Self-Funded

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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