Self-Funded

This episode is all about entrepreneurship.  The highs and the lows, and everything in between. Gabe knew he was going to be an entrepreneur from an early age, recalling that he didn't get the best grades, didn't love to follow rules, and even recounts knowing at the age of 14 he was going to build his own businesses. He studied entrepreneurship in college at Baylor University, but outside of making friends and meeting his wife there, his belief that he would have been better off taking the $150k spent on four years of school where he learned somewhat outdated information, and just setting up his own painting or landscaping business instead. Gabe also has a fantastic story to tell about financial redemption. From being on the brink of bankruptcy, where he had to move his wife and newborn child into a studio apartment after an oil market crash crushed his family business, to founding and building Factur, with 57 employees, explosive growth, and a vision to create a "100-Year Company", Gabe's story should resonate with every entrepreneur out there. The name "Factur" comes from the middle of the word Manufacturing, and this industry is one that Gabe not only knows intimately but that he believes strongly in his own team's ability to drive tremendous growth for these entrepreneurs. Factur helps with business development for manufacturing companies. They offer: 📈 Lead Generation 📲 Outsourced Business Development 💲 Marketing Services 👨‍💼 Industrial Sales Recruiting Every once and a while I like to deviate from the insurance-focused subject matter and offer up something more universal. In this episode you will hear about entrepreneurship, faith, manufacturing challenges, how fracking works, dreaming big, building a company that outlasts yourself, growth, optimism, and more! Chapters: 0:00 Intro to Gabe 5:40 The Family Business 9:54 The Collapse 16:24 Rebuilding From Scratch 23:11 What is "Factur"? 32:26 Thriving During Covid 37:12 Building a 100-Year Company 42:15 Closing Thoughts

Josh Sullivan is a Territory Manager for Morgan White Group, which creates and delivers innovative insurance products to the marketplace.   Even though they have a full suite of solutions, for today's episode, we specifically focused on their Gap Supplemental Health Plan called the "Premium Saver Plan". I have always been intrigued by the financials of a Gap Health Plan, which aims to lower the overall cost of an employer-sponsored health plan by providing a way to bridge the "gap" between the first dollar and the employee's deductible. If an employer raises their employee's major medical out-of-pocket costs, the premiums will go down as a result.  "The Premium Saver uses the money saved to fill in the out-of-pocket expense which brings the group’s plan back to its current plan design." This type of product does have some detractors in our industry, so it was great to be able to address those with Josh and hear his perspective. Gap Supplemental medical plans really only make sense when a group is in a fully insured arrangement, and those that are more averse to setting up a plan this way might argue that a group is better off (at least financially) by moving to a self-funded plan. Like every insurance product, each individual employer and their consultant need to determine what is best for their specific situation. Who knows, a Gap Health Plan might be right for you! https://mwgbrokerservices.com/ Chapters: 0:00 Intro to Josh 9:12 Starting in Life & Disability 17:00 What is the Morgan White Group 20:41 The Premium Saver 31:45 Who are Gap Plans For? 39:15 What are the Cons of a Gap Plan? 46:00 The Future of Gap Plans 50:40 Closing Thoughts

Chris Hamilton, a Partner at Hotchkiss Insurance, breaks down the evolving landscape of employee benefits. With a finance background, he reveals why many employers feel trapped by soaring healthcare costs. Discover how self-funding can empower businesses and why brokers should shift to performance-based compensation. Chris shares personal motivations stemming from his brother's medical struggles and explains the critical role of data in identifying cost drivers. The conversation highlights the renaissance in benefits, focusing on innovative solutions like concierge medicine and the impact of HSAs on middle-income employees.

Entrepreneurship in Autism Therapy - Derek Barrows of Belay On Autism Services Derek is the Founder and CEO of Belay On Autism Services, which offers Applied Behavior Analysis (ABA) therapy for children diagnosed with autism in North Texas. In this episode, Derek shares information about applied behavior analysis (ABA) therapy, a widely used approach that focuses on reinforcing positive behaviors and teaching new skills. While ABA has been shown to be effective for many children with autism, it's important to note that it may not be the best fit for every child. In this episode, you'll learn about: 👉🏼The potential benefits of play-based therapy 👉🏼 The importance of individualized therapy plans 👉🏼 Applied behavior analysis (ABA) therapy and how it can be used to help individuals with autism Derek and I have gotten to know each other over the last few years, as our wives are good friends and our daughters participate in your sports together. Derek was diagnosed with dyslexia and ADHD growing up, but never received a diagnosis of autism himself, and we discussed how those challenges played a role in the development of the mission he has with Belay On. For the baseball fans out there, Derek was a very high-level baseball player, spending a few years after college in the minor leagues pursuing a professional baseball career. For those interested in learning more, here is Belay On's website. https://belayonautismservices.com/ Chapters: 0:00 Intro to Derek 9:45 His Healthcare Career 13:24 What is Belay On 16:35 Autism Diagnosis 19:45 ABA Therapy Explained 27:04 Derek's Entrepreneurial Journey 33:45 Lessons Learned 42:34 The Future of Autism Care 45:40 Closing Thoughts

Brian is an AVP of Business Development at Goodroot. "Goodroot is a community of companies committed to reinventing healthcare one system at a time." In this episode, we specifically focus on two of the solutions that Brian represents: 1. AlignRx, which is their pharmacy consulting arm for larger employers who need individualized expertise for their unique situations. 2. CoeoRx, which has prenegotiated Pharmacy benefit contracts and custom pharmacy benefit solutions for employers that offers "choice, leverage, and savings". Interestingly, Brian has a condition known as hemophilia, a medical condition in which the blood's ability to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury. Anyone who operates in the world of self-funding knows how expensive this condition can be to an employer, but it was incredibly interesting to hear the human side directly from Brian. The crux of this episode focused on the world of PBMs, where we discuss everything from PBM contracts, to spread pricing, price transparency, claims repricing, specialty medications, and so much more! Chapters: 1:25 Getting to Know Brian 8:45 Life as a Hemophiliac 19:00 What is Goodroot 27:20 Sifting Through the PBM Noise 34:45 PBM Best Practices for Employers 39:52 What Data is Required 44:13 Specialty Meds 48:25 Alternate Sourcing of Meds 54:29 Pharmacogenomics  58:30 Closing Thoughts

How to Become Unstoppable in SaaS with TK Kader TK Kader is my latest guest on the  @SelfFunded  with Spencer podcast, where we discussed his successful track record as a SaaS entrepreneur, his company called "Unstoppable" where he helps other early-stage SaaS business owners scale their companies, as well as the outstanding YouTube channel that has over 36k+ subscribers, 1M+ views, 100k+ hours of watch time. TK is also an incredibly cool and down-to-earth guy, even gracious enough to come on my show after a cold outreach by me! Being that my company Plansight is in the SaaS space, and also that TK is a master of using video content for lead generation, I knew he would make an outstanding guest on my podcast. From his website bio: "TK Kader is an entrepreneur, international best-selling author, and also an angel investor.  TK worked at Bridgewater Associates (one of the best hedge funds in the world). He then founded ToutApp (backed by Andreessen Horowitz and Jackson Square, two of the best venture capital firms in the world).  TK sold ToutApp to Marketo (then owned by Vista Equity Partners, one of the best private equity firms in the world) and was part of the executive team at Marketo that helped drive its transformation and eventual $4.75bn sale to Adobe.  TK now leads the Unstoppable movement to help SaaS Founders build & scale incredible software companies." Links: TK's youtube channel - https://www.youtube.com/channel/UCUseoG3kofRLS6WoUaL_15w TK's Unstoppable website - https://www.tkkader.com/ TK's book - https://www.amazon.com/How-Punch-Sunday-Jitters-Face/dp/B0BF2TNGG2 Episode Highlights: 0:00 Intro to TK Kader 2:00 His first Company - "My P.I.M.P." 9:30 Joining Ray Dalio's Hedge Fund - Bridgewater 12:12 Building & Selling ToutApp 19:52 Becoming Unstoppable 28:30 3 Pillar for Go-to-Market Strategy 34:40 Time Management 38:22 Your 5-Year Vision 41:45 YouTube for Sales Leads 50:15 The Future of Unstoppable

I sat down with the CEO and Founder, Priscilla Romans to discuss the origin story of Graith Care, and how they are fighting every single day on behalf of Americans to ensure they are getting the best possible care for their unique situation. Patient Advocacy is all about empowering patients to regain control of their healthcare decisions.  When they have informed consent, and are presented with all of their options, the patient should ultimately be able to make the decision that is best for them. "Graith Care’s mission is to bring back control and transparency to the consumer. Graith Care breaks down healthcare barriers and provides a holistic view of the patient journey. This care model ultimately improves outcomes and efficiency along with saving time and money. As your Independent Patient Advocate, we provide medical advocacy, consultation, advice and recommendations in US and Internationally." Chapters: 0:00 Intro 2:57 Who is Priscilla Romans 11:30 Graith Care Origin Story 17:40 What is "Patient Advocacy" 22:00 How Graith Care Works 31:28 The Story of "Molly & Jim" 37:30 Going Viral on Tik Tok 43:05 The Future of Advocacy 49:00 Closing Thoughts

A Fiduciary's Guide to Data Analytics with Agility Innovation Partners. This episode is a follow-up to my video "The Consolidated Appropriations Act 101 - Comply or Die?"   The Consolidated Appropriations Act, otherwise known as the CAA, established protections for consumers related to surprise billing and transparency in health care.  Upcoming fines can and will be heavy, amounting to $100/day PER EMPLOYEE, which is substantially greater than the fines hospitals receiving for being non-compliant, which was only $300 total day.  In this Episode - Part 2 - we focus on an employer's fiduciary responsibility now that they have access to claims and pricing data due to the CAA regulation, and the power of using an innovative Data Analytics platform to make sense of it.   Agility Innovation Partners helps offer a data analytics platform with "at-scale pricing" to small-to-mid-market brokers who may not have the leverage on their own.  They also offer consulting after the decision to purchase a data analytics platform called Innovu, so that consultants can make sure they maximize the ROI on their investment.  Innovu also offers a CAA fiduciary tool stack with benchmarking against 4 million lives for plan design, claims cost, plan design etc, so that an employer can determine if they are paying reasonable cost for care and are compliant.  If not, now they know and can take action!   Here is a recent article covering the CAA in greater detail, and outlining the employer obligation to be compliant.  Hat's off to Dave Chase, co-founder and CEO of Health Rosetta for bringing it to my attention!   https://docket.acc.com/erisa-covered-companies-must-disclose-health-plan-costs

The Consolidated Appropriations Act 101 - Comply or Die?   The Consolidated Appropriations Act, otherwise known as the CAA, established protections for consumers related to surprise billing and transparency in health care. Upcoming fines can and will be heavy, amounting to $100/day PER EMPLOYEE, which is substantially greater than the fines hospitals receiving for being non-compliant, which was only $300 total day.  The goal for employers immediately is not to be perfect by 12/27/22, but to at least show that they made a good faith effort to be compliant. The price transparency component is where the opportunity lies for employee benefits brokers and their employers to uncover the source of their high cost claims, and then take appropriate fiduciary responsibility in order to pay more appropriate unit costs for healthcare.  While there is a cost associated with ensuring you are compliant, the opportunity to retain and win new business for consultants is massive. Right now, opaque network contracts make it difficult for healthcare consumers to know the cost of care prior to receiving it, and it is nearly impossible to make an informed decision as a patient.  The CAA will have a dramatic impact on Americans' ability to price shop on where to go for care, as well as their ability to plan for their out of pocket expense(s). The goal of the CAA is simple: People should be able to know the price ahead of time, shop using that price as well as quality of care metrics, and then they shouldn't be slapped with a giant, surprise balance bill afterward. At the end of the day, the goal is to allow people to have the tools to shop for healthcare the way that they do so for any other product or service. Here is a recent article covering the CAA in greater detail, and outlining the employer obligation to be compliant.  Hat's off to Dave Chase, co-founder and CEO of Health Rosetta for bringing it to my attention! https://docket.acc.com/erisa-covered-companies-must-disclose-health-plan-costs

Sarah is the Founder and CEO of Predictabill, a company that allows you to "compare the health insurance you have with what you could get, and see what’s different since last year."   With Predictabill you can analyze options from your employer (including COBRA), your spouse’s employer, healthcare.gov, and more.    Sarah spent 8 years in investment banking, and her area of expertise during this time was evaluating the impact that an organization's insurance expenses had on the valuation of the business.   She jokes that insurance company is "a pile of cash and a bunch of promises", and I am not sure I have heard a better definition than that! A personal experience with high deductible health plans soon after moving to New York on her own, where she was hit with a $400 out of pocket expense she didn't expect, led to an epiphany about the complexity of health insurance plan design that ultimately sent her down the path of creating Predictabill.