Listening to a risk or patient safety manager talk about ROI to an accountant or auditor sounds like the famous Abbott and Costello baseball comedy skit, “Who’s on First (Base), What’s on Second, and I Don’t Know is on Third.” Dizzying disconnects and misperceptions. 

After all, how do you put a dollar value on something that didn’t happen? And how do you claim to have done the thing that made it not happen? 

Patient safety programs are rarely expected to generate profits. Instead, leaders need to demonstrate that these initiatives are cost-neutral or create value that justifies their investment. CRICO Senior Clinical Analytics Specialist, Adam Schaffer, MD, MPH, believes malpractice data can play a unique role in ROI discussions because it provides one of the few objective ways to attach a specific financial value to adverse events. By analyzing malpractice cases with detailed clinical coding, organizations can estimate the costs associated with preventable harm and build stronger business cases for safety interventions.

Beth Israel Lahey Health Internist, Jonathan Li, MD, has a more patient-centric lens on ROI and value, having led BILH’s Ambulatory Safety Net (ASN) program. Developed to prevent missed and delayed cancer diagnoses, the program uses patient navigators and targeted outreach to ensure follow-up care for patients at risk of colorectal, breast, lung, and prostate cancers. Rather than basing success on financial metrics, Dr. Li emphasizes the importance of starting with purpose. The program gained support because clinicians, leaders, and patients recognized its impact on care quality, provider confidence, accreditation goals, and health equity initiatives. Financial results became the “cherry on top,” (e.g. a 2x return on investment with revenue generated from screening procedures), validating what stakeholders already knew: the program was improving care, as evidenced by the detection of 25 cancers in patients who could well have “slipped through the cracks.”

There are some new approaches to measuring and describing ROI and value as well. Eric Gardzina, SVP of Risk Management for the OB Hospitalist Group (OBHG), has described his organization’s concept of “Life Saves,” defined as significant clinical events in which timely intervention prevented catastrophic maternal or neonatal outcomes. While he says that 10 known OBHG Life Saves for their client hospitals’ patients represents nearly $17 million in prevented malpractice loss, like BILH’s Dr. Li, Gardzina says Life Saves resonate as more than just financial ROI stories because they reflect how demonstrate how risk management programs strengthen healthcare systems, improve outcomes, avoid anguish and suffering for families, protect clinician well-being, and reduce exposure to costly malpractice claims.

The relationship between patient handoff communication failures and patient harm and malpractice loss is irrefutable. Yet, Boston Children’s Hospital Chief of Pediatrics, Christopher Landrigan, MD, MPH, founder of the I-PASS Institute, has labored for a decade to demonstrate that a structured handoff communication solution can reduce communication-related malpractice claims by 15% and provide a 27% ROI within 5 years. Despite the growing body of ROI evidence, Landrigan agrees with the others that “value” also includes stronger cultures of safety, better clinician engagement, improved patient experiences, reduced provider burden, and enhanced organizational resilience.

Longitudinal value can be obvious

Sometimes, if ROI is not pristinely calculable, value can be obvious when looking at the effects of a program over time. CRICO’s success as an insurer can be attributed, in part, to its belief in using MPL claims data to inform risk mitigation strategies. Similarly, Candello members track trends over time to see if they see favorable change in business and clinical outcomes. Some respective examples include:

• CRICO achieved a 71 percent Close Without Pay (CWOP) rate in 2025 compared to the national average of 53 percent after operationalizing new Insurance Analytics tools
• Medical-inflation-adjusted premium per physician coverage year declined from approximately $20,000 to $10,500 while annual claim rates remained stable as CRICO’s insured population grew significantly
• Use of Settlement Pricing analytics to negotiate with plaintiff attorneys helped CRICO avoid more than $2 million in estimated overpayments during the first nine months following the Settlement Pricing tool’s implementation
• Among Candello academic medical center and health system captive members, cases asserted per 100 physicians declined from 7.9 in 2014 to 4.2 in 2024
• Across all Candello AMC and Health System captive members, the rate of Cases Asserted per 100 Physicians has declined from 7.9 in 2014 to 4.2 in 2024, a steeper decrease than the national rate. Members use the Candello analytical tool suite to compare themselves more deeply to peers on key clinical and insurance metrics