Self-Funded

Hosted by Spencer Smith

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282

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Jun 2026

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Self-Funded, hosted by Spencer Smith, is the definitive resource for benefits consultants and employers who are ready to challenge the broken healthcare status quo. Each week, you'll get an insider's playbook of actionable strategies from industry leaders that help make healthcare better, together.

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June 16, 2026Episode 2531 hr 13 min

You’re Probably Wrong About Reference-Based Pricing | with Jeff Bak

"We did this survey with a third-party consulting group who talked to 2,000 brokers. Their perception was that 25% of bills are going to be balance bills; it's actually 3%."Is Reference-Based Pricing (RBP) still something that just creates endless problems for HR?My guest this week is Jeff Bak, CEO of Imagine360. Jeff brings 30 years of healthcare and private equity experience to the table, and he's leading the charge to rebrand and evolve RBP from a defensive "pay and defend" model into a comprehensive, full-stack alternative health plan.In this episode, we tackle the persistent broker misconceptions surrounding RBP, dissecting exactly why the actual balance bill rate is closer to 3% while plan savings average over 20%. We also explore how Imagine360 blends RBP with strategic direct hospital contracts (like Baylor and Northwestern) to give employees a seamless "PPO-like" experience without the inflated PPO price tag. Jeff also breaks down the reality of the No Surprises Act (NSA) and Independent Dispute Resolution (IDR) process, and why hospitals are currently winning the majority of those arbitration cases.If you are a benefits consultant or an employer looking to truly break away from the traditional "BUCA" networks, while ensuring your employees aren't stranded with unmanageable balance bills, this conversation is the reality check you need.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Dispelling Broker Myths Around RBP (00:03:52) Jeff's Background: From the NFL to Healthcare CEO (00:10:15) Defining Reference-Based Pricing (Cost-to-Charge vs. Medicare) (00:14:22) Why Traditional Plans are Like Buying a Ford F-150 Every Year (00:16:19) The Evolution from ELAP's "Pay and Defend" to Imagine360 (00:20:09) Blending RBP with Direct Hospital Contracts (00:26:01) Unpacking the Broker Survey: Perceived vs. Actual Balance Bill Rates (00:34:19) Building an Integrated, Full-Stack Health Plan (00:39:11) How to Transition a Workforce to RBP (Dual Option & Slice) (00:45:34) Managing Single Case Agreements & Redirection (00:50:16) Navigating the NSA and the IDR Arbitration Process (00:54:26) The Ideal Employer Profile for an Alternative Health Plan (00:59:37) The Future of RBP & Price Transparency (01:04:57) Closing Thoughts: The "Barbecue Sandwich" MarginKey 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/

June 12, 202623 min

Marty Makary Resigns from FDA + May's Biggest Healthcare News | with Jonathan Lopez

"The average marketplace deductible grew by about $1,000 per person in 2026. Premium payments increased by an average of 58%... We might be seeing the death throes of the fully insured market."Welcome back to Last Month in Healthcare! This month, Spencer, Nathaniel, and special guest Jonathan Lopez break down the most impactful healthcare headlines and regulatory shifts from May 2026.The episode kicks off with a discussion on the sudden resignation of FDA Commissioner Dr. Marty Makary following reported clashes with the food, tobacco, and pharmaceutical industries. From there, the guys dive into the shocking 58% premium hikes and 37% deductible increases hitting the ACA marketplace as carriers like Cigna exit the space.Finally, Spencer and Jonathan play a World Cup-themed game guessing the cost of medical procedures across different North American cities and answer a listener question about Cost Plus Drugs and the rise of direct-to-consumer pharmacy models.If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Thank you to our sponsor, Walk On Clinic. This month, we shared a tragic reminder to our listeners on the critical importance of early cancer detection and proactive primary care. To hear Chris's brother-in-law's music, tune in here: https://open.spotify.com/artist/1SKw4DO9FNLjcZDb5Q81q4?si=Dwpuz2wOTRawhMDfR5NIsAEpisode Chapters:(00:00:00) Intro: The Importance of Early Detection & Walk-On Clinic(00:02:30) Dr. Marty Makary Resigns as FDA Commissioner(00:04:37) ACA Marketplace Premiums Skyrocket by 58%(00:07:51) HR 8163: Stopping the Squeeze on Physician Reimbursements(00:12:34) Harvard Study: AI Outperforms Doctors in ER Triage(00:14:53) The FDA's Push for Hospital-at-Home Devices(00:17:18) Game: Guess the Procedure Cost (World Cup Edition)(00:21:22) Ask Spencer Anything: Cost Plus Drugs & D2C Pharmacies

June 9, 2026Episode 2521 hr 8 min

The ERISA Fiduciary Crackdown is Here | with Jay Gepfert

"Within five years of calling us charlatans, that hospital system was sued for multiple millions of dollars by their participants... You can go from charlatan to change agent fast."Is history about to repeat itself in the health benefits world?My guest this week is Jay Gepfert, Managing Partner of Culpepper RFP. Jay spent his corporate career on the retirement and 401(k) side of the industry, where he witnessed a massive fiduciary paradigm shift 15 years ago. Driven by regulatory changes and a wave of aggressive class-action lawsuits, traditional retirement "brokers" were forced to stop taking undisclosed kickbacks, disclose 100% of their compensation, and legally sign on as fiduciaries for their clients.Now, Jay warns that a “tsunami” is hitting the health insurance space. With major lawsuits filed at the end of 2025 targeting plan sponsors and major brokers over voluntary benefits and PBM conflicts, employers can no longer hide behind the "we've always done it this way" excuse.In this episode, we break down exactly what it means for a benefits consultant to legally act as a fiduciary, how hidden compensation and broker overrides create toxic conflicts of interest, and how Jay's firm helps employers run rigorous, process-driven RFPs to audit their vendors and protect themselves from massive legal liabilities.If you are a CFO, HR leader, or benefits consultant trying to navigate the new era of ERISA compliance and Consolidated Appropriations Act (CAA) enforcement, this episode is a stark wake-up call.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.Episode Chapters(00:00:00) Intro(00:01:40) Meet Jay Gepfert and Culpepper RFP (00:03:30) Origin Story: Transitioning from 401(k)s to Health Benefits RFPs (00:06:54) The 401(k) Paradigm Shift: How Retirement Got Cleaned Up (00:08:50) The 2025 Wave of Health Benefits Fiduciary Litigation (00:13:49) Voluntary Benefits and the Commission Tsunami (00:17:19) What it Actually Means to be a Fiduciary for a Plan Sponsor (00:19:05) Mandating Your Broker Becomes a Fiduciary Consultant (00:21:05) Flat Fees, Eliminating Hidden Comp, and Disentangling Commissions (00:27:24) Exposing Toxic PBM Conflicts of Interest (00:30:19) The Customer Experience: Running a Modern Fiduciary RFP (00:35:08) Why Process and Documentation Matter More Than Perfection (00:38:13) The Consolidated Appropriations Act (CAA) & Gag Clauses (00:41:18) The Catalyst: When Will the Market Finally Shift? (00:44:14) The Multi-Million Dollar Lawsuit: From Charlatan to Change Agent (00:48:56) The 5 Questions That Eliminate Status Quo Brokers (00:56:18) The Ideal Plan Sponsor: Proactive vs. Reactive (00:58:54) Shifting the CFO Mindset & Unlocking the Bottom Line (01:04:01) Big Picture: The Breaking Point of Employer-Sponsored Care (01:06:40) Closing ThoughtsKey Links for Social:@SelfFunded on YouTube - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/

June 2, 2026Episode 25156 min

A Health Benefit That Actually Makes Employees Healthier | with Superpower

"Insurance is there for when you're sick or when something goes incredibly wrong. It's not there for prevention."The traditional healthcare system is designed to treat you when you are sick. You go to a doctor for 15 minutes, get a basic blood panel, and if you are within the "reference range," you are told you are fine. The goal of this system is to get you from -1 back to 0.My guest this week is Prabhat Dhar, the Head of Growth for Superpower, a new platform that wants to take you from 0 to 100. Rather than treating late-stage diagnoses, Superpower provides comprehensive biomarker testing, looking at advanced metrics like ApoB, Fasting Insulin, and HSCRP, to detect diseases like cardiovascular risk or metabolic dysfunction up to a decade before they materialize as claims.In this episode, we discuss how Superpower translates complex biological data into a highly personalized, AI-driven action plan for your health (and your lifestyle). We also dive into why employers must stop relying on health insurance carriers to manage wellness, the power of decoupling proactive screening from the traditional system, and how to start bending the cost curve by focusing on root-cause analysis instead of late-stage symptom management.If you want to know what the future of employee health benefits looks like when it's built on individual biology instead of group claims data, 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 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.Episode Chapters(00:00:00) Intro: Getting from 0 to 100 (Not Just -1 to 0) (00:01:21) Why the Primary Care "Quarterback" System is Broken (00:04:47) Decoupling Proactive Health from Health Insurance(00:07:42) The Origin Story of Superpower & Treating Crohn's Disease (00:12:06) Democratizing "Concierge" Functional Medicine (00:15:22) Why Traditional Blood Tests Miss the Real Signals (00:19:06) Translating Biomarkers into Personalized Action Plans (00:23:44) Overcoming "Point Solution Fatigue" with Biological Data (00:27:55) The Superpower Member Experience: How It Works (00:31:41) Integrating an AI Doctor Chat and Clinical Teams (00:33:42) How Superpower Augments Direct Primary Care (DPC) (00:41:22) The 5 Biomarkers You Need to Be Testing For (00:49:36) Moonshot: The Future of the "Health Super App" (00:54:51) Closing Thoughts: Moving from Success to SignificanceKey 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/

May 26, 2026Episode 2501 hr 33 min

The 2026 Benefits Consulting State Of The Union | with Seth Denson, Chris Hamilton & Taylor Rogers

"To quote my business partner, a broker makes you broker."To celebrate the 5-year and 250th-episode anniversary of the podcast, we recorded a special live panel in front of an audience featuring three of the most forward-thinking minds in the benefits space: Chris Hamilton (Hotchkiss Insurance), Taylor Rogers (CCIG), and Seth Denson (Acrisure).In this "State of the Union" episode, we tackle the existential crisis facing mid-market employers and the healthcare industry at large. The panel holds nothing back as we debate the illusion of PPO network discounts, the weaponization of AI in medical billing, and why staying fully-insured absolutely does not protect a CFO from fiduciary liability lawsuits. The guys also share their personal "Jerry Maguire" moments - the exact turning points in their careers when they decided to stop chasing commissions and start fighting for the patients and employers footing the bill.Following the main discussion, we hosted a Q&A featuring questions from the audience.If you are an employer looking to take control of your healthcare spend or an advisor wanting to stay relevant in a rapidly changing market, this live discussion is packed with actionable strategy.Thank you to all who have listened for helping us get to 5 years!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.Episode Chapters(00:00:00) Intro: Welcome to the 5-Year Anniversary Live Show (00:01:51) Meet the Panel: Chris Hamilton, Taylor Rogers, and Seth Denson (00:04:56) State of the Union: Is the Benefits Industry in a Crisis? (00:11:12) Broker vs. Consultant: Defining the Difference (00:17:26) Following the Money: Controlling Facility Costs & Member Experience (00:24:02) Are Traditional PPO Networks a Scam? (00:34:46) Building Tiered Benefit Structures and Narrow Networks (00:40:22) The AI Threat: Weaponized Billing and the Loss of the "Training Ground" (00:55:40) Fiduciary Responsibility and the Threat of Employer Lawsuits (01:05:03) The Next 5 Years: Breaking Up Insurance Monopolies (01:11:18) Audience Q&A: Preventing High-Cost Claimants with DPC (01:15:30) The Panel's "Jerry Maguire" Career Moments (01:20:46) The Reality of Price Transparency and Medical Shopping (01:26:03) Navigating the Wild West of the No Surprises Act (NSA) (01:29:45) Why Fully-Insured Plans Don't Protect CFOs from Fiduciary Liability (01:32:21) Closing Remarks and the 5-Year Whiskey GiveawayKey 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/

May 19, 2026Episode 2491 hr 14 min

Why Self-Funded Employers Are Abandoning National Networks

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

May 12, 2026Episode 24858 min

Advanced Primary Care 101 (With Ben Miller)

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

May 8, 202626 min

State Healthcare Regulations, ACA Shifts, Hospital Funding Loopholes | Last Month In Healthcare

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

May 5, 2026Episode 2471 hr 4 min

The Financial Case Against Fully Insured Health Plans | with John Kountz

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

April 28, 2026Episode 2461 hr 10 min

Rob Gelb’s Huge Announcement: The Future of Vālenz & Self-Funding

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