Module 4
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.
By the end of this module, you will be able to:
- Assess a centers of excellence proposal against the evidence actually behind it
- Explain why employer investment in prevention faces a shorter payback window than Medicare's
- Describe the disclosure duties that now make documented diligence necessary
- Direct Contracting and Centers of Excellence Some employers bypass the carrier and contract with health systems themselves. The mechanism is sound and the published evidence is thinner than the marketing. About 5 min
- Onsite and Advanced Primary Care Employers buying primary care directly are doing what capitated systems do, on a smaller scale and with a shorter payback window. About 5 min
- The Fiduciary Turn New disclosure duties turned a familiar ERISA obligation into a live legal exposure. Employers now have to be able to show they checked. About 5 min
Module quiz
Answer all questions to see your score.
1. How should a typical centers of excellence savings claim be read?
Employees willing to fly to another state for surgery are not a random sample of employees needing surgery. The design logic is sound; the independent evidence is thin.
2. Which return from advanced primary care is unique to an employer and invisible to a health plan?
This is why onsite clinics can be rational for an employer even when the pure claims math is marginal.
3. What does ERISA's fiduciary duty actually require of an employer managing health plan spending?
The change is not that overpaying became illegal. It is that not looking stopped being excusable, because the data is now accessible and the contractual barriers were removed.