Phia Group

The Impact of Provider Trends on Stop-Loss and Plans

On July 16, 2024
We progressively find ourselves on the receiving end of both medical provider and legislative efforts to secure more funding from payers. As costs increase, overpriced treatments gain popularity, and fallout from new laws continues to do more harm than good; things aren’t getting less expensive. Stop-loss carriers – responding to these trends – are circling the wagons and implementing new protective measures … but at what cost? Join The Phia Group as they discuss how to counterbalance rising prices as well as navigate these increasingly complex interactions with stop-loss.

The Cost of Cancer

On May 21, 2024
During the COVID 19 pandemic, experts anticipated that we would see a surge in undiagnosed cancers. That prediction proved to be accurate. Driven by this ongoing issue, on March 8 the Biden Administration announced updates to its “Cancer Moonshot.” Combining efforts to address navigation, research, treatment, costs and coverage – for health benefit plans, this new focus on cancer represents both an opportunity and risk. Cancer and oncology claims have always been one of the most expensive items health plans encounter. Only those who are aware of ongoing developments and plan ahead will minimize risks and maximize beneficial outcomes. Join The Phia Group as they delve into this and other new regulatory and legal developments, including the aforementioned “Moonshot,” the effect of the Dobbs decision on cancer care, specialty drugs, high cost threats – both present and forthcoming, and a very important personal message from Ron Peck.

Not Surprised – First NSA Analysis Shows That You’re Paying Too Much…And Phia Can Help!

On April 25, 2024
On Dec. 27, 2020, the No Surprises Act (NSA) was signed into law, with an eye towards protecting patients against so-called “surprise” balance bills. The law leaned heavily on “good faith” negotiations between payers and providers, as well as “objective” decision making via independent dispute resolution. Three years later, The Brookings Institution reported that you are paying nearly four-times what Medicare pays (an average of 390%) and are spending at least 50% MORE than an average PPO network. The bottom line? Providers are winning and you are paying MORE now than you did before the NSA’s passage.

The Skinny on Weight Loss Drugs

On February 21, 2024
From Contrave to Saxenda to Wegovy and beyond, society is being bombarded with messaging about weight loss drugs. While many publicly debate their efficacy and long term viability, far fewer are openly asking who will pay for them – and how. For those of us that sponsor and service health benefit plans, the costs arising from this trend are very real. While we want to help people lose weight, get fit, and improve their overall health – the best way to approach this matter is still uncertain. Join The Phia Group for another free webinar! Our team will discuss this very relevant topic, including related issues such as off-label drug usage, international drug importation, defining medical necessity, plan drafting and exclusions. Likewise, the importance of educating plan membership about the costs of healthcare, and what it means to be self-funded.

Navigating 2024: The Latest, Most Innovative Plan Design Features & Stop-Loss Policy Updates

On January 16, 2024
In this first webinar of 2024, our crew will provide a rundown of 2024’s biggest plan document and stop-loss updates, including matters about which our team has been asked the most. Stay ahead of the crowd, and join The Phia Group as we jump into the year with a head start. Together we will resolve lingering problems of the past and equip you with a list of changes to expect and topics you need to monitor in 2024 and beyond.

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.

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.

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!

A Duty to Serve and Protect … the Plan

On August 17, 2023
Think you can’t be sued for breaching a fiduciary duty? Think again! Lawsuits filed by plan sponsors against their claims administrators are gaining increased media attention. Between talk of a possible recession and passage of new laws such as the No Surprises Act, employers are tightening their belts and examining their partners with renewed vigor. Accusations suggest that anyone managing plan assets has a fiduciary duty to do so prudently. Regardless of fiduciary status, only those who carefully examine claims, manage appeals, navigate disputes, curb plan spending, and leverage all possible sources of reimbursement will likely avoid such scrutiny. Join The Phia Group for another complimentary webinar. Their team will contemplate strategies applicable to every stage in a claim’s lifecycle, and divulge best practices that will keep you out of the court house.

Illuminated by Phia Ignite! Leveraging A/I and Multifaceted Price and Quality Data

On July 11, 2023
Benefit plans are struggling with the No Surprises Act, are overburdened by disproportionate expenses, and are butting heads with stop-loss over inadequate risk disclosures and network terms. Meanwhile, too many are ignoring modern technology, and are overdependent on cost data while ignoring quality metrics. Join The Phia Group’s leadership team as they present and dissect case studies addressing regulatory compliance, claim appeals, and dispute resolution. From the NSA and IDR, to transparency rules and provider pricing, The Phia Group’s best and brightest will show you a defensible payment strategy with Phia Ignite, as well as determine what role artificial intelligence will play. Drive costs down and address today’s most pressing industry issues by registering for this complimentary webinar. There are sure to be some fireworks!

The Business of Benefits

On May 18, 2023
Those who service health benefit plans are usually focused on delivering the most robust coverage for the least cost. Yet, all too often we forget that our industry, like any other, only thrives when our own businesses prosper. From adjustments to a post-pandemic environment (and employee populations working remotely from numerous locations), to conflict resolution between entities (such as disputes between plans, stop-loss, and TPAs over reimbursement of fees for savings and management of the NSA), join The Phia Group as we discuss the current events and case studies that will impact whether your own organization sinks or swims.

Before and After – Examples of Mistakes that Were Addressed and How to Avoid Them

On April 20, 2023
Accidents happen, but they aren’t all inevitable. Often, errors that lead to conflicts and costly outcomes could be avoided. Join The Phia Group’s team as they dig into real case studies, and share examples where The Phia Group was called upon to address some avoidable losses, as well as compare them to scenarios where the proper preemptive steps were taken. This April, remember what Benjamin Disraeli said: "The fool wonders; the wise man asks." Register today for this free and informative webinar!

Love is in the (Health)Care!

On February 15, 2023
Roses are red, violets are blue, and The Phia Group has some hot tips for you. Whether you sponsor, administer, or service self-funded health plans, The Phia Group’s free webinar will thrill and amaze you. The Phia Group’s team presented a variety of important issues, best practices, and case studies. From disputes with providers, to subrogation, to regulatory updates, and beyond… this webinar is better than a box of chocolates. Don’t wait to unwrap your gift!

An Omnibus Edition to Kick Off 2023

On January 19, 2023
It’s only January, but 2023 already promises to be a momentous year in healthcare law. From the recent passage of The Consolidated Appropriations Act of 2023—and its inclusion of protections for pregnant and nursing mothers—to regulatory updates regarding the No Surprises Act and manufacturer assistance programs, there’s quite a bit to break down as the new year unfolds. Join The Phia Group’s panel of experts as they discuss how such sweeping changes will impact your group’s health plan.

A Flip of the Calendar: Looking Ahead to Healthcare in 2023

On December 13, 2022
With a new year comes new developments in healthcare — and 2023 will be no exception. While ever-increasing healthcare costs remain at the forefront of our attention, landmark healthcare legislation — in particular, the No Surprises Act (“NSA”) — continues to cause unforeseen issues for health plans and stop-loss carriers. Additionally, evolving business trends involving mergers, acquisitions, and investments from non-traditional entities promise to impact the industry. Join The Phia Group’s panel of cost containment experts as they look ahead to the challenges and opportunities that await us next year.