Our Methodology
How We Calculate Health Worth
We combine the best available evidence across five dimensions to reveal the true cost of delaying care. That means looking at not just what treatment costs, but what waiting costs.
Transparent. Evidence-based. Unbiased.
Every assumption is visible. Every source is listed.
From Care Delayed to Total Cost
Every delayed decision flows through the same five cost dimensions before arriving at a single, comparable number.
Care Delayed
Future Medical Costs
Additional treatments, hospitalizations, and care that may be needed later. Source basis: CMS and condition-specific literature.
Lost Productivity
Workdays lost, reduced performance, and time needed for recovery. Source basis: Bureau of Labor Statistics.
Quality of Life
Impact on daily living and overall well-being, measured in quality-adjusted life years. Source basis: utility studies and ICER.
Health Outcomes
Probability-weighted risk of complications, disability, or premature death. Source basis: condition-specific clinical literature.
Five-Year Journey Total
A probability-weighted condition estimate using one five-year window; not calculated from a procedure price alone.
The Result
Total Cost of Delay
The true value of getting care now versus paying more later.
Our Principles
Transparent
Every assumption is visible and explainable.
Evidence-Based
We use published research and trusted public data sources.
Conservative
We avoid inflating costs and use defensible assumptions.
Educational
Estimates help you understand tradeoffs - not predict individual outcomes.
Confidence Framework
Every estimate is assigned a confidence rating based on the strength and availability of evidence.
High
Direct, recent, well-matched public data or consistent high-quality evidence.
Moderate
Relevant evidence exists but requires modeling or includes material variability.
Low
Limited evidence, indirect evidence, or substantial assumptions.
Pending validation
Not yet reviewed sufficiently for a confidence rating.
Evidence labels
Plain Language
We believe everyone should understand how these numbers are calculated.
- No jargon
- No fine print
- Just clear explanations
Want the technical details?
Sources & Evidence →
We pull from best-in-class, peer-reviewed research and public datasets.
FAIR Health
Patient cost benchmarks
CMS Transparency in Coverage
(45 CFR 147.211) shoppable services
Bureau of Labor Statistics
Median daily earnings
ICER
Value-per-QALY thresholds ($100k-$150k)
Peer-Reviewed Literature
Condition-specific outcomes research
Utility Studies
QALY decrement research
Federal data cross-checks
These figures come directly from federal datasets and carry a fetch or publication date. They are cached and refreshed on a schedule - never called live on page load - and are kept separate from estimates still pending advisor validation.
Medicare national average payments
Medicare Physician & Other Practitioners - by Geography and Service · CMS Data API · fetched 2026-08-16 · refreshed annually. Used as a federal cross-check alongside hospital-published cash prices, state price data, and clearly labeled modeled planning bands.
- Total knee arthroplasty · HCPCS 27447$1,177.11
- Diagnostic/screening colonoscopy · HCPCS 45378$187.98
- Polysomnography with CPAP titration · HCPCS 95811$241.43
- Laparoscopic cholecystectomy · HCPCS 47562$470.55
- Screening mammography, bilateral · HCPCS 77067$65.2
- Open inguinal hernia repair · HCPCS 49505$450.39
Future-cost trend factor
Our future medical cost figures are grown at 5.8% per year over a 5-year window, using the CMS-projected national health expenditure growth rate rather than an internal assumption.
- Projection window
- 2024-2033
- Published
- 2025
- Last verified
- 2026-08-16
- Next annual review
- 2027-08-01
Interoperability & Data Roadmap
Today, public datasets and imported pricing files are normalized into one traceable model. The roadmap supports FHIR and USCDI+ fields, payer data through Blue Button-style APIs, and trusted exchange through TEFCA—always with consent and source lineage.
Where AI Is—and Is Not—Used
Prices, arithmetic, horizons, and probability weighting are deterministic. AI may turn cited research into plain-language education; it does not invent prices or silently change formulas. New narratives require source review before publication.
Built to Scale
A shared condition schema separates evidence, price inputs, insurance assumptions, and presentation. That lets additional conditions, populations, and data partners use the same five-year rules without rebuilding the product.
Example: Migraine journey (modeled; pending expert validation)
Medical care
Visits and treatment
Varies by journey stage and coverage
Other visible dimensions
- Work and incomeModeled
- Transportation and caregivingModeled
- Daily functionLiterature-derived
- Quality of lifeLiterature-derived
Evidence status
Pending validation
Sources, formulas, and limitations remain visible
FHIR Interoperability: Current Demonstration and Roadmap
Synthetic FHIR ingestion demonstrated. Health Worth does not currently connect to a real payer, provider, EHR, or patient record. Production connectivity will require security, privacy, legal, consent, logging, token-handling, and vendor review.
Available in this demonstration
- • Anonymous estimates remain available without login.
- • A synthetic FHIR ExplanationOfBenefit can be loaded.
- • Selected procedure and adjudication fields are validated and mapped.
- • Imported values are separated from modeled estimates.
- • Source provenance is visible.
- • Imported demonstration data is held only for the active in-browser session.
- • Disconnect clears the active synthetic record.
- • Server-side scaffolding for a future CMS Blue Button sandbox connection uses a protected, encrypted, shared session store with automatic deletion.
Roadmap — not yet implemented
- ROADMAP — NOT YET IMPLEMENTEDPatient-authorized payer authentication
- ROADMAP — NOT YET IMPLEMENTEDLive insurer claims retrieval
- ROADMAP — NOT YET IMPLEMENTEDSMART App Launch authorization
- ROADMAP — NOT YET IMPLEMENTEDProduction Blue Button or CARIN connectivity
- ROADMAP — NOT YET IMPLEMENTEDProvider/EHR clinical-data retrieval
- ROADMAP — NOT YET IMPLEMENTEDUS Core clinical-resource import
- ROADMAP — NOT YET IMPLEMENTEDTEFCA-enabled exchange
- ROADMAP — NOT YET IMPLEMENTEDProduction consent management
- ROADMAP — NOT YET IMPLEMENTEDProduction handling of protected health information
- ROADMAP — NOT YET IMPLEMENTEDPersistent longitudinal record connections
| Capability | Status |
|---|---|
| Anonymous public-data estimate | Available |
| Synthetic FHIR ExplanationOfBenefit import | Demonstrated |
| FHIR field validation and mapping | Demonstrated |
| Field-level provenance | Demonstrated |
| Session-only synthetic-data handling | Demonstrated |
| Shared, auto-expiring server session store | Implemented — sandbox not yet enabled |
| Real payer authentication | Roadmap — not yet implemented |
| Live claims import | Roadmap — not yet implemented |
| SMART App Launch connection | Roadmap — not yet implemented |
| Provider/EHR clinical-data import | Roadmap — not yet implemented |
| Production CARIN Blue Button implementation | Roadmap — not yet implemented |
| TEFCA exchange | Roadmap — not yet implemented |
| Persistent Health Worth patient account | Not part of the initial model |
Ready to explore a condition journey?
See costs, evidence, assumptions, and confidence across a five-year journey.
Explore a Condition Journey