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Phia Group Media


Empowering Plans: P66 - Bigger in Texas

Join The Phia Group’s Ron Peck and Brady Bizarro as they discuss Brady’s recent trip to Austin and presentation at the Texas Association of Benefit Administrators; with a focus on employee engagement, new ideas for cost containment, and an in depth analysis of pending litigation challenging the legality of ObamaCare.  Yeah… You’ll want to tune in for this one.

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Faces of Phia: Episode 9 - Taking Account with Lisa T!

In this episode of Faces of Phia, Adam and Brady interview the superpowered controller of The Phia Group.  From adventures in the Steel City to conquering “nice problems to have,” the team covers it all in this candid discussion.

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Empowering Plans: P65 - Hail to the Chief!

In this can’t miss episode of Empowering Plans, Brady and Ron dissect the President’s State of the Union Address, and focus in on how it will impact those of us servicing health benefit plans – and the entire healthcare industry. This one is going to be huge.

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What We Love About Self-Funding in 2019

Valentine’s Day is upon us, and we’re feeling the love.  Too often we, as an industry, spend our time discussing issues, problems, and concerns, and don’t dedicate enough time to the features and opportunities that make self-funding great.  We focus so much on “how we save” self-funding, that we forget to celebrate the reasons why self-funding is worth saving in the first place.  Join the team as they discuss what makes self-funding such a great option for so many employers and employees, as well as the incredibly cool new innovations rolling out in 2019, that will be sure to make self-funding a sweetheart for even more employers this year and beyond.

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New Action on Drug Pricing: Medicare-Like Rates?

By: Brady Bizarro, Esq.

In 2012, the annual cost of insulin needed to treat patients with type 1 diabetes was $2,864. Today, the cost has risen to over $6,000. For working-class families already struggling to keep up with everyday expenses, this increased economic burden has forced some to choose between food and life-saving medication. CBS News has reported that more than one-quarter of Americans living with diabetes have cut back on their insulin usage to ration their supply, and that can be dangerous. Skyrocketing insulin prices are just one example of high prescription drug costs, which the Trump administration has made it a priority to address.

We have written a lot before about the administration’s proposals to lower drug costs: from ending pharmacy gag rules to outlawing the use of co-pay coupons, ideas for controlling costs were in no short supply. Ideas and tweets, however, have a limited impact. Real legislation is needed to produce meaningful reform, and as we are now well into 2019, there are indications that bipartisan action may be on the horizon.

Soon after taking over powerful congressional committees, Democrats began scheduling hearings and reaching out to drug companies asking for detailed information regarding their pricing practices. On February 7th, Democrats, including 2020 hopeful Senator Sherrod Brown (D-OH), unveiled a bill that would allow Medicare, the largest purchaser of pharmaceuticals in the country, to negotiate drug prices directly with drug manufacturers. The Medicare Negotiation and Competitive Licensing Act would permit such negotiations and strip drug manufacturers of their patent protection for a drug if those negotiations failed. For self-funded plans, this is key. Not only would negotiated Medicare rates provide a benchmark for pricing (as is the case for most medical services), but failed negotiations would allow generic versions of expensive drugs to market much earlier than previously allowed by law.

For now, lawmakers are hoping to get President Trump to support this bill. The president’s support would put significant pressure on Republican congressmen to support the bill. As always, we will bring you the latest developments as they unfold.


Faces of Phia: Episode 8 - It’s Tomasz Time!

Live from Polska – a journey around the world leads to… The Phia Group. Join Adam and Brady as they take a journey through history and across oceans, to share the story of this unsung hero.

 

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Empowering Plans: P64 - Hospital Transparency!

Let’s Escargot & Meet LCARA: In this episode Ron and Brady discuss the new legal compliance and regulatory affairs team (“LCARA”) with team member Philip Qualo, and specifically address recent efforts to promote hospital transparency.

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Faces of Phia: Episode 7 - Ashley Turco… International Agent of Security!

In this episode, the crew once again sits down with a valued team member, whose role sits at the crossroads between technology and healthcare.  Ensuring that the privacy and security issues hounding all businesses don’t threaten The Phia Group as it leverages technology to better serve its clients, Ashley is unique not only at the company – but industrywide.  Listen in to find out why, and what you need to do to get her seal of approval.

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Empowering Plans: P63 - Touchdown!

How payers, providers, and those of us who serve them, can work together as a team and achieve a winning plan for the future of healthcare.  In this episode, Adam, Ron and Brady, talk about how providers – like plan sponsors – are concerned with the state of things and want to identify what’s wrong, what’s right, and how we can collaborate on a new approach that works for us all, as members of a single industry – healthcare.

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Not An Enemy

By: Ron E. Peck, Esq.

Let me first begin by reporting some good news.  Those who follow our organization closely recall back in July that I announced my wife’s diagnosis of Non-Hodgkin’s Lymphoma.  Six months later, I am pleased to announce that she is in complete remission.  It will be some time before she can be deemed well and truly “cured,” but this news is still something I am thrilled to share with you.  To the many (many) people who sent me well wishes, prayers, and requests for updates; thank you.  Relevant to this blog post, however, I also want to thank the providers – the people who saved my wife’s life, and ensured my three year old son still has his mother.

As I work on behalf of the self-funded health benefits industry, including employers, employees, brokers, stop-loss carriers, MGUs, TPAs, and pretty much every entity that plays a role in the formation and administration of said plans – one attitude consistently seems to pop up.  As payers, we assume the worst of the payees.  In other words, we routinely state that the rising cost of health care is the providers’ fault.  The affordability of health benefit plans (or lack thereof) is driven solely by exorbitant – and dare I say it – criminal pricing by hospitals and providers.

This desire to place all the blame on providers demonizes them, casts them in the light of an “enemy,” and eliminates any chance of coordinating with providers in an effort to peacefully resolve differences of opinion – hopefully before a patient is negatively affected – and fix the system we agree is flawed.

Many times have I been asked to assist in a situation where a provider has billed one amount for services rendered, the benefit plan pays a lesser amount it deems to be reasonable, and the patient is balance billed.  After reviewing the entirety of the situation with the provider, sometimes they agree to accept some amount situated between their original charged amount, and the amount paid.  The offer is fair, yet upon reviewing it with the plan sponsor or administrator, they refuse to pay more.  The rationale sometimes has to do with fiduciary duty (fair), sometimes relates to financial limitations and stop-loss availability (understandable), but sometimes the stated rationale is akin to: “I’m tired of those crooks milking me for all I’m worth, and I refuse to negotiate with terrorists.”

It pains me to see this happening.  I count myself lucky to live in an area where there are so many incredible providers of healthcare.  More of my friends are providers than any other profession, and without exception, they are all 100% focused on improving patients’ health, and 0% focused on charge-masters, billing schemes, and squeezing plans dry.  The issues (and there are many of them) are more a symptom of a broken system than intentional malfeasance on the part of all providers.  Most providers, like us, are people so exasperated by their day-to-day duties that they throw their hands in the air and default to an “us versus them” mentality.

If payers and payees cannot work together to identify a middle ground that works, is fair, and is viable long term for all involved, then “someone else” will do it for us… and I fear what that “solution” will look like.  Feel the burn?

This is why I am asking every person who reads this missive to step back, and remember who we are dealing with, and perhaps – on occasion – give them the benefit of the doubt.  They, like us, are caught in a broken system whose shortcomings perpetually fuel a death spiral; and they – like us – are just trying to do right (as they see it) for their employer and their industry.

Do we truly believe hospitals want to bite the hand that feeds them, or do they look at their own (albeit inefficient and poorly conceived) processes, witness how we in the payer community are trying to “shortchange” them, and they – like us – become defensive?

The bottom line is this.  We need to adopt and obey a process by which providers are adequately rewarded for their noble work, and on both sides waste is eliminated, innovation is awarded, and cost-containment isn’t a dirty word.  Lastly, we need to change our perspective and understand that we are all (payer and payee) part of the same entity – the healthcare industry – and that without one, the other will cease to thrive.