66. Self-Funding Explained in 60 MINUTES with Spencer Smith

In this episode, Donovan Ryckis, CEO of Ethos Benefits, sits down with Spencer Smith (SVP of Sales at Pareto Health and host of Self-Funded with Spencer) to unpack captives, stop-loss, PBMs, and the steps plan sponsors can take to finally regain control of healthcare spend.Spencer shares how short, educational content helped bring self-funding concepts downstream, why captives act like “bumpers” against catastrophic renewals, and where employers should start: data access, pharmacy, and a long-term strategy. They cover real-world examples—NICU and oncology claims, lasers, biosimilars, international sourcing—and discuss why employee contributions keep rising when nothing seems to change.You’ll walk away with a framework to move from guaranteed cost to variable cost with discipline, reduce claims costs without cutting benefits, and ask your broker the questions that matter.What You’ll Learn:Self-funded fundamentals and the role of stop-lossHow group captives improve predictability across renewalsThe first lever to pull: pharmacy strategy and data accessWhy “reduce claims” means smarter pricing and site-of-care, not less careThree questions every plan sponsor should ask at renewal: Why these solutions, specifically? How are you paid, where, and how often? What’s the long-term strategy beyond this 12-month cycle?POSIWID: the outcomes your system delivers define its true purposeTime Stamps:00:00 – Welcome & Guest Introduction02:10 – Spencer’s Journey into Self-Funding06:20 – Breaking Down Stop-Loss & Captives10:45 – Fully Insured vs Self-Funded Explained15:12 – The 401(k) Analogy for Health Plans19:20 – Why Short-Form Education Works in Benefits24:05 – Pharmacy Costs & Where to Start Saving28:48 – Broker Incentives and Transparency34:32 – Data Access, Claims, and Real-World Fixes41:20 – POSIWID Framework & Final TakeawaysGet more on our Guest at:Website: https://spencerharlansmith.com/YouTube: @SelfFunded--------------------------------Whether you're an HR professional, CFO, CEO, or just tired of rising healthcare costs, this is your call to rethink benefits strategy and finally take control.Connect with Chelsea and Donovan:Website: https://businessofbenefitspodcast.com/Instagram: https://www.instagram.com/ethoseffectpodcast/Chelsea: https://www.linkedin.com/in/chelsea-ryckis-8508a192/Donovan: https://www.linkedin.com/in/donovanryckis/Finished with the content? Claim your CE credit here: https://ideas.ethosbenefits.com/continuing-educationSHRM: Ethos Benefits is recognized by SHRM to offer professional development credits (PDCs) for SHRM-CP® or SHRM-SCP® recertification activities.HRCI: Ethos Benefits is approved to offer HRCI® recertification credits for this program. This program has been approved for 0.5 - 1 HR (General) recertification credit(s) toward aPHR®, PHR®, SPHR®, and GPHR® certification.