Medicaid presents tremendous opportunities to demonstrate the business case for improving health care quality.
Of the more than 60 million people served under Medicaid, adults with disabilities and chronic conditions represent
only one quarter of the population, while consuming nearly 70 percent of Medicaid’s resources.
Investing in programs that more effectively manage the care of these high-risk, high-cost beneficiaries can improve
health outcomes, reduce unnecessary utilization, and control Medicaid expenditures.
This investment can ensure greater value for every Medicaid dollar spent, while providing the highest quality of
care for those who need it most.
To help Medicaid stakeholders assess and demonstrate a return on investment (ROI) from projects to improve quality in health care, the Center for Health Care Strategies (CHCS) developed the ROI Calculator for Quality Initiatives (chcsroi.org). For more information about CHCS please visit our primary website at chcs.org.
Help buttons are provided within the Calculator to assist you in developing a forecast.
For additional tips and best practices, a User’s Guide is also available.
To complete an ROI forecast, you will need to provide the following information:
Timeframe/duration of initiative
Targeted population subgroups
Disease prevalence among target groups
Expected enrollment rate
Average 12 month baseline costs for intervention group members
Trend (expected growth in claims costs)
Anticipated utilization changes resulting from initiative
Estimated costs of launching and operating the initiative
Organizational cost of capital
Development of the ROI Forecasting Calculator has been supported by a
grant from the Robert Wood Johnson Foundation.