EP491: Incumbent TPAs and Consultants Getting Called to Jumbo Employer Client HQ to Answer Awkward Questions, With Elizabeth Mitchell

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Oct 30, 2025

In this engaging conversation, Elizabeth Mitchell, CEO of the Purchaser's Business Group on Health, dives into the PBGH Transparency Demonstration Project. She reveals how this initiative aims to empower jumbo employers with critical data on healthcare costs and quality. Elizabeth discusses the surprising lack of correlation between price and quality, the importance of the Consolidated Appropriations Act, and how transparency can reshape market competition. She also shares insights on improving employer strategies and the potential benefits for high-quality providers.

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INSIGHT

Price And Quality Don't Align

PBGH's demo shows zero correlation between higher prices and higher quality across providers.
Employers can no longer assume marquee brands equal better care when assessing spend.

ADVICE

Own Fiduciary Responsibility Now

Do not outsource fiduciary risk for self-insured plans; employers and named individuals remain accountable under the CAA.
Build internal teams and data processes to manage spending and compliance.

ADVICE

Use Data To Design High-Value Networks

Use transparency data to identify overspending and design high-value provider networks.
Apply it to COE design, claims audits, repricing, and targeted network steering.

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In Episode 491, Stacey Richter interviews Elizabeth Mitchell, CEO of the Purchaser's Business Group on Health (PBGH), about the PBGH Transparency Demonstration Project.

They discuss the project's aim to provide jumbo self-insured employers with transparency in healthcare costs, quality, and safety data. Collaborating with Milliman and Embold and funded by the Peterson Center on Healthcare, PBGH's project reveals no correlation between higher prices and quality in healthcare services.

The episode highlights the impacts on TPAs, consultants, and clinical organizations, and underscores the importance of employers using this new transparency data for strategic advantage and compliance with the Consolidated Appropriations Act. Richter and Mitchell delve into the broader implications for creating high-value networks and fostering market competition based on quality and affordability.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP491

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