Health Plans Miss Surgical Cost Savings by Focusing Only on Avoidance

Health plans are failing to capture significant surgical cost savings by focusing solely on surgery avoidance rather than optimizing outcomes for necessary procedures. The approach overlooks quality variation in surgical care that drives cost differences. Plans that improve patient selection, site-of-service steering, and post-operative care protocols can reduce complications and total cost of care. This represents an untapped opportunity for Medicaid MCOs managing populations with high surgical utilization.

Managed Care