"There needs to be a whole new suite of solutions that are forward looking and proactive and real time, and we gotta go and build that." - Sasha Gribov
My guest this week, Sasha Gribov, founder of Milu Health, is on a mission to build the proactive, forward-looking solutions our healthcare system desperately needs. He joins the show to discuss how he's using AI to create an "early warning system" for health, moving our model from reactive to proactive.
Sasha breaks down the Milu model, which uses AI to analyze health records and claims data in real-time. He explains how this allows his team to predict the need for surgeries an average of 90 days in advance and proactively reach out to members via text (no app required) to guide them to the right, high-value solutions already in their health plan.
We also explore the future of AI in healthcare, why he believes it will "augment" doctors, not replace them, and how this proactive approach is the key to saving lives and finally lowering costs for employers.
Tune in for a look into the future of proactive healthcare!
Chapters:
(00:00:00) How AI is Predicting Catastrophic Claims (Before They Happen)
(00:04:15) Why We Must Integrate All Health Data
(00:10:23) The "Early Warning System" for Patients
(00:12:40) Why EMRs are the Key to Proactive Care
(00:31:57) Predicting Surgeries 90 Days in Advance
(00:08:04) Will AI Replace Doctors?
(00:59:47) Building a Proactive Healthcare System
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/
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 also joined by Kyle Minick!
This episode is a bit different than usual as we focus on the many issues our physicians are dealing with in 2025, from AI to burnout to compensation. And we play a new game called the Commercial Conumdrum, where Kyle and I try to guess what drug a pharmaceutical commercial is advertising, just based on the B-Roll and editing of them.
Chapters:
0:00 - Intro
1:25 - What's Going On With Our Doctors?
1:37 - Physician Stress Returns To Pandemic Levels
6:56 - Half Of US Healthcare Workers Plan To Switch Jobs
14:31- Physicians Working More, Compensated Less
15:38 - AI Scribes Reduce Physician Burnout
19:29 - Millions In US Live Where There Is No Telehealth/Internet
23:22 - Commercial Conundrum (this month's game)
34:20 - Self-Funded Review
41:36 - Ask Spencer Anything
Sources:
“Just because someone hasn't gone to the doctor in four years does not mean they're not a walking time bomb." - Garrett Jerue
My guest this week, Garrett Jerue, argues that the key to solving our healthcare crisis is to think differently and build a truly cohesive healthcare ecosystem. Driven by his personal experience battling cancer and navigating a fragmented system, Garrett has dedicated his career to designing benefits strategies that actually work for people.
In this episode, Garrett shares his playbook for building this ecosystem. We discuss the "Ticket Health" model he developed, which integrates direct primary care, transparent PBM partnerships, and robust care navigation into a seamless experience. He explains why treating members with dignity and choice, focusing on proactive care, and challenging the status quo are essential ingredients for success.
We also dive into the critical importance of mental health support and why employers need to view their health plan not just as an expense, but as a living, breathing organism that requires constant care and innovation.
Tune in to get Garrett and I’s insight on building a healthcare ecosystem that truly serves people.
Chapters:
(00:00:00) Building A Cohesive Healthcare Ecosystem
(00:10:24) How a $600k Cancer Bill Changed Garrett’s Life
(00:17:22) Why Healthcare Financing Needs a Rethink
(00:25:28) Treating Members with Dignity & Choice
(00:38:11) The Keys to a Transparent PBM Partnership
(00:43:45) Direct Primary Care: The Foundation of the Ecosystem
(00:50:26) Care Navigation: The Glue That Holds It Together
(00:59:07) Making Mental Health a Priority in the Ecosystem
(01:12:32) The "Think Different" Mindset for Healthcare Innovation
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/
“I absolutely think we're in that tightening, hardening market... the days of the employers who were average risk seeing single digit rate increases, that's gone. It's going to be a double digit rate increase market going forward." - Jay Ritchie
The president of one of the largest stop-loss carriers is here to deliver the State of the Union for our market. My guest this week is Jay Ritchie, President of Tokio Marine HCC, and he shares the current state of the market and what to expect for 2025-2026 renewals.
Jay breaks down the trends his team is seeing, including the explosion of multi-million dollar claims driven by NICU stays and new gene therapies. We discuss why industry-wide loss ratios have jumped, how the post-COVID "rebound" is impacting rates, and why the core stop-loss product has remained unchanged while the innovation now centers on risk measurement.
But the conversation isn't all negative; we also discuss the path forward. We explore why data is the future of underwriting, how active risk management through captives creates stability in a volatile market, and why treating your stop-loss carrier as a partner, not a commodity, is more critical than ever.
Tune in for the State of the Union for our industry as we head into 2026.
Chapters:
(00:00:00) The 2025-2026 Stop-Loss State Of The Union
(00:06:18) A 40-Year Career in Stop-Loss
(00:21:33) The Explosion of Million-Dollar Claims Post-ACA
(00:40:26) Why Loss Ratios Are Climbing Across the Industry
(00:55:40) How Captives Create Stability in a Hard Market
(01:07:07) Partner vs. Commodity: The Future of Stop-Loss
(01:29:02) Why Data is the Future of Underwriting
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 biggest shift was the consolidation that happened with the insurance carriers themselves. From 25 or more carriers to just four national carriers." - John Rutledge
How did health insurance get so broken? My guest this week, 40-year industry veteran John Rutledge of Marsh McLennan Agency, joins the show to walk us through the last 40 years of decisions that led us to the consolidated, expensive, and frustrating market we have today.
John explains how the market went from over 25 competing carriers to just four national players. We discuss how the rise of carrier-owned PPOs squeezed out competition, and how the ACA later standardized coverage, locking employers into the "Buca box" with painfully limited options.
But this isn't just a history lesson. We also discuss the solution that has emerged from the ashes of the old system: the explosion of self-funding and alternative risk models like captives that empower employers to finally break free.
Tune in for a masterclass on how health insurance was broken, and more importantly, how we can start to fix it.
Chapters:
(00:00:00) How Health Insurance Was Broken Over The Last 40 Years
(00:05:01) Why Self-Funding Has Exploded Since the ACA
(00:09:58) How We Went From 25+ Carriers to Just 4
(00:12:56) The "Buca Box": Trapped with No Options
(00:31:04) The Rise of Captives as an Alternative
(00:40:31) Why Engaged Employers Win in a Captive
(01:00:56) A Call to Action for Employers & Advisors
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/
"Eat your food as medicine or medicine will become your food." - Chef Austin Simmons
Can better beef solve America's health crisis? My guests this week, Chef Austin Simmons of Chef and Rancher and benefits/nutrition expert Chris Pierron, believe it's a critical part of the solution. They join the show to discuss the deep connection between cattle genetics, our broken food system, and our exploding healthcare costs.
Chef Austin explains his "hoof to fork" model for creating "better beef." We discuss how using purebred, genetically-verified cattle and clean feeding practices, free of the seed oils and used fryer oil common in the commercial industry, produces a more nutrient-dense and flavorful product.
This isn't just about a better steak; it's about creating a healthier population from the ground up. We explore how fixing the food system is the most important step to lowering healthcare costs, and why consumer education is the key to driving this change.
Tune in today for a conversation that will change the way you think about the beef on your plate.
Chapters:
(00:00:00) How Better Beef Can Solve America's Health Crisis
(00:05:18) The Hidden Additives & "Poisons" in Most Beef
(00:19:38) Why is Prime Beef So Inconsistent?
(00:20:58) The Power of Cattle Genetics
(00:37:47) Is There Used Fryer Oil In Your Steak?
(00:54:22) Should We Federally Subsidize Beef?
(01:02:09) Why Food Education is the First Step
(01:13:26) Fixing the Food System to Fix 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/
"If we can remove the cost barrier, folks are going to engage more because it's not standing in the way of going to get the care that they need or even preventive care." - Trey Smith
High healthcare deductibles were sold to employers as a way to create better "consumers" of healthcare. My guest this week, Trey Smith of Hub International, argues that they've been a failed experiment that has done more harm than good. Instead of creating smarter shoppers, high deductibles have become a massive barrier to care, causing employees to delay or avoid necessary treatment altogether.
In this episode, Trey breaks down the alternative: first dollar coverage.
We discuss how innovative plan designs with zero deductibles can actually lower an employer's overall claim spend over time by encouraging early intervention and proactive care. He shares data showing that while utilization spikes initially, long-term costs come down significantly as members get the care they need when they need it.
This conversation is a perfect example of why the benefits consultant's role is shifting from simply brokering insurance to designing strategic solutions that solve real problems for employees and employers. I hope you'll tune in!
Chapters:
(00:00:00) High Healthcare Deductibles Are A Failed Experiment
(00:26:16) The Risk of Innovation vs. The Risk of the Status Quo
(00:29:59) The Problem: High Deductibles as a Barrier to Care
(00:34:10) The Solution: "First Dollar" Coverage
(00:38:22) Simplifying the Healthcare Experience
(00:52:17) How Data is Making New Plan Designs Possible
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/
"I can look for something on Amazon and have it shipped to my door tomorrow... so why wouldn't employees want a similar experience with their healthcare?" - Amanda Volner
Can artificial intelligence actually make healthcare feel more human?
Amanda Volner, AVP of Broker Partnerships at Healthee, joins the show for a deep dive into the real role of AI in the benefits industry. We discuss how artificial intelligence is a powerful tool to augment our abilities, but why uniquely human skills like critical thinking, building relationships, and understanding "the question behind the question" are more valuable than ever.
Amanda breaks down how Healthee is using AI to create "hyper-personalized" healthcare experiences for members, from navigating benefits to finding cost-effective pharmacy solutions. We explore how modern engagement platforms are essential for communicating with a decentralized workforce and how AI can be trained to match your own voice and tone.
The conversation also explores the human side of a demanding career, from the challenges of being a single mother in this industry to navigating sobriety in professional settings.
Tune in for a fascinating look at the intersection of AI, healthcare, and what it truly means to be human in our industry.
Chapters:
(00:00:00) Making Healthcare More Human...Using AI
(00:01:09) The One Thing AI Still Can't Do
(00:04:36) Understanding "The Question Behind the Question"
(00:26:02) The Future of "Hyper-Personalized" Healthcare
(00:37:07) Using AI to Lower Prescription Costs
(00:50:12) Balancing a Demanding Career and Family
(01:02:32) Navigating Sobriety in the Benefits World
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/
"Good entrepreneurs fall in love with their solution and their platform, but great entrepreneurs fall in love with the problem." - Matt Scovil
Matt Scovil and Nathan Gilchrist of Medify Health, have fallen in love with one of the biggest problems in benefits: nobody wants to engage with them. They joined the show to discuss their journey of building a platform designed to solve the engagement crisis and simplify the healthcare experience for everyone.
Matt and Nathan break down their "bottoms-up" approach to this problem, which focuses on engaging members when they need help through a high-touch, live support model delivered via mobile app. We discuss how they use the psychology of "loss aversion" and constant communication to drive engagement rates over 90%.
We also explore how Medify acts as the "quarterback" for a health plan, removing friction by navigating members to the right solutions. This is all part of their vision for the future of healthcare, where the experience is "heavily, heavily individualized" for each person.
Chapters:
(00:00:00) Why Employees Would Rather Clean a Toilet Than Use Their Benefits
(00:04:18) Cleaning a Toilet vs. Learning Your Benefits
(00:08:46) Falling in Love with the Problem, Not the Solution
(00:14:23) The Power of Live, Human Support
(00:19:08) Using "Loss Aversion" to Drive Engagement
(00:34:54) The Quarterback for Your Health Plan
(00:47:57) How AI is Augmenting the Human Touch
(01:00:01) The Future of Healthcare is "Individualized"
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/
"I think the three strongest words that you can use as a leader, as a salesperson, as a client relationship person is I don't know." - Scott Milson
My guest this week, 35-year industry veteran and author Scott Milson, joins the show for a deep dive into the mindset required for a long and successful career. We discuss his journey from a self-described "career B student" to a partner at a major firm, and the lessons he learned about loyalty, hard work, and what it truly means to be excellent.
Scott breaks down his personal playbook for "tuning into the frequency of excellence." He shares his "Be 5 Framework" (Be Present, Curious, Intentional, Bold, and Reflective) and explains why embracing discomfort, adopting a growth mindset, and learning through informal mentorship are crucial for professional growth.
It’s worth noting that Scott is also professionally in the benefits industry, so I wanted to have him on the show to directly speak to those in this space.
I hope you'll tune in for this insightful conversation!
Chapters:
(00:00:00) Tuning Into The Frequency Of Excellence
(00:20:08) Why Discomfort is the Path to Growth
(00:21:56) The 3 Words That Defeat Imposter Syndrome
(00:27:52) The "Success to Significance" Curve
(00:38:42) The “Be 5” Framework for Excellence
(00:40:52) The Myth of Formal Mentorship
(00:48:25) "How You Do Anything is How You Do Everything"
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/
"We spend about $528 billion a year fixing the mistakes we make with medicines." - Chris Grilli
Fixing healthcare's $528 billion dollar mistake starts with ending the "trial-and-error" prescribing that plagues our system. My guest this week, pharmacist and genomics expert Chris Grilli of RxMapper, joined the show to explain how personalized, DNA-guided medicine is the key to solving this massive problem.
Chris breaks down the RxMapper model, explaining how they analyze 36 million data points from a patient's genome to provide medication recommendations with nearly 90% accuracy. We discuss the crucial difference between genetics and genomics, and how this approach saves thousands of dollars per patient while dramatically improving outcomes.
The mission to fix this problem is also a personal one. Chris shared the story of how his grandmother's preventable death from an adverse drug event became the inspiration for building RxMapper to ensure other families don't suffer the same fate.
Tune in this week for the playbook on fixing one healthcare's most expensive mistakes.
Chapters:
(00:00:00) Fixing Healthcare's $528 Billion Dollar Mistake
(00:02:12) The $528 Billion Cost of Medication Errors
(00:04:43) Genetics vs. Genomics: What's the Difference?
(00:10:29) Are Doctors Prescribing "Poison?"
(00:14:18) The Personal Story Behind RxMapper
(00:27:17) Saving Over $8,600 Per Patient
(00:41:24) How Your DNA Impacts Ozempic's Effectiveness
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/
"There's a big difference for me in living and being alive. There's a difference between breathing and truly experiencing life." - Todd Whitthorne
My guest this week Todd Whitthorne joined me for a conversation that goes far beyond the balance sheet to explore the true meaning of well-being. We discuss why a leader's personal health is the foundational, non-negotiable asset for their professional success.
Todd breaks down the crucial role leaders play in building trust and creating a "culture of health" that yields a real financial, clinical, and cultural ROI. We explore the five pillars of well-being (fitness, nutrition, sleep, stress, and prevention), the difference between "lifespan" and "healthspan," and why investing in yourself is the least selfish thing a leader can do.
The episode concludes with the incredible true story of Todd's 70-year-old friend who survived being hit and run over by a drunk driver, which is a powerful testament to how a lifelong commitment to fitness creates true resilience. I hope you’ll tune in for this inspirational conversation!
Chapters:
(00:00:00) Lessons in Health & Leadership
(00:06:11) Why Trust is a Leader's Most Important Asset
(00:14:14) The Difference Between Lifespan and Healthspan
(00:17:06) Why Investing in Yourself Isn't Selfish
(00:48:59) The Pursuit of True Happiness
(01:05:49) The 70-Year-Old Who Survived And Thrived After a Hit-and-Run
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/
"Understanding how an underwriter thinks and how they manage risk allows you to create a solution that actually creates impact and change for the long term." - Bobby Stuart
This week on the show, I'm joined by Bobby Stuart, a benefits consultant with Hotchkiss Insurance, for a deep dive into the mindset of a modern, forward-thinking advisor. We discuss his journey into the industry and what it takes to guide employers through the complexities of self-funding.
Bobby also broke down his playbook for creating long-term value for his clients. We explore why learning to "think like an underwriter" is a crucial skill for managing risk, the importance of simplifying complex ideas for employers, and why mastering the industry's language is the first step to finding simple solutions.
We also discuss how these strategies translate into real-world results, including how Bobby's team uses direct contracts and early intervention to help members get high-cost cancer care for free, removing the financial burden so they can focus on their health.
Chapters:
(00:00:00) How To Think Like An Underwriter (And Why It’s A Game-Changer)
(00:04:03) Overcoming the Complexity of Self-Funding
(00:04:59) Learning to Speak the Language of Insurance
(00:08:49) The Power of Thinking Like an Underwriter
(00:18:48) How To Stay Optimistic As A Benefits 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 balance bill came in, it was 37 grand for this member, and we were able to get that thing fully wiped." - Patrick Haig
My guest this week, Patrick Haig, Co-Founder of Goodbill, has built a company designed to find errors in medical bills and fix them. From upcoding to time-based discrepancies, these inaccuracies cost health plans and their members a fortune.
In this episode, Patrick breaks down the Goodbill model. We discuss how their technology integrates directly with health plans to audit claims for errors before they're paid, and why that “upstream” approach is so game-changing. We also dive into one of their most powerful tools: the underutilized 501(r) IRS rule that can wipe out bills entirely, even for six-figure income families.
This episode is personal for me, as Patrick's team fixed my own son's ER bill, saving almost $1,000. I hope you’ll tune in!
Chapters:
(00:10:22) How DPC inspired Goodbill
(00:23:03) The 501(r) Secret: Hospital Financial Assistance
(00:27:15) How Upcoding Inflates Your ER Bill
(00:38:29) The Art of Negotiating a Hospital Bill
(00:48:43) Why "Upstream" Claim Auditing is a Game-Changer
(00:59:29) Can a Six-Figure Family Qualify for Assistance?
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/
"I doubled my profit when I lost 70% of my customers, which is insane." - Brad Hart
My guest this week, Brad Hart, owner of Forest Park Pharmacy, came on the show to discuss how he moved his pharmacy from struggling to survive in a broken, insurance-based reimbursement model to thriving as an all-cash, "cost-plus" business.
Brad popped on my radar because of his very popular and informative Instagram profile, where he shows how everyday Americans are getting fleeced by PBMs. We break down the mechanics of his model and discuss the "low copay trap," why the term "specialty generic" is nonsense, and how his pharmacy's Price Checker tool brings radical transparency to a purposefully confusing industry.
We also dive into the exponential overpayments Brad has uncovered in the Medicare system, where a drug that costs his pharmacy $96 is reimbursed for over $3,400.
This is one you won't want to miss!
Chapters:
(00:00:00) This Pharmacy Went Cash-Only, Lost 70% Of Customers, & Doubled Profits
(00:07:28) The "Cost-Plus" Pharmacy Model, Explained
(00:08:49) How Brad Lost 70% of Customers & Doubled Profits
(00:10:45) The Deceptive "Low Copay Trap"
(00:13:29) The Pricing Breakdown: Cost + 15% + $10
(00:34:52) Why the Term "Specialty Generic" is Nonsense
(00:47:53) What is the Average Wholesale Price (AWP)?
(00:52:41) PBM Reform vs. Direct-to-Consumer
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/
"Nomi actually stands for 'no middleman'. Take out that invented complexity... Price comes way down, becomes more simple to administer, and there's plenty of dollars to go around for providers now making more money." - Josh Walker
My guest this week, Josh Walker, Founder & COO of Nomi Health, is on a mission to rebuild healthcare by tackling its "invented complexity." He joined me on the show to explain why creating a direct relationship between the buyers and providers of care is the key to a better, more affordable system for everyone.
How does Nomi do it? We break down their playbook, which focuses on three core strategies: standardizing data formats to improve efficiency, embracing price discovery to find the true cost of care, and simplifying payment dynamics to cut out the middlemen.
This isn't just theory. Joshua shares the powerful, real-world results of their model, including how one client's benefits leader received a standing ovation from employees after switching to a plan that eliminated all financial barriers to care.
Tune in this week to learn why it’s so important to find the true cost of care, and why I’m so proud to have Nomi as a sponsor for the show!
Chapters:
(00:00:44) What Does NOMI Stand For?
(00:11:36) Finding the "True Cost of Care"
(00:23:27) Do We Even Need Networks Anymore?
(00:35:14) What Churros Can Teach Us About Data Analytics
(00:52:19) From Solution Taker to Solution Maker
(00:55:59) The "Standing Ovation" Health Plan
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/
“Does your consultant understand these kind of strategies and mechanisms are available in the market and do they know how to implement them and make them work?" - Riley DearingRiley Dearing of Hotchkiss Insurance returns to the show this week, and he’s brought with him Blake Allison, CEO of Employers Health Network (EHN) to talk all about high-performance health networks and the massive opportunity they represent.Ever wonder how high-performance health networks actually work? We broke down the real mechanics: how direct provider partnerships are built, how benefit design drives engagement to the right facilities, and how this collaborative approach leads to better data, lower costs, and predictable risk for employers.This isn't just theory; we also announce EHN's new partnership with Covenant Health, detailing how this model is being scaled to bring these powerful solutions to employers across West Texas.Tune in this week for the definitive guide on how high-performance health networks actually work!Chapters:(00:00:00) How the World's #1 Chevy Dealer Saved $3 Million on Healthcare
(00:10:30) Enhancing Healthcare Networks
(00:16:23) Making Sure Members Can Get Care In Their Area
(00:22:30) Empowering Patients
(00:25:43) Navigating Healthcare Pricing Strategy
(00:35:23) Enhancing Healthcare Affordability
(00:47:14) Data-Driven Healthcare
(00:57:17) Zero Out-of-Pocket Cost For MembersKey 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/
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 episode covers healthcare news from June to mid-July 2025.And we play a new game called the "Which Has Less Ingredients?", which is exactly like what the title suggests.Chapters: 0:00 - Intro0:22 - A proposal to ban drug ads2:48 - Pre-diabetes rates in children have tripled in 25 years5:25 - Healthcare workers leaking patient data through AI7:06 - Mark Cuban's healthcare plan10:05 - Healthcare is the top employer in most states12:49 - The Self-Funded Review19:37 - Which Has Less Ingredients? (this month's game)27:27- Ask Spencer AnythingSources: https://phys.org/news/2025-06-glass-bottles-microplastics-plastic.htmlhttps://x.com/mcuban/status/1934834421225672999https://www.scrippsnews.com/health/alarming-number-of-adolescents-have-prediabetes-new-data-from-cdc-says?utm_source=chatgpt.comhttps://x.com/utobian/status/1943127594960064713?t=BfpiRV8m7thZDIqTRMVo3Ahttps://www.medicaleconomics.com/view/health-care-workers-are-leaking-patient-data-through-ai-tools-cloud-appshttps://www.medicaleconomics.com/view/sanders-senators-float-ban-on-direct-to-consumer-ads-for-prescription-drugshttps://newsnetwork.mayoclinic.org/discussion/mayo-clinics-ai-tool-identifies-9-dementia-types-including-alzheimers-with-one-scan/
“That race car you got, that you studied all the components and now you're just tweaking horsepower and how much can you get out of it? That's what this feels like. You are really optimizing the horsepower of this engine, your employee benefit plan, and everybody likes it.” - Bently Durant
This week, I was joined by an all-star duo: Bently Durant, the COO of Classic Chevrolet, which is the #1 Chevy dealer in the world, and his benefits advisor, Riley Dearing of Hotchkiss Insurance.
Together, we discussed the story of how they saved $3 million while simultaneously improving care by eliminating deductibles and optimizing pharmacy spend, which is a playbook that every business owner, CFO, and consultant can learn from. Bently, Riley, and I talked about what makes this industry so unique and why self-funding is so beneficial for car dealerships.
We also dove into the truly innovative things they're doing now that their plan is so successful, like creating a "Good Decision Fund" to give bonus money back to their employees.
Tune in this week to learn how to optimize the horsepower of an employee benefits plan!
Chapters:
(00:00:00) How the World's #1 Chevy Dealer Saved $3 Million on Healthcare
(00:04:10) When Bently Decided To Go Self-Funded
(00:14:08) Tailoring Health Plans To Your Employees
(00:31:19) The Complicated World Of Pharmacy Spend
(00:58:27) Improving The Benefits Plan WHILE Saving Money
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/
"If employers do not think that they are in the healthcare business, they are sadly mistaken. Every employer is in the healthcare business whether they want to or not." - Stephanie Koch
I’m super excited about this week’s episode: the Empowering Employers live panel show that we recorded in front of a live audience on June 18th. I was joined on-stage by an all-star group of guests: Rachel Strauss, Kimberly Carleson, Kristen Rivers, and Stephanie Koch.
Together, we discussed some of the biggest challenges and opportunities for employers in today’s market; the diversity of perspectives on-stage made this a super insightful podcast, and whether you’re an employer, consultant, or solution provider, there’s a lot you’ll take away.
We also had live Q&A after the main podcast, with some hard-hitting questions from Omar Arif, Elaine Davis, and more.
Tune in this week to learn how we can better empower employers!
Chapters:
(00:00:00) The Empowering Employers Live Show, with Q&A
(00:13:00) How Do We Get More Transparent Healthcare Pricing?
(00:21:25) What Is The PBM’s Role In Better Healthcare Strategies?
(00:29:00) Lowering Healthcare Costs Through Claim Review
(00:40:11) PBM Reform Through Strategic Legal Actions
(00:48:45) How Do We Pay For GLP-1s?
(01:01:22) Live Audience Q&A
(01:38:10) Final Thoughts From Each Panelist
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/