appeal decision making onto The Phia Group, acting as a Plan Appointed Claim Evaluator (PACE), or defending a plan’s pricing methodology in the face of pushback, The Phia Group “protects” the plan.
Phia Outreach Committed to education and guidance, The Phia Group provides various free informational webinars and podcasts that provide the most cutting innovations, legal and regulatory updates, and state of the industry trends. The Phia Group’s passion is bottomless and they are committed to creating a more affordable healthcare system. To date The Phia Group provides services to TPAs, ASOs, stop-loss carriers, reinsurance carriers, MGUs, and brokers; representing
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municipal health plans, multi-employer health plans, and self-funded health plans. The Phia Group also works with government agencies, Medicare and Medicaid plans, Taft-Hartley entities, High Risk Pools (state and federal), as well as other consortia. Together, these entities represent thousands of employer-sponsored
#PlanHacks
12 Ways to Free-marketize Your Plan
RX Costs
Out-of-the Box Tips
• Encourage employees to “shop” for their prescriptions; costs can vary widely between pharmacies, even with a PBM.
• Cover over the counter drugs! Often, when commonly used heartburn and allergy drugs go OTC, patients switch to another RX because it’s no longer covered by their health Plan. You can cover these OTC drugs at 100% to lower your RX spend! Why stop covering it when it gets cheaper? (HDHP rules would still apply)
• Many PBM contracts make the cost of a drug higher than if it was bought with no contract in place. • If employee pays cash for lower-cost RXs, structure your Plan to reimburse these purchases. • Cover the cost of RXs purchased by the employee from their DPC; generally at wholesale prices. • Check out free market pharmacies.
Durable Medical Equipment • Many pieces of durable medical equipment (crutches, breast pumps, CPAP machines, etc.) can be bought for much less on the open market than through the network. • Incentivize your participants to shop for DME based on price! • Structure your Plan to allow reimbursement if your employee finds their equipment online or through a non-network provider and pay it at 100% (HDHP rules would still apply). 20
health plans covering millions of lives nationwide. The diverse nature of these organizations means The Phia Group is equipped to handle any problem with the highest level of professionalism and expertise. This level of passion for the self-funded industry has led to The Phia Group being a prominent figure in many leading industry organizations. Executives and employees sit on boards of the most well respected industry organizations and travel across the country to present new ideas, The Phia Group is proud to share its passion nationwide, and looks forward to helping every person take back control of their health care and empower their plans. phiagroup.com
• Work directly with high value, low cost lab providers and incentivize your employees to use them. • Place dollar caps or a reference based pricing cap on services that have the most unpredictable, and often incredibly high, cost; such as air and ground ambulance, implantable items, interoperative nerve monitoring, dialysis, and more. If an employee gets balanced billed, you can step in and help negotiate a more reasonable reimbursement. • Many out-of-network physicians and facilities are actually high value! Penalizing patients for using a ‘good guy’ even though they are a better deal is not in your Plan’s best interest. Eliminate out-of-pocket penalties for non-network providers and allow your employees to shop for the best value.
USHealthMedia.com | Vol. I | Issue 2