There used to be health management investments at two different ends of the spectrum. Employers mainly invested in “worksite wellness”, aimed at improving employees’ health by enabling them to become generally more fit, while preventing or correcting the worst unhealthy lifestyle habits. Meanwhile, insurers, including Medicare, focused primarily on managing the high-cost “outliers” who tended to run up annual sickness care cost expenses of tens of thousands of dollars a year. They adhered to the Willy Sutton maxim of going where the money was.

Gradually, the two approaches are moving toward each other and merging, so that “disease” management begins to include efforts to prevent chronic diseases in the first place, not merely manage them better once they arise. After all, whatever can be saved by managing such diseases will be less than the savings of reducing their incidence and prevalence. Moreover, as employers identify the causes of lost productivity as well as sickness care expenditures, they are adding efforts aimed at chronic conditions such as musculoskeletal pain/injury, psycho-emotional problems, allergies, headaches, sleeplessness, and high stress that cause far more lost production and impaired performance than traditional “diseases” because they affect far more workers.

What is emerging is a “total” focus – on both the full scope of “health” insofar as its effects on total labor costs and performance are concerned, and on the total population affected, which often includes dependents not just because they generate sickness care costs but because they can cause worker absence and impaired performance. This means that the total impact of health and of investments in its management become the basis for planning, implementing and evaluating health management efforts, at least when employers employees are involved.

One of the major impacts of this inclusiveness is the shift from looking at the ROI ratios achieved to looking at the ROI amounts saved. If a health management effort focuses just on the few with high risk/reward chronic conditions, there might be ROI ratios as high as 2:1 or 3:1 for example, but if the investment is low, the total savings are also low. An employer who invests a million dollars in a disease management effort, and gains an ROI of 2:1 will end up one million dollars better off.

But if that same employer invests five million dollars in a total health management effort that gains a lower ROI of 1.5:1, that means the total savings are $2.5 million, rather than only $1 million. Moreover, adding in productivity and other performance impacts is likely to increase the amount of positive financial impact by as much as four times. This could mean that the actual ROI ratios, from both the narrow DM approach and the broader total health approach, could be more like 8:1 and 6:1 respectively, multiplying the total savings by four times as well. In either case, the savings from total health management are likely to be greater.