How a Fortune 500 Company Got Its Members Into Primary Care
The costliest members are almost never new. They were rising for year before anyone noticed.
Most employers know this. What they don't have is a practical way to act on it. Risk builds quietly, in people who aren't yet sick enough to show up in a disease management report but are already on a path that ends in an ER visit, an admission, or a specialist referral that could have been avoided. Catching that early requires a doctor who has time, a member who actually goes, and a benefit design that makes going the easy thing to do. Most plans miss on all three.
One of our employer customers, a Fortune 500 employer, decided to stop working around that problem and build a different pathway instead. This is what happened in year one.
The problem with geographically dispersed workforces
The company covers roughly 75,000 employees spread across nearly 6,000 zip codes. Signing local agreements with practices market by market simply does not scale to a footprint that wide, and the further you get from a headquarters city, the thinner the options become. Meanwhile, medical spend was trending the wrong way and primary care utilization was low. When employees cannot get in to see a doctor, small problems do not stay small. They turn into emergency room visits, hospitalizations, and referrals into the most expensive parts of the system.
The new pathway
One contract with Aligned Marketplace opened access to more than 3,000 curated independent advanced primary care clinics across all 50 states.
However, access alone does not change outcomes. Enrollment does, and enrollment of the right people does most of the work. We risk-stratified the population using claims data, then ran proactive outreach to the members most likely to benefit. A personalized message that applies to the member: here are the doctors near you, here is your appointment. The employer paired that with plan-design incentives that made the new pathway the obvious choice.
By the end of year one, members had enrolled with more than 200 unique clinics nationwide, which is the practical proof that a single contract can reach a workforce that is genuinely dispersed.
What members engaged with a doctor, and how often
Roughly 70% of engaged members were high risk, the exact population where earlier, better primary care changes the trajectory. Those members averaged 4.7 additional primary care visits after their initial appointment, which means they were not just enrolling. They were building a relationship with a doctor.
Year 1 results
Engaged members showed 12% lower total cost of care in year one, or $95.79 PMPM in savings, compared with an actuarially matched benchmark population. The measurement was performed independently by Accorded.
Among engaged members, 22% had uncontrolled diabetes, against 33% in the benchmark, and 70% had hypertension under control, against 61%. Member sentiment held up alongside the clinical results, with a Net Promoter Score of +72 and 94% reporting they could get access to care.
Cost containment usually comes at the expense of member experience, and members tend to tell you about it. Here the savings and the satisfaction moved together, because the mechanism was better primary care rather than more friction.
Fees at risk
The employer's head of benefits put it plainly:
"What made this different was Aligned's model, one contract, proactive member engagement, and an arrangement where fees were at risk if results didn't follow."
Fees at risk against measurable outcomes is what keeps everyone honest about whether the pathway is actually working, and it is why the year one measurement was run by an independent third party rather than by us.
What this means for other employers
Three things we would carry into any employer conversation. First, breadth of access is a precondition. Second, targeting beats broadcasting, and claims data is the cheapest targeting tool most employers already own. Third, plan design determines whether good intentions turn into appointments.
To follow along, find Aligned Marketplace on LinkedIn.