Opportunity Dashboard · Working numbers
Where the money is actually leaking.
Six of the biggest, most fixable dollar leaks at a behavioral-health facility: vendor spend (RCM fees, denials, in-house tox margin), staffing drag, patient navigation, marketing amplification, labs (price compression + over-utilization), and pharmacy (340B capture + generic dispensing). Move the sliders. The math and the sources are open.
Reimbursement index 1.00× · labor heat 1.00× · target CPA $1,200
RCM 4.25% · denials 8% · turnover 30% · conv 30% · alumni contact 60%
Vendor Spend Leakage
Benchmark for this cohort: 4.25%. Third-party BH billers commonly 6–8%.
Cohort target: 8%. BH averages run 15–20% (Change Healthcare, KFF).
Facility-side margin after your current lab partner takes its cut.
Staffing Drag
Cohort bench: 30%/yr. BH tech typically runs 40–60% (SAMHSA).
Recruit + onboard + 60–90 days productivity dip. BH tech range ~$3–5K.
Premium over fully-loaded W-2 cost — typically 50–100%.
Patient Navigation Gaps
Cohort bench: 30%. BH median 15–20%; BIC 28–35%.
Net collections per completed episode of care, blended across LOCs.
Cohort bench: 60%. Strong alumni programs run 55–70%.
Marketing Amplification
BH digital CPA commonly runs $1,500–$4,500 depending on LOC and market.
Locale suggestion: $1,200. Blended $800–$1,500 realistic in most markets.
Labs — Price & Utilization
Definitive / GC-MS panels sent to a reference lab after a POC screen.
Cohort target: $42. Out-of-network runs $120–$250; PAMA / in-network commercial $30–$70.
Cohort target: 40%. Most operators run 70–90%; defensible utilization is 30–50%.
Pharmacy — 340B & Formulary
MAT (buprenorphine, naltrexone, Vivitrol) + adjunctive psych meds.
Share of spend attributable to patients / conditions eligible under 340B rules.
Cohort target: 88%. Most SUD operators leave meaningful $ on the table here.
Cohort target: 90%. National avg ~90%.
Illustrative annualized recoverable dollars at the current slider positions. Typical 90-day quick-win capture is 40–60% of this figure; the rest is follow-on.
Sources & assumptions
- BH claim denial rates: Change Healthcare Revenue Cycle Denials Index; KFF payer claims data.
- Third-party BH billing fees: MGMA / industry surveys — best-in-class 3.5–5%, common 6–8%.
- Toxicology margin: in-network partner lab arrangements typically recover 30–60% of UA panel markups vs. current facility net.
- Staffing: SAMHSA behavioral-health workforce reports; replacement cost ranges from SHRM + BH operator interviews.
- Denial recovery multiplier (40% of extra denials × 55% margin) is conservative — real recovery varies by payer and appeal discipline.
- Inquiry-to-admit conversion benchmarks from BH operator surveys; alumni contact-to-referral factor kept conservative at 2%.
- Digital CPA ranges from Recovery.com / operator ad-account benchmarks; blended target assumes brand + alumni-referral share lift.
- Lab pricing: CMS PAMA Clinical Lab Fee Schedule (definitive drug testing); OIG toxicology utilization reports on over-testing.
- Pharmacy 340B: HRSA program guidance; SAMHSA covered-entity analyses. 30% acquisition discount is a conservative blended assumption.
- Generic dispensing: AAM Generic Drug Access & Savings Report (national ~90% GDR).
Public planning tool — figures are illustrative estimates, not quotes. Every facility differs; use this as a starting point for the conversation.