How the Most Innovative Employers Are Embracing Disruption

The best doctor in a broken system is one who acts against their own financial interest on behalf of the patient. Lee Lewis of the Health Transformation Alliance uses that framing to anchor a sharper claim: about 10% of HTA's members are holding trend flat for multiple years without cost-shifting to employees. The mechanism is not a single intervention but a modular set of strategies built around a core principle. Identify where value exists in your market, then build incentives and communications that steer employees toward it.

Five categories account for roughly half of employer spend: orthopedics, cardiometabolic disease, cancer, behavioral health, and maternity. The waste in every category is addressable with tools available today, from step therapy protocols before orthopedic surgery to birth centers that cut maternity costs in half with better outcomes for appropriate candidates.

The more elegant solution connecting all five is excellent primary care with a trusted relationship at the center. A good PCP anchored in data can route patients toward specialists who apply restraint, avoid unnecessary procedures, and choose lower-cost sites of care when clinically equivalent. That is harder to operationalize than a point solution, but it compounds across every category simultaneously.

For anyone working in benefits, the challenge is blunt. Behave differently than everyone around you. In a system that is broken, doing what everyone else does guarantees the same results everyone else is getting.

Listen to Lee Lewis on why good primary care is the one move that tackles all five spend categories at once, and how even a 200-life employer can direct-contract its way to flat trend.