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What’s More Important – Financial ROI or Results?

Dr. Tim Church, chief medical officer for ACAP Health, struck a resounding chord with his audience during a recent conference presentation. The specific tangent focused on calculating return on investment (ROI) for different types of treatment and programs designed to improve overall health. Dr. Church sparked the debate when he asked those attending the conference,

“What is the ROI on employees’ prescriptions? Or surgery, for that matter?”

The response was immediate – no one thinks about ROI on prescriptions, surgery or hospital bills. Employers cover these healthcare costs with little-to-no questions asked. There is no money-back guarantee if the medicine, surgical procedure or hospital stay doesn’t improve the patient’s health. The medical professional and the patient go back to the drawing board to try different treatment options and hope for the best outcome.

The issue of ROI is a much different story when it comes to behavioral counseling programs, including Naturally Slim, the industry-leading digital solution for diabetes prevention, metabolic syndrome reversal and weight management. When ACAP Health sits down with a current client or prospect to detail its portfolio of employee benefit solutions, one of the first questions asked is, “What is the expected ROI for this product?” Employers want to know how much money will be saved in reduced insurance claims when they offer counseling programs to their workforce. It’s a legitimate question that affects the employer’s bottom line. Many behavioral programs claim they can deliver a financial ROI by eliminating participants’ future healthcare costs. However, that statement is extremely difficult to confirm. None of us know the future with 100 percent certainty.

The issue of ROI for health improvement is complicated. In fact, ACAP Health’s CEO, Wally Gomaa, wrote a separate blog post on this subject a little more than one year ago. One important question still needs to be answered – “If a behavioral program produces measurable clinical results, does it need to have a financial ROI?” Let’s revisit that question in a moment.

In June 2013, the American Medical Association (AMA) officially recognized obesity as a disease. That decision meant healthcare professionals could start treating obesity as a serious medical condition, including the new-found ability to bill obesity reversal procedures and programs as a medical claim, saving Americans tens of billions of dollars. Categorizing obesity as a disease also opened up new avenues for improving weight loss education for healthcare providers and refining weight loss treatments that lead to long-term, sustainable results including surgery, medications and behavioral counseling programs. With the AMA’s declaration in place, obesity would now be held to the same standard as many of the diseases it can lead to – diabetes, heart attack and stroke.

Back to the question at hand. Does a behavioral program need to have a financial ROI if it produces measurable clinical results? ACAP Health believes clinical results are the most important return on investment. ACAP Health measures ROI in terms of returning participants’ clinical lab values (high blood pressure, HDL/good cholesterol, fasting blood glucose, triglycerides and waist circumference) back to normal. If program participants lose weight and in turn, reverse their risk for diabetes, heart attack and the 30+ other diseases associated with obesity, they have likely lengthened their life span, improved their quality of life and reduced their future healthcare costs. The financial savings is a worthy added benefit, but improving human health is the biggest reward of all.

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