Editing PHKG Business Opportunities (section)

=== ROI Evidence — The Honest Picture ===

'''Industry marketing:''' Surveys and observational studies report $2–6 ROI per $1 spent on wellness. The Harvard meta-analysis found medical costs fall by ~$3.27 per $1 invested. J&J case studies report similar.

'''RCT evidence:''' Consistently null or modest when selection bias is controlled for.

* A 3-year cluster-randomized trial (160 worksites, 25 treatment / 135 control) found better self-reported health behaviors in first 18-24 months but '''little evidence of reduced healthcare spending, improved objective health measures, or changed outcomes.''
* The RAND Wellness Programs Study (Fortune 100 employer, 10 years) found overall ROI of $1.50/dollar. Disease management returned $3.80, but '''lifestyle/screening returned just $0.50 per dollar — i.e., lost money.''' Lifestyle/screening is what Stamen would offer.
* A quasi-experimental small-employer study estimated ROI of $0.585/participant with 95% CI: -$35.095 to $14.103 — wide confidence intervals straddling zero.
* Reif (2020) review: workplace wellness programs unlikely to significantly improve employee health or reduce medical use in the short term.

'''The discrepancy:''' Observational results ($2–6 ROI) are driven by self-selection — healthier employees voluntarily participate, then their lower costs get attributed to the program. RCTs controlling for this find the effect largely disappears.

'''Defensible claim:''' "Hard ROI is contested. The realistic value proposition to employers is talent/retention/engagement, not direct medical-cost savings."