Phia Group

AI to the Rescue? How Machine Learning May Revolutionize Drug Repurposing

On April 15, 2025
Without question, artificial intelligence beholds many downright frightening risks when implemented in the healthcare field. Without proper oversight, AI could have the final say in depriving a patient of a necessary procedure or steering them towards a suboptimal physician. Or the still nascent technology, if unchecked, could account for a HIPAA breach with the slapdash handling of PHI. Yet, that being said, AI is undoubtedly here to stay and as far as the healthcare industry is concerned, this technological revolution is brimming with astonishing potential, as evidenced by the recent development of AI expediting the repurposing of existing drugs for treatment of rare diseases.

Tariff Talk - How Trump’s Pharmaceutical Tariffs Could Impact You (and How You Can Prepare)

On April 11, 2025
As the self-insurance industry braces for potential changes under President Trump’s administration, one issue looms large: impending tariffs on pharmaceutical drugs. These proposed tariffs, aimed at boosting domestic manufacturing, could ripple through the healthcare ecosystem, affecting employers sponsoring self-funded health plans, third-party administrators (TPAs), stop-loss carriers, brokers, and vendors. For an industry built on balancing cost control with quality care, understanding these impacts and preparing strategically is critical. More importantly, as we navigate these changes, we must remain steadfast in our commitment to ensuring that our members get access to quality, affordable prescription drugs.

Care Empowered Pricing as a Money Saver

On April 10, 2025
For over a quarter century, The Phia Group has championed a broad spectrum of cost containment initiatives to empower health plans and ultimately, their respective participants. The Phia Group believes that its latest endeavor—Care Empowered Pricing (CEP)—may be its most robust cost containment program yet. At its core, CEP is engineered to, quite simply, save plans money and as you can see below, there are a number of ways our revolutionary offering does so.

Overhauling HHS – Can a Leaner, Meaner HHS Make America Healthy Again?

On April 7, 2025
The second Trump administration has not been shy about taking steps to shake up U.S. health policy. There has been a flurry of executive orders on a range of healthcare topics, including stepping up enforcement of price transparency rules; a push to expand coverage for and lower the out-of-pocket costs for in vitro fertilization; and taking steps to redefine sex-based discrimination in federal policy and to discourage treatments for gender dysphoria. Even so, the executive action poised to have the broadest impact on health policy may just be the sweeping changes being made to the Department of Health and Human Services (HHS).

The Social Impact of Mental Health Parity Testing

On March 24, 2025
Unknown to many of us, celebrities suffer from mental health and substance use disorders just like anyone else. Recently, country music megastar Luke Combs openly discussed his struggles with obsessive compulsive disorder (OCD). Combs hopes that his discussion of the topic will reduce stigma that often comes with a mental health diagnosis. Taylor Swift has previously discussed her own struggles with an eating disorder for similar reasons. Before Robert Downey Jr. became Iron Man on the big screen, he suffered from substance use disorders for years before seeking treatment, ultimately becoming sober and remaining so to this day.

Pancreatic Cancer Vaccine May Be on the Horizon

On March 17, 2025
Chances are that cancer has touched the lives of nearly every American. Maybe it’s a suspicious mole that turns out to be a carcinoma, an old high school friend’s social media post raising awareness of the need for mammograms after a scare, or a grandparent who battled lung cancer after years of smoking. As the years go by, studies show that the frequency is increasing. The National Cancer Institute estimated that last year alone, more than two million Americans were diagnosed with a form of cancer, and 600,000 lost their fight. This can be compared to a diagnosis rate of 1.9 million in 2022. Statistics show that the most common types of cancer remain breast, prostate and lung cancer, but one stands out above the rest as having the lowest survival rate.

RBP vs. PPO Plans

On February 27, 2025
A preferred provider organization, known colloquially as a “PPO,” is a network of contracted – or preferred – providers who offer care at a minimal out-of-pocket cost compared to rates offered by out-of-network providers. A PPO plan is a very popular type of health insurance in which the insurance plan pays its network of preferred providers a set fee to provide certain healthcare services, enabling plan participants to pay a reduced copay or coinsurance when they receive care within said network. Patients can still see providers out of their preferred network, but they will likely be subject to a higher cost-sharing amount and have to satisfy a separate out-of-network deductible.

Struggling to Breathe

On February 26, 2025
For well over a century, medical oxygen has been used for treating patients with an assortment of medical needs, most notably respiratory issues such as pneumonia, as well as those undergoing surgery, experiencing heart failure, and receiving maternal care. Utilized by over 370 million medical patients worldwide, medical oxygen was, in fact, added to the World Health Organization’s Essential Medicines List in 2017. And yet, according to a recent report published in The Lancet medical journal, well over half of the world’s population does not have access to safe and affordable medical oxygen services; unsurprisingly, this segment of the population is largely comprised of those living in lower-income and developing nations where it is more difficult to access facilities that offer basic oxygen services of reasonable quality.

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.

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.”

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.

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.

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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