The Phia Group Blog Posts

The End of a (Brief) Era

On May 2, 2024
Five years ago, Walmart, the multi-billion-dollar retail behemoth, opened its first-ever health clinic in Georgia. Soon, dozens more Walmart-sponsored clinics started opening their doors across not just Georgia, but also Arkansas, Florida, Illinois, Missouri, and Texas. Most of these pop-up clinics operated in rural communities where chronic diseases were rampant and (affordable) primary care options were scarce. Irrespective of the pandemic soon unfolding, they served their purpose: customers shopping for microwaveable dinners and bath supplies could stop by for a doctor’s appointment, get stitched up, take a flu test, or even get X-rays done, all for a very reasonable fee. As many of these shoppers/patients either lacked health insurance or had high deductible plans with imposing out-of-pocket costs, these clinics represented their only viable option for obtaining any semblance of proper healthcare. Surely, some had not been to a doctor of any type for years.

Empowering Plans: P188 – Fiduciary Duties in the Spotlight – Lewandowski v. Johnson and Johnson

On April 25, 2024
Attorneys Brady Bizarro and Andrew Silverio discuss the pending case of Lewandowski v. Johnson & Johnson, a lawsuit brought against plan fiduciaries for violating their fiduciary duties under ERISA. How did they violate those duties? By failing to negotiate drug prices and sufficiently oversee their PBM or investigate alternatives. No matter who wins, this case highlights the importance of ERISA’s fiduciary duties and the gravity of the decisions fiduciaries are (or should be) making.

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.

Empowering Plans: P187 – Decoding ACA FAQ #66: Essential Health Benefits Unpacked

On April 11, 2024
Listen in as Kelly Dempsey and Brian O'Hara hit it out of the park in this Empowering Plans episode about Essential Health Benefits (EHBs)! The regulating bodies are at it again and issued ACA FAQ #66 on April 2, 2024! Listen in for a quick refresher on EHBs - how they started, where they are now, and where we’re going - and Phia’s interpretation and analysis of FAQ #66.

IDR: The Confusion Never Ends!

On April 8, 2024
It seems like every day that The Phia Group's consulting team is presented with an IDR-related issue brought up by either a provider in an appeal or simply a TPA trying to iron out or streamline its processes. Sometimes the question centers around the specifics of the IDR process, but sometimes the question instead focuses on the very concept of IDR itself and when it becomes applicable to begin with.

The Phia Group Is Named Winner of the 2024 Top Workplaces USA Award

On April 3, 2024
Canton, MA – The Phia Group, a leading provider of health care cost containment solutions, proudly announced today that it has been honored with the 2024 Top Workplaces USA award. This prestigious recognition, presented by Energage, underscores The Phia Group's commitment to fostering an exceptional workplace environment for its employees by providing such outstanding benefits as ongoing education, philanthropic events, and zero-cost health coverage for employees that have been with the company for five or more years.

Lenmeldy: The World’s New Most Expensive Drug

On April 1, 2024
The U.S. Food and Drug Administration (FDA) stoked the fire that is the ever-present discussion surrounding gene therapy when it approved Lenmeldy on March 18, 2024. Lenmeldy is the first FDA- approved gene therapy to treat metachromatic leukodystrophy (MLD), a rare disease that affects the brains and nervous systems of children in their late infantile and early juvenile years.

The Phia Group Announces the Addition of the Renowned John Blaney as Their Chief Innovation Officer

On March 28, 2024
Canton, MA – Rarely can an organization with decades of industry leading ascendency truly claim to make a change that will both revolutionize its fundamental essence to the core, as well as deliver to its clients monumental improvements on top of what is already the industry’s best results. In other words, when does the best get even better? This is one such moment. March 30, 2024 will be remembered as the day that The Phia Group publicly announced the addition of the renown John Blaney as their Chief Innovation Officer.

Empowering Plans: P186 – Xenotransplantation: A Potential Game Changer for Self-Funded Plans

On March 28, 2024
Ham it up with attorneys Nick Bonds and Jen McCormick from the Phia Group as they dive into the groundbreaking world's first successful genetically engineered pig kidney transplant at MGH in Boston. Explore the details of this medical breakthrough, its implications for the healthcare industry, and the considerations for the future of dialysis, plan language, and stop loss provisions. Tune in to gain invaluable insights into the intersection of law, healthcare, and cutting-edge medical advancements.

Wegovy: Not Just a Weight Loss Drug

On March 20, 2024
Earlier this month, the wildly popular weight loss medication was approved in the US to help prevent life-jeopardizing cardiovascular events in people who are overweight, obese, and/or have a history of cardiovascular disease. The FDA’s stamp of approval for drugmaker Novo Nordisk to include cardiovascular benefits to Wegovy’s label meant it was the first weight loss drug to market itself in this manner. Now the million-dollar question (no pun, intended) becomes, will this label expansion make insurers feel more inclined to provide coverage? For good measure, will Medicare, currently barred by law from covering drugs for weight loss alone, be compelled to include Wegovy under its umbrella?

Empowering Plans: P185 – Weighing the Options

On March 14, 2024
Over the last twelve months we have seen major interest in GLP-1s (Semaglutide- Ozempic / Wegovy and Tirzepatide – Mounjaro / Zepbound). Although GLP-1s have been around for years as a treatment for diabetes, the recent popularity is due to their use as a weight loss drug. Join Ron Peck and Corey Crigger as they discuss the impact this surge in demand has had on health plans and consumers. Are health plans and consumers informed about the benefits and drawbacks of this drug? Are consumers too focused on the benefits? Are health plans too focused on cost? Find out as Ron and Corey discuss one of the hottest topics in the industry.

The Indirect (But Significant) Impact of a Recent Massive Healthcare Breach on Benefit Plans

On March 11, 2024
It’s not often we see a healthcare/health benefit story so big that it crosses into the mainstream. The recent cyberattack in the healthcare industry is just that type of story, however, and the American Hospital Association has already called it “the most significant cyberattack on the U.S. health care system in American history.”

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