Why Healthcare is Broken with Donovan Pyle

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.

Key Topics Covered

• 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

Chapters / Timestamps (YouTube-style)

• 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:

https://youtu.be/9vEdj0XBOyI

Connect with Shaun:

www.CallTSG.com

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.