The Phia Group Blog Posts

Empowering Plans: P211 – Network Adequacy Under MHPAEA

On February 13, 2025
Attorneys Kelly Dempsey and Bryan Dunton dive into the results of the 2024 MHPAEA Report to Congress. The EBSA and CMS have continued to improve their focus on network design and adequacy for group health plans. In this episode, Kelly and Bryan discuss how these parity problems manifest themselves in testing and what plans can do to resolve them.

The Future of Healthcare Under Trump 2.0

On February 12, 2025
Like every other industry in America right now, healthcare is at a flash point. Amidst President Donald Trump’s flurry of executive orders, everyone from healthcare executives to patients is trying to anticipate what the future holds. What will happen to directives by former President Joe Biden that reduced drug costs and broadened coverage under the Affordable Care Act and Medicaid? What’s the future of gender-affirming healthcare for transgender people under the new look HHS? Will the number of uninsured Americans spike in the coming months? What’s the latest on proposed new cybersecurity requirements for HIPAA? Naturally, such questions – and so many more – have surfaced in the wake of a tidal wave of sweeping executive orders. The Phia Group’s panel of experts provides insight into topics that matter greatly to you.

Journavx: Is Relief on the Way?

On February 11, 2025
Every year, tens of millions of opioid prescriptions are written for Americans experiencing searing pain caused by broken bones, burns, procedures, and wounds. In most cases, the medications produce efficacious results without causing patients to become overly dependent and ultimately addicted. Still, there is a relatively small percentage of users (numbering in the tens of thousands) who develop severe – and sometimes fatal – addictions, hence the well-chronicled national opioid crisis that has descended on humanity this century.

The Phia Group Celebrates 25 Years of Innovation, Perseverance, and Industry Leadership

On February 10, 2025
Twenty-five years ago, The Phia Group was nothing more than a dream. No outside investors, no loans, no safety net—just $8,000, donated hand-me-down furniture and computer equipment from friends and family, and an unwavering belief that there was a better way to serve the self-funded healthcare industry. In fact, the first Phia System was built by us and family members on nights and weekends. It’s in our core - it’s what guides us every day.

Care Empowered Pricing: The Future of RBP

On January 30, 2025
Traditional health benefit plans and insurance carriers pay medical bills that generally fall into one of two buckets, based on the “network status” of the applicable healthcare services provider. If the benefit plan or carrier is utilizing a network (such as a PPO) and the applicable provider is a participating provider, then the provider is deemed to be “in-network.”

Empowering Plans: P210 – Mental Health Parity: New Year, New Rules, New Lawsuits

On January 30, 2025
Attorneys Jen McCormick and Nick Bonds ring in the Lunar New Year by breaking down the ERIC v. HHS lawsuit in which an industry advocate challenged the federal regulators’ new Final Rules enforcing the MHPAEA and mental health parity rules. Could this case blaze a new path for challenging agency actions in a post-Chevron Doctrine world? Join us as we discuss the potential implications for group health plans.

The Invisible Truth of Healthcare

On January 24, 2025
When you’re shopping for a new car, you expect that shelling out more money will correlate with a more high-powered, fancier, and durable vehicle. The same logic – that price and quality run parallel to one another – would seemingly apply to flat screen TVs, smartphones, stereo systems, laptops, vacuum cleaners, snowblowers, and every other item that Americans race to the stores to purchase on Black Friday. It is human nature to assume that a higher price equates to higher quality . . . unless information is provided to the contrary. As savvy shoppers are well aware, there are user reviews online that could potentially reveal that the higher cost vacuum or TV is no better than (and is sometimes worse than) a lower cost alternative. As such, price transparency on its own may be harmful as people gravitate to the higher cost item based on an assumption that it is better; however, when price transparency is combined with quality metrics, consumers can truly make the most enlightened and informed decisions.

Fiduciary Challenges and Risk Exposure Growing for Plans in 2025 – What to Know, What to Do

On January 21, 2025
It must be January. Gyms are packed. W-2s are hitting the mail. Christmas trees are coming down. And the healthcare industry is bracing for new regulatory developments in the year ahead. While the new administration may indeed usher in sweeping healthcare changes, other pressing industry matters such as fiduciary liability and lawsuits – particularly cases involving Johnson & Johnson, Wells Fargo, and Blue Cross Blue Shield, warrant particularly close attention. Join The Phia Group’s roundtable of experts as they discuss potential changes that may be afoot in the new year – and ways that you can be best prepared. Just like fiduciary liability issues and lawsuits, this webinar will be impossible to ignore.

Empowering Plans: P209 – 2025 Healthcare Hot Takes

On January 16, 2025
It’s a new year, and a new type of Empowering Plans podcast! In a world full of talking heads and 2-minute news cycles, hot takes have become the norm. This is true from mainstream news media to sports talk radio. Ron Peck and Corey Crigger throw their hat in the hot take ring by speculating on what some of the biggest news stories could be in 2025. From AI to RFK Jr, join Ron and Corey as they gaze into the crystal ball and make their bold predictions of what we will be talking about all year.

First to Market

On January 13, 2025
Unfortunately, there has long been a widely held perception that the healthcare industry is largely antiquated and riddled with inefficient processes. Perhaps that can explain why last week’s announcement – that Machinify, a provider of artificial intelligence (AI)-powered software for streamlining the healthcare claims lifecycle, will become an integral part of the company recently formed through the merger of The Rawlings Group (“Rawlings”), Apixio’s Payment Integrity business (“Apixio PI”), and VARIS – was deemed particularly newsworthy. That this new conglomerate, to be named Machinify, will be leveraging next generation technology and a wealth of data to further automate and enhance healthcare administration processes has apparently captured the imagination of healthcare stakeholders worldwide, and struck a chord with those that believe the healthcare industry must do more to leverage new technologies and catch up to other innovative industries.

An App for What Ails You

On January 13, 2025
This is the future presaged by “PDURS” (Prescription Drug Use-Related Software). One of the sillier acronyms to grace the healthcare industry in recent memory, PDURS are defined by the FSDA as “software disseminated by or on behalf of a drug sponsor that accompanies one or more of the sponsor’s prescription drugs, including biological drug products.” Essentially, most patients will encounter this software as an app, paired with marquee prescription drugs, that is designed to “assist” patients and healthcare providers in the prescription and use of the medication.

The Phia Group Announces the Promotion of John Blaney to Executive Vice President of Transformation and Recovery Services

On January 9, 2025
In its ongoing efforts to be a trailblazer in the healthcare cost containment field, The Phia Group has promoted John Blaney to Executive Vice President of Transformation and Recovery Services. In his new role, Mr. Blaney will spearhead all recovery functions, including subrogation, overpayment, and other cost containment opportunities. Mr. Blaney will leverage his decades of experience serving as an executive in the healthcare field toward streamlining operations as well as automating department-wide processes, all of which will help optimize services offered to Phia’s clients. The Phia Group’s successful growth initiatives and major investments in technology have enabled us to identify more recovery opportunities and deliver higher recoveries to our clients than any other recovery vendor in the market.

Why Wesco v. BCBSM Matters (A Lot)

On January 8, 2025
Back in November, Wesco, a 55-year-old privately-held gas station chain, and the benefits fund for the Utility Workers Union of America filed a class action lawsuit, alleging that Blue Cross Blue Shield of Michigan (BCBSM), an insurance carrier serving over six million Midwesterners, engaged in an anticompetitive practice by charging an additional PEPM (“per-employee, per-month”) fee to any group that opted to use a stop-loss carrier other than BCBS. For BCBS of Michigan, the fee represents a fairly standard industry practice for charging a plan extra if it opts to use a non-preferred stop-loss carrier; conversely, for the aforementioned plaintiffs, the constantly escalating PEPM fee represents a means for inflating costs for the already cash-strapped covered groups as well as driving smaller stop-loss carriers out of the market. Looking ahead, how this case plays out in federal court in Michigan will have a monumental impact on not just the stop-loss marketplace but also the self-funding industry in its entirety.

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