Healthcare Cost Containment Insights | The Phia Group Blog

Empowering Plans: P198 – Healthcare on the Ballot

On August 15, 2024
Nick Bonds and Corey Crigger are hosting this political edition of the Empowering Plans Podcast series. With an election looming in November, Nick and Corey take a look at the policies and agendas from the Harris/Walz and Trump/Vance tickets. They discuss the impact that each administration could have on the self-funded industry and the country, in the most civil political discourse you can find. Tune in to hear what each nominee has to say about: Medical Debt, the Opioid Crisis, Public Healthcare options, and more!

Empowering Plans: P197 – The Concerns About PBMs and the Demand for Reform

On August 1, 2024
In this episode of the Empowering Plans podcast, attorneys Jon Jablon and Kendall Jackson break down the consequences of PBM steerage. Join us in the discussion of the Federal Trade Commission’s inquiry into PBM practices and the push for legislation to increase transparency in the market and hold PBMs accountable.

What the Overturning of Chevron Means for Healthcare

On July 19, 2024
For the past forty years, federal agencies have had considerable latitude to interpret and enforce regulations and subsequently advance regulatory initiatives. Per the precedent established in the Supreme Court’s 1984 decision in Chevron U.S.A., Inc. v. Natural Resources Defense Council, courts have had to defer to federal agencies regarding legal challenges over ambiguously written laws passed by Congress. The rationale was as follows: The public servants employed by the federal agencies, whether they be scientists, engineers, law enforcement officials, economists, or experts in another field, have more specialized expertise in the given matter – even more so than Supreme Court justices -- and should thus be accountable for implementing the law. But effective late last month, the High Court, believing that unelected government officials should not wield such tremendous influence, overturned that precedent, thus yielding unprecedented power to the courts to use their own discretion in interpreting laws – many of which pertain to the country’s healthcare ecosystem.

Empowering Plans: P196 – Exploring Claims Processing Models

On July 18, 2024
On this episode of the Empowering Plans Podcast, attorneys Andrew Silverio and Cindy Merrell delve into the pros and cons of the pay and chase versus pend and pay models of claims processing. They provide an in-depth discussion on the coordination of benefits and the timing of claims processing when another party may be responsible for payment.

The Impact of Provider Trends on Stop-Loss and Plans

On July 16, 2024
We progressively find ourselves on the receiving end of both medical provider and legislative efforts to secure more funding from payers. As costs increase, overpriced treatments gain popularity, and fallout from new laws continues to do more harm than good; things aren’t getting less expensive. Stop-loss carriers – responding to these trends – are circling the wagons and implementing new protective measures … but at what cost? Join The Phia Group as they discuss how to counterbalance rising prices as well as navigate these increasingly complex interactions with stop-loss.

Empowering Plans: P195 – SCOTUS Decisions: Harrington and Loper's Impact on Healthcare

On July 2, 2024
In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Corey Crigger break down two of the most significant Supreme Court cases just decided this term – the Harrington case (rejecting the largest opioid settlement in the country) and the Loper case (in which the Supreme Court ended Chevron deference). How will these cases impact the healthcare landscape? What should self-funded plans and their partners know moving forward? Tune in to hear our expert analysis.

Direct Contracting and Occam’s Razor

On June 21, 2024
Maybe I should be, but I’m not ashamed to admit that when I first heard of Occam’s Razor, I assumed it had something to do with shaving. Whatever the context, many know Occam’s Razor as a principle of decision-making holding that “the simplest explanation is the best one”. Although the real idea is similar, William of Ockham’s logic is a bit more formulaic than that. To paraphrase, Occam’s Razor suggests that when choosing between multiple options, the best choice is the one that requires the fewest assumptions to reach. Put another way, the best option is the one that has the highest likelihood of actually being the case, by requiring the fewest assumptions to achieve it.

Empowering Plans: P194 – The Rapid Evolution of the Pregnant Workers Fairness Act

On June 20, 2024
Just like the development of a child, regulations evolve in their ability to walk and talk over time. Join Jen McCormick and Kelly Dempsey as they go through the evolution of the Pregnant Workers Fairness Act – from passage in late 2022 to the final rules that took effect on June 18, 2024. They also discuss current court challenges where two courts have reached opposite conclusions and, of course, what this all means for self-funded health plans. It’s hard to keep up as this one went from crawling to running in fewer than two months!

2024 Benefest: Not Just Massachusetts in Focus

On June 14, 2024
Earlier this month, 2024 Benefest, hosted by the Massachusetts Chapter of the National Association of Benefits and Insurance Professionals (NABIP), took place at the DoubleTree by Hilton Hotel Boston-Westborough. While the conference largely focused on the Massachusetts healthcare ecosystem – panel discussions of which reached the general consensus that, from an affordability and access perspective, these are incredibly challenging times due to unprecedented staffing shortages reducing providers’ daily bandwidth – there was considerable time spent examining federal healthcare developments, including how November’s election will impact employer-sponsored benefit plans.

Empowering Plans: P193 – Stopping Esophageal Cancer In Its Tracks

On June 7, 2024
In this episode of Empowering Plans, The Phia Group’s CLO – Ron Peck – sits down with experienced surgeon, Dr. Victoria Lee, to discuss a very dangerous – and costly – threat. Esophageal cancer is generally considered to be a death sentence, and historically screening options are invasive and costly, resulting in a low uptake. With the introduction of EsoGuard, however, plans can identify which participants are at risk, and have them tested quickly, non-invasively, and inexpensively. You can save lives and money… but you cannot afford to miss this episode.

The Price is Wrong, Y’all

On June 4, 2024
National spending on healthcare was approximately $74 billion in 1970. Fast-forward to 2022, the growth alone on healthcare spending from 2021 was $175 billion, topping out around $4.5 trillion total spending for that year. It’s a well-worn saying in the healthcare industry but it still rings true: “It’s the prices, stupid.” Every ounce of work and creativity that we at The Phia Group, and many of our colleagues in the industry, pour into trying to reduce healthcare costs may ultimately be for naught if the prices continue to rise indefinitely. One of the driving factors behind those ever-increasing costs: consolidation.

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Empowering Plans: P198 – Healthcare on the Ballot

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