Self-Funded

Spencer Smith

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.

  1. 1 day ago

    The Switch: Why Employers Want To Be Led, Not Sold | with Billy Potter

    My guest this week is Billy Potter, now CEO of Snellings Walters, and we spend this episode on "the Switch," his firm's process for moving employers from fully insured to self-funded. Billy explains why he thinks it has almost nothing to do with insurance and everything to do with changing who a business trusts to lead them. We get into why "does that make sense?" is the worst question in sales, why he asks prospects "where did I lose you?" instead, and why he believes most deals aren't lost on product, they're lost on communication.  Billy breaks down how Culture Index reshaped how his firm hires, trains, and sells, why he tells skeptical prospects out loud that they shouldn't believe a word of his pitch, and why price-driven clients are usually being trained that way by their own consultant. If your presentation is technically correct but you keep losing deals anyway, this is the episode. Tune in. "People don't buy what's best for them. They buy what they understand the fastest." - Billy Potter 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: Grace, Truth, and Growth(00:03:19) Culture Index and Why It Blew Spencer's Mind(00:04:33) Billy's Background: Rugby, Sun Life, and a Borrowed ID(00:08:13) Partner vs. Vendor: Why "Supplier" Is a Dirty Word(00:12:52) What Drew Him to the Consulting Side(00:14:34) The Peanut Butter Fight and the Valley of Despair(00:16:19) Advice for Young Producers: Dream Big, Get Rejected(00:19:44) Spencer's Story: The Nursery Floor and Three Cases in a Morning(00:24:49) Becoming CEO and Learning to Manage His Emotions(00:29:08) Why He Loves Building Other People Up(00:30:44) EOS and Smoking Out the Real Issue(00:32:20) How Culture Index Runs Through the Whole Business(00:35:06) The Switch: Changing Who Gets to Lead(00:39:44) His First Big Sale: Telling a Client to Go Talk to Their Agent(00:43:02) "Billy Potter Is Gonna Mess Up, and I'll Be There"(00:45:44) Win and Lose the Same Way: The Anthony Russo Lesson(00:50:20) Why 83% of Employees Don't Understand Their Own Plan(00:53:17) The Fifth-Grade-Level Rule and Why Insurance Loves Jargon(00:56:31) "Where Did I Lose You?" and Other Pivot Questions(00:58:12) The Last Slide: "You Don't Believe Anything We Just Told You"(01:01:14) The "Oh, Damn It" Moment and Who's Really at Fault(01:03:37) Where Self-Funding Is Headed(01:05:11) AI, Robot Surgeons, and the Future of White-Collar Jobs(01:12:27) The Chick-fil-A Standard: Hospitality as a Differentiator(01:14:49) Retaining Our Humanity in an AI World(01:17:07) Closing Thoughts 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/

    The Switch: Why Employers Want To Be Led, Not Sold | with Billy Potter

  2. 5 days ago ·  Bonus

    Trump's Generic Drug Tariffs & The 14% ACA Hike | Last Month in Healthcare

    "Generic drugs are not the costly drugs. A 100% increase on a relatively inexpensive generic may not even be noticeable." In this episode of Last Month in Healthcare, Producer Nathaniel and I sat down with Sean McGowan of Centivo to break down the biggest healthcare news stories of July 2026. We started with the proposed tariffs on generic drugs - 100% in 2028, 200% in 2029 - and what that actually means when India supplies roughly half of U.S. generic volume and China supplies most of the active ingredients. We also dug into ACA marketplace insurers proposing a 14% median premium increase for 2027 and whether ICHRA adoption is quietly loading that risk pool, the Patients Deserve Price Act clearing Senate HELP 21-1 and whether posted prices change any real behavior, specialty drugs on track for a 32% jump by 2028 driven by utilization rather than unit price, and a misleading headline about $6.6 trillion in "tax help" for employer plans that's actually been on the books since the 1950s. To cap it off, we ran a point solution trade deadline in honor of the MLB deadline - six solutions on the roster, a $100 cap, and some tough calls on who's overpaid. Plus I answered a listener question on whether covering GLP-1s for weight loss locks an employer in for good. Tune in for a great conversation! Thank you to Walk-On Clinic for sponsoring this episode. Visit walkonclinic.com to learn more. Chapters: (00:00:00) Intro: Sean McGowan and Walk-On Clinic (00:01:39) 200% Tariffs on Generic Drugs by 2029 (00:04:41) ACA Insurers Want a 14% Premium Hike for 2027 (00:07:28) The Patients Deserve Price Act Clears Committee (00:10:44) Specialty Drug Costs to Jump 32% by 2028 (00:13:10) The $6.6 Trillion Tax Break Nobody Noticed (00:14:37) Game: The Point Solution Trade Deadline (00:19:52) Ask Spencer Anything: Can You Un-Cover GLP-1s?

    Trump's Generic Drug Tariffs & The 14% ACA Hike | Last Month in Healthcare

  3. 28 Jul

    Outlier Clauses: Healthcare's Best Kept Secret | with Ryan Bojrab

    "If you're expecting to pay $50k, but it hits an outlier clause, you could be paying upwards of three, four, five, six hundred thousand dollars." What if the single biggest driver of your high-cost claims isn't your discount, your network, or your utilization, but a contract provision almost nobody in this industry has ever read? My guest this week is Ryan Bojrab, who leads new solution development at Aon and came into this business through a channel almost nobody uses: he started his career as a clinician with a doctorate in physical therapy, treating patients inside a federally qualified health center.  When carriers started dictating how many visits he could give a patient, he began pulling the thread, and hasn't stopped since. Ryan and I spend this episode discussing the outlier clause: the provision buried in hospital-carrier contracts that flips your negotiated discount once billed charges cross a threshold. Expecting a 50% discount on an open heart surgery? Once the trigger hits, you may be paying 70% of billed charges on the entire episode of care, and watching a $50,000 claim become a $500,000 one.  Ryan calls it the casino's high roller table, and it's where hospitals make their money. It also produces one of the most perverse incentives in American healthcare: the longer you're in the bed, the worse your discount gets. If you've ever put two networks side by side, seen a massive pricing delta, and couldn't explain why - tune in. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) Intro: The Best Kept Secret in Network Contracts (00:05:59) From Clinician to Consultant: On the Receiving End of Every Vendor Pitch (00:10:46) Why Indiana Became a Self-Funding Powerhouse (00:16:00) What Is an Outlier Clause? The Casino's High Roller Table (00:21:00) The Hospital's Defense and the Inverted Discount (00:27:43) What You Can Actually Do: RFP Language and Direct Contracting (00:35:12) Prompt Pay Providers and the Death of Spec Advance (00:41:17) A Quarter-Million-Dollar Claim With No Checks and Balances (00:47:39) Decoupling Primary Care From Insurance (00:53:36) The Four Buckets of Quality (00:58:53) Tiering and Steering at National Scale (01:05:36) Closing Thoughts: Contract Terms Are the Next Frontier 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/

    Outlier Clauses: Healthcare's Best Kept Secret | with Ryan Bojrab

  4. 24 Jul ·  Bonus

    The HCC 2026 Stop-Loss Report: My Key Takeaways

    "What used to be a once-a-year catastrophic claim is now happening every single week across the stop-loss market." We're back for the fourth year in a row with our annual whiteboard review of Tokio-Marine HCC’s Stop Loss Report. Drawing from a massive block of over $2 billion in force premium, this report gives us one of the clearest, most objective looks at what is actually happening under the hood of self-funded health plans across the country. In this episode, I break down the biggest trends shaping the 2026 stop-loss environment. We look at the tightening stop-loss market, why underwriter discipline is ramping up, and why we likely won't see market stabilization until at least 2027. If you are a consultant, TPA, or plan sponsor trying to navigate renewals and protect your plan over the next 3 to 5 years, this breakdown is packed with actionable data. Tune in! Chapters: (00:00:00) Intro: 2026 Tokio Marine HCC Stop Loss Report Breakdown (00:01:25) The $2M Claim Spike & Tightening Stop-Loss Market (00:04:23) Catastrophic Claim Trajectory: $500K vs. $2M Thresholds (00:06:05) Top Disease Categories: Cancer, Cardiovascular & Nervous System (00:09:12) Analyzing Severity: $85 Million Across 30 Claims (00:14:43) Underwriting Mechanics: How Lag & Claims Data Impact Renewals (00:17:35) Evolution of Specific Deduuctibles & Optimal Risk Corridors (00:24:05) Pediatric Risk & High-Cost Perinatal/Neonatal Claims (00:28:57) How "Leverage Trend" Silently Inflates Your Premium (00:30:10) Mental & Behavioral Health Cost Trends (+123% Increase) (00:31:35) Macro Takeaways: IDR Arbitration, Cost Shifting, and 2027 Outlook

  5. 21 Jul

    Why Every Broker Needs A Fiduciary Co-Pilot | with Charlie Gragg

    "I relate it to one of the Wizard of Oz characters... I've seen behind the curtain. I know how it's all put together." What happens when a man who spent nearly five decades inside every corner of the self-funded industry decides his final act is to give the playbook away?My guest this week is Charlie Gragg, a true first-generation veteran of self-funding. Charlie started in the late 1970s underwriting stop-loss cases on napkins from payphone booths, went on to run his own TPA, and has now semi-retired into a role he believes the industry desperately needs: the fiduciary co-pilot.He won't take your broker of record letter; he doesn't want it. Instead, he partners with brokers, consultants, and C-suite executives to build health plans from scratch, the way an owner would.If you're a broker who knows you have a ceiling on your self-funding expertise, this episode is your permission slip to get help. Tune in. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters:(00:00:00) Intro: Behind the Curtain of Self-Funding(00:00:55) The Fiduciary Co-Pilot: Why Charlie Won't Take Your BOR(00:02:58) Charlie's Background: First-Generation TPA in the Late '70s(00:04:46) Napkin Underwriting and $2,000 Aggregate Stop-Loss(00:06:18) The Two Sales: Selling the Employer AND the Underwriter(00:07:20) Why the TPA Business Is So Hard to Do Right(00:11:27) The Fiduciary TPA: Accountant of the Health Plan(00:13:32) The 401(k) Parallel: Fiduciary Standards Are Coming for Brokers(00:14:43) Building Custom Plans vs. Buying the Box(00:16:25) Stop Haggling Over Stop-Loss — Solve the Claims Instead(00:18:46) Owning Your Stop-Loss Through a Group Captive(00:21:25) The 3-6 Month Setup: Finding Fiduciary Partners First(00:23:34) The One Question to Ask Every TPA(00:26:07) Why PBMs Need the Fiduciary Standard Too(00:28:01) Eating the Elephant: Meeting Employers Where They Are(00:30:56) Winning Over the C-Suite Before the HR Director(00:34:42) Claims Negotiators, Re-Pricers, and the Lost Art of the Phone Call(00:39:11) Do You Still Need a Carrier Network?(00:41:51) The Quality Anomaly: Why the Best Care Costs Less(00:43:34) DRG Bundles and the $20,000 Burn Unit That Never Was(00:46:52) Wellness, Behavioral Health, and the Loyalty Dividend(00:55:31) Building the Utopian Health Plan: The Blueprint(01:01:03) What's Missing? Belief.(01:04:18) The Future: Adoption in the Mid-Market(01:06:33) Closing Thoughts: The System Won't Fix Itself 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 Every Broker Needs A Fiduciary Co-Pilot | with Charlie Gragg

  6. 17 Jul ·  Bonus

    The 2026 State Of Healthcare Spend | with Dena Bravata M.D.

    "Employers have the right to expect much more from their benefit consultants than ever before. This isn't just about managing the fully insured renewal anymore." In this week’s special bonus episode, I’m joined by Dr. Dena Bravata, physician, healthcare entrepreneur, and Clinical Advisor for ParetoHealth, to break down the findings from Pareto’s inaugural 2026 State of Healthcare Spend Report. Based on responses from nearly 1,600 CEOs, finance, and HR leaders, Dena and I unpacked why employers have finally reached their "damn it" moment. We discussed the massive unpredictability of fully insured renewals, why 80% of employers are actively considering alternative funding mechanisms, and the real reason half of the market is ready to fire their current broker. We also dove into the clinical side of the data. We looked at top cost drivers like cancer, MSK, and GLP-1s, and explored why treating mental health and substance use as a core component of your medical plan is non-negotiable for cost containment. If you advise SMB employers or manage a health plan yourself, the era of the broker "apology tour" and basic renewal management is over. This episode is a reality check on exactly what clients are expecting right now. Tune in! Visit 2026 State of Healthcare Spencer Self Funding Podcast to review the report.  Thank you to ParetoHealth for sponsoring this episode! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/events/ to learn more. Episode Chapters (00:00:00) Intro: Dr. Dena Bravata & The 2026 Healthcare Spend Report  (00:01:05) Why Small & Midsize Employers Are Ignored in Healthcare Data  (00:02:37) The "Damn It" Moment: Approaching $20,000 Per Employee  (00:04:09) Survey Demographics: 1,600 Leaders Across 14 Industries  (00:05:44) 80% of Employers Saw Double-Digit Healthcare Increases  (00:07:28) Why Half of the Market is Ready to Fire Their Broker  (00:10:59) Top Medical Cost Drivers: Cancer, MSK, and GLP-1s  (00:15:01) The Amplifier Effect of Mental Health & Substance Use  (00:18:38) Pharmacy Spend & Why Primary Care Can't Manage Obesity  (00:21:14) Price Variance and the Need for Care Navigation  (00:22:18) The Era of the "Apology Tour" and Renewal Management is Over  (00:24:37) Closing Thoughts: Demand More From Your Consultant 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/

    The 2026 State Of Healthcare Spend | with Dena Bravata M.D.

  7. 14 Jul

    The Philosophy of U.S. Healthcare (And Why It Resists Change) | with Tom Stein

    "This is why insurance is such a beautiful problem... there is no solution. There are only psychological or philosophical answers to it." What if the rising cost of health insurance is a deeply ingrained philosophical problem? My guest this week is Tom Stein, CEO of American Trust Administrators (ATA). But this episode isn’t just a tactical breakdown of stop-loss and aggregate underwriting; it is a masterclass in the history, psychology, and economics of the U.S. healthcare system. Tom and I explore the deeply embedded Machiavellian forces that drive insurance carrier monopolies, and why small business owners often choose the "safe" option of a 97% fully-insured renewal simply out of a psychological fear of loss. We trace the origins of employer-sponsored care back to Henry Kaiser and WWII, discuss the ethics of "compulsion vs. choice" in taxation and single-payer models, and analyze whether the U.S. is currently in a "Fourth Turning" crisis phase of our healthcare delivery system. This is one of the most fascinating conversations you will hear all year. Tune in. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) Intro: The Philosophy of the Insurance Problem  (00:01:35) The Illusion of Comfort: Why Employers Flee Responsibility  (00:05:17) Breaking the System: When "Decent Men" Say Enough  (00:08:05) The Psychology of Loss Aversion in Benefits Consulting  (00:10:24) Are You a Serf or a Landlord? The Risk of Self-Funding  (00:13:08) The "Marshmallow Test" and Delayed Gratification in Business  (00:19:42) Tom's Background and the Origins of Level-Funding  (00:23:39) Level-Funding a 5-Life Group: The Hard Way to Underwrite  (00:30:56) The Fascinating History of U.S. Employer-Sponsored Healthcare  (00:35:13) Machiavelli, Trust, and the "Brother Rule" of Business  (00:41:09) Are We in the "Fourth Turning" of Healthcare?  (00:45:54) How AI Will Bring Deeper Value to Client Relationships  (00:49:40) Subsidizing Medicare: The Hidden Tax on Commercial Plans  (00:53:35) Milton Friedman's Four Types of Money and the State  (01:00:01) The Morality of Healthcare Bankruptcies  (01:04:27) The Crisis of Meaning and "Earned Leisure"  (01:08:23) Closing Thoughts: The Optimism of the Next Generation 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/

    The Philosophy of U.S. Healthcare (And Why It Resists Change) | with Tom Stein

  8. 10 Jul ·  Bonus

    $6.5B DOJ Crackdown, Medicare GLP-1 Shifts, Hospital Price Tags | with Sid Sinha

    "When you see $6.5 billion in healthcare fraud, we all end up absorbing that in the commercial market." In this episode of Last Month in Healthcare, Producer Nathaniel and I sat down with Sid Sinha, founder and CEO of Avant/Nara Health, to break down the biggest healthcare news stories of June 2026. We started by looking at the DOJ's massive $6.5 billion healthcare fraud crackdown and what 1,400 revoked provider privileges actually means for the commercial market. We also tackled the stark reality that only 49% of U.S. adults now feel "cost-secure" about their healthcare, debated the downstream effects of Medicare's temporary coverage for GLP-1s, and looked at a new House bill that might literally force hospitals to print their prices on clinic walls. To cap it off, we ran a World Cup bracket-style game to crown the ultimate cost-containment strategy for self-funded plans, and I answered a listener question on how to keep clients from bailing on self-funding as medical inflation continues to rise into 2027. Tune in for a great conversation! Chapters: (00:00:00) Intro: Sid Sinha and Walk-On Clinic (00:02:13) The DOJ’s $6.5 Billion Healthcare Fraud Crackdown (00:04:25) The Plunge in American Healthcare Affordability (00:07:55) Medicare’s Temporary $50 Copay for GLP-1 Drugs (00:10:33) Will Hospitals Be Forced to Put Prices on the Wall? (00:14:26) The 153% Increase in Digital Health Tool Usage (00:17:30) World Cup Bracket Game (00:28:03) Ask Spencer Anything: Beating 2027 Medical Inflation

    $6.5B DOJ Crackdown, Medicare GLP-1 Shifts, Hospital Price Tags | with Sid Sinha
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About

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.

Information

  • Creator
    Spencer Smith
  • Years Active
    2021 - 2026
  • Episodes
    294
  • Rating
    Clean
  • Copyright
    © Spencer Smith
  • Show Website
    Self-Funded

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