Over the next decade, the U.S. healthcare system has an opportunity to realize savings of approximately $12 billion if just one in five upper gastrointestinal (GI) and colonoscopy procedures move from hospital outpatient departments (HOPDs) to ambulatory surgery centers (ASCs).

ASCs have consistently demonstrated the ability to provide the same high quality outcomes as hospital-based settings and can offer patients more convenience by adding more locations to receive care and better scheduling options. Additionally, studies show that when consumers have the option to receive care at an ASC, they receive services that are delivered more efficiently, and are therefore less expensive.

Sg2 2020 Market Level Ambulatory Procedure Forecast.

Recent data even revealed consumers currently save as much as $5 billion annually in out-of-pocket costs from having procedures performed in an ASC, which, depending on the procedure, can translate to $1,000 in savings to the consumer per surgery. In addition to the cost savings, studies show that consumers simply prefer the care they receive in an ASC. ASCs also offer surgical staff more autonomy and the ability create an environment that is customized for the specific procedures they perform. For these reasons, the number of ASCs have grown significantly over recent years.

To determine if these savings could be realized for Anthem’s affiliated health plan members, Anthem’s Public Policy Institute analyzed claims data from individuals enrolled in commercial plans in 14 states and used that to show the savings that could occur at the national level. The report shows the cost of a colonoscopy or upper GI procedure in a HOPD was actually 1.7 times higher than in an ASC. While this is not for everyone, by shifting select procedures from a HOPD to an ASC, Anthem can ensure the same high quality outcomes, but provide enhanced flexibility and greater affordability.

These results indicate that significant cost savings are available not only for consumers, but the entire healthcare system. This is a significant opportunity for companies like Anthem to unlock more affordable and high quality care for consumers. Where care is received plays a large role in how much it costs, which can have a direct impact on out-of-pocket cost savings. This is key to delivering on Anthem’s commitment to creating a more affordable healthcare experience.