Self-Funded With Spencer

This episode features Patrick Martell of ClaimDOC.  Patrick came on the show to discuss one of my favorite topics - Reference Based Pricing (RBP)!  I love the potential of RBP to reduce plan spend, but I am no expert, so I asked Patrick to come to tell us the who, what, why, when, where, and how of moving your self-funded plan to this type of claims payment methodology.

Andy Near is an ex-professional baseball player, who channeled his playing experience into a successful insurance career, before finding his real calling - becoming a high performance coach for Insurance Producers.   Beyond that, Andy is an excellent storyteller and a strong advocate for utilizing content creation to build your personal brand and attract prospect's attention.    Website - https://andyneary.com/Podcasts - https://andyneary.com/bullpen-sessions-podcast/

In this Episode, Craig Clemente, President & COO of Specialty Care Management (SCM), came on the show to discuss the growing problem of Outpatient Dialysis, and how his organization specializes in controlling the cost of this treatment for self-funded employers.

Rachel Strauss is Director of Strategic Development at EHIM, "national, privately held, woman-owned (WBENC) Pharmacy Benefit Manager (PBM) and Third-Party Administrator that helps organizations proactively contain rising prescription and healthcare costs." Rachel joined me on the show to discuss the role of a PBM, the hidden costs and dark money in this space, as well as EHIM's approach to doing business the right way. She also was the person who recommended to me the Magic Merlin Sleep Suit, so if you have an infant at home that is transitioning out of being swaddled, I cannot recommend the Sleep Suit to you enough : )

Seth Denson, Co-Founder of GDP Advisors and market analyst, discusses Insurance Captives, right group sizes, and risk profiles. He also talks about his book 'The Cure' for America's healthcare crisis and the importance of being prepared for opportunities in a career.

Jonathan Lopez, Ed.D - aka "Dr. J-Lo" joins me on this episode to cover the role of the Third Party Administrator from a different perspective than covered previously.  He views the role of the TPA as the "Adjudicator", and explains what he means using a sweet "John Wick" analogy! Jonathan has an interesting story, having gotten his undergrad degree in Kinesiology, then attending OCS with the Marine Corps, before going back to complete his Doctorate in Education Leadership.  Oh, and he also used to own a Crossfit Gym! Not the typical path towards being an RVP of sales for a TPA...but that is the beauty of the insurance industry.  There is no correct path to get in, and once you are in, you can find what interests you to carve out your own path. *Correction* - 78% of hospitalizations due to Covid were overweight/obese - not 94%.  The 94% statistic was in reference to the percentage of Covid deaths that had comorbidities".

Yo, what up gang, Spencer here… Thanks for checking out “Self-Funded with Spencer”, a podcast that seeks to educate around, and advocate for, the self-funded health insurance marketplace. It has been said that the best defense against tyranny is a well-armed populace, and my goal is to arm you with information to defend against the tyranny of being fully insured! I appreciate you stopping by. Be sure to subscribe. And I’ll talk to you soon!

Episode 7 of "Self-Funded w/ Spencer" with the hardest working person in employee benefits - Lester J. Morales, Founder and CEO of Next Impact! Lester is seemingly everywhere these days, both literally and virtually, as one of the most sought after and knowledgeable consultants in the self-funded space. His passion, insight, and enthusiasm are infectious, and it was a pleasure to get to spend an hour with him to hear his story. Lester joined me on the podcast specifically to discuss the role of a General Agent (GA), and how their responsibility has morphed over time.

We have approached self-funding from many different insurance industry angles so far, but the most crucial vantage point is discussed in this episode with Tommy Fulmer - The EMPLOYER's perspective.   Tommy is responsible for accounting and finance at The Delta Companies, who has been self-funded since 2012.  He discusses his experience budgeting for monthly claims fluctuations, projecting future plan costs, and the decision-making balance that has to be struck between finance and HR.

Courtney is a Sales Executive with ZERO, which focuses on reducing claims costs to a self-funded plan by directly contracting with providers and paying for procedures with predetermined, agreed-upon pricing bundles.   An added benefit, and also where they got their name, is if a member of a health plan uses a contracted provider, they experience zero out of pocket costs themselves.