In this episode, Donovan Ryckis, CEO of Ethos Benefits, sits down with Spencer Smith (SVP of Sales at Pareto Health and host of Self-Funded with Spencer) to unpack captives, stop-loss, PBMs, and the steps plan sponsors can take to finally regain control of healthcare spend.
Spencer shares how short, educational content helped bring self-funding concepts downstream, why captives act like “bumpers” against catastrophic renewals, and where employers should start: data access, pharmacy, and a long-term strategy. They cover real-world examples—NICU and oncology claims, lasers, biosimilars, international sourcing—and discuss why employee contributions keep rising when nothing seems to change.

You’ll walk away with a framework to move from guaranteed cost to variable cost with discipline, reduce claims costs without cutting benefits, and ask your broker the questions that matter.

What You’ll Learn:

• Self-funded fundamentals and the role of stop-loss
• How group captives improve predictability across renewals
• The first lever to pull: pharmacy strategy and data access
• Why “reduce claims” means smarter pricing and site-of-care, not less care
• Three questions every plan sponsor should ask at renewal:
   Why these solutions, specifically?
   How are you paid, where, and how often?
   What’s the long-term strategy beyond this 12-month cycle?
• POSIWID: the outcomes your system delivers define its true purpose

Time Stamps:

00:00 – Welcome & Guest Introduction
02:10 – Spencer’s Journey into Self-Funding
06:20 – Breaking Down Stop-Loss & Captives
10:45 – Fully Insured vs Self-Funded Explained
15:12 – The 401(k) Analogy for Health Plans
19:20 – Why Short-Form Education Works in Benefits
24:05 – Pharmacy Costs & Where to Start Saving
28:48 – Broker Incentives and Transparency
34:32 – Data Access, Claims, and Real-World Fixes
41:20 – POSIWID Framework & Final Takeaways

Get more on our Guest at:
Website: https://spencerharlansmith.com/
YouTube: @SelfFunded

--------------------------------
Whether you're an HR professional, CFO, CEO, or just tired of rising healthcare costs, this is your call to rethink benefits strategy and finally take control.

Connect with Chelsea and Donovan:
Website: www.businessofbenefitspodcast.com
Instagram: https://www.instagram.com/ethoseffectpodcast/
Chelsea: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Donovan: https://www.linkedin.com/in/donovanryckis/

In this episode of The Business of Benefits, Donovan Ryckis sits down with attorney and national thought leader Alden J. Bianchi to expose one of the most costly and overlooked failures in employer-sponsored healthcare: the illusion of broker transparency. The Consolidated Appropriations Act (CAA) was supposed to fix hidden compensation. It didn’t. Instead, it created a fiduciary requirement to ask, without ever creating a requirement for brokers to actually tell. Employers are expected to manage fiduciary risk without pricing transparency, claims clarity, or conflict-free advice. Alden brings decades of experience advising Fortune 500 employers, consulting firms, and government agencies on ERISA, fiduciary duty, ACA compliance, transparency regulation, machine-readable files, and emerging litigation.

In this conversation, he explains why:

1. CAA compensation disclosures are “an absolute joke”
2. Brokers and ASOs avoid disclosure by redefining themselves 
3. Employers are left negotiating blindfolded
4. Current PBM and ASO lawsuits are stalled by standing issues
5. Fiduciary governance needs to mirror 401(k) standards
6. Machine-readable files and AI will change everything
7. Hidden compensation lives in places most employers never look
8. Transparency is worthless without someone who knows how to use the data

If you're a CFO, CHRO, HR Director, consultant, or fiduciary of a health plan, this conversation will change how you see the entire benefits ecosystem.

What You’ll Learn:

• Why CAA broker transparency rules failed
• How hidden compensation still influences broker recommendations 
• Why employers must build fiduciary governance like their 401(k) plans 
• The difference between named vs. functional fiduciaries 
• How data, machine-readable files, and AI tools will reshape oversight 
• Why market concentration and hospital power keep prices high 
• How reference-based pricing and captives fit into employer strategy 
• What upcoming congressional reforms might change 

Time Stamps:
00:00 – Preview
00:53 – Show Opener
01:18 – Donovan’s Introduction
02:04 – Meet Alden Bianchi
02:49 – Alden’s Background (ACA, ERISA, Romney Reform)
03:39 – Why Employer Healthcare Costs Exploded
05:10 – Fiduciary Exposure and 401(k) Lessons
07:17 – Donovan on Lack of Data in Healthcare
08:49 – ACA vs. CAA: What Transparency Actually Changed
10:12 – Machine-Readable Files: Why They Matter
10:59 – Broker Compensation Rules Are “A Joke”
12:14 – Why Disclosures Don’t Work (Undisclosed Incentives)
14:02 – Donovan on Conflicts in Broker Comp
15:30 – The True Fiduciary Standard for Employers
16:14 – Alden’s B.O.L.O.s: Override Commissions, Referral Fees
17:48 – Fiduciaries Must Become Quant Analysts
18:54 – Who Is a Fiduciary? Alden’s Simple Definition
20:36 – Why Fiduciary Exposure Is Personal
21:13 – SHRM, CAA Compliance, and Employer Pushback
21:56 – Challenges With Gag Clauses, RxDC, and Disclosures
23:33 – Why Naming a Fiduciary Protects the Board
25:40 – PBM Lawsuits: Standing Problems Explained
27:35 – Why ERISA Remedies Are So Hard to Win
29:20 – How PBM Practices Impact Premiums & Wages
30:31 – Employers Subsidizing Medicare Rates
31:13 – The $35,000 Family Plan Problem
31:44 – Extreme Cases of 16x–21x Medicare Pricing
32:29 – Alden on Reference-Based Pricing’s Role
33:29 – Why Obamacare Didn’t Lower Costs
34:27 – Hospital Profits, Medicare Rates & Misconceptions
35:08 – Are Hospitals Really Underpaid?
36:18 – Where Employers Should Actually Start
37:43 – Incentive Problems in Broker/Consultant Models
38:29 – Group Captives, AHPs, and Small Employer Solutions
39:47 – Why Transparent Products Matter
40:20 – Claims Reporting Problems (Body-Part Categories)
41:18 – The Real Issue: Market Concentration, Not Just Benefits
41:43 – PBM Regulation vs. Antitrust Problems
42:26 – Broker Compensation Should Be on Page 1 of Renewals
44:05 – Hidden Comp in MECs, Indemnity & Non-ERISA Lines
45:48 – Excess Compensation, Double-Dipping & Fiduciary Risk
46:03 – Alden’s Final Advice to Employers
46:55 – Follow Alden on LinkedIn (B.O.L.O. Posts)
47:28 – Closing Thoughts & Episode Wrap-Up

Connect With Alden Bianchi
LinkedIn: https://www.linkedin.com/in/ajbianchi/
Firm Bio: https://www.mintz.com/people/alden-j-bianchi

Connect With Donovan / The Business of Benefits / Ethos Benefits
Ethos Benefits: https://www.ethosbenefits.com 
LinkedIn – Donovan Ryckis: https://www.linkedin.com/in/donovanryckis/
LinkedIn – Ethos Benefits: https://www.linkedin.com/company/ethosbenefits
Podcast Feed: https://www.thebusinessofbenefits.com

Subscribe for Weekly Employer Insights!

In this HR Special, host Chelsea Ryckis sits down with friend and industry leader Lori Kleiman to talk about what it takes to level up from HR department-of-one to strategic business partner, without losing sight of day-to-day realities.


We cover how small to mid-size employers can decide when to hire fractional or in-house HR, why headcount matters more than revenue, and the rising complexity of multi-state compliance. We also unpack the hidden opportunity for HR to lead on healthcare and benefits strategy.

Chelsea explains renewal “stall” tactics, fiduciary responsibility on health plans, and practical steps HR can take to earn a seat at the table with data and action.

What you’ll learn:

• When a company truly needs fractional HR vs its first in-house generalist
• Why certifications like PHR and SHRM-CP help smaller employers hire confidently
• How tech can increase HR workload and employee questions, not reduce them
• A simple path to move from tactical HR to strategic HR that drives ROI
• The fiduciary duty HR has on health plans, what to ask from brokers, and how to escape the 60-day renewal crunch
• Practical ideas HR can implement now: communications, data access, compliance checklists, and off-cycle planning

Time Stamps
00:00 – Welcome to The Business of Benefits
01:08 – Meet Lori Kleiman
04:45 – Building an HR Business from the Basement
07:15 – When Small Businesses Really Need HR
10:02 – Technology’s Impact on HR Workloads
12:18 – Tactical vs. Strategic HR
15:26 – What to Look For When Hiring HR
18:41 – How Much HR Certifications Cost
21:10 – Using ExamEdge and Affordable Prep Options
23:20 – Moving from Tactical to Strategic HR
27:00 – Understanding Fiduciary Duty in Health Plans
30:36 – How HR Can Drive Benefits Strategy
33:22 – Why Benefit Renewals Feel Impossible
36:10 – Taking Back Control of Your Renewal
38:28 – Shaking Up Your Broker Relationship
40:12 – Giving Back to the HR Community
41:25 – Final Thoughts and Where to Find Lori
 
Get more on our Guest at:
Website: https://www.hrtopics.com
YouTube: @lorikleimanhrtopics7385

Whether you're an HR professional, CFO, CEO, or just tired of rising healthcare costs, this is your call to rethink benefits strategy and finally take control.

Connect with Chelsea and Donovan:
Website: www.businessofbenefitspodcast.com
Instagram: https://www.instagram.com/ethoseffectpodcast/
Chelsea: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Donovan: https://www.linkedin.com/in/donovanryckis/
--------------------------------

In this episode of The Business of Benefits Podcast, Chelsea Ryckis sits down with Dr. Zeev Neuwirth — physician, author of Reframing Healthcare and Beyond the Walls, and host of the Creating a New Healthcare podcast — for an unfiltered conversation about what’s really broken in America’s healthcare system and what employers can actually do to fix it.

From the hidden “healthcare tax” driving wage stagnation to how misaligned incentives have created a medical industrial complex, this episode dives deep into the uncomfortable truth: only 20 cents of every healthcare dollar reaches doctors, nurses, and clinicians. The rest? Lost in layers of middlemen, bureaucracy, and profit-driven waste.

Chelsea and Zeev explore how employer-sponsored healthcare became the backbone of American coverage, why primary care has been stripped of its purpose, and how direct primary care (DPC) and CEO engagement can completely change the game for employees and organizations alike. If you’re an executive, benefits advisor, or HR leader who knows there has to be a better way, this conversation will challenge everything you think you know about healthcare financing, delivery, and reform.

Listen to this episode if you want to:

• Understand how healthcare financing and delivery actually intersect
• Learn how direct primary care can lower costs and improve outcomes
• Hear real examples of CEOs transforming employee health and culture
• Be inspired to rethink your benefits strategy without the sales fluff

Time Stamps:
00:00 — Welcome to The Business of Benefits
02:15 — Dr. Zeev Neuwirth’s journey from clinician to system reformer
06:40 — The truth about the “medical industrial complex”
12:10 — Where your healthcare dollars really go
18:45 — The failure of traditional primary care
24:10 — Why CEOs are the missing link in healthcare transformation
30:40 — Lessons from the Rosen Hotels model
37:20 — Following the money: the employer’s power to change healthcare
43:30 — The caregiving crisis and what leaders often overlook
47:00 — Final thoughts and resources

Get more on our Guest at: Dr. Zeev Neuwirth
Author of Reframing Healthcare and Beyond the Walls
Podcast: Host of Creating a New Healthcare Podcast
Learn more: zevnewworthhealth.com

Whether you're an HR professional, CFO, CEO, or just tired of rising healthcare costs, this is your call to rethink benefits strategy and finally take control.

Connect with Chelsea and Donovan:
Website: www.businessofbenefitspodcast.com
Instagram: https://www.instagram.com/ethoseffectpodcast/
Chelsea: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Donovan: https://www.linkedin.com/in/donovanryckis/

Tired of shiny pitches and vague promises? In this solo episode, we break down a practical, repeatable system for holding your benefits vendors accountable so your plan actually performs.  From rock-solid RFPs to airtight contracts and respectful escalation, you’ll learn how to set clear expectations, track outcomes, and course-correct fast.

In this episode, you’ll learn:

• How to design an RFP that prevents surprises later
• What to demand in contracts: performance guarantees, termination language, fees, BAAs, data sharing, and fiduciary status
• The must-ask questions about integrations, cybersecurity, conflicts of interest, and compensation
• A simple cadence for accountability meetings that gets results, not excuses
• Real examples of catching hidden fees and fixing slow vendor response times
• How to build team culture so your staff holds vendors accountable the right way

Who this is for: 
Employers, HR leaders, CFOs, and anyone ready to transform a “set it and forget it” benefits program into a high-performing plan.If the truth is out there, are you ready to hear it?

Like, share, and subscribe for more no-BS guidance on benefits that serve your people and your P&L.

TimeStamps:

• 00:00 Intro and why accountability matters
• 02:10 Build a better RFP
• 07:35 Contract must-haves and red flags
• 13:25 Demo everything and verify claims
• 17:40 Meeting cadence and escalation that works
• 23:10 Real-world examples and fixes
• 28:30 Culture of accountability inside your team
• 32:10 Final takeaways and next steps

If this helped, like, subscribe, and share with a leader who needs to hear it.  Tell us in the comments: What is the first change you will make to your benefits strategy?

Whether you're an HR professional, CFO, CEO, or just tired of rising healthcare costs, this is your call to rethink benefits strategy and finally take control.

Connect with Chelsea and Donovan:
Website: www.businessofbenefitspodcast.com
Instagram: https://www.instagram.com/ethoseffectpodcast/
Chelsea: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Donovan: https://www.linkedin.com/in/donovanryckis/

Welcome back to the No BS. No sales pitch. Just real solutions podcast.  This week our host Chelsea Ryckis sits down with Justin Held, CEBS of the International Foundation of Employee Benefit Plans (IFEBP) to unpack what HR, CFOs, and CEOs need now: neutral education, fiduciary guardrails, and a practical path to future-proof employee benefits.


In this episode:

• What IFEBP is and how it helps plan sponsors with objective, non-lobbying education
• CEBS breakdown: curriculum, timelines, and why employers fund it
• Fiduciary duty basics after ERISA and why CAA 2021 put health plans under the spotlight
• The 2025–2026 benefits agenda: PBM contracts, data analysis, chronic conditions, GLP-1 coverage, mental and behavioral health, peer support models, and AI in plan administration
• How to run a strategic review of your plan: surveys, focus groups, utilization data, KPIs

Simple, high-impact changes most members won’t even notice, but your budget will.

Timestamps:

• 0:00 Intro
• 1:08 What IFEBP does and why it’s neutral
• 6:35 Conferences, toolkits, and daily benefits headlines
• 10:12 CEBS overview and chapter network
• 14:45 ERISA fiduciary duty in health and retirement
• 19:18 Trends: PBM contracts, GLP-1, mental health, AI, fraud prevention
• 28:40 Peer support models for mental health
• 33:10 How to future-proof benefits with data and KPIs

If you are an employer, CFO, or CEO who is tired of trend increases and status quo advice, this conversation will give you a path to real savings and better outcomes. 

If this helped, like, subscribe, and share with a leader who needs to hear it.  Tell us in the comments: What is the first change you will make to your benefits strategy?

Whether you're an HR professional, CFO, CEO, or just tired of rising healthcare costs, this is your call to rethink benefits strategy and finally take control.

Connect with our guest today at: 
Linkedin: https://www.linkedin.com/in/justin-held-cebs/
Website: https://www.ifebp.org/
YouTube: https://www.youtube.com/user/IFEBP
Listen to their podcast: https://podcasts.apple.com/us/podcast/talking-benefits/id1183535454

Connect with Chelsea and Donovan:
Website: www.businessofbenefitspodcast.com
Instagram: https://www.instagram.com/ethoseffectpodcast/
Chelsea: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Donovan: https://www.linkedin.com/in/donovanryckis/

If you have ever been told “you can’t access your own portal” or “don’t worry, we’ve got great PPO discounts,” this episode is for you. Today host Chelsea unpacks real stories employers have shared with me and the costly myths behind them. Names and details are changed, the situations are real. Use this as a checklist to protect your plan, your data, and your people.


In this episode

• The red flag no one should ignore: being blocked from your own carrier portal
• No access to your ben-admin system and why that traps you from shopping the market
• Asking for compensation disclosures under CAA 2021 and getting a flat “no”
• Fear tactics about big carriers and how to verify before you trust
• Sticker shock: $125 PEPM broker fees and how to benchmark what is reasonable
• Perks over performance: NHL boxes, steak dinners, and fiduciary duty
• “Broker severance” and the myth of 250 years of benefits experience
• “Local” vs. “large” broker labels and what actually matters
• Being told you are a “small client” and why that is never an excuse
• Shiny value-adds vs. real cost and quality outcomes

Key takeaways

• It is your plan and your data. Own the logins, the reports, the invoices.
• Verify before you trust. Ask for proof, not talking points.
• Benchmark compensation and services against outcomes, not perks.
• Hold every vendor accountable to frequency and severity of claims, not swag.

If you are an employer, CFO, or CEO who is tired of trend increases and status quo advice, this conversation will give you a path to real savings and better outcomes. 

If this helped, like, subscribe, and share with a leader who needs to hear it.  Tell us in the comments: What is the first change you will make to your benefits strategy?

Whether you're an HR professional, CFO, CEO, or just tired of rising healthcare costs, this is your call to rethink benefits strategy and finally take control.

Connect with our guest today at: 

Connect with Chelsea and Donovan:
Website: www.businessofbenefitspodcast.com
Instagram: https://www.instagram.com/ethoseffectpodcast/
Chelsea: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Donovan: https://www.linkedin.com/in/donovanryckis/

Welcome back to The Business of Benefits Podcast, your no BS, no sales guide to real solutions in employee benefits.

Today, host Chelsea Ryckis sits down with Nelson Griswold of Next Gen Benefits to unpack the so-called “big lie” in healthcare and show employers how to take control of cost and quality. Nelson Griswold is a leading voice in employer-sponsored healthcare reform and author of Healthcare’s C-Suite Solution, Fixing American Healthcare, and Life and Death Decisions in the C-Suite. He helps CEOs and CFOs manage healthcare like a supply chain and turn overspend into free cash flow.  Nelson explains why claims are not all the same, how incentives in the current system work against employers, and what it looks like to build a plan that puts your people first.

In this episode you will learn:

• Why the 80/20 ACA rule can push premiums up, and what that means for your plan
• How to move from reactive renewals to a strategic, employer-controlled model
• The difference between fully insured and self funded, and why risk is often misunderstood
• How nurse navigation and quality data reduce complications and total spend
• Practical first steps to align incentives with an advisor who works for you
• When to use bundled, direct contracting, international pharmacy, and reference based pricing
• Why better quality often equals lower cost, and how to steer members to it

If you are an employer, CFO, or CEO who is tired of trend increases and status quo advice, this conversation will give you a path to real savings and better outcomes. 

If this helped, like, subscribe, and share with a leader who needs to hear it.  Tell us in the comments: What is the first change you will make to your benefits strategy?

Whether you're an HR professional, CFO, CEO, or just tired of rising healthcare costs, this is your call to rethink benefits strategy and finally take control.

Connect with our guest today at: https://www.nextgenbenefits.com/

Connect with Chelsea and Donovan:
Website: www.businessofbenefitspodcast.com
Instagram: https://www.instagram.com/ethoseffectpodcast/
Chelsea: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Donovan: https://www.linkedin.com/in/donovanryckis/

Welcome back to The Business of Benefits Podcast – your no-BS, no-sales guide to real solutions in employee benefits.

In this solo episode, host Chelsea breaks down what it really means to have a multi-year healthcare strategy for your company. Instead of reacting to renewals at the last minute and hearing the same excuses year after year, Chelsea shows you how to treat your benefits program like a true business plan—with long-term goals, measurable KPIs, and strategies that actually deliver results.

You’ll hear a real client case study that has achieved five straight years of decreases by following a step-by-step benefits roadmap.

Chelsea also shares:
✅ What isn’t a multi-year healthcare strategy (the reactive renewal game)
✅ How to build a business plan for your benefits, just like any other department
✅ Why data access and employee trust are the foundation for long-term success
✅ The difference between a slow, steady approach and a “shock-and-awe” strategy
✅ Real savings examples—millions of dollars saved while improving employee experience

If you’re an employer tired of rising costs, empty promises, and lack of control, this episode will show you a better way to run your healthcare plan.

Whether you're an HR professional, CFO, CEO, or just tired of rising healthcare costs, this is your call to rethink benefits strategy and finally take control.

Connect with Chelsea and Donovan:

Website: www.businessofbenefitspodcast.com
Instagram: https://www.instagram.com/ethoseffectpodcast/
Chelsea: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Donovan: https://www.linkedin.com/in/donovanryckis/

In this powerful episode, Donovan Ryckis sits down with Jay Gepfert, President of The Culpepper Group, to unpack what employers don't know—and what it’s costing them. With decades of experience on both the retirement and healthcare side of the fiduciary table, Jay brings the receipts on how hidden broker compensation, lack of transparency, and outdated fee structures are draining company resources and exposing employers to serious risk. 

You’ll hear:

• Why healthcare benefits need the same due diligence as retirement plans
• How compensation models drive broker behavior—and what to demand instead
• A real case study showing 46% savings in broker fees
• Why the current healthcare system is broken—and how litigation and legislation are forcing change
• What you need to start doing now to protect your plan, your budget, and your people

If you're an HR leader, CFO, or CEO who’s ready to ask the tough questions and rethink your benefits strategy—this episode is your playbook.

Subscribe now and hit the bell so you never miss an episode. Because if the truth is out there... are you ready to hear it? Let us know your thoughts in the comments & don’t forget to subscribe for more no-BS insights.

Whether you're an HR professional, CFO, CEO, or just tired of rising healthcare costs, this is your call to rethink benefits strategy and finally take control.

Learn more about Jay's work: https://www.culpepperrfp.com/

Connect with Jay Gepfert on LinkedIn: https://www.linkedin.com/in/jay-gepfert-rfps-for-retirement-health-and-welfare-plans-a418027/

Connect with Chelsea and Donovan: Website: www.businessofbenefitspodcast.com Instagram: https://www.instagram.com/ethoseffectpodcast/

Chelsea: https://www.linkedin.com/in/chelsea-ryckis-8508a192/
Donovan: https://www.linkedin.com/in/donovanryckis/