Healthcare Cost Containment Insights

Empowering Plans: P219 – Executive Orders, Tariffs, and a Crystal Ball

On May 21, 2025
Join attorneys Bryan Dunton and Cindy Merrell as they explore President Trump’s latest moves to address the rising cost of prescription drugs. Cindy and Bryan discuss potential impacts of recent Executive Orders and proposed tariffs.

Mental Health Parity Under Trump: Navigating Compliance in a New Era

On May 15, 2025
Review hundreds of health benefit plans, and it’s unlikely you’ll find one that is fully compliant with the Mental Health Parity and Addiction Equity Act (MHPAEA). It’s not that these plans are poorly constructed, it’s just that satisfying compliance requirements is incredibly challenging. Non-quantitative treatment limitations (NQTLs) present an incredibly challenging regulatory hurdle, amid an ever-shifting governing landscape. Given the enormous penalties that plans will incur for eschewing compliance, NQTL comparative analysis testing is a lifesaver. Join The Phia Group’s mental health parity professionals and learn from unrivaled experts as they share their experiences and learnings with you, right in the heart of Mental Health Awareness Month. We break down the latest regulations and discuss cost containment options, not to mention the social impact of these issues. Plus, we explored the latest breaking development: President Trump’s executive order to cap all prescription drug prices, and what this could mean for your plan. This is one webinar you truly cannot afford to miss.

Empowering Plans: P218 – Unreasonable Plan Fees on Trial: Cunningham v. Cornell University

On May 8, 2025
In this episode, we unpack the Supreme Court’s unanimous decision in Cunningham v. Cornell University — a landmark ERISA case with major implications for retirement and health plan fiduciaries. We explain the facts behind the case, what “prohibited transactions” really mean, and why the Court's ruling on affirmative defenses matters. If your health plan pays fees to TPAs, PBMs, IDR vendors, or brokers, this episode is for you.

Eggs, housing, . . . and healthcare? A new survey found that healthcare has never been so unaffordable for Americans this decade

On May 2, 2025
Not even a month ago, on April 4, the results of the West Health and Gallup poll survey, conducted from mid-November to late December last year, were published, revealing that quality, affordable healthcare eludes 35 percent of Americans (representing some 91 million adults), a four-point jump from 2023 and the highest mark since 2021. Meanwhile, approximately 29 million Americans, or 11% of those surveyed, reported that they lacked the means to afford medication and care as recently as over the past three months. Just as unnerving—but most certainly not surprising—is that the disheartening trend has been most prominent among lower-income individuals (those who belong to families earning less than $24,000 per year) as well as Hispanic and Black Americans; conversely, there has been negligible change in this regard among mid- to high-income earners and whites. Hence, one reason why there is the ever-widening healthcare social disparity plaguing our nation.

Empowering Plans: P217 – The Most Exciting Two Minutes in Cost Containment

On May 1, 2025
The Run for the Roses is here! Join two of Phia’s Louisville, Kentucky, employees, Corey Crigger and Cindy Merrell, as they discuss the event that takes over their city once a year! Coming on the heels of a historic weather event, Corey and Cindy discuss all things Derby. From Cindy’s experience at Dawn at the Downs to predictions for winners, this podcast has it all. Don’t be fooled, this podcast isn’t just about horse racing. Corey and Cindy also discuss pitfalls of AI use in the legal world. Can attorneys depend on AI for their legal research? Meanwhile, which horse has the best chance to win the Derby? Can Corey hit the trifecta for the second year in a row? Tune in to the Empowering Plans Podcast for these answers and many more!

Navigating Mental Health Parity: What Self-Funded Plans Need to Know

On April 24, 2025
In 2008, under the George W. Bush administration, the Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted to ensure that health insurance plans did not impose more restrictive limitations on mental health and substance use disorder (MH/SUD) benefits – assuming they were initially covered – than those imposed on medical and surgical (M/S) benefits. More specifically, health insurers were forbidden from applying limitations such as prior authorizations, unreasonably high copays, or visit restrictions to mental health/substance use disorder treatments when medical/surgical treatments did not have such imposing constraints.

A Discussion of the Executive Order to Lower Drug Prices

On April 23, 2025
The high costs associated with prescription drugs consistently provoke conversation in the self-funded healthcare industry. Not only is it an issue that most health plans encounter, but it is also a concern that trickles down to the member-level. Whether you’ve personally experienced the effects of high-cost drugs, or they have impacted a close family member, we can all empathize with the stress of having to pay for an expensive prescription.

Empowering Plans: P216 – Why 2025 is the Year to Go Self-Funded

On April 22, 2025
Our consulting team has received numerous questions in Q1 2025 about employers considering self-funding their health plans. Join Attorneys Jennifer McCormick and Kelly Dempsey as they go through what the driving factors are behind employers considering self-funding, the pros and cons of self-funding, and some of the major differences employers will encounter. If you’re considering taking the leap, take a listen first!

AI to the Rescue? How Machine Learning May Revolutionize Drug Repurposing

On April 15, 2025
Without question, artificial intelligence beholds many downright frightening risks when implemented in the healthcare field. Without proper oversight, AI could have the final say in depriving a patient of a necessary procedure or steering them towards a suboptimal physician. Or the still nascent technology, if unchecked, could account for a HIPAA breach with the slapdash handling of PHI. Yet, that being said, AI is undoubtedly here to stay and as far as the healthcare industry is concerned, this technological revolution is brimming with astonishing potential, as evidenced by the recent development of AI expediting the repurposing of existing drugs for treatment of rare diseases.

Tariff Talk - How Trump’s Pharmaceutical Tariffs Could Impact You (and How You Can Prepare)

On April 11, 2025
As the self-insurance industry braces for potential changes under President Trump’s administration, one issue looms large: impending tariffs on pharmaceutical drugs. These proposed tariffs, aimed at boosting domestic manufacturing, could ripple through the healthcare ecosystem, affecting employers sponsoring self-funded health plans, third-party administrators (TPAs), stop-loss carriers, brokers, and vendors. For an industry built on balancing cost control with quality care, understanding these impacts and preparing strategically is critical. More importantly, as we navigate these changes, we must remain steadfast in our commitment to ensuring that our members get access to quality, affordable prescription drugs.

Care Empowered Pricing as a Money Saver

On April 10, 2025
For over a quarter century, The Phia Group has championed a broad spectrum of cost containment initiatives to empower health plans and ultimately, their respective participants. The Phia Group believes that its latest endeavor—Care Empowered Pricing (CEP)—may be its most robust cost containment program yet. At its core, CEP is engineered to, quite simply, save plans money and as you can see below, there are a number of ways our revolutionary offering does so.

Proceed with Caution: A.I. Has Forever Changed Healthcare – but at What Cost?

On April 10, 2025
Steven Spielberg’s 2001 summer blockbuster A.I. Artificial Intelligence may not have been the director’s most highly acclaimed film, but it may very well have been his most prescient work. Here we are, nearly a quarter century later, and A.I. continues to be all the rage in nearly every facet of society, including, yes, healthcare. The potential breakthroughs for enhancing patient outcomes are breathtaking, truly resembling features of a sci-fi flick. However, as we’ve painfully realized over the past couple years, the robots can’t be trusted to do everything – especially when patients’ information (and lives?) are at risk. Indeed, there continue to be considerable ethical concerns such as algorithmic bias and data privacy violations when A.I. meets healthcare. Undoubtedly, A.I.’s influence on healthcare is a loaded, multifaceted topic.

Overhauling HHS – Can a Leaner, Meaner HHS Make America Healthy Again?

On April 7, 2025
The second Trump administration has not been shy about taking steps to shake up U.S. health policy. There has been a flurry of executive orders on a range of healthcare topics, including stepping up enforcement of price transparency rules; a push to expand coverage for and lower the out-of-pocket costs for in vitro fertilization; and taking steps to redefine sex-based discrimination in federal policy and to discourage treatments for gender dysphoria. Even so, the executive action poised to have the broadest impact on health policy may just be the sweeping changes being made to the Department of Health and Human Services (HHS).

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