Honest, Reliable, and Replicable ROI Methodology Mary Mulcare February 9, 2023

Honest, Reliable, and Replicable ROI Methodology

ROI is at the top of every HR and payer leaders’ list. Everyone in the industry focuses on trend. We looked at that. And we have a different view.

Our goal was simple—develop an honest, reliable, and reproducible methodology aligned with our business model. To do this, we identified the medical cost impact from changes to treatment paths, avoided procedures and surgeries, and replacement of in-person physician visits courtesy of virtual consultations with Summus doctors and specialists. 

Our methodology was externally validated by Milliman, a leading actuarial firm. Milliman reproduced our findings using their own proprietary data set and determined the methodology and data were reasonable. But one of the most important components of our methodology is that it is honest. There are no inflated numbers, no vague trend analysis, no aggregate reporting to disguise real outcomes, no cherry-picking of data, and no outdated data or studies. Rather, our methodology:

  • Is condition-specific. Medical conditions vary dramatically, as do the costs associated with each condition. For example, the cost of an allergy test versus a cancer treatment or spinal surgery versus an avoided emergency department visit are very different. Our methodology addresses the leading 15 categories (e.g., oncology, musculoskeletal, cardiovascular) of claims drivers, and we can perlustrate even the rarest of conditions to provide accurate cost savings. 
  • Focuses on episodes of care. Our methodology is focused on a single episode of care allowing us to isolate our impact on treatment costs as opposed to trend-based cost savings that don’t delineate potential extraneous factors, like changes in contracted rates with providers, less expensive treatments, or statistical phenomena such as regression to the mean. In some cases, our guidance contributes to additional costs when our specialists believe it is the most appropriate course of treatment; however, this can aid in reducing long-term costs.
  • Uses geo-localized data. Costs of everything vary based on location, and healthcare is no different. Rather than using national cost averages, we use a member’s zip code to derive the most accurate cost savings numbers. For example, a member who avoided an emergency department visit in Florida saved $3,102; whereas a member in Maryland saved $623. 
  • Continuously updates data. Using data from more than 340 million patient journeys, including commercially insured, allowed patient costs 15 days prior and 30 days post procedure, we are improving the accuracy of cost impact. Cost impact calculations are continuously refreshed to provide the most current numbers as opposed to a single, static calculation.

Medical cost savings are particularly important with healthcare costs steadily outpacing inflation. With increased costs, combined with a proliferation of narrowly focused health solution offerings, it is now more important than ever for employers and health plans to understand the value delivered by their benefit offerings. Solutions that consistently demonstrate accurate and reliable financial returns and support better health outcomes will prevail.

When people have access to virtual specialty care they get the medical expertise they need to make informed decisions, big or small, about their health. Readied with information and education speeds time to an accurate diagnosis and subsequent treatment, while avoiding unnecessary surgeries and emergency room or urgent care visits. And, for employers and payers who offer virtual specialty care to their employees and members, they reap the benefit of honest and reliable medical savings.

The Summus ROI methodology

To learn more about our ROI methodology, download our Method Brief

About the Author

Mary Mulcare, MD, FACEP, is the Chief Medical Officer at Summus and Clinical Assistant Professor of Emergency Medicine at NewYork-Presbyterian/Weill Cornell. She has held several leadership roles at Weill Cornell. Dr. Mulcare graduated from Columbia University College of Physicians and Surgeons and completed a fellowship in Geriatric Emergency Medicine at Weill Cornell Medical Center.

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