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Valid Vendor of the Month: Nova Healthcare Administrators

As a recent recipient of a Validation Institute Health Value Award for Health Plan Performance Management, Nova has come a long way since the days of typical TPA operations. There was a time when, I would rather loudly advise inquiring minds to consider options other than Nova.

To be honest, they hated me. All I was doing was reporting the facts.

But my observations changed over time, because as I reviewed their figures on behalf of our joint client year over year (using the non-gamble Validation Institute methodology), they improved, steadily, every year.

They started demonstrating meaningful results for their clients, and now, here they are, on the Quizzify website. This is not just for show. Quizzify now guarantees their results, with a third of our own fees, for any joint accounts.

And, on paper this is quite a risk for Quizzify because they have so many clients now that, if we’re wrong, I’ll have to move back in with my kids, who only recently moved out of my house.

Here’s the company’s coming-of-age story.

Eliminating Silos

By the early 2010s, Nova’s order of operations (like many TPAs and most health plans) were siloed. Coworkers rarely mingled with other internal teams, let alone collaborated on the various elements of health plan management. Siloed departments fostered an “us versus them” mentality.

Then something happened. I’d like to think mine was the wake-up call, but when I’ve blown the whistle on other companies, they’ve responded by doubling down on cluelessness.

Nova’s culture transformed with its growth. Nova adopted a connected company model and shifted its approach to plan management evolving from segmented to holistic. Employees in claims, customer service, enrollment and medical management were now neighbors and desk mates who talked to one another about health plan processes and areas of operational opportunity.

The model included a dedicated business unit designed to end the silos we often see in the health care delivery system. By working cross-functionally, Nova’s associates are now able to minimize gaps in care, thereby improving outcomes.

One of the largest success stories Nova has experienced with this evolution of member care is related to their approach to outreach. By assisting members in securing a primary care physician, the 2019 ER visit rate of 161 per 1000 in 2019 came in 15% below national averages.


Claims: Rubber Stampers become Trend Spotters

All claims-payers receive reams of data. What matters is what they do with it. When it comes to consuming health plan data, you must keep asking questions. Why is this happening? What is driving cost? Where are plan participants seeking services? How can we manage it? You need a strategic approach to plan analysis. You do not need analysts mindlessly processing claims simply to reach operational benchmarks.

Organizations need to evaluate data from continuing or emerging population trends. Which trends remain top priority? Once those are addressed, you can move on down the line. The added layer of reporting that derives from Nova’s analysts working with the health plan performance team makes these trends clear.

For example, one Nova case study highlights a deeper dive into high ER utilization. One of Nova’s clients has an unusually high number of pregnancies. Research showed new mothers within the plan’s population were taking their infants to the ER for issues that could have been treated with a lower level of care. Nova’s medical management team created a program in which the new mothers were given access to care navigators during their eighth month of pregnancy. The care navigators helped the mother’s find pediatricians and urgent care centers as well as input the 24-hour nurse line into their phones. The result was a better experience for the member and a lower cost to the health plan.


The Value of Health Care: Client Perspective

Employers want to do right by their people. So how does Niagara County measure the value of services they receive? Jennifer Pitarresi, the county’s Director of Risk and Insurance Services said balancing a client’s needs for member service and cost savings is key.

“Our members are important. When my phone doesn’t ring, when legislators’ phones don’t ring, that’s how I judge satisfaction with the plan. This is how I know Nova is working for me and our members. I have a strong relationship with my client service team. They know what I expect and they know when to reach out if they have a question. That’s what everyone should look for in a TPA. A plan sponsor needs a TPA that can be an ‘extension of you.’ The right TPA partner should anticipate your issues, understand your priorities, and approach and help you manage the plan like you would yourself. Members get upset if they have to make a customer service call more than once. I don’t get those complaint calls anymore.

That said, my budget director doesn’t care about the touchy-feely customer satisfaction like I do. He wants to know what things cost and I’m able to show him studies where we spend some money to save a lot more money. We’ve invested in wellness initiatives that encourage preventive care and condition management to save money on ER and inpatient costs. We share this model with our stakeholders and I’m able to demonstrate value to various audiences in different ways, based on what is important to them. I am able to validate customer satisfaction and show the value of our benefits by reporting on areas of savings.

Our partnership with Nova offers me the opportunity to do these things. One recent example of this is Nova’s transitional care program. Niagara County members have commented on their appreciation for this timely outreach by Nova’s nurses to help coordinate care and navigate through bills received from the hospital and provider. The readmission rate 30 days after hospitalization for those Nova was able to connect with was 5% compared to 11% for those who could not be reached. In 2020, this equated to a savings of ~$100,000 for the Plan.

Nova also set up a program to outreach to our members with chronic conditions to speak with them about their risk around the Coronavirus. A member was so moved by the conversation that he shared his experience with his daughter who contacted Nova to share how ‘cared for’ her father felt. Nova is able to balance our needs for member service and savings in a way that I value.”


So, there you have it: an evolution of client care. A model designed to discover real-time trends specific to a group’s population and a team of associates who feel empowered to listen, understand, educate, and collaborate to ensure the health care delivery system continues heading in a better direction…all reasons Nova Healthcare Administrators is the Quizzify Valid Vendor of the Month. With our own fees to back our selection.


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