Host Roy Bejarano sits down with Mark Jamilkowski, a seasoned actuary and healthcare executive, to explore the dynamics of the healthcare payer industry, the challenges facing self-insured employers, and barriers to entry for new insurance providers.

In this episode, Mark shares insights into how government regulations, Medicare Advantage, and payer-provider relationships shape the industry. He also discusses his experience launching Every Health, a new insurance model focused on digital health integration and care coordination. This conversation is a must-listen for healthcare leaders, investors, and innovators navigating the ever-evolving payer landscape.

Timestamps:

• [00:01]  Introduction to Mark Jamilkowski and his 30-year career in the healthcare industry
• [02:09]  Understanding the payer landscape: Medicare, Medicaid, and employer-based insurance
• [05:55] The economics of Medicare Advantage and why insurers focus on this market
• [12:28] Myths vs. realities of the self-insured employer market
• [22:33] –you Launching Every Health: How to break into the insurance industry
• [40:47]  The role of digital health, value-based care, and provider partnerships in the future of healthcare

Key Takeaways:

• Market Segmentation Defines Success – Large payers like UnitedHealth, Humana, and Centene approach different market segments strategically, favoring high-margin Medicare Advantage plans.
• Government Influence is Unavoidable – Over 65% of U.S. healthcare spending is government-funded, shaping the priorities and strategies of insurers.
• Self-Insured Employers Are Not Taking Over – Contrary to industry narratives, the percentage of self-insured employers has remained stable for decades, despite broker-driven hype.
• Technology & Value-Based Care Will Drive the Future – Innovations in digital health, data analytics, and care coordination are reshaping how payers and providers interact, with companies like Every Health leading the charge.

Connect with the Guest:

 Website: Evry Health

LinkedIn: Mark Jamilkowski

About Mark Jamilkowski:

Mark Jamilkowski is a healthcare industry veteran with over 30 years of experience as an actuary, investment banker, and entrepreneur. He has held leadership positions at Aetna, Big Four consulting firms, and venture-backed insurance startups. As co-founder of Every Health, he is pioneering digital-first insurance solutions that integrate value-based care and provider partnerships to enhance patient outcomes.

Healthcare, Healthcare Leadership, Healthcare Trends, Roy Bejarano, Healthcare Innovations, Healthcare Industry Insights, Health Insurance Market, Medicare Advantage, Self-Insured Employers, Digital Health Solutions, Value-Based Care, Payer Market Strategy, Healthcare Consolidation, Insurance Industry Disruption, Mark Jamilkowski,