Measure the asset, not the offset

The last essay in this series ended on a question. When rigorous trials showed that wellbeing programs rarely pay for themselves in medical claims, they discredited a yardstick, not the investment. What should the yardstick be instead?

The field has had an answer for a decade. It is called value of investment, or VOI, and it asks whether a workforce health investment delivers the outcomes it was actually bought for, such as productivity, engagement, safety and retention, rather than whether it lowered last year's claims. The Health Enhancement Research Organization and the Population Health Alliance published a peer-reviewed measurement guide in this spirit in 2014. Two years later, a paper in Population Health Management titled "Beyond ROI" argued that employers should measure workforce health by the outcomes they care about, not medical cost savings alone. The vocabulary exists. What most organizations lack is the practice.

The practice is more available than leaders assume because validated instruments already exist at every layer where brain health can be measured.

Start with working conditions. Surveys such as the Copenhagen Psychosocial Questionnaire assess the features of work that set brain health day to day, including job demands, control over one's own work, support, clarity of role and how change is communicated. These are the levers leaders own, and they can be measured with the same rigor companies bring to customer satisfaction or employee engagement.

Then measure function. The World Health Organization's Health and Work Performance Questionnaire assesses how much capacity people actually bring to the job. It is the instrument behind one of the most important numbers in this field. In a study of more than 50,000 employees across ten companies, health-related productivity losses cost employers 2.3 times more than their medical and pharmacy bills combined. The losses that matter most never reach a claims file. This is the layer where they become visible.

Then track the asset itself. Composite tools such as the BrainHealth Index, developed by researchers at the University of Texas at Dallas's Center for BrainHealth, measure brain performance over time and how it responds to training. A 2023 study in Frontiers in Psychology followed 193 employees across one firm's sites through six months of brain health training, and the index moved with the training people actually completed, a difference of 52.3 units between those who finished the core modules and those who finished none. A measure that moves is a measure a leadership team can manage.

The last step is the one that makes the rest count. Link those findings to the outcomes the company already tracks, including engagement, safety, absenteeism and retention, and review them on the same cadence as any other operating number. I know the linkage can be built because building it was my job. While working at a Fortune 50 company, my team and I delivered peer-reviewed work connecting how well the company cared for its people to the business outcomes its executives already watched. It took real work, but it did not take new science.

This is what value of investment looks like in practice, an assessment architecture rather than a hope. It also changes the renewal conversation. A program judged by claims offsets will lose its budget in the first lean year. A program that demonstrably moves engagement, safety or retention is infrastructure, and organizations do not unbuild infrastructure to save a quarter. The asset deserves measurement worthy of it.