"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 have finally reached their "damn it" moment. We discussed the massive unpredictability of fully insured renewals, why 80% of employers are actively considering alternative funding mechanisms, and the real reason half of the market is ready to fire their current broker.

We also dove into the clinical side of the data. We looked at top cost drivers like cancer, MSK, and GLP-1s, and explored why treating mental health and substance use as a core component of your medical plan is non-negotiable for cost containment.

If you advise SMB employers or manage a health plan yourself, the era of the broker "apology tour" and basic renewal management is over. This episode is a reality check on exactly what clients are expecting right now. Tune in!

Visit 2026 State of Healthcare Spencer Self Funding Podcast to review the report.

Thank you to ParetoHealth for sponsoring this episode!

ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/events/ to learn more.

Episode Chapters

(00:00:00) Intro: Dr. Dena Bravata & The 2026 Healthcare Spend Report

(00:01:05) Why Small & Midsize Employers Are Ignored in Healthcare Data

(00:02:37) The "Damn It" Moment: Approaching $20,000 Per Employee

(00:04:09) Survey Demographics: 1,600 Leaders Across 14 Industries

(00:05:44) 80% of Employers Saw Double-Digit Healthcare Increases

(00:07:28) Why Half of the Market is Ready to Fire Their Broker

(00:10:59) Top Medical Cost Drivers: Cancer, MSK, and GLP-1s

(00:15:01) The Amplifier Effect of Mental Health & Substance Use

(00:18:38) Pharmacy Spend & Why Primary Care Can't Manage Obesity

(00:21:14) Price Variance and the Need for Care Navigation

(00:22:18) The Era of the "Apology Tour" and Renewal Management is Over

(00:24:37) Closing Thoughts: Demand More From Your Consultant

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