Why Aligned Marketplace Exists - Fixing the Broken Link Between Employers, Employees, and Advanced Primary Care
The US healthcare system has produced remarkable medical advances. But the way care is delivered still fails the three groups who depend on it most: the employers who pay for it, the employees who need it, and the doctors who provide it. Aligned Marketplace was built to fix that.
For many Americans, healthcare is more than an industry. It carries deep personal significance — touching every family at some point, often in moments that matter most. That's why so many dedicated leaders have invested decades trying to improve it. And despite remarkable advances in medicine and technology, the way healthcare is delivered still falls short.
It fails patients who can't access or afford the care they need. It fails doctors who entered the profession driven by purpose but find themselves trapped in a system that rewards volume over outcomes. And it fails the employers who foot the bill without any reliable way to know whether what they're buying is actually working.
The people working inside healthcare are often deeply motivated. But the system they operate within is complex, opaquely structured, and resistant to change in ways that can exhaust even the most committed reformers.
What the Aligned Marketplace founding team set out to solve
When the Aligned Marketplace founding team came together, we shared a core conviction: the best way to improve the health of America's workforce is to align the incentives between the parties involved, and simplify the delivery model.
After extensive conversations with people across every part of the healthcare system — employers, doctors, benefits administrators, patients, and payers — we kept arriving at the same conclusion. The problem was not a lack of good solutions. Advanced Primary Care had already proven it could deliver better outcomes at lower cost. Independent APC doctors were ready and willing to serve more patients. Self-insured employers were actively looking for a better approach.
No one had built the infrastructure to connect all three under a single, workable arrangement.
That is what Aligned Marketplace exists to do.
What we learned about current state of healthcare
Before explaining the solution, it helps to understand what we found when we looked closely at each of the three groups Aligned Marketplace serves.
Self-insured employers are paying the cost of a broken system
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.
The result: employers are spending more, getting less, and have limited visibility into why.
Americans are unable to access the right healthcare
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.
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.
Having health insurance, it turns out, doesn’t necessarily mean workers and their families can access the healthcare they need.
Advanced Primary Care is by far a better care model for keeping people healthy
Advanced Primary Care (APC) — primary care delivered under an outcomes-based economic model — has already proven what's possible.
Because APC doctors are paid based on patient outcomes rather than visit volume, they can practice differently. They spend more time with patients. They invest in preventive care and chronic disease management. They use data and care coordination to catch problems before they escalate. And they offer accessibility options — like 24/7 virtual support — that traditional practices can't sustain financially.
The results are consistent: higher quality care, better patient experience, lower total cost of care, and significantly lower physician burnout.⁵ Hundreds of APC doctor groups have built these capabilities and are actively seeking to serve more patients.
The problem is not the model. It's that no one has made it easy for employers to access it at scale.
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.
- Geographic fragmentation - 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.
- Contract complexity - 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.
- Member engagement at scale - 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.
Aligned Marketplace exists specifically to address all three of these issues.
We offer a single, easy-to-administer outcomes-based contract that connects self-insured employers to independent advanced primary care doctors across all 50 states. One agreement. National coverage. A marketplace of APC doctor groups with reduced out-of-pocket costs that drives the employee engagement needed to make the model work.
Our long-term vision is to make accessible, affordable Advanced Primary Care available to more than 100 million American employees and their families — and to prove that aligning incentives between employers, doctors, and patients is the most powerful lever available for improving the health of America's workforce.
Frequently Asked Questions
Why was Aligned Marketplace founded?
Aligned Marketplace was founded on the belief that Advanced Primary Care is the most effective lever for improving workforce health and reducing employer healthcare costs — and that the structural barriers preventing its adoption were solvable with the right marketplace infrastructure.
What problem does Aligned Marketplace solve for self-insured employers?
Most self-insured employers can't access Advanced Primary Care at scale because APC doctor groups are regionally fragmented, outcomes-based contracts are complex to manage, and no single solution offered national coverage. Aligned Marketplace solves all three with a single contract covering APC doctors across all 50 states.
Why is Advanced Primary Care better for employees?
APC doctors are paid based on outcomes, not visit volume — so they spend more time with patients, invest in preventive care, and coordinate care across the system. Employees get better access, more time with their doctor, and a care experience built around their health rather than throughput.
What is Aligned Marketplace's mission?
Aligned Marketplace's mission is to increase America's healthspan by making Advanced Primary Care accessible and affordable for more than 100 million American employees and their families.
2. https://www.aapa.org/download/113513/?tmstv=1684243672
3. https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs
4. https://www.kff.org/report-section/kff-health-care-debt-survey-main-findings
5. https://www.hhs.gov/surgeongeneral/priorities/health-worker-burnout/index.html