Part One: New Business Relationships Are Built on Authentic Trust
By David Dubrof, Chief Sales Officer, myMatrixx
When was the last time you asked yourself if it was time for a change? There is always a weight to the status quo, but if you consistently find yourself bumping up against the pain points of your claims management strategy, it may be a good time to ask that question.
Any new business relationship, in any industry, involves some risk. Ultimately the risk needs to be worth taking when making a significant change. The bar may even be higher when your industry is risk averse. How do you know that the goods or services you will be receiving are what were promised? Until you can verify it, you are essentially risking the difference between what was promised, what will be delivered and what you have currently.
The degree to which this risk is acceptable ultimately comes down to the power of trust. In my decades of experience in sales and operations in the workers’ compensation and health care fields, I’ve seen how easy it can be for an organization to “promise the moon” in order to gain new business. But if that organization is not able to deliver the moon, then they are exploiting trust and creating an unnecessary risk for their clients.
This is especially true for the pharmacy benefit management (PBM) space in workers’ compensation, where the risk of undelivered promises can not only have a negative financial impact, but can also affect the health of injured workers. I believe it is crucial for a workers’ compensation PBM to be a trusted and proven entity to build long-term relationships that deliver on promises.
Today, I’d like to discuss the key areas where a PBM should be working to build authentic, fact-based trust with stakeholders in any prospective new relationship. Being able to know why a PBM should have your trust is an essential part of limiting the risk inherent to starting a new partnership.
Trust in People
In an increasingly remote business environment, it’s more important than ever for relationships to be built on specific expertise. You need proven program execution that reduces risk, expense and time allocated to the targeted processes. This requires experienced and focused talent executing daily. From the very beginning, a PBM should be building trust in their ability to foster productive relationships. The actual people you interact with can establish trust by asking good questions and being responsive — doing what they say they are going to do, when they are going to do it, owning any mistakes and ensuring they are not repeated. Ideally, they should truly enjoy executing daily to achieve your objectives.
Even if it’s not face to face, you should view the quality of the interactions you have as a key indicator of what doing business with a prospective company will be like. Take red flags seriously and expect a positive track record from the beginning.
Basically, do your interactions with the sales team line up with the promises of exceptional, round-the-clock customer service you will be getting from the account executives and service personnel? We recently had an injured worker’s spouse tell us we saved her husband’s life through our persistence and dedication. Solving problems in all phases of operations will foster trust.
Trust in Reputation and Established Results
A PBM that has established itself in the industry on a long-term basis, and has a positive reputation for achieving positive outcomes, will start building trust before the first interaction. There is no substitute for a proven, evidence-based record of success, particularly in workers’ compensation, where laws and regulations vary on a state-by-state basis and highly specialized compliance expertise is a requirement. It’s a simple statement, but a PBM that can solve your problems, back up its promises with years of results and a reputation for client satisfaction will be one you can trust.
When evaluating a prospective workers’ compensation PBM, independent resources are a great asset for comparing firms within the industry. Market research group CompPharma regularly surveys workers’ compensation payers, ranking PBMs in key areas of pricing, customer service and overall reputation. Pharmacy surveys are released annually, with this year’s survey due to be released the first week of September 2021.
Trust in Honest and Transparent Pricing Practices
Pricing transparency has become a significant topic for PBMs in our industry and the larger health care arena. It is one that I’ve discussed in this publication within the past year. Disclosure of what a PBM pays a pharmacy is an indicator of a trustworthy entity, but once again, stakeholders should be mindful of how the PBM is defining transparency and how it aligns with an overall claims strategy. Do not confuse this with service providers attempting to ‘buy’ your business with illogical or below cost pricing. True transparency will allow you to see service providers’ margins, which allows them to meet investor expectations while also reinvesting in their people and infrastructure.
For a PBM to actually deliver end-to-end pricing transparency, it needs to be directly contracted with their retail pharmacy network. In contrast, many PBMs that purport to have transparent pricing are in reality leasing access to another network. It diminishes the value of transparent pricing if the PBM is paying more from their network aggregator than a directly contracted PBM.
Trust in Secure Data and Patient Information
Digitization of information has brought unprecedented efficiencies and a greater ability to analyze data, but it has also brought new challenges. Today, data breaches, hacks and ransomware represent security threats that did not exist 20 years ago. Protecting the data of clients has become a core operating concern for PBMs and yet another area where trust is essential.
This is an area where a workers’ compensation PBM can benefit from the resources and scale of a large parent company. Most sophisticated buyers will look for IT security protocols that are reviewed, tested and have third party validations. Risk managers are like the Department of Defense and other federal agencies when looking for a trusted partner. When it comes to ensuring the security of data and patient information, resources and infrastructure matter.
Trust Through Performance Guarantees from a Partner Who Will Be a Leader for Years to Come
A workers’ comp PBM you can trust should be willing to put performance guarantees in place to help underwrite a more secure program for clients. You want to ensure that a new PBM is going to improve your program every single year, not just the first year. Stakeholders of all kinds, from self-insured employers to state-funded insurers to third party administrators, should be concerned not just for financial outcomes, but also the health and safety of injured workers.
This means the expectation should be a two-fold guarantee for cost and patient outcomes. The first is built on your PBM’s confidence in the supply chain to drive the most value in the market. The second is built on their clinical capabilities that promote the safety and health of injured workers. Through our dedicated focus on workers’ compensation pharmacy, unmatched scale and decades of experience, my time with myMatrixx has shown me this organization has an unmatched ability to build trust through its reputation, resources and ability to guarantee performance outcomes.
Establishing a new PBM relationship is a risk that is mitigated through trust, but it is only the first step in building long-term success. In the next part of this article, my colleague Paul King will show what the power of trust means for PBM account management and operations. Ultimately, it’s about delivering on the promises made by the sales team and ensuring the proper calibration of expectations.
About David Dubrof
As Chief Sales Officer of myMatrixx, an Express Scripts company, David Dubrof oversees sales and market share growth for the workers’ compensation division. Working closely with both the sales and marketing teams, he works to create strategic managed care relationships with a broad spectrum of partners while leveraging key marketplace differentiators.
David brings more than two decades of executive management experience in sales, marketing and operations in the workers’ compensation, healthcare, and technology industries. His wide range of skills helps myMatrixx meet business goals and achieve its ongoing mission to help injured workers.
Prior to joining myMatrixx, David was the Vice President of Sales and Marketing for Genex Services, a leading managed care provider, where he was responsible for managing the technology and bill review sales team. Additionally, he served as vice president for a medical cost management provider for commercial, international, maritime and workers’ compensation payers. Previous leadership positions include president of a professional services organization and executive vice president at a privately held company offering pharmacy benefit management and ancillary health services.
David holds a Bachelor of Science in Business Administration from Florida State University and currently lives in Atlanta, Georgia.
myMatrixx® is a pharmacy benefit management company dedicated to workers’ compensation. The unique combination of myMatrixx and Express Scripts makes us the only workers’ compensation pharmacy benefit manager that can deliver high touch customer service, clinical expertise and actionable data analytics while leveraging Express Scripts’ pharmacy network, comprehensive clinical services, mail order program and specialty solutions to meet the individual needs of our clients and their injured workers. For more information, visit myMatrixx.com.
myMatrixx is a WorkCompWire ad partner.
This is NOT a paid placement.