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KPI & ROI Studies
Understanding outcomes: human-centered research demonstrating measurable impact and future value.
Evidence matters when access, recovery, and long-term health are the goal.
The ROI model should be interpreted as a scenario-based value proposition rather than a forecast of realized savings.
Key outputs depend on program engagement, utilization-change assumptions, benchmark costs, and projected program fees. The workbook includes two related components: a diabetes total cost of care benchmark analysis and an illustrative ROI model.
Digital and home-based interventions show potential to improve selected intermediate outcomes, including sedentary time, glycemic measures, blood pressure, body weight, and cardiovascular risk factors. The strongest support for a Fun and Moving narrative is that digitally supported, multifactorial, and home-based programs can influence behaviors and intermediate clinical measures.
Total Cost of Care Benchmark & Value Proposition
Two Analytical Components
The benchmark component compares healthcare costs for members newly identified with diabetes, members consistently identified with diabetes, and members without a diabetes indicator. The value proposition component applies selected utilization-change assumptions to fully engaged program participants and compares the resulting estimated financial impact with projected program fees.
The model defines eligible member cohorts using enrollment, age, coverage, and HCC criteria. It calculates total allowed cost, utilization, unit cost, and per member per month (PMPM) by service category for each cohort. Members must have twelve member months in both years of data, mental health and substance abuse coverage, pharmacy coverage, and be age 18 or older.
Diabetes Total Cost of Care by Cohort
| Cohort | Inpatient | Outpatient | Prof. | Other | Pharmacy | Total PMPM |
|---|---|---|---|---|---|---|
| New Diabetes Member | $568 | $544 | $419 | $33 | $489 | $2,054 |
| Consistent Diabetes Member | $313 | $505 | $390 | $45 | $927 | $2,181 |
| Non-Diabetes Member | $93 | $208 | $214 | $9 | $191 | $715 |
Consistent diabetes members have the highest total PMPM at $2,181. New diabetes members have higher total medical PMPM ($1,565) than consistent diabetes members ($1,254). Consistent diabetes members have substantially higher pharmacy PMPM ($927 vs $489).
Key Utilization Drivers for the ROI Model
| Driver | PMPM | Util/1,000 | Unit Cost |
|---|---|---|---|
| Emergency Department Reduction | $60 | 301 | $2,422 |
| Inpatient Admission Reduction | $161 | 68 | $28,427 |
| Increased Office Visits | $51 | 4,431 | $138 |
The model assesses impact by using utilization assumptions. Changing the number of times an event is expected to occur will impact the unit cost and total dollars associated with that procedure.
Illustrative Program Assumptions & Population
Gross ROI
2.58x
Estimated savings divided by projected program fees. Approximately $2.58 of modeled savings per $1.00 of projected program fees.
Net ROI
1.58x
Estimated savings less fees, divided by projected program fees. Approximately $1.58 of modeled savings after fees per $1.00 of projected program fees.
Estimated Dollar Impact
$66,776
Aggregate modeled savings for 411 fully engaged members, compared with projected program fees of $25,906.
Starting PMPM: $2,156 (baseline total cost of care). Estimated post-intervention PMPM: $2,141 after modeled driver impacts. Illustrative interpretation only — not a forecast of realized savings.
