- In this episode, Andréa Caballero of Catalyst for Payment Reform speaks with Daniel Stein, MD, MBA, President and Founder of Embold Health, about the high and hidden costs of clinical variation, how this variation shapes the trajectory of care, and what employers and employees can do to identify evidence-based providers and improve outcomes.
Key Insights
The Hidden Cost Driver Isn’t Price—It’s Variation
A major share of healthcare spending stems from unnecessary or low-value care, not just high prices. Clinical variation—where similar patients receive dramatically different treatment depending on the provider—creates waste that employers and purchasers can no longer ignore.
First Provider Choice Shapes the Entire Care Journey
The initial physician encounter often determines the trajectory of care. An evidence-based provider may guide a patient toward physical therapy and recovery, while a more aggressive approach can trigger cascades of imaging, procedures, and surgery that may not improve outcomes.
Prior Authorization Is a Back-End Fix
Prior authorization is seen as a downstream control mechanism rather than a true quality strategy. Instead of screening questionable care after it’s ordered, the bigger opportunity lies upstream: steering patients toward providers who consistently practice evidence-based medicine from the start.
Members Still Lack Meaningful Quality Visibility
Patients can usually see who is in-network, nearby, or low-cost—but rarely which physicians deliver the best outcomes for their specific condition. Historically, employers and health plans lacked the data infrastructure and analytics to make nuanced quality recommendations at the provider level. Embold Health offers critical insight into the quality of individual providers within systems.
Employers Are Becoming Active Quality Purchasers
- Large employers are beginning to move beyond passive network participation. Rather than assuming all credentialed providers offer comparable care, they are embedding quality-focused navigation tools and benefit incentives directly into the member experience.
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Even when quality tools exist, employees may default to word-of-mouth recommendations or brand-name systems. Employers are increasingly pairing provider guidance with lower cost-sharing, preferred benefit designs, and integrated navigation experiences to encourage engagement