Large employers aren’t the only ones who can do direct contracting. In this episode of Margin of Care, Lee Lewis of the Health Transformation Alliance breaks down the ways small and mid-sized employers can be more nimble and drive better health outcomes for their covered lives, all the while managing costs. New approaches aren’t out of reach.
Key Takeaways:
Employers flattening trend focus on tiering, steering, and behavior change—not just plan design.
Direct contracts aren’t just for jumbo employers—smaller companies can lead locally.
Five focus areas (ortho, maternity, cardio-metabolic, cancer, mental health) = 50% of spend.
Disruption doesn’t mean friction—it means rejecting broken incentives and reshaping value.
High-performing doctors put patients above profit—and smart plans guide people to them.
00:00 – Intro + Guest welcome
01:20 – What is HTA + which employers it serves
03:50 – Why disruption ≠ friction
06:00 – Behavioral health, DPC, and grassroots pilots
10:45 – Getting carriers to be more flexible
13:00 – Small employer advantages + direct contracting
17:15 – Steering strategies that influence systems
20:45 – Data transparency + system accountability
24:10 – Tiering + 5 spend categories (ortho, cardiac, cancer, BH, maternity)
28:40 – Innovation in mental health + birth centers
30:30 – The power of PCP relationships
32:30 – Advice for benefits leaders + Broken Benefits pod