[S1E6] Mike Trent: Beyond Self-Insured, Energizing Your Health Plan Funding with RBP

Beyond Self-Funding: Why Reference-Based Pricing Is the Solution Hiding in Plain Sight

Mike Trent, VP of Business Development at ClaimDOC, reveals why self-funding alone doesn't solve healthcare costs—and how RBP can save employers $150,000 per 100 employees annually.

Vincent and Mike discuss reference-based pricing (RBP) as an alternative to traditional PPO networks for self-funded employers. Mike shares how his wife's $67,000 hospital bill became a $7,000 claim through RBP—with no balance billing to employees. They explore the reality that most self-funded employers still pay PPO prices (250% of Medicare) without realizing it, while RBP typically reimburses at 150% of Medicare.

The conversation covers balanced billing concerns (85% of hospitals accept RBP immediately), which employers are best suited for RBP, why CFOs need to lead healthcare financing decisions, and the skills gap among brokers. Mike emphasizes his mission to educate employers on all funding options, while Vinny announces plans for the Clear Benefits Academy launching in 2026.

Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.

Transcript

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Welcome to the Clearly Beneficial podcast,

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the show where we rip off the Band-Aid and explore the future of healthcare,

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benefits,

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and the people driving innovation in the industry.

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This episode is brought to you by Health Next,

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the company leading the way in helping employers build enduring cultures of health

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and well-being,

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reducing medical cost trends,

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and increasing organizational performance.

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To learn more how they can help you, visit healthnext.com.

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Well, happy Friday.

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It's a Friday for me today.

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I don't know when you're going to be listening to this, but it's a Friday.

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And I'm super excited to be with my friend Mike Trent today with ClaimDoc.

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Mike is an industry veteran in the employee benefit space.

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And one of the things that I have been researching over the past few years is an

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alternate way for employers to fund their health care benefits.

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And the terminology is called reference based pricing.

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And Mike's an expert in this particular area,

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and I thought it would be super interesting to talk to an expert here and give us

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the perspective because there's a lot of information in the market,

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good,

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bad,

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and ugly.

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And I just wanted to talk to someone who had a solid,

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positive perspective about what this is,

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what it can do for an employer,

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and how it can be an advantage for employees and employers.

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So, Mike, thank you so much for joining me.

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Hey, thanks for having me.

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I really appreciate the opportunity.

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So tell me, just give me a high level.

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I mean,

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you and I have just met recently and I wish I knew you better,

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but tell me a little bit about yourself and your background in the employee benefit

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space.

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Well, you already started in your introduction by using the word alternative.

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So I would say I've been involved in alternatives of health plans for over 30

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years,

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if not longer.

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A lot of my time has been spent in self-funded health plans.

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I've worked with TPAs that administer them.

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I've worked as a consultant in some capacity.

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I also worked with some large insurance companies.

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But I've been on the hunt for many years of trying to figure out

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How do we lower and manage the cost for these employers?

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And you hinted at it by introducing the subject of reference-based pricing.

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So that's a subject that's actually near and dear to my heart, Vinny.

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Well, good.

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No, I appreciate that.

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And so why don't we just do a quick,

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let's fly the plane at 50,000 feet to start and give the audience just a real quick

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perspective on the way health insurance is funded today,

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right?

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We have, on the one hand, we have fully insured and, you know, take it from there.

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Yeah.

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So primarily we fund health insurance for employees through an employer's health plan.

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The employer then can decide how to fund that health plan.

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And there's different ways to do that.

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The traditional way that most people are familiar with is a fully insured plan.

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What does that mean?

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That means the employer finds an insurance company who takes all the risk,

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that employer pays that insurance company a set premium,

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and the insurance company then pays all the claims and the expenses from that set

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premium.

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The downside to that is the employer doesn't share and has no incentive on the

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success of that plan.

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Another way,

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though,

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which has developed over the years,

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is to let the employer be more involved in the financial part,

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the financial success of that health plan.

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And a common way to do that is to let the employer have what used to be called a

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participating contract.

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The word participating tells you what that's all about.

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The employer participates in the financial success.

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And over the years,

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that has evolved into self-funded plans,

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partial self-funded plans that continue to give employers more and more opportunity

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to participate in the financial results of the plan.

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I don't know if you follow this guy on LinkedIn, Dr. Eric Bricker.

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He put up a graphic this morning showing the percentage of health plans in the U.S.

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that are self-funded.

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And California was the least of all the states,

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which was interesting,

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which there's so many reasons for that.

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Yes, there are.

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Right?

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And so I feel like...

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Self-funding here on the West Coast is a little,

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I want to call it rarity,

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but it's something that people aren't jumping into as much as the rest of the

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country.

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The rest of the country, self-funding is table stakes.

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They're doing it routinely.

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Is that a fair statement?

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Absolutely.

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It varies by region, Benny, to be honest with you.

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California suffers from heavy HMO participation and penetration,

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and that tends to suppress the ability for an employer to self-fund.

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Go to Indiana,

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Ohio,

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some of the Midwestern states,

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and self-funding is a lot more prevalent out there.

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So, yeah, I totally agree with you on that.

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No, for sure.

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And it's just so interesting.

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I don't want to go into the weeds on that.

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So you covered sort of the spectrum a bit.

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You have fully insured on the one side.

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You have self-funded on the other side,

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level funding and other alternative methods in the middle.

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But maybe, I don't know, how long ago did reference-based pricing come along as a concept?

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Well, let's back up a little bit.

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So on your health plan,

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whether it's fully insured or self-funded,

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but for today's discussion,

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I'm going to be focusing on self-funded.

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The first thing that really developed was PPO plans.

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30 years ago, 35 years ago, preferred provider organizations.

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Everybody listening to this today is gonna know exactly what I'm talking about.

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Because when you have a health plan,

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you have to look at who's your network provider,

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who's your out-of-network provider.

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And that has been drilled into our heads.

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So everybody understands that dynamic.

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But what happened when they built PPOs, everybody thought PPOs were going to save us money.

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Problem is,

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after all these years,

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our employer clients are still getting 5%,

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10%,

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15%,

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20% increases.

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The PPOs, in our opinion, didn't do the job.

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Even the BHMOs, for that matter.

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Well, yeah, exactly.

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So really,

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then,

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what happened about 15 years ago,

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a couple of people,

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a couple of organizations said,

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hey,

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let's change the way that we reimburse hospitals.

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Let's reimburse them on a more reasonable basis.

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And so let's change the reference point for how we're going to reimburse a hospital.

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Instead of saying,

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oh,

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we're going to take their bill charge and we're going to get a discount from the

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top down.

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Right.

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We're going to say, no, no, no, no.

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Let's start with.

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Medicare as a base, as a reference point.

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Why?

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Because everybody understands Medicare.

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All the hospitals do.

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They all accept it.

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So what we're going to do is we're going to create an arrangement where we're going

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to start with Medicare and then pay the hospital a percentage above Medicare.

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So now when you start with that thought process and you start putting that into

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practice,

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there's significant cost savings available for that self-funded plan.

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Now,

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I wanna stop you there for a second because when I started learning about RBP a few

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years ago,

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what shocked me was when talking about,

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let's call that Medicare payment 100% of Medicare,

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right?

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What most people don't realize is that a commercial health plan,

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a fully insured commercial health plan is paying that same hospital for that same

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procedure

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two and a half times the Medicare reimbursement, right?

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They're paying 250% give or take of Medicare for that same procedure.

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So what that really means is,

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and most employers,

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most CFOs and C-suite people,

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and certainly not HR,

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they don't understand that the onus and the burden of cost shifting is shifted onto

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the employer now.

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And not because not to Medicare and Medicaid, because those aren't those prices don't change.

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It's the employers who are bearing the brunt and they have no they have no control.

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Yeah, because the employer doesn't realize what you just said.

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The employer doesn't realize that in their PPO contract that they are reimbursing

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it 250% of Medicare.

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And that's light in many markets.

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I've seen it higher than that in many places.

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So they don't even know the discussion.

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They don't even know where to begin in terms of controlling costs,

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because that's an important thing to understand,

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an important starting point.

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So the next thing that we need to say about that,

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so you mentioned 250% is a typical PPO reimbursement.

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The next question is, well, what is the RBP reimbursement come out to?

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The answer in general is about 150%.

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Give or take.

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It's going to vary.

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It varies because with all these different RBP models,

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Vinny,

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there's different ways to come up with those reimbursement formulas.

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OK, it's a whole nother discussion.

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But suffice it to say,

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if you put into that kind of a plan and you're reimbursing it 150 percent of

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Medicare and in your PPO plan,

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you're used to paying 250.

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You ask the question, where's the cost savings come from for that employer?

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Bingo.

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There it is.

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If you do that on all your claims, it starts to add up significantly.

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So let's talk about that in real practical application for the audience, right?

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So that means, I mean, I'm going to try to keep the math super simple.

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So if someone is going in for, let's pick on cardiac bypass for a second.

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Someone's going in for bypass surgery and the cost for the Medicare reimbursement

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to that hospital is $150,000.

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$100,000.

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The cost through the plan,

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the cost reimbursement through a fully insured plan or a typical negotiated PPO or

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even self-funded network contract could be $250,000.

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But RBP comes along at $150,000.

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Is that about right?

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Yeah, that's very accurate.

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Again, that $150,000 is going to depend upon other things.

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But no, that's a good, simple way to think about it.

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Yeah.

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And so let's talk about how or let's say,

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why would a hospital accept that one hundred and fifty thousand dollars?

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So here's the other part of reference-based price.

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There's two parts to a presentation.

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So if any of your employer clients want to know to see a presentation, there's two big parts.

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The first we just talked about, cost savings, saving money.

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There's no doubt at all that the employer will save money.

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But then the obvious question is, well, gee, what if the hospital doesn't accept that $150,000?

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What if they don't want to do that?

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That's where you have to have a system in place to either negotiate with them or

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have very deliberate,

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how can I say,

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legal discussions with them.

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But here's the crazy thing.

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So if an employer will accept $100,000 from Medicare,

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then, gee, if they're accepting $150,000 from the RBP employer, aren't they doing better?

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Absolutely they are.

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They're not doing as well as they would be with the PPO discount for a

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reimbursement of $250,000.

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But a lot of hospitals will take 150% of Medicare all day long.

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Some won't, though.

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Some won't.

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And when they don't,

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we have to be prepared to manage and negotiate that process with the hospital.

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And there's a lot of ways to do that.

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But let me throw a statistic out to you.

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So statistically,

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out of all the claims that we send out to hospitals,

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85% of the time,

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the hospital cashes the check.

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So 85% of the time under RBP, they're cashing it, they're paying it, okay?

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So that leaves you 15%.

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Well, out of that 15%, you're gonna get some balanced billing, you're gonna get some pushback,

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Oftentimes the result of the hospital using an automated billing system and they

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don't understand that reimbursement that they got so that we have to then go in and

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explain it to them.

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But that 15% gets whittled down to five,

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four,

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three,

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even 2% left that we have to negotiate with.

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What's that tell you?

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It's accepted more than you realize it.

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And it can be on behalf of the RBP company itself,

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which is acting on behalf of the employer and the employer's employees.

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It's a hands-on process, right?

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It's not some automated thing.

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I mean,

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we don't want dissatisfied employees because,

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you know,

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the most dissatisfied person that this is going to affect is the CEO's spouse,

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right?

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We've seen that happen time and time again.

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So how does an RBP company ensure that the kind of fluidity of the transaction is

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maintained for the member?

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We have a position for the employee.

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We tell the employee,

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look,

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all you're going to have to be responsible for paying on your health plan is your

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out-of-pocket amount,

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your deductible and out-of-pocket.

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That's it.

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So if for some reason the hospital provider pushes back and tries to get more money

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out of that member,

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they call that a balanced bill,

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the member is not responsible.

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The RBP firm,

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the vendor will take care of that,

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will manage that and take it off the responsibility of the member.

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That's significant,

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very significant,

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because if that's done well,

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Vinny,

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if we're doing that properly,

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the employee is going to be extremely happy.

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They're going to be satisfied and they're going to pay less out of their pockets, too.

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They're going to save money, too.

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Right, right.

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And so,

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I mean,

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that to me,

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what we just covered is,

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you know,

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if I've heard any downside to RBP in the marketplace,

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it's just that.

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It's kind of where that last mile,

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rubber meets the road,

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you know,

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where that employee got dissatisfied,

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they got sent to collections and,

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you know...

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they were not represented as well as they could have been by the RBP company.

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So would you say that the industry itself has gotten much,

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much better at interacting with the hospitals on behalf of the employees and the

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providers on behalf of the employees?

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Yeah,

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I think the evolution of these RBP plans has done that,

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not with all the RBP vendors,

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but with some of them,

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they've become extremely adept at communicating and negotiating with the hospitals.

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But let me illustrate something for you about this balanced billing and what happens.

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I personally was covered under a reference-based pricing plan.

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My wife and I were a couple of years ago.

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And so I've seen the good, the bad, and the ugly in all of this stuff.

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I've seen it firsthand, and I've seen it as a benefit advisor.

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My wife went to an emergency room.

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She was put in the hospital overnight.

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A couple of weeks later, she called me and says, Mike, do you know what they charged us?

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I go, no.

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She says, we got the bill in.

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They charge us $67,000.

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And we weren't even in there for 24 hours.

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I said, she said, are we going to be okay?

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And I laughed.

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I said,

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honey,

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we're going to be fine because we our program has it set up so that they will

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protect us.

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They will negotiate with us.

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And you and I are not going to see any additional bills whatsoever.

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And I said to him,

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by the way,

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what did we actually or what did our carrier or TPA actually end up paying?

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Seven thousand dollars.

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Okay, so RBP, we paid $7,000.

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They billed us $67,000.

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I never heard word one ever from the hospital.

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So that worked.

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Yeah, it works.

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Yeah, it works.

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No, no, I totally.

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And that's why I wanted to hear the good stories,

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you know,

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because I would think that employers,

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you know,

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are a little concerned,

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a little reticent.

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You know,

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if someone walks in and says,

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hey,

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you know,

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you've been and had this conversation that we had about,

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well,

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100 percent,

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250 percent.

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Well, I can sneak you in there 150 percent.

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That can almost sound a little bit too good to be true.

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Yeah.

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And I wonder, so take me through that conversation.

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So obviously there's different kinds of employers, right?

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There's the ones who are fully insured and maybe those fully insured folks are the

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right target client for RBP because it's like taking them from one end of the

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spectrum all the way to the other end of the spectrum.

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But I would imagine that someone who's already self-funded,

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who's got some experience in claims evaluation,

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understanding pricing,

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understanding pricing,

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a stop loss and all the things that go into creating a self-funded program that RBP

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becomes a little more second nature.

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So talk to me about that conversation.

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You're working for a hypothetical RBP company.

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You're a broker.

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you're sitting there with a potential client or an existing client,

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and you say,

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you know,

(00:18:45):
I've got this idea that I wanna run by you.

(00:18:48):
Okay, Mike, go.

(00:18:50):
Yeah,

(00:18:51):
well,

(00:18:52):
I've done this many times with CFOs over the years,

(00:18:55):
and I start off by saying,

(00:18:57):
we have a method to reduce your costs.

(00:19:01):
In general,

(00:19:02):
for every 100 employees that you have on your plan,

(00:19:05):
we save $150,000 on the total cost of your plan.

(00:19:08):
That's a good rule of thumb.

(00:19:11):
Now, when I started with that, Vinny, I get people's attention.

(00:19:15):
I had one employer who said, wait, Mike, I've got 300 employees.

(00:19:21):
You mean to tell me you're going to save me $450,000?

(00:19:23):
And I said, no.

(00:19:28):
Yeah, I am.

(00:19:29):
That's exactly what I'm saying.

(00:19:30):
Plus or minus.

(00:19:31):
It just depends.

(00:19:32):
So I started with the cost.

(00:19:35):
And you get them interested in how does that happen?

(00:19:39):
And then I have to explain some of the things we're talking about here.

(00:19:43):
What happens?

(00:19:44):
How do we reimburse the hospitals?

(00:19:46):
What percentage of Medicare do we actually do that with?

(00:19:50):
So at that point, you're talking finance.

(00:19:52):
You're talking savings.

(00:19:53):
You're talking about lowering the cost of their plan.

(00:19:56):
And then they're going to start asking more questions.

(00:20:00):
But what's crucial at that point is for me to tell them the rest of the story.

(00:20:04):
And you and I hinted at the rest of the story and the rest of the story then

(00:20:08):
becomes,

(00:20:09):
what if the hospital doesn't accept it?

(00:20:11):
then we have to engage them in the support and the member advocacy and the

(00:20:16):
navigation that is in place to help support the member.

(00:20:21):
And they have to be,

(00:20:22):
frankly,

(00:20:23):
they have to be more convinced that we're going to take care of their employees

(00:20:29):
than we're going to save them that money.

(00:20:31):
Okay.

(00:20:34):
Because we never we never want the employee to feel disenfranchised.

(00:20:38):
And I think, you know, one of I had a client at in Southern California who a broker had gone.

(00:20:44):
But they had made the cardinal error of taking them from fully insured and putting

(00:20:49):
them in an RBP program.

(00:20:51):
Right.

(00:20:51):
And ironically, this particular client was a bunch of lawyers.

(00:20:55):
So it was it was a dangerous move to do that anyway.

(00:20:59):
But but that said,

(00:21:02):
where the problem came up is,

(00:21:03):
you know,

(00:21:03):
the one thing about an RPP program,

(00:21:06):
right?

(00:21:06):
There really isn't a quote unquote network.

(00:21:09):
Everybody is so used to thinking about having in network,

(00:21:12):
out of network,

(00:21:13):
as you mentioned earlier.

(00:21:14):
But in the case of RBP, you just go to the providers that you choose to want to go to.

(00:21:20):
And the RBP side of the equation takes care of the negotiation.

(00:21:25):
So there really isn't a formal network.

(00:21:27):
Is that correct?

(00:21:28):
That's one of the things that we say to that employer at the very beginning.

(00:21:32):
This is a plan where we take the PPO network and throw it in the garbage.

(00:21:37):
There is no PPO network anymore.

(00:21:40):
And it makes an open enrollment meeting very interesting, right?

(00:21:43):
Because now you're in front of all these people and say, well, guess what?

(00:21:47):
You can go anywhere you want.

(00:21:49):
And people don't know what to do with that sometimes.

(00:21:52):
So you have to explain that.

(00:21:55):
And I can imagine there's a lot more flexibility,

(00:21:57):
especially when it comes to even some of the ancillary things like alternative

(00:22:01):
benefits,

(00:22:02):
even if an employer chooses to cover things like acupuncture or chiropractic or any

(00:22:07):
other of those things,

(00:22:09):
there's really an opportunity for those things to be covered.

(00:22:12):
And because I think the premise and what people don't really,

(00:22:15):
I think they need to understand is that

(00:22:18):
You know,

(00:22:18):
the RBP is going to pay in a sense for a regular doctor visit or imaging or things

(00:22:24):
like that.

(00:22:25):
That's not where the big negotiations happen.

(00:22:27):
Right.

(00:22:27):
I mean,

(00:22:27):
they're going to that's that's that's low hanging fruit and that's easy to pay for

(00:22:31):
stuff.

(00:22:31):
It's the big stuff.

(00:22:33):
It's the chronic illnesses.

(00:22:35):
It's the it's the big therapies.

(00:22:37):
It's the big surgeries really where RBP is stepping up and lowering the cost.

(00:22:43):
Yeah, exactly.

(00:22:45):
There's another thing I just want to emphasize about the benefit to the members.

(00:22:51):
Plans, deductibles, out-of-pocket.

(00:22:54):
I can't tell you,

(00:22:54):
Vinny,

(00:22:55):
how many times I've seen plan designs at employers that have had a reference-based

(00:23:00):
pricing where their deductibles are now $500.

(00:23:04):
Their out-of-pocket is maybe $500 or $1,000.

(00:23:06):
Numbers that are...

(00:23:11):
are alien to us.

(00:23:12):
We haven't seen those in years,

(00:23:14):
but I'm telling you what,

(00:23:16):
more and more employers that are having success financially with reference-based

(00:23:21):
pricing are giving back to their employees by lowering their out-of-pocket costs.

(00:23:26):
And man,

(00:23:26):
that's what we need more of in this day and age is to help people's pocketbooks,

(00:23:29):
you know,

(00:23:30):
and this does better than anything.

(00:23:33):
Absolutely.

(00:23:34):
Do you feel like there is any segments of is it white collar, blue collar?

(00:23:40):
I mean, is there any differentiation?

(00:23:42):
Is it you know, where do you feel that that there's a general fit for for this type of program?

(00:23:48):
Well, I love that question, because the real answer is it fits anywhere.

(00:23:53):
But let's let's be honest.

(00:23:56):
I have found that those employers that run their businesses and really try to

(00:24:02):
tighten up their cost structures are more apt to try out reference-based pricing.

(00:24:08):
And I'll say auto dealers,

(00:24:11):
trucking firms,

(00:24:12):
manufacturing,

(00:24:13):
blue collar,

(00:24:15):
those types of firms seem to really try to tighten down the hatches a lot more than

(00:24:20):
maybe some of the white collar firms,

(00:24:21):
to be honest with you.

(00:24:23):
Because white collar firms might sometimes say, well...

(00:24:26):
Be nice to save money, but we don't really need to.

(00:24:28):
I've seen that happen too.

(00:24:30):
What about employer size?

(00:24:32):
I mean, is it applicable to, I mean, I see it as an opportunity for a small business.

(00:24:38):
I see it opportunity for the mid market.

(00:24:41):
I mean, kind of how high an employee count makes sense.

(00:24:45):
Yeah, so the sky's the limit in terms of how hot, okay?

(00:24:49):
I've seen employers with thousands of employees doing this.

(00:24:54):
So the real key is self-funding.

(00:24:57):
The first step,

(00:24:58):
and you mentioned that,

(00:24:59):
the first step is the employer needs to be self-funded,

(00:25:02):
not fully insured,

(00:25:03):
right?

(00:25:04):
Because that's the only way that you can introduce a reference-based pricing approach.

(00:25:09):
So case size will determine that.

(00:25:11):
Can the employer, is he large enough to self-fund their plan?

(00:25:16):
Smaller employers with level funded plans are doing reference-based pricing.

(00:25:21):
It's not quite as prevalent,

(00:25:23):
but self-funding is the very first step for an employer to try to do this.

(00:25:30):
Another thing you touched on,

(00:25:31):
and this has been a hot button of mine for several years,

(00:25:36):
is you've talked specifically about engaging the CFO,

(00:25:40):
the C-suite.

(00:25:43):
And to me,

(00:25:44):
that is the sign of a smart consultant or broker is engaging with the finance side

(00:25:51):
of the house versus HR.

(00:25:52):
Yeah.

(00:25:54):
HR has a whole different perspective on things.

(00:25:58):
I hate to say it.

(00:25:59):
I really wish HR could be more well financially trained to understand the nuances

(00:26:08):
of financing healthcare.

(00:26:09):
And it's been kind of a passion project of mine that I'll probably get to eventually.

(00:26:13):
But it's really the C-suite and the CFO.

(00:26:17):
If you get their attention, that's where progress is going to be driven, right?

(00:26:23):
Yeah, exactly.

(00:26:26):
Because in some respects, this is not a benefits discussion.

(00:26:29):
This is a financial discussion where we have to be talking with the people that

(00:26:34):
have fiduciary responsibility on their health plan.

(00:26:38):
And that tends to be where the CFO,

(00:26:41):
the CEOs,

(00:26:42):
of course,

(00:26:42):
HR is crucial in the whole discussion,

(00:26:45):
right?

(00:26:45):
But the C-suite,

(00:26:47):
the CEOs and CFOs have to see this because of the financial nature of this and the

(00:26:52):
impact.

(00:26:53):
Oh, for sure.

(00:26:54):
And you said that the big F word,

(00:26:57):
fiduciary,

(00:26:58):
you know,

(00:26:59):
now that there's law and there's way more need for transparency and employees.

(00:27:06):
I've always joked that employees are your biggest compliance officers, right?

(00:27:11):
I mean, even with stuff like COBRA.

(00:27:13):
You know, if COBRA is getting messed up, really the employees are the best whistleblowers.

(00:27:19):
You know,

(00:27:19):
something like this,

(00:27:20):
especially with some of these new fiduciary responsibility rules that have come

(00:27:24):
down from the federal government.

(00:27:28):
You know, these are things that employees need to know about.

(00:27:31):
Employers need to be be open about because they if they aren't managing the

(00:27:36):
fiduciary side of of the health plan and the employee benefits programs,

(00:27:41):
they're really at risk.

(00:27:43):
But I'm glad we've mentioned the word fiduciary.

(00:27:47):
Some of the better RBP vendor firms

(00:27:50):
take on a fiduciary responsibility on the health plan itself.

(00:27:57):
So in the plan document, they are written up and listed as co-fiduciary with the employer.

(00:28:04):
That has broad ramifications for the operation of the plan and for the success of the plan.

(00:28:10):
Not all firms do that, but the better ones do, and it produces a better financial result.

(00:28:17):
I completely agree.

(00:28:18):
And I think more employers really dug in deep.

(00:28:22):
I mean,

(00:28:23):
I can speak to California because that's where I'm located and that's where my

(00:28:26):
clientele has been.

(00:28:28):
But when you look across a state like this,

(00:28:29):
where even now,

(00:28:31):
you know,

(00:28:31):
75% of all large employers over 100 in California are still fully insured.

(00:28:38):
You know,

(00:28:39):
it's a tremendous opportunity for good consultants and brokers to really educate

(00:28:45):
their clients,

(00:28:46):
educate potential clients on innovative ways to fund,

(00:28:49):
even if they're just taking them from fully insured model to a self-insured model

(00:28:54):
and ultimately to potentially an RBP model.

(00:28:56):
I think there's a tremendous amount of opportunity.

(00:29:00):
Don't sell California too short on RBP.

(00:29:03):
And here's why I've just seen a large group of 600 employees in central California

(00:29:11):
go RBP totally.

(00:29:13):
So it's happening.

(00:29:15):
It's kind of quiet, but it's out there.

(00:29:17):
No, I mean, and I've heard that RBP is, is more prevalent in places.

(00:29:21):
It's really became very prevalent in the Southeast,

(00:29:24):
you know,

(00:29:25):
Georgia,

(00:29:26):
that,

(00:29:26):
that general neck of the woods.

(00:29:27):
Is that a fair, fair statement?

(00:29:30):
Yes,

(00:29:31):
some of the earliest RBP companies and companies that win RBP are in Georgia and

(00:29:37):
some really large ones as well.

(00:29:39):
But also Texas and in the early days, Indiana.

(00:29:43):
Indiana was one of the hotbeds for RBP.

(00:29:46):
Again, wherever you find a prevalence of self-funded health plans...

(00:29:51):
That's where RBP started first, right?

(00:29:53):
From what we were talking about before.

(00:29:56):
You have to be self-funded to do that.

(00:29:59):
And here's the thing that I hope people are listening to, CEOs and CFOs.

(00:30:04):
Going self-funded requires knowledge.

(00:30:07):
You have to study it.

(00:30:08):
You have to be willing to understand it.

(00:30:11):
That's what it takes to do RBP.

(00:30:13):
And you made a couple of comments, Vinny.

(00:30:15):
Gee, it's hard to go from fully insured to RBP.

(00:30:18):
It is, but for a very simple reason.

(00:30:21):
To go from fully insured to self-funded requires a skill set that they haven't

(00:30:26):
learned yet,

(00:30:27):
that they haven't earned yet.

(00:30:28):
You got to have that skill set to operate a self-funded plan before you can jump to

(00:30:33):
the next level to have the skill set of operating an RBP plan.

(00:30:38):
If you're a CFO that's real smart and wants to study, you can do it.

(00:30:43):
Well,

(00:30:43):
at the same time,

(00:30:44):
it's not just,

(00:30:45):
and since everybody,

(00:30:47):
all these CFOs and companies are relying on brokers and consultants to help them,

(00:30:52):
The broker and consultant community has to be educated,

(00:30:55):
and I think that's been one of the challenges in California.

(00:30:59):
A lot of brokers aren't getting the training necessary to really be good.

(00:31:03):
I'm talking about the 80%,

(00:31:05):
not the 20%,

(00:31:06):
but there's a lot of brokers who don't really understand self-funding.

(00:31:09):
Their companies aren't training them in self-funding.

(00:31:12):
And so they don't even have the basic knowledge to talk about RBP.

(00:31:16):
So therefore,

(00:31:16):
the opportunity really is for those brokers that understand the concept of

(00:31:21):
self-funding and by extension can apply RBP.

(00:31:26):
Oh, 100%.

(00:31:27):
I'm glad you said that.

(00:31:28):
Brokers need to be really good students of this business and they need to

(00:31:32):
understand self-funding inside and out.

(00:31:34):
And they all don't.

(00:31:35):
You're right.

(00:31:36):
Well,

(00:31:36):
so when,

(00:31:37):
as one of the things I've told you I'm developing is the Clear Benefits Academy,

(00:31:42):
something that I'm working on for 2026 is a broker training academy.

(00:31:47):
And so RBP will definitely be a topic and I'll definitely have you back to help me with that.

(00:31:54):
As we close,

(00:31:55):
is there anything that you'd like to add or anything I didn't ask you that you

(00:31:58):
would like to add to this conversation,

(00:32:00):
Mike?

(00:32:02):
Well,

(00:32:02):
you know,

(00:32:03):
I love this conversation and I really am glad that you invited me to participate.

(00:32:08):
I've been doing this for 10 years, RBP that is.

(00:32:12):
So I started studying reference based pricing 10 years ago and started selling the

(00:32:17):
largest plans that are out there.

(00:32:19):
And I kind of fell in love with it.

(00:32:20):
I developed a passion for it to the point where the company I'm with now,

(00:32:25):
which you mentioned is claimed on.

(00:32:28):
I went with them because of my passion, because I am a believer.

(00:32:33):
And you know what?

(00:32:34):
There's a lot of people out there,

(00:32:36):
a lot of benefit advisors,

(00:32:37):
a lot of employers that just don't understand this,

(00:32:40):
that need the knowledge.

(00:32:42):
And I'm happy to help them out.

(00:32:44):
That's why I'm doing what I'm doing.

(00:32:46):
Great, Mike.

(00:32:46):
Listen, thanks so much.

(00:32:47):
Before we leave,

(00:32:49):
as I mentioned in the preamble before we got started recording,

(00:32:52):
I love wine and I have a wine Instagram called Vines with Vinny,

(00:32:59):
which is fun.

(00:33:00):
I put up some content.

(00:33:01):
I share experiences.

(00:33:02):
I talk about wine that I like or don't like sometimes.

(00:33:06):
So I'm curious.

(00:33:07):
Do you like wine?

(00:33:10):
I have a favorite white and a favorite red.

(00:33:13):
Well, tell me, what are those?

(00:33:17):
I'm not super knowledgeable, but I always order a Pinot Grigio on the white, okay?

(00:33:22):
Because it's a little drier for me.

(00:33:24):
I don't like them too sweet.

(00:33:27):
And I always order a Pinot Noir, okay?

(00:33:31):
Yep.

(00:33:32):
You're the second guest that loves Pinot Noir.

(00:33:35):
I love it.

(00:33:36):
Well,

(00:33:37):
what I learned about that,

(00:33:38):
Vinny,

(00:33:38):
is some of the best ones are just north of you up in Oregon,

(00:33:42):
right?

(00:33:43):
Correct.

(00:33:44):
So on a menu, I'm always looking, oh, where's the one?

(00:33:47):
Is it Willamette?

(00:33:48):
Willamette Valley, yep.

(00:33:50):
Willamette Valley, exactly.

(00:33:52):
Plus, the other reason I like Pinot Noir, I just like the word, Noir, Pinot Noir.

(00:33:57):
I just like the way it sounds.

(00:33:58):
That's a good enough reason to love a wine, honestly.

(00:34:01):
And no,

(00:34:03):
I'm excited that you shared that because I just love hearing people's wine

(00:34:08):
journeys,

(00:34:08):
their experiences,

(00:34:09):
what they like.

(00:34:10):
And I also know what to buy you.

(00:34:13):
So thank you very much, Mike, for joining me today.

(00:34:16):
Thanks for joining the Clearly Beneficial podcast.

(00:34:19):
And a great interview.

(00:34:21):
I really enjoyed this conversation.

(00:34:22):
Likewise.

(00:34:24):
I would be happy to have you on another time in the future.

(00:34:28):
I would love to.

(00:34:28):
I appreciate it very much.

(00:34:29):
Have a great day.

(00:34:31):
Thanks, Mike.

(00:34:34):
This podcast reflects the personal views of the host and guests,

(00:34:38):
not their employers or sponsors.

(00:34:41):
See you next time.