Course
The Employer and Commercial Market
Where 154 million people get coverage and the least has changed: self-funding and what ERISA preempts, how negotiated prices reach two and a half times Medicare, the transparency and fiduciary rules that reopened the market, and what employers can actually do about any of it.
By the end of this course, you will be able to:
- Determine whether an employer is self-funded or fully insured, and what that permits
- Explain what ERISA preemption enables for employers and forecloses for states
- Benchmark commercial prices against Medicare and identify what drives the variation
- Compare commercial value-based strategies by the strength of the evidence behind them
- Assess why the structural features of employer purchasing slow adoption regardless of intent
How Commercial Coverage Works
Employers cover 154 million people, two-thirds of them in plans where the employer pays the claims. Who holds the risk, and which rules reach them.
How Commercial Prices Are Set
Bargained rather than administered, averaging two and a half times Medicare, and public since 2022. What leverage produces and what transparency revealed.
Value-Based Contracting in Commercial
The strongest published evidence for population-based payment is a commercial contract. Plus how quality gets measured without a federal program, and network design as the everyday lever.
What Employers Do Directly
Bypassing the carrier through direct contracts and centers of excellence, buying primary care outright, and the fiduciary duties that turned inattention into legal exposure.
What Works and What Is Hard
The four structural obstacles no employer can solve alone, the strategies sorted by evidence strength, and an honest scorecard on the market that pays the most and has changed the least.