At its core, the formula is simple: focus purchasing power on high performers
Employer-sponsored healthcare in the United States is stuck in an antiquated and inflexible model that only benefits the incumbents at the expense of almost all employers. The consequences are clear and reaching the breaking point: rising costs outpacing wage growth, frustrated employees delaying needed care due to cost or complexity, and employers stuck footing the bill for a system they neither control nor understand.
The Value Formula offers a new path forward: one rooted in employer stewardship, data-driven accountability, and transparent, value-based design. It’s not another theoretical framework or lofty policy paper. It’s a practical roadmap forged from real-world implementations, employer-led innovations, and economic common sense.
But unlocking that formula requires a fundamental shift. It demands that employers stop playing defense—tweaking cost-sharing and relying on opaque carrier contracts—and instead step into the role they were always meant to play: the fiduciary stewards of their healthcare spend and their employees’ financial and physical wellbeing.
This book lays out the why and how of that shift:
Why risk-based payment models (like bundles and ACOs) realign incentives toward better outcomes at lower cost.
Why price and quality transparency—paired with meaningful financial incentives—are essential to engage employees as empowered consumers.
Why employers must confront the misalignment between how they pay providers and how employees are asked to pay for care—and fix it through episode-based cost-sharing.
How leading employers have done it already—with measurable results in cost, quality, satisfaction, and equity.