Pharmacy costs now represent 35 to 50% of total healthcare spend for many employers. Yet, most plan sponsors are still operating inside a black box they can't see into, let alone control.

In this episode, Jake Frenz, Founder and CEO of SmithRx, breaks down how the traditional pharmacy benefit manager model became one of the most opaque and conflicted structures in all of healthcare, and what employers can actually do about it. A Marine Corps veteran turned serial healthcare entrepreneur, Jake helped build Collective Health from the ground up before launching SmithRx a decade ago, now serving 1.5 million members across 5,000 self-insured companies.

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“ When you think about that $350,000 rebate check coming back to pay for the programs, think about what's going out the door. Think about from a finance standpoint, what the cash out is that you have to true up with that rebate. You're paying a bolus, you're paying an increased amount upfront to get a rebate in arrears. There's a time, value, money, and overall concern there. I think that it's an easy argument to have, or discussion really, with the CFO around move to a transparent model, try to pull back, preference biosimilars or other low net cost options. And rebates, at the end of the day, today are real. Should rebates exist in this ecosystem? Probably not. I don't think they should. But that is a matter of fact today, and you have to meet the market where it's at. Those rebates will continue even under a transparent pass-through model. They just may be less, and that's okay because you're going to look at that per member, per month, true net cost, what your cash out is going to be, and that is a very easy, simple story to tell.” – Jake Frenz

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Episode Timestamps:

*(01:24): Jake Frenz's background: from Marine Corps to PBM founder

*(03:00): A brief history of pharmacy benefit managers and how we got here

*(10:14): Jake's journey from Anthem and Collective Health to founding SmithRx

*(18:27): What transparency actually means and why it equals control

*(20:33): The questions every plan sponsor should be asking their PBM

*(40:37): AI in pharmacy benefits: where it helps and where accuracy is non-negotiable

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Links:

Connect with Jake Frenz on LinkedIn

Connect with Dane Thorwaldson on LinkedIn

Learn more about Collective Health

Learn more about Caspian Studios

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If you’re enjoying The Benefits Playbook, we’d love your support. Take a moment to rate and review the show wherever you’re listening — it really helps others discover us and join the conversation on the future of employee benefits. And while you’re there, don’t forget to hit subscribe so you never miss an episode. If you know a colleague or friend who’d enjoy the conversation, share it with them too. Thanks so much for listening, and we’ll see you next time.

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The views expressed in this podcast are those of the speakers and do not necessarily reflect the views or positions of Collective Health, its affiliates, sponsors, employees, or customers. This podcast is not intended as legal, medical, or financial advice. If you have any questions or concerns in these areas, please consult with a qualified professional.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Many employers treat high-cost healthcare claims as bad luck — something to absorb and move on from. But ignoring the details buried in those claims is costing companies millions, and the data to fight back already exists.

In this episode, Dr. Christine Hale, Chief Medical Officer, US Benefits at Gallagher, brings a rare perspective to employee benefits: she's been a physician, a McKinsey strategy consultant, and a patient navigating a complex, misdiagnosed illness for over a year. That experience shaped everything about how she thinks about healthcare and why getting the right diagnosis is the single most important thing a plan can do for a member.

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“ When I was in medical school, cancer was basically a binary disease. You either got better or you passed away, and that was the sad truth. We can now keep patients alive for over a decade on suppressive therapy, treating cancer like a chronic condition, living very happy, productive, fulfilling lives. That's incredible. However, insurance was not really set up for ongoing risk. It was set up for unknown risk and to spread that unknown risk. That's where I see a lot of organizations getting into trouble is they say, Well, I bought stop-loss. Well, if you have someone on an $800,000 a year regimen and they're going to be on it forever, the stop-loss coverage is going to run out after a few years. They're going to say, That's known risk and our business model doesn't support that. That's been the real challenge, is trying to figure out how to balance strategies that help you mitigate the lightning strike shock and awe claims, coupling it with, Wow, the water level is really rising on these ongoing claims and how expensive those are getting, and that requires a different way of thinking.” – Dr. Christine Hale

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Episode Timestamps:

*(00:37): Dr. Hale's serpentine career path

*(05:01): Redefining high-cost claimants: Lightning strikes vs. the rising tide

*(12:06): The right diagnoses: Why getting it wrong costs members and plans millions

*(18:35): Gallagher's Complex Case Navigation Program “Stella”

*(33:54): The $250K knee replacement: A case study in hidden billing fraud

*(40:50): The future of benefits

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Links:

Connect with Dr. Christine Hale on LinkedIn

Connect with Kirk McConnell on LinkedIn

Learn more about Collective Health

Learn more about Caspian Studios

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If you’re enjoying The Benefits Playbook, we’d love your support. Take a moment to rate and review the show wherever you’re listening — it really helps others discover us and join the conversation on the future of employee benefits. And while you’re there, don’t forget to hit subscribe so you never miss an episode. If you know a colleague or friend who’d enjoy the conversation, share it with them too. Thanks so much for listening, and we’ll see you next time.

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The views expressed in this podcast are those of the speakers and do not necessarily reflect the views or positions of Collective Health, its affiliates, sponsors, employees, or customers. This podcast is not intended as legal, medical, or financial advice. If you have any questions or concerns in these areas, please consult with a qualified professional.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Doctors aren't "resistant to AI" because they're technophobes. They're navigating a fundamental shift in what it means to practice medicine when patients arrive having already diagnosed themselves via ChatGPT. The path forward isn't "adopt more AI tools." It's building a new operating model for clinical practice that balances ambient documentation, patient empowerment, and the irreplaceable human elements of care.

In this episode, Dr. Spencer Dorn breaks down how AI is reshaping medicine: from eliminating "pajama time" for some clinicians to democratizing medical knowledge in ways that fray the profession's grand bargain with society. He explores why trust remains the currency that matters most, and what it means to be a physician when AI tools change faster than the relationships they're meant to serve.

For benefits leaders and consultants, the implications are just as significant. As members increasingly turn to AI before ever engaging the healthcare system, employers have a real opportunity — and responsibility — to help them navigate that information and make better care decisions. Understanding how AI is reshaping clinical practice isn't just a healthcare story. It's a cost, strategy, and member experience story too.

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“ The question that really motivates me most right now is what does it mean to be a physician in this new world? And even more so, what does it mean to be a human being as things are changing so quickly?  How do we keep our eyes open and make the best decisions that we can so that we don't go down the wrong paths, which inevitably we will, but hopefully we'll have the awareness to recognize we're going down the wrong path so we don't keep going and we'll have the agency and autonomy to shift gears.” – Dr. Spencer Dorn

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Episode Timestamps:

*(01:01): Dr. Spencer Dorn's journey from gastroenterology to clinical informatics

*(04:31): The hidden work of medicine before, during, and after patient visits

*(06:54): How AI is transforming clinical workflows

*(12:12): The democratization of medical knowledge

*(15:47): AI-first care and the healthcare math problem

*(25:00): What it means to be a physician in an AI-powered world

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Links:

Connect with Dr. Spencer Dorn on LinkedIn

Connect with Kirk McConnell on LinkedIn

Learn more about Collective Health

Learn more about Caspian Studios

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Employers are not “stuck” with a broken healthcare system because it’s too complicated. They are choosing to hand over control of something that hurts their workers and wastes money. The answer isn’t more wellness programs or better deals with insurance companies. The real answer is to treat employee healthcare like what it is: a broken business system that needs to be fixed, just like any other supply chain problem.

In this episode, Dr. Eric Bricker challenges common myths about employer healthcare. He explains why healthcare apps can’t work as easily as booking a vacation online and how powerful companies and complex rules keep the system from changing. He shares how one company kept its healthcare costs steady for five years by taking ownership and focusing on what really matters: putting employees first.

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“ That's why creative destruction is so important in healthcare because new entities need to come in and rejuvenate the space. The amount of creative destruction in healthcare is abysmally low. All of the existing institutions in healthcare have been there for decades, if not centuries. You look at industries where the customer actually is doing really well, those industries are defined by creative destruction. Whenever you have these healthcare discussions, you're like, Well, we have to look out for the interests of all stakeholders. No, that's a bunch of malarkey. You need to look out for one stakeholder, and that stakeholder is the patient.” – Dr. Eric Bricker

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Episode Timestamps:

*(00:44): What motivated Dr. Bricker to pull back the curtain on healthcare issues

*(03:04): The two broken incentives destroying healthcare

*(06:12): Why healthcare navigation requires human conversation

*(16:26): Creative destruction and the death of regulatory capture

*(23:54): Practical steps for employers to take control

*(33:24): AI’s role in healthcare (beyond the hype)

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Links:

Connect with Dr. Eric Bricker on LinkedIn

Check Out AHealthcareZ

Connect with Kirk McConnell on LinkedIn

Learn more about Collective Health

Learn more about Caspian Studios

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If you’re enjoying The Benefits Playbook, we’d love your support. Take a moment to rate and review the show wherever you’re listening — it really helps others discover us and join the conversation on the future of employee benefits. And while you’re there, don’t forget to hit subscribe so you never miss an episode. If you know a colleague or friend who’d enjoy the conversation, share it with them too. Thanks so much for listening, and we’ll see you next time.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

It’s 2026, but the healthcare system still feels like it’s stuck in the past. Costs are soaring, benefits are confusing, and employees are left navigating a system built on pieces that don’t fit together. Employers are exhausted trying to manage it all, while employees struggle to get the care they need. But it doesn’t have to be that way.

Smart employers and their consultants are flipping the script: cutting costs, simplifying the experience, and creating benefits their people actually love. On The Benefits Playbook, we uncover the bold strategies that are rewriting the rules of self-funded health benefits.

In Season 4, host Kirk McConnell speaks with industry leaders about bringing transparency to a system built on confusion, using the right financial levers to deliver real value and impact, and designing benefits that truly work for employees. We’ll talk about better data. Better tools. Better insights. Smarter decisions. And benefits strategy that finally makes sense.

This is The Benefits Playbook, Season 4. Brought to you by Collective Health.

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Links

Connect with Kirk McConnell on LinkedIn

Learn more about Collective Health

Learn more about Caspian Studios

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This episode features an interview with Christian Moreno, Executive Vice President of Lockton. With more than 20 years of experience, Christian specializes in designing health plans that are fully integrated with wellness solutions, helping employers manage the demand side of healthcare.

In this episode, Kirk and Christian discuss strategies to manage healthcare cost volatility, the efficacy of wellness programs versus high-cost medications, and the potential shift towards narrower networks to contain costs while maintaining quality care.

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“ I don't know that you can make this just an employee decision at the end of the day. It's going to have to happen further upstream if we want to have a seismic or substantial impact on cost. If we're just talking about physician A versus physician B, but I can still choose to go within any hospital system at any time with total freedom.  If we are going to leave it up to employees and just make it a broad PPO network, I don't know that they have the information just yet to make those decisions. It's going to have to have come from intelligent data tools in their hand. It's going to have to have assistance from the TPA and it's going to have to have assistance from the ecosystem around the member making those decisions.” – Christian Moreno

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Episode Timestamps:

*(00:51): Christian’s career journey

*(02:31): Volatility in healthcare costs

*(10:12): Wellness programs and GLP-1s

*(20:28): Network design and future strategies

*(27:49): Driving employees to high quality providers

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Links:

Connect with Christian on LinkedIn

Contact Christian

Connect with Kirk on LinkedIn

Learn more about Collective Health

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If you’re enjoying The Benefits Playbook, we’d love your support. Take a moment to rate and review the show wherever you’re listening — it really helps others discover us and join the conversation on the future of employee benefits. And while you’re there, don’t forget to hit subscribe so you never miss an episode. If you know a colleague or friend who’d enjoy the conversation, share it with them too. Thanks so much for listening, and we’ll see you next time.

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This episode features an interview with Siobhan Nolan Mangini and Bob Kocher from Venrock. Siobhan is a Partner at Venrock, where she focuses on investments in healthcare technology and services. Prior to joining Venrock, Siobhan was an operator passionate about transforming healthcare through building and scaling innovative companies at the intersection of healthcare and technology. Also a Partner at Venrock, Bob focuses on health tech and services investments. Before joining the company, Bob served in the Obama Administration as Special Assistant to the President for Healthcare and Economic Policy on the National Economic Council and was a Partner at McKinsey & Company.

In this episode, Kirk, Siobhan, and Bob explore Venrock's philosophy and approach to investing in transformative healthcare companies, the importance of aligning incentives, and the potential impact of AI and technology on healthcare delivery.

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“ Taking these dials that we're talking about and realizing, oh, I can carve out my PBM, I can put in benefits like Lyra, for example, behavioral health solution for my entire employee population. I can layer on maybe dynamic copays or narrow network designs, high performing networks, and actually have control. That idea that I am an agent of change, of providing better care, but a lower cost for my employees, is actually there and that they have the tools. That much more empowered driver's seat, to me, is where we'd be a decade from now, if not sooner.” – Siobhan Nolan Mangini

“ Changing healthcare is painful. It might be better at the other end, but the change is hard. People will have to change their insurance or change their doctors or change how they access care or it changes. We learned from the ACA and we've learned from everything since that people don't like that. You have to have something that's even stronger than the pain of changing how healthcare works. And then I think there's lots of ways to imagine how it could be better.” – Bob Kocher

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Episode Timestamps:

*(00:43): Siobhan and Bob’s paths to Venrock

*(04:38): The state of US healthcare today

*(15:44): The importance of aligning incentives

*(20:14): Empowering employers as agents of change

*(25:29): AI’s impact on healthcare delivery

*(27:45): Headwinds and tailwinds in the healthcare system

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Links:

Contact Siobhan

Contact Bob

Connect with Kirk on LinkedIn

Learn more about Collective Health

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This episode features an interview with Scott Burton, Commercial Market President at Providence Health Plan. Since joining the organization in 2022, Scott has been influential in the growth of central PHP business and engagement with channel partners. In his current role, Scott is responsible for state and regional commercial sales and growth strategies.

In this episode, Kirk and Scott explore the impact of rising healthcare costs on employers, the shifting role of benefits administrators, and the evolving relationships between health systems and employers.

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“ We're having conversations with many of our employers around, alright, how do we think about benefit design differently? Can we continue to move toward value-based contracting even in today's really challenging world? Employers have a lot of power to impact change, again, large employers and small. I think we're having conversations now that we haven't had in the last decade plus in healthcare and we need to. We need to move to a new paradigm because today's system is clearly broken.” – Scott Burton

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Episode Timestamps:

*(00:55): Scott’s career journey

*(02:41): Why employers should care about the state of health systems

*(08:36): The opportunity health systems have to work with employers

*(12:09): Scott breaks down Providence Health Plan

*(19:24): PHP’s role in community health plans

*(29:47): Scott's advice for employers working with local health systems

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Links:

Connect with Scott on LinkedIn

Connect with Kirk on LinkedIn

Learn more about Collective Health

Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.