assurance in the validity, integrity and accuracy of every claim,” said Rob Gelb, Chief Executive Officer. “Within the Valenz ecosystem, these two functions are inextricably linked – and fueled by data to ensure all claims are valid and true for accurate payments.”
That innovative and proprietary approach is foundational to the true value of the Valenz ecosystem and its ability to deliver the desired returns for Valenz clients. “Ensuring we consistently meet the high standards required for URAC accreditation is just one of many ways we keep our promise to engage early and often for smarter, better, faster healthcare,” said Gelb.
For more information about Valenz, visit valenzhealth.com.
About Valenz
Valenz enables self-insured employers to make better decisions that control costs across the life of a claim while empowering their members to lead strong, vigorous and healthy lives. Valenz offers transparency through data to pinpoint members at highest risk, address gaps in network designs, ensure appropriate and accurate charges, and expertly navigate employees to optimal care solutions for substantial cost savings and improved health outcomes. More information is available at valenzhealth.com. Valenz is backed by Great Point Partners.
About URAC
Founded in 1990, URAC is the independent leader in promoting healthcare quality through leadership, accreditation, measurement and innovation. URAC is a nonprofit organization using evidence-based measures and developing standards through inclusive engagement with a range of stakeholders committed to improving the quality of healthcare. Our portfolio of accreditation and certification programs span the healthcare industry, addressing healthcare management, healthcare operations, health plans, pharmacies, telehealth providers, physician practices, and more. URAC accreditation is a symbol of excellence for organizations to showcase their validated commitment to quality and accountability.