"To quote my business partner, a broker makes you broker."

To celebrate the 5-year and 250th-episode anniversary of the podcast, we recorded a special live panel in front of an audience featuring three of the most forward-thinking minds in the benefits space: Chris Hamilton (Hotchkiss Insurance), Taylor Rogers (CCIG), and Seth Denson (Acrisure).

In this "State of the Union" episode, we tackle the existential crisis facing mid-market employers and the healthcare industry at large. The panel holds nothing back as we debate the illusion of PPO network discounts, the weaponization of AI in medical billing, and why staying fully-insured absolutely does not protect a CFO from fiduciary liability lawsuits.

The guys also share their personal "Jerry Maguire" moments - the exact turning points in their careers when they decided to stop chasing commissions and start fighting for the patients and employers footing the bill.

Following the main discussion, we hosted a Q&A featuring questions from the audience.

If you are an employer looking to take control of your healthcare spend or an advisor wanting to stay relevant in a rapidly changing market, this live discussion is packed with actionable strategy.

Thank you to all who have listened for helping us get to 5 years!

Thank you to our 2026 sponsors!

ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.

Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.

Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.

Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.

Episode Chapters

(00:00:00) Intro: Welcome to the 5-Year Anniversary Live Show

(00:01:51) Meet the Panel: Chris Hamilton, Taylor Rogers, and Seth Denson

(00:04:56) State of the Union: Is the Benefits Industry in a Crisis?

(00:11:12) Broker vs. Consultant: Defining the Difference

(00:17:26) Following the Money: Controlling Facility Costs & Member Experience

(00:24:02) Are Traditional PPO Networks a Scam?

(00:34:46) Building Tiered Benefit Structures and Narrow Networks

(00:40:22) The AI Threat: Weaponized Billing and the Loss of the "Training Ground"

(00:55:40) Fiduciary Responsibility and the Threat of Employer Lawsuits

(01:05:03) The Next 5 Years: Breaking Up Insurance Monopolies

(01:11:18) Audience Q&A: Preventing High-Cost Claimants with DPC

(01:15:30) The Panel's "Jerry Maguire" Career Moments

(01:20:46) The Reality of Price Transparency and Medical Shopping

(01:26:03) Navigating the Wild West of the No Surprises Act (NSA)

(01:29:45) Why Fully-Insured Plans Don't Protect CFOs from Fiduciary Liability

(01:32:21) Closing Remarks and the 5-Year Whiskey Giveaway

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 do it for Whole Foods, which is a very large organization, why can't we do this for other employers?"

Is the era of relying on national, opaque "BUCA" networks finally coming to an end?

My guests this week are Blake Allison, CEO of Employers Health Network (EHN), and Philip Eaves, from Ascension. Together, they break down the exact blueprint they used to build a direct-to-employer, high-performance network for Whole Foods - and how they are scaling that exact same model for self-funded employers across the country.

In this episode, we explore the hospital system's perspective on direct contracting. Phil explains why massive health systems like Ascension are eager to bypass traditional carriers to work directly with employers, citing faster payments, zero collection risk, and the ability to proactively manage patient care.

We also discuss how to successfully integrate Direct Primary Care (DPC) into a localized network, the lessons commercial plans must learn from Medicare Accountable Care Organizations (ACOs), and why the future of healthcare relies on "re-localizing" how we buy medical services.

If you are an employer, benefits consultant, or healthcare provider who is fed up with the transactional, nickel-and-dime nature of traditional insurance carriers, this conversation proves that a better, more collaborative model already exists.

Thank you to our 2026 sponsors!

ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.

Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.

Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.

Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.

Chapters:

(00:00:00) Intro: Whole Foods and the Move Away from BUCAs

(00:07:29) The Whole Foods Case Study: Building a Direct Network

(00:12:15) Why Health Systems Want Direct Employer Contracts

(00:17:15) The Evolution from RBP to High-Performance Networks

(00:19:21) Integrating Direct Primary Care and Care Management

(00:23:41) The Challenges of Scaling Direct Contracts Nationally

(00:28:15) Re-Localizing Healthcare: Buying Care in Your Community

(00:33:36) Overcoming the Negative Stigma of "Networks"

(00:36:55) Applying Medicare ACO Lessons to Commercial Populations

(00:42:31) Defining True Value-Based Care and Downside Risk

(00:45:51) The Ideal Employer Profile for Direct Contracting

(00:50:52) Lowering Costs with Local, Community-Based Care

(01:05:17) Future Predictions: Site Neutrality and Price Transparency

(01:11:25) Closing Thoughts: Providers Are Open for Business

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/

"Employers are at a point where they want to help create that ideal healthcare system, not the one that they have been dictated to."

Is your company's health plan actually keeping your employees healthy, or is it just waiting for them to get sick?

My guest this week is Ben Miller, Chief Revenue Officer at Premise Health, the nation's largest direct healthcare provider operating over 850 onsite and near-site wellness centers. Ben joins the show to discuss why the traditional fee-for-service model is failing both employers and employees, and how Advanced Primary Care is stepping in to serve as the new "front door" to the healthcare system.

In this episode, we break down what Advanced Primary Care actually entails, from integrated behavioral health and lifestyle medicine to onsite pharmacies offering 90-day prescriptions for $1. Ben shares the results of a massive Milliman study showing how this model reduces total claims costs by an astonishing 30%. We also cover how employers of various sizes can implement near-site clinics, address employee privacy concerns, and utilize Epic-integrated care navigation to guide patients to high-quality, cost-effective specialists.

If you are an employer or benefits consultant looking for a proven strategy to bend the cost curve while delivering an incredible healthcare experience to employees, this episode is a must-listen.

Thank you to our 2026 sponsors!

ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.

Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.

Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.

Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.

Chapters:

(00:00:00) Intro: The Shift Towards Advanced Primary Care

(00:00:33) Meet Ben Miller & Premise Health

(00:02:17) Defining Advanced Primary Care, On-Site, and Near-Site Clinics

(00:05:06) Ben's Journey from Kaiser Permanente to Premise Health

(00:10:32) The Breaking Point: Why Employers are Flocking to APC

(00:16:07) How to Build and Customize an On-Site Clinic

(00:20:11) Creating the "Front Door" to Healthcare & Navigating GLP-1s

(00:25:20) Integrating Behavioral Health & Lifestyle Medicine

(00:28:29) The On-Site Pharmacy Experience ($1 Medications)

(00:30:22) Overcoming the "Big Brother" Privacy Stigma

(00:32:36) The Milliman Study: Proving a 30% Reduction in Claims Cost

(00:36:12) Group Size Requirements & The Power of "Coopetition"

(00:39:35) Managing Catastrophic Risk & Epic Care Navigation

(00:43:43) Expanding the Clinic: PT, Dental, and Vision Services

(00:49:54) How Claims & TPA Integration Actually Work

(00:52:33) Closing Thoughts: The Future of Employer-Sponsored Care

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/