Voices of Self Funding Episode #41 Inside the Employer Playbook: Strategies Shaping the Future of Self-Funding
7 snips
Nov 11, 2025 Lee Lewis, Chief Strategy Officer at the Health Transformation Alliance and host of the Broken Benefits podcast, shares valuable insights into reshaping employer healthcare strategies. He introduces the 'ABC' framework—Advanced Primary Care, Behavioral Health, and Centers of Excellence—as a game-changer for self-funded employers. They discuss the rise of direct primary care, innovative mental health therapies like TMS and ketamine, and how tiered networks can drive better outcomes at lower costs. Practical tips for TPAs to enhance their offerings round out this informative conversation.
AI Snips
Chapters
Transcript
Episode notes
Carriers Can't Pay Value-Based Primary Care
- Carriers struggle to pay value-based or subscription primary care because their payment systems aren't built for it.
- Employers must supplement networks to include those value-based primary care models to maintain coverage.
Contract Local DPCs Or Use Aggregators
- Small employers should contract directly with local direct primary care doctors and only pay when members use the service.
- Large employers should use enablers or TPAs that aggregate direct primary care coverage nationwide.
Think Of Networks As A Balanced Diet
- Employers should think of their PPO network as a baseline diet that needs supplements for gaps.
- The ABC framework (Advanced Primary Care, Behavioral Health, Centers of Excellence) balances the network for better outcomes.