By: David Ostrowsky

The SIIA National Conference, the world’s largest self-insurance industry event, resumed early last month at the JW Marriott Desert Ridge Resort and Spa in Phoenix, Arizona. The three-day event, which ran from October 9-11, covered a litany of timely topics, including a preview of the midterm elections (and impending regulatory changes); how evolving digital tools will enhance patient care; means by which insurance companies are accounting for emergent—and exorbitantly expensive—cell and gene therapies; the process by which captive insurance is countering “uninsurable” risk challenges; the multi-faceted relationship between TPAs and brokers; PBM business practices; far-reaching compliance matters such as the relationship between the No Surprises Act (NSA) and reference-based pricing (RBP) as well as the quest to obtain sufficient information for NQTL testing; and the booming growth of the medical stop-loss market in light of increasingly more U.S. employers transitioning to self-insurance.

This year’s SIIA conference, the largest in the institute’s history with nearly 2,000 attendees present (conferences held last decade never exceeded 1,300 people), was notable for its diverse audience. There has been a trend in recent years of the conference involving a wider spectrum of attendees and this year’s iteration was certainly no exception. In addition to the regular participants—TPAs, captive managers, stop-loss carriers, brokers, representatives of payment integrity programs, and specialty service providers—there was a sizable contingent of private equity firms seeking to gain a foothold in the healthcare space, a considerable number of AI and machine learning vendors (undoubtedly, data science is the future of the healthcare industry, hence the emergence of so many new vendors in this field), and representatives of corporate titans such as J.P. Morgan and Wal-Mart, the latter of which even sponsored the SIIA Future Leaders reception and cornhole tournament. It was also noteworthy that corporations annually represented at the SIIA National Conference, such as CVS for example, had a heightened presence. Even vastly smaller companies, including tech start-ups, established a highly visible platform by live streaming from the event and leveraging social media outlets (i.e., LinkedIn) to bolster promotional efforts.

While there was an exhaustive lineup of enlightening discussions and presentations at the SIIA National Conference, several stood out as being particularly relevant in the current environment.

• With the pandemic still lingering, as well as its residual effects, there was naturally a strong emphasis on how recent technological developments will improve patient care. Clearly, digital health technologies (DHT)—whether it be telemedicine, transportable health devices, and the reliance on artificial intelligence to make healthcare decisions—will have a long-lasting impact on the industry. During this highly relevant session which delved into DHT’s future, one moderated by SIIA’s own Joanne Wojcik, an accomplished journalist, the audience learned about the various ways providers, patients, and payers can leverage DHT toward enhancing services to members of self-insured health benefit plans.

• During the Phia Forum held this past July, our presenters noted how cell and gene therapy treatments promise to have a prominent influence on the healthcare insurance industry and subsequent regulatory developments in the coming years. Similarly, at SIIA’s conference, there was an acute focus on how risk-bearing entities (i.e., health insurance companies) are bracing themselves for these cutting-edge, potentially groundbreaking therapies entering the marketplace. In this session, moderated by Surya Singh, Chief Medical Officer of Emerging Therapy Solutions, this critical topic was addressed through the prism of the entity advancing these emerging therapies—the manufacturer.  Meanwhile, a later session addressed how the self-insurance industry can optimally prepare for fast approaching, but perhaps prohibitively expensive therapies.

• One of the final presentations of the conference provided a high-level overview of how artificial intelligence (AI) and machine learning are bolstering medical stop-loss underwriting. Evidently, these technologies are supplanting the reliance on surveys and questionnaires by medical stop-loss underwriters for specifying coverage terms. This is, indeed, a welcome development for underwriters projecting claims costs and trying to proactively recognize potentially high-cost claimants.

This year, The Phia Group sent four members of its team, each with considerable experience in the industry and at this particular event: Jason Davis, Senior Vice President, Provider Relations, Tim Callender, Esq., Vice President, Strategic Accounts and Business Development, Brady Bizarro, Esq., Senior Director, Legal Compliance and Regulatory Affairs, and Garrick Hunt, Director of Business Development. We were also honored to receive an appreciation award from SIIA for ten years of support as an exhibitor at this annual conference.

The Phia Group is proud of its reputation as an expert and thought leader in the self-funded industry. Over the course of this event, our team had numerous discussions with business leaders and other event attendees about the abundant educational materials we produce, including webinars, blogs, and podcasts. Our conversations with SIIA’s senior leadership, including Mike Ferguson, President and Chief Executive Officer, Ryan Work, Senior Vice President, Government Relations, and Attorney Chris Condeluci reinforced how Phia’s perspective on the industry carries significant clout.

In sum, with travel restrictions and health precautions largely being phased out due to the COVID-19 pandemic receding, the 2022 SIIA National Conference had an exceptionally high rate of participation among stakeholders and future leaders from many industries—and not just those directly related to healthcare. As previously noted, there was the particularly visible presence of private equity firms—as well as private equity-backed start-up TPAs—poised to make significant investments in healthcare services to bolster their respective businesses. Clearly, there is great enthusiasm among many vendors and private equity-backed companies to establish themselves in the healthcare space and a massive industry conference such as SIIA’s serves as a prime opportunity to form important business partnerships. Looking ahead to 2023, SIIA’s 43rd National Educational Conference & Expo will also be held at the JW Marriott Desert Ridge in Phoenix from October 8-10. We hope to meet some of you there!