Health Plans
Stop Paying for Surgeries That Shouldn't Happen.
SurgiQuality partners with health plans to eliminate unnecessary procedures, reduce catastrophic claims, and direct members to the highest-performing surgeons in your network — using AI-powered, procedure-specific outcomes scoring.
- Prevent member harm from unnecessary and poorly performed surgeries
- Strengthen payor-provider collaboration with transparent outcomes data
- Promote quality and prevent leakage from your network
- Mitigate stop-loss risk and gain market share
THE PROBLEM — MEMBER HARM
The System Isn't Protecting Your Members — Or Your Plan
Right now, your members are being referred to surgeons based on habit, familiarity, and geography — not performance or outcomes. The financial and human cost is staggering:
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- 15–30% of all surgeries are unnecessary — a $210B annual drain on the healthcare system
- Unnecessary spine surgeries alone cost an estimated $300B per year
- Members are routinely exposed to preventable complications from low-performing surgeons — wrong-sized implants, incomplete procedures, needless infections, and a vicious cycle of costly revision surgeries
- In-network surgeons currently have no reliable way to assess their own outcomes — leaving your plan blind to quality variation
THE SOLUTION
Give Every Member Access to the Best Surgeon for Their Procedure
SurgiQuality uses SurgiGPT™ to generate risk-adjusted outcomes scores drawn directly from each surgeon's own EMR data — so members are matched with the highest-performing surgeons, not just the closest ones.
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- Multiple opinions reduce unnecessary surgeries before they happen
- Members are connected to surgeons with verified, procedure-specific track records
- Surgery done right the first time means faster recovery and fewer revisions
- Built-in quality improvement tools help in-network surgeons benchmark and improve their own performance
Cost of Poor Quality
Poor Surgical Quality Is One of Your Largest — and Most Preventable — Cost Drivers
When members are referred to the wrong surgeon, your plan absorbs the consequences: complications, revisions, extended recovery, disability claims, and stop-loss events. SurgiQuality closes that gap by replacing habit-driven referrals with outcomes-driven intelligence.
Complications are more likely when arthroplasty (joint replacement surgery) is performed at low-volume hospitals by low-volume surgeons.1
Case Studies
Joint replacement surgery can far exceed anticipated costs in orthopedics. Infections around the prosthetic implant are problematic and costly.
SurgiQuality is committed to reducing healthcare costs related to PJI (peri-prosthetic joint infections) by connecting employees to high-performing orthopedic surgeons.
What's at Stake: The Real Cost of Surgical Complications
Periprosthetic joint infections (PJI) are among the most expensive and preventable surgical complications your plan faces. High-volume, high-performing surgeons dramatically reduce this risk — and SurgiQuality makes sure your members reach them.
- Hospital costs for a single PJI episode: $89,000–$116,000
- Lifetime cost of a hip PJI: ~$391,000
- Projected annual U.S. cost of PJI by 2030: $1.85 billion
Connecting members to the right orthopedic surgeon isn't just better medicine — it's one of the highest-ROI decisions a health plan can make.
- Patel R. Periprosthetic Joint Infection. N Engl J Med. 2023;388(3):251–262.