Provider-Sponsored Health Plans

Mission-Based Solutions for Providers to Lead the Delivery of Higher Quality Care

Competition among healthcare providers and increasing pressure to lower costs are driving health systems to consider moving toward value-based care. For many hospitals and health systems, provider-sponsored health plans (PSHPs) designed for their specific patient populations represent an opportunity to better align incentives, increase clinical coordination , diversify revenue, and reach more patients.  PSHPs enable health systems to take full responsibility for their patients – from designing a specific care plan to working with physicians and patients to implement it. Learn More 

Full Responsibility Requires New Capabilities

The idea of stepping into payers' shoes can be overwhelming, but the rewards far outweigh the risks. Valence Health's complete solutions enable provider organizations to swiftly and successfully design, implement, and operate a "high value" PSHP. Whether capabilities are employed in modules or as a whole, Valence's end-to-end services include consulting expertise, a proprietary technology platform, and all the required clinical, actuarial, and operational capabilities to take you from a standing start to full PSHP operability. Learn More 

Operating or Growing a Provider-Sponsored Health Plan (PSHP)

Operating a PSHP requires a range of many new responsibilities. Valence provides solutions and services for clients to manage a PSHP without relying on private insurers. Leveraging advances in technology and predictive modeling, our clients can apply proven actuarial analysis without having to directly employ armies of actuaries. Clients with clear visibility into financial risk can control their organization’s financial health. In addition to technology and analytics, Valence provides clients with all the necessary expertise, meaningful reports and measures, and ongoing operational management services to power your health plan. Learn More

What Valence Brings to Clients

  • Expertise: Breadth and depth of seasoned health care experts including administrators, actuaries, physicians, nurses, and IT professionals
  • Payer Experience: Strategies for Medicare, Medicaid, and Commercial
  • "Ready-to-go" Capabilities: Assessment, design, implementation, and management resources
  • Data Integration and Aggregation: Daily feeds from multiple inpatient and outpatient EMRs, labs, claims, payer data, PBM, and practice managment systems
  • Actionable Reporting Platform: Designed for various user types with both at-a-glance views and super user functionality
  • Analytics: Data integration, aggregation, analytics, and useable and actionable reporting platform Financial and actuarial expertise: Incentive alignment and risk management 
  • Financial and Actuarial Expertise: Incentive alignment and risk managment
  • TPA Services: Comprehensive end-to-end health plan management
  • Population Health Technology Platform: Comprehensive care quality platform identifies care gaps, provides registries of risk stratified patients and promotes care coordination between the plan, providers and patients
  • Provider Advocacy: Sole focus on partnerships with academic, community, urban, rural, and tertiary hospitals; IPAs; ACOs; and CO-OPs

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Key Benefits

  • Control of Care: Providers gain full responsibility for their patients, including benefit design, care delivery, quality outcomes, and efficiency
  • Effective Population Health: Leveraging  integrated systems and incentive alignment, care coordination across the entire spectrum is enhanced
  • Higher Quality Care: Research indicates that provider-sponsored health plans deliver higher quality and lower cost care than traditional payers
  • Alternative Revenue Streams: Collecting the insurance premium directly from employers or individuals means success is no longer defined by a full hospital or the number of services provided
  • More Patients Covered: Market penetration increases as health plans work to enlist and keep patients and services within the system
  • Healthy Margins: Financial stability for healthcare organization(s) and providers

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