BridgeHealth High-Value Center of Excellence Model Reduces Surgery Costs by 50%
National Benchmark Study Supports BridgeHealth’s High-Value and High-Quality Surgical Focus Against $253 Billion in Medical Claims Paid by Self-Insured Employers
Expert Reviews, Use of Appropriate Sites of Care and Centers of Excellence, and Strong Focus on Client Experience Measurably Reduces Total Cost of Care for Self-Insured Employers
BridgeHealth, a key pillar of Transcarent’s newly introduced health and care experience, announced the findings of a national claims study that analyzed two years of surgical procedures managed through BridgeHealth against a benchmark of $253 billion in paid medical claims associated with self-insured employers. The study found that BridgeHealth’s value-based care and payment model, which carefully assesses surgical necessity, bundles payments for certain elective surgical procedures, ensures appropriate site of care and use of Centers of Excellence, and manages post-surgical care, saved plan sponsors an average of 50% per procedure.
KEY INSIGHTS:
- BridgeHealth’s model provided an average overall net savings of 49.5% per procedure
- Savings were reported in two key areas — bundled case rates and shifts to the appropriate site of care
- Per surgery savings varied from 40.3% for orthopedic surgery to 76.9% for spinal surgery
- This savings analysis did not include the positive effect of fewer complications, decreased presenteeism, lower absenteeism or faster return to work
- No credit was applied for avoiding inappropriate surgeries
- The full study and its findings can be found HERE.
“These results further validate BridgeHealth’s approach to creating exceptional experiences for the people we serve – employees and their families – and the value we drive for our clients by prioritizing high quality surgical care in the appropriate setting,” said Jamie Hall, Chief Commercial Officer for Transcarent and General Manager at BridgeHealth. “From a population perspective, the cost savings realized represent a unique opportunity to create positive change in the form of increased access and affordability for stakeholders across the healthcare system. When we make the system more efficient and effective, everyone benefits.”
The third-party study is one of the most comprehensive of its kind and objectively compared claims data from two national databases, representing over 53 million lives, against claims data from more than 1 million BridgeHealth eligible employees and their dependents.
BridgeHealth, now a part of the Transcarent family of solutions, is the leader in Centers of Excellence and appropriate site of care surgical solutions for self-insured employers. BridgeHealth serves 1 million Members with more than 160 Centers of Excellence and Ambulatory Surgery Centers, more than 300 pre-negotiated surgical bundles across eight surgical categories, and provides documented improvements in quality of care, resulting in 80% lower complications. With a critical focus on the Member experience, BridgeHealth consistently reports Net Promoter Scores (NPS®) above 90, proof that if you focus on quality care and a better experience for the patient, you can also drive lower costs for everyone, including whoever is paying for the surgery.
“The BridgeHealth model is a foundational component of Transcarent’s vision to provide a high-value, high-quality care experience that employees, their families, and all of us deserve while at the same time driving down costs for self-insured employers,” said Transcarent Chief Executive Officer Glen Tullman. “Surgery costs represent a critical expenditure for self-insured employers, and these outcomes prove that the BridgeHealth model can greatly reduce those expenses, or in some cases even avoid them entirely, by eliminating unnecessary surgeries we all hear about.”
With the BridgeHealth model, employees of self-insured employers and other plan sponsors who may need surgery work with a dedicated care coordinator who guides them through the traditionally complex coordination process and connects them to the appropriate care setting for the procedure. BridgeHealth participants are met early in their healthcare journey and provided with unbiased information, trusted guidance, and easy access to high-value care, including alternative treatment options.
On Methodology
To ensure an objective comparison, BridgeHealth commissioned a third-party actuarial expert to provide the databases and MorningStar Actuarial Consulting to conduct a study to examine the financial outcomes for both plan sponsors and Members under the BridgeHealth savings methodology. The data underwent independent, third-party analyses and actuarial verification.
A leading actuarial and consulting firm summarized two national databases representing over 53 million lives and $253 billion in paid medical claims (excluding pharmacy-based prescription drug claims) to ascertain the claim experience under a traditional health plan setting. MorningStar Actuarial Consulting analyzed BridgeHealth costs compared to the national average (population level) cost benchmarks.
The data analyzed represented all BridgeHealth claims data from over 1 million Members, all surgical categories, all geographic areas and all facility types, including inpatient hospital, outpatient hospital, specialty hospital or ambulatory surgical centers over a two-year period.
