Program model
A managed pathway from claims opportunity to supported surgical care.
CareCostDown coordinates the operating model required to turn a surgical savings opportunity into a governed, voluntary employee pathway.
The program is selective by design. It is intended for eligible, non-emergency elective procedures where clinical suitability, member readiness, and employer savings potential can be evaluated together.
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
How it works
Six operating steps for a controlled pilot.
Pilot design and stakeholder alignment
Member education and eligibility screening
Physician-led clinical review
Center of Excellence matching and coordination
Post-operative handoff and employer reporting
Surgical categories
The first program focus is knee replacement and selected high-cost elective procedures where savings potential, clinical suitability, and Center of Excellence readiness are clear.
Member experience
Members receive plain-language education, eligibility review, care navigation, scheduling support, travel coordination, and post-procedure handoff planning.
Implementation
CareCostDown helps define plan fit, incentives, member communications, TPA or carrier workflow, reporting cadence, and pilot success criteria.
Reporting
Program reporting can include eligible case volume, participation, completed cases, clinical review outcomes by category, estimated savings, realized savings, and operational issues.
Design a pilot around your population and procedure mix.
We can help define eligible categories, workflow, communications, governance, and reporting before launch.