At IntoValue, we enable provider organizations’ success with
direct-to-employer healthcare.

We are uniquely positioned to enable both providers and self-insured employers to improve employee health and the care experience, all while reducing healthcare costs.

Here, we share some of the most interesting recent thought pieces about innovations in improving employer-sponsored healthcare.

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DIRECT CONTRACTING

Article | Employer-Provider Direct Contracting: Practice And Policy

Employer-provider direct contracting can not only control rising healthcare costs, but also improve quality, access, and employee satisfaction. Self-insured employer plans often suffer from misaligned incentives between employers and third-party administrators, leading to inflated charges. Direct contracting allows many employers to collaborate directly with health systems and medical groups, promoting better outcomes. This approach can lower costs, improve quality, and reduce administrative burdens. Policymakers can support direct contracting through price transparency and fair practices for smaller providers.

P.S. Check out our friends at payerset, leaders in price transparency insights.

DIRECT CONTRACTING

Article | Direct Contracting: Not New, But New Interest

This piece discusses the rising interest in direct contracting, where employers bypass insurers to work directly with providers for integrated healthcare and aligned metrics. Approximately 75% of employers currently utilize some form of direct contracting, with 41% considering it for 2025. The Purchaser Business Group on Health (PBGH) initiated a program in Seattle, where employers collaborate to contract with multiple providers using shared standards. Direct contracting enables employers to negotiate metrics and quality targets, potentially resulting in tailored healthcare approaches and proactive employee care.

DIRECT CONTRACTING

Podcast | Becker’s Healthcare – Spine and Orthopedic Podcast

In a Becker's Healthcare Podcast excerpt, MedVanta's Chief Medical Officer, Dr. Louis Levitt, argues that a direct-to-employer model focused on value-based care and direct contracting is the future of orthopedic care. This approach prioritizes physician-led care, addresses the high costs of musculoskeletal issues for employers, and improves patient access by enabling quicker appointments with orthopedic providers and integrated physical therapy services.

CARE DELIVERY INNOVATION

Article | Gatekeepers vs. Gateways: Who Owns the Patient Care Journey?

The article explores the changing dynamics in musculoskeletal (MSK) care, moving from traditional orthopedic surgeon gatekeeping to newer models involving digital platforms and navigation services. While these new models aim to lower costs, the article questions if they truly benefit patients. It advocates for a patient-centered "gateway" model that emphasizes precise triage and integrated care. The article concludes by stressing the importance of focusing on outcome ownership rather than simply mediating care.

EMPLOYER-SPONSORED INSURANCE

Report | How Affordable Is Job-Based Health Coverage for Workers?

The Commonwealth Fund’s study, which compared employee premium contributions and deductibles relative to state median income, found considerable variation in affordability across the country. Although income growth improved coverage affordability between 2022 and 2023, many states still face challenges, with premium contributions and deductibles consuming a substantial portion of household income. The article suggests policy solutions, including adjusting thresholds for marketplace premium tax credits and extending enhanced tax credits, to improve the affordability of health insurance for employees and their families.

FIDUCIARY ACCOUNTABILITY

Article | JPMorgan employees claim banking giant mismanaged benefits in class action lawsuit

JPMorgan Chase & Co. employees filed a class-action lawsuit alleging the company mismanaged their benefits. The employees claim JPMorgan prioritized relationships with CVS Caremark and other banking clients over their fiduciary duties, leading to higher prescription drug costs and other services. The lawsuit cites an example where a multiple sclerosis drug cost significantly more through the plan than without insurance. The employees are represented by Cohen Milstein Sellers & Toll PLLC and Fairmark Partners LLP, who argue that JPMorgan allowed pharmacy benefit managers (PBMs) and Big Pharma to overcharge its employees for prescription drugs and healthcare.