Healthcare Cost and Quality Changes Based on Where You Are

Location, location, location. That saying is ubiquitous in the real estate industry but could just as easily be applied to healthcare. Why? Because two variables critical to healthcare decision making, cost and quality, are largely determined by where the care is delivered. 

The cost of a knee-replacement surgery, for instance, varies widely across the nation. According to the National Chartbook on Health Care Prices published by the Health Care Cost Institute, the average cost for a knee replacement in the U.S. is roughly $33,000. But in Sacramento, Calif., the procedure will cost closer to $57,000. Meanwhile, the exact same surgery only runs around $22,000 in Tucson, Ariz.

Healthcare cost does not always correlate with quality

In terms of planned surgeries, paying more or less doesn’t necessarily mean that you get better or worse quality of care. In fact, it’s entirely possible to get higher quality for a lower cost. But to find the perfect cocktail of cost and quality, you have to shop around.

Comparison shopping for surgical procedures

Researching healthcare pricing and quality measures isn’t easy. You can find lists of the top-ranked hospitals, maybe even the top-ranked surgeons with a fairly simple search. U.S. News and World Report and the Agency for Healthcare Research and Quality (AHRQ) are good resources. Finding top-ranked surgeons or hospitals for a specific procedure is a little more difficult. However, finding pricing information for those top-ranked surgeons and hospitals and finding it for each provider and each service that takes place during an operation — and then comparing that information to other top providers across the country in search of the best combination of both cost and quality, well that is nothing short of a herculean task.

Combing through massive amounts of data to discover this elusive information combined with analyzing the extensive price and quality discrepancies — from state to state, from city to city within a state, and sometimes even within a single hospital — make it extremely difficult for plan sponsors or plan members to find good options for a member’s major operation.

The answer? A surgery benefit program and bundled pricing

A surgery benefit program has all the procedure cost and quality information on hand. It does all the heavy lifting for you. The program not only checks prices along with quality ratings to ensure you’re getting the best care at the best price, but it also contracts with top providers to offer common surgical procedures at a discounted bundled price. That means you know you’re getting high-quality care and you know, upfront, exactly what your operation is going to cost — in total, for the complete procedure. You won’t receive separate bills detailing every aspect of the surgery from the anesthesiologist, the surgeon, and the hospital.

Additionally, these programs may help you find more cost-effective facilities outside the area if you live in a high-healthcare-cost area. Oftentimes, members may not even have to pay a copay — and the plan sponsors themselves save thousands of dollars on each procedure.

BridgeHealth can help

Because geography plays such a big role in healthcare cost and quality, and because it’s difficult to do your own research for each specific surgical procedure, it pays to enlist the expertise of a partner like BridgeHealth. Our value-based surgery benefit program provides an average savings of 30% to 50% on planned surgeries when compared with a typical PPO plan — and members pay little to nothing for their surgery.

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