Faculty – Payer Partnership Forum


Michael Baldzicki
National Account Executive, BAYER HEALTHCARE PHARMACEUTICALS

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As National Account Executive for Health Plans & PBMs for Corporate & Government Customers at Bayer Healthcare, he provides business strategies for key portfolio management. Within this role, he ensures the success of the widest variety of strategic projects across departmental segments, applies strategic business development, contract negotiations, network development, marketing & outreach strategies, and other business development initiatives that cultivate opportunities that affect Bayer client segments.

Michael has over 19+ years of pharmaceutical and biotech industry experience, including his prior role at CareCentrix as Vice President of Corporate Strategy & Product Development for their Specialty & Infusion Solutions division. Mike held other roles in senior executive management within the specialty pharmacy supply group, pharmaceutical and biotech industry of managed markets, group purchasing organizations, specialty wholesale, and integrated delivery networks. He assumed various roles within the pharmaceutical organization such as Bristol-Myers Squibb, Enzon BioTech, Baxter BioScience, as well as roles within the distribution channel of AmerisourceBergen, specialty groups of Diplomat/BioRx Specialty Pharmacy, Armada Health Care, AxelaCare Health Solutions, to other manufacturer & specialty pharmacy home infusion companies.

Mike is active in the biotech community and is an Advisor/Faculty member of the Academy of Managed Care Pharmacy (AMCP) for Specialty Pharmacy Advisory Group & Biosimilars Partnership Forum, Faulty Board Member of the American Journal of Managed Care (AJMC) Specialty Pharmacy for ACOs, Guidepoint Global Committee Member for Specialty Pharmacy, and was 2014 Editorial Board Member for Specialty Pharmacy Times. Mike has published abstracts and articles surrounding plasma based infusion therapy, managed markets and specialty pharmacy. He has spoken at a variety of seminars and WebEx’s within specialty groups and other industry related settings. Mike holds a Bachelor of Arts in Business Management and a Certificate in Clinical Research Compliance and Management (CRCM). He has completed programs in leadership development at Harvard University, Quantum management, Brooks Group, Miller Heiman Account Management, and MD Anderson Center Cancer Courses.


Michelle Beozzo Anderson, Pharm.D.
Director of Pharmacy Services, DENVER HEALTH MEDICAL PLAN INC.

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Michelle Anderson is the Director of Pharmacy for Denver Health Medical Plan, Inc. (DHMP). She is responsible for all aspects of the pharmacy program related to the plan’s Medicare, Medicaid, Commercial, Child Health Plan Plus and Marketplace lines of business.

Her team has implemented multiple provider- and member-targeted programs related to controlled substance use, appropriate prescribing patterns and medication adherence. In 2015, under Michelle’s leadership, DHMP received the 2015 Quality Improvement Award from the Pharmacy Quality Alliance. The award is in recognition of achieving the largest net improvement in Part D quality metric Star Ratings of all Medicare Advantage Prescription Drug plans nationwide.

Michelle is the Managed Care delegate for the Colorado Pharmacists Society Board of Directors. She completed a Managed Care Pharmacy Residency with the University of Massachusetts Medical School, Clinical Pharmacy Services, and received her Doctor of Pharmacy degree from the University of Rhode Island.


Theresa A. Bissonnette, MBA/HCM, CPHQ
Director of Risk Adjustment and Quality, NORTH TEXAS SPECIALTY PHYSICIANS

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Theresa is the Director of Risk Adjustment and Quality for North Texas Specialty Physicians (NTSP), where she is responsible for a risk adjustment program, pay for performance program for physician members, CMS 5 Star strategies, and quality improvement programs. NTSP is an IPA that accepts risk for United Health Care and Humana lives in addition to owning their own health plans, Care N’ Care in Texas and HealthTeam Advantage in North Carolina. Theresa has 19 years of healthcare experience inclusive of Medicaid, Long Term Care, Healthcare Quality and Medicare Advantage. Theresa has spent the last six years working primarily in the CMS 5 Star arena, first at Physicians United Plan in Orlando, Florida and now with Care N’ Care and HealthTeam Advantage. In 2016, Theresa assumed responsibility for the Risk Adjustment Department, where she oversees initiatives aimed at capturing accurate documentation to reflect member medical conditions. Theresa has a bachelor’s degree from Indiana University and a master’s degree from The University of Phoenix, and is a Certified Professional in Healthcare Quality.


Andrew Capps, MBA
Director of Managed Care, AMBER PHARMACY

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Andrew has over 20 years of experience in the pharmaceutical industry with Parke-Davis, Pfizer and Bristol-Myers Squibb. His expertise includes specialty sales, sales management, senior-level management, brand marketing, compliance, market access and specialty pharmacy & 340B distribution. His most significant work in market access is in product launch strategy, strategic payer perspective and marketing development for account managers and reimbursement specialists. Andrew was directly responsible for negotiating regional payer and state Medicaid access contracts for products including: Daklinza, Eliquis, Sprycel and Opdivo.

Most recently, Andrew has worked as a Director of Managed Care for a large independent specialty pharmacy. He has extensive experience in negotiating contracts with health plan payers and PBMs for specialty pharmacy clinical services in therapeutic categories including: Anti-Inflammatory, Multiple Sclerosis, Oncology/Immunology, HCV and HIV and transplant. He is responsible for over $100MM in contracted annual revenue.

Andrew earned his B.S. degree at Kansas State University in Manhattan, KS. He earned his M.B.A. at Baker University in Baldwin City, KS.

Andrew is married, with two children and is residing in the Kansas City area.


Benjamin Chin
Analyst, CENTERS FOR MEDICARE AND MEDICAID INNOVATION

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Benjamin Chin is a graduate of Rutgers University is currently a policy analyst specializing in health care policy working for the Center for Medicare and Medicaid Innovation. Prior to joining CMS, Ben worked at the Thailand Institute of Justice in Bangkok, Thailand as a Henry Luce Scholar where he conducted research on alternatives to incarceration for drug-involved offenders throughout the ASEAN region. Ben has also worked for Abt Associates and the Substance Abuse and Mental Health Services Administration prior to working for CMS.


Aria Cohen
Executive Director of Payer Strategy, INTARCIA THERAPEUTICS

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Aria Cohen has more than 12 years of medical device, pharmaceutical and biotech experience. He is currently Executive Director, Payer Strategy and Operations at Intarcia Therapeutics, a position he has held since September 2015. In this position, Aria is responsible for the development of payer and pricing strategies that leverage Intarcia’s strengths to maximize access for physicians and patients to their innovative products. Prior to joining Intarcia Therapeutics, Inc, Aria spent 10 years in the device world where he managed Key Accounts, negotiated IDN contracts, developed KOLs and let multidisciplinary sales teams.

He received his Bachelor of Arts in international studies and economics from The American University in Washington, DC and his Master of Business Administration from Babson College in Wellesley, MA.


Representative James Dunnigan (R)
District 39, Health Reform Task Force, UTAH HOUSE OF REPRESENTATIVES

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A representative since 2003, Representative Jim Dunnigan currently serves as Chair of the Utah Health Reform Task Force and the House Business & Labor Committee. He has sponsored numerous pieces of legislation dealing with insurance and health care reform.

He serves on the National Conference of State Legislatures Health Reform Task Force and is the past Chair of their Health and Human Services Committee. He is a member of the Council of State Government’s Health Committee.

He is a member of the House Ethics Committee.

He served as Chairman of the Governor’s Medical Payment Reform work group and served on the Governor’s Medicaid Expansion Oversight committee.

He was named a Friend of the Taxpayer by the Utah Taxpayers Association and the Utah Small Business Champion of the Year by the National Federation of Independent Businesses.

Rep. Dunnigan received his B.S. in Business Management from the University of Utah, he is the owner of Dunnigan Insurance, an insurance agency with over 30 years of experience specializing in health insurance and employee benefits.


Jesse Fishman
Scientific and Real World Data Alliances Lead, UCB

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Jesse Fishman currently leads the U.S. medical affairs organization’s publication department at UCB by providing strategic development and oversight of the publications operations in their neurology patient value unit. Our division of the patient value unit seeks to communicate about the clinical and economic solutions that will serve patients with severe diseases.

Jesse has 10 years of industry experience working in various roles in clinical development, medical information and medical affairs at United Healthcare Group, Pfizer and Amgen.

He had developed and led medical writing and publications teams globally, written company publication policies and established valuation methodologies for the Sunshine Act.

His research and publication focus includes topics such as health outcomes, health literacy, and ways to improve communication between patients and healthcare providers. Jesse holds a chemistry degree from Arizona State University and a Doctor of Pharmacy from the University of Arizona. He also completed a pediatric residency at Children’s Healthcare of Atlanta and practiced as a critical care pharmacist prior to entering the pharmaceutical industry.


Lori H. Fox, BSN, MBA, CCM
Director of Ambulatory Care Coordination, GREENVILLE HEALTH SYSTEM


Jeffrey Gold
Senior Vice President and Special Counsel, HEALTH ASSOCIATION OF NEW YORK STATE

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Jeffrey Gold is Senior Vice President and Special Counsel of the Managed Care and Insurance division at HANYS, the Healthcare Association of New York State. Mr. Gold works with the payor community, state and federal regulators, and New York State government to address provider issues and has drafted, negotiated, and helped secure major packages of managed care reform legislation that impact external appeals, administrative denials, claims processing and payor practices. He has designed HANYS’ highly regarded Strategies, Weapons, and Tactics programs (SWAT) and coaches hospitals on denials management and contract negotiation strategies.

Prior to his arrival at HANYS, in 2000, Mr. Gold was Special Counsel for Health Care to the New York State Attorney General. Mr. Gold served four Attorneys General in New York and was the founding Bureau Chief of New York’s Health Care Bureau in 1997. Mr. Gold joined the Attorney General’s office in 1987 and developed his managed care background as a result of overseeing units of the Attorney General’s office at Helen Hayes Hospital in West Haverstraw, New York, Roswell Park Cancer Institute in Buffalo, and the three State University of New York medical centers in Brooklyn, Syracuse, and Stony Brook. Before 1987, he worked at two private law firms in New York City, with a focus on civil litigation.

Mr. Gold has a B.A. from the University of Pennsylvania (1975) and a J.D. from Brooklyn Law School (1979). He is a frequent lecturer at Bar Associations meetings, Health Care Conferences, and HFMA events and has published several articles.


Mary Grealy
President, HEALTHCARE LEADERSHIP COUNCIL

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Mary Grealy is president of the Healthcare Leadership Council, a coalition of chief executives of the nation’s leading healthcare companies and organizations. The HLC advocates consumer-centered health care reform, emphasizing the value of private sector innovation. It is the only health policy advocacy group that represents all sectors of the healthcare industry. She was appointed to the position in August 1999.

Ms. Grealy has an extensive background in healthcare policy. She has led important initiatives on the uninsured, improving patient safety and quality, protecting the privacy of patient medical information and reforming the medical liability laws. She testifies frequently before Congress and federal regulatory agencies.

She is a frequent public speaker on health issues and has been ranked many times by Modern Healthcare as one of the 100 Most Powerful People in Healthcare and has been named to Modern Healthcare’s list of the Top 25 Women in Healthcare.


Gina Guinasso, J.D.
Senior Director of Policy and Government Accounts, TAKEDA ONCOLOGY

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Gina has over 20 years in the biopharmaceutical industry including sales, managed care, contracting, distribution, specialty pharmacy, government policy, patient assistance, and reimbursement strategy. Currently Gina is leading a team of Directors that are responsible for Federal and State policy and access, Federal Market’s access, and reimbursement and coverage strategy. Her team is responsible for current access and preparing the organization for future changes in reimbursement and coverage. Previously, she led teams of National and Regional Account Directors and Trade and Specialty Pharmacy Managers.

Gina has extensive experience in market access contracting with commercial health plans, PBMs, Medicare Part D plan sponsors, FFS Medicaid, specialty pharmacies, wholesalers, and 3PLs.

Gina has been a member of the Washington State Bar Association since 1998. She received her BA in International Business from Washington State University and her Juris Doctor from Seattle University School of Law.


Melinda Hanisch
Director, Research Dissemination, Center for Observational and Real World Evidence, MERCK & CO., INC.


Stephen Hull
Principal and Founder, HULL ASSOCIATES LLC

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Stephen Hull is Principal and Founder of Hull Associates LLC, a specialized global reimbursement strategy firm focused on pharmaceutical, medical device, diagnostic and biotech technologies.

With 40 seasoned partners worldwide, Hull Associates LLC develops and executes strategies for reimbursement and product launches in major global markets, including the Americas, the Asia Pacific, Northern and Eastern Europe, the Middle East, and Western Europe.

Stephen Hull has more than 25 years of experience in health policy and medical product strategy, for pharmaceuticals, medical devices, diagnostics and biotech products.

Prior to forming Hull Associates, he served as Senior Vice President for Global Reimbursement at AdvaMed in Washington, D.C., the leading U.S.-based medical technology trade association. Internationally, he designed and launched numerous joint advocacy campaigns, with a primary focus on reimbursement issues, working with sister associations in the major overseas markets.

Before his trade association work, Stephen was a Principal at Covance Health Economics and Outcomes Services, where he executed numerous private and public payor reimbursement and market strategies.

Stephen has also served as chairman of the Medical Devices Council for the International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

Stephen has an advanced degree in health policy from the Johns Hopkins Bloomberg School of Public Health, and a bachelor’s degree in international relations and French from Colgate University.


Michael Kaminsky
Manager of Joint Venture Business Development, AETNA

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Michael Kaminsky is a Senior Manager in the Joint Venture Business Development group within Aetna’s Accountable Care Solutions unit. Over the past three years he has helped grow the company’s portfolio from one joint venture health plan with a provider to four distinct partnerships. Prior to joining Aetna, Michael worked at the Boston Consulting Group, focusing on the payer and provider space.


Molly MacHarris, Program Lead, Merit-Based Incentive Payment System (MIPS), Centers for Medicare and Medicaid

Molly MacHarris
Program Lead, Merit-Based Incentive Payment System (MIPS), CENTERS FOR MEDICARE AND MEDICAID

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Molly MacHarris is a program lead in the Center for Clinical Standards and Quality at CMS. She is the lead for the Merit-Based Incentive Payment System (MIPS) program under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Prior to this role, Molly led the development of policies and operations on the Physician Quality Reporting System (PQRS) and Electronic Prescribing (eRx) Incentive Programs. In this capacity, Molly provides leadership and input to a variety of aspects of the programs, including stakeholder engagement, operations, policy development and alignment with other quality programs.


Denise Murray-Leitz
Chief Operating Officer and Executive Vice President, BAYLESS HEALTHCARE GROUP


Robert Popovian, Pharm.D., M.S.
Vice President, US Government Relations, PFIZER

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Robert Popovian is Vice President, US Government Relations at Pfizer Inc. He brings almost two decades of experience in numerous facets of the biopharmaceutical and healthcare industry with a strong track record of expertise, innovation and results in Health Care Policy and Economics, Government Relations, Medical Affairs, and Strategic Planning.

Robert has published and presented extensively on the impact of biopharmaceuticals and health policies on healthcare costs and clinical outcomes, including authorship in clinical and healthcare delivery journals, and is a published expert source in Los Angeles Times, USA Today, Pink Sheet and Bloomberg News, amongst many others. He also writes a monthly column published in Morning Consult regarding health policy and economic issues relevant to the biopharmaceutical industry. He is a frequent speaker at healthcare policy and medical conferences on topics such as payment and delivery reform, the use of real-world data, policies that enable biopharmaceutical innovation, and health economics. He currently serves as a board member for the Global Healthy Living Foundation.

He is one of the few researchers who has studied and published both clinical and policy-related economic analysis as well as one of a handful who have studied and published empirical data regarding emerging payment mechanisms in the US healthcare system. He was also one of the first to secure inclusion of health outcomes data regarding labeled indication of a biopharmaceutical.

Robert completed his doctorate in pharmacy and Master of Science in pharmaceutical economics and policy degrees at the University of Southern California with honors. The degree in pharmaceutical economics and policy was the first one conferred by an accredited university in the US. He has also completed a residency in Pharmacy Practice/Adult Internal Medicine and Infectious Diseases at the Los Angeles County – University of Southern California Hospital, where he was the head pharmacy resident (primary area of research: gram negative bacteremia) and a fellowship in Pharmaceutical Economics and Policy at University of Southern California (primary area of research: payment reform).

Robert is married to Maylin Megran Popovian; they have two beautiful daughters, Katrina and Natalya. They have residences both in Los Angeles, CA and Washington, DC.


Michael Ruiz
Vice President, Provider Relations, UCARE


George G. Sauers
Vice President of Managed Care, SAVASENIORCARE

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Mr. Sauers has more than 25 successful years in key positions in Managed Care and Skilled Nursing, such as Vice President of Managed Care, SavaSeniorCare, Administrative Services, LLC; National Director of Business Development, United Health Care – Evercare; Area Vice President of Sales, Integrated Health Services; Director of Business Development, Elder Health of Florida; and Executive Director, IHS Senior Care.

A finance major by background, Mr. Sauers’ early career experiences in Health Plan Finance, Operations and Networks propelled him into leadership and executive roles for Skilled Nursing Providers. During the past 10 years in these positions, Mr. Sauers devoutly studied Health Care Trends and Reforms, steering his organizations in acknowledging the trend in Triple Aim of quality, efficiency and customer satisfaction. He directs collaboration efforts with health plans and accountable providers while providing oversight in implementing care delivery models. At present, Mr. Sauers’ organization participates in a full risk capitation model, upside and downside shared savings, and preferred provider relationships centered on metric management and volume.


Rebecca Shanahan, J.D.
Chief Executive Officer, AVELLA SPECIALTY PHARMACY

President, NATIONAL ASSOCIATION OF SPECIALTY PHARMACY

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As Chief Executive Officer, Ms. Shanahan brings extensive healthcare and specialty pharmacy experience to Avella Specialty Pharmacy. Ms. Shanahan served as Executive Vice President and Head of the Aetna Specialty Pharmacy from 2005 – 2007 and as a member of Avella Specialty Pharmacy’s board of directors from 2010 – 2013.

Prior to joining Avella Specialty Pharmacy, Ms. Shanahan was president of Shanahan Capital Ventures, LLC (SVC), a consulting firm that built strategic business initiatives and programs for a number of healthcare entities in the United States and Canada. SVC clients included Cardinal Healthcare Specialty Solutions, Shoppers Drug Mart, Rite Aid Pharmacy, US BioServices, Bayer Pharmaceuticals, Bristol-Myers Squibb, Inspirational Biologics, MedSolutions and Reliant Rehabilitation.

Prior to establishing SCV in 2008, Ms. Shanahan was the President of OTN Specialty Services.

She served as Executive Vice President, General Counsel, Strategic Initiatives & Corporate Development from 2002 through 2005 at Priority Healthcare as well as a member of the founding board of directors.

Earlier in her career, Ms. Shanahan served in executive roles at three highly regarded health systems. She was Senior Vice President of Business Development for the University of Chicago Hospitals and Faculty Practice Plan, Senior Vice President of Methodist Medical Group and Ambulatory Services and General Counsel of Community Hospitals of Indiana.

Ms. Shanahan earned her Juris Doctor from the Indiana University School of Law at Bloomington and is admitted to practice law in Indiana and Illinois.


Anindita Sinha
Director, Market Intelligence, Business Insights, Corporate and Government Customers, BAYER HEALTHCARE

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Anindita (Ani) Sinha is currently a Director of Business Insights, focusing on US Market Access at Bayer Healthcare. Her current role focuses on the entire specialty portfolio, spanning six different therapeutic areas. Prior to her role at Bayer, she was an Associate Director of Market Access Market Analytics at Celgene Corporation, supporting the hematology and oncology business units. Prior to Celgene, Ani spent several years at Campbell Alliance in their pricing and market access practice as well as at Navigant Consulting in their life sciences practice. Ani has an M.S. from Yale University in microbiology and a B.A. from Columbia University in biochemistry.


Mary Stevens
Director, Network Contracts, Compliance, Audit, Provider Relations, BCBS OF MINNESOTA

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Mary Stevens is the Director of Network Contracts, Compliance and Audit at Blue Cross and Blue Shield of Minnesota and oversees all aspects of contract drafting, regulatory filings, contract compliance and division audit activities for open access as well as managed care networks. In this position she is responsible for the design and control of the documents inside of regulatory, accreditation, corporate, and other standards and rules. Her prior experience includes financial underwriting, self-insured TPA benefit plan design and implementation, and fully insured contracting oversight. Mary’s expertise encompasses the areas of network management, regulatory, accreditation and audit compliance, and alignment of benefit plan design to network design. Mary also taught credit courses for insurance continuing education for eight years and holds a B.A. from the University of St. Catherine and an MBA from the University of St. Thomas.


Jonathan Stout
Vice President, Strategy and Business Development, ABLETO

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SVP of Strategy and Development – Jon is a passionate business leader with an innate ability to approach complex healthcare topics with authenticity and integrity. Jon leads corporate strategy and business development activities at AbleTo, where the focus is to make reliable behavior change therapy available to the those who need it, right when they need it, wherever they may be. Prior to joining AbleTo, Jon held leadership positions at Horizon Blue Cross Blue Shield of New Jersey, where he led the development and execution of enterprise-wide strategies during a period of unrivaled market disruption. Prior to Horizon, Jon spent several years in consulting with Deloitte where he oversaw complex financial transactions. Jon holds BS and MS degrees in Accounting and Taxation from Seton Hall University and is a Certified Public Accountant.


Curtis Stubblefield
Director of Value-Based Care, NATIONAL HEALTHCARE CORPORATION

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Curt Stubblefield, the Director of Value Based Care for National HealthCare Corporation (NHC), [(NYSE MKT: NHC)].

An alumunus of the University of Tennessee Martin, (BA, Communications) Mr. Stubblefield’s career in health care began in 1985 in a small private home health agency. Over the course of the 31 years since then, Mr. Stubblefield has managed health care operations for both small, private companies and large, national corporations (Beverly Enterprises and Columbia-HCA).

His experience includes the development of startup companies for healthcare consulting, medical staff leasing and medical adult day care. He has worked in many aspects of healthcare, as a provider and a Medicare Advantage payer.

Mr. Stubblefield gives credit to excellent mentors who were strong leaders and shared their understanding of modeling for change. As a result, he has seen many professional sucesses in his field. Looking ahead, he hopes to have a positive impact with the changes in the industry.


Marty VandenHerik
Associate Director of Market Access T&D, FERRING PHARMACEUTICALS

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In addition to being the proud father of three amazing children, Marty has been a professional in the Healthcare field for over thirty years. The last twenty years of his career have been spent working in account management. As a vendor working with large corporate clients, he’s seen the good, the bad and the ugly of Pharma partnerships with payers and provider networks. He also had the opportunity to work in the Animal Health space, where his company partnered with large corporate food chain customers. He gained considerable insight into how supplier business relationships might function while in that role.

He is passionate about the need for pharma to work with customers for the ultimate benefit of patients and our healthcare system. He believes the fact that the U.S. spends 60% more than other developed countries (with lesser results) should be a call to action for all healthcare professionals – suppliers as well as payers and provider networks. In an era of changing business models, low trust, and intense compliance scrutiny, he still believes partnerships that add incremental value are possible.


Pritpal Virdee
Regional Vice President, ANTHEM/ WELL POINT