Creating a Meaningful Scoreboard for Surgery Navigation and Return to Work

A football scoreboard includes just a few key elements—scores, down and distance to first down, quarter and time remaining.

The football rulebook, however, is a different story, coming in at just under 100 pages.

As we set out to create a Return on Investment model for our Goldfinch Health surgery and recovery navigation program, we aimed for a simple scoreboard (and not an incomprehensible rulebook).

Our guiding principles:

  1. The ROI measurement should be meaningful to customers (purchasers of healthcare, primarily self-funded employers)
  2. The ROI measurement should be backed by evidence
  3. The ROI measurement should be simple to understand, implement and track on an ongoing basis

Enhanced Recovery After Surgery (ERAS) care pathways have been shown in hundreds of clinical studies over a decade-plus to offer many benefits, including:

  • Fewer complications
  • Less pain
  • Higher patient (and provider) satisfaction
  • Faster return to normal activities, including work
  • Positive economic return

Needless to say, we had many options when selecting an approach to measuring ROI and keeping a meaningful scoreboard for our program. Ultimately, we selected “Saved Days” as our key metric.

What are “Saved Days”?

Envision an employee who takes time away from work to undergo a hysterectomy. Let’s say this employee doesn’t have access to surgery/recovery navigation through Goldfinch—so she ends up with a status quo surgical experience. National averages available from a large, third-party database indicate this individual will be out of work for 43 days

Now envision a woman who needs the same hysterectomy procedure but who, in this case, has the expert guidance of a Goldfinch Health Nurse. This employee finds a provider who embraces ERAS and, with the help of ongoing support from a Nurse Care Guide, she returns to work in 21 days.

National Average Return to Work (RTW) 43 days
Actual RTW with Goldfinch Experience 21 days
Saved Days 43 days – 21 days = 22 days

Over the course of the year, we total Saved Days in this manner.

We then take the Saved Days multiplied by the average wage/benefits per day for employees at the company to arrive at a financial savings.

Continuing the example above:

Average Annual Wages + Benefits for Employee’s Company* (per year) $60,000/year
Average Annual Wages + Benefits for Employee’s Company (per day) $60,000/year / 250 work days/year = $240/day
Savings (from Saved Days) 22 Saved Days x $240/day = $5,280

*We use the average wage + benefits specific to each company enrolling in the Goldfinch program.

Why did we choose Saved Days as a key metric?

Returning to our ROI model guiding principles:

1. Meaningful to employer? We’ve heard from employers of all sizes their two largest concerns are:  (1) finding skilled employees, retaining those employees and making them as productive as possible; and (2) healthcare costs.
2. Backed by evidence? See the Evidence.
3. Simple? We believe the concept of comparing how long someone is out of work for a given diagnosis/surgical procedure vs. national average for the same diagnosis/procedure provides a straightforward approach to tracking performance. In comparison to a common alternative approach to ROI measurement—estimating healthcare costs avoided—we believe Saved Days is much simpler to understand, implement and track.

That being said, we are the first to admit this model is not perfect.

A rundown of the imperfections:

1. The model captures only direct labor costs. This is true. Yet, the ERAS evidence points to savings accruing to the employer and/or employee in the following additional categories:

  • reduced administrative costs (which, by the way, OSHA projects as greater than the direct costs of care)
  • reduced medical costs (fewer complications, fewer surgical revisions)
  • reduced medication costs (less pain, fewer opioids)
  • higher employee productivity
  • and higher employee engagement.

We believe the Saved Days model, while not capturing the universe of savings, adequately captures the relative success of the employee’s recovery. After all, if an employee is back at work, he/she likely is not in the hospital, incapacitated by complications, overcome by opioid addiction, etc.

2. Many workers are salaried and thus there are no direct labor savings. While in some settings, there will be a need to pay overtime or hire short-term replacement workers, this does not apply in all settings.

We agree, there will often be team members who step up to fill the gaps. There may be recovering employees who take care of work remotely. And, frankly, there may be some work that will just have to wait until the employee is back.

But, consider, what are the costs of:

  • Repeatedly relying on the team to absorb extra workload
  • Working through a tangle of regulations (FMLA, FSLA), short-term disability policy fine print and other legal considerations to have employees working from home while recovering
  • A delayed project or a delayed customer response by days or even weeks

And what about workplace morale?

3. Average wages/benefits per day is not how employees are valued. If you consider a CFO who is earning $200,000 in wages + benefits each year (or $800/day), we believe Saved Days actually shortchanges the benefits of the program. Let’s say the Goldfinch Experience (ERAS, informed provider selection and nurse navigation) could help the CFO back to work 10 days earlier than status quo. What is the value to the company of not further delaying a key deal, an audit and/or an important hiring process? It’s likely much greater than $8,000 the Saved Days model would indicate.

Mark Twain once said, “I didn’t have time to write a short letter, so I wrote a long one instead.”

We’ve considered the long version of the ROI model to provide a Goldfinch scoreboard. We’ve thoughtfully implemented the simpler version instead.

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