Issue 46

All Stakeholder Meeting: August 26, 2026 11am – 1pm ET in Jasper, Indiana

EFI will feature a live example of a direct-to-employer arrangement on August 26 in Jasper, Indiana. The event will highlight the direct agreement between EFI member Patoka Valley Health Cooperative and Jasper Holdings, in partnership with Deaconess Health System. Panelists will include:

• Doug Bawel, Chairman of the Board, Jasper Holdings, Inc
• Alissa Brosmer, Executive Director, Patoka Valley Health Cooperative
• Shawn McCoy, CEO, Deaconess Health System
• Cheryl Wathen, SVP & Chief Financial Officer, Deaconess Health System

The discussion will focus on the real barriers and opportunities, for both employers and hospitals, in building effective direct contracting arrangements. Indiana’s new legislation has created a framework. This event is about what it takes to actually use it.

Calendar invites have been sent to members. If you are an EFI member and do not have this on your calendar, please contact Sara Otte.

EFI has released its latest Law-to-Action, focused on anticompetitive contract clauses and the new Indiana laws that give employers greater plan oversight and benefit design authority.

It outlines how employers can identify contract provisions that limit steering, tiering, carve-outs, data access, audits, and other purchasing strategies that can interfere with effective oversight of TPAs, PBMs, and healthcare vendors. It also highlights practical steps employers can take to review contracts, negotiating renewals, and when evaluating vendor arrangements. View the LTA library here.

As transparency laws take hold, employers are being asked a basic question: does what you pay for healthcare reflect fair value? That kind of analysis requires a tool built for the job.

Sage Transparency 2.0 brings together hospital pricing, quality, and financial data in a single searchable platform covering more than 4,000 hospitals and 2,000 ambulatory surgery centers nationwide, with peer benchmarking and Medicare comparisons built in.

A new video shows how the platform works and how employers can start using it. If you haven’t explored Sage Transparency yet, this is a good place to start.

On May 20^th, EFI was hosted by Fort Wayne Community School Corporation for our first regional All Stakeholder Meeting. At the event, Linda Brady shared Boeing’s journey into advanced primary care, a strategy the manufacturer began over a decade ago that has grown into several near-site clinics across multiple markets. Key elements of Boeing’s approach include:

• Ensuring primary care is comprehensive and includes informed referrals to the highest-quality, best-value specialists
• Moving away from fee-for-service funding so providers have adequate time with patients
• Prioritizing timely access to care as a core design principle
• Boeing’s approach has led to improved outcomes and patient experience, greater access to primary care, and cost savings for both the company and employees.

Three Indiana employers also shared their own primary care models, which varied from near-site clinics to dedicated onsite primary care. Like Boeing, Indiana employers are also seeing better access to care, improved outcomes, and cost savings. One employer discussed adding GLP-1 management as a new offering through their onsite clinic.

The consistent message, given the positive results they’ve seen, is that employers are looking to grow their direct primary care models further.

Indiana is taking on powerful nonprofit hospitals by incentivizing them to lower their prices or face the loss of their nonprofit status by 2029. Governor Mike Braun has been direct about the rationale: “Government has to intervene, because healthcare is run like an unregulated utility.”

For EFI member Doug Bawel, Chairman of Jasper Holdings, the law’s requirement that nonprofit hospitals offer direct-to-employer arrangements is already reshaping negotiations. Bawel said he expects the state’s price controls on direct deals to “significantly strengthen his negotiating leverage with hospitals.”

Creating the law is just the beginning. Leveraging it is the work ahead, and the August 26 Jasper event will focus on exactly that.

Indiana hospitals report a 17% surge in emergency department visits, driven by a wave of uninsured patients after ACA subsidies expired and Medicaid rolls were cut. When uncompensated care rises, hospitals often use it to argue for higher commercial prices. EFI’s Jonathan Levin pushed back in the Indiana Capital Chronicle:

“Indiana employers already pay some of the highest hospital prices in the country… the available evidence has not supported the conclusion that higher employer-sponsored insurance prices are necessary to offset increases in uncompensated care.”

Georgetown’s Center on Health Insurance Reforms just published a close look at whether ERISA, the federal law governing most employer health plans, is equipped to control costs. The short answer: it has real tools, but Congress could do more.

The report examines how ERISA’s fiduciary rules, transparency requirements, and Department of Labor enforcement can be used and strengthened to rein in PBMs, TPAs, and other service providers. Worth a read for anyone navigating plan governance or vendor negotiations.