Proximity Isn’t the Same as Quality
Care close to home sounds ideal but is it always the safest and most effective option?
Most assume that a nearby in-network option is a reliable choice. But that assumption overlooks a critical truth: surgical quality varies significantly, and not just by facility, but also by procedure type, physician experience, care protocols…to name a few. When proximity is prioritized over quality care, outcomes can suffer.
And this variation isn’t hypothetical. It shows up more than most people realize. One study on U.S. hospitals published by the British Medical Journal (BMJ) and cited by CNN revealed that over one third of U.S. surgical patients suffer complications overall – leading to significantly higher costs, slower recoveries, repeat procedures, and avoidable ER visits.¹
Traditional Networks Prioritize Access, But at What Cost?
To meet demand, traditional networks often emphasize broad geographic coverage and network participation over outcomes-based quality. But this approach ignores the nuances of surgical care: from different physician expertise to inconsistent pre- and post-operative protocols, even two surgeries performed in the same zip code can yield vastly different results.
For employers, the ripple effects are tangible:
Higher medical costs from complications and avoidable surgeries.
Lost productivity due to prolonged recovery or readmissions.
Employee frustration with a healthcare benefit experience that feels inefficient and lacks compassion.
The Cost of Convenience vs. Quality
Comparing traditional networks to Transcarent Surgery Care:
Traditional Networks | Transcarent Surgery Care |
Prioritizes local access to in-network providers, regardless of quality. | Prioritizes proven outcomes and top-tier providers close to home and across the country. |
Payment tied to volume (Fee-For-Service ). Varying costs and hidden fees. | Payment tied to quality and value. One simple upfront payment and capped fees that don’t fluctuate with surgical complexity. |
Limited oversight of clinical necessity. | Multi-step clinician review to ensure necessity. |
No support beyond the surgery itself. | End-to-end care navigation: pre-op, post-op, recovery support. |
High variation in outcomes and complications. | Consistently lower rates of complications and readmissions. |
The False Choice Between Access & Quality
Employers are often made to feel they must choose between two imperfect options:
Broad local coverage.
Steering access exclusively to high-quality care.
Delivering both has long seemed too good to be true.
But Transcarent eliminates this tradeoff. We deliver local access (85% of Transcarent Members access local care)2 and consistent high-quality outcomes by re-engineering the surgical journey from the ground up. Our model is built on rigorous quality standards, multi-step clinician reviews, and complete care navigation—not just provider access at lower rates.
What Employees Actually Need
When facing a complex medical decision, Members don’t need an option in their neighborhood, they need confidence that:
Surgery is indeed the best choice for their care.
Their surgeon is deeply experienced and successful in their specific procedure.
Their Care Team is proactively guiding them to the safest and most effective path.
That’s exactly where Transcarent Surgery Care makes a measurable difference.
A New Model for Surgical Excellence
Transcarent reimagines every stage of the Member surgery journey from diagnosis to recovery with one clear goal: getting the Member’s care right the first time. Location matters, but it’s just one factor in a broader, quality-first equation.
What makes the Transcarent model different:
Upfront clinical validation
ViewFi and 2nd. MD deliver expert diagnoses and second opinions to ensure the necessity of care before its ever scheduled.
Embedded nurse-led care coordination
Registered nurses oversee every critical step of the journey and work directly with the COE surgical team to optimize pre- and post-operative protocols.
Data-driven provider selection
Providers are continuously evaluated based on specialty, procedure, and outcomes. Only the top-performing providers are surfaced for the safest, most effective care.
Condition to recovery navigation and closed loop reporting
When surgery isn’t the right path, Members are guided to and through integrated conservative care options like virtual physical therapy that spans the care continuum or comprehensive Care Experiences like Weight Health.
Payment that’s tied to outcomes
We don’t make more money when surgeries increase in complexity and we align our incentives with yours to eliminate runaway costs.
And the results speak for themselves:
A .05% readmission rate, 99% lower than the readmission rate typically seen with inpatient procedures.3
23% of surgeries are avoided, through accurate diagnosis and conservative care pathways.4
Nearly $18,000 in savings per surgical episode, with 27% attributed to avoided unnecessary care and reduced complications.5
Designing Surgery Benefits that Rewards What Works
Unlocking both access and quality in surgical care requires a fundamental shift away from legacy models. Traditional networks lack the tools to ensure surgical quality and appropriateness in addition to proximity, which is why more employers are turning toward outcomes-based solutions that:
Ensure clinical necessity.
Elevate high-quality providers.
Deliver complete care (and not just a procedure).
The Real Cost of Convenience
When networks prioritize proximity over quality, they expose Members and employers to avoidable risk. The true cost of convenience isn’t measured in miles but in the missed opportunities to deliver safe and effective care from the beginning. Transcarent replaces chance with certainty and helps employers move from reactive networks to a proactive approach where surgical decisions are validated, quality is non-negotiable, and outcomes are consistently positive.
Ready to move beyond your traditional network?
Learn how Transcarent Surgery Care reduces spend, improves outcomes, and restores trust in the employee healthcare experience.
Sources
Transcarent is committed to providing accurate, evidence-based information.
CNN Health. Over a third of US surgical patients suffer complications, increasing cost and risk. Based on BMJ study. https://www.cnn.com/2024/11/15/health/surgical-complications-medical-errors
Transcarent Book of Business Data, 2025. 85% of Transcarent Members access local care.
Transcarent Book of Business Data, 2024. 0.05% 30-day inpatient readmission rate (Clavien-Dindo Grade IV–V), which is 99% lower than industry benchmarks for inpatient procedures.
Transcarent Book of Business Data, 2024. 23% of recommended surgeries avoided through second opinions and conservative care.
Transcarent Book of Business Data, 2024. Nearly $18,000 in average savings per surgical episode (27% from avoided procedures and reduced complications).
This article is not a substitute for professional medical advice. Always seek guidance from a physician or qualified provider regarding medical conditions.
