Model Design by Kelly Emrick, DHSc, PhD, MBA, (ARRT)R

Two Models Below

Healthcare Fiscal Performance

The Highest-Leverage Fix in Healthcare

Redesign incentives around timely access, prevention, and measurable outcomes — and model the dollars. Adjust any assumption; every cost pool, projection, and return metric recalculates live.

The investment case at a glance

Front-door friction quietly funds avoidable ED use, delayed diagnoses, clinician turnover, avoidable admissions, leakage, and rework. Here is what redirecting a slice of that waste returns.

Addressable friction / yr

Total recoverable waste

Steady-state benefit / yr

Savings + value-based upside

Net benefit / yr

After recurring opex

Why it matters
Healthcare fails not at one point in the system, but through accumulated friction at the front door. Remove that friction and the entire system begins to perform differently.
“Remove friction at the front end, and the entire system begins to perform differently.

Assumptions & drivers

Replace these defaults with your organization’s actuals. Everything downstream updates instantly.

Population & Demand
Workforce
Administrative Friction
Financial Parameters

Downstream failure costs

The six friction-driven cost pools that compound when the front door breaks.

Cost poolAnnual cost% of total
Emergency department overuse
Avoidable admissions
Delayed diagnoses
Clinician burnout & turnover
Patient frustration / leakage
Administrative friction & rework
Total addressable friction100%

Where the waste sits

The highest-leverage fix

Not another isolated program — a payment & operating model with six levers. Edit each lever’s one-time and recurring cost.

Lever
One-time ($)
Annual recurring ($)
Digital triage & self-scheduling24/7 booking + symptom triage routing patients to the right setting
Primary-care capacityAdded APP slots & extended hours to absorb avoidable ED demand
Care coordinationCare managers preventing avoidable admissions & readmissions
Early intervention / preventionRisk stratification & outreach catching disease before it escalates
Specialty accessE-consults & referral management cutting wait times and leakage
Measurable outcomesRegistry, dashboards & analytics enabling value-based capture

Total one-time investment

Upfront build

Total annual recurring

Operating cost

Impact model

Set the achievable reduction on each cost pool. Savings are steady-state (full ramp).

Subtotal — cost savings
Value-based incentive (new revenue)
Total annual benefit
Blended reduction across pools

Baseline cost vs. realizable savings

5-year financial projection

Year 0 is the build year (you staff up before savings arrive). Savings ramp via the realization curve.

$ (000s)Year 0Year 1Year 2Year 3Year 4Year 5
Total benefits
Total costs
Net cash flow
Cumulative

Benefits, costs & cumulative cash flow

ROI, NPV & payback

The headline financial case, discounted at your cost of capital.

5-yr net cash flow

Undiscounted

5-yr total benefits

Undiscounted

5-yr total costs

Incl. one-time

5-yr return on investment

Net / total cost

Removing front-door friction converts recurring downstream waste into a self-funding investment: steady-state net benefit exceeds annual operating cost, and the program pays back its build cost well inside the horizon.

Scenario analysis

Stress-test the same program. Multipliers scale savings, incentive capture, and cost.

Conservative

5-yr NPV
benefit-cost ratio
net benefit / yr

Base

5-yr NPV
benefit-cost ratio
net benefit / yr

Aggressive

5-yr NPV
benefit-cost ratio
net benefit / yr

Multipliers

Cons savings
Cons incentive
Cons cost
Aggr savings
Aggr incentive
Aggr cost

5-year NPV by scenario

Measurable outcomes — KPI scorecard

Proof the system is performing differently. Access targets are illustrative; utilization targets are computed live from your reductions.

Access & friction (targets)
KPIBaselineTargetImprovement
Third-next-available (days)247-71%
New-patient call abandonment18%6%-67%
Online self-scheduling share10%60%+500%
Referral leakage rate25%12%-52%
No-show rate14%8%-43%
Utilization & financial (live)
KPIBaselineTargetImprovement
Avoidable ED visits / yr
Avoidable admissions / yr
Provider turnover rate
Steady-state net benefit

Avoidable utilization: baseline vs target

Illustrative model — replace defaults with local actuals before relying on outputs. KellyEmrick.com · .org · .blog
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