For self-funded employers, few challenges are more frustrating than the unpredictability of healthcare costs. Each year, they face volatile claims expenses that make it nearly impossible to budget accurately or plan benefits with confidence.
Traditional pricing models, like PPO-negotiated discounts, only add to the problem. Costs fluctuate year over year, leaving employers caught in a cycle of uncertainty.
Costs fluctuate year over year, leaving employers caught in a cycle of uncertainty.
Direct contracting changes this. By offering locked-in, transparent, bundled rates, health systems can provide the predictability employers crave—while ensuring providers are fairly compensated.
Why Price Predictability Matters
Healthcare costs are one of the largest and fastest-growing expenses for employers. Rising stop-loss premiums and high deductibles impact both organizations and their employees.
Without predictable costs, employers struggle to:
- Forecast healthcare spend year to year.
- Design competitive benefits packages.
- Protect employees from financial surprises.
What employers want is simple: upfront answers, not post-pay surprises.
The Transparency Problem in Traditional Models
Under the traditional model, true cost transparency is almost impossible.
- Fragmented billing: Facility, provider, anesthesia, pathology, and other services are billed separately, often leading to surprise charges.
- Repricing after the fact: Employers see “savings” only after claims are repriced, without employees ever knowing the cost upfront.
- Wild variation: “Allowed amounts” vary dramatically, even for the same procedure at similar facilities.
This opacity erodes trust and creates avoidable friction between providers, employers, and employees.
The Tendo Care Connect Approach
1. Bundled, All-Inclusive Pricing
Every Care Connect bundle includes facility and professional fees, presented as a single upfront price. Employers and employees know the cost before care is scheduled—no hidden fees, no surprise bills.
2. Direct Contracting = Stable Rates
Rates are set based on market conditions, services, and population needs. While rates can be adjusted, they typically remain consistent throughout the year, giving organizations predictable pricing and protection from frequent PPO fluctuations.
3. Claims Repricing & Savings Analysis
Tendo conducts a claims repricing analysis against an employer’s historical claims to model potential savings. This provides clear insights into expected cost reductions and helps forecast spend with confidence.
4. Seamless Integration
Care Connect supports real-time adjudication and bundled 837/835 claims processing. This reduces complexity for TPAs, simplifies workflows, and improves reporting accuracy.
Real-World Cost Comparisons
Take knee replacement surgery as an example:
- Regional PPO average: 243% of Medicare.
- Care Connect contracted average: 132% of Medicare.
The platform is built to serve both hospitals and employers equitably, aligning incentives to make direct contracting sustainable for all parties.
For Employers: Predict Next Year’s Costs, Today
With Care Connect, employers can:
- Plan with certainty using a known fee schedule.
- Improve employee experience by eliminating billing anxiety.
- Design smarter plans by using bundled pricing to guide benefit design and steerage strategies.
It’s a practical way to replace guesswork with guaranteed predictability.
Getting Started
Tendo makes it easy to take the first step. Our team can analyze your claims file, model potential savings, and build a custom employer bundle strategy. Implementation takes just 30–60 days, with full support for contracting, training, and EMR integration.
Say goodbye to pricing volatility. Say hello to predictable, transparent care.
Contact Tendo today for a claims repricing consultation and start building a more stable, cost-efficient benefits strategy.
