Vālenz® Health Open Solution

An integrated, dynamic approach to Reference Based Pricing, powered by VMS®

Today’s self-insured employers need more innovative solutions to manage rising medical costs and improve health outcomes. Valenz Open Solution provides an open, non-contracted reimbursement approach with care coordination from NaVcare to reduce health costs, provide a new level of transparency and improve the overall member experience. It’s an excellent alternative to standard reference-based pricing (RBP) agreements.

Fueled by analytics that blend payment, cost and charge-based data

Valenz Open Solution integrates deep analytical insights with member-centric services to find balance in the cost-quality equation. This non-network reimbursement strategy focuses on active collaboration between all parties to ensure transparency and reduce friction among the payer, provider and patient.

Valenz Open Solution also leverages the VMS® Repricing Methodology to deliver fair, defensible, consistent claims pricing. With personalized care navigation as the point of entry, fair market pricing as the goal, and a high-value provider network as a future outcome, this option improves savings, access and quality while also fostering positive, equitable relationships with providers.

Streamline the path to lower costs and healthier lives

By engaging early and often for smarter, better, faster healthcare, Valenz Open Solution delivers many advantages:

  • Cost Control: Fair, acceptable market pricing based on geography
  • Defendable Reimbursement Methodology: Reliable, algorithmic decision-making powered by VMS®, complete with support for appeals*
  • Data-Driven Insights: Access to quality metrics and performance outcomes for increased provider accountability
  • Pre-Service Negotiations: Agreements with providers and facilities to drive high-value network development, steerage and utilization
  • Contracting Support: Valenz contracting experts support the plan and members through ongoing expansion and development of advantageous agreements with providers and facilities, driving high-value network development, direction of care and high-quality provider utilization
  • Centralized Care Coordination: Our NaVcare navigators serve as the central point of contact for members, providers, payers and administrators
  • Seamless Integration: Extend the power of the Valenz platform to continuously drive cost and quality improvement, including quality and outcomes metrics for greater provider accountability.
  • Also includes out-of-network solutions to replace wrap networks, full-service claim management, and a member portal with provider quality and cost data

* Valenz provides support and additional resources for appeal resolution and to defend employees against balance billing and attempts at collection.

Get Started Today

Where other companies limit services to network design or care management, we go infinitely further: We bring member-centric services and data-driven insights into the patient journey, connecting the dots at every step for lower-cost, higher-quality healthcare.

Contact us today and we will provide a real-life view into the network savings your organization will experience with the Valenz Open Solution. Engaging early and often for smarter, better, faster healthcare – that’s the Valenz promise.

Complete the form below or call us at (800) 834-2312 to get started with Valenz today.

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Valenz Network Design Solutions Suite

Explore the full breadth and depth of customizable, cost-saving options available in our Network Design Solutions Suite:

MEC Solution

Replaces wrap networks with Minimum Essential Coverage for assured payment and minimal risk of balance billing.

MEC Solution is an open-access network solution, complete with assured payment options that minimize member disruption and provider friction for the vast majority of claims. Includes access to high-quality providers and facilities at fair, reasonable costs for substantial savings improvement.

Contracted Network

Builds a new provider network to improve access, drive a higher standard of care and increase savings.

Contracted Networks are rigorously vetted, quality-first networks of top-performing physicians, hospitals and ancillary providers. We use advanced cost, quality and outcomes analytics to custom build and continuously optimize your high-value, high-performance contracted network.

Assured Payment

Eliminates the risk of balance billing, member disruption and provider friction for the majority of your claims.

Assured Payment delivers assured payment options for our Open Solution, Navigated Network or Contracted Network solutions. We blend payment, cost and charge-based data with biometrics and clinical data for fair pricing, integrating comprehensive bill reviews to ensure accuracy.

Open Solution

Maximizes plan dollars with a non-network reimbursement strategy that fosters equitable provider relationships.

Open Solution, an open, non-contracted reimbursement approach with NaVcare, provides an excellent alternative to standard reference-based pricing agreements. Our model provides transparent quality and outcomes data for fair, defensible and consistent reimbursement recommendations.