Illustrative policy and research demonstration

What Medical Claims Miss

Medical claims and price files can show services, billed amounts and payments. They generally do not describe every effect illness has on a person's work, transportation, caregiving responsibilities, daily function or quality of life.

Health Worth's shared condition-journey framework demonstrates how these dimensions can be represented alongside medical costs. This page examines the structure of Health Worth's currently published journeys to identify recurring burden categories and evidence gaps.

This is an illustrative analysis of Health Worth's catalog - not a nationally representative study, expenditure estimate or demonstrated policy outcome.

Published condition journeys: 22
With structured lived-experience review records: 5
Analysis generated: 2026-09-22

Methodology · Validation & Impact · Sources

Cross-condition burden matrix

One row per published journey. Every cell shows an evidence status in text. No dollar amounts appear here, and none are combined or compared across conditions.

Search by condition

Burden category

Evidence type

Modeling status

Lived-experience review

Showing 22 of 22 published condition journeys.

Burden representation by published condition journey. Each cell states an evidence status in words; colour is not used to convey status.
Condition	Medical costs	Patient out-of-pocket	Work and income	Transportation	Caregiving	Childcare	Daily function	Quality of life	Diagnostic delay	Cost of waiting	Financial assistance	Lived-experience review	Current validation status
Knee Osteoarthritis	Public-data-derived	Modeled	Modeled	Modeled	Modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Breast Cancer	Public-data-derived	Modeled	Modeled	Modeled	Modeled	Modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Type 2 Diabetes	Public-data-derived	Modeled	Modeled	Modeled	Modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Completed	Lived-experience reviewed; clinical and economic review pending
Obstructive Sleep Apnea	Public-data-derived	Modeled	Modeled	Modeled	Not yet modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Colorectal Cancer	Public-data-derived	Modeled	Modeled	Modeled	Modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Coronary Artery Disease	Public-data-derived	Modeled	Modeled	Modeled	Modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Depression	Public-data-derived	Modeled	Modeled	Modeled	Modeled	Modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Completed	Lived-experience reviewed; clinical and economic review pending
Anxiety	Public-data-derived	Modeled	Modeled	Modeled	Not yet modeled	Modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Throat Cancer	Public-data-derived	Modeled	Modeled	Modeled	Modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Completed	Lived-experience reviewed; clinical and economic review pending
Stomach Cancer	Public-data-derived	Modeled	Modeled	Modeled	Modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Hypertension / High Blood Pressure	Public-data-derived	Modeled	Modeled	Modeled	Not yet modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Obesity	Public-data-derived	Modeled	Modeled	Modeled	Not yet modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Prostate Cancer	Public-data-derived	Modeled	Modeled	Modeled	Not yet modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Lung Cancer	Public-data-derived	Modeled	Modeled	Modeled	Not yet modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Alzheimer's Disease	Public-data-derived	Modeled	Modeled	Modeled	Not yet modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Dementia	Public-data-derived	Modeled	Modeled	Modeled	Not yet modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Lyme Disease	Public-data-derived	Modeled	Modeled	Modeled	Modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
COVID-19	Public-data-derived	Modeled	Modeled	Modeled	Modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Asthma	Public-data-derived	Modeled	Modeled	Modeled	Not yet modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Completed	Lived-experience reviewed; clinical and economic review pending
Migraine	Public-data-derived	Modeled	Modeled	Modeled	Not yet modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Completed	Lived-experience reviewed; clinical and economic review pending
Rheumatoid Arthritis	Public-data-derived	Modeled	Modeled	Modeled	Modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded
Endometriosis	Public-data-derived	Modeled	Modeled	Modeled	Modeled	Not yet modeled	Not documented	Literature-derived	Not documented	Modeled	Public-data-derived	Not documented	No completed review recorded

Legend

Public-data-derived: Built directly from a public government dataset or a publicly published price file.
Literature-derived: Built from published research literature rather than from a transactional dataset.
Modeled: Calculated by Health Worth by combining public inputs with documented assumptions.
Illustrative: Shown to explain a concept; not an estimate for any individual.
Not yet modeled: Health Worth does not currently have enough documented evidence to publish an estimate. It does not mean the burden is zero.
Not applicable: This dimension does not apply to the condition as modeled.
Not documented: No structured record exists for this dimension yet, so no cross-condition claim is made.
Mixed: More than one evidence type contributes to this dimension.

Aggregate findings

Every count is computed from the current catalog and states its denominator.

22 of 22 currently published journeys represent work or income effects.
22 of 22 currently published journeys represent transportation burdens.
12 of 22 currently published journeys represent caregiving burdens.
3 of 22 currently published journeys represent childcare burdens.
Journeys that represent daily-function effects: A reliable cross-condition count is not yet available. The journey schema has no structured daily-function field, so no count is published.
22 of 22 currently published journeys represent quality-of-life effects.
Journeys that represent diagnostic-delay effects: A reliable cross-condition count is not yet available. Diagnostic delay is not captured as a structured field separate from the cost-of-waiting model.
22 of 22 currently published journeys include a cost-of-waiting model.
22 of 22 currently published journeys have a financial-assistance resource configuration.
0 of 22 currently published journeys contain at least one not-yet-modeled stage.
5 of 22 currently published journeys have a structured lived-experience review record.
2 of 22 currently published journeys map to a procedure or claims code.
2 of 22 currently published journeys use public pricing evidence for a mapped procedure.
0 of 22 currently published journeys have a documented clinical review.
0 of 22 currently published journeys have a documented health-economic review.

What medical claims can and cannot show

What claims and price data can contribute

Billed services
Procedure and diagnosis codes, where available
Allowed or negotiated amounts, depending on the source
Payer and patient-responsibility amounts in applicable claims
Timing of services
Historical utilization

What they generally do not capture directly

Missed or reduced work
Unpaid caregiving
Transportation burden
Childcare required to attend care
Reduced daily function
Good-health days lost
Emotional and administrative burden
Difficulty locating financial assistance

Claims and price files remain valuable for the purposes they were designed to serve. Health Worth uses public data, published literature, modeling and lived-experience review to represent some of these additional dimensions, and displays the evidence status and limitations alongside each one.

Evidence-gap analysis

“Not yet modeled” means Health Worth does not currently have enough documented evidence to publish an estimate. It does not mean the burden is zero.

How often each burden category carries each evidence status across the 22 published journeys.
Burden category	Public-data-derived	Literature-derived	Modeled	Not yet modeled	Not documented	Most common status
Medical costs	22	0	0	0	0	Public-data-derived
Patient out-of-pocket	0	0	22	0	0	Modeled
Work and income	0	0	22	0	0	Modeled
Transportation	0	0	22	0	0	Modeled
Caregiving	0	0	12	10	0	Modeled
Childcare	0	0	3	19	0	Not yet modeled
Daily function	0	0	0	0	22	Not documented
Quality of life	0	22	0	0	0	Literature-derived
Diagnostic delay	0	0	0	0	22	Not documented
Cost of waiting	0	0	22	0	0	Modeled
Financial assistance	22	0	0	0	0	Public-data-derived

A missing estimate is a gap in documented evidence, not evidence that the burden does not exist.

Potential applications - not demonstrated policy outcomes

Research prioritization

Recurring not-yet-modeled categories could help identify where better public data or research may be valuable. If caregiving appears across many journeys but frequently lacks defensible estimates, caregiving may warrant additional measurement and research. This analysis alone is not a basis for allocating funding.

Patient-centered data design

An illustrative set of fields a future patient-centered cost-of-illness dataset might include:

Work disruption
Transportation
Caregiving
Childcare
Daily function
Quality of life
Financial assistance needs
Evidence classification
Source provenance
Confidence
Lived-experience-review status

These are illustrative complementary fields. Health Worth is not claiming that they are currently required by federal interoperability standards.

Program and resource planning

Patient organizations, benefits navigators and public programs might use aggregate burden patterns to consider transportation assistance, caregiver support, workplace resources, benefits navigation, medication assistance and charity-care education.

Eligibility, prevalence and local-availability information would be required before using this analysis for actual program decisions.

Pricing-data gaps

Turquoise-derived hospital observations are used where eligible data passes Health Worth's confidence checks. Coverage is limited and is not nationwide.
Other verified state or facility pricing sources are used where available.
CMS federal benchmarks act as the fallback.
Where nothing passes the confidence checks, the result is shown as low-confidence or unavailable rather than being filled in.

A price-data gap does not mean no price exists. It means Health Worth does not currently have a sufficiently reliable source for that result.

Verified Tennessee CPT 73721 example (Turquoise-derived) · CMS-fallback example (ZIP 60601) · Methodology · Sources

Limitations

This analyzes Health Worth's published catalog, not a representative patient population.
Conditions were selected for product development, not statistical sampling.
Evidence strength and review status differ across journeys.
Dollar totals are not compared or combined across conditions anywhere on this page.
Modeled values are not observed patient outcomes.
Clinical and health-economic review remains undocumented unless a specific record says otherwise.
Public datasets may be national or statewide rather than local.
Claims data and price files have different purposes and data semantics.
Additional stakeholder and expert review would be required before policy reliance.
This analysis does not demonstrate that Health Worth has affected policy.
5 of 22 journeys currently have structured lived-experience review records.

Download the aggregate dataset

Catalog-level classifications only. The files contain no dollar estimates, patient data, claims records, CMS sandbox information, synthetic FHIR fields, restricted raw pricing records, survey responses or reviewer information.

Data dictionary for the downloadable files.
Field	Meaning
conditionId	Health Worth journey identifier (slug).
conditionName	Published condition-journey name.
published	Whether the journey is publicly available.
medicalCost	Evidence status for total medical spending in the journey.
patientOutOfPocket	Evidence status for estimated patient responsibility.
workAndIncome	Evidence status for missed or reduced work.
transportation	Evidence status for travel to and from care.
caregiving	Evidence status for unpaid caregiving burden.
childcare	Evidence status for childcare required to receive care.
dailyFunction	No structured field exists yet; always not-documented.
qualityOfLife	Evidence status for health-state utility effects.
diagnosticDelay	No structured field exists yet; always not-documented.
costOfWaiting	Whether a documented cost-of-waiting model exists.
financialAssistance	Whether an assistance-resource configuration exists.
codeMapping	Whether the journey maps to a procedure or claims code.
pricingEvidence	Evidence status of the pricing attached to that mapping.
evidenceTypes	Distinct source categories cited by the journey stages.
unmodeledCategoryCount	Number of journey stages with no publishable estimate.
livedExperienceReview	Status from the centralized validation records.
clinicalReview	Status from the centralized validation records.
healthEconomicReview	Status from the centralized validation records.
validationStatusLabel	Plain-language summary of review status.
generatedOn	Date this artifact was generated in the browser.