Meet the Candidates
All AMCP Active Members (Pharmacists, Physicians, and Nurses) are eligible to vote in the annual election to fill vacancies on the AMCP Board of Directors. A new President-elect, and three new Directors will be elected this year. The individuals elected will begin their terms at the conclusion of AMCP2022, Mar. 29 - Apr. 1, 2022, in Chicago. Directors serve on the Board for two years, while the President-elect serves a total of three years — one each as President-elect, President, and Immediate Past President.
AMCP uses electronic voting for its Board elections. Active Members will receive an email with voting credentials on Oct. 28, 2021 from our election services partner, Election Services Corporation. Online voting closes at 5:00 PM ET on Dec. 2, 2021.
Meet the Candidates for President-Elect and Director
Candidates' biographical summaries, platform statements, and responses to the ballot questions are provided below.
Candidates for President-Elect
2022 - 2025
James R. Hopsicker, RPh, MBA
Senior Leader, Health and Pharmacy Management
MVP Health Care, Inc.
PLATFORM STATEMENT
Based on the goals of AMCP’s new strategic priorities, explain how you would contribute to the success of AMCP during your term on the Board.
For AMCP to optimize value and access, continued focus must be on the identification and engagement of key stakeholders that can remove the barriers to enhance our patient’s health. The key to this engagement must be the bi-directional, interactive communication and sharing of ideas to bring forward actionable solutions to address value, access, and affordability. I have a proven record of bringing together multidisciplinary groups to achieve common goals.
In increasing awareness for its members, AMCP must continue to partner with its’ member organizations and members to highlight the role that managed care pharmacy can play to address the disparities in medication access, use, and outcomes. I believe that addressing social determinants of health is critical to optimizing medication use, and I have experience working with diverse patient populations to optimize medication use. I will bring forward those ideas and work to enhance our understanding and reduce current disparities in health care.
Smart membership growth is essential to allow AMCP to fulfill its mission to ensure that patients receive the medications they need at a price that they can afford. I have supported AMCP membership growth through mentorship, student scholarship, and the buddy program. Through these experiences, I will bring the first-hand knowledge on what works to grow membership. As we have all helped our families, friends, coworkers, and AMCP family through the pandemic, we need to strengthen what AMCP can offer to our communities to fulfill our mission.
ELECTION QUESTION
As the conversation around value in healthcare evolves, how can AMCP ensure actionable progress to support population health goals?
The conversation regarding value continues to evolve, and AMCP has made it one of their strategic priorities. AMCP needs to provide a platform to exchange ideas and then promote solutions that will improve medication use, engage its’ membership and external experts to endorse these solutions, leverage data and actual case studies that showcase the value of managed care pharmacy, and advocate to ensure these practices continue to be part of the toolbox for managed care health care professionals.
Specifically, AMCP can assume a leadership role to endorse managed care pharmacy through learning from the COVID pandemic, substance use disorder (SUD) awareness and management, value-based agreements, value frameworks and tools, biosimilar support, supporting/advancing quality issues, and the use of technology to support electronic prior authorization (PA) and other practices.
We all agree that the patient must be at the center of any conversation regarding health care. As a result of COVID-19, telemedicine, pharmacist as immunizer/tester, and pharmacy as care coordinator have provided enhanced opportunities for managed care pharmacy.
COVID-19 has also highlighted the continued issue of SUD and the increased need of patient support for behavioral health in general. As pharmacy is the most utilized service on a regular basis, I feel pharmacy can play an integral role in the overall success of population health goals related to mental health and substance use issues. AMCP continues to bring stakeholders together in SUD workgroups to help educate and bring forward solutions in this area.
AMCP must be a leader in support of Value-Based Arrangements (VBA) for medications. This must include education, advocacy to remove barriers that impede adoption (both regulatory and legal barriers such as Medicaid best price and anti-kickback statutes), and the development of a common framework for effective arrangements.
Value in health care conversations must include value frameworks and assessment tools. AMCP must be a key partner and engage multiple stakeholders to have open conversations with the goal to create and endorse validated frameworks that utilize real-world evidence. Continued use of subject matter expert panels such as the AMCP Partnership Forums will help raise awareness and create educational content to share with all stakeholders.
Biosimilar adoption and access must be a focus for the health care system. AMCP can assume a leadership role through stakeholder engagement and input, collaboration with BBCIC to evaluate funded research, support of educational sessions at AMCP meetings, and review/update AMCP’s policy on biosimilars.
Quality issues can have a profound impact on population health. Medicare STAR rating measures, Medicaid programs, and patient-reported outcomes are a few examples of key pharmacy areas to measure. AMCP needs to continue to engage other quality organizations (i.e., PQA, HQF, URAC) to develop an action plan to address key issues and engage its’ members.
AMCP must continue its work on electronic prior authorization and other technologies that support managed care practices. We must demonstrate the value under Medicare Part D, engage stakeholders, and reduce provider burden. We must develop research and create use cases that demonstrate the value of managed care practices.
I am a firm believer in the saying “what gets measured gets done”. For AMCP to ensure actionable progress is achieved we must set metrics and monitor success against those metrics, never forgetting that value is not just about cost, but must include other factors such as safety and access.
BIOGRAPHIC STATEMENT
Jim’s managed care career spans over 25 years with experience in Commercial/Exchange, Managed Medicaid, and Medicare Part D programs. As Senior Leader of Health and Pharmacy Management for MVP Health Care, a 700,000 member health insurance company servicing New York and Vermont, he oversees the development and maintenance of pharmacy policies, formulary management, and all pharmacy vendor relationships. Through partnerships with all stakeholders he is passionately committed to ensure high quality, cost effective use of medications and other therapies.
Jim is Adjunct Faculty at Albany College of Pharmacy and Health Sciences, is a student preceptor for three schools, and serves on the Board of Directors of the Alzheimer’s Association, Northeastern New York Chapter.
Jim has been an active member of AMCP for more than 25 years, previously serving on multiple AMCP Committees, the AMCP Northeast Affiliate Board and the AMCP Board of Directors.
Debra J. Minich, BS Pharm, RPh
Director, Client Services
Prescient Holdings Group
PLATFORM STATEMENT
Based on the goals of AMCP’s new strategic priorities, explain how you would contribute to the success of AMCP during your term on the Board.
It is an interesting and exciting time to work in managed care pharmacy. Healthcare will continue to be a prominent topic of discussion at the national level and AMCP has established itself as the leading professional association to help patients obtain medications they need at a cost they can afford. To that end, as a member of AMCP we all have an obligation to deliver on the promise focusing on the three strategic priorities; optimizing value and access, addressing health disparities, and supporting strong membership growth.
My years of managed care pharmacy experience and volunteering for the Academy in various capacities with increased leadership responsibility will serve me well if elected as President-elect. I have conscientiously chosen to contribute my time to the Academy supporting pillars such as the optimization of value and access by participating at Legislative Days in Washington, DC. Our team met with 16 representative offices to discuss topics relevant to value and access related to PIE.
The Academy continues to be an influential leader to address health disparities, as exemplified by upcoming meeting programming to assure members understand the issues and can develop effective methods to overcome the challenges.
I have served as the President of the Midwest Affiliate, with the Day of Education recognized as a hallmark success model such that other affiliates have also implemented similar programming which has contributed to strong membership growth.
I have a deep understanding of AMCP’s strategic priorities and would be able to quickly and effectively contribute as President-elect.
ELECTION QUESTION
As the conversation around value in healthcare evolves, how can AMCP ensure actionable progress to support population health goals?
One critical way to ensure actionable progress to support population health goals today is to holistically address the increased spend on specialty agents with roughly 50% of that is seen on the pharmacy side, while another 50% is attributed to the medical side of a member’s benefit. These agents have brought cures to diseases where no treatment was previously available or have improved outcomes significantly over previously available treatment modalities. While utilization of these agents is still low compared to traditional medications, they account for significant amount of every payers’ spend. The pipeline is robust and will continue to bring forward advances in patient care. The members of AMCP are in a unique position to assure we are good stewards of the total healthcare spend. Academy members have access to various educational, research and resources through both the Annual meeting and Nexus, for example, to engage in the discussion on how best to monitor and advocate the place in therapy for these agents with proven improved outcomes over what is currently available. Specialty agents by definition are high cost and require high touch to assure the member understands their disease, the agent’s administration/storage intricacies as well as potential adverse events and how to manage them.
The Academy is and will continue to be thought leaders in these strategic, clinically based initiatives. The Academy is a credible and authoritative voice as it relates to the various stakeholders monitoring specialty spend and trend, along with supporting the advent and utilization of biosimilars. Using managed care principles that have been proven time and again, our members are in an advantageous position to influence specialty agent utilization management tools assuring the right drug gets to the right patient at the right dose for the right length of treatment and the right price. I was taught this my first day in pharmacy school and our current students of managed care, through the Academy’s work with schools of pharmacy and student chapters are being trained to assure these principals remain. Now more than ever, as specialty and biosimilar agents can routinely cost thousands of dollars per month, to millions of dollars for a single dose, are these pillars of managed care critical to assure the affordability of the benefit is monitored for the longer term. We are seeing the opportunity to work with pharmaceutical manufacturers for outcomes-based rebates, which rely heavily on data. This is an interesting opportunity to reward agents that achieve the results seen in clinical trials and translate to real world experience.
It’s an exciting time to be in managed healthcare and part of an organization that takes its responsibility to provide leading edge delivery of quality and affordable healthcare as a strategic priority. AMCP members are the individuals who help patients receive the medications they need at a cost they can afford.
BIOGRAPHIC STATEMENT
As an active and dedicated member of the Academy for several decades, I have greatly benefitted from those who have served in leadership roles with the vision to optimizing medicines and improving lives. I have worked in managed care for over 30 years within a large health plan, a specialty pharmacy and several PBMs. Those roles have afforded me the ability to develop and implement innovative and evidence based clinical programs to numerous beneficiaries, while improving the value of the pharmacy benefit and patient outcomes. In addition to my work experience, my Academy work has included past Board Member, Chairperson of Membership, Organizational Affairs, past President of the Midwest Affiliate and other volunteer opportunities; a Conference Buddy and Diplomat for several colleges of pharmacies. The combination of my work experience and AMCP committee work will serve me well, if given the privilege to serve as a President-elect.
Candidate for Director
2022–2024
Jody H. Allen, BS, PharmD, FASHP
Clinical and Specialty Lead, CVS Heath, IngenioRx Division
CVS Health
PLATFORM STATEMENT
Based on the goals of AMCP’s new strategic priorities, explain how you would contribute to the success of AMCP during your term on the Board.
AMCP has three strategic priorities introduced in Spring 2021:
- Optimizing Value and Access
- Addressing Health Disparities
- Smart membership growth
I believe I can contribute to AMCP’s priorities from experience in leadership roles in public policy and advocacy and my passion for service to others, including AMCP, our members, and our patients.
It is critical to optimize health outcomes and improve access to care, advocacy, and exchange of ideas. AMCP members voices must be heard by policy makers about our critical role in helping patients get the medications they need at a cost they can afford. AMCP is off to a good start with our Partnership Forums, AMCP collaborate, legislative newsletters, “Where We Stand” statements, State Advocacy Leader program, and our Action Alerts. We need to continue more member involvement and support ongoing efforts by AMCP’s staff.
Health disparities continue to be a public health concern arising from social and economic inequalities, language, and cultural disparities and racial and ethnic discrimination--leading to differences in health care quality. We must learn how to address the effects of these factors on health care. Managed care pharmacists can play a major role by assuming leadership roles in building systems and increasing awareness to reduce disparities in healthcare.
Our work affects the health of millions of Americans. Our goal is to improve patient health by ensuring access to high-quality, cost-effective medications. MCP must continue to educate, advocate, and engage our membership in opportunities to optimize value and reduce health disparities in our ever-changing healthcare.
ELECTION QUESTION
As the conversation around value in healthcare evolves, how can AMCP ensure actionable progress to support population health goals?
Population health is identifying the right opportunity to enable proactive engagement. We need to create interventions while at the same time reducing spend and improving health outcomes. The goal of population health is the systematic and transparent delivery of services to improve the health status of a given population, ultimately delivering better outcomes at lower cost (Becker’s Hospital Review 2015). Population health management emphasizes prevention and wellness, reduction in waste, and recognition and elimination of health disparities.
Many factors contribute to population health including social determinants of health. These include poverty, education, and housing. Health outcomes of populations are often Influenced by social factors more than by medical care. Evidence increasingly shows that to improve population health and constrain the rate of growth in health care costs, it is necessary to address the underlying social determinants of health. As managed care pharmacy professionals, we must learn how to address the effects of these disparities on health care.
We can ensure actionable progress to support population health goals by assuming leadership roles to increase awareness and build systems to address inequalities. We should help patients get the medications they need at a cost they can afford and improve health outcomes. AMCP’s mission is to improve patient health by ensuring access to high quality, cost-effective medications. This mission is aligned with the principles of population health. We can ensure actionable progress toward population health goals through leadership, education, creativity, and collaboration with other disciplines and professions.
As managed care professionals, we must work in collaboration with others to improve health—focusing on proactive support to help patients achieve better adherence and improve medication therapies-- while controlling costs through managed care tools. We can work together to drive medical savings to reduce readmissions and closing gaps in care. Continuous and rigorous evaluation of emerging models of care are essential. AMCP and managed care professionals can be researchers to conduct studies to address and assess actions and health outcomes. We can evaluate the efficacy of interventions. We can assess models to address disparities. We can measure progress toward population health goals. AMCP can contribute through education and forums on the concept of population health, health outcomes and importance of eliminating disparities.
A goal of population health management is to improve the health of a population. We can achieve this by engaging patients as consumers by helping them make better choices about their own health, support wellness, and by providing the right care at the earliest time at the most cost-effective point in the care continuum. This is a significant departure from many health systems today, and will require developing new clinical, analytic, and coordination capabilities.
Population health management is not just a change in how a system operates-- it's a major change in the culture of healthcare delivery. Healthcare leaders, including managed care, will play a critical role in creating a culture of innovation. Such change will include engaging managed care clinicians as they work to meet new cost, value, and quality goals, and ensure that the commitment to delivering value is reinforced throughout the organization.
BIOGRAPHIC STATEMENT
Jody currently leads the clinical and specialty teams at CVS Health supporting the IngenioRx business. She has practiced in managed care pharmacy for over 20 years, serving in leadership roles as Vice President, Clinical Services, Express Scripts; Vice President, Clinical Account Management Medco Health; and Director, Account Management First Health Services (Magellan). She also served as Vice President, Public Policy and External Affairs at Medco Health Solutions.
She has served in leadership roles in several professional organizations including AMCP Legislative and Regulatory Action Committee (current member/past chairman); State Advocacy Leader (current member), Public Policy Committee(chairman); and Organizational Affairs(member). Jody as Chairman, Virginia Board of Pharmacy, and member for 8 years (appointed by Republican and Democratic administrations). She was adjunct faculty at Virginia Commonwealth University. She served as President of VSHP, ASHP Organizational Affairs (chairman), ASHP Legal and Public Affairs, ASHP Delegate for 8 years, and member of AJHP Editorial Board.
Jessica Daw, PharmD, MBA, FAMCP
VP, Pharmacy
Sentara Health Plans
PLATFORM STATEMENT
Based on the goals of AMCP’s new strategic priorities, explain how you would contribute to the success of AMCP during your term on the Board.
To optimize value and access, the conversation should focus on formulary decision making, value-based arrangements with both pharmaceutical manufacturers and physicians, affordability, and quality. My experience in improving patient outcomes and controlling rising healthcare costs through a focus on quality, medication therapy management, clinical programs, formulary and utilization management, value-based payment models, and PBM contracting will align to the AMCP strategic direction. I will utilize those experiences to provide input in driving the direction for the organization. To address health disparities, I will identify opportunities through day-to-day practice and research and help AMCP partner with patient advocacy groups to build awareness. I will encourage AMCP to convene subject matter experts in health disparities to identify best practices. Through smart membership growth, I will seek to engage members with all experience levels in managed care and support member recruitment that will align with our mission to bring professional growth opportunities to our overall membership. As an AMCP visionary, as well as through my own contributions to committees, educational programming, and volunteering at meetings, I have a strong understanding of what AMCP membership can offer. I will work to optimize the AMCP experience for all members. With over fifteen years of managed care experience in integrated delivery systems, I will provide AMCP with a unique perspective to contribute to the AMCP Strategic Plan.
ELECTION QUESTION
As the conversation around value in healthcare evolves, how can AMCP ensure actionable progress to support population health goals?
The conversation around value in health care aligns to the AMCP strategic priorities to optimize value and access. Optimizing value and access through formulary decision making, value-based arrangements, payment models, affordability, and quality are key to supporting overall population health goals and the mission of AMCP. Value needs to be differentiated from affordability and include a multi-stakeholder approach to defining outcomes and success.
Formulary decision making should incorporate both value and affordability. AMCP can continue to support best practices around defining the value of a drug and measuring affordability through the AMCP Format for Formulary Submissions. AMCP should build partnerships and convene organizations to identify improvements related to how decision makers incorporate value and affordability into the formulary process and the challenges they face. The conversation needs to be inclusive of healthcare disparities and how these are addressed, especially if the data is lacking.
Deciding which drugs will be covered on a formulary with considerations of value and affordability can often lead into value-based arrangements and changes in our payment models that incentivize value. These multi-stakeholder payment models should include value-based contracting with manufacturers, payment to retail pharmacies, and risk sharing models with physicians.
AMCP should support best practices for value-based contracts with pharmaceutical manufacturers for rare diseases, which are a small population, but a high per-member-per-month or one-time cost (gene therapy). These contracts should promote shared risk for the outcomes of a medication. Traditional diseases should also be supported for best practices, as these disease states are top drivers of total cost of care considering both the medical and pharmacy benefits. Measuring the real world outcomes of medications is important for moving value forward and meeting population health goals.
Moving away from fee-for-service arrangements and toward value-based care also supports population health goals. Value-based payment models allow the patient and population to be viewed in a more holistic way. AMCP should convene integrated delivery networks, accountable care organizations, and health plans to discuss how these arrangements can differ regionally and by design. Understanding best practices in these different scenarios will provide learnings for improving the process. These best practices should consider how to leverage the knowledge of a health plan in population health management and translate it into individual physician practices or groups. The focus should be on generating value in terms of cost-effective drug utilization, clinical opportunities to optimize medication use, reduce medical costs, and improve quality. Today most of these arrangements focus on physicians, but there is an opportunity to consider how we pay pharmacies differently in the future. Retail and specialty pharmacies can help to drive value through patient care with a focus on quality, including the ability to capture patient reported outcomes. Sharing data between the health plan and the dispensing pharmacy improves available information to enhance clinical programs and interactions with patients. Using both the pharmacy and physician relationships offers an opportunity to optimize drug utilization mix and coordinate care for patients.
AMCP has clearly identified value as a key strategic priority in future years. AMCP should be an organization that collects best practices, establishes pilot projects, and identifies available resources to innovate around value in healthcare. AMCP has an opportunity to be a convener of a multi-stakeholder group of people with diverse experience to promote and educate on new models of payment and value.
BIOGRAPHIC STATEMENT
Jessica Daw, PharmD, MBA currently serves as the VP, Pharmacy for Sentara Health Plans and has over fifteen years of managed care experience focusing in quality, medication therapy management, care management programs, formulary and utilization management, value-based contracting, physician risk sharing arrangements, compliance, and PBM oversight/contracting. She has experience in multiple lines of business – Commercial, Medicaid, Medicare, and Exchange.
Jessica has been a member of AMCP since 2004. She currently serves on the AMCP Board of Directors and has participated on both the Professional Practice Committee and Educational Affairs Committee, serving as a Chair for both. She also participated on the Nominations Committee. Jessica worked on the AMCP/ISPOR/NPC Comparative Effectiveness Research Collaborative and spoke at several events related to this project. She is also currently the Co-Chair of the North American Health Technology Assessment (HTA) Roundtable for ISPOR.
Jeffrey D. Dunn, PharmD, MBA
PLATFORM STATEMENT
Based on the goals of AMCP’s new strategic priorities, explain how you would contribute to the success of AMCP during your term on the Board.
I believe I have a unique perspective concerning how payers can Optimize Value and Access. Typically, value is defined as comparative outcomes divided by comparative costs. But as cost of therapies continues to exponentially grow, we need to figure out how to avoid the denominator dominating the value equation. As I have built and managed our P&T Committees, I have tried to focus on comparative cost effectiveness, essentially discussing clinical and cost at the same time, not separating them and thereby “siloing” them (further misaligning incentives). I can bring additional experience concerning novel benefit designs that focus on managing costs while addressing member affordability (multiple specialty tiers, appropriate closed formularies, etc.).
AMCP can help Address Health Disparities by defining and implementing future roles of health technology (apps, digital therapeutics, data aggregation, registries, etc.). Further, we can bridge the gap between population management and individual outcome maximization. Approaches to definitions and solutions regarding social determinants of health can be shaped by proactive AMCP research, education, and advocacy.
Smart Membership Growth is crucial to maintain the important role that AMCP has regarding regulation, advocacy, and education. We can focus AMCP programs on pharmacy schools and state chapters. Resources can be directed to exposing more people to the opportunity and advantages of managed care.
As a Board member, I will help AMCP continue to be THE voice for managed care issues as regulation focuses on pharma and payers – we can’t let third parties dictate our role in the delivery of quality, cost-effective health care.
ELECTION QUESTION
As the conversation around value in healthcare evolves, how can AMCP ensure actionable progress to support population health goals?
AMCP plays a crucial role in the advancement of managed care pharmacy. It is a place where disparate stakeholders can come together in a collegial setting to share ideas and work together to find common goals. AMCP advocates on behalf of managed care pharmacy to ensure that the interests of the members and the patients they serve are considered in federal and state health care policy decisions that could impact the profession. The Academy also represents managed care pharmacy in meetings with federal agency officials and by submitting comments on proposed rules and regulations.
AMCP must be the facilitator of “fair” legislation initiatives. We need to continue to partner with patient advocacy and external groups such as ICER and NCCN to find “better” ways to support appropriate utilization; and find ways to have pharmaceutical companies and payers find common ground – it may be too difficult to address transparency and pricing, but we can focus on education, social determinants of health, and advancement of more appropriate quality metrics. AMCP can assist in driving improvement in healthcare delivery by sharing examples of how payers have been successful in meeting quality metrics, improving care management and disease management, and bending the curve in drug costs.
In my opinion, affordability is, if not the biggest issue, one of the most important things that will impact long-term outcomes moving forward. As long as risk for costs is one-sided, members will continue to bear the brunt through exclusionary formularies, increasing premiums and deductibles, and more co-insurance. The system cannot continue to afford therapies which means we cannot leverage the science and improvements in treatments that could change the course of the patient journey.
Subsequently, social determinants of health will be much more important moving forward. These will inform population health initiatives. The stated goal of population health is to improve the quality of care and outcomes while managing costs for a defined group of people. The defined group of people and the health management interventions can be identified by demographic differences, health needs such as chronic diseases or disabilities, or the health needs of the underserved. This doesn’t fully explain or acknowledge the role that different stakeholders (providers, pharma, and payers) must take to impact those outcomes.
Further, the CDC “views population health as an interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally. This approach utilizes non-traditional partnerships among different sectors of the community – public health, industry, academia, health care, local government entities, etc. – to achieve positive health outcomes. Population health brings significant health concerns into focus and addresses ways that resources can be allocated to overcome the problems that drive poor health conditions in the population.
Therefore, AMCP can be, and must be, the entity that drives the focus on population health. We have the data and resources to be on the forefront of changing how health care is delivered so all patients can continue to have access to needed resources.
BIOGRAPHIC STATEMENT
I have been in managed care for 20+ years working for a regional health plan/IDN, regional PBM, national PBM, and employer coalition. During this time, I have been actively involved in all end-to-end pharmacy and formulary issues, including P&T, rebates, clinical programs, industry relations, etc. I have always been an active member of AMCP, including being a founding member of the Utah AMCP chapter, where I have served as Vice President and President, as well as moderating and speaking in over 2 dozen symposia at national meetings. My wife and I have endowed a pharmacy scholarship at the University of Utah for students interested in managed care. I have been directly involved in developing managed care residency programs at SelectHealth and VRx and we also precept pharmacy students from many different schools. For years I have helped teach sections of managed care classes at the University of Utah.
Manjula D. Jayabalan, PharmD, MBA
Director of Drug Trend & Formulary Rebate Strategy
Express Scripts
PLATFORM STATEMENT
Based on the goals of AMCP’s new strategic priorities, explain how you would contribute to the success of AMCP during your term on the Board.
The AMCP Strategic Priorities are optimizing value and access, membership growth and addressing healthcare disparities. My professional work experience in managed care pharmacy combined with my years on AMCP committees, accepting roles of increasing leadership has provided me a thorough understanding of the AMCP organization and the landscape of managed care. As President of Midwest AMCP, I organized our regional conferences, which are widely recognized as a beacon of excellence in multistakeholder dialogue and collaboration. These experiences and my payer learnings provided me with the knowledge and perspective to contribute to value, access and affordability initiatives so we can deliver on our promise to help patients get the medications they need at a cost they can afford.
I am passionate about member engagement and advancing the managed care profession. As a diplomat, I learned that early career engagement of students yields lifelong AMCP members. I believe that our members are our greatest strength. Investing in our existing membership by providing expanded resources to position them as thought leaders and brand ambassadors will drive interest and new members to the organization.
As a brown, immigrant woman, I am passionate about addressing healthcare disparities. The COVID-19 pandemic’s disproportionate effect on communities of color have highlighted racism as a public health crisis. I believe we need to incorporate actionable and measurable social justice initiatives throughout AMCP’s strategic planning. I will work to ensure this remains a priority and that AMCP is viewed as a catalyst for these necessary changes within our healthcare system.
ELECTION QUESTION
As the conversation around value in healthcare evolves, how can AMCP ensure actionable progress to support population health goals?
Pharmaceutical pricing and medication access are public health issues that have drawn national attention and justified scrutiny from politicians. Simply lowering costs without attention to population health outcomes achieved provides an inflated sense of savings and impedes efforts to shift from our current “sick care” model to a focus on preventive care. This balance of outcomes with costs has come to represent “value” within our industry.
Value, however, is in the eye of the beholder. AMCP can play a crucial role in balancing opposing viewpoints, goals and ideologies in what defines value within our diverse membership, comprised of various stakeholder perspectives. We need a patient-centric approach to define value as it provides a unified vision that will resonate with our many stakeholders including payers, manufacturers, patients and providers: We can all agree that our patients are our paramount priority. This provides common ground for these entities to work together towards a shared set of goals supporting population health outcomes.
AMCP should continue to provide forums that allow for collaboration, dialogue and idea exchange between various participants. AMCP can play a key role in identifying best practices for payment models and benefit designs that incentivize value as these are commonly used mechanisms to support population health outcomes. This can include assessments of value based contracting, physician risk models tied to cost and quality goals and benefit designs that reward or incentivize positive patient behaviors or medication adherence. AMCP can leverage the expertise within our membership and invite members to share their innovative programs, pilots, learnings and best practices that others can implement and perhaps help establish industry standards. Exceptional work uncovered within these forums can be recognized through national awards and it can also be extrapolated into key learnings for educational programming.
AMCP needs to maintain its visibility and influence within the legislative and regulatory arena. AMCP has made great strides by making preapproval information exchange (PIE) a top federal legislative priority for several years. This has allowed population health decision makers sufficient time to appropriately evaluate the value of new and breakthrough therapies. The success of PIE highlights opportunities for AMCP to continue to introduce new legislation that can positively impact patient health outcomes while aligning various stakeholder perspectives. AMCP must also continue to be vocal on other legislative issues such as biosimilars and drug pricing as they ultimately impact patient outcomes.
As the field of population health management evolves, it is imperative that related continuing education programming is expanded both in terms of the number of programs offered as well as the way in which it is developed. For example, there has been increased attention in recent years to social determinants of health (SDOH) which has major impacts to health equity initiatives and population health outcomes. Given the broad reach of SDOH, the development of educational programming must be through a multidisciplinary lens that includes input from social workers, behavioral health experts, pharmacists practicing in various settings, physicians and educators, among others. This can be used to create standards and a framework for the development of educational programming targeting SDOH and other population health initiatives. AMCP can also encourage pharmacy schools to include a greater focus on population health outcomes within their curricula. Educating our existing membership while also developing future pharmacists to expand their knowledge and skills in this area is crucial to the long-term success of population health outcomes programs and initiatives.
AMCP is nationally recognized as the leading voice and pioneer in driving value of pharmaceuticals to make progress towards achieving population health goals. Together, we as AMCP members, can make these goals a reality.
BIOGRAPHIC STATEMENT
Manjula has been an active member of AMCP for many years, serving on national committees, leading advocacy focused advisory groups, serving as a diplomat and taking on board roles as past treasurer and current President of the AMCP Midwest Affiliate. She also has committee experience within Michigan Pharmacists Association. In 2019, she received the AMCP Grassroots Advocacy award.
Manjula Jayabalan has significant managed care experience across multiple disciplines and lines of business spanning both PBMs and health plans. Manjula is the Director of Drug Trend and Formulary Rebate Strategy at Express Scripts. She creates client solutions that optimize value by providing financially sustainable access to clinically appropriate therapy. She also has extensive client experience, focusing on maximizing savings while achieving optimal population health outcomes. Dr. Jayabalan has experience teaching, mentoring and precepting pharmacy students interested in managed care. She also has experience in community pharmacy and drug research.
Matt Mitchell, PharmD, MBA, FAMCP
Executive Director, Pharmacy
SelectHealth
PLATFORM STATEMENT
Based on the goals of AMCP’s new strategic priorities, explain how you would contribute to the success of AMCP during your term on the Board.
Current leadership within AMCP have identified several relevant and timely strategic priorities in 2021. Never has there been a more important time than now to optimize access for drugs and technology based on their true value. However, access alone is not adequate. Afterall, a drug of value can be put on formulary and not get utilization. I have experience in several capacities educating providers and members about which drugs and technology bring value. This is well beyond sending a PDL or list of formulary changes. I have been integral in rolling out different programs in order to help members not only understand cost-effective options but help them work with providers to obtain them. These efforts have helped with member satisfaction and engagement allowing for better outcomes in addition to cost savings. In the last 20 years I have also had many opportunities to work with provider groups to understand what motivates them to change their practice, if needed, to optimize use of products bringing the best value.
If elected, I will work with AMCP to promote transparency tools for members and providers. Examples of these tools for members include specific cost-savings options through apps, mail, and text, in addition to education, helping members understand the importance of all their medications and how to obtain them while fitting the needs of different populations. I will also work with AMCP to further define materials for PBMs and Health Plans in order to deploy expansive tools for providers such as real-time benefit checker.
ELECTION QUESTION
As the conversation around value in healthcare evolves, how can AMCP ensure actionable progress to support population health goals?
Form a utilitarian standpoint, effective population health is the holy grail. If we have learned anything from Indiana Jones and Monty Python, the holy grail is difficult, but not impossible to obtain. With up to 30% of the health care dollar tied to pharmaceuticals, optimal drug management is key to quality and affordability and is an integral variable within population health.
In 2017, I was able to work with other members of the Professional Practice Committee who drafted and published a white paper on Population Health Management. These concepts and principles have not changed in the last four years. The identified requirements include improvements in health information technology and robust data sharing as well as new care delivery models. Four years later there are still huge gaps in these areas needed to execute and maintain population health. While there are pockets across the country doing well within portions of their population, population health is not consistent nor is it expansive or optimal across the country.
AMCP should partner with organizations with expertise in pharmacy specific health information technology identifying even one or two opportunities for pharmacists and other health care providers to improve patient care on a broad level. While CMS and HEDIS have identified benchmarks for incentives and accreditation, currently there is a lack of benchmarks for payers to compare best in class health information technology. As standards are set on a broad level, AMCP can help payers hit targets of the triple aim. One key component will be AMCP publishing tool kits for payers to use in order to achieve their identified health information technology targets.
Implementation of new care delivery models is a colossal task. Most would even say insurmountable across all lines of business, especially in Commercial populations. Many different types of population health-based models have been implemented across the county. However, there is a knowledge gap for payers and PBMs looking for best practices. It is difficult to know the number of different models, especially those outside of Managed Medicaid, Managed Medicare, and Comprehensive Primary Care Plus type models. Another gap is identifying the number of lives attributed to these different models. With these numbers, one can really assess the need and opportunity.
While populations within Medicaid, Medicare, and Commercial products are very different, there are superior pharmaceutical management techniques that can be used in a similar fashion across the population health models of care. AMCP needs to evaluate programs used by the top payers and health systems. Understanding the models used by these systems which integrate payers, providers and patients will help all stakeholders of AMCP. After top programs are identified, AMCP can work on education series for AMCP members in order to implement specific opportunities. Partnering with other professional pharmacy organizations as well as other proactive health care organizations such as NAMCP will help expedite implementation efforts. While there are current challenges with population health, including pharmaceutical management, there are several opportunities for AMCP to support payers meet these challenges.
BIOGRAPHIC STATEMENT
Matthew Mitchell, PharmD, MBA, MHP, FAMCP is Executive Director of Pharmacy Services for SelectHealth, in Salt Lake City, Utah. Dr Mitchell oversees clinical programs, savings initiatives, pharmaceutical rebates and the specialty and infusible drug network contracting in the management of well over $1 Billion in pharmacy and medical injectable/infusible drug claims annually. He chairs the Pharmacy and Therapeutics committee, as well as several other high-level management strategy and operational committees. A few of his areas of expertise include specialty drug management, pharmacy benefit management, health-system pharmacy integration, outcomes research and operational effectiveness. He is actively involved in several professional societies and was recognized as a Fellow of AMCP in 2014. He has published numerous papers and sits on the editorial board for several peer-reviewed journals. While not working, you will likely see Dr Mitchell at one of his kids’ soccer, basketball, or football games.
Carly F. Rodriguez, PharmD, FAMCP
Vice President & Chief Pharmacy Officer
Moda Health
PLATFORM STATEMENT
Based on the goals of AMCP’s new strategic priorities, explain how you would contribute to the success of AMCP during your term on the Board.
AMCP’s new strategic priorities focus on optimizing value and access, addressing health disparities, and strategic membership growth. Having served on the Board of Directors as these strategic priorities were vetted and adopted, I am well positioned to contribute to AMCP’s success in achieving these priorities. With the emergence of accelerated approval pathways and the medication pipeline expanding with innovative yet high-cost therapies, assessing value and ensuring affordable access to new treatments continues to be of critical importance. Coupled with this, is the need to create benefit designs and value-assessment frameworks that address health disparities.
If re-elected, I will continue to work with the Board, AMCP staff, and other AMCP leaders to position AMCP as a catalyst to ensure equitable and affordable access to medications. These engagements can include developing policy, generating position statements, establishing partnership forums, creating educational programming, and promoting research that informs how value assessments and benefit design can evolve to address health disparities. These efforts can also support smart membership growth by engaging related healthcare disciplines to further inform AMCP’s direction. For example, engaging healthcare actuary professionals can inform benefit designs and their associated impact on affordability, while at the same time expanding AMCP’s membership to a related and critically important discipline in managed care. Diversifying the AMCP membership to related professions presents opportunity to broaden educational program offerings for all members. As a Board member, I will work with AMCP staff and Committees to engage professional organizations representing professionals that we wish to target for membership.
ELECTION QUESTION
As the conversation around value in healthcare evolves, how can AMCP ensure actionable progress to support population health goals?
Population health management is a growing area of interest and focus across nearly all segments of healthcare. To identify, establish, and measure goals related to population health it is critical to understand all factors that contribute to healthcare trends. Population health programs require clinical, utilization, and cost data to manage them effectively. While many managed care pharmacy professionals may not be trained in conducting healthcare data analyses, being able to interpret these analyses and provide actionable recommendations is a critical skill to be successful in population health management.
Value-based benefit design and value-based payment models are frequently used tools to promote population health management goals. Examples can include waiving copayment/coinsurance or deductibles to influence or reward healthy behaviors, establishing risk-sharing agreements with providers for quality and cost measures, and creating benefit designs that encourage participation in high value programs or services. Some states have passed legislation, or have otherwise made commitments, to increase the proportion of healthcare payments that are tied to value. As medication spend under both the medical and pharmacy benefits continues to comprise a larger portion of the overall healthcare spend, managed care pharmacy professionals must ensure that medication management is included in models aimed at meeting those commitments. Medications are a critical component of chronic disease management, so promoting medication adherence and incentivizing optimal medication utilization can play an important role in overall program success. Pharmacists are uniquely qualified to build and refine these programs over time.
AMCP is well positioned to support progress towards population health management goals given its broad reach and thought leadership within the managed care community. Managed care pharmacy professionals who have the skills and experience necessary to effectively design and implement population health and value-based care programs typically acquire these skills through on-the-job training. AMCP should grow this knowledge base by creating forums for sharing best practices across interdisciplinary teams, establishing educational programming, encouraging research, and providing training programs.
Continuing education is important for managed care pharmacy professionals to make meaningful contributions towards reaching population health management goals. For example, social determinants of health such as education, employment, and access to healthcare have major implications for program success. AMCP should foster learning in these areas by bringing together thought leaders across various disciplines, such as medicine, social work, and pharmacy, by forming a partnership forum or advisory group to share best practices. One goal of these collaborations should be to provide direction to the AMCP Educational Affairs Committee on developing educational programming for national meetings. This programming will provide an accessible venue for the broader membership to build or enhance their skillset in an area that is so critical to population health management.
The evolution of population health programs is data-driven. Another educational need is training around clinical, utilization, and cost data interpretation. As managed care pharmacy professionals develop and inform pharmacy aspects of population health models, they must have the skills to critically evaluate a variety of data to identify trend drivers which will influence program improvements. AMCP should partner with other organizations to develop training programs to help members build these important skills.
While these ideas are targeted towards existing membership, AMCP should build upon these programs to influence curricula within schools of pharmacy to introduce these critical skills to students early in their careers. These opportunities can position AMCP to not only support, but lead actionable progress towards population health goals. As experience is gained through facilitating education and information exchange, AMCP should provide leadership in defining the role of pharmacy within population health models, which will help states, providers, and payers reach their goals.
BIOGRAPHIC STATEMENT
Carly Rodriguez is Vice President & Chief Pharmacy Officer at Moda Health where she provides strategic leadership for clinical initiatives, operations, innovation, and integration of medication management across pharmacy and medical benefits. She has spent her entire career in managed care pharmacy, including in several leadership roles.
Carly is an active AMCP member of 13 years and was recognized as a Fellow in 2019 for exceptional contribution, commitment, and sustained excellence in managed care pharmacy. She currently serves on the AMCP Board of Directors and is a Past President for the Northwest Affiliate. She is most proud of her career-long dedication to mentorship of pharmacy students. She is Diplomat to University of Washington, is a past Chair of the Schools of Pharmacy Relations Committee, and has provided student programming at AMCP meetings.
Carly earned her PharmD from University of Washington and resides in Oregon with her husband and three children.