EP 516 ENCORE: Rethinking Provider Networks - with Scott Smith

We revisit how PPOs got built on discounts and show why total value beats sticker price. Scott Smith joins us to explain nationally curated high-performance networks that rank providers on effectiveness, appropriateness, and cost, and how that changes renewals, member experience, and fiduciary risk.

• why traditional PPO discounts miss total cost of care
• how consolidation and narrow networks increase abrasion
• claims-based scoring at the provider NPI level
• quality metrics that matter: effectiveness, appropriateness, cost
• member tools: stars, plain-language summaries, mobile access
• plan design that waives cost sharing for high-quality choices
• PEPM pricing without shared savings games
• national footprint for TPAs and large employers
• faster ROI and improved MLR through reduced waste
• roadmap to a true BUCA alternative

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