ROI Calculator

CoCM ROI Calculator

Step 1 of 3

Tell us about your practice

Select your state to load current reimbursement rates, then enter your practice size.

Location

Sets Medicare & Medicaid fee schedule rates for your state

State Required

Practice Size

How many providers will participate in CoCM?

Number of PCPs Total physician count

% Advanced Practice Providers NPs, PAs

20%

Use Incident-To Billing? (APPs bill at MD rate)

Advanced AssumptionsApril Health Defaults

Pre-filled from April Health partner averages. Adjust if your practice differs.

% Providers Engaged in CoCM Participation rate

80%

Avg. Patients Referred / Provider / Month Before conversion

Typically 60% of referred patients start the program.

Avg. Months per Patient in Program Before completing or churning

7 mo.

Avg. Add-On Codes / Patient / Month 99494 additional episodes

Billing Overhead Rate % of revenue

Unpaid Co-Pay Rate % of revenue uncollected

Step 2 of 3

What does your payor mix look like?

Enter the approximate share of patients covered by each payor. Rates are pre-filled from your state's fee schedule.

Payor Mix

Should total 100%

Medicare

Medicaid

Commercial

✓ Payor mix totals 100%

Billing Rates (per code, MD)

Pre-filled from your state's fee schedule — adjust to your contracted rates

Payor	99492	99493	99494
Medicare
Medicaid
Commercial

About these rates: Medicare and Medicaid rates are pre-filled from the fee schedule for your state. Commercial rates reflect typical averages. Update to match your contracted rates for a more precise estimate.

Step 3 of 3

Your CoCM ROI estimate

Based on your practice profile, here's the projected financial return from launching CoCM with April Health.

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← Edit inputs

CoCM May Not Be FFS-Profitable at These Rates

Based on your payor mix and state rates, FFS revenue from CoCM may not cover program costs in Year 1. This is common in states with no or low Medicaid FFS rates, or practices with a high Medicaid patient mix.

If your state has high Medicaid MCO penetration, many managed care plans cover CoCM at rates that may make the math work. Practices in value-based care or ACO arrangements can also generate significant upside through shared savings and quality bonuses not reflected here.

The April Health team can help you work through a detailed analysis that accounts for your payor contracts, MCO coverage in your market, and any VBC upside — to give you a full picture of the program economics.

Let's Work Through the Full Analysis Together →

Year 1 Net Profit

—

FFS revenue above cost

Year 2 Net Profit

—

As census stabilizes

Steady-State Patients

—

Active at end of Year 2

Annual Model Summary

Revenue, cost, and profit by year

Year 1

Revenue—

April Health Cost—

Net Profit—

Year 2

Revenue—

April Health Cost—

Net Profit—

Year 3+ (Steady State)

Revenue—

April Health Cost—

Net Profit—

Fee-for-Service Analysis Only

This model reflects only direct FFS billing returns. For practices in value-based care or ACO arrangements, CoCM can generate significant additional upside through shared savings, risk adjustment, and quality bonuses. Share your VBC contract details with the April Health team and we'll build a complete picture of your total program ROI.

Ready to get started with April Health?

Let our team build a custom ROI model for your practice with real-world data from similar partners.

This calculator provides estimates based on CoCM billing data from Medicare, Medicaid, and commercial payors. Actual results will vary based on practice-specific factors including payor contracts, patient population, and care team configuration. April Health rates are illustrative; final pricing subject to contract terms.

Estimate your practice's return on investment.

Tell us about your practice

Location

Practice Size

What does your payor mix look like?

Payor Mix

Billing Rates (per code, MD)

Your CoCM ROI estimate

Annual Model Summary

Ready to get started with April Health?