ROI in Healthcare Explained: Metrics, Challenges, and Impact

The journey of healthcare innovation is fueling demands for measurable outcomes. 

ROI in healthcare has never been more critical; institutions must justify every investment with data. 

Let us explore how understanding return on investment can transform patient care and financial sustainability in the modern digital healthcare landscape worldwide.

Healthcare systems today operate under tight budgets and high expectations. Return on Investment (ROI) in healthcare has become a key concept for providers and policymakers who must demonstrate that new programs or technologies improve outcomes and value. 

In the United States, which spends 17.6% of GDP on health – experts note a “strikingly disappointing ROI” compared to other developed nations. (Source: gjia) 

With digital health and AI reshaping medicine, decision-makers from the US to the UAE and India ask: what is ROI in healthcare, and how can we measure it? 

This article reviews the formal definition of ROI in healthcare, explains how to calculate it, surveys benchmarks (including what is a good ROI in healthcare), and highlights processes (like the ROI process in US healthcare). 

We also cover digital health ROI and AI in healthcare ROI, present real case studies, and discuss challenges and future trends.

What is ROI in Healthcare?

ROI in healthcare generally refers to the financial and clinical value derived from investments in healthcare programs or technologies. 

Formally, ROI is the ratio of net benefits to costs: (financial benefits – costs) ÷ costs, expressed as a percentage or ratio. (Source: outofpocket). 

For example, if a new telehealth platform yields $200,000 in cost savings and generates $200,000 in new revenue for a $100,000 investment, the ROI is ($400,000–$100,000)/$100,000 = 300% (or 3:1). 

However, healthcare ROI goes beyond dollars: it often includes cost avoidance and improved outcomes. 

A systematic review found that ROI in healthcare quality programs is viewed as “value or benefit” from combined outcomes for patients and stakeholders. (Source: springer) 

In practice, ROI in healthcare analyses varies: some focus only on fiscal savings (avoided costs), while others monetize broader benefits (better health, lives saved). (Source: pmc) 

For instance, public health interventions can yield extraordinary ROI – a review of 34 studies found that every $1 spent on public health saves about $14 in healthcare and social costs. (Source: pew) 

This wide range shows that ROI in healthcare must be carefully defined and contextualized.

Importance of Measuring ROI in Healthcare

Measuring ROI in healthcare is vital for justifying investments and guiding strategy. 

Providers and payers face resource constraints and must select projects that improve care quality and efficiency. 

For example, telehealth programs require high upfront costs but promise lower ER visits and travel burdens; to convince funders, health systems must quantify their return on investment. 

As one industry expert puts it, proving ROI is crucial to “vouch for the use of scarce resources” in any healthcare budget. 

Indeed, CMS data reveal that US health spending has skyrocketed (now ~$4.9 trillion), yet outcomes like life expectancy lag behind other nations. Such inefficiency underscores the need to measure value.

Beyond finances, ROI measurement aligns with broader goals. Leaders increasingly include clinical outcomes and patient impact in ROI. 

A recent survey found that over half of hospital executives rank “improved patient outcomes” as the top ROI metric for digital health investments. (Source: seniorexecutive) 

In other words, a project’s “return” may be reflected in lives saved or quality improvements, not just profit. 

For example, AI tools that accelerate stroke care can improve patient survival and generate downstream revenue (see Case Study: OSF HealthCare below). 

Measuring ROI also drives accountability: hospitals tying program performance to ROI can reduce readmissions and inefficiencies.

In summary, understanding what is ROI in healthcare helps organizations focus on value – blending financial returns with improved care. 

It supports evidence-based decisions across regions (from Canada’s cost-effectiveness mandates to India’s growing private sector) and ensures that investments yield real benefits to patients and the healthcare system.

How to Calculate ROI in Healthcare?

Calculating ROI in healthcare follows the basic financial formula, but requires careful identification of costs and benefits. 

The classic formula:

ROI (%) = (Total Financial Benefits – Total Costs) / Total Costs × 100%

Costs include all investment outlays (capital, equipment, staff training) and ongoing expenses. Benefits can be direct (e.g. additional revenue, reduced hospital costs) or indirect (avoided ER visits, faster throughput, better patient outcomes). 

For example, an RPM (remote patient monitoring) hypertension program at NYU Langone tallied costs (devices, personnel) against reimbursements and estimated avoided treatment costs.

When calculating ROI:

• Define the time horizon (short-term vs multi-year impact). Long-term benefits (like prevented heart attacks) may take years to realize.
• Include all relevant returns: e.g., increased patient volume, better billing, and also intangible gains (fewer complications, higher patient satisfaction). Senior executives note that ROI in healthcare often incorporates nonfinancial value such as patient trust and quality metrics.
• Use net present value (NPV) if costs and savings occur at different times (discount future benefits).
• Estimate conservatively and conduct sensitivity analyses. The NYU RPM study found ROI could vary widely (from –11% to +93% per patient) depending on compliance and costs.

In practice, the steps are listed below:

1. Identify Costs: Purchase prices, implementation, training, maintenance.
2. Identify Benefits: Quantifiable savings (reduced readmissions, staffing costs) and revenue (new patients served).
3. Calculate Net Return: Subtract costs from benefits.
4. Compute ROI: Divide net return by initial cost. Express as percentage or ratio (e.g. 150% ROI = 1.5× return).
5. Interpret: ROI > 0% means net gain; often, organizations look for ROI well above break-even to justify risk.

Importantly, healthcare ROI calculations often include quality-adjusted measures. 

For example, tele-ICU programs have been evaluated in terms of cost per quality-adjusted life year, showing tele-ICU is cost-effective at roughly $45,000 per QALY, well below the $100,000 threshold. (Source: intercepttelehealth) 

Combining financial ROI with clinical value gives a more complete picture of a project’s impact.

Key Metrics and Benchmarks of ROI in Healthcare

When measuring ROI in healthcare, several key metrics and benchmarks are used to gauge performance.

• ROI Percentage or Ratio: Core return metric, often targeting 150%–200%.
  Example: Healthcare tech clients reported 150%–250% ROI over three years.
• Payback Period: The time required to recover the investment costs.
  Example: The public health system recouped costs within 5 years.
• Net Present Value (NPV): Present value of benefits minus total costs.
  Example: Positive NPV indicates added organizational value.
• Break-Even Point: When cumulative gains equal total project costs.
  Example: A shorter break-even period improves the overall risk profile.
• Clinical and Utilization Metrics: Measures care quality and usage.
  Example: A Telehealth study showed no rise in follow-ups or prescriptions.
• Quality-Adjusted Metrics: Cost per QALY or similar value measures.
  Example: Tele-ICU increased QALYs at lower-than-typical costs.
• Industry Benchmarks: ROI expectations vary by project type.
  Example: Healthcare IT targets 1.5×–3× ROI, public health up to 20×.
• Qualitative Benchmarks: Tracks non-financial success indicators.
  Example: Over half of hospital leaders prioritize patient outcomes.

Key takeaway: There is no single “good” ROI in healthcare. Generally, any ROI above 0% indicates cost-effectiveness, and higher is obviously better. Policymakers have observed that population health and prevention often far exceed basic medical interventions in ROI. 

What is a Good ROI in Healthcare?

Defining what is a good ROI in healthcare depends on the context. In business terms, any ROI above 100% (i.e. doubling the investment) is attractive. 

Healthcare projects often set a minimum break-even ROI (100%) and target 200–300% ROI to account for risk and nonquantifiable benefits. 

For example, an AI revenue cycle tool (AuthAway) achieved 150%–250% ROI in practice, which was viewed as excellent.

However, benchmarks across domains indicate that some health investments are far more lucrative. 

Preventive and public health initiatives routinely achieve very high ROI: multiple studies show $1 invested can save $10–$20 (or more) in future healthcare costs. 

Similarly, infrastructure projects like electronic reporting had 142% ROI with full payback in ~5 years. 

In contrast, complex clinical systems (EHRs, new devices) often yield more modest ROIs. The NYU Langone RPM program, for instance, saw an average ROI of only 22.2% (net $1.22 per $1) at 55% patient compliance – positive, but not massive.

Industry analysts suggest aiming for at least a positive ROI (≥100%) for new initiatives, while noting that ROI in healthcare should not be viewed purely financially. 

A “good” ROI may include qualitative gains. The BMC systematic review of healthcare quality programs argued that ROI is properly seen as “value or benefit” from improved outcomes. 

In sum, stakeholders often expect quick break-even (1–3 years) and incremental ROI beyond. Projects yielding ROI in the 2:1 to 3:1 range are usually considered solid, especially if they also improve quality.

In practice, what counts as “good” ROI varies by stakeholder.

• Hospitals may target ROI sufficient to satisfy administrators and investors, often in consultation with CFOs.
• Insurers and government agencies (e.g. NHS, CMS) may look at ROI in terms of cost-effectiveness thresholds (like cost per QALY) rather than raw return.
• Payers moving to value-based payments will judge ROI partly on patient outcomes (again echoing the survey that outcomes are a top metric).

Ultimately, a good ROI in healthcare is one that justifies the investment given the alternatives.

For example, if a telemedicine program saves $2 for every $1 spent while also improving access, most stakeholders would consider that a strong ROI. 

By contrast, an ROI below break-even might be acceptable if the project is mandatory (e.g., regulatory compliance) or leads to long-term strategic gains.

The ROI in Healthcare Process in the US

In the United States, the ROI process often involves rigorous analysis aligned with value-based care goals. 

Proposals for new technologies or programs must fit into existing strategic frameworks and payment models. 

Industry experts advise that any healthcare ROI pitch should address five key questions.

• Does the project solve an identified problem for the organization?
• How does it align with payment and reimbursement models?
• Can it integrate into current workflows/EHR?
• How will it engage patients and providers?
• What is the clear ROI?

This ROI process in U.S. healthcare reflects the system's complexity. 

For example, a health system’s telehealth ROI analysis (Intermountain Healthcare) considered costs across its insurer (SelectHealth) and clinics, comparing 21-day episode costs for virtual vs. in-person urgent care. (Source: amwell) 

The result showed that virtual care episodes cost significantly less overall (with “substantial opportunity for cost savings”), and importantly, shifting patients online did not increase follow-up rates. 

In other words, the ROI process included both financial claims data and clinical follow-up metrics.

In summary, the ROI process in US healthcare typically involves multidisciplinary review. 

It requires linking cost data with expected clinical outcomes, understanding the payer landscape, and articulating both quantitative ROI (financial return) and qualitative ROI (better care). 

Digital ROI in Healthcare: Impact and Examples

“Digital health” – including telemedicine, mobile apps, and health IT – has become a major area of investment. 

Measuring digital health ROI entails examining both financial returns and improvements in access and quality. 

For example, implementing an electronic health record (EHR) system entails substantial costs, but studies have shown that it can reduce inpatient costs. 

One analysis found an average 6% reduction in patient-care costs after hospitals adopted EHRs. 

Over tim,e this can translate into large financial ROI for health systems, even though the ROI may accrue gradually.

Telemedicine and Cost Savings Through Virtual Care

Telehealth provides a clear case of digital ROI. Intermountain Healthcare’s Connect Care virtual urgent clinic reduced costs per episode dramatically, since tele-visits eliminated many expensive in-person procedures. 

Their analysis showed that directing appropriate cases to virtual care “saves lower overall health plan cost” without raising follow-up visits or antibiotic use. 

In practical terms, shifting non-emergency cases online reduced the cost of care episodes for the health plan. 

Although exact dollar ROI wasn’t given, this confirms that digital substitution can generate savings.

Another domain is remote patient monitoring. The NYU Langone RPM for hypertension not only improved blood pressure control but also delivered positive ROI. 

Their study calculated a 22.2% ROI (i.e. $1.22 return per $1 invested) at typical patient compliance. 

This shows that RPM, a digital service, can be financially sustainable in a large hospital system.

Here are some illustrative examples of digital health ROI 

• Electronic Health Records: A multi-hospital study found 6% lower inpatient costs post-EHR implementation, reflecting savings from fewer redundant tests and errors. (Source: phraze)
• Telemedicine: Intermountain Healthcare found that urgent care via telehealth cost substantially less per episode than in-person, implying significant cost savings.
• Remote Monitoring: The NYU Langone hypertension program achieved 22.2% ROI, validating the financial case for RPM.
• Digital Screening Tools: (See case study below on Mount Sinai)

These examples show that digital health ROI is realized through efficiency gains and avoided costs, as well as revenue (new patients, higher reimbursement) in some models. 

Importantly, the impact often extends beyond finances. Telehealth and apps also deliver ROI in access and patient satisfaction – factors that drive longer-term financial performance (e.g. retaining insured members, preventing expensive complications).

AI in Healthcare ROI: Promises and Pitfalls

Artificial Intelligence offers great promise for ROI in healthcare, but it comes with challenges. 

AI tools can automate workflows (e.g. revenue cycle, image analysis), often yielding fast financial returns once deployed.

For example, one healthcare AI product claims 5:1 ROI on day 1, finding hidden revenue opportunities. In clinical care, AI has delivered concrete ROI: an AI imaging platform at OSF HealthCare contributed an estimated $2.6 million in additional annual revenue by identifying more stroke patients who needed treatment. (Source: healthcareitnews). 

Likewise, Mount Sinai’s in-house malnutrition detection AI generated about $20 million in revenue impact by improving inpatient nutrition care. (Source: beckershospitalreview) 

These high-dollar figures illustrate how AI can turn clinical insights into financial returns.

However, achieving ROI with AI requires overcoming several hurdles. 

AI projects often demand up-front investment in data and infrastructure, and their benefits can be diffuse. 

Data must be integrated into clinical workflows; clinicians need to trust and act on AI recommendations. 

Many experts argue that ROI for AI (and digital health in general) should account for both financial and clinical benefits. 

For instance, the Senior Executive Think Tank emphasizes that “true ROI isn’t only return on investment – it’s return on impact,” meaning real improvements in care quality are part of the equation.

Common pitfalls 

• Overstating benefits: Vendors may hype AI outcomes. Hospitals should pilot rigorously (as OSF did) and measure actual changes in volumes or cost.
• Integration costs: If an AI requires new processes or systems, its ROI calculation must include those hidden costs.
• Limited evidence: Some AI tools (e.g. clinical decision support) lack long-term ROI studies. Organizations must set realistic expectations.

Ultimately, AI in healthcare has shown that substantial ROI can be achieved, especially when the focus is on both efficiency and patient outcomes. 

The case studies below illustrate successful AI ROI. But decision-makers should measure results carefully and remember that ROI often includes improved outcomes and workflow, not just dollars saved.

Case Studies

OSF HealthCare – AI-Enhanced Stroke Care

Problem: OSF HealthCare (Midwest US health system) faced delays and variability in stroke diagnosis across its hospitals. Limited ICU capacity and staffing shortages made it critical to identify stroke patients quickly and consistently. Variations in imaging interpretation risked poor outcomes and unnecessary transfers.

Solution: OSF deployed an AI-driven imaging platform (RapidAI) system-wide. The AI analyzes CT scans for stroke indicators (bleeds, clots) and integrates with their existing EHR. It provides fast, standardized alerts to clinicians 24/7, streamlining triage and transfer decisions. This “AI virtual assistant” enabled rapid, consistent case review, even after hours, without new staff.

Results: The AI initiative markedly increased diagnosis and treatment volumes:

• +17% more intracranial hemorrhage (ICH) patients identified per month.
• +34% more ICH procedures performed system-wide.
• Despite a 9% drop in ER visits, +155% increase in ischemic stroke diagnoses.
• +347% increase in mechanical thrombectomy procedures.
• 111 additional thrombectomies/year, translating to ~$2.6 million in extra revenue.

By using AI to improve clinical decision-making, OSF achieved better patient outcomes and a clear ROI. The $2.6M revenue gain (on presumably modest AI investment) demonstrates substantial financial return. 

The project underscores what is ROI in healthcare when AI amplifies diagnostic accuracy – it’s both improved care and strengthened financial sustainability.

Source: Healthcare IT News

Mount Sinai Health System – AI-Driven Nutrition Screening

Problem: Mount Sinai (NYC) identified malnutrition in hospitalized patients too late. Missing this condition leads to longer stays and lost reimbursement, impacting both patient health and hospital revenue.

Solution: An interdisciplinary team developed an internal AI model that scans patient data to flag malnutrition risk. The AI integrates with Mount Sinai’s EHR and proactively alerts clinicians to perform nutrition interventions early. The project was built in-house using patient data and adopted by the clinical nutrition team.

Results: The nutrition AI tool significantly improved case capture and financial outcomes:

• Detected hundreds of at-risk patients earlier, enabling timely intervention (quantities not disclosed).
• Generated approximately $20 million in additional revenue impact through better documentation and care of malnourished patients.
• (Note: Revenue impact from improved coding and avoided penalties rather than direct billing.)

By automating malnutrition detection, Mount Sinai turned clinical insights into financial return. The $20M ROI reflects better compliance with coding rules and improved patient care. 

This example highlights what is a good ROI in healthcare for a relatively small investment: achieving tens of millions in value from AI-based clinical suppor

Source: Becker’s Hospital Review 

NYU Langone Health – Remote Hypertension Monitoring

Problem: At NewYork-Presbyterian/NYU Langone, many cardiology patients had uncontrolled high blood pressure, risking complications and hospitalizations. Traditional in-office follow-ups were insufficient to manage this chronic condition effectively.

Solution: The Cardiology Division implemented a Remote Patient Monitoring (RPM) program for hypertension (RPM-HTN). They enrolled 100 patients, providing home blood pressure devices and an app to send readings to clinicians. A nurse practitioner monitored the data weekly and adjusted treatment as needed, with cardiologist oversight. This digital program aimed to improve control without extra clinic visits.

Results: A formal ROI analysis of NYU’s RPM-HTN program showed:

• ROI is 22.2% on average, corresponding to approximately $1.22 in returns per $1 invested (at 55% patient compliance).
• ROI ranged from –11.1% to +93.3% per patient depending on program costs (e.g. high vs low staff time).
• Department-level ROI was ~19.5% in the base case scenario.
• Overall, the program achieved positive ROI, indicating financial sustainability.

In this case, the digital health investment yielded more than its cost back (a 22% gain), even without counting longer-term health benefits. 

These results helped justify scaling the RPM program. They also illustrate how to calculate ROI in healthcare by incorporating reimbursements (via billing codes) and avoided costs of uncontrolled hypertension.

Source: JMIR Cardio (NYU study).

Challenges in Measuring Healthcare ROI

Measuring ROI in healthcare is complex due to long timelines, mixed outcomes, and inconsistent evaluation methods. These challenges make it difficult to compare projects and fully capture their true value.

Defining and Quantifying Benefits: Identifying what counts as a benefit is often unclear and inconsistent.

• Some ROI studies count only direct cost savings.
• Others include monetized health benefits like lives saved.
• Different definitions make cross-project comparisons difficult.

Long and Uneven Time Horizons: Healthcare benefits often emerge over extended periods.

• Many benefits accrue years after implementation.
• Short ROI windows may understate true value.
• Long-term gains like prevented strokes are often excluded.

Non-Financial Benefits Are Often Missed: Important outcomes are difficult to express in monetary terms.

• Patient satisfaction and quality of life are rarely monetized.
• Staff morale and workflow improvements are often excluded.
• ROI is frequently conceptualized as broader “value or benefit.”

Methodological Inconsistencies: Differences in ROI calculation methods reduce comparability.

• Studies vary in included costs and benefits.
• ROI figures cannot always be benchmarked directly.
• Reports must be interpreted cautiously due to assumptions.

Implementation and Adoption Risks: ROI depends heavily on real-world usage and engagement.

• Patient compliance strongly influences financial outcomes.
• ROI can swing widely based on adherence levels.
• Low adoption can cause otherwise sound investments to fail.

Because of these challenges, experts recommend triangulating ROI findings with other indicators. 

Financial ROI is only part of the picture; qualitative outcomes and strategic alignment are also important.

Future of Healthcare ROI

The concept of ROI in healthcare is evolving alongside technology and payment reform. 

Future ROI assessments will likely adopt a holistic view that blends financial returns with health impact. 

According to thought leaders, traditional ROI (headcount reductions or cost savings) is “no longer sufficient”. 

Instead, value will be measured by clinical outcomes, adoption, and even social impact. As one expert puts it, the next phase of healthtech ROI will include “patient trust and sustainable adoption” in addition to dollars.

Emerging trends suggest the future of healthcare ROI will feature:

• Value-Based Metrics: Greater emphasis on ROI in terms of population health and value-based care results. For instance, tying ROI to reductions in readmissions or improvements in chronic disease control.
• Real-Time Data: Use of analytics and dashboards to track ROI continuously. For example, automated reporting could show in real-time how an AI tool affects throughput and costs.
• Global Perspectives: ROI calculations may incorporate global benchmarks. Developing countries and emerging markets (India, MENA) will adapt ROI frameworks to their needs, often focusing on scalable, high-impact interventions like telemedicine.
• Patient-Centric ROI: Future ROI may explicitly include patient and clinician satisfaction as quantifiable metrics. Surveys indicate that satisfaction and engagement are already key value indicators for digital health purchasers.
• AI and Predictive ROI: As artificial intelligence matures, predictive models may estimate ROI before implementation. Early adopters of ML tools (e.g., for scheduling and imaging) are beginning to estimate their own ROI using historical data.

One forward-looking analysis refers to ROI in healthcare as “return on impact,” emphasizing improvements in human well-being alongside financial gains. 

This multidisciplinary view means executives will need to define ROI using new frameworks and convince stakeholders of value both in accounts and outcomes. 

It also means that achieving ROI will increasingly depend on integration (seamless EHR/EHR interoperability) and equity (ensuring technology benefits all populations).

In sum, the future of healthcare ROI will reward investments that both optimize costs and drive measurable patient benefit. 

Executives who learn to quantify ROI across these dimensions will be better positioned to fund innovation and sustain high-quality care.

Conclusion: Why Digital Health ROI Matters for Modern Healthcare Systems

Return on investment in healthcare is a critical lens for evaluating any major initiative – from digital transformations to clinical programs. 

ROI in healthcare combines financial returns with value improvements (patient outcomes, access, efficiency). By carefully calculating ROI (considering both costs and benefits), organizations can make informed decisions. 

While the acceptable ROI in healthcare varies by project, a positive ROI generally indicates more efficient resource utilization and is often associated with improved care.

Digital health and AI present huge ROI potential, as illustrated by real-world cases (e.g., OSF HealthCare’s $2.6M AI boost). 

Yet they also demand rigorous analysis and realistic expectations. Many challenges – such as measuring intangible benefits and aligning incentives – make ROI complex. 

Stakeholders should interpret ROI results cautiously, understanding the assumptions behind the numbers.

Looking ahead, the emphasis on ROI will only grow. As health systems in the US, UK, Canada, UAE, India, and beyond face financial pressures, proving “value for money” will be paramount. 

Embracing a broad view of ROI (return on impact) can ensure investments in healthcare deliver maximum benefit. 

Ultimately, strong ROI aligns patient care with financial sustainability, enabling healthcare.

As digital health investments grow, healthcare leaders need more than point solutions. They need platforms that turn ROI goals into operational reality, without long build cycles or fragmented systems. This is where AppsRhino stands out.

Why Choose AppsRhino for Digital Health ROI?

• Faster time to value with low-code deployments in weeks, not months
• Proven efficiency gains, including reduced wait times and staff workload
• Seamless integration with EHRs, telemedicine, and remote monitoring systems
• AI-ready architecture that supports predictive analytics and automation
• Measurable ROI focus, aligning technology outcomes with cost savings and care quality

AppsRhino helps healthcare organizations move beyond experimentation and realize sustained digital health ROI through scalable, compliant, and workflow-aligned solutions.

Frequently Asked Questions (FAQ's)

How long does it typically take to measure digital health ROI in hospitals?

Digital health ROI often emerges over 6 to 24 months, as efficiency gains, reduced utilization, and improved outcomes compound gradually across workflows, patient populations, and reimbursement cycles.

What metrics matter most when evaluating digital health ROI beyond cost savings?

Key metrics include patient access improvements, satisfaction scores, clinical outcomes, staff productivity, reduced readmissions, and long-term retention, all of which influence sustainable financial performance indirectly.

Does digital health ROI differ between small clinics and large hospital systems?

Yes. Smaller clinics may achieve faster operational ROI, whereas large systems often realize higher long-term ROI through scale, reduced complications, and system-wide efficiency gains.

How does interoperability impact digital health ROI outcomes?

Strong interoperability reduces manual work, prevents data silos, and enables coordinated care, thereby directly improving efficiency-based ROI and accelerating returns on digital health investments.

Can digital health ROI be achieved without replacing existing legacy systems?

Yes. Many organizations improve digital health ROI by layering automation, analytics, and virtual care on top of legacy systems rather than replacing them outright.

Why do some digital health initiatives show delayed ROI despite strong adoption?

ROI may lag when benefits are tied to prevention and avoided costs, which take time to materialize, even though access, quality, and patient experience improve early.