How health plans benefit from ambulatory surgical centers.

January 6, 2022
Josie Livengood

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When people think of what’s good for patients and what’s good for health insurance plans, the assumption is usually that they’re very different. Most people assume:

  • Patients want whatever care is going to make them feel their best and not cost them an arm and a leg.
  • Medical plans want to make as much profit as possible while spending as little as possible.

Although these are both partly true, we know that the desires of patients and health insurance plans are much more aligned than that. Both want to see high-quality care outcomes, and both want to save money on medical costs. For health insurance plans, like discount medical plans, short term plans, and limited benefit medical plans, there are even higher stakes to make sure that patients receive affordable, high-quality care. So, what solution exists that allows both parties to get what they want? Ambulatory surgical centers. Let us explain.

First off, what is an ambulatory surgical center (ASC)?

According to the Ambulatory Surgery Center Association (ASCA):

“ASCs are highly regulated healthcare facilities that provide outpatient surgery and preventive care. For many healthcare  procedures, ASCs are the right choice for the right patients at  the right price.”

 ASCs can perform many out-patient procedures such as:

  • Joint replacement
  • Minor joint procedures
  • Colonoscopies
  • Endoscopies
  • And cataract removal, just to name a few.

Why they’re great for patients.

ASCs are great for patients because they often have higher quality care outcomes than hospitals. In 2019, one study found that 99.3% of patients who received a joint replacement procedure in an ASC completed an infection-free surgery and were discharged without requiring a hospital visit. If someone is receiving an outpatient procedure, odds are they want to be back home as soon as possible. Research shows that time spent by a patient in an outpatient surgery center (such as an ASC) was close to 26% less than the time spent in a hospital for the same surgery. For patients that may have to pay for a portion of the procedure out-of-pocket (which is pretty common for discount medical plans, short term plans, and limited benefit medical plans) ASCs are, on average, far more affordable than hospitals. One study found that Outpatient surgery centers can be 45-60% less expensive than hospitals.

Why they’re great for health insurance plans.

A great reason for discount medical plans, short term plans, and limited benefit medical plans to guide members towards ambulatory surgical centers is to improve member satisfaction and outcomes. For example, if half of all in-patient hip and knee replacements in hospitals were performed in ASCs instead, 500,000 people would avoid an overnight hospital stay every year. And if that’s not enough, procedures done in ASCs cost 144% less than the average price for common procedures done in hospitals’ outpatient departments. If your member is receiving a set amount for their procedure, they will appreciate you helping them go where they can get the most bang for their buck.

Final thoughts.

The stats and facts listed in this blog, plus the fact that more than 80% of all surgeries are now done in an outpatient setting anyway, mean that leading members to ASCs for care can save you money, save the member money, improve care outcomes, and improve member satisfaction.

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Download Your Guide to 2022's Healthcare Policy Changes

Discover the major changes happening that affect you, how to prepare, and even how to make the new rules work in your favor.

Download How to Leverage Ambulatory Surgical Centers for Lower Costs and Higher Satisfaction

Discover how TPAs, health cost sharing groups, and limited benefit medical plans can benefit from the use of ASCs.

Download the Patient Advocacy 2.0 White Paper

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download the Complete Guide to Retaining Health Plan Members.

Learn the best strategies and tips for retaining your members while keeping costs low.

Download the Complete Guide to Growing Your Health Plan Membership

Learn the best strategies and tips for growing your members while keeping costs low.

Download the Complete Guide to Lowering Member Costs

Discover what health plan members had to say about the value of patient advocacy in our survey.

Download Healthcare Consumerism 101: A Playbook for Health Plans

Learn the best strategies and tips for retaining your members while keeping costs low.

Download Your Guide to the Transparency in Coverage Rule

Discover how the the new rule will affect TPAs and health plans and how you can start your journey to compliance.

Download Your Guide to Unique Benefit Offerings that Don't Break the Bank

Discover how to add value to your health offerings that delight clients and members but don’t cost a fortune.

Download the Complete Sedera Case Study

Discover what health plan members had to say about the value of patient advocacy in our survey.

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