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"We are not going after the high. What we're going for is symptom relief. Based on our research, employers are going to be saving $5,000 per participant per year." Is it time for employers to start covering medical cannabis? My guest this week is Emily Fisher, Founder of LeafWell. As a stage 4 breast cancer patient, Emily experienced firsthand the therapeutic benefits of cannabis when traditional opioid painkillers failed her. However, she also experienced the frustration of navigating the dispensary system without any clinical guidance or oversight. She founded LeafWell to solve this problem by connecting patients with licensed healthcare providers via telehealth to receive personalized, clinically-guided cannabis care plans. Now, LeafWell has served over 500,000 patients and is bringing their platform directly to self-funded employers. In this episode, we tackle the stigma and misconceptions surrounding medical cannabis in the workplace. Emily explains how LeafWell differentiates between "presence and impairment," the strict guardrails they use for safety-sensitive jobs, and why clinically-guided cannabis therapy is helping patients reduce or eliminate highly addictive opioids and expensive pharmaceuticals. If you are an employer or a benefits consultant looking for an innovative, holistic approach to managing chronic pain and reducing pharmacy spend, this conversation will completely change how you view cannabis as an employee benefit. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) Intro: Medical Cannabis as an Employee Benefit?  (00:04:05) Emily’s Story: Surviving Stage 4 Breast Cancer  (00:08:25) Launching LeafWell: Increasing Access, Education, & Research  (00:11:55) Dispensary "Bud Tenders" vs. Clinically Guided Care  (00:15:24) Why Cannabis is a $29 Billion Healthcare Savings Opportunity  (00:18:01) Reducing Prescription Drugs & Avoiding the ER  (00:21:15) Addressing the Elephant in the Room: Impairment at Work  (00:26:32) Differentiating Between Presence (Urine Tests) and Impairment  (00:29:29) Form Factors: Tinctures, Capsules, and Avoiding Inhalables  (00:35:47) How the Endocannabinoid System Works  (00:42:00) The Future: Will the Government Reschedule Cannabis?  (00:46:54) How Employers Can Roll Out a Medical Cannabis Program Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Revolutions are never won by the ruling class... if you want to fix healthcare, you have to be willing to accept a negative sum game. Someone is losing." Why are self-funded employers still paying for healthcare on a "fee-for-service" basis, where every single transaction is billed separately with zero guarantee of a positive outcome? My guests this week are Francois and Jeremy from XO Health, a new type of health plan built explicitly for self-funded employers. Instead of relying on traditional, opaque carrier networks (the "BUCAs"), XO Health is introducing a new accounting system for healthcare: the Care Package. In this episode, we explore how XO packages an entire episode of care - from a knee replacement to the ongoing management of chronic diabetes or maternity - into a single, predictable, fixed price. We discuss how this model shifts financial accountability back to the provider (while also protecting them through embedded risk corridors and "mini-spec" policies), eliminates the perverse incentives of traditional networks, and ultimately allows employers to offer a health plan that employees actually want to use (complete with "hugs and kisses" for $0 out-of-pocket costs). If you are an employer or a benefits consultant tired of 10% medical trend and unpredictable renewals, this episode provides a blueprint for how true risk-sharing can finally fix the system. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) Intro: Setting a "Circuit Breaker" for Provider Risk  (00:01:21) What is XO Health? (And where the name comes from)  (00:06:51) The Flawed "Unit of Service" Accounting System  (00:08:33) Introducing the "Care Package" (Episodic & Chronic Bundles)  (00:15:37) The Maternity Example: Guaranteed Pricing & Provider Risk  (00:20:13) How Embedded Risk Corridors ("Mini-Specs") Protect Providers  (00:27:14) Value-Based Care: What is it Really?  (00:32:32) Measuring Clinical Outcomes (Experience, Mobility, & A1C)  (00:38:07) Building a High-Performance Network & Incentivizing Steerage  (00:46:13) The Regulatory Tailwinds Pushing Employers to Act  (00:50:35) The "Negative Sum Game": Why Someone Has to Lose  (00:54:05) Closing Thoughts: Flattening Medical Trend Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I can't fathom a world where employers are expected to budget and create a plan for their future without understanding what the costs of their healthcare are. Everything needs to be grounded in fact and truth." Is the traditional insurance network obsolete? My guest this week is Amy Wykoff, Chief Product Officer at Nomi Health. After starting her career building foundational AI models at IBM Watson, Amy pivoted to healthcare with a massive new challenge: rebuilding the insurance network from scratch. In this episode, we explore Nomi’s radical approach to the "Network as a Product." Rather than negotiating opaque discounts off inflated Charge Master rates, Nomi negotiates fair, transparent cash rates with providers and guarantees them 100% payment. In return, self-funded employers can offer their employees a true $0 copay, $0 deductible health plan. We discuss the logistics of building a direct-contracted network across 40 major MSAs, how to overcome "point solution fatigue" by reassembling the vendor stack, and why the ultimate goal of healthcare innovation should be to stop using AI to fight over claims denials - and start using it to improve actual patient care. Tune in to this week’s Self-Funded to learn exactly how the free market is finally fighting back! Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) Intro: IBM Watson & The Origins of Healthcare AI(00:02:56) Leaving AI to Build "Network as a Product" at Nomi Health(00:05:07) The $0 Copay, $0 Deductible Health Plan(00:07:09) Scaling a Direct-Contracted Network to 40 MSAs(00:08:44) The Insanity of Traditional Carrier Reimbursement(00:13:08) Why Providers Actually Want Transparent Cash Pricing(00:15:10) The Economic Drain: How Bad Networks Hurt Local Economies(00:19:07) Why Employees Hate Their Health Insurance(00:23:44) Reassembling the Vendor Stack: Navigation & TPAs(00:28:13) Why Healthcare is Now a CFO Decision(00:32:02) "The Tears of Joy": Real Patient Stories(00:37:31) The AI War: Why "Bots Fighting Bots" is a Waste of Talent(00:43:51) Closing Thoughts: Unbundling the Health Plan Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"There’s no bad risk, there’s just mispriced risk... we helped one carrier achieve a 29.1% improvement in their loss ratio just through better risk selection." How do stop-loss carriers and self-funded employers accurately predict which groups are going to run well and which ones are about to see skyrocketing claims? My guest this week is Ali Panjwani, Founder and CEO of Merit Medicine. Ali transitioned from a career in biotech and pharmaceutical public policy, where he helped price and launch complex, rare-disease drugs, to solving one of the biggest problems in self-funded healthcare: predicting catastrophic risk before it happens. In this episode, we dive into the evolution of predictive analytics and medical underwriting. Ali explains how Merit Medicine uses AI and access to a massive database (covering 95% of commercial claims in the US) to project a group's healthcare spend using just a simple census file. We discuss why a group that ran poorly last year might actually be a great risk this year, how to prevent underwriters from "playing on tilt," and the ongoing debate over how to finance multi-million-dollar cell and gene therapies. If you are a benefits consultant, an MGU, or a stop-loss carrier trying to understand how technology is fundamentally changing the way healthcare risk is predicted and priced, this episode is a must-listen. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com/spencer to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) Intro: The Evolving Landscape of Healthcare Risk(00:04:28) Ali's Background: From Biotech to Public Policy(00:09:47) The Complexity of Launching & Pricing New Drugs(00:13:30) Shifting Focus: Who Actually Pays for Healthcare?(00:16:34) The Data Access Problem for Self-Funded Employers(00:19:50) How Merit Medicine Predicts Risk with Just a Census File(00:23:24) Why Merit Looks Backwards to Predict the Future(00:26:27) How Stop-Loss Carriers & MGUs Use Predictive Analytics(00:29:41) "There Is No Bad Risk, Only Mispriced Risk"(00:33:04) The Danger of Underwriting "On Tilt" (Past vs. Future Claims)(00:37:37) Can Predictive AI Help Apply Specific Lasers?(00:40:10) The Evolution of Underwriting Tech(00:45:04) Proving the Model: A 29.1% Loss Ratio Improvement(00:49:10) The Cell & Gene Therapy Debate: Public Pools vs. Financing(00:55:14) Closing Thoughts: The Future of Predictable Premiums Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

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

"We are in a $5 trillion US healthcare consumer market with no consumer in it... I basically decided we had been surgically removed from the US healthcare system." My guest this week is Mark Galvin, a serial entrepreneur who successfully funded his own company's healthcare by pairing a $10,000 High Deductible Health Plan with a fully funded HSA and HRA - saving his company 32% and his employees 50%. When he realized that brokers, carriers, and even the state insurance department were financially disincentivized from sharing this strategy, he decided to force transparency into the market himself. In this episode, Mark shares the incredible story of how he secured a DVD containing 100% of New Hampshire’s post-adjudicated claims data and built the first true shopping tool for medical procedures. We discuss his meetings at the White House that helped shape the Transparency in Coverage Rule, the absurdity of $68,000 knee replacements, and his new platform that calculates a "Universally Acceptable Payment Amount" (UAPA) for every provider in the country. If you are an employer, broker, or patient who is tired of flying blind and wants to understand how true cash prices are finally coming to healthcare, this episode is a must-listen. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com/Spencer to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) Intro: Aligning Financial Incentives in Healthcare  (00:02:41) Mark's Background: Voice Over IP to Healthcare Tech  (00:04:47) The Early Days of Direct Primary Care (DPC)  (00:09:08) Hacking the HDHP: Saving 32% on Premiums  (00:11:28) Why Brokers & Carriers Hate Cost-Saving Strategies (The MLR Problem)  (00:18:33) Discovering the All-Payer Claims Database (APCD)  (00:21:49) The $1,600 vs. $6,800 Nuclear Stress Test  (00:26:00) Building a Commercial Solution to Fight Lobbyists  (00:29:40) The "Proficiency Score": Why Price Does Not Equal Quality  (00:31:48) Scraping EOBs to Build a National Price Database  (00:33:27) The White House Meetings & The Transparency in Coverage Rule  (00:43:03) Inventing "Transparency 2.0" and the UAPA (Cash Pay)  (00:51:13) Shared Savings Rewards: Paying Employees to Shop  (00:53:56) The Future: In-App Repricing and "Tap-to-Pay" at the Doctor  (00:57:52) Can We Shop for 70% of Healthcare?  (01:04:18) Using UAPA as a Full Network Replacement  (01:11:19) The Path to an "Amazon-Like" Healthcare Market  (01:15:19) Closing Thoughts: Why 12% of Shoppers Can Change the System Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I've got a patient in Washington state. He's traveling 100 miles every other week to receive an infusion. We moved this patient into the home and saved the plan $700,000 on this one patient...on gout treatment." Why are infusion drugs quietly destroying your health plan's budget? This week, my guest is Rob LaHayne, Co-Founder of Leap Health. We pull back the curtain on one of the most overlooked and expensive categories in healthcare: Specialty Infusion Care. Because these drugs are administered by a medical professional, they are billed through the medical plan under "J&Q Codes" - subjecting them to massive hospital markups and "buy-and-bill" margin games. In this episode, Rob explains how Leap Health is solving this by taking over the supply chain, procuring the drugs transparently without margin, and redirecting patients to their own homes or convenient infusion centers. We discuss how these J&Q codes are often the hidden culprit behind breached stop-loss deductibles and skyrocketing renewals, and why shifting the site of care is a win for both the employer's budget and the patient's quality of life. If you're a benefits consultant trying to figure out why your client's medical spend is out of control, or an employer tired of paying massive hospital markups for necessary medications, you need to understand J&Q codes. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com/Spencer to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) Intro: The Hidden Problem of J&Q Codes  (00:04:13) Rob's Background & The Genesis of Leap Health  (00:08:24) Why Hospital "Buy-and-Bill" Margins Drive Up Costs  (00:13:22) How Leap Health Provides Transparent, Zero-Margin Pricing  (00:16:31) Shifting Site of Care: The Power of Home Infusions  (00:23:44) Overcoming Headwinds: Patient Engagement & Plan Design  (00:27:01) Taking Over the Supply Chain to Bypass the "BUCA" PBMs  (00:32:51) Stop-Loss Renewals: Why Identifying J&Q Codes is Critical  (00:37:04) Saving $700,000 on a Single Gout Patient  (00:41:39) The Future: Unbundling the Health Plan & "Point Solution Fatigue"  (00:45:41) Closing Thoughts: Why Consultants Must Request J&Q Code Data Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

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

"We don't view ourselves as a TPA, we view ourselves more as a platform... our goal is to simplify and reduce the barriers of entry into the TPA space." The role of the Third-Party Administrator is undergoing a massive evolution. No longer just a back-office claims processor, the modern TPA is being asked to serve as the high-tech, high-touch "nucleus" of the entire health plan. My guest this week is Vinny Esposito, CEO of Reflect Health (formerly S&S Health). Drawing on a decade of experience in the hedge fund world, Vinny recognized a massive opportunity to bring scalable, asset-light infrastructure to the self-funded market. Today, Reflect Health acts almost like the "Intel Inside" of the industry, licensing its proprietary claims technology to other TPAs and health plans. In this episode, we explore exactly what it takes to build the TPA of the future. We discuss how to solve "point solution fatigue" through a centralized marketplace, the mechanics behind infusion drug carve-outs, and how to successfully deploy dynamic deductibles to incentivize better care routing. Vinny also shares his bold vision for "frictionless claims" paid instantly at the point of service, moving us closer to an Amazon-style shopping experience for healthcare. If you want to understand the technological and administrative innovations driving the self-funded market forward, this episode provides the blueprint. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) Intro: Competing on Service in the TPA Market  (00:01:56) Meet Vinny Esposito & Reflect Health  (00:03:35) Rebranding from S&S Health  (00:07:32) From Hedge Funds to Healthcare Disruption  (00:11:05) The Platform Model: Licensing Tech to Other TPAs  (00:15:05) The Marketplace & Infusion Drug Carve-Outs  (00:19:14) How the TPA Role is Expanding (The "Nucleus")  (00:24:12) Direct Contracting, RBP, and DPC Integration  (00:29:15) Dynamic Deductibles & Tiered Networks  (00:33:25) Curing "Point Solution Fatigue"  (00:41:09) The Future of Stop-Loss and Preventative Care  (00:45:44) The Fiduciary Breaking Point & 80% Renewals  (00:50:26) Frictionless Claims & Amazon-Style Healthcare Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow 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 Carriers Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow 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 Software Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow 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 Steelman The 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 Resistance Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow 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 Wells My 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 MDs Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow 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 Johnson My 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/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/