Driving Accountability and Innovation in Pharmacy Benefits Management

Seattle | Feb. 4 from 8 AM to 12:15 PM

Agenda:

Hear from WHA’s Executive Director Denise Giambalvo, who has spent more than a decade working with employers and health plan sponsors on pharmacy benefits.

Rachel Means, the founder and CEO of Sage TPA, the third-party administrator behind Mark Cuban’s employee benefits, will join us as the keynote speaker. Means has unmatched experience negotiating contracts drive real savings for employers. A strong TPA can help bring an employer’s needs and culture forward to ensure the best pharmacy benefit program that puts the patient first without outsized costs.

Learn more about Sage TPA.

This session will explore how an employer’s aligned values-first approach to the RFP led to the Big 3 opting out of participating. Learn about what led them to take this approach, the integral role their independent consultant played, and the savings forecasted based on contract terms with their new Medication Benefit Manager (MBM) partner Ventegra, a community organization that leads with integrity and transparency.

Panel includes:

  • Michele Ritala, Benefits Strategist, King County
  • Tim Thomas, Owner, Crystal Clear Rx
  • Robert T. Taketomo, Pharm. D, MBA, President & CEO, Ventregra Foundation

 

 

There will be a short break to network with your peers and colleagues across the benefits industry.

Learn how an employer’s new understanding of the PBM industry prompted them to pursue an RFP to identify a partner that would remove misaligned incentives from their contract. Hear from their consultant how they tightly managed the process to include a large, mid-sized, and small PBM as finalists. Meet the PBM partner, AffirmedRx, a community organization, and learn how their values are reflected in their business practices.

Panel includes:

  • Sandra Spellmeyer, Total Rewards Manager, Port of Seattle
  • Ashley Vander Linde, Head of Sales, AffirmedRx
  • Kelvin Richards, Pharm. D, MBA, Vice President of Pharmacy Services, Aon

 

This closing session will synthesize the day’s discussions and tackle what hasn’t yet been addressed.

Confirmed panelists include: 

  • Michael Lee, Pharm. D, Clinical Account Executive, US-Rx Care
  • Mark Lyons, Principal, Business Development, Amazon Pharmacy
  • Alysha Fluno, Pharm. D, MBA, Partner, National Pharmacy Practice Leader, Mercer
  • Shawn Gremminger, President & CEO, National Alliance of Healthcare Purchaser Coalitions

Denise Giambalvo will wrap up the events with a look toward how WHA’s membership can build on what was shared to drive transparency and accountability in pharmacy benefits.

Speaker Bios:

Rachel began her career in benefits consulting in 2004 as an account manager for a Houston based consulting firm. Very shortly after, she was hired as a producer by a well-known, publicly traded firm, and began growing her knowledge in the self-funded large employer consulting space. Eventually, she left the corporate consulting world to find a better way to build transparent health plans from the ground up for Clients and their Employees, this was the start of EBC in 2016. EBC acquired the Benefits division of Threlkeld & Company in 2017 doubling the size of the business.

In 2023, Rachel formed and created Sage TPA to service the Clients who desired a better TPA partnership with transparency and innovation.

Rachel lives in Tyler, TX with her Husband Robert and has three boys – Caden, a student at Texas A&M(21), William(16), and Harris(10). She is a news enthusiast, always reading and researching new trends, ideas, and concepts. She enjoys spending weekends at the family farm in Corsicana, TX when she isn’t in the office. Rachel and Robert are also capital partners/operators in a few restaurant concepts and real estate projects in Texas.

As a business-woman, Rachel understands the burdens on decision makers that come with multi-location businesses in multiple industries. She can identify with the problems and challenges confronting her Clients both from competitors, and from regulators, and she deploys that capability to increase bottom line profits for every client.

Michele has 20+ years of experience in employee benefits and health plan management for public and private sector employers ranging in size from 3,000 to 100,000 employees. Early roles include manager for communications and appeals departments and a wellness program for a state administered health plan covering 240,000 lives. Michele worked on the employer purchaser side as the health benefits program manager for Washington’s largest energy company, and benefits strategist for the Washington State PEBB Program. Prior to working in employee benefits, Michele was the Public Information Officer for the Health Policy Analysis Program at the University of Washington School of Public Health. Michele earned a master’s degree in public administration from the UW Evans School of Public Policy and Governance. Michele has been with King County as their benefits strategist since 2019.

Tim Thomas is a graduate of the University of South Carolina College of Pharmacy and has built a career that spans both hospital and retail pharmacy. After residency training he served as Director of Pharmacy at hospitals and an HMO.

For more than 30 years, Tim has focused on managed care pharmacy, developing expertise in formulary design, pharmacy benefits, and data analytics. In 1993, he launched his first PBM company, growing it successfully before selling it in 1998.

In 2008, Tim founded Crystal Clear Rx, a pharmacy benefit consulting firm that helps clients get the most value from their PBM relationships. His team specializes in pharmacy claims analytics, auditing, and improving the overall performance of pharmacy benefit programs.

Tim has written and spoken on topics such as PBM transparency, auditing, and employee benefits, and remains passionate about helping organizations make smarter, more informed decisions about their pharmacy benefits.

Robert T. Taketomo, Pharm.D., MBA is a seasoned professional with more than four decades of experience and innovation in pharmacy, healthcare management, and business leadership. He holds a Doctor of Pharmacy degree from the University of Southern California School of Pharmacy and earned his Master of Business Administration from Pepperdine University. Dr. Taketomo’s expertise spans clinical, technological, business, and pharmacy practice areas.

Sandra Spellmeyer is the Total Rewards Manager at the Port of Seattle, where she oversees benefits for nearly 2,500 employees. With a strong foundation in the public sector, Sandra has over 18 years of experience and is passionate about designing holistic, value-driven benefit solutions that serve both employees and the organization. She has been instrumental in launching innovative programs that enhance employee well-being, streamline administrative processes, and promote transparency across the Port’s total rewards strategy.

Kelvin is a Vice President in our Pharmacy practice. In this role he is responsible for helping self-funded employer, hospital/health systems and public-sector clients manage their pharmacy benefit programs.

Ashley has worked in the health benefits industry for over a decade, with various roles in sales. Before joining AffirmedRx, she led channel partnerships at Amazon Care, Amazon’s virtual primary care model. In her role she worked with benefits consultants and brokers and developing partnership, referral and sponsorship agreements. Ashley also spent 8 years with Cigna in both international and domestic business as a New Business Manager connecting with benefit’s buyers to mitigate risk across all lines of business.

Michael Lee is a Clinical Account Executive at US-Rx Care, where he manages relationships with existing clients, serves as their primary clinical point of contact, and helps drive continued growth by delivering transparent, value-driven, and clinically sound pharmacy benefit strategies. He graduated from the Washington State University College of Pharmacy and completed a Managed Care Pharmacy Residency at Kaiser Permanente Washington. Before his current role, Michael managed drug coverage for a self-funded employee health plan and consulted on pharmacy benefit strategy and PBM RFPs. He is an active member of the Academy of Managed Care Pharmacy’s Northwest Affiliate. Outside of work, Michael enjoys traveling and playing tennis and other racket sports.

Mark brings a unique perspective to pharmacy benefits, combining frontline clinical experience with strategic healthcare innovation. He earned his Pharmacy degree from the University of Washington, following an early career as a high school science teacher where he developed his passion for education and communication.

Throughout his career, Mark has held leadership positions across the pharmacy ecosystem, including clinical pharmacy practice in hospital settings, pharmacy benefit management (PBM), and pharmacy consulting at a Blues organization. Most notably, he led pharmacy benefits strategy at Amazon, where he co-authored the foundational Amazon Pharmacy whitepaper and subsequently joined the implementation team to launch Amazon Pharmacy.
Today, Mark partners with large employers, small to medium-sized PBMs, and select benefit consultants to reimagine pharmacy benefits delivery. His work focuses on creating sustainable value for payers and patients while elevating the customer experience in an industry ripe for transformation.

Alysha is a senior healthcare executive with over 25 years of clinical, technology, and leadership experience; dedicated to transforming the pharmacy benefit industry. Based in Chicago, Alysha is Mercer’s National Pharmacy Practice Leader.

Dr. Hayes has over 40 years’ experience in the health care consulting and pharmacy benefit management industry. She is a founder of Pharmacy Investigators and Consultants (PIC) and is responsible for the strategic direction of the 30-year-old firm and is the lead project manager for the firm’s Fortune 500 companies, health plan and government clients. Dr. Hayes specializes in analytics and Big Data, Machine Learning and Data Science in healthcare to solve complex issues such as fraud detection, investigation and resolution. Both of her inventions, the COPsTM and CARsTM systems are trademarked products. She also assists clients with complex procurement projects (for Pharmacy Benefit Managers), audits and clinical and administrative consulting projects.

Dr. Hayes has published numerous professional and academic articles and provided expert witness services in over 35 key legal cases such as Rutledge vs. PCMA, providing key information that formed the winning opinion, adjudicated by the United States Supreme Court. Dr. Hayes has testified for the Committee on Oversight and Government Reform and for the Department of Justice and Federal Trade Commission. She is the author of a chapter on healthcare crimes in the textbook, White Collar Crimes: A Practitioner’s Perspective.

Simultaneous to her role at PIC, Dr. Hayes is the Director and Assistant Professional Practice Professor of the Health Informatics Master’s Degree Program for Roosevelt University where she oversees approximately 100 students’ progress, develops curriculum and teaches core courses.
Dr. Hayes has a Doctoral Degree in Criminology from the University of Portsmouth, United Kingdom, Centre for Counter-Fraud Studies, a master’s degree from Boston University and a bachelor’s degree from Northeastern Illinois University. She is a Certified Registered Pharmacy Technician in Illinois and a Licensed Private Detective in Illinois and Washington. Susan earned her Accredited Healthcare Fraud Investigator (AFHI) designation from the National Healthcare Anti-Fraud Association.

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