EMS Sustainability Task Force, Phase IV
Colorado EMS Financial Models
Eight interactive models covering cost structure, revenue analysis, consolidation scenarios, and policy impact. Statewide baseline: $774.3M system cost · $666.8M estimated net collections · $95.5M structural funding gap.
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Data through CY2025
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Sources: Colorado insurance claims · RAND/CMS national data · State EMS account actuals
From explanation to analysis
Putting the Numbers to Work
The How EMS Works page explains the structural funding gap: why Colorado ambulance agencies collect only about 43 cents per dollar of operating cost, and why the state EMS account minimums have not moved since 2000. These eight models let you explore that gap quantitatively: how large it is in different regions, what drives it, and what policy or operational changes would affect it.
The statewide baseline is a $774.3M estimated system cost against $666.8M in estimated net collections, a structural gap of approximately $95.5M per year at Colorado actual reimbursement rates. That gap is not evenly distributed. It is larger in rural and frontier counties with high Medicare and Medicaid payer mixes, lower call volumes, and no ability to spread fixed costs across a large population. These models show where the pressure concentrates and what the options look like.
About these models
These models are analytical tools for comparing scenarios. They draw on Colorado insurance claims data, national ambulance cost research, state EMS account figures, and regional transport volumes. All models use official Colorado state data.
Outputs are estimates for comparing directions, not audited financials, actuarial analyses, or formal fiscal notes. They are not designed to produce precise projections for any individual agency or county. If you return to a model and see a different result, check the version number in the model’s header. Results may change when underlying data or methods are updated.
These models do not represent a position of CDPHE, SEMTAC, or any member county. They are produced by NCRETAC for regional planning and policy discussion.
How the models work
Colorado ambulance agencies bill insurance after every transport, but what they actually collect falls well short of operating costs. Two revenue estimates set the range of uncertainty in every model:
National average ceiling
Based on the Ground Ambulance Data Collection System (GADCS): national ambulance cost research published by RAND for the federal Centers for Medicare and Medicaid Services (CMS) in December 2024. This is what agencies would collect if Colorado matched the national average reimbursement rate. It is higher than what Colorado payers actually pay, so it serves as the upper bound in every model.
Colorado actual floor
Based on the Colorado All Payer Claims Database (APCD): a comprehensive record of what Colorado health insurers actually paid per ambulance transport. This is the conservative lower bound used in all models because it reflects what payers in Colorado contractually allow, not what is theoretically possible nationally.
Billing collection rate
The percentage of billed charges actually collected after write-offs and bad debt. Rural agencies typically collect around 60 percent of what they bill. Urban agencies may reach 85 to 90 percent. The default in every model is 70 percent, adjustable so you can test different assumptions.
On version numbers: Each model shows its version number in the page header. If you use a model for analysis or share results, note the version. When data or methods change, the version number increments and results may differ. Export files are stamped with version and date.
Exports
Each model page offers PDF, spreadsheet (XLSX), and CSV downloads at the model’s default settings. To save a specific scenario you have configured, use your browser’s Print → Save as PDF while the model shows that state.
Eight interactive models
The Model Suite
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Ambulance Cost Structure & Economies of Scale Five-tier cost model. Statewide baseline: $774.3M system cost. Shows how cost per call changes with agency size and what efficiencies of scale look like across the Colorado agency spectrum. |
Colorado County EMS Cost Baseline Index Normalized index comparing estimated EMS cost burden across all 64 Colorado counties, adjusted for geography, population density, call volume, and wage differences. |
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Payer Mix & Revenue by Regional Council Revenue estimates calibrated against Colorado insurance claims data for each of Colorado's 11 regional councils. Shows how the mix of insurance types in each region drives revenue outcomes. |
Payer Mix & Revenue Analysis Side-by-side national average and Colorado actual revenue estimates. Toggle individual insurer categories to model the effect of payer mix shifts on total revenue and the funding gap. |
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Very Small Agency Consolidation Scenarios Models three types of consolidation for agencies under 500 annual calls. Shows potential cost savings without reducing geographic coverage or response time compliance. |
County-Level Consolidation Analysis County-level profiles aggregating all agencies within each county. Models consolidation scenarios within and across counties for all 64 Colorado counties. |
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Funding Scenario Dashboard Combines all major funding levers in one dashboard: billing collection rate, state account surcharge level, consolidation savings, and value-based care revenue. Shows the combined effect on the $95.5M structural funding gap. |
Treatment in Place & Alternative Destination Savings Models the financial impact of treating patients on scene without transport and transporting to lower-acuity facilities instead of the emergency room. Shows both payer savings and the direct effect on the structural gap if these options were reimbursed. |
Start with Model 07: it shows the full picture in one view. Models 01–04 provide the underlying cost and revenue detail. Models 05–06 address consolidation. Model 08 addresses alternative care pathways.
Data & Reports
These models are part of NCRETAC’s broader data and regional analysis work. If you are new to how Colorado EMS is funded and governed, start with the plain-language explainer before working through the models. For additional reports, statewide data, and regional planning documents, visit the Data & Reports section.
Model suite v4.0. Data through CY2025. Produced by NCRETAC EMS Sustainability Task Force, Phase IV Funding Workgroup. Questions: [email protected].