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ROI Calculators For Improved Primary Care Access

The following calculations will help you estimate the potential return on your investment with a primary care solution that increases access to high-quality care, reduces inappropriate care and increases employee productivity.

The following calculators can be used separately or in any combination. The default numbers shown in each calculator are based on industry averages. Customizing the data to your specific organization is suggested to get the most accurate results.

Custmize your Total Potential Savings using the fields below

Increase in Primary Care Visits1-3

$
.00

Emergency Room Avoidance through After Hour Care4-7

$
.00

Avoidance of Urgent Care Visits8-10

$
.00

Decrease in Inappropriate Specialist Visits

$
.00

Total Potential Savings

$
$
$

Projection of % Uptake

Discover the hidden link between boosting primary care and maximizing productivity. The calculator below reveals the incredible potential for financial gain. Please note that this calculator is not linked to the primary care ROI results mentioned above.

Lost Productivity Cost from Primary Care Visits Calculator

$
.00

Lost Productivity Cost from Primary Care Visits

$
$
$

Data Sources

  1. One study from U.S. Bureau of Labor Statistics by Ma (2019). The study showed that after eliminating primary care visit co-payments, there was a 0.9% increase in primary care visits and a medical cost saving of $12 per member per month (in 2015 USD). The calculator assumes that every 0.9% increase in primary care visits is associated with a decrease in the total medical cost of $12 per member per month.
  2. Reference for default cost of outpatient visit (for ROI calculation): https://www.allinahealth.org/-/media/allina-health/files/customer-service/billing-and-insurance/2022-primary-care-top-25-cpt-codes-and-pricing.pdf
  3. Reference for detault # of primary care visits: Reference for # of visits (for ROI calculation): https://www.cdc.gov/nchs/fastats/physician-visits.htm
  4. Three studies that shows extended hours in primary care reduced emergency room visits (Whittaker 2016; Lippi Bruni 2016; and Devlin 2020). These studies showed that extended access in the evenings or over the weekends substitutes primary care visits for 10% to 33% of non-urgent emergency room visits. The amount of savings depends on the payment difference between extended primary care visits and non-urgent emergency room visits.
  5. Default for cost of average cost of emergency room visit: https://www.unitedhealthgroup.com/newsroom/posts/2019-07-22-high-cost-emergency-department-visits.html
  6. Default for average of emergency room visits: Around 40 emergency room visits per 100 covered lives (https://www.cdc.gov/nchs/products/databriefs/db434.htm)
  7. Default for avoidable number of avoidable ER visits comes from: U.S. Bureau of Labor Statistics by Ma (2019).
  8. Reference for default cost of urgent care visit (for ROI calculation): https://www.allinahealth.org/-/media/allina-health/files/customer-service/billing-and-insurance/2022-primary-care-top-25-cpt-codes-and-pricing.pdf
  9. Default for average number of urgent care visit: https://www.cdc.gov/nchs/products/databriefs/db409.htm
  10. Default for avoidable number of avoidable ER visits comes from: U.S. Bureau of Labor Statistics by Ma (2019).

References

  • Bradley CJ, Neumark D, Walker LS. The effect of primary care visits on other health care utilization: A randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia. J Health Econ. 2018;62:121-133.
  • Devlin RA, Kpelitse KA, Li L, Mehta N, Sarma S. After-hours Incentives and Emergency Department Visits: Evidence from Ontario. Canadian Public Poliy. 2020. Vol. 46, No. 2 (June 2020), pp. 253-263.
  • Lippi Bruni M, Mammi I, Ugolini C. Does the extension of primary care practice opening hours reduce the use of emergency services? J Health Econ. 2016;50:144-155.
  • Ma Q, Sylwestrzak G, Oza M, Garneau L, DeVries AR. Evaluation of Value-Based Insurance Design for Primary Care. 2019;25.
  • U.S. Bureau of Labor Statistics. Consumer Price Index. Published 2023. https://data.bls.gov/cgi-bin/surveymost?bls
  • Sepúlveda MJ, Roebuck MC, Fronstin P, Vidales-Calderon P, Parikh A, Rhee K. Elimination of the Out-of-Pocket Charge for Children’s Primary Care Visits: An Application of Value-Based Insurance Design. The Journal of Pediatrics. 2016;175:195-200.