Workers with health insurance coverage through several large employers including Walmart and Lowes now have the option of getting a joint replacement free of charge. Through the Employers Centers of Excellence Network established by the Pacific Business Group on Health (PBGH), four providers—Johns Hopkins Bayview Medical Center (Baltimore), Virginia Mason (Seattle), Kaiser Permanente Orange County (Irvine, CA), and Mercy Hospital (Springfield, MO)—negotiated bundled-payment agreements based on their high volumes, better-than-average outcomes, and lower-than-average complication rates. Instead of paying the usual deductibles and copays, patients travel to one of these four providers and don’t pay a penny for the procedure or travel expenses. The non-profit PBGH has 60 large-company members that provide health care coverage to 10 million people, including active employees, retirees, and dependents.