JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Health Value Award Application Form 2023
Application open through April 6, 2023
Sign in to Google
to save your progress.
Learn more
* Indicates required question
I'm nominating
*
My company
Someone else (for Spotlight, Employer of the Year, Broker of the Year Awards)
Another company
Validated Provider
*Applications submitted by/for an employer’s health, wellness, or benefits program will be considered
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Title/Role
*
Your answer
Organization Name
*
Your answer
Organization size
*
Small 1-999
Medium 1000-4999
Large 5000-19,999
Jumbo 20,000+
Organization Website URL
*
Your answer
Describe the organization/individual and who they serve in 300 words or less
*
Your answer
Have you or the organization being nominated applied for a Health Value Award before?
*
Yes
No
Select Award Category:
*
Audit, Transparent Marketplace
Behavioral Health
Care Coordination
Care Management
Diabetes Management
Digital Health (Digital Therapeutics)
Disease Management
Drug Outcomes
Fertility & Reproductive Health (Special Fertility)
Health Analytics
Health Literacy
Kidney Care
Mental Health
Musculoskeletal Management
Obstetrics
Pharmacy Benefit Management
Population Emergency Medicine
Population Health Management
Predictive and Preventive Health
Primary Care
Special Savings
Specialty Imaging
Telehealth & Telemedicine
Third Party Administrator
Vision Care
Well-being
Wellness
Broker of the Year
Health Care Value Thought Leader
Employer of the Year
Employee Engagement
Spotlight(Please fill in details in the next question)
Spotlight (Award Category): Award recipient of this category has made meaningful impact on the health and well-being and contributed to significant improvements in healthcare delivery and outcomes.
Your answer
What is the name of your organization’s/nominating organization’s or individual’s program you are submitting a Health Value Award application for?
*
Your answer
Does the organization/individual work with a vendor/solution provider to offer the program?
*
Yes
No
If yes, name the vendor/solution Provider:
Your answer
Describe what service or support the program/individual provides in 500 words or less
*
Your answer
Choose one numeric measure of the program's success and describe it below. Examples of measures include:
*
ED visits per 1,000 member months pre- and post-program
Pain score improvement for participants and matched comparison group
Actual rate of complications compared to a published benchmark
Not applicable
More guidance on choosing and describing a measure can be found here
http://validationinstitute.com/wp-content/uploads/2022/10/Vendor-Evaluation-Overview-of-this-Multi-Part-Series.pdf
Is your program new or unique in the market?
*
Yes
No
Describe why the organization’s program/individual should receive a Health Value Award in 500 words or less
*
Your answer
Describe the organization’s/individual’s recent accomplishments in 500 words or less (include links to news updates, marketing materials, publications, if any)
*
Your answer
Has your organization’s program been validated by the Validation Institute?
*
Yes
No
I am interested in learning more about validating my organization’s program/product
How did you hear about the Health Value Awards
*
Validation Institute website
LinkedIn
Email
Friend or Colleague
Other:
Application Fee:
*
I understand the application fee is $150.00 and I will be invoiced for this.
This is an existing and current validated program – no application fee
I have a promo code:
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Validation Institute.
Report Abuse
Forms
