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
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
“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.
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
Royo presented her findings to
network physicians at a summit hosted
at an upscale hotel, where panel
presenters discussed the findings from
“We tried to make it congenial,
Unifying Stakeholders to Drive Change
so people could enjoy some cocktails
but still be educated about how their
practices were impacting my program,”
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.
Rosa Royo finds the balance between cost control and high-quality care for injured workers.
Goodyear is one of the largest tire
companies in the world, and it is also
vertically integrated, with 48 facilities
in 22 countries, including facilities that
produce rubber chemicals incorporated
Goodyear has a robust business
continuity program, supported by a
cross-functional team, including risk
The team’s preparation and
perseverance were put to the test in
2017 when Hurricane Harvey swept
over the U.S. Gulf Coast where
Goodyear has chemical manufacturing,
warehousing and retail facilities. The
storm forced evacuations and left heavy
flooding, creating operational, logistical
and human-resource challenges.
Craig Melnick joined Goodyear
just a few months before the storm.
He is part of both the company’s risk
management and business continuity
groups. As with many 2018 Risk All
Stars, he is quick to stress that he is
only as good as his colleagues.
“It was truly a team effort and
our business continuity plan worked
extremely well,” he said. “Before and
during the storm, we met every day.
Functional departments reported on
status and associates on the ground
were able to provide timely and
important updates. Within a short
period after the storm, we began to
have meaningful information both
on the impacts to our people and on
damage to affected facilities.”
Melnick remained at the corporate
headquarters in Akron, Ohio, and
coordinated the tracking of costs in
collaboration with the affected locations.
Operational preparations included
moving inventory out of the storm zone
and keeping in contact with suppliers and
customers about changes in deliveries.
“One effective step was contacting
remediation firms to be sure they were
ready to come to us as soon as the
storm passed,” said Melnick.
“We also got our insurers involved
“You can’t effect change if the
very early, including identifying who
our adjuster would be and all the third
As if being the new guy during a
significant event was not sufficiently
fraught, the hurricane hit just two
weeks before the quarterly financial
closing. So as part of his cost
coordination efforts, Melnick worked
to keep the finance team updated.
“My primary function is customer
service,” Melnick said emphatically.
“My customers are my coworkers, and
I am responsible for giving timely and
substantive responses to every inquiry
from the field. That enables them to
do their jobs.”
Colleagues concur. “Craig always
says he has 64,000 customers within
the organization. It is important for
him that everyone knows it is not a
one-man show,” said Kevin Garvey,
client executive at Aon. As a broker,
Garvey lauded Melnick’s technical
expertise, especially in handling the
complex claims arising from Harvey.
That in turn enabled a strong
presentation for renewals in April.
“The markets always appreciate
a risk manager who demonstrates
ownership. Craig was able to
communicate the steps his company
took to minimize the impact of the
storm and thus the claims, and also what
they had learned from the incident.”
— Gregory DL Morris
Goodyear’s Craig Melnick used consistent communication and foresight to help
his company rebound quickly from a major storm.
physicians are not on board.”
— Rosa Royo, director, workers’ compensation,
Miami-Dade County Public Schools
“My customers are my coworkers,
and I am responsible for giving
timely and substantive responses
to every inquiry from the field.
That enables them to do their
— Craig Melnick, senior manager, risk management,