Self-Funded With Spencer

"The balance bill came in, it was 37 grand for this member, and we were able to get that thing fully wiped." - Patrick HaigMy 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/@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/

"I doubled my profit when I lost 70% of my customers, which is insane." - Brad HartMy 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-ConsumerKey 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/

"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 WalkerMy 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 PlanKey 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/

Blake Allison, CEO of Employers Health Network, and Riley Dearing from Hotchkiss Insurance explore the transformative world of high-performance health networks. They demystify how direct partnerships can lower costs and improve care, revealing real-world success stories like a healthcare savings of $3 million. The conversation covers innovative strategies for risk management, enhancing patient access, and fostering collaboration in West Texas. They also touch on the significance of data-driven approaches and building effective partnerships in the evolving healthcare landscape.

Dive into a wild mix of healthcare headlines, including the alarming rise of pre-diabetes in kids and healthcare workers' AI data leaks. Hear about Mark Cuban's bold healthcare reform vision focusing on patient autonomy and cash payments. Explore the rapid growth of healthcare as America's top employer and the implications of lobbying on public health. Enjoy a fun segment comparing snack foods while navigating healthcare legislative challenges. There's nothing boring about these pressing topics!

“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 DurantThis 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 MoneyKey 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 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 KochI’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 PanelistKey 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/

David Silverstein, a healthcare consultant with Amaze Health, is on a mission to simplify the convoluted U.S. healthcare landscape. He discusses how the system is designed to create friction, from hidden prices to unnecessary tests. Silverstein shares his struggles with lobbying for transparency legislation, emphasizing the need for clear pricing. He also highlights innovative tech solutions for healthcare navigation, aiming to empower patients and enhance their access to necessary care.

“As a broker, our job is counting cards against the system. Because everything catches up 5-10 years later. Every other broker, every other consultant gets in like, oh, that's a great idea. We're always trying to find the next little thing, and then the system eventually shuts it down because it messes with somebody's money." - Taylor OrtonWhat does it mean to be on the bleeding edge of employee benefits? My next guest, Taylor Orton, CEBS, of Cottingham & Butler, frames the work of a top consultant as “counting cards against the system”, and trying to continuously stay ahead of the market. Taylor broke down several of the key areas of cost containment that are often employed by brokers and gave his take, as well as what it means to be on the “bleeding edge” of benefits. He also shared with me why cost containment doesn’t just mean lowering the “unit cost” of healthcare; it also means trying to reduce the number of “units”. Much of this conversation was on the big picture of the healthcare landscape, so if you’re a self-funded geek, this one is for you.Chapters:(00:00:00) Why Brokers Need To Be Constantly Innovating | with Taylor Orton(00:10:44) Optimizing Healthcare Benefits Plans(00:16:14) Why Procurement Strategies Are So Key To Cost Management(00:33:22) Market Forces' Impact on Healthcare Pricing(00:46:54) Employer Transparency About HealthcareKey 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/

“There's this ability to impact people directly through the employer in a very cost effective way, giving everyone the chance to improve their health. The more employers that we can impact, the more people we're going to impact." - Erica ArmstrongI recently had the pleasure of speaking with Erica Armstrong, MD, IFMCP, the founder of Root Functional Medicine, who is on a mission to use functional medicine to find and treat the root cause of our health issues. After first connecting with Erica on LinkedIn, I was excited to have her on the show to discuss her holistic approach to healthcare.We discussed the core pillars of functional medicine, including a nutrition-first care model, the critical importance of a healthy gut microbiome, the keys to inflammation management, and even the potential for reversing chronic conditions. We also cover how she is bringing this new, more comprehensive model to employers and their employees.Tune in this week to learn all about functional medicine!Chapters:(00:00:00) Functional Medicine 101 | with Erica Armstrong(00:05:37) The “Root Cause” Approach(00:07:03) Holistic Approach Of Functional Medicine (00:16:56) Nutrition-First Care(00:25:59) The Importance Of A Healthy Gut Microbiome(00:34:46) Chronic Condition Reversal(00:44:10) The Key To Inflammation ManagementKey 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/