Tradespace Analysis of Workplace Health System Focusing on Diabetes

Abstract

The health system is transitioning financial and outcome risk-bearing from the health insurance to the employers themselves. In the US, there are about 165 million people who are on health insurance with employers. A surprising statistic shows that 96% of companies larger than 5000 employees are self-insured. (Mercer, 2018) This means that companies pay their employees’ healthcare costs out of their pocket through the insurance claimed services. This gives the employers the incentive to keep their employees healthier than ever before. For that reason, many digital health solutions emerge and try to answer the demand for cost-cutting in both utilization and prevention.

However, this is not a well-designed health system. Each element in the system is separated from the other. Despite having more innovations, employers cannot quantify or utilize the highest potential of such a system because each element is not connected. Literature review shows that even in the traditional health system, prevention and treatment are not well connected, and researchers have designed multiple approaches to tackle this problem, e.g., Chronic Care Model, Patient-Centered Medical Home.

This thesis reviews the whole employer health system focusing on diabetes, comparing estimated health outcomes, the system's performance with investment cost, and healthcare reimbursement cost. Performance of the system is calculated from health outcome, employee engagement level, and productivity. The Tradespace analyses found that the elements that connected the health system can play an essential role in the health outcome and performance of the system. While the investment cost is more expensive than other systems, the healthcare reimbursement cost can be much lower. Also, the participation of the employee in the system development team can make a significant shift in higher health outcomes while requiring a minimum budget. Therefore, system thinking is crucial to increase efficiency in the employer health system, especially in Diabetes.

The approach taken does not go into detail, explaining which method or choice is better. The insight from this thesis can be used as a guideline to think through, yet a more profound analysis would be required to give a definite answer. In order for this framework to work better, two more components are required: real-world data and system dependency study.