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 Visit BenaPower.ai or email info@BenaPower.com to schedule a demo For more information, visit HatcherMedia.net — that’s H A T C H E R Media.net 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

<description>&lt;p&gt;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.&lt;br/&gt;&lt;br/&gt;• defining quality as reducing variation across cost, outcomes, experience&lt;br/&gt;• Kate’s path from patient escort to quality leader&lt;br/&gt;• why NCQA alone falls short for measuring provider performance&lt;br/&gt;• additional metrics: infection rates, readmissions, team engagement, co-management&lt;br/&gt;• building value-based networks that screen out low-performing providers&lt;br/&gt;• real-time care navigation via nurses, MAs, and app-based prompts&lt;br/&gt;• behavior change through waived cost-sharing and premium reductions&lt;br/&gt;• the downside of PEPM fees and paying for non-performance&lt;br/&gt;• differentiating value-based care from old-school HMO denial tactics&lt;br/&gt;• employers moving from back seat to driver’s seat&lt;br/&gt;• tech adoption gaps and the next five-year horizon&lt;br/&gt;&lt;br/&gt;Visit BenaPower.ai or email info@BenaPower.com to schedule a demo&lt;br/&gt;For more information, visit HatcherMedia.net — that’s H A T C H E R Media.net&lt;br/&gt;&lt;br/&gt;&lt;br/&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;em&gt;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&lt;/em&gt;&lt;/b&gt;&lt;/p&gt;</description>

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 met...

EP 518 ENCORE: Quality Without Guesswork - with Kate Grohall

We revisit the rising problem of the “functionally uninsured” and ask how to restore real access for employees who delay care because of confusion and cost. Paymedix CEO Tom Policelli shares how a super EOB, upfront provider payment, and 0% financing change behavior and bend trend. • confusion outranking cost as the top barrier to care • hospitals pushing prepayment and the access wall it creates • income-tier patterns driving ER and inpatient overuse • super EOB mechanics and single monthly reconciliation • provider payment upfront and revenue-cycle relief • employer savings of two to three trend points annually • advisor positioning and retention benefits • partnerships with EXO Health to improve network economics • TempoPay for pharmacy access and first-dollar fills • risk management via broad pooling and automatic eligibility • national expansion through aligned partners and TPAs • a third path beyond prepay or bill-and-pray collections “Go to PayMedix.com.” 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

<description>&lt;p&gt;We revisit the rising problem of the “functionally uninsured” and ask how to restore real access for employees who delay care because of confusion and cost. Paymedix CEO Tom Policelli shares how a super EOB, upfront provider payment, and 0% financing change behavior and bend trend.&lt;br/&gt;&lt;br/&gt;• confusion outranking cost as the top barrier to care&lt;br/&gt;• hospitals pushing prepayment and the access wall it creates&lt;br/&gt;• income-tier patterns driving ER and inpatient overuse&lt;br/&gt;• super EOB mechanics and single monthly reconciliation&lt;br/&gt;• provider payment upfront and revenue-cycle relief&lt;br/&gt;• employer savings of two to three trend points annually&lt;br/&gt;• advisor positioning and retention benefits&lt;br/&gt;• partnerships with EXO Health to improve network economics&lt;br/&gt;• TempoPay for pharmacy access and first-dollar fills&lt;br/&gt;• risk management via broad pooling and automatic eligibility&lt;br/&gt;• national expansion through aligned partners and TPAs&lt;br/&gt;• a third path beyond prepay or bill-and-pray collections&lt;br/&gt;&lt;br/&gt;“Go to PayMedix.com.”&lt;br/&gt;&lt;br/&gt;&lt;br/&gt;&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;em&gt;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&lt;/em&gt;&lt;/b&gt;&lt;/p&gt;</description>

We revisit the rising problem of the “functionally uninsured” and ask how to restore real access for employees who delay care because of confusion and cost. Paymedix CEO Tom Policelli shares how a super EOB, upfront provider payment, and 0% financing change behavior and bend trend.  • confusion outranking cost as the top barrier to care • hospitals pushing prepayment and the access wall it creates • income-tier patterns driving ER and inpatient overuse • super EOB mechanics and single monthly...

EP 531 ENCORE: Solving The Health Payment Puzzle - with Tom Policelli

Pharmacy benefits shouldn’t feel like a black box. We sit down with Susan Thomas, Chief Commercial Officer at Lucy Rx, to unpack why drug costs keep rising and what it takes to build a benefit that serves patients and plans—not middlemen. Susan started as an oncology nurse and moved into PBM leadership, and that dual lens shows up in everything we cover: from the real-world stress of waiting days for an oral chemo to the hidden economics of rebate chains and vertically integrated networks. We dig into the two biggest levers for change. First, formulary autonomy: instead of being locked to a single, opaque GPO, a marketplace approach lets employers compare multiple rebate contracts, see drug-level net cost, and choose the best path for categories like Humira biosimilars or GLP-1s. That shift enables utilization management that protects value without opening the floodgates. Second, network independence: when PBMs own specialty and mail, steering is inevitable. By contracting with integrated health systems for specialty and modern mail partners for home delivery, plans can speed therapy, reduce waste from 30-day auto-ships, and improve member experience at a lower overall cost. We also talk fiduciary duty, policy momentum, and technology. Employers need verifiable net-cost math—not averages—to defend decisions in a post–J&amp;J lawsuit world. Washington’s scrutiny is rising, and incumbents are signaling changes, but structural misalignments remain. On the tech front, AI-driven reporting and specialty navigation are already here, while precision medicine and pharmacogenomics promise to target high-cost drugs to the patients who will benefit most. The question is whether the industry will embrace smaller, smarter populations when volume shrinks and outcomes improve. If you care about cutting pharmacy spend without compromising care, this conversation is a practical roadmap: ask for drug-level net cost, insist on formulary choice across GPOs, require independent specialty and mail, and set utilization criteria that put patients first. Subscribe, share this episode with a colleague who manages pharmacy benefits, and leave a review with the one PBM metric you wish you’d had sooner.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

<description>&lt;p&gt;Pharmacy benefits shouldn’t feel like a black box. We sit down with Susan Thomas, Chief Commercial Officer at Lucy Rx, to unpack why drug costs keep rising and what it takes to build a benefit that serves patients and plans—not middlemen. Susan started as an oncology nurse and moved into PBM leadership, and that dual lens shows up in everything we cover: from the real-world stress of waiting days for an oral chemo to the hidden economics of rebate chains and vertically integrated networks.&lt;br/&gt;&lt;br/&gt;We dig into the two biggest levers for change. First, formulary autonomy: instead of being locked to a single, opaque GPO, a marketplace approach lets employers compare multiple rebate contracts, see drug-level net cost, and choose the best path for categories like Humira biosimilars or GLP-1s. That shift enables utilization management that protects value without opening the floodgates. Second, network independence: when PBMs own specialty and mail, steering is inevitable. By contracting with integrated health systems for specialty and modern mail partners for home delivery, plans can speed therapy, reduce waste from 30-day auto-ships, and improve member experience at a lower overall cost.&lt;br/&gt;&lt;br/&gt;We also talk fiduciary duty, policy momentum, and technology. Employers need verifiable net-cost math—not averages—to defend decisions in a post–J&amp;amp;J lawsuit world. Washington’s scrutiny is rising, and incumbents are signaling changes, but structural misalignments remain. On the tech front, AI-driven reporting and specialty navigation are already here, while precision medicine and pharmacogenomics promise to target high-cost drugs to the patients who will benefit most. The question is whether the industry will embrace smaller, smarter populations when volume shrinks and outcomes improve.&lt;br/&gt;&lt;br/&gt;If you care about cutting pharmacy spend without compromising care, this conversation is a practical roadmap: ask for drug-level net cost, insist on formulary choice across GPOs, require independent specialty and mail, and set utilization criteria that put patients first. Subscribe, share this episode with a colleague who manages pharmacy benefits, and leave a review with the one PBM metric you wish you’d had sooner.&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;em&gt;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&lt;/em&gt;&lt;/b&gt;&lt;/p&gt;</description>

Pharmacy benefits shouldn’t feel like a black box. We sit down with Susan Thomas, Chief Commercial Officer at Lucy Rx, to unpack why drug costs keep rising and what it takes to build a benefit that serves patients and plans—not middlemen. Susan started as an oncology nurse and moved into PBM leadership, and that dual lens shows up in everything we cover: from the real-world stress of waiting days for an oral chemo to the hidden economics of rebate chains and vertically integrated networks.  W...

EP 505 ENCORE: Fixing PBM Conflicts - With Susan Thomas

What if benefits work leaped from horse‑and‑buggy speed to highway pace? We sit down with Julian Lago, co‑founder and CEO of BenePower, to explore how AI is already compressing days of quoting, enrollment, and service into minutes—and what that means for brokers, HR leaders, and members who need clear answers right now. We dig into the practical side of agentic AI and retrieval‑augmented generation: how specialized models fetch plan rules, accumulators, and pending claims to answer real‑world questions like “what’s left on my deductible?” with accuracy. Julian explains why virtual care is no longer just telemedicine, how ambient documentation can free clinicians to focus on patients, and why unified front‑door experiences beat a jumble of point solutions. Along the way, we talk about emotion AI that detects stress, switches languages seamlessly, and brings empathy to urgent moments—like getting an ID card to a parent driving to urgent care—without losing speed or precision. For employers, the conversation moves from tools to outcomes: steering to high‑value care, reducing surprise bills, and designing plans people actually use. For advisors, it’s a playbook for differentiation—showing clients how to use data, automation, and hyper‑personalization to improve health and lower costs while keeping a human in the loop for sensitive decisions. We also address the hard edges: privacy, HIPAA alignment, model hallucinations, and emerging state regulations that set boundaries around clinical advice. If you’re ready to trade legacy friction for clear, measurable gains, this episode lays out where to start, what to watch, and how to scale. Subscribe, share with a colleague, and leave a review telling us which workflow you want AI to fix first.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

<description>&lt;p&gt;What if benefits work leaped from horse‑and‑buggy speed to highway pace? We sit down with Julian Lago, co‑founder and CEO of BenePower, to explore how AI is already compressing days of quoting, enrollment, and service into minutes—and what that means for brokers, HR leaders, and members who need clear answers right now.&lt;br/&gt;&lt;br/&gt;We dig into the practical side of agentic AI and retrieval‑augmented generation: how specialized models fetch plan rules, accumulators, and pending claims to answer real‑world questions like “what’s left on my deductible?” with accuracy. Julian explains why virtual care is no longer just telemedicine, how ambient documentation can free clinicians to focus on patients, and why unified front‑door experiences beat a jumble of point solutions. Along the way, we talk about emotion AI that detects stress, switches languages seamlessly, and brings empathy to urgent moments—like getting an ID card to a parent driving to urgent care—without losing speed or precision.&lt;br/&gt;&lt;br/&gt;For employers, the conversation moves from tools to outcomes: steering to high‑value care, reducing surprise bills, and designing plans people actually use. For advisors, it’s a playbook for differentiation—showing clients how to use data, automation, and hyper‑personalization to improve health and lower costs while keeping a human in the loop for sensitive decisions. We also address the hard edges: privacy, HIPAA alignment, model hallucinations, and emerging state regulations that set boundaries around clinical advice.&lt;br/&gt;&lt;br/&gt;If you’re ready to trade legacy friction for clear, measurable gains, this episode lays out where to start, what to watch, and how to scale. Subscribe, share with a colleague, and leave a review telling us which workflow you want AI to fix first.&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;em&gt;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&lt;/em&gt;&lt;/b&gt;&lt;/p&gt;</description>

What if benefits work leaped from horse‑and‑buggy speed to highway pace? We sit down with Julian Lago, co‑founder and CEO of BenePower, to explore how AI is already compressing days of quoting, enrollment, and service into minutes—and what that means for brokers, HR leaders, and members who need clear answers right now.  We dig into the practical side of agentic AI and retrieval‑augmented generation: how specialized models fetch plan rules, accumulators, and pending claims to answer real‑worl...

EP 538 From Buggy Whips To AI - with Julian Lago, Benepower

Change can energize or paralyze—so we chose energize. We sat down with Eric Silverman, founder of Voluntary Disruption and a four-time guest, to unpack what’s actually moving the needle in enhanced benefits today. The surprise? Products haven’t radically shifted, but execution has. Simple, high-interest options like pet insurance, ID protection, legal plans, and life paired with long-term care continue to win attention. The real breakthroughs are how teams communicate, guide choices, and run enrollment with less friction and more trust. We dig into decision support tools and their mid-market roadblocks, then map how AI can personalize choices with Amazon-like clarity. Think smart nudges that connect plan design to real life: a high-deductible plan paired with accident coverage, or young families steered toward urgent care-friendly options. We also trace a major distribution shift—from carrier direct to advisor-led strategies—where brokers step up to own the full package: medical, pharmacy, disability, life, and voluntary. That move isn’t just good practice; it’s how you reduce risk across absenteeism, presenteeism, and unexpected costs. Communication is where results jump. Text-first outreach beats inbox fatigue. Short, captioned videos from HR leaders outperform generic vendor clips. Family-focused messaging, including the emergency contact, turns open enrollment into a shared decision. We share a practical playbook: launch midweek, keep enrollment windows short, host content on a 24/7 microsite with searchable chapters, and go off the January 1 cycle to escape fourth-quarter chaos. Virtual, self-service enrollment replaces one-on-one sales pressure and leaves a clean digital trail that cuts buyer’s remorse and HR headaches. If you advise employers—or lead HR—and want better participation without arm twisting, this conversation gives you the modern blueprint. Subscribe, share with a colleague who needs a smarter enrollment strategy, and leave a review with your top takeaway so we can dive deeper next time.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

<description>&lt;p&gt;Change can energize or paralyze—so we chose energize. We sat down with Eric Silverman, founder of Voluntary Disruption and a four-time guest, to unpack what’s actually moving the needle in enhanced benefits today. The surprise? Products haven’t radically shifted, but execution has. Simple, high-interest options like pet insurance, ID protection, legal plans, and life paired with long-term care continue to win attention. The real breakthroughs are how teams communicate, guide choices, and run enrollment with less friction and more trust.&lt;br/&gt;&lt;br/&gt;We dig into decision support tools and their mid-market roadblocks, then map how AI can personalize choices with Amazon-like clarity. Think smart nudges that connect plan design to real life: a high-deductible plan paired with accident coverage, or young families steered toward urgent care-friendly options. We also trace a major distribution shift—from carrier direct to advisor-led strategies—where brokers step up to own the full package: medical, pharmacy, disability, life, and voluntary. That move isn’t just good practice; it’s how you reduce risk across absenteeism, presenteeism, and unexpected costs.&lt;br/&gt;&lt;br/&gt;Communication is where results jump. Text-first outreach beats inbox fatigue. Short, captioned videos from HR leaders outperform generic vendor clips. Family-focused messaging, including the emergency contact, turns open enrollment into a shared decision. We share a practical playbook: launch midweek, keep enrollment windows short, host content on a 24/7 microsite with searchable chapters, and go off the January 1 cycle to escape fourth-quarter chaos. Virtual, self-service enrollment replaces one-on-one sales pressure and leaves a clean digital trail that cuts buyer’s remorse and HR headaches.&lt;br/&gt;&lt;br/&gt;If you advise employers—or lead HR—and want better participation without arm twisting, this conversation gives you the modern blueprint. Subscribe, share with a colleague who needs a smarter enrollment strategy, and leave a review with your top takeaway so we can dive deeper next time.&lt;/p&gt;&lt;p&gt;&lt;b&gt;&lt;em&gt;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&lt;/em&gt;&lt;/b&gt;&lt;/p&gt;</description>

Change can energize or paralyze—so we chose energize. We sat down with Eric Silverman, founder of Voluntary Disruption and a four-time guest, to unpack what’s actually moving the needle in enhanced benefits today. The surprise? Products haven’t radically shifted, but execution has. Simple, high-interest options like pet insurance, ID protection, legal plans, and life paired with long-term care continue to win attention. The real breakthroughs are how teams communicate, guide choices, and run ...

EP 537 Enhanced Benefits Evolution - With Eric Silverman, Voluntary Disruption

Change either paralyzes or energizes - the choice is yours. Hear from businesses and entrepreneurs who have become energized and who have profited by shaping the shifts in their markets and practices. Become a SHIFTSHAPERS INSIDER and get our latest download, advance notice of all podcasts, podcast summaries, and special INSIDER-ONLY content. <a href="https://thesaltzmangroup.com/download/">INSIDER SIGN UP</a>

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