“I realized that 95% of the scheduled surgeries, like shoulder/knee repairs, back fusions, even some pelvic floor surgeries, they're no more effective than doing nothing at all, on average.” - Heidi Ojha Heidi Ojha, founder of Aware Health and recently a part of our MSK roundtable, joined me this week in studio to talk about why there are so many unnecessary surgeries performed in this country, why these surgeries happen in the first place, and how she’s trying to change that. Heidi’s worked as a clinician before founding Aware and estimates that about 95% of scheduled surgeries led to no more positive outcomes than doing nothing at all. This is especially alarming given that MSK is the biggest chronic spend on most health plans. Heidi and I also expanded on the notion that behavioral health plays a huge part in why and how so many surgeries are performed. Outside of the cost to the plan, unnecessary surgeries are often risky for the patient and can lead to complications, and even other surgeries that add even more risk. Join us this week to find out how we can stop unnecessary surgeries from happening. Chapters: 00:00:00 Meet Heidi Ojha 00:09:14 Exploring Non-Invasive Healthcare Options 00:15:33 MSK Chronic Spend 00:18:14 Managing Surgery Claims for Cost Savings 00:27:11 Incentivize Care, Not Profit 00:35:08 Claims Data Impact on Diagnostic Accuracy 00:41:13 The Necessity Of Imaging 00:50:14 Patient-Centered Approach To Healthcare Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen 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/ Key Words: #MSKHealthcareCosts #ConservativeCare #BehavioralHealthExpenses #EmployerPlanSpend #FeeForServiceModel #DataAccessibility #DiagnosticAlgorithms #PatientEmpowerment #HealthcareSystemsOptimization #AvoidingSurgeries #ChronicHealthcareSpending #PatientCenteredCare #selffunded #podcast MSK Healthcare Costs, Conservative Care, Behavioral Health Expenses, Employer Plan Spend, Fee For Service Model, Data Accessibility, Diagnostic Algorithms, Patient Empowerment, Healthcare Systems Optimization, Avoiding Surgeries, Chronic Healthcare Spending, Patient Centered Care, self funded, podcast

“In what other industry are you just not covered up with business if you're cheaper and better? This is America, for God's sake." - Keith Smith

This is a special episode with a special guest: Dr. Keith Smith from the Surgery Center of Oklahoma. Keith realized in the 1990s that the surgery system in America was exploitative and unfair, and decided to “rebel”, setting up a “parallel market” to sell surgeries direct to consumer at a listed price without any middlemen.

The idea of a consumer knowing the price ahead of purchasing a service (and not being charged afterward!) seems fundamental and obvious in every industry in our country, but it’s a completely revolutionary way of doing business in the healthcare industry. I talked with Keith about what made him realize that there had to be a better way of doing business, what it was like to be such a trailblazer, and why publicly posting his prices on his website was such a big deal.

If you want to hear an amazing conversation with a doctor who’s made real change in curbing price gouging in our industry, tune in this week on Self-Funded with Spencer with Dr. Keith Smith.

Chapters:

00:00:00 Meet Dr. Keith Smith

00:00:20 Spencer’s Son’s ER Trip
00:05:53 Transparent Surgical Bundle Pricing
00:22:17 Setting Surgical Prices Over The Phone
00:24:30 Allowing The Market To Drive Prices
00:40:21 Empowering Consumers By Posting Prices Online
00:42:30 Incentivizing Informed Healthcare Choices
00:53:03 Teaching Consultants On This Model
01:06:34 The Return To Free Market Healthcare

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen 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/

Key Words:

#DirectPricingModel #HealthcareTransparency #BundledSurgicalProcedures #PackagedPricing #SelfFundedEmployers #ZeroDeductible #ConsultantsInHealthcare #FreeMarketHealthcare #HealthcareCostSavings #TransparentHealthcare #BetterHealthcareChoices #ConsumerCentricHealthcare #selffunded #podcast

Direct Pricing Model, Healthcare Transparency, Bundled Surgical Procedures, Packaged Pricing, Self Funded Employers, Zero Deductible, Consultants In Healthcare, Free Market Healthcare, Healthcare Cost Savings, Transparent Healthcare, Better Healthcare Choices, Consumer Centric Healthcare, self funded, podcast

"No one wins alone. And you know what? You can't do it on your own." - John Butler

John Butler, from JB Benefits Consulting, joined the show this week to talk the big-picture future of health insurance.

From AI sales tools to ICHRA plans to Health Sharing Plans, John Butler is constantly thinking about the future of this industry, and it was fun to hear about how his life experience as a consultant led him to where he currently is.

John and I also focused on making Americans actually healthier and how that could shift us away from the current “sickcare” mentality into an actually health-focused healthcare system.

Join us this week on Self-Funded as we focus on the future!

Chapters:

00:00:00 Meet John Butler

00:02:48 Driving Awareness of Health Solutions in Businesses
00:08:29 Managing Insurance Benefits for Employer Clients
00:12:46 Revolutionizing Sales and Marketing with AI Voices
00:15:38 Regenerative Medicine: Healing with Stem Cells
00:18:11 Health Sharing: A Cost-Effective Employer Solution
00:24:08 Real-time Reimbursements and Efficient Healthcare Solutions
00:31:47 Customized Healthcare Benefits for Cost Efficiency
00:34:22 Innovative Healthcare Models for Cost-Effective Care
00:51:17 Health Sharing Communities Transform Healthcare Insurance
00:52:30 Real-time Reimbursement Health Sharing Plans

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen 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/

Key Words:

#MarketingAwareness #BrokerBusiness #AIinSales #StemCellHealthcare #EmployerCostSavings #HealthcareTechnology #EmployeeBudgetOptimization #CostSavingsStrategies #FutureHealthInsurance #HealthInsuranceInnovation #SelfInsurance #FullyInsuredPlan #selffunded #podcast

Marketing Awareness, Broker Business, AI in Sales, Stem Cells, Employer Cost Savings, Healthcare Technology, Employee Budget Optimization, Cost Savings Strategies, Future Health Insurance, Health Insurance Innovation, Self Insurance, Fully Insured Plan self funded, podcast

Does bone-on-bone contact always lead to pain? What's the best way to get good, new solutions in the hands of brokers? How many MSK surgeries are really necessary?

Chris Hamilton, Heidi Ojha, and Mark Testa joined me in studio to answer those questions and many more in this special bonus episode of Self-Funded with Spencer, The MSK Roundtable.

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen 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 always knew there was more. I always knew there was a different dimension to what this personnel or HR thing was." - Monica Panetta Monica Panetta, Chief People Officer at ParetoHealth (a show sponsor and the company I work for), joined me for an evening podcast in studio as we talked all things HR/People, starting with why the industry has moved away from saying HR. Monica’s so well-versed in the field that she actually started the HR program at her college as she was attending it, and the curriculum is still taught today. We talk how she got started in the field, how the field has evolved post-COVID, and how she made her way to Pareto. Join us this week to find out a bit about Pareto, and a lot about what it means to be a Chief People Officer. Chapters: 00:00:00 Meet Monica Panetta 00:01:38 Employee-Centric Leadership: How HR Has Evolved 00:02:38 Transitioning From “HR” to “People” 00:05:00 Getting Started In HR 00:13:16 Monica’s Career Journey 00:21:31 Strategic Benefits Management As An HR Employee 00:23:31 Empowering Employees Through Mental Health Support Programs 00:24:32 Promoting The EAP Program Internally 00:40:13 Recognizing Every Employee’s Journey 00:41:39 Cultural Compatibility Evaluation In The Hiring Process Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen 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/ Key Words: #ChiefPeopleOfficer #HRterminology #CareerExploration #FinancialAcumen #EmployeeAssistancePrograms #UtilizationStrategies #EmployeeExperience #Onboarding #CultureFitAssessment #HRroles #WorkplaceWellness #JobSatisfaction #selffunded #podcast Chief People Officer, HR terminology, Career Exploration, Financial Acumen, Employee Assistance Programs, Utilization Strategies, Employee Experience, Onboarding, Culture Fit Assessment, HR roles, Workplace Wellness, Job Satisfaction, self funded, podcast

"I think the more questions the employer asks, and just the deeper that they're willing to think about this and have already thought about it, the more they're able to buy into this mission." - Russell Pekala

Russell Pekala, co-founder of Yuzu Health, joined me in studio for this week’s episode focused on controlling pharmacy costs and emergency claims.

Yuzu Health is a startup in the TPA space aiming to change how the claims process work. Rather than having the member get care and then deal with lowering costs after the fact, Yuzu pre-adjucates claims when possible, issuing a credit card to members to pay for care and avoiding huge bills on the backend.

In addition to the claims talk, Russell and I chatted about his Harvard days, what founding a dating app was like, and the ramen-related health accident that pushed Russell into the healthcare startup space.

Chapters:

0:00 - Meet Russell Pekala

5:53 - Working On A Dating App At Harvard
08:26 - The Art and Science of Stop Loss Insurance
18:47 - Yuzu's Innovative Startup Health Insurance Solution
20:44 - How Did Yuzu Get Started?
21:45 - Improving Healthcare Transparency and Accessibility with Yuzu
28:48 - Navigating Pharmacy Costs with SmithRX
32:51 - Revolutionizing Emergency Claims in Healthcare
39:26 - Employers Seeking Alternative Healthcare Approaches
54:26 - Revolutionizing healthcare through predictive wearables

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen 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/

Key Words:

#healthcare #healthinsurance #startups #technology #costcontrol #pharmacy #employers #predictivedata #wearables #futureofinsurance #selffunded #podcast

healthcare, health insurance, startups, technology, cost control, pharmacy, employers, predictive data, wearables, future of insurance, self funded, podcast

“To me, a private equity firm should never look at a healthcare vertical and say, God, there's opportunity there. That means that there's profit exploitation to be had in those areas.” - Taylor Rogers

Taylor Rogers, former professional baseball pitcher turned insurance consultant, joined me this week for a podcast focused on profit exploitation in the current healthcare system, and what we need to do as an industry to bring back competition and lower prices.

There are a huge number of people in this space who used to be college or professional athletes, so I was excited to hear what led to Taylor’s baseball career and what also led him to insurance.

Competition is an inherent component of capitalism, one that leads companies to try to lower prices as much as they can to appeal to consumers, but it’s incredibly absent from this field. Join Taylor and I this week on Self Funded as we try to figure out why.

Chapters:

0:00 - Meet Taylor

07:38 - Consistency, in Baseball and Comedy
09:36 - The Importance of Failure in Growth
12:50 - The Evolution of Insurance Consulting Strategies
18:00 - bridging the gap with accessible communication
23:28 - Navigating Risk Management Challenges in Insurance
25:01 - Guiding employees through the healthcare system
31:26 - Limitations of 24/7 emergency care navigation
35:16 - Strategic guidance and business acumen in consulting

46:29 - The Potential of Direct Primary Care

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen 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/

Key Words:

#insurance #healthcare #consulting #businessstrategy #privateequity #affordablehealthcare #riskmanagement #selffunding #carenavigation #consultingpractice #podcast #selffunded

insurance, healthcare, consulting, business strategy, private equity, affordable healthcare, risk management, self funding, care navigation, consulting practice, podcast, self funded