What are your “non-negotiables” for your PBM partner?

In this article

How do you know they’re the one?

Does everything point to making a commitment?

Or maybe it’s time to call it quits?

There are thousands of articles that offer advice on how you should assess your most significant personal relationships, and for good reason. Choosing the right person to spend your life with could be important to your happiness in every aspect of your life.

When making decisions about personal relationships, many people have “non-negotiables” in mind. These are qualities, characteristics, or shared values that are crucial to the relationship’s survival. Non-negotiables are a hard reality, but a great place to start. When you’re making a long-term commitment, you want to know you have the right partner.

What’s true in personal life also holds true in business. When selecting a business partner, it’s important to prioritize the “non-negotiables,” ask the important questions, and feel comfortable and confident that the answers point to a successful and lasting relationship.

Five characteristics to prioritize in a PBM partnership

Does the PBM understand your needs?
Your PBM’s role is to help you solve the challenges you are facing, both in the industry and within your organization. They can’t do that if they’re not focused on understanding the unique challenges you face. Your organization needs a partner who is focused on listening and learning, will work alongside you to advocate for your initiatives, and is committed to supporting your long-term success.
Does the PBM make you a priority?
When your company has an issue, how quickly does your PBM partner respond? Do they solicit feedback from your team on innovation? Does their roadmap include projects that directly address your needs? In the words of Maya Angelou, "Never make someone a priority when all you are to them is an option." If you are giving your business to an exclusive partner, you should expect that the management of your business is their priority, backed by a dedicated team of strong, intelligent individuals providing service and support at all levels.
Do you have open, honest communication?
Your PBM should be proactively sharing information with you, good news or bad. Yes, your PBM should absolutely celebrate your collaborative wins and be proud of the program success you have built together. However, as a dedicated partner, they should also share information about any areas that have underperformed and provide timely, actionable recommendations for changes that will improve your program. And, while delays, missed deadlines, or defects should be rare, they may occur. When life does happen, it’s important for your PBM to communicate with you transparently and proactively to review impact and plans for resolution. Make sure your PBM has the stability and maturity to protect your business in challenging circumstances.
Does the PBM share your values and goals?
You have a set of values that represent what your company means to your clients, employees, and injured individuals you serve. And every year, there are goals you strive to meet or exceed. Your PBM should not only understand your values and the goals related to your PBM program but should share them. When the PBM is planning new features, capabilities, and program enhancements, their roadmap should be built with your goals in mind and offer tactical solutions that will help you achieve them.
Are they kind, supportive, and respectful?
There is a place for automation, integration, and AI. But at the end of the day, people are at the heart of a successful partnership. The people who support your program — from the customer care agents who work with your adjusters, to the clinicians who provide recommendations on your claims, to the account managers and leaders who provide insights to make your program successful — should treat every interaction as an opportunity to provide service with kindness and respect.

Partnering to build a better program: An Optum case study

Optum Workers’ Compensation and Auto No-Fault has been providing PBM services for almost 50 years, collaborating with clients as they support those who are injured or ill. We are on a mission to deliver the best client experience possible. We know that starts by listening to our clients and understanding their needs, and that each of their questions, requests, or conversations should feel like a meaningful interaction with a trusted friend.

In a recent effort to be a better partner, we engaged with our clients through user surveys and focus groups to gather the functional and user experience requirements for a full redesign of our client portal. By working closely with client users, we were able to stay focused on our clients’ priorities and make sure we met our shared goals to modernize the portal’s look and feel, while still retaining and building upon all of its powerful functionality.

Throughout the project, our Optum Client Experience team worked in close collaboration with our Product Innovation teams. These teams, headed by experienced leaders with an average of 20 years of industry experience each, responded carefully to client input and also worked to proactively anticipate future needs, so that along with an enhanced user experience the portal would include new and innovative technological features. The resulting solution streamlines the adjuster workflow, reduces inefficiencies, and will deliver expanded AI capabilities that provide adjusters with clear recommendations for action.

A long-term, successful partnership starts with a positive experience, but it doesn’t end there. For a relationship to last, the positive experience must be sustained over months and years. Without communication, collaboration, trust, and shared goals, the relationship can’t flourish. Think about your “non-negotiables,” and look for a PBM partner with a proven history to deliver on them.