RocketTools · Tiered Network Simulator · San Antonio MSA Read the report →Your health plan
How the dollars are figured
Default 17%: inpatient facility spending was about $1,154 of $6,710 per person for employer-insured people in 2022 (Health Care Cost Institute). Doctor fees, outpatient and pharmacy are the rest.
Savings % comes from the cards below (allowed cost vs BCBS PPO as sold). Members who do not choose the design stay on the plan as sold. Inpatient hospital facility cost only; outpatient savings are not counted.
Where the money moves
| Procedure | Stays | BCBS as sold | Chosen network as sold | Chosen network, tiered | Tiered vs BCBS as sold | Stays at Tier 1 / in network |
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Hospitals and tiers for one procedure
| Hospital | Allowed per stay | Quality | Tier | Copay | Share today → tiered |
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Doctors for this procedure
| Hospital | Doctor type | Doctors | Stay length vs expected | Complications vs expected | Saving if all use best-quarter doctors |
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Named surgeons for this procedure
| Surgeon | Specialty | Medicare cases | Best-tier hospitals for this procedure |
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How this works
Each procedure (DRG) is tiered on its own. Hospitals are ranked by the selected network's average allowed cost per real stay — which already reflects how long that hospital's patients stay — or by quality, and split into equal-count tiers (Tier 1 = best). Copays step geometrically from Tier 1 to the top tier. Members move toward lower copays only partly: share at hospital j = φ × (today's share × e−β·copay/100, normalised) + (1−φ) × today's share. Central values (inpatient φ 0.70, β 0.04 per $100; childbirth φ 0.85) come from published tiered-network studies (Massachusetts GIC, BCBSMA, CalPERS); "Everyone" sends all stays to Tier 1. Plan paid = allowed − copay (never above allowed). Hospitals with the same price share a tier. Hospitals with fewer than 5 stays for a procedure are pooled and kept in a middle tier (never Tier 1). Childbirth copays apply to delivery stays only.