Review claims opportunity
Evaluate targeted procedure categories and domestic allowed amounts.
For CFO and finance leadership
Evaluate high-cost surgical claims with a measurable, clinically governed pathway.
CareCostDown helps finance leaders at self-funded employers evaluate savings opportunities for eligible elective surgery spend through a physician-led overseas Center of Excellence program.
Healthcare cost trend is difficult to manage when a small number of high-cost procedures can create large claims volatility. CareCostDown gives CFOs a targeted way to address selected elective procedures with clear savings assumptions, clinical review, and employer-level 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
Pain points
Surgical claims can create avoidable budget pressure.
For self-funded employers, elective procedures can carry significant price variation across facilities, networks, and geographies. Finance teams often see the cost after the claim has already hit the plan.
- Rising healthcare cost trend
- High-cost claims volatility
- Limited control over planned surgical spend
- Incomplete visibility into procedure-level savings opportunities
- Point solutions that are difficult to measure
- Programs that require implementation effort before financial fit is clear
Why CareCostDown
A focused cost-control lever for eligible elective surgery.
CareCostDown helps employers identify where an overseas Center of Excellence pathway may create meaningful savings without positioning it as a universal replacement for domestic care.
- Claims-based opportunity review
- Procedure-specific savings modeling
- Physician-led clinical eligibility review
- Voluntary member participation
- Case-level and aggregate reporting
- Pilot structure before broader rollout
- Program economics that can be aligned with realized savings
Program workflow
From claims opportunity to measurable savings.
CareCostDown gives finance teams a structured path to evaluate, pilot, and measure the program.
Estimate savings scenarios
Model eligible case volume, participation assumptions, travel support, incentives, and net employer savings.
Define pilot economics
Establish the financial structure, reporting cadence, and success criteria.
Launch with governance
Eligible cases move through clinical review, member navigation, and Center of Excellence coordination.
Report outcomes
Finance receives savings, utilization, and program performance reporting.
Surgical savings scenario
Model the financial case before expanding the program.
This illustrative scenario shows how a CFO can pressure-test assumptions for a targeted elective surgery category. It is not a guarantee of savings or participation.
Example: Total knee replacement opportunity
| Annual covered lives | 5,000 |
|---|---|
| Target eligible surgeries | 12 total knee replacement cases |
| Domestic allowed benchmark | $55,000 per case |
| COE pathway cost | $25,000 per case |
| Travel + incentive + coordination | $8,000 per case |
| Estimated net savings per case | $22,000 |
| Modeled annual savings | $264,000 |
Actual results depend on claims data, member eligibility, voluntary participation, clinical exclusions, travel suitability, domestic follow-up planning, and agreed program economics.
Objection handling
Built for financial scrutiny.
How do we know savings are real?
The savings model starts with domestic allowed benchmarks, expected COE pathway cost, travel and incentive assumptions, coordination cost, and completed-case reporting. Estimates are not treated as guarantees; they are compared against employer-approved assumptions and actual utilization.
What if only a few members participate?
The pilot can still be evaluated on a completed-case basis. A low-volume pilot may validate workflow, member acceptance, and per-case economics before broader promotion.
What costs are included in net savings?
Net savings modeling should include the COE pathway cost, travel support, member incentive budget, coordination fees, and any agreed administrative costs before comparing against the domestic allowed benchmark.
Can this be piloted before a full rollout?
Yes. CareCostDown is designed to support a focused pilot by procedure category, population segment, or client group before broader rollout decisions are made.
How is employer reporting handled?
Reporting can include eligible case volume, inquiries, completed cases, exclusions, domestic benchmark assumptions, modeled or realized net savings, and aggregate program performance. Reporting is employer-facing and avoids patient medical detail in general business summaries.
Metrics and outcomes
The metrics CFOs need to see.
Program reporting is designed to support financial review, not broad marketing claims.
- Eligible procedure volume
- Domestic benchmark allowed amounts
- Estimated and realized net savings
- Participation rate by procedure category
- Program cost per completed case
- Incentive and travel support impact
- Case-level savings summary
- Aggregate employer reporting
FAQ
Questions this team asks first.
Is this intended to replace our domestic network?+
No. CareCostDown is a selective pathway for eligible, non-emergency elective procedures.
Is there upfront cost?+
Pilot structures can be designed to limit upfront financial exposure and align program economics with measurable savings.
What savings should we expect?+
Savings vary. For suitable cases, employers may see up to 30-50% savings versus selected domestic allowed amounts after program costs.
What procedures are in scope first?+
The initial focus is knee replacement and other high-cost elective procedures where clinical suitability and savings potential are clear.
Model the opportunity before committing resources.
Share targeted claims assumptions or begin with a structured briefing. CareCostDown will help your team evaluate savings potential, pilot fit, and implementation requirements.