The Phia Group Blog Posts

The Phia Group's 4th Quarter 2023 Newsletter

On October 24, 2023
The Phia Group is off to a great start in the fourth quarter of 2023! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

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.

Empowering Plans: P173 – Gene-y in a Bottle: A Magical Overview of Cell and Gene Therapy

On October 12, 2023
Your wish is our command! Join Ron Peck and Corey Crigger as they discuss how this emerging treatment can impact self-funded health plans. With prices as high as $3.5 million, you can’t just wish for a strategy for dealing with these therapies, you must plan for it. Ron and Corey discuss the motivations to cover, the future benefits, and the concerns they are hearing from clients. You don’t know what we can see, so join us on a magic carpet ride around this life saving, but costly treatment.

District Court Strikes a Blow to Copay Accumulator Programs

On October 11, 2023
Many of our clients are aware of, or even utilize, “copay accumulator” programs – these programs create plan savings by not counting amounts received by patients from manufacturer assistance programs toward annual deductibles and out-of-pocket maximums. Some programs go a step further by actually increasing the applicable copayment for certain drugs to maximize the amount a patient may be eligible to receive from manufacturers.

Empowering Plans: P172 – Navigating the Gag Clause Prohibition

On September 28, 2023
In this installment of The Phia Group’s Empowering Plans podcast, attorneys Jon Jablon and Kendall Jackson delve into the issue of the gag clause prohibition, a mysterious law that continues to confound the self-funded industry. With the first attestation requirement approaching at the end of 2023, now is the time to make sure you know what needs to be done, how to do it, and how to keep yourself safe and compliant.

Empowering Plans: P171 – Mass Torts 101

On September 15, 2023
From time to time, do you hear about mass torts in the news but feel like you could use a little more background knowledge? Look no further than the latest edition of the Empowering Plans podcast series, (“Mass Torts 101”) in which attorneys Cindy Merrell and Lisa Hill explain the difference between the two types of mass tort cases -- class action and multidistrict litigation (MDL) – while delving into a couple of the larger MDLs making news of late.

Empowering Plans: P170 – PSA on the NSA

On August 31, 2023
It’s 10’o clock, do you know where your IDR determinations are? Join Attorneys Brian O’Hara and Corey Crigger as they issue a public service announcement on the state of the No Surprises Act, and specifically the challenges with the IDR process. Friends don’t let friends miss this podcast! In addition to the PSA on NSA, Corey discusses a case study highlighting the benefits of the Safeguard Program. Just Say No to skipping this episode of Empowering Plans.

Empowering Plans: P169 – Let’s Keep Learning - Back to (Law) School

On August 17, 2023
In the latest edition of the Empowering Plans podcast series, “Let’s Keep Learning - Back to (Law) School,” Attorneys Kelly Dempsey and Corey Crigger are here to take us all back to school! Listen as they discuss renewal season preparation items and a variety of late breaking lawsuits that pertain to multiple aspects of the self-funded industry. From civil courts hearing cases about NSA administrative issues all the way to ACA compliance (or lack thereof) there is something in this podcast for everyone. Once you listen to the podcast - class dismissed!

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.

Empowering Plans: P167 – Who is a Fiduciary and Does it Even Matter? Lawsuits Abound!

On July 21, 2023
In this episode of Empowering Plans, The Phia Group’s Chief Legal Officer – Ron Peck – and Sr. VP of Consulting – Jennifer McCormick, analyze recent lawsuits involving self-funded plan sponsors and their third party administrators, and accusations of fiduciary breach on the part of TPAs. We delve into whether TPAs can be fiduciaries, what this means, and whether it even matters when it comes down to how administrators manage plans. Finally, are plan sponsors signing contracts enabling TPAs to do things contrary to ERISA, and who is to blame when this is the case? Anyone and everyone handling self-funded plan assets needs to tune into this one!

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!

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The Phia Group's 4th Quarter 2023 Newsletter

The Stacks – 4th Quarter 2023 Newsletter