While only 7% of large employers in a recent survey reported currently having a direct contracting relationship with a hospital or health system, results suggest that this number could almost double in 2014.

It’s not surprising—close relationships with providers can help employers reduce rising health care costs and increase employee productivity, while allowing providers to secure market share and expand population health initiatives. But direct contracting is tricky, and risk-based direct contracting especially so.

While sharing risk aligns provider and employer incentives by making both parties responsible for employee cost and quality outcomes, it also requires intensive, ongoing negotiation and monitoring, not to mention analysis of complicated and often incomplete financial and utilization data. In addition, reducing risk factors and unnecessary costs also requires an entirely different service portfolio and delivery model.