From Lazy PPO Networks to Smart Collaboration — A Roadmap for Direct-to-Employer Specialty Care

Direct-to-Employer Specialty Care and Centers of Excellence 3.0, With Ryan Wells, Leo Spector, MD, and Adam Stavisky Why Self-Insured Employers and Specialists Need to Start Talking Directly Instead of Through a Lazy Middle. Episode 503.

Self-insured employers and the specialists who actually deliver care sit on opposite ends of a long, crowded road—with carriers, ASOs, TPAs, and consolidated health systems clogging up the middle. Stacey Richter talks with Ryan Wells, founder and CEO of Health Here; Leo Spector, MD, MBA, CEO of OrthoCarolina; and Adam Stavisky, a board member at Omada Health and former SVP of U.S. Benefits at Walmart, about what it actually takes to bring those two ends together through direct contracting and smart collaboration.

WHAT YOU'LL LEARN

✅ Why self-insured employers and specialists—the two ends of the healthcare "road"—rarely talk directly, with carriers, ASOs, TPAs, and consolidated health systems clogging the middle

✅ Why "disruption analyses" trap traditional carrier networks into keeping every doctor in-network, even when that means highly variable quality and safety sit side by side

✅ Why patient-reported outcomes are largely missing from most quality data, and how appropriateness—not just surgical skill—has to anchor any real comparison between clinicians

✅ How direct contracting has evolved from Centers of Excellence 1.0 (fly to a brand-name hospital) to 2.0 (scaled but still riding fee-for-service rails) to an emerging 3.0 model built on new infrastructure

✅ Why benefit design and value-based contracts are "peanut butter and jelly"—without aligned incentives like waived cost-sharing, a direct-contracting program gets built and nobody uses it

WHY THIS MATTERS

Self-insured employers and the specialists actually delivering care are natural allies on cost and quality, but the rails of the healthcare system were built for fee-for-service, not for direct collaboration between the two. Left alone, that gap defaults to lazy networks, where price and quality are highly variable within the same plan and carriers compete only on discounts, not outcomes. Bridging it, as this conversation lays out, requires new infrastructure, better data on appropriateness and outcomes, and benefit design that actually rewards patients for using it.

MENTIONED IN THIS EPISODE

EP294 with Steve Schutzer, MD: Apple Podcasts | Spotify | Other Apps

Take Two: EP398 with Jacob Asher, MD: Apple Podcasts | Spotify

EP501 with Ivana Krajcinovic, PhD: Apple Podcasts | Spotify | Other Apps

EP308 with Mark Fendrick, MD: Apple Podcasts | Spotify | Other Apps

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🔗 Show Notes with all mentioned links: Show Notes

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00:00 Introduction.

00:32 Collaboration as the next breakthrough innovation.

02:24 A summary of the upcoming conversation.

05:45 A summary of where we are and what the future looks like.

06:24 A relevant post from Jonathan Baran.

08:12 The conversation with Ryan Wells, Dr. Leo Spector, and Adam Stavisky: collaboration from the standpoint of a specialist.

12:22 The pitfalls of data accuracy and defining what quality means from the POV of a self-insured employer.

15:36 Defining quality and data accuracy from the POV of a physician.

15:57 How do you measure outcomes when assessing quality and looking at the available data?

22:06 Scale and operationalization: How do we do it?

27:00 Shout-out to OrthoForum.

30:30 How things could be better.

33:29 One last complication and how to structure benefit design to align incentives.

35:33 What an "anti-cricket" program looks like.

37:34 How do we operationalize benefit design and aligned incentives?

39:39 What we're seeing today in Centers of Excellence 2.0.

41:47 What Adam wants to make clear in all of this.