Self-Funded With Spencer

Chris Grilli, a pharmacist and genomics expert at RxMapper, dives deep into the staggering $528 billion wasted on medication errors in healthcare. He reveals how personalized, DNA-guided medicine can dramatically reduce these costs and improve patient outcomes with nearly 90% accuracy. Chris shares a personal story that inspired him to develop RxMapper after a family tragedy, and he discusses the powerful role genetics plays in medication efficacy. Tune in to learn how this innovative approach is set to revolutionize healthcare!

Todd Whitthorne, a former TV personality turned healthcare executive, dives deep into the essence of well-being and leadership. He shares insights on the importance of a leader's personal health as a cornerstone for professional success. The conversation spans the five pillars of wellness, distinguishing between 'lifespan' and 'healthspan.' Todd underlines that self-investment is key for leaders, and narrates a powerful story of resilience involving a 70-year-old who survived a serious accident, exemplifying the impact of lifelong fitness.

Bobby Stuart, a benefits consultant with Hotchkiss Insurance, shares insights on navigating the complexities of self-funding and risk management. He emphasizes the importance of 'thinking like an underwriter' to create impactful solutions for employers. Bobby discusses simplifying complex insurance jargon and the real-world strategies his team employs, such as using direct contracts for high-cost cancer care. His optimistic approach and focus on proactive healthcare can transform lives while alleviating financial burdens.

"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!

This week features Bently Durant, COO of Classic Chevrolet, and Riley Dearing, a benefits consultant from Hotchkiss Insurance. They share how they saved $3 million by restructuring employee benefits while improving care. Discover the power of self-funding, the benefits of eliminating deductibles, and innovative strategies like the 'Good Decision Fund.' They discuss the complexities of pharmacy spend and the importance of education for employees to make informed healthcare choices. Tune in for insights that could transform business benefit strategies!

"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/