Question / Intervention Goal / Objectives

Quizzify provides a health literacy promotion program, which engages employees in a game using short, multiple-choice and true-false quizzes.  Participants learn about various topics, such as opioids, Humira, sleep, CT scans, stents, health hazards, and hidden sugars.  Studies have shown a link between health literacy and more judicious use of medical services[1], especially emergency department visits[2] and inpatient hospital stays[3].


Method/ Calculation

Though Quizzify is a content tool, the guarantee is engagement: using the Validation Institute’s own Benefits Engagement Survey Tool (BEST), Quizzify’s score will be farther “above the line” (drawn at 45 degrees) than any other health benefit measured, as indicated in this example.

The Y-axis of the plot is based upon responses to the two-question BEST survey. Respondents give the number of times they used a program and rate how useful they found it. An optional third question asks whether having the program offered enhances the respondent’s perception of the employer.

In addition, the employer supplies the cost for each program.  This data sets the X axis of the plot.



The context of this graph is described in this explainer.

The survey needs to include at least three benefits and ideally, up to seven, and to get responses from a minimum of the lower of 100, or 10% of employees.


Findings / Metric/ Outcome/ Savings

Quizzify has achieved this outcome in every instance.

Therefore, Quizzify will place 100% of its fees at risk for being the farthest above the 45-degree line. Since the formula for the Y-axis is uses times usefulness, if Quizzify fails to achieve this goal, the monthly pricing will be reset to zero until Quizzify is indeed farther above the line than any other health benefit.



While the same question set is asked of all the benefits measured, the survey is not a validated instrument. Subjectivity, and self-selection amongst survey respondents, introduce biases. The biases should be the same for all the benefits measured, however, because the same subset of the employee population completes the survey for all the benefits measured.


[1] Haun et al, Association between health literacy and medical care costs in an integrated healthcare system: a regional population-based study. BMC Health Services Research 2015; 15:249

[2] Balkakrishnan et al, The Association of Health Literacy with Preventable Emergency Department Visits: A Cross-Sectional Study, Journal of Academy of Emergency Medicine, 2017 Sep;24(9):1042-1050

[3] Baker DW et al. Functional health literacy the the risk of hospital admission among Medicare managed care enrollees. American Journal of Public Health. 2002 Aug; 92(8):1278-83.