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. Managing the Exploding Costs of Specialty Drugs | with Jake Velie

    há 6 dias

    Managing the Exploding Costs of Specialty Drugs | with Jake Velie

    "There's no reason why I should be able to do an infusion for 50% of the cost of what it's currently being allowed at. We've seen allowed amounts between $57,000 and $80,000 for Keytruda. I typically can have that in the home at $29,000." My guest this week is Jake Velie, CEO and co-founder of National Integrative Health (NIH). After spending the first half of his career in the clinical "meat grinder" of value-based care on the provider side, Jake realized the only way to truly fix the system was to control the dollars on the commercial plan side. Today, NIH acts as the ultimate watchdog and independent pharmacy solution for self-funded employers, actively managing J-codes, specialty drugs, and clinical coordination. In this episode, we unpack the exorbitant markups hospitals charge for infusions and how NIH has spent years building a 50-state network to redirect patients to safe, comfortable, and massively discounted at-home infusion care. Jake also breaks down the brutal reality of GLP-1 adherence, why his team refuses to fill 90-day prescriptions for weight-loss drugs, how they enforce formularies to switch patients from expensive biologics like Humira to low-cost biosimilars like Yusimry, and the absolute truth about the safety of international drug sourcing. If you want to know how to stop the bleeding on your pharmacy and medical claims while actually improving the white-glove customer service your employees receive, this is a masterclass in specialty cost containment. 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: Moving Keytruda to the Home Setting  (00:01:47) Defining True Value-Based Care  (00:03:20) The Genesis of NIH and Leaving the Provider "Meat Grinder"  (00:07:01) Building a 50-State Home Infusion Network  (00:09:22) Why Specialty Meds Drive 90% of Pharmacy Spend  (00:14:53) Demystifying J-Codes and Q-Codes  (00:17:01) Exorbitant Hospital Markups and Hidden Fees  (00:24:59) The Mechanics of Redirection: Mandatory vs. Voluntary  (00:30:27) Coordinating Carve-Outs with Stop-Loss Carriers  (00:34:08) Enforcing Formularies: Converting Humira to Yusimry  (00:41:12) The Reality of International Sourcing and the FDA  (00:47:35) Managing GLP-1s and the Danger of 90-Day Fills  (00:51:48) The Ideal Employer Profile for NIH  (00:58:04) Overcoming Healthcare's Terrible Customer Service  (01:02:05) The Future: Oncology, Cell, and Gene Therapies 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/

    1h 7min
  2. You’re Probably Wrong About Reference-Based Pricing | with Jeff Bak

    16 de jun.

    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" Margin 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/

    1h 14min
  3. Marty Makary Resigns from FDA + May's Biggest Healthcare News | with Jonathan Lopez

    12 de jun. ·  Bônus

    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=Dwpuz2wOTRawhMDfR5NIsA Episode 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

    24 min
  4. The ERISA Fiduciary Crackdown is Here | with Jay Gepfert

    9 de jun.

    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 Thoughts Key Links for Social: @SelfFunded on YouTube - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/

    1h 8min
  5. A Health Benefit That Actually Makes Employees Healthier | with Superpower

    2 de jun.

    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 Significance 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/

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

    26 de mai.

    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 Giveaway 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/

    1h 34min
  7. Why Self-Funded Employers Are Abandoning National Networks

    19 de mai.

    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 Business 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/

    1h 15min
  8. Advanced Primary Care 101 (With Ben Miller)

    12 de mai.

    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 Care 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/

    58 min
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Sobre

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.

Informações

  • Criado por
    Spencer Smith
  • Anos de atividade
    2021 - 2026
  • Episódios
    284
  • Classificação
    Explícito
  • Copyright
    © Spencer Smith
  • Site do podcast
    Self-Funded

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