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The U.S. surgical procedures market size is projected to hit $1,673 billion by 2035, further underscoring the challenge facing many plan members and plan payers: healthcare costs that are exponentially growing with no end in sight.
Due in part to the adoption of expensive robotic surgery, advanced imaging, and a rise in overall utilization of medical services, plan payers can expect to shell out increasingly more for surgical expenses year after year.
Despite their significant impact on healthcare spending, surgical costs receive far less attention than they should when it comes to potential cost-containment solutions.
The good news: Health plans can proactively and efficiently manage surgical spend with innovative strategies — and Vālenz Health® has the solutions to make it happen.
How Surgical Spending Affects Employers
According to a survey of benefits leaders, surgical spending in 2022 accounted for approximately 34% of an employer’s medical spend. And, with the average cost of healthcare up by roughly 25% since then, employers are paying more than ever to cover a population that, on average, is much sicker than in years past.
Unexpected procedures drive those costs up even more: On average, emergency surgeries cost $13,645 more per patient than planned surgeries, for a total 33% increase in hospitalization costs.
With 75% of employers saying that reducing surgical costs would significantly lower their overall healthcare spend, it’s clear that payers recognize the financial pressure this category of care places on a plan.
What most of them lack, however, is the solutions required to do something about it.
Engaging Early and Often to Reduce Surgical Spend Through Member-Focused Strategies
Through innovative solutions that act across the entire member journey, Valenz optimizes the cost, quality, and utilization of care for everyone. Given the high financial burden that surgical costs create for plan payers and plan members, we’ve developed a cost-containment strategy that focuses on early intervention and care navigation — guiding members to smarter choices for their surgical needs to proactively reduce costs before care is ever accessed.
Below, learn more about these strategies, including how they work to deliver significant savings for our clients.
1. Empower Employees with Information
Many employees may not realize how much control they have over their healthcare choices — but not for lack of interest.
Research shows that 58% of Americans said they would be willing to shop for their care choices if pricing information was disclosed beforehand. And, with price and quality transparency tools like Valenz Bluebook, they can.
Using a digital platform, plan members can research the care options available to them and evaluate the cost and quality information of physicians performing common procedures. Valenz Bluebook highlights “Fair Price” providers to aid in their decision making, guiding members toward high-value providers proven to deliver positive outcomes at a market-defensible price.
Healthcare navigation tools like Valenz Bluebook fill a crucial gap in the current healthcare system, educating and empowering plan members to take charge of their own care journeys. The effects compound over time; healthcare literacy is a significant factor in overall care outcomes, with higher health literacy linked to better adherence to treatment plans.
Members who adhere to treatment plans are less likely to experience complications that can lead to costly interventions, including expensive, avoidable surgical procedures.
2. Provide Access to High-Value, Low-Cost Surgery Options
Giving members the tools to understand provider pricing is just one piece of the puzzle. Plans must also invest in networks that give members access to lower-cost surgical options in the first place.
Research has shown time and again that the price of surgical procedures can vary greatly depending on the provider and facility. Consider the price of a simple joint replacement with no complications: A 2025 study revealed the 75th price percentile ($38,010) cost twice as much as the 25th price percentile ($21,472), with a minimal link between price and quality of service.
Unfortunately, many members are unaware of these discrepancies and can unknowingly choose providers on the higher end of the pricing schedule. That’s why it’s critical for health plans to make high-value, low-cost care a default option through plan design.
With Surgical and Imaging bundles, a feature of Valenz Precision Care, health plans get access to the nation’s largest surgical and imaging direct contracting solution. Vetted facilities in all 50 states are available to meet members’ surgical needs, supporting average savings of 50% per surgical procedure for the plan — and a $0 out-of-pocket cost for employees.
By combining a network of high-value surgical providers with personalized care navigation services (more on that below), Surgical and Imaging bundles provide a seamless experience for patients while simplifying the payment process for payers through bundled contracts.
Learn more about how Surgical and Imaging bundles can help reduce your overall surgical spend by contacting a Valenz team member today.
3. Invest in Care Management Solutions
While reducing the actual cost of surgical procedures is important, the most effective way to bring down surgical spend over time is to reduce the need for these procedures in the first place.
At Valenz, we accomplish that through proactive, personalized care management, delivered via our Clinical Engagement solution suite.
Using an approach that spans the entire care journey, our team of nurses engages early and often with members to guide smarter healthcare decisions, improving care quality while simultaneously reducing unnecessary utilization and spend through:
- Utilization Management, which identifies high-impact care opportunities before services occur, helping plans make timely, evidence-based decisions that support appropriate care and cost control
- Case Management, which connects members with experienced nurse case managers who provide personalized advocacy, care coordination, and support during complex and high-cost health events (including surgical procedures)
- Disease Management, which delivers ongoing coaching and support to help members better manage chronic conditions and improve long-term health outcomes
As a result, our Clinical Engagement suite delivers significant savings for plans that reflects the reduction in spending from unnecessarily high-cost procedures, including surgical and imaging.
Rein in Your Surgical Spend with Member-Focused Strategies
While the advancements in surgery over the last decade have substantially improved care outcomes, they’ve also created a financial quandary for those plan payers footing the bill.
But passing the buck to members via cost-shifting strategies is not the only solution.
Through proactive, member-focused solutions, employers and plan payers can still protect patient access to high-quality surgical procedures, without simply accepting the high price tag as an unavoidable side effect.
With strategies such as member education, care navigation, and contracted provider networks, Valenz can help your plan reduce expensive surgical and imaging costs while simultaneously improving member outcomes.
Learn how our integrated solution suite can work within your plan design — and unlock your potential surgical savings — by contacting one of our team members today.
