Business of Benefits. The podcast.
Conversations with employers, physicians, pharmacists and policy makers about what health care really costs and who pays. Every episode has a full transcript.
- Benefits Dirty Dozen, Part 2. Health plan tactics 6 to 1.Episode 89 · Oct 22, 2026 · 57 minEmployers can expose most hidden health plan costs by securing claim-level data and audit rights in their contracts. In Part 2 of the Benefits Dirty Dozen, the Ethos Benefits team covers cross-plan offsetting, commissions that rise with premium, point solution pile-ons, PBM compensation, voluntary benefits that fund free technology, and blocked data access.
- How to Vet Benefits Vendors. With ERISA Attorney Christopher VanderWolk.Episode 88 · Oct 8, 2026 · 58 min · Christopher VanderWolkEmployers vetting a new cost-containment vendor carry the fiduciary responsibility for that decision, even when a broker brings the idea. ERISA attorney Christopher VanderWolk and Chelsea Ryckis explain how to read a compliance memo, spot a wellness tax scheme, judge whether a fee is reasonable and tell whether the advice you get is conflicted.
- Benefits Dirty Dozen, Part 1. Health plan tactics 12 to 7.Episode 87 · Sep 25, 2026 · 64 minEmployers can spot six common health plan tactics by laying the broker disclosure, the contract and the invoice side by side. In Part 1 of the Benefits Dirty Dozen, the Ethos Benefits team covers PEPM fees that become PMPM, contracts that drift from the proposal, hidden ownership interests, PBM collectives, captives and controlled market checks.
- Employer Health Coalitions and Smarter Purchasing. With Karen van Caulil.Episode 86 · Sep 10, 2026 · 42 min · Karen van CaulilEmployers that join an employer-led health coalition can move from paying for health care to purchasing it. Karen van Caulil of the Florida Alliance for Healthcare Value tells Chelsea Ryckis how coalitions build collective buying power, why claims data access comes first, how to use upcoming PBM rules now and how to judge the vendors you already buy.
- Stop-Loss, Risk Transfer and Your Highest-Cost Claimants. Brett Morris of the Samaritan Fund Program.Episode 85 · Aug 25, 2026 · 35 min · Brett MorrisSelf-funded employers have four ways to manage health plan risk: avoid it, reduce it, retain it or transfer it. Chelsea Ryckis and Brett Morris of the Samaritan Fund Program discuss why transfer through stop-loss costs the most, how charity funding can help high-cost claimants leave a plan voluntarily, and the compliance questions employers ask first.
- Self-Funded Health Insurance, PBMs and Reference-Based Pricing. The People's Picks: our most-watched moments.Episode 84 · Aug 13, 2026 · 43 min · Rachel Strauss, Spencer Smith, Danielle Young, Mark Cuban, Brittany GeorgeEmployers weighing self-funded health insurance get the moments viewers watched most this year in one episode: how PBMs and rebate aggregators work, how self-funding compares to fully insured coverage, how to roll out reference-based pricing without balance-bill surprises, and why Mark Cuban says benefits RFPs protect incumbents.
- Department of Labor Audits Start With Your Process. Patrick Williams of Fiduciary in a Box.Episode 83 · Jul 30, 2026 · 39 min · Patrick WilliamsEmployers that sponsor a health plan are judged on their process, not their outcomes. Chelsea Ryckis and Patrick Williams of Fiduciary in a Box explain what ERISA prudence asks of plan sponsors, how the CAA brought 401(k)-style committees to health plans, and how to document decisions before a Department of Labor audit letter arrives.
- Employee Wellness Programs Built on Data. Dr. Romie Mushtaq.Episode 81 · Jul 2, 2026 · 43 min · Dr. Romie MushtaqEmployers that want a wellness program with measurable results should start by measuring burnout and building trust, not by buying another app. Dr. Romie Mushtaq, a neurologist and chief wellness officer, tells Chelsea Ryckis how to spot burnout in engagement and claims data, why manager empathy training matters, and where to start with no budget.
- PBM Rebates and Who Really Pays. Mark Cuban.Episode 75 · Apr 9, 2026 · 50 min · Mark CubanEmployers that rely on PBM rebates and partial claims data may be paying more than they realize. Mark Cuban joins Chelsea Ryckis and Talia Carbah to explain who really funds rebates, why every employer should demand all of its claims, how direct-to-employer drug programs work, and how to tell whether a benefits advisor's incentives are aligned.
- Hospital Bill Errors and 501(r) Financial Assistance. With Patrick Haig.Episode 71 · Jan 20, 2026 · 42 min · Patrick HaigEmployers can lower what employees pay for hospital care without raising premiums or narrowing access. Donovan Ryckis and Patrick Haig explain how IRS Section 501(r) hospital financial assistance works, who typically qualifies, why so few brokers offer it, and how itemized hospital bill review catches billing errors that claims processing misses.
- PBM Spread Pricing Hides in the Contract. Trace Voshell on generic drug costs.Episode 69 · Dec 30, 2025 · 29 min · Trace VoshellEmployers can find PBM spread pricing by reading the AWP terms in their contract and comparing their claims, line by line, with what a pharmacy actually pays for each drug. Trace Voshell, chief revenue officer of GoGoMeds, and Donovan Ryckis explain cost-plus generic pricing, why incumbents resist outside pharmacies and how to review a PBM contract with AI.
- Benefits Consultant Fees Are Only Part of the Price. Chris Deacon on paying more and getting less.Episode 68 · Dec 16, 2025 · 53 min · Chris DeaconEmployers often choose a benefits consultant by the lowest quoted fee without seeing what else the advisor earns. Attorney Chris Deacon, former director of New Jersey's State Health Benefits Program, joins Donovan and Chelsea Ryckis on consultant pay, hospital pricing, carrier incentives, blocked bill review and how to make the case to a CFO.
- How One Employer Broke the Renewal Cycle. Axiom Healthcare Services.Episode 67 · Dec 11, 2025 · 36 min · Brenda Kruse, Eric DysonBrenda Kruse of Axiom Healthcare Services, a senior living management company with about 1,000 employees, talks with Donovan Ryckis about how Axiom stopped waiting for renewal increases, formed a benefits committee, got access to its claims data and fixed its pharmacy benefit.
- Self-Funding Explained: Stop-Loss, Captives and Claims. Spencer Smith of ParetoHealth.Episode 66 · Dec 4, 2025 · 45 min · Spencer SmithEmployers that move from fully insured to self-funded health insurance trade guaranteed cost for variable cost they can see and control. Donovan Ryckis of Ethos Benefits and Spencer Smith of ParetoHealth cover stop-loss, group captives, pharmacy as the first place to look, and three questions every plan sponsor should ask at renewal.
- Health Plan Fiduciary Duty Starts With the Employer. Alden Bianchi on ERISA exposure.Episode 65 · Oct 3, 2025 · 47 min · Alden BianchiAn employer that sponsors a health plan is a fiduciary under ERISA, whether or not it has named one. ERISA attorney Alden Bianchi and Donovan Ryckis explain who the fiduciary is, why broker compensation disclosures are only a baseline, how health plan lawsuits stood at the time of recording in 2025, and where an employer should start.
- Benefits Broker Conflicts and Hidden Compensation. Jay Gepfert of Culpepper RFP.Episode 57 · Aug 7, 2025 · 49 min · Jay GepfertEmployers can find benefits broker conflicts of interest by asking how the broker is paid, including overrides and bonuses that are rarely disclosed. Donovan Ryckis of Ethos Benefits and Jay Gepfert of Culpepper RFP compare health plans with retirement plans, where commissions and revenue sharing gave way to fixed fees and fiduciary agreements. Gepfert explains how an independent RFP for a broker or consultant works and why he expects litigation and legislation to force the same change in benefits.
- Reference-Based Pricing, Part 2: What Employees Experience. Danielle Young of ClaimDoc.Episode 56 · Jul 24, 2025 · 34 min · Danielle YoungEmployers moving to reference-based pricing usually hear two fears from employees: my doctor won't take it, and I'll get a balance bill. In Part 2 of her conversation with Chelsea Ryckis of Ethos Benefits, Danielle Young of ClaimDoc explains how provider acceptance and balance bills work in practice, why some brokers sell against reference-based pricing, and how to communicate the plan to employees all year.
- Reference-Based Pricing for Employers, Part 1. Danielle Young of ClaimDoc.Episode 55 · Jul 10, 2025 · 31 min · Danielle YoungEmployers using reference-based pricing pay hospitals a set markup over Medicare instead of a discount off billed charges. In Part 1 of a two-part conversation, Chelsea Ryckis of Ethos Benefits and Danielle Young of ClaimDoc explain how it works, why fully insured employers pay for inflated claims too, and how to prepare a plan and its employees before open enrollment.
- What a Third Party Administrator Does for Your Health Plan. Eugene Starks, a TPA industry veteran.Episode 53 · Jun 12, 2025 · 46 min · Eugene StarksA third party administrator pays a self-funded health plan's claims, manages eligibility and connects the PBM, stop-loss carrier and network. Chelsea Ryckis of Ethos Benefits and TPA partner Eugene Starks cover what a TPA does, the questions to ask before hiring one, and the fees and contract terms to watch.
- Leaving Traditional Health Insurance, Live on Stage. Bryan Orr of Kalos Services.Episode 52 · May 29, 2025 · 30 min · Bryan OrrEmployers leaving traditional health insurance usually change one part of the plan at a time. Recorded live at the 2025 Florida Health Care Alliance conference in Orlando, Chelsea Ryckis and Donovan Ryckis of Ethos Benefits talk with Bryan Orr of Kalos Services, who replaced his TPA, stop-loss, network and PBM in one year, about how he won employee buy-in, handled provider pushback and what he would tell other employers in the room.
- ERISA Fiduciary Duty and Your Health Plan. Conference Episode, Part 1.Episode 51 · May 15, 2025 · 38 minEmployers that sponsor a health plan carry ERISA fiduciary duty, and the Consolidated Appropriations Act gives them the tools to meet it. In Part 1 of a live conference session, Chelsea Ryckis and Donovan Ryckis of Ethos Benefits compare the letter of the law with what they see in practice for fee disclosure, RxDC reporting and the gag clause attestation, and explain the spirit behind each rule.
- How One Employer Took Control of Its Healthcare Costs. Bryan Orr of Kalos Services.Episode 47 · Mar 20, 2025 · 43 min · Bryan OrrEmployers can lower healthcare costs by controlling what the plan pays for each claim rather than cutting benefits. Donovan Ryckis of Ethos Benefits and Bryan Orr, president of Kalos Services, walk through what Kalos changed: full claims data, a pharmacy benefit manager fix, negotiating high-dollar claims against Medicare rates, care navigation and direct primary care.
- Fiduciary Liability Insurance for Your Benefits Committee. Paul Hacker of Axis Insurance Services.Episode 46 · Mar 6, 2025 · 36 min · Paul HackerEmployers that make health plan decisions act as fiduciaries under ERISA, and recent lawsuits have named HR and finance leaders personally. Chelsea Ryckis of Ethos Benefits and professional liability broker Paul Hacker walk through fiduciary liability insurance, D&O, E&O, cyber and crime coverage, how underwriters price them, and why every health plan vendor should carry its own coverage.
See what your plan is really costing you.
A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture.