By Mary Bacaj

For union and employer-sponsored health funds, the pressure is intensifying. Healthcare costs are projected to rise by nearly 10% in 2026, placing increasing strain on benefit structures that must balance affordability with access and quality. At the same time, national health expenditures continue to grow due to increased utilization and expanded coverage, reinforcing the urgency for sustainable cost-management strategies.

In this environment, many funds are asking a critical question: Can care management programs truly bend the cost curve—or do they simply create short-term fluctuations that fail to deliver lasting financial impact?
The answer depends on how you measure success.

Looking beyond the first-year illusion
Traditional evaluations of care management often focus on short timeframes—typically less than 12 months—which can produce results that appear modest or inconsistent. This narrow lens not only limits visibility into long-term impact, but also introduces statistical distortion, such as regression to the mean, that can either overstate or understate true program performance when viewed in isolation.

A more complete view requires a longitudinal perspective—one that captures how member behavior and utilization patterns evolve over time.

A longitudinal analysis of large labor populations conducted by Conifer Population Health shows that nurse-led care management follows a predictable pattern:
● Year One: Stabilization—members re-engage with care, address deferred needs, and begin aligning with primary care
● Year Two: Transformation—meaningful reductions in hospitalizations, emergency visits, and overall cost trends emerge

When viewed over multiple years, the utilization data shows a sustained behavioral change and measurable financial return.

Two ways to measure ROI—and why both matter
To understand the full value of nurse-led care management, it’s important to evaluate ROI from two perspectives:

1. Episode-Level Impact (Micro ROI)
At the individual level, nurse engagement reduces avoidable emergency department visits, inpatient admissions, and high-cost episodes. These are immediate, measurable savings tied directly to intervention.

2. Population-Level Impact (Macro ROI)
More importantly for union funds, long-term analysis shows that engaged members consistently diverge from non-engaged members in both utilization and cost trends. Over time, this creates a sustained cost advantage across the population.

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