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CareAdvantage, Inc. has created an ROI measurement tool
to help clients assess cost savings obtained from using RPNavigator. The tool focuses
on several areas to capture the impact of RPNavigator as completely
as possible. Areas of
focus include:
- Medical
cost savings
- Increase
new business and retention of existing business
- Staffing
impact
The following client information is
needed to populate the model:
- Current
membership
- Current
Admits per 1000
- Anticipated
impact of other medical management programs implemented before,
and separate from, RPNavigator
- Average
cost per admission or average cost per day
- Average
length of stay (ALOS)
- Medical
cost trends – what were the projected trends for periods under
evaluation
- Average
premium PMPM
- Average
margin on new and old business
RPNavigator provides information that
enables clients to improve case management and disease management
programs and to identify members who would benefit from these
programs. This information results in decreases in admissions, readmissions,
prolonged lengths of stay and the use of other medical services. RPNavigator also helps identify opportunities to redirect
patient access to care.
CAI has determined the impact of
RPNavigator on ongoing utilization and medical costs. The ROI model takes into account ongoing medical trend and results of current programs. Potential cost savings are dependent upon the
client’s willingness to commitment resources to implement
RPNavigator recommendations. The model also compensates for the reduced analytic needs and
improved retention of profitable business. These factors create a more realistic ROI calculation.
Using actual client data, CAI has confirmed the
validity of the model and the impact of RPNavigator.
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