March 19, 2026
As technology and the ability to effectively utilize vast amounts of health care data have expanded, emerging startups and innovators implementing point solutions have been able to target specific portions of the health care ecosystem for optimal results. But there’s a potential downside to the point solutions available for employers. These tools focus only on specific slices of the health care experience or patient populations, leaving employers to wonder, “Where does this solution fit into my benefits strategy as a whole?”
The following sections take a close look at issues employers should consider as they strive to build a cohesive and innovative benefits strategy and health care experience.
Evolution of Innovation in Health Care: The Challenge of Optimizing One Piece of the Puzzle
Employers often work with a dozen or more health care vendors. Adding a niche solution can create extra complexity and may confuse employees, strain internal benefits teams and contribute to fragmentation across the health care ecosystem, even if the solution is highly effective. Growth in virtual health solutions, advances in artificial intelligence (AI) and ongoing primary care access challenges across the health care ecosystem further highlight the need for partnerships with vendors that can address issues holistically rather than in isolated slices or coordinate well with other providers. For employers, innovation isn’t just partnering with exciting startup companies. In some cases, vendors may achieve better integration by partnering with health plans, providers or aggregators, who are often better positioned to incorporate new solutions into coordinated services.
The process of incorporating vendors across procurement, legal, IT, communication and other departments can be onerous, and integrating a new solution into the employer’s existing vendor ecosystem is a major headwind. A solution on its own may be compelling but will not have long-term impact or viability if it isn’t integrated effectively within the broader ecosystem and benefit strategy, alongside employers’ other partners and vendor solutions. For strategic considerations and further insight into integration of benefits, check out Business Group on Health’s resource, Integrated Benefits Experience: Four Key Considerations for Employers.
Effective Innovation in Primary Care Is Integrated
The challenge of integration is particularly acute in primary care, which is ripe with opportunity and a common target for innovation. Traditional primary care follows a fee-for-service (FFS) reimbursement model that marginalizes the patient experience, frustrates providers and limits innovation. Primary care, however, remains the most common touchpoint within the health care system, alongside the pharmacy counter. Ideally, primary care is a refuge for patients in what is often a fragmented, confusing and expensive health care system. A key competency of an effective primary care system is that it coordinates care for patients, guiding them through their journey within the primary care provider (PCP) office and beyond.
The breadth of the primary care experience means that some elements are often targeted by emerging vendor partners for improvement. This approach, however, isn‘t always the optimal solution. When slices of primary care are carved out, it can hamper providers’ ability to coordinate care, deliver effective preventive services and support their patients holistically with services for both physical and mental health conditions. This isn’t to say that the status quo of FFS primary care is acceptable or without substantial room for improvement, but it behooves employers to give additional scrutiny to vendors looking to optimize only one part of the primary care system. What’s more, AI developments in the primary care space are amplifying the pace of change, creating an additional level of complexity for employers.
We Need to Optimize Primary Care, Not Just Elements of Primary Care
Across the country, there are examples of primary care arrangements that are succeeding in delivering high-quality care at a total cost better than that found in the market. Almost without exception, these arrangements accept some risk for outcomes and total costs or have moved away from FFS reimbursement altogether. Once FFS incentives have been blunted or removed, a PCP and their team are better able to innovate and practice in ways that optimize population health and coordination across other provider groups, embracing some of the vendor point solutions alluded to above while improving their bottom line.
No one vendor, provider group or employer will be able to solve the challenges of primary care alone. When incentives are aligned, data shared and patients empowered, there are tremendous opportunities to improve the primary care experience across the board, including by establishing ways for traditional providers, virtual care vendors and other point solutions to work in concert to improve the lives of the people they serve.
Taking a Step Back: Identifying Primary Care "Nirvana"
Recognizing these challenges, the Business Group convened multiple stakeholders, led by employers, to create a holistic view of what an optimal primary care experience would look like for patients. By coming to consensus on what a primary care “nirvana” could be, they reasoned that they could work backward to better assess whether a new plan design, network or vendor strategy will help advance the cause of promoting this ideal state. The next section on “Principles for an Optimal Primary Care Experience” explores what this should look like.
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