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In this episode, Bryan Haakenson sits down with longtime Alpha Warranty friends Vinny Miller and Justin Thompson of TPA Risk Management (TPARM) to discuss what it really takes for a dealer or agent to launch and run a successful third-party administrator. Vinny and Justin share why strong underwriting relationships, consistent claims processes, and the right people matter more than the contract itself, and why AI is a powerful tool that still needs a trained eye behind it. Vinny began his career at General Motors and later led claims and risk management for Assurant Solutions before founding TPARM in 2005. He has worked with Alpha Warranty almost from the beginning, helping build its early claims processes. Justin is a BMW Master Certified Technician with more than 20 years of repair and warranty experience. Together, they bring a rare view of both the service bay and the claims desk. The conversation covers early warning signs to watch for and the key questions every dealer should ask before becoming their own TPA.
"We pay them a $2,500 flat fee for the time that they spend with the patient and make that recommendation for no surgery. If you don't, then you've wasted their time." - Matt EureyMost of healthcare is paid for volume, so employers end up paying for surgeries that never needed to happen. When RAND studied Carrum Health's data, about 30% of surgeries were avoided once the first step was checking whether the patient actually needed one.Matt Eurey ran benefits at Lowe's, which spent about a billion dollars a year on healthcare. He explains how Carrum pairs bundled prices with surgeon-held warranties and charges nothing per employee per month. He also covers why more than half of Carrum's new buyers last year made the program mandatory, and how the model extends to cancer and substance use disorder.If surgical and specialty claims are driving your trend, this is the episode for you. Tune in.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: Paying Surgeons Not to Operate(00:00:20) Meet Matt Eurey and Carrum Health(00:01:56) How Carrum Decides if Surgery Is Appropriate(00:05:34) Rooting Out Perverse Incentives(00:07:01) Running Benefits for 225,000 at Lowe's(00:13:26) The Early Days of Care Navigation(00:18:49) Why Matt Joined Carrum(00:20:50) What Value-Based Care Actually Means(00:26:33) Why Carrum Doesn't Use Benchmarks(00:28:44) Zero PEPM: How Carrum Gets Paid(00:30:28) Mandated vs. Voluntary Programs(00:37:01) Can This Become the Standard?(00:41:01) How Claims Flow Back to the TPA(00:43:17) The Member Experience, Start to Finish(00:49:03) Cancer and the Two-Year Warranty(00:51:45) Substance Use Disorder Care in Hours(00:56:14) Why Carrum Added Cancer and SUD(00:59:44) Why Wouldn't an Employer Do This?(01:01:33) What's Next for Carrum(01:03:10) What Happens If We Don't Fix Costs(01:05:08) Closing ThoughtsKey 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 pay them a $2,500 flat fee for the time that they spend with the patient and make that recommendation for no surgery. If you don't, then you've wasted their time." - Matt EureyMost of healthcare is paid for volume, so employers end up paying for surgeries that never needed to happen. When RAND studied Carrum Health's data, about 30% of surgeries were avoided once the first step was checking whether the patient actually needed one.Matt Eurey ran benefits at Lowe's, which spent about a billion dollars a year on healthcare. He explains how Carrum pairs bundled prices with surgeon-held warranties and charges nothing per employee per month. He also covers why more than half of Carrum's new buyers last year made the program mandatory, and how the model extends to cancer and substance use disorder.If surgical and specialty claims are driving your trend, this is the episode for you. Tune in.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: Paying Surgeons Not to Operate(00:00:20) Meet Matt Eurey and Carrum Health(00:01:56) How Carrum Decides if Surgery Is Appropriate(00:05:34) Rooting Out Perverse Incentives(00:07:01) Running Benefits for 225,000 at Lowe's(00:13:26) The Early Days of Care Navigation(00:18:49) Why Matt Joined Carrum(00:20:50) What Value-Based Care Actually Means(00:26:33) Why Carrum Doesn't Use Benchmarks(00:28:44) Zero PEPM: How Carrum Gets Paid(00:30:28) Mandated vs. Voluntary Programs(00:37:01) Can This Become the Standard?(00:41:01) How Claims Flow Back to the TPA(00:43:17) The Member Experience, Start to Finish(00:49:03) Cancer and the Two-Year Warranty(00:51:45) Substance Use Disorder Care in Hours(00:56:14) Why Carrum Added Cancer and SUD(00:59:44) Why Wouldn't an Employer Do This?(01:01:33) What's Next for Carrum(01:03:10) What Happens If We Don't Fix Costs(01:05:08) Closing ThoughtsKey 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 Small Business Association of Michigan’s Small Business Weekly Podcast
On today's program, Michael Rogers talks with Ime Ekpenyong, PhD, owner of SGRX Health and a VIP member of the Small Business Association of Michigan. SGRX is a Michigan-based healthcare organization that's been providing a combination of pharmacy benefit management services and third-party administration (TPA) services to private and public sector payers since 2001. On the pharmacy benefit front, they work with employer groups to help manage employee benefits from a prescription management standpoint. They also recently launched a prescription savings program called SGRX Saves, tailored for both the uninsured and underinsured who face high copays or deductibles, and partnered with major chains including CVS, Walgreens, Walmart and Kroger. The Small Business Association of Michigan is the only statewide and state-based association that focuses solely on serving the needs of Michigan's small business community. We have been successfully serving small businesses like yours in all 83 counties of Michigan since 1969. We're located in Lansing, just one block from the Capitol. Our mission is to help Michigan small businesses succeed by promoting entrepreneurship, leveraging buying power and engaging in political advocacy. When small businesses band together through the Small Business Association of Michigan, they achieve more than they could on their own. Our 32,000 members are as diverse as Michigan's economy. From accountants to appliance stores, manufacturers to medical, and restaurants to retailers, what unites the SBAM membership is the spirit of entrepreneurship…a spirit that drove you to start and continue to operate your own business because you believe you can do something better than anyone else is doing it! (music licensed from www.jukedeck.com)
Retireholics crew & the 401(k)ouple dive deep into how AI is reshaping advisor workflows, the role of private equity in retirement plans, and what plan design looks like when TPAs and recordkeepers are at the table. This episode tackles the biggest trends hitting the 401(k) industry right now. The panel breaks down how AI is changing plan administration and advisor workflows, and whether it's a tool that makes advisors more valuable or a threat to their role. You'll hear candid takes on private equity's growing presence in retirement plans, the tension between compliance and participant outcomes, and how plan design is evolving for employers without dedicated financial professionals. We also explore Schwab's market moves, Fidelity's role as a recordkeeper and TPA, and why customized target date funds matter more than ever. The conversation touches on practical topics like employer discretionary contributions, unlimited PTO policies, and salary transparency, all issues that affect plan adoption and participant engagement. Whether you're an advisor, TPA, plan sponsor, or recordkeeper, this episode serves up straight talk on the tools and trends shaping your practice. Plus, you'll get the Retireholics signature blend of industry insight and irreverent humor. CHAPTERS 0:00 Cold Open with Robe Guy 6:05 Award Win for the Podcast 13:29 Fidelity and Third Party Administrators 18:47 Plans Without Financial Professionals 20:08 Schwab, Anthropic, and AI Advisors 24:15 AI as a Tool vs Replacement 29:56 Formula One's Artificial Intelligence Commentator 39:34 Balancing Compliance and Participant Outcomes 44:11 Employer Discretionary Contributions 47:23 Unlimited PTO Policies 53:34 Salary Transparency Concerns 57:19 Private Equity in Retirement Plans 1:04:56 Customized Target Date Funds 1:09:52 Technology and Third Party Administrators 1:16:13 Wrap Up and Final Thoughts MORE FROM RETIREHOLICS Full episode notes & transcript: https://retireholics.com/episodes/401kouple-discuss-ai-private-equity-plan-design/ All past episodes: https://retireholics.com/episodes/ Live every 1st & 3rd Thursday at 4:30pm PT: https://retireholics.com/live/ Get show reminders: https://retireholics.com/get-reminders/ SUBSCRIBE YouTube: https://www.youtube.com/@Retireholics Apple Podcasts: https://podcasts.apple.com/us/podcast/retireholics/id1490618217 Podbean: https://retireholiks.podbean.com/ Retireholics is the show changing the retirement industry one beer at a time. Hosted by JD Carlson and co-hosts, covering 401(k) plan design, fiduciary responsibility, fees, investments, and industry news for retirement plan advisors and professionals.
The restoration industry is going through a tough stretch - but is this downturn really like the others?Michelle with Timothy Hull, CR and John Monroe, of Violand Management Associates, dig into what's happening behind the scenes: what the companies struggling have in common, what the successful ones are doing differently, and whether anyone is truly immune.They talk about TPA dependence, claim volume, knowing your numbers, early warning signs, and perhaps most importantly - what owners can do when they realize something isn't right.
The restoration industry is going through a tough stretch - but is this downturn really like the others?Michelle with Timothy Hull, CR and John Monroe, of Violand Management Associates, dig into what's happening behind the scenes: what the companies struggling have in common, what the successful ones are doing differently, and whether anyone is truly immune.They talk about TPA dependence, claim volume, knowing your numbers, early warning signs, and perhaps most importantly - what owners can do when they realize something isn't right.
About the episode:Architect Kelly Grace breaks down how thoughtful home design can support indoor air quality, reduce mold risk, and make a house feel healthier day to day. She explains why climate, wall assemblies, insulation, flooring, HVAC, lighting, and bathrooms all matter more than most people realize.This conversation is especially useful for anyone building a home, renovating, or trying to make an existing house safer and simpler. Kelly also shares practical examples from her own work and home, including what she avoids, what she prefers, and why she believes architecture should be both durable and low-tox.About the guest:Kelly Grace is an accomplished architect based out of Washington DC, and the Managing Principal of Travis Price Architects, an award-winning architecture firm, widely applauded for their visionary aesthetics, informed by ecology, mythology, and technology. TPA seeks to create an enduring archaeology for tomorrow, through culturally diverse inspirations, natural self-reliance, and high-performance building practices.Kelly is known to many as the “NONTOXARCHITECT” on social media, where she shares her advice on material selections, design details, indoor air quality, water filtration, biohacking, EMF mitigation, moisture control, and much more. She is dedicated to designing healthy buildings, using non-toxic products, to promote wellness habits and optimal living. Kelly is also a Founding Member of the Healthy Building Alliance, a platform to connect healthy building professionals; architects, builders, engineers, homeowners, consultants, and product manufacturers, to provide a network of resources and educational tools, based on proven building biology and building science principles. What the episode covers:How Kelly became focused on non-toxic architectureWhy fewer than 10% of homes are designed with an architectHow climate affects materials and wall assembliesWhy walls need to dry properly to help prevent moldInsulation options and why Kelly avoids spray foamHealthier flooring and material choicesBedroom improvements for sleep and indoor air qualityHVAC systems, ventilation, and moisture controlBathroom design and mold preventionSimple home maintenance habits that make a differenceKell's links:Website: www.travispricearchitects.comInstagram: https://www.instagram.com/nontoxarchitect/Stephanie's links:Tiktok: https://www.tiktok.com/@drstephpeacockInstagram: https://www.instagram.com/drstephpeacock/Website: https://stephaniepeacock.com/Substack: https://substack.com/@holistichubcommunityRetreat in November: https://www.vitalresetretreat.com/ code VITAL for discount
24/09/2026 | Movistar+ cuenta sus planes de futuro desde Donosti, pero además cerramos el FesTVal de Gasteiz con el director de contenidos de RTVE Play, así como de TVG, TPA, IB3 y los presentadores Patxi Alonso y Txurru. También el 'tetris' de las distintas versiones de 2Cat, adelantadas por José Pablo, las agendas y las reflexiones finales de Diestro y de Radiochips, que trae de vuelta su carta.
On Today's MJ Morning Show:Mosquito sprayin in south TampaMorons in the newsSocial media creators... fake e-mails at the register, buying spray paintArizona Iced Tea founder vs his longtime masseuseRoad rage incident near Memorial Highway and Hillsborough AvenueLinkedin, the unlikely dating siteThere's a new Birkin bagMJ's visit to the Tampa Airport post officeBailey's trip to New OrleansMJ went to dinner with neighborsTampa Bay Rays, AL East ChampsSt. Pete liquor license questionTSA at TPA found a flashlight a knife in itPreschoolers who blink more have better self control?Never throw away your receipts... Here's why.Bartender tells "secret" about margaritasPeople are now drinking lessDolly's nephew faces possible restraining orderTheory about Bailey's experience last week at her gymLionel Richie hospitalized againPinellas student Lexi Stephens on "The Voice"Simone Biles' Porsche stolen from her home by armed menCarrot Top updatePowerball winner arrested... AGAIN.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Welcome to RIMScast. Your host is Justin Smulison, Business Content Manager at RIMS, the Risk and Insurance Management Society. In this episode, Justin interviews Roy Hock about "Future-proofing" a risk program and what it means. They discuss energy awareness and its importance, especially for an energy company. Roy tells of the insurance career journey that led him to Valero. He explains some of the products Valero provides. Roy tells how his Risk team mitigates risk for Valero. He explains how he manages Valero's captive insurance company. More than ever, there are regulatory risks that need to be mitigated where possible. Roy speaks of the South Texas RIMS Chapter and its engagement programs, including a shooting event and golf events. Listen for Roy's advice for young risk professionals who want to become strategic risk leaders over the next 10 years. Key Takeaways: [:01] About RIMS and RIMScast. [:16] About this episode of RIMScast. Our topics are energy awareness and future-proofing a risk program. Our guest is Roy Hock, Director of Risk Finance & Casualty Insurance at Valero. But first… [:45] RIMS-CRMP: RIMS Certification Week will be held from September 21st through the 25th. The week is a global celebration of the RIMS Certified Risk Management Professional certification. [:57] It is a virtual event for you to learn about the certification, how it can strengthen your career and organization, and to understand how the RIMS-CRMP is shaping the future of risk management. [1:07] A link to Certification Week is in this episode's show notes. You can also find it at RIMS.org/Webinars. [1:14] Webinars: There are lots more RIMS Webinars coming up. On October 1st, Brown and Brown make their RIMS Webinars debut by discussing "The Future of Captives: What Risk Managers Should Think about Now." [1:27] Global Risk Consultants will return on October 8th to present "The 2027 Risk Agenda: 10 Engineering Priorities Risk Leaders Should Act on Now". [1:37] On Oct. 15, Verisk Maplecroft will lead the session "Beyond the Horizon: Turning External Risk Into Decision-Ready Insight". [1:46] On Oct. 22, Zurich returns to tell us all about "Cybercrime, Fraud and AI: Real-World Threats and Practical Defenses for Business Leaders". [1:57] Origami Risk returns on October 29th to present "Managing Insurance Programs at Scale: What Complex Portfolios Require". [2:06] On Nov. 5th, Riskonnect returns to deliver the session "Signal Over Noise: Smarter Risk Analytics". Visit RIMS.org/Webinars to register. [2:17] RIMS is back on YouTube. Our handle is @RIMSOfficialChannel. We've got plenty of videos there, including RIMScast, RIMScast Canada video podcasts, and other informative and entertaining content from RIMS. Subscribe to the channel today! [2:36] On with the Show! Our guest today is Roy Hock, the Director of Risk Finance & Casualty Insurance at Valero, one of the world's largest oil refineries. We will discuss what it takes to future-proof Valero's risk program, and we will discuss Energy Awareness Month in October. [3:08] You may know Roy from his presence in the RIMS Houston Chapter. He is a former president of that chapter, and you probably saw him at the RIMS Texas Regional in 2026. [3:23] Announcement: The speaker's views are his own, and not necessarily the views of Valero. [3:29] I'm looking forward to hearing how he manages risk for Valero, so let's get to it! [3:34] Interview! Roy Hock, welcome to RIMScast! [3:48] Roy started working for an insurance company right out of school. Most of his career has been in Houston. For the last six years, he has been in San Antonio at Valero. [4:03] Roy shares his early career path: underwriting, reinsurance, broker. Then he got his ARM. One of his friends was looking for a risk manager for a startup in Houston. Roy took the opportunity. He loved it until it was sold. [4:55] Roy moved on to another job. After a couple of years, Valero approached him, looking for a risk manager with experience in the oil and gas industry, for a job in San Antonio. Roy said yes. It's a wonderful city. He was very excited to be given the opportunity. [5:21] Roy says, six years later, he's Director of Risk Finance & Casualty Insurance, and loving every minute of it. [5:52] Roy says his work days are varied. Every day is an exciting new challenge. Roy oversees captive, casualty insurance, directors and officers insurance, and all other types of insurance. He works in a large team and is often the backup when people are out. He's keeping up his skills. [6:27] Roy also oversees the Risk Information Management System. Part of his team focuses on that, and he helps support them. [6:38] Roy says it's a big organization of 10,000 people, and there's always something happening. You never know what you're going to get from day to day. [6:48] Justin says he and Roy met right after RISKWORLD for a session with Origami Risk, "Future-Proofing Your Risk Program". Justin wanted to extend the dialog with Roy with Energy Awareness Month coming up in October. [7:06] Justin asks how important Energy Awareness Month is at Valero. Roy says every minute of every day is about energy awareness. [7:24] Valero is a refiner. They buy crude and refine it into jet fuel, diesel, and unleaded gas. They also produce ethanol and renewable diesel. They have their hands in a lot of things, all geared to moving people around the world. [7:52] Valero is always looking at how to create efficiencies and keep costs down. Energy is a big piece of that. They are in Texas, where wind and solar are big. Valero is a big energy consumer. [8:10] They try to keep the energy costs down and build efficiencies within the operation, not only to keep costs down but also to be more self-sustaining so they're taking less off the grid. [8:47] Roy says a risk manager not only has to understand the insurance side and the claims side, and how they interrelate, but you have to understand them in the context of your business. [8:58] You need to know how you make money, where the risks are, the trends you see, and help the organization identify those trends and find ways to address them when possible, via a captive or an outside carrier or internally with programs to mitigate risks and keep losses down. [9:23] Roy says if you don't understand the business, you can't do that very effectively. You need to understand the business. You don't need to know all the details of how a business works, but you need to know a very strong baseline and know who does know the answers. [9:38] Roy says creating that internal network is just as important as having the external network you get in the insurance world. You need to sit in between those two. [9:50] Roy has been at Valero for six years and two months. He came from an oil and gas background, on the insurance side of the business. He knew how the flow worked and what all the pieces did. Even after six years at Valero, Roy is still learning something every day. [10:22] Roy says it took a good year or two to feel comfortable "speaking" the business. He got there by listening to executives talk to carriers, by listening to earnings calls, and by listening to businesses asking Valero for things. Roy loves being a learner. [10:51] That's how Roy has gotten a baseline comfort with the business, and he knows who to ask when there are specific questions. [11:05] Roy has four people on his team, acting as internal support on top of other things they do for the company. The broad risk management group is around 20 people, including an internal TPA and risk engineers with niche knowledge in fire, water, and protection. [12:04] Roy says most companies don't do that. It's just how Valero developed over the years. [12:21] Justin asks what future-proofing a risk program means to Roy. Roy says it's staying on the pulse of what's going on in the business and in the insurance commercial markets, and maintaining a strong network across the board. Use that information. Does this apply to Valero? [12:58] Roy says you have to look at the workforce. Some people may retire. What does that mean? What will we look like in five years? Roy says we do a five-year team outlook for the knowledge transfer. What's on the horizon? [13:27] Twenty years ago, cyber was a thing, but it wasn't a real thing. Now, it's a bigger thing. It's something we have to look at. It's been insane. Roy asks, What's this AI going to do to us? [13:47] Roy says a lot of that is coming from internal questions and resources. People from different departments bring questions. Roy says it's going to RIMS conferences and learning what's going on in the world, in the RIMS space, and in the technology space. [14:07] Roy says bringing all that together is what helps future-proof us. [14:39] Roy says he thinks all risk managers inherently do that. We're always trying to stay ahead of the ball. They want to stay at the forefront of what's going on in the world, so they can address it before it becomes a problem. That's the key. You're trying to address it. [14:59] If it is a business decision, bring to bear your business knowledge in discussions: If we do this, this is what could happen, and this is how we can mitigate it. Do you want to take the cost of that mitigation? Roy says that having those discussions helps a lot, as well. [15:21] A Quick Break! Many fantastic RIMS events are coming up in 2026. The RIMS Western Regional Conference will be held from October 4th through the 7th in Seattle, Washington. The agenda is live, and registration is open. [15:38] Visit RIMSWesternRegional.com and the link in this episode's show notes for more information. [15:44] Save the dates: October 18th through the 21st. In Quebec City, we will be hosting the 50th Annual RIMS Canada Conference. Booth sales are open, and sponsorship opportunities are still available. Visit RIMSCanadaConference.ca for more information. [16:01] Also, remember to check out RIMS.org/Canada for our spinoff show, RIMScast Canada, with a new episode every month. [16:10] The RIMS ERM Conference 2026 will be held on November 19th and 20th in Columbus, Ohio. Registration is open. Visit RIMS.org/ERM2026. [16:23] We're already looking to RISKWORLD 2027, which will be held over four days in New Orleans, Louisiana, from April 18th through the 21st! Member-only Registration will open on November 4th, and General Registration will open on December 2nd. [16:41] Get first access to the hotel block. Hotel reservations open on October 28th, ahead of public registration. Sitting this out is the real risk! The link to registration is in this episode's show notes. [16:54] Let's Return to Our Interview with Roy Hock of Valero! [17:01] Justin asks if electric vehicles (EVs) are a risk for Valero. Roy answers that Valero is a supply-and-demand organization. Futurists have predicted we would hit peak oil and we would not need oil. That has not come to pass. [17:40] Valero's philosophy is to do what is right, what makes profit for shareholders, and what's good for the world as they see it. So far, that's been doing very well for them. Valero is proud of what they've accomplished. [18:03] Roy says Valero has done things internally that people don't see to bring down its carbon footprint. Some regulatory switches have caused Valero to put those numbers forward. Roy says Valero is proud of those numbers and that their metrics are industry-leading. [19:06] Roy says Valero has a good story to tell and now they are telling it. It has been interesting. Some things they have been doing; some things have been in their plans for 20 years, as part of trying to run a good business. They've been doing all the right things, all along. [19:43] Roy says he thinks Valero's culture of humility is helping to future-proof the business. Interns and new hires seem to love Valero. Numbers are good. Retention numbers are really good. If young employees are unhappy with a company's culture, they look for something else. [20:31] Roy says, not only do we compensate them well, but also the culture keeps them engaged and wanting to work for us. Someone retired from Roy's team after 35-plus years. Roy says that is very common there. People like to work at Valero. It's a good spot. [20:53] Justin asks how geopolitical risks affect Roy's risk work at Valero. Roy says Valero has been forced to step up and participate in new ways recently. Around the world, regulations have changed. It's hard to plan a business around regulations that are here today and gone tomorrow. [21:47] Roy says they have to be at the table to try to mitigate that risk. Roy says "100%" there is more volatility on the regulatory side than when Valero started. The regulatory environment across the world swings back and forth. Valero is just trying to run a good business. [22:26] Roy says one side of the aisle doesn't like it, and the other side of the aisle doesn't like it for a completely different reason. [22:35] Valero is having to come sit at the table more often than ever to try to make sure their voice is heard and that what they're trying to do is coming across, to try to mitigate that risk as much as possible. It's not an insurance risk but a legal-type risk that Valero has to address. [23:08] Roy says that Risk has the attention of the C-Suite. In Roy's experience, even at previous companies, insurance is one of the big "spends" of a company. It's the Risk Management Group's role to mitigate risks, process claims, and make sure they stay under control. [23:43] Roy says that through Legal, or Treasury, or directly to the CFO, there's usually a line of sight to the C-Suite and the Board. Roy says sometimes you're placing insurance for the Board. Roy helps his VP get ready for the annual update to the Board and the big renewal cycles. [24:15] Roy says, in the renewal cycle, if Risk sees something on the horizon, it's easy for them, because of the networks they've built, to go to the C-Suite and communicate those risks or options to them. It's periodic. It happens all the time. [24:43] One more Quick Break! RIMS, The Foundation for Risk ManagementTM, is dedicated to shaping the future of the profession. By making a contribution, you are strengthening the global risk management community and investing in the future of the industry. [25:02] The Foundation also supports the Spencer Educational Foundation but has a different mission. The Foundation focuses on providing opportunities for those professionals who have already decided to enter risk management and are just getting started. [25:16] You can learn more about the Foundation by visiting www.RIMS.org/FRM. While you're there, be sure to check out information about the Susan Meltzer Scholarship Fund, which was established to honor Ms. Meltzer, who was RIMS President in 1999 and 2000. [25:35] Susan Meltzer was a cherished RIMS President and contributed so much to RIMS and the greater risk community. Learn more at RIMS.org/FRM. [25:44] Let's Return to Our Interview with Roy Hock of Valero! [25:50] Justin and Roy talk about Roy's membership in the South Texas RIMS Chapter. Roy is the former President of the RIMS Houston Chapter. He says the South Texas RIMS Chapter is fantastic. [26:18] Roy says there are a lot of businesses coming into Texas, which means a lot of risk functions are moving in. The different chapters are growing. Everybody is doing a good job keeping their members engaged. They keep growing and finding new avenues of engagement. [26:40] Roy says 32 years ago the South Texas RIMS Chapter led the way and started a shooting event in the Spring. Roy was a traditional golfer in Houston. Roy says the shooting event is awesome. They still do a golf event as well. Valero is a big sponsor of these types of events. [27:03] Roy says his boss, Jeremy Bergeron, is a former President of the local chapter. Jeremy reports to the Board annually. Everybody on the team is hands-on, periodically touching base with the different groups. [27:34] Roy says Valero has a long history with and a love of RIMS. Often, the South Texas RIMS Chapter gets invites to play golf with different vendors, and Valero has been very good about supporting that. [27:52] Instead of chapter members going, they'll bring in students from St. Mary's University to attend these events as the future of the risk management industry. It's important to have them get engaged in these types of events, so the chapter helps support them and brings them in. [28:12] Roy sits on the St. Mary's Risk Advisory Board. It's been a pleasure. He loves it, and he says these kids are great. He says we have great future people coming into the industry. [28:30] Roy describes managing a captive for Valero. He has always been interested in how insurance companies function and work. When Valero approached him, it was for risk management and running a captive insurance company. He said, Sign me up! [28:58] Roy says it's great. Day to day, they're doing everything an insurance company does. They talk to regulators, they have managers, they have investments, and all the different things that accompany an insurance company. [29:09] Roy says Valero's captive is a company within a company, and an insurance company within a non-insurance-company environment. They insure Valero. Roy has a CPA on staff who is very helpful. She came from Valero's Accounting side, so she knows their needs. [29:39] Roy says that's one of the unique things about a captive. You need to be able to integrate with your parent company to consolidate everything correctly. The CPA is the bridge that does that for the captive. She has been very helpful to Roy and has helped him learn about it. [29:55] Roy says he didn't have a strong finance background. He knew basic accounting, but running a company is a little bit different. You need to know a little bit more. The CPA has helped Roy get educated on that. Accounting rules evolve, and regulations change all the time. [30:21] Roy says he likes policies and insurance. Reading a policy may not be for everybody, but it is for Roy, so it has been great. He gets to generate policies, which is even more fun. He gets to interact with a lot of fun and exciting people at Valero and outside. [31:08] Roy says they've redomiciled their captive to Texas. It's a growing captive, so there are a lot of moving parts, like a startup. He has to wear many hats. Valero allows Roy the opportunity to engage in helping with the process of pushing legislation. He likes the opportunity. [32:00] Roy would advise young risk professionals coming out of schools today, already understanding policies and risk registers, to continue their education. Designations are important, including the RIMS-CRMP. Roy got the ARM before the RIMS-CRMP was available. [33:10] Roy says things are changing constantly. When Roy took the ARM, there was no cyber piece. There is a piece on cyber now. It's a dynamic and ever-changing industry. Always keep your education up. Roy also advises that you need to build your network. [33:38] Roy says in insurance and risk management, and in your organization, you need to build your network so you can do your job and learn about what other people are doing in your organization and outside your organization. [33:53] Going to conferences helps in ways you don't even understand. As an industry, risk stands out as being more personable. You have data, systems, and risks, but you layer a personal connection on top of all of it. [34:23] Roy says a lot of students come out of school without a network. Roy tells his team to introduce these students to as many people as you can. Make sure that they get to all the conferences that they can. In the industry, we have a responsibility to help them with that. [34:58] As new risk professionals join the workforce, Roy says they should know that the traditional industries are not going anywhere. They are still very valuable and have a lot of career "legs" in them. You can make a great career working at an energy or energy-related company. [35:14] Roy says new risk professionals should keep an open mind to it and see what they like. As many pieces as there are on the insurance side, there are as many on the energy side. There are all types of energy and all types of places to play. [35:35] Roy says to move around, learn about these different pieces, and see what speaks to you. If you don't like what you're doing, you're not going to do as good a job. If you like what you're doing, you're always going to push yourself to do the best job. [35:33] Special thanks again to Roy Hock for joining us here on RIMScast! I've got a link in this episode's show notes to the on-demand video of "Future-Proofing Your Risk Program: Keeping Pace with Scale, Complexity, and Visibility," featuring Roy Hock and presented by Origami Risk. [36:10] Visit https://www.RIMS.org/Webinars and scroll down the page to find it. [36:14] Happy Energy Awareness Month! [36:16] Plug Time! Become a RIMS member and get access to the tools, thought leadership, and network you need to succeed. Visit RIMS.org/membership or email membershipdept@RIMS.org for more information. [36:34] Risk Knowledge is the RIMS searchable content library that provides relevant information for today's risk professionals. Materials include RIMS executive reports, survey findings, contributed articles, industry research, benchmarking data, and more. [36:50] For the best reporting on the profession of risk management, read Risk Management Magazine at RMMagazine.com. It is written and published by the best minds in risk management. [37:03] Justin Smulison is the Business Content Manager at RIMS. Please remember to subscribe to RIMScast on your favorite podcasting app. You can email us at Content@RIMS.org. [37:15] Practice good risk management, stay safe, and thank you again for your continued support! Links: ChicagoLand Risk Forum | Sept. 24, 2026 RIMS Certification Week: Sept. 21‒24 | Complimentary For All RIMS Western Regional Conference — Oct. 4‒7, 2026 | Seattle, WA | Register Today. RIMS Canada Conference — Oct. 18‒21, 2026 | Quebec City | www.rimscanadaconference.ca | Sponsorship Opportunities Available RIMS ERM Conference 2026 | November 19‒20 in Columbus, Ohio | Registration Now Open! | www.rims.org/ERM2026 RISKWORLD 2027 Registration RIMScast Canada — Episodes Now Live — Watch the new video with Sophie Grégoire Trudeau. The Strategic and Enterprise Risk Center RIMS, the Foundation for Risk Management Spencer Educational Foundation — Scholarships and Grants | Open Calls and Timelines. RIMS Now RIMS-Certified Risk Management Professional (RIMS-CRMP) | Insights Video Series Featuring Joe Milan! RIMS Diversity Equity Inclusion Council RIMS-CRMP Stories RISK PAC | RIMS Advocacy RIMScast on YouTube! RIMS Risk Management Magazine | Contribute | Q2 2026 Issue Now Available Sponsor RIMScast — Sales@RIMS.org "Future-Proofing Your Risk Program: Keeping Pace with Scale, Complexity, and Visibility" Upcoming RIMS-CRMP Virtual Workshops: Full RIMS-CRMP Prep Course Schedule See the full calendar of RIMS Virtual Workshops Upcoming RIMS Webinars: RIMS.org/Webinars RIMS Certification Week: Sept. 22‒24 | Complimentary For All "The Future of Captives: What Risk Managers Should Be Thinking About Now" | Sponsored by Brown & Brown | Oct. 1, 2026 "The 2027 Risk Agenda: 10 Engineering Priorities Risk Leaders Should Act on Now" | Sponsored by Global Risk Consultants | Oct. 8, 2026 "Beyond the Horizon: Turning External Risk Into Decision-Ready Insight" | Sponsored by Verisk Maplecroft | Oct. 15, 2026 "Cybercrime, Fraud and AI: Real-World Threats and Practical Defenses for Business Leaders" | Sponsored by Zurich | Oct. 22, 2026 "Managing Insurance Programs at Scale: What Complex Risk Portfolios Require" | Sponsored by Origami Risk | Oct. 29, 2026 "Signal Over Noise: Smarter Risk Analytics" | Sponsored by Riskonnect | Nov. 5, 2026 Related RIMScast Episodes: "From Wellhead to Burner Tip: Eric Lobser's ERM Journey" "When Geopolitics Hits the Balance Sheet with Cari Stinebower" Sponsored RIMScast Episodes: "48 Hours From a Storm: What to Do Before A Hurricane Strikes" | Sponsored by Global Risk Consultants, a TÜV SÜD Company (New!) "AI-Scale, Risk Ready: Engineering Controls for the New Data Center Boom" | Sponsored by Global Risk Consultants, a TÜV SÜD Company "Facing Into Risk: Navigating the New Risk Landscape" (New!) | Sponsored by AXA XL "Secondary Perils, Major Risks: The New Face of Weather-Related Challenges" | Sponsored by AXA XL "The ART of Risk: Rethinking Risk Through Insight, Design, and Innovation" | Sponsored by Alliant "Mastering ERM: Leveraging Internal and External Risk Factors" | Sponsored by Diligent "Cyberrisk: Preparing Beyond 2025" | Sponsored by Alliant "The New Reality of Risk Engineering: From Code Compliance to Resilience" | Sponsored by AXA XL "Change Management: AI's Role in Loss Control and Property Insurance" | Sponsored by Global Risk Consultants, a TÜV SÜD Company "Demystifying Multinational Fronting Insurance Programs" | Sponsored by Zurich "Understanding Third-Party Litigation Funding" | Sponsored by Zurich "What Risk Managers Can Learn From School Shootings" | Sponsored by Merrill Herzog "Simplifying the Challenges of OSHA Recordkeeping" | Sponsored by Medcor "How Insurance Builds Resilience Against an Active Assailant Attack" | Sponsored by Merrill Herzog "Third-Party and Cyber Risk Management Tips" | Sponsored by Alliant RIMS Publications, Content, and Links: RIMS Membership — Whether you are a new member or need to transition, be a part of the global risk management community! RIMS Virtual Workshops On-Demand Webinars RIMS-Certified Risk Management Professional (RIMS-CRMP) RISK PAC | RIMS Advocacy RIMS Strategic & Enterprise Risk Center RIMS-CRMP Stories — Featuring RIMS President Manny Padilla! RIMS Events, Education, and Services: RIMS Risk Maturity Model® Sponsor RIMScast: Contact sales@rims.org or pd@rims.org for more information. Want to Learn More? Keep up with the podcast on RIMS.org, and listen on Spotify and Apple Podcasts. Have a question or suggestion? Email: Content@rims.org. Join the Conversation! Follow @RIMSorg on Facebook, Twitter, and LinkedIn. About our guest: Roy C. Hock, Director, Risk Finance & Casualty Insurance, Valero October is Energy Awareness Month. Production and engineering provided by Podfly.
Ryan checks in with Tampa Bay Business Journal Editor-at-Large Ashley Kritzer about her Waymo ride experience around Tampa and the new concessions coming to TPA.See omnystudio.com/listener for privacy information.
Are you giving clients a spreadsheet and expecting the numbers to sell the solution for you? In this episode, I sit down with Jason Powers, Partner and Co-Founder of Legacy Brokers, to talk about what it takes to become a more confident, consultative advisor in the self-funded market. We dive into why so many producers hesitate to enter self-funding, what happens when you compete primarily on rate, and how the right support gives you the confidence to lead the conversation. Jason also shares the story behind his journey into insurance and the mission of the “Self-Funded Sensei” brand. Get ready to shift from presenting options to confidently recommending the strategy that's right for your client.In this Episode, You Will LearnWhat led Jason from a TPA administration role into sales and eventually agency ownership.Why a spreadsheet should support your recommendation, not your sales story.The mindset shift from presenting options to making a recommendation.What can keep experienced brokers from entering the self-funded market.Why competing on rate can make your business vulnerable.The value of building trust before introducing a self-funded strategy.How advisors can manage the anxiety that comes with delivering difficult renewal news.Why showing historical performance can change a renewal conversation.How the right GA support can help producers sell with greater confidence.Resources + LinksAccelerate your insurance sales - schedule a discovery call here FollowFollow Jason Powers: @legacybrokersFollow Andy Neary on LinkedIn for more insurance sales strategies and high-performance insights.Learn more about Complete Game Consulting:https://completegameconsulting.com
Monique Burke buys more stop-loss than almost anyone in this business, and the rate is the last thing she looks at.She built OneDigital's stop-loss center of excellence starting with a spreadsheet, an offshore data team, and one other person. It's doubled year over year since. Now it covers everything from marketing a case through claims reimbursement, plus TPA and captive selection, because every time they solved one problem another piece of the stack turned out to be broken.We get into what she checks first on every quote and why, the non-negotiables she won't place a policy without, and why a panel needs roughly ten carriers to function. Monique also explains why a carrier quoting 10% of what you send them is normal, what happens when an employer keeps a sick employee on the plan out of loyalty and finds out too late they weren't eligible, and what her underwriter and nurse are seeing right now in the claims data.If you've ever put a stop-loss spreadsheet in front of a client, this one will change how you read it. Tune in.“We look at what are the contingencies, what are the exclusions. Those are the two things I will always go to first, because that's going to make or break the policy or the decision. I don't care what your rate is." - Monique Burke, OneDigitalThank 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: Building a Stop-Loss Center of Excellence(00:05:00) Why the TPA Choice Makes or Breaks the Plan(00:10:25) If You Want Change, You Have to Make Changes(00:16:00) Meet Monique Burke(00:20:00) Tell Me the Problem, Not the Solution(00:24:00) Building the Panel From Scratch(00:26:00) Why You Need Ten Carriers(00:28:00) They Quoted 48 Out of 412(00:34:00) Pharmacy and the Claims Nobody Caught(00:38:30) What the Claims Data Looks Like Right Now(00:43:00) The Two Things She Checks First(00:46:30) The Non-Negotiables(00:48:30) The Eligibility Trap(00:55:00) Inside OneDigital(01:05:00) When a Captive Beats Going It Alone(01:13:00) Closing ThoughtsKey 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/
Monique Burke buys more stop-loss than almost anyone in this business, and the rate is the last thing she looks at.She built OneDigital's stop-loss center of excellence starting with a spreadsheet, an offshore data team, and one other person. It's doubled year over year since. Now it covers everything from marketing a case through claims reimbursement, plus TPA and captive selection, because every time they solved one problem another piece of the stack turned out to be broken.We get into what she checks first on every quote and why, the non-negotiables she won't place a policy without, and why a panel needs roughly ten carriers to function. Monique also explains why a carrier quoting 10% of what you send them is normal, what happens when an employer keeps a sick employee on the plan out of loyalty and finds out too late they weren't eligible, and what her underwriter and nurse are seeing right now in the claims data.If you've ever put a stop-loss spreadsheet in front of a client, this one will change how you read it. Tune in.“We look at what are the contingencies, what are the exclusions. Those are the two things I will always go to first, because that's going to make or break the policy or the decision. I don't care what your rate is." - Monique Burke, OneDigitalThank 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: Building a Stop-Loss Center of Excellence(00:05:00) Why the TPA Choice Makes or Breaks the Plan(00:10:25) If You Want Change, You Have to Make Changes(00:16:00) Meet Monique Burke(00:20:00) Tell Me the Problem, Not the Solution(00:24:00) Building the Panel From Scratch(00:26:00) Why You Need Ten Carriers(00:28:00) They Quoted 48 Out of 412(00:34:00) Pharmacy and the Claims Nobody Caught(00:38:30) What the Claims Data Looks Like Right Now(00:43:00) The Two Things She Checks First(00:46:30) The Non-Negotiables(00:48:30) The Eligibility Trap(00:55:00) Inside OneDigital(01:05:00) When a Captive Beats Going It Alone(01:13:00) Closing ThoughtsKey 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/
¿Debemos tener miedo a la IA? Tras todas las informaciones que están saliendo en los últimos días, ponemos en contexto la situación con la participación de Marina Dader, de la primera promoción de graduados en Ciencia e Ingeniería de Datos por la Universidad de Oviedo y especializada en IA, junto a oyentes y opinantes. Vuelve Lucía López con la comunicación digital y sus novedades. Recuperamos los buenos hábitos con Mercedes Mérida y la alimentación saludable: ¿qué no tener en casa? Estrenamos sección con Unai Graña, estudiante de 18 años, que nos pondrá al día de las noticias que inquietan a su generación. La divulgación científica vuelve con Noemí Piñeiro Alonso, astrofísica, investigadora distinguida de ICTEA y colaboradora de la NASA. Y cerramos con una interesante charla con Álex Galán y Ángeles Caso, creadora de «Asturias, el pasado que somos», la nueva serie sobre el patrimonio arqueológico de Asturias que se estrena hoy en TPA, que ambos dirigen y que supone la vuelta a la televisión de Ángeles Caso.
La actualidad marcada por el comienzo de las clases universitarias y el fracaso del informe PISA, que pone en jaque el uso de pantallas en las aulas, con oyentes, opinantes y José García Fanjul, Decano del Colegio de Ingenieros Informáticos del Principado de Asturias. A punto de arrancar este sábado la nueva temporada de Los Fernández en TPA, hablamos con “Lita”, la actriz Nerea Vázquez, y con el creador de la serie, Juan Mata. Planes para los próximos días con Esteban Girón, organizador del festival El Pueblo; Lluís Nel Estrada, organizador de Gastrosónica; Sofía Castañón, que dará un recital de poesía en Mieres, y Antía Seijas, coordinadora de La Benéfica de Piloña. Hoy, en Filósofas en la historia, abordamos la conciliación en las mujeres artistas con Cristina Guirao, especialista en sociología de la cultura y del arte y en pensamiento feminista contemporáneo. Los cotidiáfonos con David Varela y una última charla con Jorge Iván Argiz, codirector de las Jornadas del Cómic Villa de Avilés, y Héctor Fernández, autor del cómic El repunante paisanu .
John Lestock joins JD Carlson to expose predatory 401(k) sales tactics and break down the latest industry acquisitions reshaping the recordkeeper landscape. From USI to Aon to Empower's bold moves, here's what advisors and plan sponsors need to know. The 401(k) industry is consolidating fast, and not all of it is good news for advisors and their clients. In this episode, guest John Lestock dives deep into the predatory sales practices advisors encounter daily, then shifts gears to analyze the major M&A activity dominating 2026: USI's acquisition by Aon, Empower's move into defined benefit plans, and Vanguard's acquisition of the Altruist trading platform. We also tackle the messy reality of payroll integration, data warehouses, and the tension between client responsibility and scalability. What happens when recordkeepers promise seamless integrations but the backend doesn't deliver? And how do plan sponsors and advisors navigate the fine line between their fiduciary duty and what's actually feasible at scale? Whether you're a TPA, plan sponsor, recordkeeper, or independent advisor, this conversation hits the pain points of the current market. The team breaks down what these acquisitions mean for your practice, why some sales tactics work (and why they shouldn't), and how to stay competitive when the big players keep getting bigger. Perfect for anyone managing 401(k) plans or advising clients in the defined contribution space. CHAPTERS 0:00 Cold Open: The Retireholics Team 0:34 Episode Agenda and Banter 7:42 Predatory 401k Sales Tactics Exposed 17:24 Industry Acquisitions: USI and Aon 24:22 Empower's Defined Benefit Plan Acquisition 26:51 Vanguard Acquires Altruist Trading Platform 34:19 Mystery Stock: Hims and Hers 43:50 Census Data Collection Challenges 49:48 Payroll Integration and Data Warehouses 54:43 Client Responsibility vs. Scalability 1:02:11 Wrap Up and Closing Remarks MORE FROM RETIREHOLICS Full episode notes & transcript: https://retireholics.com/episodes/john-lestock-predatory-sales-ma-trends-retireholics/ All past episodes: https://retireholics.com/episodes/ Live every 1st & 3rd Thursday at 4:30pm PT: https://retireholics.com/live/ Get show reminders: https://retireholics.com/get-reminders/ SUBSCRIBE YouTube: https://www.youtube.com/@Retireholics Apple Podcasts: https://podcasts.apple.com/us/podcast/retireholics/id1490618217 Podbean: https://retireholiks.podbean.com/ Retireholics is the show changing the retirement industry one beer at a time. Hosted by JD Carlson and co-hosts, covering 401(k) plan design, fiduciary responsibility, fees, investments, and industry news for retirement plan advisors and professionals.
The restoration industry is facing a new reality: fewer insurance claims, tighter margins and a changing consumer mindset. In this episode, Jeff Moore, Chief Acquisitions Officer at ATI Restoration, breaks down what's driving the decline in claim volume and why restorers can't rely on the old business model to carry them forward.Jeff shares why understanding your bottom line matters more than ever, how higher deductibles and rising premiums are changing consumer behavior, and why restoration companies need to become more proactive about connecting directly with consumers.From shrinking TPA volume to narrowing profit margins, this conversation explores what restorers can do now to adapt, remain profitable and find opportunity in a changing market.
The restoration industry is facing a new reality: fewer insurance claims, tighter margins and a changing consumer mindset. In this episode, Jeff Moore, Chief Acquisitions Officer at ATI Restoration, breaks down what's driving the decline in claim volume and why restorers can't rely on the old business model to carry them forward.Jeff shares why understanding your bottom line matters more than ever, how higher deductibles and rising premiums are changing consumer behavior, and why restoration companies need to become more proactive about connecting directly with consumers.From shrinking TPA volume to narrowing profit margins, this conversation explores what restorers can do now to adapt, remain profitable and find opportunity in a changing market.
Hoy lunes, en nuestra sección de Sector Primario, conoceremos la situación de la vendimia asturiana junto a Alicia Fernández, directora técnica de la DOP Cangas.El otoño se acerca y Emma Álvarez Alba, responsable de La Piniesta, en nuestra sección de Medio Ambiente, nos hablará del otoño en Somiedo.Ponemos rumbo a las montañas asturianas con Juan Carlos Martínez, de la web Pasu a Pasu, para descubrir una nueva propuesta de rutas.El sabor llegará de la mano de David Montes, “El Furtivu”, que nos traerá una nueva entrega de nuestra sección Gastro.Abordaremos el bienestar emocional junto a Teresa Bobes, presidenta de la Sociedad Española de Psicología Clínica, en nuestra sección de Salud Mental.La mirada se trasladará después al pasado con Álvaro Solano, profesor de Historia Medieval en la Universidad de Oviedo, para acercarnos a un nuevo episodio de nuestra sección de Historia.Y cerraremos con Sonia Carbajal, directora de “Móntate un programa”, en la TPA.
Whole genome sequencing costs about $1,000 today. Ten years ago it was fifteen. Clinical guidelines already say kids with epilepsy or developmental delay should be escalated to it, and more than half of them never are.My guest this week is Joshua Resnikoff, founder of Sunstone Health and a former bench scientist at Harvard. He came to this the hard way. His middle son started spiking 105-degree fevers at 18 months old, and it took three years and several pediatricians to name the condition. When they finally did, the answer was that there's no treatment.Josh knew the tests existed. He just couldn't reach them. So he built a business that runs employer claims data, finds kids with a likely genetic basis for their disease, and gets them trio whole genome sequencing in twelve weeks instead of seven years.The part that matters for a plan sponsor: this runs as a voluntary benefit. No new plan language, no TPA codes, no prior auth, no insurance in the equation at all. Four documents and a claims feed. Josh takes the testing cost at risk, and getting a family to a diagnosis meaningfully cuts their utilization from there.We also cover why single-gene and exome testing miss 97% of the genome, what it costs, and why these families are already expensive whether you find them or not.If you're looking for cost containment that actually helps the member, this is the episode. Tune in."We can help you deal with that before it ever actually becomes a claim." - Joshua Resnikoff, Sunstone HealthThank 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 Black Box of Healthcare Pricing(00:04:24) 98.6 to 105 in the Time It Takes to Get Milk(00:11:01) Everything on the Shelf, Nothing Within Reach(00:16:40) One in Ten Americans(00:22:45) What Genetic Testing Actually Means(00:29:33) Who Pays, and Why the Families Already Know(00:34:56) The Case for Sequencing Everyone(00:40:00) The Guidelines Say Do It. Half Don't.(00:45:17) Direct Primary Care and the Voluntary Benefit Model(00:50:57) The Mechanics: Four Documents and a Claims Feed(00:55:40) Vendor Fragmentation and the Netflix Problem(01:00:48) The Moonshot and the $2 Trillion in WasteKey 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/
What happens when asset owners stop managing asset classes and start managing the whole fund? How do portfolios change, and how does the industry reorient their business models around them? In this episode, a practical sequel to Season 1's introduction, we break down how TPA changes investment processes, how portfolios differ under an SAA framework, and what this means for external managers. With insights from CPP Investments, NZ Super, Blue Owl, and Capital Group, the conversation highlights how partnership, transparency, and solution-oriented relationships reshape the manager-investor relationship in a TPA world.Guests:Geoffrey Rubin, Chief Investment Strategist, Total Portfolio Management, CPP Investment BoardCharles Hyde, Head of Asset Allocation, New Zealand Superannuation Fund Eugene Podkaminer, Institutional Solutions, Capital GroupJames Clarke, Senior Managing Director, Global Head of Institutional Capital, Blue Owl CapitalEpisode Sources
Whole genome sequencing costs about $1,000 today. Ten years ago it was fifteen. Clinical guidelines already say kids with epilepsy or developmental delay should be escalated to it, and more than half of them never are.My guest this week is Joshua Resnikoff, founder of Sunstone Health and a former bench scientist at Harvard. He came to this the hard way. His middle son started spiking 105-degree fevers at 18 months old, and it took three years and several pediatricians to name the condition. When they finally did, the answer was that there's no treatment.Josh knew the tests existed. He just couldn't reach them. So he built a business that runs employer claims data, finds kids with a likely genetic basis for their disease, and gets them trio whole genome sequencing in twelve weeks instead of seven years.The part that matters for a plan sponsor: this runs as a voluntary benefit. No new plan language, no TPA codes, no prior auth, no insurance in the equation at all. Four documents and a claims feed. Josh takes the testing cost at risk, and getting a family to a diagnosis meaningfully cuts their utilization from there.We also cover why single-gene and exome testing miss 97% of the genome, what it costs, and why these families are already expensive whether you find them or not.If you're looking for cost containment that actually helps the member, this is the episode. Tune in."We can help you deal with that before it ever actually becomes a claim." - Joshua Resnikoff, Sunstone HealthThank 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 Black Box of Healthcare Pricing(00:04:24) 98.6 to 105 in the Time It Takes to Get Milk(00:11:01) Everything on the Shelf, Nothing Within Reach(00:16:40) One in Ten Americans(00:22:45) What Genetic Testing Actually Means(00:29:33) Who Pays, and Why the Families Already Know(00:34:56) The Case for Sequencing Everyone(00:40:00) The Guidelines Say Do It. Half Don't.(00:45:17) Direct Primary Care and the Voluntary Benefit Model(00:50:57) The Mechanics: Four Documents and a Claims Feed(00:55:40) Vendor Fragmentation and the Netflix Problem(01:00:48) The Moonshot and the $2 Trillion in WasteKey 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/
Tod Ruble from Custodia breaks down hybrid capital structures, 3(38) fiduciary responsibilities, and what advisors need to know about plan custodian security after the TrueStage cyber disaster. Learn the real risks and pricing models. In this episode, host JD Carlson sits down with Tod Ruble to explore Custodia's role in the 401(k) ecosystem and the growing complexity of 3(38) fiduciary arrangements. We dig into what hybrid capital means for plan sponsors, the specific fiduciary responsibilities advisors take on when recommending custodial services, and the pricing models that actually work in the field. Tod also walks us through the TrueStage cybersecurity incident: what happened, the timeline, and what it means for transparency and trust in the industry. We don't shy away from the hard questions: participant loan defaults, loan insurance products, ACH payment security, and loan portability all get the Retireholics treatment. Whether you're a TPA, plan sponsor, recordkeeper, or advisor, this conversation covers critical ERISA compliance considerations and practical custodian selection criteria. Plus, we test some new AI-powered compliance monitoring tools in our "Dope or Nope" segment. Perfect for anyone managing fiduciary risk or evaluating custodial partners. Grab a cold one and tune in. CHAPTERS 0:00 Cold open and introductions 4:08 Introducing guest Tod Ruble 9:28 Opening toast and guideline discussion 10:58 Custodia and hybrid capital explained 15:43 3(38) fiduciary responsibilities and risks 21:29 Pricing for 3(38) services 33:31 TrueStage cyber security debacle 39:33 Timeline and transparency issues 43:51 Participant loan defaults and accessibility 47:33 Loan insurance product overview 53:24 ACH payments and loan portability 1:01:38 Dope or nope segment begins 1:10:27 AI tools for compliance monitoring 1:15:30 Closing remarks and thank yous MORE FROM RETIREHOLICS Full episode notes & transcript: https://retireholics.com/episodes/tod-ruble-custodia-338-fiduciary-risks-cyber-retireholics/ All past episodes: https://retireholics.com/episodes/ Live every 1st & 3rd Thursday at 4:30pm PT: https://retireholics.com/live/ Get show reminders: https://retireholics.com/get-reminders/ SUBSCRIBE YouTube: https://www.youtube.com/@Retireholics Apple Podcasts: https://podcasts.apple.com/us/podcast/retireholics/id1490618217 Podbean: https://retireholiks.podbean.com/ Retireholics is the show changing the retirement industry one beer at a time. Hosted by JD Carlson and co-hosts, covering 401(k) plan design, fiduciary responsibility, fees, investments, and industry news for retirement plan advisors and professionals.
Send us Fan MailIn our latest episode, Yvonne and Rafael talk to Denise Evans, Director of Claims at Staffmark Group.Guest Bio:Denise Evans | Director of Claims, Staffmark Group37 years in the workers' compensation industryNational temp staffing program leadership—managing claims across multiple industries and statesStrategic program architect and industry connector; active in the National Council of Self-InsuredsOur ConversationIn this episode, we tackle unbundling—a strategic choice most self-insured companies face, but few really understand. It affects your costs, outcomes, control, and flexibility.The Choice: Bundled vs. UnbundledBundled: You contract with a carrier or TPA. They handle provider networks, vendor relationships, and medical management. You get discounts from their preferred partners and operational convenience in exchange for limited control. It's predictable. It's hands-off.Unbundled: You build and manage your own program, or parts of your program. You choose providers, set vendor relationships, own day-to-day decisions. You lose some negotiated discounts but gain control and flexibility.For most companies, bundling is the default. The real question is whether it actually works for your business.You Don't Have to Unbundle Everything at Once: Here's what most people miss: unbundling doesn't have to be all or nothing. You can be selective and phased. Build the option into your contract, then unbundle component by component as your capacity grows. Denise unbundles specific areas where control matters most to Staffmark—nurse case management, pharmaceutical, DME, bill review, transportation, translation. The point is to move at your own pace rather than changing the entire program all at once. That's what distinguishes companies that successfully unbundle from those that get overwhelmed and abandon it.Why This MattersThe case for unbundling: When you need control over outcomes that matter to your business—return-to-work rates, duration management, cost containment. You have a specific workforce (or multiple workforces) requiring tailored medical management. You have the internal capacity to manage vendors.Denise's example: Staffmark handles employee leasing and staffing. Workers move between client sites, industries, and states. A one-size-fits-all bundled network doesn't work. They unbundled to have more agility—the ability to build relationships with providers who understand Staffmark's unique recovery demands.The case for bundling: You want predictability. You lack bandwidth for vendor management. You'll accept good-enough outcomes for operational simplicity.The hard truth: Unbundling isn't cost-cutting. It's an investment. You're paying for vendor management infrastructure, relationship-building, and reporting sophistication to defend your program to carriers. Without that capacity, you'll end up worse off than you started.The Core QuestionIs your current program structure actually supporting your business outcomes?If your business depends on a specific workforce profile, recovery timeline, or outcome metric—and your bundled program doesn't optimize for that—you're paying for convenience while leaving money on the table.If you unbundle without infrastructure to manage it, you're paying more for worse results.Let the decision be driven by what you're optimizing for. Not cost. Not convenience. What outcome matters most? Then ask: which structure gets you there?Your Carrier Relationship ChangesUnbundling shifts accountability. When you bundle, the carrier owns program quality and accountability. When you unbundle, you do.Carriers will want data, evidence of sound decisions, transparency into what's working. If your unbundled program underperforms, that becomes a negotiation point at renewal—and it can be expensive.This is why infrastructure matters. You need reporting, metrics, proof points to show carriers your program is solid. If you can defend your approach with data, you have leverage. If you can't, you're vulnerable.Workforce Complexity Drives the DecisionStaffmark operates across temp staffing—workers move between client sites, industries, and geographies. Claims span manufacturing, healthcare, and logistics in the same population.A bundled one-size-fits-all network becomes a liability. You need providers who understand different recovery demands across industries and can move fast. Unbundling becomes a business necessity, not a luxury.Single-industry, stable-geography workforce? Bundling's convenience might be your sweet spot. Complex, multi-industry workforce? You may not have a choice.The Fragmentation FactorManaging a national program across 50+ state regulations, different medical networks, and different carrier relationships is expensive and fragmented.The companies doing this well aren't isolated. They're connected to others solving the same problems. They attend conferences not for networking, but because that's how they hear about approaches that actually work, meet vendors who get it, and stay current on what's changing. That's operational necessity, not optional.Key TakeawaysLet strategy drive structure. What outcome matters most to your business? Answer that first. Too many companies let vendor relationships or carrier preferences dictate strategy.Unbundling requires investment. You need vendor management capacity, reporting sophistication, and the ability to defend your program to carriers. Without it, you'll end up worse off.You own the quality when you unbundle. Expect more carrier scrutiny, more data requirements, more accountability at renewal. But you also get leverage if your program performs.Your business model determines complexity. Multi-industry, multi-state workforce? Your program needs flexibility. Single industry, single state? Bundling might be your answer.Making This DecisionDon't let bundling be your default just because it's convenient. Talk with your team, your carrier, and peers who've navigated this.The real question: does your current structure support your business outcomes? That's worth figuring out. Denise mentioned her work with the National Council of Self-Insurers. Next year, the conference will be at the historic Grove Park Inn in Asheville, NC. It's a great conference to attend if you want to connect with people actually doing this kind of work.¡Muchas Gracias! Thank you for listening. We would appreciate you sharing our podcast with your friends on social media. Find Yvonne and Rafael on Linked In or follow us on Twitter @deconstructcomp
Michael Harrison told his insurance agent he'd do $250,000 his first year in business. He finished at $1.6 million.In this episode, host Clinton James sits down with Michael Harrison, owner of Mid-South Restoration Services and 1-Tom-Plumber Memphis. Michael started in the trade at 14 as his brother's helper and spent 20 years learning it at franchises and independents before two phone calls on one drive home pushed him to go out on his own.You'll walk away with:How he built a 100% referral business on insurance agents and adjustersWhy he tells agents straight when a loss isn't worth filing a claim onWhy his $6M year was less profitable than his smaller yearsWhy he turned down a TPA that wanted a cut of referrals he already earnedHow he cash funded a 1-Tom-Plumber franchise to be the first call when a building floodsThe culture decision he sat on too long, and what it cost himWant to connect with Michael or learn more about Mid-South Restoration Services and 1-Tom-Plumber Memphis?www.1tomplumber.com/memphis-tnwww.midsouthrestoration.com-----Subscribe to Restoration Pros Unplugged and visit restorationprosunplugged.com-----Running a restoration company and want to get more jobs from your online marketing? Book a free discovery call with Water Restoration Marketing at https://waterrestorationmarketing.com/discovery-call/
Ary Rosenbaum talks about why plan sponsors can't rely completely on a TPA because they're still on the hook for liability.
Send us Fan MailWe spend roughly 90% of our lives indoors, but how often are our homes actually designed with our health in mind?In this episode of Never Been Sicker, Michael Rubino sits down with Kelly Grace, a non-toxic architect, to uncover what goes into creating a truly healthy home.Kelly explains why conventional architecture and building practices often prioritize cost, aesthetics, efficiency, and basic safety while overlooking how materials and design choices can affect the people living inside.They dive into building materials, moisture and mold, ventilation, flooring, drywall, furniture, mattresses, air quality, and the hidden decisions that can make the difference between a beautiful home and a health-supporting one.Kelly also reveals materials she personally avoids, why she believes drywall has no place in bathrooms, the problems she sees with popular flooring options like LVP, and why even brand-new homes can develop moisture problems.-----------------------------------------------------------------------------------------------CHAPTERS:00:00 Introduction01:00 What Is a Non-Toxic Architect?04:00 Why Kelly Started Designing Healthier Homes07:00 Are Modern Homes Actually Built for Health?10:00 The Problem With Conventional Building Materials14:00 Mold, Moisture & Modern Construction18:00 Why Kelly Wouldn't Put Drywall in a Bathroom22:00 Building Codes vs. Human Health26:00 The Ventilation Problem30:00 Flooring a Non-Toxic Architect Avoids34:00 Hidden Toxins in Furniture & Mattresses39:00 Why New Homes Can Still Have Mold44:00 Building a Healthy Home From Scratch49:00 Healthier Changes You Can Make Right Now54:00 Kelly's Biggest Healthy Home Takeaways57:00 Where to Find Kelly Grace-----------------------------------------------------------------------------------------------Kelly Grace is an accomplished architect based out of Washington DC, and the Managing Principal of Travis Price Architects, an award-winning architecture firm, widely applauded for their visionary aesthetics, informed by ecology, mythology, and technology. TPA seeks to create an enduring archaeology for tomorrow, through culturally diverse inspirations, natural self-reliance, and high-performance building practices.Kelly is known to many as the “NONTOXARCHITECT” on social media, where she shares her advice on material selections, design details, indoor air quality, water filtration, biohacking, EMF mitigation, moisture control, and much more. She is dedicated to designing healthy buildings, using non-toxic products, to promote wellness habits and optimal living. Kelly is also a Founding Member of the Healthy Building Alliance, an up-and-coming platform to connect healthy building professionals; architects, builders, engineers, homeowners, consultants, and product manufacturers, to provide a network of resources and educational tools, based on proven building biology and building science principles.Kelly and her husband Matt live in Davidsonville, MD with their three children, Atlas, Adelyn, and Roark, twenty chickens, and dogs Blue and Ruby.
Brad from Public Interest Alberta and I discuss the TPA campaign https://www.albertareferendum2026.org/ encourage others to apply for their special ballot, sign up for volunteering and scrutineering.https://drive.google.com/drive/folders/1gBLWL_q2oZw7xYbfkq-VVK3F4_MjeJt-?usp=drive_link ★ Support this podcast on Patreon ★
Sheri Fitts joins JD Carlson to break down stretch matches vs. non-elective contributions, fiduciary responsibilities, and the latest on pooled employer plans. Essential listening for 401(k) advisors staying ahead of plan design trends. In this episode, Sheri Fitts dives deep into critical plan design strategies that every 401(k) advisor needs to master. We explore the nuances of stretch match versus non-elective contribution approaches, and when to deploy each strategy for your clients. A major highlight: Fred Reish's breakdown of 3(38) fiduciary duties and what they mean for your advisory practice. Understanding fiduciary responsibilities under ERISA is non-negotiable, and this segment cuts through the complexity. We also tackle the evolving landscape of target date funds and alternative assets, discussing how to position these solutions for plan sponsors. Plus, hear Sheri's perspective on personal branding in financial services, a competitive edge many advisors overlook. Rounding out the conversation: Strong Point Partners TPA tools, advisor technology and data integration challenges, pooled employer plans (PEPs) and their role in plan innovation, and key takeaways from the Nashville conference. Whether you're a TPA, plan sponsor, recordkeeper, or independent advisor, this episode delivers actionable insights on compliance, plan design strategy, and building your practice in a competitive market. CHAPTERS 0:00 Cold Open and Welcome Back 6:24 Stretch Match vs. Non Elective Contributions 15:35 Fred Reish on 3(38) Fiduciary Duties 23:48 Target Date Funds and Alternative Assets 25:52 Nashville Conference Recap and Gratitude 28:07 Personal Branding in Financial Services 38:38 Strong Point Partners TPA Tools 43:12 Advisor Technology and Data Integration 56:37 Industry Updates and Conference Drops 1:01:39 Pooled Employer Plans, Innovation or Packaging 1:10:03 Wrap Up and Thanks MORE FROM RETIREHOLICS Full episode notes & transcript: https://retireholics.com/episodes/sheri-fitts-plan-design-fiduciary-duties-peps-retireholics/ All past episodes: https://retireholics.com/episodes/ Live every 1st & 3rd Thursday at 4:30pm PT: https://retireholics.com/live/ Get show reminders: https://retireholics.com/get-reminders/ SUBSCRIBE YouTube: https://www.youtube.com/@Retireholics Apple Podcasts: https://podcasts.apple.com/us/podcast/retireholics/id1490618217 Podbean: https://retireholiks.podbean.com/ Retireholics is the show changing the retirement industry one beer at a time. Hosted by JD Carlson and co-hosts, covering 401(k) plan design, fiduciary responsibility, fees, investments, and industry news for retirement plan advisors and professionals.
Katy Talento ran healthcare at the White House Domestic Policy Council and helped push through the price transparency executive order. Now she runs health plans for a living, including for the convent where she once lived as a nun.She spends this episode on why a post-network world keeps hitting the same wall: the three-way contracts between carrier, TPA, and provider that make the network Plan A by force. She explains why she thinks those provisions violate the Sherman Act, what DOJ has started doing about it, and why the workarounds employers use today amount to an underground railroad rather than a functioning market.We also cover the 2026 CAA and the DOL rule that together make PBMs fiduciaries and may do the same to TPAs, her four-part "school choice for healthcare" plan to scale cash pay nationally, and the AI upcoding wave she thinks is breaking stop-loss actuarial models right now.If you've ever wondered why the obvious fix isn't available to you, this is the episode. Tune in."Nobody in the entire town understands employer-sponsored care. All the oxygen is on 20 million people on the ACA. But 180 million people over here, we're not doing any policy for." - Katy TalentoThank 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(00:01:05) From Epidemiologist to Capitol Hill(00:05:37) The Nun Years and Her First Client(00:10:50) Inside the Price Transparency Executive Order(00:16:58) Why Washington Ignores 180 Million People(00:20:33) What Transparency Data Can Actually Do Now(00:25:55) The Plantation Contracts(00:29:01) DOJ, the Sherman Act, and Anti-Competitive Provisions(00:33:04) The CAA and the DOL Rule That Reset Fiduciary Duty(00:39:16) Why the Big Three PBM Model Is Now Illegal(00:46:53) RBP's Access Problem: The Nuns at NYU Langone(00:54:54) The Holy Grail: One Cash Price(00:57:46) School Choice for Healthcare(01:13:43) AI Upcoding and Why Stop-Loss Models Broke(01:21:15) Closing Thoughts: Tell Your StoryKey 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/
Katy Talento ran healthcare at the White House Domestic Policy Council and helped push through the price transparency executive order. Now she runs health plans for a living, including for the convent where she once lived as a nun.She spends this episode on why a post-network world keeps hitting the same wall: the three-way contracts between carrier, TPA, and provider that make the network Plan A by force. She explains why she thinks those provisions violate the Sherman Act, what DOJ has started doing about it, and why the workarounds employers use today amount to an underground railroad rather than a functioning market.We also cover the 2026 CAA and the DOL rule that together make PBMs fiduciaries and may do the same to TPAs, her four-part "school choice for healthcare" plan to scale cash pay nationally, and the AI upcoding wave she thinks is breaking stop-loss actuarial models right now.If you've ever wondered why the obvious fix isn't available to you, this is the episode. Tune in."Nobody in the entire town understands employer-sponsored care. All the oxygen is on 20 million people on the ACA. But 180 million people over here, we're not doing any policy for." - Katy TalentoThank 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(00:01:05) From Epidemiologist to Capitol Hill(00:05:37) The Nun Years and Her First Client(00:10:50) Inside the Price Transparency Executive Order(00:16:58) Why Washington Ignores 180 Million People(00:20:33) What Transparency Data Can Actually Do Now(00:25:55) The Plantation Contracts(00:29:01) DOJ, the Sherman Act, and Anti-Competitive Provisions(00:33:04) The CAA and the DOL Rule That Reset Fiduciary Duty(00:39:16) Why the Big Three PBM Model Is Now Illegal(00:46:53) RBP's Access Problem: The Nuns at NYU Langone(00:54:54) The Holy Grail: One Cash Price(00:57:46) School Choice for Healthcare(01:13:43) AI Upcoding and Why Stop-Loss Models Broke(01:21:15) Closing Thoughts: Tell Your StoryKey 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 say it all the time on this show: sales first. But sales without financial controls is a mess waiting to happen, and that's exactly why we're launching our monthly money talk with Jim Emerich, founder of Backbone Fractional CFO Consultants. Jim brought a story about a multigenerational contractor that doubled from 5 to 10 million and started losing money. Margins squeezed, line of credit maxed, wrong desk at the bank. The lesson for every business owner in the trades: scaling the top line without watching your pricing, cost structure, and cash flow is how good companies go under. We dig into the 13-week cash flow forecast, collecting receivables faster, and why the "real money is in commercial" mindset nearly bankrupts contractors who don't plan for those payment terms. This is practical financial management for blue-collar businesses, and it's a conversation I think every owner needs to hear. Restoration, roofing, HVAC, plumbing, landscaping. If you build it, fix it, or maintain it, this show is for you. Hope you enjoy, Brandon and Chris Why You Should Listen [4:49] The ankle story: what pushing through pain costs you in your body and your business [9:20] How a contractor doubled revenue, lost money, and ended up sideways with their bank [14:28] The 13-week cash flow forecast: one weekly discipline that changes your decision making [30:49] Making restoration cash flow predictable: collection time, TPA terms, and job duration [34:05] Residential vs commercial: pricing for payment terms before they bury you Need a fractional CFO partner? Find Jim and his team at BackboneCFO.com. About the Show Head, Heart, & Boots is for the men and women who build things for a living. Restoration, roofing, HVAC, plumbing, landscaping, and every blue collar trade in between. Hosts Brandon Reece and Chris Nordyke built and scaled real companies in the restoration industry, and they have carried those hard-won lessons into every blue collar trade they work with today. Every week they dig into the head (strategy), the heart (culture and people), and the boots (execution) of running a business worth owning. This show is the front door to Floodlight Consulting Group, where Brandon, Chris, and the team help trades businesses find the money already sitting inside them and build companies worth far more than the day they started. Same people, same mission, whether you are listening or working with us directly. Ready to see what that looks like in your business? Start Here! Owning a business in the trades can be the loneliest job there is. Head, Heart, & Boots exists to change that, because the best leaders don't go it alone, and neither should you.
18 months into JCBA negotiations, talks have slowed with key sticking points around pay banding for larger narrowbodies, vacation and sick leave provisions, and other cost and control items. The Transition and Process Agreement (TPA) is guiding how new and growth aircraft are assigned—recently assigning 737 freighters to Alaska pilots and an A330 freighter to Hawaiian pilots until seniority list integration (SLI). The TPA protects minimum fleet and block-hour levels for each pilot group until SLI, complicating plans to replace Hawaiian 717s with 737-800s in Honolulu. If the JCBA is ratified, SLI could take up to about 13 months to complete; next negotiation meetings are scheduled for August 18–19. Pilots are encouraged to stay engaged through updates and local events.
AI is everywhere, but are property management companies asking the right questions before implementing it? In this episode of the #DoorGrowShow, Jason Hull sits down with Mo Hussain to discuss why successful AI adoption has far less to do with technology and far more to do with operational clarity. Instead of chasing the latest AI tools, Mo introduces his Measure, Map, Automate framework to identify operational bottlenecks, uncover hidden profit leaks, and build workflows that actually improve business performance. Together, they explore why clean data is the foundation of automation, how undocumented processes create costly inefficiencies, and why AI should enhance human decision-making rather than replace it. You'll Learn [00:00] Meet Mo Hussain and the Measure, Map, Automate Framework [03:20] Why Most Companies Ask the Wrong AI Questions [08:10] The Role of Clean Data in AI Success [12:45] Mapping Workflows Before Automating Them [15:30] The Process Myth and Better Operational Systems [21:10] Building Accountability Into AI Workflows [25:15] Designing AI Agents That Actually Perform [27:45] Turning Operational Data Into Business Growth [29:15] Final Advice for Property Management Leaders Quotables "AI value really truly is workflow value." Mo Hussain "AI depends on trusted operational data." Mo Hussain "The winners are not gonna be the companies that have the most amount of data, but they're the ones that can convert data into consistent operating actions." Mo Hussain Resources DoorGrow and Scale Mastermind DoorGrow Academy DoorGrow on YouTube DoorGrowClub DoorGrowLive Transcript Jason Hull (00:00) welcome everybody. I'm Jason Hull, the founder and CEO of DoorGrow, the world's leading and most comprehensive coaching and consulting firm for long-term residential property management entrepreneurs. For over a decade and a half, we have brought innovative strategies and optimization to the property management industry. At DoorGro, we are on a mission to transform property management business owners and their businesses. We want to transform the industry, eliminate the BS, build awareness, change perception, expand the market, and help the best property management entrepreneurs win. Now let's get into the show. And my guest today is Mo Hussain, and we're going to be talking about how property management companies can stop drowning in data and start turning it into real operational growth. In this episode, Mo is breaking down the measure, map, and automate framework that he has built and approach an approach to uncovering hidden margins, reducing manual oversight, and getting more value out of every door in your portfolio. right. is Mo Hussain. Mo, welcome to the show. Mo Hussein (01:01) Hey Jason, happy to be here. Jason Hull (01:03) So today we're going to be chatting a little bit about how property management companies can stop drowning in data and start turning it into real operational growth. And Mo's going to break down the measure, map, and automate framework, his approach for uncovering hidden margins, reducing manual oversight, and getting more value out of every door in your portfolio. So cool, measuring is important. We'll get into that. So before we get into that, Mo, Can you give people a little bit of background on yourself? How did you get into entrepreneurism? How did you get connected to property management? And help everybody understand who Mo is. Yeah. Mo Hussein (01:42) Yeah. great question. So I I've been in this industry now for probably coming up on 20 years at this point. I I worked at some of the prop tech and software providers that are prevalent in the space. Namely, I worked at both YARTI App Folio, which are both kind of headquartered in in Santa Barbara. and a little bit over ten years ago, I started a consultancy and accounting CPA practice that specifically focuses on Jason Hull (01:56) Namely, I worked at both YARDIE and at Folio, which are both kind of headquartered in in Santa Barbara. a little bit over ten years ago, I started a consultancy and accounting TPA practice that specifically focuses on prop tech and real estate. So we offer consultations with implementations, custom reporting, operationalizing around technology, which is which is now the buzz around kind of AI and automation at this point. Mo Hussein (02:11) Prop tech and real estate. So we offer consultations with implementations, custom reporting, operationalizing around technology, which is which is now the buzz around kind of AI and automation at this point. and then we've also built products for the space to help with automations, help with you know accounting compliance and bringing visibility and custom reporting capabilities to operators. So kind of leveraging all the experience. Jason Hull (02:25) And then we've also built products for the space to help with automations, help with you know, accounting compliance and bringing visibility and custom reporting capabilities to operators. So kind of leveraging all the experience Mo Hussein (02:40) from working as a consultant and also as an accountant and even working as some of these tech providers now being a actual supplier in the industry. Jason Hull (02:41) from working as a consultant and also as an accountant and even working as some of these tech providers now being a aqua supplier in the industry. Very cool. Very cool. So you're a little bit nerdy. Mo Hussein (02:52) A little bit. Data. I love data. Right. Jason Hull (02:53) Okay, so am I. So am I. All right. So cool. So let's talk nerdy to me, Mo. All right. So let's let's chat about this. So let's get into it. So t tell us about this. Wha why is this wh how'd you come up with this framework? Why is this important? I love frameworks because frameworks are usually where we take something that we notice a pattern in, there's some complexity involved, and we make it simple. So explain to us. Mo Hussein (02:59) Yeah. Jason Hull (03:18) Where does the measure map and automate framework kind of come from? Mo Hussein (03:22) Right, right. And this is this kind of stems from a conversation you probably have with plenty of your your clients and even prospects when you start engaging, you know, the the the very popular question now of how do we use AI? I want to streamline and automate. And it's a very loaded, it's a very loaded, fairly ambiguous question, right? How do we use AI? We want to implement AI into our operations, right? Jason Hull (03:23) And this is this kind of stems from a conversation you probably have with plenty of your You know, the the the the very popular question now, how do we use AI? It's a very loaded, fairly ambiguous question, right? How do we use AI? We want to implement AI more. Mo Hussein (03:48) when conversely, like you know, operators and property managers should be starting with a different qu set of questions, right? Like how like where are we losing things like NOI, margin, time, control, or even consistency, right? AI really only matters when it connects and automation really only matters when it connects to a to a revenue lever or some type of a cost lever or productivity gain or or risk reduction, right? Jason Hull (03:50) Conversely, like you know, operators, property managers should be starting with a different set of questions, right? Like how like where are we losing things like NOI, margin, time, control, or even consistency, right? AI really only matters when it connects in automation really only matters when it connects to a to a revenue lever or some type of a cost lever, productivity gain or or risk reduction, right? Yeah. there's there's a couple Mo Hussein (04:14) and there's there's a couple of key components Jason Hull (04:16) key components in even conversations that you've probably even had with with property managers today is that firstly like you know operators today they already have a lot of data. They probably have access to a lot of different data sets across, you know, operations, but it's probably, you know, disconnected and disjointed and different reports and disconnected systems, hidden in spreadsheets and and dashboards that probably don't drive much much action, right? and everybody wants Mo Hussein (04:17) in even conversations that you've probably even had with with property managers today is that firstly, like, you know, operators today, they already have a lot of data. They probably have access to a lot of different data sets across, you know, operations, but it's probably, you know, disconnected and disjointed and different reports and disconnected systems hidden in spreadsheets and and dashboards that probably don't drive much much action, right? and everybody wants to Jason Hull (04:43) to automate and execute Mo Hussein (04:43) automate and execute an operational kind of workflow. But the hard part is not whether, you know, AI can really do something, but the hard part is whether a company even knows where value is leaking and who owns that action and and whether these workflows are even clear enough to to be able to automate. And that's kind of the premise of this framework is to kind of measure what that pain is, you know, map that workflow, automate that repetitive work and manage Jason Hull (04:45) an operational kind of workflow. The hard part is not whether you know AI can really do something, but the hard part is whether a a company even knows where value is leaking and who owns that action and and whether these workflows are even clear enough to to be able to automate. And that's kind of the premise of this framework is to kind of measure what that pain is, you know, map that workflow, automate that repetitive work, and manage ideally performance through some type of closed loop accountability. We just put an actual word to it, right? A framework to it, I'm sure Mo Hussein (05:07) ideally performance through some type of a closed loop accountability. We just put an actual word to it and a framework to it, but I'm sure very similarly to the conversations that you're probably having also even with customers. Jason Hull (05:15) Very similarly to the conversations that you're probably having also with customers. Yeah, yeah, got it. Yeah. it's interesting because we're now seeing a lot of these tech companies or tech forward companies that are kind of backtracking on AI a little bit. They were giving out basically blank checks to use AI as much as they could. Some were even creating sort of a contest internally, incentivizing like who could use the most tokens. Mo Hussein (05:29) Mm. Right. You're right. Jason Hull (05:41) Which is a little bit insane to just give people a blank check as if that always the more tokens you burn, the more productivity is being created, right? Mo Hussein (05:51) Right, right, right. And we're seeing, yeah, and you know, as we're seeing these newer models that are coming out, whether it's, you know, through Cloud, Anthropic or even these other these other LLMs, the token utilization is becoming more and more expensive, especially with these newer models. And so now the question of just like, hey, how is that utilization actually translating to actual business value? Right. And this was a question that eventually would have been would have been pushed, right? Jason Hull (05:54) Yeah and you know. Of just like, hey, how's that utilization actually translating to actual business value? Right. Yeah. Yeah. Yeah. I love it. Like how to use AI. Yeah. Bad question. A better question is how do we actually make sure we're creating more profit? How do we actually make sure we are lowering costs? Like And that's the the idea, they think, well, AI must be so much cheaper than people. And what's interesting, I've also seen some reports lately showing the amount of money these different LLMs are losing right now. They're spending a massive amount of money to deliver AI to us at a super cheap price right now. And but they're losing money. Every time we're chatting, they're losing money. Mo Hussein (06:47) Mm-hmm. Right. Right. Jason Hull (07:01) And that's that's a wild business model. They're obviously hoping to win some sort of AI race. They're hoping to get us maybe in the future. And there's a lot of talk lately as well of people thinking we gotta shift to local models. Like we gotta I gotta run this AI stuff on my own computer and not be giving all my money to anthropic or open AI you know, open AI or whatever. So okay. Mo Hussein (07:15) Mm-hmm. Right, right. Right. Jason Hull (07:26) Cool. So let's continue on. Me measure, map and automate. Yeah. Yeah. Mo Hussein (07:29) Yeah. Yeah. And by the way, going on your point, Jason, it's you know, you you also, you know, creating automation and leveraging these models locally, it there's definitely value in that. But you know, now more than ever, f you know, teams are kind of distributed, right? And so ideally, if you've built automations and leveraging these L LMs and Jason Hull (07:35) Yeah, y you also you know Locally it is definitely that Teams are kind of distributed, right? Yeah. Ideally, if you've built automations and leveraging these LLMs and Mo Hussein (07:52) And things of that sort. You probably want to have like some type of an interface that's like cloud based, right? Or for folks to be able to kind of collaborate in some type of a ideally like a safe environment, right? and so measure, map and and automate. So you know, there's there's kind of those three components to be able to actually fully ideally leverage leverage AI. But Jason Hull (07:55) some type of a an interface that's like cloud based, right? Or for folks to be able to kind of collaborate in some type of a ideally like a safe environment, right? yeah. So measure, map and and automate. So you know there's there's kind of those three components to be able to actually fully ideally leverage leverage AI but there's there's a couple like kind of key core components that feel like Mo Hussein (08:20) There's there's a couple of like kind of key core components that I feel like is very important for folks to to really understand before they can they they can even take advantage of of AI, right? so one is you know AI, AI value really truly is workflow value. And so like the most the biggest opportunities when it comes to automation leveraging AI is things that are repetitive. Jason Hull (08:25) is very important for folks to to really understand before they can they they can take advantage of of AI, right? so one is, you know, a AI AI value really truly is a workflow value. And so like the most automation leveraging AI as things that are repetitive, you know, judgment heavy, ideally high volume workflows. Think about things like you know, leasing follow-up, delinquency, turns, maintenance, triage, variance explanations. another another key thing to understand is you know AI depends on trusted ideal operational data. And so if you don't have accurate or clean property unit, resident, vendor, Mo Hussein (08:44) you know, judgment heavy, ideally high volume workflows. Think about things like you know, leasing follow-up, d delinquency, terms, maintenance triage, variance explanations. another another key thing to understand is, you know, AI depends on trusted ideally operational data. And so if you don't have accurate or clean property unit, resident vendor payment data and it's and it's inconsistent, you know, AI just Jason Hull (09:10) payment data and it's and it's inconsistent, you know, AI just helps accelerate the wrong answer, right? This notion of like hallucinations also kind of exist. and you know insights without ownership is is just is really just theater. And so although AI may identify a problem and recommend an action, things need to be routed, right? And asci you know action needs to be assigned, there needs to be some accountability that gets created there and then a measurement of of of Mo Hussein (09:13) helps accelerate r the wrong answer, right? And the this notion of like hallucinations also kind of exist. and you know insights without ownership is is just is really just theater. And so although AI may identify a problem and recommend an action, things need to be routed, right? And as I you know action needs to be assigned. There needs to be some accountability that gets created there and then a measurement of of of a of of a of a result. Jason Hull (09:40) of of a of a result. and then lastly like humans humans control still matters, right? Things that have a very high potential opportunity cost. you know, operators should be very careful on how they utilize AI. So, you know, things around fair housing, sensitive sensitive decisions like screenings, evictions, legal communication, you know, employee decisions and maybe even large payment loopholes and so Mo Hussein (09:42) and then lastly like humans, humans control still matters, right? Things that have a very high potential opportunity cost. you know, operators should be very careful on how they utilize AI. So, you know, things around fair housing, sensitive sensitive decisions like screenings, evictions, legal communication, you know, employee decisions and maybe even large payment approvals. And so Once we have these kind of these table stake table stake items, if you will, kind of address, then you know we can move on to kind of you know the our framework of kind of measure, map, and automate. And so in each of these different components have different purposes, you know. The whole point of the measure step is is to quantify where pain exists and to validate kind of being buying versus buy like building. And so you want to ask things like where Jason Hull (10:09) Once we have these kind of these table stakes stakeheads, if you will, kind of addressed, then you know, we can move on to kind of, you know, the our framework of kind of measure, map, and automate. And so and each of these different components have different purposes, you know. The whole point of the measure step is is to quantify where pain exists and to validate kind of being buying versus buy like building. And so you want to ask things like where Mo Hussein (10:36) where time, where margin, where service quality or accountability is lost today, right? Examples can be things like, you know, days vacant, you know, delinquency rate, maintenance response times. These would be kind of like outputs like invoice coding time, reporting hours, renewal conversions, right? Jason Hull (10:37) Where time, where margin, where service quality or accountability is lost today, right? Examples can be things like, you know, days vacant, you know, delinquency rate, maintenance response times. These would be kind of like outputs like invoice coding time, reporting hours, renewal conversions, right? Yeah. Got it. Yeah, that that makes a lot of sense. So you've got to be you have to have good data. Which the crux of th where their data is all probably housed is inside of their property management software. Mo Hussein (11:06) Right. Jason Hull (11:07) And so hopefully that software is kinda tracking some of this stuff. But, you know, everybody's had a CRM that the team didn't put enough notes in. And then it becomes kind of useless, right? So you're like, what happened with Fred on that call earlier, you know, or previously? I I think I think we talked about this. Can't remember. Why aren't you putting in notes? And so then the flaw becomes the human in the loop in a lot of instances. But then you're saying, you know, also humans matter. Like Mo Hussein (11:14) Right. Right. Jason Hull (11:34) Related to fair housing. We've got to have the human in the loop making decisions. I don't think it would go fair very well to be standing in front of a judge and say, Well, the AI messed this up. It wasn't me. Mo Hussein (11:43) Right. Right. Right. Yeah, that's very that's very correct. the the the other thing is is that you know software is a tool, right? So they you know, for like that example that you just gave of like, hey, you know, I had a conversation with Freddie or an owner or what have you, and you know, the notes weren't captured. And so if there's if if if if there's there needs to be also a cultural Jason Hull (11:46) Yeah, that's very that's very Yeah, they you know, put like that example that you just gave of like, Hey, you know, I had a conversation And you know, the notes weren't captured. And so if there's if if if if there's there needs to be also Mo Hussein (12:06) shift within the organization to become more performance kind of driven, right? And using, you know, places of truth. You know, I, you know, we use Salesforce in our own internal kind of CRM and you know, there's this old ad like this old saying of just, you know, hey, if it didn't happen to Salesforce, it didn't happen at all. In other words, if your system of record hasn't been updated and things haven't been added to it Jason Hull (12:06) cultural shift within the organization to become more performance kind of driven, right? And using, you know, places of truth. You know, I you know, we use Salesforce in our own internal kind of CRM and you know, there's this this old like this old thing of just, you know, hey, if it didn't happen in Salesforce, it didn't happen at all. Right. Mo Hussein (12:29) to to ensure that it is correct and accurate and up to date, then Jason Hull (12:29) to it to to ensure that it is correct and accurate and up to date, then the organization sees it as, you know, as it didn't happen. And somebody, you know, using anecdotal feedback like, well I did this, but I just didn't update this. And so that's it's very important that, you know, whatever system you're using to kind of measure different KPIs and metrics, that that, you know, that behaviors within the organization are shifting towards that. And it's it's something it's a cultural shift that needs to also Mo Hussein (12:32) the organization sees it as you know as it didn't happen. And somebody, you know, using anecdotal feedback of like, well I did this, but I just didn't update this, it means it didn't happen. And so that's it's very important that, you know, whatever system you're using to kind of measure different KPIs and metrics, that that, you know, that behaviors within the organization are shifting towards that. And it's it's some it's a cultural shift that needs to also cascade also from from leadership down as well. Jason Hull (12:57) Cascade also from leadership down. Yeah, the advantage we have nowadays with all the AI stuff that's come out is now pretty much everything gets transcribed everywhere. So calls get transcribed, notes can be created automatically. You can also go back and ha check the transcription on a call or a zoom call or recording, figure out what happened. So that you know, not leaving notes in the CRM is a little bit less of a problem than it was in the past. So we've so we've chatted a bit about measure. What is what's important about mapping or map? Yeah. So this is this goes back to my previous point about like you know AI value being it it is workflow value. Yeah so you know you've measured you've identified you know your measurements and KPIs. So whatever those KPIs may be. Next what you need to do is map what the actual Mo Hussein (13:30) The mapping. Yeah. So this is this goes back to my previous point about like, you know, AI value being it is workflow value. And so, you know, you've measured, you've identified, you know, your measurements and KPIs, you know, days vacant, delinquency, whatever those KPIs may be. Next, what you need to do is map what the actual what the actual workflows that are happening, not how leadership or staff thinks it's happening. Jason Hull (13:53) what the actual workflows are happening, not how leadership or staff thinks it's happening. There's a very key kind of a distinction is that, you know, a lot of operators and teams kind of assume, hey, you know, we have a set process, but it may not be happening the way that they are envisioning or the way that they're assuming that this is happening. Yeah. And and map that entire workflow end to end. Mo Hussein (13:59) The very key kind of distinction is that, you know, a lot of operators and teams kind of assume, hey, you know, we have a set process, but it may not be happening the way that they are envisioning or the way that they're assuming that this is happening. And and map that entire workflow end to end. identify what systems are involved, where handoffs occur, where approvals are required. Jason Hull (14:21) identify what systems are involved, where handoffs occur, where approvals are required, Mo Hussein (14:27) where judgment calls are are are are kind of made. And so, you know, every company has, you know, things like experienced managers and accountants and maintenance folks and and they usually know what good looks like versus what bad looks like. And so AI here is to help kind of convert that tribal knowledge ideally into a repeatable operating model. And so examples of how that mapping Jason Hull (14:28) where judgment calls are kind of made. And so every company has you know things like experienced managers and accountants and maintenance folks, and and they usually know what good looks like versus what bad looks like. And so AI here helped kind of convert that tribal knowledge ideally into an overviewable operative model. So examples of that mapping would be is you know, hey, what is the entire need to lease workflow? Mo Hussein (14:50) would be is, you know, hey, what is the entire lead to lease workflow? You know, Jason Hull (14:54) You know, what is the work order to completion, you know? what is our renewal offer to sign and executed actual renewal? And so and actually and again documenting that, a a lot of organizations have some notion of what that workflow kinda looks like. but Mo Hussein (14:54) What is the work order to completion? You know? what is our renewal offer to signed and executed actual renewal? And so and actually, and again, documenting that. A a lot of organizations have some notion of what that workflow kind of looks like. but you know, they haven't actually done they may not have documented, or if they did, it's not updated and they have an out of date SOP or a process diagram. Jason Hull (15:12) you know, they haven't actually gotten any INOT documents in or if they did, it's not updated and they have an out of data so P or a process diagram. Mo Hussein (15:22) And that's that's and that's that's that's a very important kind of key aspect of kind of this process. Jason Hull (15:22) and that's that's and that's that's that's a very important kind of key aspect of kind of this process. Yeah, yeah. Well I a lot of times I end up talking with clients and I've noticed kind of this pattern or trend in the industry of I call it the process myth where everybody thinks if we just had better processes all of our hopes and dreams would come true when it comes to the off side of the business and we would be more profitable. And especially see this in the two to four hundred door range in single family or small multi-residential property management. And so the challenge there is th that it's impossible to create enough processes, KPIs, and systems to make mediocre people be great. But they pe that doesn't stop business owners from trying. They they're like Mo Hussein (15:59) Right. Right. Jason Hull (16:04) They they they wake up in the morning, they're like, I want to play an impossible game today. And they they still try. And I call it the process myth because if you have really great people, even if your processes are garbage, that I've seen these businesses still perform well. But the reverse is not true. You have mediocre people, you could have insane amounts of systems and processes and stuff, and the business still has a lot of headaches and problems. Mo Hussein (16:16) Mm-hmm. Jason Hull (16:29) And so I've kind of noticed this pattern. I call it the three levels of process. And level one is documentation. It's just like writing stuff out. But that's kind of like the owner's manual in the glove box of the car. Nobody looks at it, it doesn't get updated. You know, it's like it's it's it's gathering dust, and people don't actually, that's not actually how the processes are run. And over time, things gravitate towards ease or grace or what the flows best for the person doing the job. Mo Hussein (16:39) Mm-hmm, mm-hmm. Jason Hull (16:57) Not for what's best for the job sometimes. And so it gravitates a little bit towards chaos or being worse. Then there's this level two, which is checklists. This is where people are using things like Asana or Process Street or Lead Simple or they some sort of checklist space system where now they're verifying the works getting done in a certain way. But checklist has its own problems in that it's very linear and not every process is linear. Mo Hussein (16:59) Right, right. Read simple. Mm-hmm. Mm-hmm. Jason Hull (17:24) There's decisions and splits and merges and sting things happening concurrently in property management. And so the challenge with checklist also it can tend to slow things down. It's not as efficient. So the next level and the problem I had with checklist, we used to use process street, is that it it if anytime a process got complicated, I had to build logic and you know, if-then sort of situations into it. And it usually got to the point where I didn't even understand it. Like a year later, I'm looking at a process. I'm like, I had to retranslate this back into something that made sense to my brain. And I always, and the nerd had to be the one that did all the updates on it because nobody else could understand it. So then we eventually graduated to level three. So level three is visual workflow. This is for humans. Mo Hussein (18:01) Right. Mm-hmm. Jason Hull (18:13) And so, and with with this, my tip to everybody listening, if you have a system, whether it's checklist or it's any of these three levels, you know, documentation, checklist, or visual workflow, that you your first two processes you make as an operator or as a business owner is how to create a process in this system is number one. And number two, how to QA. Mo Hussein (18:26) Did Jason Hull (18:37) A process that is made in the system to know it's actually a good one. If you just make those two, you don't have to do any of the other stuff. Everybody else can do it. You just make those two. That's my tip for all you business owners. And now with AI, you can start adding AI. Once you have things visually mapped out, it's you've got the map like you're talking about. Now you can figure out all right, where can AI take over some of this stuff? And where do we still need the human in the loop? Right. So yeah. Mo Hussein (18:43) Mm. And automation. Mm-hmm. Yep. Yeah. Right, Jason Hull (19:05) So any tips for those listening to this that are already geeking out with AI, they're doing a little bit of this measuring and mapping and automating. What are some of the biggest challenges you've noticed where this kind of breaks down or people are making mistakes? Mo Hussein (19:19) It's it's honestly it's the it's the you know, AI value. it's it's a lot of the small individual decisions that are made in a in a repetitive fashion and that that are made a lot that really are gonna unlock like true value for for any operator. And so like, you know, having very clean data, standardized, you know, systems of truth by what we mean by that is that, you know, hey, you know. Jason Hull (19:20) It's it's honestly it's the it's the you know, AI value it's it's like true value for for any op clean data, standardized, you know, systems of truth. But what we mean by that is that, you know, hey, you know, you know, whatever work order system that you're using, for example, has accurate, you know, work order data. People, you know, you're making a segment for actually closing out the work order when they complete it. Hey, the end of the week, I'm gonna now try to remember what I did earlier in the week. Mo Hussein (19:47) you know, whatever work order systems that you're using, for example, has accurate, you know, work order data. People, you know, your maintenance technicians are actually closing out the work order when they complete it. Not just, hey, the end the week, I'm gonna now try to remember what I did earlier in the week. Close it out. So the data is the data can't be trusted, then AI is just going Jason Hull (20:04) data the be trusted and AI Mo Hussein (20:07) to cause additional kind of confusion. And so having accurate systems of record. And I gave that example of of of a work order when a technician kind of closes that, right? the process map, I think the you know, the three buckets are like three level that you kind of gave, I think is a great, great. Jason Hull (20:20) Yeah, yeah. Yeah, that makes sense. yeah. level that you kinda gave I think it's a great, great anecdote and framing of how processes should be kind of looked at. And and I think one thing that a lot of operators usually tend to overlook or assume is you know how things are being done versus how they actually are being done within the schemes, right? So an owner somebody at some point said, okay hey this is a process we're gonna take and then over time that just kind of got changed. Mo Hussein (20:29) anecdote and framing of how processes should be kind of looked at. And and I think one thing that a lot of operators usually tend to overlook or assume is you know how things are being done versus how they actually are being done within the teams, right? It's an owner, somebody at some point said, okay, hey, this is the process we're gonna take. And then over time that just kind of got changed. And there may be, you know, two different property managers Jason Hull (20:55) And there may be, you know, two different property managers Mo Hussein (20:58) operating in two different regions in the same company that are doing leasing renewal differently, right? That going back to that point that you mentioned about systematizing and having accountability loops and task base or like checklist items and ensuring that those things are actually done in that same quality and that same fashion is very, very key. And so getting data, like getting the right data, accurate data, Jason Hull (20:58) operating in two different regions in the same company that are doing these things renewal differently. Right. That point that you mentioned about synthesizing and having accountability loops and task based or like checklist items and ensuring that those things are actually done in that same quality, in that same fashion is very, very key. And so getting data, getting the right data, accurate data Mo Hussein (21:23) and then also like your process mapping and your Jason Hull (21:24) And then also like your process mapping and your processes kind of documented. I think I think the visual representation is a great way to have that. And those are the two key things that ninety percent of folks that are trying to leverage AI and automation and even the folks that are starting to try to jump into this space and try to automate and use AI for these things like usually we're like where where they're really struggling with. got it. Yeah, I think Mo Hussein (21:26) processes kind of documented. I think I think the visual representation is a great way to have that. Those are the two key things that ninety percent of folks that are trying to leverage AI and automation and even the folks that are starting to try to jump into this space and trying to automate and use AI for these things like usually we're like we're where they're really struggling with. Jason Hull (21:50) I was just on a webinar recently and they were talking about building AI agents and they were talking about if you want to make really effective AI agents, you need to give them a really good job description, just like a human. And what what's really funny is if you we coach clients on this a lot, but if we tell the clients to to go, we coach clients on Creating job descriptions. We call our version of them R docs because each section starts with an R, like role, responsibility, et cetera, all the typical stuff. But then we have some additional sections that we found really paramount. So what we'll tell them to do is go ask your team members, give them this framework, and have them create their own R Doc. And then you take a look at this and see if that's what you would have created. Because it's never like what they think their job is. It's usually very different than what the business owner thinks their job is. Mo Hussein (22:25) Mm-hmm. Right. Jason Hull (22:36) And maybe even different what the manager, the ops person thinks the job is, but then you can actually literally get on the same page with them. You can be like negotiate this and be like, this is what we think your priorities should be, and what your outcomes should be, and what we want you to be able to accomplish. And this is helpful for them to know what they're aiming for so that they can please you because your team members want to please you if they're good. But usually there's a big disconnect, like you're saying, between what Mo Hussein (23:00) Mm-hmm. Mm-hmm. Jason Hull (23:05) the the employee thinks their j role and job is versus what their manager thinks they should be doing versus what the business owner thinks everybody should be doing. And so nobody's on the same page. And then you're everybody's roles are a little messy. And then you're going, let's give them processes now to work on. And they're not even clear on what their job is or what their role is. Yeah. And so same thing if you were going to build an AI agent and you were like, I want you to try and be good at everything. And then suddenly it's like really Mo Hussein (23:29) Right. Jason Hull (23:34) Hallucinating a lot and it's messing everything up and yeah. And it's not a realistic creature, you know, just like some people give create job descriptions that are for like four different personality types. Right. And then they hire somebody that maybe can actually do all four things, and we call those really highly adaptable, weird creatures entrepreneurs. And then they wonder why that property manager left and stole all their clients. Mo Hussein (23:34) Horrible. Right. Yeah. Jason Hull (23:57) Instead of finding somebody that's like really good at being one thing. Right. Yeah. And that's how you should see Asia. Mo Hussein (24:00) Right. That that that that role clarity is very, very, very important, right? And that's how you should see agents as well, is that like, hey, it's like a trained employee. And so you should exp you should expect the same level of, you know, investment involvement, if you will, and trying to and try to help them be the best of like, you know, whether it's a leasing agent, a maintenance coordinator, or whatever that their role may be. And I I think another aspect is and I'm curious how like how Jason Hull (24:12) you should expect the same level of you know investment involvement if you will and trying to and try to help them be the best of like you know whether it's a leasing agent a maintenance coordinator or whatever that their role may be and I I think another aspect is and I'm curious that like how you know when you guys are having conversations with clients around role descriptions stuff it's the concept of ownership like hey what you know how to how to align ownership to and lining that up to hopefully the mental business Mo Hussein (24:28) you know, when you guys having conversations with clients around role descriptions and stuff, it's the concept of ownership. Like, hey, what, you know, how to how to align ownership to and lining that up to hopefully an eventual business outcome or KPI or something so that, you know, their performance drives also the business performance, right? How have you guys had this conversation or how do you talk about kind of that concept? I can kind of allude to it without kind of explicitly calling it out. Jason Hull (24:42) Kate guy or something so that you know their performance derives also the business performance, right? Yeah. How do you talk about kind of that concept? You kind of allude to it without kind of explicitly calling it out. Yeah, I think well, sometimes I'll just totally call a business owner out on things. But I think what I think will be interesting is people are building starting to build agents. I think that they should. They should have an understanding of personality types. I think they should have an understanding maybe or a conversation with AI about what Myers Briggs type might be good for this agentic role. And because like somebody that's really good at like strategy and the strategist role, which would be like an INTJ in Myers Briggs, might be good at some operational stuff, but they would be really terrible at customer service. Mo Hussein (25:19) Mm-hmm. Jason Hull (25:33) Because a lot of INTJs don't even like humans, right? And so they're logical thinkers and they're really judging and they're practical and they're in you know introverted and they're really bad at understanding how the other person feels or even expressing that. And so you're you you don't want to create these try and create AI AI agents that are multiple split personality types, because I don't think they're gonna be as effective. And you can't also, just like you wouldn't want somebody building the process. QE QA QA of the process. You don't want them both. You don't want AI to be checking itself. Right. Right. The the brain that had problems doing the messing things up, maybe, or didn't do it totally right. You don't want them checking their own work. Right. And so, yeah, so I think this is going to be interesting that people are going to be building agents and they usually think just logically here's the context it needs, here's the role, whatever. But I think also maybe give it the personality that it. Mo Hussein (26:08) Right, right. Right. Jason Hull (26:29) What's the disc assessment for this person, this agent? What's the Myers Briggs type for this agent? And then if especially if they're communicating with humans or doing a task that you want them to be somewhat human like, they're going to be much better at doing this if you give it you create them in the right way. Just an idea. the other thing to know as a business owner, you need to know who you are so that you can build your dream team around you. So your advisors, whether they're agentic or human, your advisors, your team members, it should be built ultimately around you thriving and being healthy in your own business so that you've got the tea the tools and the resources that fit you. But most business owners make the mistake. Of trying to build the business around the business and then wonder why they're miserable and why they're kind of a slave to their own business. Right. Mo Hussein (27:16) Right. Right. Right. Jason Hull (27:20) So anyway, Mo, measure, map, automate, MMA. Doesn't involve fighting too much. You know, like mixed martial arts. It's a little bit on the, you know, less physical side of things. fun chatting about. Mo Hussein (27:26) No. Jason Hull (27:34) all the the AI stuff that's going. How can people anything else that you want to add to our conversation here about yeah this model? And then could you tell us a little bit about what you do and how maybe you help property managers with this stuff? Yeah. Yeah. so I guess just to put it succinct, kind of a a sandwich kind of takeaway. So yeah, operators need to wait for a perfect AI. Mo Hussein (27:48) Yeah. Yeah. so I guess just to put it succinctly, kind of a a a sandwich kind of takeaway. So, yeah, operators don't need to wait for a perfect AI strategy. Start by identifying, measuring where value exists, where things are leaking, then mapping workflows and then deciding what can be safely automated and measuring whether those actions improve performance. and so Jason Hull (28:00) Identifying, measuring where value exists, where things are leaking, then mapping workflows, and then deciding what can be safe and automated, and measuring whether. Mo Hussein (28:10) like you know, over time we'll see that you know the winners are not gonna be the companies that have the most amount of most amount of data, but they're the ones that can convert data into consistent operating actions across how they've operated every door. if you we help clients with you know putting together SOPs, also mapping their technology needs, where where they're where they're having operational leaks in the business can be Jason Hull (28:10) So like you know over time we'll see that you know the winners are not gonna be the companies that have the most amount of most amount of data, but they're the ones that can convert data into consistent operating actions across how they've operated every door. if you we help clients with you know putting together SOPs, also mapping their technology needs, where where they're where they're having operational leaks and the business can be optimized. Mo Hussein (28:37) Optimized further using Jason Hull (28:38) Further using technology and automation, we have a platform that we've built, Prop Strata, to actually connect and help with that automation type effort. and we're also we also do a lot of accounting and and CPA work. you can reach us at www.balanceasset solutions.com, and my emails mo at propstrata.com, or you can reach out to our team at info at balance asset. Mo Hussein (28:39) technology and automation. We have a platform that we've built, Prop Strata, to actually connect and and help with that automation kind of efforts. then we're also we also do a lot of accounting and and CPA work. you can reach us at www.balanceasset solutions.com and and then my email is mo at at propstrata.com or you can reach out to our team at info at balanceasset solutions.com. Jason Hull (29:03) Cool. So they could take a look at this at propstrata.com. Mo Hussein (29:07) Correct. W dot propstrata.com. Jason Hull (29:11) Okay, cool. Very cool. All right. yeah, check that out, everybody. It sounds interesting. All right. Well, Mo, I appreciate you coming out and hanging out with me here on the DoorGro show and sharing everything. All right. So if If you have ever felt stuck or stagnant in your property management business and you want to take it to the next level, reach out to us at doorgrow.com. We are the world's best at creating high-growth property management companies in the single-family residential space or the small multi-space. And if for a free training or how to get unlimited leads for free, text the word leads to 512-648-4608. That's 512-648-4608. Also, join our free community just for property management business owners at doorgrowclub.com. And if you want tips, tricks, and ideas to learn about our offers, subscribe to our newsletter by going to doorgrow.com slash subscribe. And if you found this even a little bit helpful, don't forget to subscribe and leave us a review on whatever channel you saw or heard this on. We'd really appreciate it. And until next time, remember the slowest path to growth. is to do it alone. So let's grow together. Bye everyone.
Ken Bunn, Vice President of Claims at Builders Mutual Insurance Company, joins hosts James Benham and Rob Galbraith to explore how a construction only Southeast insurer built its claims department from scratch, why the AI tools that stick are the ones adjusters never have to think about, and what it takes to keep training junior adjusters into seniors.Ken's path ran through 18 years at Nationwide, rotating between claims leadership, field training, and IT program management, before Builders Mutual asked him to build a claims department that didn't exist yet. Twelve years later, the company has grown from roughly 200 million to 650 million in revenue, and Ken still leads much of the original team he brought over from an outsourced TPA.In this episode:• Why Builders Mutual pulled its claims department in-house, and how they kept close to 30 of the original 40 people they brought over. • The predictive AI models that worked exactly as designed and still failed to stick. • The unglamorous automation, document routing, indexing, and med record summaries, that actually delivered the ROI. • Ken's leadership philosophy for change management with no formal program at all. • Why work comp rate softening may be hitting a floor as catastrophic claims costs climb. Key Quotes:"You can't work on an assembly line and do brain surgery at the same time.""It's not going to solve all your problems. It's going to help.""There might be something wrong when your claims adjusters are the happiest people in the room.""Be real. Tell people what's going to happen and why you're doing it.""Pick and choose your tools well so they inform the adjuster, not just replace them."
There is a new service coming to Tampa Bay that is going to be taking you from TPA right to Downtown st. Pete! Katie Sommers has all the details with the top stories!
There is a new service coming to Tampa Bay that is going to be taking you from TPA right to Downtown st. Pete! Katie Sommers has all the details with the top stories! See omnystudio.com/listener for privacy information.
"What used to be a once-a-year catastrophic claim is now happening every single week across the stop-loss market."We're back for the fourth year in a row with our annual whiteboard review of Tokio-Marine HCC's Stop Loss Report. Drawing from a massive block of over $2 billion in force premium, this report gives us one of the clearest, most objective looks at what is actually happening under the hood of self-funded health plans across the country.In this episode, I break down the biggest trends shaping the 2026 stop-loss environment. We look at the tightening stop-loss market, why underwriter discipline is ramping up, and why we likely won't see market stabilization until at least 2027.If you are a consultant, TPA, or plan sponsor trying to navigate renewals and protect your plan over the next 3 to 5 years, this breakdown is packed with actionable data. Tune in!Chapters:(00:00:00) Intro: 2026 Tokio Marine HCC Stop Loss Report Breakdown(00:01:25) The $2M Claim Spike & Tightening Stop-Loss Market(00:04:23) Catastrophic Claim Trajectory: $500K vs. $2M Thresholds(00:06:05) Top Disease Categories: Cancer, Cardiovascular & Nervous System(00:09:12) Analyzing Severity: $85 Million Across 30 Claims(00:14:43) Underwriting Mechanics: How Lag & Claims Data Impact Renewals(00:17:35) Evolution of Specific Deduuctibles & Optimal Risk Corridors(00:24:05) Pediatric Risk & High-Cost Perinatal/Neonatal Claims(00:28:57) How "Leverage Trend" Silently Inflates Your Premium(00:30:10) Mental & Behavioral Health Cost Trends (+123% Increase)(00:31:35) Macro Takeaways: IDR Arbitration, Cost Shifting, and 2027 Outlook
"I relate it to one of the Wizard of Oz characters... I've seen behind the curtain. I know how it's all put together."What happens when a man who spent nearly five decades inside every corner of the self-funded industry decides his final act is to give the playbook away?My guest this week is Charlie Gragg, a true first-generation veteran of self-funding. Charlie started in the late 1970s underwriting stop-loss cases on napkins from payphone booths, went on to run his own TPA, and has now semi-retired into a role he believes the industry desperately needs: the fiduciary co-pilot.He won't take your broker of record letter; he doesn't want it. Instead, he partners with brokers, consultants, and C-suite executives to build health plans from scratch, the way an owner would.If you're a broker who knows you have a ceiling on your self-funding expertise, this episode is your permission slip to get help. Tune in.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: Behind the Curtain of Self-Funding(00:00:55) The Fiduciary Co-Pilot: Why Charlie Won't Take Your BOR(00:02:58) Charlie's Background: First-Generation TPA in the Late '70s(00:04:46) Napkin Underwriting and $2,000 Aggregate Stop-Loss(00:06:18) The Two Sales: Selling the Employer AND the Underwriter(00:07:20) Why the TPA Business Is So Hard to Do Right(00:11:27) The Fiduciary TPA: Accountant of the Health Plan(00:13:32) The 401(k) Parallel: Fiduciary Standards Are Coming for Brokers(00:14:43) Building Custom Plans vs. Buying the Box(00:16:25) Stop Haggling Over Stop-Loss — Solve the Claims Instead(00:18:46) Owning Your Stop-Loss Through a Group Captive(00:21:25) The 3-6 Month Setup: Finding Fiduciary Partners First(00:23:34) The One Question to Ask Every TPA(00:26:07) Why PBMs Need the Fiduciary Standard Too(00:28:01) Eating the Elephant: Meeting Employers Where They Are(00:30:56) Winning Over the C-Suite Before the HR Director(00:34:42) Claims Negotiators, Re-Pricers, and the Lost Art of the Phone Call(00:39:11) Do You Still Need a Carrier Network?(00:41:51) The Quality Anomaly: Why the Best Care Costs Less(00:43:34) DRG Bundles and the $20,000 Burn Unit That Never Was(00:46:52) Wellness, Behavioral Health, and the Loyalty Dividend(00:55:31) Building the Utopian Health Plan: The Blueprint(01:01:03) What's Missing? Belief.(01:04:18) The Future: Adoption in the Mid-Market(01:06:33) Closing Thoughts: The System Won't Fix ItselfKey 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/
This week's special guest is Kevin Spaeth of PenChecks Trust. Topics to include: Voya Financial partners with SinglepointAI Inc. in TPA onboarding tech play, (k)quote and 3(38) Investment Fiduciaries become FIDUCION, PLANSPONSOR Magazine's 2026 Recordkeeping Survey
What does it take to move from fixing one broken corner of healthcare to reimagining the whole thing? On this episode of Astonishing Healthcare, host Justin Venneri sits down with two of his favorite guests together for the first time: Judi Health's CEO, AJ Loiacono, and Chief Commercial Officer, Kristin Begley, PharmD.The catalyst for this special episode is the company's rebrand, the evolution from Capital Rx, the transparent PBM that built Judi®, into Judi Health, a unified health technology company. AJ and Kristin explain why the "Rx" designation remains a core piece of the company's identity but no longer fully reflects the organization's evolving mission. They also describe the difference between "little T" transparency and the real thing, why incentive alignment matters so much, and what it took to build the first platform to process medical, pharmacy, dental, and vision claims on one system. They also express gratitude to the team and share bold predictions for where health benefits go next.Key TakeawaysThe rebrand reflects an expanded mission, not a new one. Capital Rx launched as a transparent PBM, with "Rx" signaling its focus on pharmacy. Over eight years, the company broadened its administrative capabilities, including medical claims processing, and much more - all powered by Judi. Thus, the primary brand: Judi Health, with services harmonized as Judi Rx (pharmacy), Judi Care (medical administration, TPA, navigation), and Judi Cloud (platform licensing for health plans and TPAs).There's a real difference between "little T" transparency and true transparency. AJ argues that true transparency means an auditable workflow: full disclosure of all compensation, proof that every customer receives the same pricing and benefit, and no hidden earnings. He calls out the "little H" holding company trick and explains why alignment yields better outcomes for plans and their members.Nobody had built unified claims processing before. AJ recalls initial skepticism around unified claims. His response: "If Netflix had kept mailing DVDs, we wouldn't be talking about Netflix." To date, no other organization has built a unified claims processing platform. Judi is the exception.Unified claims processing will become the standard. Once employers realize they have options, markets shift quickly. AJ, who predicted the rise of transparent PBMs, makes a new call: unified claims will be the industry norm.Related ContentJudi Health™ Announces Capital Rx is Now Judi Rx™, Launches Judi Care™ and Judi Cloud™ to Power the Next Era of Health Benefits Administration and Patient CareAH100 - The End of the Age of Confusion, It's Time for Acceptance, with AJ LoiaconoAH067 - Aligned Health Benefits and the Freedom to Unbundle, with Kristin Begley, PharmDWhat is a Core Administrative Processing System (CAPS) in Healthcare Payer Operations?AH111 - Building a Single Source of Truth for Medical and Pharmacy Benefits, with Kevin Sundquist & Liya LomsadzeFor more information about this episode, please visit Judi Health Insights.
Send us Fan MailSend us Fan MailSchedule an Rx AssessmentWhat if your team held the best ideas for growing your pharmacy and you just needed to get out of the way?On this episode of the Bottom Line Pharmacy Podcast, we sit down with Dr. Jay Phipps, owner of Phipps Pharmacy and founder of the Phipps Tank concept, to break down:What Phipps Tank is and how to run it in your pharmacyWhy culture is a bottom line strategy, not just a feel-good initiativeHow psychological safety drives team performance and real revenue growthWhy your fear of change might be your biggest financial liabilityAnd more!More About Our Guest: Dr. Jay Phipps is a Pharmacy Gladiator, Pharmacy Doctor, Founder, Entrepreneur President, and CEO with over 29 years of experience in pharmacy. At Phipps Pharmacy, Dr. Jay leads a team of dedicated and professional Pharmacy Doctors and technicians who provide personalized and high-quality care for patients. Phipps Pharmacy, Inc. is an independent pharmacy with 5 locations in Tennessee and Mississippi. Dr. Jay is also the President and CEO of PhippsCare that focuses on Pharmacy Doctor provided healthcare and Health Insurance Solutions who specializes in medical and pharmacy plans for seniors. Dr. Jay currently serves on multiple Boards of Directors and committees on the national, state, and local levels. He has served as the American Pharmacist Association-Academy Students of Pharmacy National President, on the APhA Board of Trustees, President of the Tennessee Pharmacists Association (TPA), on the Board of Directors for TPA, Chair, Tennessee Pharmacy Research Education Foundation, Co-Chair, Carroll County Drug Prevention Coalition and a District 8 County Commissioner. Dr. Phipps received a Doctor of Pharmacy degree from The University of Tennessee Health Science Center, where he also completed a residency in Drug Information and Pharmacotherapy and is currently pursuing an MBA with a major in Leadership and Strategy from the #1 ranked online MBA program at Indiana University - Kelley School of Business. Dr. Phipps plans to graduate in the fall of 2024. Connect with Dr. Jay Phipps, PharmD:Jay Phipps LinkedInPharmacy Gladiator WebsitePharmacy Gladiator InstagramPharmacy Gladiator TikTokPharmacy Gladiator YouTubeStay connected with us:FacebookTwitterLinkedInScotty Sykes – CPA, CFP LinkedInScotty Sykes – CPA, CFP TwitterBonnie Bond – CPA LinkedInBonnie Bond – CPA Twitter More resources on this topic: Podcast - Becoming a Pharmacy GladiatorPodcast – Driving Independent Pharmacy Profitability in 2026 with Nicolette Mathey, PharmD, CEO of Atrium24Podcast – 2026 Quarter 2 Pharmacy UpdatePodcast – America 250, The history of Pharmacy, Q&A
Brian Danos joins JD Carlson to break down participant vs. employer-paid fee strategies, recordkeeper pricing tactics, and how AI is transforming 401(k) compliance documents. Essential insights for advisors navigating fee debates and modernizing plan administration. In this episode of Retireholics, Brian Danos dives deep into some of the thorniest issues facing 401(k) advisors today. We start with the ongoing fee debate: should participants or employers shoulder the cost? Brian walks through real recordkeeper pricing strategies and how to benchmark fees effectively in a competitive market. As compliance requirements evolve, we tackle the practical challenges of electronic delivery and notice requirements, plus best practices for communicating with terminated participants. But the real game-changer? Artificial intelligence's growing role in 401(k) administration. Brian explores how AI is reshaping legal documents, improving plan notices, and helping advisors create compliance materials that actually get read by participants. We also dig into the data challenges advisors face when working with recordkeepers, what's broken, what's fixable, and how to demand better tools. Whether you're a TPA, plan sponsor, recordkeeper, or independent advisor, this conversation covers the regulatory, operational, and strategic issues that keep 401(k) professionals up at night. Grab a cold one and tune in. CHAPTERS 0:00 Cold Open: Retireholics Intro 2:08 Welcoming Guest Brian Danos 11:22 Fee Debates: Participant vs Employer Paid 20:30 Record Keeper Pricing Strategies 26:33 Electronic Delivery and Notice Requirements 35:03 Terminated Participant Communications 46:59 Artificial Intelligence in 401k 54:12 AI's Impact on Legal Documents 1:00:16 Plan Notice: The Company Pitch 1:03:18 Data Challenges with Record Keepers 1:08:42 Making Compliance Documents Actually Useful 1:11:31 Wrap Up and Final Thoughts MORE FROM RETIREHOLICS Full episode notes & transcript: https://retireholics.com/episodes/brian-danos-retireholics/ All past episodes: https://retireholics.com/episodes/ Live every 1st & 3rd Thursday at 4:30pm PT: https://retireholics.com/live/ Get show reminders: https://retireholics.com/get-reminders/ SUBSCRIBE YouTube: https://www.youtube.com/c/Retireholiks Apple Podcasts: https://podcasts.apple.com/us/podcast/retireholics/id1490618217 Podbean: https://retireholiks.podbean.com/ Retireholics is the show changing the retirement industry one beer at a time. Hosted by JD Carlson and co-hosts, covering 401(k) plan design, fiduciary responsibility, fees, investments, and industry news for retirement plan advisors and professionals.
Some guests just drop bombs for an hour straight, and Griffin Brand is one of them. Griffin is a former 75th Ranger Regiment special operator who, at 26, found himself as the lone military advisor to the U.S. ambassador in Kabul, wrangling 20 different three-letter agencies into one room. Now he's in private equity with High Ground, working deals across the restoration industry. If you caught last week's episode with Griffin and his co-author Dan Casey on their book Bring Your Own Pencil, this is the deep dive into the man behind it. This conversation is loaded for anyone leading a business in the trades: restoration, roofing, HVAC, you name it. We get into General McChrystal's "fast and flat" philosophy and how to break down the silos killing your company's speed. Extreme ownership, owning the inputs so the outcomes take care of themselves, why veterans are the best hires in blue collar, and a story Griffin had never told before about an insider attack at the embassy and what it taught him about empathy and leadership. Trust me, you'll want a notebook. Owning a business in the trades can be the loneliest job there is. Head, Heart, & Boots exists to change that, because the best leaders don't go it alone, and neither should you. Why You Should Listen: [11:03] The third door: how Griffin got through every door he was told was closed, including Ranger Regiment [15:09] The leadership move that built instant trust with the highest-ego room on the planet [18:53] Fast and flat: McChrystal's team of teams, and one practical way to run it in your shop tomorrow [34:07] The insider attack story Griffin processes live for the first time, and the empathy lesson he took from it [52:39] Why veterans are the hire your business needs, and how to find them Grab Bring Your Own Pencil on Amazon, Audible, or bringyourownpencil.com. Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
Every once in a while you record an episode and you know, before you even hit stop, that it's a top-tenner. This is that one. Chris and I sat down with Dan Casey and Griffin Brand - a football coach turned historian and an Army Ranger, to talk about their book Bring Your Own Pencil, the leadership playbook of the legendary Bill Walsh. But this isn't a football episode. It's a masterclass for anyone leading a crew or building a business in the trades - roofing, HVAC, restoration, you name it. How to hold a standard without becoming a tyrant. How Walsh turned betrayal into the greatest coaching tree in NFL history. Imposter syndrome, self-belief before the evidence shows up, and why you should never quit a hit show. Grab a notebook - and bring your own pencil. Owning a business in the trades can be the loneliest job there is. Head, Heart, & Boots exists to change that, because the best leaders don't go it alone, and neither should you. -Brandon Why You Should Listen [10:19] The Hacksaw Reynolds story behind the title — one sentence that set the standard for a dynasty [18:31] Holding standards without a toxic, maniacal culture (their answer punched me right in the face) [21:49] Bill Walsh's origin story is failure — and what he built from it [43:20] The four most powerful words a leader can say [54:53] Lightning round: the books and daily habits every leader should steal Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
The ASO vs. TPA Decision That Quietly Costs Self-Funded Employers More What's the real difference between an ASO and a TPA — and why does it matter that self-insured employers working with an ASO pay, by one referenced estimate, about 4.7% more than the insured book of business for the same care? In this Ask Me Anything, Stacey Richter puts a listener question from Dr. Alex Sommers, MD, ABEM, DipABLM, president of Astia Health, to Claire Brockbank, newly appointed director of the 32BJ Health Fund, who breaks down how ASO and TPA models diverge on ownership, networks, and incentives. WHAT YOU'LL LEARN ✅ How an ASO (administrative services only) arrangement differs structurally from a TPA (third-party administrator) — in Claire Brockbank's words, an ASO is essentially "a TPA that's owned by one of the big insurance carriers" ✅ Why bringing your own network, doing carve-outs, or direct contracting is typically much easier with a TPA than with an ASO, since an ASO's network comes bundled in ✅ How ASO incentive structures can lead carriers to charge self-funded employers more to offset thinner margins on their insured book — and why a study referenced by Luke Prettol found self-insured ASO clients pay roughly 4.7% more on average ✅ Why many TPAs, as newer market entrants built around technology, can move faster on things like claims-audit integrations than legacy carrier systems that can take up to 18 months to implement changes ✅ A real-world example of how network rigidity under an ASO made it difficult for one employer to remove 40 identified unsafe physicians from its network ✅ Why reading a TPA contract carefully still matters, since aligned incentives are a structural possibility with a TPA, not a guarantee WHY THIS MATTERS ASO and TPA are routinely used interchangeably across the industry, but as Claire Brockbank lays out, the distinction isn't just terminology — it's what determines how much actual control a self-funded employer has over its own health plan. An ASO bundles in the carrier's network and legacy systems, often with built-in incentive misalignments that can show up as higher costs than the insured book of business pays. A TPA leaves more room to bring your own network, negotiate direct contracts, and move quickly when something needs to change. For any plan sponsor sorting out vendor options, knowing which model is actually on the table is foundational to getting the rights, rates, and flexibility they're after. MENTIONED IN THIS EPISODE Post by Luke Prettol EP453 with Claire Brockbank: Apple Podcasts | Spotify | Other Apps EP498 with Mark Noel: Apple Podcasts | Spotify | Other Apps === LINKS ===
Few careers in military medicine trace an arc as wide as that of CAPT (Ret) Kimberly Elenberg, DNP, RN. In this episode she sits down with WarDocs to map a journey that began as an ROTC cadet who joined because she saw students rappelling down a building in Philadelphia, and that has since carried her from the bedside at Walter Reed Army Medical Center to the role of principal investigator on a Carnegie Mellon University team competing in the DARPA Triage Challenge. Along the way she changed uniforms, disciplines, and altitudes of responsibility, but never lost the thread that ties it all together: people first, and the relationships that make hard things possible. CAPT (Ret) Elenberg describes how early mentors shaped her. Colonel Graham showed her that putting people first is a practice, not a slogan. Major McGee backed her instinct for innovation, and as a young nurse on Ward 51 she built one of the first patient education centers in a military treatment facility, learned to set up networks and hardware, and pursued nursing informatics before the field was common. She recounts moving to research at NIH, where her work on TPA for clearing central line catheters was later adopted as best clinical practice, and her decision to volunteer as an EMT and medic so she would understand field medicine as well as hospital medicine. From there the conversation follows her into the U.S. Public Health Service, where after 9/11 the Surgeon General asked her to help build the nation's deployable response teams from concept to operation, training them in real communities facing real crises. She explains how anthrax and zoonotic disease drew public health into agriculture and food security, how her long relationship with Carnegie Mellon's Auton Lab began with a bus trip and a phone call, and how that mathematical grounding in probabilistic modeling resurfaced when she was asked to model the effects of policy during COVID and, later, to track military security assistance flowing to Ukraine. The episode closes on the present and the future: autonomous triage payloads that can read a casualty's physiological state without touching them, robotic snakes that might pack non-compressible hemorrhage, swarms of drones and ground robots that find the wounded and feed the right information to the right echelon. Throughout, CAPT (Ret) Elenberg returns to her core lessons — trust your chain of command, define what success really looks like, build on small wins, and never limit yourself to your military occupational specialty. From an orphanage and a food-service background to teaching at the National Defense University, hers is a story about doors held open and relationships that endure. Chapters (00:54-07:11) From Rappelling Cadet to Innovating Army Nurse (07:11-16:48) Building the Nation's Public Health Response Teams (16:48-22:24) Biosurveillance Modeling COVID and Ukraine Aid (22:24-32:32) The Power of Relationships Across a Career (32:32-37:37) Autonomy Confidence and Knowing When to Explore (37:37-51:33) The DARPA Triage Challenge and Lessons That Last Chapter Summaries (00:54-07:11) From Rappelling Cadet to Innovating Army Nurse The guest traces her start as an ROTC cadet drawn in by students rappelling down a Philadelphia building, her commissioning as an Army nurse, and her first duty station at Walter Reed Army Medical Center. Early mentors, including Colonel Graham and Major McGee, taught her that people truly come first and backed her instinct for innovation. On Ward 51 she built one of the first patient education centers in a military treatment facility while teaching herself websites, networking, and nursing informatics. (07:11-16:48) Building the Nation's Public Health Response Teams Her NIH research on TPA for central line catheters was later adopted as best clinical practice, and she volunteered as an EMT and medic to learn field medicine. After moving to the U.S. Public Health Service for family stability, she answered the Surgeon General's call following 9/11 to build the nation's deployable response teams from concept to operation. Anthrax and zoonotic disease pulled public health into agriculture and food security across the federal enterprise. (16:48-22:24) Biosurveillance Modeling COVID and Ukraine Aid Tasked to advise on detecting events and discerning intent, she leaned into probabilistic modeling and a long relationship with Carnegie Mellon's Auton Lab that began with a bus trip and a phone call. As Director of Population Health at the Defense Health Agency she modeled total force fitness, then was asked to model the effects of policy during COVID rather than the disease itself. The work forced coordination across agencies, departments, and services on a scale not seen since World War II. (22:24-32:32) The Power of Relationships Across a Career Describing herself as an introvert, she explains why relationships are the engine of accomplishment, recalling a Ranger literally pushing her up a mountain during advanced camp after a car accident. Those bonds endured and resurfaced decades later in Texas during the DARPA Triage work. She recounts retiring out of Poland after 28 years, where she stood up a secure network to coordinate 26 non-doctrinal partners supporting aid to Ukraine. (32:32-37:37) Autonomy Confidence and Knowing When to Explore She makes the case for military service as a path to clinical autonomy and the chance to think, decide, and do research that civilian roles often do not allow. She reflects on how to know when to pursue a new opportunity: trust your chain of command, negotiate and listen when you are the one in charge, and act on principles of doing no harm. Confidence, she says, means not being afraid to fail. (37:37-51:33) The DARPA Triage Challenge and Lessons That Last She gives a plain-language tour of her team's autonomous triage work — payloads that read physiological state without touching a casualty, visual reasoning models tempered by Bayesian rigor, and platforms that deliver the right information to each echelon. Using a DoD-wide tobacco policy as a case study, she explains the art of the doable and building success on small wins. She closes with advice on confidence, integrity, and holding doors open for the next generation. Take Home Messages Cross disciplines to scale care: The greatest gains often come from teaming up outside your own specialty. Pairing clinical insight with engineering, informatics, and operations lets a single provider extend capability and capacity far beyond what one profession can deliver alone. People first is a practice, not a slogan: Leaders who genuinely put people first earn the trust that makes hard missions possible. The example of a leader who recognized her team while facing her own serious illness shows that the principle is proven in action, not in words. Relationships are the engine of accomplishment: No one knows everything, and progress depends on the people willing to push you up the mountain. Networks built early endure for decades and can be called on when the mission needs them most. Define what success really looks like: Insisting on the perfect outcome can stall progress entirely; agreeing on the art of the doable moves the mission forward. Real success is often a series of small wins that build on one another over time. Confidence means not being afraid to fail: Growth lives outside the comfort zone, and everyone fails sometimes. Acting with honesty, integrity, and your best effort each day — then trusting tomorrow brings another chance — is what builds lasting confidence. Episode Keywords military medicine, Army nurse, military nursing, WarDocs, military medicine podcast, public health service, USPHS, DARPA Triage Challenge, autonomous triage, battlefield medicine, combat casualty care, Carnegie Mellon University, Auton Lab, nursing informatics, biosurveillance, COVID modeling, population health, Defense Health Agency, Walter Reed, military innovation, medical robotics, drone medicine, military mentorship, veteran leadership, military medical research Hashtags #MilitaryMedicine, #WarDocs, #ArmyNurse, #PublicHealth, #BattlefieldMedicine, #DARPA, #MilitaryInnovation, #VeteranLeadership Biography Dr. Kimberly Elenberg, a retired USPHS Captain, is the Director of Data and Mission Partner Sharing at ECS. A distinguished leader in biosurveillance and emergency response, she applies data science to enhance national security. Notably, she served as the incident response commander for modeling and analytics for the Secretary of Defense COVID Task Force. Previously, as a principal scientist at Carnegie Mellon University, she advanced autonomous systems for biosurveillance. Dr. Elenberg consistently bridges theoretical research with practical healthcare delivery, leveraging her clinical expertise and military discipline to safeguard public health. Her exceptional contributions have earned her several highly prestigious awards, including the 2022 Defense Superior Service Medal, the 2022 USPHS Distinguished Service Medal, and the 2020 National Emergency Preparedness Award for her outstanding operational acumen. Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission- WarDocs exists to honor the legacy of Military Medicine, preserve its history, and inspire every generation — across all Services, Corps, and Ranks — to serve with excellence and pride. Through mentorship, coaching, and education, we equip those considering, entering, and serving in military medicine with the knowledge, connections, and community they need to thrive. We celebrate Who we are, What we do, and, most importantly, How we serve Our Patients, the DoW, and Our Nation. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms. Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast
CardioNerds (Amit and Dan), Billy Joe Mullinax, and Saahil Jumkhawala discuss the long term management of pulmonary embolism with Dr. Soophia Naydenov. The episode focuses on the approach to patients who struggle with persistent symptoms like dyspnea and fatigue even after completing the acute phase of anticoagulation. This spectrum of disease, ranging from mild post-PE impairment to chronic thromboembolic pulmonary hypertension (CTEPH), requires a structured follow-up. The discussion covers the critical importance of identifying CTEPH early, the necessary timelines for follow-up, and the appropriate objective screening tools and invasive testing to guide patient care toward full functional recovery. Audio editing by CardioNerds academy intern, Grace Qiu. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Acronyms PE: Pulmonary Embolism PERT: Pulmonary Embolism Response Team CTEPH: Chronic Thromboembolic Pulmonary Hypertension QL: Quality of Life VTE: Venous Thromboembolism DASH: D-dimer, Age, Sex, History of non-provoked PE (a risk score) CPET: Cardiopulmonary Exercise Testing PFTs: Pulmonary Function Tests VQ Scan: Ventilation-Perfusion Scan DOACs: Direct Oral Anticoagulants TPA: Tissue Plasminogen Activator (Thrombolytics) ECMO: Extracorporeal Membrane Oxygenation Pearls: Post-PE “Syndrome” is a Spectrum: It is more accurately a spectrum of disease (sequelae of PE) rather than a single syndrome, ranging from mild fatigue/dyspnea to the most severe form, CTEPH. Structured Follow-up is Mandatory: All PE survivors need a structured follow-up, typically with checkpoints at 3, 6, 12, and 16–24 months, with the primary goal being to detect CTEPH, the deadliest, yet potentially curable, disease on the spectrum. Screening Should Be Objective and Practical: When screening for persistent symptoms, use objective assessment tools like the Post-VTE Functional Status (PVFS) scale or the Modified Medical Research Council (MMR-C) scale, as highly comprehensive but cumbersome tools (like the PE Quality of Life questionnaire) may not be practical for routine clinical use. Recurrence Risk Scores Aid in Anticoagulation Duration: Simple scores like the DASH score or the HERDO2 score (for women) can provide guidance when considering the continuation versus discontinuation of anticoagulation after the initial treatment phase. Invasive Testing for Persistent Symptoms: If a patient remains symptomatic at the 6-month mark despite normal non-invasive testing (chest X-ray, ECG, PFTs, six-minute walk, echo, VQ scan, CPET), consider invasive testing such as Right Heart Catheterization (RHC) at rest or with exercise, or an invasive CPET. Notes: Notes drafted by Saahil Jumkhawala. 1. The Spectrum of Post-PE Disease The term “post-PE syndrome” should be used with caution, as it refers to a spectrum of disease rather than a single entity. This spectrum includes symptoms (sequelae) that exist in a patient’s life following an incidental PE event that they did not have before. On one extreme is Chronic Thromboembolic Pulmonary Hypertension (CTEPH): The definition is clear, but it is the most deadly type, though thankfully rare (2% to 4%). It involves a residual clot and pulmonary hypertension identifiable at rest. In the middle is Chronic Thromboembolic Disease (CTED): Patients may have residual defects seen on a VQ or CT scan, but they do not have pulmonary hypertension. On the other side is a milder disease, which can include fatigue, dyspnea, or a patient’s perceived impairment, where the definitions of CTEPH and CTED are not met, but the patient remains symptomatic. 2. Structured Follow-up and Screening for Post-PE Symptoms Structured follow-up is key for all PE survivors, though the structure may vary based on available resources (PCP, Cardiology, Pulmonary, or multidisciplinary clinic). Recommended Timeline for Follow-up: Data from studies like ELOPE and FOCUS suggest checkpoints at 3, 6, 12, and up to 16 to 24 months. This timeline is designed to identify patients who may develop CTEPH. 88% of patients who develop CTEPH will be identified within about a year. A structured follow-up can reduce the delay in CTEPH diagnosis from 10–12 months to 4–6 months. Personal Practice Note: A quick 2–3 week/30-day check-in is recommended for severely ill patients (e.g., those who had TPA, profound shock, or ECMO support) to ensure medication compliance, manage symptoms, and identify red flags. Screening Tools (Objective Assessment): The first step is an inventory of patient symptoms, leaning toward objective rather than subjective assessment. Recommended Simple Tools: Modified Medical Research Council (MMR-C) for dyspnea evaluation. Post-VTE Functional Status (PVFS) scale. The Pulmonary Embolism Quality of Life (QL) questionnaire is comprehensive but long, making it tedious and better suited for research. Future Utility: Technology (AI/electronic tools) may assist in administering these questionnaires before the clinic visit, presenting the information as a “dashboard” for the provider. 3. Management of Persistent Symptoms and Further Testing Initial Non-Invasive Tests (Often done at 3 months): Echocardiogram VQ Scan Full PFTs Six-minute walk CPET Further Evaluation for Persistent Symptoms (e.g., at 6 months): If non-invasive tests (Chest X-ray, ECG, CPET) are normal but symptoms persist, more invasive testing should be considered as the patient has not returned to baseline. Repeat VQ scan or echocardiogram if symptoms have changed. Right Heart Catheterization (RHC) at rest or with exercise. Invasive CPET. PA gram (Pulmonary Angiogram) to assess vasculature. 4. Recurrence Risk and Anticoagulation Duration The decision to continue or discontinue anticoagulation depends on the patient’s risk factors, the situation of the PE (provoked or unprovoked), presence of active cancer, and patient preference. Recurrence Risk Scores: Simple scores are preferred for practicality. DASH Score. HERDO2 Score (particularly for women). The Vienna Score can be considered if the question is whether to restart anticoagulation after a disruption. Role of D-dimer in Abbreviation: While D-dimer can be used to guide the decision to restart anticoagulation after a planned pause (if D-dimer is high, resume), patient symptoms are preferable to guide management decisions like early abbreviation. 5. Prevention of Post-PE Syndrome Currently, there is no clear tool known to prevent the post-PE syndrome/spectrum of disease. Best Current Advice for Prevention/Recovery: Anticoagulation compliance. Pulmonary rehabilitation, which aids in faster recovery. General precautions, such as smoking cessation and body weight management. Future Research: Ongoing trials are investigating whether acute management strategies (e.g., using thrombolytics in intermediate-risk PE) can prevent long-term sequelae. (The PYTHO trial did not show a reduced rate of CTEPH in intermediate-risk PE patients who received thrombolytics). References: Khan, F., Tritschler, T., Kahn, S. R., & Rodger, M. A. “Venous Thromboembolism.” The Lancet, vol. 398, no. 10294, 2021, pp. 64-77. doi:10.1016/S0140-6736(20)32658-1. Kearon, C., & Kahn, S. R. “Long-Term Treatment of Venous Thromboembolism.” Blood, vol. 135, no. 5, 2020, pp. 317-325. doi:10.1182/blood.2019002364. Kahn, S. R., & de Wit, K. “Pulmonary Embolism.” The New England Journal of Medicine, vol. 387, no. 1, 2022, pp. 45-57. doi:10.1056/NEJMcp2116489. Di Nisio, M., van Es, N., & Büller, H. R. “Deep Vein Thrombosis and Pulmonary Embolism.” The Lancet, vol. 388, no. 10063, 2016, pp. 3060-3073. doi:10.1016/S0140-6736(16)30514-1. Chopard, R., Albertsen, I. E., & Piazza, G. “Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review.” JAMA, vol. 324, no. 17, 2020, pp. 1765-1776. doi:10.1001/jama.2020.17272.
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