Why Claims Comparisons are the Only Way to Evaluate Surgery Centers of Excellence
Employers and benefit consultants have likely heard similar promises from surgery benefit vendors and solutions: lower costs, better outcomes, streamlined experiences. But how do you know which deliver on their commitments? The answer isn’t in the pitch or the demo. It’s in the data.
Real claims can be leveraged to give self-insured employers the confidence, clarity, and control needed to choose the best Centers of Excellence (COE) for their people. Decisions can be tied to objective facts based on real-world spend and not subjective assumptions or averages.
Employers and consultants need a reliable new standard for analysis that prioritizes quality and value while removing the guesswork from comparing surgery COEs.
Apples-to-Apples: Why Claims Data Matters
Whether it’s a traditional network or a COE specialty vendor—not all surgery benefit solutions are created equal. Some vendors price retrospectively. Others bundle prospectively. Some include full care coordination and recovery support, and others outsource large components or only partially bundled care.
Surface-level comparisons like discount percentages or generic average savings are not only insufficient, but potentially misleading. A truly fair comparison requires a standardized, “apples-to-apples” method rooted in your actual surgical claims history.
Transcarent helps employers proactively make smarter decisions by evaluating their surgery spend with a targeted claims comparison, which defines:
What you actually paid for employee surgical care under your current setup - whether you have a COE solution or not.
What you would have paid with Transcarent’s all-inclusive prospective bundles and capped case management fees.
How we stack up against other solutions, including other COE vendors.
How it Works: Get an Apples-to-Apples Comparison in Three Simple Steps
1. Provide a small sample of past surgeries—no financial data required
The employer shares a list of 15-20 past surgeries employees have had in the last few years - like knee replacements, spinal procedures, or bariatric surgeries. No need to include detailed financial data. We’ll take the sample, match it to our bundled pricing, and show what those same surgeries would have cost through Transcarent.
2. We show what you paid, and what you could have saved
Using the surgeries shared by the employer, we recreate the complete picture of what was billed - including hospital fees, surgeon charges, anesthesia, labs, and follow-up visits. Then, we match those exact services to our all-in bundled rates with high-quality providers. This lets you see a precise apples-to-apples comparison between what you paid and what you could have paid with Transcarent.
3. You get a vetted claims comparison methodology to “take home” and use to compare similar options
Because this method allows you to see a clear line-item view of the bundle, you can use the same claims-based method to evaluate competing vendors and understand how much they may or may not save you.
The result? Employers get full transparency into what their projected savings with Transcarent will be - no embellishments, opaque math, or averages. This transparency allows employers and consultants to walk away with confidence in their decisions, have a deeper understanding of the components of a value-based surgical bundle, and offers fresh opportunities to improve both care and cost.
Why Employers and Consultants Benefit from Transcarent’s Claims Comparison Analysis
Our transparent approach gives employers confidence that they’re making the right decision for their population. Instead of relying on extrapolated benchmarks, they get a transparent, data-driven view of what different solutions would have saved. That means no guesswork - just a clear line of sight into where value is created or eroded.
It also gives benefit leaders and consultants a consistent framework for evaluating competing COE solutions, helping to move beyond anecdotal or one-size-fits-all ROI claims. With Transcarent, employers and consultants not only get the transparent numbers, they also get the actuarial expertise and partnership to tell a compelling, credible story to stakeholders.
Here’s the value the Transcarent claims comparison analysis gets you:
Unmatched transparency: No vague estimates. Just concrete, data-backed savings projections tied to your actual claims experience.
Fair methodology: Same sample. Same services. A true apples-to-apples comparison across vendors.
Decision-ready output: Clear, defensible results that stand up to scrutiny - and support smarter decision-making.
Whether employers are exploring a surgery COE solution for the first time or re-evaluating long-standing partnerships, an objective, real-world claims comparison takes the guesswork out of the equation and replaces assumptions with evidence, setting a higher standard for how surgical benefit solutions should be evaluated and purchased.
Ready to see how your current surgery spend stacks up? Let us uncover real savings potential. No guesswork. Just a transparent side-by-side look at what you paid - and what you could have saved.
This article is not a substitute for professional medical advice. Always seek guidance from a physician or qualified provider regarding medical conditions.
