RxBridge Takes on the Goliaths of the PBM World
Like many Dublin, Ohio-based tech companies, RxBridge is in a space where the competition continues to keep the status quo.
The Big Box PBMs — pharmacy benefit managers like Optum and Express Scripts, which manage prescription drug benefits on behalf of employers — see revenues into the billions, but that doesn’t necessarily point to a better value for customers.
But RxBridge, which specializes in the workers’ comp pharmacy space and competes against those PBMs, believes it has a different approach.
CEO Ron Carter has had a long career in the technology sector, rising through the ranks as the CIO of an organization that was eventually acquired by Optum. After a couple of acquisitions, he decided he didn’t want to be a part of a huge, billion-dollar company.
Carter says there are a lot of problems in the workers’ comp arena, and clients are looking for a better solution.
“Basically, worker’s comp is still doing things the same way today that they basically did 20 years ago,” says Carter. “They’ve put some lipstick on a pig at times to make it look good, but at the end of the day it’s done the good, old-fashioned way.”
A part of what RxBridge does differently is its use of artificial intelligence and machine learning technology.
“If you look at what technology brings to the table, it really becomes a tool that’s underutilized in the worker’s compensation space,” says Carter. “It’s underutilized in healthcare in general, but it’s definitely underutilized in the worker’s compensation space.”
RxBridge uses AI and ML to navigate cases that have the potential to be a risk to a company’s employees, by comparing best practices and treatment guidelines to get the right drug to the right injured worker at the right time.
For instance, says Carter, the treatment guidelines for one employee may be different than they are for the other, even if they both have a broken arm, treated at the same hospital and by the same doctor, and work for the same company.
An example of this has been seen in the opioid epidemic. If a pharmacist loads an injured worker with opioids as a form of treatment, that will cause that employee more pain and suffering, not to mention the employee will be out of work longer, and in turn cost the employer more dollars.
AI fills in the blanks of what can’t be seen on the surface, giving the company the ability to interpret parameters without all the known information.
“If we don’t know all the parameters, either we A, wait until we get more information, or B, we can release AI and ML against a set of data and say, ‘Tell me what I don’t know,’” says Carter. “Point out the claims that are going to have a higher cost or an elongated return to work pattern based upon unknowns that we can’t see as a human being.”
Because of their use of this technology, RxBridge can also work to customize solutions for its clients.
Workers’ comp varies state-by-state, not to mention the needs of different employees and employers can be varied as well. RxBridge prides itself on its ability to be flexible for its clients.
Solutions and requests that take RxBridge four days to fill, Carter says a big box PBM probably couldn’t even have that discussion within that time.
“Customization is not a thing that big, huge companies can do well. We can,” says Carter.
RxBridge recently released technology to allow injured workers to be able to video chat with a pharmacist. The technology is just another way the company is trying to get injured workers involved in their own care and ensure comorbidities and other “unknowns” are factored into the drugs injured workers are given.
Carter says a lot of RxBridge’s customer base does not understand the approach the company is taking. But as the little guy, when RxBridge is given the opportunity to compete for clients, it wins.
“You have to serve an industry that’s, as I said before, been doing things the same way for 20 years. You have to really explain that the approaches differ, and why that different approach is creating value for them,” says Carter. “A lot of times it’s David versus Goliath. But we’re winning a lot of those, because of the things that we can bring to the table.”
For more information on RxBridge, visit www.rxbridge.com.
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