There’s a reasonable chance – some experts put it at 30% – that within the next two election cycles, the U.S. moves toward some form of Medicare Advantage for All.
If that happens, pricing becomes irrelevant. Every plan pays the same. The only thing that separates one employer from another is access. And access means one thing: how long your people wait.
Think about what that looks like. Countries with universal healthcare systems all share the same problem – wait times measured in weeks or months for routine care. Employers who already have direct provider relationships could get their people seen in days. Everyone else gets in line.
The cement is still wet right now. The provider landscape is still flexible enough to build something. But once it hardens – once hospitals are flooded with new demand and have no reason to sign new direct contracts – that window closes.
Three Places to Start Building
Advanced Primary Care. All the primary care doctors who take insurance are full. Not accepting new patients. But there’s a whole network of Direct Primary Care (DPC) practices that are – they just don’t take insurance. You can contract with them directly. Your employees get a doctor who knows them, takes their calls, and isn’t rushing through a 7-minute appointment to hit their quota. Our clients who have this or an onsite clinic LOVE IT.
Behavioral Health. No carrier in the country is fully meeting mental health parity requirements. That’s not opinion – the Department of Labor has said it publicly. Your carrier’s behavioral health network is a starting point, not a solution. Supplemental vendors exist and they’re worth the conversation, especially with emerging therapies that are effective and affordable today but will get repriced by pharma tomorrow.
Centers of Excellence. Your carrier will never build these for you (they can’t publicly rank their own providers). This has to be employer-driven – direct contracts or bundled arrangements with top-tier surgical, imaging, and specialty providers layered on top of your existing network.
None of this requires a massive budget or a 10,000-life group. It requires intention and a willingness to build relationships before you desperately need them.
The employers who will be fine in five years are the ones building now. Not because they can predict exactly what’s coming, but because access is the one thing that matters regardless of how the policy shakes out. Price might change. Regulations will change. But your employees needing to see a doctor quickly and affordably – that doesn’t change.
Is your provider strategy something you’re actively building, or something you’re hoping your carrier handles?
