"In what other industry could a purveyor put out 99% bad bills and stay in business?" - Linda Komisak

“They're diagnosing things for things that you don't even have. And that’s scary.” - Kimberly Carleson

Kimberly Carleson, CEO of US Beacon, and Linda Komisak, founder of Upturn Consulting LLC, joined me to talk about two critical ways of increasing healthcare transparency: claims reviews and quality metrics.

These two topics are key to understanding why the healthcare system is so broken. If you buy any other service, you can (a) expect to only be billed for the services that were performed and (b) have the ability to research the quality of vendors and pick the best one.

Why can’t we do that in healthcare?

This is an incredibly informative episode, and we cover more than just those two topics including nurse staffing shortages, how to identify the best hospital systems, and why it’s so important to gather feedback from nurses.

Chapters:

00:00:00 Meet Kimberly Carleson and Linda Komisak
00:01:11 Taking Feedback from Nurses
00:06:30 Nurses' Impact on Hospital Quality
00:11:31 Why Are There Nursing Shortages?
00:18:18 Nurse Advocacy for Enhanced Patient Experience
00:25:18 Quality Metrics and Patient Billing Integrity
00:39:11 The Importance of Nurse Feedback
00:49:17 Surgeon Incentives in Billing
00:58:12 Healthcare Cost Savings Through Billing Review

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 Quality, Nurse Insights, Patient Experience, Claims Integrity, Quality Metrics, Upcoding Practices, Nursing Shortage, Billing Transparency, Nurse Anonymity, Healthcare Billing, Hospital Quality, Nurse Feedback, insurance, nursing, healthcare, health insurance, podcast, self funded, self funding

#HealthcareQuality #NurseInsights #PatientExperience #ClaimsIntegrity #QualityMetrics #UpcodingPractices #NursingShortage #BillingTransparency #NurseAnonymity #HealthcareBilling #HospitalQuality #NurseFeedback #insurance #nursing #healthcare #healthinsurance #podcast #selffunded #selffunding

"Quit tolerating mediocrity. Go get in action. Find the right broker consultant that will take you to a new place. Don't give up hope." - Scott Conard

Dr. Scott Conard tragically lost 3 patients one summer to unexpected heart problems, and immediately changed how he thought of healthcare.

This week on Self-Funded, we talk about “conscious capitalism”, and by extension “conscious healthcare”, what the 7 numbers that everybody needs to know are, and how we need to change the way we approach health risk.

Chapters:

00:00:00 Meet Scott Conard
00:02:08 Crony Capitalism In Healthcare
00:06:34 Focus On Aligning Incentives
00:15:38 Holistic Well-being Approach To Healthcare
00:27:12 Revolutionizing Self-Insurance
00:37:54 Healthcare Advocacy And Engagement
00:42:22 How Do We Get People To Care About Their Health?
00:49:08 Primary Care's Role in 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:

Conscious Capitalism, Employer Driven Healthcare, insurance, healthcare, health insurance, Empowering Employers, Incentive Programs, Risk Management, Alternative Risk, health risk, fixing healthcare, selffunded, podcast

#ConsciousCapitalism #EmployerDrivenHealthcare #insurance #healthcare #healthinsurance #EmpoweringEmployers #IncentivePrograms #RiskManagement #AlternativeRisk #healthrisk #fixinghealthcare #selffunded #podcast

"It's progress we couldn't have envisioned decades ago." - Oscar

“I felt interested in being part of something bigger than my practice and something that will impact even more people that I was able to in the hospital.” - Carolina

Dr. Oscar Bronsther and Dr. Carolina Escobar from Interlink joined me this week to discuss the exciting and scary world of cell and gene therapy, CRISPR, and how we fund these amazing medical advances.

In addition to me attempting to act smart enough to be in the same room as these two, we covered their wholistic approach to this emerging scientific field, which promises potential cures for rare and debilitating diseases, but often comes with 7-figure price tags. The rare genetic diseases are known as “orphan diseases”, and there have been some recent incredible advances in detecting them early on in life.

We talked about what this all means for individuals as well as the insurance space as a whole, and how it has the potential to increase medical costs in this country even further.

Chapters:

00:00:00 Meet Oscar and Carolina
00:09:16 Genetic Therapy Solutions for Orphan Diseases
00:14:39 Detecting and Targeting Single Gene Mutations
00:26:52 CRISPR Technology
00:30:08 Equitable Access To Gene/Cell Therapy
00:37:21 How Do We Finance This?
00:46:13 The Ethical Concerns Of Cell/Gene Therapy
00:59:45 Economic Implications of This Technology

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:

Rare Diseases, Gene Therapy, CRISPR technology, CRISPR, Healthcare Skepticism, Healthcare Warranties, Medical Revolution, Healthcare Advances, Orphan Diseases, Cell Therapy, Healthcare Innovation, self funded, podcast

#RareDiseases #GeneTherapy #CRISPRtechnology #CRISPR #HealthcareSkepticism #HealthcareWarranties #MedicalRevolution #HealthcareAdvances #OrphanDiseases #CellTherapy #HealthcareInnovation #selffunded #podcast

"If my child needs a gene therapy to live, they should get it and anyone's child should. So let's figure out how to pay for it." - Jake Frenz

On the final of four podcasts filmed at a recent healthcare thinktank I hosted in Frisco, Texas, Jake Frenz, the founder and CEO of SmithRx, joined me to share his journey from the Marine Corps to Pharmacy Benefit Management, and what makes him so passionate about ending prescription drug price gouging.

Jake and I discussed what some of the core challenges are in the PBM space, why he was so inspired by Mark Cuban’s venture Cost Plus Drugs, and what the “watershed” moment in US healthcare will look like.

I’m grateful to have had the opportunity to talk to one of the best minds in the PBM space, and I hope you enjoy this week’s episode of Self-Funded with Spencer.

Chapters:

00:00:00 Meet Jake Frenz
00:08:06 Consumer-Driven Healthcare
00:15:53 Transparency in the PBM Industry
00:20:57 The “Watershed Moment” in US Healthcare
00:36:14 Mark Cuban's Innovative Healthcare Venture
00:39:34 Subscription-Based Models Disrupting Pharmacy Competition
00:52:34 Revolutionizing Healthcare
00:55:14 Empowering Americans to Drive Healthcare Reform

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 Insights, Pharmacy Benefit Managersm, Simplify Healthcare, Watershed Moment, Cost Plus, cost plus drugs, mark cuban, Big Picture Healthcare, American Spirit, Healthcare Innovation, Affordable Medications, price gouging, self funded, podcast

#HealthcareInsights #PharmacyBenefitManagers #SimplifyHealthcare #WatershedMoment #CostPlus #costplusdrugs #markcuban #BigPictureHealthcare #AmericanSpirit #HealthcareInnovation #AffordableMedications #pricegouging #selffunded #podcast

"I would say a lot of it is education, helping both the member and the provider realize that it's okay for them to get healthcare in home." - Dan Cochran

On the third of four podcasts filmed at a recent healthcare thinktank I hosted in Frisco, Texas, Dan Cochran, CEO of Cochran Health Ventures, joined me to discuss infusions, in-home healthcare, why the future of healthcare will be personalized, and how we educate consumers.

I, and many others in this industry, consistently advocate that much of healthcare is way too complex for the average consumer and that they don’t know how to utilize the solutions when they are available. Dan and I discussed that problem, ways that people can educate themselves, and how we can push for more healthcare education in America.

Chapters:

00:00:00 Meet Dan Cochran
00:09:58 The Future Of Self-Insurance for Employers
00:12:09 The Payer-Provider Dynamic
00:19:19 How Do Consumers Navigate Healthcare?
00:28:29 Sustainable Business Success By Focusing On Clients
00:36:12 We Can Fix Healthcare By Focusing On Patients
00:42:01 Healthcare Cost-Saving Strategies
00:45:34 Empowering Consumers Through Healthcare Education

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:

Self Insurance, Cost Management, Healthcare Solutions, Client Retention, Consumer Education, Healthcare Complexity, Care Appropriateness, Plan Design, Payer Insights, Infusion, Home Infusion, Remote Specialty Care, Future Healthcare, Healthcare, Insurance, self funded, podcast

#SelfInsurance #CostManagement #HealthcareSolutions #ClientRetention #ConsumerEducation #HealthcareComplexity #CareAppropriateness #PlanDesign #PayerInsights #Infusion #HomeInfusion #RemoteSpecialtyCare #FutureHealthcare #Healthcare #Insurance #selffunded #podcast

"There can be a better path forward. We don't have to remain adherent to the system that is built against us. It's just going to take some rolling up of the sleeves and a commitment to it." - Shawn Sanford

This week, another ParetoHealth colleague joins the show: Shawn Sanford, RVP of Sales and Pod Leader.

Shawn and I discussed his transition from pro baseball to ancillary benefit sales to Pareto, and what he learned from each step along the way.

We also discuss some of the biggest problems in this industry and why they excite Shawn so much, and what he sees as the single biggest case of “highway robbery” in healthcare.

Join us this week on Self-Funded as we discuss the opportunity we have to fix healthcare.

Chapters:

00:00:00 Meet Shawn Sanford
00:14:02 An Unexpected Career Transition Into Insurance
00:22:43 The Importance Of Networking In Sales
00:25:48 Building Trust With Brokers
00:31:39 Transition to ParetoHealth
00:42:25 Having The Right Sales Process
00:51:49 Equity and Transparency in Healthcare
00:55:54 Aligning Incentives Properly

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:

Sales Success, Career Transition, Relationship Building, Healthcare Reforms, Insurance Industry, Education Matters, Sales Process, Healthcare Awareness, Healthcare Challenges, Healthcare Transformation, Sales Networking, Career Advancement, self funded, podcast

#SalesSuccess #CareerTransition #RelationshipBuilding #HealthcareReforms #InsuranceIndustry #EducationMatters #SalesProcess #HealthcareAwareness #HealthcareChallenges #HealthcareTransformation #SalesNetworking #CareerAdvancement #selffunded #podcast

“There's a reason why every insurance carrier likely owns or is owned by a pharmacy benefit management company, that’s one of the ways that they can drive revenue." - Kristen Rivers

My guest this week, Kristen Rivers from ParetoHealth, is one of the strongest healthcare advocates I know.

This week on Self-Funded, Kristen and I discuss her upbringing, how that affects the work she does today, what caused her to leave a position at the biggest insurance company in the world, and why she believes in the work she’s doing at ParetoHealth today.

Along the way, we talk about some of the biggest problems in healthcare, from the user experience to misaligned incentives that profit from driving up the cost of healthcare.

The main takeaway: we need more advocates like Kristen if we’re going to fix this industry.

Chapters:

00:00:00 Introducing Kristen Rivers
00:08:16 Kristen’s Introduction To Health Insurance
00:16:10 The Importance of Data Transparency and Choice
00:19:50 Advocating For Better Healthcare
00:33:23 Renewal Increases in California Insurance Market
00:35:18 Medicare Cuts
00:41:18 Employer-led Healthcare Plans
00:51:06 Misaligned Incentives
00:53:26 Driving Down Healthcare Costs through Employer Advocacy

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 Industry Transition, Transparency Matters, Navigating Healthcare, California Insurance Market, Medicare Cuts, Self Funded Plans Healthcare Quality Metrics Industry Complexities, Employer Advocacy, CAA Regulations, Healthcare System, Cost Management, self funded, podcast

#HealthcareIndustryTransition #TransparencyMatters #NavigatingHealthcare #CaliforniaInsuranceMarket #MedicareCuts #SelfFundedPlans #HealthcareQualityMetrics #IndustryComplexities #EmployerAdvocacy #CAARegulations #HealthcareSystem #CostManagement #selffunded #podcast

Luke Aslesen, founder of INFRMD, joined me a few weeks ago for the podcast, and we also filmed this extended interview after, in which Luke asks me about my comedy background, upbringing, relationship with my wife, and more.

If you’re a long-time listener of the podcast and want to get to know me a bit better, or you just stumbled onto the podcast and want to know who I am, this is a great place to start!

Chapters:

00:00:00 Luke/Spencer Q+A
00:00:35 When/how did you think of bringing your entertainment background into insurance?
00:01:35 What’s the biggest thing you’ve taken from stand-up in the work you do today?
00:02:37 How did your upbringing affect the work that you do now?
00:03:36 How do you not burn out with all the work you do?
00:05:03 How do you balance doing both creative and logical work?
00:06:33 How do you keep yourself accountable?
00:08:57 Have you already seen the rewards of the work you’re putting in, or is that down the road?
00:10:57 What does “justice” mean in the work that you do?

00:12:31 How do you keep the hope alive?

00:13:54 What do you do to keep yourself motivated?

00:15:20 Where do you find the time to do all of those things?

00:16:41 Where did Tom Broker come from?

00:18:21 Favorite comic of all time?

00:19:57 What has the response been to using comedy?

00:22:03 Does using comedy open doors for you?

00:24:29 Why don’t more people build personal brands?

00:26:30 Where did your love for people come from?

00:27:42 If you could have a 4-hour dinner with anybody, who would it be and why?

00:28:46 How has your relationship with your wife shaped your success?

00:35:53 When you’re retired, how do you want to be remembered?

00:36:44 Tell us about your car.

00:39:08 Favorite comedy movie and series?

00:41:05 Favorite drama movie and series?

00:42:41 If you could have one message on a billboard that everyone could see, what would it be?

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:

#QA #spencersmith #infrmd #insurance #entertainment #standup #creativity #justice #accountability #comedy #celsius #joerogan #mustangs #selffunded #selffunding #podcast

QA, spencer smith, infrmd, insurance, entertainment, standup, creativity, justice, accountability, comedy, celsius joe rogan, mustangs self funded, self funding, podcast