Self-Funded

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 b...

In this episode, Seth Denson, Co-Founder and CSO of GDP Advisors joined me on the podcast to help explain Insurance Captives.  Seth talks about the right size group, the appropriate risk profile to join a captive, as well as the technical mechanics of how they work. In addition to GDP Advisors, Seth is authored the book "The Cure: A Blueprint for Solving America’s Healthcare Crisis", availabl...

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 th...

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 s...

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...

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, projectin...

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.

4 episodes in and I finally got to talk some stop loss again!   Jeff Petty is the President of PACE Underwriters, a Dallas-based Managing General Underwriter (MGU ) of Stop Loss Insurance.  He joined me to discuss what an MGU does, and what specific role they play in the broader marketplace.   Jeff has spent his entire career around stop loss, and is one of the few people that actua...

Come for education on the Healthcare Navigation industry, and stay for a discussion on Alpacas!   Dr. Eric Bricker is a physician, built a successful healthcare navigation company, and is the founder of AHealthcareZ, which focuses on creating education content around the healthcare industry.   He has also written a book called "Healthcare Money Campfire Stories", and has his own podcast...

In this episode we begin to drill down into the self-funded conversation to look at the individual moving parts.   Today's component is the Third Party Administrator, also known as a "TPA".   Jennifer Morgan of Collective Health joined me to discuss what a TPA is, and the pivotal role they play in coordinating a self-funded health plan.   Jennifer brings a wealth of brokerage knowle...

This is the inaugural episode of Self-Funded with Spencer, where I am joined by the Practice Leader at Roach Howard Smith Barton (RHSB) Insurance, Dennis Fowler.   Dennis helped me define Self-Funded for this and future episodes, and brings a decade of experience as a broker/consultant in the employee benefits space.  We discussed a wide range of topics around self-funding strategies, mi...