“I think the next stage of American capitalism includes co-opetition." - Dutch Rojas

On the last episode of Self-Funded with Spencer in 2025, Dutch Rojas joins the show to expose the financial "arbitrage" that he believes is destroying independent medical practices in America. Dutch explains how current CMS incentives allow hospitals to buy independent clinics and immediately charge 165% more for the exact same services, which is a practice that is crushing employers and patients alike.

In this episode, Dutch lays out his bold vision for "Co-opetition”, a new playbook where independent practices, manufacturers, and even churches band together to leverage their collective buying power. We discuss why the traditional "HR-led" model of buying benefits is failing, why CFOs need to take the wheel, and his dream of creating a true "Healthcare Commodities Exchange" to normalize pricing.

We also get personal about his journey from the Netherlands to the U.S., the importance of social media for building influence in DC, and why he believes the next 10 years will be defined by those who can master media.

Tune in for a fascinating look at the future of independent medicine.

Chapters:

(00:00:00) What is "Co-opetition" in Healthcare? 

(00:01:00) How Hospital Arbitrage Kills Private Practices 

(00:06:40) Why Independent Doctors Don't Work Together (Yet) 

(00:14:00) The 165% Markup

(00:29:40) The Dream of a Healthcare Commodities Exchange 

(00:41:00) Why HR Shouldn't Make Healthcare Decisions 

(00:49:00) Aggregating Buying Power: Churches & Manufacturers 

(00:57:00) The 4-Stage Plan to Fix 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/

"Healthcare has had no star score, there's been no reliable pricing. It's all been just a black box." - Will Bruhn

An estimated 21% of all medical care in the U.S. is completely unnecessary. My guest this week is Will Bruhn, CEO and Co-Founder of GAM (Global Appropriateness Measures), and he joins the show to explain exactly where that waste comes from and how we can fix it.

Will argues that we've been measuring quality wrong. Instead of just looking at outcomes (did the surgery go well?), we need to measure appropriateness (should the surgery have happened at all?). We discuss the perverse financial incentives driving this waste, using real-world examples like unnecessary spinal fusions and the statistical spike in C-sections on Friday afternoons.

But this episode isn't just about the problem; it's about the fix. Will breaks down how GAM uses data to identify high-value providers and how employers can redesign plans to guide members away from wasteful care, potentially saving millions while protecting patients from unnecessary risks.

Tune in for a blueprint on eliminating the 21% of healthcare spending that shouldn't exist.

Chapters:

(00:00:00) 21% Of Medical Care Is Wasteful. Here’s How We Prevent It.

(00:00:34) Why 21% of Medical Care is Wasteful 

(00:01:57) The Missing Metric: Appropriateness of Care 

(00:08:29) How Financial Incentives Drive Bad Medicine 

(00:17:02) Case Study: Unnecessary Spine Surgeries 

(00:24:06) How We Fix It: Identifying the Right Doctors 

(00:31:22) Changing Plan Design to Stop the Waste 

(00:33:52) The ROI of Steering to High-Value Care 

(00:48:44) The Debate on Government Regulation & Drug Prices 

(00:53:31) The Future of Healthcare Transparency

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/

"Why in every other industry can we just check out and know exactly what it's going to cost? Why can't it be the same in healthcare? Why are we still mailing physical checks in 2025?" - Cory Morin

My guest this week is Cory Morin, Co-Founder of Benji Card, who has developed a "virtual wallet" strategy that is revolutionizing how self-funded plans pay for care. Cory joined the show to explain how giving members and care coordinators instant access to funds can drastically lower medical claim costs.

Cory breaks down the mechanics of the Benji Card, a virtual payment solution that acts as the financial rails for modern cost containment. We discuss the strategy behind it: by guaranteeing providers immediate payment via a virtual card, plans can negotiate significant discounts (often cash rates) that aren't available through traditional insurance.

We explore how this "virtual wallet" approach aligns incentives - providers get paid instantly without administrative bloat, and employers save 30-50% on claims. We also dive into Cory's entrepreneurial journey and why he believes this model could eventually make traditional PPO networks obsolete.

Tune in to learn how a virtual wallet strategy can fix the broken economics of healthcare.

Chapters:

(00:00:00) The "Virtual Wallet" Strategy for Lowering Medical Claims 

(00:12:16) From Insurance Agent to Fintech Founder 

(00:20:59) What is the Benji Card? 

(00:26:43) Why Healthcare Needs Virtual Payments 

(00:29:40) How Instant Payments Negotiate Lower Rates 

(00:38:51) Empowering Care Coordinators with a Virtual Wallet 

(00:44:03) The Challenge of Scaling Fintech in Healthcare 

(00:49:24) Will Virtual Wallets Replace Networks?

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 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/