Episodes

"Generic drugs are not the costly drugs. A 100% increase on a relatively inexpensive generic may not even be noticeable." In this episode of Last Month in Healthcare, Producer Nathaniel and I sat down with Sean McGowan of Centivo to break down the biggest healthcare news stories of July 2026. We started with the proposed tariffs on generic drugs - 100% in 2028, 200% in 2029 - and what that actually means when India supplies roughly half of U.S. generic volume and China supplies most of the act...

"If you're expecting to pay $50k, but it hits an outlier clause, you could be paying upwards of three, four, five, six hundred thousand dollars." What if the single biggest driver of your high-cost claims isn't your discount, your network, or your utilization, but a contract provision almost nobody in this industry has ever read? My guest this week is Ryan Bojrab, who leads new solution development at Aon and came into this business through a channel almost nobody uses: he started his career a...

"What used to be a once-a-year catastrophic claim is now happening every single week across the stop-loss market." We're back for the fourth year in a row with our annual whiteboard review of Tokio-Marine HCC’s Stop Loss Report. Drawing from a massive block of over $2 billion in force premium, this report gives us one of the clearest, most objective looks at what is actually happening under the hood of self-funded health plans across the country. In this episode, I break down the biggest trend...

"I relate it to one of the Wizard of Oz characters... I've seen behind the curtain. I know how it's all put together." What happens when a man who spent nearly five decades inside every corner of the self-funded industry decides his final act is to give the playbook away?My guest this week is Charlie Gragg, a true first-generation veteran of self-funding. Charlie started in the late 1970s underwriting stop-loss cases on napkins from payphone booths, went on to run his own TPA, and has now semi-...

"Employers have the right to expect much more from their benefit consultants than ever before. This isn't just about managing the fully insured renewal anymore." In this week’s special bonus episode, I’m joined by Dr. Dena Bravata, physician, healthcare entrepreneur, and Clinical Advisor for ParetoHealth, to break down the findings from Pareto’s inaugural 2026 State of Healthcare Spend Report. Based on responses from nearly 1,600 CEOs, finance, and HR leaders, Dena and I unpacked why employers...

"This is why insurance is such a beautiful problem... there is no solution. There are only psychological or philosophical answers to it." What if the rising cost of health insurance is a deeply ingrained philosophical problem? My guest this week is Tom Stein, CEO of American Trust Administrators (ATA). But this episode isn’t just a tactical breakdown of stop-loss and aggregate underwriting; it is a masterclass in the history, psychology, and economics of the U.S. healthcare system. Tom and I ...

"When you see $6.5 billion in healthcare fraud, we all end up absorbing that in the commercial market." In this episode of Last Month in Healthcare, Producer Nathaniel and I sat down with Sid Sinha, founder and CEO of Avant/Nara Health, to break down the biggest healthcare news stories of June 2026. We started by looking at the DOJ's massive $6.5 billion healthcare fraud crackdown and what 1,400 revoked provider privileges actually means for the commercial market. We also tackled the stark re...

"Fee-for-service has led to transactional primary care where providers have 10 or 15 minutes to code as much as they can just to keep the doors open. We’ve moved away from the idea of primary care as the quarterback of the entire health ecosystem." My guest this week is Matt Taylor, VP of Sales at Castlight. Having spent his career navigating the complex landscape of health plans, telehealth, and enterprise analytics, Matt has a unique vantage point on why our current approach to "sick care" is...

"The most unused cash in the country right now is the money you're wasting on healthcare... If you save a million dollars a year, that's $20 million in market cap." Is your company treating its healthcare spend like a business strategy, or are you just writing a blank check to the major insurance carriers every year? In this episode, I was (finally) joined by Mark Cuban, Ann Lewandowski, and Matt Miron. After answering how he would approach healthcare for a hypothetical company on Shark Tank,...

"There's no reason why I should be able to do an infusion for 50% of the cost of what it's currently being allowed at. We've seen allowed amounts between $57,000 and $80,000 for Keytruda. I typically can have that in the home at $29,000." My guest this week is Jake Velie, CEO and co-founder of National Integrative Health (NIH). After spending the first half of his career in the clinical "meat grinder" of value-based care on the provider side, Jake realized the only way to truly fix the system w...

"We did this survey with a third-party consulting group who talked to 2,000 brokers. Their perception was that 25% of bills are going to be balance bills; it's actually 3%." Is Reference-Based Pricing (RBP) still something that just creates endless problems for HR? My guest this week is Jeff Bak, CEO of Imagine360. Jeff brings 30 years of healthcare and private equity experience to the table, and he's leading the charge to rebrand and evolve RBP from a defensive "pay and defend" model into a c...

"The average marketplace deductible grew by about $1,000 per person in 2026. Premium payments increased by an average of 58%... We might be seeing the death throes of the fully insured market." Welcome back to Last Month in Healthcare! This month, Spencer, Nathaniel, and special guest Jonathan Lopez break down the most impactful healthcare headlines and regulatory shifts from May 2026. The episode kicks off with a discussion on the sudden resignation of FDA Commissioner Dr. Marty Makary follow...

"Within five years of calling us charlatans, that hospital system was sued for multiple millions of dollars by their participants... You can go from charlatan to change agent fast." Is history about to repeat itself in the health benefits world? My guest this week is Jay Gepfert, Managing Partner of Culpepper RFP. Jay spent his corporate career on the retirement and 401(k) side of the industry, where he witnessed a massive fiduciary paradigm shift 15 years ago. Driven by regulatory changes an...

"Insurance is there for when you're sick or when something goes incredibly wrong. It's not there for prevention." The traditional healthcare system is designed to treat you when you are sick. You go to a doctor for 15 minutes, get a basic blood panel, and if you are within the "reference range," you are told you are fine. The goal of this system is to get you from -1 back to 0. My guest this week is Prabhat Dhar, the Head of Growth for Superpower, a new platform that wants to take you from 0 t...

"To quote my business partner, a broker makes you broker." To celebrate the 5-year and 250th-episode anniversary of the podcast, we recorded a special live panel in front of an audience featuring three of the most forward-thinking minds in the benefits space: Chris Hamilton (Hotchkiss Insurance), Taylor Rogers (CCIG), and Seth Denson (Acrisure). In this "State of the Union" episode, we tackle the existential crisis facing mid-market employers and the healthcare industry at large. The panel hol...

"If we can do it for Whole Foods, which is a very large organization, why can't we do this for other employers?" Is the era of relying on national, opaque "BUCA" networks finally coming to an end? My guests this week are Blake Allison, CEO of Employers Health Network (EHN), and Philip Eaves, from Ascension. Together, they break down the exact blueprint they used to build a direct-to-employer, high-performance network for Whole Foods - and how they are scaling that exact same model for self-fun...

"Employers are at a point where they want to help create that ideal healthcare system, not the one that they have been dictated to." Is your company's health plan actually keeping your employees healthy, or is it just waiting for them to get sick? My guest this week is Ben Miller, Chief Revenue Officer at Premise Health, the nation's largest direct healthcare provider operating over 850 onsite and near-site wellness centers. Ben joins the show to discuss why the traditional fee-for-service mod...

Welcome back to Last Month in Healthcare! This month, Spencer and Nathaniel sit down without a guest to unpack the biggest healthcare headlines and regulatory shifts from April 2026. From state-level crackdowns on PBMs to a surprising loophole that allows urban hospitals to siphon rural hospital aid, the guys dissect the policy changes and market moves that are actively reshaping the industry. They also discuss the affordability crisis driving a 26% surge in ACA Bronze plan enrollment, Amazon's...

"I would rather take this risk because I will never give another dime to a fully-insured carrier as long as I live." In an era of double-digit medical trend and skyrocketing fully-insured renewals, is the traditional insurance broker obsolete? This week, my guest is John Kountz, a benefits consultant at Frost Insurance who believes that the days of the "renewal carousel" - shopping the big 4 carriers and accepting double-digit increases every year - are finally over. In this episode, John shar...

"I'm going to leave the ladder, I'm going to leave the window open, I'm going to leave the lights on." This week on the podcast, I am joined by Rob Gelb, CEO of Vālenz. Rob has led Vālenz through an era of explosive growth, transforming the company from a 60-person shop in 2018 into a 550-employee powerhouse driving innovation in the self-funded healthcare space. But this episode isn't just about healthcare - it’s about leadership, vulnerability, and knowing when to pass the torch. In a surpr...

"We are not going after the high. What we're going for is symptom relief. Based on our research, employers are going to be saving $5,000 per participant per year." Is it time for employers to start covering medical cannabis? My guest this week is Emily Fisher, Founder of LeafWell. As a stage 4 breast cancer patient, Emily experienced firsthand the therapeutic benefits of cannabis when traditional opioid painkillers failed her. However, she also experienced the frustration of navigating the dis...

"Revolutions are never won by the ruling class... if you want to fix healthcare, you have to be willing to accept a negative sum game. Someone is losing." Why are self-funded employers still paying for healthcare on a "fee-for-service" basis, where every single transaction is billed separately with zero guarantee of a positive outcome? My guests this week are Francois and Jeremy from XO Health, a new type of health plan built explicitly for self-funded employers. Instead of relying on traditio...

"I can't fathom a world where employers are expected to budget and create a plan for their future without understanding what the costs of their healthcare are. Everything needs to be grounded in fact and truth." Is the traditional insurance network obsolete? My guest this week is Amy Wykoff, Chief Product Officer at Nomi Health. After starting her career building foundational AI models at IBM Watson, Amy pivoted to healthcare with a massive new challenge: rebuilding the insurance network from ...

"There’s no bad risk, there’s just mispriced risk... we helped one carrier achieve a 29.1% improvement in their loss ratio just through better risk selection." How do stop-loss carriers and self-funded employers accurately predict which groups are going to run well and which ones are about to see skyrocketing claims? My guest this week is Ali Panjwani, Founder and CEO of Merit Medicine. Ali transitioned from a career in biotech and pharmaceutical public policy, where he helped price and launch...