The Solution

Reclaiming Control in a Broken System

If the healthcare system feels unfixable, it’s because employers have been playing on a field they didn’t design. But forward-thinking organizations are proving that meaningful change is possible—through smarter strategies, better partnerships, and collective pressure for transparency.

Redesign the Funding Model

For many employers, the first step is to reshape how they purchase healthcare—moving from passive premium payers to active plan managers.

  • Self-funding or level-funding offers greater visibility into claims data and cost drivers while enabling tailored plan design based on workforce needs.

  • Reference-based pricing (RBP) can reset reimbursement rates to a transparent, rational standard instead of inflated hospital chargemasters.

  • Coalition or captive models allow employers to pool resources and negotiate better rates, aligning incentives around value, not volume.

Demand Transparency and Accountability

Knowledge is leverage. Employers must insist on clear data from every stakeholder in the healthcare value chain.

  • Require full claims data access from third-party administrators (TPAs).

  • Partner with advisors and analytics firms capable of benchmarking costs and exposing pricing disparities.

  • Push vendors for performance-based contracts where payment ties to outcomes, not utilization.

  • Advocate for laws and tools that enforce provider and PBM transparency—from negotiated rates to drug rebate flows.

Strengthen Vendor and Provider Alignment

The system won’t fix itself—but employers can choose partners committed to reform.

  • Leverage direct primary care (DPC) and center-of-excellence (COE) models to reward high-quality, lower-cost care pathways.

  • Choose PBMs that offer full pass-through pricing, real-time rebate data, and fiduciary accountability.

  • Collaborate with vendors that integrate mental health and chronic condition management into the care experience rather than adding fragmented point solutions.

Engage and Empower Employees

Even the best plan design fails if employees can’t navigate it. Empowering users reduces waste and improves satisfaction.

  • Provide decision support tools and concierge navigation services that help employees make cost-effective choices.

  • Offer incentives for preventive care, wellness, and condition management to reduce downstream costs.

  • Educate through concise, plain-language communication—turning benefit literacy into a competitive advantage.

Drive Collaboration and Advocacy

Employers are uniquely positioned to push systemic change.

  • Join or form employer coalitions that pressure carriers, PBMs, and health systems to modernize.

  • Support legislative reforms promoting price transparency, site-neutral payments, and fair competition.

  • Partner across industries to develop open-source or shared purchasing models that increase scale and bargaining power.

A Path Forward

Healthcare reform won’t arrive from the top down. It will come from employers—those who bear the costs and now have the tools, data, and determination to demand better. The message to the system is clear: the status quo is no longer sustainable, and employers refuse to fund it blindly.