Outlier Clauses: Healthcare's Best Kept Secret | with Ryan Bojrab

"If you're expecting to pay $50k, but it hits an outlier clause, you could be paying upwards of three, four, five, six hundred thousand dollars." What if the single biggest driver of your high-cost claims isn't your discount, your network, or your utilization, but a contract provision almost nobody in this industry has ever read? My guest this week is Ryan Bojrab, who leads new solution development at Aon and came into this business through a channel almost nobody uses: he started his career a

"What used to be a once-a-year catastrophic claim is now happening every single week across the stop-loss market." We're back for the fourth year in a row with our annual whiteboard review of Tokio-Marine HCC’s Stop Loss Report. Drawing from a massive block of over $2 billion in force premium, this report gives us one of the clearest, most objective looks at what is actually happening under the hood of self-funded health plans across the country. In this episode, I break down the biggest trend

"I relate it to one of the Wizard of Oz characters... I've seen behind the curtain. I know how it's all put together." What happens when a man who spent nearly five decades inside every corner of the self-funded industry decides his final act is to give the playbook away?My guest this week is Charlie Gragg, a true first-generation veteran of self-funding. Charlie started in the late 1970s underwriting stop-loss cases on napkins from payphone booths, went on to run his own TPA, and has now semi-

"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

"This is why insurance is such a beautiful problem... there is no solution. There are only psychological or philosophical answers to it." What if the rising cost of health insurance is a deeply ingrained philosophical problem? My guest this week is Tom Stein, CEO of American Trust Administrators (ATA). But this episode isn’t just a tactical breakdown of stop-loss and aggregate underwriting; it is a masterclass in the history, psychology, and economics of the U.S. healthcare system. Tom and I

"When you see $6.5 billion in healthcare fraud, we all end up absorbing that in the commercial market." In this episode of Last Month in Healthcare, Producer Nathaniel and I sat down with Sid Sinha, founder and CEO of Avant/Nara Health, to break down the biggest healthcare news stories of June 2026. We started by looking at the DOJ's massive $6.5 billion healthcare fraud crackdown and what 1,400 revoked provider privileges actually means for the commercial market. We also tackled the stark re