The rising cost of healthcare in the United States leaves consumers feeling helpless, but there are ways to gain control. John’s story is a great example.  

John’s Story 

John needed a full knee replacement and expected it to cost a fortune. According to his research, the typical cost of the surgery alone was $40,000 to $60,000 — not including phys­ical therapy, post-surgery visits and potential complications.  

Fortunately, John researched alternative providers that participated in a bundled service program he had heard about in his employee benefits meeting and was relieved — within 20 minutes of his house was a nationally recognized surgery center that participated in the bundled services pro­gram. A flat rate including the surgery and all post-operative care, including physical therapy was available and was con­siderably less than the cost of the surgery alone at providers that did not participate. John still had to meet his deductible, but a cash incentive from his employer for using bundled services would help offset his out-of-pocket expense.  

Knowing exactly what the total cost of the surgery and all follow-up care would be, John scheduled his surgery im­mediately.  

Why utilize a provider offering bundled services?  

Bundled services allow patients to receive the best care while saving on medical costs. Rather than paying for each part of a large medical procedure separately (hospital stay, operation, post-operative therapy, follow-up office visits, etc.), bundled services provide all stages of medical care for a specific surgical procedure at a fixed price. Employees know upfront the total cost of getting all the care they need. Additionally, most bundled services are guaranteed for a predetermined time period (90 days on average). When ser­vices are provided in a bundle, the focus is on the outcome, rather than the different pieces along the way. A member is paying for a fixed shoulder or a replaced knee, rather than paying a fee for every service received. The goal of bundled payments is to increase quality and care coordination.

For employers, bundled services substantially lower out-of-pocket expenses, providing savings of up to 50% over standard contract rates. Since employers save significant amounts of money when a provider participating in a bun­dled service program is utilized, they can con­sider providing employees with benefits like cash incentives for taking advantage of these plans.  

Benefits of HPS for Bundled Services  

John is one of many employees with a Health Payment Systems (HPS) benefits plan that has saved money with bundled services.  

Benefits of HPS bundled services include:  

  • Concierge program — Easy appointment scheduling (optional and included in many bundles)  
  • SuperEOB consolidated billing — Exclusive to HPS, this is a single, comprehensive, easy-to-understand monthly statement of all in-network providers’ bills and related claims, requiring only one payment, regardless of the number of providers seen  
  • Easy claims process — This process remains the same for the employer (all bundled costs flow through the third-party administrator and stop-loss carrier, contribut­ing to the stop-loss insurance deductible and minimizing annual total out-of-pocket exposure)  
  • Ability to offer cash incentives — Employers working with HPS often use some of their cost-savings to offer incentives for employees who use bundled services 
  • Best cost and care outcome — With HPS, em­ployers can provide employees with the best cost and care outcomes using bundled services (e.g., waiving the deductible and coinsurance)  

With HPS, it’s possible to have bundled services that pro­vide access to nationally recognized, high-quality providers, simplified billing and reduced healthcare costs. Contact us today to learn more!  

HPS is a Milwaukee-based health care technology and services organization offering solutions to enhance the con­sumer billing and payments experience, while driving value to health care providers, health insurance companies and employers. HPS’ patented solutions include its comprehen­sive independent provider network in Wisconsin and a single consolidated statement of medical services for patients.  

Marie Foley

Marie Foley

Marie Foley, VP of Provider Relations & Actuarial Services, HPS

Leave a Reply