Introducing a new path forward for Self-Insured Employers, Patients, and Primary Care Providers

Aligned Marketplace’s mission is to increase America’s healthspan. 

We are doing this by providing employees of self-insured employers with an affordable, accessible, high-quality, and aligned advanced primary care experience. 

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For many Americans, healthcare is more than an industry. It’s something that has deep personal significance, touching everyone at some point in their lives. That’s why so many dedicated leaders have invested their efforts and resources for decades in pursuit of improving the healthcare system. But despite remarkable advances in medicine and its related technologies, the way healthcare is delivered often falls short. It can fail to serve not just the patients who receive it, but the providers who deliver it, and the people who purchase and administer it. People who work in healthcare are often driven by a profound sense of purpose, but the challenges they face when trying to bring about change can be enormous, and the system they work within is often complex and opaquely structured.

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When our founding team came together to establish Aligned Marketplace, we shared the conviction that the best way to help companies improve the health of employees and their dependents is to align the incentives between parties, and simplify the delivery model. After extensive conversations with people involved in every aspect of the healthcare system, we realized it was possible to bring together employers, advanced primary care providers, and patients in order to create a streamlined, aligned care delivery model.

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But before going any deeper into the solution Aligned Marketplace is pursuing, we should explain what we’ve learned about the current state of self-insured employers, patients, and advanced primary care providers:

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Employers: The employer-sponsored healthcare market is currently set up in a way that inherently misaligns incentives, preventing it from acting as a well-functioning market. Self-insured employers pay the medical claims of their employees, which means they’re incentivized to reduce the total cost of medical claims while also ensuring a healthy workforce. The first drives savings, and the second drives employee recruitment and ultimately business outcomes.

In practice, though, self-insured employers that sponsor health plans for employees and their families face a complex situation, where they must purchase benefits and care in a market that makes it extremely difficult to understand and compare real value. Employers, therefore, have to strike a delicate balance between three competing forces: 

• First, they need to offer a competitive benefits plan that can both attract and retain top talent in the current tight labor market. They need an affordable, accessible, and equitable solution that ultimately improves the employee experience.  

• Second, they face the challenge of containing medical costs, which have risen at an alarming rate over the past decade—McKinsey projects 9-10% annual employer medical cost increases in 2024-2026¹. 

• Third, employers are constantly seeking ways to better manage the administrative burden of creating and operating a health plan within the constraints of busy HR teams. 

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Patients: According to a recent study conducted by the Harris Poll and AAPA², many patients are so frustrated with the US healthcare system that it’s negatively impacting their healthcare usage, and ultimately their health outcomes. The study of over 2500 patients highlighted pain points associated with cost, complicated care coordination, long wait times to schedule appointments, and clinicians and providers who can’t spend enough time with their patients. 

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Several studies from the Kaiser Family Foundation³ confirm these findings, especially the fact that many patients are postponing or deferring medical care due to cost concerns. One study found that about half of US adults say they have difficulty affording healthcare; about 40% say they’ve delayed or gone without medical care in the last year due to cost⁴. 

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Having health insurance, it turns out, doesn’t necessarily mean workers and their families can access the healthcare they need. 

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Advanced Primary Care Providers: Advanced Primary Care, or APC, is primary care paid for under a value-based economic model, with a more comprehensive range of services available to patients. Providers working under this model are able to offer several things that typical providers can’t:

1. A more informed, personalized patient experience—since the primary care group doesn’t have to depend on packing many short appointments into a day in order to stay financially viable.
2. Greater accessibility to patients—since the primary care group has the resources to invest in more capacity and hybrid virtual support options, like 24/7 texting.
3. A more proactive care model—due to better integration of patient data & analytics, plus in-house care management and coordination capabilities.

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Advanced Primary Care has shown itself to reliably increase the quality of care and patient experience, and reduce costs by reducing low-value care. Clinicians also report a better experience under advanced primary care models, since many of the causes of health worker burnout are built into the design of traditional healthcare systems. These include poor care coordination, misaligned incentives that drive increased cost, and burdensome administrative tasks that prevent providers from spending the time with patients needed to improve health outcomes⁵. 

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Advanced Primary Care began growing significantly about a decade ago. And while its growth has been most noticeable in the Medicare market, through a variety of value-based care arrangements, APC has also seen plenty of success in the commercial market.

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Hundreds of provider groups have developed APC capabilities in recent years, and are now seeking to leverage their investments by serving additional patient populations. A few members of the Aligned Marketplace founding team have worked at some of the largest APC companies in the US, and bring broad experience of its inner workings, including a deep understanding of the kinds of people, processes, and technologies necessary to make it work for self-insured employers.

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We founded Aligned Marketplace on the belief that the best way to increase the healthspan of America’s workforce is by increasing adoption of Advanced Primary Care. Which raises a question: Given the current state of employers, patients, and APC providers, why haven’t more employers adopted it?  In our view, the answer has three parts.

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First, the current system has too much friction to allow most employers to easily contract with APC providers and provide an inclusive patient experience. Many large employers have members spread across numerous physical locations—especially post-COVID—while many APC providers are regionalized to specific geographies. Population-specific APC companies, which provide more tailored, culturally competent care models, have also become more common. All of this makes the task harder for employers, who may need to contract with dozens of different APC providers in order to offer coverage and employee choice across geographies.

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Second, managing a value-based care economic arrangement can be unfamiliar to benefits managers, which can add complexity to an already complex job. In many cases, a neutral third party is best positioned to manage the arrangement between employers and advanced primary care companies. 

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Finally, primary care is a deeply personal choice for members and their families. For large companies with thousands of employees, it can be challenging to try and engage with their entire member population on something so personal. This means that, for an APC benefit to work for big, self-insured employers with employees in numerous physical locations, it needs to offer a choice of providers in every one of those locations. So far, no single APC benefit has been able to do that.

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Aligned Marketplace exists specifically to address these issues. We do it by offering a single, easy-to-administer shared risk contract that includes thousands of providers across the country, and builds patient affordability, accessibility, and high-quality care into the model. We believe that offering members a marketplace of APC provider groups with reduced out-of-pocket costs will increase member engagement, increasing the quality of care they receive while lowering employer total medical costs by more than 15%.   

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Ultimately, our vision is to use this model to provide accessible, affordable Advanced Primary Care for more than 100 million American employees and their families. We’re under no illusions that this will be easy to accomplish—it’s a bold mission, and there’s a lot of work to do before it’s achieved. But we also see the enormous positive impact we could have by pursuing, and that both energizes and humbles us, especially after all the positive responses we’ve received from members, providers, and employers.

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So we’re inviting you to join us on this transformative journey. Together we can reshape the future of employer-purchased health insurance, and create a system that truly serves the needs of patients, providers, and purchasers. Stay tuned for more updates, case studies, insights, and opportunities to be a part of this important movement. 

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