The Phia Group Blog Posts

Is the Department of Labor Offsetting a Major Problem?

On January 3, 2024
As if Americans on employer-based health plans didn’t face enough obstacles in trying to obtain reasonably priced healthcare.

Time’s Up! It’s Gag Clause Attestation Season

On December 26, 2023
As the year wraps up and plans and TPAs around the country are scrambling to handle renewals, another challenge looms large in 2023 – the first annual gag clause attestation. As a reminder, the Consolidated Appropriations Act, 2021 (CAA) prohibits plans from entering into any contracts with providers and certain other entities that contain “gag clauses” – and requires them to attest annually that their contracts are free of them. The first attestation is due at the end of 2023, and it will cover the period of December 27, 2021 through December 31, 2023. The goal of the legislation is transparency, but it has glaring holes – contracts can’t prohibit plans from sharing certain information with other entities, but nothing requires them to be granted access to this information in the first place.

For Sickle Cell Disease Patients, Hope Has Arrived – but at What Cost?

On December 21, 2023
For generations of sickle cell disease (SCD) patients, the suffering has been unbearable – with no end in sight. SCD, an inherited genetic red blood cell disorder that affects hemoglobin, the protein that carries oxygen throughout the body, torments nearly 100,000 Americans (20 million people worldwide), a disproportionate number of whom are African-American. Among other symptoms, SCD often triggers chronic bouts of excruciating pain that require regular hospitalization, organ failure, strokes, and shortened life expectancy. Meanwhile, the only known cure for the insidious disease has been a bone marrow transplant.

Empowering Plans: P178 – Back to December (Phia’s Version)

On December 21, 2023
It is the last podcast of the year, and you know All Too Well that it is Phia’s 2023 year-in-review! Sparks Fly as Kendall Jackson and Corey Crigger talk about how Everything in PGC and Provider Relations Has Changed in 2023. If you need to catch up on anything from the No Surprises Act to Gag Clause Attestations, You Need To Calm Down and Stay Stay Stay tuned into this podcast episode. In addition to the big changes in 2023, we look forward to 2024 and ask, are you … Ready For It?

Is Artificial Intelligence the New Frontier for Healthcare?

On December 12, 2023
The ills of the American healthcare system, namely an undue administrative burden on healthcare providers and a labor supply not keeping pace with the demand for services, have been well documented. But now, as we grind through the 2020s, relief may be on the way with the booming popularity (or in some cases, acceptance) of artificial intelligence (AI). Many healthcare experts believe that AI – a mechanism grounded in the simulation of human intelligence by computerized systems and one that has already changed how many humans learn and work – could revolutionize the field. But as enticing as the prospect of AI driving forward greater industrywide systemic efficiency may be, should this gargantuan development be universally celebrated?

MAHP 2023 Annual Health Care Conference: Health Care Affordability, Quality and Equity in a Post Pandemic World

On November 28, 2023
Last November, the Massachusetts Association of Health Plans (MAHP) Annual Conference focused on healthcare challenges and opportunities – both from a regional and national perspective -- amidst a receding pandemic. The 2022 conference, headlined by then-Governor Charlie Baker, homed in on two topics: a.) healthcare equity and b.) regulation of provider prices. Twelve months later, on November 17, 2023, the MAHP 2023 Annual Conference, held once again at the Seaport Hotel in downtown Boston, had an eerily familiar theme: “Health Care Affordability, Quality and Equity in a Post Pandemic World.”

Minor Members and Third Party Settlements

On November 27, 2023
Does a self-funded ERISA plan have a right of recovery from a minor’s third-party liability claim? The answer is yes. However, there are various factors that can influence the Plan’s recovery in these circumstances. Federal courts across the country have recently considered a few challenges to a health plan’s right of recovery and clarified an ERISA plan’s right of recovery through reimbursement. What is abundantly clear is good plan language is vital to a health plan’s recovery.

Empowering Plans: P176 – Copay Accumulator Programs Take a Hit: What’s Next?

On November 21, 2023
Attorneys Brady Bizarro and Andrew Silverio discuss a recent federal court decision that saw drug manufacturers and patients alike score a win against copay accumulator programs – programs that help maximize the manufacturer assistance available to patients but decline to count those amounts toward deductibles and out-of-pocket maximums. With the latest rule being struck down, where does the law stand now and what will happen next?

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.

Being Mindful of Telemedicine Access

On November 9, 2023
From a healthcare standpoint, two of the most significant byproducts of the COVID-19 pandemic have been the exploding popularity of Telemedicine, the practice of providing medical and mental health services remotely, and a heightened awareness of many Americans’ longstanding mental health issues. Due to a confluence of prolonged extenuating circumstances, it became readily apparent to healthcare providers, politicians, social workers, employers, teachers, and parents on both sides of the Mississippi that a.) the inimitable convenience of virtual healthcare does not compromise quality (at least for some patients and practitioners) and b.) many Americans experiencing emotional distress have long been suffering in silence.

Empowering Plans: P175 – No Surprises Act Brings More Surprises & Other Surprises for 2024

On November 9, 2023
Join Provider Relations Senior Attorney, Brian O’Hara, and Vice President of Consulting, Kelly Dempsey, for a quick rundown of changes to be prepared for as we near 2024. While there are the regular recurring changes to ACA and IRS out-of-pocket limits, this podcast will uncover a couple lesser-known items hidden in some NSA proposed rules and a couple other items for 2024 that might have fallen off the radar, including COVID-19 tolling requirements. (COVID may be over but the impact on certain items could extend well into 2024…).

Update on the Federal IDR Process

On October 27, 2023
Recently there has been significant discussion about the federal IDR process. The IDR process is an important tool of the No Surprises Act (“NSA”) as it resolves claims for payment for out-of-network items and services. It not only provides a procedure for settling disputed claims but is also an integral mechanism for supporting the NSA’s protection for plan members against potentially crippling expenses from balance billing for high-cost out-of-network claims.

Phia Group

Phia Group Media