TABLE 11-4Savings Estimate: Commercially Insured Population

Total for Six Chronic Conditionsa (n = 1,361,685)Total for Seven Acute Medical/Proceduresb (n = 22,242)Total for 13 Conditions/Acute Medical/Proceduresc (n = 1,383,927)Total for 13 Conditions/Acute Medical/Proceduresc (n = 1,383,927)
Base cost of care$6,909,752,883$736,537,303$7,646,290,186$7,646,290,186
Underuse allowance$687,559,658$0$687,559,658$687,559,658
Evidence-informed cost$7,597,312,541$736,537,303$8,333,849,844$8,333,849,844
PAC target rate24%10%23%0%
Allowance for PACs$3,319,149,766$95,329,613$3,414,479,379$0
Total expected cost$10,916,462,307$831,866,917$11,748,329,224$8,333,849,844
Net savings opportunity$2,951,882,322$95,329,613$3,047,211,935$6,461,691,315
Net savings for all commercially insured plan members$162,353,527,710$5,243,128,730$167,596,656,440$355,393,022,299

These conditions include congestive heart failure (CHF), diabetes, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), asthma, and hypertension.


These conditions include acute myocardial infarction (AMI), pneumonia, stroke, coronary artery bypass graft surgery (CABG), hip replacement surgery, knee replacement surgery, and bariatric surgery.


These conditions include the 13 conditions listed above.

From: 11, Payment and Payer-Based Strategies

Cover of The Healthcare Imperative
The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary.
Institute of Medicine (US) Roundtable on Evidence-Based Medicine; Yong PL, Saunders RS, Olsen LA, editors.
Washington (DC): National Academies Press (US); 2010.
Copyright © 2010, National Academy of Sciences.

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