myMatrixx, an Express Scripts Company October 2018

Founded in 2001, myMatrixx, an Express Scripts company, began as a pharmacy benefit manager in Tampa, FL with AmeriSys as our first and longest standing client. Today, we are proud to state that our portfolio of clients affords us the opportunity to process thousands of prescriptions on a daily basis, serving patients across the entire United States. We don’t take a day off to serve our clients and patients because our Customer Service Center is open 24 hours per day, 365 days per year.

 myMatrixx, an Express Scripts Company was founded in 2001 

IAIABC: How does your organization serve the workers’ compensation industry or what do you see as the most important role you play in the workers’ compensation industry?This area of expertise has led to the development of solutions that focus on patient care

Kim Ehrlich, Director of Workers' Compensation Regulatory Compliance, myMatrixx, an Express Scripts Company: myMatrixx, an Express Scripts company, provides pharmacy benefit management (PBM) services to meet the specialized needs of workers’ compensation clients and injured workers. This area of expertise has led to the development of solutions that focus on patient care while simplifying claims management, including evidence-based clinical programs, automated medication authorizations, a user-friendly portal, actionable analytics and industry-leading service.

IAIABC: What do you see as some of the major challenges the industry is facing, and how can we as a community address them?we have seen 15 states to-date that have implemented formularies and/or pain guidelines specifically aimed at curbing the prescription of these medications.

KE: The opioid crisis generates a growing awareness that corrective action is imperative for all engaged in the pharmacy delivery system. There has been more communication and collaboration between prescribers, providers and payers over the past few years. Payers are implementing evidence-based programs as they look to prevent abuse, misuse and fraud. Payers are also implementing many utilization management programs around quantity limits, coverage duration and prior authorizations (PAs). On the regulatory front, we have seen 15 states to-date that have implemented formularies and/or pain guidelines specifically aimed at curbing the prescription of these medications. 

enables the participants to identify and determine opportunities to improve administration

IAIABC: Why is your organization a member of the IAIABC? What would you tell others about the benefits of membership?

KE: IAIABC provides an environment for stakeholders to share their information and perspectives. This is an environment, which enables the participants to identify and determine opportunities to improve administration within the workers’ compensation system.

 

 

 

 

Virginia Workers' Compensation Commission September 2018

The Virginia Workers' Compensation Commission (VWC) has 13 departments under two major divisions, Administration and Judicial. VWC is led by three Commissioners: Commissioner R. Ferrell Newman, Chairman, Commissioner Robert A. Rapaport and Commissioner Wesley G. Marshall. Chief Deputy Commissioner James Szablewicz provides senior leadership for the Judicial Division, Evelyn V. McGill is the Executive Director responsible for the Administrative Division and day-to-day operations of the VWC. The organization has been operating since 1919 and is currently in the onset of its Centennial. 

VWC Headquarters Staff Photo

 Hosted IAIABC Conventions in 1931, 1940 & 2018 

IAIABC: How does your organization serve the workers’ compensation industry or what do you see as the most important role you play in the workers’ compensation industry?The VWC's vision is to: Lead the nation as the most effective and innovative state agency.

Evelyn V. McGill, Executive Director, Virginia Workers' Compensation Commission: The Virginia Workers' Compensation's vision is to: Lead the nation as the most effective and innovative state agency. VWC serves the workers' compensation industry as the State of Virginia's regulator of the Virginia Workers' Compensation Act. Our mission is to: Serve injured workers, victims of crimes, employers, and related industries by providing exceptional services, resolving disputes, and faithfully executing the duties entrusted to us by the Commonwealth of Virginia.

 

IAIABC: What do you see as some of the major challenges the industry is facing, and how can we as a community address them?

Virginia Workers' Compensation Commission accepting the 2016 IAIABC Innovation Award.

EM: Various challenges exist for VWC to meet its vision and mission, as the state’s regulatory agency for workers’ compensation. Serving our various stakeholders requires continuous process improvements, state of the art systems and services, understanding and responding to their needs, and ensuring that our employees are provided tools, resources, support and direction to succeed.  

In 2018, VWC is:

  • Recognizing the start of its Centennial/100th Anniversary
  • Increasing stakeholder engagement
  • Performing facility, system, and service enhancements
  • Implementing and evaluating Virginia's medical fee schedules
  • Reviewing an enhancing compliance initiatives
  • Conducting process efficiency studies to improve overall service delivery
  • Finding E-billing regulatory requirements

IAIABC: Are there any projects/programs/initiatives going on at your organization that your are particularly excited or enthusiastic about?

Our redesign efforts of all our facilities with state of the arts technology, systems and enhanced security ensure that VWC’s current environment responds to the needs of our stakeholders and our most important resource, our employees.

EM: We are extremely excited to have assisted a panel of stakeholders in the development of Virginia’s first medical fee schedule, as a result of statutory mandates from our legislature. Our fee schedule is quite unique and it has been rewarding to hear from individual regulators around the United States on their interests in the schedule and various new services, including enhanced compliance initiatives in insurance and electronic data interchange and our mediation program.

E-Billing requirements are also being planned and will go live early next year as a result of statutory mandates. Working with other regulators around the country on their e-billing rules and requirements, as well as the IAIABC’s Medical Issues Committee made, this process much easier to design and develop. Automated systems are always quite challenging to research, plan and execute a go-live; the IAIABC and its members continue to assist us in these endeavors.

Our redesign efforts of all our facilities with state of the art technology, systems and enhanced security ensure that VWC’s current environment responds to the needs of our stakeholders and our most important resource, our employees. Team VWC makes our organization operate in an effective manner and our goal is to provide a safe and comfortable work environment.

 

The IAIABC has assisted VWC in making its vision and mission a reality and it has provided resources to VWC to assist in the design of various complex initiatives.IAIABC: Why is your organization a member of the IAIABC? What would you tell others about the benefits of membership?

EM: It has been very rewarding to have various members of our team present at national meetings and to hold various offices in organizations such as the IAIABC. Our vision to lead the nation is possible because of our strong team. #WeWorkAsOne is our mantra and it exudes the importance of working together and success without individual credit.

The IAIABC has assisted VWC in making its vision and mission a reality and it has provided resources to VWC to assist in the design of various complex initiatives like the fee schedule, e-billing, automated systems, reporting, mediation, compliance and various services. VWC values its strong relationship with the IAIABC, as it has opened doors to communicating with regulators around the country and world. It has helped us share our successful programs, systems, and services with other jurisdictions along with providing the opportunity for VWC to reach out to other states on their programs to assist us with the design of new, innovative services. The IAIABC also offers recognition awards to members for their leadership, outstanding work in being innovative, and actively participating to improve workers' compensation. Over the years, VWC Team Members have been awarded the 2018 NextGen Award, 2017 Frances Perkins Award, and the 2016 Innovation Award.

WorkComp Strategies August 2018

The core mission of WorkComp Strategies is to provide independent analysis and guidance to public sector clients seeking to undertake strategic projects and initiatives. Sample projects include technology modernization and related initiatives; program analysis and improvement; and overall system reform analysis and recommendations.
WorkComp Strategies was founded in 2010

Matt Bryant and Greg Krohm

 

 

 

 

 

 

 

 

 

 

IAIABC: How does your organization serve the workers’ compensation industry or what do you see as the most important role you play in the workers’ compensation industry?

Matt Bryant, President, WorkComp Strategies: One of the more important roles we play is providing expertise to support effective decision-making. “What have other jurisdictions done in this area, and was it effective? Why? Did the stakeholders support the direction taken?” We help jurisdiction leaders and administrators build on proven ideas and avoid costly mistakes.

IAIABC: What do you see as some of the major challenges the industry is facing, and how can we as a community address them?

Workers' compensation systems have to find ways of understanding value beyond cost.

MB: A significant focus in the performance of workers' compensation systems has been placed on cost.In almost any other scenario where cost is a major factor, then necessarily value is called into question. But workers’ compensation systems don’t have a very standardized method of understanding value, which leaves cost as the predominant benchmark, and almost a substitute for value. Workers’ compensation systems have to find ways of understanding value beyond cost. We have been working with the IAIABC on a project in which the results of dispute system services can be compared across jurisdictions. The goal of this effort is to establish benchmarks and practices that drive innovation and improvement, or in other words, value.

IAIABC: Are there any projects/programs/initiatives going on at your organization that your are particularly excited or enthusiastic about?

Ryan Guppy, Vickie Kennedy, and Matt Bryant

MB: Many US and Canada jurisdictions are in the early phases of modernizing their systems and processes. We have ongoing projects with several such jurisdictions, and it is exciting to work towards improvement and innovation on these projects. Some of the key objectives include both efficiency and effectiveness. In other words, these projects involve modernizing not only to increase efficiency, but also to make the agency more effective at providing services. Re-orienting government services toward a direction of improving service levels requires asking questions like, “Who are our customers? What do they need? How can we best support that?” Finding answers to questions like these and taking steps to act on them puts a refreshing perspective on government services.

 

The IAIABC is committed to innovation and improvement, and not status quo. This is the sort of association that matches our values.IAIABC: Why is your organization a member of the IAIABC? What would you tell others about the benefits of membership?

MB: We value the opportunity to engage in policy discussions with workers’ compensation leaders across the US and internationally. Committees and working groups provide a ready network of team members to dig into the key issues facing workers’ compensation today. The IAIABC is committed to innovation and improvement, and not status quo. This is the sort of association that matches our values.

 

 

 

Michigan Workers Compensation Agency July 2018

Michigan is one of the 15 founding members of the IAIABC and site of the first ever IAIABC Convention in 1914. We thought it natural for the Michigan Workers' Compensation Agency to be our first "Member Spotlight."

We need to think differently and approach statutory construction and regulations with flexibility

IAIABCWhat do you see as some of the major challenges the industry is facing, and how can we as a community address them?

Mark Long, Director, Michigan Workers' Compensation AgencyThe speed at which industries are moving makes it difficult to establish an appropriate level of regulation. As the new economy grows it is impacting everything from how we travel to how we work to how we see the doctor. We must learn from each other, which includes our international jurisdictions.

Mark LongHosted IAIABC Conventions 1914,1951,1981,2002
 
 

 

 

 

 

 

IAIABC: Are there any projects going on at your organization that you are particularly excited or enthusiastic about?

Kathy Rademacher and Lori Raby
ML: We are in the midst of an IT system overhaul. We have already replaced two legacy systems and are presently working on our primary system. The replacement project will provide us the opportunity to overhaul our rules for processing data and will move us a long way towards eliminating paper. We are also in the process of establishing billing and reimbursement guidelines for telehealth.

4 IAIABC Presidents have been from MichiganIAIABC: Why is your organization a member of the IAIABC? The IAIABC is an opportunity to collaborate nationally and internationally with industry leaders.

ML: It provides occasion to gain an immense amount of feedback from a very dedicated group of professionals. The committee work is always top-notch and the white papers are thoroughly developed.