Health Plans
From the OR to the health-plan boardroom
I’ve operated in your networks for 33 years. Let me show you how to enhance member experience — without disrupting the hospital and health-system relationships you depend on.
Every health plan has the same challenge: differentiate the member experience in a category that has commoditized around access, premium, and network breadth. Member NPS, retention, and Stars ratings are decided on the moments that matter — and almost none of them happen at enrollment. They happen when a member needs surgery, doesn’t know what to ask, can’t evaluate the surgeon options, and ends up disappointed.
And every health plan has the same constraint: the local hospitals and health systems in your network are partners you cannot afford to disrupt. Any tool that surfaces surgical-quality information has to strengthen those relationships, not jeopardize them.
“SurgiQuality is the only surgical decision-support infrastructure that does both: differentiates your member experience with information no other plan provides, and works with your hospital and health-system partners — not against them.”
The differentiation problem
Member experience is the differentiator. Surgical decisions are where it’s won or lost.
Every plan in your market offers the same network breadth, similar premium pricing, comparable benefit structures. The category has commoditized around what’s easy to compare and underpriced what actually matters to members. Member NPS, retention, and Stars are decided on the surgical decision that didn’t go well — not on the enrollment paperwork.
The brokers selling your plans, the employers buying them, and the ASO clients renewing with you all ask the same question: what does this plan offer my people that the next one doesn’t? Today the honest answer is “not much.” SurgiQuality changes that answer.
Member-facing surgical decision support — smart information, multi-opinion access, outcomes transparency — is the category of differentiation that almost no health plan has built into its member experience. It’s the differentiator your broker and ASO conversations have been missing.
For health plans
Member experience differentiation no other plan can offer.
SurgiQuality empowers your members with smart surgical-decision information — multi-opinion access, risk-adjusted outcomes data, cross-specialty consultation. The kind of capability your brokers ask for, your ASO clients reward, and your hospital partners welcome.
Member experience
The capability your members didn’t know they could have.
Members facing surgical decisions get smart information no plan currently provides. Member-facing, members appreciate, members tell their HR teams about.
- Multi-opinion access — members get independent opinions from outcomes-scored surgeons in 14–21 days. Not utilization review. Not gatekeeping. Decision support.
- Outcomes transparency — members see risk-adjusted surgeon outcomes for the procedure they’re considering, not aggregator star ratings.
- Cross-specialty consultation — cases that should be reviewed by more than one specialty automatically are.
- Member NPS impact — the moments that drive NPS are exactly the moments SurgiQuality serves.
ASO retention & new wins
The story your ASO sales team has been missing.
ASO clients are looking for unique solutions. SurgiQuality is the kind of differentiated capability that retains your ASO book and wins new business.
- ASO renewals get easier — bringing surgical decision-support capability to the renewal conversation changes the dynamic from rate to value.
- New ASO wins. Most plans compete on admin fees and network. SurgiQuality is a category your competitors don’t have.
- Broker friendliness. Brokers want capabilities they can show their employer clients. SurgiQuality gives brokers something concrete to walk in with.
- Easy to introduce. ASO clients have flexibility to add value-added capabilities. Easier path to market than fully-insured product changes.
Hospital relationship preservation
Strengthens your network partnerships — doesn’t threaten them.
The hospitals and health systems in your network are partners you can’t afford to disrupt. SurgiQuality works with them, not around them.
- No network steering. SurgiQuality doesn’t route members away from in-network providers. Members choose; we surface options.
- Facility-friendly infrastructure. Hospitals and ASCs in your network can sign up for SurgiQuality’s facility portal — cases route to their surgeons through their existing block schedules.
- Quality reporting your hospital partners can use. AI-powered risk management and quality oversight is something CMOs and risk-management directors want.
- Aligned interests. Better-informed members + outcomes-validated surgeons + facility participation = stronger network performance.
ASO is where the easiest path to market lives.
ASO clients are looking for unique solutions you can bring to them. They have flexibility to layer value-added capabilities onto their plan administration that fully-insured product cycles take years to deliver. The plans that can introduce member-facing surgical decision support to their ASO book — without conflicting with their network relationships — have a retention and new-business story other plans can’t tell.
SurgiQuality is structured for exactly this path. We integrate behind your existing member portal, app, or concierge experience. Your ASO client gets the capability under your brand. Your hospital network partners stay aligned because the case-routing infrastructure works through their existing surgeons and facilities. Your broker conversations get easier. Your renewal conversations get easier. Your new-business conversations get something different to lead with.
Hospital and health-system alignment
SurgiQuality is built to strengthen the relationships you depend on.
Health plans operate inside hospital and health-system relationships that took decades to build. Any surgical-quality tool that creates conflict with those partners is a non-starter. SurgiQuality is designed from the ground up to work with hospitals and health systems — not around them.
Facility portal participation
Hospitals and ASCs in your network can sign up for SurgiQuality’s facility portal at facility.surgiquality.com. Cases route through their existing surgeons and block schedules — SurgiQuality is the infrastructure between the member looking for a surgeon and the facility where they operate.
No competition with network providers
SurgiQuality doesn’t employ surgeons, operate ORs, or compete with your hospital partners for surgical volume. We’re an information-and-routing layer that surfaces options — members choose providers, including in-network providers.
Hospital risk-management benefit
The AI-powered risk management and quality oversight infrastructure SurgiQuality offers hospitals is a benefit to your network partners — reducing the kinds of catastrophic outcomes that hurt everyone, including your plan’s claims experience.
Equity reporting alignment
Anonymized review means equity-by-design surgical decision-making — reportable as part of both your plan’s and your network partners’ health-equity programs.
Why we don’t promise referrals — and why your network partners appreciate that.
Any platform offering to route your members to specific providers in exchange for participation is structuring something that won’t survive federal regulatory review — and creates exactly the conflict with your network partners that you can’t afford. SurgiQuality is an anti-kickback-compliant service: we surface outcomes data, members choose, network partners benefit when their surgeons participate. Member choice with better data — not platform routing — is the model that’s durable for plans and their hospital relationships.
Ready to model SurgiQuality for your ASO book?
30-minute scoping call with Sanjay, founder & CEO — 33-year practicing surgeon, ASC operator, author of Resetting Healthcare. We’ll walk through how SurgiQuality fits your member experience, ASO sales strategy, and hospital network alignment.
SurgiQuality does not guarantee, generate, or sell referrals. Members choose their surgeons based on transparent, risk-adjusted outcomes data. Health plans and their ASO clients 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 and to preserve plan-hospital network alignment.