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Employers to shift to ACOs, build IT platforms to aid worker health

More employers increasingly will drop relationships with payers and instead contract directly with providers through accountable care organizations.

More employers increasingly will drop relationships with payers and instead contract directly with providers through accountable care organizations.

Employers will want to work with ACOs with the intent of focusing on the population health of their employees, according to a new study by Frost & Sullivan, a consulting and research firm.

The study, entitled Global Employee Health Management IT Market, suggests that under this new model, employee health management information technology (EHM IT) platforms will handle provider eligibility assessment, benefits cost management, employee enrollment to ACOs, ROI assessment and shared saving incentives.

EHM IT platforms are also expected to handle payer contracting, employee eligibility assessment, program enrollment, treatment outcomes assessment and wellness programs.

Mature employers expect to promote the development of Centers of Excellence to target employees who are at risk for chronic diseases, such as diabetes, cancer, chronic kidney disease or chronic obstructive pulmonary disease, the study found.

Frost & Sullivan say the shift away from payers toward ACOs and EHM IT is a result of the heavy financial toll of unhealthy employees. “Employers around the world are losing an aggregate of $300 billion annually in medical and productivity costs due to increasing incidences of employees suffering major illnesses,” the study estimates. “To tackle this global challenge, companies are collaborating with progressive EHM IT solution providers to deploy state-of-the-art wellness programs that ensure employee well-being, resulting in better financial performance.”

Chronic disease is causing a loss of productivity because of absenteeism, disability and hospital readmissions, the study found. This is causing employers to scramble for ways to address the social and behavioral health determinants that influence the health of their employees.

Employee awareness of this problem is also making the environment ripe for change, opening the way for employees to welcome disease-specific medical services at work and at home.

Frost & Sullivan forecasts that the surge in demand for EHM IT services will lead that market sector to grow at a compound annual growth rate of 25 percent between 2019 and 2024—rising from $1.15 billion in 2019 to $3.52 billion in 2024.

Many employers have already tried investing in holistic approaches to workplace wellness, but they have overlooked employee-specific health benefit plans, the study says. Going forward, employers are expected to focus on the adoption of personalized wellness programs, behavior change, surgical rehabilitation and benefits management services for their employees.

According to Frost & Sullivan, some barriers exist to the trend toward use of EHM IT. They include a lack of corporate buy-in to invest in EHM IT solutions because many of these products have not achieved tangible results; a lack of infrastructure to support adoption, scalability and governance of EHM IT solutions at a regional level; and employees don’t trust EHM IT fearing that the collection of their data might put them at risk for losing their medical benefits or even their jobs.

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