Define administrative model
Align on eligibility files, referral triggers, plan design fit, and reporting scope.
For TPAs, carriers, and fronting organizations
A clinically governed overseas COE pathway designed to fit plan operations.
CareCostDown is designed for evaluation by TPAs, carriers, fronting organizations, and plan administrators that need clear workflow, risk controls, and reporting boundaries for eligible elective surgery pathways.
Plan administrators and carriers need cost-containment programs that can be administered cleanly. CareCostDown is built around defined eligibility, physician-led review, member navigation, Center of Excellence governance, and employer reporting that fits within existing operational realities.
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
Pain points
Cost innovation fails when administration is unclear.
TPAs, carriers, and plan administrators are often asked to support new benefit strategies without enough detail on workflow, data exchange, claims handling, or risk controls.
- Eligibility and referral workflow
- Claims routing and reimbursement logic
- Member communication boundaries
- Data privacy and PHI handling
- Network governance and provider standards
- Liability and complication protocols
- Reporting expectations from employers and brokers
- Commercial model and operational workload
Why CareCostDown
Structured for operational fit, not informal referrals.
CareCostDown provides a managed program layer designed to align with appropriate plan administration workflows.
- Defined eligibility criteria
- Procedure-specific program rules
- Physician-led clinical review
- Center of Excellence selection standards
- Member navigation workflow
- Travel and care coordination support
- Reporting framework for employers and advisors
- Administrative collaboration with TPAs, carriers, and fronting organizations
Program workflow
Clear handoffs across eligibility, navigation, care, and reporting.
CareCostDown works with evaluating organizations to define the operating model before live cases begin.
Establish workflow
Map how members enter the pathway, how cases are screened, and how handoffs occur.
Apply clinical review
Move eligible cases through physician-led review before Center of Excellence coordination.
Coordinate care pathway
Manage member preparation, scheduling, travel coordination, and COE communication.
Support claims and reporting
Align reporting outputs with employer, broker, TPA, carrier, and plan administrator needs while respecting privacy boundaries.
Review commercial model
Commercial structure can reflect implementation scope, savings participation, referral structure, or administrative role.
Objection handling
Addressing operational and risk questions early.
How does this fit our claims workflow?
The workflow is designed during implementation based on the organization's role, plan design, and employer requirements.
What data is required?
The program can begin with limited claims and eligibility data for opportunity analysis, then define appropriate data exchange for live operations.
How is clinical risk managed?
Cases are screened through eligibility criteria, physician-led review, exclusions, and Center of Excellence governance.
What happens if a case is not appropriate?
The member does not proceed through the overseas pathway and remains within the appropriate domestic care route.
Metrics and outcomes
Operational reporting for evaluating organizations and employers.
Reporting can be aligned with administrative responsibilities, employer oversight, and privacy requirements.
- Eligible case referrals
- Screened and approved cases
- Declined or excluded cases by category
- Procedure category activity
- Member pathway status
- Completed procedures
- Savings summaries
- Administrative performance indicators
- Escalation and issue tracking
FAQ
Questions this team asks first.
Is CareCostDown a network replacement?+
No. It is a selective overseas Center of Excellence pathway for eligible elective procedures.
Does CareCostDown require full claims integration on day one?+
Not necessarily. Initial opportunity modeling can be lighter, with deeper integration defined for live program operations.
How are complications handled?+
Program design includes risk screening, escalation planning, Center of Excellence protocols, and return-home continuity planning.
Can this be white-labeled or offered through another organization?+
Commercial models can be discussed based on administrative role, employer relationship, and implementation structure.
Explore whether CareCostDown fits your administrative model.
We can review workflow, data requirements, governance standards, employer reporting, and commercial model options with your team.
TPA / carrier partnership inquiry
Discuss administrative fit and workflow requirements.
Use this form for TPA, carrier, fronting organization, or plan administrator conversations about workflow, reporting, governance, and commercial structure.