While the benefit of personalizing medical treatments for diseases such as cancer has been demonstrated already, the customization of management efforts aimed at maintaining health, reducing risks and keeping chronic disease from crises, complications and worsening over time, has not been widely tested.  In general, standardized, one-size-fits-all options are offered by employers, insurers, and specialized providers of such options, with consumers having the option of enrolling in them or not.

Some degree of customization typically occurs as a natural course of events when individual consumers interact with individual providers in face visits or phone coaching sessions.  More explicit customization is also achieved through automated analysis of individual consumers’ health risk assessments, for example.  If there are as few as 20 questions, each with five possible answers in such an assessment, this will generate 95 trillion different possible combinations of answers, though even that large number of possibilities will not guarantee there are no duplications.

Customization in health/risk/disease management (HRDM) must serve at least three purposes, where in treatment of diseases such as cancer, it serves mainly one – ensuring that the most effective option is used for each patient.  HRDM customization should yield interventions that are:

1.   most likely to be effective in achieving the desired results
2.   most attractive and satisfying to the individuals being managed
3.   the least costly possible while meeting the first two criteria

HRDM “treatments” can run the gamut from minimally expensive to very costly.  Disease management efforts tested by participants in one of the Medicare demonstration projects, for example, varied from $80 to $444 per participant per month.  Such costs only make sense when both the prospects of and actual savings results achieved more than cover them.  And the savings potential of different HRDM interventions varies widely by the kind of problem being addressed.

Health management, defined as any combination of maintaining or improving the health of already risk-free people (of which there are only a few) so that they do not become at risk, is potentially worth only what would have happened without any intervention.  If, for example, there would be a 30% risk that such people would “move up” to one risk in a year, and their added cost to payers were $100 per year, it could only make sense to invest $30 for every person in the no-risk cohort, and that would only achieve a break-even result.

By contrast, keeping people who have one or more risks from moving up to a higher level, while enabling them to reduce their overall risks, could save significantly more.  A 1999 study indicated that employees with 0-1 risks generated medical costs of $1389 per year each and 2.45 days of STD expense , on average; those with 2-3 risks, $1730 and 5.28 days; those with 4+ risks $2701 and 13.16 days.  If these employees were being paid at a rate of $50,000 per year, their STD replacement costs would represent roughly $200 for each day used, or $490 for those with 0-1 risks, $1056 in STD costs for those with 2-3 risks, and $2632 STD for those with 4+ risks.

For each employee moved from the 4+ to the 2-3 risk level, savings would be as much as $2632–$1056 = $1576 in STD costs, plus $2701–$1730 = $971 in medical costs, or a total of $2547 in total costs.  This means that costs of interventions could be as much as a thousand dollars or more and still yield a positive ROI. [R. Loeppke “The Business Impact of Health and Health-Related Productivity” American Occupational Health Conference May 4, 2003 (www.acoem.org)]

For some chronic diseases, such as congestive heart failure, effective management has been shown to save many thousands of dollars a year in medical costs alone, plus many more in reduced absenteeism and presenteeism, as well as STD and LTD costs.  It would often be possible to invest five thousand dollars and more and still obtain a positive ROI in such cases.  Customization by cost is easily the most essential form of personalizing in HRDM, where quality is the dominant concern in personalizing sickness treatment.

Customizing HRDM efforts based on what works best is clearly just as desirable, while savings potential serves mainly to put a cap on how much an effective intervention can cost and still be cost-effective.  But customizing to the preferences of consumers may be at least as important.  If an HRDM intervention is not attractive and satisfying enough to attract and retain enough participants, it cannot hope to yield enough savings to cover costs.  Just what is “enough” participation will depend on how expensive the problem is and how cost-effective the solution in each case.  But one-size-fits-all examples have rarely achieved the desired level of participation.

A Wall Street Journal/Harris Interactive poll of employees, for example, found that only 25% of respondents were even aware that their employer offered some kind of wellness program, and only 9% said they participated in such program.  While satisfaction among participants was quite high (55% rated the program as somewhat and 44% very helpful), such low participation, given the almost guaranteed majority of employee who would benefit from participation, guarantees sub-optimal results. [“Staying Well” Marketing Health Services Summer 2004 p.5]

By contrast, “participation” in a wellness program need be no more than taking the health risk assessment (HRA) or other screening that is included in almost all such programs.  When the Principal Financial Group followed up its employee health screening, for example, it found that 47% of those who participated reported they had improved their diet, 45% were exercising more, and 42% were paying more attention to healthier options. [“Screening Process” Marketing Health Services Summer 2005 p.5]

As marketers in general are gradually learning, offering consumers choices and customizing products and services to individual preferences is clearly more effective in generating sales, though it adds to costs.  This is at least as true in HRDM intervention marketing, with the advantage that the dollar benefit of HRDM participation is far easier to predict and calculate than is usually the case in other situations.  Whether used to constrain investments up front, or better, to calculate the best overall investment to make, customization in managing health will be at least as important as it is becoming in treating sickness.