We explore how reducing variation in cost, outcomes, and experience creates real value, and why deep provider metrics and real-time member support outperform box-checking credentialing. Kate Grohal shares a playbook for aligning incentives without repeating the mistakes that soured HMOs.

• defining quality as reducing variation across cost, outcomes, experience
• Kate’s path from patient escort to quality leader
• why NCQA alone falls short for measuring provider performance
• additional metrics: infection rates, readmissions, team engagement, co-management
• building value-based networks that screen out low-performing providers
• real-time care navigation via nurses, MAs, and app-based prompts
• behavior change through waived cost-sharing and premium reductions
• the downside of PEPM fees and paying for non-performance
• differentiating value-based care from old-school HMO denial tactics
• employers moving from back seat to driver’s seat
• tech adoption gaps and the next five-year horizon

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This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com