A return on investment evaluation of the Citibank, N.A., health management program

Citibank, N.A., initiated a comprehensive health, demand, and disease management program in 1994, using program services offered by Healthtrac, Inc., of Menlo Park, California. Program components included an initial screening of employees, computerized triage of subjects into higher and lower risk intervention programs, extensive follow-up with the higher risk subjects, and general health education and awareness building. The objective of this study was to estimate the financial impact of this program on medical expenditures.

A quasiexperimental design was applied comparing medical expenditures before vs. after the intervention for program participants and nonparticipants. The 22,838 subjects (11,194 program participants and 11,644 nonparticipants) were followed for an average of 38 months before and after administration of a Healthtrac health risk appraisal (HRA) instrument that triggered the start of the program. To adjust for selection bias to the extent possible with these data, multiple regression models were used to estimate the savings in medical expenditures associated with program participation. The resulting dollar savings were compared to program costs to estimate the economic return on the company's investment in the program.

The return on investment (ROI) was estimated to be between $4.56 and $4.73 saved per dollar spent on the program, depending on the discount rate applied. These results are similar to published evaluations of Healthtrac programs implemented with other populations.

Despite limitations inherent in any retrospective observational study, the strong, positive ROI shown here suggests that a well-designed health management program (HMP), which focuses interventions on high risk populations, can result in monetary savings to an organization.