Episodes

Monique Burke buys more stop-loss than almost anyone in this business, and the rate is the last thing she looks at. She built OneDigital's stop-loss center of excellence starting with a spreadsheet, an offshore data team, and one other person. It's doubled year over year since. Now it covers everything from marketing a case through claims reimbursement, plus TPA and captive selection, because every time they solved one problem another piece of the stack turned out to be broken. We get into wha...

Two kids called Brett Morris to tell him he saved their father's life. The man had cancer and had decided not to fight it. He'd spent his working life saving for their education and he wasn't going to spend it on himself. Samaritan Fund covered his care, he changed his mind, and he beat it. That's the business. Brett finds people facing catastrophic medical costs, sources third-party funds to cover their premiums and out-of-pocket maximum, and the employer's plan gets relief as a byproduct. He...

"I look at it as an opportunity for everybody else. You're already seeing people on LinkedIn saying, I can't wait for the disruption." - Lamont Thurston, BeneRe In this episode of Last Month in Healthcare, Producer Nathaniel and I sat down with Lamont Thurston, founder and CEO of BeneRe, to break down the biggest healthcare news stories of August 2026. We started with Aon's $17 billion all-cash acquisition of USI, a deal that lit up LinkedIn for a week straight. KKR took USI private for $4.3 b...

There are roughly 9,000 ambulatory surgery centers in the United States, and most of them aren't running at capacity. Ronen Elefant figured out that he didn't need to build another one; he just needed to reach the ones already sitting half empty. My guest this week is a trauma surgeon in Pennsylvania who has been flying his own plane to work for fourteen years. About a year ago he turned that into a business: rent time at an ASC, fly in, do the cases, fly home. One bundled price covering the fa...

This episode was recorded live on LinkedIn with Bill Dembereckyj, CFO of Imagine360, and it's a look at renewal season from the seat that ultimately signs off on it. Bill walks through three real cases: a 250-life senior living facility staring at a 50% increase, an 85-life restaurant group facing a $450,000 jump, and a 140-life private school looking at 60%. We get into why CFOs are being brought in far too late, why Bill started his own plan renewal in Q1, and what happens when finance only ...

Whole genome sequencing costs about $1,000 today. Ten years ago it was fifteen. Clinical guidelines already say kids with epilepsy or developmental delay should be escalated to it, and more than half of them never are. My guest this week is Joshua Resnikoff, founder of Sunstone Health and a former bench scientist at Harvard. He came to this the hard way. His middle son started spiking 105-degree fevers at 18 months old, and it took three years and several pediatricians to name the condition. W...

Half of what this pharmacy compounds is GLP-1s. The other half is a category most benefits professionals have never had to think about, and probably will within a few years. I got a tour of Optimal Balance Pharmacy's facility and sat down with co-owner Rick Manuel to talk through what peptides actually are, how the FDA's category two list works, and what happens if those compounds move to category one. We get into why BPC-157 has a better safety profile than ibuprofen and the mechanism behind ...

Everyone in this market is optimizing for the wrong thing. Consumers want the most weight loss for the cheapest price, and up to 40% of what they're losing is muscle. My guests this week are Nicholas Syhler, a former cardiologist who left his residency to work upstream of the heart attacks he was treating, and Paul Elsass, an exercise physiologist who spent years in startup land before landing on the one root cause nobody had solved. Their company, Embla, runs a coach-first GLP-1 program out o...

Katy Talento ran healthcare at the White House Domestic Policy Council and helped push through the price transparency executive order. Now she runs health plans for a living, including for the convent where she once lived as a nun. She spends this episode on why a post-network world keeps hitting the same wall: the three-way contracts between carrier, TPA, and provider that make the network Plan A by force. She explains why she thinks those provisions violate the Sherman Act, what DOJ has start...

My guest this week is Billy Potter, now CEO of Snellings Walters, and we spend this episode on "the Switch," his firm's process for moving employers from fully insured to self-funded. Billy explains why he thinks it has almost nothing to do with insurance and everything to do with changing who a business trusts to lead them. We get into why "does that make sense?" is the worst question in sales, why he asks prospects "where did I lose you?" instead, and why he believes most deals aren't lost on...

"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...