Episode 484

3 Burning Questions Every Self-Insured Employer Should Be Asking Right Now, With Dave Chase. EP484

Aug 21, 2025

31:58

Episode Description

Across the country, self-insured employer teams are waking up to the fact that "I trusted my consultant" is not a legal defense. Not under ERISA. Not under the Consolidated Appropriations Act. And the lawsuits — J&J, Wells Fargo, Tiara Yachts versus Blue Cross Blue Shield of Michigan, Osceola County — are making it impossible to ignore. In this episode, Stacey Richter asks Dave Chase, co-founder and CEO of Health Rosetta, to answer the three most burning questions plan sponsors are asking right now: how to verify a benefits advisor actually works for you, how to avoid personal liability when TPA contracts have hidden conflicts, and how to tell if pharmacy costs are being systematically inflated despite PBM guarantees.

WHAT YOU'LL LEARN

✅ The four canaries in the coal mine of trust for any benefits advisor: comprehensive compensation disclosure with no excuses, full data and reporting access, real experience with high-performance health plan components, and a meaningful share of their book of business with independent plan administrators

✅ Why unfettered access to claims data is the single most predictive factor of a high-performance health plan — confirmed by a Tufts University study of 2,000 to 3,000 Health Rosetta plan grade reports — and why being blocked from that data is a near-certain sign you are being overcharged

✅ How spread pricing works on the medical side: the Tiara Yachts lawsuit documents Blue Card claims being repriced out-of-network to inflate so-called savings, with the carrier collecting fees larger than what was actually paid to the provider

✅ Why pharmacy guarantees can hide systematic overcharges: PBMs have created approximately 50 different revenue streams, rebate guarantees often retain manufacturer revenue, and without net cost disclosure after all fees, the numbers that appear favorable on paper conceal the actual extraction happening in the background

✅ What the Ann Lewandowski whistleblower case revealed: one EBC's TPA arm took $20 million in client pharmacy rebates and funneled them into their executive bonus pool — not a single client discovered this without the whistleblower

✅ What Health Rosetta and Nautilus Health Institute have open-sourced for free: an advisor RFP template, a TPA contract template, a data platform, and a PBM Field Guide — tools that represent approximately $4 million in direct investment, available at nautilushealth.org

WHY THIS MATTERS

The retirement industry went through this same reckoning 15 to 20 years ago. The status quo players disappeared and a completely different set of market leaders emerged. Dave Chase argues the same thing is happening now in employer-sponsored health benefits — and the employers who act on these three questions before the lawsuits find them are the ones who will come out ahead, with better health outcomes for their members and meaningfully lower costs.

MENTIONED IN THIS EPISODE

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