Value Based Care Solutions
Value Health empowers provider networks—especially large hospital systems—to transition smoothly into value-based care models by optimizing operations, enhancing patient engagement, and reducing overheads. With deep expertise in U.S. healthcare delivery and proven capabilities in Gen AI, automation, and workforce optimization, Value Health helps providers navigate the growing complexity of modern healthcare—from patient engagement and benefit verification to billing and clinical documentation.
Their solutions are tailored to address the unique needs of providers who are under increasing pressure to improve outcomes, reduce administrative load, and stay financially viable in an environment of shrinking reimbursements and rising patient expectations.
Challenges
Transition to Value-Based Care
Shifting away from volume-driven models to outcome-based reimbursement adds complexity to care delivery and billing.
Staffing Shortages
Recruiting and retaining skilled clinical and administrative staff is increasingly difficult, impacting service delivery.
Provider & Nurse Burnout
Excessive documentation and administrative tasks reduce face-time with patients, driving high stress and low satisfaction.
Patient Dissatisfaction
With rising expectations, patients demand more personalized, coordinated, and tech-enabled care experiences.
No-show Appointments
Missed appointments disrupt schedules and reduce care continuity.
Decreasing Reimbursements
Providers face mounting financial pressures due to shrinking margins and increased denial rates.
Tech Fragmentation
Managing and maintaining distributed systems (EHRs, portals, communication tools) drains resources and adds inefficiency.
Benefit Verification Complexity
Ensuring eligibility across diverse payers and services is time-consuming and prone to errors.
Training Gaps
Continuous upskilling for clinical and non-clinical staff is necessary but often inconsistent or unavailable
Benefits
Improved Clinical Efficiency
Automation tools like scribing assistants reduce provider documentation burden and increase daily patient load capacity.
Higher Revenue Retention
Automated AR follow-up, denial prevention, and better benefit verification reduce claim aging and write-offs.
Enhanced Patient Experience
Engagement platforms, appointment management, and omnichannel outreach improve satisfaction and reduce no-shows.
Operational Scalability
Offshore/onsite hybrid delivery and domain-specific resources provide 24/7 operational support without overextending internal teams.
Burnout Reduction
Streamlined workflows and Gen AI tools free up time for providers to focus on care, not paperwork.
How we do it
Value Health delivers a fully integrated approach that addresses clinical, operational, and revenue-related priorities
Patient-Centric Solutions
- Personalized Engagement: Use of omnichannel platforms and patient portals to drive preventive care and manage expectations.
- Appointment Optimization: Tools to reduce no-shows and improve scheduling efficiency.
- Experience Design: Real-time support that caters to patient preferences, education, and satisfaction.
Resource-Centric Solutions
- Skilled Staffing Models: Access to a pool of trained nurses, coordinators, and virtual agents for PSP and care navigation.
- Burnout Mitigation: Use of Gen AI scribing, workflow simplification, and case preparation tools to reduce manual load.
- Training Enablement: Tailored programs for clinical and administrative upskilling using proven processes and tools.
Revenue Enhancement Framework
- Benefit Verification & eBV: Real-time, AI-based eligibility checks reduce delays and improve coverage accuracy.
- Claim Submission & AR Follow-up: Intelligent claim routing, scoring, and appeals handling to reduce aging AR and accelerate payments.
- Process Automation: Custom-built workflows for prior authorizations, billing, and collections to minimize manual errors.
Case Study 1
Boosting Radiologist Efficiency with Scribing Assistants
Challenge
A major U.S. specialty provider network was struggling with radiologist overload. Each radiologist was spending 30–50% of their time on administrative tasks like reviewing images, organizing case files, verifying image quality, and preparing documentation—before even starting their diagnostic interpretation. This inefficiency was creating delays in patient diagnosis, increased stress among radiologists, and underutilization of radiology infrastructure. With a national shortage of radiologists, the system couldn't keep up with demand.
Our Solution
Value Health deployed a dedicated team of Radiology Scribing Assistants to take over all non-diagnostic tasks associated with imaging workflows. The implementation included:
Solution Highlights
- Queue Prioritization: Cases were sorted and assigned based on urgency and individual radiologist workloads. This ensured high-priority cases were addressed faster.
- Image Quality Validation: Before sending cases to radiologists, scribing assistants verified image quality against order forms. If the image was unclear or incomplete, they sent automated communications to technicians for re-scans.
- Unified Case Compilation: Assistants consolidated current images with historical scans and notes, giving radiologists a single, streamlined case view.
- Communication Efficiency: The scribing team served as a link between imaging technicians and radiologists, reducing back-and-forth and unnecessary delays.
Business Outcomes
2.3% to 1.6%
Billing errors dropped from 2.3% to 1.6%, by ensuring complete, high-quality documentation during case prep
Patients
Patients received faster diagnostic results, enhancing care quality and satisfaction—key indicators in value-based care models
Radiologists
Radiologists experienced less administrative burden, reducing fatigue and improving job satisfaction
Case Study 2
Reducing Aging Accounts Receivable for a Provider Network
Challenge
A multi-specialty U.S. provider network faced significant financial pressure with over 35% of its accounts receivable (AR) aged beyond 120+ days. The delays were largely due to inefficient claim follow-ups, lack of prioritization, and inconsistent appeal processes. This not only impacted cash flow but also created operational instability, limiting the organization’s ability to invest in patient care initiatives under its value-based care strategy.
Our Solution
Value Health implemented a dual-layered AR recovery strategy:
Solution Highlights
- Run-Down Model for Aged Claims: A specialized team focused solely on clearing out high-dollar, high-risk claims in the 90+ and 120+ day buckets. These were systematically categorized, tracked, and escalated using predefined protocols.
- Proactive AR Prevention Layer: Simultaneously, a second team began engaging claims as soon as they crossed the 60-day mark, preventing them from aging further.
Additional interventions included
- ✅ Claim Scoring Engine: Developed a scoring algorithm to assign priority levels to each claim, ensuring complex or high-risk claims were routed to experienced agents.
- ✅ Streamlined Workflows: Introduced new workflows that reduced the number of touches needed to resolve each claim.
- ✅ Appeals Optimization: Created a standardized and efficient appeal submission process, increasing first-pass resolution rates.
- ✅ Denial Trend Analysis: Within 3 months, the team performed a trend analysis that identified 28 recurring denial reasons, allowing process corrections and training to prevent future errors.
Business Outcomes
provider
The provider regained financial stability and redirected resources to patient services—supporting their long-term value-based care goals
4.2 to 1.19
Claim resolution touchpoints dropped from 4.2 to 1.19 per claim, streamlining operations and reducing manual effort
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