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ARKA Clinical Decision Support is designed to meet all four criteria for Non-Device CDS under FD&C Act §520(o)(1)(E) and FDA's January 2026 final guidance on Clinical Decision Support Software. Recommendations support, not replace, the clinician's judgment. Every recommendation is anchored in a published guideline or peer-reviewed source, with the basis available for independent review. CLIN emphasizes imaging appropriateness at order entry.
This recommendation is intended to support, not replace, clinical judgment. It is generated by ARKA, software designed to meet the four criteria for Non-Device Clinical Decision Support under FD&C Act §520(o)(1)(E) and FDA's final guidance on Clinical Decision Support Software (January 2026). The clinician is responsible for the final decision.
ARKA ROI · RISK BUYER · §9 PER ATTRIBUTED LIFE
The same per-attributed-life dollar model as /risk— live sliders by risk arrangement, sourced inputs, figures labelled measured, modeled, or illustrative. Start from a free baseline.
← Back to homeBuyer attribution roster / MSSP assigned beneficiary count
Convergence is the argument — bottom-up utilisation and top-down Medicare literature both land near the same avoidable-spend anchor.
Anchor — avoidable low-value imaging / 100,000 attributed lives / year
Modeled$1,050,000
Product-model avoidable spend normalised to 100,000 lives. Route A and Route B both converge near this figure at defaults.
Retained PMPM
Modeled$0.44
Modeled avoided spend
Modeled$1,050,000
Sensitivity (low · base · high DiD)
Modeled$875,000 · $1,050,000 · $1,225,000
6.0 pp (trial midpoint)
1.00×
12 months
Calibrated measured pool: $4.2M low-value imaging per 100,000 attributed lives (Vol III §9.1 Route A). Expected reduction defaults to the trial difference-in-differences (~6 pp), never the raw within-arm drop — the control arm fell 11 points on secular trend alone. Figures are labelled measured, modeled, or illustrative.
Modeled for 100,000 attributed lives under the Vol III §9 per-attributed-life model. Each figure carries a provenance chip — measured, modeled, or illustrative.
~$1M
Modeledavoidable low-value imaging / yr per 100,000 attributed lives
Vol III §9.1 two-route derivation via computeDollarModel — Route A and Route B both land near $1M.
50–75%
Modeledof avoided spend retained under Shared Savings Program tracks
MSSP BASIC Level E 50%; Enhanced up to 75% — Vol III §9.2.
Zero
MeasuredEHR integrations for the first product
Modules 1–2 run on a claims extract; architectural guarantee.
$525K
Modeledretained by buyer / yr at 50% MSSP track (100k lives)
modeledAvoidedSpend × sharedSavingsRetentionRate from the §9 dollar model.
Each lever below is a modeled projection under the assumptions in the next section — see the full ROI methodology for how each is computed.
Modeled avoided spend: $1.05M / yr · retained by buyer: $525K
Each input is tagged Measured (from a cited study), Modeled (an ARKA projection), or Illustrative (an operator-adjustable planning input). Full derivations live in the ROI methodology.
Claims-based LVC pool at Medicare allowed for 100,000 attributed lives (Route A calibration).
DiD-bounded reduction (5–7 pp), never the raw within-arm drop — Vol III §5.1.
Buyer retention at MSSP BASIC Level E (50%); Enhanced tracks retain up to 75%.
Modules 1–2 run on a claims extract. If you stop, you stop sending a file — no schema residue.
Priced at ~$0.30–$0.50 PMPM — a modeled ~2.3× first-year return.
ModeledModeled ARKA annual cost ($228K) vs. retained by buyer ($525K) at ~2.3× return on retained shared savings.
~$1M avoidable low-value imaging per 100,000 attributed lives (modelled, two derivations).8
Vol III §9.1 ↗1. Change Healthcare 2020 Denials Index
86% of denials are potentially avoidable; 34% are unequivocally avoidable; ~48% of avoidable denials are never recovered.
https://www.rivethealth.com/blog/denials-revenue-cycle-management2. KFF — ACA Marketplace claims denials & appeals (2023)
HealthCare.gov insurers denied ~19–20% of in-network claims; consumers appealed fewer than 1% of denials; 56% of appealed denials were upheld.
https://www.kff.org/private-insurance/claims-denials-and-appeals-in-aca-marketplace-plans-in-2023/3. MGMA / Change Healthcare — cost to rework a denied claim
~$25 average administrative cost to rework a claim; up to ~$118 fully loaded; MGMA estimates 50–65% of denials are never reworked.
https://www.mgma.com/mgma-stats/6-keys-to-addressing-denials-in-your-medical-practice-s-revenue-cycle4. CAQH Index (2023 / 2024)
Manual prior authorization costs providers ~$10.97 per transaction and ~24 minutes of staff time; full electronic PA cuts cost and time dramatically.
https://www.caqh.org/hubfs/43908627/drupal/2024-01/2023_CAQH_Index_Report.pdf5. AMA 2024 Prior Authorization Physician Survey
Practices complete ~39 prior authorizations per physician per week; physicians and staff spend ~13 hours/week on PA; 94% of physicians report PA delays care; 78% report patients abandon treatment.
https://www.ama-assn.org/practice-management/prior-authorization/exhausted-prior-auth-many-patients-abandon-care-ama-survey6. Johns Hopkins — commercial vs. Medicare radiology prices (2021)
Median commercial price for MRI brain w/wo contrast ~$1,788 (4x Medicare $446); CT head w/o contrast ~$813 (5.9x Medicare $137).
https://hub.jhu.edu/2021/12/13/radiological-services-compared-to-medicare/7. HHS OIG — Medicare Advantage prior-authorization denials
Among denied payment requests reviewed, ~18% met Medicare coverage and billing rules — i.e., were improperly denied.
https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf8. Meeker et al. JAMA 2016 — behavioural interventions RCT
Difference-in-differences 5–7 percentage points for peer comparison and accountable justification; control fell 11.0 pp on secular trend alone.
https://pubmed.ncbi.nlm.nih.gov/26864410/Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes. Aggressive case ≈ 1.5× the conservative figures.
ARKA Clinical Decision Support is designed to meet all four criteria for Non-Device CDS under FD&C Act §520(o)(1)(E) and FDA's January 2026 final guidance on Clinical Decision Support Software. Recommendations support, not replace, the clinician's judgment. Every recommendation is anchored in a published guideline or peer-reviewed source, with the basis available for independent review. CLIN emphasizes imaging appropriateness at order entry.
This recommendation is intended to support, not replace, clinical judgment. It is generated by ARKA, software designed to meet the four criteria for Non-Device Clinical Decision Support under FD&C Act §520(o)(1)(E) and FDA's final guidance on Clinical Decision Support Software (January 2026). The clinician is responsible for the final decision.
ARKA ROI · RISK BUYER · §9 PER ATTRIBUTED LIFE
The same per-attributed-life dollar model as /risk— live sliders by risk arrangement, sourced inputs, figures labelled measured, modeled, or illustrative. Start from a free baseline.
← Back to homeBuyer attribution roster / MSSP assigned beneficiary count
Convergence is the argument — bottom-up utilisation and top-down Medicare literature both land near the same avoidable-spend anchor.
Anchor — avoidable low-value imaging / 100,000 attributed lives / year
Modeled$1,050,000
Product-model avoidable spend normalised to 100,000 lives. Route A and Route B both converge near this figure at defaults.
Retained PMPM
Modeled$0.44
Modeled avoided spend
Modeled$1,050,000
Sensitivity (low · base · high DiD)
Modeled$875,000 · $1,050,000 · $1,225,000
6.0 pp (trial midpoint)
1.00×
12 months
Calibrated measured pool: $4.2M low-value imaging per 100,000 attributed lives (Vol III §9.1 Route A). Expected reduction defaults to the trial difference-in-differences (~6 pp), never the raw within-arm drop — the control arm fell 11 points on secular trend alone. Figures are labelled measured, modeled, or illustrative.
Modeled for 100,000 attributed lives under the Vol III §9 per-attributed-life model. Each figure carries a provenance chip — measured, modeled, or illustrative.
~$1M
Modeledavoidable low-value imaging / yr per 100,000 attributed lives
Vol III §9.1 two-route derivation via computeDollarModel — Route A and Route B both land near $1M.
50–75%
Modeledof avoided spend retained under Shared Savings Program tracks
MSSP BASIC Level E 50%; Enhanced up to 75% — Vol III §9.2.
Zero
MeasuredEHR integrations for the first product
Modules 1–2 run on a claims extract; architectural guarantee.
$525K
Modeledretained by buyer / yr at 50% MSSP track (100k lives)
modeledAvoidedSpend × sharedSavingsRetentionRate from the §9 dollar model.
Each lever below is a modeled projection under the assumptions in the next section — see the full ROI methodology for how each is computed.
Modeled avoided spend: $1.05M / yr · retained by buyer: $525K
Each input is tagged Measured (from a cited study), Modeled (an ARKA projection), or Illustrative (an operator-adjustable planning input). Full derivations live in the ROI methodology.
Claims-based LVC pool at Medicare allowed for 100,000 attributed lives (Route A calibration).
DiD-bounded reduction (5–7 pp), never the raw within-arm drop — Vol III §5.1.
Buyer retention at MSSP BASIC Level E (50%); Enhanced tracks retain up to 75%.
Modules 1–2 run on a claims extract. If you stop, you stop sending a file — no schema residue.
Priced at ~$0.30–$0.50 PMPM — a modeled ~2.3× first-year return.
ModeledModeled ARKA annual cost ($228K) vs. retained by buyer ($525K) at ~2.3× return on retained shared savings.
~$1M avoidable low-value imaging per 100,000 attributed lives (modelled, two derivations).8
Vol III §9.1 ↗1. Change Healthcare 2020 Denials Index
86% of denials are potentially avoidable; 34% are unequivocally avoidable; ~48% of avoidable denials are never recovered.
https://www.rivethealth.com/blog/denials-revenue-cycle-management2. KFF — ACA Marketplace claims denials & appeals (2023)
HealthCare.gov insurers denied ~19–20% of in-network claims; consumers appealed fewer than 1% of denials; 56% of appealed denials were upheld.
https://www.kff.org/private-insurance/claims-denials-and-appeals-in-aca-marketplace-plans-in-2023/3. MGMA / Change Healthcare — cost to rework a denied claim
~$25 average administrative cost to rework a claim; up to ~$118 fully loaded; MGMA estimates 50–65% of denials are never reworked.
https://www.mgma.com/mgma-stats/6-keys-to-addressing-denials-in-your-medical-practice-s-revenue-cycle4. CAQH Index (2023 / 2024)
Manual prior authorization costs providers ~$10.97 per transaction and ~24 minutes of staff time; full electronic PA cuts cost and time dramatically.
https://www.caqh.org/hubfs/43908627/drupal/2024-01/2023_CAQH_Index_Report.pdf5. AMA 2024 Prior Authorization Physician Survey
Practices complete ~39 prior authorizations per physician per week; physicians and staff spend ~13 hours/week on PA; 94% of physicians report PA delays care; 78% report patients abandon treatment.
https://www.ama-assn.org/practice-management/prior-authorization/exhausted-prior-auth-many-patients-abandon-care-ama-survey6. Johns Hopkins — commercial vs. Medicare radiology prices (2021)
Median commercial price for MRI brain w/wo contrast ~$1,788 (4x Medicare $446); CT head w/o contrast ~$813 (5.9x Medicare $137).
https://hub.jhu.edu/2021/12/13/radiological-services-compared-to-medicare/7. HHS OIG — Medicare Advantage prior-authorization denials
Among denied payment requests reviewed, ~18% met Medicare coverage and billing rules — i.e., were improperly denied.
https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf8. Meeker et al. JAMA 2016 — behavioural interventions RCT
Difference-in-differences 5–7 percentage points for peer comparison and accountable justification; control fell 11.0 pp on secular trend alone.
https://pubmed.ncbi.nlm.nih.gov/26864410/Modeled, conservative estimate. ARKA is Non-Device CDS — figures are decision-support economics, not a guarantee of outcomes. Aggressive case ≈ 1.5× the conservative figures.