Self-Funded With Spencer

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

I sat down with the CEO and Founder, Priscilla Romans to discuss the origin story of Graith Care, and how they are fighting every single day on behalf of Americans to ensure they are getting the best possible care for their unique situation. Patient Advocacy is all about empowering patients to regain control of their healthcare decisions.  When they have informed consent, and are presented with all of their options, the patient should ultimately be able to make the decision that is best for them. "Graith Care’s mission is to bring back control and transparency to the consumer. Graith Care breaks down healthcare barriers and provides a holistic view of the patient journey. This care model ultimately improves outcomes and efficiency along with saving time and money. As your Independent Patient Advocate, we provide medical advocacy, consultation, advice and recommendations in US and Internationally." Chapters: 0:00 Intro 2:57 Who is Priscilla Romans 11:30 Graith Care Origin Story 17:40 What is "Patient Advocacy" 22:00 How Graith Care Works 31:28 The Story of "Molly & Jim" 37:30 Going Viral on Tik Tok 43:05 The Future of Advocacy 49:00 Closing Thoughts

A Fiduciary's Guide to Data Analytics with Agility Innovation Partners. This episode is a follow-up to my video "The Consolidated Appropriations Act 101 - Comply or Die?"   The Consolidated Appropriations Act, otherwise known as the CAA, established protections for consumers related to surprise billing and transparency in health care.  Upcoming fines can and will be heavy, amounting to $100/day PER EMPLOYEE, which is substantially greater than the fines hospitals receiving for being non-compliant, which was only $300 total day.  In this Episode - Part 2 - we focus on an employer's fiduciary responsibility now that they have access to claims and pricing data due to the CAA regulation, and the power of using an innovative Data Analytics platform to make sense of it.   Agility Innovation Partners helps offer a data analytics platform with "at-scale pricing" to small-to-mid-market brokers who may not have the leverage on their own.  They also offer consulting after the decision to purchase a data analytics platform called Innovu, so that consultants can make sure they maximize the ROI on their investment.  Innovu also offers a CAA fiduciary tool stack with benchmarking against 4 million lives for plan design, claims cost, plan design etc, so that an employer can determine if they are paying reasonable cost for care and are compliant.  If not, now they know and can take action!   Here is a recent article covering the CAA in greater detail, and outlining the employer obligation to be compliant.  Hat's off to Dave Chase, co-founder and CEO of Health Rosetta for bringing it to my attention!   https://docket.acc.com/erisa-covered-companies-must-disclose-health-plan-costs

The Consolidated Appropriations Act 101 - Comply or Die?   The Consolidated Appropriations Act, otherwise known as the CAA, established protections for consumers related to surprise billing and transparency in health care. Upcoming fines can and will be heavy, amounting to $100/day PER EMPLOYEE, which is substantially greater than the fines hospitals receiving for being non-compliant, which was only $300 total day.  The goal for employers immediately is not to be perfect by 12/27/22, but to at least show that they made a good faith effort to be compliant. The price transparency component is where the opportunity lies for employee benefits brokers and their employers to uncover the source of their high cost claims, and then take appropriate fiduciary responsibility in order to pay more appropriate unit costs for healthcare.  While there is a cost associated with ensuring you are compliant, the opportunity to retain and win new business for consultants is massive. Right now, opaque network contracts make it difficult for healthcare consumers to know the cost of care prior to receiving it, and it is nearly impossible to make an informed decision as a patient.  The CAA will have a dramatic impact on Americans' ability to price shop on where to go for care, as well as their ability to plan for their out of pocket expense(s). The goal of the CAA is simple: People should be able to know the price ahead of time, shop using that price as well as quality of care metrics, and then they shouldn't be slapped with a giant, surprise balance bill afterward. At the end of the day, the goal is to allow people to have the tools to shop for healthcare the way that they do so for any other product or service. Here is a recent article covering the CAA in greater detail, and outlining the employer obligation to be compliant.  Hat's off to Dave Chase, co-founder and CEO of Health Rosetta for bringing it to my attention! https://docket.acc.com/erisa-covered-companies-must-disclose-health-plan-costs

Sarah is the Founder and CEO of Predictabill, a company that allows you to "compare the health insurance you have with what you could get, and see what’s different since last year."   With Predictabill you can analyze options from your employer (including COBRA), your spouse’s employer, healthcare.gov, and more.    Sarah spent 8 years in investment banking, and her area of expertise during this time was evaluating the impact that an organization's insurance expenses had on the valuation of the business.   She jokes that insurance company is "a pile of cash and a bunch of promises", and I am not sure I have heard a better definition than that! A personal experience with high deductible health plans soon after moving to New York on her own, where she was hit with a $400 out of pocket expense she didn't expect, led to an epiphany about the complexity of health insurance plan design that ultimately sent her down the path of creating Predictabill.

Cariloop provides coaching and support for the caregiver.      Cariloop has been recently recognized as number 40 in the "Dallas 100", which means they are the 40th fastest growing company in Dallas/Fort Worth!  In this episode, I sat down with their co-founder and CEO, Michael Walsh to learn more about Cariloop, as well as to hear his personal story of entrepreneurship.  The Cariloop tagline is "take care of your loved ones with an experienced Care Coach in your corner." and they consider themselves the "World's First Human-Powered Caregiver Support Platform"    Anyone who has ever found themselves tasked with taking care of a loved one, be it an ailing parent, or a child that needs continual mental or physical care, knows just how emotionally difficult that role can be.    Cariloop seeks to provide coaching and support for anyone who finds themselves in that position.   Whether you need logistical support to coordinate care, assistance navigating the complex healthcare world, or simply just someone to talk to, Cariloop is there to help.

Sales Mastery - Part 3 - Ryan Miller - Sales Performance Coach   Ryan Miller is a highly sought after sales performance coach, and I am grateful that he helped me close out the 3-part miniseries of my podcast on "Sales Mastery"   Ryan started off selling high-end wheels/rims for custom cars, and didn't discover the world of benefits until later in life.  He also has overcome numerous personal challenges, from having a strained relationship with his father, developing bad habits in his teens and 20's that nearly lead to jail time, and even being present with his wife at the infamous Las Vegas mass shooting where a bullet went straight through his wife's trucker hat without hitting her!   Ryan eventually found his way to God, was able to salvage a marriage on the brinks, and to eventually building a successful sales and performance coaching business infused with his faith in Christ.   He is a master of real authenticity, and this episode is absolutely loaded with great advice.

Chris Hamilton is a Partner at Hotchkiss Insurance.  He is also one of the best sales consultants I have met in the employee benefits industry, for which many of his peers agree. Chris, like me, didn't get into sales until his 30's, having spent the bulk of his career before that in investment banking.  His ability to discuss financials, coupled with his experience in Mergers and Acquisitions, helped prepare Chris to have very complex conversations with business owners.   Chris is the antithesis of your "stereotypical" salesperson.  He doesn't speak so fast you can't follow his words.  He doesn't use sales tricks or focus on always closing the deal.  He simple brings expertise, along with a deep level of integrity, to his prospects to build rapport and trust.   In short, Chris is a modern benefits consultant, and our entire industry could learn from the example he has set!

Sales Mastery - Part 1 - Jennifer Bryson - Mercer This is the first installment of a 3-part series dedicated to sales mastery. Not only is Jennifer Bryson an absolutely lovely human being, she is always a killer producer! She had a career-defining year in 2021 for Mercer and we talked about everything from how she builds long standing relationships, to her keen recognition of when to pull in other rockstars on her team to help solve big problems for her clients. Although Jennifer and my next two guests come from the employee benefits industry, each of the 3 conversations is focused on universal sales best practices. Enjoy