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2018 Risk All Star: Rosa Royo

One School District’s Prescription Medication Costs Dropped 42 Percent Thanks to This Risk Manager

2018 Risk All Star Rosa Royo finds the balance between cost control and high-quality care for injured workers.
By: | September 14, 2018 • 2 min read

Prescription costs were creeping up in Miami-Dade County Public Schools’ workers’ compensation program, and director Rosa Royo was hearing complaints from injured workers about the quantity of medications they were being told to take and their adverse side effects.

Rosa Royo, director, workers’ compensation, Miami-Dade County Public Schools

Concerned about unsustainable expenses and poor patient outcomes, she decided to do some digging. Whereas one national provider was prescribing medication to seven percent of patients, medical providers in her South Florida network were writing scripts for 65 percent of patients — largely due to the rise of physician dispensing.

“When a physician is acting as the pharmacy, they have financial incentives to prescribe particular drugs. We were seeing custom dosages, additional drugs being dispensed and more refills, which also led to more office visits and increased nursing costs on files where a nurse is assigned,” Royo said.

And pain medications weren’t always the top concern.

“We were seeing more secondary medications meant to alleviate the side effects of pain medications. Omeprazole, for example, to ease stomach upset caused by ibuprofen. Over the counter, omeprazole at most costs $13 for 150 pills. The dispensed rate in workers’ comp is about $288, and we were seeing a three-fold increase in what was being dispensed,” Royo said.

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To rein in physician dispensing, Royo would need the medical providers on her side. She began by working with her TPA and PBM — Gallagher Bassett and MyMatrixx — to gather and analyze the right data that would demonstrate to doctors how their prescribing patterns were impacting her program.

“The data was really important,” said Kristy Sands, VP, marketing and communications, Gallagher Bassett. “Refining our reports brought clarity to where we could make necessary adjustments. And Rosa was adept at making sure the medical community understood what she was looking at.”

“You can’t effect change if the physicians are not on board.” — Rosa Royo, director, workers’ compensation, Miami-Dade County Public Schools

Royo presented her findings to network physicians at a summit hosted at an upscale hotel, where panel presenters discussed the findings from different perspectives.
“We tried to make it congenial, so people could enjoy some cocktails but still be educated about how their practices were impacting my program,” she said.

She then arranged one-on-one meetings with the top 100 providers in her network to review data specific to their practices. And when Royo eventually worked with her PBM to create a formulary, she made sure prescribers had a seat at the table.

“Our first go at the formulary was a miss, because we didn’t know everything we needed to,” Royo said. “We had occupational medicine doctors saying, ‘You don’t have anything for burns on here,’ or ‘You need different types of antibiotics.’ We fixed that by bringing more physicians to the table.”

The formulary — and cooperation from all stakeholders — has helped to achieve a 42 percent reduction in prescription medication costs. Royo credits the success to thorough and frequent reporting and to true partnerships with medical providers fostered through open communication.

“You can’t effect change if the physicians are not on board,” she said. &

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Risk All Stars stand out from their peers by overcoming challenges through exceptional problem solving, creativity, clarity of vision and passion.

See the complete list of 2018 Risk All Stars.

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

2018 Risk All Stars

Stop Mitigating Risk. Start Conquering It Like These 2018 Risk All Stars

The concept of risk mastery and ownership, as displayed by the 2018 Risk All Stars, includes not simply seeking to control outcomes but taking full responsibility for them.
By: | September 14, 2018 • 3 min read

People talk a lot about how risk managers can get a seat at the table. The discussion implies that the risk manager is an outsider, striving to get the ear or the attention of an insider, the CEO or CFO.

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But there are risk managers who go about things in a different way. And the 2018 Risk All Stars are prime examples of that.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Goodyear’s Craig Melnick had only been with the global tire maker a few months when Hurricane Harvey dumped a record amount of rainfall on Houston.

Brilliant communication between Melnick and his new teammates gave him timely and valuable updates on the condition of manufacturing locations. Melnick remained in Akron, mastering the situation by moving inventory out of the storm’s path and making sure remediation crews were lined up ahead of time to give Goodyear its best leg up once the storm passed and the flood waters receded.

Goodyear’s resiliency in the face of the storm gave it credibility when it went to the insurance markets later that year for renewals. And here is where we hear a key phrase, produced by Kevin Garvey, one of Goodyear’s brokers at Aon.

“The markets always appreciate a risk manager who demonstrates ownership,” Garvey said, in what may be something of an understatement.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Dianne Howard, a 2018 Risk All Star and the director of benefits and risk management for the Palm Beach County School District, achieved ownership of $50 million in property storm exposures for the district.

With FEMA saying it wouldn’t pay again for district storm losses it had already paid for, Howard went to the London markets and was successful in getting coverage. She also hammered out a deal in London that would partially reimburse the district if it suffered a mass shooting and needed to demolish a building, like what happened at Sandy Hook in Connecticut.

2018 Risk All Star Jim Cunningham was well-versed enough to know what traditional risk management theories would say when hospitality workers were suffering too many kitchen cuts. “Put a cut-prevention plan in place,” is the traditional wisdom.

But Cunningham, the vice president of risk management for the gaming company Pinnacle Entertainment, wasn’t satisfied with what looked to him like a Band-Aid approach.

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Instead, he used predictive analytics, depending on his own team to assemble company-specific data, to determine which safety measures should be used company wide. The result? Claims frequency at the company dropped 60 percent in the first year of his program.

Alumine Bellone, a 2018 Risk All Star and the vice president of risk management for Ardent Health Services, faced an overwhelming task: Create a uniform risk management program when her hospital group grew from 14 hospitals in three states to 31 hospitals in seven.

Bellone owned the situation by visiting each facility right before the acquisition and again right after, to make sure each caregiving population was ready to integrate into a standardized risk management system.

After consolidating insurance policies, Bellone achieved $893,000 in synergies.

In each of these cases, and in more on the following pages, we see examples of risk managers who weren’t just knocking on the door; they were owning the room. &

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Risk All Stars stand out from their peers by overcoming challenges through exceptional problem solving, creativity, clarity of vision and passion.

See the complete list of 2018 Risk All Stars.

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]