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Strategizing for 2024: New AI Regulations and Transparency Rules Impacting Healthcare

On November 15, 2023
Goodbye 2023, hello 2024. The future has arrived, and we thank you for your efforts to date; the robots will take it from here. Just kidding… maybe? For those who are tracking developments in Artificial Intelligence, this technology is both intimidating and exciting. Regardless of your position on the matter, you won’t be able to escape the meaningful impact A/I will have on our industry. We believe that with the right measures, A/I will be a tool we can use for good in the advancement of our mission to provide the best benefits for the lowest cost. Coupled with other regulatory developments – such as price transparency, a new emphasis on quality metrics, and general public engagement – and 2024 might be one of the best years ever, at least for those who prepare now. Join The Phia Group’s team as they discuss these and other technological and legal improvements that are sure to dictate how you survive and thrive in the coming year.

Being Mindful of Telemedicine Access

On November 9, 2023
From a healthcare standpoint, two of the most significant byproducts of the COVID-19 pandemic have been the exploding popularity of Telemedicine, the practice of providing medical and mental health services remotely, and a heightened awareness of many Americans’ longstanding mental health issues. Due to a confluence of prolonged extenuating circumstances, it became readily apparent to healthcare providers, politicians, social workers, employers, teachers, and parents on both sides of the Mississippi that a.) the inimitable convenience of virtual healthcare does not compromise quality (at least for some patients and practitioners) and b.) many Americans experiencing emotional distress have long been suffering in silence.

Empowering Plans: P175 – No Surprises Act Brings More Surprises & Other Surprises for 2024

On November 9, 2023
Join Provider Relations Senior Attorney, Brian O’Hara, and Vice President of Consulting, Kelly Dempsey, for a quick rundown of changes to be prepared for as we near 2024. While there are the regular recurring changes to ACA and IRS out-of-pocket limits, this podcast will uncover a couple lesser-known items hidden in some NSA proposed rules and a couple other items for 2024 that might have fallen off the radar, including COVID-19 tolling requirements. (COVID may be over but the impact on certain items could extend well into 2024…).

Update on the Federal IDR Process

On October 27, 2023
Recently there has been significant discussion about the federal IDR process. The IDR process is an important tool of the No Surprises Act (“NSA”) as it resolves claims for payment for out-of-network items and services. It not only provides a procedure for settling disputed claims but is also an integral mechanism for supporting the NSA’s protection for plan members against potentially crippling expenses from balance billing for high-cost out-of-network claims.

Empowering Plans: P174 – PCORI and Parity and Lawsuits, Oh My!

On October 26, 2023
It’s the spookiest time of the year, and I’m not just talking about renewal season. In this Halloween episode of the Empowering Plans podcast, Jennifer McCormick and Nick Bonds talk through some of the scary issues creeping up on health plans: rising PCORI fees, proposed regulations on mental health parity rules, and two fascinating court cases that may have significant implications for ERISA plans going forward. But don’t be scared, Phia is here to help!

Empowering the 2023 SIIA National Conference

On October 26, 2023
Earlier this month, the self-insurance industry’s most prominent thought-leaders, innovative service providers, and esteemed subject matter experts convened at the 2023 Self-Insurance Institute of America (SIIA) National Conference at the JW Marriott Phoenix Desert Ridge Resort & Spa. The SIIA National Conference, which this year covered such pressing topics as artificial intelligence, surprise billing, emerging trends impacting the employer stop-loss market, and recent legislative and regulatory updates, is widely considered to be the self-insurance industry’s annual marquee event, bringing together hundreds of industry professionals including TPAs, vendors (there were over 950 booths representing industry vendors stationed in the exhibitor hall), brokers, captive managers, stop-loss carriers, and solution providers.

The Phia Group's 4th Quarter 2023 Newsletter

On October 24, 2023
The Phia Group is off to a great start in the fourth quarter of 2023! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

The Stacks – 4th Quarter 2023 Newsletter

On October 24, 2023
This is "The Stacks" from The Phia Group's 4th Quarter 2023 Newsletter

Cell and Gene Therapy: Industry and Claim Cost Impact

On October 18, 2023
Drugs are on our mind! In our industry, they are what can make or break the bank. Is this an episode of Breaking Bad? No – It’s American healthcare. From specialty drugs and gene therapy to pharmacogenomics and international drug importation, prices aren’t the only thing getting high. Join The Phia Group’s innovators as they discuss frightening trends in drug costs, define the risks and present solutions you can implement today.

Empowering Plans: P173 – Gene-y in a Bottle: A Magical Overview of Cell and Gene Therapy

On October 12, 2023
Your wish is our command! Join Ron Peck and Corey Crigger as they discuss how this emerging treatment can impact self-funded health plans. With prices as high as $3.5 million, you can’t just wish for a strategy for dealing with these therapies, you must plan for it. Ron and Corey discuss the motivations to cover, the future benefits, and the concerns they are hearing from clients. You don’t know what we can see, so join us on a magic carpet ride around this life saving, but costly treatment.

District Court Strikes a Blow to Copay Accumulator Programs

On October 11, 2023
Many of our clients are aware of, or even utilize, “copay accumulator” programs – these programs create plan savings by not counting amounts received by patients from manufacturer assistance programs toward annual deductibles and out-of-pocket maximums. Some programs go a step further by actually increasing the applicable copayment for certain drugs to maximize the amount a patient may be eligible to receive from manufacturers.

Choking on the Gag Clause

On October 4, 2023
Whether you’re a health plan, TPA, broker, or anyone else, join The Phia Group’s consulting team leaders as they gather to discuss the prohibition on gag clauses, best practices, and next steps to ensure a gag-free tomorrow!

Empowering Plans: P172 – Navigating the Gag Clause Prohibition

On September 28, 2023
In this installment of The Phia Group’s Empowering Plans podcast, attorneys Jon Jablon and Kendall Jackson delve into the issue of the gag clause prohibition, a mysterious law that continues to confound the self-funded industry. With the first attestation requirement approaching at the end of 2023, now is the time to make sure you know what needs to be done, how to do it, and how to keep yourself safe and compliant.

Fall Is Here & So Are the Cold-Weather Germs – New CDC Recommendations

On September 26, 2023
Fall is officially here as the fall equinox has passed and with fall comes the impending “flu season” which also brings a bunch of other germs – new strains of COVID-19 and a rise in RSV cases. If you have children who have headed back to school (even college kids), you’ve probably noticed an uptick in stuffy noses and tummy aches already.

Three Shots for Autumn

On September 18, 2023
It’s a daunting Venn diagram – the interplay of three potentially fatal diseases: Respiratory Syncytial Virus (“RSV”), COVID-19, and influenza. And with summer slipping into fall, this triple-headed monster is (once again) threatening to rear its ugly head. But, thanks to modern medicine, could this cold-weather season have a less devastating toll on humanity than what transpired a year ago?
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