Best fit
500+ employees / self-funded or level-funded / meaningful elective surgery claims
For self-funded employers
Cut avoidable high-cost elective surgery spend without turning benefits into medical tourism.
CareCostDown helps self-funded employers evaluate surgical savings through physician-led review, savings modeling, member support, and a clinically governed overseas Center of Excellence pathway.
Built for self-funded employers, benefits consultants, TPAs, and plan administrators evaluating high-cost elective surgery spend.
Program view
Surgical spend pathway
Savings
30-50%
Governance
Clinical review
Reporting
Case-level
Knee replacementEligible review$42k domestic benchmark
Orthopedic bundleCOE pathwayNet savings modeled
Member supportVoluntaryNavigator assigned
Employer reporting snapshot
12
Eligible cases
3
Clinical exclusions
Modeled
Pilot savings
Initial focus
Knee, hip, and selected orthopedic procedures
Not for
Emergency care, unstable medical conditions, or direct patient inquiries
The problem
Elective surgery is one of the most visible and variable cost centers in the health plan.
For self-funded employers, clinically appropriate procedures can still produce wide claims cost variation, unpredictable spend, and limited visibility into quality alternatives.
Many employers already manage pharmacy, primary care, chronic conditions, and network strategy. But high-cost elective procedures often remain difficult to control. A single surgery can generate a large claim, while employees may have little practical support comparing pathways, understanding options, or navigating complex care decisions.
- High allowed amounts for common elective procedures
- Limited member navigation before surgery decisions are made
- Inconsistent visibility into surgical alternatives
- Cost volatility from large but non-emergency claims
- Difficulty translating savings opportunities into an employee-ready program
The solution
A managed overseas Center of Excellence pathway, led by clinical governance.
CareCostDown coordinates the operational, clinical, and member-support layers needed to make an international surgical pathway appropriate for employer benefit strategy.
The program combines claims opportunity analysis, eligibility screening, physician-led clinical review, Center of Excellence matching, travel coordination, case management, and post-procedure handoff.
- Voluntary member participation
- Physician-led appropriateness review
- Defined Center of Excellence evaluation criteria
- Clear exclusions and risk controls
- Dedicated member navigation
- Employer-facing savings and utilization reporting
Savings model
A disciplined savings model for high-cost elective procedures.
CareCostDown helps employers estimate potential savings using claims history, procedure categories, participation assumptions, incentives, travel support, and program costs.
Savings vary by employer, plan design, procedure mix, geography, participation rate, and clinical eligibility. The model is designed for CFO and benefits review, not headline claims.
Employer model
Surgical savings scenario
Savings range for suitable casesUp to 30-50%
Program postureVoluntary and selective
Primary inputsClaims, eligibility, procedure fit
Net employer savings
After program costs, incentives, and coordination support.
Reporting cadence
Built for finance, HR, brokers, and plan administrators.
How it works
A clear pathway from claims opportunity to supported member care.
CareCostDown manages the process from employer analysis through post-procedure reporting.
Identify the opportunity
Review targeted surgical spend and estimate eligible procedure categories.
Design the pilot
Define plan fit, member incentives, communications, reporting, and operating workflow.
Screen eligible cases
Guide members through program education, eligibility review, and voluntary participation.
Conduct clinical review
Evaluate appropriateness, risk factors, exclusions, and care pathway fit.
Coordinate the COE pathway
Support provider matching, scheduling, travel logistics, and member preparation.
Manage return and reporting
Support post-procedure handoff and provide case-level and aggregate reporting.
Clinical governance
Clinical governance comes before savings.
A credible surgical cost strategy must be clinically disciplined, transparent, and selective.
CareCostDown is designed around physician-led review and Center of Excellence standards. Not every employee, condition, or procedure is appropriate for an overseas pathway.
Physician-led review
Cases are reviewed for appropriateness, risk factors, exclusions, and pathway fit.
Center of Excellence criteria
Potential facilities are evaluated against procedure capability, documentation, safety, and escalation standards.
Documentation discipline
Program records support clinical review, member consent, care coordination, and reporting.
Privacy boundaries
Employer reporting focuses on performance and savings, not unnecessary clinical detail.
Clinical governance detail
A structured review pathway before any overseas care is considered.
CareCostDown is designed around screening, documentation review, suitability checks, exclusion criteria, care handoff planning, and employer reporting. It does not replace treating clinician judgment or guarantee clinical outcomes.
Clinical Review Process
A conservative review sequence helps identify when a case may be suitable for education, coordination, and further clinical evaluation.
1
Medical record review
Clinical documentation is reviewed through a controlled case process when a member is evaluating a pathway.
2
Procedure appropriateness
The pathway is evaluated for whether the requested procedure category appears suitable for the program scope.
3
Travel suitability
Travel-related considerations are reviewed before a member proceeds beyond education and eligibility screening.
4
Risk exclusions
Cases with clinical, travel, documentation, or continuity concerns can be excluded from the pathway.
5
Domestic follow-up planning
Return-to-care expectations and domestic follow-up needs are considered before care coordination advances.
COE Evaluation Criteria
Center of Excellence selection is framed around documented standards, care coordination capability, and escalation readiness. Criteria are evaluated before inclusion in an employer pathway.
Surgeon credentialing
Procedure volume
Accreditation / facility standards
Infection control
Outcomes documentation
Escalation pathway
English-language coordination
Post-op protocol
Medical record transfer
Risk Exclusion Framework
Exclusions help keep the program focused on selected elective use cases where documentation, travel suitability, and domestic follow-up can be appropriately reviewed.
Emergency cases excluded
The program is designed for selected elective procedures, not urgent or emergency care.
Unstable patients excluded
Members with unstable clinical status require appropriate local evaluation and continuity.
High travel-risk cases excluded
Travel suitability is considered before an overseas pathway can move forward.
Cases without suitable domestic follow-up excluded
Post-operative continuity must be practical before the pathway is considered.
Complex cases requiring local continuity excluded
Cases that depend on tightly coordinated local care are not appropriate for this pathway.
Employer value
A surgical cost strategy built for self-funded employers.
CareCostDown helps employers add a targeted, measurable pathway to their broader cost-containment strategy.
- Lower net cost for selected high-cost elective procedures
- A structured alternative to unmanaged surgical spend
- Better visibility into eligible case volume and savings potential
- Support for benefits communication and member navigation
- Reporting for finance, HR, brokers, and plan administrators
- A pilot structure that validates results before broader rollout
Member experience
Supported, voluntary, plain-language
Program education in plain language
Eligibility and clinical review
Dedicated care navigation
Scheduling and travel coordination
Pre-procedure preparation
Support during the care episode
Post-procedure follow-up and domestic handoff planning
Employee experience
A supported member experience, not a self-service medical travel referral.
Employees need clarity, clinical confidence, and human support when evaluating a surgical pathway.
Participation is voluntary. Members receive structured education, coordination support, and guidance throughout the process so the pathway is understandable, supported, and respectful of the member's decision-making process.
Stakeholder navigation
Designed for every stakeholder in the benefits decision.
CareCostDown gives each team the information they need to evaluate fit, risk, savings, and implementation.
CFOs
Evaluate surgical spend reduction with a clear financial model, pilot economics, and savings reporting.
HR and Benefits Leaders
Offer a voluntary care pathway with plain-language education, employee support, and clinical safeguards.
Brokers and Consultants
Bring clients a differentiated surgical spend strategy with implementation and briefing support.
TPAs and Carriers
Review administrative fit, workflow, governance, reporting boundaries, and commercial model options.
Program focus
Focused first on knee replacement and other high-cost elective procedures.
The program starts where cost variation, clinical suitability, and employer savings potential are most meaningful.
CareCostDown is not designed for emergency care, complex unstable conditions, or procedures where travel adds inappropriate clinical risk. Each category is reviewed through a clinical, operational, and financial lens before being offered within an employer program.
Knee replacement
Hip replacement
Selected orthopedic procedures
Selected spine procedures after additional review
Risk management
A conservative approach to risk, eligibility, and plan fit.
A global care pathway only works when the program is selective, transparent, and operationally controlled.
CareCostDown does not position overseas care as a universal substitute for domestic care. The program uses defined criteria to determine when a member may be eligible and when a case should remain within the domestic care system.
- Voluntary participation only
- Clear medical exclusions
- Physician-led clinical review
- No emergency or urgent care use cases
- Defined travel suitability screening
- Transparent member education
- Continuity planning before and after the procedure
- Employer reporting focused on program performance
Evaluate whether a managed surgical pathway fits your population.
Start with a focused briefing or savings model. CareCostDown can help your team assess claims opportunity, eligible procedures, pilot design, and stakeholder requirements.
A pilot briefing is designed for employers, brokers, consultants, TPAs, carriers, and plan administrators evaluating a structured approach to high-cost elective surgery spend.