High domestic price variation
Total knee replacement is a common elective procedure where allowed amounts can vary significantly by facility, network, and geography.
Savings model
Model Your Surgical Savings
CareCostDown helps CFOs and Benefits Consultants estimate the financial opportunity for eligible high-cost elective procedures before launching a pilot.
The savings logic is straightforward: compare the domestic claims baseline for eligible procedures against the total managed program cost, including Center of Excellence care coordination, travel support, and employee incentives. The review should remain conservative, claims-based, and clinically governed.
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
Savings explanation
A savings model built around claims cost, eligibility, and program economics.
CareCostDown does not ask employers to accept a generic savings claim. The model should begin with the employer's own procedure mix and domestic allowed amounts.
For suitable cases, employers may see up to 30-50% savings compared with selected domestic allowed amounts after program costs. Actual savings depend on plan design, clinical eligibility, member participation, procedure category, incentive design, and Center of Excellence availability.
- Procedure category and expected annual eligible volume
- Average domestic allowed amount for the target procedure
- Estimated Center of Excellence program cost
- Employee incentive and travel support budget
- Clinical eligibility and expected participation assumptions
- Net employer savings after program costs
Example procedure
Total Knee Replacement
A practical starting point for evaluating high-cost elective surgery spend.
Planned, non-emergency pathway
Because the procedure is planned, eligible members may have time for education, clinical review, pathway comparison, and voluntary decision-making.
Governance before savings
Medical necessity, travel suitability, surgical complexity, recovery needs, and post-operative continuity should be reviewed before a case proceeds.
Savings calculator
Estimate annual savings for eligible procedures.
Adjust the assumptions below to model a simple annual opportunity. Costs are treated as per-procedure assumptions unless noted.
Estimated annual savings
$250,000
Estimated savings rate
45.5%
Savings per completed case
$25,000
Domestic claims baseline$550,000
Program cost plus incentives$300,000
Estimated net savings$250,000
This calculator is intentionally simple. A formal review should account for claims history, case mix, participation, clinical eligibility, travel support, plan design, and implementation costs.
Estimates only
This model is not a guarantee of savings.
Calculator outputs are directional estimates only. Actual savings depend on claims data, domestic allowed amounts, clinical eligibility, member participation, procedure mix, travel and incentive design, program costs, plan design, and Center of Excellence availability. A formal savings review should be completed before relying on any estimate for budgeting or procurement decisions.
Request a savings review for your procedure mix.
CareCostDown can help your team review claims opportunity, Total Knee Replacement assumptions, eligible case volume, incentives, program costs, and pilot economics.