Incentive Misalignment Battle Group

Places your partners win when you lose.

Incentive Misalignment focuses on the uncomfortable reality: brokers, PBMs, and some vendors often get paid more when your costs rise. Kincaid IQ makes those conflicts visible, quantifiable, and fixable.

What this battle group answers

• Where are we literally paying partners to keep costs high?
• How much spread and rebate skew is structurally driven?
• Which contracts embed "win-lose" instead of "win-win"?
• What alignment changes would materially shift behavior?

Spread exposure

$1.1M

PBM paid more as your cost rises

Rebate skew

72%

rebates retained vs. passed through

Broker comp at risk

0.4 pts

of premiums tied to volume, not value

Alignment opportunity

High

multi-year incentive reset

Incentive map — who wins when costs rise?

A clear view of which parties benefit from higher spend — and by how much.

Audit view

CounterpartyYouBrokerPBMCarrier

Higher Rx spendLoseWinWinWin

Higher GLP-1 volumeLoseWinWinNeutral

Rebate optimizationUnclearNeutralWinNeutral

Trend reductionWinLoseLoseLose

Once you can see the incentive map, you can renegotiate it. Kincaid IQ supports both structural changes (comp plans, fee models, contract language) and tactical moves (carve-outs, alternative funding, and alignment clauses).

Illustrative case

2,800-life services company — misalignment in plain sight.

De-identified; pattern is typical, numbers are illustrative.

Inputs

• Broker fee + bonus schedules
• PBM rebate guarantees and terms
• 3 years of claims and premium history

Findings

• Broker bonuses tied to gross premium growth
• PBM rebate structure favoring higher WAC drugs
• No downside for partners if trend worsens

Modeled outcome

• New broker comp tied to PMPM trend and quality
• PBM terms realigned to net cost, not rebate
• 0.3–0.5 pts of EBITDA upside from alignment shift

Run an Incentive Misalignment scan.

We'll show you exactly where partners are rewarded when your costs go up — and how to reset the game.

Request misalignment scan Back to all battle groups