Can Advanced Primary Care Lower Employer Health Costs? Patrick Nelli on Health Tech Nerds

Aligned Marketplace CEO and co-founder Patrick Nelli joined Kevin O'Leary of Health Tech Nerds for a company briefing. They covered why primary care is the most underused lever in employer health spend, where the savings actually come from, how Aligned curates more than 3,000 in-person clinics, and what the One Big Beautiful Bill Act changes for direct primary care.

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Primary care is a small budget line that steers far more downstream spend

Primary care accounts for about 6% of employer health spend, but it influences up to 90% of the total through referrals, chronic condition management, and transitions of care.*

The problem is access. Over the past two decades, hospitals and large corporate entities have steadily acquired practices and brought doctors onto their payrolls, to the point where they now employ 82% of clinicians.** Hospitals play a vital role in American healthcare, but they earn most of their margin on surgeries and other high-acuity care, which leaves them little financial reason to invest in the kind of proactive care that keeps people out of the hospital in the first place.

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Patients have felt the effects for years. Appointments have gotten shorter and harder to come by, and referral rates have climbed fourfold over the same twenty-year stretch, a pattern that has quietly become one of the forces behind rising medical costs for employers.***

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Many of the best primary care doctors have reached their limit with that system. Burned out and facing what many describe as moral injury, they’ve left to open independent advanced and direct primary care practices, where they see fewer patients, spend real time with each one, and refer to wherever is best for the patient rather than whoever happens to be down the hallway.

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The catch is that most of these doctors sit outside the health plan, so a plan member can’t see them unless their employer builds an onsite clinic or signs a direct contract with the practice. That’s manageable for a company with one location, but for an employer with people spread across the country, it means negotiating hundreds of separate contracts.

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Savings start in year one with lower prices and fewer hospital visits, then grow as members get healthier

You might expect longer visits and smaller patient panels to cost more, but the best independent practices run leaner than hospital-owned clinics. They’re paid to keep members healthy rather than billing visit by visit, which strips out much of the overhead, so they’re priced at roughly what employers already pay for primary care for members with chronic conditions.

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The savings come from three places, and they arrive on different timelines.

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1. Lower unit prices: When an independent doctor sends a patient for labs, imaging, a specialist visit, or a colonoscopy, those services usually cost far less outside a hospital system, and that alone can lower total cost of care by a few percentage points in year one.
2. Less downstream use: Patients who can reach their doctor the same day or week end up with fewer avoidable ER visits, specialist visits, and hospitalizations. This also shows up in year one savings.
3. Better health: The third takes longer to materialize, but it may be the most meaningful. As members get healthier, cancers are detected earlier and chronic conditions are better managed, reducing the need for costly interventions. These improvements can take two plus years to translate into measurable financial savings, but the benefits compound over time. Employers have reported total cost of care savings of up to 15%.

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Large, geographically dispersed employers can now offer advanced primary care at scale

Aligned Marketplace brings together more than 3,000 independent advanced and direct primary care clinics across all 50 states, along with virtual care options. Through a single contract, employers can extend access to advanced primary care across their workforce without changing their existing health plan.

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For members, that means access to primary care at no out-of-pocket cost, personalized clinic recommendations based on where they live and work, and support scheduling their first appointment. Recommendations prioritize clinics with near-term availability, helping members connect with care when they need it.

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Recent legislation opens the door to free primary care

The One Big Beautiful Bill Act, which took effect January 1, 2026, removed several obstacles that had held direct primary care back. It cleared up confusion over whether a direct primary care membership counts as a health plan, it lets members pay for memberships with HSA dollars, and it gives employers more flexibility to cover memberships on their employees’ behalf. The effect has been quick, with more employers now making this care completely free to members and some building new plan designs around it, including dedicated tiers of free care.

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It’s still early, but as Patrick put it,

"The short of it is, it is very positive and it should be a tailwind for direct primary care for years to come."

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12% savings and flat 2027 premiums at a national employer

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The clearest evidence comes from a large national employer that added Aligned as one of a handful of changes to its benefits strategy. A third-party actuarial study using a matched cohort found 12% total cost of care savings. About 20% of members enrolled, and because Aligned worked hardest to reach people with chronic conditions, care gaps, and missed screenings, 70% of those engaged were high risk.

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Members also kept coming back, which is where the savings really take hold. Satisfaction, measured independently of the clinics, came in with an NPS above 70, members reported 94% access to care, and the average member returned to the same clinic more than four times a year. Preventive screenings more than doubled, hospitalizations and ER visits fell, and after a couple of years of savings, the employer is holding premiums flat in 2027.

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Watch the full conversation

The full briefing goes further, covering how Aligned defines advanced primary care versus direct primary care and concierge medicine, why Patrick sees the market as limited by demand rather than supply, and which strategies large employers are consolidating around right now. You can watch it on Health Tech Nerds.

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Want to see what this looks like for your workforce? Talk to our team or explore advanced primary care for large employers.

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