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 month, we’re joined by Chris Hamilton! We talk about the J&J lawsuit being dismissed, Eli Lilly switching PBMs, AI in healthcare, and much more. We also play a Christmas game called Home Alone: The Wet Bandit's Bills, where Chris and I try to guess the average hospital price for the injuries incurred by the bandits from the Home Alone films.

Chapters: 

0:00 - Intro

0:42 - J&J Lawsuit Dismissed

9:20 - Eli Lily Switches PBMs

11:17 - New FDA Rules On Biosimilars

16:36 - AI Adoption In The Healthcare Industry

25:21 - Survey On At-Home Medical Devices

29:57 - Home Alone: The Wet Bandit's Bills

42:32 - Ask Spencer Anything

Sources: 

• https://www.healthcaredive.com/news/fda-biosimilars-guidance-speed-development-comparative-efficacy-studies/804191/

• https://www.beckerspayer.com/legal/judge-dismisses-lawsuit-accusing-jj-of-mismanaging-employee-drug-benefits/?origin=PayerE&utm_source=PayerE&utm_medium=email&utm_content=newsletter

• https://www.healthcare-brew.com/stories/2025/11/25/eli-lilly-switches-big-3-pbm-alternative-transparent-rival

• https://www.fiercehealthcare.com/health-tech/amid-shutdown-health-it-vendors-say-hospitals-are-cutting-back-spending

• https://www.techtarget.com/virtualhealthcare/news/366633680/Survey-At-home-monitoring-devices-popular-affordable

• https://pubmed.ncbi.nlm.nih.gov/41265449/

• https://www.emarketer.com/content/ai-spending-healthcare-outpaces-overall-us-economy-

"Success leaves clues. And sometimes that clue is healthy leadership that is just able to take them from plateau to plateau." - Trey Marinello

My guest this week, Trey Marinello of Houlihan Lokey, is an expert in a topic everyone is constantly talking about: Private Equity. Trey joined the show to demystify the world of investment banking and explain exactly why private equity firms are pouring billions of dollars into the employer-sponsored healthcare space.

Trey breaks down the current trends, explaining why PE isn't just about leverage and debt, but about "turning the propeller faster" through distribution expertise and strategic growth. We discuss why categories like TPAs, cost containment, and innovative funding models are red-hot, while "wellness" and "population health" have struggled to prove their ROI.

We also explore the potential of AI to revolutionize mental health care, why “ICHRA” is still a wild card, and how smart brokers are becoming essential value-drivers in M&A deals.

Tune in for a masterclass on following the money in healthcare!

Chapters:

(00:00:00) Why Private Equity is Pouring Billions Into Employer Healthcare

(00:00:35) Why Private Equity Loves Healthcare 

(00:08:59) What Does an Investment Banker Actually Do? 

(00:17:25) How PE Firms Use Distribution to Scale 

(00:20:06) Is ICHRA the Future or a Fad? 

(00:28:50) The Rise of Alternative Funding 

(00:42:34) Why "Wellness" Investments Failed 

(00:57:16) How Brokers Drive Enterprise Value 

(01:02:47) The Hottest Category in Healthcare M&A

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 love working with people who aren't afraid to own up to their mistakes. Integrity is the most important thing to me." - Cara Kirsch

What is the secret to a perfect broker-partner relationship? My guests this week, Cara Kirsch and Libby Henry, join the show to answer that question. They share the story of how a single "virtual lunch" during the pandemic sparked one of the most effective partnerships in the industry.

Cara and Libby break down the ingredients of their success: radical transparency, the ability to have difficult conversations without breaking trust, and a shared commitment to integrity. We discuss why the best partnerships aren't just about the lowest spreadsheet number, but about who you can trust when things go wrong.

We also dive into the results of this partnership, including how they worked together to turn a client's 74% fully insured renewal into millions in savings. Plus, we explore the reality of balancing high-powered careers with motherhood and why women need to claim their seat at the table.

Tune in to learn how to build business relationships that actually last.

Chapters:

(00:00:00) The Secret to a Perfect Broker-Partner Relationship 

(00:05:07) The "Virtual Lunch" That Started It All 

(00:15:20) Why Honesty Trumps Being "Nice" 

(00:18:04) Building Trust Through Intentionality 

(00:21:57) Balancing Motherhood & A Career 

(00:42:22) Turning a 74% Renewal into Savings 

(00:44:08) Why Strong Partnerships Close More Deals

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/

"People do more research on buying a refrigerator than they do on buying their health plan. And so I saw that as a level of brokenness that I felt... we as consultants could actually make a profound impact." - Trey Halbert

The old-school, transactional broker is dead. My guest this week, Trey Halbert, CEO of ExperINS, joins the show to discuss the rise of the modern "Strategic Consultant" and what that evolution means for employers.

Trey breaks down the playbook for this new, elevated role. We discuss why consultants must align the benefits program with the C-suite's core business strategy, not just the HR department. We also explore how AI is not a threat, but a powerful tool to augment advisors by handling menial tasks (like contract review), freeing them up for the high-level critical thinking and problem-solving where humans truly add value.

This entire shift is part of a bigger journey: moving from a career focused on success and "resume virtues" to one focused on significance and "eulogy virtues."

Tune in for a high-level discussion on the future of benefits consulting!

Chapters:

(00:00:00) Aligning Benefits with the C-Suite: The Modern Consultant's Playbook 

(00:06:23) The Evolution of Self-Funding 

(00:15:05) Why Consultants Are More Critical Than Ever 

(00:20:46) The Power of a Peer Network (True Network) 

(00:29:07) Speaking to the C-Suite, Not Just HR 

(00:35:51) How Benefits Drive Business Valuation 

(00:43:19) How AI Will Augment, Not Replace, Brokers 

(01:04:35) The "No A**holes" Rule & Building Culture

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/

"One out of seven people in the United States have some form of chronic kidney disease... 90% of those individuals have not been properly diagnosed." - Mark Masson

My guest this week is Mark Masson, President of Renalogic, here to shine a light on one of the most expensive and hidden risks in every health plan: Chronic Kidney Disease (CKD). It's a "silent killer" that affects 1 in 7 Americans, but a staggering 90% of them don't even know they have it until it's too late.

In this episode, Mark breaks down the staggering cost of this disease, explaining how a market duopoly inflates dialysis costs to an astonishing 700-900% of Medicare rates. He shares the Renalogic playbook, which combines proactive clinical management to "hold the line" for early-stage patients and a powerful cost-containment model that saves plans over $100,000 per year on active dialysis claims.

We also discuss the importance of early detection, the benefits of home dialysis, and why employers must be proactive in managing this catastrophic risk. Tune in to learn about the silent killer in every health plan.

Chapters:

(00:00:00) The "Silent Killer" 90% of Your Members Don't Know They Have 

(00:07:38) The 1-in-7 Statistic: 90% are Undiagnosed 

(00:12:17) Slowing Progression: How to "Hold the Line" 

(00:19:55) The Duopoly: Why Dialysis Costs 700-900% of Medicare 

(00:27:11) The Benefits of Home Dialysis 

(00:54:20) The Renalogic Solution: Containing Dialysis Costs 

(01:03:38) Why We Need More Competition in Healthcare

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 needs to be a whole new suite of solutions that are forward looking and proactive and real time, and we gotta go and build that." - Sasha Gribov

My guest this week, Sasha Gribov, founder of Milu Health, is on a mission to build the proactive, forward-looking solutions our healthcare system desperately needs. He joins the show to discuss how he's using AI to create an "early warning system" for health, moving our model from reactive to proactive.

Sasha breaks down the Milu model, which uses AI to analyze health records and claims data in real-time. He explains how this allows his team to predict the need for surgeries an average of 90 days in advance and proactively reach out to members via text (no app required) to guide them to the right, high-value solutions already in their health plan.

We also explore the future of AI in healthcare, why he believes it will "augment" doctors, not replace them, and how this proactive approach is the key to saving lives and finally lowering costs for employers.

Tune in for a look into the future of proactive healthcare!

Chapters:

(00:00:00) How AI is Predicting Catastrophic Claims (Before They Happen) 

(00:04:15) Why We Must Integrate All Health Data 

(00:10:23) The "Early Warning System" for Patients 

(00:12:40) Why EMRs are the Key to Proactive Care 

(00:31:57) Predicting Surgeries 90 Days in Advance 

(00:08:04) Will AI Replace Doctors? 

(00:59:47) Building a Proactive Healthcare System

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/

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 month, we’re also joined by Kyle Minick!

This episode is a bit different than usual as we focus on the many issues our physicians are dealing with in 2025, from AI to burnout to compensation. And we play a new game called the Commercial Conumdrum, where Kyle and I try to guess what drug a pharmaceutical commercial is advertising, just based on the B-Roll and editing of them.

Chapters: 

0:00 - Intro

1:25 - What's Going On With Our Doctors?

1:37 - Physician Stress Returns To Pandemic Levels

6:56 - Half Of US Healthcare Workers Plan To Switch Jobs

14:31- Physicians Working More, Compensated Less

15:38 - AI Scribes Reduce Physician Burnout

19:29 - Millions In US Live Where There Is No Telehealth/Internet

23:22 - Commercial Conundrum (this month's game)

34:20 - Self-Funded Review

41:36 - Ask Spencer Anything

Sources: 

• https://youtu.be/XqrWU-BkKYc?si=E18CcR6cck7WaLcP
• https://youtu.be/bzYetKHGEv4?si=HHTFjFs1ZkFJRfq8
• https://youtu.be/LFif-BTYzys?si=04Z8ilxSis7SxKwS
• https://youtu.be/7M5LTlzot4o?si=HjQfsikvBlRQ6gSO
• https://youtu.be/ecq1k3VmEtE?si=yrZTF64P1pF-Hbly
• https://kffhealthnews.org/news/article/dead-zone-sickest-counties-slow-internet-broadband-desert-health-care-provider-shortage/
• https://www.medpagetoday.com/publichealthpolicy/workforce/117530
• https://www.reuters.com/business/healthcare-pharmaceuticals/over-half-us-healthcare-workers-plan-switch-jobs-by-next-year-survey-finds-2025-09-15/
• https://www.healthcaredive.com/news/physicians-working-more-reimbursement-falling-kaufman/757406/
• https://medicine.yale.edu/news-article/ai-scribes-reduce-physician-burnout-return-focus-to-the-patient/

“Just because someone hasn't gone to the doctor in four years does not mean they're not a walking time bomb." - Garrett Jerue

My guest this week, Garrett Jerue, argues that the key to solving our healthcare crisis is to think differently and build a truly cohesive healthcare ecosystem. Driven by his personal experience battling cancer and navigating a fragmented system, Garrett has dedicated his career to designing benefits strategies that actually work for people.

In this episode, Garrett shares his playbook for building this ecosystem. We discuss the "Ticket Health" model he developed, which integrates direct primary care, transparent PBM partnerships, and robust care navigation into a seamless experience. He explains why treating members with dignity and choice, focusing on proactive care, and challenging the status quo are essential ingredients for success.

We also dive into the critical importance of mental health support and why employers need to view their health plan not just as an expense, but as a living, breathing organism that requires constant care and innovation.

Tune in to get Garrett and I’s insight on building a healthcare ecosystem that truly serves people.

Chapters:

(00:00:00) Building A Cohesive Healthcare Ecosystem 

(00:10:24) How a $600k Cancer Bill Changed Garrett’s Life

(00:17:22) Why Healthcare Financing Needs a Rethink 

(00:25:28) Treating Members with Dignity & Choice 

(00:38:11) The Keys to a Transparent PBM Partnership 

(00:43:45) Direct Primary Care: The Foundation of the Ecosystem 

(00:50:26) Care Navigation: The Glue That Holds It Together 

(00:59:07) Making Mental Health a Priority in the Ecosystem 

(01:12:32) The "Think Different" Mindset for Healthcare Innovation

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 absolutely think we're in that tightening, hardening market... the days of the employers who were average risk seeing single digit rate increases, that's gone. It's going to be a double digit rate increase market going forward." - Jay Ritchie

The president of one of the largest stop-loss carriers is here to deliver the State of the Union for our market. My guest this week is Jay Ritchie, President of Tokio Marine HCC, and he shares the current state of the market and what to expect for 2025-2026 renewals.

Jay breaks down the trends his team is seeing, including the explosion of multi-million dollar claims driven by NICU stays and new gene therapies. We discuss why industry-wide loss ratios have jumped, how the post-COVID "rebound" is impacting rates, and why the core stop-loss product has remained unchanged while the innovation now centers on risk measurement.

But the conversation isn't all negative; we also discuss the path forward. We explore why data is the future of underwriting, how active risk management through captives creates stability in a volatile market, and why treating your stop-loss carrier as a partner, not a commodity, is more critical than ever.

Tune in for the State of the Union for our industry as we head into 2026.

Chapters:

(00:00:00) The 2025-2026 Stop-Loss State Of The Union 

(00:06:18) A 40-Year Career in Stop-Loss 

(00:21:33) The Explosion of Million-Dollar Claims Post-ACA 

(00:40:26) Why Loss Ratios Are Climbing Across the Industry 

(00:55:40) How Captives Create Stability in a Hard Market 

(01:07:07) Partner vs. Commodity: The Future of Stop-Loss 

(01:29:02) Why Data is the Future of Underwriting

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 biggest shift was the consolidation that happened with the insurance carriers themselves. From 25 or more carriers to just four national carriers." - John Rutledge

How did health insurance get so broken? My guest this week, 40-year industry veteran John Rutledge of Marsh McLennan Agency, joins the show to walk us through the last 40 years of decisions that led us to the consolidated, expensive, and frustrating market we have today.

John explains how the market went from over 25 competing carriers to just four national players. We discuss how the rise of carrier-owned PPOs squeezed out competition, and how the ACA later standardized coverage, locking employers into the "Buca box" with painfully limited options.

But this isn't just a history lesson. We also discuss the solution that has emerged from the ashes of the old system: the explosion of self-funding and alternative risk models like captives that empower employers to finally break free.

Tune in for a masterclass on how health insurance was broken, and more importantly, how we can start to fix it.

Chapters:

(00:00:00) How Health Insurance Was Broken Over The Last 40 Years 

(00:05:01) Why Self-Funding Has Exploded Since the ACA 

(00:09:58) How We Went From 25+ Carriers to Just 4 

(00:12:56) The "Buca Box": Trapped with No Options 

(00:31:04) The Rise of Captives as an Alternative 

(00:40:31) Why Engaged Employers Win in a Captive 

(01:00:56) A Call to Action for Employers & Advisors

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/