The Business of Benefits Podcast

The Business of Benefits Podcast The Business of Benefits is where employers go to learn the truth about healthcare and employee benefits. We’re here to prove otherwise.

For decades, HR leaders, CFOs, and CEOs have been told they can’t control healthcare costs.

"If you're not able to see all of your options, or you're not being informed of all of your options, you can't really ma...
10/02/2026

"If you're not able to see all of your options, or you're not being informed of all of your options, you can't really make an informed decision."

Patrick Ansara, Director of Client Operations at Ethos Benefits, said this while describing undisclosed ownership between advisors, TPAs, and the vendors they route business through.

Read the sentence again and notice the two halves. Not able to see is one failure. Not being informed is a different one, and it's the one that's harder to catch, because the options were never presented in the first place. You can't audit an absence you don't know about.

That's what makes this different from most cost conversations. The information you'd need to catch the problem is held by the party with an interest in you not catching it.

Patrick's example: a TPA that owns a pharmacy arrangement and routes prescriptions through it, without ever disclosing the relationship.

For CEOs and CFOs, this isn't really a healthcare question. It's a decision quality question, and you already have a framework for it. In any other capital decision, you'd want to know what alternatives were considered and rejected, and why.

So make that the ask at your next renewal: show me what you looked at and didn't recommend, and tell me why.

The options you were never shown are the ones worth asking about.

Link is in the comments.

10/02/2026

"You don't have a lot of leverage, and the carriers do know that."

Patrick Ansara, Director of Client Operations at Ethos Benefits, on the single most fixable mistake employers make at renewal: starting late.

Sixty days before open enrollment, your options have already closed. You can't run a real market check, you can't meaningfully renegotiate terms, and the other side knows exactly how little room you have left. That isn't a negotiation. It's an acceptance.

What his team does instead: start at least 150 days before renewal depending on client size, and stretch that to 180 or even 360 days when the procurement process is long.

There's a second piece worth hearing. When the rates aren't ready yet, most employers just stop and wait. Patrick doesn't. If the pricing isn't available, ask for the renewal contract anyway, because the terms are half the deal and you can be working them while the numbers catch up.

For CFOs and HR leaders: this one costs nothing to fix. It's a calendar decision, made once, that determines how much leverage you have when it actually counts.

When does your renewal clock start?

Link is in the comments.

10/01/2026

If you've ever sat through a 401(k) review, you already understand this one.

Donovan Ryckis, CEO of Ethos Benefits, compares broker owned pharmacy collectives to proprietary funds. Every firm has them. Every firm sells them. And occasionally the proprietary version really is marginally better than the copy on the open market.

But it's still built on something that exists on the open market anyway, with the firm's own compensation layered in.

Apply that to pharmacy. A collective is assembled by an agency, and it's meant to generate revenue for that agency. That revenue has to be additive. It isn't coming out of their pocket.

His conclusion is blunt: a fiduciary PBM will beat any collective any day of the week, with any client. And it's available to employers of every plan size, not just the largest ones.

Then the tell. These arrangements tend to restrict your data and resist sharing or quantifying the value. If there were real savings there, they'd be showing you the spreadsheet.

For CFOs: when someone claims savings and won't show the math, the missing math is the finding.

Link is in the comments.

"One of our mentors said that this industry pays incredibly well for mediocrity, and I couldn't agree more."Donovan Ryck...
10/01/2026

"One of our mentors said that this industry pays incredibly well for mediocrity, and I couldn't agree more."

Donovan Ryckis, CEO of Ethos Benefits, said this at the close of an episode spent naming specific tactics that cost employers money.

It's worth being precise about what he means, because he is careful about it himself. This is not an accusation that everyone in the industry is acting in bad faith. His actual position: the tactics are not always nefarious, but if they're not, then bring the data.

That's a standard, not an insult. And it reframes the whole conversation for an employer.

You don't have to determine whether your advisor is conflicted, lazy, or simply working from habit. That's an unanswerable question from where you sit, and chasing it turns every renewal into an exercise in suspicion.

Ask for the math instead. Why these carriers. What the compensation actually was last plan year. What the alternative priced at. How the recommendation was reached.

Someone doing good work will welcome the question, because the data is the easiest part of their job to hand over.

Mediocrity is what survives when nobody ever asks.

What's the last recommendation you accepted without seeing the numbers behind it?

Link is in the comments.

09/30/2026

"My broker said we were meeting affordability."

Chelsea Ryckis, President of Ethos Benefits, hears versions of this constantly from employers who are just starting to work with her team. Somebody told them they were fine. And there is no actual check anywhere in the contract.

This is bigger than sales proposals. It's the verbal layer. A rep says yes, it's a guaranteed renewal for two years. Everyone nods. Nobody writes it down.

Then you get into it and the guarantee turns out to be everything except this one thing, and this one thing, and this one thing. Chelsea's team finds it where it was always going to be found, in the contract.

Part of the problem is structural. Sales and implementation are often two different groups, and the person making the promise is frequently gone by the time it's tested.

For CFOs and HR leaders, the exposure here is real. Compliance assurances that live only in somebody's memory of a phone call are not assurances. They're a liability with a friendly tone.

Her rule: never assume what somebody's telling you. It has to be in writing.

What are you currently treating as settled that exists nowhere in your documents?

Link is in the comments.

"You don't have a lot of leverage, and the carriers do know that."Patrick Ansara, Director of Client Operations at Ethos...
09/29/2026

"You don't have a lot of leverage, and the carriers do know that."

Patrick Ansara, Director of Client Operations at Ethos Benefits, on the 60 day window before open enrollment.

That last clause is the one to read twice. Not that you lack leverage, but that the party across the table has already priced in exactly how little you have.

Everything that gives an employer negotiating power takes time to build. A real market check takes time. Getting claims data released takes time. Getting multiple underwriters to look at your risk and form a consensus takes time. At 60 days, none of that is available, so the conversation stops being a negotiation and becomes an acceptance with extra steps.

Patrick's team starts at least 150 days before renewal, and extends to 180 or 360 days when procurement runs long.

What makes this quote worth acting on is how cheap the fix is. Most cost problems in a health plan require expertise, vendor changes, or a multi year strategy. This one requires a calendar entry.

For CFOs and HR leaders: find your renewal date. Count back 150 days. Put it on the calendar today, for next year, before anything else competes for that week.

When does your renewal clock actually start?

Link is in the comments.

09/29/2026

You decide to change brokers. Then you find out your stop loss arrangement won't let you.

Donovan Ryckis, CEO of Ethos Benefits, walks through a structure most employers never see coming.

A broker places you into a group captive. Your broker's compensation gets built into the captive layer rather than sitting as a line item with your TPA. And to protect the relationship, that compensation is written as unassignable to anyone else.

Read what that actually does. The insurance protecting your company and the broker selling it have now aligned with each other, against your ability to make a change. You decide the relationship isn't working, you pick new representation, and the captive says no, we won't sign that.

Donovan is direct about why it exists: it's designed to make taking over that account worthless to anybody else.

For a CEO or CFO, this is a governance issue before it's a benefits issue. You should be able to change your advisor without unwinding your risk protection.

The fix he gives: keep advisor compensation out of the captive contract entirely and hold it as a TPA line item, where it's transparent and assignable.

Do you know where your broker's compensation actually sits?

Link is in the comments.

An employer was in a pharmacy collective. Ethos went direct to that same PBM and asked for a reprice study.On a $9 milli...
09/28/2026

An employer was in a pharmacy collective. Ethos went direct to that same PBM and asked for a reprice study.

On a $9 million claim spend, the pricing came back $1.4 million better outside of the collective.

Patrick Ansara, Director of Client Operations at Ethos Benefits, shares this one in the episode, and the detail underneath it is the part worth sitting with.

The gross plan cost was identical in both columns. What changed was the rebates, which came back significantly higher outside the collective.

So the dollars existed the whole time. The question Patrick raises is simply where they were going instead.

For a CFO, run the math on your own plan. That's roughly 15 percent of pharmacy spend, sitting inside an arrangement that was presented as a way to save money through group buying power.

The pitch for these collectives sounds completely reasonable. Join with thousands of other employers, get leverage you could never get alone. It's the same logic behind every group purchasing arrangement you've ever evaluated.

The problem is that the collective is assembled by an agency, and it has to generate revenue for that agency.

If you're in a pharmacy collective right now, ask for a reprice study direct with the same PBM. One request. One comparison.

Link is in the comments.

09/28/2026

She asked for monthly reporting instead of quarterly. The vendor said yes, then quietly deleted a performance guarantee and never mentioned it.

Chelsea Ryckis, President of Ethos Benefits, caught it in the contract review.

When she asked where the member response time guarantee went, the answer was almost casual: now that we're providing reporting every month, we just needed to take something away.

Nobody flagged it. Nobody sent a redline note. And the two items weren't even related, which is the part that should concern you. This wasn't a trade inside one category. A service guarantee tied to how fast your employees get help simply disappeared to pay for a reporting change.

If you're a CFO or benefits leader, here is why this should land. You are almost certainly comparing the price on the proposal to the price on the contract. Most people do. Meanwhile the terms are moving, and terms are where the actual protection lives.

The fix isn't complicated. Before you sign, lay the original proposal next to the final contract and read the guarantees line by line.

What changed between the pitch and the paper?

Link is in the comments.

09/25/2026

"If it's the same three every single year, that's a shortlist. That's not really a market check."

Chelsea Ryckis, President of Ethos Benefits, gives employers a two minute audit in this clip.

Pull your last three renewals. Find the page where your broker says they went to market. Count the distinct vendors.

If the same three names appear every year, you did not have a market check. You had a shortlist, and somebody else picked it.

This matters because "we went to market" is doing a lot of work in most renewal presentations. It sounds like due diligence. It gets recorded in the file as due diligence. And for a plan sponsor carrying a fiduciary obligation, it looks like the box is checked.

Then Donovan Ryckis adds the harder part: if your advisor tells you they work for you, they shouldn't be getting paid by the other side of the table.

Count the names on your own renewals this week. It takes ten minutes and it tells you most of what you need to know.

Link is in the comments.

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