The Phia Group's Podcast

On this episode of the Empowering Plans Podcast, attorneys Jon Jablon and Cindy Merrell explore the changing landscape of several state and federal laws that affect coverage of gender-affirming care. 

Attorneys Brady Bizarro and Andrew Silverio discuss today’s senate committee hearing on GLP-1 drug pricing and strategies that self-funded employers are using to manage the extreme costs of these drugs while we wait and hope for congressional action. 

Regulators finally announced the long-awaited MHPAEA Final Rules on September 9, 2024. Many of these changes will directly affect group health plan design and modify the NQTL comparative analysis testing requirements - many of which will be significant for plans as they prepare for 2025. Join attorneys Jennifer McCormick and Bryan Dunton for their discussion on several critical considerations for...

Dr. Marty Makary is a New York Times bestselling author, renowned Johns Hopkins surgeon, and globally recognized expert on medical research. In its most recent edition of the Empowering Plans podcast series (“Recognizing Our Blind Spots”), Dr. Makary was a special guest as he engaged in conversation with CEO Adam V. Russo about his new book, Blind Spots: When Medicine Gets It Wrong, and What It Me...

The regulators rush to finalize a suite of marquee regulations as the clock gradually runs out on the Biden administration. Even when finalized, these regulations may be vulnerable in the post-Chevron landscape. Attorneys Kelly Dempsey and Nick Bonds pick apart some of the big rules we’re looking forward to and the challenges they may face. 

Nick Bonds and Corey Crigger are hosting this political edition of the Empowering Plans Podcast series. With an election looming in November, Nick and Corey take a look at the policies and agendas from the Harris/Walz and Trump/Vance tickets. They discuss the impact that each administration could have on the self-funded industry and the country, in the most civil political discourse you can find....

In this episode of the Empowering Plans podcast, attorneys Jon Jablon and Kendall Jackson break down the consequences of PBM steerage. Join us in the discussion of the Federal Trade Commission’s inquiry into PBM practices and the push for legislation to increase transparency in the market and hold PBMs accountable.

On this episode of the Empowering Plans Podcast, attorneys Andrew Silverio and Cindy Merrell delve into the pros and cons of the pay and chase versus pend and pay models of claims processing. They provide an in-depth discussion on the coordination of benefits and the timing of claims processing when another party may be responsible for payment.

In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Corey Crigger break down two of the most significant Supreme Court cases just decided this term – the Harrington case (rejecting the largest opioid settlement in the country) and the Loper case (in which the Supreme Court ended Chevron deference). How will these cases impact the healthcare landscape? What should self-fund...

Just like the development of a child, regulations evolve in their ability to walk and talk over time. Join Jen McCormick and Kelly Dempsey as they go through the evolution of the Pregnant Workers Fairness Act – from passage in late 2022 to the final rules that took effect on June 18, 2024. They also discuss current court challenges where two courts have reached opposite conclusions and, of course,...

In this episode of Empowering Plans, The Phia Group’s CLO – Ron Peck – sits down with experienced surgeon, Dr. Victoria Lee, to discuss a very dangerous – and costly – threat.  Esophageal cancer is generally considered to be a death sentence, and historically screening options are invasive and costly, resulting in a low uptake.  With the introduction of EsoGuard, however, plans can identify which...

In this installment of The Phia Group’s Empowering Plans podcast series, attorneys Jon Jablon and Cindy Merrell discuss a health plan that lost its ERISA protections because of a pre-cert snafu. Specifically, the provider was quoted benefits at U&C, but that’s not quite what the SPD said – so the court called it a promise outside the SPD, and the security blanket of federal law flew right out...

In this concluding episode of our special two-part series on the Empowering Plans Podcast, Adam Russo and Corey Crigger return to unpack more significant developments in the self-funded space. This episode focuses on Walmart’s surprising withdrawal from the healthcare arena—a sector it heavily invested in just a year ago. Listen as they analyze the impact of this move on rural markets and what it...

Join us for a captivating two-part episode of the Empowering Plans Podcast. Adam Russo, CEO and Founder of The Phia Group, is back alongside Corey Crigger to delve into the exhilarating 150th Kentucky Derby and share why Corey’s insights are indispensable. This episode also addresses pressing concerns in the self-funded sector that are crucial for our clients. Packed with valuable information, we...

The Empowering Plans podcast gets a southern infusion in this very Kentucky-centric podcast! Cindy Merrell and Corey Crigger get together to discuss the 150th running of the Kentucky Derby. Before you hear about all things Derby, Cindy and Corey review two impactful Supreme Court cases that were argued in the last session and discuss the implications of presidential immunity as well as the role EM...

Attorneys Brady Bizarro and Andrew Silverio discuss the pending case of Lewandowski v. Johnson & Johnson, a lawsuit brought against plan fiduciaries for violating their fiduciary duties under ERISA. How did they violate those duties? By failing to negotiate drug prices and sufficiently oversee their PBM or investigate alternatives. No matter who wins, this case highlights the importance of ERI...

Listen in as Kelly Dempsey and Brian O'Hara hit it out of the park in this Empowering Plans episode about Essential Health Benefits (EHBs)! The regulating bodies are at it again and issued ACA FAQ #66 on April 2, 2024! Listen in for a quick refresher on EHBs - how they started, where they are now, and where we’re going - and Phia’s interpretation and analysis of FAQ #66.

Ham it up with attorneys Nick Bonds and Jen McCormick from the Phia Group as they dive into the groundbreaking world's first successful genetically engineered pig kidney transplant at MGH in Boston. Explore the details of this medical breakthrough, its implications for the healthcare industry, and the considerations for the future of dialysis, plan language, and stop loss provisions. Tune in to ga...

Over the last twelve months we have seen major interest in GLP-1s (Semaglutide- Ozempic / Wegovy and Tirzepatide – Mounjaro / Zepbound). Although GLP-1s have been around for years as a treatment for diabetes, the recent popularity is due to their use as a weight loss drug. Join Ron Peck and Corey Crigger as they discuss the impact this surge in demand has had on health plans and consumers. Are hea...

In his third State of the Union address, President Biden touted his administration’s record and outlined the issues he and his team will likely be campaigning on heavily as the 2024 presidential race kicks off in earnest. Sprinkled throughout were a number of policy wish list items, including some key healthcare initiatives that we’ll be keeping a close eye on in the coming months. Attorney’s Brad...

The DOL recently issued new guidance on the long-standing contraceptive coverage mandate, and this time they took a different approach. Instead of clarifying prior guidance or issuing novel interpretations of the law, the DOL is giving health plans an alternative way to comply with the contraceptive coverage mandate: either follow the prior guidance issued in 2022… or don’t! The DOL introduced the...

Attorneys Andrew Silverio and Cindy Merrell discuss a newly decided case which provides a roadmap for pursuing settlement funds after disbursement. Who has the burden of proof when the funds have been dissipated? What is lowest intermediate balance rule? 

In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O’Hara discuss the legal doctrine involved in two cases now before the Supreme Court – Chevron deference. They’ll explain what it means, why it is important for federal agency action, and how it impacts the entire healthcare industry. With a decision expected by this summer, you do not want to miss our take on how t...

One might think they’re listening to a broken record when hearing Jennifer McCormick and Kelly Dempsey discuss the ever-shifting landscape of the Mental Health Parity and Addiction Equity Act (MHPAEA), but alas, this is a brand new podcast! As we start 2024, we are reframing our mindset and are making some changes to address the evolving MHPAEA regulations and insights we have received from regula...

The trend of provider consolidation is primed to pick up pace in 2024, distilling some areas into ever more highly concentrated healthcare markets. Ron Peck and Nick Bonds break down how this concentration impacts the costs of healthcare and can drive costs upward for employers and employees alike. With fewer provider options, higher prices, and patients caught in the middle, Ron and Nick outline...