9.2% Employer Cost Climb Sparks a Direct Contracting Coalition
Employer healthcare costs are projected to rise 9.2% in 2027. That is the Business Group on Health number. Not a blip. Another year of premiums climbing while the middlemen keep the map.
Last week a coalition called the Association for Direct Care launched. Employers. Clinicians. Health tech. Their job is to expand direct contracting: the buyer negotiates care and price with the doctor or hospital, not through traditional insurance first. Direct primary care. Centers of excellence. The number on the door is the number you pay.
Taylor Hittle, the executive director, said Americans and the job creators who cover workers are sick and tired of watching premiums rise year after year. Direct contracting lowers costs, cuts administrative waste, and brings transparency. Jenny Goins at the National Alliance of Healthcare Purchaser Coalitions called it an important tool for employers who still want quality without the annual surprise.
They listed 6 policy priorities. A federal framework for employer-provider deals. Joint purchasing. End contract language that blocks steering to higher-value care. Give employers claims, pricing, and audit data. Clearer multi-state rules. DOL grants and help for smaller providers and administrators. That is not a slogan. That is a shopping list.
I am not anti-insurance. Keep a policy for the wreck. I am anti paying a middle layer to hide the oil-change price. Direct care was already the door for patients. Now the buyers who write the checks finally showed up as a coalition.
9.2% is the forecast if nothing changes. The coalition is proof someone refused to shrug.
medcitynews.com/2026/09/new-coalition-launches-to-expand-direct-contracting/
MaineHealth Now Sells Primary Care for $119 a Month
On September 28, MaineHealth cut a ribbon in Brunswick. It was the second clinic for Trellis Health, the system's membership primary care arm. The first sits on Congress Street in Portland.
The price is right there on the website. $119 a month for an individual. $109 if you pay for the year. $109 per person for families. Primary care, physical therapy, behavioral health, medication management, health coaching, and annual labs are listed at $0 once you're in.
Read that again. The biggest health system in Maine looked at the way it has billed primary care for decades and decided to sell a membership instead.
I won't pretend that doesn't feel like vindication. For years independent direct care doctors were told this was a boutique fad, a concierge thing, a model that couldn't scale. Now a hospital system is copying the menu, down to the published price.
But copying the menu is not the same as cooking the meal.
Trellis says its members had roughly 30% fewer ER visits, admissions, and specialist referrals. Maybe. The release that carried that number came with no sample size, no comparison group, and no time window. Until it does, it's a belief, not a result.
And the fine print wobbles. One page on the Trellis site says that when you join, they take over as your primary care team. Another page, written for members of an insurance plan that paid the fee, says Trellis is an addition, not a replacement, and you don't have to leave your doctor. Both were live on October 1. Those are two different products. Only one of them is a doctor who knows you.
That insurance plan is Mending Health. It covered the Trellis membership in full. It leaves Maine on January 1, 2027.
So here is what the ribbon actually tells us. Patients want a price they can read. Employers want a monthly number they can budget. Even hospital systems now know the fee-for-service visit is a lousy way to buy primary care.
The question is who holds the scissors. A system that owns the hospital, the imaging, and the specialists has every reason to keep the referral pipeline full. An independent doctor whose only revenue is the membership has every reason to keep you out of it.
$119 a month is a fair number to put on a website. The hard part is what happens after you join.
www.dpcinsider.com/blog/2026-10-01-trellis-second-clinic-mending-insurer-exit/
The $15 Breaker Switch
In a 2022 federal case, a salesman testified about a customer whose technician reported a failed compressor. She bought a brand-new $22,000 system. The actual problem was a $15 breaker switch.
That story comes from Worse on Purpose's investigation into HVAC, and it could just as easily describe a hospital bill.
Three things happened to heating and cooling at once. Private equity bought the biggest regional contractors and tied technician pay to what they sell. Manufacturing consolidated until six companies made the 34 most common brands, and hardware prices climbed 53% since 2020. And rules on who can buy refrigerant or install a unit pushed every repair through a licensed, and increasingly consolidated, gatekeeper.
Swap the nouns and you're describing medicine. Small independent practices get bought and put under productivity targets. A handful of large systems and insurers control what gets done and what it costs. Licensing and billing rules send every simple problem through the most expensive door available.
None of this is a conspiracy. It's what the incentives produce. Pay people to sell, and they'll sell. Pay a system per procedure, and procedures multiply. Pay an insurer a percentage of spending, and spending doesn't have much reason to fall. Your hospital got worse on purpose. Your insurance got worse on purpose. Even your scheduling got worse on purpose, because a two-week wait keeps the expensive urgent care and ER visits coming.
The fix isn't a better salesman. It's getting the sale out of the room. In direct primary care, patients pay one flat membership. No code pays more for a scarier diagnosis, and the doctor makes nothing extra from replacing the whole system. When the breaker is the problem, you fix the breaker, and the patient keeps the $22,000.
Small HVAC shops and small clinics have the same enemy and the same advantage. The enemy is ownership that turns judgment into quotas. The advantage is that honest, flat, transparent pricing is still something a small operator can offer and a roll-up can't.
32% of Privately Insured Adults Are Paying Off Medical Debt
Coverage was supposed to be the shield. The Commonwealth Fund just counted what is still getting through.
32% of working-age adults with private insurance are paying off medical bills or debt over time. Nearly half of those with debt owe $2,000 or more. That is about 15% of all privately insured working-age adults carrying at least $2,000 they have not finished paying. 64% of the debt came from hospital care. 43% pointed at a doctor's office visit. 39% said it was for a chronic condition. The card cleared. The bill did not.
68% of people with unpaid medical bills said the debt caused worry or anxiety. 30% delayed or avoided needed care. 30% cut food, heat, or rent to keep up. 37% burned savings. A quarter were already paying a collection agency. Insurance was active the whole time.
I am not anti-insurance. Keep a policy for the wreck. I am anti pretending a deductible and a facility fee are the same thing as protection. Direct care is the boring fix for the oil change. Flat monthly fee. Price on the door. No claim. No surprise after the visit. Keep coverage for the crash. Stop financing everyday care like a hospital stay.
32% is not a story about people without a plan. It is what happens when the plan still leaves you negotiating with a mailbox.
One Hundred Eighty Million From Codes the Chart Did Not Support
The HHS Office of Inspector General just posted audits of two Medicare Advantage plans run by the biggest names in the business. HumanaChoice and UnitedHealthcare of Wisconsin. The charge is simple: diagnosis codes went to CMS that the medical records did not back up. Risk scores went up. Capitation followed.
For HumanaChoice, one hundred seventy-eight of two hundred twenty sampled enrollee-years failed. Extrapolated, that is at least one hundred thirty point nine million dollars in overpayments for twenty twenty and twenty twenty-one. For UnitedHealthcare of Wisconsin, one hundred eighty-three of two hundred fifty failed. Another forty-six point nine million. Add them and you get almost one hundred eighty million from two contracts, two years, and a payment model that pays more when the code list looks sicker.
Source: oig.hhs.gov/reports/all/2026/medicare-advantage-compliance-audit-of-specific-diagnosis-codes-that-humanachoice-contract-h5216-submitted-to-cms/ and oig.hhs.gov/reports/all/2026/medicare-advantage-compliance-audit-of-specific-diagnosis-codes-that-unitedhealthcare-of-wisconsin-inc-contract-h5253-submitted-to-cms/
I am not shocked. When the check gets bigger every time the chart gets longer, the chart gets longer. Both plans say the methodology is flawed and they do not plan to send the money back. That is their right to argue. It does not change the incentive.
I am not anti-insurance. Keep a policy for the wreck. I am anti a system that turns a diagnosis into a billing asset and then acts surprised when the codes outrun the care. We take care of patients for a flat monthly fee. No claim. No risk score. No bonus for a sicker-looking list. The number on the door is the number you pay.
One hundred eighty million is not a rounding error. It is what happens when payment follows the code instead of the visit.