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The Middleman's Cut: Unpacking the Role of Middlemen in HealthcareWho’s really looking out for employers and patients when it comes to healthcare costs? In this episode of Full Disclosure, hosts Chris Estep and Andy Rodriguez sit down with healthcare expert and author Steve Ditto to discuss his book, The Middleman’s Cut, and the often-overlooked role middlemen play in driving healthcare costs. Steve shares his personal experiences navigating the healthcare system and explains why employers need to take a closer look at their pharmacy benefit manager (PBM) contracts, understand their fiduciary responsibilities, and demand greater transparency and accountability from their healthcare partners. The conversation explores the importance of working with unconflicted advisors, the hidden complexities within healthcare agreements, and how Steve’s Contract X-ray tool can help employers identify problematic contract terms and make more informed decisions. Whether you’re an employer, broker, benefits advisor, or simply someone looking to better understand where healthcare dollars go, this episode offers valuable insights into challenging the status quo and taking a more informed approach to healthcare. Because you don’t need all the answers, but you do need visibility.

# Unpacking Self-Funding: Insights with Katrina Johnson   > Understanding the shift to self-funded health plans for mid-market employers.   Good to have you here. Today, we dive into the world of self-funding health plans, a topic that's gaining traction among mid-market employers. With insights from Katrina Johnson, Senior Vice President of Employee Benefits at Gallagher, we explore the realities of self-funding and what it means for your organization.   ## The Misunderstanding of Self-Funding Katrina starts by addressing a common misconception: many mid-market employers believe they can't afford to self-fund.   > "In most cases they've been misinformed about what self-funding actually costs versus what they're already paying."   The truth is, when you self-fund, you might actually save money while gaining visibility into your healthcare spending.   ## What Does Self-Funding Mean? For those unfamiliar, self-funding involves a company paying for its employees' healthcare claims directly instead of paying a fixed premium to an insurance carrier.   Katrina highlights that about 20% of employers with under 200 employees are now self-funding, marking a significant trend.   > "When you're fully insured, you're paying a carrier fixed premium every month, and they are betting that they will collect more in premiums than they had to pay out in claims."   In contrast, self-funding eliminates the middleman, allowing companies to keep the savings when claims are low.   ## Key Considerations for Employers Katrina emphasizes that the decision to self-fund is not solely about headcount. Factors such as claims history and industry play a pivotal role.     > "Groups at 100 employees and above are genuinely candidates depending on claims history and industry."   Employers spending over $800,000 annually on total premiums should seriously consider self-funding, as the administrative costs typically become negligible compared to the savings potential.   ## The Transition to Self-Funding When making the switch, employers must engage actively in the process. Katrina warns against treating self-funding like a fully insured plan.     > "Control requires major engagement by not only the employer but the broker."   Employers often fail to read their contracts carefully, leading to unexpected costs and challenges.   ## Navigating the Stop Loss Market As the conversation shifts to the stop loss market, Katrina notes that it has significantly changed, especially post-pandemic. Employers should brace for higher costs and stricter terms during renewal periods.   > "Employers going to renewal should expect stop loss quotes to be more expensive and potentially more restrictive than their initial quotes were three or four years ago."   Understanding your pharmacy benefit manager (PBM) relationship is crucial, as it can directly affect what you pay for stop loss coverage.   ## Final Thoughts The shift to self-funding can seem daunting, but with the right information and proactive management, it can lead to significant benefits for mid-market employers. The key takeaway? Transparency and engagement are vital for success in this model.   For a deeper dive into this essential topic, listen to the full episode with Katrina Johnson and gain insights that could transform your approach to employee benefits.

In this episode of Full Disclosure, Chris Estep and Andy Rodriguez sit down with Winston Walters of HUB International to talk about how the role of the benefits broker is changing and what it takes to stay relevant in today’s healthcare landscape. The broker’s job has evolved far beyond simply helping employers select an insurance plan. Today, brokers are expected to understand increasingly complex areas like PBMs, compliance, claims data, technology, and emerging healthcare solutions while helping employers make sense of it all. Winston shares his perspective on what separates modern advisors from the traditional broker model, why data literacy has become such an important skill, and how technology is changing both employee expectations and the way benefits strategies are built. The conversation also explores the importance of continuous education, helping employers better understand where their healthcare dollars are going, and why brokers who are willing to challenge the status quo may be best positioned for the future. In this episode: How the broker’s role has evolvedWhy understanding healthcare and pharmacy data mattersThe growing importance of technology and digital health solutionsHow brokers can help employers make more informed decisionsThe skills benefits advisors will need to succeed in 2026 and beyondWhy education, adaptability, and transparency are becoming essential Whether you’re a broker, employer, consultant, or simply interested in where the benefits industry is headed, this conversation offers a look at what the next generation of benefits advising may look like. Full Disclosure — Where Transparency Takes the Mic.

Chris Deacon discusses the complexities of healthcare purchasing, the pitfalls of vertical integration, and how employers can better navigate the system by understanding incentives, transparency, and partner selection.

Healthcare is complicated, but is that complexity protecting employers and patients, or protecting the business models operating behind the scenes? In this episode of Full Disclosure, Chris Estep and Andy Rodriguez sit down with Chris Deacon, healthcare attorney, founder of VerSan Consulting, former public health plan leader, author of The Great American Healthcare Heist, and a nationally recognized voice on healthcare transparency and reform. Chris shares what she has learned from testifying before Congress, leading public health plans, reviewing audits and contracts, and working alongside employers, unions, policymakers, and healthcare purchasing coalitions. The conversation explores why transparency must be the starting point for meaningful reform, what CAA 2026 could mean for fiduciary responsibility, and why employers must look beyond vendor labels to understand the actual functions, incentives, and financial relationships operating within their health plans. They also discuss hidden transaction fees, carrier and PBM relationships, claims data restrictions, stop-loss arrangements, misleading guarantees, and the difference between the lowest price, the best value, and the lowest true net cost. Most importantly, Chris explains what employers should be asking during the proposal and renewal process, which red flags should make them pause, and how the right broker, consultant, PBM, carrier, or healthcare partner should make the employer smarter not make them feel difficult for asking questions. Because employers do not need to have every answer. But if they are responsible for the decision, they should be able to follow the money, understand the tradeoffs, and get clear answers.

In this episode of Full Disclosure we sit down with Dave Chase, Co-Founder of Health Rosetta, to talk about what it actually takes to fix a broken benefits system. Dave has been one of the loudest voices challenging the status quo in healthcare, pushing employers, advisors, and plan fiduciaries to stop accepting opaque contracts, misaligned incentives, and “that’s just how it works” as an answer. We dig into the Health Rosetta movement, the importance of fiduciary alignment, the role of transparent PBM contracts, and why tools like Nautilus and Contract X-Ray matter for employers who want to understand what they are really buying. This conversation is about more than pharmacy benefits. It is about employer accountability, smarter plan design, better contracting, and putting the health plan back in service of the people it was built for. Whether you are an employer, broker, consultant, or just someone tired of healthcare shell games, this episode is worth the listen.

Episode 2: The Truth About Spread Pricing with Brian Schram What exactly is spread pricing—and why has it become one of the most controversial topics in pharmacy benefits? In this episode of Full Disclosure, Chris Estep and Andy Rodriguez sit down with DisclosedRx Vice President of Sales Brian Schram, someone who has seen the industry from nearly every perspective imaginable: broker, employer, and now PBM executive. That unique journey gives Brian a front-row seat to how pharmacy pricing really works—and where employers often get left in the dark. Together, we break down the mechanics of spread pricing, why it's so difficult to identify, how it impacts employer health plans, and why increasing scrutiny from lawsuits, regulations, and employers themselves is bringing the issue into the spotlight. We also discuss what employers and brokers should be asking their PBMs if they want to understand where their pharmacy dollars are actually going. Whether you're a broker, consultant, employer, or simply trying to understand why prescription drug costs continue to rise, this episode offers a candid look at one of the most misunderstood—and costly—practices in healthcare. Topics Covered: • What spread pricing is and how it works • Why employers often don't know it's happening • The incentives driving pharmacy benefit costs • Recent lawsuits and industry scrutiny • CAA 2026 and the future of PBM transparency • Questions every employer should be asking their PBM • What brokers should look for when evaluating pharmacy contracts The more transparent the pricing, the harder it is to hide the spread. 🎙️ Full Disclosure with Chris Estep & Andy Rodriguez — Where Transparency Takes the Mic.

Episode 1: Why DisclosedRx Exists with Co-Founder Zack Robinson In our debut episode, we sit down with one of the founders of DisclosedRx, Zack Robinson, to discuss the problem he saw in the pharmacy benefits industry and why he decided to build something different. We dive into the realities of spread pricing, rebate retention, hidden revenue streams, and the lack of visibility that many employers face when managing pharmacy benefits. Zack shares the story behind DisclosedRx, the principles that shaped the company, and why they chose a fiduciary-first approach built on transparency, 100% pass-through pricing, full rebate pass-through, and true NDC-11 claim visibility. Whether you're an employer, consultant, broker, or simply curious about how the PBM world really works, this episode provides an inside look at the challenges facing the industry and one company's attempt to change the status quo. Topics covered: • Why DisclosedRx was founded • What spread pricing really is • The rebate debate • Fiduciary responsibility in pharmacy benefits • NDC-11 transparency and why it matters • What employers should be asking their PBM Where Transparency Takes the Mic. 🎙️ This is Full Disclosure with Chris Estep and Andy Rodriguez.