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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.
Two Analytical Components
A diabetes total cost of care benchmark analysis and an illustrative ROI model that applies selected utilization assumptions to fully engaged program participants.
Clinical Evidence
Digital and home-based interventions show potential to improve sedentary time, glycemic measures, blood pressure, body weight, and cardiovascular risk factors.
Narrative Support
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
The benchmark component compares healthcare costs across diabetes cohorts. The value proposition component applies utilization-change assumptions to fully engaged participants.
Cost of Care Benchmark
Compares medical and pharmacy costs for members newly identified with diabetes, consistently identified with diabetes, and members without a diabetes indicator. Allowed cost, utilization per 1,000, unit cost, and PMPM by service category.
Value Proposition
Applies assumed emergency department, inpatient, and office-visit utilization changes. Calculates estimated post-intervention PMPM and aggregate dollar impact. Compares with projected program fees to calculate gross and net ROI.
Diabetes Total Cost of Care by Cohort
Key Utilization Drivers for the ROI Model
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
Financial Impact Summary
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.
Supporting Evidence Studies
Digital Health & Sedentary Behavior
Digital interventions reduced overall sitting time by 30.8 minutes relative to comparators.
Digital Health in Type 2 Diabetes
Improved HbA1c, fasting glucose, and postprandial glucose; no significant improvement in physical activity.
Home-Based Exercise & Hypertension
Endurance, isometric strength, and breathing programs appeared effective in reducing blood pressure.
A1C Improvement & Acute-Care Utilization
0.9–1.1 point A1C reduction accompanied by lower diabetes-related hospitalizations and ED visits.
Telemonitoring & ED Visits
Greater A1C reduction, fewer ED visits, and reported healthcare savings over six months.
Glycemic Control & Acute-Care Costs
HbA1c <7% associated with lower annual acute-care costs and total medical costs.
The Evidence Base Will Continue to Grow
- Utilization and savings assumptions should be validated using client-specific claims data or a program-specific outcomes evaluation.
- Clearly separate evidence-supported findings from hypothetical assumptions in the workbook and in any client-facing presentation.
- Present conservative, expected, and optimistic scenarios, with each scenario tied to documented sources, observed program experience, or clearly stated clinical rationale.
- Use clinical judgment and, where available, program-specific data to support any assumed relationship between clinical improvement and financial impact.
