Why Every Employer Healthcare Strategy Involves a Tradeoff - And How to Fix That

Self-insured employers have tried every available strategy to control healthcare costs without sacrificing employee experience.

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The Promise and Disconnect in the Employer-Sponsored Healthcare Market

The employer-sponsored healthcare market has all the ingredients of a well-functioning market. Self-insured employers cover more than 100 million patients in the United States¹ and purchase roughly $800 billion in healthcare each year. Because they pay their employees' medical claims directly, they have every incentive to get this right — reducing unnecessary costs while keeping their workforce healthy, recruited, and retained.

And yet, in practice, self-insured employers face a fundamental market disconnect. They are purchasing benefits and care in a system that makes it nearly impossible to understand or compare real value. The result is an endless cycle of tradeoffs — where every strategy that solves one problem creates another.

Aligned Marketplace was built to end that cycle.

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Why are employer healthcare costs still rising despite years of investment?

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Employers have not been passive. They have invested heavily in point solutions, navigation tools, narrow networks, direct contracting arrangements, and plan design changes, all on the promise of savings and a better employee experience.

The results have been disappointing. Employer healthcare costs are now rising at their fastest rate in 15 years. According to Aon, US employer healthcare costs are projected to rise 9.5% in 2026, exceeding $17,000 per employee, marking the third consecutive year of near-double-digit increases.² Meanwhile, average family premiums have climbed roughly 26% over the past five years, according to KFF, and employees are increasingly absorbing the difference through higher deductibles and out-of-pocket costs.³

At the same time, employee satisfaction with health benefits is falling. The Employee Benefit Research Institute found satisfaction dropped from 60% to 55% between 2021 and 2022, even as employers spent more.⁴

According to research, half of organizations are now managing between 4 and 9 separate point solutions, and some manage entirely different sets for different employee populations.⁵ Meanwhile, 88% of employers surveyed by Willis Towers Watson are actively seeking to change their health and wellness vendors.⁶

Employers are spending more on a more fragmented, less satisfying experience for the employees they are trying to serve.

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What strategies have self-insured employers tried, and what are the tradeoffs?

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Over the years, employers have tested various strategies, each addressing different facets of the challenge while requiring major tradeoffs:

• Point solutions + navigation: One strategy is purchasing multiple best in class point solutions and a navigation solution. This helps with employee choice but is difficult to administer and understand if there are cost savings.
• Narrow networks: Another strategy is to purchase narrow networks, which can increase quality and reduce costs, but it limits employee choice and can be difficult for an employer to manage across geographies.
• Direct contracting: Another strategy is direct contracting with centers of excellence or surgical networks. This can increase quality but can be difficult to drive utilization and incorporate into current Third Part Administrator (TPA) networks.
• Plan design: Another strategy is making plan design adjustments which can be easy to administer but it can and has challenged employee affordability.

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What would an employer healthcare strategy without tradeoffs look like?

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It would need to deliver all of the following simultaneously:

• National geographic reach, so every employee has access regardless of where they live and work
• Meaningfully lower out-of-pocket costs for employees, driving real engagement
• Measurable cost savings for the employer, with clear attribution
• Genuine employee choice across doctor groups, not a single narrow option
• A single contract, so the administrative burden stays manageable

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How does Aligned Marketplace eliminate the tradeoffs?

Aligned Marketplace is an Advanced Primary Care Marketplace that connects self-insured employers to independent advanced primary care doctors across all 50 states under a single outcomes-based contract.

• ‍Geographic reach. A distributed employee base can access advanced primary care across all geographies under a single shared savings arrangement, with no patchwork of regional contracts required.‍
• Increased access and affordability. Employees access their APC doctor at $0 copay, removing the cost barrier that causes employees to delay or avoid care and the downstream costs that follow.‍
• Measurable cost savings. Aligned Marketplace delivers between 6 and 20% in total medical cost savings for employers, with clear outcomes-based attribution.‍
• Expanded employee choice. A single employer contract provides access to dozens of independent APC doctor groups, giving employees genuine choice while keeping administration simple.‍
• Integrated care. Advanced primary care serves as the hub for integrating mental health and specialty medical services, reducing fragmentation rather than adding to it.

The result is a healthcare benefits strategy where tradeoffs are not part of the equation, one that improves employee experience, reduces total cost of care, and simplifies administration all at once.

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Frequently Asked Questions

What is point solution fatigue?
Point solution fatigue occurs when employers and employees are overwhelmed by the number of disconnected health benefit vendors they must manage and navigate. It leads to lower employee engagement, higher administrative burden, and difficulty measuring whether any individual solution is actually delivering value.

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‍How does Aligned Marketplace work for employers with employees in multiple states?
Aligned Marketplace operates nationally, connecting employers to independent advanced primary care doctors across all 50 states under a single contract, eliminating the geographic fragmentation that makes most APC arrangements impractical for distributed workforces.

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