KROGER
Prepared by
Joe Nalley
show your work.
Governance-backed healthcare programs
for a workforce that feeds America.
Five programs. Substance use treatment. Specialty pharmacy governance. Behavioral health navigation. Claims verification. Maternity navigation. Performance-guaranteed. Claims-verified. 90 days to prove it on your own data.
Joe Nalley
02
Your Workforce
409,000 associates. Physical labor.
Ohio and Kentucky. Our backyard.
409K
Associates across grocery, distribution, pharmacy, and manufacturing
Kroger 10-K FY2024
65%
Hourly workforce — store clerks, warehouse, distribution, deli, bakery
BLS / Kroger workforce disclosures
2,750+
Stores across 35 states. Concentrated in OH, KY, IN, TN corridor.
Kroger 10-K FY2024
5.6x
Grocery warehouse injury rate vs. general private industry
BLS SOII 2023 — NAICS 4244
2,200+
Kroger Pharmacy locations. Your organization already speaks clinical.
Kroger Health 2024
$3.5B+
Estimated annual health benefits spend for self-insured workforce at industry benchmarks
Milliman employer benchmarks 2024
Your associates stock shelves, lift cases, and work cold storage for a living. The musculoskeletal injury rate in grocery distribution is nearly six times the national average. You run 2,200 pharmacies — you already know what happens after the injury. You just don't have a program that intervenes.
Joe Nalley
03
The Gap
You employ pharmacists who dispense buprenorphine.
But there's no SUD program for your own people.
SUD in the grocery workforce
Grocery and food service workers have a 16.9% past-year substance use disorder rate — the highest of any industry. Your associates work physical, high-turnover, often night-shift roles. The Appalachian corridor you operate in was ground zero for the opioid crisis. There is no dedicated treatment program for the workforce most at risk.
Behavioral health beyond the EAP
Standard EAP provides a handful of sessions. For a workforce dealing with acute psychiatric episodes, residential SUD, eating disorders, and co-occurring conditions, that's triage — not treatment. The gap between the EAP handoff and actual clinical placement has no program managing it.
Claims verification at 409K-life scale
Self-insured at this scale, high-cost claims above $25K flow daily. Your TPA processes and audits those claims. Nobody independent verifies them before payment. At a 4% discrepancy rate on high-cost claims, the preventable overpayment is measured in tens of millions.
Maternity without navigation
Roughly 55% of your workforce is female. Maternity is the most expensive predictable clinical episode — $20,416 average, $71,158 per NICU admission. Facility-level quality data and delivery site steering aren't available to your associates making the most consequential healthcare decision of their lives.
Kroger Pharmacy dispenses 224 million prescriptions a year, including MAT medications. Your organization understands clinical sophistication. The benefits side just hasn't caught up to what your pharmacy operation already knows.
SUD prevalence: NSDUH 2022 / SAMHSA. Prescriptions: Kroger Health annual report 2024. Maternity costs: Peterson-KFF 2024, HCCI 2021.
Joe Nalley
04
The Portfolio
Five programs. Each independent.
Each designed to prove itself in 90 days.
Lead Program
Continuum
Virtual-first OUD/SUD treatment with buprenorphine and navigator continuity
Delivery-anchored virtual MAT program. Buprenorphine via permanent DEA telehealth pathway. Named navigator manages full episode — intake through stabilization through step-down. Built for the injury-to-opioid pipeline and the workforce demographics that make grocery the highest-SUD-prevalence industry in America. 42 CFR Part 2 compliant. KY and OH operations.
9 hrs/week IOP standard · 42 CFR Part 2 compliant · Fee-first, earning into risk ·
continuumhealth.care
Lead Program
Cadence
Specialty therapy continuation governance — published clinical framework
You run 2,200 pharmacies. You dispense specialty medications daily. But nobody audits whether your own employees' specialty therapies should still be running. Cadence is an 8-section clinical governance framework (CGS v1.1) that evaluates continuation appropriateness across 4 drug classes. 65,234 patients across 3 locked cohorts, including NIH All of Us federal validation. Published in Pharmacy Times (April 2026).
Lead Program
Curated
Independent behavioral health navigation with readmission warranty
One named navigator per member across every BH episode — acute psych, IOP, PHP, residential SUD, eating disorders, PTSD. 13 clinical areas. Quality-scored provider database across 13 clinical areas. 30-day readmission warranty on SUD residential and acute psych. Not an EAP. Not a referral list. Episode-chain continuity for a workforce that cycles through behavioral health crises without anyone managing the whole episode.
200K+ patients managed · 80%+ residential completion · Single-digit readmission ·
curatedhealth.care
Supporting Program
Caliber
Pre-payment billing verification — advisory-only claims governance
Verifies high-cost claims (>$25K) before payment using seven-check Billing Governance Standard. Issues Billing Governance Certificate. Advisory-only — never denies claims, routes findings to your team. Independent of your TPA. At 409K associates, the math on prevented overpayments is immediate.
Supporting Program
Waybright
Warranty-backed maternity navigation for self-funded employers
Claims-integrated early risk identification at weeks 16–20. Facility-level quality data in the consumer's hands. Delivery site steering. 30-day readmission warranty held by credentialed delivery providers. Our platform fee is at risk against maternity outcomes across your population.
$1,677 modeled savings per navigated pregnancy · 4-tier steerability ·
waybright.health
Each program operates independently. Adopt one, two, or all five. No bundling requirement. No platform lock-in.
Joe Nalley
05
Continuum · Substance Use
Grocery workers have the highest SUD rate
of any industry. Yours are in Ohio and Kentucky.
The NSDUH data is unambiguous: food service and grocery workers report 16.9% past-year substance use disorder — higher than construction, higher than mining. Your workforce sits in the Ohio-Kentucky-Appalachian corridor where opioid prescribing rates are 50% above the national average. The combination of physical labor, high turnover, and geographic risk makes Kroger the single most natural fit for this program in America.
The Model
01
Buprenorphine via permanent DEA telehealth pathway. No in-person prescribing barrier — critical for associates in rural store locations.
02
Named navigator from intake through stabilization through step-down. Same person, every visit, every call.
03
42 CFR Part 2 compliant. Employer never sees individual SUD records. SDOH and health equity fields built in.
04
Fee-first model, earning into risk-sharing in year two. You pay for results before we share in them.
Why Kroger
Your pharmacists dispense buprenorphine every day. Your organization already understands MAT at a clinical level. The gap is on the benefits side — there's no program connecting your associates who need treatment to the modality your own pharmacies help deliver.
KY and OH operations mean our clinical team is local. Continuum's provider network covers the exact geographies where your distribution centers, manufacturing plants, and store clusters concentrate. An associate in Sharonville gets the same access as one in rural Pike County.
16.9%
Past-year SUD rate among grocery/food service workers — highest of any sector
NSDUH 2022 / SAMHSA
50%+
Higher opioid prescribing rate in Appalachian OH/KY vs. national average
CDC MMWR 2023
Joe Nalley
06
Curated · Behavioral Health
Your EAP hands off after a few sessions.
Nobody catches them on the other side.
Episode-chain continuity
One named navigator stays with your associate across every behavioral health episode for the life of their enrollment. Not a call center. Not a new intake every time. The same person who knows their history, their medications, their work schedule.
Readmission warranty
30-day readmission warranty on SUD residential and acute psych episodes. If a navigated member is readmitted for a preventable delivery complication, the delivering provider covers it under their warranty terms. Our fee is at risk against population-level outcomes. Active after 100 measured episodes — actuarial discipline, not a marketing claim.
Independence
We don't deliver care. We don't own facilities. We don't have downstream economic interest in where your associate goes. The navigator's only incentive is the right placement at the right time.
13 Clinical Areas Curated
Acute psychiatric
Residential SUD
IOP / PHP
MAT programs
Eating disorders
PTSD / trauma
Adolescent BH
Dual diagnosis
Detox
Crisis stabilization
Outpatient therapy
Neuropsych
Co-occurring medical
200K+
Patients managed across BH episodes
80%+
Residential completion rate
$3–7
PEPM tiered by population
+ episode spread + gain-share year 2+
Joe Nalley
07
Cadence · Specialty Pharmacy
You run 2,200 pharmacies.
Nobody audits your own employees' specialty therapies.
Cadence Governance Standard (CGS v1.1)
8-section clinical framework with 7 reassessment triggers. Evaluates whether specialty therapies across 4 drug classes should still be running. Not utilization management. Not prior auth. Continuation appropriateness — the question nobody else is asking.
65,234 patients. 3 locked cohorts.
Including NIH All of Us federal validation. 29.1% flag rate — nearly one in three specialty therapy continuations warrant clinical reassessment. 58–60% Review Influence Rate. $14.3M in first-cycle savings value across the study population.
Published in Pharmacy Times
April 2026. A pharmacy-operating company will understand what that means. This isn't a white paper or a vendor blog post. It's a peer-reviewed publication in the journal your own pharmacists read.
Why Kroger
Kroger operates one of the largest pharmacy networks in the United States. Your pharmacists dispense specialty medications every day. But on the benefits side, nobody is evaluating whether the specialty therapies running on your own employees' claims should still be running.
Your organization has the clinical literacy to understand what a 29.1% flag rate means. It means nearly a third of specialty continuations across 4 drug classes warranted reassessment. Across a self-insured plan covering 250K+ lives, that's not a marginal finding. It's a governance gap with a dollar sign attached.
29.1%
Flag rate across 65,234 patients — specialty continuations warranting reassessment
3 locked cohorts incl. NIH All of Us
$14.3M
First-cycle savings value across 4 drug classes
Pharmacy Times, April 2026
$3–6
PEPM, volume-tiered with performance guarantee
409K associates = deepest tier
Joe Nalley
08
Supporting Programs
Two more programs. Same pilot structure.
Same 90-day proof window.
Caliber · Claims Verification
Your TPA audits their own work.
At 409,000 associates, high-cost claims above $25K flow through your TPA daily. Caliber verifies them before payment using a seven-check Billing Governance Standard — CODEVAL, DUPCHECK, RATEVAL, DURVAL, CREDVAL, SVCVAL, BUNDLEVAL. Advisory-only. Never denies claims. Issues a Billing Governance Certificate. Independent of your TPA.
4–6%
Expected discrepancy rate on high-cost claims
OIG / AHLA / MGMA
10 days
Standard turnaround. 5 days for expedited holds.
Waybright · Maternity
The most expensive predictable episode.
Approximately 225,000 female associates and dependents. Claims-integrated risk identification catches complications 4 weeks earlier than standard screening. Facility-level quality data — C-section rates, NICU admissions, readmissions by hospital — in her hands before she picks a delivery site.
$20,416
Average commercial maternity episode
Peterson-KFF 2024
$71,158
Average NICU admission. 1 in 10 pregnancies.
HCCI 2021
Caliber and Waybright are independent of Continuum and Curated. Adopt any combination. Each proves itself on your data.
Joe Nalley
09
The Pilot
You evaluate 224 million prescriptions a year.
We ask you to evaluate us for 90 days.
We don't pitch outcomes we can't verify. We don't ask you to commit before you've seen proof. The pilot is the product — your claims data, your baseline, your measurement. Performance guarantees and warranties are active from day one. If we don't move the numbers, you walk away with the data and owe us nothing beyond the pilot fee.
Scope
Defined population. Minimum 1,000 lives for BH/SUD programs. Maternity and claims programs scale to your full book. You choose the segment — we prove on the population you pick.
Timeline
90-day measurement window. Claims-verified outcomes, not self-reported surveys. Baseline established from your prior 12 months. Outcomes measured against your own history, not an industry average.
Guarantees
Performance guarantees are active from pilot day one. Our platform fee is at risk from the first navigated member. If population outcomes miss the baseline, we forfeit the at-risk portion.
Exit
If it doesn't work, you walk. No termination fee. No penalty. No lock-in. You keep the data, the baseline analysis, and the scorecard. Win or lose, you leave with better intelligence than you started with.
The Scorecard
Every pilot produces a claims-verified scorecard at day 30, 60, and 90. Metrics are agreed before launch — not after we see the results. You define success. We measure against it. The scorecard is the decision document for full deployment.
Continuum: treatment retention, MAT adherence, ED utilization, return-to-work
Curated: readmission rate, completion rate, cost per episode, navigation engagement
Caliber: discrepancy rate, prevented overpayment, turnaround time
Cadence: flag rate, review influence rate, continuation appropriateness, savings per cycle
Waybright: C-section rate, NICU rate, readmission rate, steering acceptance
Why This Works for Kroger
You operate 2,200 pharmacies. Your organization evaluates clinical data every day — NDC codes, drug interactions, formulary exceptions, clinical protocols. You know the difference between a vendor showing engagement metrics and a vendor showing claims-verified outcomes. The scorecard isn't new to you. You just haven't seen it applied to benefits.
Three things you learn in 90 days that you can't learn any other way:
1. Whether your claims baseline matches what you think it is
2. Whether navigation changes associate behavior, or just generates reports
3. Whether a vendor will put their own fee at risk against their own performance
The pilot isn't the beginning of a sales cycle. It's the end of one. Either the numbers move or they don't. That's the whole conversation.
Joe Nalley
10
Unit Economics
What the 90 days cost.
What we expect them to return.
| Program | PEPM | Annual (est.) | Primary Lever |
|---|
| Continuum | Per patient | Variable | ED diversion + retention |
| Curated | $3–7 | $1.2–3.4M | Readmission + completion |
| Caliber | $3–5 | $1.0–2.5M | Prevented overpayment |
| Cadence | $3–6 | $0.9–1.8M | Continuation appropriateness |
| Waybright | $4.50–8.50 | $2.0–4.2M | NICU reduction + steering |
Illustrative: ~250K covered lives (full-time associates + dependents)
Pilot: start with one program, one population segment
PEPM tiers by volume — 409K associates = deepest tier pricing
We publish the economics honestly. If the modeled savings don't exceed the program cost in the expected case, we say so. The remainder buys governance, guarantees, and risk transfer.
Continuum ROI Signal
Average employer cost per SUD episode without early intervention: $9,000+. ED visits for opioid-related events average $3,400 each. At the grocery-sector SUD prevalence rate, even modest interception across your OH/KY workforce population moves millions.
Caliber ROI Signal
At a 4% discrepancy rate on claims >$25K, a 250K-life self-insured plan typically sees $3–8M in preventable overpayments annually. Caliber's PEPM is a rounding error against the recovery.
Portfolio Discount
Two or more programs: 15–20% combined PEPM discount. Three or more: 20–25%. Single scorecard, single data feed, one vendor relationship across all programs.
Joe Nalley
11
Competitive Position
What we do that your current
vendors structurally can't.
Dimension
Standard EAP
Typical Navigation
Show Your Work
SUD treatment
Rehab referral. Maybe 6 sessions.
Not SUD-specific
Virtual MAT. Buprenorphine. Named navigator. KY/OH local.
BH depth
Limited sessions. Referral list.
Triage only
13 clinical areas. Full episode chain. Readmission warranty.
Maternity
Not maternity-specific
Education only
Claims-integrated. Facility steering. Warranty.
Claims audit
None
None
Pre-payment. 7-check BGS. Advisory-only.
Cost guarantee
None
Engagement metrics
Provider-held delivery warranty. Platform fee at risk. The only vendor in the category that warrants outcomes.
Pilot terms
Multi-year
Annual contract
90 days. Walk-away. No penalty.
We don't replace your EAP or your existing navigation vendor. We fill the gaps they weren't designed to fill — with programs that prove themselves on your claims data before you commit.
Joe Nalley
12
The Team
Built from the payer seat.
Designed for the employer buyer.
Joe Nalley
Founder & CEO
15 years building healthcare organizations and governance structures. Specialty risk products at a Fortune 25 payer — maternity, MSK, oncology, CHF — across millions of commercial members. Direct visibility into how payers price, manage, and lose money on the exact episodes these programs address.
Built and scaled a 13-location health system (BH, SUD, MAT, primary care, surgical center, community hospital). 30,000+ patients. Exited. Founded ClearBill — $9.2M returned to payers in the first six months. Exited. The programs in this deck aren't concepts — they're built on the same architecture, sold to the same buyer, governed by the same standards.
Cadence: 65,234 patients · 3 independent cohorts · NIH federal validation · Published in Pharmacy Times
M.S. Applied Behavioral Analysis, Northeastern ·
joe-nalley.com
Platform
7 Products Built and Published
Curated, Continuum, Waybright, Caliber, Cadence, Compass, Covenant — each with its own site, canon, and governance standard. Same infrastructure. Same employer buyer.
Payer Fluency
Speaks Your TPA's Language
Claims integration, risk stratification, actuarial reserving, and stop-loss coordination are built in — not outsourced to a consultant after the sale.
Capital
Founder-Led, Capital-Backed
Active capital conversations with healthcare-focused investors. Employer pilots are the proof points. Every signed pilot validates the model and accelerates deployment.
Joe Nalley
13
Next Steps
We're in Cincinnati.
This is a local meeting, not a cold pitch.
Your headquarters is on Vine Street. We're across the river.
This isn't a vendor flying in from San Francisco with a slide deck. This is a neighbor with proof.
Week 1–2
Introductory call. Identify which programs fit. Agree on pilot population and scorecard metrics.
Week 3–4
Claims data review. Baseline analysis. Pilot agreement signed. No setup fees.
Day 1–90
Programs live. Scorecards at day 30, 60, 90. Warranties and guarantees active throughout.
Day 91
Decision. Scorecard in hand. Continue, expand, or walk away. No penalty either way.
Timing
Pilot can launch within 30 days of agreement. No implementation timeline. No technology integration required for initial deployment. Claims data feed is the only prerequisite. A one-page pilot term sheet is available on request.
The Geography Advantage
Continuum's KY and OH clinical operations overlap with your highest employee concentration. Your distribution centers in the Greater Cincinnati corridor, your stores across Ohio and Kentucky, your manufacturing facilities — the provider network is already built for where your people live and work. This isn't a national vendor scaling down. It's a local program scaling up.
Start Here
We recommend starting with Continuum (SUD/OUD treatment) and Curated (behavioral health navigation) — the highest-impact programs for your workforce demographics and geography. Add Caliber and Waybright in wave two once the scorecard proves the model.