Self-Funded With Spencer

"If we can do it for Whole Foods, which is a very large organization, why can't we do this for other employers?"Is the era of relying on national, opaque "BUCA" networks finally coming to an end?My guests this week are Blake Allison, CEO of Employers Health Network (EHN), and Philip Eaves, from Ascension. Together, they break down the exact blueprint they used to build a direct-to-employer, high-performance network for Whole Foods - and how they are scaling that exact same model for self-funded employers across the country.In this episode, we explore the hospital system's perspective on direct contracting. Phil explains why massive health systems like Ascension are eager to bypass traditional carriers to work directly with employers, citing faster payments, zero collection risk, and the ability to proactively manage patient care. We also discuss how to successfully integrate Direct Primary Care (DPC) into a localized network, the lessons commercial plans must learn from Medicare Accountable Care Organizations (ACOs), and why the future of healthcare relies on "re-localizing" how we buy medical services.If you are an employer, benefits consultant, or healthcare provider who is fed up with the transactional, nickel-and-dime nature of traditional insurance carriers, this conversation proves that a better, more collaborative model already exists.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Whole Foods and the Move Away from BUCAs  (00:07:29) The Whole Foods Case Study: Building a Direct Network (00:12:15) Why Health Systems Want Direct Employer Contracts (00:17:15) The Evolution from RBP to High-Performance Networks (00:19:21) Integrating Direct Primary Care and Care Management (00:23:41) The Challenges of Scaling Direct Contracts Nationally (00:28:15) Re-Localizing Healthcare: Buying Care in Your Community (00:33:36) Overcoming the Negative Stigma of "Networks" (00:36:55) Applying Medicare ACO Lessons to Commercial Populations (00:42:31) Defining True Value-Based Care and Downside Risk (00:45:51) The Ideal Employer Profile for Direct Contracting (00:50:52) Lowering Costs with Local, Community-Based Care (01:05:17) Future Predictions: Site Neutrality and Price Transparency (01:11:25) Closing Thoughts: Providers Are Open for BusinessKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Employers are at a point where they want to help create that ideal healthcare system, not the one that they have been dictated to."Is your company's health plan actually keeping your employees healthy, or is it just waiting for them to get sick?My guest this week is Ben Miller, Chief Revenue Officer at Premise Health, the nation's largest direct healthcare provider operating over 850 onsite and near-site wellness centers. Ben joins the show to discuss why the traditional fee-for-service model is failing both employers and employees, and how Advanced Primary Care is stepping in to serve as the new "front door" to the healthcare system.In this episode, we break down what Advanced Primary Care actually entails, from integrated behavioral health and lifestyle medicine to onsite pharmacies offering 90-day prescriptions for $1. Ben shares the results of a massive Milliman study showing how this model reduces total claims costs by an astonishing 30%. We also cover how employers of various sizes can implement near-site clinics, address employee privacy concerns, and utilize Epic-integrated care navigation to guide patients to high-quality, cost-effective specialists.If you are an employer or benefits consultant looking for a proven strategy to bend the cost curve while delivering an incredible healthcare experience to employees, this episode is a must-listen.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: The Shift Towards Advanced Primary Care (00:00:33) Meet Ben Miller & Premise Health (00:02:17) Defining Advanced Primary Care, On-Site, and Near-Site Clinics (00:05:06) Ben's Journey from Kaiser Permanente to Premise Health (00:10:32) The Breaking Point: Why Employers are Flocking to APC (00:16:07) How to Build and Customize an On-Site Clinic (00:20:11) Creating the "Front Door" to Healthcare & Navigating GLP-1s (00:25:20) Integrating Behavioral Health & Lifestyle Medicine (00:28:29) The On-Site Pharmacy Experience ($1 Medications) (00:30:22) Overcoming the "Big Brother" Privacy Stigma (00:32:36) The Milliman Study: Proving a 30% Reduction in Claims Cost (00:36:12) Group Size Requirements & The Power of "Coopetition" (00:39:35) Managing Catastrophic Risk & Epic Care Navigation (00:43:43) Expanding the Clinic: PT, Dental, and Vision Services (00:49:54) How Claims & TPA Integration Actually Work (00:52:33) Closing Thoughts: The Future of Employer-Sponsored CareKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

Welcome back to Last Month in Healthcare! This month, Spencer and Nathaniel sit down without a guest to unpack the biggest healthcare headlines and regulatory shifts from April 2026.From state-level crackdowns on PBMs to a surprising loophole that allows urban hospitals to siphon rural hospital aid, the guys dissect the policy changes and market moves that are actively reshaping the industry. They also discuss the affordability crisis driving a 26% surge in ACA Bronze plan enrollment, Amazon's aggressive new play into the GLP-1 and primary care market, and why CMS is finally (and officially) killing the fax machine by 2028.Plus, Spencer plays a game of "Blind Ranking," attempting to properly order the top 10 best practices and features of a modern self-funded health plan (including pass-through PBMs, cash-pay surgery networks, and pharmacogenomics) without knowing what's coming next.Thank you to this year's sponsor, Walk On Clinic!If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Chapters: (00:00:00) Intro & Sponsor Shoutout: Walk On Clinic (00:01:42) Bipartisan State Healthcare Regulations & PBM Oversight (00:04:40) ACA Shifts: The Rise of Bronze Plans & HSA Eligibility (00:08:38) The FTC's Vague New Healthcare Task Force (00:10:10) The Rural Hospital Aid Loophole Exploited by Urban Hospitals (00:11:27) Amazon Launches a $149/mo GLP-1 & Primary Care Program (00:15:18) CMS is Finally Ending the Fax Machine (Saving $781M) (00:16:48) Game: Blind Ranking the Best Self-Funded Plan Features (00:24:45) PSA: Watch Out for These Hidden Carrier Contract Clauses

"I would rather take this risk because I will never give another dime to a fully-insured carrier as long as I live."In an era of double-digit medical trend and skyrocketing fully-insured renewals, is the traditional insurance broker obsolete?This week, my guest is John Kountz, a benefits consultant at Frost Insurance who believes that the days of the "renewal carousel" - shopping the big 4 carriers and accepting double-digit increases every year - are finally over. In this episode, John shares his journey from feeling completely helpless as a broker to discovering the power of true consulting.We discuss the critical differences between a "broker" and a "consultant," how he uncovered that an employer was secretly paying 45% of their entire $10 million pharmacy spend in rebates, and how taking a fully-insured client directly to Reference-Based Pricing (RBP) cut their $1,000/month employee-only premium completely in half. John also breaks down the emerging power of pharmacogenomics, why 2026 is poised to be an even more brutal renewal year, and why you must replace your traditional broker with a true consultant.If you are an employer tired of throwing away money on fully-insured premiums, or a broker wanting to make the jump to self-funding, this conversation is the push you need.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Why the Benefits Consultant is Healthcare's Most Important Role (00:04:03) Staying Independent in an Era of Broker Consolidation (00:11:51) Getting Out of the "Renewal Carousel" (00:18:18) The Turning Point: Discovering 45% of Rx Spend Was Going to Rebates (00:20:41) Converting a Fully-Insured Group to Reference-Based Pricing (RBP) (00:30:11) The Real Definition of Self-Funding (The Chassis vs. The Car) (00:36:05) Finding the Root Cause: Diet, Inflammation & Autoimmune Disease (00:46:04) The Future of Prescribing: Pharmacogenomics (00:57:20) Why the 2026 Renewal Season Will Be a "Bloodbath" (01:02:00) Closing Thoughts: Stop Working With Traditional BrokersKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I'm going to leave the ladder, I'm going to leave the window open, I'm going to leave the lights on."This week on the podcast, I am joined by Rob Gelb, CEO of Vālenz. Rob has led Vālenz through an era of explosive growth, transforming the company from a 60-person shop in 2018 into a 550-employee powerhouse driving innovation in the self-funded healthcare space.But this episode isn't just about healthcare - it's about leadership, vulnerability, and knowing when to pass the torch.In a surprising and highly emotional moment, Rob uses this episode to make a massive public announcement regarding his future at Valenz and the next chapter of his career. He opens up about the deep self-reflection required to make this major life decision, why true leaders must surround themselves with people smarter than they are, and his ultimate mission to "leave a ladder" for the next generation of executives.We also discuss the "Kobe Bryant mentality" of embracing failure, why playing "not to lose" is a recipe for disaster, and why the future of self-funded healthcare relies entirely on "coopetition" and sharing the blueprint for success.If you are a business leader, an entrepreneur, or anyone trying to make a meaningful impact in your industry, this is an absolute must-listen.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Why the Smartest Leaders Are the "Dumbest" in the Room (00:02:44) The "Broken Glass" Leader & Leaving Ego at the Door (00:04:18) The Kobe Bryant Mentality: Loving to Win vs. Hating to Lose (00:11:41) Playing "Not to Lose" & The Danger of Playing it Safe (00:18:09) Becoming a First-Time CEO at 52 (The "Lattice" Career Path) (00:26:07) "The Obvious is Only Obvious to Those Who Can See It" (00:28:28) Time as the Great Contextualizer (The 3 Dots Framework) (00:32:51) Operating in the "Land Before Time" (Why Healthcare is Broken) (00:39:51) The "Coaching Tree" of Healthcare(00:43:02) Leaving a Ladder: Mentorship & Creating the Future (00:51:27) Overcoming the Inability to Scale in Self-Funded Healthcare (00:56:01) Why We Need "Coopetition" to Fix the $5 Trillion Problem (00:58:42) Rob's Huge Announcement Regarding His Future at Valenz (01:05:15) Closing Thoughts: The Legacy of Leadership & What's NextKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"We are not going after the high. What we're going for is symptom relief. Based on our research, employers are going to be saving $5,000 per participant per year."Is it time for employers to start covering medical cannabis?My guest this week is Emily Fisher, Founder of LeafWell. As a stage 4 breast cancer patient, Emily experienced firsthand the therapeutic benefits of cannabis when traditional opioid painkillers failed her. However, she also experienced the frustration of navigating the dispensary system without any clinical guidance or oversight.She founded LeafWell to solve this problem by connecting patients with licensed healthcare providers via telehealth to receive personalized, clinically-guided cannabis care plans. Now, LeafWell has served over 500,000 patients and is bringing their platform directly to self-funded employers.In this episode, we tackle the stigma and misconceptions surrounding medical cannabis in the workplace. Emily explains how LeafWell differentiates between "presence and impairment," the strict guardrails they use for safety-sensitive jobs, and why clinically-guided cannabis therapy is helping patients reduce or eliminate highly addictive opioids and expensive pharmaceuticals.If you are an employer or a benefits consultant looking for an innovative, holistic approach to managing chronic pain and reducing pharmacy spend, this conversation will completely change how you view cannabis as an employee benefit.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Medical Cannabis as an Employee Benefit? (00:04:05) Emily's Story: Surviving Stage 4 Breast Cancer (00:08:25) Launching LeafWell: Increasing Access, Education, & Research (00:11:55) Dispensary "Bud Tenders" vs. Clinically Guided Care (00:15:24) Why Cannabis is a $29 Billion Healthcare Savings Opportunity (00:18:01) Reducing Prescription Drugs & Avoiding the ER (00:21:15) Addressing the Elephant in the Room: Impairment at Work (00:26:32) Differentiating Between Presence (Urine Tests) and Impairment (00:29:29) Form Factors: Tinctures, Capsules, and Avoiding Inhalables (00:35:47) How the Endocannabinoid System Works (00:42:00) The Future: Will the Government Reschedule Cannabis? (00:46:54) How Employers Can Roll Out a Medical Cannabis ProgramKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Revolutions are never won by the ruling class... if you want to fix healthcare, you have to be willing to accept a negative sum game. Someone is losing."Why are self-funded employers still paying for healthcare on a "fee-for-service" basis, where every single transaction is billed separately with zero guarantee of a positive outcome?My guests this week are Francois and Jeremy from XO Health, a new type of health plan built explicitly for self-funded employers. Instead of relying on traditional, opaque carrier networks (the "BUCAs"), XO Health is introducing a new accounting system for healthcare: the Care Package.In this episode, we explore how XO packages an entire episode of care - from a knee replacement to the ongoing management of chronic diabetes or maternity - into a single, predictable, fixed price. We discuss how this model shifts financial accountability back to the provider (while also protecting them through embedded risk corridors and "mini-spec" policies), eliminates the perverse incentives of traditional networks, and ultimately allows employers to offer a health plan that employees actually want to use (complete with "hugs and kisses" for $0 out-of-pocket costs).If you are an employer or a benefits consultant tired of 10% medical trend and unpredictable renewals, this episode provides a blueprint for how true risk-sharing can finally fix the system.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Setting a "Circuit Breaker" for Provider Risk (00:01:21) What is XO Health? (And where the name comes from) (00:06:51) The Flawed "Unit of Service" Accounting System (00:08:33) Introducing the "Care Package" (Episodic & Chronic Bundles) (00:15:37) The Maternity Example: Guaranteed Pricing & Provider Risk (00:20:13) How Embedded Risk Corridors ("Mini-Specs") Protect Providers (00:27:14) Value-Based Care: What is it Really? (00:32:32) Measuring Clinical Outcomes (Experience, Mobility, & A1C) (00:38:07) Building a High-Performance Network & Incentivizing Steerage (00:46:13) The Regulatory Tailwinds Pushing Employers to Act (00:50:35) The "Negative Sum Game": Why Someone Has to Lose (00:54:05) Closing Thoughts: Flattening Medical TrendKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I can't fathom a world where employers are expected to budget and create a plan for their future without understanding what the costs of their healthcare are. Everything needs to be grounded in fact and truth."Is the traditional insurance network obsolete?My guest this week is Amy Wykoff, Chief Product Officer at Nomi Health. After starting her career building foundational AI models at IBM Watson, Amy pivoted to healthcare with a massive new challenge: rebuilding the insurance network from scratch.In this episode, we explore Nomi's radical approach to the "Network as a Product." Rather than negotiating opaque discounts off inflated Charge Master rates, Nomi negotiates fair, transparent cash rates with providers and guarantees them 100% payment. In return, self-funded employers can offer their employees a true $0 copay, $0 deductible health plan.We discuss the logistics of building a direct-contracted network across 40 major MSAs, how to overcome "point solution fatigue" by reassembling the vendor stack, and why the ultimate goal of healthcare innovation should be to stop using AI to fight over claims denials - and start using it to improve actual patient care.Tune in to this week's Self-Funded to learn exactly how the free market is finally fighting back!Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: IBM Watson & The Origins of Healthcare AI(00:02:56) Leaving AI to Build "Network as a Product" at Nomi Health(00:05:07) The $0 Copay, $0 Deductible Health Plan(00:07:09) Scaling a Direct-Contracted Network to 40 MSAs(00:08:44) The Insanity of Traditional Carrier Reimbursement(00:13:08) Why Providers Actually Want Transparent Cash Pricing(00:15:10) The Economic Drain: How Bad Networks Hurt Local Economies(00:19:07) Why Employees Hate Their Health Insurance(00:23:44) Reassembling the Vendor Stack: Navigation & TPAs(00:28:13) Why Healthcare is Now a CFO Decision(00:32:02) "The Tears of Joy": Real Patient Stories(00:37:31) The AI War: Why "Bots Fighting Bots" is a Waste of Talent(00:43:51) Closing Thoughts: Unbundling the Health PlanKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"There's no bad risk, there's just mispriced risk... we helped one carrier achieve a 29.1% improvement in their loss ratio just through better risk selection."How do stop-loss carriers and self-funded employers accurately predict which groups are going to run well and which ones are about to see skyrocketing claims?My guest this week is Ali Panjwani, Founder and CEO of Merit Medicine. Ali transitioned from a career in biotech and pharmaceutical public policy, where he helped price and launch complex, rare-disease drugs, to solving one of the biggest problems in self-funded healthcare: predicting catastrophic risk before it happens.In this episode, we dive into the evolution of predictive analytics and medical underwriting. Ali explains how Merit Medicine uses AI and access to a massive database (covering 95% of commercial claims in the US) to project a group's healthcare spend using just a simple census file. We discuss why a group that ran poorly last year might actually be a great risk this year, how to prevent underwriters from "playing on tilt," and the ongoing debate over how to finance multi-million-dollar cell and gene therapies.If you are a benefits consultant, an MGU, or a stop-loss carrier trying to understand how technology is fundamentally changing the way healthcare risk is predicted and priced, this episode is a must-listen.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com/spencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: The Evolving Landscape of Healthcare Risk(00:04:28) Ali's Background: From Biotech to Public Policy(00:09:47) The Complexity of Launching & Pricing New Drugs(00:13:30) Shifting Focus: Who Actually Pays for Healthcare?(00:16:34) The Data Access Problem for Self-Funded Employers(00:19:50) How Merit Medicine Predicts Risk with Just a Census File(00:23:24) Why Merit Looks Backwards to Predict the Future(00:26:27) How Stop-Loss Carriers & MGUs Use Predictive Analytics(00:29:41) "There Is No Bad Risk, Only Mispriced Risk"(00:33:04) The Danger of Underwriting "On Tilt" (Past vs. Future Claims)(00:37:37) Can Predictive AI Help Apply Specific Lasers?(00:40:10) The Evolution of Underwriting Tech(00:45:04) Proving the Model: A 29.1% Loss Ratio Improvement(00:49:10) The Cell & Gene Therapy Debate: Public Pools vs. Financing(00:55:14) Closing Thoughts: The Future of Predictable PremiumsKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's podcasts, headlines, and listener-submitted questions.This month, we're joined by Jeff Bak from Imagine360!Together, we react to the latest headlines from March, including the new CMS rule enforcing actual dollar amounts in hospital price transparency files. We also discuss Medicare expanding coverage for GLP-1s to treat obesity, Roche's massive $65M investment in NVIDIA AI chips for drug discovery, and the Department of Labor's new PBM fee disclosure rules. Plus, we react to the shocking story of two insurance executives sentenced to 20 years for a $233 million ACA enrollment fraud scheme.Then, Jeff and I play a game of "Blind Ranking" where we have to rank the worst practices in health insurance (like PBM spread pricing, ER upcoding, and surprise balance billing) without knowing what is coming next. Finally, we answer a listener question about the viability of ICHRAs (Individual Coverage HRAs) as an alternative to brutal fully-insured renewals in 2026.Thank you to our sponsor, Walk On Clinic! Visit walkonclinic.com to learn more about their on-site health clinics.Chapters:0:00 - Intro & Live Show Announcement3:08 - CMS Enforces Dollar-Amount Price Transparency6:54 - Medicare Expands GLP-1 Coverage to Obesity12:15- Roche Buys $65M in NVIDIA AI Chips for Drug Discovery15:45 - The DOL Proposes New PBM Fee Disclosure Rules19:40 - Insurance Execs Sentenced to 20 Years for $233M ACA Fraud22:20 - Game: Blind Ranking the Worst Practices in Health Insurance30:41 - Ask Spencer: Are ICRAs a Smart Option After Huge Renewals?

"We are in a $5 trillion US healthcare consumer market with no consumer in it... I basically decided we had been surgically removed from the US healthcare system."My guest this week is Mark Galvin, a serial entrepreneur who successfully funded his own company's healthcare by pairing a $10,000 High Deductible Health Plan with a fully funded HSA and HRA - saving his company 32% and his employees 50%. When he realized that brokers, carriers, and even the state insurance department were financially disincentivized from sharing this strategy, he decided to force transparency into the market himself.In this episode, Mark shares the incredible story of how he secured a DVD containing 100% of New Hampshire's post-adjudicated claims data and built the first true shopping tool for medical procedures. We discuss his meetings at the White House that helped shape the Transparency in Coverage Rule, the absurdity of $68,000 knee replacements, and his new platform that calculates a "Universally Acceptable Payment Amount" (UAPA) for every provider in the country.If you are an employer, broker, or patient who is tired of flying blind and wants to understand how true cash prices are finally coming to healthcare, this episode is a must-listen.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com/Spencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Aligning Financial Incentives in Healthcare (00:02:41) Mark's Background: Voice Over IP to Healthcare Tech (00:04:47) The Early Days of Direct Primary Care (DPC) (00:09:08) Hacking the HDHP: Saving 32% on Premiums (00:11:28) Why Brokers & Carriers Hate Cost-Saving Strategies (The MLR Problem) (00:18:33) Discovering the All-Payer Claims Database (APCD) (00:21:49) The $1,600 vs. $6,800 Nuclear Stress Test (00:26:00) Building a Commercial Solution to Fight Lobbyists (00:29:40) The "Proficiency Score": Why Price Does Not Equal Quality (00:31:48) Scraping EOBs to Build a National Price Database (00:33:27) The White House Meetings & The Transparency in Coverage Rule (00:43:03) Inventing "Transparency 2.0" and the UAPA (Cash Pay) (00:51:13) Shared Savings Rewards: Paying Employees to Shop (00:53:56) The Future: In-App Repricing and "Tap-to-Pay" at the Doctor (00:57:52) Can We Shop for 70% of Healthcare? (01:04:18) Using UAPA as a Full Network Replacement (01:11:19) The Path to an "Amazon-Like" Healthcare Market (01:15:19) Closing Thoughts: Why 12% of Shoppers Can Change the SystemKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I've got a patient in Washington state. He's traveling 100 miles every other week to receive an infusion. We moved this patient into the home and saved the plan $700,000 on this one patient...on gout treatment."Why are infusion drugs quietly destroying your health plan's budget?This week, my guest is Rob LaHayne, Co-Founder of Leap Health. We pull back the curtain on one of the most overlooked and expensive categories in healthcare: Specialty Infusion Care. Because these drugs are administered by a medical professional, they are billed through the medical plan under "J&Q Codes" - subjecting them to massive hospital markups and "buy-and-bill" margin games.In this episode, Rob explains how Leap Health is solving this by taking over the supply chain, procuring the drugs transparently without margin, and redirecting patients to their own homes or convenient infusion centers. We discuss how these J&Q codes are often the hidden culprit behind breached stop-loss deductibles and skyrocketing renewals, and why shifting the site of care is a win for both the employer's budget and the patient's quality of life.If you're a benefits consultant trying to figure out why your client's medical spend is out of control, or an employer tired of paying massive hospital markups for necessary medications, you need to understand J&Q codes.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com/Spencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: The Hidden Problem of J&Q Codes (00:04:13) Rob's Background & The Genesis of Leap Health (00:08:24) Why Hospital "Buy-and-Bill" Margins Drive Up Costs (00:13:22) How Leap Health Provides Transparent, Zero-Margin Pricing (00:16:31) Shifting Site of Care: The Power of Home Infusions (00:23:44) Overcoming Headwinds: Patient Engagement & Plan Design (00:27:01) Taking Over the Supply Chain to Bypass the "BUCA" PBMs (00:32:51) Stop-Loss Renewals: Why Identifying J&Q Codes is Critical (00:37:04) Saving $700,000 on a Single Gout Patient (00:41:39) The Future: Unbundling the Health Plan & "Point Solution Fatigue" (00:45:41) Closing Thoughts: Why Consultants Must Request J&Q Code DataKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's headlines and listener-submitted questions.This month, we are officially in the new studio! Nathaniel and I react to the latest headlines from February, including the FTC's landmark settlement with Express Scripts over insulin pricing and the new bipartisan bill aimed at breaking up the "Big Medicine" monopoly of insurers, PBMs, and providers. We also discuss the FDA's crackdown on compounded weight loss drugs (GLP-1s) and the privacy concerns surrounding OpenAI's new ChatGPT Health feature.Plus, we play a new game called "Drug Cost or Car Payment?" where I try to guess whether a monthly prescription is more expensive than the lease payment on a luxury car (like a Porsche 911 Carrera or a Bugatti Chiron). Finally, we answer a listener question about the absolute minimum employee headcount required to go fully self-funded in 2026.Thank you to our sponsor, Walk On Clinic!Chapters:0:00 - Intro: Welcome to the New Studio!1:24 - "PBM Reform Comes To Washington"2:25 - FTC / Express Scripts Settlement5:19 - The Bill to "Break Up Big Medicine"6:34 - The FDA Cracks Down on Compounded GLP-1s7:55 - OpenAI Launches ChatGPT Health12:14 - Game: Drug Cost vs. Car Payment?18:33 - Ask Spencer: Minimum Headcount to Go Self-Funded?

"We don't view ourselves as a TPA, we view ourselves more as a platform... our goal is to simplify and reduce the barriers of entry into the TPA space."The role of the Third-Party Administrator is undergoing a massive evolution. No longer just a back-office claims processor, the modern TPA is being asked to serve as the high-tech, high-touch "nucleus" of the entire health plan.My guest this week is Vinny Esposito, CEO of Reflect Health (formerly S&S Health). Drawing on a decade of experience in the hedge fund world, Vinny recognized a massive opportunity to bring scalable, asset-light infrastructure to the self-funded market. Today, Reflect Health acts almost like the "Intel Inside" of the industry, licensing its proprietary claims technology to other TPAs and health plans.In this episode, we explore exactly what it takes to build the TPA of the future. We discuss how to solve "point solution fatigue" through a centralized marketplace, the mechanics behind infusion drug carve-outs, and how to successfully deploy dynamic deductibles to incentivize better care routing. Vinny also shares his bold vision for "frictionless claims" paid instantly at the point of service, moving us closer to an Amazon-style shopping experience for healthcare.If you want to understand the technological and administrative innovations driving the self-funded market forward, this episode provides the blueprint.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Competing on Service in the TPA Market (00:01:56) Meet Vinny Esposito & Reflect Health (00:03:35) Rebranding from S&S Health (00:07:32) From Hedge Funds to Healthcare Disruption (00:11:05) The Platform Model: Licensing Tech to Other TPAs (00:15:05) The Marketplace & Infusion Drug Carve-Outs (00:19:14) How the TPA Role is Expanding (The "Nucleus") (00:24:12) Direct Contracting, RBP, and DPC Integration (00:29:15) Dynamic Deductibles & Tiered Networks (00:33:25) Curing "Point Solution Fatigue" (00:41:09) The Future of Stop-Loss and Preventative Care (00:45:44) The Fiduciary Breaking Point & 80% Renewals (00:50:26) Frictionless Claims & Amazon-Style HealthcareKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

“Show me an incentive structure and I'll show you human behavior... until employers realize they have more power than they give themselves credit for, this can't continue."My guest this week is Norm Volsky, Managing Partner at DRI and Founder of MVP Growth Partners. Norm has spent the last decade as one of the top executive recruiters in the digital health and employer benefits space - placing the commercial teams that helped build unicorns like Livongo and Hinge Health.In this episode, Norm explains why the next wave of healthcare innovation isn't about adding more "point solutions" to an already fatigued market. Instead, smart money is betting on companies that carve out high-margin, inefficient services directly from the major insurance carriers - like radiology, fertility, and specialty infusion.We discuss how Norm built an "army" of over 500 industry executives to crowdsource due diligence, why the traditional VC model fails in healthcare, and why employers and their benefits leaders are finally at a watershed moment where they must demand true fiduciary alignment from their vendors.If you want to know where the smart money is moving in employer healthcare, and why the "BUCA" carriers should be worried, this episode is a must-listen.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:[00:00:00] Intro: Recruiting in the Early Days of Digital Health[00:04:12] The Livongo Story: Selling Healthcare Direct to Employers[00:08:44] What Makes a Great Salesperson in Healthcare?[00:11:46] Spotting the Next Unicorn: The Hinge Health Experience[00:17:28] Private Equity vs. Venture Capital[00:20:00] Using Recruitment Data to Drive VC Investments[00:23:41] The "One Imaging" Pitch & Carving Out Radiology[00:30:40] Building an Army: Crowdsourcing VC Due Diligence[00:36:26] Why MVP Growth Partners Only Invests in "At-Risk" Pricing[00:41:40] Point Solution Fatigue & Identifying the "Good Actors"[00:46:17] Why Employers Must Demand Fiduciary Responsibility[00:50:41] The Future: The Erosion of the Big 3 PBMs and CarriersKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Why are we paying $10,000 for a $30 drug?"My guest this week is Pramod John, a former Silicon Valley tech entrepreneur who entered the healthcare space to tackle the largest economic problem in the country: skyrocketing healthcare costs. Pramod quickly realized that healthcare's dysfunction is actually not a technology problem - it is a deeply ingrained problem with economic incentives.In this episode, we dive into the murky waters of Pharmacy Benefit Managers (PBMs) and why the traditional model is designed to drive up costs rather than lower them. We discuss the shocking statistics of drug spend (where 2% of people account for 55% of the costs), why FDA approval doesn't always mean a drug is effective (using the infamous Alzheimer's drug as an example), and the implications of recent fiduciary lawsuits like the one against J&J.Pramod explains how we can bring common sense back to healthcare by treating drugs like any other consumer purchase. By utilizing an "open market" drug management model, he argues that we can effectively replace traditional PBMs with transparent transaction processing software - saving plans 30% to 50% without relying on restrictive formularies or rebate games. Tune in this week for a clear roadmap for how to actually fix the irrational economics of our healthcare system.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Why We Talk About Cost Instead of Quality (00:02:42) From Silicon Valley & Defense Tech to McKesson (00:10:43) Why Healthcare is NOT a Technology Problem (00:15:53) Fiduciary Responsibility & The J&J Lawsuit (00:19:03) The Butter Knife vs. Pareto: The Math of Drug Spend (00:23:54) Building an "Open Market" Alternative to PBMs (00:29:40) Why Doctors Fly Blind on Drug Pricing & Formularies (00:35:42) FDA Approval vs. Real-World Efficacy (00:45:44) How to Actually Fix the Model: The Real-Time "Pause" (00:58:36) Why International Sourcing & PAPs Aren't the Fix (01:11:00) Replacing PBMs with Simple Transaction SoftwareKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"My wife would come back to check on me late at night, asleep at the keyboard, and she would be like, 'Is he dead?' The burnout, what we call moral injury, is more real than anybody knows." - Will SteelmanThe American healthcare system is crushing its doctors. Faced with "assembly line" quotas of 25+ patients a day, hours of unpaid administrative work ("pajama time"), and a suicide rate higher than that of veterans, physicians are fleeing the profession in droves.My guest this week is Dr. Will Steelman, a board-certified internal medicine physician who lived through this crisis firsthand. After 12 years as a hospitalist, Dr. Steelman reached his breaking point during the pandemic and realized the only way to save his career, and his life, was to exit the system entirely.In this episode, we explore why Direct Primary Care (DPC) is the only viable path forward for the future of medicine. Will explains how DPC restores the doctor-patient relationship by reducing patient panels from 3,000 to 600, allowing for 90-minute visits, true price transparency, and a focus on root-cause resolution. We also discuss the clinical benefits of having time to care, including using ketogenic therapies to treat mental illness and reversing chronic metabolic disease, rather than just managing it with pills.If you want to understand why your doctor is exhausted, why your premiums are going up, and why DPC is the solution we can't afford to ignore, listen to this episode.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: The Link Between Diet & Mental Clarity (00:04:18) The Road to Burnout: 12 Years as a Hospitalist (00:09:17) "Is He Dead?": The Reality of Physician Suicide & Moral Injury (00:11:08) The Way Forward: Concierge vs. Direct Primary Care (00:15:35) The Math of Failure: Why 2,500 Patients is Unsustainable (00:21:16) "Click Fatigue" and the Administrative Burden (00:23:58) Leaving the System: Launching Steelman Medical Group (00:32:06) Saving the Profession: Why DPC Offers Work-Life Balance (00:40:12) True Transparency: Why DPC Lab Costs Are Dropping (00:48:58) The Luxury of Time: Treating Mental Health with Ketogenic Diets (00:59:32) The Statin Controversy & Insulin ResistanceKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's podcasts, headlines, and listener-submitted questions.This month, we're joined by John Kountz from Frost Insurance! We react to the record-breaking lobbying spend by drugmakers in 2025 and discuss the historic slump in Hospital M&A activity. We also cover the rising cost of medical real estate forcing doctors into co-working spaces, the critical decline in nursing home capacity, and the consolidation of federal lawsuits linking GLP-1s to vision loss.Plus, we play a game called "Real or Fake Medical Codes," where John and I try to guess if ICD-10 codes like "Struck by Turtle," "Sucked into a jet engine," or "Burned due to water skis on fire" are actually real. Finally, we answer a listener question about what a successful Q1 looks like for a new broker in the benefits industry.I'm also thrilled to announce that Last Month In Healthcare is now sponsored by Walk On Clinic! We are excited to partner with a team that is redefining primary care access.Chapters:0:00 - Intro0:37 - Drugmaker Lobbying Reaches Historic Highs4:30 - Hospital M&A Slump & Financial Distress7:39 - Doctors Moving to Co-Working Spaces10:05 - The Decline in Nursing Home Capacity11:57 - GLP-1 Vision Loss Lawsuits15:41 - Game: Real or Fake Medical Codes?21:41 - Ask Spencer: Successful Q1 for New Brokers

"If you ask the surgeon how much time they have to spend thinking about the business side of their practice, it's too high... Let's let doctors be doctors." - Ryan WellsMy guest this week is Ryan Wells, Founder and CEO of Health Here. Ryan joins me to explain why the key to fixing the broken doctor-patient relationship is getting providers out of the debt collection business.We explore how Episodic Care (bundled payments) can finally align the financial incentives of self-funded employers and high-value specialists. Ryan breaks down how his platform automates payments, getting surgeons paid in under 15 days while eliminating patient liability entirely.We dive deep into Ryan's background in the OR, the lessons learned from the "Metal on Metal" hip recall, and why we need to move from "open enrollment confusion" to real-time, event-driven patient navigation.If you are tired of administrative waste and want to see a model where doctors focus on care instead of claims, this episode is for you.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Let Doctors Be Doctors(00:03:04) Ryan's Journey: From Anthropology to the OR (00:07:00) Lessons from Medicare's Acute Care Episode Demo (00:10:46) Defining the "Bundle" vs. Fee-for-Service (00:13:00) Value-Based Care = Outcome / Cost (00:16:14) Why Orthopedics is the Perfect Starting Point (00:18:32) Moving from "Elective" to "Discretionary" Care (00:21:38) The Navigation Problem: Open Enrollment Fails (00:31:48) Owning the Payment Rails: 15-Day Payments (00:37:38) Automating the "Outlier Workflow" (00:41:35) The "Metal on Metal" Hip Recall & Registries (00:48:30) Expanding to Cardiology and Bariatrics (00:53:03) The Moonshot: Removing the Business Burden from MDsKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"If financial services and healthcare are 10 years behind everybody else from a technology adoption standpoint, insurance distribution is usually 10 years behind that." - Will JohnsonMy guest this week is Will Johnson, Founder and CEO of Gyde, who is building what he calls the first "AI-native" insurance brokerage. After spending a decade at Oscar Health, Will realized that while brokers are the critical "entry point to care," they are operating without the infrastructure needed to scale in the modern era.In this episode, we define exactly what "AI-native" means for an agency. It isn't just about buying software; it's a new holding company model that acquires agencies to deploy AI infrastructure - automating renewals and client service to effectively "triple the capacity" of the best brokers.We dive deep into the difference between the traditional "asset aggregation" model (roll-ups) and Gyde's "partner activation" model. Will also shares why Gyde raised a Series A just 14 weeks after launching and his moonshot vision to converge health insurance and wealth management into a single advisory role.If you are an agency owner feeling the ceiling of growth, this episode maps out what the next generation of distribution looks like.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) What is an "AI-Native" Brokerage? (00:03:11) Will's Journey: 10 Years at Oscar Health (00:07:10) The Infrastructure Gap in Distribution (00:12:27) Why Acquisition? The Case for Economic Alignment (00:23:22) The Tech Stack: Automating Renewals & Service (00:27:32) AI as a "Capacity Amplifier" vs. Replacement (00:37:22) The Anti-Rollup: "Partner Activation" vs. "Asset Aggregation" (00:46:12) Branding: Powered by Guide vs. Becoming Guide (00:49:49) Raising a Series A in 14 Weeks Key Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I stopped doing what I didn't want to do anymore. It's not hard to stop doing something you don't want to do... I didn't want to drink anymore." - Chris LeverettIn this incredibly vulnerable and powerful episode, we step away from the usual technical discussions of self-funding and insurance captives to tackle a pervasive, often silent issue in our industry: addiction and sobriety.My guest is Chris Leverett, Executive Vice President and Managing Director of Employee Benefits at TexCap Insurance. While Chris is a veteran in the benefits space, today he shares his personal testimony of battling high-functioning alcoholism while trying to maintain a career, a marriage, and a family.Chris opens up about the "boiling frog" effect of social drinking in the business world, the crushing weight of keeping up appearances, and the terrifying rock-bottom moments, including a lapse in insurance coverage during his daughter's premature birth, that finally led him to seek help.We discuss the freedom found in admitting powerlessness, how he replaced the "monster" of addiction with the discipline of Ironman triathlons, and how to navigate the alcohol-heavy social scene of insurance events without losing your edge.If you or someone you know is struggling in silence, this episode provides a blueprint for finding hope, help, and a better life on the other side.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: TexCap Insurance & Going Up-Market (00:04:48) Sobriety: It Doesn't Have to Be a "Life Sentence" (00:09:26) The High-Functioning Trap & Social Lubricant (00:13:24) Rock Bottom #1: No Insurance During a Crisis (00:17:27) The Final Wake-Up Call & A Wife's Dream (00:19:21) The Power of Admitting "I Am an Alcoholic" (00:28:25) Trading Addiction for Ironman Triathlons (00:38:30) How to Navigate Happy Hours Sober (00:45:13) The Blueprint: Steps to Finding HelpKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Imagine getting a real-time snapshot of your health just by looking into your phone's camera for 30 seconds." - SimonMy guests this week are Simon Spurr, Founder of VivaScore, and Chris Burns, a veteran benefits advisor with over 40 years of experience at firms like Mercer and Sequoia. They join the show to demonstrate a piece of technology that feels like science fiction but is actually here today: rPPG (Remote Photoplethysmography).We discuss how this technology turns a standard smartphone camera into a diagnostic tool capable of measuring blood pressure, heart rate variability (HRV), and stress levels with medical-grade accuracy, no wearables required.In this episode, we explore whether this "digital avatar" of employee health could become the new front door to primary care. We dive into how employers are using this data to spot "silent killers" like hypertension before they become claims, why engagement rates are hitting 50%+, and how this platform connects the "worried well" to actual care pathways.Tune in to see how we can finally move from "sick care" to true preventative maintenance, all through an iPhone lens.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Is This App the Future of Primary Care? (00:06:12) Global Healthcare: Why Costs Are Rising Everywhere (00:08:02) Chris Burns: From Mercer to Sequoia to Tech Advisor (00:12:45) Why Employers are Tired of "Point Solutions" (00:22:26) How rPPG Technology Works (The Face Scan) (00:30:18) The "What Next?" Strategy for Employers (00:39:06) Why Everyone is Talking About HRV (Heart Rate Variability) (00:44:37) Finding the "Silent Killers" in Your Population (00:51:46) Gamification: How to Get 50% EngagementKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I asked him, 'What is it that you're teaching undergraduate students about benefits?''…Just two slides. That blew me away." - Kyle MinickMy guest this week is Kyle Minick, Vice President of Employee Benefits at Summit Financial Group. Kyle returns to the show to expose a massive systemic failure: Universities are not teaching HR professionals how to manage their second-largest expense.Kyle shares the shocking story of how he discovered that major university HR programs dedicate almost zero curriculum to healthcare strategy. Instead of complaining about it, he decided to fix it. We discuss the 6-week accredited college course he built from scratch to teach the next generation of buyers about Stop-Loss, PBMs, and TPA contracts before they enter the workforce.But before we dive into the classroom, we dissect the broken market they are inheriting. We debate why Reference-Based Pricing (RBP) is failing in hospital-dominated markets like Texas, why relating prices to Medicare might be backfiring, and whether the government should step in to establish a "median price" for care.Tune in to see how we can bridge the education gap and finally train buyers to demand better.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Why RBP Struggles in Texas Monopolies (00:03:30) The "Medicare Price" Fallacy (00:11:00) Should the Government Set a Median Price? (00:25:00) The Education Gap: How Universities Failed HR (00:29:25) The "Two Slide" Curriculum Problem (00:33:00) Kyle's Solution: Building an Accredited Benefits Course (00:43:00) Teaching HR to Audit Their Consultants (00:54:30) The Syllabus: Stop-Loss, PBMs, and Contracts (01:07:00) How to Enroll & The Future of Benefits EducationKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Whoever makes patient care more convenient is likely to win." - Chris YarnMy guest this week is Chris Yarn, Founder of Walk On Clinic, who joins me to explain why convenience is the ultimate currency in healthcare. Chris shares his journey from insurance broker to building a direct primary care (DPC) model that brings care directly to the employee's doorstep - literally.Chris breaks down the "Walk On" model, which combines mobile on-site clinics, near-site access, and virtual care to achieve utilization rates that are double the industry average. We discuss why traditional "near-site" clinics often fail to engage employees, how nurse practitioners are the key to scaling primary care, and why the human connection is what truly drives ROI.We also dive into the hard numbers, discussing how to prove ROI with real claims data (not just fuzzy math), and Chris shares his personal battle with cancer in 2024 that reinforced his belief in the importance of early detection and primary care access.Tune in to the first episode of 2026 to learn why the future of healthcare is hyper-convenient.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Why Convenience is King in Healthcare (00:07:37) The Legend of "Frank Mic Dropper" (00:14:15) The "Walk On" Model Explained (00:19:38) Mobile vs. Near-Site: The Utilization Difference (00:26:24) Removing Barriers: No Build-Out Costs for Employers (00:32:06) Scaling DPC with Nurse Practitioners (00:39:27) How to Prove ROI with Real Data (00:47:53) A Personal Battle: Chris's Cancer Journey (00:53:09) The Future of Primary Care in AmericaKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's podcasts, headlines, and listener-submitted questions.This month, we're doing something a little different to close out 2025. Instead of just looking back at December, we are ranking the biggest healthcare stories of the entire year on a Tier List, from "Not Impactful" to "Super Impactful." We cover everything from the FTC suing the Big 3 PBMs and the J&J fiduciary lawsuit dismissal to the "bloodbath" of 2026 renewals and the explosion of GLP-1 usage.Plus, we debut a new "Explain Like I'm 5" segment where I break down complex concepts like Reference-Based Pricing, Captives, and Stop-Loss using simple analogies involving candy shops and dirt bikes. Finally, we answer a listener question about building confidence as a young professional in the industry.Chapters:0:00 - Intro: Last Year in Healthcare0:51 - Tier List19:05 - Explaining Insurance To A 5-year-old24:24 - Ask Spencer Anything

“I think the next stage of American capitalism includes co-opetition." - Dutch RojasOn the last episode of Self-Funded with Spencer in 2025, Dutch Rojas joins the show to expose the financial "arbitrage" that he believes is destroying independent medical practices in America. Dutch explains how current CMS incentives allow hospitals to buy independent clinics and immediately charge 165% more for the exact same services, which is a practice that is crushing employers and patients alike.In this episode, Dutch lays out his bold vision for "Co-opetition”, a new playbook where independent practices, manufacturers, and even churches band together to leverage their collective buying power. We discuss why the traditional "HR-led" model of buying benefits is failing, why CFOs need to take the wheel, and his dream of creating a true "Healthcare Commodities Exchange" to normalize pricing.We also get personal about his journey from the Netherlands to the U.S., the importance of social media for building influence in DC, and why he believes the next 10 years will be defined by those who can master media.Tune in for a fascinating look at the future of independent medicine.Chapters:(00:00:00) What is "Co-opetition" in Healthcare? (00:01:00) How Hospital Arbitrage Kills Private Practices (00:06:40) Why Independent Doctors Don't Work Together (Yet) (00:14:00) The 165% Markup(00:29:40) The Dream of a Healthcare Commodities Exchange (00:41:00) Why HR Shouldn't Make Healthcare Decisions (00:49:00) Aggregating Buying Power: Churches & Manufacturers (00:57:00) The 4-Stage Plan to Fix HealthcareKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Healthcare has had no star score, there's been no reliable pricing. It's all been just a black box." - Will BruhnAn estimated 21% of all medical care in the U.S. is completely unnecessary. My guest this week is Will Bruhn, CEO and Co-Founder of GAM (Global Appropriateness Measures), and he joins the show to explain exactly where that waste comes from and how we can fix it.Will argues that we've been measuring quality wrong. Instead of just looking at outcomes (did the surgery go well?), we need to measure appropriateness (should the surgery have happened at all?). We discuss the perverse financial incentives driving this waste, using real-world examples like unnecessary spinal fusions and the statistical spike in C-sections on Friday afternoons.But this episode isn't just about the problem; it's about the fix. Will breaks down how GAM uses data to identify high-value providers and how employers can redesign plans to guide members away from wasteful care, potentially saving millions while protecting patients from unnecessary risks.Tune in for a blueprint on eliminating the 21% of healthcare spending that shouldn't exist.Chapters:(00:00:00) 21% Of Medical Care Is Wasteful. Here's How We Prevent It.(00:00:34) Why 21% of Medical Care is Wasteful (00:01:57) The Missing Metric: Appropriateness of Care (00:08:29) How Financial Incentives Drive Bad Medicine (00:17:02) Case Study: Unnecessary Spine Surgeries (00:24:06) How We Fix It: Identifying the Right Doctors (00:31:22) Changing Plan Design to Stop the Waste (00:33:52) The ROI of Steering to High-Value Care (00:48:44) The Debate on Government Regulation & Drug Prices (00:53:31) The Future of Healthcare TransparencyKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Why in every other industry can we just check out and know exactly what it's going to cost? Why can't it be the same in healthcare? Why are we still mailing physical checks in 2025?" - Cory MorinMy guest this week is Cory Morin, Co-Founder of Benji Card, who has developed a "virtual wallet" strategy that is revolutionizing how self-funded plans pay for care. Cory joined the show to explain how giving members and care coordinators instant access to funds can drastically lower medical claim costs.Cory breaks down the mechanics of the Benji Card, a virtual payment solution that acts as the financial rails for modern cost containment. We discuss the strategy behind it: by guaranteeing providers immediate payment via a virtual card, plans can negotiate significant discounts (often cash rates) that aren't available through traditional insurance.We explore how this "virtual wallet" approach aligns incentives - providers get paid instantly without administrative bloat, and employers save 30-50% on claims. We also dive into Cory's entrepreneurial journey and why he believes this model could eventually make traditional PPO networks obsolete.Tune in to learn how a virtual wallet strategy can fix the broken economics of healthcare.Chapters:(00:00:00) The "Virtual Wallet" Strategy for Lowering Medical Claims (00:12:16) From Insurance Agent to Fintech Founder (00:20:59) What is the Benji Card? (00:26:43) Why Healthcare Needs Virtual Payments (00:29:40) How Instant Payments Negotiate Lower Rates (00:38:51) Empowering Care Coordinators with a Virtual Wallet (00:44:03) The Challenge of Scaling Fintech in Healthcare (00:49:24) Will Virtual Wallets Replace Networks?Key Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's podcasts, headlines, and listener-submitted questions. This month, we're joined by Chris Hamilton! We talk about the J&J lawsuit being dismissed, Eli Lilly switching PBMs, AI in healthcare, and much more. We also play a Christmas game called Home Alone: The Wet Bandit's Bills, where Chris and I try to guess the average hospital price for the injuries incurred by the bandits from the Home Alone films.Chapters: 0:00 - Intro0:42 - J&J Lawsuit Dismissed9:20 - Eli Lily Switches PBMs11:17 - New FDA Rules On Biosimilars16:36 - AI Adoption In The Healthcare Industry25:21 - Survey On At-Home Medical Devices29:57 - Home Alone: The Wet Bandit's Bills42:32 - Ask Spencer AnythingSources: https://www.healthcaredive.com/news/fda-biosimilars-guidance-speed-development-comparative-efficacy-studies/804191/https://www.beckerspayer.com/legal/judge-dismisses-lawsuit-accusing-jj-of-mismanaging-employee-drug-benefits/?origin=PayerE&utm_source=PayerE&utm_medium=email&utm_content=newsletterhttps://www.healthcare-brew.com/stories/2025/11/25/eli-lilly-switches-big-3-pbm-alternative-transparent-rivalhttps://www.fiercehealthcare.com/health-tech/amid-shutdown-health-it-vendors-say-hospitals-are-cutting-back-spendinghttps://www.techtarget.com/virtualhealthcare/news/366633680/Survey-At-home-monitoring-devices-popular-affordablehttps://pubmed.ncbi.nlm.nih.gov/41265449/https://www.emarketer.com/content/ai-spending-healthcare-outpaces-overall-us-economy-

"Success leaves clues. And sometimes that clue is healthy leadership that is just able to take them from plateau to plateau." - Trey MarinelloMy guest this week, Trey Marinello of Houlihan Lokey, is an expert in a topic everyone is constantly talking about: Private Equity. Trey joined the show to demystify the world of investment banking and explain exactly why private equity firms are pouring billions of dollars into the employer-sponsored healthcare space.Trey breaks down the current trends, explaining why PE isn't just about leverage and debt, but about "turning the propeller faster" through distribution expertise and strategic growth. We discuss why categories like TPAs, cost containment, and innovative funding models are red-hot, while "wellness" and "population health" have struggled to prove their ROI.We also explore the potential of AI to revolutionize mental health care, why “ICHRA” is still a wild card, and how smart brokers are becoming essential value-drivers in M&A deals.Tune in for a masterclass on following the money in healthcare!Chapters:(00:00:00) Why Private Equity is Pouring Billions Into Employer Healthcare(00:00:35) Why Private Equity Loves Healthcare (00:08:59) What Does an Investment Banker Actually Do? (00:17:25) How PE Firms Use Distribution to Scale (00:20:06) Is ICHRA the Future or a Fad? (00:28:50) The Rise of Alternative Funding (00:42:34) Why "Wellness" Investments Failed (00:57:16) How Brokers Drive Enterprise Value (01:02:47) The Hottest Category in Healthcare M&AKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I love working with people who aren't afraid to own up to their mistakes. Integrity is the most important thing to me." - Cara KirschWhat is the secret to a perfect broker-partner relationship? My guests this week, Cara Kirsch and Libby Henry, join the show to answer that question. They share the story of how a single "virtual lunch" during the pandemic sparked one of the most effective partnerships in the industry.Cara and Libby break down the ingredients of their success: radical transparency, the ability to have difficult conversations without breaking trust, and a shared commitment to integrity. We discuss why the best partnerships aren't just about the lowest spreadsheet number, but about who you can trust when things go wrong.We also dive into the results of this partnership, including how they worked together to turn a client's 74% fully insured renewal into millions in savings. Plus, we explore the reality of balancing high-powered careers with motherhood and why women need to claim their seat at the table.Tune in to learn how to build business relationships that actually last.Chapters:(00:00:00) The Secret to a Perfect Broker-Partner Relationship (00:05:07) The "Virtual Lunch" That Started It All (00:15:20) Why Honesty Trumps Being "Nice" (00:18:04) Building Trust Through Intentionality (00:21:57) Balancing Motherhood & A Career (00:42:22) Turning a 74% Renewal into Savings (00:44:08) Why Strong Partnerships Close More DealsKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"People do more research on buying a refrigerator than they do on buying their health plan. And so I saw that as a level of brokenness that I felt... we as consultants could actually make a profound impact." - Trey HalbertThe old-school, transactional broker is dead. My guest this week, Trey Halbert, CEO of ExperINS, joins the show to discuss the rise of the modern "Strategic Consultant" and what that evolution means for employers.Trey breaks down the playbook for this new, elevated role. We discuss why consultants must align the benefits program with the C-suite's core business strategy, not just the HR department. We also explore how AI is not a threat, but a powerful tool to augment advisors by handling menial tasks (like contract review), freeing them up for the high-level critical thinking and problem-solving where humans truly add value.This entire shift is part of a bigger journey: moving from a career focused on success and "resume virtues" to one focused on significance and "eulogy virtues."Tune in for a high-level discussion on the future of benefits consulting!Chapters:(00:00:00) Aligning Benefits with the C-Suite: The Modern Consultant's Playbook (00:06:23) The Evolution of Self-Funding (00:15:05) Why Consultants Are More Critical Than Ever (00:20:46) The Power of a Peer Network (True Network) (00:29:07) Speaking to the C-Suite, Not Just HR (00:35:51) How Benefits Drive Business Valuation (00:43:19) How AI Will Augment, Not Replace, Brokers (01:04:35) The "No A**holes" Rule & Building CultureKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"One out of seven people in the United States have some form of chronic kidney disease... 90% of those individuals have not been properly diagnosed." - Mark MassonMy guest this week is Mark Masson, President of Renalogic, here to shine a light on one of the most expensive and hidden risks in every health plan: Chronic Kidney Disease (CKD). It's a "silent killer" that affects 1 in 7 Americans, but a staggering 90% of them don't even know they have it until it's too late.In this episode, Mark breaks down the staggering cost of this disease, explaining how a market duopoly inflates dialysis costs to an astonishing 700-900% of Medicare rates. He shares the Renalogic playbook, which combines proactive clinical management to "hold the line" for early-stage patients and a powerful cost-containment model that saves plans over $100,000 per year on active dialysis claims.We also discuss the importance of early detection, the benefits of home dialysis, and why employers must be proactive in managing this catastrophic risk. Tune in to learn about the silent killer in every health plan.Chapters:(00:00:00) The "Silent Killer" 90% of Your Members Don't Know They Have (00:07:38) The 1-in-7 Statistic: 90% are Undiagnosed (00:12:17) Slowing Progression: How to "Hold the Line" (00:19:55) The Duopoly: Why Dialysis Costs 700-900% of Medicare (00:27:11) The Benefits of Home Dialysis (00:54:20) The Renalogic Solution: Containing Dialysis Costs (01:03:38) Why We Need More Competition in HealthcareKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"There needs to be a whole new suite of solutions that are forward looking and proactive and real time, and we gotta go and build that." - Sasha GribovMy guest this week, Sasha Gribov, founder of Milu Health, is on a mission to build the proactive, forward-looking solutions our healthcare system desperately needs. He joins the show to discuss how he's using AI to create an "early warning system" for health, moving our model from reactive to proactive.Sasha breaks down the Milu model, which uses AI to analyze health records and claims data in real-time. He explains how this allows his team to predict the need for surgeries an average of 90 days in advance and proactively reach out to members via text (no app required) to guide them to the right, high-value solutions already in their health plan.We also explore the future of AI in healthcare, why he believes it will "augment" doctors, not replace them, and how this proactive approach is the key to saving lives and finally lowering costs for employers.Tune in for a look into the future of proactive healthcare!Chapters:(00:00:00) How AI is Predicting Catastrophic Claims (Before They Happen) (00:04:15) Why We Must Integrate All Health Data (00:10:23) The "Early Warning System" for Patients (00:12:40) Why EMRs are the Key to Proactive Care (00:31:57) Predicting Surgeries 90 Days in Advance (00:08:04) Will AI Replace Doctors? (00:59:47) Building a Proactive Healthcare SystemKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's podcasts, headlines, and listener-submitted questions. This month, we're also joined by Kyle Minick!This episode is a bit different than usual as we focus on the many issues our physicians are dealing with in 2025, from AI to burnout to compensation. And we play a new game called the Commercial Conumdrum, where Kyle and I try to guess what drug a pharmaceutical commercial is advertising, just based on the B-Roll and editing of them.Chapters: 0:00 - Intro1:25 - What's Going On With Our Doctors?1:37 - Physician Stress Returns To Pandemic Levels6:56 - Half Of US Healthcare Workers Plan To Switch Jobs14:31- Physicians Working More, Compensated Less15:38 - AI Scribes Reduce Physician Burnout19:29 - Millions In US Live Where There Is No Telehealth/Internet23:22 - Commercial Conundrum (this month's game)34:20 - Self-Funded Review41:36 - Ask Spencer AnythingSources: https://youtu.be/XqrWU-BkKYc?si=E18CcR6cck7WaLcPhttps://youtu.be/bzYetKHGEv4?si=HHTFjFs1ZkFJRfq8https://youtu.be/LFif-BTYzys?si=04Z8ilxSis7SxKwShttps://youtu.be/7M5LTlzot4o?si=HjQfsikvBlRQ6gSOhttps://youtu.be/ecq1k3VmEtE?si=yrZTF64P1pF-Hblyhttps://kffhealthnews.org/news/article/dead-zone-sickest-counties-slow-internet-broadband-desert-health-care-provider-shortage/https://www.medpagetoday.com/publichealthpolicy/workforce/117530https://www.reuters.com/business/healthcare-pharmaceuticals/over-half-us-healthcare-workers-plan-switch-jobs-by-next-year-survey-finds-2025-09-15/https://www.healthcaredive.com/news/physicians-working-more-reimbursement-falling-kaufman/757406/https://medicine.yale.edu/news-article/ai-scribes-reduce-physician-burnout-return-focus-to-the-patient/

“Just because someone hasn't gone to the doctor in four years does not mean they're not a walking time bomb." - Garrett JerueMy guest this week, Garrett Jerue, argues that the key to solving our healthcare crisis is to think differently and build a truly cohesive healthcare ecosystem. Driven by his personal experience battling cancer and navigating a fragmented system, Garrett has dedicated his career to designing benefits strategies that actually work for people.In this episode, Garrett shares his playbook for building this ecosystem. We discuss the "Ticket Health" model he developed, which integrates direct primary care, transparent PBM partnerships, and robust care navigation into a seamless experience. He explains why treating members with dignity and choice, focusing on proactive care, and challenging the status quo are essential ingredients for success.We also dive into the critical importance of mental health support and why employers need to view their health plan not just as an expense, but as a living, breathing organism that requires constant care and innovation.Tune in to get Garrett and I's insight on building a healthcare ecosystem that truly serves people.Chapters:(00:00:00) Building A Cohesive Healthcare Ecosystem (00:10:24) How a $600k Cancer Bill Changed Garrett's Life(00:17:22) Why Healthcare Financing Needs a Rethink (00:25:28) Treating Members with Dignity & Choice (00:38:11) The Keys to a Transparent PBM Partnership (00:43:45) Direct Primary Care: The Foundation of the Ecosystem (00:50:26) Care Navigation: The Glue That Holds It Together (00:59:07) Making Mental Health a Priority in the Ecosystem (01:12:32) The "Think Different" Mindset for Healthcare InnovationKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

“I absolutely think we're in that tightening, hardening market... the days of the employers who were average risk seeing single digit rate increases, that's gone. It's going to be a double digit rate increase market going forward." - Jay RitchieThe president of one of the largest stop-loss carriers is here to deliver the State of the Union for our market. My guest this week is Jay Ritchie, President of Tokio Marine HCC, and he shares the current state of the market and what to expect for 2025-2026 renewals.Jay breaks down the trends his team is seeing, including the explosion of multi-million dollar claims driven by NICU stays and new gene therapies. We discuss why industry-wide loss ratios have jumped, how the post-COVID "rebound" is impacting rates, and why the core stop-loss product has remained unchanged while the innovation now centers on risk measurement.But the conversation isn't all negative; we also discuss the path forward. We explore why data is the future of underwriting, how active risk management through captives creates stability in a volatile market, and why treating your stop-loss carrier as a partner, not a commodity, is more critical than ever.Tune in for the State of the Union for our industry as we head into 2026.Chapters:(00:00:00) The 2025-2026 Stop-Loss State Of The Union (00:06:18) A 40-Year Career in Stop-Loss (00:21:33) The Explosion of Million-Dollar Claims Post-ACA (00:40:26) Why Loss Ratios Are Climbing Across the Industry (00:55:40) How Captives Create Stability in a Hard Market (01:07:07) Partner vs. Commodity: The Future of Stop-Loss (01:29:02) Why Data is the Future of UnderwritingKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"The biggest shift was the consolidation that happened with the insurance carriers themselves. From 25 or more carriers to just four national carriers." - John RutledgeHow did health insurance get so broken? My guest this week, 40-year industry veteran John Rutledge of Marsh McLennan Agency, joins the show to walk us through the last 40 years of decisions that led us to the consolidated, expensive, and frustrating market we have today.John explains how the market went from over 25 competing carriers to just four national players. We discuss how the rise of carrier-owned PPOs squeezed out competition, and how the ACA later standardized coverage, locking employers into the "Buca box" with painfully limited options.But this isn't just a history lesson. We also discuss the solution that has emerged from the ashes of the old system: the explosion of self-funding and alternative risk models like captives that empower employers to finally break free.Tune in for a masterclass on how health insurance was broken, and more importantly, how we can start to fix it.Chapters:(00:00:00) How Health Insurance Was Broken Over The Last 40 Years (00:05:01) Why Self-Funding Has Exploded Since the ACA (00:09:58) How We Went From 25+ Carriers to Just 4 (00:12:56) The "Buca Box": Trapped with No Options (00:31:04) The Rise of Captives as an Alternative (00:40:31) Why Engaged Employers Win in a Captive (01:00:56) A Call to Action for Employers & AdvisorsKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Eat your food as medicine or medicine will become your food." - Chef Austin SimmonsCan better beef solve America's health crisis? My guests this week, Chef Austin Simmons of Chef and Rancher and benefits/nutrition expert Chris Pierron, believe it's a critical part of the solution. They join the show to discuss the deep connection between cattle genetics, our broken food system, and our exploding healthcare costs.Chef Austin explains his "hoof to fork" model for creating "better beef." We discuss how using purebred, genetically-verified cattle and clean feeding practices, free of the seed oils and used fryer oil common in the commercial industry, produces a more nutrient-dense and flavorful product.This isn't just about a better steak; it's about creating a healthier population from the ground up. We explore how fixing the food system is the most important step to lowering healthcare costs, and why consumer education is the key to driving this change.Tune in today for a conversation that will change the way you think about the beef on your plate.Chapters:(00:00:00) How Better Beef Can Solve America's Health Crisis (00:05:18) The Hidden Additives & "Poisons" in Most Beef(00:19:38) Why is Prime Beef So Inconsistent? (00:20:58) The Power of Cattle Genetics (00:37:47) Is There Used Fryer Oil In Your Steak? (00:54:22) Should We Federally Subsidize Beef?(01:02:09) Why Food Education is the First Step (01:13:26) Fixing the Food System to Fix HealthcareKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"If we can remove the cost barrier, folks are going to engage more because it's not standing in the way of going to get the care that they need or even preventive care." - Trey SmithHigh healthcare deductibles were sold to employers as a way to create better "consumers" of healthcare. My guest this week, Trey Smith of Hub International, argues that they've been a failed experiment that has done more harm than good. Instead of creating smarter shoppers, high deductibles have become a massive barrier to care, causing employees to delay or avoid necessary treatment altogether.In this episode, Trey breaks down the alternative: first dollar coverage. We discuss how innovative plan designs with zero deductibles can actually lower an employer's overall claim spend over time by encouraging early intervention and proactive care. He shares data showing that while utilization spikes initially, long-term costs come down significantly as members get the care they need when they need it.This conversation is a perfect example of why the benefits consultant's role is shifting from simply brokering insurance to designing strategic solutions that solve real problems for employees and employers. I hope you'll tune in!Chapters:(00:00:00) High Healthcare Deductibles Are A Failed Experiment (00:26:16) The Risk of Innovation vs. The Risk of the Status Quo (00:29:59) The Problem: High Deductibles as a Barrier to Care (00:34:10) The Solution: "First Dollar" Coverage (00:38:22) Simplifying the Healthcare Experience (00:52:17) How Data is Making New Plan Designs PossibleKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I can look for something on Amazon and have it shipped to my door tomorrow... so why wouldn't employees want a similar experience with their healthcare?" - Amanda VolnerCan artificial intelligence actually make healthcare feel more human?Amanda Volner, AVP of Broker Partnerships at Healthee, joins the show for a deep dive into the real role of AI in the benefits industry. We discuss how artificial intelligence is a powerful tool to augment our abilities, but why uniquely human skills like critical thinking, building relationships, and understanding "the question behind the question" are more valuable than ever.Amanda breaks down how Healthee is using AI to create "hyper-personalized" healthcare experiences for members, from navigating benefits to finding cost-effective pharmacy solutions. We explore how modern engagement platforms are essential for communicating with a decentralized workforce and how AI can be trained to match your own voice and tone.The conversation also explores the human side of a demanding career, from the challenges of being a single mother in this industry to navigating sobriety in professional settings.Tune in for a fascinating look at the intersection of AI, healthcare, and what it truly means to be human in our industry.Chapters:(00:00:00) Making Healthcare More Human...Using AI (00:01:09) The One Thing AI Still Can't Do (00:04:36) Understanding "The Question Behind the Question" (00:26:02) The Future of "Hyper-Personalized" Healthcare (00:37:07) Using AI to Lower Prescription Costs (00:50:12) Balancing a Demanding Career and Family (01:02:32) Navigating Sobriety in the Benefits WorldKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Good entrepreneurs fall in love with their solution and their platform, but great entrepreneurs fall in love with the problem." - Matt ScovilMatt Scovil and Nathan Gilchrist of Medefy Health, have fallen in love with one of the biggest problems in benefits: nobody wants to engage with them. They joined the show to discuss their journey of building a platform designed to solve the engagement crisis and simplify the healthcare experience for everyone.Matt and Nathan break down their "bottoms-up" approach to this problem, which focuses on engaging members when they need help through a high-touch, live support model delivered via mobile app. We discuss how they use the psychology of "loss aversion" and constant communication to drive engagement rates over 90%.We also explore how Medefy acts as the "quarterback" for a health plan, removing friction by navigating members to the right solutions. This is all part of their vision for the future of healthcare, where the experience is "heavily, heavily individualized" for each person.Chapters:(00:00:00) Why Employees Would Rather Clean a Toilet Than Use Their Benefits (00:04:18) Cleaning a Toilet vs. Learning Your Benefits (00:08:46) Falling in Love with the Problem, Not the Solution (00:14:23) The Power of Live, Human Support (00:19:08) Using "Loss Aversion" to Drive Engagement (00:34:54) The Quarterback for Your Health Plan (00:47:57) How AI is Augmenting the Human Touch (01:00:01) The Future of Healthcare is "Individualized"Key Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I think the three strongest words that you can use as a leader, as a salesperson, as a client relationship person is I don't know." - Scott MilsonMy guest this week, 35-year industry veteran and author Scott Milson, joins the show for a deep dive into the mindset required for a long and successful career. We discuss his journey from a self-described "career B student" to a partner at a major firm, and the lessons he learned about loyalty, hard work, and what it truly means to be excellent.Scott breaks down his personal playbook for "tuning into the frequency of excellence." He shares his "Be 5 Framework" (Be Present, Curious, Intentional, Bold, and Reflective) and explains why embracing discomfort, adopting a growth mindset, and learning through informal mentorship are crucial for professional growth.It's worth noting that Scott is also professionally in the benefits industry, so I wanted to have him on the show to directly speak to those in this space.I hope you'll tune in for this insightful conversation!Chapters:(00:00:00) Tuning Into The Frequency Of Excellence (00:20:08) Why Discomfort is the Path to Growth (00:21:56) The 3 Words That Defeat Imposter Syndrome (00:27:52) The "Success to Significance" Curve (00:38:42) The “Be 5” Framework for Excellence (00:40:52) The Myth of Formal Mentorship (00:48:25) "How You Do Anything is How You Do Everything"Key Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"We spend about $528 billion a year fixing the mistakes we make with medicines." - Chris GrilliFixing healthcare's $528 billion dollar mistake starts with ending the "trial-and-error" prescribing that plagues our system. My guest this week, pharmacist and genomics expert Chris Grilli of RxMapper, joined the show to explain how personalized, DNA-guided medicine is the key to solving this massive problem.Chris breaks down the RxMapper model, explaining how they analyze 36 million data points from a patient's genome to provide medication recommendations with nearly 90% accuracy. We discuss the crucial difference between genetics and genomics, and how this approach saves thousands of dollars per patient while dramatically improving outcomes.The mission to fix this problem is also a personal one. Chris shared the story of how his grandmother's preventable death from an adverse drug event became the inspiration for building RxMapper to ensure other families don't suffer the same fate.Tune in this week for the playbook on fixing one healthcare's most expensive mistakes.Chapters:(00:00:00) Fixing Healthcare's $528 Billion Dollar Mistake (00:02:12) The $528 Billion Cost of Medication Errors (00:04:43) Genetics vs. Genomics: What's the Difference? (00:10:29) Are Doctors Prescribing "Poison?" (00:14:18) The Personal Story Behind RxMapper (00:27:17) Saving Over $8,600 Per Patient (00:41:24) How Your DNA Impacts Ozempic's EffectivenessKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"There's a big difference for me in living and being alive. There's a difference between breathing and truly experiencing life." - Todd WhitthorneMy guest this week Todd Whitthorne joined me for a conversation that goes far beyond the balance sheet to explore the true meaning of well-being. We discuss why a leader's personal health is the foundational, non-negotiable asset for their professional success.Todd breaks down the crucial role leaders play in building trust and creating a "culture of health" that yields a real financial, clinical, and cultural ROI. We explore the five pillars of well-being (fitness, nutrition, sleep, stress, and prevention), the difference between "lifespan" and "healthspan," and why investing in yourself is the least selfish thing a leader can do.The episode concludes with the incredible true story of Todd's 70-year-old friend who survived being hit and run over by a drunk driver, which is a powerful testament to how a lifelong commitment to fitness creates true resilience. I hope you'll tune in for this inspirational conversation!Chapters:(00:00:00) Lessons in Health & Leadership (00:06:11) Why Trust is a Leader's Most Important Asset (00:14:14) The Difference Between Lifespan and Healthspan (00:17:06) Why Investing in Yourself Isn't Selfish (00:48:59) The Pursuit of True Happiness (01:05:49) The 70-Year-Old Who Survived And Thrived After a Hit-and-RunKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Understanding how an underwriter thinks and how they manage risk allows you to create a solution that actually creates impact and change for the long term." - Bobby StuartThis week on the show, I'm joined by Bobby Stuart, a benefits consultant with Hotchkiss Insurance, for a deep dive into the mindset of a modern, forward-thinking advisor. We discuss his journey into the industry and what it takes to guide employers through the complexities of self-funding.Bobby also broke down his playbook for creating long-term value for his clients. We explore why learning to "think like an underwriter" is a crucial skill for managing risk, the importance of simplifying complex ideas for employers, and why mastering the industry's language is the first step to finding simple solutions.We also discuss how these strategies translate into real-world results, including how Bobby's team uses direct contracts and early intervention to help members get high-cost cancer care for free, removing the financial burden so they can focus on their health.Chapters:(00:00:00) How To Think Like An Underwriter (And Why It's A Game-Changer)(00:04:03) Overcoming the Complexity of Self-Funding (00:04:59) Learning to Speak the Language of Insurance (00:08:49) The Power of Thinking Like an Underwriter (00:18:48) How To Stay Optimistic As A Benefits ConsultantKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"The balance bill came in, it was 37 grand for this member, and we were able to get that thing fully wiped." - Patrick HaigMy guest this week, Patrick Haig, Co-Founder of Goodbill, has built a company designed to find errors in medical bills and fix them. From upcoding to time-based discrepancies, these inaccuracies cost health plans and their members a fortune.In this episode, Patrick breaks down the Goodbill model. We discuss how their technology integrates directly with health plans to audit claims for errors before they're paid, and why that “upstream” approach is so game-changing. We also dive into one of their most powerful tools: the underutilized 501(r) IRS rule that can wipe out bills entirely, even for six-figure income families.This episode is personal for me, as Patrick's team fixed my own son's ER bill, saving almost $1,000. I hope you'll tune in!Chapters:(00:10:22) How DPC inspired Goodbill(00:23:03) The 501(r) Secret: Hospital Financial Assistance (00:27:15) How Upcoding Inflates Your ER Bill (00:38:29) The Art of Negotiating a Hospital Bill (00:48:43) Why "Upstream" Claim Auditing is a Game-Changer (00:59:29) Can a Six-Figure Family Qualify for Assistance?Key Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I doubled my profit when I lost 70% of my customers, which is insane." - Brad HartMy guest this week, Brad Hart, owner of Forest Park Pharmacy, came on the show to discuss how he moved his pharmacy from struggling to survive in a broken, insurance-based reimbursement model to thriving as an all-cash, "cost-plus" business.Brad popped on my radar because of his very popular and informative Instagram profile, where he shows how everyday Americans are getting fleeced by PBMs. We break down the mechanics of his model and discuss the "low copay trap," why the term "specialty generic" is nonsense, and how his pharmacy's Price Checker tool brings radical transparency to a purposefully confusing industry.We also dive into the exponential overpayments Brad has uncovered in the Medicare system, where a drug that costs his pharmacy $96 is reimbursed for over $3,400.This is one you won't want to miss!Chapters:(00:00:00) This Pharmacy Went Cash-Only, Lost 70% Of Customers, & Doubled Profits(00:07:28) The "Cost-Plus" Pharmacy Model, Explained (00:08:49) How Brad Lost 70% of Customers & Doubled Profits (00:10:45) The Deceptive "Low Copay Trap" (00:13:29) The Pricing Breakdown: Cost + 15% + $10 (00:34:52) Why the Term "Specialty Generic" is Nonsense (00:47:53) What is the Average Wholesale Price (AWP)? (00:52:41) PBM Reform vs. Direct-to-ConsumerKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Nomi actually stands for 'no middleman'. Take out that invented complexity... Price comes way down, becomes more simple to administer, and there's plenty of dollars to go around for providers now making more money." - Josh WalkerMy guest this week, Josh Walker, Founder & COO of Nomi Health, is on a mission to rebuild healthcare by tackling its "invented complexity." He joined me on the show to explain why creating a direct relationship between the buyers and providers of care is the key to a better, more affordable system for everyone.How does Nomi do it? We break down their playbook, which focuses on three core strategies: standardizing data formats to improve efficiency, embracing price discovery to find the true cost of care, and simplifying payment dynamics to cut out the middlemen.This isn't just theory. Joshua shares the powerful, real-world results of their model, including how one client's benefits leader received a standing ovation from employees after switching to a plan that eliminated all financial barriers to care.Tune in this week to learn why it's so important to find the true cost of care, and why I'm so proud to have Nomi as a sponsor for the show!Chapters:(00:00:44) What Does NOMI Stand For? (00:11:36) Finding the "True Cost of Care" (00:23:27) Do We Even Need Networks Anymore? (00:35:14) What Churros Can Teach Us About Data Analytics (00:52:19) From Solution Taker to Solution Maker (00:55:59) The "Standing Ovation" Health PlanKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

“Does your consultant understand these kind of strategies and mechanisms are available in the market and do they know how to implement them and make them work?" - Riley DearingRiley Dearing of Hotchkiss Insurance returns to the show this week, and he's brought with him Blake Allison, CEO of Employers Health Network (EHN) to talk all about high-performance health networks and the massive opportunity they represent.Ever wonder how high-performance health networks actually work? We broke down the real mechanics: how direct provider partnerships are built, how benefit design drives engagement to the right facilities, and how this collaborative approach leads to better data, lower costs, and predictable risk for employers.This isn't just theory; we also announce EHN's new partnership with Covenant Health, detailing how this model is being scaled to bring these powerful solutions to employers across West Texas.Tune in this week for the definitive guide on how high-performance health networks actually work!Chapters:(00:00:00) How the World's #1 Chevy Dealer Saved $3 Million on Healthcare(00:10:30) Enhancing Healthcare Networks (00:16:23) Making Sure Members Can Get Care In Their Area(00:22:30) Empowering Patients(00:25:43) Navigating Healthcare Pricing Strategy(00:35:23) Enhancing Healthcare Affordability(00:47:14) Data-Driven Healthcare(00:57:17) Zero Out-of-Pocket Cost For MembersKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's podcasts, headlines, and listener-submitted questions.This episode covers healthcare news from June to mid-July 2025.And we play a new game called the "Which Has Less Ingredients?", which is exactly like what the title suggests.Chapters: 0:00 - Intro0:22 - A proposal to ban drug ads2:48 - Pre-diabetes rates in children have tripled in 25 years5:25 - Healthcare workers leaking patient data through AI7:06 - Mark Cuban's healthcare plan10:05 - Healthcare is the top employer in most states12:49 - The Self-Funded Review19:37 - Which Has Less Ingredients? (this month's game)27:27- Ask Spencer AnythingSources: https://phys.org/news/2025-06-glass-bottles-microplastics-plastic.htmlhttps://x.com/mcuban/status/1934834421225672999https://www.scrippsnews.com/health/alarming-number-of-adolescents-have-prediabetes-new-data-from-cdc-says?utm_source=chatgpt.comhttps://x.com/utobian/status/1943127594960064713?t=BfpiRV8m7thZDIqTRMVo3Ahttps://www.medicaleconomics.com/view/health-care-workers-are-leaking-patient-data-through-ai-tools-cloud-appshttps://www.medicaleconomics.com/view/sanders-senators-float-ban-on-direct-to-consumer-ads-for-prescription-drugshttps://newsnetwork.mayoclinic.org/discussion/mayo-clinics-ai-tool-identifies-9-dementia-types-including-alzheimers-with-one-scan/