My Healthcare Experience

Here is a quick summary of my healthcare experiences:

1. Worked with the Mallinckrodt Institute of Radiology on an Activity Based Costing model comparing the cost and outcomes of two different treatments.  We subsequently published the article in the International Journal of Radiation Oncology Physics in 1996.
2. Led the development of the Ernst & Young LLP point-of-view (POV) on how the Internet was going to affect managed care.  This became our key offering in the managed care space where I worked with several E&Y partners to evangelize this POV to MCOs across the US (Aetna, Pacificare, Wellmark, BCBS SC, and others).  This led to several engagements including one at BCBS of KC where I worked with the implementation team.
3. Hindsight is 20-20, but one of our more exciting projects out of this was a 3-day Accelerated Solution Environment project with United Healthcare on CDHC (Consumer Drive HealthCare) back in 1999.  (As we all know now, they are clearly one of the leaders in this space.)
4. Actively worked with Firepond (while at E&Y) to co-sell a broker configuration tool to the MCOs including CareFirst.
5. Managed the e-prescribing (eRx) vendor relationship for Express Scripts including looking at how the vendors were going to work with RxHub (the Express Scripts JV) and developing collateral for clients around e-prescribing.
6. Developed and managed a generic sampling program for Express Scripts where we provided 7-day samples of six different generic drugs (e.g., fluoxetine, lisinopril) to approximately 1,000 physicians in PA and FL.  This was a pilot program to determine whether Medco’s program (GenericsFirst) had a material effect on dispensing or was simply a marketing ploy.  In the end, we were able to show that their program had no material results and disbanded our program.
7. Became the generic drug champion for Express Scripts which meant that I evangelized generic drugs to our clients, did press interviews, developed materials for clients and patients, sat on the generic committee, and even created collateral for Barrett Toan to present at the Generic Pharmaceutical Association’s national meeting.
8. Developed the Express Scripts Step Therapy Rapid Response program which provided letters to patients that were rejected at the POS (point-of-service) and never filled a drug in the therapy class.  This became a very popular offering with clients.
9. Worked with one of our clients (Connecticare) to productize a Zero Dollar Copay program which encouraged patients on select brand drugs to move to the therapeutically equivalent generic drug (e.g., Nexium to omeprazole) in return for having their copays waived for up to six months.  This program won the PBMI Innovation Award.
10. Developed GenericsWork which was Express Scripts’ most comprehensive trend management program where the company was willing to do risk based pricing.  This blended formulary design, copayments, utilization management programs, and communications into an off-the-shelf offering for plans.  The pilot client dropped their pharmacy spend by 20% in year one.
11. Managed the implementation of the Express Scripts Client Pledge.  This was a high level set of guiding principles that Express Scripts put out the align ourselves with the clients.  My job was to make sure that the SOPs (standard operating procedures) and systems supported what we promised.
12. Managed the Express Scripts’ academic detailing team which was responsible for detailing physicians on formulary alternatives (brand and generic).
13. Managed the Drug Choice Management program at Express Scripts which was the controversial program which shifted appropriate utilization from higher cost drugs to lower cost brand drugs.  Under my leadership, this program was shifted to a brand-to-generic substitution program focused on therapeutic alternatives not simply chemical alternatives.
14. Led the internal team responsible for presenting Express Scripts Senior Staff with a recommendation on how to respond to the Medco Settlement where they agreed to a long list of legal and systemic changes to address perceived and real issues of transparency.
15. Led the team responsible for mail promotion (i.e., encouraging patients to move their maintenance prescriptions from retail stores to Express Scripts’ mail order pharmacy).  This included development of a strategy, review and creation of materials, campaign design and management, modification of the targeting algorithm, client upsells, and reporting.  In 2005, we targeted 10M patients, increased the success rate by 25%, and moved $300M in prescriptions to mail order which was 10x more profitable.
16. Conducted several webinars at Express Scripts for internal audiences on our product offerings and for external audiences around generics, plan design, and mail order.
17. Championed the internal push at Express Scripts for the creation of a single view of the patient which although not funded became the catalyst for several smaller projects.
18. Business lead on the CRM committee for Express Scripts’ internal technology for patient targeting and letter fulfillment for clinical and trend management programs.
19. Led the rollout of Express Scripts mandatory mail offering internally and externally which was the first time Express Scripts had gone to market pushing mail order.
20. Led the rebranding of mail to home delivery in order to soften the offering and address perceived concerns.
21. Contributed content to Express Scripts Drug Trend Report in 2003, 2004, and 2005 and presented to clients at our annual Outcomes conference which was for our top 900 clients.
22. Led the transition of clients and patients from Claritin and Prilosec to their OTC (over-the-counter) alternatives.  This included addressing the call centers, retail pharmacies, internal staff, adjudication system, clients, and plan design to minimize the disruption and maximize the patient and client savings while optimizing Express Scripts profit.
23. Part of the core team responsible for addressing the CVS and Walgreen opt-out of Express Scripts mandatory mail network and creating numerous options for how to respond.
24. Part of numerous teams that looked at eRx vendors to decide if Express Scripts should work with them and how.
25. Helped finalize the CDHC strategy that was presented to Sr. Staff at Express Scripts in 2006 including doing competitive intelligence and researching topics such as rewards and incentives to drive wellness.
26. Developed the Express Scripts roadmap and several innovative solutions for rapidly shifting marketshare from Lipitor to Zocor to prepare for Zocor’s patent expiration in 2006.  This has been a story they have presented to the street based on how successful it was at moving marketshare.
27. In order to address the worker’s compensation challenge of capturing the first fill of a prescription and eliminating the third party billers, developed a joint venture with an eRx company to build and take to market a worker’s compensation eRx solution for Express Scripts.
28. Part of the core Express Scripts team charged with looking for process improvements at mail order and producing a 3-year roadmap for improvement.
29. Created and presented a 5-year vision for the pharmacy landscape to BCBS MA, Express Scripts’ biggest client at the time.
30. Co-led the development of Express Scripts options on how to respond and redirect the company in preparation for the adoption of fiduciary legislation at the state level.
31. Developed and launched a company (CentralScript) to develop a self-service pharmacy kiosk where patients could scan in their prescriptions, talk with a pharmacist via video conferencing, and get their prescription dispensed real-time
32. Worked with Silverlink (a healthcare communications company) to develop a PBM product strategy for them.
33. Developed a proposed approach with Silverlink for MCOs to do communication mapping to decrease the number of communications received by patients and increase their effectiveness per marketing dollar.