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