Needs Evaluation Intake Form

For example, which disease condition(s) did you capture? What units are the outcomes measured in? Do you also have access to associated health claim data?

For example, the ideal unit is per member, per year claim costs, categorized by specific disease condition when appropriate.

ROI should be calculated as: ROI = (benefits of program MINUS costs of program) / (costs of program)

Please be as specific as possible in describing who the population was that received the intervention (demographics, health history, etc.), where the intervention was performed, who administered the intervention, how long it lasted, what your rates of attendance and attrition were, how you measured outcomes, and what kind of follow-up you performed.

Please be as specific as possible and report exactly what your results were in terms of changes in health outcomes and financial benefits if you were able to calculate them. If you did not calculate the ROI, please make an estimate of the cost of the intervention per member, per year.

The strengths and limitations could refer to your methods, the conclusions you are able to draw from the data, or anything else about the intervention.