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What to Expect in 2019 – Part 2

On December 12, 2018
To build on last month’s webinar (Part 1), join The Phia Group’s legal team for an hour on December 12, 2018, as they present the second part of this two-part series on What to Expect in 2019. Touching on topics such as appeals, stop-loss trends, reference-based pricing, and much more, this webinar will highlight current industry happenings and our predictions to help you look forward to the coming year. Just like last month: miss this one, and you’ll be left behind.

Faces of Phia: Episode 3 – Flying High with Judy

On November 29, 2018
In this episode, Ron and Adam sit down with Judith McNeil. Judith is the most recent winner of our “Employee of the Quarter” award, as well as our second Face of Phia. Judith’s story goes from inspiring to hilarious, and is one you certainly won’t want to miss. Expect to see things differently by the time you’re done with this episode.

Empowering Plans: P59 - Talkin’ with TPAC

On November 16, 2018
In this “Partners in Empowerment” episode, Ron and Brady enjoy chatting with Michael Meloch, President of TPAC Underwriters and valued member of The Phia Group’s own advisory board. Michael isn’t shy when it comes to diagnosing the issues, boiling healthcare cost containment down to simple basics we can all appreciate, and telling it like it is. His employer based perspective and focus on the bottom line (a/k/a “risk”) is as refreshing as it is informative. Don’t miss this one!

Faces of Phia: Episode 2 – Not Your “Norma-l” Employee

On November 16, 2018
In today’s episode, our hosts chat with Norma Phillips… our first official “Face of Phia;” (sorry Matt). Norma explains what makes her different (and special) as well as what makes The Phia Group so unique. From Friday night films, to saving the American workers’ job… Norma and the team touch all the bases.

Faces of Phia: Episode 1 – A Chat With Matt

On October 24, 2018
In this episode we sit down with The Phia Group’s Marketing & Accounts Manager, Matthew Painten. Matt tells about how his time with the organization has changed him, and educated him regarding healthcare and what everyone can do to reduce their expense. Matt will give us insight into his transformation as well as how he accomplishes his work for the betterment of all.

Empowering Plans: P51 - A Healthcare Homerun

On August 8, 2018
In this episode, Adam Russo, Brady Bizarro, and Ron Peck (yes - he’s back!), chat with Mark S. Gaunya – Chief Innovation Officer and Principal of Borislow Insurance. As an author, innovator, and passionate industry advocate touting more than 25 years of experience, Mark doesn’t pull punches as he addresses the biggest opportunities and threats facing employers, employees, and their plans. If you want to know what’s wrong with the nation’s healthcare system, what we need to do to fix it, and enjoy it when someone teases Adam – this episode is a must listen.

Empowering Plans: P47 - Coaching the Self-Funded Industry

On July 11, 2018
In this episode of Empowering Plans, Adam and Brady interview Rick Koven, President of Koven Consulting & Coaching. They discuss his work with health plan startups, small regional TPAs, and micro-insurance in developing countries. Rick also explains his role as a coach for executives and corporate leaders in our industry. As a special treat, they are also joined by Lisa from the claims department.

Empowering Plans: P46 - You’ve Gotta Fight, For Your Right, to Try!

On June 29, 2018
Welcome to Empowering Plans a show dedicated to identifying waste and undo expense in the health benefits industry. Discovering ways to maximize benefits while minimizing costs, and empowering employers, administrators, and consultants to emphasize once again the benefit in benefit plan. Today’s episode is brought to you by the Phia Group Empowering Plans Since 1999, now here are your hosts the Phia Group’s own CEO Adam Russo, and senior vice president and general counsel Ron Peck, and Brady. ADAM: Hello everybody, and welcome to another episode of Empowering Plans with the Phia Group. Hello everybody! Hi-lo audience! I am your co-host, and the CEO, and co-founder of the Phia Group, Adam Russo. With me as always is our general counsel, senior VP Ron Peck. Say hello Ron RON: Hello Ron. ADAM: And what else can you say about Jen? Everyone just check. Just look at Jen. What can you say? Our amazing, the smartest, the brightest, the wonderful, the LinkedIn superstar, once we put Jen’s picture on anything the views go up. RON: You’re giving away my secret weapon. ADAM: That is Ron’s secret weapon. RON: That’s how I get all those hits. ADAM: Our vice president of our recovery services, Jennifer McCormick. Say hello Jen. JEN: Hello. ADAM: She always does the “Hello” that’s it. So folks Jen is a little freaked out. This is our first, I guess, it’s not a podcast, what do you call these Ron? RON: A vlog? ADAM: A vlog? We are videotaping live. Pat our producer is here, he is sweating too. Pat has multiple jobs today. RON: Funny too because he is off the camera, I mean he could actually be naked right now. ADAM: He might actually be on camera; I don’t know how wide this lenses is. Folks, we appreciate you all joining us on a short notice. This is a big, big, big deal for us for two reasons. One, you can see our beautiful faces. But two, this right to try law that was recently passed by President Trump. People have already reached out to us many times in regards to the impact. We figured, just based on the amount of responses, the amount of impact we feel this has on our industry we thought we would bring in our expert. And as she likes to say, “The right to try, is it right for you?” And we will talk to you about it a little bit. Jen, do you want to give them a little background, and we will take it from there guys. JEN: Sure. The right to try while it is a new law that was actually just issued in May of 2018, so it’s about a month old or so at this point, this is not a new concept. This concept has been along for about ten years at this point. And this was an FDA expanded access program that was giving individuals the right to receive certain treatments that were not otherwise FDA approved throughout the entire process. ADAM: So if is not something new, then why is it new? JEN: So the caveats to the right to try act are that now instead of having to go through FDA approval you can get your physician to sign off on it. And you can get it through that process instead of having those extra steps of that FDA red tape. ADAM: So I was reading about the FDA red tape, and that fact that 99% of the time the FDA approves it anyways. Again let’s be honest if I have a terminally ill family member, and I’m meeting with our doctor, and they can approve it right then and there, let’s be straight up like having to go through the FDA process in my mind even though at the time I’m assuming no one knows that it’s 99% approved, it’s daunting, right? To go through that process. JEN: It is intimidating. RON: I think, Adam actually you make a good point. ADAM: Oh Ron, everyone check out Ron’s suit RON: Hey hey, feeling good ADAM: Is that a new one, Ron? RON: Uh no.. this is one of ADAM: Why are the tags still on the suit, Ron? You should probably take those tag off before RON: I just figured if someone tries to take it away, I could always get it back, you know? You gotta label everything these days. But anyway, you mentioned the FDA and the existing expanded right use rules and the fact that in essence it mirrors the RTT or the right to try up until a certain point when all of a sudden the FDA has to basically make an exception on a per case basis. And Adam your point that they say, “Oh but we make an exception 99% of the time, so why do you need to get around it?” When it’s basically going to pass right through. I think that there are a number of people who didn’t even try because they knew either they weren’t going to get approval, or they didn’t have the time, or they were daunted by it. ADAM: Or they were scared! Obviously, it is a process. You have family member, a loved one is dying, and you have to go through the FDA to get approval to take a drug that may or may not work that just passed phase one. I get it. RON: That is why they say 75% of statistics are made up, right? ADAM: Right RON: Because ultimately, you know the only people who are submitting it for FDA approval are the ones who know they are going to get it passed, which is why you have a 99% success rate. JEN: Right, the other thing here that’s complicating is that ADAM: We actually should let Jen talk, Ron. This is her expertise JEN: Right RON: Alright JEN: Well the cost, right? Previously, you would assume that if you have to go through the FDA approval process it is going to be expensive. Right? RON: Sure JEN: New drugs are always expensive. So now, under the new RTT regulations the drug manufacturers actually have to provide the drug at actual cost. ADAM: So you actually know, again transparency, you actually know the cost of the drug? RON: That’s true ADAM: If there was a drug, again, these are all trial right, they are first phase or past phase one testing so you know the cost of it. Here is my question, okay: one, who pays for it? Who is actually paying? So even if it’s the cost and that cost is a thousand dollars, who is paying that thousand bucks? JEN: The patient. Right, so right now, there is no requirement; no obligation for anyone (health insurance, self-funded plan) no one is required to pay this cost. This is on the patient. ADAM: So as a self-funded employer, there is no negative effect on me. I don’t have to cover this. If anything, if I care about my employee I can decide I guess if I want to cover it. But I might actually save their life. JEN: Right ADAM: So what is the negative? JEN: The negative potentially could be “I’m going to cover the drug, but it’s only gone through phase 1 of the FDA trails. So we don’t know what happens in phase 2, what happens in phase 3.” ADAM: What if there is a side effect? RON: Yup JEN: Right. Exactly ADAM: Who pays for that? RON: Good question JEN: And what about the complications? Right. So that piece of it has made people a little bit wearied to add this to their current plan because they say “Great maybe this is a super alternative…” ADAM: Okay, let’s say it’s not added to the plan again we are going to use our self-funded plan. Knock on wood, I get really sick. I go “Alright, the plan is not going to pay for it, nor should they; I get it you’re going to cover FDA approved drugs.” I pay for it myself. I have side effects. Whose responsibility is it to pay for the complications? RON: Right ADAM: The plans? JEN: Right now, under the current regulations, the plan has zero obligation to do that. But, how can you tell what is an obligation, or what is a side effect of that particular drug? It’s only gone through phase 1 testing, how do you know? ADAM: Right. So let’s say I get the flu afterwards. RON: Is flu a side effect, or did you just get the flu? That is one of the difficulties ADAM: Bingo. That is some of the areas where there is difficulty. RON: A lot of people have said when you look at most plans usually, not only do they exclude a certain treatment or service, but then they also exclude side effects or complications of that excluded treatment. So people are hanging their hat on that. And the thing is if it is something you know is excluded; let’s say plastic surgery, cosmetic surgery that’s absolutely excluded. The person goes in for cosmetic surgery, next thing you know they have some sort of infection, a surgical infection. You could draw the line, one to one and exclude that too. But you are right because these things are so unknown, how do you know that is a complication? ADAM: So, Jen. I guess my question for you is you know, we are an empowering plans podcast, right? What advice do we have for our self-funded clients? What advice do we have to their advisor brokers? On what do they need to talk to their clients about? If anything. What changes are there in the plan design, if any? How does this affect stop loss? I know it’s a lot of questions but run us through the whole thing JEN: The first step is right to try, this means that there is now an opportunity for people to have access to drugs they did not have access to before. ADAM: Potentially, good JEN: Potentially a good thing. ADAM: Potentially, bad JEN: So is this an opportunity that as an employer you want to take advantage of? Yes or no? Regardless of whether it is yes or no, you still need to look at your plan document. If you say yes, you need to make sure you are revising the plan to accommodate a non-FDA approved drug. You are making sure you are potentially modifying- ADAM: For critically ill patients JEN: For terminally ill patients. RON: You want to mirror the law ADAM: How do they define terminally ill? JEN: It is a life threatening disease where there is not otherwise a clinical trial that’s going to be available for that individual, and your physician otherwise agrees that this would be the path for you. ADAM: Well, I didn’t know she would have the answer so fast. RON: Yeah there you go ADAM: I thought I’d get her.. it didn’t work RON: In essence, Adam well, if you mirror the definition in the law, I think that is the best way to go. JEN: Right ADAM: So, you are looking at plan definition changes, exclusion changes if any? JEN: So, the exclusion you are going to want to caveat is “the complications of a non-covered service” to make sure that the references are not to non-FDA approved drugs. You are going to want to potentially look at your definition of drug. But when you are covering this there is no requirement that if you cover it you have to cover the whole thing. So maybe you want to cover up to $5,000. Maybe you want to cover one dose of treatments. Maybe you want to have precertification requirements. You can add those types of caveats and conditions on this drug because this is not an essential health benefit. ADAM: Got it JEN: You can put any of these limitations in place that would be the most appropriate for the plan, while still helping. But, you still really need to address the side effects and the complications issue. I think that is going to be the trickiest piece. That is going to require some sort of clinical analysis to decide on a case-by-case basis whether that particular drug has side effects that cause some sort of illness. ADAM: My last question: stop loss. How does it affect your stop loss policies and the interactions with the carriers? JEN: Yeah, when it comes to stop loss similar to those RIO writers that we started seeing five, six, or seven years ago, this is going to be a similar situation to that. Cause right now, every stop loss carrier has in their policy an E and I provision. In that E and I provision it says non-FDA approved drugs are E and I. ADAM AND RON: Right JEN: So this is a non-FDA approved drug. ADAM: So, even if the plan wanted to cover something chances are their stop loss carrier is not going to reimburse them. RON: You are going to need to coordinate with them ahead of time. ADAM: But, even if the plan decides to cover this experimental drugs, the plan can still say “But we are not going to cover any complications.” I mean, let’s be honest what self-funded plan is going to say “Yeah, not only are we going to cover this experimental drug, {hey fyi patient I am going to do you a favor, I’m gonna cover that cost].” No one is going to say, “I’m going to cover every side effect too.” RON AND JENN: Right. ADAM: From a standpoint of expenses, the plan will know if they decide to cover these. Again, these are rare things that happen; if you have a 1000 employees, our typical self-funded employer has 250 employees, if you include the all dependents and everyone it’s about 600 lives. You’re not having, there is no multiple, there are not multiple people in a 600-life plan that are going to have life-threatening diseases where there is no available treatment on the market. JEN: Right ADAM: It is rare. This is a rare event. RON: I mean, Adam think about it. The expanded use program, that’s already been out for nearly a decade, if you are a self-funded planner or you’re an administrator, how many instances have you seen where a plan participant wanted the plan to pay for that? ADAM: Have we ever seen that, Jen? JEN: No. RON: No, never. ADAM: And we represent millions of lives RON: Millions and millions! ADAM: Millons! RON: Now, so let’s say RTT ends up seeing 10 times the amount of people, which is big but I don’t think it’s going to be that. But let’s say, so one person. I mean, again, you are absolutely right. I don’t think it’s going to be this earth shattering number. JEN: No. ADAM: But, again here’s what we know it is going to happen to somebody. RON: Uh huh ADAM: Somebody is going to mess this up, and probably we will be getting a phone call. RON: It keeps it interesting ADAM: Any other thoughts Ron? RON: Yeah, there are two more things that you have to take note of that are not necessarily tied into the plan document, but if you are thinking about RTT, these are the two things you need to think about. One, the law itself issues a waiver of liability; it basically protects from legal liability, the physician, the drug manufacturer, the patient, the person it does not protect is the payer. So, if you are a plan, and you want to either incentivize the use of an experimental drug, or you are just paying for the experimental drug, and then something does go wrong; you need to make sure you are protected to the same extent that the physician and drug manufacturer are by law. So, you are going to need something in writing ahead of time, some sort of whole harmless agreement. ADAM: So, Ron is basically telling all you folks at home to contact Ron. RON: So if you read between the lines there you go. ADAM: What was your second point? RON: The second point is when you talk about reasons to actually cover these drugs. I think people are looking at this and are thinking “Oh no, there is going to be all these people who want to use these experimental drugs. How do I avoid paying for it?” It is actually quite simple. The law allows you to do so. For those who start to think about “Hey, what are reasons to start to cover it?”One: the altruistic willingness and desire to help save people save their lives I think is absolutely a noble idea. The second, there may actually be a financial reason to do it. Because let’s say hypothetically somebody has a disease that is terminal; they are eligible for RTT, but its long, it’s drawn out. In the meantime taking in an approved drug, something that is covered. And that drug, a specialty drug, whatever, is extremely expensive. If this experimental drug actually results in them either being cured more quickly, or replaces that other drug it could be that, this is an in lieu of a much more expensive treatment that you are required to pay under law. ADAM: Right JEN: But you are still not otherwise excluding that other more expensive treatment. ADAM: Right RON: Right. That was one of the concerns we actually looked at is that can you make the willingness to pay for an RTT experimental drug contingent? ADAM: What Ron is saying is if you had (knock on wood) cancer RON: Sure ADAM: instead of taking normal drugs, he wants you to go to Chile, and meet with the witch doctor because it might cost 20 bucks. RON: Well, you know so the thing to remember though ADAM: That’s that non – not covered, but it might work! RON: Like Jenn said! ADAM: Maybe you won’t need chemo. You’ll save hundreds of thousands of dollars on the plan! JEN: You never know! ADAM: Let’s cover that guy! RON: It’s funny, I mean the thing is, like Jen said, you are going to have to continue paying for the chemo, but the hope is that this experimental drug will hopefully have a good result. And therefore you shorten the amount of time that the person is taking chemo. ADAM: Jen, any last words before we turn these cameras off? JEN: No, I think that it is important to make a decision about how you’re going to cover this plan or how this benefit is going to be covered. ADAM: So basically, she is saying contact Jen McCormick at the Phia Group in order to do that too. RON: I do want to make one point for our maiden voyage with the video podcast/vlog, isn’t it funny that we replaced Brady? ADAM: Because well, he’s not that good looking. RON: You are going to have to tune if you want to see Brady live. ADAM: However, we do want you to vote on who’s swag is nicer! This beautiful, nice batting helmet, little difference, nice Cleveland Indian paraphernalia with this beautiful family. Or Ron’s collection of…. Just very weird stuff. RON: Look, they jiggle. ADAM: And some random kid, we don’t even know who’s kid that is? It’s just.. That photo is actually a photo that they give you when you buy the frame. RON: That child is so beautiful it can’t possibly be real! PAT: There you go ADAM: Let’s vote online, if that’s actually Ron’s child! JEN: I was told I couldn’t even bring anything! ADAM: Do you notice that Jen has nothing. Yeah we just… you’re not that important though, Jenn RON: You’re subletting space from Brady Bizarro JEN: Oh, okay ADAM: Right we can have Brady’s stuff here. JEN: Right, oh god, yeah. ADAM: Which I would be afraid to even know what that be RON: If you want a bust of Nixon? You’re good to go. ADAM: Well everybody on behalf of Pat Santos, our producer, Ron Peck, our special guest Jen McCormick, and myself your host Adam Russo thank you for empowering your plans with the Phia Group. Have a great day.

Empowering Plans: P45 - Super-Empowerment

On June 22, 2018
Welcome to Empowering Plans a show dedicated to identifying waste and undo expense in the health benefits industry. Discovering ways to maximize benefits while minimizing costs, and empowering employers, administrators, and consultants to emphasize once again the benefit in benefit plan. Today’s episode is brought to you by the Diversified Group, discovering and creating innovating solutions to evolving healthcare demands. Now here are your hosts the Phia Group’s own CEO Adam Russo, senior vice president and general counsel Ron Peck, and director attorney Brady Bizzaro. ADAM: Hello everybody, and welcome to another episode of Empowering Plans with the Phia Group. I am your co-host Adam Russo. Alongside me as always, my good friend, our senior VP and general counsel of the Phia Group, Ron Peck. Say hello Ron. RON: Hello Ron ADAM: As always and I have to say that nicely, As always with us for better or worse, whether we like it or not, the infamous, D.C insider, Brady Bizzaro. Say hello Brady. BRADY: Hello Brady ADAM: So Brady, I don’t know if you are aware, but I am going to be in D.C tomorrow. Ron, are you going to be there too? No? RON: I will be here holding down the fort, Adam ADAM: Tomorrow is a big meeting in D.C. I know you are very jealous. BRADY: I’m jealous ADAM: I will make sure I do the walk of Brady. The Brady tour where you literally walk by nothing famous just stuff that Brady did while he was living in D.C. that’s what you walk past. RON: It’s a nice meandering path. You don’t actually get up to anything worth seeing, but you can usually get a pretty good angle on those things in a distance, maybe take a selfie? ADAM: So those of you aren’t aware we have a new studio now here at the Phia Group Empowering Plans Podcasts. It’s a new room because we are going to be having live, I guess there not podcasts if it’s video, is it still a podcast? RON: A video cast? BRADY: It’s a vlog actually ADAM: It’s a vlog? RON: OOOH ADAM: So, Pat Santos; our very amazing producer, our very low priced, amazing producer has set this all up for us. But we have a pretty cool room, we have a nice set up, we got stuff in the background, I got all my Cleveland Indians paraphernalia in front of me. But the only strange part about this room is, in order for me to talk to Ron I have to look past Brady. It’s freaking me out Ron. RON: I’m thinking this is an issue we need to address. ADAM: I think we need to remove Brady from the podcast RON: Maybe put Brady in another spot, somewhere BRADY: Sit in a triangle, maybe that ADAM: Something has to happen with Brady. Make your seat lower? Something, I don’t know RON: We can get some cable extenders and put them in the bathroom over there. ADAM: Remember in the old days if a kid was bad in class that they would literally put your desk in the corner RON: Oh, yeah ADAM: They don’t do that anymore RON: No ADAM: I think it’s like.. it’s bullying or some kind if you put a kid’s desk in the corner BRADY: That’s what it is ADAM: We had a horseshoe shape, where they would put the bad kid literally in his desk by himself in the middle of the horseshoe RON: I like where this is going. ADAM: That’s what I’m thinking for Brady. Anyways, folks this is a very special episode of Empowering Plans. About a few weeks ago, we had our Phia Forum, for those of you who are avid listeners of our podcast you are aware, we had a big event in Gillette and there was one very big winner (other than the Phia Group) after that event, and that was our friends at Diversified Group down in Connecticut. A very few people can say the words down in Connecticut most people have to say up in Connecticut, right? RON: That’s a very interesting observation ADAM: And with us is their top chef, their big dog, the man, the myth, the legend, Brooks Goodison. Those who are close to him get to call him Brooksie as my wife and I get to call him. But we want to say welcome Brooks to the Empowering Plans Podcast. What’s up buddy? BROOKS: How are you guys doing? Great to be with you today. ADAM: It’s a great day. Hope everyone enjoyed father’s day. So really quick story, I was lucky enough, or maybe smart enough, well I had a strategy in place; I sent my wife for her 40th birthday, I sent her away with her sister and her best friend for four days to Aspen, Colorado for the food and wine festival. She had a great time. I’ll tell you it was the best thing I ever did. That women came back last night, late last night, after four days of me alone with four of my kids, Ron, Brady. Like, just me. I had some help but it was typically just me. Those were the hardest, most fulfilling, but literally the hardest four days of my entire life. There is nothing comparable to having to spend four days with your four kids in a car, where they keep asking the same questions over and over and over again. Like there was a car on fire on the highway: the number of times that my son Sam asked me ‘why is the car on fire’ and I kept giving him the same answer but I guess it wasn’t good enough. He just kept repeating it. But anyways my wife came back late last night; so she missed father’s day, I was alone with the kids on father’s day. I think, like she has never been this nice to me. It is almost like when I give Ron a raise, it happens once every five years. He’s just a very nice person for the next few days. RON: Well, that’s it. You know, it’s either that, or if you let me go on a vacation, and watch my 4 kids then I would be nice to you. Wow, so you enjoyed your father’s day. ADAM: I definitely did. I’m back in the office, and it’s so nice to be able to yell to someone to make my coffee. It was the greatest feeling this morning to make somebody do something, and not be the one to have to do it. So, anyways Brooks. I know we went off on a tangent. BROOKS: I do have one question. ADAM: Sure BROOKS: Were you sober when your wife got home? ADAM: (sighs) Alright, very honest answer there. So, I had a countdown knowing that my last kid would fall asleep at about 8:45 last night. At 9 o’clock, I definitely had a few cocktails. There’s no questions about that. So, I was sleeping by the time she got home, but man I was counting down the hours before those kids went to bed last night. Thanks for that question it was a good one. I definitely felt I needed a few drinks after the four days I went through. BROOKS: Well, you know TGIF, right? ADAM: Yes BROOKS: Thank God It’s Friday? ADAM: It was a thank God it’s Sunday night at one in the morning and my wife is finally home that’s what it was. So folks, those of you who don’t know this was the first time we decided to have a trophy to recognize the one client of Phia, the one partner that in our mind inspired their employers, inspired the employees of those employers, and inspired all their partners to take proactive measures, innovative steps, and really take risks to manage their risk; someone, an organization that really goes above and beyond. Now we had a bunch of people to choose from, but there was no question in all of our minds that one organization stood out from the rest. This wasn’t about who had the biggest TPA, who was had largest TPA, who makes the most revenue. It was an organization that we felt, as a self-funded plan, I would be proud to say they were the ones that were managing my hard-earned dollars. And this year’s winner was Diversified Group, and I think it shocked Brooks. Brooks, what was your first reaction when you heard that you won? BROOKS: I had absolutely no idea that you guys were going to call out Diversified’s name. And I was surprised and I was pleased. I look at this as a standing ovation. It’s what we try to turn out, that’s what we are trying to provide our clients. It was almost as if you were reading it right out of our playbook. Page 1 Chapter 1, this is what we are trying to accomplish for our clients. ADAM: And I think it’s one thing to be able to-I agree with you on your mission about what you are trying to accomplish. It’s one thing to try and accomplish what you are doing in a more pro-business, more pro-self-funded type state or area. The fact that you are doing this and pulling it off successfully. Obviously there’s hiccups and I want to get in to some of the biggest challenges later on but the fact that you’re doing it in a state like Connecticut that is so heavily BUCA: Blue Cross, United, Cigna, Aetna, where that’s the environment of the large carrier. That is the home of the large carrier; the fact that you have to do that in their own backyard, I think it makes it so much more impressive. BROOKS: I agree and I have a very simple answer to that. If we’re not good, we’re dead. ADAM: So, Brooks, really couple of follow-ups. One, why are you in this business? What made you want to do this? First question. And then two, what makes you not want to do this anymore? I mean there’s got to be obviously- What’s that biggest challenge? What makes you happy that you are doing if every day? What brought you into this business? What kept you here? And then secondly, what are the biggest challenges you are facing today that let’s be honest maybe scares you a little bit in the future? BROOKS: Sure, the thing that brought me to the business the most was being able to understand what is actually happening in our healthcare space, and how by simply providing employers with information about where their money is going that you can change the trajectory of their healthcare space. You can make a difference. We can make a difference simply by having access to that data, which many groups here before have been told that they don’t own it. They cannot have it. Is it a regularity decision? Is it a policy decision? Why can’t they have access to this information? And giving them that access, and helping them make changes with that is why I get up every single day. RON: So Brooks, it’s Ron here. Some people may be wondering why Diversified was the pick for the Empowered Plan Award this year. And just go kind give you an idea of the credentials that we threw against the wall to see who the top score was it wasn’t just about “oh you know, revenue and services.” It was more about collaboration, beta testing new services, new products, taking risks to reward not only their own clients but the industry at large. And it just seems any time we have some crazy idea to get creative and contain plan costs; you are always at the front of the line volunteering to try it out. I would say that maybe someone looks at that and think, “Oh he’s trying to be an early adopter hopefully he gets this benefit that others might not have.” But, you have been very altruistic when it comes to the industry as well, this is what topped it off and got you the award is the work you have done at the legislative level for the industry. Particularly the work in Connecticut. I wonder if you might tell us a little bit about your experiences in dealing with the lawmakers in Connecticut. BROOKS: Sure. In Connecticut, we are in an environment where TPAs are licensed and regulated. We have to by virtue of the fact that we can’t be in the Capitol, in the legislative office building as a full time job we have to hire and do hire and keep on staff a lobbyist who goes there every single day to keep an eye on any issues that may affect Diversified as a company and our clients. They sit there, essentially and watch for those things, and bring them to our attention so we can act on them. Whenever we have run into remarkable challenges we have great partners in the business (like you guys at Phia) that help us sort of understand these challenges that come up. Associations like HCAA, SIIA, all of these people help us to manage our way through, and provide in person, local input into our local legislation about how these things would affect employers, how they would affect our plan members, and us as a company. Basically, it’s a do or die situation. If we sit on the sidelines, we are going to find out that somebody else made all these decisions for us. ADAM: Speaking of sitting on the sidelines, one of the things I want to ask you, if you don’t mind patting yourself on the back for a little bit, what do you think makes you, your organization, the people you have different from your typical administrator out there in this country? BROOKS: You know the thing that makes us different is the thing that makes us somehow vulnerable at times. It is our independence. We are family owned. It’s myself and two other guys, Charlie Soleau and Dan Soucier. The three of us own this business, and we don’t have any insurance care ownership. It allows us a lot of freedom to do things, to try things that we believe are right and that are good. At the same time, that also leaves you sort out there on your own at certain times with not a lot of resources like the bigs have to withstand the storms when they come. It’s a challenge, but that’s one of the things that sticks out in my mind when you asked me that question. RON: So you are talking about challenges, and I am wondering you know what are some big challenges you are facing today, big challenges not only for you, but potentially you see to impact the entire industry. BROOKS: I think one of the challenges that sticks out the most to me right now is specialty pharmacy. We struggle with that. Ten years ago, all of the drugs you see advertised on the television every single night didn’t exist. Every one of those drugs costs at least as much as a new Audi or a Maserati. On an annual basis ADAM: Hey, hey relax, relax with the Maserati. Let’s relax with the Mas. I got rid of it RON: He’s driving a pick up now! ADAM: I’m driving a pick up now BROOKS: Oh I never knew you had one. ADAM: OHHHH RON: OHHH YEAH YOU DID! ADAM: Brooks I had a Maserati for about two and a half years. Yes I did I was that a-hole with the Maserati that was me. But I gave it up- BROOKS: I remember you from your Nissan days. ADAM: Ohh! Very nice! RON: Ohh BROOKS: You had a Nissan Maxima or something? BRADY: What’s wrong with a Nissan? RON: Humble russ! ADAM: I had the Altima. So hey BROOKS: Altima, oh!! ADAM: Just so everyone understands that’s how far back I go with Diversified. So, real quick before I ask my next question before we finally let Brady be involved is for those of you who don’t know you know that’s one of the things we love about Diversified when they say risk, when you said risk, Ron earlier who’s willing to take a risk, they were! You know before Phia was this powerful, podcast organization with thousands of followers on our webinars etc, we were lucky to try to get anyone just to talk to us. And these guys down in Connecticut gave me one of the first opportunities I ever had to speak publically at an event, at one of their client conferences. And I never forget that. You’re right I drove there in the Nissan Altima that I had at the time. I think that was 2003/2004 when we were a very small company, not who we are today, so very impressive that you bring that up. So, speaking of that, when I think about opportunity, right so that to me was when you allowed us the opportunity to come there, speak to your clients and prospects. That obviously, back then we knew there were opportunities when the ACA came, when everyone thought it was the worst thing that ever happened to our industry, TPAs were dying to get sold, we saw that here at Phia as an opportunity to actually now finally get new business because people would be forced to deal with healthcare costs and premiums head on since everyone had to purchase health insurance. Two questions: one, why didn’t you sell when everyone else was selling? And two: what do you feel is the biggest opportunity that we do have today? Now we know the challenges of specialty drugs; everyone is facing it. We are going to deal with that situation as time comes. But those two part questions if you don’t mind answering. BROOKS: Why didn’t we sell? There are numerous opportunities to sell in this market. The big thing for us here at Diversified is why. I have a big why. Why do I come to work every single day, and we hit that earlier in the call. A lot of the people that are interested in buying us they do not really have a great why. If we were ever going to partner on a situation like that, it would have to be somebody that would help us hit the accelerator. Help us move forward. Help us conquer these problems. I just don’t see those out on the marketplace right now, and that’s probably the number one reason. There is plenty of money; there is plenty of people interested, but there is not a lot of good reasons why they want it. ADAM: So basically, the bottom line is they are looking at your profitability, and saying “oh we can add that to our portfolio.” But, you have this idea, this innovation, this product, this service unless their willing to make that ten times bigger, where you could you know not be that small David versus Goliath scenario you don’t see a reason why doing that. So what is the biggest opportunity that you do see? BROOKS: A lot of things that we do see would be disempowering. It would be the exact opposite way of what we have been doing. I think the opportunity is in the flexibility, and the ability to adapt and to move quickly. I think if you don’t have that ability to adopt and move quickly you are going to struggle moving forward. BRADY: Hey Brooks. This is Brady. I want to jump in before all the time gets used up, and ask a question. You mentioned challenges before, and I’m looking here at an article from last week that you had commented on LinkedIn. It’s about hospital mergers in this case it’s about Milford and Bridgeport in Connecticut. In Massachusetts, we have the same thing going on; we have large hospital systems merging together. Every day it seems like you are hearing something else across the country. I am wondering what your thoughts are if you think this is good for the industry at large. I mean of course, they all promise they are going to lower prices, but how do you see it in Connecticut when there are talks about these big hospitals joining together? BROOKS: I think competition is gonna be a key. If we are going to be successful as an industry, competition is necessary. We need competition. We need competition amongst hospitals, competition amongst providers. We need transparency, and we need people to succeed or fail in that system. Any time there are mergers our legislatures, and the public mind set is taught that it is somehow going to relate to a lower price. All I see as a result of these mergers is the hospitals are getting more profitable. I have yet to see anyone praise hospitals for lowering their healthcare costs. So we are sold a bill of goods on these mergers, our politicians appear to buy in, lock, stock and barrel and the people who pay all the bills; our plan members that pay all the bills, are left holding the bag every time. I think that’s a bad move, and it bothers me more because we keep making it over and over in our state and every other state around us. We’ve gotta change how these decisions are made. BRADY: I think that is a sentiment you will hear in many other states as well. One last thing on Connecticut is I wanna point out that we mentioned how Connecticut has a lot of legislative activity regulating TPAs, and also stop loss like many other states. But I wanted to point out that it is not always the case that these bulletins that come out from the state are always negative. In one case, we reviewed a bulletin that actually was beneficial for our plans. I do not know if you had any thoughts on the fact that not every regulatory action by the state is just about to have a negative impact on stop loss carriers or plans. Sometimes there is a good once. The one I am thinking of makes it easier for plans to rely on their own exclusions rather than worrying about stop loss sort of relying on their own exclusions and how I think it is not as well-known as it should be in the industry, that some of these legislative actions are actually good for the plans. ADAM: As you can tell Brady is pro legislation. Brady’s all about politicians and regulators making as much money as they can. So every once in a while he is going to say “Hey not all regulation is bad, some regulation can be good.” BRADY: Trying to sneak that in there! ADAM: So just so you know, we have the luxury, Brooks looking at of seeing what Brady is talking about. The bulletin is from 2015, so this is nothing recent. RON: Yeah ADAM: It’s an old one BRADY: It’s the end of 2015 ADAM: It’s two and a half years old BROOKS: It’s was a bulletin BRADY: That’s right ADAM: Brady went back two and a half years to find a bulletin. RON: He dug deep for “hug a senator day” ADAM: He wants you to say regulation is good, Brooks. Don’t fall for it. BRADY: *laughing* BROOKS: It was Brady; I see where you are going. The bulletin was a bulletin it did not go through any legislative process at all. It was basically just pinned on the insurance commissioner’s desk. I think it was right before the 4th of July weekend. I remember to this day when that bulletin came out nobody knew about it, not even our lobbyists. No one ADAM: You got it right on! BROOKS: It took everybody by surprise. ADAM: Perfect timing, issued on July 8th BROOKS: It worked well for us, but I am not sure how on purpose it was RON: You know Brooks, I seem to recall that the Phia Group and Diversified we were the ones who first discovered it, and together issued a newsletter or a little email to the industry to let them know it had popped up. So as we are talking about it, I am starting to remember this is just one more example of the collaboration we have had in the past. ADAM: So Ron, got any last questions for Brooks? RON: I don’t have any questions, I actually have a comment, Brooks. I just want to let you know how much, I know I speak for myself and everybody else at not only the Phia Group, but the industry when I say thank you for the work you and your team have been doing. For those who don’t know, Brooks is not only an early adopter of our services, and also helps us work out all the wrinkles and the kinks that end up benefiting everybody. And not only does He and his team appear before lawmakers and lobby for what’s really important to the industry. He also a member of our advisory board and he is always available to give us some advice, guidance, and feedback. And I just want to let you know that what you do, just like all the other crowdsourced services out there where other people benefit from the brain trust that is the industry. You are definitely a leader there, and I hope people truly do appreciate what you do for them. BROOKS: I appreciate that guys, and right back at you. I’ll have to say we have been doing business together for at least fifteen years, and you have never let us down. We turn to you guys when we are scratching our heads, or looking for some talk about how to move forward, and to solve problems. Your whole team Adam, you, Brady, everyone is there to help us, and you have never let us down. We appreciate it. It’s meant a lot to us and it’s meant a lot to our clients. ADAM: For those of you who are interested, just so you know all the brokers out there, our biggest piece of our audience are our brokers all across the country if you are looking at self-funding options for your employer groups. Pick up the phone. Reach out to Brooks Goodison. Their website is diversifiedgb.com, again diversifiedgb.com or feel free to call any of us here on the podcast. Reach out to Brady, Ron, or myself, and we can make sure we point you in Brooks’s direction. He has a great team behind him. So Brooks, we want to say thank you so much for taking about thirty minutes to speak with us today on Empowering Plans with the Phia Group. Like we want our entire audience to know, you run one of the best organizations, a classy organization, one of the top TPAs in the country. A leader in what you are doing, a pioneer. And we look forward to working with you for many years to come. On behalf of Ron Peck, Brady Bizzaro, our producer Pat Santos, and myself the Adam Russo thank you for joining us here on Empowering Plans with the Phia Group. Have a great day.

Final Rule on Association Health Plans and YOU: Phia's Take

On June 21, 2018
On Tuesday, June 19th, the Department of Labor issued a final rule on Association Health Plans. Supporters claim the rule will allow millions of Americans to access more affordable coverage options. Critics contend that it will reduce patient access and weaken the insurance markets, leading to increased costs for all. Join The Phia Group's legal team in this special edition webinar in which they will break down the final rule and explain the significant impact it is expected to have on the self-funded industry.

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