The secret to our success is our people.
The Valence Health team is comprised of seasoned professionals with decades of hands-on healthcare operations, finance, technology and leadership experience.
Client: PHO
Summary: Valence Health is working with this 700-physician, 4 hospital IPA to negotiate and then manage three risk-based contracts with the major payors in the marketplace representing 160,000 lives. Support includes development and management of a pay-for-performance physician incentive program that distributes over $6 million annually, development of a reporting system utilized to focus on areas needing the most attention to manage medical costs, developed and managed the financial aspects of the organization, developed fee schedules, and provided actuarial support. Valence also provided interim management support when the existing CEO was unable to manage the organization.
Client: Children’s Hospital-based HMO
Summary: A hospital-sponsored health plan for low income children outsourced its Third Party Administrative Services to Valence. Valence is responsible for claims administration, customer service, provider relations, finance and actuarial analysis, and medical management and regulatory reporting this HMO.
In addition, Valence is responsible for managing the Children’s Hospital’s Case Management function.
Client: Hospital-based Health Plan
Summary: Valence provides Third Party Administrative support to this hospital-based Health Plan to include claims administration, customer service, provider reimbursement strategies, medical management and actuarial support.
Client: PHO
Summary: For this 500-physician, two hospital PHO, Valence has implemented its clinical integration strategy. Valence’s support has included development of clinical pathways, extracting data out of the physician practice management systems and providing clinical integration reporting to support this PHO’s mission to improve overall quality of care provided by its member providers.
Client: IPA
Summary: For this 300-physician IPA, Valence has supported its strategy to clinically integrate. Valence has worked with these physicians to develop its clinical protocols. Valence will be utilizing payor claims data to support the management of the protocols.
Client: Children’s Hospital
Summary: Conducted a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis to determine this Children’s Hospital’s managed care strategy. The end result was a recommendation to pursue formation and management of its own Health Plan to provide health care to the underprivileged children in its market. This Children’s Hospital has formed and is currently operating the Health Plan.
Client: Children’s Hospital PHO
Summary: Conducted a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis to determine this Children’s Hospitals PHO managed care strategy. The end result was a recommendation to pursue risk contracts with all the payors in its market. This Children’s Hospital PHO has full-risk contracts with all the Health Plans in its market totaling approximately 200,000 lives.
Client: IPA/Payer Joint Venture
Summary: Valence Health worked with the IPA to develop a 50/50 joint venture with a prominent regional payer. The joint venture is at full-risk for the lives assigned to the IPA’s PCPs. Valence Health initially supported the IPA in its negotiations with the payor to include premium sufficiency analysis and pro forma models to validate the operations plan. Valence provided ongoing support to the joint venture to include financial management, compensation development, data warehousing, analysis, claims reconciliation, and physician profiling.
Client: Independent Delivery System
Summary: Valence Health provided interim management for a risk-assuming delivery network consisting of 2 health systems and 600 physicians. Valence created a collaborative development stage allowing physicians and health system representatives the opportunity to test ideas and recommendations with the physicians, nurses and administrators who would ultimately run the program. The result was a new, fully integrated system successfully managing 50,000 full risk lives, including 12,000 Medicare recipients. Under Valence’s interim management guidance, the network was also delegated full commercial and Medicare medical management.
Valence Health also developed a customized Physician Profiling Program. This monthly reporting application provides physicians with critical benchmarking data and financial indices, detailed physician practice patterns and thorough patient profiles. This easy to use, integrated data exchange has allowed the organization to realize its primary goal: physicians directly managing their own financial and medical risk.
Client: Provider-Owned HMO
Summary: Valence worked directly with independent physicians to create and manage a physician-owned HMO. Valence provided the organizational leadership to file and receive HMO licensure, implement an integrated claims management system, utilization review, financial and clinical reporting, credentialing and provider compensation programs.
In two years, the initial organization of eight physicians increased participation to 2600 physician investors, gained approval as a Commercial and Medicare HMO, currently manages 40,000 lives, and continues to grow.
In early 1996, Valence prepared a Medicare contract application that was reviewed and approved without any request for substantial modification or revisions after the initial submission to HCFA.
Valence Health is now assisting physician-owned HMO to expand regionally. In these expansion areas, Valence Health worked with committees of physician investors to develop new medical management programs, funds flow models and provider compensation programs.
Client: Physician Hospital Organization
Summary: Valence was retained by this 175 physician PHO to orchestrate the development of an organization wide fee schedule. Valence aided principal management by conducting a series of educational sessions and consensus building exercises to educate physicians on the dynamics fee schedules play in contract negotiation. Valence developed a comprehensive fee schedule based on aggregate organization data and regional trends relative to contract type and payer history.
Client: HMO
Summary: Under its portfolio of functions, this large health system currently manages a PPO with self-insured clients and a full-risk contract with a major HMO. The organization implemented its own HMO and Medicare+Choice Provider-Sponsored Organization. Valence Health developed a pro forma application to explore a variety of revenue models for its new managed care products. A premium sufficiency model was also developed to monitor ongoing financial performance by contract type, employer and benefit structure.
Client: IPA
Summary: Valence was contracted to develop a Standing Offer Messenger Model Fee Schedule for an IPA. Valence created and administered a physician survey, fee schedule guidelines and assessment of survey results. Valence also provided a software application for managing this fee schedule agreement across the IPA’s 800-member group.
