Self-Funded

Independent Benefits Consulting with Chris Wolpert of GBS

PBM Consulting - Bringing Transparency to Pharmacy with Trevor Daer of Granite Peak Analytics

Links:

Trevor LinkedIn Profile - https://www.linkedin.com/in/trevor-daer-22455b30/

Granite Peak Analytics LinkedIn - https://www.linkedin.com/company/granite-peak-analytics-llc/

Granite Peak Analytics Website - https://granitepeakrx.com/

Spencer LinkedIn Profile - https://www.linkedin.com/in/spencer-smith-self-funded/

Self-Funded with Spencer on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=89a1b922dcf84da0

Self-Funded with Spencer on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286

Self-Funded with Spencer YouTube Channel - https://www.youtube.com/@SelfFunded

Unlocking Cost Savings with Reference Based Pricing (RBP) - ClaimDOC - Omar Arif

This week I sit down with Omar Arif, SVP of Growth with ClaimDoc to answer the question, "What is Reference Based Pricing, aka "RBP"?"

Omar Arif, the SVP of Growth for Claim Doc, a cost containment vendor, was sold on RBP when he discovered it. Claim Doc provides a balanced approach to RBP, combining both "pay and defend" and "negotiate and settle strategies".

Omar states that their network replacement is the most buttoned up in the industry, with all legal work, provider relations, and member services done in-house. The give and take of pay and defend vs. negotiate and settle is up to the individual to decide.

Claim Doc's clinical team of nurses and coding experts performs a clinical audit on every single bill before re-pricing the claim. They also cap themselves out per claim to avoid being egregious and to be more friendly to stop loss markets.

Stop loss carriers that have taken the time to learn ClaimDoc's model and have experience with them will often offer lower stop loss rates. Claim Doc is also transparent about how they get paid, taking a percentage of the build charge.

Claim Doc is a family owned boutique company that is not the norm in the healthcare reimbursement space, which is mostly private equity or venture capital backed firms. They have 120 employees, with half of them being member facing to ensure access to care outside of a traditional contract and handle any billing questions.

Why are so many people switching to ClaimDoc?

It is because they say "They're working to make your self-funded insurance plan remarkable. Using next-generation technology paired with a human touch, they deliver transparent medical claim pricing and allow our clients' health plans to thrive."

Links:

Self Funded on YouTube: https://www.youtube.com/c/SpencerSmithSelfFunded/videos?app=desktop

Self Funded With Spencer (Audio Version): https://podcasters.spotify.com/pod/show/spencer-harlan-smith

ClaimDoc Website - https://claim-doc.com/

ClaimDoc LinkedIn Page - https://www.linkedin.com/company/claimdoc/

Omar Arif LinkedIn Page - https://www.linkedin.com/in/omararif1/

Timestamps:

5:00 - Lamborghini Dreams

7:45 - Playing Pro Baseball

14:56 - Getting Hooked On Sales

21:30 - What Is An RBP?

35:23 - RBP Implementation

41:11- Employer Communication

47:41 - Medicare As A Reference Point

54:10 - Will RBP Ever Become The Norm?

59:06 - Conclusion

#entrepreneurship #LamborghiniDreams #ProBaseball #ContrarianSelling #ReferenceBasedPricing #RBPNetworkReplacement #RBPImplementation #MedicareReimbursementRates #RBPBenefits #TheEntrepreneursJournal

Pro Soccer, Super Bow Bids, and Formula One? - Neal Carter of Cvent

Episode 100! - The Benefits Roundtable with Seth Denson, Dennis Fowler & Chris Hamilton

Self-Funded with Spencer is excited to release the 100th episode of the podcast!

For this episode, we set out to deliver a truly unique experience, with 3 guests, 5 cameras, and 90 minutes of insights from the brightest minds in employee benefits!

With a wide variety of opinions from their extensive experience in insurance and benefits companies, Spencer, Dennis, Scott and Chris explore major trends in the industry like vertical integration into the provider space, understanding workplace spending habits, and navigating the employee lifecycle in a more efficient manner.

From this, they form a discussion on how to unbundle and re-bundle products seamlessly and provide doctor access through direct primary virtual care. The guests offer insight on being an agent vs consultant, finding a mentor, financial literacy in the population, and preparing a new generation for the future. They explain that companies are competing for talent and need to educate employees through financial literacy as well as insights from a mentor.

Last, they discuss the need to make healthcare efficient and create a scale of a prudent buyer, the benefits of a self-insuring plan and its application, and the importance of taking time to celebrate milestones.

Join Spencer and his guests for an engaging and informative episode about the benefits industry and its changes.

Topics with Timestamps:

[00:00:0] Intro

[00:03:50] Emergence of Three Trends in the Benefits Industry

[00:07:03] Managing the Employee Lifecycle in a Post-Pandemic Workplace

[00:09:40] Unbundling and Re-Bundling Healthcare

[00:12:30] Making Accessible Health Care for People in Unique Occupations.

[00:15:55] The Need to Restructure the Healthcare System

[00:18:34] The Benefits of Human Connections in Decision-Making

[00:21:09] Generational Shift in Training

[00:24:07] Establishing a Foundation for Educational Success

[00:27:56] Competing for Talent: Education and Financial Literacy

[00:30:50] The Benefits of Consulting vs Selling Insurance

[00:35:32] The Role of Fee-Based Advisory Firms in the Future

[00:39:08] Navigating the On and Off Ramps of the Superhighway

[00:44:29] Being the Expert vs Bringing In an Expert

[00:48:00] Finding a Mentor for Success

[00:53:08] Audience Questions - Best Client Case Study

[00:57:15] Most Rewarding Client Story

[0059:14] How to Address Change in the Small Group Market

[01:06:55] What Was your First Car?

[01:12:45] Celebrate a Milestone on The Podcast

[01:14:25] The Power of Education

[01:16:30] The Origin Story of The Self-Funded with Spencer Podcast

[01:17:45] Enjoying The Process vs Outcome Obsession

[01:19:30] Building Broad Knowledge with Content

[01:21:03] Learning from Others

[01:24:25] The Biggest Surprises from Podcasting

[01:26:00] The Growth of an Entrepreneur

[01:27:45] Joining ParetoHealth

[01:29:50] Closing Thoughts

[01:31:28] Thank You to Nathaniel

This episodes features:

1. Seth Denson, Head of Employee Benefits at @AcrisureOfficial

Company Website - https://www.acrisure.com/

LinkedIn Profile - https://www.linkedin.com/in/sethdenson/

2. Dennis Fowler, Employee Benefits Practice Leader at @baldwinriskpartners8375

https://baldwinriskpartners.com/

LinkedIn Profile - https://www.linkedin.com/in/dennis-fowler-b105a6b/

3. Chris Hamilton, Employee Benefits Practice Leader at @hotchkissinsurance8816

Company Website - https://hotchkissinsurance.com/

LinkedIn Profile - https://www.linkedin.com/in/chamilton/

The Benefits Insider - https://hotchkissinsurance.com/benefitsinsider

How AI Could Repair our Healthcare System - Meet Healthee

he Connective Tissue of a Health Plan - Planned Administrators Inc

In the latest episode of "Self-Funded with Spencer," host Spencer Smith invites George Stiles, the President and COO of Planned Administrators Inc (PAI), to discuss the transformation of the TPA industry and what makes a good TPA partner.

George shares his journey from claims processor at Blue Cross Blue Shield to his current role at PAI.

The conversation covers topics from data analytics, and direct primary care, to how to navigate the new regulations in transparency. Hear about PAI's reliable data center with top-notch security and where over a billion claims run through every year.

Listen in as Spencer and George provide insight and knowledge on the ever-changing healthcare industry. Listeners will also gain insights into data analytics, the trends in the stop-loss market, and the optimism surrounding the future of healthcare

The dynamic conversation also includes discussions on transparency in healthcare pricing, attracting the next generation of superstars in the industry, and the importance of collaboration between TPAs and brokers

Visit their website, paisc.com, to connect and discover inbound activities as a proof of their successful podcast.

You won't want to miss this engaging episode filled with valuable information and expert insights!

[00:00:09] George Styles' Journey to Providing TPA Services

[00:03:12] The Guest's Journey in Healthcare and Public Policy

[00:06:28] Blue Cross Technical Support and Data Center

[00:09:35] The Benefits of Corporate Entrepreneurship and Third-Party Administrators

[00:15:36] Level funding as a stepping stone

[00:18:32] Challenges and Benefits of Direct Primary Care Expansion

[00:21:46] Quality Healthcare and Medical Expenses Correlation

[00:24:48] The Value of Data Analytics in Employee Benefits Management

[00:27:52] Data Analytics in Self-Funded Healthcare Plans

[00:30:56] The Value of a Trusted TPA Partner

[00:33:48] Stop Loss Marketing Shift

[00:40:06] Advantages of healthcare transparency

[00:43:05] Nurturing Young Talent and Industry Innovation

#healthcareindustry #TPAservices #dataanalytics #healthpolicy #selffunding #directprimarycare #employeefinancialhealth #transparency #insuranceindustry #innovation #longtermpartnerships #healthcareconsulting #TPApartnerships #insuranceconsultants #employeebenefits #healthcarereform #entrepreneurmindset #healthcaredata #stoplosscarriers #futureofhealthcare #TPAadvantages #employeehealth #healthcareauditing #employeetransparency #healthcaretechnology #healthcareaccessibility #insurancedata #healthcareanalytics #healthcarequality #medicare #healthcare

Health Payment Accounts (HPA) with Paytient CEO - Brian Whorley

Welcome to Self-Funded with Spencer, where we dive into the world of healthcare and explore ways to make healthcare coverage more accessible and effortless for everyone.

In this episode, Spencer Smith welcomes Brian Whorley, CEO and founder of Paytient. Brian is creating a new category for health payment accounts that helps remove the impediment of out-of-pocket costs for patients. Together they discuss the importance of creating a feeling of security, peace of mind, and confidence in the form of a Visa card for health plan members.

Throughout the podcast, Spencer and Brian cover a range of topics, from the importance of empathy and considering patient needs to the impact of removing barriers to healthcare consumption.

They delve into Paytient's product experience that allows employers to offer medical, dental, vision, pharmacy, and veterinary expense repayment options to employees, enabling them to make tax-advantaged payments for eligible transactions.

In this episode, you'll also hear about Brian's previous venture, "Big Tree," and the journey that led to the creation of Paytient. Spencer and Brian discuss the various decisions and policies that shape a patient's healthcare journey, and how Paytient is working to make healthcare accessible and affordable through a frictionless and effortless system.

Get ready to be inspired by a team focused on creating real-world solutions to a real-world problem. Tune in to Self-Funded with Spencer to learn more about how Paytient is making healthcare better for everyone, regardless of their situation.

Timestamps:

[00:00:09] Pareto Health and Paytient's Benefit Solutions

[00:03:13] Guest's Work Experience & Passion in Healthcare Industry

[00:06:55] The Importance of Empathy in Patient Care

[00:10:33] Innovative Food Platform and Entrepreneurial Lessons

[00:13:23] Name badge payments for workplace expenses

[00:16:17] Paying for healthcare challenges and credit card solution

[00:19:52] Introducing Patient: An Innovative Payment Card Solution

[00:23:29] Flexible Employee Benefits Platform

[00:26:55] Equitable Health Plan ROI

[00:30:24] Accessible Healthcare Payments for Better Outcomes

[00:33:35] Improving healthcare accessibility and quality

[00:37:24] Improving Future Healthcare through Innovation

[00:41:11] The Future of Frictionless Healthcare

[00:44:32] The Future of Retirement and Healthcare

[00:47:59] Public Catastrophic Plan for Healthcare

[00:51:34] Working with consultants and brokers in healthcare

Quotes:

"And so that's what motivated me, like, every single day of of how do we serve others?"

" I love building things or creating things and kinda going from 0 to 1...Or trying to make things that exist a little bit better. And so that's kind of core to my DNA, what I enjoy doing."

#employeebenefits #selffunded #healthpaymentaccount #healthcareaccess #healthoutcomes