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/

"Eat your food as medicine or medicine will become your food." - Chef Austin Simmons

Can better beef solve America's health crisis? My guests this week, Chef Austin Simmons of Chef and Rancher and benefits/nutrition expert Chris Pierron, believe it's a critical part of the solution. They join the show to discuss the deep connection between cattle genetics, our broken food system, and our exploding healthcare costs.

Chef Austin explains his "hoof to fork" model for creating "better beef." We discuss how using purebred, genetically-verified cattle and clean feeding practices, free of the seed oils and used fryer oil common in the commercial industry, produces a more nutrient-dense and flavorful product.

This isn't just about a better steak; it's about creating a healthier population from the ground up. We explore how fixing the food system is the most important step to lowering healthcare costs, and why consumer education is the key to driving this change.

Tune in today for a conversation that will change the way you think about the beef on your plate.

Chapters:

(00:00:00) How Better Beef Can Solve America's Health Crisis 

(00:05:18) The Hidden Additives & "Poisons" in Most Beef

(00:19:38) Why is Prime Beef So Inconsistent? 

(00:20:58) The Power of Cattle Genetics 

(00:37:47) Is There Used Fryer Oil In Your Steak? 

(00:54:22) Should We Federally Subsidize Beef?

(01:02:09) Why Food Education is the First Step 

(01:13:26) Fixing the Food System 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/

"If we can remove the cost barrier, folks are going to engage more because it's not standing in the way of going to get the care that they need or even preventive care." - Trey Smith

High healthcare deductibles were sold to employers as a way to create better "consumers" of healthcare. My guest this week, Trey Smith of Hub International, argues that they've been a failed experiment that has done more harm than good. Instead of creating smarter shoppers, high deductibles have become a massive barrier to care, causing employees to delay or avoid necessary treatment altogether.

In this episode, Trey breaks down the alternative: first dollar coverage. 

We discuss how innovative plan designs with zero deductibles can actually lower an employer's overall claim spend over time by encouraging early intervention and proactive care. He shares data showing that while utilization spikes initially, long-term costs come down significantly as members get the care they need when they need it.

This conversation is a perfect example of why the benefits consultant's role is shifting from simply brokering insurance to designing strategic solutions that solve real problems for employees and employers. I hope you'll tune in!

Chapters:

(00:00:00) High Healthcare Deductibles Are A Failed Experiment 

(00:26:16) The Risk of Innovation vs. The Risk of the Status Quo

(00:29:59) The Problem: High Deductibles as a Barrier to Care 

(00:34:10) The Solution: "First Dollar" Coverage 

(00:38:22) Simplifying the Healthcare Experience 

(00:52:17) How Data is Making New Plan Designs Possible

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 can look for something on Amazon and have it shipped to my door tomorrow... so why wouldn't employees want a similar experience with their healthcare?" - Amanda Volner

Can artificial intelligence actually make healthcare feel more human?

Amanda Volner, AVP of Broker Partnerships at Healthee, joins the show for a deep dive into the real role of AI in the benefits industry. We discuss how artificial intelligence is a powerful tool to augment our abilities, but why uniquely human skills like critical thinking, building relationships, and understanding "the question behind the question" are more valuable than ever.

Amanda breaks down how Healthee is using AI to create "hyper-personalized" healthcare experiences for members, from navigating benefits to finding cost-effective pharmacy solutions. We explore how modern engagement platforms are essential for communicating with a decentralized workforce and how AI can be trained to match your own voice and tone.

The conversation also explores the human side of a demanding career, from the challenges of being a single mother in this industry to navigating sobriety in professional settings.

Tune in for a fascinating look at the intersection of AI, healthcare, and what it truly means to be human in our industry.

Chapters:

(00:00:00) Making Healthcare More Human...Using AI 

(00:01:09) The One Thing AI Still Can't Do 

(00:04:36) Understanding "The Question Behind the Question" 

(00:26:02) The Future of "Hyper-Personalized" Healthcare 

(00:37:07) Using AI to Lower Prescription Costs 

(00:50:12) Balancing a Demanding Career and Family 

(01:02:32) Navigating Sobriety in the Benefits World

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/

"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/