Employers
From the OR to the CFO’s desk
I spent 33 years operating on your members. Let me show you what your plan was paying for.
Self-insured employers pay the bill for every surgical procedure their members undergo — including the ones that shouldn’t have happened, the ones that should have used a different approach, and the ones that went to a surgeon whose actual outcomes data, if anyone had bothered to look, would have raised the question of whether this was the right surgeon for the case.
I spent 33 years in solo surgical practice. I saw what your members got, what your bills showed, and the gap between the two. The bills don’t tell you what your plan was actually buying.
“The economic alignment that never existed between the patient and the insurance carrier exists in full between the patient and the self-insured employer. The carrier gets paid no matter the outcome. Your plan pays the cost of the bad outcome directly — the reoperation, the disability claim, the lost productivity, the long-term complication. You just never had a way to see it coming.”
What your plan is paying for
Your members are making surgical decisions on incomplete information. Your plan absorbs the variance.
Every self-insured employer pays for surgical care without seeing what they’re buying. Members choose surgeons based on Yelp ratings, proximity to home, in-network search results, and what their primary-care doctor said over a five-minute hallway conversation. Not on risk-adjusted outcomes data. Not on second opinions. Not on whether the surgery was even the right answer.
The plan absorbs the cost of every consequence: the unnecessary procedure that shouldn’t have happened, the wrong-approach choice that led to reoperation, the surgeon-selection choice that produced a complication preventable by a more experienced operator. The variance shows up in your annual claims data — not in a line item labeled “member made a suboptimal surgical decision.”
$500 to $1,000 per employee per year in surgical-spend variance is what most mid-market self-insured plans absorb without ever attributing it to surgical decision quality. SurgiQuality makes that variance addressable.
For Employers · Brokers · TPAs
Smart information for self-funded surgical decisions.
SurgiQuality gives your members access to risk-adjusted outcomes data, multi-opinion infrastructure, and cross-specialty consultation — so they make surgical decisions on the data your plan was always paying for them to have.
How it works for your members
From “I’ve been told I need surgery” to a defensible decision.
A member faces a surgical decision. Today they Google the procedure, ask a friend, and pick a surgeon their PCP mentioned. With SurgiQuality, here’s what happens instead:
- Member submits their case through your plan’s SurgiQuality access — web, iOS, or Android. Diagnosis, imaging, history. About 15 minutes.
- Case is anonymized — race, gender, insurance type, geographic origin removed before any surgeon reviews. Opinions are rendered on clinical merit, not patient demographics.
- Multiple opinions — vetted, outcomes-scored surgeons render independent opinions on the case within 14–21 days. The member sees what each surgeon recommends and why.
- Cross-specialty consultation when appropriate — the surgeon who would have done the spine fusion sees the orthopedic recommendation. The orthopedist sees the pain-medicine perspective. Cases that should never have been single-specialty stay multi-specialty.
- Member chooses — based on transparent, risk-adjusted outcomes data and what the multiple opinions say. The member retains full choice; SurgiQuality does not steer.
- Outcome reported back to the plan — aggregate, de-identified data so the plan sees procedure mix, second-opinion rates, and outcome quality across the population.
For self-insured employers
The visibility your plan has never had.
Your members make surgical decisions; your plan pays the bill. SurgiQuality is the bridge between the two.
- Surgical-spend variance addressable. Members making outcomes-informed decisions reduce the high-cost-bad-outcome tail of your claims data.
- Member benefit, not benefit cut. Surgical decision support is a value-added benefit your members appreciate, not a utilization-management gatekeeper.
- Aggregate reporting for your plan administrator — second-opinion rates, procedure mix, outcomes patterns. De-identified at the population level.
- Health-equity reporting built in — anonymized review means equity-by-design in your surgical decision support program.
For benefits brokers
The differentiator your book of business has been missing.
Brokers win and retain self-insured clients by bringing solutions other brokers don’t. SurgiQuality is that solution for surgical spend.
- Client retention. Bringing SurgiQuality to a self-insured client’s benefit committee positions you as the broker who sees surgical-spend variance and brings the answer.
- New-client wins. The surgical-decision-support category is white space for most broker pitches. Leading with it differentiates immediately.
- Renewal conversations get easier — aggregate reporting from SurgiQuality gives you something to talk about at renewal beyond “your claims went up.”
- Member experience — members tell their HR teams about SurgiQuality, and HR tells their brokers. Word-of-mouth differentiation.
For TPAs & navigation partners
A capability your members ask for and your platform doesn’t yet offer.
TPAs and benefit-navigation platforms compete on member services. Surgical decision support is a category most haven’t built.
- Integration-ready. SurgiQuality can be surfaced through your existing member portal, app, or concierge service — we’re the infrastructure behind your branded experience.
- Outcomes data for the plans you administer — risk-adjusted, fairly compared, the kind of artifact your stop-loss carriers and reinsurers will care about.
- Equity-by-design built into the workflow — reportable evidence for any plan sponsor who wants it.
- Surgical case routing integrated with the facility portal for ASCs and hospitals in your network.
The ROI
Illustrative math for a mid-market self-insured plan.
Self-insured employers with 1,000–10,000 covered lives typically see surgical-spend variance in the $500–$1,000 per employee per year range — variance that’s addressable when members have outcomes-informed access to second opinions.
Illustrative ranges — actual savings depend on your plan’s claims profile, surgical procedure mix, and member engagement. We’ll model your specific plan during the scoping call.
Two-component pricing. Platform fee waived for qualifying employers.
Platform fee
Per-member-per-month subscription
A modest PMPM fee gives every covered member access to SurgiQuality’s multi-opinion infrastructure, outcomes-scored surgeon discovery, and cross-specialty consultation. Waived for qualifying employers — the criteria depend on plan size, claims profile, and channel partner. Scoping call covers details.
Per-case administrative fee
Charged only on completed reviews
When a member submits a case and reviewing surgeons render opinions, a per-case administrative fee covers the case review, anonymization, and outcomes-data infrastructure. Cost-of-completed-review, not cost-of-availability.
Why we don’t promise referrals — and why that matters to your plan.
Any platform offering to route your members to specific surgeons in exchange for participation is structuring something that won’t survive federal regulatory review — and that wouldn’t serve your members anyway. SurgiQuality is an anti-kickback-compliant service: we make outcomes data visible to your members and let them choose. Member choice with better data — not platform routing — is the model that’s durable. Your members get smarter information. Your plan absorbs less variance. Surgeons earn visibility through their outcomes. Nobody pays for placement.
Ready to model your plan’s surgical-spend variance?
30-minute scoping call with Sanjay, founder & CEO — 33-year practicing surgeon, ASC operator, author of Resetting Healthcare. We’ll walk through your plan’s claims profile and model the addressable variance specific to your population.
SurgiQuality does not guarantee, generate, or sell referrals. Members choose their surgeons based on transparent, risk-adjusted outcomes data. Self-insured employers, brokers, and TPAs pay service fees for surgical decision-support infrastructure, member access, and outcomes-data reporting — never for placement, ranking, or referrals. SurgiQuality’s anti-kickback-compliant model is designed to be durable across federal regulatory scrutiny.