This is co-authored with Siobhan Nolan Mangini and Brian Zhao.

Primary care is supposed to be the front door to the healthcare system: the place where problems get caught early, chronic conditions get managed, and patients get pointed toward the right specialist before a small issue evolves into a bigger and expensive one. 

Today, for most employers and health plans, that front door is often shut. Wait times to see an available primary care physician can take more than 12 weeks and too often primary care providers listed in health plan directories are not accepting new patients when a patient calls.  Four in five physicians now work for a hospital or other large corporate entities¹ where institutional incentives may drive referrals to in-house providers over independent providers who may be available sooner, higher quality, and more affordable. The result is a system where employer healthcare costs keep climbing by 7 to 10 percent a year², while the quality and accessibility of the care driving those costs keeps declining or remains unchanged. We believe better access to very high quality primary care is an important and underutilized lever for improving outcomes and lowering healthcare costs.

Today, we’re excited to announce our investment in Aligned Marketplace’s Series A, a company built to fix this from the ground up.

Aligned Marketplace has built the only national marketplace for independent membership-based advanced primary care, and value-based specialty care, spanning all 50 states and more than 3,000 clinics. The idea is simple, but the execution is surprisingly complex: give employees free or low-cost access to independent primary care physicians who spend more time with patients and build trusted relationships to deliver more effective primary care and when needed to route them toward the highest-value specialists, imaging, labs, and surgical centers, instead of whatever is most convenient for a hospital system’s referral network.

The difference between traditional and Aligned Marketplace’s network of primary care clinicians shows up in nearly every metric that matters. Traditional practices carry panels of 2,500 to 3,000 patients, book appointments weeks out, and spend about 15 minutes per visit. Aligned Marketplace’s practices carry smaller panels, see patients same-day or same-week, and spend 30 to 60 minutes per visit. They’re paid a monthly fee rather than fee-for-service. That difference compounds: independent, membership-based primary care has been shown to reduce total cost of care by up to 15 percent over three to five years³, driven by lower-cost referrals, reduced emergency and specialist utilization, and better management of chronic conditions like diabetes, hypertension, and obesity.

What makes this especially relevant for employers right now is that primary care, despite representing less than 5 percent of total healthcare spend⁴, influences as much as 80 to 90 percent of it. The employees who benefit most are also the ones every employer worries about most: the roughly 15 percent of a population who are higher-risk, who account for the large majority of total healthcare spend, plus the employees who are not engaged with primary care providers and at risk of developing serious conditions.  Aligned Marketplace’s model is built specifically to reach and engage these members, using data to identify who needs care, personalized outreach, and plan design incentives to get them into it.

Critically, none of this requires an employer to replace its existing health plan. Aligned Marketplace layers on top of current benefits and third-party administrators, preserves existing PCP relationships for employees who want to keep them, and requires no network changes. Employers pay through utilization-based payments with fees at risk based on performance, aligning incentives around outcomes rather than volume. Recent legislation has also opened the door to genuine $0 cost-sharing options for primary and specialty care, something Aligned Marketplace is positioned to take advantage of in ways that are difficult for traditional network structures to replicate.

We think this combination – a curated, national marketplace of high quality independent primary care providers who can actually see you right away; a payment model that shares risk; and a go-to-market that doesn’t force disruptive plan changes – is what has been missing from prior attempts to improve primary care. Physical bricks and mortar-clinic models have proven the value-based care thesis works, but access to these clinics is capital intensive for many employers.  Aligned Marketplace was the first to stitch together a curated primary care marketplace to bring the membership-based primary care model to a national, self-insured employer, or health plan population without asking them to change carriers or networks. 

The team, led by founder and CEO Patrick Nelli, alongside a product and engineering team with backgrounds spanning primary care, technology, and healthcare operations, has built something with a clear and, frankly, overdue mission: increase America’s healthy years. It’s a mission that resonates because it aligns everyone’s incentives. Employees get free or low-cost access to clinicians who actually have time for them. Employers and payors get a credible path to bending their cost curve without disrupting the plans and coverage their employees already have. And independent primary care practices, the ones actually delivering better outcomes, get access to the patient populations and payment models that reward them for delivering better outcomes, better access, and more affordable care.

We’ve spent a long time looking for a company solving primary care access and cost at a genuinely national scale, with a business model built around shared risk rather than another layer of fees. Aligned Marketplace is that company, and we’re proud to be partnering with Patrick and the team as they bring it to more employers, payors, and the millions of members they serve.

1. PAI-Avalere Health Report on Physician Employment Trends and Practice Acquisitions 2018-2026 ↩︎
2. 2026 Milliman Medical Index ↩︎
3. Employer Strategies: The Case for Adopting and Implementing Advance Primary Care – National Alliance of Healthcare Purchaser Coalitions ↩︎
4. Sufficient and Efficient Spending on Primary Care Benefits National Health and Health Systems – Milbank Quarterly ↩︎