Proactively managing surgery costs through patient engagement, shared decision-making, and a focus on quality can achieve better outcomes and lower costs. Surgeries account for over 30% of healthcare costs but many decisions are made without full awareness of treatment alternatives. BridgeHealth's Surgery Benefit Management solution identifies members considering major surgeries, provides education on options, and assists in choosing high-quality providers to avoid unnecessary procedures and lower costs. Studies show this approach can reduce surgery rates by 30% and costs by up to 20%.

1. Proactively managing surgery costs through patient
engagement, shared decision-making, and a focus on quality.

2. The Business Issue…
Annual U.S. Healthcare Spending ($2.3 trillion)
“Unmanaged” Surgery Costs
Surgery
31%
Surgical procedures account for over 30% of a
company’s healthcare costs.
Other
46%
But unlike pharmacy or radiology, surgical
decisions are largely “unmanaged” with minimal
Pharma
10%
patient awareness of cost, quality, or alternative Radiology
6%
Behavioral
Health
7%
treatment options prior to incurring a large
surgical claim.
“Clinical evidence shows that many patients undergo surgery that they would decline if fully informed and shared
decision-making can satisfy physicians’ ethical obligations and reduce unwanted procedures”.
American Society of Law, Medicine & Ethics
“Although patients always have the right to participate in decisions about their medical treatment, using formal
shared decision-making processes can be especially useful in cases where more than one treatment option is
available, and no treatment is considered ‘best’ according to clinical evidence.
Report of the Council on Medical service. CMS report. American Medical Association.

3. The Opportunity
Proactive Surgery Benefit Management
 An opportunity exists to achieve better outcomes and lower costs
by proactively engaging plan members in their treatment decisions.
 Independent research shows that as much as 30% of major
surgical procedures are unnecessary and could be avoided or
handled in less invasive and less costly ways.
 Additional studies show as much as a 20% reduction in costs
when utilizing “shared decision making” leading to less invasive
and less expensive alternatives to major surgery.
And when surgery is required, choosing a provider offering the
highest quality outcomes for that particular procedure results is
additional savings.
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4. The Solution
BridgeHealth Surgery Benefit Management
BridgeHealth SBMTM gains control over unmanaged surgery costs
with three integrated programs:
 BridgeHealth Early Indicators™ - identifying major surgical claims
early in the process, when there is an opportunity to intervene.
 BridgeHealth Engagement™ - providing medical
education, resources and support related to treatment options and
alternatives.
 BridgeHealth SurgeryPath™ – providing access to providers offering
the optimal combination of quality and value.
Early Member Quality Network
Identification Engagement Access
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5. BridgeHealth Early IndicatorsTM
BridgeHealth uses a combination of claims analyses, communications
and case management to identify plan members early in the decision
process.
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6. BridgeHealth EngagementTM
Plan Members are provided resources, education and support that
enable them to make informed health care decisions.
Research shows that when given information on alternative
treatments with similar outcomes, patients will generally choose
a less invasive approach prior to surgery. (Dartmouth Atlas Report 2011)
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7. BridgeHealth SurgeryPathTM
Plan Members that require surgery are assisted by BridgeHealth
Care Coordinators to identify and access the high quality providers
available within their health plan.
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8. The Importance of “Quality”
Quality Matters…utilizing highly rated providers results in lower
costs, fewer complications and faster “return to work”.
BridgeHealth Care Coordinators utilize Delta CareChexTM to
identify the providers offering the highest quality outcomes for the
desired procedure.
In addition to identifying the highest rated providers within the
plan members local area, BridgeHealth also offers access to a
Centers of Excellence across the country:
With case pricing that results in additional savings, and
Plan provisions that offer advantages for the plan member.
“Patients can improve their chances of survival substantially at high-volume hospitals
who perform the operations frequently.”
New England Journal of Medicine
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9. Savings from BridgeHealth SBMTM
BridgeHealth SBMTM delivers savings two ways:
 By avoiding unnecessary surgeries…
 when the Plan Member, after learning about treatment
options, avoids an unnecessary surgery or chooses a less
invasive, less costly, but equally effective alternative
treatment.
 By utilizing the highest quality providers…
 when the Plan Member, after learning about the importance
of quality, chooses an alternative provider for their surgery.

10. Quantifying the Savings Opportunity
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11. Proactive Surgery Benefit Management
 Engage
 Educate
 Empower
 Higher quality outcomes
“People do not realize that their clinician does not always fully understand their preferences and
values. When this happens, the clinician’s treatment recommendations may be different from what
their patients would have chosen had they been give the opportunity to be fully informed”.
Dartmouth Atlas Report 2010
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12. Contact us for a free analysis of the savings a
BridgeHealth SBMTM program could offer…
Gordon Larson
CMO/Executive Vice President
BridgeHealth Medical, Inc.
630-841-7566 Direct
glarson@bridgehealthmedical.com
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