In Conversation: myMatrixx’s Mike Cirillo on What Data Analytics Will Mean for the Future of PBMs

At National Comp 2023, Risk & Insurance sat down with myMatrixx president Mike Cirillo to discuss the changes affecting the pharmacy benefit manager space.
By: | December 27, 2023

Mike Cirillo, president of myMatrixx, sat down with Risk & Insurance at National Comp 2023 in September. That conversation touched on topics ranging from Cirillo’s experience in the workers’ comp space to the current challenges and future opportunities facing pharmacy benefit managers.

When asked to explain what differentiates myMatrixx from other PBMs, Cirillo described the three pillars of service, pricing and data. “Step one, I always go back to, you have to have a service mindset.”

Pricing, always a consideration for PBMs, doesn’t define myMatrixx, however. “I don’t ever want to be measured on price, but I do think it’s a critical part of being successful in the PBM space.”

In Cirillo’s view, the more important question is one of sustainability. To wit: As the PBM space has matured, it has attracted private equity. Mergers and consolidation have reduced the number of players and capacity available.

And while many of these groups compete on price, “the challenge sometimes that I see with private equity is they’re more focused on pricing and growth for revenue as opposed to pricing and growth for a sustainable program,” he said.

Cirillo’s third pillar — data and how it’s used — speaks to a topic that resonated throughout National Comp 2023. At myMatrixx, for example, analytics link injury, medical, outcome and other forms of data to score injured workers’ risk and reveal possible programmatic improvements.

And with more data and improved analytics come not just insights but also opportunities for streamlining operations.

“I think what you’re starting to see is an environment where you can use data to drive processes that make sense and don’t necessarily require all the starts and stops of human intervention,” Cirillo said. “Call it straight-through processing, but it’s really analytics-driven, as opposed to bringing processes, bring a human element, bringing starts and stops to the process.”

COVID and the resulting talent squeeze, Cirillo explained, spurred an appetite for more automation and updates to established workflows.

Cirillo’s parting advice to anyone shopping around for a PBM: “Kick the tires … Kick the tires hard.” &

The R&I Editorial Team can be reached at [email protected].