Employer-sponsored healthcare costs have climbed 7-10 percent annually for years, yet the system driving those costs has grown less responsive to employees, not more: over 80 percent of physicians now work for hospital systems or large corporate entities whose financial incentives favor volume and in-house referrals over prevention and outcomes. Primary care, the front line that could interrupt that cycle, has been absorbed into the same machine, leaving self-insured employers with a workforce spread across dozens of markets and no scalable way to connect them to the independent, patient-first primary care physicians who consistently produce better health outcomes at lower cost. Aligned Marketplace closes that gap with a national marketplace of more than 3,000 independent advanced and direct primary care clinics across all 50 states, accessible to employers through a single contract with fees tied to clinical outcomes rather than visit volume. Rather than waiting for members to find care on their own, Aligned proactively identifies rising-risk and high-risk members and connects them with a physician before manageable conditions become costly ones, a model that delivered a third-party actuarial firm-validated 12 percent reduction in total cost of care, equivalent to $96 per member per month, at a large Fortune 500 employer in its first year. The company is now expanding the marketplace into value-based specialty care, extending the same independent, outcomes-oriented approach to the referral layer where a large share of employer health spending actually occurs.
AlleyWatch sat down with Aligned Marketplace CEO and Founder Patrick Nelli to learn more about the business, its future plans, recent funding round that brings total funding to $31M, and much, much more…
Who were your investors and how much did you raise?
We raised an additional $20M capital, including a $16M Series A led by Venrock, bringing our total fundraise to date to $31M.
Tell us about the product or service that Aligned Marketplace offers.
Aligned Marketplace gives American workers and their families access to independent advanced primary care, so they can live healthier, longer lives. We do that by connecting plan members at employers we serve to our marketplace of independent advanced and direct primary care practices. These doctors have smaller panels, spend more time with their patients, and mostly operate outside of traditional plan networks, so they have been out of reach for most employers until now. But access alone doesn’t change anything if people don’t use it. Rather than waiting for members to seek us out, we proactively reach out to help members find the right doctor, including identifying people who are at rising risk or already high risk and connecting them with care before a manageable problem becomes an expensive one. We only succeed when our customers do: our fees are tied to outcomes, not visits, so employers pay for care that actually works.
What inspired the start of Aligned Marketplace?
It came from a combination of experience and data. I spent a decade at Health Catalyst, where the company served large hospital systems, independent primary care organizations, health insurers, and life science companies. Across that work, the data kept pointing to the same conclusion: the best health outcomes came from keeping people out of the hospital, and most of what drives health isn’t acute care, it’s proactive care, behavior, and socioeconomic factors.
At the same time, I noticed that so much of the innovation happening in primary care was concentrated in Medicare. That didn’t sit right with me from a systems perspective.
To maximize the positive health impact we could have as a society, we should be seeing people in their 30s, 40s, 50s, and 60s, before they age into Medicare.
The final piece came from my own seat as an employer. As CFO, benefits reported to me, and Health Catalyst itself started looking for better care models for its own employees. That’s when I saw firsthand how good these independent, advanced, and direct primary care clinics could be, and how hard they were to actually access and purchase at scale, because healthcare is inherently local and these clinics exist market by market, while employers have people spread across the whole country.
That gap—great care that already existed but couldn’t reach employees nationally—is what Aligned was built to close. And what made the problem worth solving was that it was a win-win-win, benefiting employers, clinicians, and members all at once.
How is Aligned Marketplace different?
Primary care is well established as a proven way to lower total cost of care and improve health outcomes. What’s been missing isn’t conviction, it’s a scalable way to buy it. Aligned Marketplace solves that buying problem.
Independent advanced and direct primary care doctors, the ones with smaller patient panels, more time per patient, and no financial incentive to over-refer, have existed for years, but employers with workforces spread across the country had no scalable way to reach them. Onsite clinics and direct local contracts work, but only for employers concentrated in one place. Traditional plan networks, by contrast, are mostly owned by hospitals and large corporate entities that profit when care stays inside their own systems, which drives the access problems and poor experience employees already know.
Aligned closes that gap by bringing more than 3,000 independent advanced and direct primary care clinics into one marketplace, accessible through a single agreement, covering more than 80% of the U.S. population across all 50 states. It doesn’t stop at access: Aligned proactively identifies rising-risk and high-risk members and helps get them into care before a manageable issue becomes an expensive one, rather than waiting for people to seek it out themselves. And our fees are tied to outcomes, not visits, so employers pay when the care actually works.
What market does Aligned Marketplace target and how big is it?
Self-insured, geographically dispersed employers, specifically those with a workforce spread across multiple markets rather than concentrated in one location. That’s the segment onsite clinics and direct local contracts can’t serve well, and it’s the gap Aligned was built to close.
We have over 3,000 independent advanced and direct primary care clinics on the marketplace, within driving distance of more than 80% of the U.S. population, across all 50 states, and 500k covered lives so far.
What’s your business model?
Aligned charges employers and puts its own fees at risk against clinical quality and cost outcomes.
Self-insured employers pay Aligned to access its marketplace of more than 3,000 independent advanced and direct primary care clinics through a single agreement, rather than negotiating hundreds of individual local contracts themselves. That agreement replaces the administrative burden of trying to buy this kind of care market by market.
On top of the marketplace itself, Aligned adds a service layer by proactively engaging members and working extra hard to identify rising-risk and high-risk members to help get them into care before a manageable issue becomes expensive. That’s part of what employers are paying for, not just doctor access, but active engagement that gets members to use it.
Aligned is also expanding the model into specialty care, extending the same independent, outcomes-based approach to the referral and specialist layer, where a large share of employer healthcare spend actually happens.
How has the business changed since we last spoke after Aligned Marketplace’s seed extension round last year?
The biggest shift is that we now have third-party validated proof at scale. In a program launched January 1, 2025, engaged members at a Fortune 500 employer cost 12% less than a risk-matched national benchmark, measured independently by a third-party actuarial firm, a savings of $96 per member per month. And critically, this wasn’t an easy population: 70% of engaged members were identified as high risk going in, and they moved their care toward their Aligned doctor, averaging 4.7 visits with that doctor and 1.6 fewer visits elsewhere. That deeper relationship also drove meaningful gains in preventive care, with engaged members roughly doubling their mammogram rate and nearly tripling their colonoscopy rate after their first visit. Members felt the difference too: 94% said they could get care when they needed it, with a 9.2 out of 10 average experience rating.
What was the funding process like?
Similar to our seed round, we wanted to find partners that cared deeply about our mission to increase America’s healthy years and were in it for the long term value created in our model. The world is appropriately focused on AI currently, and while we use AI throughout our business and clinics leverage AI to better support patient needs, we searched for investors that believe that a significant portion of individuals, and especially individuals with chronic conditions, would prefer and benefit from having a longitudinal relationship with a primary care clinician who has the time to support their care journey. Furthermore, new AI-driven care models need ways to get paid for and distributed across the ecosystem, and Aligned can fill this need. In some ways, betting on in-person, more accessible primary care is one of the items we believe won’t change with the AI-wave as humans desire the relationship and comfort of a human supporting their care needs. We feel very fortunate to have found a mission-aligned partner in Venrock to be on this journey together.
What are the biggest challenges that you faced while raising capital?
The hardest part wasn’t convincing investors that better primary care lowers costs, most sophisticated healthcare investors already believe that. The real challenge was finding investors who would take the time to assess how advanced and direct primary care would evolve in the age of AI and how it remains a key lever in our healthcare system.
What factors about your business led your investors to write the check?
Bob Kocher, Siobhan Nolan Mangini, and Brian Zhao at Venrock laid this out well in their own writeup announcing the investment. They pointed to three things specifically: a curated, national marketplace of independent primary care doctors who can actually see patients quickly, a payment model built around shared risk rather than another layer of fees, and a go-to-market that doesn’t force employers into disruptive plan changes. They noted they’d spent a long time looking for a company solving primary care access and cost at genuinely national scale, and that Aligned was the first to bring the membership-based primary care model to a national, self-insured employer population without requiring a change in carriers or networks.
What are the milestones you plan to achieve in the next six months?
We’re focused on a few things. First, bringing advanced primary care to more employers and Third-Party Administrators, expanding access and affordability for members while reducing employer healthcare spend. Second, continuing to enable independent advanced and direct primary care to make high value referrals, including benefits that an employer has contracted for directly. And third, growing our team to support that expansion, bringing on mission-aligned individuals who want to increase America’s healthy years.
We see a future where we can unlock demand for these better care models in advanced and direct primary care, enabling more clinicians to move to these care models that they dreamed about as kids wanting to be clinicians, and helping employers bend the cost curve by improving their members’ health.
What advice can you offer companies in New York that do not have a fresh injection of capital in the bank?
If you are more confident today in your model than when you founded it, keep going. Find anything you can do to keep the business alive if you believe in the mission and are increasingly confident it will succeed. Changing the world is hard so it requires relentless application of force so you need to believe in your mission in order to apply force continuously.
Where do you see the company going now over the near term?
We’re seeing real innovation open up in how advanced primary care gets embedded into plan design, including alternative health plans and new $0 cost-sharing options that recent legislation has made possible. That’s an area we want to keep pushing on, because the easier it is for employers to make this the default rather than an add-on, the faster the model can scale.
Underneath it all, the plan is the same as it’s always been: keep proving the model works with real, independently measured outcomes, and use that proof to unlock more demand from self-insured employers who are looking for a credible way to control costs without disrupting the coverage their people already have. Enabling a win-win-win between employers, members, and clinicians is what we strive to do every day in pursuit of increasing America’s healthy years.
What’s your favorite summer destination in and around the city?
My family just moved to the NYC-area in the last few years so we have loved exploring all that the northeast has to offer. We have three little kids so getting them outside and on the water brings us deep joy.
