Self-Funded Plan Savings on ABA Therapy

This case study outlines how a self-funded health plan achieved significant cost savings on high-cost applied behavior analysis (ABA) therapy through the services of Vālenz Health. The plan faced over $5 million in billed charges for pediatric ABA therapy, with a substantial portion remaining unpaid, leading to financial risk and administrative challenges. To address these issues, the plan engaged Vālenz for payment integrity review, utilizing their Clinical Bill Review solution. The Valenz team implemented its proprietary Valenz Market-Sensitive (VMS®) repricing methodology, which is based on extensive claims data and industry benchmarks. This approach resulted in an approximate 66% reduction in billed charges, translating to nearly $4 million in potential savings. The case study emphasizes the effectiveness of Vālenz's negotiation strategies and ongoing support for access to care, showcasing a successful resolution to the financial burdens faced by the health plan.