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ROI narrative

Low-value imaging is a measurable line in shared savings.

Here's the money — conservatively. Modeled for 100,000 attributed lives, avoidable low-value imaging lands near $1.05M/yr, of which $525K is retained at a 50% Shared Savings track^[8]. Your inputs will differ — run your own numbers.

ARKA helps organisations carrying total cost of care turn low-value imaging into attributable shared savings — a risk-adjusted peer comparison ledger for attributed lives, with no EHR integration for the first product — ~$1M avoidable per 100,000 lives modelled, of which 50–75% is retained under ACO Shared Savings Program tracks.

Modeled, conservative estimate under the Vol III §9 per-attributed-life model. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes. Reduction rate is the trial difference-in-differences, never the raw within-arm drop.

Four steps — where the dollars come from

Each step below is a conservative, sourced estimate under the Vol III §9 per-attributed-life model. ARKA is Non-Device CDS — the ordering clinician retains full responsibility for the final decision.

Measured low-value imaging

Claims-based LVC pool at Medicare allowed for 100,000 attributed lives — $4.20M^[8].

Modeled avoided spend

DiD-bounded reduction (6 pp), never the raw within-arm drop — $1.05M/yr^[8].

Retained under shared savings

Buyer retention at MSSP BASIC Level E (50%); Enhanced tracks retain up to 75% — $525K retained at the default track.

No EHR integration

Modules 1–2 run on a claims extract. If you stop, you stop sending a file — no schema residue, no IT committee for the first product.

Compliance risk avoided

CMS-0057-F sets a specific denial reason requirement enforced through 2026 and four FHIR APIs (including Da Vinci PAS) by January 1, 2027. CMS-0057-F compliance matrix. The risk thesis does not depend on this rule.

Worked example — mid-sized system

100,000 attributed lives · measured LVC pool $4.20M · 50% shared-savings retention^[8].

Modeled — your inputs will differ. Figures use the Vol III §9 per-attributed-life model; each assumption, its source, and its provenance are documented in the ROI methodology.

Modeled ROI for 100,000 attributed lives under the §9 dollar model
Measured LVC pool $4.20M^[8] Modeled	Modeled avoided / yr $1.05M^[8] Modeled	Retained by buyer $525K^[8] Modeled	Year-1 net $297K^[8] Modeled

Avoided spend uses the trial difference-in-differences, never the raw within-arm drop. Retained dollars apply the Shared Savings Program track. Payback uses a ~2.3× first-year return multiple on retained savings. Payback under six months at defaults.

How we measure it with you

Modeled economics get you to a business case. Measured outcomes get you to a contract. We align on KPIs before go-live — low-value imaging rate against a locked pre-period, retained shared savings by risk track, and appropriateness distribution — using the framework in our Outcomes & KPI guide.

Sources

Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable; 34% are unequivocally avoidable; ~48% of avoidable denials are never recovered.
KFF — ACA Marketplace claims denials & appeals (2023) — HealthCare.gov insurers denied ~19–20% of in-network claims; consumers appealed fewer than 1% of denials; 56% of appealed denials were upheld.
MGMA / Change Healthcare — cost to rework a denied claim — ~$25 average administrative cost to rework a claim; up to ~$118 fully loaded; MGMA estimates 50–65% of denials are never reworked.
CAQH Index (2023 / 2024) — Manual prior authorization costs providers ~$10.97 per transaction and ~24 minutes of staff time; full electronic PA cuts cost and time dramatically.
AMA 2024 Prior Authorization Physician Survey — Practices complete ~39 prior authorizations per physician per week; physicians and staff spend ~13 hours/week on PA; 94% of physicians report PA delays care; 78% report patients abandon treatment.
Johns Hopkins — commercial vs. Medicare radiology prices (2021) — Median commercial price for MRI brain w/wo contrast ~$1,788 (4x Medicare $446); CT head w/o contrast ~$813 (5.9x Medicare $137).
HHS OIG — Medicare Advantage prior-authorization denials — Among denied payment requests reviewed, ~18% met Medicare coverage and billing rules — i.e., were improperly denied.
Meeker et al. JAMA 2016 — behavioural interventions RCT — Difference-in-differences 5–7 percentage points for peer comparison and accountable justification; control fell 11.0 pp on secular trend alone.

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ROI narrative

Low-value imaging is a measurable line in shared savings.

Four steps — where the dollars come from

Measured low-value imaging

Claims-based LVC pool at Medicare allowed for 100,000 attributed lives — $4.20M^[8].

Modeled avoided spend

DiD-bounded reduction (6 pp), never the raw within-arm drop — $1.05M/yr^[8].

Retained under shared savings

Buyer retention at MSSP BASIC Level E (50%); Enhanced tracks retain up to 75% — $525K retained at the default track.

No EHR integration

Modules 1–2 run on a claims extract. If you stop, you stop sending a file — no schema residue, no IT committee for the first product.

Compliance risk avoided

Worked example — mid-sized system

100,000 attributed lives · measured LVC pool $4.20M · 50% shared-savings retention^[8].

Modeled — your inputs will differ. Figures use the Vol III §9 per-attributed-life model; each assumption, its source, and its provenance are documented in the ROI methodology.

Modeled ROI for 100,000 attributed lives under the §9 dollar model
Measured LVC pool $4.20M^[8] Modeled	Modeled avoided / yr $1.05M^[8] Modeled	Retained by buyer $525K^[8] Modeled	Year-1 net $297K^[8] Modeled

How we measure it with you

Sources

Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable; 34% are unequivocally avoidable; ~48% of avoidable denials are never recovered.
KFF — ACA Marketplace claims denials & appeals (2023) — HealthCare.gov insurers denied ~19–20% of in-network claims; consumers appealed fewer than 1% of denials; 56% of appealed denials were upheld.
MGMA / Change Healthcare — cost to rework a denied claim — ~$25 average administrative cost to rework a claim; up to ~$118 fully loaded; MGMA estimates 50–65% of denials are never reworked.
CAQH Index (2023 / 2024) — Manual prior authorization costs providers ~$10.97 per transaction and ~24 minutes of staff time; full electronic PA cuts cost and time dramatically.
AMA 2024 Prior Authorization Physician Survey — Practices complete ~39 prior authorizations per physician per week; physicians and staff spend ~13 hours/week on PA; 94% of physicians report PA delays care; 78% report patients abandon treatment.
Johns Hopkins — commercial vs. Medicare radiology prices (2021) — Median commercial price for MRI brain w/wo contrast ~$1,788 (4x Medicare $446); CT head w/o contrast ~$813 (5.9x Medicare $137).
HHS OIG — Medicare Advantage prior-authorization denials — Among denied payment requests reviewed, ~18% met Medicare coverage and billing rules — i.e., were improperly denied.
Meeker et al. JAMA 2016 — behavioural interventions RCT — Difference-in-differences 5–7 percentage points for peer comparison and accountable justification; control fell 11.0 pp on secular trend alone.

Loading…

ROI narrative

Low-value imaging is a measurable line in shared savings.

Four steps — where the dollars come from

Measured low-value imaging

Claims-based LVC pool at Medicare allowed for 100,000 attributed lives — $4.20M^[8].

Modeled avoided spend

DiD-bounded reduction (6 pp), never the raw within-arm drop — $1.05M/yr^[8].

Retained under shared savings

Buyer retention at MSSP BASIC Level E (50%); Enhanced tracks retain up to 75% — $525K retained at the default track.

No EHR integration

Modules 1–2 run on a claims extract. If you stop, you stop sending a file — no schema residue, no IT committee for the first product.

Compliance risk avoided

Worked example — mid-sized system

100,000 attributed lives · measured LVC pool $4.20M · 50% shared-savings retention^[8].

Modeled — your inputs will differ. Figures use the Vol III §9 per-attributed-life model; each assumption, its source, and its provenance are documented in the ROI methodology.

Modeled ROI for 100,000 attributed lives under the §9 dollar model
Measured LVC pool $4.20M^[8] Modeled	Modeled avoided / yr $1.05M^[8] Modeled	Retained by buyer $525K^[8] Modeled	Year-1 net $297K^[8] Modeled

How we measure it with you

Sources

Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable; 34% are unequivocally avoidable; ~48% of avoidable denials are never recovered.
KFF — ACA Marketplace claims denials & appeals (2023) — HealthCare.gov insurers denied ~19–20% of in-network claims; consumers appealed fewer than 1% of denials; 56% of appealed denials were upheld.
MGMA / Change Healthcare — cost to rework a denied claim — ~$25 average administrative cost to rework a claim; up to ~$118 fully loaded; MGMA estimates 50–65% of denials are never reworked.
CAQH Index (2023 / 2024) — Manual prior authorization costs providers ~$10.97 per transaction and ~24 minutes of staff time; full electronic PA cuts cost and time dramatically.
AMA 2024 Prior Authorization Physician Survey — Practices complete ~39 prior authorizations per physician per week; physicians and staff spend ~13 hours/week on PA; 94% of physicians report PA delays care; 78% report patients abandon treatment.
Johns Hopkins — commercial vs. Medicare radiology prices (2021) — Median commercial price for MRI brain w/wo contrast ~$1,788 (4x Medicare $446); CT head w/o contrast ~$813 (5.9x Medicare $137).
HHS OIG — Medicare Advantage prior-authorization denials — Among denied payment requests reviewed, ~18% met Medicare coverage and billing rules — i.e., were improperly denied.
Meeker et al. JAMA 2016 — behavioural interventions RCT — Difference-in-differences 5–7 percentage points for peer comparison and accountable justification; control fell 11.0 pp on secular trend alone.

ROI narrative

Low-value imaging is a measurable line in shared savings.

Four steps — where the dollars come from

Measured low-value imaging

Claims-based LVC pool at Medicare allowed for 100,000 attributed lives — $4.20M^[8].

Modeled avoided spend

DiD-bounded reduction (6 pp), never the raw within-arm drop — $1.05M/yr^[8].

Retained under shared savings

Buyer retention at MSSP BASIC Level E (50%); Enhanced tracks retain up to 75% — $525K retained at the default track.

No EHR integration

Modules 1–2 run on a claims extract. If you stop, you stop sending a file — no schema residue, no IT committee for the first product.

Compliance risk avoided

Worked example — mid-sized system

100,000 attributed lives · measured LVC pool $4.20M · 50% shared-savings retention^[8].

Modeled — your inputs will differ. Figures use the Vol III §9 per-attributed-life model; each assumption, its source, and its provenance are documented in the ROI methodology.

Modeled ROI for 100,000 attributed lives under the §9 dollar model
Measured LVC pool $4.20M^[8] Modeled	Modeled avoided / yr $1.05M^[8] Modeled	Retained by buyer $525K^[8] Modeled	Year-1 net $297K^[8] Modeled

How we measure it with you

Sources

Change Healthcare 2020 Denials Index — 86% of denials are potentially avoidable; 34% are unequivocally avoidable; ~48% of avoidable denials are never recovered.
KFF — ACA Marketplace claims denials & appeals (2023) — HealthCare.gov insurers denied ~19–20% of in-network claims; consumers appealed fewer than 1% of denials; 56% of appealed denials were upheld.
MGMA / Change Healthcare — cost to rework a denied claim — ~$25 average administrative cost to rework a claim; up to ~$118 fully loaded; MGMA estimates 50–65% of denials are never reworked.
CAQH Index (2023 / 2024) — Manual prior authorization costs providers ~$10.97 per transaction and ~24 minutes of staff time; full electronic PA cuts cost and time dramatically.
AMA 2024 Prior Authorization Physician Survey — Practices complete ~39 prior authorizations per physician per week; physicians and staff spend ~13 hours/week on PA; 94% of physicians report PA delays care; 78% report patients abandon treatment.
Johns Hopkins — commercial vs. Medicare radiology prices (2021) — Median commercial price for MRI brain w/wo contrast ~$1,788 (4x Medicare $446); CT head w/o contrast ~$813 (5.9x Medicare $137).
HHS OIG — Medicare Advantage prior-authorization denials — Among denied payment requests reviewed, ~18% met Medicare coverage and billing rules — i.e., were improperly denied.
Meeker et al. JAMA 2016 — behavioural interventions RCT — Difference-in-differences 5–7 percentage points for peer comparison and accountable justification; control fell 11.0 pp on secular trend alone.