Commercial & Employer Contracts

Coordinated Healthcare Solutions for Employers and Commercial Organizations

Hospitals Without Walls™ works with employers and commercial organizations to design healthcare programs that support eligible employees, dependents, retirees, and other defined populations across traditional care settings.

Our objective is to improve access, strengthen care coordination, support people with complex health needs, and promote responsible healthcare utilization without compromising medically necessary care.

Request a Commercial Contract Discuss Your Population

Healthcare coordination for commercial and employer organizations

Healthcare that extends beyond the workplace

Supporting the Whole Person Wherever Care Is Needed

An individual's health needs do not begin and end at the workplace.

Employees and their family members may receive care through hospitals, physician practices, urgent-care centers, rehabilitation facilities, pharmacies, behavioral-health providers, home health organizations, virtual platforms, and community services.

When these services are poorly connected, people may experience:

Hospitals Without Walls™ helps contracting organizations develop a structured model for connecting appropriate services around the person.

Difficulty navigating the healthcare system
Delayed follow-up
Conflicting or incomplete information
Medication related concerns
Missed appointments
Repeated assessments
Unaddressed social or functional barriers
Poorly supported transitions
Increased caregiver strain
Potentially avoidable use of higher-cost services

Who we work with

Flexible Contracting for Different Commercial Populations

Potential contracting partners may include:

Self funded employers
Fully insured employers
Large corporations
Small and midsized businesses
Labor organizations
Union health and welfare funds
Taft Hartley plans
Third party administrators
Employer coalitions
Benefit consultants
Occupational-health organizations
Commercial health plans
Accountable care organizations
Risk bearing provider organizations
Workers' compensation stakeholders, where appropriate
Retirement and retiree-health programs
Educational institutions
Hospitality organizations
Transportation and logistics companies
Manufacturing organizations
Healthcare employers
Other commercial entities responsible for defined populations

The structure of each relationship depends on the organization, population, benefit arrangement, funding model, requested services, applicable law, and written contract.

Populations that may benefit

Programs Designed Around Identified Needs

A commercial or employer sponsored program may be designed for:

Participation and eligibility must be defined by the applicable program and cannot be assumed from inclusion in one of these categories.

Employees with multiple chronic conditions
Individuals returning home after hospitalization
People at elevated risk during transitions of care
Employees or dependents with mobility limitations
Older employees
Retirees
Family members caring for an aging or seriously ill relative
Individuals with substantial medication burden
People with behavioral and physical health needs
Individuals who experience difficulty accessing conventional care
Employees working remotely
Employees with demanding or irregular schedules
Geographically distributed workforces
Eligible dependents with complex healthcare needs

Potential program components

A Contract Built Around Your Population

Depending on the organization's needs and the final written agreement, a program may include:

Comprehensive Health and Risk Assessment: Assessment of relevant medical, functional, behavioral, medication-related, social, environmental, and caregiver needs by appropriately qualified professionals.
Chronic Disease Support: Coordinated support for eligible individuals living with one or more chronic conditions.
Transitional Care: Structured follow-up and care coordination after hospitalization or another significant transition.
Telehealth and Virtual Care: Technology-enabled access to authorized healthcare professionals when clinically appropriate and legally permitted.
Mobile Health Delivery: Eligible services delivered in the home, workplace, residential setting, or another authorized location.
Remote Patient Monitoring: Collection and review of selected health information when ordered, appropriate, available, and supported by a defined clinical-response protocol.
Medication Support: Medication reconciliation, education, adherence support, or referral for professional medication review.
Behavioral and PsychoSpiritual Support: Appropriate behavioral, emotional, and whole-person support provided according to the individual's needs, preferences, consent, and available qualified professionals.
Palliative and Supportive Care: Symptom management and supportive care for eligible individuals living with serious illness.
Caregiver and Family Support: Education, resource navigation, and care coordination for authorized caregivers and family members.
Healthcare Navigation: Assistance understanding available services, referrals, appointments, transitions, and community resources.
Return-to-Work Coordination: Communication and coordination related to return-to-work planning when authorized, clinically appropriate, and consistent with employment and disability laws.

Hospitals Without Walls™ does not make employment decisions or determine whether an employee is legally qualified to perform a particular job unless that responsibility is expressly and lawfully assigned to a qualified entity under a written agreement.

For employees and eligible participants

Care Focused on the Person—not the Employer's Employment Decisions

Eligible participants may receive support designed to help them:

Understand their care plan
Connect with appropriate services
Prepare for and recover from care transitions
Manage appointments and referrals
Identify barriers interfering with care
Understand medication instructions
Communicate with authorized healthcare professionals
Obtain appropriate caregiver resources
Monitor defined health concerns
Recognize when urgent or emergency care may be necessary
Participate meaningfully in healthcare decisions

Participation in a healthcare or wellness program should not be misrepresented as a guarantee of employment, benefits, insurance coverage, improved health, or financial savings.

For employers

A Responsible Population-Health Strategy

A carefully designed program may help an employer pursue objectives such as:

These are program objectives. They are not guaranteed results.

Improving access to appropriate care
Supporting employees with complex health needs
Strengthening continuity after hospitalization
Helping employees navigate fragmented services
Supporting caregivers within the workforce
Promoting appropriate use of healthcare resources
Improving the employee healthcare experience
Supporting an organization's health and benefit strategy
Developing more meaningful performance information
Identifying population-level service gaps
Coordinating with existing benefit and healthcare partners

For caregivers in the workforce

Supporting Employees Who Also Care for Others

Many employees are responsible for helping an older adult, a person with a disability, or a family member living with serious illness.

Caregiving responsibilities may involve:

Coordinating appointments
Managing medications
Communicating with multiple providers
Arranging transportation
Responding to changes in condition
Supporting daily activities
Navigating insurance and community resources
Preparing for care transitions
Making authorized healthcare decisions
Balancing employment and caregiving responsibilities

An employer-sponsored caregiver-support program may provide education, navigation, coordination, and access to appropriate resources while protecting the privacy and autonomy of both the employee and the person receiving care.

For retirees and older adults

Continuing Support Beyond Active Employment

Employers and benefit organizations may choose to develop programs for eligible retirees and older dependents.

Potential areas of focus may include:

Comprehensive geriatric assessment
Chronic disease management
Frailty and functional decline
Medication complexity
Fall risk
Cognitive concerns
Transitional care
Home safety
Palliative support
Caregiver needs
Healthcare navigation
Coordination with treating professionals

Services must be based on individual clinical need, authorization, availability, benefit coverage, and applicable law.

Our commercial contracting process

From Population Need to Measurable Program

1
Step 1
Organizational Consultation
We meet with the organization and its authorized representatives to understand:
- The population to be served
- The principal healthcare challenges
- Existing benefits and services
- Geographic distribution
- Access barriers
- Available data
- Desired outcomes
- Operational requirements
- Budget and contracting structure
2
Step 2
Population and Needs Assessment
Where lawful data are available, the parties may evaluate:
- Population characteristics
- Chronic condition burden
- Healthcare access
- Utilization patterns
- Care transition needs
- Service gaps
- Caregiver needs
- Geographic considerations
- Existing vendor capabilities
Individually identifiable health information should not be provided to an employer unless the disclosure is lawful, authorized, necessary, and consistent with the applicable program.
3
Step 3
Program Design
The proposed program defines:
- Eligibility
- Scope of services
- Participating providers
- Referral pathways
- Consent procedures
- Care coordination workflows
- Clinical escalation protocols
- Technology requirements
- Data responsibilities
- Privacy safeguards
- Performance measures
- Reporting procedures
- Implementation timeline
4
Step 4
Legal and Compliance Review
The parties evaluate the laws and requirements applicable to the particular arrangement.
- Employer sponsored health plans
- Employee benefits
- Disability related inquiries
- Medical examinations
- Genetic information
- Nondiscrimination
- Program voluntariness
- Reasonable accommodations
- Health information privacy and security
- State medical privacy laws
- Professional licensure
- Telehealth
- Marketing and communications
- Tax treatment
- Labor agreements
- Fiduciary obligations
The exact legal requirements depend on the program. Each organization should obtain advice from its own qualified legal and benefits professionals.
5
Step 5
Written Contract
The written agreement establishes:
- Contracting parties
- Covered population
- Services
- Responsibilities
- Fees and payment
- Data use
- Privacy and security
- Quality standards
- Insurance requirements
- Indemnification
- Reporting
- Performance measures
- Governance
- Termination rights
- Dispute procedures
6
Step 6
Implementation
Implementation may include:
- Workflow development
- Technology configuration
- Personnel training
- Participant communications
- Referral activation
- Data testing
- Escalation testing
- Quality review procedures
- Program launch
7
Step 7
Measurement and Improvement
Performance is evaluated according to agreed measures, and the program is refined through the established governance process.

Privacy and employment separation

Healthcare Information Must Be Protected

Healthcare participation should be separated from inappropriate employment use.

Unless expressly permitted by law and properly authorized, an employer should not receive an individual participant's:

Diagnosis
Medical history
Medication information
Genetic information
Treatment details
Behavioral health information
Disability related information
Individual assessment results
Individually identifiable healthcare utilization
Personal communications with healthcare professionals

Where appropriate and lawful, employers may receive aggregated or de-identified reports designed to evaluate the program without identifying individual participants.

Healthcare information must not be used unlawfully to discriminate, retaliate, interfere with protected rights, or make prohibited employment decisions.

Voluntary participation

Informed Choice Must Be Respected

When voluntariness is required, participation must be genuinely voluntary.

Eligible individuals should receive understandable information explaining:

What the program provides
Who operates it
What information will be collected
Why the information is collected
How the information may be used
Who may receive it
How it will be protected
Whether participation affects benefits
Whether incentives apply
How to decline or withdraw
Whom to contact with questions or complaints

Incentives, eligibility conditions, and communications must comply with the legal requirements applicable to the particular program.

Nondiscrimination and accessibility

Programs Must Be Designed for Fair Access

A commercial or employer sponsored program should be evaluated for accessibility and lawful nondiscrimination.

Program design may need to address:

Disability access
Reasonable accommodations
Language access
Health literacy
Digital access
Alternative communication methods
Geographic limitations
Cultural considerations
Meaningful alternatives
Equal access for similarly situated individuals
Protection against health status discrimination

A technology-dependent program should not automatically exclude an otherwise eligible person when a reasonable alternative is required or appropriately available.

Clinical independence

Employment Objectives Do Not Control Medical Judgment

Qualified healthcare professionals must be able to exercise independent clinical judgment.

An employer, benefits administrator, or commercial contracting organization should not direct a clinician to:

Withhold medically necessary care
Avoid an appropriate emergency referral
Change a diagnosis for financial or employment purposes
Conceal a material clinical finding
Disregard professional standards
Act beyond the clinician's authorized scope
Disclose protected information unlawfully
Modify a medical opinion improperly

Employment, productivity, attendance, and cost objectives must not override patient safety or lawful clinical judgment.

Measuring performance

Defined Measures. Transparent Methods. Honest Conclusions.

A commercial contract may include measures addressing:

Access

Referral to contact time
Appointment completion
Successful service connection
Participant access to appropriate support

Engagement

Eligible population reached
Voluntary participation
Assessment completion
Follow up completion

Care Coordination

Care plans completed
Medication reconciliation
Post discharge follow up
Closed loop referrals
Identified barriers addressed

Quality and Safety

Documented escalation
Adverse events
Patient reported experience
Complaint resolution
Protocol adherence

Utilization

Emergency department utilization
Hospital admissions
Readmissions
Use of other defined services

Financial Performance

Program cost
Cost per participant
Allowed healthcare expenditures
Cost trends
Return on investment, when methodologically supportable

Workforce Measures

When lawful, appropriate, and agreed upon:

Absence related measures
Return to work measures
Employee experience
Caregiver support utilization

Each measure must identify its definition, data source, eligible population, exclusions, baseline, measurement period, and analytical method.

Association does not prove that the program caused an observed result. Claims of savings or return on investment should be made only when supported by an appropriate comparison and reliable data.

Financial models

Contract Structures Designed for the Engagement

Depending on the program, possible financial structures may include:

Fixed administrative fees
Per member per month fees
Per participant fees
Fee for service arrangements
Episode based fees
Implementation fees
Technology fees
Performance based components
Shared savings arrangements
Hybrid models

No financial arrangement should reward the denial of medically necessary care, unlawful patient steering, inappropriate restriction of choice, or manipulation of reported outcomes.

The final structure must be documented in a written agreement and reviewed for legal, clinical, operational, and financial appropriateness.

Integration with existing benefits

Designed to Coordinate not Unnecessarily Duplicate

Hospitals Without Walls™ may coordinate with authorized existing resources, such as:

Health plans
Third party administrators
Pharmacy benefit arrangements
Employee assistance programs
Behavioral health programs
Occupational health services
Primary care providers
Specialty networks
Telehealth vendors
Disease management programs
Leave and disability administrators
Workers' compensation programs
Community resources

The objective is to identify responsibilities, close appropriate gaps, and avoid unnecessary duplication.

Integration depends on authorization, technical capability, contractual cooperation, and applicable privacy requirements.

Why Hospitals Without Walls™

A Whole Person Model With Measurable Accountability

Our approach combines:

We do not offer a universal promise of savings or improved outcomes.

We offer a structured model that can be designed, implemented, measured, and evaluated for the population your organization serves.

Whole person assessment
Person centered care planning
Clinical and nonclinical coordination
Mobile and virtual delivery options
Support across care transitions
Caregiver and family engagement
Defined responsibilities
Privacy conscious reporting
Contract specific quality measures
Continuous program improvement

Request a commercial or employer contract

Let Us Design the Right Program for Your Organization

Our team will evaluate whether an appropriate, compliant, operationally feasible, and measurable program can be developed.

Tell us:

Whom you want to serve
Where the population is located
Which healthcare challenges you want to address
What services already exist
What outcomes matter
What data are available
What implementation timeline you are considering

Important notice

Hospitals Without Walls™ is an independent healthcare-delivery and collaboration model. It is not an employer, health plan, insurance company, benefit-plan administrator, utilization review organization, or government program unless a particular written agreement expressly and lawfully assigns such a role.

Services vary by program, location, participating provider, eligibility, clinical need, benefit coverage, authorization, operational availability, and applicable law.

No improvement in health, productivity, attendance, retention, healthcare utilization, financial performance, or return on investment is guaranteed.

Nothing on this page constitutes medical, legal, employment, insurance, benefits, tax, or financial advice.

If you believe you are experiencing a medical emergency, call 911.