Utilization Management
Valence Health delivers proven methodologies and technologies to enable plans to deliver the right medical care at the right level while monitoring compliance with regulations. We utilize independent care guidelines in the medical decision-making process. Our services include prospective, concurrent and retrospective reviews for inpatient and outpatient procedures that integrates care information with the claims management system.
Case Management
Through utilization management and the inpatient discharge planning process, Valence Certified Case Managers are able to identify patients appropriate for case management. A care plan, prepared by the discharge planner and the patient’s physician, is given to Valence to be implemented. Scheduled telephonic re-assessments are conducted by Valence with the patient and as milestones are achieved, information is shared with the patient’s physician.
Disease Management
Valence tracks the continuum of care for adult and pediatric patient populations and we actively manages high-risk populations. We encourage a collaborative effort between the primary care physician, patient, and Valence’s Certified Case Managers to promote wellness and to maximize the patient’s quality of life within a cost-effective health care environment. Our internally developed health risk assessment tool allows the case manager to track the patient’s progress towards defined, medically accepted goals while allowing for the adjustments of medical interventions when needed.
Quality Improvement Studies
Valence can conduct a range of Quality Improvement as well as HEDIS studies to meet any plan requirements. Our thorough processes and our ability to gather and analyze data enables health plans to document and demonstrate care to patient populations.
Proprietary Care Management Tools
vScope, Valence’s integrated patient data tool, is a complete solution for care management and disease management – creating efficiencies in managing patient data while providing information for determining the medical necessity of inpatient care and outpatient procedures. Medical staff has a source of accurate and up-to-date information, including prescription information that reduces the need to maintain multiple record systems for each patient. vScope includes task tracking, for appropriate and timely follow-ups, and can be fully integrated with the claims management information system. Authorizations and referral information can be entered, and vScope allows for entering free-form notes and clinical notations.