The Phia Group Blog Posts

Industry Crossroads – How the 2024 Election Impacts You & Major Implications For Our Industry

On October 17, 2024
Although healthcare hasn’t stolen the limelight as it did in past elections, those “in the know” know that the results of this historic election will have a major impact on healthcare and health benefit plans alike. Between soaring drug costs, increased fiduciary litigation, the impact of A/I, and growing popularity of weight-loss drugs (which is likely to escalate as the year ends), to thrive in 2025 and beyond industry insiders must understand the current state of the market as well as predict what is to come. Join us as we discuss these and other pressing issues. Also, speaking of A/I, our team will present a live demonstration of SoPhia, our very own chatbot, which will engage with audience questions.

Cobenfy: A Potential Game-Changer for Schizophrenia Patients – But at What Price?

On October 9, 2024
As you’re reading this blog, millions worldwide are suffering from the horrors of schizophrenia, one of the most complex, debilitating, and stigmatized mental disorders inflicted on humanity, the symptoms of which typically manifest themselves in early adulthood, though they are not always so easy to detect. Those afflicted by this condition are desperately trying to manage an array of frightening symptoms (hearing voices, delusions, memory lapses to name a few) while carrying on with their lives. In this country alone there are approximately 2.8 million Americans living with schizophrenia; tragically, many of those 2.8 million Americans won’t be living much longer as there is a particularly acute rate of suicide among people battling schizophrenia. Meanwhile, so many others suffering often experience prolonged bouts of homelessness and/or run afoul of the law. And for decades, pharmacological innovation has moved at such a glacial pace that treatment has largely yielded inadequate improvement in symptoms and/or intolerable side effects during therapy that many have felt inclined to discontinue usage.

Healthcare and Politics… Ugh. Old News!

On September 27, 2024
Donald Trump recently stated that while he will never give up on repealing the ACA, he also said that he was not running on terminating the ACA. This is likely a smart decision, given that a recent Kaiser Family Foundation (KFF) poll revealed that for Republican voters, repealing Obamacare was an important issue for a very small percent of respondents. Is this demonstrative of a more widespread loss of interest in health care as a political talking point?

The Phia Group Announces the Hiring of Justin Forton as a Client Success Account Executive

On September 19, 2024
CANTON, MA – September 19, 2024 – In its continued dedication to bolstering the health benefits industry, The Phia Group has hired Justin Forton as a Client Success Account Executive. Justin will channel his data analytics experience and industry-focused customer service expertise to support and collaborate with The Phia Group’s clientele.

The First Ten: Medicare Unveils Inaugural List of Negotiated Drug Prices

On September 16, 2024
Last month, while many of us were busy vacationing or doing last-minute back-to-school shopping, the Biden administration announced that it had reached an agreement with the titans of the pharma industry to lower prices on the 10 costliest prescription drugs under Medicare, thus bringing to fruition Democrats' decades-long push to allow the government to negotiate directly with pharmaceutical manufacturers. While individual plans had previously been able to haggle over prices with Big Pharma, this development marks a seminal moment as it is the first time that Medicare used its clout to be able to negotiate for the program as a whole.

Empowering Plans: P201 – Diving Into the Parity Pool: MHPAEA’s Latest Updates

On September 12, 2024
Regulators finally announced the long-awaited MHPAEA Final Rules on September 9, 2024. Many of these changes will directly affect group health plan design and modify the NQTL comparative analysis testing requirements - many of which will be significant for plans as they prepare for 2025. Join attorneys Jennifer McCormick and Bryan Dunton for their discussion on several critical considerations for plans as renewal season approaches.

The Phia Group Announces Enhancement to Ecosystem of Services: Care Empowered Pricing

On September 11, 2024
The Phia Group’s industry-leading ecosystem of cost containment services, including ICE, Subrogation & Recovery, PACE, and Phia Unwrapped, has been bolstered with Care Empowered Pricing, a cutting-edge Reference-Based Pricing (RBP) model providing quality care and fair pricing tailored to your needs.

Empowering Plans: P200 – Recognizing Our Blind Spots

On September 5, 2024
Dr. Marty Makary is a New York Times bestselling author, renowned Johns Hopkins surgeon, and globally recognized expert on medical research. In its most recent edition of the Empowering Plans podcast series (“Recognizing Our Blind Spots”), Dr. Makary was a special guest as he engaged in conversation with CEO Adam V. Russo about his new book, Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health, https://geni.us/blindspots. This is an episode jampacked with enlightening and engaging anecdotes that will leave you with new insight into commonly held assumptions about healthcare. After all, in order to fix the healthcare industry, people need to have access to correct information about modern medicine.

Section 1557 Final Rule: Where Do We Stand?

On August 30, 2024
The implications of the Section 1557 Final Rule are currently in flux since the Final Rule was issued on April 26, 2024. The purpose of the Final Rule was to extend the protections against discrimination in healthcare, with a particular emphasis on gender identity. The inclusion of gender-affirming care within the protection against sex discrimination was a huge step forward in strengthening the scope of Section 1557 beyond what was originally afforded when the rule first passed.

Empowering Plans: P199 – Summer Regulation Rundown

On August 29, 2024
The regulators rush to finalize a suite of marquee regulations as the clock gradually runs out on the Biden administration. Even when finalized, these regulations may be vulnerable in the post-Chevron landscape. Attorneys Kelly Dempsey and Nick Bonds pick apart some of the big rules we’re looking forward to and the challenges they may face.

Healthcare in Rural America

On August 19, 2024
Whether it’s met with great anticipation or utter dread, summer will soon be giving way to autumn. For many people living in picturesque New England, where The Phia Group is headquartered, seasonal change means an upcoming weekend of leaf-peeping. But when we’re checking out apple orchards and roadside maple sugar shacks, it’s easy to forget the sobering reality: life isn’t always so sweet for residents in these one-stoplight rural outposts as many face imposing barriers to healthcare.

Don't Be Surprised - Phia's Keys to Success with The No Surprises Act and Appeals Management

On August 19, 2024
As the dog days of summer drag on, the No Surprises Act and its benefactors are feeling the heat. Case volume is overloading the IDR process. Courts are split over whether and how parties can enforce arbitration awards. Payers, including group health plans, are paying nearly four times as much for services as CMS. Combined, this all threatens to undermine the original intent of the law and drive up costs for all. Now, more than ever, it is paramount to understand how these developments impact you and to enact a process to triage billing disputes - separating NSA claims from appeals. Phia is the option for success in this arena. Join our legal team on Tuesday, August 20th, at 1:00 P.M. ET, as we discuss our unique, battle tested processes for handling NSA claims and appeals. From utilizing intelligent out-of-network pricing methodologies and benchmarking to deploying cutting edge appeal review software, we cover all the bases and reveal the best practices for success.

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