Wellness visits, or yearly checkups, are a form of preventative healthcare that has seen increased adoption and promotion within the healthcare industry. Many insurers completely cover wellness visits for which the subscriber does not even have to pay their co-pay. We analyzed several facets of healthcare, including prescriptions, doctor visits, medical device usage, covered costs, practitioners’ information, and patient records, to uncover data insights.


We analyzed 17 large datasets (a total size of approximately 8 GB) that we generated using an open-source synthetic patient data generator called Synthea[1]. The datasets contained electronic health records (EHRs), prescriptions, patient visits, diagnostic codes, healthcare practitioner information, and health insurance medical claim details. We used RxNav, the National Library of Medicine repository of standard names for clinical drugs, to classify prescriptions. 188 inputs were used in the analysis, along with several techniques to handle missing or incomplete data. We also used the Python programming language to create relationships and correlations among all datasets.


However, the synthetic datasets are not random: the framework for generating the datasets uses publicly available data sources and health statistics (including US Census Bureau demographics, Centers for Disease Control and Prevention prevalence and incidence rates, and National Institutes of Health reports). It also employs clinical guidelines and methods that preserve realistic properties in synthetic EHRs. The datasets use coded entries in the Health Level-7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard format, and all EHRs correspond to the residents of a virtual Commonwealth of Massachusetts.



Patient encounters are the interactions between patients and medical professionals. Understanding the distribution of different encounter types helps paint a picture of the most relevant, highest revenue-generating fields in a region. The top three types of patient encounters are wellness, ambulatory, and outpatient. Wellness visits consist of interactions between general practitioners and their patients. They could take the form of a yearly physical checkup with a physician. Ambulatory care refers to medical services performed on an outpatient basis, without admission to a hospital or other facility Outpatient visits are defined as those in which a patient does not spend the night at a care center. Encounters use the HL7 encounter code.

Frequency distribution of patient encounter types
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Patient encounter types each have unique costs and unique propensities for insurance coverage. Analyzing the discrepancy between the average cost of an encounter and the average insurance payout for it helps highlight the fields in which insurance companies are most liable. For example, wellness visits between patients and their general practitioners tend to have higher rates of coverage than ambulatory visits. This difference is expected because yearly physicals are more predictable and therefore easier for insurance companies to cover.

Average claim cost per patient vs average amount covered*
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*The encounters billed used the average prices from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096340/.

To examine the average costs and rates of coverage for different encounter types over time, we designed a dynamic scatterplot with values from the years 2000 to 2021. This year-over-year analysis demonstrates when each encounter type has its highest and lowest rate of coverage over that period. Wellness encounters consistently fall near the "full coverage" line, while ambulatory visits, for example, have lower coverage and are visibly farther away from the line. Some other encounter types, such as emergency room visits, have stationary ratios of cost to coverage over the years. Understanding the behavioral trends in medical insurance coverage for different encounter types helps identify potential areas of new coverage in coming years.

Coverage of medical claims per calendar year for the years 2000-2021

Knowing a person's age can help researchers understand their likelihood of engaging in each type of encounter class. The tree map of age groups and their corresponding encounter class ratios sheds light on some interesting trends and insights. For instance, it indicates that wellness visits and outpatient visits are inversely correlated. Without extrapolating causation, we could at least claim that age groups with higher proportions of wellness visits tend to require fewer outpatient visits. Therefore, under a controlled study, we would expect people who have more frequent physical checkups to be less likely to make visits to the hospital. Also, people tend to schedule more wellness visits as they get older (starting at age 35 and ending at age 75), and ambulatory visits are surprisingly common across all age groups.

How patient encounters vary across age groups
*Click to explore. Click 'Age' to go back.

The scatterplot of average encounter cost to number of wellness encounters per patient demonstrates a definitive trend. As patients accumulate more wellness visits, their average cost per visit tends to be lower, thus indicating a cost savings associated with attending dedicated physical checkups. This information, in conjunction with the insight that wellness visits are inversely correlated with outpatient visits, contributes to the idea that scheduling annual checkups can keep someone healthy at a diminishing cost over time.

Average number of wellness visits per patient versus average claim cost
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Investigating a bucketed histogram of wellness encounters per patient versus other encounter types also shows that across the board, other medical encounter types are highest when a patient has more wellness visits. Patients with a greater number of wellness visits tend to be older and are also at the highest risk of running into other medical complications.

Average number of wellness visits per patient versus non-wellness visits

[1] Jason Walonoski, Mark Kramer, Joseph Nichols, Andre Quina, Chris Moesel, Dylan Hall, Carlton Duffett, Kudakwashe Dube, Thomas Gallagher, Scott McLachlan Synthea: An approach, method, and software mechanism for generating synthetic patients and the synthetic electronic health care record, Journal of the American Medical Informatics Association, Volume 25, Issue 3, March 2018, Pages 230–238, https://doi.org/10.1093/jamia/ocx079

Healthcare Dashboards

Medical device cost and usage duration

Hemodialysis machines are often the most used devices; accordingly, they contribute to $1.21 million/$2.99 million (~40.5%) of all total claim costs. The average cost per minute and average usage duration for hemodialysis machines is $571/min and 180 minutes, respectively. While the cost per minute for hemodialysis machines is not the highest( for example, implantable defribillator devices cost is $10,042.52/min), costs add up due to the frequency of hemodialysis machine use. Thus, further research into reducing the cost per minute could significantly decrease the overall cost of a claim. For example, it may sometimes be possible to switch to lower cost medical staff (Medical Assistants [MAs]/Licensed Practical Nurses [LPNs] versus Registered Nurses [RNs]).

How patient visits are distributed based on type of visit and covered cost

The most common visit type for all patients is general examinations, which account for 39.5% of all visits. However, revenue from them make up ~47.7% of total revenue because ~92.5% of general exam visits are covered. Not only are general exams good for patients, but they also are good for the hospitals and providers.

How healthcare practitioners are distributed based on specialty and insurance provider

Uninsured encounters make up ~53.5% of all uncovered costs. To address this, practitioners could offer uninsured patients cash discounts, help them with payment plans, and get them in touch with someone who can help them sign up for health insurance, which may be subsidized. The ratio of practitioners to patients is highest for wellness visits (78%) and lowest for emergency visits (4%). There was a spike in emergency visits around 2011, which was not met with a significant increase in emergency practitioners. In contrast, there was a spike in both wellness visits and wellness practitioners in 2011. Consequently, there may be an opportunity to explore burnout rates in emergency departments (EDs) and whether EDs are understaffed. Similarly, ambulatory and outpatient visits did not show significant increases in practitioners compared to increases in patients around 2011 and later.

How medical conditions vary across age groups and insurance providers

Some specific medical conditions are more common in certain geographical areas, age groups, and months of the year than in others. These unique conditions are also covered at different rates depending on which health insurance provider a patient uses. Some conditions, for instance, viral sinusitis, occur multiple times in a single patient. In fact, there were nearly twice as many cases as there were admitted patients with viral sinusitis compared to a condition such as COVID-19, which has a nearly equal number of cases and patients admitted. The dashboard filters and drop down menus can be used to identify the frequencies of conditions by the time of year, county, and age group along with their relative coverage by major insurance providers.


Healthcare provider revenue based on medical treatment of patients

Analyzing the breakdown of medical conditions from a revenue perspective helps frame the healthcare business climate across the same filters of age group, county, time, and insurer. Not only can we see how much revenue each insurance company generates for a given set of conditions, but we can also compare the relative costs associated with providing each type of care. By adjusting the filters and selecting specific age groups in the tree map, we can see what type of customers are covered by each insurance carrier, where they tend to live, and what their contribution to healthcare provider revenue is.


Medical prescription cost as a function of patient encounter type

Prescriptions and medications can be written and administered by medical professionals across various fields, not just general practice physicians. The relative average costs of such medications and prescriptions vary depending on what type of professional provides them. The average base cost of prescribed medications associated with annual checkups and the average number of reported conditions decreases as a patient accumulates more wellness visits. This decrease in prescription medication costs contributes to the idea that visiting a general practitioner on a regular basis results in fewer medical conditions and more cost savings over time. Also, aging patients with increasing rates of wellness visits see an increase in the percentage of wellness visits compared to more critical visits, a trend that again emphasizes the benefits of regular wellness visits.


Medical prescriptions administered as a function of practitioner’s specialty

General practice physicians clearly offer more prescriptions to patients than any other type of professional, followed closely by nurse practitioners, internal medicine professionals, and therapists. The interactive filters can be used to display relative providers by specialty, count of prescriptions, related costs, and distribution by time of specific medications. This analysis can get even more granular should research entail the specific names of medical professionals in a certain region, the distribution of each type of medication that each professional prescribes, and the distribution of each class of medication with the proportions of medications in each class.