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

Aligned Marketplace Founding Team
September 1, 2023
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. 

Healthcare holds personal significance for each of us at different stages of life, which is why numerous dedicated and purpose-driven leaders have devoted decades to enhancing the healthcare system. However, despite remarkable advancements in science and technology, the healthcare delivery system often falls short in serving its intended recipients - patients, providers, and purchasers. Those who work in healthcare are driven by a profound sense of purpose, yet they often face formidable challenges when striving to effect positive changes within the complex and opaquely structured system. 

When our founding team came together to establish Aligned Marketplace, we shared a firm conviction that to maximize the positive impact a company can have on individuals' health, it is crucial to align incentives between parties and simplify the healthcare delivery model. After extensive conversations with numerous healthcare stakeholders, including patients, providers, and purchasers, we discovered that three key stakeholders could be brought together to create a streamlined and aligned care delivery model: employers, advanced primary care providers, and patients.

Before going deeper into our Aligned Marketplace solution, we would like to share a synthesis of what we have learned about the current state of self-insured employers, patients, and advanced primary care providers: 

Employers: The employer-sponsored healthcare market is set up with inherently aligned incentives to be a well-functioning market. The fact that self-insured employers pay the medical claims of their employees means they are incentivized to strike the right balance between reducing the total cost of medical claims to drive profitability, while also ensuring a healthy workforce to drive recruitment, retention and ultimately business outcomes. Unfortunately, in practice self-insured employers that sponsor health plans for their employees and families face a complex and challenging situation and purchase benefits and care in a market that makes seeing and purchasing value extremely challenging. Employers must navigate the delicate balance of 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 want an affordable, accessible, and equitable solution to ultimately increase employee experience.  Second, they face the challenge of containing rising medical costs, which have steadily increased at an alarming rate over the past decade and McKinsey projects 9-10% annual employer medical cost increases in 2024-20261. Lastly, employers are constantly looking for ways to effectively and efficiently manage the administrative burden of creating and operating a health plan within the constraints of busy HR teams.  

Patients: According to a recent study conducted by the Harris Poll and AAPA2, the state of US healthcare has caused such a high level of frustration that it negatively impacts usage behavior and ultimately health outcomes for patients. The study of over 2,500 patients highlighted patient pain points associated with cost and affordability concerns, complicated care coordination, long wait times to schedule an appointment and clinicians and providers having less time to spend with patients. The findings around patient cost and affordability concerns driving postponed or deferred medical care are consistent with multiple studies from the Kaiser Family Foundation3. One such KFF study found that about half of U.S. adults say they have difficulty affording health care costs and about four in ten U.S. adults say they have delayed or gone without medical care in the last year due to cost4. This data illustrates that having health insurance doesn’t mean workers and their families have the healthcare access they need.  

Advanced Primary Care Providers: Advanced primary care is primary care paid for under a value-based economic model, which allows the primary care company to create: (i) an affordable patient experience (since the primary care group isn’t dependent on having many short appointments to be sustainable, (ii) an accessible patient experience (since the primary care group can invest in more capacity and hybrid virtual support options like 24/7 texting), and (iii) a proactive care model that has data & analytics and care management and coordination built in.  Advanced Primary Care  has shown to increase the quality of care, patient experience, and reduce costs by reducing low-value care.  Clinician experience has also improved under advanced primary care models since many of the causes of health worker burnout are related to way our current healthcare system is designed including misaligned incentives driving increased cost, poor care coordination and burdensome administrative tasks that prevent providers from spending necessary time with patients to drive health outcomes5.  Advanced Primary Care grew significantly starting approximately a decade ago, and while the Medicare market has more deeply adopted advanced primary care through numerous value-based care arrangements, advanced primary care has also been proven to work in the commercial market. Over the last decade hundreds of groups have developed advanced primary care capabilities and are wanting to leverage the investment they have made in advanced primary care by serving additional patient populations. A few of the Aligned Marketplace founding team members have worked at some of the largest advanced primary care companies in the US and have deep experience in the necessary people, processes, and technologies needed to make advanced primary care successful in the employer population.  

At Aligned Marketplace, we believe increasing adoption of advanced primary care has the potential to significantly increase the healthspan of America’s workforce and their families. So, given the current state of employers, patients, and advanced primary care providers, why haven’t more employers adopted advanced primary care?   

Our belief is that the current system has too much friction to enable most employers to easily contract with advanced primary care companies and provide an inclusive patient experience.  Specifically, a large portion of employers (especially post-Covid) have members across many geographies and advanced primary care companies are highly fragmented and regionalized to specific geographies. In addition, there has been a growth of population-specific advanced primary care companies focused on providing more tailored care models and culturally competent care. It is difficult for an employer to contract with dozens of different advanced primary care companies to provide necessary geographic coverage and optimal employee choice. Also, managing a value-based care economic arrangement is complicated and it is helpful to have a neutral third party manage the arrangement between employers and advanced primary care companies.  Lastly, there are complexities in providing an advanced primary care benefit on top of the current health plan structure that must be overcome to remove the administrative burden of an employer and advanced primary care company and provide an affordable member experience. 

At Aligned Marketplace, we are on a mission to offer self-insured employers access to advanced primary care across geographies, through a single, easy-to-administer shared risk contract that has patient affordability, accessibility, and high-quality care built into the model.  We believe offering members a marketplace of affordable advanced primary care companies will increase member engagement in advanced primary care, increasing the quality of care provided to members and lowering employer total medical costs by more than 15%.   

Our vision is to provide an accessible and affordable advanced primary-care membership for more than 100 million American employees and their families under aligned, value-based care arrangements. By doing so, we will enhance the quality of care received, significantly improve the patient experience, and reduce overall healthcare costs for employers and American families. This is a noble and bold mission that certainly will not be easy to accomplish.  We feel energized by the potential positive impact that we can have, and we are humbled by the positive response we have received. 

We invite you to join us on this transformative journey. Together, we can reshape the future of employer-purchased health insurance, creating a system that truly serves the needs of patients, providers, and purchasers alike. Stay tuned to our blog for more updates, insights, and opportunities to be a part of this important movement. 

Are you a self-insured employer health plan sponsor with the same vision? Are you a healthcare industry expert with experience you want to share? Or someone interested in learning more? We want to hear from you! Please reach out, message our founding team or Get in Touch.

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