This article is second in our series examining the long-term impact of COVID-19 on health and healthcare issues for the self-insured industry.
Chronic conditions are the leading cause of death in the United States, as well as the primary driver of our $3.5 trillion annual healthcare costs. Long before COVID-19 hit, providers, payers and self-insured employers grappled with the challenge of ensuring that patients with chronic illnesses receive effective care.
Recent surveys indicate many patients have put their chronic care needs on hold during the pandemic, potentially leading to more expensive scenarios in the future. Consider these findings from a recent survey:
- Seven in 10 patients reported a negative impact on their ability to manage their high-risk conditions due to COVID-19, with one in four expressing a high impact.
- One in three patients reported a reluctance to leave their homes for treatments, with 70 percent sharing they were more worried than usual about their health at this time.
- Less than 40 percent of respondents felt prepared to manage their health during COVID-19, with more than half expressing concern they would lose access to essential care.
- More than one in 10 patients reported they were unable to receive their medication.
Even with heightened safety precautions that have made office visits and routine care widely available again, many patients have been slow to return – especially for people with long-term conditions like asthma, heart disease and diabetes, who are at significantly higher risk of severe illness from COVID-19.
As the health industry adapts to consumerism by adapting care deliver to meet the evolving needs of consumers, so too must payers and self-insured employers. Here are five solutions that take significant steps towards improving service and care for chronic disease patients during the pandemic and potentially beyond:
1: Telehealth and virtual care
Expanded telehealth access has been the key component of the rise of virtual care utilization, allowing care continuity while all parties maintain physical distancing. Combined efforts by the federal government, individual states, private insurance companies and self-funded groups have facilitated telehealth as a viable care option during the pandemic, lowering regulatory barriers that had limited its use and the reimbursement of services. According to the American Medical Association, physician telehealth adoption is now estimated at 60-90 percent.
In addition, a survey by Accenture in July 2020 reported that providers were largely able to maintain or even improve on the patient experience with virtual care technology, which also includes live video, audio and instant messaging. With 41 percent of respondents taking advantage of virtual tools – the majority of them for the first time ever – patients reported more personal interactions, faster response times, and the convenience of managing care from home. Virtual care and telehealth are proving especially useful for chronic disease patients in rural and remote areas.
2: Patient-centric care navigation
For self-insured employers, brokers and third-party administrators, care-coordination solutions like NaVcare help members navigate their health journey more effectively, delivering personalized service and guidance for high-quality care and improved outcomes. Real-time data-driven insights, combined with in-depth health plan knowledge, are critical for identifying patients with complex, chronic conditions. Providing those patients with comprehensive care management helps avoid more serious and costly health events.
Informed by data – including claim, pharmaceutical and demographic data –NaVcare tailors services to each employer and illuminates individual care needs for members. Care navigators facilitate virtual care when available for enhanced patient convenience and engagement as well.
3: Behavioral health integration
People with chronic diseases are more likely to experience depression or behavioral issues as they often face impaired mobility and loss of independence. According to the Center for Medicare Advocacy, 43.8 million U.S. adults struggle with mental illness each year, and 26 percent of those are Medicare beneficiaries – a population that is highly vulnerable to the effects of isolation, increased stress and more limited access to regular care, even before the pandemic.
Traditionally, the care delivery models to address physical and behavioral health have been independent of each other. More and more, providers and health organizations are acknowledging the significant correlations between physical and mental health, turning to integrated care solutions that treat the whole person and deliver improved outcomes with lower costs – up to 10 percent savings in the nation’s overall healthcare expenses, according to the American Psychiatric Association.
4: Prescription cost management
Following a national trend that has continued for the past decade, costs have risen for chronic disease medications and depression/anxiety drugs during the pandemic, with total prescription spend predicted to reach $610 billion in 2021. Before COVID-19, one in three Americans did not take their medications as prescribed because of high costs, but during a global pandemic, forgoing medications involves even more risks for chronic care patients and incurs even higher costs in the long run.
Cost-containment solutions for self-insured employers, brokers and third-party administrators include a range of PBM solutions and specialty medication case management services. Such solutions create long-term reductions in medication spend while passing on lower costs to members and delivering highly personalized case management services and advocacy.
5: Remote patient monitoring
Recent studies connecting COVID-19 to long-term heart and lung damage, among other serious conditions, accentuate the benefits of remote monitoring technologies for high-risk patients. As it tracks and transmits vital signs in real time, remote patient monitoring allows providers to regularly check pulmonary function, blood pressure, body temperature and other physiology for proactive management of changes in disease progression.
A joint report from AHIP, the national association of America’s Health Insurance Plans, and C-TAC, the Coalition to Transform Advanced Care, concludes that remote patient monitoring is among the most efficient and effective tools available to manage chronic disease — particularly in older patients with diabetes, heart failure, and chronic obstructive pulmonary disease.
Solutions for today and tomorrow
Patients with chronic illnesses are more vulnerable to some of COVID-19’s most significant threats. As the global health crisis continues to present new challenges in treating patients with long-term conditions, it also has opened up new opportunities. It is exciting to be part of the evolution of solutions that will serve patients well beyond the pandemic – showing us all the next level of smarter, better, faster healthcare.
***
Rob Gelb is Chief Executive Officer of Vālenz™, one of the nation’s leading data-driven, medical cost containment and care management organizations offering expanded solutions to support the self-insured industry.
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.
Building an Effective Compliance Management Program: What You Need to Know
/in Featured, Valenz Assurance/by kamryn cainTo help prevent fraud and abuse – and all the punitive setbacks that come with broken health care laws and unmet regulations – having a robust compliance program is key. There is no one-size-fits-all approach to compliance management, however, and it is most effective to tailor your program to your organization’s structure and type. The following FAQs are designed to help you understand the basics and formulate next steps for your compliance program.
What is a compliance program, and why do I need one?
A compliance program is a set of internal policies and procedures that helps your organization comply with the law in its daily operations. A proactive plan helps you maintain compliance with today’s regulations, as well as providing a framework for implementing future requirements.
What are the basic components every compliance program should include?
Effective compliance programs include these essential components:
Why should I customize my organization’s compliance program?
Every organization is structured differently, has unique staffing and contracting programs, provides a different mix of services, and has a specific profile of patient demographics and payer mix. While the basic essentials apply to any compliance program, the specifics will vary based on your organization’s unique operations, structure, and areas of risk.
What resources are available to help me customize my compliance program?
To help you develop a compliance program that is most impactful for your organization, the Office of Inspector General (OIG) has developed a set of principles, called Compliance Program Guidance (CPG). These guidance documents are geared toward different segments of the healthcare industry, including:
Use the CPGs as a starting point, and then tailor them for your organization. The OIG provides many additional compliance resources to encourage effective internal controls to monitor and manage adherence to applicable statutes, regulations, and program requirements.
Also, remember that a compliance program is never done – it evolves with your business and with changing regulations. It is forward-looking, and focused not only on risk containment, but also on best care and management practices.
This sounds like more than my small team can manage. Can I outsource my compliance program instead?
Yes! At Vālenz™, we offer a range of compliance software and support solutions to help assure you are not the “last to know” about a sanctioned provider or other compliance issue. With three tiers of service to accommodate any need and every budget, we take the complexity out of compliance and deliver peace of mind. To learn how we help you protect your organization from the risks of non-compliance, call 888-395-9029.
The Effects of COVID-19 on Chronic Disease Management – and Five Solutions Insurers Should Embrace
/in Announcements, Featured/by Maris PanjadaThis article is second in our series examining the long-term impact of COVID-19 on health and healthcare issues for the self-insured industry.
Chronic conditions are the leading cause of death in the United States, as well as the primary driver of our $3.5 trillion annual healthcare costs. Long before COVID-19 hit, providers, payers and self-insured employers grappled with the challenge of ensuring that patients with chronic illnesses receive effective care.
Recent surveys indicate many patients have put their chronic care needs on hold during the pandemic, potentially leading to more expensive scenarios in the future. Consider these findings from a recent survey:
Even with heightened safety precautions that have made office visits and routine care widely available again, many patients have been slow to return – especially for people with long-term conditions like asthma, heart disease and diabetes, who are at significantly higher risk of severe illness from COVID-19.
As the health industry adapts to consumerism by adapting care deliver to meet the evolving needs of consumers, so too must payers and self-insured employers. Here are five solutions that take significant steps towards improving service and care for chronic disease patients during the pandemic and potentially beyond:
1: Telehealth and virtual care
Expanded telehealth access has been the key component of the rise of virtual care utilization, allowing care continuity while all parties maintain physical distancing. Combined efforts by the federal government, individual states, private insurance companies and self-funded groups have facilitated telehealth as a viable care option during the pandemic, lowering regulatory barriers that had limited its use and the reimbursement of services. According to the American Medical Association, physician telehealth adoption is now estimated at 60-90 percent.
In addition, a survey by Accenture in July 2020 reported that providers were largely able to maintain or even improve on the patient experience with virtual care technology, which also includes live video, audio and instant messaging. With 41 percent of respondents taking advantage of virtual tools – the majority of them for the first time ever – patients reported more personal interactions, faster response times, and the convenience of managing care from home. Virtual care and telehealth are proving especially useful for chronic disease patients in rural and remote areas.
2: Patient-centric care navigation
For self-insured employers, brokers and third-party administrators, care-coordination solutions like NaVcare help members navigate their health journey more effectively, delivering personalized service and guidance for high-quality care and improved outcomes. Real-time data-driven insights, combined with in-depth health plan knowledge, are critical for identifying patients with complex, chronic conditions. Providing those patients with comprehensive care management helps avoid more serious and costly health events.
Informed by data – including claim, pharmaceutical and demographic data –NaVcare tailors services to each employer and illuminates individual care needs for members. Care navigators facilitate virtual care when available for enhanced patient convenience and engagement as well.
3: Behavioral health integration
People with chronic diseases are more likely to experience depression or behavioral issues as they often face impaired mobility and loss of independence. According to the Center for Medicare Advocacy, 43.8 million U.S. adults struggle with mental illness each year, and 26 percent of those are Medicare beneficiaries – a population that is highly vulnerable to the effects of isolation, increased stress and more limited access to regular care, even before the pandemic.
Traditionally, the care delivery models to address physical and behavioral health have been independent of each other. More and more, providers and health organizations are acknowledging the significant correlations between physical and mental health, turning to integrated care solutions that treat the whole person and deliver improved outcomes with lower costs – up to 10 percent savings in the nation’s overall healthcare expenses, according to the American Psychiatric Association.
4: Prescription cost management
Following a national trend that has continued for the past decade, costs have risen for chronic disease medications and depression/anxiety drugs during the pandemic, with total prescription spend predicted to reach $610 billion in 2021. Before COVID-19, one in three Americans did not take their medications as prescribed because of high costs, but during a global pandemic, forgoing medications involves even more risks for chronic care patients and incurs even higher costs in the long run.
Cost-containment solutions for self-insured employers, brokers and third-party administrators include a range of PBM solutions and specialty medication case management services. Such solutions create long-term reductions in medication spend while passing on lower costs to members and delivering highly personalized case management services and advocacy.
5: Remote patient monitoring
Recent studies connecting COVID-19 to long-term heart and lung damage, among other serious conditions, accentuate the benefits of remote monitoring technologies for high-risk patients. As it tracks and transmits vital signs in real time, remote patient monitoring allows providers to regularly check pulmonary function, blood pressure, body temperature and other physiology for proactive management of changes in disease progression.
A joint report from AHIP, the national association of America’s Health Insurance Plans, and C-TAC, the Coalition to Transform Advanced Care, concludes that remote patient monitoring is among the most efficient and effective tools available to manage chronic disease — particularly in older patients with diabetes, heart failure, and chronic obstructive pulmonary disease.
Solutions for today and tomorrow
Patients with chronic illnesses are more vulnerable to some of COVID-19’s most significant threats. As the global health crisis continues to present new challenges in treating patients with long-term conditions, it also has opened up new opportunities. It is exciting to be part of the evolution of solutions that will serve patients well beyond the pandemic – showing us all the next level of smarter, better, faster healthcare.
***
Rob Gelb is Chief Executive Officer of Vālenz™, one of the nation’s leading data-driven, medical cost containment and care management organizations offering expanded solutions to support the self-insured industry.
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.
Vālenz™ Access Assured: An Integrated, Dynamic Approach to Reference Based Pricing
/in Announcements, Featured, Valenz Access/by Maris PanjadaPHOENIX, Ariz. (Oct. 15, 2020) – Employers and private health plans pay hospitals nearly 2.5 times more than Medicare, according to a recent study by the RAND Corporation. And while employers and their members pay more each year, researchers found no strong link between hospital pricing and healthcare quality or safety ratings. To manage rising medical costs while improving health outcomes, self-insured employers need solutions which definitively balance the cost-quality equation.
To answer that growing need, Valenz Assured Access provides an integrated, dynamic approach to reference based pricing. As the innovators behind a comprehensive ecosystem designed to effectively bend the Claim Cost Arc℠ for payers and improve patient experiences for members, Vālenz™ has established a next generation RBP model that integrates deep analytical insights with member-centric services while collaborating with providers and payers to ensure transparency.
Using the proprietary VMS℠ Repricing Methodology, Valenz Access Assured blends payment, cost and charge data sets to produce reimbursement recommendations that are fair, defensible, transparent and consistent for everyone.
“VMS recognizes that not all Current Procedural Terminology (CPT) codes or services delivered in healthcare have a Medicare rate, so we incorporate two additional data sources – paid claim data and Usual, Customary, Reasonable (UCR) data – to provide a more structured and defensible reimbursement recommendation,” said Rob Gelb, Chief Executive Officer. “When leveraging these sources of data, we offer our customers a more robust and well-rounded view of reasonable reimbursement levels.” Supporting a consistent and substantiated reimbursement model not only reduces costs, Gelb explained, it reduces friction among the payer, provider and patient.”
With Valenz Access Assured, member-centric coordination begins at the outset of care, where dedicated care navigators serve as the central point of contact for all stakeholders. Through NaVcare, members receive concierge-level guidance as well as the URAC-accredited care management services of Valenz Care. As a result, members are guided toward high-quality care and empowered to make better health decisions that control costs, improve health outcomes and elevate the member experience.
Provider collaboration also starts before care delivery. The Valenz Assured Access team engages providers and facilities in pre-service negotiation to procure contractual agreements before services are rendered, creating transparency of cost and eliminating the risk of balance billing. From there, a Valenz contracting expert works to secure a long-term agreement, continually supporting the plan and members through high-value network development and expansion, direction of care and high-quality provider utilization.
When contracting is not an option and a provider appeals reimbursement levels, Valenz Assured Access protects the member and the plan with comprehensive support, including negotiations with the provider and legal advocacy.
“We designed all program components with the member in mind, following our guiding philosophy that everyone who engages with the Valenz ecosystem should be strong, vigorous and healthy,” said Amy Gasbarro, Chief Operating Officer. “Ease of access to high-quality providers, appeal support, development of new provider agreements and next-generation pricing models – these approaches integrate seamlessly to deliver on our core promise: engaging early and often for 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 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.
Vālenz™ NaVcare Delivers Data-Driven Care Navigation, Improves Network Utilization, Member Satisfaction and Health Outcomes
/in Announcements, Featured, Press, Valenz Care/by ryan kesnerPHOENIX, 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
/in Announcements, Featured, Press, Valenz Claim/by kamryn cainPHOENIX, 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:
“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
/in Announcements, Featured/by ryan kesnerThis 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
/in Announcements, Featured/by Maris PanjadaPHOENIX, 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: Significant Savings and Enhanced Services
/in Announcements, Featured, Valenz Care/by kamryn cainPHOENIX, 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 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:
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 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.
Vālenz VzReturn Offers Employers Safe Return-to-Work Solution During COVID-19 Pandemic
/in Featured, Valenz Care/by kamryn cainPHOENIX, 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
/in Featured, Valenz Claim/by kamryn cainPHOENIX, 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.