The Phia Group Forum

Held at the historic Omni Parker House in Boston, MA, June 10th and 11th, 2010, The Phia Group Forum – Boston 2010 explored the theme of “A Revolutionary Passion for Savings” with industry leading speakers presenting on the innovative and efficient cost containment strategies available to the health insurance industry today.

Speakers & Sessions

Session 1: Provider Bills: The High Cost of Getting Healthy
This presentation is designed to give an overview of what to look for internally as potential problems in assessing a provider bill and offer strategies for handling billing concerns. Detailed examples and true billing scenarios will be given.

Stacy Borans, MD
Chief Medical Officer and Founder
Advanced Medical Strategies (AMS)

Bio:
Dr. Borans is the Chief Medical Officer and Founder of Advanced Medical Strategies (AMS). Advanced Medical Strategies was founded with the purpose of combining clinical expertise and experience with financial sensitivity and understanding to give clients high-level cost containment insight and guidance.

Dr. Borans has worked with Managing General Underwriters, Third Party Administrators, stop loss carriers and managed care plans to assess both clinical and financial questions on catastrophic claims. She has assisted in cost projection analysis for underwriting risk, reviewed medical necessity and experimental concerns as well as directed educational seminars for claims professionals. Dr. Borans is currently the outsourced medical director for several companies within the stop-loss industry.

Session 2: Under the Microscope. . . Effectively Managing Catastrophic Claims
This session will provide best practices from TPAs that have reduced the number of high dollar claims in their covered population through care management outreach, access to specialized provider contracts, direct negotiation, focused case management and comprehensive claims review.

Glenn S. McLellan
President
McLellan Consulting Services

Bio:
Glenn S. McLellan, is president of McLellan Consulting Services providing professional insight to a wide range of companies, including third party administrators (TPAs), insurers, managing general underwriters, managed care organizations and large employers. With the exception of a 21-month period in which he was Executive Vice President of one of his former clients, CenBen USA, Glenn has spent 22 years as president of McLellan Consulting Services (MCS). In his role at CenBen USA, Glenn was responsible for managing all national sales, account management and marketing efforts for CenBen USA’s TPA subsidiaries.

Specific areas of expertise for Glenn include marketing and sales strategies; product design and implementation; project management; operational review and enhancement; customer reporting and analysis; vendor selection and contracting; and quality improvement.

Glenn has served over 200 clients, including: Sun Life of Canada, Pacific Life & Annuity, Medical Excess Insurance Services/AIG, City of Las Vegas, Professional Benefit Administrators, Wells Fargo TPA, Trisurant, EBMS, United Medical Resources, Claim Management Services, Silver Legacy & Eldorado Casinos, Volusia County, Washoe County, Coresource, Intermountain Administrators/Allegiance, The Parker Group and Delta Health Systems.

Session 3: The Patient Protection & Affordable Care Act of 2010
This session will provide an “insider’s” perspective on how the health care reform legislative process has continued to evolve in Washington, DC and future prospects for legislative action that could affect self-insured group health plans.

Michael Ferguson
Chief Operating Officer
Self-Insurance Institute of America, Inc. (SIIA)

Bio:
Michael W. Ferguson serves as chief operating of the Self-Insurance Institute of America, Inc. (SIIA), responsible for the association’s day-to-day operations as well as serving as a federal lobbyist. Mr. Ferguson has been with the association for more than 15 years in various positions ranging from government relations, event planning and membership services.

He is widely considered to be an expert on self-insurance matters related to group health plans, workers’ compensation programs and captive insurance companies.

Prior to joining SIIA, he was a corporate communications specialist for Rockwell International at the company’s world headquarters. Mr. Ferguson holds a bachelor’s degree in political science from California State University, Long Beach and is member of the American Society of Association Executives.

Session 4: Exploring The Phia Group Mission
Reducing the cost of health plans through innovative technologies, legal expertise, and focused, flexible customer service is The Phia Group’s mission. We will explore what the industry can do to slow the rising costs and other nagging issues, allowing our industry to expand and thrive. Working together, we can exercise negotiation power, create immediate benefits, and demand change for our clients and plan members.

Adam V. Russo, Esq.
Chief Executive Officer
The Phia Group, LLC

Bio:
Adam V. Russo, Esq. is the co-founder and visionary of The Phia Group, LLC, an innovative cost containment leader in the health insurance industry located in Braintree, MA. In addition, Attorney Russo is the founder and managing partner of The Law Offices of Russo & Minchoff, a full-service law firm with offices in Boston and Braintree, MA.

Attorney Russo’s practice is devoted to representing employers, plan fiduciaries, third-party administrators and carriers in employment and employee benefits matters throughout the United States. Attorney Russo is a frequent speaker and author on health care and employee benefits topics at conferences and seminars across the country. Attorney Russo’s industry leading blog, www.passionforsubro.com is regularly updated with news and information relevant to the entire healthcare industry.

Attorney Russo obtained a Juris Doctorate degree from Suffolk University Law School and a Masters Degree in Finance from the Frank Sawyer School of Management at Suffolk University in Boston, Massachusetts. Attorney Russo also acquired an undergraduate degree from Suffolk University, where he double majored in Political Science and Public Relations.

Attorney Russo was recognized by Suffolk University with the 2005 Outstanding Alumni Achievement Award. He is the Co-Chair for the 2010 Health Track Subrogation Litigation: Skills and Management Conference, advisor to the Board of Directors at the Texas Association of Benefit Administrators (TABA) and was named to the National Association of Subrogation Professionals (NASP) Legislative Task Force. Attorney Russo is admitted to the Massachusetts Bar and the U.S. Court of Appeals for the First Circuit.

Session 5: Evidence-Based Treatment: Reducing Costs and Improving Employee Health
Ten to twenty percent of plan members have filled a prescription for an antidepressant or other psychotropic drug in the last 12-months. General medical doctors provide suboptimum care, and resistance to treatment is increasing. Rising healthcare costs and a decrease in productivity are the results of improper treatment. We will discuss the solution, as well as the patent pending Pharmacy Intervention Protocol (PIP).

Fred Newman
Chief Executive Officer and Founder
Interface EAP, Inc.

Bio:
Fred Newman is the founder and CEO of Interface EAP and Coordinated Health Solutions. In the mid-1980s he was the CFO of a public company that owned and managed psychiatric hospitals. It was in this position that he saw the need for a behavioral healthcare company with a proactive approach for addressing the impact mental health has on medical costs, productivity, and other labor costs.

Fred recently completed 4+ years on the board of the Texas Association of Benefit Administrators (TABA) and the Benefits Committee for the Self Insurance Institute of America (SIIA). He has presented programs on behavioral healthcare management to numerous groups including Benefit Management Forum & Expo, SPBA, TABA, WorldatWork, SIIA, URAC, Pharmacy Benefit Management Institute (PBMI), Health Action Council of Ohio, Midwest Business Group on Health, and Health Care Administrators Association (HCAA).

Session 6: Today’s Transplant Network Marketplace: The Good, The Bad, and The Ugly
This session is intended to provide the attendee with a strong working knowledge of transplant network product design with a primary focus on the clinical, financial and operational elements of a well-designed transplant network.

Robert P. Ziomek, Jr.
Principal
Axia Strategies, Inc.

Bio:
Robert Ziomek is Principal for Axia Strategies. Bob’s entire 26-year professional career has been in the health care industry. Prior to joining Axia Strategies, Bob spent fourteen years as the Senior Vice President of Sales and co-founder of United Resource Networks, the transplant network division of United Health Group (UHG). Bob’s focus was on designing transplant benefit management solutions on behalf of reinsurance/stop-loss carriers, indemnity insurers, health plans and large corporations. Before joining UHG, Bob held senior sales executive positions with Tokos Medical, CIGNA Health Plans and Johnson & Johnson.

Bob earned his Bachelor of Arts degree in English from Boston College in 1980. He has also written and published various articles on the Centers of Excellence marketplace and is recognized in the industry for his extensive knowledge within this area of managed health care.

Session 7: Leveraging Data to Deliver Optimized Cost Management
No matter your view of today's healthcare issues, there is one thing we can all agree on: There are tremendous savings opportunities available that are not capitalized, based today's fragmented approach to cost containment. In this interactive session you will see examples of how to analyze your own data, comparing it to current trends to create a road map for cost management that maximizes savings by enhancing today's methodologies and integrating them with the technology of tomorrow.

John Powers
Executive Vice President and CMO
Premier Healthcare Exchange, Inc. (PHX)

Bio:
John with EVP Premier Healthcare Exchange, Inc. (PHX), is one of the most visible spokesmen for the fraud investigative industry. He frequently interviewed by national media including A & E’s Investigative Reports, Dateline NBC and the New York Times. He has lectured on fraud across the nation, as well as at international conferences on four continents. John is the coauthor of Surveillance Risk Management 101 and the author of Greenhorn Traveler. He is widely known as one of the most successful investigators in the industry having conducted investigations in all 50 states and over 60 countries internationally.

He is a board member of the North American Training Group, a firm that specializes in continuing education for the insurance industry. Prior to PHX, Powers served as an officer for a Midwestern based insurance company as well as serving as President of the insurance fraud investigative division for Kroll, one of the world’s leading risk consulting firms.

Session 8: Innovative Solutions Through Plan Language
We will analyze many of the controversies presently faced by benefit plans, and discuss how to emerge victorious from these battles by not only drafting plan language which will provide the upper hand, but will allow us to avoid these conflicts in the first place.

Ron E. Peck, Esq.
General Counsel
The Phia Group, LLC

Bio:
Ron Peck is an attorney with The Phia Group, LLC, and has been a member of The Phia Group’s team for almost four years. As an attorney with The Phia Group, Ron has been an innovative force in the drafting of improved benefit plan provisions, handled complex subrogation and third party recovery disputes, and spearheaded efforts to combat the steadily increasing costs of healthcare.

Ron has lectured at and participated in many industry gatherings such as NASP’s Litigation Skills Conference, HCAA, SIIA, and TABA. Ron is also frequently called upon to educate plan administrators and stop-loss carriers regarding changing laws and strategies. Ron’s theories regarding benefit plan administration and healthcare have been published in many industry periodicals, and have received much acclaim. Prior to joining The Phia Group, Ron was a member of a major pharmaceutical company’s in-house legal team, a general practitioner’s law office, and served as a judicial clerk. Ron is also currently of-counsel with The Law Offices of Russo & Minchoff.

Ron obtained his Juris Doctorate from Rutgers University School of Law and earned his Bachelor of Science degree in Policy Analysis and Management from Cornell University. Ron is also a Certified Subrogation Recovery Professional (“CSRP”).

Session 9: The Future for TPAs and The Small Payer Industry
As Washington tinkers with healthcare care financing and delivery there are a variety of ways the industry could move that will dramatically affect regional payers. From changes that could dramatically increase the viability of the non-BUCA payers to those that will cast a spotlight on the industry’s warts the ability to be nimble and pursue positive service delivery changes have never been at more of a premium. This session will focus on our industry’s fatal flaws and the changes that could open new doors to growth and prosperity.

Mike Dendy, MBA / MHA
Chief Executive Officer and President
Advanced Medical Pricing Solutions (AMPS)

Bio:
Mike Dendy is a Principal and serves as CEO/President of Advanced Medical Pricing Solutions (AMPS) a healthcare cost containment company based in Phoenix, Arizona. Mike accepted the position to be AMPS’ Chief Executive Officer in February 2005 and executed the turnaround of the once bankrupt company over the next 24 months. Mike also serves as Chairman of MDM Covenant Insurance Group based in Nashville, Tennessee and provides consulting on group benefits services for the agency.

Previously, Mike served as Chairman and CEO of HPS Paradigm Administrators Inc., a health insurance administrative services firm (TPA) serving corporate and government employer groups, from 1997 until its sale in 2004.

Mike serves on the Advisory Board for the Robinson College of Healthcare Administration at Georgia State University and is the former Board Chairman for the National Safe Care Campaign. Mike is a frequent speaker on healthcare issues and the future of healthcare delivery at many of the national healthcare associations including SPBA, SIIA, and TABA.

Session 10: On-Site Medical Clinics
Companies and municipalities are considering on-site medical clinics. What are the driving goals, values and deliverables, and what are the minimum thresholds for success? What are “Patient-Center Medical Homes”? What applications can impact self-funded health plans, and how do we benefit from them? We will examine what these and other propositions mean, analyzing the variables and impacts.

Ernest A. Clevenger, III
President
CareHere, LLC

Bio:
Mr. Clevenger is President of CareHere, LLC, a Brentwood-based company CareHere provides onsite medical clinic and pharmacy management for public and private employers.

CareHere online systems including appointment scheduler, electronic medical records, patient lab reporting, and more, enable over 250,000 appointments annually. Physicians are recruited from the local area. CareHere operates 90 clinics in 20 states.

Mr. Clevenger has held other positions including: • Chairman, Self-Insurance Institute of America, Inc. (SIIA) • Chairman, Workgroup for Electronic Data Interface (WEDI), the organization named in HIPAA to advise United States DHHS Secretary on selecting electronic healthcare transaction standards. • Co-Founder of EBM Solutions, a provider of evidence-based medical guidelines • President, Nashville Rotary Club. • President, MyHealthGuide, publisher of the weekly email MyHealthGuide Newsletter for the Self-Funded Community.

Board positions include: • Faith Family Medical Clinic (dedicated to serving the uninsured working population of Middle Tennessee) • Lodge Manufacturing Corporation (cast iron cookware firm based on South Pittsburg, TN) • Calmetto Management Group (association managers) • Nations University (on-line university serving over 3,800 students worldwide).

Mr. Clevenger's education includes and an MBA from Vanderbilt University, a BA in Mathematics from David Lipscomb University, and a FLMI from the Fellow Life Management Institute.

Attendee Feedback
 

"It's great to be working with a team that has a vision and passion for what they do. Keep it up!"
 
Jeff Q.
Vice President, Sales

“I really enjoyed the conference last week.  You team did a great job.”
 
John Y.
CEO
 
“I just wanted to let you know how much I enjoyed the conference.  You did an awesome job from the food to the speakers and subject matter.
 
“It was a pleasure to meet you "face-to-face" finally.  I was impressed by not only your "passion for subro," but with your passion for people.  I almost felt like I was at one of my family (Italian) reunions...lots of love, passion and great food, of course!  It was a wonderful experience.  Thanks so much for making it all happen.”
 
Karen V.
Vice President, Operations
 
“Thank you for including us in The Phia Forum.  I was amazed at the number of participants you had.  It is the most successful event I have ever seen put on by someone”
 
Joe B.
President
 
“Wow!!!  And Double WOW!!  It has been many years since I have been to a “symposium” and could walk away with the following:
·       Fun
·       Entertaining
·       Informative
·       Great Speakers
·       Great Hotel
·       Great Food
·       Fun
·       Great City
·       Wonderful Company
·       Good People
 
Looks like PHIA hit the grand slam.  It tells me that our industry is stagnant and we have not tried something new in quite sometime.  Hopefully, people will walk away with a new sense of vigor and continue to carry your message of “keep going!”   
 
Julie B.
Director, Account Management

Words do not express what a great conference you hosted!  Great job!  Way to make a difference in our industry.
 
Please tell everyone at Phia that they did a spectacular job of hosting a great conference.
 
Rick P.
President

Great gathering last week for the Phia Forum.  Good group of attendees and excellent presentations by all.
 
Congratulations – great company and great people.
 
Excellent discussion amongst key industry people.
 
Thanks again.  You continue to reinforce that we have chosen an excellent business partner.
 
Steve C.
Vice President & Chief Operating Officer
 
I would like to thank you and The Phia Group for a wonderful conference.
 
We all attend many conferences and some are better than others.  The Phia conference was excellent.  The speakers and the topics were both relevant and on point as to our industry.
 
Dan R.
President

Great seminar!    I thought it was great.  Very helpful and informative.  Thank you for inviting me.  It was truly FIRST CLASS!!
 
Jan C.
Operations Director
 
Thanks again for putting on such a great event.  Your team did a great job!  I am so inspired by your drive to control costs and I see that same passion in myself.  I confidently believe that the topics addressed at the seminar are the future of this business.
 
Thanks also for the hotel room, the cocktails and meals.  Much appreciated by my staff and me too.
 
Brooks G.
President

You guys presented your company beautifully last week.  I am proud to be associated with you.
 
Hope you enjoyed your weekend.  You deserved some time off.
 
Mike D.
President & Chief Executive Officer

I just wanted to take a moment to thank you for the amazing conference.  It truly was the best one I have ever been to.  Let me just say that you and your employees are truly a pleasure to work with and your professionalism is to be commended.  I look forward to a great partnership with your company.
 
I know that I made the best decision in choosing your firm to partner with.
 
Sue S.
Director of Cost Management
 
I would like to thank you guys so much for the awesome conference!!!
It was one of the best I’ve been to!  You managed to make it informative, creative, and entertaining!
 
I can’t even begin to imagine the work that went into planning such a fantastic event!!
 
Maureen M.
Medical Solutions Manager