Self-Funded With Spencer

Jason Scott is First Vice President for Alliant Insurance Services in Dallas, TX. Jason originally learned the art of sales from his Dad, who taught him how to sell without being "sales-y".  He also taught Jason the power of getting to the yes or the no as fast as possible, because the "maybe's" are career killers.  His Dad was actually instrumental in helping popularize a seasoning in the United States called "Tajin", which is a mixture of lime, chili powder, and salt, and is very popular within the Hispanic community. His first sales role was at Paycom, which inadvertently opened the door for him to enter the insurance world, as one of his payroll prospects was a large regional insurance brokerage in Dallas called MHBT.  They kept calling him back multiple times to present the same thing, but to new people, and he started to realize they were actually interested in hiring him to work for the firm instead! Jason was offered roles within MHBT in both the Employee Benefits and Property & Casualty departments,  but he gravitated toward EB because there were a couple of other young producers in that department he liked, plus he found the subject matter more interesting and creative. Eventually, he found himself at Alliant after the acquisition of his prior firm called Crystal & Company, and there he had the opportunity to help hone best practices within his new, larger employer.  Big on company culture, Jason stresses the idea of servant leadership and making sure the people that work for you feel valued and supported. Jason isn't all business, though, as he also coaches his young sons in baseball at a very competitive level.  However, it is not all about talent for him, as Jason brings the emphasis of team culture from his work life to the baseball diamond, and won't accept new players onto the roster based on pure ability alone.  They also need to be respectful, and polite to their coaches, and he also manages the expectations and egos of the parents as well. In the big picture of healthcare, Jason is bullish on the private sector to solve the problems we encounter and believes more consumer-driven plans will eventually prevail. He also believes innovation in our space is only going to accelerate, and that the BUCAH's of the world will continue to stay relevant as long as they can, but face stiff competition from new entrants into the market. Chapters 0:00 Intro to Jason 12:15 Bringing "Tajin" to the US 16:42 Developing Sales Skills 20:32 Working for Alliant 32:00 The Importance of Company Culture 36:16 Lessons from Baseball 42:55 Respect from your Peers 47:13 The Future of Healthcare 52:14 Closing Thoughts

Can one app manage pricing, communications, and payments for health plans? In short, YES!  Medxoom "unifies member identity, pricing, communication and payments into one, easy-to-use app". For Episode 82, my guest is James the EVP of Strategy and Growth for MedXoom. His hobbies are triathlons, for which he trains 16-20 hours a week to prepare for events, and scuba diving.  Jame calls himself "a back-of-the-pack triathlete", and recently he had to back out of a full Ironman race in Florida about 36 hours prior to it starting because of a lung infection. James has also performed well over 500+ deep dives, saying it is the most peaceful and exhilarating experience simultaneously.  He even once found a 1-carat diamond ring during his adventures, as well as visited many underwater shipwrecks. James started his career out in the legal world, then moved on to sales with ADP, then PEO sales, before finding himself in SaaS tech centering around human resources with Namely. His current company is MedXoom, which is a technology platform that has the ability to improve the financial outcomes for both plans and members. Medxoom creates a true white-labeled member experience, with clients ranging from Third Party Administrators, Health Plans, Brokers, and many other solution providers selling out to employers directly. Health Plans have nearly an infinite number of combinations of solutions folded together including things like Telehealth, Direct Primary Care, carved-out PBM’s, Reference Based Pricing, etc, and Medxoom allows the administrator to bring all of those components together, white-label in one singular experience, so the member has one place to go. Members can do things like: - Use their Benefits Wallet - Search for Care - Engage with a Care Navigator - Align with a Provider on Price James said one of the reasons they get such good member engagement is that many of their employer clients have gone fully digital, even eliminating plastic ID cards.  “You go fully digital and you get adoption” With plans who have done this, they see 70% + in downloads and enrollment within the first week of launch. They also partner with 3rd-party data providers in order to large ingest machine-readable files with pricing data so members can easily search for cost details of care, which helps employers be compliant with the CAA. In the near future, the app will even be able to recognize if certain procedures are searched for and turn that information over to a case manager to proactively help determine the best course of action. Medxoom is also assisting with improving the provider payment process, using something called a “Single Payment Credential” or SPC card.  This functions as a single-use, virtual credit card loaded with plan dollars allowing for a closed-loop transaction that pays the provider in full.  Medxoom takes it a step beyond and can even float the money for their clients to ensure a frictionless transaction.  All of this has led to 100% acceptance of payments using this method. Best of all, Medxoom’s clients are giving them data that shows on average, using the SPC method of payment, they are realizing a 40% reduction in unit cost versus traditional network arrangements! Chapters: 0:00 Triathlons & Skydiving 11:58 James' Career Path 20:30 Intro to Medxoom 31:20 Medxoom Partners 38:53 Solving the Payment Problem 46:07 Who is it for? 55:00 Future of Healthcare 56:50 Closing Thoughts

Join me as I sat down with Ahmed Marmoush, Founder and CEO of Handl Health to hear his story, and learn more about Handl Health. Ahmed was born in Egypt but grew up in New Zealand, where he studied at the University of Auckland and received a Bachelor of Pharmacy.   He then went to work at a Hospital in New Zealand as a clinical pharmacist where he got to experience everything from primary care in the field to geriatric care in a hospital setting.  This gave him a ton of exposure to healthcare operations, where his frustration with the status quo in the system started.   An encounter with the US Healthcare system, where he was charged $800 for a blood test when he was under the impression that his preventative care was free, introduced him to the complex insurance model of care in America and sent him down the path that eventually led to the creation of Handl Health. Handl Health is a consumer-facing application that employers use to help them comply with the healthcare price transparency legislation, known as the CAA. With Handl, members can digitally shop for healthcare, arrange their appointments, and manage their personal healthcare finances with ease. The ideal employer for Handl's solution is a self-funded employer, typically above 50 lives, who want to offer a care management tool for their employees. Handl ingests thousands of terabytes of data from hospital pricing files, normalizes that data, and uses it to assist in the member shopping experience for healthcare. The focus is not just on price, but the quality of care being delivered as well. Handl Health is poised to make a big impact on the healthcare industry, and it's an exciting time to witness the digital transformation and transparency push happening in the marketplace. Don't miss this episode and learn more about the future of healthcare with Handl Health! Chapters: 0:00 Intro to Ahmed 4:33 Quarantine in New Zealand 9:15 Intro to New Zealand Healthcare 20:52 Early Entrepreneurship 27:53 What is Handl Health? 36:35 Compliance with the CAA 41:22 Price Shopping Tool 45:55 Public vs Private Healthcare 51:20 Future of Handl Health 54:35 Closing Thoughts

This episode is focused on the topic of Direct Primary Care, also known as "DPC". The DPC model transforms primary care into a membership-based model, rather than the traditional fee-for-service model. The goal is to provide all of the same routine services that patients receive from their primary care physician but eliminate the incentive for fast patient turnover, which often leads to a decrease in the quality of care provided.  Our guest, Andy Bonner, the President & CEO of Healthcare2U, shares his experience in the healthcare industry and how a personal misdiagnosis led to the creation of Healthcare2U, a company that offers a hybrid model of primary care services.  He also shares what he learned working in business process outsourcing, where he helped develop the concept of "Near-Site/On-Site" and how it has led to the creation of Healthcare2U. In this episode, you will learn about the benefits of DPC, including: * More time with your doctor * Stronger patient-doctor relationship * Improved physician quality of life * Elimination of claims to insurance * Less Administrative Burden Tune in to this episode to understand the potential of DPC and how it can change the way we approach primary care! Chapters: 0:00 Intro to Andy Bonner 8:36 Andy's Cancer Scare 14:30 A Calling to Healthcare 22:00 Direct Primary Care Defined 29:31 HealthCare2U Explained 35:48 Coordinating Medical Records 40:00 Scaling DPC Nationally 47:28 Who is DPC For? 55:12 The Big Picture 59:59 Closing Thoughts

This episode is all about entrepreneurship.  The highs and the lows, and everything in between. Gabe knew he was going to be an entrepreneur from an early age, recalling that he didn't get the best grades, didn't love to follow rules, and even recounts knowing at the age of 14 he was going to build his own businesses. He studied entrepreneurship in college at Baylor University, but outside of making friends and meeting his wife there, his belief that he would have been better off taking the $150k spent on four years of school where he learned somewhat outdated information, and just setting up his own painting or landscaping business instead. Gabe also has a fantastic story to tell about financial redemption. From being on the brink of bankruptcy, where he had to move his wife and newborn child into a studio apartment after an oil market crash crushed his family business, to founding and building Factur, with 57 employees, explosive growth, and a vision to create a "100-Year Company", Gabe's story should resonate with every entrepreneur out there. The name "Factur" comes from the middle of the word Manufacturing, and this industry is one that Gabe not only knows intimately but that he believes strongly in his own team's ability to drive tremendous growth for these entrepreneurs. Factur helps with business development for manufacturing companies. They offer: 📈 Lead Generation 📲 Outsourced Business Development 💲 Marketing Services 👨‍💼 Industrial Sales Recruiting Every once and a while I like to deviate from the insurance-focused subject matter and offer up something more universal. In this episode you will hear about entrepreneurship, faith, manufacturing challenges, how fracking works, dreaming big, building a company that outlasts yourself, growth, optimism, and more! Chapters: 0:00 Intro to Gabe 5:40 The Family Business 9:54 The Collapse 16:24 Rebuilding From Scratch 23:11 What is "Factur"? 32:26 Thriving During Covid 37:12 Building a 100-Year Company 42:15 Closing Thoughts

Josh Sullivan is a Territory Manager for Morgan White Group, which creates and delivers innovative insurance products to the marketplace.   Even though they have a full suite of solutions, for today's episode, we specifically focused on their Gap Supplemental Health Plan called the "Premium Saver Plan". I have always been intrigued by the financials of a Gap Health Plan, which aims to lower the overall cost of an employer-sponsored health plan by providing a way to bridge the "gap" between the first dollar and the employee's deductible. If an employer raises their employee's major medical out-of-pocket costs, the premiums will go down as a result.  "The Premium Saver uses the money saved to fill in the out-of-pocket expense which brings the group’s plan back to its current plan design." This type of product does have some detractors in our industry, so it was great to be able to address those with Josh and hear his perspective. Gap Supplemental medical plans really only make sense when a group is in a fully insured arrangement, and those that are more averse to setting up a plan this way might argue that a group is better off (at least financially) by moving to a self-funded plan. Like every insurance product, each individual employer and their consultant need to determine what is best for their specific situation. Who knows, a Gap Health Plan might be right for you! https://mwgbrokerservices.com/ Chapters: 0:00 Intro to Josh 9:12 Starting in Life & Disability 17:00 What is the Morgan White Group 20:41 The Premium Saver 31:45 Who are Gap Plans For? 39:15 What are the Cons of a Gap Plan? 46:00 The Future of Gap Plans 50:40 Closing Thoughts

There is a better way to construct a healthcare plan, and that is why I had Chris Hamilton, Partner at Hotchkiss Insurance back on the  @SelfFunded  with Spencer podcast after spending the last episode discussing Sales Best Practices only. You can view Chris' episode on Sales mastery here - https://www.youtube.com/watch?v=VrdbOgRxYis&t=1205s Chris came from the finance world before coming to benefits, and what drew him to our industry was that he kept seeing very sophisticated employers with huge healthcare plan spend, continually acting helplessly when it came to their renewals. Chris couldn't understand why they didn't try harder to save money on their healthcare spend, even when it was the 2nd or 3rd biggest line item on their P/L.   This problem, plus witnessing a personal issue where his brother went bankrupt from out-of-pocket costs from a medical procedure, sent him down the path to being one of the best brokers in the benefits business today. Key points: What drew Chris to Employee Benefits Why Chris Changed His Mind on HSAs How Employers Can Take Control of Their Plan Spend by Self-Funding The Best Way for Brokers to Be Compensated Why we are Going Through a Renaissance in Benefits What The Benefits Insider Is and Who it Helps Keywords: self-funded insurance, employee benefits, cost savings, flexibility, risk management, third-party administrator, legal guidance, financial guidance, broker, consultant, advisor, finance Chapters: 0:00 Intro to Chris 8:35 Entering the Benefits World 14:55 His "Why" 20:10 How Big is the Problem? 26:56 Self-Funding for the Win! 32:25 The Benefits Insider 37:09 The Power of Social Media 41:00 Pros & Cons of HSAs 51:15 A Renaissance in Benefits 54:25 Closing Thoughts

Entrepreneurship in Autism Therapy - Derek Barrows of Belay On Autism Services Derek is the Founder and CEO of Belay On Autism Services, which offers Applied Behavior Analysis (ABA) therapy for children diagnosed with autism in North Texas. In this episode, Derek shares information about applied behavior analysis (ABA) therapy, a widely used approach that focuses on reinforcing positive behaviors and teaching new skills. While ABA has been shown to be effective for many children with autism, it's important to note that it may not be the best fit for every child. In this episode, you'll learn about: 👉🏼The potential benefits of play-based therapy 👉🏼 The importance of individualized therapy plans 👉🏼 Applied behavior analysis (ABA) therapy and how it can be used to help individuals with autism Derek and I have gotten to know each other over the last few years, as our wives are good friends and our daughters participate in your sports together. Derek was diagnosed with dyslexia and ADHD growing up, but never received a diagnosis of autism himself, and we discussed how those challenges played a role in the development of the mission he has with Belay On. For the baseball fans out there, Derek was a very high-level baseball player, spending a few years after college in the minor leagues pursuing a professional baseball career. For those interested in learning more, here is Belay On's website. https://belayonautismservices.com/ Chapters: 0:00 Intro to Derek 9:45 His Healthcare Career 13:24 What is Belay On 16:35 Autism Diagnosis 19:45 ABA Therapy Explained 27:04 Derek's Entrepreneurial Journey 33:45 Lessons Learned 42:34 The Future of Autism Care 45:40 Closing Thoughts

Brian is an AVP of Business Development at Goodroot. "Goodroot is a community of companies committed to reinventing healthcare one system at a time." In this episode, we specifically focus on two of the solutions that Brian represents: 1. AlignRx, which is their pharmacy consulting arm for larger employers who need individualized expertise for their unique situations. 2. CoeoRx, which has prenegotiated Pharmacy benefit contracts and custom pharmacy benefit solutions for employers that offers "choice, leverage, and savings". Interestingly, Brian has a condition known as hemophilia, a medical condition in which the blood's ability to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury. Anyone who operates in the world of self-funding knows how expensive this condition can be to an employer, but it was incredibly interesting to hear the human side directly from Brian. The crux of this episode focused on the world of PBMs, where we discuss everything from PBM contracts, to spread pricing, price transparency, claims repricing, specialty medications, and so much more! Chapters: 1:25 Getting to Know Brian 8:45 Life as a Hemophiliac 19:00 What is Goodroot 27:20 Sifting Through the PBM Noise 34:45 PBM Best Practices for Employers 39:52 What Data is Required 44:13 Specialty Meds 48:25 Alternate Sourcing of Meds 54:29 Pharmacogenomics  58:30 Closing Thoughts

How to Become Unstoppable in SaaS with TK Kader TK Kader is my latest guest on the  @SelfFunded  with Spencer podcast, where we discussed his successful track record as a SaaS entrepreneur, his company called "Unstoppable" where he helps other early-stage SaaS business owners scale their companies, as well as the outstanding YouTube channel that has over 36k+ subscribers, 1M+ views, 100k+ hours of watch time. TK is also an incredibly cool and down-to-earth guy, even gracious enough to come on my show after a cold outreach by me! Being that my company Plansight is in the SaaS space, and also that TK is a master of using video content for lead generation, I knew he would make an outstanding guest on my podcast. From his website bio: "TK Kader is an entrepreneur, international best-selling author, and also an angel investor.  TK worked at Bridgewater Associates (one of the best hedge funds in the world). He then founded ToutApp (backed by Andreessen Horowitz and Jackson Square, two of the best venture capital firms in the world).  TK sold ToutApp to Marketo (then owned by Vista Equity Partners, one of the best private equity firms in the world) and was part of the executive team at Marketo that helped drive its transformation and eventual $4.75bn sale to Adobe.  TK now leads the Unstoppable movement to help SaaS Founders build & scale incredible software companies." Links: TK's youtube channel - https://www.youtube.com/channel/UCUseoG3kofRLS6WoUaL_15w TK's Unstoppable website - https://www.tkkader.com/ TK's book - https://www.amazon.com/How-Punch-Sunday-Jitters-Face/dp/B0BF2TNGG2 Episode Highlights: 0:00 Intro to TK Kader 2:00 His first Company - "My P.I.M.P." 9:30 Joining Ray Dalio's Hedge Fund - Bridgewater 12:12 Building & Selling ToutApp 19:52 Becoming Unstoppable 28:30 3 Pillar for Go-to-Market Strategy 34:40 Time Management 38:22 Your 5-Year Vision 41:45 YouTube for Sales Leads 50:15 The Future of Unstoppable