MCM

What MCM does

MCM operates in the healthcare cost-management space under the brand Vālenz Health® (also stylized as Valenz Health), a privately held company headquartered in Wayne, Pennsylvania, with an additional Utilization Management operations site in Phoenix, Arizona. The firm provides population health management and clinical engagement services to health plans, Third-Party Administrators (TPAs), self-funded employers, Taft-Hartley funds, healthcare providers, brokers and consultants, and stop-loss producers. Per the firmographic record, MCM was founded in 1986 and operates with a 101–250 employee base.

The company's core offering is the Valenz Clinical Engagement suite, which integrates Utilization Management (UM), Case Management (CM), and Disease Management (DM) on a shared platform. Clinical decisions for pre-certification are grounded in third-party evidence sources MCG and NCCN guidelines, and the firm holds URAC accreditation for Health Utilization Management (HUM010057) through January 1, 2028. Adjacent product lines include Valenz Bluebook (cost and quality transparency, with sub-products Bluebook Rx for pharmaceuticals and Precision Care for personalized guidance), the integrated ValenzONE platform, and a Payment Integrity suite (ABN Medical Necessity Validation, Clean Claim Verification, Clinical Bill Review, In- and Out-of-Network Repricing) and Provider Quality modules (Credentialing, Sanction Monitoring, CareChex Awards, Outcomes Analytics via Quantros).

MCM generates revenue primarily through managed-services contracts with healthcare payers and plan administrators. Pricing is quote-based at the enterprise level and not publicly disclosed. The go-to-market combines direct enterprise sales targeting health plans and large employers with channel partnerships through TPAs, brokers, and benefits consultants. Documented client outcomes include 20:1 ROI for UM, 10:1 ROI for CM, 3:1 ROI for DM, 17% average member engagement in CM, $120 million in additional savings for a multi-state health plan, $40,000 average savings per claim, and 14% additional savings beyond PPO discount for a Children's Hospital client. Marketing is multi-channel (blog, YouTube, LinkedIn, resource center, industry events) and the company appeared on the Inc. 5000 list in 2024.

Name

MCM

Legal name

Valenz Health

Website

https://medicalcost.com

Company type

Private

Founded year

1986

Operating status

Operating

Headcount range

101–250 employees

Short description

MCM operates Vālenz Health®, a private healthcare cost-management firm providing Utilization Management, Case Management, Disease Management, payment integrity, and provider-quality solutions to health plans, TPAs, self-funded employers, and Taft-Hartley funds.

Ownership category

akta.pro rank

Headquarters

HQ city

Chicago

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Healthcare Cost Management Services: Revenue generated through clinical engagement and care management services delivered to health plans, TPAs, employers, and providers. Services include Utilization Management, Case Management, and Disease Management to reduce healthcare costs.

Go-to-market motion2 records

Distribution channels3 records

Marketing channels5 records

Core offering

MCM delivers population health management solutions and services through clinical engagement, payment integrity, provider quality, and plan performance offerings designed to promote better health and meet community health needs. The company combines clinical decision support with claims cost and quality data (Valenz Bluebook) and an integrated technology platform (ValenzONE) to lower healthcare costs for self-funded employers, health plans, TPAs, and stop-loss carriers.

Product overview

Vālenz Health offers a unified platform-based approach to healthcare management, centered on the Clinical Engagement suite. This core offering integrates three modules: Utilization Management (UM), Case Management (CM), and Disease Management (DM). These components work together to proactively identify high-risk members, coordinate complex care episodes, and manage chronic conditions. The platform is complemented by Valenz Bluebook (including Bluebook Rx and Precision Care sub-products) for cost and quality transparency, and connects to additional solutions including Payment Integrity, Provider Quality, and Plan Performance modules through the ValenzONE integrated platform.

Differentiator

Problem solved

Functional benefit

Brands

• Valenz Clinical Engagement: Comprehensive care management solution integrating Utilization Management, Case Management, and Disease Management for TPAs, employers, and health plans.
• Valenz Bluebook
• ValenzONE
• Bluebook Rx
• Precision Care

Products and services

• Clinical Engagement
• Valenz Bluebook
• Payment Integrity
• Provider Quality
• Plan Performance

Quantifiable outcome

• 20:1 ROI for Utilization Management services
• +7 more outcomes

Named customers3 records

Segments8 records

Ideal customer profiles5 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Scale indicators10 records

Broad incumbents

• Optum (UnitedHealth Group): Optum is the largest healthcare services and innovation arm of UnitedHealth Group, offering payment integrity, utilization management, analytics, and care management at massive scale. Competes with Valenz broadly across all service lines and customer segments.
• Change Healthcare (now part of Optum): Change Healthcare provides revenue cycle, payment integrity, and clinical decision support solutions to payers and providers. Although now owned by Optum, it remains a recognized competitor in the payment integrity and utilization management space.

Direct peers

• Zelis: Zelis is a leading healthcare cost management and payments platform serving health plans, TPAs, employers, and providers with payment integrity, network solutions, and claims management. Highly comparable to Valenz's payment integrity and clinical engagement offerings.
• Pareto Intelligence: Pareto Intelligence offers healthcare payment integrity, risk adjustment, and quality analytics solutions to health plans, with similar customer profiles and outcomes-driven value propositions to Valenz.
• Edifecs: Edifecs provides healthcare data interoperability, payment accuracy, and value-based care solutions to health plans. Comparable to Valenz's data-driven Payment Integrity and Clinical Engagement offerings.
• Cotiviti: Cotiviti specializes in payment integrity and value-based care analytics for health plans, with strong overlap with Valenz's Payment Integrity and Provider Quality modules. Both serve similar payer clients with claim-line-level review and accuracy solutions.
• MultiPlan: MultiPlan is a major provider of healthcare cost management solutions including payment integrity, network-based services, and claims analytics. Directly competes with Valenz in serving TPAs, employers, and health plans on cost containment.

Emerging players

• Vatica Health: Vatica Health provides risk adjustment and preventive care solutions for health plans and providers, with overlap to Valenz's provider quality and population health adjacent offerings.
• Clarify Health Solutions: Clarify Health delivers AI-driven healthcare analytics and value-based care enablement for payers and providers. Comparable in offering data-driven insights for plan performance and provider quality, though more focused on analytics than UM services.
• Health Catalyst: Health Catalyst offers healthcare data and analytics platform solutions for payers and providers, partially comparable to the ValenzONE integrated platform through its data warehousing and outcomes analytics capabilities.

Market position

Strengths5 records

Weaknesses5 records

Key risks6 records

Key highlights6 records

Customer concentration

• YouTubeyoutube.com/@valenzhealth
• LinkedInlinkedin.com/company/valenz
• Xx.com/MCM_MEDCOSTMGMT

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about MCM