By Paul King, Chief Client Officer, myMatrixx
The saying about trust taking years to build and seconds to break is just as true in business relationships as it is in personal relationships. In the first part of this article, my colleague David Dubrof discussed why workers’ compensation PBMs need work to build trust with prospective businesses during the sales phase.
To establish the necessary trust to overcome the risks of entering into a new partnership, David emphasized the importance of trustworthy people, a strong reputation, honest pricing practices, secure data and performance guarantees. This is the foundation needed to start the years-long process of a trusting relationship.
On the account management side, it’s about affirming that trust by delivering on these promises each day and by building a program that you can rely on to deliver for years to come. For a business to be able to answer yes to the question, “Do you trust your PBM?” that PBM needs to deliver, while having the consistency that does not cause trust to be broken with even a few poor interactions. At the end of the day, it’s about keeping the promises and rising to the expectations that clients have for the critical services that a PBM performs.
PBMs Build Trust Through Consistent Execution of Fundamentals
In workers’ compensation, clients should be able to trust a pharmacy benefit manager to provide the fundamental elements required for successful claims management. This means, first and foremost, ensuring that any prescriptions written for a claim are clinically appropriate, compliant with state laws and regulations and are filled in the most cost-effective way possible. The organizational resources and expertise required to accomplish this are significant, including clinical capabilities, regulatory compliance experience, analytical abilities and a high-performing customer service team.
A PBM should draw on these fundamentals to regularly meet and exceed client expectations. There should be demonstrable case studies and clear examples of first-year client savings through increased operational efficiencies combined with data-backed clinical intervention outcome mitigation.
It’s not just about cost savings, though. Effective clinical programs need to be specifically designed to keep patients safe by identifying dangerous drug combinations, recommending appropriate dosage levels and implementing weaning programs to curb the potential for dangerous misuse of certain drugs, including opioids.
Ultimately, the mission of worthwhile PBMs is to prioritize the safety of injured workers while providing value to our clients. We understand that building trust and long-term relationships is not achieved through short-term revenue opportunities. Our own data repeatedly demonstrates that we put the needs of our clients first.
Dependability and Resources to Adapt to the Unexpected
There has been much discussion over the past 18 months around managing the uncertainty and weathering the impact of the COVID-19 pandemic. There is obviously good reason for this, and I believe the disruption we have all been experiencing only serves to highlight the importance of organizational stability and adaptability. The pandemic created a highly uncertain environment, but anyone in risk management will tell you that uncertainty is a constant in our industry.
Organizations that were successfully managing uncertainty before COVID were invariably better equipped to handle the turbulence of 2020. Specifically, a stable workers’ comp PBM that will still be participating in the market in five to ten years should have the resources, infrastructure and the financial backing to weather both regular uncertainty and outlier events — from a pandemic to natural disasters. Trustworthy PBMs should be fully invested in their sector and fully committed to long-term stability and performance.
We are proud to have adapted to the pandemic and remote operations without a disruption in service to our clients. Additionally, our Clinical and Business Intelligence teams began analyzing the effects that the pandemic would have on the industry almost from day one. In our most recent Drug Trend Report, myMatrixx and Express Scripts clinical pharmacists isolated the critical impact that the decrease in new claims had on utilization statistics in workers’ compensation. This “COVID Distortion Effect” helped us better understand the post-pandemic environment and represents the thought leadership this organization has brought to the industry for years.
Trusting in Compliance Expertise for any Location
State-based workers’ compensation laws add a large degree of complexity to any company that provides services to injured workers. Clients need to be able to trust that their PBM will be able to meet and adapt to new legislative requirements across multiple jurisdictions. Once again, doing this successfully requires the right balance of resources and experience.
Here, trust means knowing that any medication outside of a state-based formulary will be reviewed by a clinician to ensure compliance. As just one example, the state of New York has highly specific formulary requirements for workers’ compensation that need careful oversight. To meet and deliver against more complex jurisdictional requirements, a strong PBM will develop dedicated resources to help clients navigate the environment
Trust in the Right People, in the Right Place, at the Right Time
In the previous article, David emphasized the highly personal nature of trust. Whether it’s face-to-face or on a screen, you can only build trust through your words and actions. From an account management perspective, trustworthy words and actions will shine through only if we know the people on our team are able to consistently give our clients what we are promising them.
This means a highly trained, United States-based customer service team that is fully committed to workers’ compensation pharmacy. It means clinical pharmacists with decades of combined industry experience who are always available. It means data and technology professionals who leverage extensive resources to analyze data and find efficiencies to make workers’ compensation pharmacy predictable and affordable. Every facet of a PBM should hold a deep commitment to building trust with the people around them, whether it’s a teammate or a client, for the ultimate service and trust of injured workers.
About Paul King
As Chief Client Officer of myMatrixx, an Express Scripts Company, Paul King oversees our Account Executive team, working to meet the needs of clients. In this capacity, King ensures that the wide range of myMatrixx clients maximize their opportunities within the area of pharmacy-related claim expenses.
King brings over 27 years of career growth and experience in the health, workers’ compensation, casualty and personal lines insurance industry, delivering successful program design for medical, indemnity and ancillary product solutions. This experience includes addressing the total cost of risk associated with claim administration for carriers, third party administrators, self-insured entities, captives and associations.
Before joining myMatrixx, King held executive roles in a wide range of leading organizations in the industry, including ISG, ESIS, Sedgwick and myMatrixx parent company Cigna. He received his Masters of Business Administration from the McCallum Graduate School of Business at Bentley University in Waltham, Massachusetts.
King is a devoted husband and father to three daughters who is also dedicated to maintaining a work-life balance that ensures energy, passion and excellence on both fronts, and believes this idea is fundamental to a successful workplace culture.
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.