"We are in a $5 trillion US healthcare consumer market with no consumer in it... I basically decided we had been surgically removed from the US healthcare system."

My guest this week is Mark Galvin, a serial entrepreneur who successfully funded his own company's healthcare by pairing a $10,000 High Deductible Health Plan with a fully funded HSA and HRA - saving his company 32% and his employees 50%. When he realized that brokers, carriers, and even the state insurance department were financially disincentivized from sharing this strategy, he decided to force transparency into the market himself.

In this episode, Mark shares the incredible story of how he secured a DVD containing 100% of New Hampshire’s post-adjudicated claims data and built the first true shopping tool for medical procedures. We discuss his meetings at the White House that helped shape the Transparency in Coverage Rule, the absurdity of $68,000 knee replacements, and his new platform that calculates a "Universally Acceptable Payment Amount" (UAPA) for every provider in the country.

If you are an employer, broker, or patient who is tired of flying blind and wants to understand how true cash prices are finally coming to healthcare, 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 ParetoHealth.com/Spencer 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: Aligning Financial Incentives in Healthcare

(00:02:41) Mark's Background: Voice Over IP to Healthcare Tech

(00:04:47) The Early Days of Direct Primary Care (DPC)

(00:09:08) Hacking the HDHP: Saving 32% on Premiums

(00:11:28) Why Brokers & Carriers Hate Cost-Saving Strategies (The MLR Problem)

(00:18:33) Discovering the All-Payer Claims Database (APCD)

(00:21:49) The $1,600 vs. $6,800 Nuclear Stress Test

(00:26:00) Building a Commercial Solution to Fight Lobbyists

(00:29:40) The "Proficiency Score": Why Price Does Not Equal Quality

(00:31:48) Scraping EOBs to Build a National Price Database

(00:33:27) The White House Meetings & The Transparency in Coverage Rule

(00:43:03) Inventing "Transparency 2.0" and the UAPA (Cash Pay)

(00:51:13) Shared Savings Rewards: Paying Employees to Shop

(00:53:56) The Future: In-App Repricing and "Tap-to-Pay" at the Doctor

(00:57:52) Can We Shop for 70% of Healthcare?

(01:04:18) Using UAPA as a Full Network Replacement

(01:11:19) The Path to an "Amazon-Like" Healthcare Market

(01:15:19) Closing Thoughts: Why 12% of Shoppers Can Change the System

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/

"I've got a patient in Washington state. He's traveling 100 miles every other week to receive an infusion. We moved this patient into the home and saved the plan $700,000 on this one patient...on gout treatment."

Why are infusion drugs quietly destroying your health plan's budget?

This week, my guest is Rob LaHayne, Co-Founder of Leap Health. We pull back the curtain on one of the most overlooked and expensive categories in healthcare: Specialty Infusion Care. Because these drugs are administered by a medical professional, they are billed through the medical plan under "J&Q Codes" - subjecting them to massive hospital markups and "buy-and-bill" margin games.

In this episode, Rob explains how Leap Health is solving this by taking over the supply chain, procuring the drugs transparently without margin, and redirecting patients to their own homes or convenient infusion centers. We discuss how these J&Q codes are often the hidden culprit behind breached stop-loss deductibles and skyrocketing renewals, and why shifting the site of care is a win for both the employer's budget and the patient's quality of life.

If you're a benefits consultant trying to figure out why your client's medical spend is out of control, or an employer tired of paying massive hospital markups for necessary medications, you need to understand J&Q codes.

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 ParetoHealth.com/Spencer 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 Hidden Problem of J&Q Codes

(00:04:13) Rob's Background & The Genesis of Leap Health

(00:08:24) Why Hospital "Buy-and-Bill" Margins Drive Up Costs

(00:13:22) How Leap Health Provides Transparent, Zero-Margin Pricing

(00:16:31) Shifting Site of Care: The Power of Home Infusions

(00:23:44) Overcoming Headwinds: Patient Engagement & Plan Design

(00:27:01) Taking Over the Supply Chain to Bypass the "BUCA" PBMs

(00:32:51) Stop-Loss Renewals: Why Identifying J&Q Codes is Critical

(00:37:04) Saving $700,000 on a Single Gout Patient

(00:41:39) The Future: Unbundling the Health Plan & "Point Solution Fatigue"

(00:45:41) Closing Thoughts: Why Consultants Must Request J&Q Code Data

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 you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's headlines and listener-submitted questions.This month, we are officially in the new studio! Nathaniel and I react to the latest headlines from February, including the FTC's landmark settlement with Express Scripts over insulin pricing and the new bipartisan bill aimed at breaking up the "Big Medicine" monopoly of insurers, PBMs, and providers. We also discuss the FDA's crackdown on compounded weight loss drugs (GLP-1s) and the privacy concerns surrounding OpenAI’s new ChatGPT Health feature.Plus, we play a new game called "Drug Cost or Car Payment?" where I try to guess whether a monthly prescription is more expensive than the lease payment on a luxury car (like a Porsche 911 Carrera or a Bugatti Chiron). Finally, we answer a listener question about the absolute minimum employee headcount required to go fully self-funded in 2026.Thank you to our sponsor, Walk On Clinic!

Chapters:0:00 - Intro: Welcome to the New Studio!1:24 - "PBM Reform Comes To Washington"2:25 - FTC / Express Scripts Settlement5:19 - The Bill to "Break Up Big Medicine"6:34 - The FDA Cracks Down on Compounded GLP-1s7:55 - OpenAI Launches ChatGPT Health12:14 - Game: Drug Cost vs. Car Payment?18:33 - Ask Spencer: Minimum Headcount to Go Self-Funded?

"We don't view ourselves as a TPA, we view ourselves more as a platform... our goal is to simplify and reduce the barriers of entry into the TPA space."

The role of the Third-Party Administrator is undergoing a massive evolution. No longer just a back-office claims processor, the modern TPA is being asked to serve as the high-tech, high-touch "nucleus" of the entire health plan.

My guest this week is Vinny Esposito, CEO of Reflect Health (formerly S&S Health). Drawing on a decade of experience in the hedge fund world, Vinny recognized a massive opportunity to bring scalable, asset-light infrastructure to the self-funded market. Today, Reflect Health acts almost like the "Intel Inside" of the industry, licensing its proprietary claims technology to other TPAs and health plans.

In this episode, we explore exactly what it takes to build the TPA of the future. We discuss how to solve "point solution fatigue" through a centralized marketplace, the mechanics behind infusion drug carve-outs, and how to successfully deploy dynamic deductibles to incentivize better care routing. Vinny also shares his bold vision for "frictionless claims" paid instantly at the point of service, moving us closer to an Amazon-style shopping experience for healthcare.

If you want to understand the technological and administrative innovations driving the self-funded market forward, this episode provides the blueprint.

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 ParetoHealth.com 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: Competing on Service in the TPA Market

(00:01:56) Meet Vinny Esposito & Reflect Health

(00:03:35) Rebranding from S&S Health

(00:07:32) From Hedge Funds to Healthcare Disruption

(00:11:05) The Platform Model: Licensing Tech to Other TPAs

(00:15:05) The Marketplace & Infusion Drug Carve-Outs

(00:19:14) How the TPA Role is Expanding (The "Nucleus")

(00:24:12) Direct Contracting, RBP, and DPC Integration

(00:29:15) Dynamic Deductibles & Tiered Networks

(00:33:25) Curing "Point Solution Fatigue"

(00:41:09) The Future of Stop-Loss and Preventative Care

(00:45:44) The Fiduciary Breaking Point & 80% Renewals

(00:50:26) Frictionless Claims & Amazon-Style Healthcare

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/

“Show me an incentive structure and I'll show you human behavior... until employers realize they have more power than they give themselves credit for, this can't continue."

My guest this week is Norm Volsky, Managing Partner at DRI and Founder of MVP Growth Partners. Norm has spent the last decade as one of the top executive recruiters in the digital health and employer benefits space - placing the commercial teams that helped build unicorns like Livongo and Hinge Health.

In this episode, Norm explains why the next wave of healthcare innovation isn't about adding more "point solutions" to an already fatigued market. Instead, smart money is betting on companies that carve out high-margin, inefficient services directly from the major insurance carriers - like radiology, fertility, and specialty infusion.

We discuss how Norm built an "army" of over 500 industry executives to crowdsource due diligence, why the traditional VC model fails in healthcare, and why employers and their benefits leaders are finally at a watershed moment where they must demand true fiduciary alignment from their vendors.

If you want to know where the smart money is moving in employer healthcare, and why the "BUCA" carriers should be worried, 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 ParetoHealth.com 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: Recruiting in the Early Days of Digital Health

[00:04:12] The Livongo Story: Selling Healthcare Direct to Employers

[00:08:44] What Makes a Great Salesperson in Healthcare?

[00:11:46] Spotting the Next Unicorn: The Hinge Health Experience

[00:17:28] Private Equity vs. Venture Capital

[00:20:00] Using Recruitment Data to Drive VC Investments

[00:23:41] The "One Imaging" Pitch & Carving Out Radiology

[00:30:40] Building an Army: Crowdsourcing VC Due Diligence

[00:36:26] Why MVP Growth Partners Only Invests in "At-Risk" Pricing

[00:41:40] Point Solution Fatigue & Identifying the "Good Actors"

[00:46:17] Why Employers Must Demand Fiduciary Responsibility

[00:50:41] The Future: The Erosion of the Big 3 PBMs and Carriers

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/

"Why are we paying $10,000 for a $30 drug?"

My guest this week is Pramod John, a former Silicon Valley tech entrepreneur who entered the healthcare space to tackle the largest economic problem in the country: skyrocketing healthcare costs. Pramod quickly realized that healthcare's dysfunction is actually not a technology problem - it is a deeply ingrained problem with economic incentives.

In this episode, we dive into the murky waters of Pharmacy Benefit Managers (PBMs) and why the traditional model is designed to drive up costs rather than lower them. We discuss the shocking statistics of drug spend (where 2% of people account for 55% of the costs), why FDA approval doesn't always mean a drug is effective (using the infamous Alzheimer's drug as an example), and the implications of recent fiduciary lawsuits like the one against J&J.

Pramod explains how we can bring common sense back to healthcare by treating drugs like any other consumer purchase. By utilizing an "open market" drug management model, he argues that we can effectively replace traditional PBMs with transparent transaction processing software - saving plans 30% to 50% without relying on restrictive formularies or rebate games.

Tune in this week for a clear roadmap for how to actually fix the irrational economics of our healthcare system.

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 ParetoHealth.com 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: Why We Talk About Cost Instead of Quality

(00:02:42) From Silicon Valley & Defense Tech to McKesson

(00:10:43) Why Healthcare is NOT a Technology Problem

(00:15:53) Fiduciary Responsibility & The J&J Lawsuit

(00:19:03) The Butter Knife vs. Pareto: The Math of Drug Spend

(00:23:54) Building an "Open Market" Alternative to PBMs

(00:29:40) Why Doctors Fly Blind on Drug Pricing & Formularies

(00:35:42) FDA Approval vs. Real-World Efficacy

(00:45:44) How to Actually Fix the Model: The Real-Time "Pause"

(00:58:36) Why International Sourcing & PAPs Aren't the Fix

(01:11:00) Replacing PBMs with Simple Transaction Software

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/

"My wife would come back to check on me late at night, asleep at the keyboard, and she would be like, 'Is he dead?' The burnout, what we call moral injury, is more real than anybody knows." - Will Steelman

The American healthcare system is crushing its doctors. Faced with "assembly line" quotas of 25+ patients a day, hours of unpaid administrative work ("pajama time"), and a suicide rate higher than that of veterans, physicians are fleeing the profession in droves.

My guest this week is Dr. Will Steelman, a board-certified internal medicine physician who lived through this crisis firsthand. After 12 years as a hospitalist, Dr. Steelman reached his breaking point during the pandemic and realized the only way to save his career, and his life, was to exit the system entirely.

In this episode, we explore why Direct Primary Care (DPC) is the only viable path forward for the future of medicine. Will explains how DPC restores the doctor-patient relationship by reducing patient panels from 3,000 to 600, allowing for 90-minute visits, true price transparency, and a focus on root-cause resolution.

We also discuss the clinical benefits of having time to care, including using ketogenic therapies to treat mental illness and reversing chronic metabolic disease, rather than just managing it with pills.

If you want to understand why your doctor is exhausted, why your premiums are going up, and why DPC is the solution we can't afford to ignore, listen to this episode.

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 ParetoHealth.com 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 Link Between Diet & Mental Clarity

(00:04:18) The Road to Burnout: 12 Years as a Hospitalist

(00:09:17) "Is He Dead?": The Reality of Physician Suicide & Moral Injury

(00:11:08) The Way Forward: Concierge vs. Direct Primary Care

(00:15:35) The Math of Failure: Why 2,500 Patients is Unsustainable

(00:21:16) "Click Fatigue" and the Administrative Burden

(00:23:58) Leaving the System: Launching Steelman Medical Group

(00:32:06) Saving the Profession: Why DPC Offers Work-Life Balance

(00:40:12) True Transparency: Why DPC Lab Costs Are Dropping

(00:48:58) The Luxury of Time: Treating Mental Health with Ketogenic Diets

(00:59:32) The Statin Controversy & Insulin Resistance

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 you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.Each month on Last Month In Healthcare, producer Nathaniel joins me to discuss the previous month's podcasts, headlines, and listener-submitted questions.This month, we’re joined by John Kountz from Frost Insurance! We react to the record-breaking lobbying spend by drugmakers in 2025 and discuss the historic slump in Hospital M&A activity. We also cover the rising cost of medical real estate forcing doctors into co-working spaces, the critical decline in nursing home capacity, and the consolidation of federal lawsuits linking GLP-1s to vision loss.Plus, we play a game called "Real or Fake Medical Codes," where John and I try to guess if ICD-10 codes like "Struck by Turtle," "Sucked into a jet engine," or "Burned due to water skis on fire" are actually real. Finally, we answer a listener question about what a successful Q1 looks like for a new broker in the benefits industry.I'm also thrilled to announce that Last Month In Healthcare is now sponsored by Walk On Clinic! We are excited to partner with a team that is redefining primary care access.Chapters:0:00 - Intro0:37 - Drugmaker Lobbying Reaches Historic Highs4:30 - Hospital M&A Slump & Financial Distress7:39 - Doctors Moving to Co-Working Spaces10:05 - The Decline in Nursing Home Capacity11:57 - GLP-1 Vision Loss Lawsuits15:41 - Game: Real or Fake Medical Codes?21:41 - Ask Spencer: Successful Q1 for New Brokers