Care Value Optimizer

High quality, low costs via NaVcare Enhanced

Finally, there is a solution that triages network selection, care and treatment based on both the financial and health needs of the member. Introducing NaVcare Enhanced with Care Value Optimizer, a data-enabled tool used by Vālenz® navigators and nurses to swiftly identify the best care options available to members based on their income, location, benefits and health care need. NaVcare Enhanced with Care Value Optimizer tailors care to each member, offering provider networks that range from low-cost to no-cost options to Centers of Excellence (COE) pre-negotiated care bundles for those who don’t qualify for charity care. Our care guidance balances quality, utilization and cost with an emphasis on keeping members in-network at the highest possible level of quality care for the lowest cost. See how it works:

Here’s how it works:

  • When members have a care need, they call into our NaVcare Enhanced phone line to engage with a NaVcare team member who will advocate for best care value.
  • If the member is a match for the low-/no-cost opportunity, the navigator guides him/her through the necessary paperwork, scheduling, and selection of a provider prior to care, which can eliminate some or all of the member’s costs while reducing overall plan spend and lowering future stop loss premiums for the employer.
  • If the member is not a match, the navigator evaluates alignment to one of our COE care bundles, covering thousands of procedures across the country from high-quality providers.
  • If neither of the above is a good match, the Care Value Optimizer provides insight into the member’s available in-network options. Only as a last resort will the navigator select an out-of-network solution.
  • All levels are wrapped with our Care Management Model to ensure best value and continuity of care.

More than 100 million Americans living at or below 400% of the Federal Poverty Level (e.g., a family of four earning up to $106,000) would be likely to qualify for charity care assistance. As the front end of the Care Value Optimizer, this ensures that more people get access to those benefits.

Complete Nationwide Coverage

Our Procedures and Treatments

If members don’t quality for charity care, we offer COE bundles with access to thousands of bundles at our nation’s top facilities. This allows us to manage the costliest, most variable, and complex procedures and treatments.

  • Bariatric Surgery
  • Behavioral Health
  • Cardiovascular
  • Complex Cancer
  • Ear, Nose and Throat
  • Executive Health
  • Gastroenterology
  • Gender Affirmation
  • Gene Therapy
  • Neurosurgery
  • Opthalmology
  • Orthopedic
  • Spine Surgery
  • Thyroid & Parathyroid
  • Transplant
  • Virtual

Contact us today to learn more about how the Care Value Optimizer and the NaVcare Enhanced solution drives smarter, better, faster healthcare: (866) 762-4455

Experience the Synergy

When we say the Valenz ecosystem is comprehensive, we mean it. With a complete selection of fully integrated wraparound solutions to complement the core solutions featured below, we deliver benefits far greater than the sum of all these parts individually.

Vālenz Access

Combine a quality-first provider network or open solution with a range of customized, data-driven services from the Access Solutions Suite.

Vālenz Care

Guide members to better care and outcomes at lower costs, for you and for them, with RN-led, triple URAC-accredited care management.

Vālenz Claim

Reduce costs and ensure accurate payments with comprehensive bill reviews and repricing methodologies, integrated analytics, and more.

Vālenz Assurance

Improve coding, reimbursement assurance, auditing, claim accuracy and compliance monitoring, all while saving time and costs.

v-Lens

Use advanced, drill-down analytics and predictive modeling to continuously disrupt the cost curve without compromising quality.

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