Outcomes
The UK’s first, data-driven, value-based reimbursement fee structure
- Crafted a should-cost model encompassing key factors: surgical time, variations based on specialism, surgeon expertise, clinical risk cost, and admin costs
- Delivered benchmarking insights showing client reimbursements compared to market averages, and specifically against another larger insurer
- Compiled a comprehensive report highlighting key findings, outlining urgent need for changes, and providing an initial should-cost model design
Background
Consultants complain about the client’s current reimbursement structure for surgeons and anaesthetists, citing rising practice costs and other unaddressed factors
- Current fee structures do not reflect specialism levels, patient complexities, or actual procedure lengths
- A “one-size-fits-all” approach fails to account for the varying time demands of different consultations
- We used an initial sample set of 20 pre-agreed CCSD codes as the basis for our investigations and interviews
Curzon Approach
Benchmarking Analysis
- Comparing the client’s reimbursements on a like-for-like basis across 4 major competitors for surgeons and anaesthetists
Should-Cost Model
- Consulted surgeons and anaesthetists through interviews and survey to understand their views on fees, and used thematic analysis to map key points of consensus and divergence
- Leveraged data on the number of surgeons in different UK specialisations, NHS bands, typical procedure time,, and private practice costs to develop should cost model
