Measuring the Human and Financial ROI of Advanced Primary Care

For more than a decade, organizations have faced a challenging reality: escalating healthcare costs. Healthcare cost inflation, let alone macroeconomic uncertainty, has put growing pressure on benefits and finance leaders to control spending. Too often, the result has been cutting benefit offerings or shifting more cost burden to employees. And not infrequently—both.

According to the 2025 Milliman Medical Index, healthcare costs have surged 188% over the last 20 years, while wages have increased just 84%. Most HR consulting firms project another year of healthcare cost trend nearing 10%. And with costs showing no signs of slowing down, 51% of employers expect to shift costs in 2026, up from 45% in 2025, according to Mercer.

Beyond economic and regulatory forces, many cost drivers stem from a fundamental failure: lack of affordable and accessible preventive care. A recent study by Aflac underscores the impact:

• Nearly 20% of Americans do not have a primary care physician.
• More than 40% primarily rely on ERs and urgent care for their health needs.

The lack of access leads many consumers to delay care until they need emergency or specialty services or to use high-cost settings for needs that could be addressed in primary care. These challenges are especially profound for individuals with multiple chronic conditions, which—when left unmanaged—worsen and ultimately lead to costly medical interventions.

The problem goes beyond short-term budget pressures. Employers and labor organizations must find ways to contain costs and improve outcomes in the long term. But this burden shouldn't fall on plan sponsors alone—benefits solutions providers must demonstrate reliable return-on-investment (ROI), both in terms of real dollars and human impact.

So how can you measure the ROI of advanced primary care (APC)?

Measuring the financial ROI

Every benefits solution vendor promises ROI—but many struggle to define or quantify it. To build a credible business case, organizations need provable data that demonstrate real impact. When evaluating the ROI of APC, look for these key elements in your or the provider's assessment:

• Rigorous methodology: Your partner should use a third-party assessed, actuarially sound methodology built on your organization’s member population profile, claims data, plan design, and other factors that materially impact healthcare use and costs—not hypotheticals. Sharing your claims data ensures a reliable reflection and prediction of your real-world experience. Look for the use of industry-standard assumptions, and for adjustments for outliers (e.g., demographics, large claims) that could skew results or affect generalizability. At the same time, watch for “softer” costs—like productivity gains or reduced presenteeism—which, while certainly important, can be harder to quantify and easily inflate ROI results.
• Timeline to impact: Don’t just ask if ROI is achievable, ask when. Understanding the timeline helps you set realistic expectations with stakeholders and evaluate the provider’s ability to impact cost trend over time.
• Levers that drive ROI: Dig into the specific mechanisms that drive cost savings. How does increased engagement affect costs? How does preventive care consumption impact acute care utilization? Understanding these and similar levers can help you optimize design.

Making it real: Marathon Health recently performed a claims-based ROI study, using third-party-assessed methodology, to quantify the financial impact of our APC model. The study evaluated two cohorts, representing more than 3 million medical claim records—totaling over $1 billion in claims. The results indicated positive ROI in year one, with ROI growing over 300% by year five. What’s driving the return? Filling a critical gap in healthcare: accessible, high-quality primary care. With same- or next-day access, and crucially—a trusted and continuous provider relationship—APC increases preventive care engagement, catching and managing cost-driving conditions before they become severe, high-cost claims.

DOWNLOAD NOW TO READ THE FULL STUDY

Celebrating the human ROI

While the financial ROI is critical for business decisions, we must not overlook the life-changing impact APC has on the health and well-being of employees and their families.

Pairing quantitative data with qualitative insights—like patient stories, testimonials, and satisfaction metrics—offers a more complete picture of a program’s value. These human moments reflect outcomes that numbers alone can’t quite capture.

Our client Tricia Griggs, Aflac’s Manager of Employee Wellness & Safety, puts it best:

"When I talk ROI, I think about our employees like Rachel, who just wasn’t feeling ‘right’ and had an appointment at one of our health centers, which eventually led to a diagnosis of cervical cancer. Or Nigel, who went in for his regular annual physical feeling completely healthy, but bloodwork showed he was in the early stages of prostate cancer. And TJ, who felt his thyroid medication needed some adjusting and saw a clinician in our health center which led to a diagnosis of thyroid cancer. I am happy to say because their visits led to early diagnoses, all have beat their cancers and are doing well!"

Taking action with ROI reporting

Measuring ROI isn’t the end of the story—it’s a powerful tool to support the business case of your benefits strategy. Claims analyses provide real-world insights into the health and wellness needs of your workforce, eliminating guesswork so you can make informed decisions. To maximize the value of ROI reporting, be sure to:

• Measure ROI Annually: Regular measurement keeps your insights fresh and informs program optimization.
• Share with key stakeholders: Consistently communicate both the financial value and human impact with executives, finance, and total rewards leaders. And expect readily forwardable reporting from your solution providers. This transparency helps gain or maintain buy-in for new and existing investments.
• Test and learn: Stay open to sound, evidence-based experimentation. Calculated risks can reveal what truly impacts your employee population and instruct when it's time for a larger strategic move. As far as the “how,” a strategic partner can make all the difference. As Griggs said, "Not only does Marathon Health respond positively to my ‘crazy ideas,’ they translate the ideas into realistic initiatives.”

See what ROI looks like for 60 of your peers

The strategies we’ve shared are part of the commitment we make to every client. We partner with 630+ employers and labor organizations nationwide to provide transformative care for millions of employees and union members—and diligently measure the impact.

Download our recent ROI study, where we analyzed data from 60 plan sponsors to reveal the real-world ROI of advanced primary care. More of an audible learner? Watch our on-demand webinar Advanced Primary Care and ROI: Reversing Trend and Improving Outcomes from Year One