Self-Funded

"Good entrepreneurs fall in love with their solution and their platform, but great entrepreneurs fall in love with the problem." - Matt Scovil

Matt Scovil and Nathan Gilchrist of Medefy Health, have fallen in love with one of the biggest problems in benefits: nobody wants to engage with them. They joined the show to discuss their journey of building a platform designed to solve the engagement crisis and simplify the healthcare experience for everyone.

Matt and Nathan break down their "bottoms-up" approach to this problem, which focuses on engaging members when they need help through a high-touch, live support model delivered via mobile app. We discuss how they use the psychology of "loss aversion" and constant communication to drive engagement rates over 90%.

We also explore how Medefy acts as the "quarterback" for a health plan, removing friction by navigating members to the right solutions. This is all part of their vision for the future of healthcare, where the experience is "heavily, heavily individualized" for each person.

Chapters:

(00:00:00) Why Employees Would Rather Clean a Toilet Than Use Their Benefits 

(00:04:18) Cleaning a Toilet vs. Learning Your Benefits 

(00:08:46) Falling in Love with the Problem, Not the Solution 

(00:14:23) The Power of Live, Human Support 

(00:19:08) Using "Loss Aversion" to Drive Engagement 

(00:34:54) The Quarterback for Your Health Plan 

(00:47:57) How AI is Augmenting the Human Touch 

(01:00:01) The Future of Healthcare is "Individualized"

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

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

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

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I think the three strongest words that you can use as a leader, as a salesperson, as a client relationship person is I don't know." - Scott Milson

My guest this week, 35-year industry veteran and author Scott Milson, joins the show for a deep dive into the mindset required for a long and successful career. We discuss his journey from a self-described "career B student" to a partner at a major firm, and the lessons he learned about loyalty, hard work, and what it truly means to be excellent.

Scott breaks down his personal playbook for "tuning into the frequency of excellence." He shares his "Be 5 Framework" (Be Present, Curious, Intentional, Bold, and Reflective) and explains why embracing discomfort, adopting a growth mindset, and learning through informal mentorship are crucial for professional growth.

It’s worth noting that Scott is also professionally in the benefits industry, so I wanted to have him on the show to directly speak to those in this space.

I hope you'll tune in for this insightful conversation!

Chapters:

(00:00:00) Tuning Into The Frequency Of Excellence 

(00:20:08) Why Discomfort is the Path to Growth 

(00:21:56) The 3 Words That Defeat Imposter Syndrome 

(00:27:52) The "Success to Significance" Curve 

(00:38:42) The “Be 5” Framework for Excellence 

(00:40:52) The Myth of Formal Mentorship 

(00:48:25) "How You Do Anything is How You Do Everything"

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

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

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

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"We spend about $528 billion a year fixing the mistakes we make with medicines." - Chris Grilli

Fixing healthcare's $528 billion dollar mistake starts with ending the "trial-and-error" prescribing that plagues our system. My guest this week, pharmacist and genomics expert Chris Grilli of RxMapper, joined the show to explain how personalized, DNA-guided medicine is the key to solving this massive problem.

Chris breaks down the RxMapper model, explaining how they analyze 36 million data points from a patient's genome to provide medication recommendations with nearly 90% accuracy. We discuss the crucial difference between genetics and genomics, and how this approach saves thousands of dollars per patient while dramatically improving outcomes.

The mission to fix this problem is also a personal one. Chris shared the story of how his grandmother's preventable death from an adverse drug event became the inspiration for building RxMapper to ensure other families don't suffer the same fate.

Tune in this week for the playbook on fixing one healthcare's most expensive mistakes.

Chapters:

(00:00:00) Fixing Healthcare's $528 Billion Dollar Mistake 

(00:02:12) The $528 Billion Cost of Medication Errors 

(00:04:43) Genetics vs. Genomics: What's the Difference? 

(00:10:29) Are Doctors Prescribing "Poison?" 

(00:14:18) The Personal Story Behind RxMapper 

(00:27:17) Saving Over $8,600 Per Patient 

(00:41:24) How Your DNA Impacts Ozempic's Effectiveness

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

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

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

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"There's a big difference for me in living and being alive. There's a difference between breathing and truly experiencing life." - Todd Whitthorne

My guest this week Todd Whitthorne joined me for a conversation that goes far beyond the balance sheet to explore the true meaning of well-being. We discuss why a leader's personal health is the foundational, non-negotiable asset for their professional success.

Todd breaks down the crucial role leaders play in building trust and creating a "culture of health" that yields a real financial, clinical, and cultural ROI. We explore the five pillars of well-being (fitness, nutrition, sleep, stress, and prevention), the difference between "lifespan" and "healthspan," and why investing in yourself is the least selfish thing a leader can do.

The episode concludes with the incredible true story of Todd's 70-year-old friend who survived being hit and run over by a drunk driver, which is a powerful testament to how a lifelong commitment to fitness creates true resilience. I hope you’ll tune in for this inspirational conversation!

Chapters:

(00:00:00) Lessons in Health & Leadership 

(00:06:11) Why Trust is a Leader's Most Important Asset 

(00:14:14) The Difference Between Lifespan and Healthspan 

(00:17:06) Why Investing in Yourself Isn't Selfish 

(00:48:59) The Pursuit of True Happiness 

(01:05:49) The 70-Year-Old Who Survived And Thrived After a Hit-and-Run

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

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

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

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Understanding how an underwriter thinks and how they manage risk allows you to create a solution that actually creates impact and change for the long term." - Bobby Stuart

This week on the show, I'm joined by Bobby Stuart, a benefits consultant with Hotchkiss Insurance, for a deep dive into the mindset of a modern, forward-thinking advisor. We discuss his journey into the industry and what it takes to guide employers through the complexities of self-funding.

Bobby also broke down his playbook for creating long-term value for his clients. We explore why learning to "think like an underwriter" is a crucial skill for managing risk, the importance of simplifying complex ideas for employers, and why mastering the industry's language is the first step to finding simple solutions.

We also discuss how these strategies translate into real-world results, including how Bobby's team uses direct contracts and early intervention to help members get high-cost cancer care for free, removing the financial burden so they can focus on their health.

Chapters:

(00:00:00) How To Think Like An Underwriter (And Why It’s A Game-Changer)

(00:04:03) Overcoming the Complexity of Self-Funding 

(00:04:59) Learning to Speak the Language of Insurance 

(00:08:49) The Power of Thinking Like an Underwriter 

(00:18:48) How To Stay Optimistic As A Benefits Consultant

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

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

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

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"The balance bill came in, it was 37 grand for this member, and we were able to get that thing fully wiped." - Patrick Haig

My guest this week, Patrick Haig, Co-Founder of Goodbill, has built a company designed to find errors in medical bills and fix them. From upcoding to time-based discrepancies, these inaccuracies cost health plans and their members a fortune.

In this episode, Patrick breaks down the Goodbill model. We discuss how their technology integrates directly with health plans to audit claims for errors before they're paid, and why that “upstream” approach is so game-changing. We also dive into one of their most powerful tools: the underutilized 501(r) IRS rule that can wipe out bills entirely, even for six-figure income families.

This episode is personal for me, as Patrick's team fixed my own son's ER bill, saving almost $1,000. I hope you’ll tune in!

Chapters:

(00:10:22) How DPC inspired Goodbill

(00:23:03) The 501(r) Secret: Hospital Financial Assistance 

(00:27:15) How Upcoding Inflates Your ER Bill 

(00:38:29) The Art of Negotiating a Hospital Bill 

(00:48:43) Why "Upstream" Claim Auditing is a Game-Changer 

(00:59:29) Can a Six-Figure Family Qualify for Assistance?

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

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

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

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"I doubled my profit when I lost 70% of my customers, which is insane." - Brad Hart

My guest this week, Brad Hart, owner of Forest Park Pharmacy, came on the show to discuss how he moved his pharmacy from struggling to survive in a broken, insurance-based reimbursement model to thriving as an all-cash, "cost-plus" business.

Brad popped on my radar because of his very popular and informative Instagram profile, where he shows how everyday Americans are getting fleeced by PBMs. We break down the mechanics of his model and discuss the "low copay trap," why the term "specialty generic" is nonsense, and how his pharmacy's Price Checker tool brings radical transparency to a purposefully confusing industry.

We also dive into the exponential overpayments Brad has uncovered in the Medicare system, where a drug that costs his pharmacy $96 is reimbursed for over $3,400.

This is one you won't want to miss!

Chapters:

(00:00:00) This Pharmacy Went Cash-Only, Lost 70% Of Customers, & Doubled Profits

(00:07:28) The "Cost-Plus" Pharmacy Model, Explained

(00:08:49) How Brad Lost 70% of Customers & Doubled Profits 

(00:10:45) The Deceptive "Low Copay Trap" 

(00:13:29) The Pricing Breakdown: Cost + 15% + $10 

(00:34:52) Why the Term "Specialty Generic" is Nonsense 

(00:47:53) What is the Average Wholesale Price (AWP)? 

(00:52:41) PBM Reform vs. Direct-to-Consumer

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

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

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

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

"Nomi actually stands for 'no middleman'. Take out that invented complexity... Price comes way down, becomes more simple to administer, and there's plenty of dollars to go around for providers now making more money." - Josh Walker

My guest this week, Josh Walker, Founder & COO of Nomi Health, is on a mission to rebuild healthcare by tackling its "invented complexity." He joined me on the show to explain why creating a direct relationship between the buyers and providers of care is the key to a better, more affordable system for everyone.

How does Nomi do it? We break down their playbook, which focuses on three core strategies: standardizing data formats to improve efficiency, embracing price discovery to find the true cost of care, and simplifying payment dynamics to cut out the middlemen.

This isn't just theory. Joshua shares the powerful, real-world results of their model, including how one client's benefits leader received a standing ovation from employees after switching to a plan that eliminated all financial barriers to care.

Tune in this week to learn why it’s so important to find the true cost of care, and why I’m so proud to have Nomi as a sponsor for the show!

Chapters:

(00:00:44) What Does NOMI Stand For? 

(00:11:36) Finding the "True Cost of Care" 

(00:23:27) Do We Even Need Networks Anymore? 

(00:35:14) What Churros Can Teach Us About Data Analytics 

(00:52:19) From Solution Taker to Solution Maker 

(00:55:59) The "Standing Ovation" Health Plan

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

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

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

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

“Does your consultant understand these kind of strategies and mechanisms are available in the market and do they know how to implement them and make them work?" - Riley DearingRiley Dearing of Hotchkiss Insurance returns to the show this week, and he’s brought with him Blake Allison, CEO of Employers Health Network (EHN) to talk all about high-performance health networks and the massive opportunity they represent.Ever wonder how high-performance health networks actually work? We broke down the real mechanics: how direct provider partnerships are built, how benefit design drives engagement to the right facilities, and how this collaborative approach leads to better data, lower costs, and predictable risk for employers.This isn't just theory; we also announce EHN's new partnership with Covenant Health, detailing how this model is being scaled to bring these powerful solutions to employers across West Texas.Tune in this week for the definitive guide on how high-performance health networks actually work!Chapters:(00:00:00) How the World's #1 Chevy Dealer Saved $3 Million on Healthcare

(00:10:30) Enhancing Healthcare Networks

(00:16:23) Making Sure Members Can Get Care In Their Area

(00:22:30) Empowering Patients

(00:25:43) Navigating Healthcare Pricing Strategy

(00:35:23) Enhancing Healthcare Affordability

(00:47:14) Data-Driven Healthcare

(00:57:17) Zero Out-of-Pocket Cost For MembersKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.

Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's podcasts, headlines, and listener-submitted questions.

This episode covers healthcare news from June to mid-July 2025. And we play a new game called the "Which Has Less Ingredients?", which is exactly like what the title suggests.

Chapters:

0:00 - Intro

0:22 - A proposal to ban drug ads

2:48 - Pre-diabetes rates in children have tripled in 25 years

5:25 - Healthcare workers leaking patient data through AI

7:06 - Mark Cuban's healthcare plan

10:05 - Healthcare is the top employer in most states

12:49 - The Self-Funded Review

19:37 - Which Has Less Ingredients? (this month's game)

27:27- Ask Spencer Anything

Sources:

https://phys.org/news/2025-06-glass-bottles-microplastics-plastic.html

https://x.com/mcuban/status/1934834421225672999

https://www.scrippsnews.com/health/alarming-number-of-adolescents-have-prediabetes-new-data-from-cdc-says?utm_source=chatgpt.com

https://x.com/utobian/status/1943127594960064713?t=BfpiRV8m7thZDIqTRMVo3A

https://www.medicaleconomics.com/view/health-care-workers-are-leaking-patient-data-through-ai-tools-cloud-apps

https://www.medicaleconomics.com/view/sanders-senators-float-ban-on-direct-to-consumer-ads-for-prescription-drugs

https://newsnetwork.mayoclinic.org/discussion/mayo-clinics-ai-tool-identifies-9-dementia-types-including-alzheimers-with-one-scan/