UAPA as network replacement or wrap

"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/