Fewer than 8 percent of U.S. adults receive all the preventive services recommended for them. That number comes from a 2018 Health Affairs analysis of CDC data, and it has barely moved. Employers, insurers, and policymakers pour billions into value-based primary care arrangements meant to close exactly that gap. Most of those arrangements reward the provider and the plan sponsor. The employee still faces the same copay, the same deductible, and an abstraction that outcomes will improve somewhere down the line.
WellthCare™ changed that by making the employee an economic participant in prevention, not just a subject of it.
A Payment Fix That Skips the Patient
Value-based primary care rewires how a clinic gets paid. Instead of fee-for-service volume, the practice takes a per-member-per-month payment or shares in savings when quality targets are hit. The logic is sound: pay for outcomes, not transactions. Employers with self-funded plans adopt these arrangements because they promise lower total cost of care over time. Evaluations of the Medicare Shared Savings Program confirm that well-run accountable care organizations trim a few percentage points off spending, mostly by reducing hospital admissions and unnecessary imaging.
What those studies do not show is any change in the employee’s financial experience at the point of care. A 2023 Kaiser Family Foundation survey found that 28 percent of adults skipped or postponed needed medical care because of the cost. The deductible is still the deductible. A value-based contract between an employer and a primary care group does not make a $40 copay or a $1,500 deductible feel smaller to the person holding the insurance card. The incentive to book the preventive visit is abstract, and abstract incentives lose to the immediate pressure of a household budget.
The practice has a financial reason to close care gaps. The patient does not. WellthCare bridges that gap by attaching a direct, personal financial consequence to the behaviors that make value-based primary care work.
Real Dollars for Verified Actions
WellthCare operates as a self-insured supplemental medical plan structured under IRC §105. It sits alongside the employer’s existing ACA-compliant major medical plan and gets used first. When an employee completes a verified preventive health action-a biometric screening, a chronic-condition lab panel, a plan-of-care follow-up-the platform records the standardized preventive care code, confirms completion, and posts reward dollars to the employee’s WellthCare Store™ account.
Those are real, spendable dollars. Not points, not credits. The WellthCare Store carries more than 3,000 FSA-approved products aligned to each person’s plan of care. There is no reimbursement paperwork. The employee uses the dollars at the point of purchase, the way they would use a gift card. The convenience is possible because the compliance infrastructure is thorough: every plan of care is drafted by AI and reviewed by a nurse practitioner and physician, every trigger event maps to a defined plan benefit, and the recordkeeping satisfies ERISA and HIPAA requirements. The legal structure is supported by formal ERISA and tax opinions. All of that runs in the background. The employee sees a scan, a confirmation, and a balance they can spend.
That shifts the economics of prevention for the person whose decision determines whether the screening gets done. When a biometric check-up takes 20 minutes and puts $75 of purchasing power into a household’s health budget, the cost-benefit arithmetic changes. Value-based primary care suddenly has a new engine: employees acting on their own financial interest in the very behaviors that generate the quality metrics the practice is paid to hit.
Prevention That Builds Retirement Wealth
WellthCare adds a second payout that no traditional value-based care contract includes. The savings an employer realizes from lower claims fund automatic contributions into employees’ retirement accounts. The employer commits the savings; the deposit lands in a SEP or pension plan. Every verified preventive action builds a visible balance that grows over time.
This addresses a practical barrier. A quarter of Americans ages 55 and older have no retirement savings, according to the Federal Reserve’s 2022 Survey of Consumer Finances. For many workers, retirement is a distant abstraction until it isn’t, and then it is a source of anxiety. WellthCare makes wealth accumulation observable in the present. An employee logs in, sees a retirement balance that increased because they completed a diabetes screening or a medication review, and understands that health actions compound financially. That feedback loop is absent from a typical value-based care agreement, where the employer’s actuary sees the savings but the employee sees nothing.
Three Employer Benefits When Employees Have Skin in the Game
Employers that add a WellthCare Plan to their existing benefits package typically see effects that reinforce each other.
- Claims leakage drops. Employees use WellthCare’s $0-co-pay services-telehealth, urgent care, diagnostics, care coordination-before their primary plan pays a claim. Preventive actions that would otherwise sit undone for years get completed and verified, catching issues before they become high-cost events.
- Hard data replaces guesswork. After 6 to 12 months of real usage, the patent-pending WellthCare Readiness Index™ produces an employer-specific report that shows what expanding the program would save and when. The Readiness Index uses the employer’s own claims pattern, not industry averages. It answers the question “how much would we save by adding pharmacy or Medicare integration?” with mathematics rather than marketing.
- Retention gets a real lift. HR leaders consistently report that benefits employees actually use are the ones that reduce turnover. A WellthCare Plan delivers tangible reward dollars every month, not a discount card that sits in a drawer. Frontline and hourly workers-roughly 40 million people whose benefits options are often thin-get the same $0-co-pay access, store rewards, and retirement building as the executive team.
None of this requires the employer to rip out the existing health plan. WellthCare sits alongside it. The employer’s new out-of-pocket cost is zero because the program is funded through employee pre-tax elections and the tax efficiencies built into the §125 and §105 structure. There is no disruption to the existing carrier relationship, no new network to explain, and no compliance burden for HR. The plan documents, summary plan descriptions, and compliance-grade recordkeeping are part of the WellthCare system.
Closing the Loop Value-Based Care Left Open
Value-based primary care fixed the wrong incentive. It aligned providers with payers and assumed patients would follow. The data says they don’t, at scale, because the immediate cost of a doctor visit outweighs a future health benefit in most household budgets.
WellthCare closes that loop. Reward dollars and retirement contributions land in employees’ accounts when they complete the preventive actions that value-based care is built on. The employer gets the lowered claims trend that a capitated or shared-savings model promised. The employee gets something far more concrete than a quality score: money they can spend today and wealth they can watch grow.
Healthcare costs are not high by accident. They are high by design-layers of intermediaries, spread pricing, and incentives that reward volume over health. Value-based payment was a structural fix, and it remains necessary. But it will not reach its potential until the person sitting in the exam chair has a financial reason to show up. That is the gap WellthCare fills.
Ask your broker: Do we have a WellthCare Plan? Or contact WellthCare to see what one would look like for your workforce.
This article is for general information only and is not legal, tax, or medical advice. Employers should consult their own advisors.