KPI & ROI STUDIES September 2026 ROI Study calendar_today Published Q3 2026

Measuring outcomes.
Demonstrating potential value.

Explore the evidence, assumptions, and modeled financial impact behind Fun & Moving’s digital health and lifestyle programs.

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Framework Statement: Our ROI model is designed as a scenario-based value proposition, illustrating potential financial impact based on selected healthcare utilization assumptions, program engagement, benchmark costs, and projected program fees.

Explore the ROI Model south View Methodology & Benchmarks
Key Metric Summary 100k Cohort
Gross Modeled ROI 2.58x
Net Modeled ROI 1.58x
Post-Intervention Delta -$15.00 PMPM
Modeled Financial Impact $66,776
Engagement trajectory 50% fully engaged
Source: Merative MarketScan Commercial Claims Cohorts & September 2026 Actuarial Dossier.
Section 06 // Interactive Modeling Tool

Calculate your potential ROI

Use this simple calculator to explore how program participation could affect the modeled opportunity for your organization based on our verified actuarial methodology.

Cohort Scale Inputs

Diabetes Prevalence Rate 8.2%
Program User Adoption Rate 10.0%
Engaged Completion Rate 50.0%
Starting Diabetic PMPM $2,156.00
Post-Intervention PMPM $2,141.00 (-$15)
Calculator Disclaimer: This calculator provides an illustrative scenario based on the assumptions used in the September 2026 ROI model. It is not a prediction or guarantee of actual savings.
Modeled Pathway Results Based on 100,000 lives
Identified Diabetics 8,224
Program Users 822
Fully Engaged 411
Projected Fees $25,906
Total Modeled Impact
$66,776

Aggregate annual claims variance

Modeled Net Value
$40,870

Impact after full program fee deduction

Gross Modeled ROI 2.58x
trending_up
Net Modeled ROI 1.58x
savings
Section 01 // Foundation

Understanding the model

The Fun & Moving actuarial model operates on two distinct yet interlinked analytical pillars. Separating clinical prevalence baselines from engaged participant economics allows healthcare leaders to evaluate feasibility transparently.

1

Diabetes Total Cost of Care Benchmark Analysis

Empirical longitudinal cost profiles established across 76+ million member months from comprehensive commercial claims, categorizing acute and outpatient medical utilization.

2

Illustrative ROI Model on Fully Engaged Members

Scenario-based economic modeling strictly isolating participants who meet compliance and engagement thresholds, assessing utilization attenuation against transparent fee schedules.

Study at a glance

Illustrative Model Inputs & Population Assumptions

100k Benchmark Cohort
Covered Lives Baseline
100,000

Standardized corporate or commercial health plan census

Diabetes Prevalence
8.2%

Adult commercial diagnostic benchmark cohort

Estimated Members with Diabetes
8,224

Identified via dual-year HCC medical diagnostic coding

Projected Program Users
10.0%

Active opt-in rate from total identified diabetic pool

Estimated Program Users
822.4

Enrolled and onboarded participants

Projected Fully Engaged Rate
50.0%

Sustained digital session & movement completion criteria

Primary Clinical Cohort
411 Estimated Fully Engaged Members
Basis for all downstream cost-avoidance & PMPM trajectory modeling
Section 02 // Financial Analysis

The modeled opportunity

Projected financial returns derived from modeled healthcare utilization mitigation among fully engaged digital therapeutic participants.

Active Cohort 411 Fully engaged members
Baseline Cost $2,156 Starting diabetic PMPM
Modeled Post-Intervention $2,141 Estimated post PMPM (-$15)
Modeled Total Impact $66,776 Annualized cohort delta
Projected Fees $25,906 FAM program delivery fees
Gross Model Return trending_up
2.58x

Gross Modeled ROI

Approximately $2.58 in modeled gross healthcare savings generated per $1.00 of program fee.

Formula: $66,776 Total Modeled Impact / $25,906 Program Fees
Net Economic Value account_balance
1.58x

Net Modeled ROI

Approximately $1.58 in modeled net savings after subtracting all program fees per $1.00 spent.

Formula: ($66,776 Impact - $25,906 Fees) / $25,906 = $40,870 Net / $25,906

Actuarial Disclaimer: These figures represent an illustrative scenario-based model and should not be interpreted as a forecast or guarantee of realized savings. Modeled outcomes depend strictly on client-specific prevalence, adherence, and actual claims baseline trajectories.

Section 03 // Funnel Logic

How the model works

A stepwise mathematical attrition funnel that isolates eligible, enrolled, and fully adherent participant cohorts to prevent speculative overestimation.

Step 01 groups
Covered Lives

Plan population baseline

100,000
Step 02 analytics
Prevalence

Diagnosed rate

8.2%
Step 03 person_search
Eligible Members

Identified diabetic pool

8,224
Step 04 how_to_reg
Adoption Rate

Initial program opt-in

10.0%
Step 05 app_registration
Program Users

Enrolled participants

822.4
Step 06 verified
Full Engagement

Sustained compliance

50.0%
Step 07 flag
Engaged Cohort

Modeled ROI members

411
Section 04 // Claims Benchmark Data

The cost of diabetes

The benchmark analysis compares healthcare spending across new diabetes members, consistent diabetes members, and members without diabetes using actuarial claims data across 76.0M+ member months.

info Benchmark Caveat: This represents empirical commercial spend patterns, not a direct measure of FAM-generated savings.
Cohort 01 1,228,056 Member Months

New Diabetes Member

Newly diagnosed commercial diabetic population

$2,054 Total PMPM
Inpatient ($568) 27.7%
Outpatient ($544) 26.5%
Professional ($419) 20.4%
Pharmacy ($489) 23.8%
Other ($33) 1.6%
Characterized by acute acute diagnostic testing and onset hospital stabilization.
Primary Target Profile
Cohort 02 // Baseline 5,028,648 Member Months

Consistent Diabetes Member

Established multi-year diagnosed chronic cohort

$2,181 Total PMPM
Pharmacy ($927) 42.5%
Outpatient ($505) 23.2%
Professional ($390) 17.9%
Inpatient ($313) 14.4%
Other ($45) 2.1%
3.05x higher total healthcare expense than non-diabetic peers, heavily weighted in pharmacy and chronic outpatient care.
Cohort 03 // Reference 69,820,764 Member Months

Non-Diabetes Member

General commercial population reference standard

$715 Total PMPM
Professional ($214) 29.9%
Outpatient ($208) 29.1%
Pharmacy ($191) 26.7%
Inpatient ($93) 13.0%
Other ($9) 1.3%
Broad commercial baseline with negligible acute endocrine risk load.
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Key Benchmark Finding

Consistent diabetes members have the highest total PMPM at $2,181, compared with $2,054 for new diabetes members and $715 for non-diabetes members.

Source: 2024 Merative MarketScan Commercial
Section 05 // Actuarial Sensitivity

What drives the modeled impact?

Changing the assumed frequency of healthcare events changes the modeled unit cost and total financial impact. Core financial drivers should therefore be reviewed whenever assumptions are changed or new drivers are introduced.

Driver 01 emergency

Emergency Department

Acute episodic diabetic events

Benchmark PMPM $60
Annual Utilization 301 / 1,000
Actuarial Unit Cost $2,422
Driver 02 local_hospital

Inpatient Admissions

Severe diabetic complications & ketoacidosis

Benchmark PMPM $161
Annual Utilization 68 / 1,000
Actuarial Unit Cost $28,427
Driver 03 medical_services

Office & Ambulatory Visits

Routine endocrine & primary consultations

Benchmark PMPM $51
Annual Utilization 4,431 / 1,000
Actuarial Unit Cost $138
calculate Every 1 admission avoided per 1,000 lives yields roughly $28.4k in gross claims reduction; the model assumes conservative fractional reductions strictly across fully engaged members.
Section 07 // Peer-Reviewed Index

The evidence behind the opportunity

Clinical trials, systematic reviews, and meta-analyses establishing the behavioral and biological plausibility of home-based digital movement interventions.

Sedentary Behavior 26 RCTs • n=3,800

Digital Health & Sedentary Reduction

Finding: Reduced overall sitting time by ~30.8 minutes per day among adult intervention arms.

Actuarial Message: Supports behavioral movement pathway, but does not directly establish medical cost savings on standalone basis.
Skaggs et al. // Systematic Review
Type 2 Diabetes 118 RCTs • n=21,662

Digital Health Interventions in T2D

Finding: Statistically significant improvements in HbA1c, fasting plasma glucose, and postprandial glucose curves.

Actuarial Note: No statistically significant improvement observed for physical activity or HOMA-IR; suggests multimodal requirements.
Zhang et al., 2025 // Network Meta-Analysis
Hypertension 27 Clinical Trials

Home-Based Exercise & Blood Pressure

Finding: Endurance exercise, isometric strength routines, and guided breathing programs demonstrated marked reductions in systolic blood pressure.

Actuarial Message: Confirms home-delivery feasibility and cardiometabolic plausibility without direct acute admission link.
Xue et al., 2025 // Clinical Trial Review
Cardiovascular Systematic Review

Digital Lifestyle & CVD Risk Factors

Finding: Combined physical movement and dietary coaching interventions showed superior efficacy across aggregate cardiovascular scorecards.

Actuarial Message: Lifestyle intervention is most potent when pairing daily kinetic activity with nutritional structure.
Rodrigues et al., 2022 // Heart & Circulatory Outcomes
Nutrition Therapy 3 Reviews • 30 RCTs

Medical Nutrition Therapy (MNT) Impact

Finding: Documented long-term cardiometabolic improvements and potential healthcare cost offsets.

Actuarial Note: Do NOT directly transfer external MNT economic savings directly to FAM program claims without clinical adjustment.
Tegegne et al., 2024 // Health Economics & Nutrition
Point-of-Care Narrative Synthesis

Point-of-Care A1C Diagnostics

Finding: Rapid diagnostic feedback accelerates behavioral adaptation and improves A1C outcomes cost-effectively.

Actuarial Message: Immediate biomarker visibility reinforces ongoing participant adherence within digital coaching modules.
Clinical Diagnostic Review Series
Biomarker Tracking n=7,669 Cohort

Continuous Glucose Monitor Adherence

Finding: Higher rates of CGM adherence correlated positively with sustained HbA1c reductions across all demographics.

Actuarial Message: Confirms that engagement intensity is directly coupled with glycemic control magnitude.
Endocrine Society Registry Analysis
Acute Care 74,679 Adults with T2D

A1C Shifts & Acute-Care Utilization

Finding: A 0.9–1.1 percentage point A1C reduction was accompanied by lower rates of diabetic hospitalizations and ED visits.

Critical Caveat: Do not present this observational correlation as a direct causal FAM program savings guarantee.
National Health & Claims Multi-Year Study
Telemonitoring 100 Insulin-Treated T2D

Telehealth Remote Monitoring Feasibility

Finding: Greater A1C reductions and fewer unplanned ED visits; positive net program ROI observed in small cohort.

Actuarial Note: Limited sample size (n=100); findings cannot be generalized across commercial populations without adjustment.
Specialized Diabetes Telehealth Cohort Trial
Economics 59,830 Adults with T2D

Glycemic Control & Acute-Care Costs

Finding: HbA1c maintained under 7% was strongly associated with lower acute-care admissions and reduced overall medical claims.

Critical Caveat: This literature represents an association; not an exact "dollar savings per A1C reduction point" guarantee.
Longitudinal Health Economics Claims Evaluation
Section 08 // Causal Hypothesis

Evidence to potential value pathway

The conceptual link from daily digital activity to economic risk mitigation follows a multi-stage clinical cascade. All economic claims are scenario-based and dependent on adherence.

devices

Digital Intervention

Home movement, streaming routines, daily prompts

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directions_run

Behavior Change

~30.8 min/day less sedentary sitting

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vital_signs

Glycemic Measures

Stabilized HbA1c & postprandial levels

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CVD Risk Factors

Controlled blood pressure & weight metrics

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medical_information

Utilization Impact

Potential reduction in acute ED & inpatient events

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payments

Potential Value

Modeled 2.58x Gross / 1.58x Net Return

Analytical Principle: Each link represents an evidence-supported potential pathway, not an automated financial pipeline. Scenario-Based Demonstration
Section 09 // Input Governance

Model assumptions

Full structural transparency regarding origin, parameters, and sensitivity levers governing the FM September 2026 economic model.

Assumption Category Source / Origin Baseline Model Parameter Methodological Role
Program Engagement Rates Supplied directly by FAM Management 10.0% Initial Adoption • 50.0% Sustained Engagement Filters gross diagnosed population into active cohorts
Program Fee Projections Supplied directly by FAM Enterprise Pricing $25,906 per 100,000 Covered Lives / Year Deducted from gross claims savings to calculate Net ROI
Healthcare Utilization Delta Scenario Assumption Framework -$15.00 PMPM mitigation on engaged participants Hypothetical post-intervention clinical variance
Prevalence & Unit Costs 2024 Merative MarketScan Commercial 8.224% Prevalence • $28,427 Inpatient Admits • $2,422 ED Empirical actuarial grounding across commercial members
Dependencies: Final employer ROI will fluctuate depending on actual client employee engagement, negotiated pricing tiers, regional cost-of-care factors, and verified clinical adherence.
Section 10 // Actuarial Documentation

Methodology & cohort definition

Detailed specification of data extraction criteria, claims completion, and diagnostic filtering applied in the commercial claims benchmark.

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Data Source & Claims Completeness

All benchmark healthcare spending calculations are extracted from the Merative MarketScan Commercial Database (2024). Claims reflect greater than 99% run-out completion, eliminating interim IBNR (Incurred But Not Reported) volatility for inpatient, outpatient, professional, and prescription drug lines.

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Cohort Identification & HCC Mapping

Diabetes identification is governed by Hierarchical Condition Category (HCC) diagnostic code mappings. Members classified under "Consistent Diabetes" demonstrated qualifying diagnostic encounters across two consecutive calendar measurement years.

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Enrollment Inclusion Criteria

Population criteria mandate age 18+, continuous 12-month commercial enrollment, integrated pharmacy benefit coverage, and comprehensive behavioral health/substance abuse coverage in both baseline and follow-up periods.

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Actuarial Independent Review

Portions of the benchmarking framework were reviewed for reasonableness by Wakely Consulting Group. Wakely did not perform an independent audit of underlying Merative database records.

Section 11 // Boundaries & Rigor

What this study does — and does not — tell us

Responsible healthcare economics demands strict delineation between academic evidence, empirical claims baselines, and illustrative financial models.

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Sedentary Reduction is Supported

Peer-reviewed meta-analyses clearly support that digital programs can reduce sedentary sitting time and modestly enhance glucose markers.

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Client-Specific Validation Required

Enterprise employers and payers should validate model assumptions using their own historical claims distributions and internal workforce engagement profiles.

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Separation of Evidence vs. Hypothetical Assumptions

Evidence-supported clinical observations must remain strictly distinguished from hypothetical actuarial model runs.

“Evidence supports the plausibility of the pathway. The financial result is illustrative and assumption-dependent.”

Section 12 // Academic Citations

References & research data

  1. Skaggs, P., et al. (2024). Effectiveness of Digital Health Interventions on Sedentary Behavior Among Working Adults: A Systematic Review and Meta-Analysis. Journal of Medical Internet Research. Reduced sedentary time by 30.8 min/day (95% CI: 18.2 to 43.4).
  2. Zhang, Y., Liu, H., & Chen, W. (2025). Digital Health Interventions for Glycemic Control in Adults with Type 2 Diabetes: A Systematic Review and Network Meta-Analysis of 118 Randomized Controlled Trials (n=21,662). The Lancet Digital Health.
  3. Xue, K., et al. (2025). Efficacy of Home-Based Exercise Delivery Modalities on Blood Pressure and Hemodynamic Biomarkers in Essential Hypertension (27 trials). American Journal of Preventive Medicine.
  4. Rodrigues, A. M., et al. (2022). Combined Lifestyle Interventions and Cardiovascular Risk Factor Mitigation in Employer-Sponsored Digital Health Initiatives. Circulation: Cardiovascular Quality and Outcomes.
  5. Tegegne, T. K., et al. (2024). Economic Evaluations and Cardiometabolic Outcomes of Medical Nutrition Therapy and Lifestyle Modification (30 RCTs). Pharmacoeconomics.
  6. Wakely Consulting Group. (2025). Actuarial Cost Guide & Benchmark Compendium: Diabetes Claims Stratification Reference (Diabetes_2025.07.20.xlsx). Derived from Merative MarketScan Commercial Claims.
Comprehensive Documentation

Want to explore the full study?

Review the detailed model documentation, methodology, assumptions, evidence, and supporting analysis in the complete September 2026 Fun & Moving research folio.

picture_as_pdf PDF Format (42 Pages) • verified September 2026 Edition • Actuarial Appendices Included

Final Professional & Regulatory Disclosure

This documentation and interactive model were prepared for Fun & Moving (FAM) management, enterprise benefits directors, and participating actuarial review teams. Calculations and potential cost reductions described herein are derived from scenario-based economic models and benchmark literature; they do NOT constitute guaranteed financial returns, statutory underwriting warranties, or formal clinical prescriptions.

1. Model Outputs: Purely scenario-based mathematical models.
2. Benchmark Data: Merative 2024 claims reference cohorts.
3. Research Evidence: Peer-reviewed published RCT literature.
4. FAM Assumptions: Internal pricing and engagement models.