Designing Surgery Benefits Around People, Not Procedures
Lauren Gums, EVP, General Manager, MSK & Surgery, Transcarent
For years, Centers of Excellence (COEs) have been positioned as a surgical win-win: better outcomes and lower costs. But dig deeper, and a more complicated picture emerges—one where volume, not value, still drives the bottom line.
It’s a quiet flaw baked into even some of today’s most celebrated COEs. While they’re a step forward from traditional PPO networks, many still operate within conventional fee-for-service models—meaning the COEs benefit when surgeries increase, not when people avoid them.1
That’s more than misaligned, it’s backwards. And while some outcomes may improve with this approach, the goalposts haven’t shifted nearly far enough to consistently prioritize people over procedure count.
COEs have largely been a welcome improvement; that much is clear. By contracting directly with rigorously vetted, high-quality providers and leveraging bundled payments, employers and their employees receive cost predictability while employees receive reliable care and peace of mind.
The fact remains, however, that many COEs still miss the mark when it comes to true alignment with health outcomes and a focus on reducing the total cost of care. Declaring progress and calling it done does the system a disservice by overlooking the gaps that remain, and the opportunity to close them by putting people first.
Misaligned Incentives
At the heart of the problem is a simple truth: too many COEs still get paid more when they complete more surgeries.
In traditional fee-for-service healthcare, financial rewards are not tied to better outcomes and often lead to unnecessary treatments and ultimately undermine the goal of high-quality, people-centered care.
Fee-for-service healthcare inherently encourages intervention over prevention and often deprioritizes second opinions and conservative care. Plus, it too often shifts the focus away from what’s best for the person and toward what’s billable under the system. COEs operating under such models might be pressured to increase throughput and procedure volume to generate revenue, potentially compromising the focus on quality.
For employers and employees alike, the result is an experience that looks more advanced but still has too many avenues for elevated risk and lack of transparency. Unnecessary procedures, higher complication risks,2 and surprise bills are just a few byproducts of the standard approach. Rebuilding trust in the surgery experience starts with aligning every part of the system around what’s best for the person rather than the bottom line, and employers can move beyond the status quo by choosing partners committed to this.
A Truly People-Centered COE
We don’t need to look far for a better model, because it’s already happening. It’s what we built at Transcarent, a complete condition to recovery experience with people at the center, that prioritizes:
Outcomes over volume
It starts with redefining success: avoiding unnecessary surgery is a victory. Surgery benefits are designed with a multi-step clinical review that includes expert case reviews and second opinions that often recommend conservative care pathways as the first step, if appropriate.Support from diagnosis to recovery
The goal isn’t fewer surgeries at any cost but to support better decisions. When surgeries do happen, nurse-led care teams partner closely with the COE surgeon to optimize pre- and post-operative protocols, improving recovery and reducing complications. They also guide Members to the most appropriate rehabilitative care, following the surgeon’s recommendation, driving better outcomes and continuity of care.Clarity in cost
Capped fees and bundled surgical pricing (not only for the surgery itself, but for anesthetics, facility fees, and intraoperative care) eliminate surprise bills and unpredictable spend.
When these elements come together, the result is a more trustworthy, transparent system for everyone involved.
Progress in Practice
With benefits designed this way, the impact is measurable.
For our Members, a truly human-centered experience means fewer unknowns. They’re not left to navigate referrals, weigh major decisions alone, or brace for unexpected bills. Instead, they’re supported by clinical experts, guided toward the right care at the right time, and given the tools like virtual physical therapy and guided nurse support to recover safely and confidently. For someone facing medical uncertainties, that experience alone can be transformational.
The value doesn’t stop at the individual level. Employers see the impact, too. Fewer complications, shorter recovery times, and fewer follow-up procedures all lead to lower healthcare costs, reduced absenteeism, and higher employee satisfaction and retention. Transcarent’s model yields an average savings of $17,943 per surgical episode; of those savings, 27% comes from avoided surgeries and complications. Transcarent has the lowest readmission rate in the industry at 0.05%.3
Beyond Just "Better"
We’ve come a long way, but we’re not there yet.
For too long, surgery COEs have measured success by the number of procedures completed. But measuring something different—like how many were safely avoided—changes the entire equation.
It reframes care that prioritizes the best option for each person, not just surgery as the default. And it holds every partner accountable for what matters most: positive outcomes, getting the people the right care, and a more empathetic experience that ultimately reduces costs.
This is Transcarent Surgery Care, a Care Experience that integrates clinical expertise throughout the entire journey. It’s the One Place that prioritizes people over processes and outcomes over operations. The One Place that gives employers cost confidence and Members the assurance they’re getting the right care, not just more of it.
Moving beyond legacy models isn’t easy, but it’s necessary to deliver better care and rebuild trust with those seeking it. Aligning incentives to create value is how we rebuild trust, reduce wasteful and unnecessary care, and help our modern care system finally deliver on its promise.
Learn how Transcarent Surgery Care is redefining how success is measured.
Transcarent is committed to providing accurate, evidence-based information to help you make informed health decisions.
Mayo Clinic Proceedings. Extent of Diagnostic Agreement Between Referring and Final Diagnoses in Patients Referred for Second Opinions at a Tertiary Care Center. Accessed July 17, 2025. https://www.mayoclinicproceedings.org/article/S0025-6196(14)00245-6/fulltext
The BMJ Journal. Assessment of the Appropriateness of Lumbar Spine Magnetic Resonance Imaging in a Rheumatology Unit. Accessed July 17, 2025. https://ard.bmj.com/content/74/Suppl_2/629.2
Internal Data, Transcarent. Surgical Care Program Performance Summary. Accessed July 17, 2025.
This article is not a substitute for professional medical advice. Always seek guidance from a physician or qualified provider regarding medical conditions.
