WEBINAR

Quality Over Cost: Rethinking Health Plan Alternatives for Employers and Health Plans

Health plan innovation isn’t new.

For years, employers and health plans have introduced new models designed to control costs. High-deductible plans. Narrow networks. Transparency tools. More recently, alternative health plans.

And yet, cost trend persists. So what’s missing?

That was the question at the center of Embold Health’s recent webinar, Quality Over Cost: Rethinking Health Plan Alternatives for Employers and Health Plans.  

The Problem Isn’t Just Cost

Most alternative models focus on plan design. How care is financed. How members share in the cost. But they rarely address the underlying driver of spend: variation in provider performance.

As discussed in the webinar, the same condition in the same market can lead to vastly different outcomes and costs depending on where a patient receives care. Not because patients are different, but because care is delivered differently.

More Tools, Same Behavior

Transparency and steerage were meant to change how people choose care. In reality, most solutions still expect members to do the work themselves. And when decisions feel complex or uncertain, behavior doesn’t change.  

As Keith Passwater put it: “If the cost share structure is so complex… people don’t understand what you’re trying to guide them to do. This isn’t going to work.”  

The Shift: Build Quality Into the Model

The takeaway from the discussion is clear: quality can’t sit on the sidelines. It has to be built directly into how care is accessed and how decisions are made. As Matthew Resnick, MD, MPH noted, “This idea of quality or cost is actually a false choice. We have the ability to optimize both.”  

That means moving beyond models that rely on member interpretation or plan overlays and toward approaches that:

• Use independent, clinically rigorous measures of provider performance

• Direct members to higher-performing providers by default

• Align incentives so better care is also the lower-cost option

When those elements are in place, behavior changes more naturally and cost begins to follow quality.

The Real Question for Employers

For organizations evaluating alternatives, the question isn’t which plan design is new or different. It’s whether the model actually changes care decisions in a meaningful way.

That requires looking beyond features and asking:

• Is quality driving where members go for care?

• Is the data trusted and independent?

• Are incentives reinforcing better outcomes, not just lower utilization?

The models that deliver on those questions are the ones most likely to impact long-term cost trend.

Watch the full webinar below to hear how industry leaders are approaching these decisions and what it takes to make quality the foundation of health plan design.  

If you’re exploring alternative health plan options, contact us to learn how Embold can implement a quality-driven approach: https://emboldhealth.com/demo