66. Self-Funding Explained in 60 MINUTES with Spencer Smith cover art

66. Self-Funding Explained in 60 MINUTES with Spencer Smith

66. Self-Funding Explained in 60 MINUTES with Spencer Smith

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 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

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

Finished with the content? Claim your CE credit here: https://ideas.ethosbenefits.com/continuing-education

SHRM: Ethos Benefits is recognized by SHRM to offer professional development credits (PDCs) for SHRM-CP® or SHRM-SCP® recertification activities.

HRCI: Ethos Benefits is approved to offer HRCI® recertification credits for this program. This program has been approved for 0.5 - 1 HR (General) recertification credit(s) toward aPHR®, PHR®, SPHR®, and GPHR® certification.
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