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. Will PBM Reform Actually Happen? | Last Month In Healthcare

    HACE 3 DÍAS · CONTENIDO EXTRA

    Will PBM Reform Actually Happen? | Last Month In Healthcare

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

    21 min
  2. Building The TPA Of The Future

    HACE 6 DÍAS

    Building The TPA Of The Future

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

    57 min
  3. Why Venture Capital Is Betting Against Insurance Carriers in 2026

    3 MAR

    Why Venture Capital Is Betting Against Insurance Carriers in 2026

    “Show me an incentive structure and I'll show you human behavior... until employers realize they have more power than they give themselves credit for, this can't continue." My guest this week is Norm Volsky, Managing Partner at DRI and Founder of MVP Growth Partners. Norm has spent the last decade as one of the top executive recruiters in the digital health and employer benefits space - placing the commercial teams that helped build unicorns like Livongo and Hinge Health. In this episode, Norm explains why the next wave of healthcare innovation isn't about adding more "point solutions" to an already fatigued market. Instead, smart money is betting on companies that carve out high-margin, inefficient services directly from the major insurance carriers - like radiology, fertility, and specialty infusion. We discuss how Norm built an "army" of over 500 industry executives to crowdsource due diligence, why the traditional VC model fails in healthcare, and why employers and their benefits leaders are finally at a watershed moment where they must demand true fiduciary alignment from their vendors. If you want to know where the smart money is moving in employer healthcare, and why the "BUCA" carriers should be worried, this episode is a must-listen. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: [00:00:00] Intro: Recruiting in the Early Days of Digital Health [00:04:12] The Livongo Story: Selling Healthcare Direct to Employers [00:08:44] What Makes a Great Salesperson in Healthcare? [00:11:46] Spotting the Next Unicorn: The Hinge Health Experience [00:17:28] Private Equity vs. Venture Capital [00:20:00] Using Recruitment Data to Drive VC Investments [00:23:41] The "One Imaging" Pitch & Carving Out Radiology [00:30:40] Building an Army: Crowdsourcing VC Due Diligence [00:36:26] Why MVP Growth Partners Only Invests in "At-Risk" Pricing [00:41:40] Point Solution Fatigue & Identifying the "Good Actors" [00:46:17] Why Employers Must Demand Fiduciary Responsibility [00:50:41] The Future: The Erosion of the Big 3 PBMs and Carriers Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

    1 h y 3 min
  4. Why Health Plans Pay $10,000+ For Drugs That Don't Even Work

    24 FEB

    Why Health Plans Pay $10,000+ For Drugs That Don't Even Work

    "Why are we paying $10,000 for a $30 drug?" My guest this week is Pramod John, a former Silicon Valley tech entrepreneur who entered the healthcare space to tackle the largest economic problem in the country: skyrocketing healthcare costs. Pramod quickly realized that healthcare's dysfunction is actually not a technology problem - it is a deeply ingrained problem with economic incentives. In this episode, we dive into the murky waters of Pharmacy Benefit Managers (PBMs) and why the traditional model is designed to drive up costs rather than lower them. We discuss the shocking statistics of drug spend (where 2% of people account for 55% of the costs), why FDA approval doesn't always mean a drug is effective (using the infamous Alzheimer's drug as an example), and the implications of recent fiduciary lawsuits like the one against J&J. Pramod explains how we can bring common sense back to healthcare by treating drugs like any other consumer purchase. By utilizing an "open market" drug management model, he argues that we can effectively replace traditional PBMs with transparent transaction processing software - saving plans 30% to 50% without relying on restrictive formularies or rebate games.  Tune in this week for a clear roadmap for how to actually fix the irrational economics of our healthcare system. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) Intro: Why We Talk About Cost Instead of Quality  (00:02:42) From Silicon Valley & Defense Tech to McKesson  (00:10:43) Why Healthcare is NOT a Technology Problem  (00:15:53) Fiduciary Responsibility & The J&J Lawsuit  (00:19:03) The Butter Knife vs. Pareto: The Math of Drug Spend  (00:23:54) Building an "Open Market" Alternative to PBMs  (00:29:40) Why Doctors Fly Blind on Drug Pricing & Formularies  (00:35:42) FDA Approval vs. Real-World Efficacy  (00:45:44) How to Actually Fix the Model: The Real-Time "Pause"  (00:58:36) Why International Sourcing & PAPs Aren't the Fix  (01:11:00) Replacing PBMs with Simple Transaction Software Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

    1 h y 17 min
  5. The Physician Burnout Crisis: Why DPC Is The Only Way Forward

    17 FEB

    The Physician Burnout Crisis: Why DPC Is The Only Way Forward

    "My wife would come back to check on me late at night, asleep at the keyboard, and she would be like, 'Is he dead?' The burnout, what we call moral injury, is more real than anybody knows." - Will Steelman The American healthcare system is crushing its doctors. Faced with "assembly line" quotas of 25+ patients a day, hours of unpaid administrative work ("pajama time"), and a suicide rate higher than that of veterans, physicians are fleeing the profession in droves. My guest this week is Dr. Will Steelman, a board-certified internal medicine physician who lived through this crisis firsthand. After 12 years as a hospitalist, Dr. Steelman reached his breaking point during the pandemic and realized the only way to save his career, and his life, was to exit the system entirely. In this episode, we explore why Direct Primary Care (DPC) is the only viable path forward for the future of medicine. Will explains how DPC restores the doctor-patient relationship by reducing patient panels from 3,000 to 600, allowing for 90-minute visits, true price transparency, and a focus on root-cause resolution.  We also discuss the clinical benefits of having time to care, including using ketogenic therapies to treat mental illness and reversing chronic metabolic disease, rather than just managing it with pills. If you want to understand why your doctor is exhausted, why your premiums are going up, and why DPC is the solution we can't afford to ignore, listen to this episode. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) Intro: The Link Between Diet & Mental Clarity  (00:04:18) The Road to Burnout: 12 Years as a Hospitalist  (00:09:17) "Is He Dead?": The Reality of Physician Suicide & Moral Injury  (00:11:08) The Way Forward: Concierge vs. Direct Primary Care  (00:15:35) The Math of Failure: Why 2,500 Patients is Unsustainable  (00:21:16) "Click Fatigue" and the Administrative Burden  (00:23:58) Leaving the System: Launching Steelman Medical Group  (00:32:06) Saving the Profession: Why DPC Offers Work-Life Balance  (00:40:12) True Transparency: Why DPC Lab Costs Are Dropping  (00:48:58) The Luxury of Time: Treating Mental Health with Ketogenic Diets  (00:59:32) The Statin Controversy & Insulin Resistance Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

    1 h y 6 min
  6. Recapping January's Biggest Healthcare Stories | with John Kountz

    13 FEB · CONTENIDO EXTRA

    Recapping January's Biggest Healthcare Stories | with John Kountz

    If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's podcasts, headlines, and listener-submitted questions.This month, we’re joined by John Kountz from Frost Insurance! We react to the record-breaking lobbying spend by drugmakers in 2025 and discuss the historic slump in Hospital M&A activity. We also cover the rising cost of medical real estate forcing doctors into co-working spaces, the critical decline in nursing home capacity, and the consolidation of federal lawsuits linking GLP-1s to vision loss.Plus, we play a game called "Real or Fake Medical Codes," where John and I try to guess if ICD-10 codes like "Struck by Turtle," "Sucked into a jet engine," or "Burned due to water skis on fire" are actually real. Finally, we answer a listener question about what a successful Q1 looks like for a new broker in the benefits industry.I'm also thrilled to announce that Last Month In Healthcare is now sponsored by Walk On Clinic! We are excited to partner with a team that is redefining primary care access.Chapters:0:00 - Intro0:37 - Drugmaker Lobbying Reaches Historic Highs4:30 - Hospital M&A Slump & Financial Distress7:39 - Doctors Moving to Co-Working Spaces10:05 - The Decline in Nursing Home Capacity11:57 - GLP-1 Vision Loss Lawsuits15:41 - Game: Real or Fake Medical Codes?21:41 - Ask Spencer: Successful Q1 for New Brokers

    27 min
  7. Let Doctors Be Doctors: Why Providers Shouldn't Be Debt Collectors

    10 FEB

    Let Doctors Be Doctors: Why Providers Shouldn't Be Debt Collectors

    "If you ask the surgeon how much time they have to spend thinking about the business side of their practice, it's too high... Let's let doctors be doctors." - Ryan Wells My guest this week is Ryan Wells, Founder and CEO of Health Here. Ryan joins me to explain why the key to fixing the broken doctor-patient relationship is getting providers out of the debt collection business. We explore how Episodic Care (bundled payments) can finally align the financial incentives of self-funded employers and high-value specialists. Ryan breaks down how his platform automates payments, getting surgeons paid in under 15 days while eliminating patient liability entirely. We dive deep into Ryan's background in the OR, the lessons learned from the "Metal on Metal" hip recall, and why we need to move from "open enrollment confusion" to real-time, event-driven patient navigation. If you are tired of administrative waste and want to see a model where doctors focus on care instead of claims, this episode is for you. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) Let Doctors Be Doctors (00:03:04) Ryan's Journey: From Anthropology to the OR  (00:07:00) Lessons from Medicare’s Acute Care Episode Demo  (00:10:46) Defining the "Bundle" vs. Fee-for-Service  (00:13:00) Value-Based Care = Outcome / Cost  (00:16:14) Why Orthopedics is the Perfect Starting Point  (00:18:32) Moving from "Elective" to "Discretionary" Care  (00:21:38) The Navigation Problem: Open Enrollment Fails  (00:31:48) Owning the Payment Rails: 15-Day Payments  (00:37:38) Automating the "Outlier Workflow"  (00:41:35) The "Metal on Metal" Hip Recall & Registries  (00:48:30) Expanding to Cardiology and Bariatrics  (00:53:03) The Moonshot: Removing the Business Burden from MDs Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

    57 min
  8. The "Next Generation" Insurance Agency: What AI-Native Means

    3 FEB

    The "Next Generation" Insurance Agency: What AI-Native Means

    "If financial services and healthcare are 10 years behind everybody else from a technology adoption standpoint, insurance distribution is usually 10 years behind that." - Will Johnson My guest this week is Will Johnson, Founder and CEO of Gyde, who is building what he calls the first "AI-native" insurance brokerage. After spending a decade at Oscar Health, Will realized that while brokers are the critical "entry point to care," they are operating without the infrastructure needed to scale in the modern era. In this episode, we define exactly what "AI-native" means for an agency. It isn't just about buying software; it's a new holding company model that acquires agencies to deploy AI infrastructure - automating renewals and client service to effectively "triple the capacity" of the best brokers. We dive deep into the difference between the traditional "asset aggregation" model (roll-ups) and Gyde’s "partner activation" model. Will also shares why Gyde raised a Series A just 14 weeks after launching and his moonshot vision to converge health insurance and wealth management into a single advisory role. If you are an agency owner feeling the ceiling of growth, this episode maps out what the next generation of distribution looks like. Thank you to our 2026 sponsors! ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more. Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more. Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more. Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com. Chapters: (00:00:00) What is an "AI-Native" Brokerage?  (00:03:11) Will’s Journey: 10 Years at Oscar Health  (00:07:10) The Infrastructure Gap in Distribution  (00:12:27) Why Acquisition? The Case for Economic Alignment  (00:23:22) The Tech Stack: Automating Renewals & Service  (00:27:32) AI as a "Capacity Amplifier" vs. Replacement  (00:37:22) The Anti-Rollup: "Partner Activation" vs. "Asset Aggregation"  (00:46:12) Branding: Powered by Guide vs. Becoming Guide  (00:49:49) Raising a Series A in 14 Weeks  Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

    1 h y 3 min
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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.

Información

  • Creador
    Spencer Smith
  • Años de actividad
    2021 - 2026
  • Episodios
    266
  • Clasificación
    Apto
  • Copyright
    © Spencer Smith
  • Mostrar sitio web
    Self-Funded

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