Strategies to Address Rising Pharmacy Costs

It’s no secret that rising pharmacy costs are a serious challenge for health plans. Cumulatively from 2013 to 2018, prescription drug spending is projected to rise by an average of 7.3 percent annually compared to a projected 5.2 percent growth in total personal health care services. One area that increasingly accounts for a significant proportion of overall health care spending is specialty drugs.

But how are drug prices determined, and what strategies can you implement to address these growing costs? Presenters will discuss the trends in growing pharmacy costs as compared to overall health care spend. In addition, presenters will review drivers of specialty pharmacy spend and discuss drug cost management strategies.

The presentation will conclude with a Q & A session to allow participants to engage with presenters.

We invite you to join Pete Biagioni, Managing Partner at Cumberland Consulting Group, and Marcia Lambert, Partner at Cumberland Consulting Group, for this informative webinar.   Click here to register.


Ferris Taylor, Board Chair, Healthcare Executive Group


Pete Biagioni,

Managing Partner, Cumberland Consulting Group

An industry veteran, Pete has more than 25 years of experience in executive positions with healthcare IT companies and management roles with “Big 5” consulting firms. Prior to joining Cumberland as Managing Partner of the firm’s Payer Division, Pete was president and CEO of Oleen Pinnacle Healthcare Consulting. His areas of expertise include: Health strategy development and deployment; operations; sales and business development; organizational engineering; IT systems selection, planning and architecture; vendor contract negotiation; budget creation and management; customer management; and investor relations.


Marcia Lambert,

Partner, Cumberland Consulting Group

With nearly 30 years of experience in solution delivery in the pharmaceutical and biotech industries, Marcia Lambert is an IT executive who offers a unique blend of sharp business acumen and strong technical expertise. As partner of Cumberland’s Life Sciences Division, Marcia serves as a trusted adviser for her pharmaceutical clients across the country. Having held leadership positions at pharma manufacturers, consulting firms and software vendors, Marcia has a well-rounded view of the industry and brings thoughtful insight to every engagement.

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Value Based Care: Transformation Through Collaboration

The transformation of healthcare towards value-based reimbursement continues unabated.  Payers and providers are working to achieve the Triple Aim, leveraging evolving alternative payment models. Payers continue to implement value-based strategies to shift risk to provider groups and implement programs while struggling with provider buy-in, expertise, infrastructure and capital requirements. While payers continue to look for ways to increase the total amount of premium dollars they pay for value-based care, the recent launch of Next Generation ACOs and the implementation of MACRA add new opportunities for providers to engage and progress down the path of accepting risk.

Successful implementation of alternative payment models will rely on the implementation of successful IT interoperability. Several health delivery systems currently exchange data successfully. However, the ability to effectively share information to support care collaboration tend to be limited to large Integrated Delivery Systems, large Provider Groups, and ACOs.

During the presentation, we will discuss the current state of industry transformation and IT interoperability and the correlation to the successful migration to a value-based healthcare delivery system. Through the presentation we will lay out the three key steps you should take to assess your organization’s readiness for value-based care:

  • Discover how to determine the human and technology resources required to facilitate transformation
  • Evaluate what type of changes to workflows must occur to deliver value-based care
  • Discover how to develop a phased payer-provider collaboration and engagement plan

If you are interested in joining this cutting-edge conversation click here to register


Norberto Correa

Senior Director of Consulting – Change Healthcare

Mr. Correa is a seasoned healthcare executive with varied experience in the academic, hospital and managed care business sectors. His areas of expertise are: Integrated Healthcare Delivery Systems, Information Technology, Health Plan Operations, Value Based Payer and Provider models. He has led several complex projects that have resulted in organizational improvements, efficiencies, growth, and profitability. He has also developed and deployed Population Health and Value Based Reimbursement model strategies that include ACO, IPA, Risk, and Shared Savings Medicaid and Medicare payer networks..

Provider and Payer Integration: the Eight Questions You Should Be Asking Yourself

Payers and providers are being challenged to achieve the heady task of improving the quality of patient care while managing to rising costs of delivering that care. Fortunately, CMS is supporting the health care industry through the investment of millions of dollars to help providers acquire systems to promote the creation of environments to enable interoperability across organization boundaries.

Organizations will need to have patience to address both organizational and technical barriers while recognizing the need to push forward as an industry to make progress. These efforts are not for the faint of heart, nor will they be addressed in a short-time frame.

We invite you to listen and discuss how we as organizations move forward with these business ventures and ask, What are the critical success factors that need to be addressed to help mitigate risks and improve the likelihood of success.


  1. The Business Strategy Perspective
    1. Business impact of various novel payment models
    2. Macro trends driving the market towards payment models
  2. The Technology Perspective
    1. First understand the business drivers and strategies and the new ecosystem you must navigate
    2. It is all about the data and who needs access to it and in what form
    3. Next define the requirements for technology strategies for payer and provider integration it is all about interoperability and access to data
    4. Align business requirements with the overall technology strategy and architecture
    5. Create a program approach that establishes governance and aligns incentives
    6. Use standards and get others to use these standards
    7. Establish interim goals

If you are interested in joining this cutting-edge conversationClick Here to Register

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How Total Consumer Health is Impacted by Technology and the Human Touch

As value-based care continues to impact the provision of key healthcare services, health plans and providers are seeing an urgent need for improved collaboration centering on the individual member. Total consumer health increasingly relies on innovative technology systems to incorporate data based on life issues and social determinants of health. Providers and care givers must assess, capture and integrate key information that goes beyond mere observation.

By leveraging a mix of actionable data insights and on-the-ground support, health plans are in position to integrate critical technology with a high touch and hyper local approach to care coordination. Total consumer health outcomes are improved when key social determinants are combined with important medical information.

Join Dr. Alan Spiro, MD, MBA, Chief Medical Officer at Medica, and Harry Merkin, Vice President of Marketing at HealthEdge for this informative webinar.

Attendees will learn:

    • The appropriate balance between high and low tech options for care coordination
    • How to incorporate innovative tools and methods to address social determinants of health and other factors
    • Real-world examples of innovative collaborative arrangements that are making a positive impact on outcomes

If you are interested in joining this cutting-edge conversation click here to register


Dr. Alan Spiro, MD, MBA, Chief Medical Officer, Medica

As Chief Medical Officer, Dr. Spiro has overall responsibility for the work of Medica’s Health Management segment. This includes working with Medica’s provider partners to develop new models of collaboration aimed at improving quality, patient experience and value. It also includes working with Health Management staff and leaders from other Medica segments to build on the work currently underway to improve the quality and cost of health care.

Most recently, Dr. Spiro served as executive vice president, Chief Medical Officer and Chief Health Assistant for Accolade Inc., which provides specialized, on-demand health care services to employers, health plans, and health systems. Previously, Dr. Spiro had a leadership role with Anthem Inc., a managed care system that is part of the Blue Cross and Blue Shield Association. Dr. Spiro has also served as a national health care consultant for Towers Perrin and the Venlo Group. He has been a visiting professor at several universities, including the Harvard School of Public Health, and a frequent speaker at national conferences for organizations such as the Association of Health Insurance Plans (AHIP).

Dr. Spiro holds a Doctor of Medicine degree from the Columbia University College of Physicians and Surgeons and a Masters of Business Administration degree from the Northwestern University Kellogg School of Management.

Harry Merkin, Vice President, Marketing, HealthEdge

Harry Merkin is a senior marketing executive and is responsible for the company’s demand generation programs, strategic partnerships, product marketing and thought leadership initiatives. He also frequently represents HealthEdge as a speaker at industry conferences and events. Harry has collaborated with many transformative entities across the healthcare landscape including both payers and providers. Prior to HealthEdge, he was Vice President of Product Marketing at Evariant, a healthcare CRM company serving large health systems. Before that, he was Senior Director of Product Marketing at NaviNet, where he helped launch NaviNet Open, a multi-payer portal network serving a wide variety of health plans. Prior to NaviNet, Harry held senior marketing positions with Exact Software, an ERP company serving small and medium size manufacturers, General Electric’s Intelligent Platforms division and Intellution, an industrial automation software company. He holds a B.A. degree in Economics from Brandeis University.

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Ensuring Your Meaningful Use Funding and Avoid the Ticking Time Bomb

HighPoint Solutions delivers practical solutions that solve strategic problems. They partner with their clients in the healthcare and life sciences industries to provide direct access to the people and technology that get things done. On every project, with every client, their objective is to build a better way of doing business.
During this webinar HighPoint Solutions executives Jim Slubowski and Jay Fisher will discuss Meaningful Use Audit, from the perspective of an auditor and present best practices for evaluating provider attestation (pre-submission) against the potential of being selected for CMS audit. The team will provide insights and industry expertise on:

  • The characteristics of documentation to provide a sound audit defense
  • Discuss mock audit, from engaging independent third parties, to the creation of strategies that enable internal audit teams to effectively deliver mock audit
  • Educate on preparations for attestation through 2021 with retroactive auditing and increased scrutiny
  • Discuss where Meaningful Use fits in over time
  • Discuss a broader overview of CMS compliance requirements, with an eye towards the impact on providers and potentially on payers

If you are interested in joining this cutting-edge conversation click here to register.



Jim Slubowski

SVP, Healthcare at HighPoint Solutions, LLC

Jim is Senior Vice President of Healthcare Solutions at HighPoint Solutions. Jim is responsible for business and financial growth, new product/service development, strategic planning, business partnerships, and staff development across our healthcare practices.
Prior to joining HighPoint, Jim spent 14 years as CIO and VP of Enterprise Operations at Priority Health. He has also held senior positions as JS Advisory Services, Ernst & Young, and Henry Ford Health System. His academic credentials include a B.A. in Computer Science from Wayne State University.

Jay Fisher

Partner, HighPoint Solutions LLC

Jay Fisher is an accomplished leader, organizer and teacher when deployed by his clients in a project or program management role. His education as a CPA fosters a predisposition toward objectivity and metrics-based management, which results in clear, concise communication to all involved a primary key to success on any large endeavor.
He led a team of developers and auditors in the creation of a software tool for Meaningful Use administration, which today supports over 40 hospitals and 5,000 physicians in creating efficiencies around Meaningful Use Management. His team also manages compliance help desk around these complex regulations, and supports annual Mock Audits of Meaningful use.

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From Concept to Reality: Practical Considerations of Implementing Alternative Reimbursement Models

Various ways of reimbursing medical providers have come in and out of fashion over the last 20 years and many thousands of words have been written on the topic but often from a theoretical, what if perspective.

From Concept to Reality: Practical Considerations of Implementing Alternative Reimbursement Models will do just that present and discuss concrete, real world experiences of payers and providers seeking to reengineer the way we pay for care with the goal of driving value in place of volume. We will eschew theory and talk only about on-the-ground efforts: what works, what does not, overcoming barriers, and developing payer-provider relationships that align incentives. After listening to our panelists you should have information on which to base a realistic approach with which to design and implement reimbursement which supports the volume-to-value revolution.

David DiLoreto, MD -Chief Executive Officer at Presence Health Partners – will talk about how delivery systems are responding to new reimbursement models and provide his perspective on ways payers can work more effectively with their networks.

Dan Tuteur – Chief Strategy Officer at Colorado HealthOP – will share his lessons from developing innovative reimbursement methods in a startup health plan forging brand new provider relationships.

Craig Samitt, MD, MBA – Partner and Global Provider Practice Leader – will talk about actualizing the vision of changing physician behavior by aligning incentives based on his personal experience.

After their respective brief presentations the panel will take your questions and engage in a lively discussion.

How to Participate

No Registration is Required.

Before The Event:

  1. Download the Meeting Planner (Above): It contains the dial-in number required for the event.

On The Day Of the Event:

  1. Dial-in to Conference Line 877.345.2580,622.61.750#
  2. Listen in and ask your questions at the end



Catherine Roth

Vice President at HTMS

Catherine Roth, a vice president at HTMS, has over 25 years of experience working with both health plans and healthcare providers. Her background includes co-founding and serving as president and COO of a major payer systems software company, serving as CEO of a for-profit subsidiary of the California Medical Association, and developing the business plan and leading operations of a messenger model PPO. She has a masters in public policy from the Goldman School, University of California, Berkeley.

David DiLoreto, MD

Chief Executive Officer at Presence Health Partners

Dr. DiLoreto leads the strategic advancement and development of innovative population health capabilities for Presence Health Partners, Presence Healths physician-led, clinically integrated payor/accountable care organizations. In 2009, he joined the organization as the first Chief Medical Officer for the former Resurrection Health Care and later became the Chief Clinical Operations and Innovation Officer for Presence. Prior to joining Presence, he was Senior Vice President and Chief Medical Officer at Baptist Health Care in Florida. He received his doctor of medicine from the University of Florida and his MBA from Emory University.

Dan Tuteur

Chief Strategy Officer at Colorado HealthOP

Dan Tuteur has 35 years of diverse experience in health care in Colorado, much of which has been centered on improving services to low income people. From 1980 to 1995, Dan held a variety of administrative and financial leadership positions at National Jewish Health, a national referral center and research institute for respiratory and immunologic disorders. Between 1995 and 1997, he was Chief Financial Officer at a fledgling nonprofit Medicaid health plan, Colorado Access. In 1997 he became the first Chief Executive Officer of the Colorado Community Managed Care Network (CCMCN), a shared services organization for Colorado's Federally Qualified Health Centers. CCMCN's scope included managed care contracting, quality improvement programs, electronic health record support and data aggregation. CCMCN grew from a startup to an organization of over 20 employees in 2012 serving 17 FQHCs along with client organizations beyond the FQHC domain.

Craig Samitt, MD, MBA

Partner and Global Provider Practice Leader

Dr. Samitt is a Partner and the Global Provider Practice Leader in Oliver Wyman's Health & Life Sciences Practice. He has led turnarounds at major health systems for 20 years, most recently serving as the President & CEO of HealthCare Partners, a division of DaVita HealthCare Partners. From 2006 through 2013, Dr. Samitt was President & CEO of the Dean Clinic, one of the largest integrated delivery systems in the Midwest and one of the nation's leading examples of a high-performance Accountable Care Organization. Previously, he served as Chief Operating Officer at Fallon Clinic (now Reliant Medical Group), as Senior Vice President on the turnaround team of Harvard Pilgrim Health Care and as Chief of Medicine and Site Medical Director at Harvard Vanguard Medical Associates (now Atrius Health). Dr. Samitt is currently in his third year as an appointee on the Medicare Payment Advisory Commission (MedPAC).

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HealthCare Security: The New Normal

Security attacks against healthcare companies is growing in number and velocity, is this the New Normal? What is driving this behavior? What can executive stakeholders do to mitigate risks?

Key takeaways

  • Nowcast of the healthcare industry landscape
  • Expected security threats
  • Best practices to secure your organization and customer’s data.
  • Best practices of where to begin



Mike Ragan

Senior Vice President of Life Sciences and Healthcare at NTT DATA

Michael Ragan is a Global IT Innovator delivering global technology-enabled services and solutions to clients around the world. In this role, Mr. Ragan oversees Sales, Alliances and Business Development for North America within the industry sub-sectors of Healthcare Insurance, Life Sciences, Hospital, and Healthcare Technologies.

Bruno Kelpsas

Director of Cloud Healthcare & Life Sciences at NTT Data

Bruno Kelpsas mission is to assist clients in transforming the business of healthcare through Next Generation IT. Bruno's experience with enterprise security has ranged from the Navy Marine Corps Intranet (NMCI) to Microsoft's internal IT to Cloud. He also incorporates seven years of corporate governance experience and fiscal year planning into security decision-making.

Eric Sorenson

CIO CISO at Arches Health Plan

Eric Sorenson has more than 15 years of experience in technology and security. He worked as Information Security Officer at HealthEquity, Inc., the nation's oldest and largest dedicated health savings trustee which manages just over $1billion. He is well experienced in enacting policies, procedures, and safeguards to ensure regulatory compliance around HITECH, HIPAA, PCI, and GLBA and instituted a vendor risk assessment program to identify and mitigate risks posed by third party service providers. Prior to HEQ, he worked for Zions Bancorporation and IBM.

Johnathan Hyler

Delivery Management at NTT DATA

Experienced in IS/IT Security & Risk Management. Sub domain specialties include compliance, eDiscovery, expert witness testimony, managing external audit engagements (E&Y) & responding to control deficiencies. Specialty skills include mastery of implementing reusable controls to satisfy both SOX 404 & HIPAA requirements, as well as consolidating technologies and/or bringing in new technologies & partners to streamline an organization's approach to IT Security.

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Retail Health Care: We shop for everything else, why can’t we shop for health care? Using Incentives to Drive Shopping Behaviors

Helping people make smarter health care choices is a relatively new phenomenon.  While almost all health plans offer their members some type of transparency tools or assistance, an average of only 1-3% of those members actually use the tools.

Rewards programs are increasingly used in health care to help close that member engagement gap.  During this webinar you will:

  1. Learn when – and when not – to use rewards to encourage transparency tool use
  2. What level of rewards you should offer
  3. Who you should offer rewards to for the greatest success

John Surie -Webinar Presenter

Customer Insights Director, M Health, LLC

A full-service advertising agency based in Philadelphia serving global, national and regional clients. John began as a medical representative with Merck Sharp & Dohme before moving into advertising and brand development.

John, a board director with Saatchi & Saatchi before founding his own businesses, has worked on countless innovation and strategic brand development for major consumer packaged goods manufacturers such as Procter & Gamble. John has also done product and corporate brand development for various healthcare, life science and pharmaceutical firms such as Siemens Healthcare, Pfizer, BMS, AstraZeneca, Novartis, Schering-Plough, Johnson & Johnson and Boehringer Ingelheim.

Retail Health Care


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Payment Reform: Exploring Technology Implications for Health Insurers

Payment reform is much talked about, often written about and now becoming real in today’s world. The move to value-based reimbursements and other new business models is an inevitable reality that is dramatically reshaping the US healthcare system. The underlying technology systems health insurers are using to run their businesses must have the agility to change as new business models are introduced. Otherwise, there is tangible risk of those health plans being left behind.

This webinar will explore the technology implications for health insurers as they face the swelling wave of payment reform. Using the recent MACRA rule as a case study, executives from Medica and HealthEdge will discuss how:

  • health plans must be ready to capture data related to new quality and performance measures
  • to leverage a technology infrastructure with the agility to manage new benefit and payment models quickly and efficiently
  • health plans can adjust the way services delivered are reimbursed while embracing new models


Andrew Davis, VP & GM, Medicare Segment, Medica

AndrewAndrew Davis is the Vice President and General Manager of the Medicare Segment. Medica serves over 175,000 Medicare beneficiaries in Minnesota, North Dakota, South Dakota and Wisconsin. Andrew joined Medica in January of 2013 with more than 20 years of diverse healthcare leadership experience. He most recently was a vice president at Express Scripts, Inc where he was part of the leadership team that oversaw the UnitedHealth Group account. He has also held leadership roles related to corporate business development, health care reform strategy and has led a national Medicare Part D Prescription Drug Plan. Early in his career, he held positions with the Minnesota Departments of Health and Commerce as well as served as a legislative assistant to U.S. Rep. James Oberstar.

Andrew received a Bachelor of Arts degree in Political Science from The George Washington University.

Harry Merkin, Vice President of Product Marketing, HealthEdge

3bf5dd8Harry Merkin has worked with both payers and providers through many dynamic changes in healthcare for a number of years. He is currently responsible for Product Marketing at HealthEdge and previously had similar responsibilities at Evariant and NaviNet. Merkin has collaborated with many transformative entities across the healthcare landscape. He has helped introduce and promote enterprise software solutions that enable payers to improve their competitive effectiveness, as well as perform valuable communications between payers and providers, and allow providers to effectively collaborate with patients and consumers as well as with each other. He received a BA in economics from Brandeis University.

Click on the above video player to view the entire recorded webinar