For Payors
Reduce total cost of care across your surgical network.
Recovery Insights helps commercial insurers — Aetna, UHC, BCBS, and others — lower post-surgical spend by catching complications early, steering patients away from the ER, and improving outcomes across every contracted facility.
Every preventable readmission costs the system $15-25K in direct costs — plus the hidden cost of care coordinator burnout and nursing overtime required for manual follow-up.
Schedule a ConversationThe real cost isn't the surgery — it's what happens after.
Post-surgical complications drive 30–40% of total episode cost. Most of that spend is preventable with proactive recovery monitoring.
$15K–$25K
per surgical readmission
Each avoidable readmission adds five figures to an episode that was already paid for. Recovery Insights catches warning signs before they become ER visits.
62%
of follow-up never happens
Phone-based follow-up fails silently. Patients who miss post-op check-ins are 3× more likely to present to the emergency department with a preventable complication.
$2,800+
avg. ER visit cost
When patients can't reach their care team, they default to the ER. Most post-surgical ER visits are for issues that could have been managed via a single escalation message.
Designed for value-based contracts
Recovery Insights aligns incentives across payors, providers, and patients — making bundled payment and shared-savings models actually work.
Bundled Payment Alignment
Under CMS TEAM and commercial bundled models, the total cost of a surgical episode — including readmissions and complications — determines margin. Recovery Insights reduces post-acute cost, improving performance against target prices for payors and providers alike.
Shared Savings Integration
For ACO and shared-savings arrangements, every avoided complication flows directly to the savings pool. Recovery Insights provides the outcome data to quantify payor-side savings and attribute them to proactive monitoring.
Risk Stratification
Patient-reported data from Recovery Insights enables real-time risk scoring across surgical populations. Payors can identify high-risk episodes early and allocate care management resources where they'll have the greatest impact.
Quality Incentive Performance
Readmission rates, patient satisfaction, and complication rates are core quality metrics in value-based contracts. Recovery Insights moves all three in the right direction — generating performance bonuses rather than penalties.
Claims impact per 1,000 surgical episodes
Projected impact on post-surgical claims cost based on readmission reduction, ER diversion, and complication prevention.
40–60
readmissions avoided
Continuous monitoring catches complications before they escalate to inpatient admission
$900K+
in avoided readmission cost
At $15K–$25K per readmission, even modest reduction rates generate significant savings
120–180
ER visits diverted
Patients with questions and concerns are steered to their care team instead of the emergency department
$340K+
in avoided ER cost
ER diversion alone can offset the cost of deploying Recovery Insights across a surgical network
$2,400–$4,200
saved per 1,000 surgical episodes
In avoided readmission claims alone, Recovery Insights delivers measurable savings at scale.
Reduced ER Utilization
from early complication detection
Continuous SMS monitoring catches complications before they escalate to costly emergency department visits.
Fewer FTEs
provider network efficiency
Practices using Recovery Insights need fewer FTEs for follow-up — reducing network-wide labor costs that show up in your contracts.
Scales across your entire surgical network
Deploy once, benefit everywhere. Recovery Insights works across all contracted facilities without per-site configuration.
Multi-Facility Deployment
Roll out across hospitals, ASCs, and surgical centers in your network. No site-by-site IT integration required — discharge notes flow in via API or secure upload.
Aggregate Analytics
See readmission rates, complication trends, and recovery timelines across your entire book of surgical business. Identify underperforming facilities and high-performing protocols.
HIPAA-Compliant by Design
Zero PHI in SMS messages. All clinical data encrypted at rest (AES-256) and in transit (TLS 1.3). BAA coverage with all vendors. Designed for payor-grade security requirements.
Improve member satisfaction & Star Ratings
Members who feel supported during recovery rate their plan higher. Recovery Insights drives the experience metrics that move Star Ratings.
Member Experience
- Proactive SMS check-ins make members feel cared for — not forgotten after discharge
- No app to download — SMS works on every phone, every demographic, every literacy level
- Multilingual support ensures health equity across diverse member populations
Star Rating Impact
- CAHPS survey performance improves when members experience coordinated post-surgical care
- Readmission reduction directly impacts quality measures that determine bonus payments
- Each half-star improvement in MA Star Ratings can represent millions in quality bonus revenue
Smarter utilization management
Steer post-surgical patients to the right care setting — not the most expensive one.
ER Diversion
When patients experience post-surgical concerns, Recovery Insights provides immediate AI-guided triage. Questions that would otherwise drive an ER visit are resolved through escalation to the surgical team — at a fraction of the cost.
Outpatient Steering
For issues that do need clinical attention, patients are directed to outpatient follow-up rather than the emergency department. The right care, in the right setting, at the right time.
Reduced Skilled Nursing Facility Utilization
Proactive recovery monitoring gives patients and families confidence to manage recovery at home. Fewer patients default to costly post-acute facilities when they have continuous clinical support via SMS.
Cost of care by setting
Illustrative cost comparison. Actual costs vary by market and procedure.
Medicare & CMS Alignment
Recovery Insights is built for the regulatory and quality landscape that defines modern payor strategy.
CMS TEAM Model Compliance
741 hospitals need this infrastructure. Recovery Insights provides the post-discharge monitoring required for TEAM model participation and performance.
HRRP Penalty Reduction
Demonstrated readmission prevention through proactive SMS monitoring helps your network hospitals avoid costly Hospital Readmissions Reduction Program penalties.
CMS Star Rating Improvement
Readmission measures directly impact plan ratings. Recovery Insights moves the quality metrics that determine Star Ratings and associated bonus payments.
CMMI Innovation Alignment
CMMI innovation priorities align with SMS-based, no-app digital health delivery. Recovery Insights fits squarely within CMS's vision for scalable, low-friction care innovation.
Health Equity
SMS reaches underserved and rural populations without broadband or smartphone requirements. Recovery Insights closes the digital divide in post-surgical care access.
Provider Workforce Impact
The hidden cost driver in your surgical network isn't just clinical — it's operational.
When your network providers burn out, it shows up in your claims data. Recovery Insights reduces administrative burden across your surgical network — fewer follow-up FTEs needed, lower overtime costs, and better provider retention.
Fewer FTEs
needed for manual follow-up across your network
Lower Overtime
reduced nursing and coordinator overtime costs
Better Retention
providers stay when administrative burden decreases
HEDIS measures that move
Recovery Insights directly affects the quality measures that determine bonus payments, Star Ratings, and network contract negotiations.
PPC-E
Postpartum & Post-Surgical Care
Structured post-discharge SMS engagement increases timely follow-up compliance — directly improving this HEDIS domain across your contracted surgical network.
FUH / FUM
Follow-Up After Hospitalization
Recovery Insights automates and documents post-discharge contact within 7 and 30 days — satisfying the follow-up timeliness requirements at scale.
AMR / PDC
Medication Adherence
Personalized medication reminders built from each discharge note improve adherence rates across anticoagulants, antibiotics, and post-surgical drug regimens.
Commercial model options
Recovery Insights can be structured as a per-member-per-month benefit, an episode-based shared-savings arrangement, or a network contract overlay across contracted facilities. We work with your actuarial team to find the right fit.
Quantify the impact for your book
Use our ROI calculator to model the claims cost reduction for your surgical volume.
Open ROI Calculator →Lower surgical episode costs across your network.
Let's map Recovery Insights to your highest-volume surgical categories and model the claims impact for your member population.
Schedule a Conversation