--- title: "Case Study: $31 Million in Incremental Savings with Valenz Out-of-Network Repricing" description: Discover how Valenz Market-Sensitive repricing saved $31M on a claims dataset—delivering a 44% boost in total possible savings. image: https://info.valenzhealth.com/hubfs/Case%20Studies/VMS%20Case%20Study/vms-case-study-featured.png --- [Skip to content](https://info.valenzhealth.com/vms-case-study#page-content) [![Valenz Health](https://info.valenzhealth.com/hubfs/web/logo.svg)](https://www.valenzhealth.com/?hsLang=en) - [Who We Serve](https://www.valenzhealth.com/who-we-serve/?hsLang=en) - [Solutions](https://www.valenzhealth.com/solutions/member-experience/?hsLang=en) - [About Us](https://www.valenzhealth.com/about-us/?hsLang=en) - [Resources](https://www.valenzhealth.com/resources/?hsLang=en) - [Contact](https://www.valenzhealth.com/contact/?hsLang=en) ### [Patients](https://www.valenzhealth.com/who-we-serve/members/?hsLang=en) ### Payers - [Employers](https://www.valenzhealth.com/who-we-serve/employers/?hsLang=en) - [Taft-Hartley Funds](https://www.valenzhealth.com/who-we-serve/taft-hartley-funds/?hsLang=en) ### Providers - [Healthcare Facilities and Providers](https://www.valenzhealth.com/who-we-serve/healthcare-facilities-and-providers/?hsLang=en) ### Plans - [Health Plans](https://www.valenzhealth.com/who-we-serve/health-plans/?hsLang=en) - [Third-Party Administrators](https://www.valenzhealth.com/who-we-serve/third-party-administrators-tpas/?hsLang=en) - [Brokers and Consultants](https://www.valenzhealth.com/who-we-serve/brokers/?hsLang=en) - [Stop Loss Producers](https://www.valenzhealth.com/who-we-serve/stop-loss-producers/?hsLang=en) #### Partner with Us Discover how Vālenz Health® can simplify the healthcare experience with our innovative solutions. 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[• Bluebook Rx](https://www.valenzhealth.com/solutions/member-experience/bluebook-rx/?hsLang=en) - [Precision Care](https://www.valenzhealth.com/solutions/member-experience/valenz-bluebook/?hsLang=en#precision-care/) Back ### Plan Performance - [Overview](https://www.valenzhealth.com/solutions/plan-performance/?hsLang=en) - [Stop Loss](https://www.valenzhealth.com/solutions/plan-performance/stop-loss/?hsLang=en) - [Variable Copay](https://www.valenzhealth.com/solutions/plan-performance/variable-copay/?hsLang=en) Back ### Search # Case Study: Driving Superior Cost Savings with Valenz Market-Sensitive (VMS®) Repricing How Valenz Out-of-Network Repricing Generated $31.1M in Additional Savings ## Executive Summary A comprehensive claims analysis comparing a client's current out-of-network (OON) repricing solution to the Valenz Market-Sensitive (VMS®) repricing methodology demonstrates that Vālenz Health® delivers materially higher savings, lower allowables, and consistent performance across all claim types. Using a dataset of 97,301 medical claims totaling **$144.6 million in billed charges**, Valenz generated **$31.1 million in incremental savings** beyond the current approach — a **44.7% improvement in total possible savings** for the client. This case study highlights how Valenz outperforms the current solution through tighter allowable pricing, stronger facility claim management, and scalable impact across high-volume professional claims. ![Total Financial Impact](https://info.valenzhealth.com/hs-fs/hubfs/Case%20Studies/VMS%20Case%20Study/Total%20Financial%20Impact.png?width=1920&name=Total%20Financial%20Impact.png "Total Financial Impact") ### Sem Ipsum Lorem ipsum dolor sit amet consectetur adipisicing elit. Ratione hic quaerat magnam accusantium sequi inventore non quod, maiores veniam recusandae maxime repudiandae impedit, obcaecati atque, iusto molestiae repellendus veritatis commodi illo ex ab! Maxime harum est ad suscipit sint delectus. ## Challenge: Healthcare cost-containment efforts often struggle to balance savings consistency across facility and professional claims. Many solutions deliver savings in isolated categories while underperforming at scale or failing to materially reduce allowed amounts. The objective of this analysis was to evaluate whether, when operating on the same claims dataset as the client’s current solution, Valenz could deliver the following: - Lower overall allowables - Higher savings rates - Incremental financial value beyond the current solution ![placeholder-800x450](https://f.hubspotusercontent20.net/hub/5486129/hubfs/placeholder-800x450.jpg?width=800&name=placeholder-800x450.jpg "placeholder-800x450") ### Short-term goal Lorem ipsum dolor sit amet consectetur adipisicing elit. Ratione hic quaerat magnam accusantium sequi inventore non quod, maiores veniam recusandae maxime repudiandae impedit. ### Long-term goal Lorem ipsum dolor sit amet consectetur adipisicing elit. Ratione hic quaerat magnam accusantium sequi inventore non quod, maiores veniam recusandae maxime repudiandae impedit. ## Solution: To analyze the large set of OON claims, Valenz deployed the proprietary VMS repricing methodology (a feature of the Valenz Out-of-Network Repricing Solution), which aggregates years of robust claims data from multiple sources to ensure fair, defensible, and market-supported reimbursements. The analysis evaluated 97,301 claims across four major claim categories: - Facility Inpatient - Facility Outpatient - Facility Other - Professional Key financial metrics compared included: - Billed charges - Allowed Amounts - Total Savings - Savings Percentage - Net Incremental Savings vs. Current ## Results: With its industry-leading approach to repricing, Valenz delivers a significant improvement in overall cost reduction, identifying more than $31 million in potential savings across a variety of claim categories. As a whole, these outcomes highlight the ability of the VMS repricing methodology to deliver both high-impact and high-scale cost containment for meaningful financial value across the full claims spectrum. ### Total Financial Impact The VMS repricing methodology reduces total allowed spend by more than **$31 million**, delivering a step-change improvement in cost performance without any increase in billed charges. ![Total Financial Impact](https://info.valenzhealth.com/hs-fs/hubfs/Case%20Studies/VMS%20Case%20Study/Total%20Financial%20Impact.png?width=1920&name=Total%20Financial%20Impact.png "Total Financial Impact") ### Facility Claims: Consistent, High-Impact Savings Facility claims typically represent the highest cost and complexity in OON charges. Valenz delivered strong and consistent improvements across all facility categories, achieving savings rates ranging **from** **65% to nearly 80%** and generating more than **$15 million** in incremental value against the current solution. ![Facility Claims](https://info.valenzhealth.com/hs-fs/hubfs/Case%20Studies/VMS%20Case%20Study/Facility%20Claims.png?width=1920&name=Facility%20Claims.png "Facility Claims") ### Professional Claims: Scalable Savings at Volume Professional claims accounted for 87,766 claims in the dataset (90% of total volume). While individual claim values are smaller, Valenz demonstrated its ability to scale effectively to deliver a 66.16% savings rate for incremental savings of $16 million. This performance confirms that Valenz delivers operationally scalable savings — not just isolated wins in high-dollar claims. - Current Allowable: $43.4M - Valenz Allowable: **$27.3M** - Incremental savings: $16M - Savings rate: 66.16% ## Conclusion: VMS Repricing from Vālenz Health® Delivers Superior Savings and Cost Containment As this analysis demonstrates, Valenz delivered clear, quantifiable, and repeatable financial advantages compared to the client's current repricing solution in three critical ways:   1. **Lower Allowables Across the Board:** Valenz consistently reduced allowed amounts in every claim category, driving systemic savings rather than selective improvements. 2. **Stronger Facility Claim Management:** With savings approaching 80% in certain facility categories, Valenz demonstrated exceptional control in the most challenging areas of spend. 3. **Scalable Performance at Volume:** Valenz delivered meaningful incremental savings across tens of thousands of professional claims, proving it can operate efficiently at scale. Bottom line: On the same claims and the same billed charges, Valenz delivered **$31 million more in value** compared to the client's current repricing solution — demonstrating the potential for other organizations to achieve meaningful incremental savings through the VMS repricing methodology. Fusce a quam. Curabitur vestibulum aliquam leo. In dui magna, posuere eget, vestibulum et, tempor auctor, justo. Suspendisse eu ligula. Suspendisse non nisl sit amet velit hendrerit rutrum. Praesent egestas tristique nibh. Donec posuere vulputate arcu. Vestibulum turpis sem, aliquet eget, lobortis pellentesque, rutrum eu, nisl. Praesent metus tellus, elementum eu, semper a, adipiscing nec, purus. Sed libero. 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