The Book of Russo:

As many of you know, I love history and reading as many books as I can about how the world got to be the place it is today. Whether it’s a book about how Americans explored the western United States or about Napolean’s conquests throughout Europe and beyond, I feel that history teaches us about leadership and management better than any “how-to” book. Thus, why I never read them! In fact, I would be hard-pressed to find a leadership book that can teach any of us life lessons better than a biography of a prominent historic figure. What I find most valuable is what an individual does when they face a crucible moment. A crucible is, by definition, a transformative experience through which an individual comes to a new or an altered sense of identity.

It is perhaps not surprising then that one of the most common types of crucibles we chronicle involves dealing with crisis. Difficult and, in some cases, career- or life-threatening events are called leadership crucibles. They are trials and tests — points of deep self-reflection that force you to question who you are and what really matters. They don’t happen often but when they do, it truly tells you a lot about a person and the company they lead. It is at this momentous occasion that you learn so much about a leader – will they be accountable, speak the truth, and guide their team through the ordeal with a carefully designed plan or will they make excuses, cower and hide from the world? 

 Recent events across the world have shown most of us defining examples of true leadership – from the attempted assassination of our former president to a worldwide computer shutdown caused by the CrowdStrike outage. The initial reactions and steps taken by the CEO of CrowdStrike and the head of the Secret Service tell you all you need to know. When life is going great, it’s easy to lead; it’s when everything craters around you that you truly know who you are and what really matters. For me, the first thoughts I had when we faced the COVID shutdown were how I would take care of my employees and my clients – devising a plan to deal with both. No excuses, just action. This is the true identity of Phia – a company that I am proud to lead. The OnePhia mentality focuses on the lives of our employees, the clients who allow us to grow and offer careers to our people, and the charitable organizations that we serve with the fruits of our labor. I truly hope that you feel the same about us in this crazy world we all live in. Well, that’s it for my deep reflections – happy reading!

Service Focus of the Quarter: Phia Unwrapped 

Ah, Phia Unwrapped – Phia’s out-of-network claims management solution. It features seamless EDI integration, industry-leading savings, a best-in-class customer experience, access to Phia’s attorneys and other experts, and much more. And best of all, fees are based on actual savings. 

What do we mean by actual savings? Well, when a vendor reprices a claim and tells you the rate that should be paid, is the difference from billed charges really, truly “savings”? When you pay that amount, sure, you’re saving money on the initial payment – but what about what happens next: provider pushback, balance billing, and sometimes, ultimately settlement? Paying a fee based on the initial repricing, when you might still need to pay more down the line, really distills the meaning of “savings”, doesn’t it? 

If you haven’t used Phia Unwrapped, then you probably haven’t experienced a contingency fee that is only based on real, true, actual savings. We take a holistic view of savings, rather than locking in fees based on front-end theoretical payment advice. By not earning a fee unless you actually save money, we can sleep well at night knowing that we’ve paired a best-in-class service with best-in-class pricing. 

Phia Unwrapped is powered by the Phia Ignite Pricing Engine, designed to be as accurate and defensible as possible, which is absolutely crucial in the current health insurance climate. Historically averaging 74% savings off billed charges, Unwrapped handles claims of all shapes and sizes, and it is supported by our Provider Relations team made up of experts in conflict resolution and claims settlement. 

 For more information about Phia Unwrapped and how it can help you, please contact [email protected].

Enhancement of the Quarter: Phia Ignite & “Crosswalks”  

The Phia Ignite Repricing Engine, which many of you reading this already know and love, is getting smarter. Not only are we incorporating more AI and expertly-crafted logic into Ignite’s “brain”, but we’re also fine-tuning its ability to price medical claims even when Medicare won’t touch them with a ten-foot pole. 

By incorporating crosswalk logic to help Phia Ignite reprice claims accurately and defensibly even where Medicare and other vendors’ repricing software falls short, we’re doing our best to make sure Phia Ignite is the best option out there. Being able to price claims even when traditional solutions can’t is especially important in the context of the No Surprises Act and IDR. 

If you haven’t yet tried Phia Ignite or seen it in action, you’re in for a treat! Get a live demo by contacting [email protected] today. 

Phia Case Study: IDR Timeframes  

The Phia Group’s Provider Relations department received an Independent Dispute Resolution (IDR) notice for an extremely large disputed balance on a claim incurred and previously adjudicated as paid by a group enrolled in Phia’s NSA Support service. Within one day, Phia informed the TPA and began analyzing and benchmarking the claim. 

As part of its review process, Phia’s team noticed that the provider did not meet some of the NDA’s timeframes. Phia attempted to contact the IDR Entity to have the claim dismissed, since the NSA specifies that this process is effectively set in stone and a provider or plan forfeits its recourse if it doesn’t follow the process, but the IDR Entity did not respond. 

Phia proceeded with its analysis and advice to the TPA, including an IDR offer from the Plan, although Phia’s Provider Relations team also wrote a detailed memo in the offer letter explaining the missed deadlines and arguing that the claim should be dismissed regardless of the amounts at stake. 

Not long after, Phia received word that the IDR Entity agreed with Phia’s assessment, and the claim was dismissed – resulting in savings of a whopping $777,000. 

Fiduciary Burden of the Quarter: The Duty of Prudence

When most people in the self-funded industry think about fiduciary duties, they think about getting claims right and administering benefits compliantly. While the importance of that can’t be minimized, a recent high-profile lawsuit filed against Johnson & Johnson highlights the duty of prudence – specifically, when initially choosing plan vendors. 

In the complaint, it’s suggested that J&J failed to satisfy the duty of prudence when it knowingly elected to utilize a PBM that had its own, rather than the plan’s, best interests at heart. Without getting into the specifics of the allegations – since two Phia attorneys have already done that at length – we want to underscore that fiduciary duties begin far earlier in the claims process than many expect. 

Like so many other things in life, self-funding is much easier with a bit of help. There is certainly a lot that goes into sponsoring and administering a health plan, but vendors like Phia can help root out contractual and other issues before they happen and take a best practices approach to cost containment and compliance. Take advantage of our ICE service today!

Webinars:

• On May 21, 2024, The Phia Group presented “The Cost of Cancer,” in which we discussed new regulatory and legal developments, including the “Cancer Moonshot,” the effect of the Dobbs decision on cancer care, specialty drugs, high cost threats – both present and forthcoming, and a very important personal message from Ron Peck. 

• On April 25, 2024, The Phia Group presented “Not Surprised – First NSA Analysis Shows That You’re Paying Too Much…And Phia Can Help!,” in which we discussed the First NSA Analysis and how we can help.

Be sure to check out all of our past webinars!

Podcasts:

• On June 20, 2024, The Phia Group presented “The Rapid Evolution of the Pregnant Workers Fairness Act” in which our hosts, Jen McCormick and Kelly Dempsey, discussed the evolution of the Pregnant Workers Fairness Act – from passage in late 2022 to the final rules that took effect on June 18, 2024. 

• On June 7, 2024, The Phia Group presented “Stopping Esophageal Cancer In Its Tracks” in which our host, Ron Peck, and guest host, Dr. Victoria Lee, discussed esophageal cancer and new screening options. 

• On May 23, 2024, The Phia Group presented “Places, Promises, and Plan Documents” in which our hosts, Jon Jablon and Cindy Merrell, discussed a health plan that lost its ERISA protections because of a pre-cert snafu. 

• On May 14, 2024, The Phia Group presented “Derby Reflections and Gambles on Healthcare Strategies (Part 2),” in which our hosts, Adam Russo and Corey Crigger, discussed Walmart’s surprising withdrawal from the healthcare arena. 

• On May 9, 2024, The Phia Group presented “Derby Insights and Gambles on Healthcare Strategies (Part 1),” in which our hosts, Adam Russo and Corey Crigger, discussed pressing concerns in the self-funded sector that are crucial for our clients. 

• On May 3, 2024, The Phia Group presented “SCOTUS Showdowns and Derby Delights,” in which our hosts, Cindy Merrell and Corey Crigger, discussed two impactful Supreme Court cases that were argued in the last session and the implications of presidential immunity as well as the role EMTALA can play in state regulations. 

• On April 25, 2024, The Phia Group presented “Fiduciary Duties in the Spotlight – Lewandowski v. Johnson and Johnson,” in which our hosts, Brady Bizarro and Andrew Silverio, discussed the pending case of Lewandowski v. Johnson & Johnson, a lawsuit brought against plan fiduciaries for violating their fiduciary duties under ERISA. 

• On April 11, 2024, The Phia Group presented “Decoding ACA FAQ #66: Essential Health Benefits Unpacked,” in which our hosts, Kelly Dempsey and Brian O'Hara, discussed Essential Health Benefits (EHBs).

Be sure to check out all of our latest podcasts!

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Phia Fit to Print:

• BenefitsPro – The Supreme Court's Mifepristone ruling & its implications for self-funded health plans – June, 2024 

• The Self-Insurer – Self-funding plan preparation for 2024 – June, 2024 

• BenefitsPro – How investing in Cancer research now will save money in the long term – May, 2024

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From the Blogoshpere:
 

• The Price Is Wrong, Y’all. Healthcare spending is at an all-time high, with over $4.5 trillion having been spent in recent years. 

• HIPAA Final Rule Protects Access to Reproductive Healthcare. The HHS Office for Civil Rights (OCR) released a HIPAA Privacy Rule to Support Reproductive Health Care Privacy (Final Rule). 

• The Stewardship of Hospitals. When staffing levels and adherence to patient safety protocols start to wane, trouble looms. 

• The End of a (Brief) Era. While Walmart made a commendable effort to leverage its massive financial scale and brick-and-mortar presence to provide convenient, reasonably priced healthcare services to patients in rural outposts, ultimately the multi-trillion-dollar American healthcare system, one rife with systemic inefficiencies and complications, proved immune to undergoing radical change. 

• IDR: The Confusion Never Ends! The NSA is intended to apply to claims that are payable in some amount.

To stay up to date on other industry news, please visit our blog.

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The Phia Group's 2024 Charity

At The Phia Group, we value our community and everyone in it. As we grow and shape our company, we hope to do the same for the people around us.

The Phia Group's 2024 charity is the Boys & Girls Club of Metro South.

The mission of The Boys & Girls Club is to nurture strong minds, healthy bodies, and community spirit through youth-driven quality programming in a safe and fun environment.

The Boys & Girls Club of Metro South (BGCMS) was founded in 1990 to create a positive place for the youth of Brockton, Massachusetts. It immediately met a need in the community; in the first year alone, 500 youths, ages 8 to 18, signed up as club members. In the 30-plus years since then, the club has expanded its scope exponentially by offering a mix of Boys & Girls Clubs of America (BGCA) nationally developed programs and activities unique to this club.

Since their founding, more than 20,000 youths have been welcomed through their doors. Currently, they serve more than 1,000 boys and girls ages 5-18 annually through the academic year and summertime programs. 

Volunteer Day

The Phia Group had the opportunity to visit The Boys & Girls Clubs of Metro South to participate in some fun activities for the kids! With over 100 kids to entertain all day, we had plenty for people to do. Temporary tattoos, Tie-dye, face painting, hiking, and so many more activities filled the day with so much joy and left us with so many memories. We are looking forward to next year’s Volunteer Day!

Youth of the Year Scholarship

Each year, the Boys & Girls Club of Metro South holds a competition to award the most prestigious honor that a teenager can receive as a member of their local Boys & Girls Club. The Youth of the Year award is the Boys & Girls Club’s signature effort to foster a new generation of leaders, fully prepared to live and lead in a diverse and integrated world economy. The Phia Group is a proud sponsor of the local competition and awards the winner with a $5,000 scholarship and a laptop. 

On March 28, 2024, we hosted the competition for this scholarship in our Canton office. There were a number of candidates, and the winner for the 2024 Youth of the Year award is Markayla Petit-Frere, pictured below!

The Phia Group Great Futures Scholarship

The Great Futures Scholarship was established in 2018 by Adam V. Russo, Esq., Co-Founder and CEO, of The Phia Group. Once a Boys & Girls Club kid himself, Adam has set his mind and heart on supporting the ambitions of our club kids and their amazing potential. Adam has first-hand experience understanding the struggles and challenges of overcoming obstacles, facing adverse circumstances, and the determination necessary for self-preservation. The Great Futures Scholarship annually recognizes one graduating senior for their commitment to education and dedication to a better future. With Adam’s vision, our club annually awards a $10,000 scholarship to assist one student in their pursuit of their educational dreams as they develop a strong work ethic and self-appreciation. 

The 2024 Phia Group Great Futures Scholarship winner was Mila Dafov. Congratulations Mila, and we wish you the very best in your bright future!

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Phia News: 

Phia on the News

The Phia Group’s CEO, Adam Russo, appeared on Boston 25 News to discuss the incredible partnership with The Boys & Girls Club of Metro South. He shared his personal story of involvement with the club as a child and expressed how meaningful it is to give back to the organization that helped him in his youth.

Hygiene Item Drive

The Thanks to the Phia family’s ongoing generosity, we made a donation of about 600 hygiene products to The Boys & Girls Club of Metro South!

Boys & Girls Club Gala

The Phia Group attended the Boys & Girls Club of Metro South 2024 Bids for Kids Gala Auction in April, at Gillette Stadium. Thanks to the bids, donations, and dedication from the Boys & Girls Club’s partners, including Phia and the Patriots’ special surprise guest, this event raised half a million dollars for youth development programming!

Phia BBQ

The Phia Family got to enjoy some fun in the sun and great conversations while Jeff Booth and Ron Peck grilled up some burgers and dogs. The weather was absolutely beautiful, and we hope everyone had as much fun as Jeff and Ron!

Opening Day & Adam’s Birthday

In early April, Phia held a BBQ to celebrate Cleveland’s Opening Day, as well as Adam’s birthday!

May Is Mental Health Awareness Month

In May, Phia held different activities each week such as yoga & meditation, encouraging employees to take a break from their busy days for a brief guided meditation to help reduce negative emotions and build concentration. Employees were able to follow along anywhere — at their desks, outside, or at home! Phia also held Wellness Wednesdays to provide employees with fun and stress-free activities during/after lunch, including trivia, Origami, and painting. Meanwhile, our remote employees got together for nature walks!

Get to Know Our Employee of the Quarter: Jimmy Newell

Being named Employee of the Quarter is an achievement that is for Phia employees who truly go above and beyond their responsibilities. This person must not only transcend their established job description but also demonstrate such unparalleled dedication and passion to The Phia Group and its employees that it cannot go without recognition. 

The Phia Explore team unanimously agrees that there is no one more deserving than Jimmy Newell to be recognized as The Phia Group’s Employee of the Quarter for Q2 of 2024.

Congratulations, Jimmy, and thank you for your ongoing and future contributions.

Phia Attending the SIIA National Conference

Several of Phia’s industry experts will attend SIIA’s 2024 National Conference in Phoenix, Arizona, from September 22nd – 24th. If you are interested in attending or learning more about SIIA’s National Conference, visit their website: 

Get more details: https://siiaconferences.org/nationalconference/2024/Index.cfm

Job Opportunities:

• Case Investigator 

• Sr. Claim Recovery Specialist 

• PGC Project Coordinator 

• Recovery Service Onboard & Support Specialist

See the latest job opportunities, here: https://www.phiagroup.com/About-Us/Careers

Promotions

• Kate MacDonald has been promoted from Health Benefit Plan Consultant I to Health Benefit Plan Consultant II. 

• Samantha Crawford has been promoted from Case Investigator to Claims Recovery Specialist III

New Hires

• Becca Hilbert was hired as a VP, Operations 

• Laura Simberg was hired as a Sr. Subrogation Attorney 

• John Blaney was hired as a Chief Innovation Officer 

• Rand Lennox was hired as a Solutions Architect 

• John Gibo was hired as a Team Lead, Mass Tort 

• Katherine Turner was hired as a Case Analyst 

• Justin Saunders was hired as a Manager, IT Infrastructure 

• Lorie Davis was hired as a KP Claim Recovery Specialist 

• Chad Farris was hired as a Claim Specialist 

• Kim Young was hired as a Sr. Claim Recovery Specialist - WC 

• Gavin Cox was hired as a Sr. Claim Recovery Specialist 

• Kenny Truong was hired as an IT Intern 

• Traci Gaddie was hired as a Subrogation Attorney 

• Stone Boone was hired as an Office Intern 

• Kennedy Slayton was hired as an Office Intern 

• Michael Hedges was hired as a Case Investigator 

• David Cooperman was hired as a Provider Relations Coordinator 

• Whitney McClure was hired as a Sr. Claim Recovery Specialist 

• Matthew Armatis was hired as a Sr. Software Engineer 

• Skye Kaserman was hired as a Customer Service Representative 

• Marissa Feldstein was hired as a Customer Service Representative 

• Bradley Wiseman was hired as a Sr. Claim Recovery Specialist 

• Carlie Flynn was hired as a Customer Service Representative 

• Paola Lopez was hired as a Customer Service Representative

The Phia Group Reaffirms Commitment to Diversity & Inclusion

At The Phia Group, our commitment to fostering, cultivating, and preserving a culture of diversity and inclusion has not wavered from the moment we opened our doors 20 years ago. We realized early on that our human capital is our most valuable asset, and fundamental to our success. The collective sum of individual differences, life experiences, knowledge, inventiveness, innovation, self-expression, unique capabilities, and talent that our employees invest in their work, represents a significant part of not only our culture, but also our company’s reputation and achievements.

We embrace and encourage our employees’ differences, including but not limited to age, color, ethnicity, family or marital status, gender identity or expression, national origin, physical and mental ability or challenges, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique.

The Phia Group’s diversity initiatives are applicable to all of our practices and policies, including recruitment and selection, compensation and benefits, professional development and training, promotions, social and recreational programs, and the ongoing development of a work environment built on the premise of diversity equality.

We recognize that the success of our company is a direct reflection of each team member’s drive, creativity, diversity, and willingness to exercise initiative. With this in mind, we always seek to attract and develop candidates who share our passion for the healthcare industry and our commitment to diversity and inclusion.

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