2022 Validation Report
Review for: Nova Healthcare Administrators
Validation Achieved: Savings
Savings Valid Through: January 2023
Company Profile
Category:
Third Party Administrator
Website:
Public or Private:
Private
Year Established:
1982
President:
James Walleshauser
Company Contact:
Description:
Evolving over the last 30 years, Nova aims to manage trend to reduce health care spend and improve health plan performance. Headquartered in Buffalo, NY, Nova is a wholly-owned affiliate of Independent Health.
Nova works with flexibility to provide the solutions clients need in the way clients need them including medical, dental, vision, COBRA, reimbursement account administration, and private-labeled partnerships. Nova provides clients with unique cost management and customized health plan strategies through personalized service.
Claim Assertion
Nova Healthcare Administrators creates a cost and risk management strategy tailored to each employer’s benefit plan, culture, and goals. The strategy uses medical, behavioral, and pharmacy claims, plus biometric test screening results and a company-level assessment. The strategy addresses preventive care, early detection of illness, improving treatment compliance, appropriateness of services, and reducing cost of necessary care. Nova’s clients have had annual rate increases that are lower by half than a national benchmark.
Intervention link to outcome
- Describe the outcome being measured
- Per member per month paid and per member per month allowed amounts for medical and pharmacy claims.
- Has the applicant shown with published literature or other credible sources that the outcome being measured is correlated with the intervention being described?
- The intervention encompasses care management based upon a detailed analysis of the employer-client’s benefit plan, culture, and on participant level health status. The Nova team emphasizes practical, useful, and meaningful solutions, tailoring communications and outreach based upon a comprehensive look at data from various sources.
- Does the applicant discuss published literature or other credible source demonstrating correlation between intervention and outcome? If yes, describe the correlation and the source cited by applicant. If no, does the literature exist to demonstrate a correlation between intervention and outcome?
- There is literature about care management for specific chronic diseases, and treatment compliance having an impact on use of acute care and on costs. Similarly, there is literature showing that treatment compliance leads to fewer hospital admissions. Nova’s program uses a wide range of care management and intervention tools, which were not described in detail nor linked to literature sources.
Method/Calculation/Examples
Nova calculated the per member per month medical and pharmacy claims paid for 2015, a baseline year, and for 2016, 2017, and 2018. Nova also calculated the PMPM medical and pharmacy claims allowed amounts for each of the four years. The annual percentage increase for 2016, 2017, and 2018 was calculated and compared to Price Waterhouse Coopers Health Research Institute’s published medical cost trends for the same years. (See: https://www.pwc.com/us/en/industries/health-industries/library/behind-the-numbers.html )
Data Source
- Describe the data source.
- The data for the PMPM paid and PMPM allowed comes from Nova’s own administrative system for its clients. The benchmark comes from Price Waterhouse Cooper’s Health Research Institute.
- Did the applicant have adequate data from a credible, reliable source?
- Yes.
- How is the data source appropriate for the outcome being measured?
- The PMPM figures are a direct reflection of what the plan (and its members) have spent on medical care. The PwC benchmark shows the trend that employers nationwide are experiencing on average.
Methodology
- Describe the evaluation methodology, i.e. trend from pre- to post-, comparing similar groups, etc.
- Nova compared its clients’ annual percentage increase to a national benchmark.
- Did the applicant collect and manage data in accord with standard evaluation methodology? Comment on any issues with compiling the measure, such as missing or incomplete data or lack of data on non-participants.
- Yes.
Findings & Validation
Below is a table showing Nova’s PMPM paid, PMPM allowed, the annual percentage change, and Price Waterhouse Coopers national trend.
Limitations
Since the calculation includes all Nova clients, we do not know how widely varied the clients’ rate increases were. This data would have strengthened the presentation.
The various care management interventions were not described in detail, and so could not be verified with a literature search.
Validation and Credibility Guarantee
Nova Healthcare Administrators achieved validation for Savings. Validation Institute is willing to provide up to a $25,000 guarantee as part of their Credibility Guarantee Program. To learn more, visit https://validationinstitute.com/credibility-guarantee/.
Program Validation
Program has strong evidence of significant impact on both patient outcomes and on medical costs. Evidence is assessed based upon the certainty it provides that the result is due to the program and not to other factors, such as recruiting people to participate in the program who are most likely to succeed.
Savings
Can reduce health care spending per case/participant or for the plan/purchaser overall.
Outcomes
Product/solution has measurably improved an outcome (risk, hba1c, events, employee retention, etc.) of importance.
Metrics
Credible sources and valid assumptions create a reasonable estimate of a program’s impact.
Contractual Integrity
Vendor is willing to put a part of their fees "at risk" as a guarantee.
About Validation Institute
Validation Institute is a professional community that advocates for organizations and approaches that deliver better health value - stronger health outcomes at lower cost. We connect, train, and certify health care purchasers, and we validate and connect providers delivering superior results. Founded in 2014, the mission of the organization has consistently been to help provide transparency to buyers of health care.
Validation Review ProcessValidation Institute has a team of epidemiologists and statisticians who review each program. The team focuses on three components:
- Evidence from published literature that a similar intervention had similar results.
- The reliability and credibility of the data sources.
- The rigor of the approach to calculating results
To achieve validation, the program has to satisfy each of these components. VI’s team then summarizes the review into a report which is publicly available. Details of VI’s review are available with the program’s permission.
