The Book of Russo:

We have all seen the same reports – Large health insurance carriers suffering record losses in 2024, with no relief in sight. In a panic, rates are multiplied to stop the bleeding. Employers, feeling powerless, are led to believe that they either need to acquiesce to these skyrocketing rates (and reduced coverage), or cease providing health benefits to their valued staff and families. A toxic combination of ignorance, laziness, and risk aversion leads to a very limited set of options being presented; cookie cutter solutions and a choice of columns A, B, or C – none of them good. If this isn't a time to self-fund, I don’t know what is!

“Sure, Adam…” you’re likely saying to yourself. “Easy for you to say. When you and your team live and breathe this stuff – in the capital of quality healthcare no less – it’s easy to maintain a high quality, low cost health plan. What about the rest of us?” I get it, and I promise that we can all elevate our plans. Customization, data analysis, partnerships and effort are the key ingredients to empower your plan and your people to lower costs while increasing quality. Is anything more important than your employees and their families? At The Phia Group, we’ve always believed in leading by example. Nearly two decades ago, we told the industry that self-funding health benefits shouldn’t be reserved for only large employer groups. We said that a small group of dedicated, informed health care consumers could self-fund sucessfully. We proved it with a plan (our plan) that – at the time – covered fewer than twenty people. As our costs dropped and benefits improved (in direct opposition to the national health insurance trends), people said it couldn’t be replicated because our members were too young and healthy. We matured. People said it couldn’t be replicated because we were too centralized in one location, Boston, where health care and awareness is unrivaled. We expanded to every State in the nation. People said it couldn’t be replicated because we were (ironically) too small. We multiplied our enrollees by more than ten-fold. People said it couldn’t be replicated because our staff are too well informed regarding benefits and cost containment. We taught clients and their many diverse plans to do the same thing. The time for excuses is over. With some knowledge, innovation, and elbow grease, we can bend the curve. That is why we exist - it is our sole mission to ensure all Americans have access to low cost and high-quality care. This isn't a fantasy. It's a reality for our “Phia family” and many of our closest partners and client’s plans. Nobody enjoys less member abrasion, the highest discounts, and net savings with quality facilities than us and those like us that are willing to ask the questions, and do the work. Combine that with best-in-class plan design and compliance, and you’ve got a team of passionate all-stars excited to bring you along for the journey. Oh, I forgot to say that in the world of subrogation, we recover the most (by far) compared to our competition. Yeah; that “Passion for Subro” still burns. Ensuring the right parties pay the right amount in the right order for the best results? Phew. That’s what gets me up in the morning. We have been your trusted industry partner for 25 years by focusing on your needs and taking care of you (and our!!!) employees. It's a simple formula that too few follow. Let’s change that!

I'm proud to be the CEO and co-founder of Phia. Come and find out why. Happy reading!

Service Focus of the Quarter: PACE 

The Phia Group's Plan Appointed Claim Evaluator (PACE) service is revolutionizing how self-funded health plans manage final-level internal appeals. PACE alleviates the administrative burden and fiduciary risks traditionally borne by plan administrators and their TPAs; PACE ensures that second-level appeals are processed in strict accordance with plan terms, while also providing a robust layer of protection against fiduciary breaches. Whether your plan uses traditional PPO networks, reference-based pricing, or other unique designs, PACE seamlessly integrates to promote compliance and streamline decision-making. With The Phia Group’s legal expertise and clinical resources, PACE delivers peace of mind by handling complex appeals and mitigating exposure to costly external reviews or lawsuits. 

What sets PACE apart is its proactive approach. From reviewing plan documents for compliance to coordinating with IROs, PACE ensures optimal outcomes at every step. Through PACE, plans and TPAs can focus on their core operations while reducing risks and costs associated with complex appeals handling.

PACE not only protects plans, but also enhances their operational effectiveness, making the service an indispensable resource in today’s challenging benefits landscape.  

Enhancement of the Quarter: John Blaney  

This quarter, The Phia Group celebrates a pivotal enhancement to its leadership team with the promotion of John Blaney to Executive Vice President of Transformation and Recovery Services. 

With decades of experience in healthcare cost-containment, John is now spearheading (and taking a deep dive into) all recovery functions, including subrogation, overpayment, and other cost-saving opportunities. His leadership has already driven significant advancements in automation and process optimization, ensuring that The Phia Group continues to deliver unmatched recovery results for its clients; by leveraging cutting-edge technology and innovative strategies, John is positioning the company to further elevate its industry-leading services. 

John’s promotion represents more than just a title change – it’s a transformative shift in how The Phia Group approaches recovery and cost-containment as a whole. Under his guidance, Phia’s recovery departments are streamlining operations and identifying new opportunities to enhance client outcomes.

This leadership enhancement underscores The Phia Group’s commitment to staying at the forefront of healthcare cost-containment, empowering plans to achieve greater savings and operational efficiency.

Phia Case Study: Paying Second-to-None

It seems like every other week that someone discusses with our consulting team the ability to “coordinate” benefits with Medicare even when a participant has not enrolled in Medicare. 

The short answer? Can’t be done. It ends up being either – or both, generally – a violation of the Medicare Secondary Payer Act, or age discrimination. Coordination can only be performed if there are multiple payers; when the plan is the only payer, there can be no coordination, and so in practice the plan would be systematically subtracting 100% of Medicare from plan benefits for individuals over 65. 

Recently, a broker inquired about an audit that had been in progress for quite some time but had expanded in scope since its inception. The Department of Health and Human Services had some questions regarding Medicare coordination, and the broker ran the language by us, under the impression it was fully compliant. We informed the broker, TPA, and group of the issue, and they promptly fixed it, and presented the fix to HHS as a good faith effort to ensure compliance. 

This change did not affect the plan’s past language (though, very luckily, the plan had never actually had occasion to apply this provision!), but the auditor looked upon it favorably and it appears the plan has avoided any formal enforcement action. But the close call is a good reminder: a provision that “coordinates” with Medicare, when Medicare isn’t actually a payer, risks violating federal law. 

Fiduciary Burden of the Quarter: Aligning Written and Operational Processes

In the course of performing NQTL comparative analyses for self-funded groups, The Phia Group’s team often comes across situations where the SPD says one thing – like requiring pre-cert for all substance use disorder treatment – but the UM vendor’s processes don’t actually enforce it. On the surface, that might seem like a harmless (or even helpful) disconnect. After all, not enforcing this type of overly broad requirement can alleviate parity concerns in practice. 

But here’s the problem: even if not enforced, the written requirement is still there. The DOL has been clear that this NQTL in plan documents, regardless of how it’s applied, can constitute a parity violation. In other words, “don’t worry, we don’t enforce it!” isn’t a valid defense, since the SPD says the plan can enforce it.

It’s a good idea to do a periodic check-in with vendors to make sure what they’re doing actually matches what the SPD says they’re doing. Catching these mismatches early isn’t just about compliance; it’s about protecting the plan and its fiduciaries from risk that’s avoidable with a little bit of coordination.

Webinars:

• On February 12, 2025, The Phia Group presented “The Future of Healthcare Under Trump 2.0,” in which we discussed President Donald Trump’s flurry of executive orders. 

• On January 21, 2025, The Phia Group presented “Fiduciary Challenges and Risk Exposure Growing for Plans in 2025 – What to Know, What to Do,” in which we discussed potential changes that may be afoot in the new year – and ways that you can be best prepared.

Be sure to check out all of our past webinars!

Podcasts:

• On March 13, 2025, The Phia Group presented “Unpacking Weight Loss Drugs,” in which our hosts, Corey Crigger and Kendall Jackson, discussed the hot button topic of weight loss drugs. 

• On March 13, 2025, The Phia Group presented “Error 304: Good Faith Negotiation Not Found,” in which our hosts, Brian O’Hara and Jon Jablon, discussed real-life examples of AI-driven responses in the No Surprises Act’s Open Negotiations process that range from nonsensical to outright misleading, where negotiating with AI is like trying to haggle with a toaster. 

• On February 27, 2025, The Phia Group presented “Lewandowski v. Johnson & Johnson – Big win or warning?,” in which our hosts, Brady Bizzaro and Cindy Merrell, discussed the details of the Lewandowski v. Johnson & Johnson case. 

• On February 13, 2025, The Phia Group presented “Network Adequacy Under MHPAEA,” in which our hosts, Kelly Dempsey and Bryan Dunton, dove into the results of the 2024 MHPAEA Report to Congress. 

• On January 30, 2025, The Phia Group presented “Mental Health Parity: New Year, New Rules, New Lawsuits,” in which our hosts, Jen McCormick and Nick Bonds, discussed the ERIC v. HHS lawsuit in which an industry advocate challenged the federal regulators’ new Final Rules enforcing the MHPAEA and mental health parity rules. 

• On January 16, 2025, The Phia Group presented “2025 Healthcare Hot Takes,” in which our hosts, Ron Peck and Corey Crigger, delved into their bold predictions of what we will be talking about in 2025. 

• On January 2, 2025, The Phia Group presented “The Evolution of the Birth Control Benefits Mandate,” in which our hosts, Kendall Jackson and Brian O’Hara, discussed the Biden administration’s decision to withdraw proposed rules that would have expanded the birth control benefits mandate.

Be sure to check out all of our latest podcasts!

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Phia Fit to Print:

• BenefitsPro – Beyond the recipients: How Medicaid cuts could change health care forever – March 2025 

• Newsweek – Map Shows States With the Worst Health Care – February, 2025 

• The Self-Insurer – Navigating In The New Age Of Cybersecurity Threats – February 2025 

• ABC 4 News – SC ranks near the bottom of new healthcare cost to quality index: Phia Group – February, 2025 

• BenefitsPro – GLP-1s: The pros, cons, and my personal weight loss journey – February 2025 

• Worklife – WorkLife Research: How today’s HR pros match job seekers with open roles – January, 2025 

• The Self-Insurer – The Obesity Epidemic is Forcing New Health Plan Coverage Decisions – January 2025

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From the Blogoshpere:
 

• RBP vs. PPO Plans. Learn the ins and outs of RBP and PPO plans. 

• Journavx: Is Relief on the Way? Every year, tens of millions of opioid prescriptions are written for Americans experiencing searing pain. 

• House Republicans’ Proposal Related to HSA-Qualified HDHPs. The vast number of new proposals related to reducing government spending is unsurprising. 

• Why Wesco v. BCBSM Matters (A Lot). Was it a standard administrative cost or a true “phantom tax” allegedly stifling competition? 

• No Extension for HDHPs and Telehealth. 2025 has arrived with no extension to the telehealth services safe harbor for high deductible health plans that are HSA-qualified.

To stay up to date on other industry news, please visit our blog.

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The Phia Group's 2025 Charity

At The Phia Group, we value our community and everyone in it. As we grow and shape our company, we hope to do the same for the people around us.

The Phia Group's 2025 charity is the Boys & Girls Club of Metro South.

The mission of The Boys & Girls Club is to nurture strong minds, healthy bodies, and community spirit through youth-driven quality programming in a safe and fun environment.

The Boys & Girls Club of Metro South (BGCMS) was founded in 1990 to create a positive place for the youth of Brockton, Massachusetts. It immediately met a need in the community; in the first year alone, 500 youths, ages 8 to 18, signed up as club members. In the 30-plus years since then, the club has expanded its scope exponentially by offering a mix of Boys & Girls Clubs of America (BGCA) nationally developed programs and activities unique to this club.

Since their founding, more than 20,000 youths have been welcomed through their doors. Currently, they serve more than 1,000 boys and girls ages 5-18 annually through the academic year and summertime programs. 

Youth of the Year

Each year, The Boys & Girls Clubs of America (BGCA) holds a nationwide competition to award the most prestigious honor a teenager can receive as a member of their local Boys & Girls Club. Each Club across the country selects and honors one member who goes on to compete in statewide and regional Youth of the Year competitions, and then annually one exceptional nominee is selected to be BGCA's National Youth of the Year, serving as an ambassador for all Boys & Girls Club youth across America as well as a voice for all of our nation’s young people. The winner was awarded a $5,000 scholarship & a laptop, courtesy of Phia!

Wizard of Oz: The Play

The Phia Group invited 30 children from The Boys & Girls Clubs of Metro South to watch Wizard of Oz at the Inly School. They were accompanied by a large number of Phia employees and had a blast watching Adam and the cast put on a phenomenal show!

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Phia News: 

Phia Turns 25!

On Monday, February 10, 2025, we celebrated our 25th birthday. We started off the celebration with a party in the office, followed by a fun day of bowling, and ending the day at Trillium Brewery. We look forward to the next 25 years!

How Many M&M's

Phia held its annual M&M Counting Contest. The Phia Family made some great guesses, but there was one person who came particularly close to guessing the exact number. Congratulations to Mitch Hilbert on guessing 1,157 M&Ms. This was a good guess, as we had 1,166 M&Ms in the jar!

Candy Heart Contest

As is tradition, Phia held its annual Candy Heart Contest. The Phia Family made some great guesses, but there was one person who came particularly close to guessing the exact number. Congratulations to Kelvin Chun on guessing 485 pieces of candy hearts. This was a very close guess, as we had 486 pieces of candy hearts in the jar!

Kentucky Hiring Event

The Phia family is growing! We hosted a hiring event at our Louisville, KY, office in February, and had an amazing turnout. The office was buzzing with candidates and we had a huge number of positions filled due to this event’s success.

Get to Know Our Employee of the Quarter: Irene Yalch

Being named Employee of the Quarter is an achievement that is for Phia employees who truly go above and beyond their responsibilities. This person must not only transcend their established job description but also demonstrate such unparalleled dedication and passion to The Phia Group and its employees that it cannot go without recognition. 

The Phia Explore team unanimously agrees that there is no one more deserving than Irene Yalch to be recognized as The Phia Group’s Employee of the Quarter for Q1 of 2025.

Congratulations, Irene, and thank you for your ongoing and future contributions.

Phia Attending the SIIA National Conference

Several of Phia’s industry experts will attend SIIA’s 2025 National Conference in Phoenix, Arizona, from October 12th – 14th. If you are interested in attending or learning more about SIIA’s National Conference, visit their website: https://www.siia.org/i4a/calendar/?pageid=7767&showTitle=1

Job Opportunities:

• Sr. Claim Recovery Specialist 

• Claims Specialist 

• Reimbursement Specialist 

• Accounting Assistant 

• Software Engineer 

• Sr. IT Administrator 

• Automation Data Engineer 

• Project Coordinator

See the latest job opportunities, here: https://www.phiagroup.com/About-Us/Careers

Promotions

• Olesya Avramenko has been promoted to Team Lead, PGC 

• Mattie Bean has been promoted to Vice President, Recovery Services 

• Hillary Burmester has been promoted to Training and Auditing Specialist 

• Samantha Canestraro has been promoted to Training and Auditing Specialist (March 2025) 

• Nicole Capozzoli has been promoted to Team Lead, Case Investigation 

• Amanda DeRosa has been promoted to Sr. Manager, Recovery Services • Hemant Dua has been promoted to Chief Technology Officer (CTO) 

• Bryan Dunton has been promoted to Health Benefit Plan Consulting Attorney III 

• Rebekah Dye has been promoted to Vice President, Subrogation Efficiency 

• Brittany Farr has been promoted to Training and Auditing Specialist 

• Kaitlyn Fedele has been promoted to KP Administrator 

• Ethan Forrest has been promoted to Team Lead, Recovery Services 

• Trina Garcia has been promoted to Health Benefit Plan Consultant, Process Improvement 

• John Gresh has been promoted to Sr. Attorney, Provider Relations 

• Jeff Hanna has been promoted to Team Lead, Accounting 

• Mitch Hilbert has been promoted to Manager, Provider Relations 

• Lisa Hill has been promoted to Director, Recovery Services 

• Sarah Hobbs has been promoted to Senior Subrogation Service Onboarding & Support Specialist 

• Alex Houle has been promoted to Asst. Vice President, Provider Relations 

• Kendall Jackson has been promoted to Health Benefit Plan Consulting Attorney II 

• Rose Jardim has been promoted to Director, Accounting Administration 

• Jamie Johnson has been promoted to Sr. Manager, Recovery Services 

• Amy-Jo Justice-Isaacs has been promoted to Team Lead, Recovery Services 

• LaTrisha Keierleber has been promoted to Team Lead, HBPC & QAS 

• Emily Kewer has been promoted to Team Lead, Recovery Services 

• Caitlin Lankston has been promoted to Sr. Data Scientist (Transfer to IT) 

• Vanessa Leurini has been promoted to Claim Recovery Specialist 

• Kate MacDonald has been promoted to Health Benefit Plan Consultant III 

• Krishna Malyala has been promoted to Data Architect (Transfer to IT) 

• Zack McLaren has been promoted to Team Lead, Recovery Services 

• Ashley McSweeney has been promoted to Team Lead, Provider Relations 

• Larry Moffett has been promoted to Sr. Reimbursement Analyst 

• Michelle Moyal has been promoted to Team Lead, HBPC & QAS 

• Angela Norris has been promoted to Team Lead, Provider Relations 

• Naveen Omkar has been promoted to Manager, Infrastructure 

• Elizabeth Pels has been promoted to Sr. Manager, Recovery Service Onboarding & Support 

• Ania Russo has been promoted to Sr. Manager, Training Development & Coordination 

• Jackie Ryan has been promoted to Accounting Administrator II 

• Kerri Sherman has been promoted to Sr. Reimbursement & Business Analyst 

• Stephanie Smith has been promoted to Health Benefit Plan Consultant I 

• Lindsay Stewart has been promoted to Case Analyst 

• Alex Stoner has been promoted to KP Recovery Specialist 

• Giuliano Stracco has been promoted to Sr. Data Quality Analyst 

• Ashley Turco has been promoted to Director, Infrastructure & IT Security 

• Saheed Yussuff has been promoted to Staff Accounting II

New Hires

 • Amy Smith was hired as an HM First Party Claim Recovery Specialist 

 • Mandy Deese was hired as a Mass Tort - Claim Recovery Specialist 

 • Justin Stafford was hired as a Sr. Data Analyst 

 • Allyssa Pogue was hired as a Health Benefit Plan Consultant 

 • Rhys Cundiff was hired as a Subrogation Attorney 

 • Sydney Sumner was hired as a Case Investigator 

 • Karlee Castorena was hired as a Sr. Claim Recovery Specialist 

 • Stewart Miller was hired as a Subrogation Attorney 

 • Cassidy Osbourne was hired as a Sr. Claim Recovery Specialist 

 • John Gullett was hired as a Subrogation Attorney 

 • Ronnie Lytle, Jr. was hired as a Sr. Claim Recovery Specialist 

 • Eric Belmonte was hired as a Sr. Claim Recovery Specialist 

 • Naga Vivekanandan was hired as a Health Benefit Plan Consulting Attorney 

 • Harsh Neelathi was hired as a Software Engineer 

 • Ivy McGehee was hired as a Sr. Claim Recovery Specialist 

 • Katie Corrigan was hired as an AR Specialist 

 • Autumn Boone was hired as a Health Benefit Plan Consultant 

 • Stephanie Burgraff was hired as a Claims Specialist 

 • Patricia Smart was hired as a Sr. Contested Claim Recovery Specialist 

 • Matt Jelacic was hired as a Sr. Contested Claim Recovery Specialist 

 • Robert Balchunas was hired as a Configuration Specialist 

 • Tyler Hammons was hired as a Sr. Contested Claim Recovery Specialist 

 • Leslie Decker was hired as a Sr. Contested Claim Recovery Specialist 

 • Jennifer Rose was hired as a Third Party Recovery Specialist 

 • Gracie Beck was hired as a Notice Specialist 

 • Blake Drake was hired as a Sr. Contested Claim Recovery Specialist 

 • Chelsea Mullis was hired as a Claims Specialist 

 • Courtney Justice Isaacs was hired as a Sr. Contested Claim Recovery Specialist 

 • John Shouse was hired as a Sr. Contested Claim Recovery Specialist

The Phia Group Reaffirms Commitment to Diversity & Inclusion

At The Phia Group, our commitment to fostering, cultivating, and preserving a culture of diversity and inclusion has not wavered from the moment we opened our doors 20 years ago. We realized early on that our human capital is our most valuable asset, and fundamental to our success. The collective sum of individual differences, life experiences, knowledge, inventiveness, innovation, self-expression, unique capabilities, and talent that our employees invest in their work, represents a significant part of not only our culture, but also our company’s reputation and achievements.

We embrace and encourage our employees’ differences, including but not limited to age, color, ethnicity, family or marital status, gender identity or expression, national origin, physical and mental ability or challenges, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique.

The Phia Group’s diversity initiatives are applicable to all of our practices and policies, including recruitment and selection, compensation and benefits, professional development and training, promotions, social and recreational programs, and the ongoing development of a work environment built on the premise of diversity equality.

We recognize that the success of our company is a direct reflection of each team member’s drive, creativity, diversity, and willingness to exercise initiative. With this in mind, we always seek to attract and develop candidates who share our passion for the healthcare industry and our commitment to diversity and inclusion.

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