Let’s all admit it: the myth and misalignment around ROI is the elephant in the room. As Alan Martin, chartered insurer with 30+ years experience in the Life and Health Insurance industry put, “Many insurers have yet to see ROI from prevention, largely because they have focused too much on relatively superficial wellness engagement, and failed to develop truly meaningful propositions that have a transformative impact on health, and therefore claims.”
So, how can we move from anecdotal evidence to actionable data? Is there a best way to demonstrate the tangible impact of preventative health programs before the long-term claims data fully matures?
The key lies in adopting a structured metrics framework that tracks both leading and lagging indicators. This approach allows insurers to measure progress, demonstrate early value, and build a compelling, data-driven narrative for preventative care initiatives.
A Practical Framework for Prevention ROI Measurement:
Instead of waiting years for definitive claims reduction data, focus on a multi-layered approach:
Layer 1: Engagement & Participation Metrics (Leading Indicators)
These metrics show if members are interacting with the preventative tools and resources provided. They are the earliest signs of potential impact.
- % of eligible members activated on the wellness platform.
- Frequency of logins/app usage.
- Completion rates for Health Risk Assessments (HRAs).
- Engagement rates with specific preventative content (e.g., articles on smoking cessation, healthy eating webinars).
- Participation rates in targeted challenges (e.g., step challenges, preventative screening reminders).
- Utilization of connected services (e.g., virtual consultations for preventative advice, mental wellness sessions).
- What’s next: Don’t worry - CareVoice has your back. CareVoiceOS platform tracks these consistently - and it’s segmented by demographics, risk profiles, and initial engagement channels to help insurers best understand what drives participation.
Layer 2: Health Behavior & Knowledge Metrics (Intermediate Indicators)
This layer measures shifts in behaviors and awareness directly linked to health outcomes.
- Self-reported improvements in lifestyle habits (via surveys/check-ins: e.g., increased physical activity, healthier food choices).
- Increased knowledge scores on health topics (pre/post content consumption).
- Progress towards personal health goals set within the platform.
- Completion rates for recommended preventative screenings (e.g., mammograms, colonoscopies - often tracked via incentives or self-reporting).
- Changes in biometric data points captured via connected devices or screenings (where available/permissible).
- What’s next: CareVoice helps you correlate these metrics with Layer 1 engagement. Are highly engaged users showing more positive behavioral shifts? Use platform surveys and data integrations to capture this information.
Layer 3: Health Outcome & Risk Reduction Metrics (Lagging Indicators - Shorter Term)
Here, we start connecting platform activity to tangible health indicators, often precursors to claims reduction.
- Reduction in key risk factors identified in HRAs over time (e.g., lower BMI, improved blood pressure readings within specific cohorts).
- Shift in members moving from high-risk to moderate/low-risk categories based on updated HRA/biometric data.
- Increased adherence rates to medication for chronic conditions (if tracked).
- Correlation between engagement in specific programs (e.g., diabetes management) and stabilization/improvement in related biometrics.
- What’s next: This requires longitudinal analysis. CareVoice assists you with comparing baseline data with subsequent data points for engaged vs. non-engaged cohorts. Statistical significance testing becomes important here.
Layer 4: Financial & Claims Impact Metrics (Lagging Indicators - Longer Term)
This is the traditional ROI measure, but it becomes more meaningful when linked to the preceding layers.
- Lower average claims cost for highly engaged members vs. non-engaged members (controlling for baseline risk).
- Reduced frequency of hospital admissions or ER visits for specific conditions targeted by preventative programs within engaged cohorts.
- Lower overall healthcare expenditure per member per year (PMPY) for engaged populations over a multi-year period.
- Impact on member retention/loyalty (reduced churn among engaged users).
- What’s next: Work closely with actuarial teams. Use data from Layers 1-3 to build predictive models and strengthen the attribution of claims changes to the wellness program. Rigorous cohort analysis and control group comparison are essential.
Making it Actionable:
- Technology is Key: A flexible digital health platform (like Carevoice) is crucial for capturing Layer 1 & 2 data efficiently and integrating with other data sources.
- Start Simple: Don't try to track everything. Identify the key preventative goals of your program and focus on the most relevant metrics across the layers.
- Segment Ruthlessly: Average results hide valuable insights. Analyze data by risk level, demographic, engagement level, and program participation.
- Tell the Story: Combine metrics from all layers to build a narrative. Show how engagement leads to behavioral change, which influences risk reduction, ultimately impacting the bottom line.
By implementing a structured, multi-layered framework, insurers can move beyond guesswork and provide clear, quantifiable evidence of the value preventative health programs deliver – building the business case and demonstrating tangible ROI long before the final claims data tells the full story.