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Episode & Leakage Simulator Model the economic impact of structured AI across the three episode phases — pre-admission (ERAS, pre-auth), day-of (digital check-in), and post-discharge (readmission prevention, leakage recovery, RPM). Spain peer-reviewed evidence (CARME, Diz-Ferreira, Aguilar-Rodríguez, González-Arévalo).
Service line Numbers vary materially by line. Pick the line you want to model first — readmission baseline, leakage baseline, LOS, and ERAS impact all auto-fill from peer-reviewed Spain evidence.
Cardiology (HF focus) Orthopedic (hip / knee) General surgery Cardiac surgery Oncology Internal medicine
Volume + revenue Phase A — Pre-admission Elective surgery cancellation rate Spain: 5-15% (González-Arévalo 2009 Can J Anaesth). Same-day cancellations included.
Pre-authorization turnaround (days) Industry typical 1-5 days when handled manually. Each day beyond 2 adds ~0.5pp of preventable cancellations (clearance expires, patient drops). Direct contracts with insurers can drop this to <1 day.
Pre-auth denial rate Industry typical 5-15%. About 40% of denials become effective cancellations (the rest get appealed/recovered in the same window). High denials suggest documentation or coding gaps at admission.
ERAS adoption ERAS = Enhanced Recovery After Surgery. Pilot = one service line. Full = systemic protocol across surgical services. Diz-Ferreira 2025 Spain meta: cardiac surgery −1.24 LOS days, −25% complications full protocol.
Not adopted Pilot Full protocol
Phase B — Day of Digital check-in adoption % of admissions using digital check-in (pre-arrival forms + ID + insurance verification). Spain post-COVID: 20-50% in urban privado. Compounds the cancellation lever — 0% adoption = 1.0× effect, 90% adoption ≈ 1.9× (day-of adherence and no-show prevention).
Phase C — Post-discharge 30-day readmission rate EU/Spain median for this service line. Auto-set from service line; adjust if your number differs.
Patient leakage rate % of downstream episodes (rehab, follow-up procedures, specialist consults) going out-of-network.
RPM enrollment of eligible patients % of RPM-eligible patients (HF, COPD, post-surgical) currently enrolled in remote monitoring. EU/US best-in-class: 60-70%. The intervention only counts headroom up to ~95% — higher current enrollment = smaller additional uplift.
Member experience intervention Choose the maturity of the AI layer touching your post-discharge journey. Each level adds capabilities.
Basic — Manual phone follow-up Intermediate — Digital check-in + reminders Advanced — RPM + AI re-engagement (Layer 3)
No uplift modeled. Manual phone calls only; numbers stay at the baselines above.
Total economic impact (annual)
€0 Sum of the four drivers below at the chosen service line, ERAS level, and intervention level.
Readmission avoidance
€0 0 readmissions avoided × €4,500 average cost per readmission.
Leakage retention
€0 0 downstream episodes retained × your revenue per episode.
Capacity recovery
€0 0 bed-days ≈ 0 additional surgeries possible without expanding capacity.
Cancellation reduction
€0 Reducing same-day / pre-op cancellations recovers 0 additional episodes × revenue per episode.
Additional RPM enrollments
+0 Eligible cohort × your selected intervention uplift. CARME 2011 reported −67.8% HF readmissions for the enrolled cohort — that clinical impact is reported separately, not double-counted into readmission avoidance.
Total economic impact by driver
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Model your own scenario in under a minute. Free account. No card required. Save scenarios, compare 2-4 side by side, export PDF for your team. Calibrated for Spain privado hospitals (CARME, Diz-Ferreira, Aguilar-Rodríguez).
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