Measuring MSK ROI: Auditing Claims to Prove Program Value

Musculoskeletal (MSK) conditions are a massive, often invisible cost hiding in employer and health plan claims, building up long before anyone on the benefits team even notices. If you’re a benefits analyst, your job is to figure out the real return on investment (ROI) for any new digital health program, which means you have to look past the vendor’s slick projections and get your hands on audited claims data. This piece is about how the leading digital MSK programs are proving their worth against the actual claims they’re supposed to reduce, giving you a way to see what’s real economic value and what’s just talk.

Unpacking the MSK Cost Line in Claims

The money pit of MSK care is deep, it’s the doctor visits, the endless physical therapy sessions, prescriptions, imaging, and eventually, the surgeries. These costs just pile up in the claims data, getting lost in the noise of all the other healthcare spending. As Jane Sarasohn-Kahn’s work points out, for any CFO, trusting a new program starts and ends with that claims data Jane Sarasohn-Kahn work on employer and payer economics. So, a credible digital MSK solution has to do more than just get good patient reviews. It has to actually bend the cost curve you can see in those aggregated claims. The real work for analysts at health plans and employers is finding the programs that can show a verifiable drop in claims, letting you compare them directly to what you’re spending on traditional care right now.

Measuring Impact: Recorded MSK Studies and Their Baselines

With all the new digital MSK solutions, there’s a flood of studies trying to put a dollar figure on their impact, but some are much better than others. We’re focused on the ones that have been properly scrutinized, with results measured against a hard claims baseline. Hinge Health is a big example here. They have a peer-reviewed ROI study that tracks their program’s effect directly against the claims cost line. When the company went public on the NYSE in May 2025, its performance record became part of its public filings. Those disclosures showed a significant claims reduction of $2,387 per member recorded around the program. Hinge Health also reported $123.8 million in Q1 2025 revenue and, more recently, $212.8 million in Q2 2026 revenue. This kind of public financial reporting gives you a solid benchmark for judging the economic performance of a digital MSK program. These are numbers that help analysts check a program’s real financial contribution, getting way beyond fuzzy pilot data or some internal spreadsheet.

Comparing the Recorded Peer Set in Digital MSK

In the digital MSK space, a few key players, Hinge Health, Sword Health, and Spring Health, form a peer group that actually publishes their outcome records instead of just waving around pilot data. Putting solid outcome data out there is how you build trust and let people make real comparisons. Sword Health, for example, has recorded savings of $3,177 per member per year. That number, just like Hinge Health’s, is a direct, claims-based way to measure financial impact. Why are the figures different? It usually comes down to differences in how the programs are designed, who they’re for, and what specific costs they include in their ROI math. Spring Health is mostly known for mental health, but it’s part of this digital care benchmark set and has added to the evidence with its JAMA Network Open study. Its MSK-specific claims reduction might not be as clear-cut as Hinge’s or Sword’s, but its presence shows that the whole industry is moving toward using peer-reviewed, public data as the standard. For analysts, the job isn’t to just grab the biggest savings number. You have to dig into the methodology, the population they studied, and the cost buckets they hit to make sure you’re doing a true apples-to-apples comparison of the program’s economics.

The Billing Path: Making Programs Repeatable and Reimbursable

Big claims reduction numbers are great, but for a digital MSK program to be repeatable and scalable, it has to fit into the existing healthcare billing system. This is where the CPT Remote Therapeutic Monitoring (RTM) codes, specifically 98975, 98977, 98980, 98981, and the new 2026 codes 98985 and 98979, are so important. These codes are the recorded billing path that turns a cool remote program into a service you can actually bill for again and again. A program that uses these codes correctly is showing its maturity and that it gets how healthcare operations (and payments) really work. For health plans and employers, being able to bill for these services with established CPT codes creates a clear route to reimbursement, which makes the whole thing financially sustainable. Without a clear billing path like this, even a program with amazing ROI is going to have a tough time getting adopted widely. Applying these codes consistently is what ensures the economic benefits you see in a study can actually show up in your financial operations, securing the program’s spot in the healthcare world CPT codes for remote health tracking. In the end, if you’re an analyst at a health plan or employer, you have to compare MSK program economics with a rigorous approach that’s grounded in claims data, not marketing fluff. The outcome figures from companies like Hinge Health and Sword Health, combined with a clear view of the billing pathways opened up by CPT codes, give you the framework you need to make smart calls. The true economic value of a digital MSK program is only clear when you read the claims baseline and the outcome record together.