Case Study: Driving Superior Cost Savings with Valenz Market-Sensitive (VMS®) Repricing

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.

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

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.

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%