Podcast: ROI or VOI with Dr. Catherine Bass
In this episode of the Well-Being Experts podcast, we’re discussing member inputs and outputs, and a big piece of that conversation is ROI versus VOI (Value on Investment). We sat down with Dr. Catherine Bass, Director of Informatics at Onlife Health, to get her insights about the metrics that matter when evaluating wellness programs.
“Wellness programs are born out of a need to have a better cost control of healthcare spending because employers are the ones who shoulder that burden.”
Want to dive deeper into this Well-Being Experts podcast? Here's the full transcript from our discussion with Dr. Catherine Bass, Director of Informatics at Onlife Health.
Dr. Bass: Wellness programs are born out of a need to have a better cost control of healthcare spending because employers are the ones who shoulder that burden.
Host: This is the Well-Being Experts podcast and you just heard from Dr. Catherine Bass, Director of Informatics at Onlife Health. We had the chance to sit down and discuss member inputs and outputs, and a big piece of that conversation is ROI versus VOI, or Value on Investment. In this conversation we get Dr. Bass’ insights about the metrics that matter when evaluating wellness programs.
Dr. Bass: I do believe that the value of a wellness program is much broader than the financial aspect of it which is, again, kind of segueing back to why we should be measuring value on investment rather than solely return on investment.
Host: For more content like this, go to onlifehealth.com/resources. Enjoy the conversation!
Dr. Bass: Hello. My name is Dr. Catherine Bass. I am the Director of Informatics at Onlife Health. I’ve been here for 13 years. Our department has two pretty distinct functions. We take care of anything that’s related to transforming data into information. We do all of basic reporting; we do ad hoc analytics, predictive modeling, and evaluations of data.
Host: We’re going to be talking about different member inputs and outputs. All about how, like you just said, you can take data and be able to not only understand the member, the employee, but you can also really see his or her story and see how we can help them. Let’s start off first with just what kind of data you have to work with. This is basically just what types of member information do you typically have access to measure and work with?
Dr. Bass: We have all kinds of demographic information on the member. We get that typically from the employer at the beginning of each year that they are having their services with us. That would include, first name, last name, but also what area of the country they live in. We sometimes will do analysis based on regions. We have a little demographic information about that.
We then start gathering the health information about them, some of which is self-reported. They’ll give us information about their lifestyles, a little bit of their health history through the health assessment that we do with them annually. A couple of clients give it more than once a year, but it’s mostly annually. We’ll get that information. They’ll also give us a little bit of information about what they might be ready to work on with a health coach. That kind of information is helpful from an operations standpoint as well.
Then some of the reported data that we get from a measured professional would be what we consider our biometric data that will come from either a physician’s office – a walk-in kind of clinic – or we often have clients who will host screening events on site. We’ll bring in a team and we’ll actually run people through that. They can get their biometric screenings done right then, get a little coaching right afterwards, and then we get that information into our system. That’s validated, measured by professional data.
Host: You say, you also take information from where they’re located at in the country?
Dr. Bass: We do. We get that typically from –
Host: What is that data? What does that translate into?
Dr. Bass: It allows us to group people by certain regions in the country and there’s other databases that we can access that might show us other trends that are happening for that region, all the way down to a zip code. Some of that can be very interesting.
It also allows us to look at benchmarks that might be created by something like the CDC where we’re seeing people in the Southeast region might have higher rates of tobacco use. You can benchmark companies. If we have a company who is primarily based in the Southeast region, instead of just giving them a national benchmark of smoking use or tobacco use, we can actually say, “The national average is X, but in your region, specifically, it’s Y and this is how you compare to that.” It allows us to group people by regions that might have important benchmarks available.
Host: What types of activities or data – I’m not sure how you would want to define it – do you actually measure and why are those measured?
Dr. Bass: We measure, I would say activity data is one way to describe that. That would be anything that the member is doing. That can be participatory information. For example, we measure how many people do health assessments, and how many people do screenings, and how many people do other components of our program so that we know what they’ve done as far as a level of engagement. Then that allows us on the back end to say, “Okay, people who participate at this level of engagement, we might have to define that as three different things.” If they do a health assessment and a biometric screening and a coaching call, you can put them in one group. Then you might be able to also create other levels of engagement. People who do four to six things, people do seven or more activities, and then you can do some comparison between them.
We do measure activity and the things that they’re doing in the program. the ways in which they’re participating. But then we also take into account other types of data that might result from those participatory activities. For example, with the health assessment, they’re giving us all kinds of self-reported data there. From biometric screening, they’re giving us all kinds of information about their blood pressure, cholesterol, blood sugars. Then throughout the course of participating with the coaches and the portal and the other activities they can do there, they’re giving us additional information. We’ve got all of that information that we can actually calculate outcomes from. We might say, “At the beginning of the year, Alice had a blood pressure of 140 over 90. Then throughout the program, she has reported her blood pressure and it’s now down to 125 over 85,” which is a change that you can classify as a good change or bad change.
Then we also have claims data. Oftentimes, from a client, we’ll get the claims data and that’s another way for us to marry up some financial information with programmatic activity, whether that’s the participation levels or the actual outcomes they achieved. We might be able to say, “Groups that participated at X level,” We’ll define X, “Have PMPM, per member per month, healthcare cost of $140, whereas members who participated at Y level might have had a healthcare costs of $120 PMPM, per member per month.” You can from that point extrapolate if you get people to do Y level – whatever that was defined as – then maybe those people will cost less than people who didn’t do that.
Host: What types of decisions can you make? You have all this data that you’re talking about now, you have some understanding of who they are, what their background is, and maybe what they’re going through, and what they’re dealing with. What kind of decisions can you make now?
Dr. Bass: What will happen is we’re giving that information back in two different ways. We give it back internally to our product development team. If we see, for example, people are participating in a certain activity, but when they do that, they’re not significantly different than people who don’t participate, that’s a signal that, hey, that feature may not be working very well. Let’s maybe look into that, see what’s happening. They can go back and maybe make some adjustments. We give it back internally so that we’ve got some information on what is and what is not working, and where we may want to drive customers to spend their time or encourage their members to spend their time.
It also will go into the bank of knowledge about how we consult with our clients and that really is the other way we’re giving this information back. We’re giving it to the clients either directly or sometimes we’ll give it to the clients through the consultation process. Let’s say, you’ve got members who are doing – let’s just make something up – a course. They’re really kind of clicking through that very quickly, it’s not really coming out with outcomes on the end of it. Maybe let’s adjust how much we’re incenting people to do that to something else that we know works really well. It’s very much in the decision-making process about how the program is set up.
Or, on the other side, gosh, this is really working well and people are doing X. That’s really resulting in some really different changes, some better outcomes, some savings, so let’s make sure we’re adjusting people towards those activities. It really goes into the implementation and design of the program. It goes back into our internal feedback loop and making sure that we’re producing products that work.
Part of the way we’re handling some of that demographic data in compliance with HIPAA standards – everything has to be de-identified. But that’s part of the reason we get down to zip code levels because we don’t single out any kind of individuals in reporting. Everything is at an aggregate level. But we have de-identified data that we can still say, these people are in certain regions or they are in a certain section of a company that might be not visible as far as being able to identify an actual person, but you might have enough characteristics to group them into people who are like them so that you can have comparisons and benchmarks that are made.
Well-Being Experts is supported by Onlife Health. Onlife Health is a comprehensive wellness provider serving health plans and large employers nationwide. With over ten million members and 20 years of industry experience, Onlife takes a high-touch, high-tech approach to wellness that creates real results for your population. Find out more at onlifehealth.com.
Host: Do you find that there are either two or three metrics that clients really want to know? I can really tell, there’s a lot of different options that you pull together, but why do you suggest that they focus on those two or three more than maybe others?
Dr. Bass: The clients are really interested in – if I had to narrow it down to two things – they really want to know engagement levels. They want to know how many of their people are doing things and what they’re doing. Then they want to know, almost secondarily, ROI, which is return on investment. And the bottom line of that is, “Is my program saving me money? Am I saving more money than I’m spending on this program?” They’re really focused on those things and you can imagine why.
They’re very focused on the money, obviously, because everything is about the money. Wellness programs are born out of a need to have a better cost control of healthcare spending because employers are the ones who shoulder that burden in America. We run our insurance through our employers, so they’re very interested in saving that money. Health plans are as well. They’re very focused on how this program worked financially. Then, when we do those evaluations, that is also an opportunity to talk about, if they’re spending a lot of money on incentives, maybe how they could back that down and say, you can probably still achieve these rates at this level which will help with the ROI equation.
Also, back onto the engagement, they’re very interested in the participation which I support that. I support both of those, but I really support participation because what we have seen consistently over the years is that people who are involved in the program, even at a minimal level, but of course we’d like them to be more involved than just minimal activities, but even at a minimal level, the people who are involved in the program as opposed to people who are not using the program save money and cost less than people who don’t participate. I understand the ROI focus and I would like to see us as an industry shift a little bit away from this laser-focused, intense interest in ROI onto kind of value on investment or VOI conversation. We could talk about that a little bit too.
Host: Yeah, we’ll talk – we’ll definitely talk about that.
Dr. Bass: But I do support very much the participation aspect of it. Because if you’re program works, great. It doesn’t mean anything if people aren’t doing it. You have to got to get people to do it. Engagement is really, I think, the nut that everyone is trying to crack in the industry. You need to get people engaged without having to spend a ton of money on doing that.
The way we have traditionally gotten people engaged is to incent them to do certain activities and there’s a time and place for that. The ideal model would be that the program could be formulated in such a way that it is an intrinsically motivated situation rather than extrinsically motivated situation. Creating a culture of health that would have the membership voluntarily participating in these things and not thinking about wellness as something else they’re doing, but something that is a part of their day and how we can, as a company, drive wellness being a part of your day. How do our products, and features, and services support that being a part of your every day.
The participation is really where people are focused, making sure that they’re getting their people in the programs or doing the things because those people are going to be healthier, they’re going to have better savings. Or really, I should say, they have better utilization. Because sometimes, when you’re doing the right things, you might actually have an uptick in how much you’re spending from a health plan perspective. Because you might have someone who doesn’t go to the doctor at all, isn’t doing preventive care. If they have high blood pressure, for example, maybe not visiting the pharmacy on a regular basis, but you don’t want those things. If you get somebody into a program and go over with them the reasons why those things are so important for them to comply with, what you might actually see are more doctors visits and more prescriptions to be fulfilled at the pharmacy. But that’s an appropriate cost. It’s the cost that you want to have because it prevents catastrophic events that are, of course, disruptive to someone’s life and very expensive.
Host: Right. One of the things – and I know we just mentioned a reference to VOI – before I get to that versus ROI – are there any things that companies are typically not paying enough attention to? Maybe the answer was, actually, it should be more VOI. Is that it or are there other things?
Dr. Bass: Actually, that’s a great segue into VOI, Value On Investment, because the value on investment measurement is a much broader concept than just ROI. If you think about value on investment, it encompasses – there’s definitely a financial piece to that – but ROI would be a subset of what you’re measuring within value on investment. It’s a broader concept. It’s been much more frequently discussed, I would say, in the last four years or so. Although the term has been out there for probably 15 years. But the term value on investment is going to encompass the financial piece. It’s also going to encompass an employee piece – some of which is already being measured, some of which is not. For example, the things that might fall into the employee section of VOI – and this is my conceptualization of it – it’s still being kind of concretely defined.
I think, personally, that it will vary client to client because it will be something that’s defined for what’s specific to that client, what is applicable to them, as well as what data they have available. But just kind of broadly in my mind, some of the things that you might measure from an employee standpoint are presenteeism which is the concept of being at work, but not fully productive, because of either mental, emotional, or physical ailments distracting you from being fully productive. That’s a huge cost and it’s more of one of the softer costs rather than direct medical cost. Absenteeism, morale, employee engagement and those kind of things. Some of those things are measured and some of them are not measured, so they would fall into that category of these are some things I really think organizations should be more focused on.
One of the other major pieces that I think is a good measurement is sort of the organizational piece of this which would really encompass things like retention, recruitment efforts, a company’s profitability to be really kind of broad; all of those things fall under that broader measurement. I think one of the good things that’s come out of the wellness industry and seeing how people, health plans and employers are still finding value in these programs is I do believe that the value of a wellness program is much broader than the financial aspect of it which is again kind of segueing back to why we should be measuring value on investment rather than solely return on investment.
Host: That is really the perfect transition, I think, because one of things I want to make sure we did talk about is, more or less, what a health plan should be paying attention to and if there are differences between that and employers.
Dr. Bass: I do think that there are some common things and I think there are a couple things that might feel like pretty distinct differences. For health plans, they’re very focused on the financial side of this because, typically, they’re the ones that are going to be – for the membership that they would be covering – they might be the ones that are actually shouldering the financial burden as opposed to an employer setting. If an employer’s contracting with us directly, the employer is the one who’s responsible for that financial burden. The health plan is going to be very interested in the financial piece of this and employers are as well. Health plans, maybe more than employers, are going to be very interested in the appropriate utilization of the medical plan.
That gets back to what I was saying before about preventive screenings and making sure you’re compliant with your pharmaceuticals, making sure that you have not just your well visits and preventive screenings, but that you’re using walk-in clinics, your doctor’s office, an emergency room services appropriately. One way that health plans will look at their data – this is not something that we typically do within our industry, just our specific little wellness industry, but as a part of a bigger picture – one thing that wellness plans will do is look at emergency room utilization and you’ll sometimes find little pockets like a little town and they almost only use the emergency room. They are not really taking advantage of their primary care physicians and walk-in clinics and those kind of things. They might actually do specific, targeted campaigns. You can kind of see different trends and patterns when you look in the data and that’s huge cost savings for a health plan, if you can get members to more appropriately use those services and only go to the emergency room when it warrants that, but take advantage of the other services they’ve got in place.
One other thing that employers might be more focused on that segues us back into the value on investment conversation is the softer metrics that are related to employee morale, what I refer to as organizational citizenship. These are all things that come from people, employees in this context, being happier and healthier. People who are happier and healthier, mentally and physically, tend to exhibit more organizational citizenship behaviors which are a voluntary investment beyond regular routine duties into the company’s benefit. They tend to be more problem solvers, they think outside the box, they work better on a team, they’re self-starters. They’re just a better employee overall. That is something that’s much more distinguished in the employer setting versus the health plan setting.
Host: I like that. For you, as a scientist, what kinds of numbers are you looking for and why do you focus in on those?
Dr. Bass: In the financial perspective of this, we are often looking at the trend of members who are doing activities, participating in the wellness program as opposed to those who are not participating. We’re actually looking for any differences there. We do some testing and statistical modeling to see if those differences are significant. Sometimes a significant difference means something that you might look at just with the naked eye and it doesn’t look like a big difference.
It might be that someone who does not participate costs $20 per member per month as opposed to someone who did participate, maybe they cost $18 per member per month. $2 a month doesn’t sound like a lot, but that might be a significant difference. That’s when you can really say, “Okay, these people have a significant difference. Let’s look at what they were doing and see what the model needs to be, the best practice needs to be, to achieve those significant differences.” What kind of characteristics do they have? What kind of participation did they have? You can really begin to feed that back into your consultation loop and make some of those decisions.
Then we’re also looking at your outcomes and we also have some, again, what we refer to as significant differences. We’re looking at people, for example, not just who lost weight, we want to celebrate any kind of outcomes that people are achieving. If you’ve lost two pounds, that’s awesome. We would also love for people to achieve what we consider clinically-significant differences. For example, with weight, you want people to lose 5% or more of their total body weight and that threshold is determined from your national standards. It’s where you really begin to see some of the biometric changes happening, your cholesterol levels improving, so you can really see some changes with your blood pressure once you get down to that significant level.
Once you have some of those thresholds that you’re aiming for, that’s really where we start reporting back to the client. You had this many people who lost weight, which is great, and this proportion of the people actually lost a significant amount of weight to really drive the outcomes. We also are looking at those people and making sure we can say – we’re trying to look backwards and say, “Is there anything different about the way they participated, how many times we talked to them, the way in which we talked to them. If they did tracking versus people who didn’t do tracking. Were they using a [fitness] device? What are some of the things they we’re doing to achieve that clinically significant level?” Really, significance is where all that comes in, whether it’s the financial side or the clinical side and that feeds back into the client and, again, our product development team and how we form everything.
Host: What information do you not have that would be helpful to have?
Dr. Bass: Sometimes we do not get claims data from the clients for a variety of reasons. Sometimes claims feeds are an extra expense that they don’t want to pay. In that case, we’re a little bit more limited on the kinds of reporting that we can give them. It’s helpful when we have the claims; we can just have a richer story to tell. They do get a lot of analysis from their actual claims vendor, so sometimes they just choose not to have that extra expense.
The other kinds of data that I personally would love to have really relates to the value on investment story. I would love to have more information on an employee’s absenteeism, for example. I would love to have their engagement, I’d love to measure their morale. All of those things really play into this broader calculation of value on investment that takes into account the financials, the culture of health of the company, the employees, – again, self-explanatory – level of engagement with their jobs, satisfaction measures. Some of those things, that really would contribute to a richer measure of value on investment, are not available in some cases because they’re just not easily measured.
Absenteeism is notoriously skewed data because it’s not something that is collected in a mandatory fashion. When you enter into a system where you might be saying, “I’d like to take off,” or if you’ve been sick and so you enter your information later, usually, there’s no required place to put a reason in. That is just data that’s hit or miss and it’s just got a lot of holes in it. That would be great information to have, but it’s just not collected in a very valid manner.
Validated data, so more points that are less self-reported. There’s certainly a time and place for self-reported data and I definitely want to incorporate that into our measures. I think there are some people who write it off wholesale. I’m not one of those. I think there’s a time and a place for it, but when you can have professionally measured data, that is a great data source to contribute to the analytics we’d like to do. We have clients who don’t have any of those data points that are available, it’s all self-reported data. Again, that’s fine, there’s just some limitations that you’re accepting when you only have the self-reported data.
Host: As always, I really enjoyed talking with you. This is all really fascinating topics for me that I’m really interested to learn more about, so I really appreciate you sharing a little about your story and what you’re working on.
Dr. Bass: Thanks. It was great to be here.
Host: Thank you to today’s guest and a big thank you to you for listening along with us. Well-Being Experts is brought to you by Onlife Health, a comprehensive wellness solutions company that has spent years working with health plans and large employers nationwide.
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