Identify the opportunity
Review targeted surgical spend and estimate eligible procedure categories.
Employer healthcare cost control
Manage high-cost elective surgery spend with a physician-led Center of Excellence pathway.
CareCostDown helps self-funded employers evaluate eligible elective procedures through a fully supported overseas Center of Excellence program built around clinical review, employee experience, and measured claims cost opportunity.
This is not a travel-first program. It is a managed surgical cost strategy with physician-led review, Center of Excellence standards, care coordination, and employer reporting.
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
Built for the teams responsible for healthcare cost, quality, and member trust.
Designed for self-funded employers and the advisors who support them.
CFOsHR and Benefits LeadersBrokers and ConsultantsTPAs and Plan Administrators
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.
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.
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.