Health Plans
Prevent Member Harm
Strengthen Payor-Provider Collaboration
Promote Quality and Prevent Leakage from your Network
Mitigate Stop Loss Risk and Gain Market Share
Problems
Member Harm
- 15-30% of all surgeries are unnecessary ($210B) Unnecessary Spine Surgery
- Members subjected to poor outcomes from inept surgeons ($300B)
Solutions
Empower members/ PCPs with
- Multiple Opinions
- SurgiGPT™ risk-adjusted outcomes scores, derived from surgeon's EMR, Ask How
Cost of Poor Quality
Problems
Members referred to surgeons by habit and have procedures by inept surgeons:
- Wrong-sized implants,
- Wrong approaches to tumors,
- Unnecessary morbidity,
- Incomplete surgery,
- Needless infections,
- Scar tissue formation,
- Vicious cycle of revision surgery.
In-network surgeons have no way to assess own outcomes
Solutions
Members referred to surgeons using SurgiGPT™ risk-adjusted outcomes scores from surgeons EMR systems:
Members connect to best outcomes surgeons
- Surgery performed the correct way the first time
- Quick recovery
Quality Improvement tool for surgeons
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.
The treatment of PJI is expensive, time-consuming, and resource intensive.1
- Hospital costs per episode are approximately $89,000 and $116,000 for hip and knee PJI, respectively.
- PJI of the hip ultimately costs approximately $391,000 over the course of a lifetime.
- Hospital costs in the United States for PJI of the hip and knee will amount to an estimated $1.85 billion annually by 2030.
1. Patel R. Periprosthetic Joint Infection.
N Engl J Med. 2023 Jan 19;388(3):251-262.