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 aggressive new play into the GLP-1 and primary care market, and why CMS is finally (and officially) killing the fax machine by 2028.

Plus, Spencer plays a game of "Blind Ranking," attempting to properly order the top 10 best practices and features of a modern self-funded health plan (including pass-through PBMs, cash-pay surgery networks, and pharmacogenomics) without knowing what's coming next.

Thank you to this year's sponsor, Walk On Clinic!

If you'd like your question answered on next month's episode, call/text 469-213-6381 and leave us a voicemail/text.

Chapters:

(00:00:00) Intro & Sponsor Shoutout: Walk On Clinic

(00:01:42) Bipartisan State Healthcare Regulations & PBM Oversight

(00:04:40) ACA Shifts: The Rise of Bronze Plans & HSA Eligibility

(00:08:38) The FTC's Vague New Healthcare Task Force

(00:10:10) The Rural Hospital Aid Loophole Exploited by Urban Hospitals

(00:11:27) Amazon Launches a $149/mo GLP-1 & Primary Care Program

(00:15:18) CMS is Finally Ending the Fax Machine (Saving $781M)

(00:16:48) Game: Blind Ranking the Best Self-Funded Plan Features

(00:24:45) PSA: Watch Out for These Hidden Carrier Contract Clauses

"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 shares his journey from feeling completely helpless as a broker to discovering the power of true consulting.

We discuss the critical differences between a "broker" and a "consultant," how he uncovered that an employer was secretly paying 45% of their entire $10 million pharmacy spend in rebates, and how taking a fully-insured client directly to Reference-Based Pricing (RBP) cut their $1,000/month employee-only premium completely in half. John also breaks down the emerging power of pharmacogenomics, why 2026 is poised to be an even more brutal renewal year, and why you must replace your traditional broker with a true consultant.

If you are an employer tired of throwing away money on fully-insured premiums, or a broker wanting to make the jump to self-funding, this conversation is the push you need.

Thank you to our 2026 sponsors!

ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.

Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.

Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.

Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.

Chapters:

(00:00:00) Intro: Why the Benefits Consultant is Healthcare's Most Important Role

(00:04:03) Staying Independent in an Era of Broker Consolidation

(00:11:51) Getting Out of the "Renewal Carousel"

(00:18:18) The Turning Point: Discovering 45% of Rx Spend Was Going to Rebates

(00:20:41) Converting a Fully-Insured Group to Reference-Based Pricing (RBP)

(00:30:11) The Real Definition of Self-Funding (The Chassis vs. The Car)

(00:36:05) Finding the Root Cause: Diet, Inflammation & Autoimmune Disease

(00:46:04) The Future of Prescribing: Pharmacogenomics

(00:57:20) Why the 2026 Renewal Season Will Be a "Bloodbath"

(01:02:00) Closing Thoughts: Stop Working With Traditional Brokers

Key Links for Social:

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

Listen/watch 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'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 surprising and highly emotional moment, Rob uses this episode to make a massive public announcement regarding his future at Valenz and the next chapter of his career. He opens up about the deep self-reflection required to make this major life decision, why true leaders must surround themselves with people smarter than they are, and his ultimate mission to "leave a ladder" for the next generation of executives.

We also discuss the "Kobe Bryant mentality" of embracing failure, why playing "not to lose" is a recipe for disaster, and why the future of self-funded healthcare relies entirely on "coopetition" and sharing the blueprint for success.

If you are a business leader, an entrepreneur, or anyone trying to make a meaningful impact in your industry, this is an absolute must-listen.

Thank you to our 2026 sponsors!

ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.

Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.

Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.

Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.

Chapters:

(00:00:00) Intro: Why the Smartest Leaders Are the "Dumbest" in the Room

(00:02:44) The "Broken Glass" Leader & Leaving Ego at the Door

(00:04:18) The Kobe Bryant Mentality: Loving to Win vs. Hating to Lose

(00:11:41) Playing "Not to Lose" & The Danger of Playing it Safe

(00:18:09) Becoming a First-Time CEO at 52 (The "Lattice" Career Path)

(00:26:07) "The Obvious is Only Obvious to Those Who Can See It"

(00:28:28) Time as the Great Contextualizer (The 3 Dots Framework)

(00:32:51) Operating in the "Land Before Time" (Why Healthcare is Broken)

(00:39:51) The "Coaching Tree" of Healthcare

(00:43:02) Leaving a Ladder: Mentorship & Creating the Future

(00:51:27) Overcoming the Inability to Scale in Self-Funded Healthcare

(00:56:01) Why We Need "Coopetition" to Fix the $5 Trillion Problem

(00:58:42) Rob’s Huge Announcement Regarding His Future at Valenz

(01:05:15) Closing Thoughts: The Legacy of Leadership & What’s Next

Key Links for Social:

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

Listen/watch 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/