This calculator will allow you to input three key variables to determine an estimate for annual savings in cost avoidance and return on investment.

• For the Enter Number of Medicaid Members field, simply enter your current Medicaid population.

• For the Enter Average Drug Expense/Medicaid Utilizer field, enter your plan’s average Rx cost per medicaid utilizer. In a recent case study with a MCO with 1.4 million Medicaid lives, we determined an average Rx savings of $69/Medicaid utilizer.

• For the Enter Average Medical Expense/Medicaid Utilizer field, enter your plan’s average medical cost per utilizer. In the same case study as above, we determined an average medical savings of $1011/Medicaid utilizer.

Assumptions:

• The Medicaid Plan will fully utilize ProTPL for eligible OHI discovery opportunities.

• This calculator has been developed based on actual case studies, but an eligibility OHI discovery test file is the only way to empirically evaluate value to your Medicaid plan.