Healthcare premiums keep rising, but plan quality often stays the same (or gets worse). In this conversation, Shaun Enders sits down with Donovan Pyle—CEO of Health Compass and author of Fixing Healthcare—to unpack why the employer-sponsored healthcare market functions the way it does.
Donovan explains the "hidden supply chain" behind your healthcare spend, why broker incentives often conflict with employer outcomes, and how CEOs can start reclaiming wasted dollars by getting unbiased, fiduciary-aligned guidance and improving visibility into unit pricing.
Why employer healthcare spend feels unstoppable, and why that belief is "trained"
The healthcare supply chain and how lack of transparency drives waste
How brokers were historically designed to function (and why incentives matter)
Why networks can hide prices and distort the price/quality relationship
The "discount off infinity" problem behind EOBs (Explanation of Benefits)
Regulatory capture and why some states limit small-business options
Certificate of Need ("CON") laws and how they restrict competition
The shift toward fiduciary models (similar to what happened in retirement plans)
Practical steps for CEOs: visibility, vendor stack, and unbiased advisory support
00:01 – Welcome + why this topic matters to Shaun (20 years of premium increases)
01:17 – The big numbers: employer-sponsored coverage, $1.3T spend, and the "waste" claim
02:03 – Why finance/HR teams aren't set up to understand healthcare procurement
03:54 – The broker dilemma: "the only voice you have" vs. conflicts of interest
05:29 – Why Donovan focuses on the employer-sponsored market (not Medicare/Medicaid)
07:27 – The origin story: the first U.S. insurance plan (1929) and what became Blue Cross
09:26 – Brokers as "retail distribution" and why costs rising helps the sell-side
11:59 – ACA, cost-plus dynamics, and why vertical integration changed the game
14:52 – Reframing healthcare: not one line item—a supply chain
16:31 – Shaun's parallel: higher education costs and "cracks in the veneer"
19:14 – The strategy universe expands once you get unbiased advice
21:21 – Cash pricing: why individuals sometimes get better pricing than big insurers
23:34 – Shaun's billing experience: allowed vs billed, even in integrated systems
25:35 – EOBs as marketing: "Island Speak" and the illusion of savings
29:40 – Small business reality in CA/NY/WA: limited options and why
34:50 – Certificate of Need ("CON") laws: regulating supply and blocking competition
42:07 – ACA subsidies: what's expiring and what the market may revert to
46:31 – The most practical step: get unbiased, fiduciary-aligned advice
51:16 – Parallels to financial services: commissions → fee-based fiduciary models
57:14 – Real example: PBM RFP leading to multi-million-dollar savings
59:18 – Bringing it back to purpose: time, meaning, and what drives Donovan
01:05:29 – Where to find Donovan + free executive summary roadmap
https://assessment.healthcompassconsulting.com/tba
Watch on YouTube:
Connect with Shaun:
www.BusinessFinanceAndSoul.com
https://www.linkedin.com/in/shaunenders/
People / Organizations Mentioned Donovan Pyle – CEO, Health Compass; author of Fixing Healthcare Validation Institute – referenced as a place to find fiduciary-based firms RAND Corporation (2021 study referenced) – cash pricing / employer pricing dynamics David Goldhill – author of Catastrophic Care (chapter: "Island Speak") Harris Rosen – Rosen Hotels (Orlando), example of long-term employer healthcare strategy Resources Mentioned Free executive summary + roadmap: FixingHealthcare.com Book: Fixing Healthcare (Donovan Pyle) Book: Catastrophic Care (David Goldhill)
Disclaimer This episode discusses healthcare financing and benefits strategy from an employer perspective. It is not medical, legal, or financial advice.
