Why Now?

Provider-Sponsored Health Plans Put Providers in Charge of Care

With a range of health systems taking on risk and providing health plans—from Scott & White (a regional IDN merged with Baylor Healthcare) to Cincinnati Children’s (a nationally-recognized pediatric hospital) to Ohio Health Group (a 300-doctor IPA) to Hamilton Healthcare (a single hospital IDN in Dalton, Georgia)—industry experts realize that just about any provider organization can be successful in this transformation. Provider-sposored health plans (PSHPs) deliver high quality care for patients and populations—and financial stability. A health plan can be the best option for providers to get closest to the first dollar and empower them to be in full control of the quality of the care delivered. Hospitals and health systems sponsoring health plans have a significant competitive advantage in their markets.

PSHPs offer several advantages to providers. When incentives are fully-aligned around quality, costs and coordination, providers can deliver higher quality care that is both efficient and effective for their community. PSHPs give providers first dollar control so they are no longer financially reliant on non-caregiving entities. Care coordination improves with integrated systems, enabling effective population health and improved wellness capabilities for the community. PSHPs market penetration strategies drive expansion of the patient lives influenced—simply put, a PSHP helps an organization touch more patient lives. Finally, generating revenue beyond care delivery provides the fuel to help providers focus on outcomes, chronic care managment, patient safety, and invest in keeping their community healthy. Valence Health provides end-to-end solutions to help you design, implement and manage your provider-sponsored plan.

Why Valence

  • Expertise: Breadth and depth of seasoned healthcare experts including administrators, actuaries, physicians, nurses and IT professionals
  • Ready-To-Go Capabilities: Assessment, design, implementation and management resources
  • Data Integration and Aggregation: Daily feeds from multiple inpatient & outpatient EMRs, lab and pharmacy
  • Actionable Reporting Platform: Designed for various user types with both at-a-glance views and "super user" functionality
  • Analytics: Medical cost trends, underwriting support, provider contracting and network modeling
  • Financial and Actuarial Expertise: Incentive alignment and risk management
  • 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 and the providers
  • Experience: Commercial, Medicaid and Medicare Plans

Key Benefits

  • Control: Providers gain full responsibility for their patients, including benefit design, care delivery efficiency, and quality outcomes
  • Effective Population Health: Leveraging integrated systems and incentive alignment, care coordination is enhanced across the entire spectrum
  • Higher Quality: Research indicates that provider-sponsored health plans deliver higher quality and lower cost care than traditional payors
  • Alternative Revenue Streams: Collecting the insurance premium directly from employers or individuals means success is no longer solely 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