Explore my professional journey as a pharmacist, from residency and managed care to independent consulting and speaking engagements.

Responsibilities

• Advised employers on pharmacy benefit strategy by translating clinical evidence, utilization trends, and market dynamics into actionable, value-driven recommendations.
• Founded and authored "The Fiduciary Files," a quarterly newsletter designed to educate plan sponsors on emerging trends in the pharmacy benefit landscape, including drug pipeline developments, pharmacy benefit strategies, market dynamics, and legislative and regulatory updates that may impact employer-sponsored health plans.
• Advanced the organization's reporting capabilities from developing new analytical models and insights to transparently share with plan sponsors related to their performance and enhanced reporting decks with more aesthetics and illustrations to more easily and effectively communicate the drug utilization analytics of plan's performance.
• Evaluated PBM performance, contractual compliance, and clinical programs to ensure cost containment, accountability, and member-focused care.
• Identified and advanced business development opportunities in collaboration with client services leadership, supporting growth through strategic insights and client engagement.

Responsibilities

• Appointed as the pharmacy subject matter expert, advising clients and internal teams on industry trends, clinical strategies, and health plan pharmacy benefit design best practices.
• Led a team of analysts and directed all pharmacy operations within the organization, ensuring operational excellence, strategic alignment, and continuous improvement in team performance.
• Contributed to developing analytical models to detect and prevent payment inaccuracies, fraud, waste, and abuse (FWA), and optimized pharmacy reimbursement accuracy through data-driven insights and process improvements.
• Translated complex financials, PBM contracts, business strategies, and utilization data into clear, actionable insights for internal leadership and external clients, including director-level and C-suite audiences.

Accomplishments

• Pioneered and built SmartLight Analytics' PBM RFP practice from the ground up, successfully transitioning self-funded employers (from mid-sized organizations to Fortune 500 companies) to new alternative PBMs.
• Redesigned internal pharmacy referral workflows and delivery processes, resulting in a 35% increase in guarantees achieved from total identified savings.

Responsibilities

• Managed drug coverage benefits for MultiCare's Employee Health Plan (EHP) covering 40,000 lives along with Ventegra, First Choice Health, and USI Insurance Services to optimize benefit structures for plan members.
• Designed and implemented pharmacy initiatives like drug conversions and patient/provider education programs to support value-based arrangements (VBA) where MultiCare assumed risk.
• Performed pharmacy consultancy on pharmacy benefit management for other self-funded employer (provider) groups partnered with PSW and provided independent support for a PBM Request for Proposal.
• Presented clinical programs and metrics/trends to chief medical officers, internal medical directors, AVPs, and VPs of pharmacy programs to ensure EHP and VBA work were strategically aligned with health system pharmacy objectives.

Accomplishments

• Delivered $1.8M in plan paid savings for MultiCare's Employee Health Plan by optimizing the Wellness Drug List, strategically managing brand coverage, and leveraging copay cards to offset reinstated cost-shares.
• Audited GLP-1 utilization, revealing 20% use related to off-label weight loss. Implemented utilization management tools resulting in $1 million in annual plan paid savings.
• Achieved a 65% conversion rate resulting in $596K cost-offset savings by implementing a therapeutic conversion strategy: DPP-4i to SGLT-2i, with or without GLP-1, increasing use of renoprotective drugs to reduce kidney disease progression and cardiorenal-related hospitalizations.

Drug Utilization & Trend Management

• Led utilization strategies such as Keytruda vial optimization and Vascepa to Lovaza conversion, resulting in annual savings of $800,000 and $55,000, respectively.
• Managed utilization of preferred long-acting injectable antipsychotics, implemented a conversion to Biktarvy, and transitioned to preferred mycophenolate formulation via cost-analysis and data analytics.

Clinical Pharmacy Practice

• Managed patients with diabetes, hypertension, ASCVD, and asthma under a collaborative drug therapy agreement within the chronic disease management (CDM) program.
• Performed post-hospital med reconciliations for high-risk patients to reduce readmissions and provided medication management recommendations to healthcare providers prior to patients' follow-up appointments.
• Developed an in-house heart failure module to train clinical pharmacists in heart failure management.

Benefit Design & PBM Oversight

• Performed a market analysis of competing Medicare Part D health plan coverage in WA state by reviewing Evidence of Coverage files and presented findings to the Medicare oversight team for determination of CY2022 health plan changes.