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What Does FDA CBD Approval Mean For Self-Funded Plans?

On July 2, 2018
The FDA recently approved medical marijuana for the United States. Read more to see how CBD will impact self-funded health insurance plans.

Expansive Paid Leave Legislation for Massachusetts Employers

On June 29, 2018
Governor Charlie Baker recently signed new legislation that will directly impact employers of Massachusetts. Learn more about what this includes!

Empowering Plans: P46 - You’ve Gotta Fight, For Your Right, to Try!

On June 29, 2018
Welcome to Empowering Plans a show dedicated to identifying waste and undo expense in the health benefits industry. Discovering ways to maximize benefits while minimizing costs, and empowering employers, administrators, and consultants to emphasize once again the benefit in benefit plan. Today’s episode is brought to you by the Phia Group Empowering Plans Since 1999, now here are your hosts the Phia Group’s own CEO Adam Russo, and senior vice president and general counsel Ron Peck, and Brady. ADAM: Hello everybody, and welcome to another episode of Empowering Plans with the Phia Group. Hello everybody! Hi-lo audience! I am your co-host, and the CEO, and co-founder of the Phia Group, Adam Russo. With me as always is our general counsel, senior VP Ron Peck. Say hello Ron RON: Hello Ron. ADAM: And what else can you say about Jen? Everyone just check. Just look at Jen. What can you say? Our amazing, the smartest, the brightest, the wonderful, the LinkedIn superstar, once we put Jen’s picture on anything the views go up. RON: You’re giving away my secret weapon. ADAM: That is Ron’s secret weapon. RON: That’s how I get all those hits. ADAM: Our vice president of our recovery services, Jennifer McCormick. Say hello Jen. JEN: Hello. ADAM: She always does the “Hello” that’s it. So folks Jen is a little freaked out. This is our first, I guess, it’s not a podcast, what do you call these Ron? RON: A vlog? ADAM: A vlog? We are videotaping live. Pat our producer is here, he is sweating too. Pat has multiple jobs today. RON: Funny too because he is off the camera, I mean he could actually be naked right now. ADAM: He might actually be on camera; I don’t know how wide this lenses is. Folks, we appreciate you all joining us on a short notice. This is a big, big, big deal for us for two reasons. One, you can see our beautiful faces. But two, this right to try law that was recently passed by President Trump. People have already reached out to us many times in regards to the impact. We figured, just based on the amount of responses, the amount of impact we feel this has on our industry we thought we would bring in our expert. And as she likes to say, “The right to try, is it right for you?” And we will talk to you about it a little bit. Jen, do you want to give them a little background, and we will take it from there guys. JEN: Sure. The right to try while it is a new law that was actually just issued in May of 2018, so it’s about a month old or so at this point, this is not a new concept. This concept has been along for about ten years at this point. And this was an FDA expanded access program that was giving individuals the right to receive certain treatments that were not otherwise FDA approved throughout the entire process. ADAM: So if is not something new, then why is it new? JEN: So the caveats to the right to try act are that now instead of having to go through FDA approval you can get your physician to sign off on it. And you can get it through that process instead of having those extra steps of that FDA red tape. ADAM: So I was reading about the FDA red tape, and that fact that 99% of the time the FDA approves it anyways. Again let’s be honest if I have a terminally ill family member, and I’m meeting with our doctor, and they can approve it right then and there, let’s be straight up like having to go through the FDA process in my mind even though at the time I’m assuming no one knows that it’s 99% approved, it’s daunting, right? To go through that process. JEN: It is intimidating. RON: I think, Adam actually you make a good point. ADAM: Oh Ron, everyone check out Ron’s suit RON: Hey hey, feeling good ADAM: Is that a new one, Ron? RON: Uh no.. this is one of ADAM: Why are the tags still on the suit, Ron? You should probably take those tag off before RON: I just figured if someone tries to take it away, I could always get it back, you know? You gotta label everything these days. But anyway, you mentioned the FDA and the existing expanded right use rules and the fact that in essence it mirrors the RTT or the right to try up until a certain point when all of a sudden the FDA has to basically make an exception on a per case basis. And Adam your point that they say, “Oh but we make an exception 99% of the time, so why do you need to get around it?” When it’s basically going to pass right through. I think that there are a number of people who didn’t even try because they knew either they weren’t going to get approval, or they didn’t have the time, or they were daunted by it. ADAM: Or they were scared! Obviously, it is a process. You have family member, a loved one is dying, and you have to go through the FDA to get approval to take a drug that may or may not work that just passed phase one. I get it. RON: That is why they say 75% of statistics are made up, right? ADAM: Right RON: Because ultimately, you know the only people who are submitting it for FDA approval are the ones who know they are going to get it passed, which is why you have a 99% success rate. JEN: Right, the other thing here that’s complicating is that ADAM: We actually should let Jen talk, Ron. This is her expertise JEN: Right RON: Alright JEN: Well the cost, right? Previously, you would assume that if you have to go through the FDA approval process it is going to be expensive. Right? RON: Sure JEN: New drugs are always expensive. So now, under the new RTT regulations the drug manufacturers actually have to provide the drug at actual cost. ADAM: So you actually know, again transparency, you actually know the cost of the drug? RON: That’s true ADAM: If there was a drug, again, these are all trial right, they are first phase or past phase one testing so you know the cost of it. Here is my question, okay: one, who pays for it? Who is actually paying? So even if it’s the cost and that cost is a thousand dollars, who is paying that thousand bucks? JEN: The patient. Right, so right now, there is no requirement; no obligation for anyone (health insurance, self-funded plan) no one is required to pay this cost. This is on the patient. ADAM: So as a self-funded employer, there is no negative effect on me. I don’t have to cover this. If anything, if I care about my employee I can decide I guess if I want to cover it. But I might actually save their life. JEN: Right ADAM: So what is the negative? JEN: The negative potentially could be “I’m going to cover the drug, but it’s only gone through phase 1 of the FDA trails. So we don’t know what happens in phase 2, what happens in phase 3.” ADAM: What if there is a side effect? RON: Yup JEN: Right. Exactly ADAM: Who pays for that? RON: Good question JEN: And what about the complications? Right. So that piece of it has made people a little bit wearied to add this to their current plan because they say “Great maybe this is a super alternative…” ADAM: Okay, let’s say it’s not added to the plan again we are going to use our self-funded plan. Knock on wood, I get really sick. I go “Alright, the plan is not going to pay for it, nor should they; I get it you’re going to cover FDA approved drugs.” I pay for it myself. I have side effects. Whose responsibility is it to pay for the complications? RON: Right ADAM: The plans? JEN: Right now, under the current regulations, the plan has zero obligation to do that. But, how can you tell what is an obligation, or what is a side effect of that particular drug? It’s only gone through phase 1 testing, how do you know? ADAM: Right. So let’s say I get the flu afterwards. RON: Is flu a side effect, or did you just get the flu? That is one of the difficulties ADAM: Bingo. That is some of the areas where there is difficulty. RON: A lot of people have said when you look at most plans usually, not only do they exclude a certain treatment or service, but then they also exclude side effects or complications of that excluded treatment. So people are hanging their hat on that. And the thing is if it is something you know is excluded; let’s say plastic surgery, cosmetic surgery that’s absolutely excluded. The person goes in for cosmetic surgery, next thing you know they have some sort of infection, a surgical infection. You could draw the line, one to one and exclude that too. But you are right because these things are so unknown, how do you know that is a complication? ADAM: So, Jen. I guess my question for you is you know, we are an empowering plans podcast, right? What advice do we have for our self-funded clients? What advice do we have to their advisor brokers? On what do they need to talk to their clients about? If anything. What changes are there in the plan design, if any? How does this affect stop loss? I know it’s a lot of questions but run us through the whole thing JEN: The first step is right to try, this means that there is now an opportunity for people to have access to drugs they did not have access to before. ADAM: Potentially, good JEN: Potentially a good thing. ADAM: Potentially, bad JEN: So is this an opportunity that as an employer you want to take advantage of? Yes or no? Regardless of whether it is yes or no, you still need to look at your plan document. If you say yes, you need to make sure you are revising the plan to accommodate a non-FDA approved drug. You are making sure you are potentially modifying- ADAM: For critically ill patients JEN: For terminally ill patients. RON: You want to mirror the law ADAM: How do they define terminally ill? JEN: It is a life threatening disease where there is not otherwise a clinical trial that’s going to be available for that individual, and your physician otherwise agrees that this would be the path for you. ADAM: Well, I didn’t know she would have the answer so fast. RON: Yeah there you go ADAM: I thought I’d get her.. it didn’t work RON: In essence, Adam well, if you mirror the definition in the law, I think that is the best way to go. JEN: Right ADAM: So, you are looking at plan definition changes, exclusion changes if any? JEN: So, the exclusion you are going to want to caveat is “the complications of a non-covered service” to make sure that the references are not to non-FDA approved drugs. You are going to want to potentially look at your definition of drug. But when you are covering this there is no requirement that if you cover it you have to cover the whole thing. So maybe you want to cover up to $5,000. Maybe you want to cover one dose of treatments. Maybe you want to have precertification requirements. You can add those types of caveats and conditions on this drug because this is not an essential health benefit. ADAM: Got it JEN: You can put any of these limitations in place that would be the most appropriate for the plan, while still helping. But, you still really need to address the side effects and the complications issue. I think that is going to be the trickiest piece. That is going to require some sort of clinical analysis to decide on a case-by-case basis whether that particular drug has side effects that cause some sort of illness. ADAM: My last question: stop loss. How does it affect your stop loss policies and the interactions with the carriers? JEN: Yeah, when it comes to stop loss similar to those RIO writers that we started seeing five, six, or seven years ago, this is going to be a similar situation to that. Cause right now, every stop loss carrier has in their policy an E and I provision. In that E and I provision it says non-FDA approved drugs are E and I. ADAM AND RON: Right JEN: So this is a non-FDA approved drug. ADAM: So, even if the plan wanted to cover something chances are their stop loss carrier is not going to reimburse them. RON: You are going to need to coordinate with them ahead of time. ADAM: But, even if the plan decides to cover this experimental drugs, the plan can still say “But we are not going to cover any complications.” I mean, let’s be honest what self-funded plan is going to say “Yeah, not only are we going to cover this experimental drug, {hey fyi patient I am going to do you a favor, I’m gonna cover that cost].” No one is going to say, “I’m going to cover every side effect too.” RON AND JENN: Right. ADAM: From a standpoint of expenses, the plan will know if they decide to cover these. Again, these are rare things that happen; if you have a 1000 employees, our typical self-funded employer has 250 employees, if you include the all dependents and everyone it’s about 600 lives. You’re not having, there is no multiple, there are not multiple people in a 600-life plan that are going to have life-threatening diseases where there is no available treatment on the market. JEN: Right ADAM: It is rare. This is a rare event. RON: I mean, Adam think about it. The expanded use program, that’s already been out for nearly a decade, if you are a self-funded planner or you’re an administrator, how many instances have you seen where a plan participant wanted the plan to pay for that? ADAM: Have we ever seen that, Jen? JEN: No. RON: No, never. ADAM: And we represent millions of lives RON: Millions and millions! ADAM: Millons! RON: Now, so let’s say RTT ends up seeing 10 times the amount of people, which is big but I don’t think it’s going to be that. But let’s say, so one person. I mean, again, you are absolutely right. I don’t think it’s going to be this earth shattering number. JEN: No. ADAM: But, again here’s what we know it is going to happen to somebody. RON: Uh huh ADAM: Somebody is going to mess this up, and probably we will be getting a phone call. RON: It keeps it interesting ADAM: Any other thoughts Ron? RON: Yeah, there are two more things that you have to take note of that are not necessarily tied into the plan document, but if you are thinking about RTT, these are the two things you need to think about. One, the law itself issues a waiver of liability; it basically protects from legal liability, the physician, the drug manufacturer, the patient, the person it does not protect is the payer. So, if you are a plan, and you want to either incentivize the use of an experimental drug, or you are just paying for the experimental drug, and then something does go wrong; you need to make sure you are protected to the same extent that the physician and drug manufacturer are by law. So, you are going to need something in writing ahead of time, some sort of whole harmless agreement. ADAM: So, Ron is basically telling all you folks at home to contact Ron. RON: So if you read between the lines there you go. ADAM: What was your second point? RON: The second point is when you talk about reasons to actually cover these drugs. I think people are looking at this and are thinking “Oh no, there is going to be all these people who want to use these experimental drugs. How do I avoid paying for it?” It is actually quite simple. The law allows you to do so. For those who start to think about “Hey, what are reasons to start to cover it?”One: the altruistic willingness and desire to help save people save their lives I think is absolutely a noble idea. The second, there may actually be a financial reason to do it. Because let’s say hypothetically somebody has a disease that is terminal; they are eligible for RTT, but its long, it’s drawn out. In the meantime taking in an approved drug, something that is covered. And that drug, a specialty drug, whatever, is extremely expensive. If this experimental drug actually results in them either being cured more quickly, or replaces that other drug it could be that, this is an in lieu of a much more expensive treatment that you are required to pay under law. ADAM: Right JEN: But you are still not otherwise excluding that other more expensive treatment. ADAM: Right RON: Right. That was one of the concerns we actually looked at is that can you make the willingness to pay for an RTT experimental drug contingent? ADAM: What Ron is saying is if you had (knock on wood) cancer RON: Sure ADAM: instead of taking normal drugs, he wants you to go to Chile, and meet with the witch doctor because it might cost 20 bucks. RON: Well, you know so the thing to remember though ADAM: That’s that non – not covered, but it might work! RON: Like Jenn said! ADAM: Maybe you won’t need chemo. You’ll save hundreds of thousands of dollars on the plan! JEN: You never know! ADAM: Let’s cover that guy! RON: It’s funny, I mean the thing is, like Jen said, you are going to have to continue paying for the chemo, but the hope is that this experimental drug will hopefully have a good result. And therefore you shorten the amount of time that the person is taking chemo. ADAM: Jen, any last words before we turn these cameras off? JEN: No, I think that it is important to make a decision about how you’re going to cover this plan or how this benefit is going to be covered. ADAM: So basically, she is saying contact Jen McCormick at the Phia Group in order to do that too. RON: I do want to make one point for our maiden voyage with the video podcast/vlog, isn’t it funny that we replaced Brady? ADAM: Because well, he’s not that good looking. RON: You are going to have to tune if you want to see Brady live. ADAM: However, we do want you to vote on who’s swag is nicer! This beautiful, nice batting helmet, little difference, nice Cleveland Indian paraphernalia with this beautiful family. Or Ron’s collection of…. Just very weird stuff. RON: Look, they jiggle. ADAM: And some random kid, we don’t even know who’s kid that is? It’s just.. That photo is actually a photo that they give you when you buy the frame. RON: That child is so beautiful it can’t possibly be real! PAT: There you go ADAM: Let’s vote online, if that’s actually Ron’s child! JEN: I was told I couldn’t even bring anything! ADAM: Do you notice that Jen has nothing. Yeah we just… you’re not that important though, Jenn RON: You’re subletting space from Brady Bizarro JEN: Oh, okay ADAM: Right we can have Brady’s stuff here. JEN: Right, oh god, yeah. ADAM: Which I would be afraid to even know what that be RON: If you want a bust of Nixon? You’re good to go. ADAM: Well everybody on behalf of Pat Santos, our producer, Ron Peck, our special guest Jen McCormick, and myself your host Adam Russo thank you for empowering your plans with the Phia Group. Have a great day.

A Bit of Relief From the 2nd Circuit

On June 27, 2018
The subrogation industry has taken a toll from the 2nd Circuit relating to the provision of employee benefits. Learn more about the issues of subrogation today!

Empowering Plans: P45 - Super-Empowerment

On June 22, 2018
Welcome to Empowering Plans a show dedicated to identifying waste and undo expense in the health benefits industry. Discovering ways to maximize benefits while minimizing costs, and empowering employers, administrators, and consultants to emphasize once again the benefit in benefit plan. Today’s episode is brought to you by the Diversified Group, discovering and creating innovating solutions to evolving healthcare demands. Now here are your hosts the Phia Group’s own CEO Adam Russo, senior vice president and general counsel Ron Peck, and director attorney Brady Bizzaro. ADAM: Hello everybody, and welcome to another episode of Empowering Plans with the Phia Group. I am your co-host Adam Russo. Alongside me as always, my good friend, our senior VP and general counsel of the Phia Group, Ron Peck. Say hello Ron. RON: Hello Ron ADAM: As always and I have to say that nicely, As always with us for better or worse, whether we like it or not, the infamous, D.C insider, Brady Bizzaro. Say hello Brady. BRADY: Hello Brady ADAM: So Brady, I don’t know if you are aware, but I am going to be in D.C tomorrow. Ron, are you going to be there too? No? RON: I will be here holding down the fort, Adam ADAM: Tomorrow is a big meeting in D.C. I know you are very jealous. BRADY: I’m jealous ADAM: I will make sure I do the walk of Brady. The Brady tour where you literally walk by nothing famous just stuff that Brady did while he was living in D.C. that’s what you walk past. RON: It’s a nice meandering path. You don’t actually get up to anything worth seeing, but you can usually get a pretty good angle on those things in a distance, maybe take a selfie? ADAM: So those of you aren’t aware we have a new studio now here at the Phia Group Empowering Plans Podcasts. It’s a new room because we are going to be having live, I guess there not podcasts if it’s video, is it still a podcast? RON: A video cast? BRADY: It’s a vlog actually ADAM: It’s a vlog? RON: OOOH ADAM: So, Pat Santos; our very amazing producer, our very low priced, amazing producer has set this all up for us. But we have a pretty cool room, we have a nice set up, we got stuff in the background, I got all my Cleveland Indians paraphernalia in front of me. But the only strange part about this room is, in order for me to talk to Ron I have to look past Brady. It’s freaking me out Ron. RON: I’m thinking this is an issue we need to address. ADAM: I think we need to remove Brady from the podcast RON: Maybe put Brady in another spot, somewhere BRADY: Sit in a triangle, maybe that ADAM: Something has to happen with Brady. Make your seat lower? Something, I don’t know RON: We can get some cable extenders and put them in the bathroom over there. ADAM: Remember in the old days if a kid was bad in class that they would literally put your desk in the corner RON: Oh, yeah ADAM: They don’t do that anymore RON: No ADAM: I think it’s like.. it’s bullying or some kind if you put a kid’s desk in the corner BRADY: That’s what it is ADAM: We had a horseshoe shape, where they would put the bad kid literally in his desk by himself in the middle of the horseshoe RON: I like where this is going. ADAM: That’s what I’m thinking for Brady. Anyways, folks this is a very special episode of Empowering Plans. About a few weeks ago, we had our Phia Forum, for those of you who are avid listeners of our podcast you are aware, we had a big event in Gillette and there was one very big winner (other than the Phia Group) after that event, and that was our friends at Diversified Group down in Connecticut. A very few people can say the words down in Connecticut most people have to say up in Connecticut, right? RON: That’s a very interesting observation ADAM: And with us is their top chef, their big dog, the man, the myth, the legend, Brooks Goodison. Those who are close to him get to call him Brooksie as my wife and I get to call him. But we want to say welcome Brooks to the Empowering Plans Podcast. What’s up buddy? BROOKS: How are you guys doing? Great to be with you today. ADAM: It’s a great day. Hope everyone enjoyed father’s day. So really quick story, I was lucky enough, or maybe smart enough, well I had a strategy in place; I sent my wife for her 40th birthday, I sent her away with her sister and her best friend for four days to Aspen, Colorado for the food and wine festival. She had a great time. I’ll tell you it was the best thing I ever did. That women came back last night, late last night, after four days of me alone with four of my kids, Ron, Brady. Like, just me. I had some help but it was typically just me. Those were the hardest, most fulfilling, but literally the hardest four days of my entire life. There is nothing comparable to having to spend four days with your four kids in a car, where they keep asking the same questions over and over and over again. Like there was a car on fire on the highway: the number of times that my son Sam asked me ‘why is the car on fire’ and I kept giving him the same answer but I guess it wasn’t good enough. He just kept repeating it. But anyways my wife came back late last night; so she missed father’s day, I was alone with the kids on father’s day. I think, like she has never been this nice to me. It is almost like when I give Ron a raise, it happens once every five years. He’s just a very nice person for the next few days. RON: Well, that’s it. You know, it’s either that, or if you let me go on a vacation, and watch my 4 kids then I would be nice to you. Wow, so you enjoyed your father’s day. ADAM: I definitely did. I’m back in the office, and it’s so nice to be able to yell to someone to make my coffee. It was the greatest feeling this morning to make somebody do something, and not be the one to have to do it. So, anyways Brooks. I know we went off on a tangent. BROOKS: I do have one question. ADAM: Sure BROOKS: Were you sober when your wife got home? ADAM: (sighs) Alright, very honest answer there. So, I had a countdown knowing that my last kid would fall asleep at about 8:45 last night. At 9 o’clock, I definitely had a few cocktails. There’s no questions about that. So, I was sleeping by the time she got home, but man I was counting down the hours before those kids went to bed last night. Thanks for that question it was a good one. I definitely felt I needed a few drinks after the four days I went through. BROOKS: Well, you know TGIF, right? ADAM: Yes BROOKS: Thank God It’s Friday? ADAM: It was a thank God it’s Sunday night at one in the morning and my wife is finally home that’s what it was. So folks, those of you who don’t know this was the first time we decided to have a trophy to recognize the one client of Phia, the one partner that in our mind inspired their employers, inspired the employees of those employers, and inspired all their partners to take proactive measures, innovative steps, and really take risks to manage their risk; someone, an organization that really goes above and beyond. Now we had a bunch of people to choose from, but there was no question in all of our minds that one organization stood out from the rest. This wasn’t about who had the biggest TPA, who was had largest TPA, who makes the most revenue. It was an organization that we felt, as a self-funded plan, I would be proud to say they were the ones that were managing my hard-earned dollars. And this year’s winner was Diversified Group, and I think it shocked Brooks. Brooks, what was your first reaction when you heard that you won? BROOKS: I had absolutely no idea that you guys were going to call out Diversified’s name. And I was surprised and I was pleased. I look at this as a standing ovation. It’s what we try to turn out, that’s what we are trying to provide our clients. It was almost as if you were reading it right out of our playbook. Page 1 Chapter 1, this is what we are trying to accomplish for our clients. ADAM: And I think it’s one thing to be able to-I agree with you on your mission about what you are trying to accomplish. It’s one thing to try and accomplish what you are doing in a more pro-business, more pro-self-funded type state or area. The fact that you are doing this and pulling it off successfully. Obviously there’s hiccups and I want to get in to some of the biggest challenges later on but the fact that you’re doing it in a state like Connecticut that is so heavily BUCA: Blue Cross, United, Cigna, Aetna, where that’s the environment of the large carrier. That is the home of the large carrier; the fact that you have to do that in their own backyard, I think it makes it so much more impressive. BROOKS: I agree and I have a very simple answer to that. If we’re not good, we’re dead. ADAM: So, Brooks, really couple of follow-ups. One, why are you in this business? What made you want to do this? First question. And then two, what makes you not want to do this anymore? I mean there’s got to be obviously- What’s that biggest challenge? What makes you happy that you are doing if every day? What brought you into this business? What kept you here? And then secondly, what are the biggest challenges you are facing today that let’s be honest maybe scares you a little bit in the future? BROOKS: Sure, the thing that brought me to the business the most was being able to understand what is actually happening in our healthcare space, and how by simply providing employers with information about where their money is going that you can change the trajectory of their healthcare space. You can make a difference. We can make a difference simply by having access to that data, which many groups here before have been told that they don’t own it. They cannot have it. Is it a regularity decision? Is it a policy decision? Why can’t they have access to this information? And giving them that access, and helping them make changes with that is why I get up every single day. RON: So Brooks, it’s Ron here. Some people may be wondering why Diversified was the pick for the Empowered Plan Award this year. And just go kind give you an idea of the credentials that we threw against the wall to see who the top score was it wasn’t just about “oh you know, revenue and services.” It was more about collaboration, beta testing new services, new products, taking risks to reward not only their own clients but the industry at large. And it just seems any time we have some crazy idea to get creative and contain plan costs; you are always at the front of the line volunteering to try it out. I would say that maybe someone looks at that and think, “Oh he’s trying to be an early adopter hopefully he gets this benefit that others might not have.” But, you have been very altruistic when it comes to the industry as well, this is what topped it off and got you the award is the work you have done at the legislative level for the industry. Particularly the work in Connecticut. I wonder if you might tell us a little bit about your experiences in dealing with the lawmakers in Connecticut. BROOKS: Sure. In Connecticut, we are in an environment where TPAs are licensed and regulated. We have to by virtue of the fact that we can’t be in the Capitol, in the legislative office building as a full time job we have to hire and do hire and keep on staff a lobbyist who goes there every single day to keep an eye on any issues that may affect Diversified as a company and our clients. They sit there, essentially and watch for those things, and bring them to our attention so we can act on them. Whenever we have run into remarkable challenges we have great partners in the business (like you guys at Phia) that help us sort of understand these challenges that come up. Associations like HCAA, SIIA, all of these people help us to manage our way through, and provide in person, local input into our local legislation about how these things would affect employers, how they would affect our plan members, and us as a company. Basically, it’s a do or die situation. If we sit on the sidelines, we are going to find out that somebody else made all these decisions for us. ADAM: Speaking of sitting on the sidelines, one of the things I want to ask you, if you don’t mind patting yourself on the back for a little bit, what do you think makes you, your organization, the people you have different from your typical administrator out there in this country? BROOKS: You know the thing that makes us different is the thing that makes us somehow vulnerable at times. It is our independence. We are family owned. It’s myself and two other guys, Charlie Soleau and Dan Soucier. The three of us own this business, and we don’t have any insurance care ownership. It allows us a lot of freedom to do things, to try things that we believe are right and that are good. At the same time, that also leaves you sort out there on your own at certain times with not a lot of resources like the bigs have to withstand the storms when they come. It’s a challenge, but that’s one of the things that sticks out in my mind when you asked me that question. RON: So you are talking about challenges, and I am wondering you know what are some big challenges you are facing today, big challenges not only for you, but potentially you see to impact the entire industry. BROOKS: I think one of the challenges that sticks out the most to me right now is specialty pharmacy. We struggle with that. Ten years ago, all of the drugs you see advertised on the television every single night didn’t exist. Every one of those drugs costs at least as much as a new Audi or a Maserati. On an annual basis ADAM: Hey, hey relax, relax with the Maserati. Let’s relax with the Mas. I got rid of it RON: He’s driving a pick up now! ADAM: I’m driving a pick up now BROOKS: Oh I never knew you had one. ADAM: OHHHH RON: OHHH YEAH YOU DID! ADAM: Brooks I had a Maserati for about two and a half years. Yes I did I was that a-hole with the Maserati that was me. But I gave it up- BROOKS: I remember you from your Nissan days. ADAM: Ohh! Very nice! RON: Ohh BROOKS: You had a Nissan Maxima or something? BRADY: What’s wrong with a Nissan? RON: Humble russ! ADAM: I had the Altima. So hey BROOKS: Altima, oh!! ADAM: Just so everyone understands that’s how far back I go with Diversified. So, real quick before I ask my next question before we finally let Brady be involved is for those of you who don’t know you know that’s one of the things we love about Diversified when they say risk, when you said risk, Ron earlier who’s willing to take a risk, they were! You know before Phia was this powerful, podcast organization with thousands of followers on our webinars etc, we were lucky to try to get anyone just to talk to us. And these guys down in Connecticut gave me one of the first opportunities I ever had to speak publically at an event, at one of their client conferences. And I never forget that. You’re right I drove there in the Nissan Altima that I had at the time. I think that was 2003/2004 when we were a very small company, not who we are today, so very impressive that you bring that up. So, speaking of that, when I think about opportunity, right so that to me was when you allowed us the opportunity to come there, speak to your clients and prospects. That obviously, back then we knew there were opportunities when the ACA came, when everyone thought it was the worst thing that ever happened to our industry, TPAs were dying to get sold, we saw that here at Phia as an opportunity to actually now finally get new business because people would be forced to deal with healthcare costs and premiums head on since everyone had to purchase health insurance. Two questions: one, why didn’t you sell when everyone else was selling? And two: what do you feel is the biggest opportunity that we do have today? Now we know the challenges of specialty drugs; everyone is facing it. We are going to deal with that situation as time comes. But those two part questions if you don’t mind answering. BROOKS: Why didn’t we sell? There are numerous opportunities to sell in this market. The big thing for us here at Diversified is why. I have a big why. Why do I come to work every single day, and we hit that earlier in the call. A lot of the people that are interested in buying us they do not really have a great why. If we were ever going to partner on a situation like that, it would have to be somebody that would help us hit the accelerator. Help us move forward. Help us conquer these problems. I just don’t see those out on the marketplace right now, and that’s probably the number one reason. There is plenty of money; there is plenty of people interested, but there is not a lot of good reasons why they want it. ADAM: So basically, the bottom line is they are looking at your profitability, and saying “oh we can add that to our portfolio.” But, you have this idea, this innovation, this product, this service unless their willing to make that ten times bigger, where you could you know not be that small David versus Goliath scenario you don’t see a reason why doing that. So what is the biggest opportunity that you do see? BROOKS: A lot of things that we do see would be disempowering. It would be the exact opposite way of what we have been doing. I think the opportunity is in the flexibility, and the ability to adapt and to move quickly. I think if you don’t have that ability to adopt and move quickly you are going to struggle moving forward. BRADY: Hey Brooks. This is Brady. I want to jump in before all the time gets used up, and ask a question. You mentioned challenges before, and I’m looking here at an article from last week that you had commented on LinkedIn. It’s about hospital mergers in this case it’s about Milford and Bridgeport in Connecticut. In Massachusetts, we have the same thing going on; we have large hospital systems merging together. Every day it seems like you are hearing something else across the country. I am wondering what your thoughts are if you think this is good for the industry at large. I mean of course, they all promise they are going to lower prices, but how do you see it in Connecticut when there are talks about these big hospitals joining together? BROOKS: I think competition is gonna be a key. If we are going to be successful as an industry, competition is necessary. We need competition. We need competition amongst hospitals, competition amongst providers. We need transparency, and we need people to succeed or fail in that system. Any time there are mergers our legislatures, and the public mind set is taught that it is somehow going to relate to a lower price. All I see as a result of these mergers is the hospitals are getting more profitable. I have yet to see anyone praise hospitals for lowering their healthcare costs. So we are sold a bill of goods on these mergers, our politicians appear to buy in, lock, stock and barrel and the people who pay all the bills; our plan members that pay all the bills, are left holding the bag every time. I think that’s a bad move, and it bothers me more because we keep making it over and over in our state and every other state around us. We’ve gotta change how these decisions are made. BRADY: I think that is a sentiment you will hear in many other states as well. One last thing on Connecticut is I wanna point out that we mentioned how Connecticut has a lot of legislative activity regulating TPAs, and also stop loss like many other states. But I wanted to point out that it is not always the case that these bulletins that come out from the state are always negative. In one case, we reviewed a bulletin that actually was beneficial for our plans. I do not know if you had any thoughts on the fact that not every regulatory action by the state is just about to have a negative impact on stop loss carriers or plans. Sometimes there is a good once. The one I am thinking of makes it easier for plans to rely on their own exclusions rather than worrying about stop loss sort of relying on their own exclusions and how I think it is not as well-known as it should be in the industry, that some of these legislative actions are actually good for the plans. ADAM: As you can tell Brady is pro legislation. Brady’s all about politicians and regulators making as much money as they can. So every once in a while he is going to say “Hey not all regulation is bad, some regulation can be good.” BRADY: Trying to sneak that in there! ADAM: So just so you know, we have the luxury, Brooks looking at of seeing what Brady is talking about. The bulletin is from 2015, so this is nothing recent. RON: Yeah ADAM: It’s an old one BRADY: It’s the end of 2015 ADAM: It’s two and a half years old BROOKS: It’s was a bulletin BRADY: That’s right ADAM: Brady went back two and a half years to find a bulletin. RON: He dug deep for “hug a senator day” ADAM: He wants you to say regulation is good, Brooks. Don’t fall for it. BRADY: *laughing* BROOKS: It was Brady; I see where you are going. The bulletin was a bulletin it did not go through any legislative process at all. It was basically just pinned on the insurance commissioner’s desk. I think it was right before the 4th of July weekend. I remember to this day when that bulletin came out nobody knew about it, not even our lobbyists. No one ADAM: You got it right on! BROOKS: It took everybody by surprise. ADAM: Perfect timing, issued on July 8th BROOKS: It worked well for us, but I am not sure how on purpose it was RON: You know Brooks, I seem to recall that the Phia Group and Diversified we were the ones who first discovered it, and together issued a newsletter or a little email to the industry to let them know it had popped up. So as we are talking about it, I am starting to remember this is just one more example of the collaboration we have had in the past. ADAM: So Ron, got any last questions for Brooks? RON: I don’t have any questions, I actually have a comment, Brooks. I just want to let you know how much, I know I speak for myself and everybody else at not only the Phia Group, but the industry when I say thank you for the work you and your team have been doing. For those who don’t know, Brooks is not only an early adopter of our services, and also helps us work out all the wrinkles and the kinks that end up benefiting everybody. And not only does He and his team appear before lawmakers and lobby for what’s really important to the industry. He also a member of our advisory board and he is always available to give us some advice, guidance, and feedback. And I just want to let you know that what you do, just like all the other crowdsourced services out there where other people benefit from the brain trust that is the industry. You are definitely a leader there, and I hope people truly do appreciate what you do for them. BROOKS: I appreciate that guys, and right back at you. I’ll have to say we have been doing business together for at least fifteen years, and you have never let us down. We turn to you guys when we are scratching our heads, or looking for some talk about how to move forward, and to solve problems. Your whole team Adam, you, Brady, everyone is there to help us, and you have never let us down. We appreciate it. It’s meant a lot to us and it’s meant a lot to our clients. ADAM: For those of you who are interested, just so you know all the brokers out there, our biggest piece of our audience are our brokers all across the country if you are looking at self-funding options for your employer groups. Pick up the phone. Reach out to Brooks Goodison. Their website is diversifiedgb.com, again diversifiedgb.com or feel free to call any of us here on the podcast. Reach out to Brady, Ron, or myself, and we can make sure we point you in Brooks’s direction. He has a great team behind him. So Brooks, we want to say thank you so much for taking about thirty minutes to speak with us today on Empowering Plans with the Phia Group. Like we want our entire audience to know, you run one of the best organizations, a classy organization, one of the top TPAs in the country. A leader in what you are doing, a pioneer. And we look forward to working with you for many years to come. On behalf of Ron Peck, Brady Bizzaro, our producer Pat Santos, and myself the Adam Russo thank you for joining us here on Empowering Plans with the Phia Group. Have a great day.

Final Rule on Association Health Plans and YOU: Phia's Take

On June 21, 2018
On Tuesday, June 19th, the Department of Labor issued a final rule on Association Health Plans. Supporters claim the rule will allow millions of Americans to access more affordable coverage options. Critics contend that it will reduce patient access and weaken the insurance markets, leading to increased costs for all. Join The Phia Group's legal team in this special edition webinar in which they will break down the final rule and explain the significant impact it is expected to have on the self-funded industry.

Right to Try... Right for You? Understanding What is Right, and Wrong, for Self-Funded Plans in Response to the New Right to Try Law

On June 21, 2018
Are you seeking insurance coverage options for drug treatment? If so, this article will explain everything about the new Right To Try legislation.

The MHP Hits Just Keep on Coming

On June 20, 2018
Mental Health Parity violations keep resurfacing in court cases more frequently. Learn more about the recent case involving Catholic Health Initiatives here.

An Addiction to Health Insurance

On June 18, 2018
Health insurance continually blinds people from the actual cost of healthcare. Read why more people are more addicted to health insurance more than ever.

The Complicated Issue of ACA’s Section 1557 and Gender Identity Protections

On June 13, 2018
The Affordable Care Act prohibits health programs to discriminate people based on their attributes. But is gender identity protected? Click here to find out!

The Buck Stops…Where? Pointing Fingers in the Self-Funded Industry

On June 12, 2018
In a financial climate where saving money has to be made a top priority, so many entities within the insurance industry have fallen victim to someone trying to shift blame onto them. Regardless of fault, it’s in everyone’s best interests to work together to overcome issues rather than point fingers – but it’s not always that simple.

Empowering Plans: P44 - The Phia Group “MVP” Post-Mortem

On June 12, 2018
Welcome to Empowering Plans a show dedicated to identifying waste and undo expense in the health benefits industry. Discovering ways to maximize benefits while minimizing costs, and empowering employers, administrators, and consultants to emphasize once again the benefit in benefit plan. Today’s episode is brought to you by the Phia Group Empowering Plans Since 1999, now here are your hosts the Phia Group’s own CEO Adam Russo, and senior vice president and general counsel Ron Peck, and Brady. ADAM: Hello everybody, and welcome to another episode of Empowering Plans with the Phia Group. I am your co-host, co-founder, CEO of the Phia Group, Adam Russo. With me as always is our senior VP, general counsel, my good friend, Phia Forum collaborator, whatever you want to call him, Ron Peck. Say hello Ron RON: Hello Ron. ADAM: In addition, as always the great, the infamous, Brady Bizzaro. Say hello Brady. BRADY: Hello Brady. ADAM: And as Ron likes to say, and I feel bad because I always talk about Pat at the end. Ron’s right nobody is listening by the end. Our great producer Pat Santos, say hello Pat. He has nodded, He’s waving. It’s amazing. Folks we have some exciting news, even though our internal HIPAA people, security people are frowning upon our decision. The minute this podcast ends Pat, Ron, Brady, and myself are going to tear down the room, take all the equipment out, and we are moving our studio into the hallway, into a corner, right near one of our unisex bathrooms. We will have yes, video not just audio, but now in the future you will be able to see all of us. You will be able to see the Phia swag, the bobble heads. We are going to make this way better than any ESPN studio, and we do not care if there is a concern that all the equipment is going to be stolen. If somebody wants to steal this stuff, we will find him or her and punish him or her. We are excited about the move. I think all of you (we have been hearing it over and over again) want us to have some live feeds occasionally. We are going to appease you. In addition to all the Phia Groupies out there who love our podcast, who decided this week to come to our Forum. Yes, they stalked Ron for a little bit. (Ron: they were not actually invitees of the event; they were just crowding around the stadium). When they hand write their name into the badge that’s when you know those are the people that weren’t actually invited, but you couldn’t say no to them because you are petrified they might do some bodily harm to you. (Ron: Yes, the smiley face with the googley eyes instead of the photo of the attendee was a dead giveaway.) We wanted to let everyone know. I want to thank personally Ron Peck for putting on a great show. I did all the actual live work at the event that people saw so I am the front man, but trust me the work that Ron did behind the scenes: every slide, every topic, and every speaker. We raised over $1300 for the Boys and Girls Club of Brockton with our silent auction, which was amazing. Ron’s choice of venue at Gillette Stadium was unbelievable. Seeing the Phia Group logo at Gillette Stadium right next to that horrible cheating Patriot’s logo (even though I hate the Pats), it was inspiring to see our logo up there on the field. RON: I have to tell you it was a lot of work from the original concept to actually seeing it come to life. It meant a lot. I was happy to see it all come together as it did. I just wanted to take a moment, if you don’t mind, Adam, to give some credit where it’s due, a lot of other individuals that helped me bring it to reality. (Adam: C’mon just say it you did all the work, its fine). I will admit that I was the seed of creation. I was the creative inspiration. (Adam: So now, you are calling yourself God). I’m not going to, but the other speakers were awesome, Adam. Your co-owner Mike Bronco did a lot of work with the venue, the people there. He obviously made a good impression because they threw many bells and whistles in that were not necessarily part of the package. Because of the reputation, because of the relationship he built with them. (Adam: That’s right). Mike’s right hand and left hand, Cindy Monfils, was on the phone, getting on people, RSVPs. The clients obviously, the attendees they were amazing. The people over at the Boys and Girls Club and the resources they provided to us, to help get that auction up and going, their connections were amazing. ADAM: Well, you know what I am noticing and hearing from Ron. What did Ron actually do? Sounds like everybody else did the work. Everything I thought Ron did he’s now telling me somebody else was doing. RON: Adam, what I actually did was I came up with concepts, and delegated the actual work. I’m learning from the best (Adam: I am the king of that.) I have to throw Hannah’s and Matt’s names out there too. They were helping with a lot of the packaging, the flyers, the folders, the swag that we gave out that I was in love with this year. ADAM: I don’t think our listeners need to know every person that made a box, or hung something up on a wall. Anyways I know we are going to get bombarded with this “why wasn’t I invited?” Folks this was an invitation only event. This was 9th year we have done this conference. Back in the day, we literally had it open to anybody, and hundreds of people came. However, we realized that we were going to get a lot more use of our time if we focused on our actual clients, our biggest clients. Not only the biggest in revenue, but also the clients that are most collaborative and willing to be our beta. The ones that have new ideas for us to come up with new services. Organizations that are leaders in our industry, and those are the folks that we wanted to make sure we had in the room. We invited 75. We got 75. Then we added about 20 people from our own organization as well because obviously we want them to mingle. It was a three-day event. It was unbelievable. Next year my goal is to have it at Progressive Field. Yes, Jacob’s Field in Cleveland for the 10th year anniversary of the Phia Forum. What better place than in the land. RON: Is that a rhetorical question or a real question? I thought you were trying to keep this podcast short. ADAM: This podcast already went over time. Couple of things I want to bring up. Pat Santos will be working very hard over the next two weeks to put together a nice, detailed, video, audio show that we can share with all of you. Just the highlights of the Forum, so even if you were not there, even if you weren’t cool enough to get the invitation to the Peck, Brady, and Russo party, you will still be able to watch it for free. RON: We were videotaping. We were audio recording. What better way to honor the Patriots at their own stadium than to have video and audio equipment everywhere. Tracking everyone’s movements, and listening to everything everyone said. BRADY: I think we left some behind too, for the practices. RON: It’s in the visitor’s locker room. ADAM: We had a podcast with Pat Patriot, and he can’t talk which is amazing. RON: That is innovation. That is how you do it. ADAM: I saw him in the corner with the cheerleaders. I wanted to find out if he was talking to them. He was not he is in character. That man thinks it’s 1776, the musket, he’s all about it.Okay. Folks just so you know we did an awesome survey during the Phia Forum. I think we learned a couple lessons from it. It was a live survey during the actual event. It told us a lot about not only where we are today as a company, but also what we need to focus on going forward. This is what I got out of it. What I learned was people are very interested in reference-based pricing. Not as the end, all be all solution to our health cost problem, but as a step in the right direction. I thought that was so amazing to hear that most of the people think that it is the right direction. Because there are some vendors out there, their whole marketing, their whole pricing model is based on RBP being the actual final solution to the problem. Whereas most of our industry thinks, it is just a step in the right direction. I think it is very important when you look at RBP you speak to different vendors that are out there doing it: What is it that they believe? Is it the end result or is it a step in right direction? RON: I think you are right, Adam. I think when you look at the way we have been pricing claims for so long, it’s almost like hitting things with a rock, and reference based pricing is a lot like a hammer. It’s a tool that is far more advanced than what we have been doing, but ultimately it’s still just one tool in the tool box. ADAM: Right. In addition, what people also care about is balance billing of patients. The biggest thing (and we are going to have a Webinar about it in July) is specialty drug trends. That is a huge issue that people have. Moreover, one of the biggest ones that we knew, but didn’t realize it was such a big problem is overpayments. So there are a lot of overpayments in our industry, and the reason why you don’t see a lot of information about it anywhere is because most TPAs and administrators are afraid to talk about them because it makes it look like they did something wrong. When most of the time there is no negligence on the part of the administrator, it is just because of their proactiveness they found something after paying the claim that nobody else would have found, but they are still afraid to come out of the shadows. RON: I think we need to start a trend. Have it go viral and push back against overpayment shaming. Because honestly the fact that people think the only reason there is an overpayment is because the claim’s processor made a mistake is OP shaming, and it’s not a good thing. How many overpayments occur because of fraud, or mispricing, or a mistake on the part of the provider? How often does an overpayment occur because of miscommunication on the part of some third party or whether somebody is actually enrolled or properly enrolled? Maybe a plan member reports somebody is their spouse when the truth is they are not actually married. That is not on the TPA, yet it is being wrapped up in this shame. ADAM: In addition, what I think we found is that finally people looked at themselves and were honest. Even though a TPA in their administrator’s agreement is not looked upon as a fiduciary, when we asked the audience what they thought; 80% of them said they were not confident that the actual plan makes the claims decision and not the TPA. 80% of the TPAs feel that an argument can be made that they are the ones making the claim decision, which is not good. That is why Ron is going to be sharing some information with our clients on how to get around that. But what more and more brokers and plans are also asking is that TPA to take on that fiduciary risk which is a big part of our PACE product, and something that I think is helpful. However, the biggest thing I think I realized more than anything else, and I’m not even talking about claim negotiation or Phia unwrapped. Here is what we learned: Folks I love doing these podcasts, we love doing the webinars. We get 5,000 people on a webinar, we get hundreds of people listening to the podcasts, we get emails from our Phia groupies across the country. Thank you by the way, keep those emails and love letters coming. But here is what we realized, the number one way people learn about our services isn’t from these podcasts. It isn’t even from our sales team, which you would think is the number one way. It’s from seeing us perform somewhere speaking, somewhere else at a conference. Number 1 way people learn about our services. So I guess I am on the road that is why we have all these people on the road all the time. I thought because of social media it may shift, but no, people still want to touch you, people still want to see you. Even though the voice is there, our studio is going to be awesome, nothing makes up for me actually being able to spit on somebody in the first row of my speech. RON: Adam, I think you are right it is great to watch a game high definition surround sound, but sometimes you have to go sit in the seat, feel the weather, see the players, and enjoy a beer. ADAM: So what am I missing Ron? What did you get out of the Forum? It’s great to see the clients. So many of them came to our open house the next day. So many of them saw where this podcast takes place, which is by the way going to be moving. But what else did you guys get out of this? As far as what I got out of it, I saw a huge interest in the industry. Something I didn’t bring up is a lot of people have that same belief and interest in getting future leaders involved. More and more people want young people involved in the industry. They are turning to Phia to help them know how to do it, and more importantly from a training standpoint; how we train, how we educate the industry about self-funding, and the right way to do it versus the wrong way is another big take away I got which I wasn’t necessarily expecting. RON: Tied to what you just mentioned, Adam. I was happy to see pretty much all the same faces when it comes to leadership at the organizations that represent our MVPs (most valuable partners). What I saw this year that I have not seen years in the past is that those leaders brought with them new faces, fresh faces, and a I feel that among these MVPs they are starting to expose that next level of leadership, those future leaders to their partners (that being the Phia Group). Kudos to those clients that did bring new people with them to expose them, and get them trained. The other thing that I noticed, Adam, was that a lot of our clients even though they think that their issues, their problems, and their concerns are unique to them, when we did these surveys and we asked “What’s troubling you? What are you seeing in the industry?” The vast majority of people all agreed. 75%, 85%, 95%, of people were all answering the same way, which goes to show you they all agree on what the problems are. The difference lies in the vision of what the solutions will be. Lastly, everyone seemed to mention that there is not enough collaboration in the industry. Not enough crowdsourcing when it comes to coming up with these solutions. The fact that everyone is having the same issues, one comes up with a great solution, but no one else ever hears about it, and then they end up suffering the same problem. That in itself is a problem. BRADY: Whenever you are asked to speak last it’s always the case that you have nothing left to say because it’s been said already. I think the topic of future leaders is huge, and I think I scared them when presenting and saying “look we are getting older as an industry, and millennials you may hate a lot of them but they are the future whether you like it or not. You got to take action now” ADAM: Just so you know while Ron was talking, I got two emails asking for more information of the future leaders program. So I’ll just forward those over to Brady. BRADY: Great. I’ll add that to my plate. But yes, that’s a big deal. I was also surprised about how popular direct primary care was. There was a number of questions asked during the presentation by Dr. Gule. I think that is the way of the future. People like the idea of less red tape, these direct contracts, skipping all the bureaucracy and all the administrators. ADAM: The only thing that I’m not surprised about is when we asked the one thing to improve about Phia. The answer was replacing Brady. I’m not joking folks we have the slides and results to prove it. Replacing Brady was number one. I want to take that slide and frame it, and put it in our podcast room. Replace Brady was by far there’s not even a top three. It was replace Brady and then everything else. BRADY: I think that is because they want me to work for them. RON: Sure, they want to be a free agent. I’ll actually tell you a quick, funny story because you know we were at Gillette Stadium when we were doing that slide. We had the survey up and people were filing in the blank about what they felt was the number one thing we needed to improve. Replace Brady came up in big letters and obviously everyone jumped on the bandwagon. Thought it was hysterical. At that moment, Adam, a tour was passing at the next level, over the balcony. They were looking down at this group of professionals wearing suits at Gillette Stadium with a big slide that says “Next Step: Replace Brady.” And you have these tour people taking pictures with their phones sending it to Barstool and ESPN thinking they just stumbled upon…. (Adam: are you serious) I kid you not, the children were crying up on the balcony, I kid you not there was a tour going around the stadium at that moment. ADAM: Replace Brady was definitely there. Who knows maybe they will take us up on it. That would be Ron’s worst nightmare. Anything else you want to add? (No) So listen folks as we said in a couple weeks we will have all the information about the forum. If you want any information about our services, or even want the slides please feel free to contact Brady, Ron, or myself. On behalf of Ron Peck, Pat Santos, Brady Bizarro, and myself thank you so much for empowering your plans with the Phia Group. Have a great day.

May Day: Two States Enact Individual Health Insurance Mandates

On June 11, 2018
Many states have defied the Trump Administration’s repeal of Obamacare, but why? Click here to learn more.

Bridging the Gaps Between...Everything

On June 4, 2018
Our new Phia Certification Program is to ensure all our employees understand our industry and how we operate. Click here to learn more.

Empowering Plans: P43 - A Debrief of SIIA’s Fly-In on the Hill

On June 1, 2018
Welcome to Empowering Plans a show dedicated to identifying waste and undo expense in the health benefits industry. Discovering ways to maximize benefits while minimizing costs, and empowering employers, administrators, and consultants to emphasize once again the benefit in benefit plan. Today’s episode is brought to you by the Phia Group Empowering Plans Since 1999, now here are your hosts the Phia Group’s own CEO Adam Russo, and senior vice president and general counsel Ron Peck, and Brady. ADAM: Hello, welcome to another episode of Empowering Plans with the Phia Group. I am your co-host the one that matters the most, Adam Russo, CEO and co-founder of The Phia Group, with me not in studio again, this guy just likes to stay home. Brady, what’s going on with Ron? BRADY: I don’t know ADAM: Ron, do you have a bad case of acne or something, is there a reason why you do not want to come to the office? Do you have a big zit or is there something going on that we are not aware of? RON: I am working on a project at home Adam, and it’s going to change the industry forever. BRADY: Oh boy ADAM: Really? So he must have gotten some facial reconstruction, somethings that’s a cosmetic surgery; not covered by the plan, that’s why he paid for it cash. Pure transparency. With me as always on the phone is Ron Peck, our senior VP and general counsel, say hello Ron. RON: Hello Ron, it’s a pleasure to be there? ADAM: Our newest co-host, the infamous, the Washington insider, the guy who just wants to be in DC all the time Brady Bizzaro. Say hello Brady. BRADY: Hello Brady ADAM: And as always even though he does not have a mic, he’s sitting here, he’s smiling, he’s happy, our producer Pat Santos. Say hello Pat. He has waved to us. Pat has waved. So guys, today’s a special edition, we needed to do this once because yesterday was a very special day here at the Phia Group. And I’ll be honest there was no reason for me to go to DC other than the fact that I wanted to see Brady Bizzaro in action in Washington D.C. on Capitol Hill, where this guy just fits. It’s like bees with honey, it’s like peanut butter and jelly. Brady just belongs on Capitol Hill. It was absolutely amazing. Yesterday and the day before, Brady, Ron, and I flew down to DC with SIIA (which is the Self Insured Institute of America). We did what the annual trip is called “The walk on The Hill” or “The attack on The Hill” or “Let’s go meet with our Democratic representatives and actually get nothing accomplished Day” whatever you want to call it. But it was pretty interesting, and all I got to say is..(Ron you have t to agree with me) I mean Brady was light on his feet yesterday wouldn’t you say? RON: It was amazing to see Brady Bizarro in his habitat. It was like watching a penguin on land is just so clumsy, but once it hits the water, it is a thing of beauty. ADAM: So for those of you who don’t know, I like to walk fast and I sort of have people trying to keep up with me. We leave the hotel and I’m like you know guys “lets walk” and Brady goes “Uh, it’s like twenty minutes.” “Oh twenty minute walk it’s no big deal” Folks we walked for forty five minutes, Brady I think purposely had us walk by certain things so he could say “Oh I went to school there” “Oh I was an intern at this building” “Oh I used to go to this Starbucks.” I mean literally this guy took us on his own personal Brady Bizzaro tour. Ron? RON: Yes, but now I know where Washington D.C.’s best Shawarma cart is so it was worth it. ADAM: Folks you should have seen Ron walking, Ron had a jacket on and Ron’s jacket is a very..let’s just say thick coat (Brady: It’s like a wool coat almost) yes wool. Ron was sweating three minutes in there was no way Ron would have made it to the Capital building with his jacket intact without dying. I truly believe that. RON: Adam, I think it was actually more about the pressure and stress of meeting our nation’s leaders. You know it was getting to me. ADAM: So let’s talk about those leaders, so Brady I know this is all about you. It was funny we walked into these meetings and Brady was supposed to lead every meeting. Brady was supposed to be the person that started the conversation. I think Brady just got nervous. I think he just got scared. Brady walked into these offices, and he could not take the stage. He just froze (Ron laughing: he was star struck) he was star stuck Ron and I were like “Uh well Brady supposed to lead but I guess…” and he just sat there with a smile and a stare, and would just stare at these aids and not say a damn word. That is just what happened. BRADY: I seem to have a different recollection, (Adam: Uhh) but as far as I can recall I think I got us in with the right people, and shepherded us around the right tunnels, and got us in at the right spots at the right time. ADAM: You asked random people which tunnels for us to take, Brady. You had no idea (Brady: It has been a long time they changed the tunnels up I think.) Okay, so Brady since you know we were making fun of you a little bit, I mean that’s part of our routine right? Can you tell the fine folk who we met with, and what you think we accomplished yesterday? BRADY: Sure, well I think we accomplished a lot. We met with and I think this is actually in order: Jim McGovern, a democratic representative from Massachusetts, and Stephen Lynch, who represents actually our district in Boston, and part of where you grew up Adam. Then we met with the two senators, and I say senators, I mean they are staffs: Ed Markey and Elizabeth Warren. The last one there I did a little solo act for, but essentially it’s a busy day on Capitol Hill. Every day is busy but because there is a long weekend coming up there was almost no chance that the member themselves would be there, and they were not. But (Adam: Even though we had Brady with us) right I try to pull all the strings I could, but you know it only goes so far even for me unfortunately. ADAM: So my question for you is this Brady in order of I would say the type of influence that we had. Would you agree that when you had your solo act with Elizabeth Warren’s office that was probably the least productive of the four meetings? BRADY: It was and it was because (Adam: it was because you were by yourself) yes when you have one person with you, and because there was four other groups there, and she is by far the most in demand person and arguably one of the most in the senate. I met with a person that probably just started that day. ADAM: But you know what the funny thing is right, and again we met with these folks… I think part of this was more about just I would say explaining our interests. That being how we are trying to lower the overall cost of health insurance and health care, and to improve health care options for the typical American worker and their families. I think one of the thing we realized after yesterday was, and again I apologize for patting ourselves on the back here, but just the amount of lives we represent in the state of Massachusetts, the number of employers that we impact every day in the state of Massachusetts. Let’s face it then guys we have over 100,000 employee lives that we represent directly; lowering the cost of care….union plans, school districts, cities and towns, private employers that are in these folks’ districts. I think once we said that I don’t know about you, but it seems like once we explained the number of employers and employees and voters we represent in their districts; it seemed like they paid a lot more attention to us than before that. What would you think? BRADY: Having worked on The Hill for a while I can tell that in these meetings, you have to watch and see when they are taking notes, what they are writing down. When we were talking about the union plans, the teachers and the firefighters, and the cities and towns that are actually self-funded you saw them taking lots of notes. They were paying attention definitely at those points ADAM: So it’s interesting right. I was talking to my wife about this last night, and what we’re doing: self-funding. It was has nothing to do with being democratic or republican it really doesn’t. At the end of the day if you look at whom we represent most half-heartly plans, most union plans are self-funded. Most cities and towns are self-funded, most public employees are self-funded, so the constituents who typically vote democratic {for the democrats right?} (Brady: Yup) They are self-funded, so we went there to protect SIPAC. Brady you want to explain what that is, and how it’s going to impact our industry going forward. BRADY: Yes, so one of the primary goals and why we were there was to remind the members that they voted for what’s called the Self Insurance Protection Act which passed last year in The House by an extremely rare vote of what I think was 400 to 14 or something insane like that. That Act is designed at preventing the federal government from redefining stop-loss as health insurance. So it’s really just a preemptive measure; we don’t want to see even more regulation at the federal level of stop-loss. It’s bad enough what we have to deal with with the States, but every member we met with voted for that bill, and this was really just getting their staff to understand what stop loss insurance is, why it’s important for self-funded plans to have it, and basically just to get their support moving forward. Just to be aware frankly of self-funding, and how important it is for their constituents who have plans that are self-funded. ADAM: I think all of our followers need to understand is that what we need that message to be is very simple “You don’t break what’s already working.” So all of these plans are already self-funded. Most of these plans have stop-loss coverage. Any state or federal law that would mess around with defining stop-loss as health insurance potentially has the ability to hurt the self-funded industry, and basically impair somebody’s ability to actually offer a self-funded plan. We have 200 people on our plan; the bottom line fact is if we could have purchased stop loss at a $30,000 or $50,000 specific deductible we could not be self-funded. If that number was a $100,000, if that state of Massachusetts mandated that we have stop loss at a $100,000 specific deductible, I’ll be straight forward we would not be self-funded today. We would be fully insured with Blue Cross, and that is unacceptable. We would not be able to do all the innovative stuff that we have been talking about over the past few years in our health plan design. Incentivizing employees, direct primary care, all the things that we are doing would all go away by a simple law that the state of Massachusetts could pass that says, “You cannot purchase stop loss unless you have a $100,000 specific deductible. If that happened, we are out of business when it comes to self-funding, and that’s scary. Ron? RON: One of the things Adam, and this ties in with what you’re saying, is that when we were sitting there talking to these legislative aids. We are talking to them about self-funding and the benefits of a self-funded benefit plan; it is amazing how the conversation eventually goes to that individual telling us about their own health conditions and their family. It just goes to show that even when there lawmakers are focused on “what does these guys want?” and “what’s going on?” and “what’s my next meeting about?”; when you actually start to talk to them about the ability of a self-funded plan to customize its benefits, and provide more benefits for less cost. They actually start to engage you and talk about “Well here’s what the Senate’s health insurance is ... that self-funded plan sounds way better.” (Brady: They are people too.) It does not matter who you are talking to eventually it becomes very personal. ADAM: And I was going to use that word. I actually wrote it down. The word personal. Health care is personal to people, but you are right Ron. I don’t know who the women was; I think it was in McGovern’s office right? (Ron: Yes.) When we started talking to her, she brings up her mom, and when we are telling her about some of the incentives and the innovative ideas, we have at the Phia Group she goes “Don’t tell my mother about this, she would be all over that.” Nevertheless, we are talking about somebody, a truly liberal democrat who probably believes in single payer for all; who his top aid is looking at this going “Wow you guys are really doing some innovative stuff, and you’re able to offer health insurance coverage to your employees at a very low cost, and with some amazing benefits.” Folks let’s not forget (pat on the back again) we won most innovative health plan design for a self-funded plan under 250 lives. Our plan works because it’s innovative. It’s making our patients become consumers. I really think we accomplished a lot yesterday, but I have to say it again I think a lot more could have been done it Ron and I were in that meeting with Senator Warren’s aid and you Brady. Brady on the record you dropped the ball on that last one when you were on your own, but folks I wanted to let you know Brady is a company man. Instead of spending an additional $500 on Phia to take a nice, quick hour and a half flight home, he could have been home by 7 o’clock. I guess he doesn’t have any kids or anything so what’s the difference 7 or midnight? But Brady decided instead to take the Amtrak train, right Brady? BRADY: Just like Joe Biden that’s right. ADAM: And what time do you get home? BRADY: I got home around 2:30 in the morning. So that’s good. ADAM: So 2:30 in the morning. He was still at work bright and early, 9 o’clock. You are the best intern in the business. I just wanted you to know that. Ron any last thoughts? RON: Not today Adam. ADAM: Really? Wow, that is a first. So folks on behalf of Ron Peck, Pat Santos, Brady Bizarro, and myself thank you so much for empowering your plans with the Phia Group. Have a great day.