This episode was recorded live on LinkedIn with Bill Dembereckyj, CFO of Imagine360, and it's a look at renewal season from the seat that ultimately signs off on it.

Bill walks through three real cases: a 250-life senior living facility staring at a 50% increase, an 85-life restaurant group facing a $450,000 jump, and a 140-life private school looking at 60%.

We get into why CFOs are being brought in far too late, why Bill started his own plan renewal in Q1, and what happens when finance only gets handed the result and asked to bless it.

Audience questions from the live cover captives with RBP, whether stripping the network hurts steerage, and what happens when a member needs care somewhere you're not contracted.

If you want to be more useful to the CFO in the room this renewal season, this is the episode. Tune in.

"You've taken away all my other strategic choices. Now the only lever I have left is how much employees pay versus how much the company pays." — Bill Dembereckyj, CPA

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: What Is Imagine360 and What Is RBP?

(00:02:56) The CFO's Role in the Renewal

(00:04:35) The Bias Toward Procrastination

(00:08:13) Balancing HR, Finance, and the CEO

(00:09:36) Audience Question: Captives, RBP, and Cash Pay

(00:13:40) Case One: Senior Living, 250 Lives, 50% Renewal

(00:18:30) Fixed Budgets and the Fear of Maximum Exposure

(00:21:09) Case Two: Restaurant Group, 85 Lives, 60% Renewal

(00:24:19) What Healthcare Inefficiency Does to Company Value

(00:28:31) Don't Pull Every Lever at Once

(00:29:50) Audience Question: Does RBP Hurt Steerage?

(00:33:08) Pharmacy: The $400,000 Rebate Nobody Saw

(00:38:13) Case Three: Private School, 140 Lives, 60% Renewal

(00:43:24) What Bill Wants From Consultants

(00:49:09) Give Your Broker Some Grace

(00:52:16) Closing Thoughts

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/

Whole genome sequencing costs about $1,000 today. Ten years ago it was fifteen. Clinical guidelines already say kids with epilepsy or developmental delay should be escalated to it, and more than half of them never are.

My guest this week is Joshua Resnikoff, founder of Sunstone Health and a former bench scientist at Harvard.

He came to this the hard way. His middle son started spiking 105-degree fevers at 18 months old, and it took three years and several pediatricians to name the condition. When they finally did, the answer was that there's no treatment.

Josh knew the tests existed. He just couldn't reach them. So he built a business that runs employer claims data, finds kids with a likely genetic basis for their disease, and gets them trio whole genome sequencing in twelve weeks instead of seven years.

The part that matters for a plan sponsor: this runs as a voluntary benefit. No new plan language, no TPA codes, no prior auth, no insurance in the equation at all. Four documents and a claims feed. Josh takes the testing cost at risk, and getting a family to a diagnosis meaningfully cuts their utilization from there.

We also cover why single-gene and exome testing miss 97% of the genome, what it costs, and why these families are already expensive whether you find them or not.

If you're looking for cost containment that actually helps the member, this is the episode. Tune in.

"We can help you deal with that before it ever actually becomes a claim." - Joshua Resnikoff, Sunstone Health

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 Black Box of Healthcare Pricing

(00:04:24) 98.6 to 105 in the Time It Takes to Get Milk

(00:11:01) Everything on the Shelf, Nothing Within Reach

(00:16:40) One in Ten Americans

(00:22:45) What Genetic Testing Actually Means

(00:29:33) Who Pays, and Why the Families Already Know

(00:34:56) The Case for Sequencing Everyone

(00:40:00) The Guidelines Say Do It. Half Don't.

(00:45:17) Direct Primary Care and the Voluntary Benefit Model

(00:50:57) The Mechanics: Four Documents and a Claims Feed

(00:55:40) Vendor Fragmentation and the Netflix Problem

(01:00:48) The Moonshot and the $2 Trillion in Waste

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/

Half of what this pharmacy compounds is GLP-1s. The other half is a category most benefits professionals have never had to think about, and probably will within a few years.

I got a tour of Optimal Balance Pharmacy's facility and sat down with co-owner Rick Manuel to talk through what peptides actually are, how the FDA's category two list works, and what happens if those compounds move to category one.

We get into why BPC-157 has a better safety profile than ibuprofen and the mechanism behind that, how lyophilization quietly strips 30 to 40% of protein concentration out of the product people buy online, and what to look for in a compounding pharmacy's sterility and endotoxin testing. Rick also explains why compounded GLP-1s can be dosed twice weekly instead of once, why physicians are having to self-educate on a category medical school never covered, and why he thinks insurance coverage for peptides is roughly a decade away.

If you've been seeing this stuff on Instagram and wondering what's real, this is a look behind the curtain. Tune in.

This episode is a discussion of an emerging category and is not medical advice.

"It's not the drug that's making you lose muscle. It's the reduction of appetite." — Rick Manuel

Chapters:

(00:00:00) What Peptides Actually Are

(00:00:46) The FDA Category Two List

(00:01:44) Why BPC-157 Beats Ibuprofen

(00:04:15) How Peptides Signal the Body

(00:07:20) The Instagram Problem and Lyophilization

(00:09:24) Inside Optimal Balance's Testing and Compliance

(00:12:33) Educating Physicians on a New Category

(00:14:27) Compounded vs. Brand GLP-1s

(00:15:54) The Rules for Compounding Right Now

(00:16:38) Why Twice a Week Beats Once

(00:20:36) The Recovery Blend

(00:24:23) Protein, Resistance Training, and Muscle Loss

(00:26:50) Where This Goes Next

(00:28:18) Why Peptides May Never Be FDA Approved

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/