The Real Financial ROI on Wellness Is Not Important; Disease Is

I’ve been sitting on this topic for quite some time now, but not because I know it’s a heated and controversial topic. I’ve been sitting on this because I’m so incredibly passionate about what I’m going to say, that I wanted it to be just right.

As a former financial officer for both a hospital system and an insurance company, I can talk all day about ROI. Here’s the thing–there’s a pattern by some in our industry for committing “math crimes” over the last two decades. I’m not sure if I coined this two-word phrase on accident or if I heard it somewhere and it stuck, but math crimes in healthcare are real. This won’t necessarily get you a prison sentence, but it has given employers a bad taste in their mouth for broken promises on financial savings and results that were not grounded on honest statistics and truth.

Sadly, over the last two years, I’ve seen an increase in the creativity of these crimes where some take medical results achieved from a controlled laboratory setting and then extrapolate them as the gospel truth in the real world. The problem is the real world is a lot more brutal, and humans act very differently when they aren’t cherry picked and paid to participate in a laboratory study. It’s cheating the system all in the name of ROI.

Here’s a shocker: I don’t actually care. At the end of the day, it all comes back to clinical results. Are we reversing out-of-range blood pressure, cholesterol, blood sugar, and body weight back to normal levels? If you want to know if your company’s wellness program is really working, look at the lab results because the blood does not lie. I’ve never found a CFO who’s “bought in” to a financial ROI model. But ask them whether they’ll invest in returning out-of-range lab values to normal, and they’ll almost always make that investment.

Plus, if we don’t believe that getting clinical results matters, then shouldn’t we just stop asking physicians to prescribe expensive medicine for cholesterol, blood pressure, and the whole host of other diseases wreaking havoc in our nation?

At ACAP Health, we’re committed to solutions that provide measurable clinical improvements. In fact, if we don’t improve the risk factors we know contribute to costly conditions, then we don’t get paid. I encourage employers to focus on initiatives that reward clinical outcomes as opposed to participation.

I get sometimes we’ll invest in wellness programs we can’t directly trace back to financial savings or clinical results. We do that for many reasons, including cultural gains and the fact that some of these programs are fun and make us smile. But we do have challenges we must deal with if we want to leave the campground cleaner than we found it.

As a country, we’re producing disease at an alarming rate. In fact, one out of every two adults in the country is either pre-diabetic or currently living with diabetes. That’s not a future projection–that’s happening today. For those who are pre-diabetic, the majority will develop diabetes at some point in their adult lives. If we can’t find a way to fix the problem, our system won’t be able to handle the disease burden. We have an epidemic of mass proportion, but when I look at the passion of our clients for improving health, I remain hopeful and optimistic that we will win the battle.

So while there are some people making headlines and adamantly bashing companies for what they’re reporting on ROI, I think we should celebrate companies trying to do the right thing. They’re dealing with the real enemy in healthcare: disease. They’re bold leaders and warriors trying to improve health and save lives.

These companies, just like ours, are trying to make a difference. We’re doing it because it’s the right thing to do. We want there to be more years and better years for our employees, our clients’ employees, and their families. Rather than publicly trying to shame people, I would suggest the people doing the shaming pick up a weapon and help us in this battle against the enemy known as disease. Forget about ROI. If we don’t deal with the production of disease in America, it’s game over for the next generation.

Wally Gomaa is the CEO of ACAP Health, a consulting company that provides programs that measurably decrease chronic disease in America.

Posted in Expert Opinions.
  • Ken Malcolmson

    As always, Wally is right on with these insightful observations. As I’ve heard him say on many occasions – providers and payers shouldn’t be enemies. The real enemy is disease ! Thanks for your perspectives