Direct Employer
🛡️ Public data only — no PHI permitted on this instance.
Direct-to-Employer Contract Analyzer
Self-insured employer contracts · COE bundles · on-site clinics · ERISA structure · RFP pipeline — 1,555 corpus deals
Employers
10
Covered Lives
5,005,000
Annual Revenue
$687M
Blended PMPY
$137
COE Margin
36.2%
Onsite Capacity
72.1%
Pipeline Markets
8
Corpus Deals
1,555
Employer Contract Portfolio
| Employer | Industry | Covered Lives | Contract Type | Revenue ($M) | Utilization | PMPY | Renewal | Churn Risk |
|---|---|---|---|---|---|---|---|---|
| Walmart Centers of Excellence | Retail | 1,650,000 | COE bundle | $85.50 | 0.80% | $3,250 | 2027 | low |
| Amazon Internal Health (Amazon Care alt) | Tech | 1,200,000 | On-site + COE | $62.50 | 3.20% | $1,820 | 2026 | medium |
| Boeing Touchstone Network | Aerospace | 185,000 | Direct PPO | $38.20 | 24.00% | $4,200 | 2028 | low |
| GM EBCH Network | Manufacturing | 235,000 | COE + DPC | $48.50 | 18.00% | $2,500 | 2027 | medium |
| Cleveland Clinic Employer Solutions | Multi-employer | 420,000 | Direct access | $92.50 | 22.00% | $3,100 | 2029 | low |
| JPMorgan Chase Premium Network | Financial | 280,000 | COE + on-site | $55.80 | 15.00% | $2,880 | 2026 | medium |
| Disney Cast Member Health | Entertainment | 195,000 | On-site clinic | $28.50 | 4.50% | $1,850 | 2025 | high |
| Lowe's Home Improvement | Retail | 310,000 | DPC + COE | $42.80 | 2.50% | $1,620 | 2027 | low |
| Intel Corp Platforms | Tech | 105,000 | On-site + DPC | $32.50 | 6.80% | $3,480 | 2028 | low |
| FedEx Freight Network | Logistics | 425,000 | COE bundle | $45.20 | 1.20% | $1,340 | 2026 | medium |
Centers of Excellence (COE) — Bundled Procedures
| Procedure | Bundled Price ($k) | FFS Benchmark ($k) | Gross Margin | Annual Volume | Revenue ($M) | Travel ($k) |
|---|---|---|---|---|---|---|
| Hip Replacement | $38.50 | $54.50 | 38.0% | 380 | $14.63 | $2.50 |
| Knee Replacement | $34.80 | $48.20 | 41.0% | 650 | $22.62 | $2.80 |
| Spinal Fusion | $78.50 | $112.00 | 32.0% | 185 | $14.52 | $3.20 |
| Cardiac Bypass (CABG) | $72.50 | $98.00 | 28.0% | 145 | $10.51 | $3.50 |
| Bariatric Surgery | $24.80 | $38.50 | 44.0% | 520 | $12.90 | $2.20 |
| Oncology Episode (Breast) | $85.00 | $125.00 | 30.0% | 125 | $10.63 | $4.20 |
| Complex GI Procedure | $42.50 | $62.00 | 35.0% | 210 | $8.93 | $2.50 |
| Fertility Cycle (IVF) | $22.50 | $38.00 | 38.0% | 385 | $8.66 | $1.80 |
| Maternity Complex | $15.80 | $24.00 | 30.0% | 780 | $12.32 | $1.50 |
| Behavioral Health 90-day | $18.50 | $32.00 | 42.0% | 420 | $7.77 | $0.00 |
On-Site Clinic Operations
| Location | Employer | Employee Lives | Annual Visits | Annual Fee ($M) | Capacity Util | NPS |
|---|---|---|---|---|---|---|
| Bentonville HQ | Walmart | 18,000 | 32,000 | $4.80 | 72.0% | 78 |
| Seattle Campus | Amazon | 42,000 | 68,000 | $6.20 | 85.0% | 82 |
| Detroit Plant | GM | 12,000 | 18,500 | $2.80 | 78.0% | 74 |
| JPMC Manhattan | JPMorgan | 25,000 | 35,000 | $5.50 | 82.0% | 81 |
| Everett Factory | Boeing | 18,000 | 28,500 | $4.20 | 68.0% | 72 |
| Burbank Studios | Disney | 14,000 | 22,000 | $3.50 | 65.0% | 69 |
| Mooresville HQ | Lowe's | 8,500 | 12,000 | $1.90 | 55.0% | 76 |
| Folsom Campus | Intel | 11,500 | 17,000 | $2.60 | 72.0% | 80 |
ERISA Structural Considerations
| Topic | Description | Exposure ($M) | Mitigation |
|---|---|---|---|
| Self-Insured Plan Structure | All direct contracts with self-insured employers fall under ERISA preemption, limiting state-law exposure. | $0.00 | Standard structure; no material exposure |
| State Mandate Override Risk | State attempts to impose benefit mandates on ERISA plans historically preempted, but activist states (NY, CA) testing limits. | $3.50 | Monitor state regulation; maintain ERISA preemption documentation |
| Non-Network Balance Billing | Direct contracts outside of employer's TPA network may generate balance bills; employer must contract explicit. | $2.80 | Ensure employer explicit in-network designation in contract |
| Stop-Loss Interaction | Bundled-case pricing creates stop-loss claim timing issues; reinsurance may disallow certain bundled payments. | $8.50 | Pre-clear bundled pricing structure with employer's stop-loss carrier |
| Travel Reimbursement Tax Treatment | Travel for COE may be taxable imputed income to employee unless structured as medical-expense reimbursement. | $1.80 | Structure as IRS §213 medical expense; consult employer's ERISA counsel |
| Fiduciary Exposure for Employers | DOL has signaled increased scrutiny on PBM / employer direct-contract fiduciary duty; transitive exposure to provider. | $0.00 | Indemnification clause in direct-contract SPA |
RFP Pipeline — Direct-Primary-Care Market Expansion
| Market | Employer Count | Employee Lives | RFP Pipeline ($M) | Win Probability | Expected Rev ($M) |
|---|---|---|---|---|---|
| Dallas-Fort Worth Metro | 85 | 720,000 | $45.50 | 35.0% | $15.90 |
| Atlanta Metro | 68 | 540,000 | $38.50 | 30.0% | $11.50 |
| Phoenix-Mesa | 58 | 480,000 | $32.50 | 38.0% | $12.40 |
| Minneapolis-St. Paul | 48 | 425,000 | $28.50 | 42.0% | $12.00 |
| Nashville Metro | 42 | 320,000 | $22.50 | 40.0% | $9.00 |
| Charlotte Metro | 38 | 295,000 | $19.50 | 35.0% | $6.80 |
| Denver Metro | 45 | 385,000 | $26.80 | 28.0% | $7.50 |
| Austin Metro | 55 | 420,000 | $32.50 | 45.0% | $14.60 |
Direct-Employer Thesis: 10 employer contracts covering 5,005,000 lives produce $687M annual revenue at $137 PMPY.
COE bundled pricing delivers 36.2% gross margin vs fee-for-service benchmark — a premium the employer captures as overall plan cost savings.
Onsite clinic capacity averages 72.1% utilization; additional $89.7M in expected revenue from active RFP pipeline.
Direct-to-employer is a durable revenue stream (3-5 year contracts, low churn for high-performing providers) with ERISA preemption protecting against state-mandated network rules.
Stop-loss pre-clearance and fiduciary indemnification are standard but require early diligence.