Voices of Self Funding

Episode 44 How stop loss carriers are looking at small group funding, and how has this changed

In this episode of "Voices of Self-Funding," host Ramesh Kumar welcomes Jonathan Socko, President of East Coast Underwriters, LLC, a Managing General Underwriter (MGU) specializing in Stop Loss insurance.

Jonathan shares his perspective on stop-loss underwriting for small groups and unveils the blueprint for a remarkable success story: a 30-life employer group that has been successfully self-funded for 10 years with their PMPM costs increasing only 10% over that decade.

You'll learn:
- The crucial role of partner cohesion between the broker, TPA, and stop-loss carrier to manage claims proactively.
- Why data transparency and a specific data flow are non-negotiable for effective claim prediction and management.
- The essential mindset shift—and commitment to aggressively attacking costs—that ensures a small group’s self-funded plan remains successful and sustainable.

Don't miss this conversation for an insider's view on stop-loss and the strategy that delivers long-term savings. 

This podcast is sponosred by zakipoint Health. At zakipoint Health, we are transforming the healthcare experience by delivering transparency, direction, and personalized support to members of self-insured plans. Our powerful platform unifies all benefit services, data, insights, and tools into one intelligent ecosystem empowering members to make informed decisions and take proactive steps toward better health outcomes. With AI at its core, zakipoint Health functions as the “Intel Inside” of healthcare navigation driving engagement, reducing risk, and delivering measurable cost savings. Employers and partners benefit from robust reporting, actionable insights, and tools that not only identify healthcare risks but also guide members toward high-value care. By bridging the gap between complexity and clarity in the U.S. healthcare system, we help organizations lower costs, improve outcomes, and support healthier, more engaged populations making healthcare less stressful and more effective for millions.

 

Episode 43 From HR Leader to Healthcare Reformer: Matt Ohrt on Employer Power and Free Market Medicine

In this episode of Voices of Self Funding, host Tom Testa sits down with Matt Ohrt, National Executive Director of the Free Market Medical Association (FMMA), to explore how employers can take back control of healthcare costs and quality through free market principles. Matt shares his personal journey – from a 25-year HR career and near-fatal accident to leading national reform movements like Self Fund Health, Rise Up Health, and Healthcare Best Practice Group. Together, they explore how self-funded employers can drive meaningful change by demanding transparency and value, the rise of direct primary and specialty care as cost-saving, patient-centered alternatives, and why breaking healthcare’s “monopoly mindset” is key to restoring competition, affordability, and trust – all while looking ahead to what’s next for self-funding and free market reform in 2026 and beyond.

This episode is sponsored by zakipoint Health. At zakipoint Health, we are transforming the healthcare experience by delivering transparency, direction, and personalized support to members of self-insured plans. Our powerful platform unifies all benefit services, data, insights, and tools into one intelligent ecosystem empowering members to make informed decisions and take proactive steps toward better health outcomes. With AI at its core, zakipoint Health functions as the “Intel Inside” of healthcare navigation driving engagement, reducing risk, and delivering measurable cost savings. Employers and partners benefit from robust reporting, actionable insights, and tools that not only identify healthcare risks but also guide members toward high-value care. By bridging the gap between complexity and clarity in the U.S. healthcare system, we help organizations lower costs, improve outcomes, and support healthier, more engaged populations making healthcare less stressful and more effective for millions.

Voices of Executive Forum -- Mike Strong

In this preview episode of Voices of Self‑Funding, host Tom Testa sits down with Mike Strong, Director of Policy & Operations Strategy, Health Plan Cost Containment at Reliant Health Partners, to discuss his upcoming Executive Forum 2026 session: “Who Really Wins? Transforming the TPA Playbook for IDR.” Mike offers a candid look at how the Independent Dispute Resolution (IDR) process is evolving, why traditional arbitration strategies may no longer be enough, and what TPAs can do now to protect margins while strengthening payer‑provider relationships.

Hear the full session live at Executive Forum 2026 — register now and be part of the industry’s most important conversations.

Voices of Executive Forum 2026 — Hermine Tranie & Alex Andrei

In this preview episode of Voices of Self-Funding, host Tom Testa sits down with ClarityCare AI co-founders Hermine Tranie and Alex Andrei to discuss their groundbreaking Executive Forum 2026 session: “How to Actually Use AI: A Hands-On Mini-Hackathon for Self-Insured Leaders.”

Unlike typical conference talks, this immersive 90-minute workshop invites attendees to roll up their sleeves and build with AI in real time. Hermine and Alex preview what to expect from the hackathon format, share how AI is already reshaping prior auth and utilization management, and explain why TPAs and self-funded employers need to stop talking about AI – and start using it.

Don’t miss this unique opportunity to get practical with AI at Executive Forum 2026. Register now and secure your seat in the Ballroom.

Voices of Executive Forum 2026 – Mike Abrashoff

In this special episode of Voices of Self-Funding, host Tom Testa sits down with Executive Forum 2026 keynote speaker Mike Abrashoff, former Commander of the USS Benfold and best-selling author of It’s Your Ship. Hear how Abrashoff turned the Navy’s lowest-performing ship into the top-ranked vessel in just one year – without changing a single crew member.

In this quick preview, Mike shares lessons on leadership, culture, and accountability that apply far beyond the military and offers a taste of the powerful message he’ll bring to San Antonio this February.

Catch the keynote session live at Executive Forum 2026 — register today to reserve your seat and join the industry’s most important conversations. 

Voices of Executive Forum 2026 -- Ron Peck

In this special preview episode of Voices of Self Funding, co-host Tom Testa sits down with Ron Peck, Chief Legal Officer at The Phia Group, to discuss his highly anticipated session at Executive Forum 2026: “Fiduciary Gotchas and the Company You Keep.” From revenue-sharing arrangements to PBM contracts and vendor disclosures, Ron shares what TPAs need to know now as courts and regulators sharpen their focus on fiduciary responsibilities. With plaintiff attorneys getting more creative and DOL audits on the rise, this conversation is a must-listen for anyone looking to protect their business and stay compliant.

Catch the full session live at Executive Forum 2026 — register today to reserve your seat and join the industry’s most important conversations. 

Episode 42 AI in Action: Transforming Utilization Management, Prior Auth, and the Future of Self-Funding

In this episode of Voices of Self-Funding, host Tom Testa speaks with MIT-trained AI researcher and ClarityCare AI co-founder Hermine Tranie about how artificial intelligence is delivering measurable wins in utilization management (UM) and prior authorization (PA). Hermine explains how AI agents convert unstructured records into structured insights, drive real-time approvals at the point of care, and free up nurses for higher-value tasks – boosting accuracy, efficiency, and compliance.

As a preview to her interactive “AI Mini-Hackathon” session at HCAA’s 2026 Executive Forum, Hermine shares a practical roadmap for adoption and what TPAs and self-funded employers can do today to start seeing ROI. Click here to register.

Episode 41 Inside the Employer Playbook: Strategies Shaping the Future of Self-Funding

In this episode of Voices of Self-Funding, host Ramesh Kumar welcomes Lee Lewis, Chief Strategy Officer at the Health Transformation Alliance and host of the Broken Benefits podcast. Together, they explore how some of the nation’s largest employers are reshaping healthcare and what smaller self-funded employers and TPAs can learn from their playbook. Lee introduces his “ABC” framework: Advanced Primary Care, Behavioral Health, and Centers of Excellence. They dive into why direct primary care is gaining traction, how advanced behavioral therapies like TMS and ketamine can unlock cost-effective mental health care, and why Centers of Excellence and tiered networks are becoming essential levers for better outcomes at lower cost.

From strategies to supplement traditional networks to practical steps TPAs can take to differentiate and deliver value, this is a powerful conversation packed with actionable insights for anyone rethinking healthcare benefits in a self-funded world.

Registration is now open for HCAA’s Executive Forum 2026, where conversations like this continue live. Learn more at HCAA.org.

Episode 40 Why AI pilots fail and what can you do to extract the most value from AI initiatives

In this episode of Voices of Self-Funding, host Ramesh Kumar welcomes Arun Santhebennur, Co-founder and CEO of Voicegain, to explore how voice AI is reshaping healthcare operations for TPAs, payers, and health plans.

They tackle the tough truth that 95% of AI pilots fail, unpacking why — from hype and skill gaps to the “build vs. buy” dilemma and change management challenges. More importantly, they share where AI is already succeeding: automating claims status calls, streamlining utilization management, and making complex health plan information accessible to members.

Listeners will hear a roadmap for launching successful AI pilots — starting with proven use cases, aligning incentives, and using AI to augment (not replace) people. It’s a forward-looking conversation on turning AI from a risky experiment into a real value driver.

This episode was sponsored by WLT Software. For more information, visit HCAA.org.

Episode 39 Merging for Independence: How TPAs Drive Innovation and Customer Experience

In this episode of Voices of Self Funding, Jeff Walter and Jim Farley discuss their strategic merger, titled "Merging for Independence". They reveal how independent TPAs like JP Farley and PBA are uniting to drive innovation and enhance customer experience, avoiding absorption by larger firms.

Discover how this merger focuses on enhanced service with PBA's EOS system and in-house IT, improving operational efficiency, data management, and enabling quick, independent service delivery for customers. The discussion also highlights their future focus on Direct Primary Care (DPC) and the use of nurse navigators to optimize member experience and efficiency. It’s a compelling conversation for understanding how TPAs are evolving to offer superior, independent solutions and seamless third-party integration.

This episode was sponsored by WLT Software. For more information, visit HCAA.org.