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
a

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

b

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

c

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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