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

"If you ask the surgeon how much time they have to spend thinking about the business side of their practice, it's too high... Let's let doctors be doctors." - Ryan Wells

My guest this week is Ryan Wells, Founder and CEO of Health Here. Ryan joins me to explain why the key to fixing the broken doctor-patient relationship is getting providers out of the debt collection business.

We explore how Episodic Care (bundled payments) can finally align the financial incentives of self-funded employers and high-value specialists. Ryan breaks down how his platform automates payments, getting surgeons paid in under 15 days while eliminating patient liability entirely.

We dive deep into Ryan's background in the OR, the lessons learned from the "Metal on Metal" hip recall, and why we need to move from "open enrollment confusion" to real-time, event-driven patient navigation.

If you are tired of administrative waste and want to see a model where doctors focus on care instead of claims, this episode is for you.

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) Let Doctors Be Doctors

(00:03:04) Ryan's Journey: From Anthropology to the OR

(00:07:00) Lessons from Medicare’s Acute Care Episode Demo

(00:10:46) Defining the "Bundle" vs. Fee-for-Service

(00:13:00) Value-Based Care = Outcome / Cost

(00:16:14) Why Orthopedics is the Perfect Starting Point

(00:18:32) Moving from "Elective" to "Discretionary" Care

(00:21:38) The Navigation Problem: Open Enrollment Fails

(00:31:48) Owning the Payment Rails: 15-Day Payments

(00:37:38) Automating the "Outlier Workflow"

(00:41:35) The "Metal on Metal" Hip Recall & Registries

(00:48:30) Expanding to Cardiology and Bariatrics

(00:53:03) The Moonshot: Removing the Business Burden from MDs

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 financial services and healthcare are 10 years behind everybody else from a technology adoption standpoint, insurance distribution is usually 10 years behind that." - Will Johnson

My guest this week is Will Johnson, Founder and CEO of Gyde, who is building what he calls the first "AI-native" insurance brokerage. After spending a decade at Oscar Health, Will realized that while brokers are the critical "entry point to care," they are operating without the infrastructure needed to scale in the modern era.

In this episode, we define exactly what "AI-native" means for an agency. It isn't just about buying software; it's a new holding company model that acquires agencies to deploy AI infrastructure - automating renewals and client service to effectively "triple the capacity" of the best brokers.

We dive deep into the difference between the traditional "asset aggregation" model (roll-ups) and Gyde’s "partner activation" model. Will also shares why Gyde raised a Series A just 14 weeks after launching and his moonshot vision to converge health insurance and wealth management into a single advisory role.

If you are an agency owner feeling the ceiling of growth, this episode maps out what the next generation of distribution looks like.

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) What is an "AI-Native" Brokerage?

(00:03:11) Will’s Journey: 10 Years at Oscar Health

(00:07:10) The Infrastructure Gap in Distribution

(00:12:27) Why Acquisition? The Case for Economic Alignment

(00:23:22) The Tech Stack: Automating Renewals & Service

(00:27:32) AI as a "Capacity Amplifier" vs. Replacement

(00:37:22) The Anti-Rollup: "Partner Activation" vs. "Asset Aggregation"

(00:46:12) Branding: Powered by Guide vs. Becoming Guide

(00:49:49) Raising a Series A in 14 Weeks

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 stopped doing what I didn't want to do anymore. It’s not hard to stop doing something you don't want to do... I didn't want to drink anymore." - Chris Leverett

In this incredibly vulnerable and powerful episode, we step away from the usual technical discussions of self-funding and insurance captives to tackle a pervasive, often silent issue in our industry: addiction and sobriety.

My guest is Chris Leverett, Executive Vice President and Managing Director of Employee Benefits at TexCap Insurance. While Chris is a veteran in the benefits space, today he shares his personal testimony of battling high-functioning alcoholism while trying to maintain a career, a marriage, and a family.

Chris opens up about the "boiling frog" effect of social drinking in the business world, the crushing weight of keeping up appearances, and the terrifying rock-bottom moments, including a lapse in insurance coverage during his daughter's premature birth, that finally led him to seek help.

We discuss the freedom found in admitting powerlessness, how he replaced the "monster" of addiction with the discipline of Ironman triathlons, and how to navigate the alcohol-heavy social scene of insurance events without losing your edge.

If you or someone you know is struggling in silence, this episode provides a blueprint for finding hope, help, and a better life on the other side.

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: TexCap Insurance & Going Up-Market

(00:04:48) Sobriety: It Doesn't Have to Be a "Life Sentence"

(00:09:26) The High-Functioning Trap & Social Lubricant

(00:13:24) Rock Bottom #1: No Insurance During a Crisis

(00:17:27) The Final Wake-Up Call & A Wife's Dream

(00:19:21) The Power of Admitting "I Am an Alcoholic"

(00:28:25) Trading Addiction for Ironman Triathlons

(00:38:30) How to Navigate Happy Hours Sober

(00:45:13) The Blueprint: Steps to Finding Help

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/

"Imagine getting a real-time snapshot of your health just by looking into your phone’s camera for 30 seconds." - Simon

My guests this week are Simon Spurr, Founder of VivaScore, and Chris Burns, a veteran benefits advisor with over 40 years of experience at firms like Mercer and Sequoia. They join the show to demonstrate a piece of technology that feels like science fiction but is actually here today: rPPG (Remote Photoplethysmography).

We discuss how this technology turns a standard smartphone camera into a diagnostic tool capable of measuring blood pressure, heart rate variability (HRV), and stress levels with medical-grade accuracy, no wearables required.

In this episode, we explore whether this "digital avatar" of employee health could become the new front door to primary care. We dive into how employers are using this data to spot "silent killers" like hypertension before they become claims, why engagement rates are hitting 50%+, and how this platform connects the "worried well" to actual care pathways.

Tune in to see how we can finally move from "sick care" to true preventative maintenance, all through an iPhone lens.

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) Is This App the Future of Primary Care?

(00:06:12) Global Healthcare: Why Costs Are Rising Everywhere

(00:08:02) Chris Burns: From Mercer to Sequoia to Tech Advisor

(00:12:45) Why Employers are Tired of "Point Solutions"

(00:22:26) How rPPG Technology Works (The Face Scan)

(00:30:18) The "What Next?" Strategy for Employers

(00:39:06) Why Everyone is Talking About HRV (Heart Rate Variability)

(00:44:37) Finding the "Silent Killers" in Your Population

(00:51:46) Gamification: How to Get 50% Engagement

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 asked him, 'What is it that you're teaching undergraduate students about benefits?’’…Just two slides. That blew me away." - Kyle Minick

My guest this week is Kyle Minick, Vice President of Employee Benefits at Summit Financial Group. Kyle returns to the show to expose a massive systemic failure: Universities are not teaching HR professionals how to manage their second-largest expense.

Kyle shares the shocking story of how he discovered that major university HR programs dedicate almost zero curriculum to healthcare strategy. Instead of complaining about it, he decided to fix it. We discuss the 6-week accredited college course he built from scratch to teach the next generation of buyers about Stop-Loss, PBMs, and TPA contracts before they enter the workforce.

But before we dive into the classroom, we dissect the broken market they are inheriting. We debate why Reference-Based Pricing (RBP) is failing in hospital-dominated markets like Texas, why relating prices to Medicare might be backfiring, and whether the government should step in to establish a "median price" for care.

Tune in to see how we can bridge the education gap and finally train buyers to demand better.

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) Why RBP Struggles in Texas Monopolies

(00:03:30) The "Medicare Price" Fallacy

(00:11:00) Should the Government Set a Median Price?

(00:25:00) The Education Gap: How Universities Failed HR

(00:29:25) The "Two Slide" Curriculum Problem

(00:33:00) Kyle’s Solution: Building an Accredited Benefits Course

(00:43:00) Teaching HR to Audit Their Consultants

(00:54:30) The Syllabus: Stop-Loss, PBMs, and Contracts

(01:07:00) How to Enroll & The Future of Benefits Education

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/

"Whoever makes patient care more convenient is likely to win." - Chris Yarn

My guest this week is Chris Yarn, Founder of Walk On Clinic, who joins me to explain why convenience is the ultimate currency in healthcare. Chris shares his journey from insurance broker to building a direct primary care (DPC) model that brings care directly to the employee's doorstep - literally.

Chris breaks down the "Walk On" model, which combines mobile on-site clinics, near-site access, and virtual care to achieve utilization rates that are double the industry average. We discuss why traditional "near-site" clinics often fail to engage employees, how nurse practitioners are the key to scaling primary care, and why the human connection is what truly drives ROI.

We also dive into the hard numbers, discussing how to prove ROI with real claims data (not just fuzzy math), and Chris shares his personal battle with cancer in 2024 that reinforced his belief in the importance of early detection and primary care access.

Tune in to the first episode of 2026 to learn why the future of healthcare is hyper-convenient.

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) Why Convenience is King in Healthcare

(00:07:37) The Legend of "Frank Mic Dropper"

(00:14:15) The "Walk On" Model Explained

(00:19:38) Mobile vs. Near-Site: The Utilization Difference

(00:26:24) Removing Barriers: No Build-Out Costs for Employers

(00:32:06) Scaling DPC with Nurse Practitioners

(00:39:27) How to Prove ROI with Real Data

(00:47:53) A Personal Battle: Chris's Cancer Journey

(00:53:09) The Future of Primary Care in America

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 doing something a little different to close out 2025. Instead of just looking back at December, we are ranking the biggest healthcare stories of the entire year on a Tier List, from "Not Impactful" to "Super Impactful."

We cover everything from the FTC suing the Big 3 PBMs and the J&J fiduciary lawsuit dismissal to the "bloodbath" of 2026 renewals and the explosion of GLP-1 usage.

Plus, we debut a new "Explain Like I'm 5" segment where I break down complex concepts like Reference-Based Pricing, Captives, and Stop-Loss using simple analogies involving candy shops and dirt bikes. Finally, we answer a listener question about building confidence as a young professional in the industry.

Chapters:

0:00 - Intro: Last Year in Healthcare

0:51 - Tier List

19:05 - Explaining Insurance To A 5-year-old

24:24 - Ask Spencer Anything