Fraud, Waste, and Abuse Information Sheet 2022

Sheila Thomas, PharmD, RPh

Dr. Sheila M. Thomas is a Senior Consultant for The Pharmacy Group (TPG), a leading consulting firm specializing in assisting healthcare service providers, information technology firms, and pharmaceutical companies in growing revenue and enhancing the financial performance of their products and services.

A pharmacist by training, Dr. Thomas brings over 20 years of senior leadership experience in the pharmaceutical and life sciences industry, with specific expertise in market access, reimbursement strategies, patient insights, diversity in clinical trials, health care policy, real-world evidence, and healthcare economics. With a proven ability to craft tailored solutions for payers, pharmaceutical companies, and healthcare organizations, she bridges the gap between cutting-edge therapies and sustainable healthcare systems.

With deep knowledge of global and regional regulatory landscapes, Dr. Thomas ensures compliance while optimizing market entry and drug adoption strategies. She excels in therapeutic class reviews, designing utilization management protocols, and guiding payers in formulary decision-making. Her specialized expertise spans therapeutic areas such as oncology, rare diseases, neurology, cardiology, and endocrinology. She focuses on evaluating therapeutic advancements, conducting comparative effectiveness and outcomes research, and employing predictive modeling and health technology assessment (HTA) methodologies to assess the economic and clinical value of emerging therapies.

Dr. Thomas is dedicated to advancing sustainable, patient-centered outcomes in the ever-evolving healthcare environment. She has authored over 50 peer-reviewed publications on health economics and outcomes research and has most recently successfully supported product launches in oncology, neurology, and dermatology across diverse markets, driving optimal payer uptake.

Dr. Thomas earned both her Bachelor of Science in Pharmacy and her Doctor of Pharmacy degree from The Ohio State University. In addition to her industry achievements, she has experience practicing in community, managed care, prescription benefit management, and healthcare system settings. She served on Ohio’s Public Health Advisory Board and Public Health Council for 21 years and the Ohio Medicaid Drug Utilization Review Committee. In 2020, she was named as one of the Top Women in Health, Wellness and Beauty and honored with a Business Excellence Award by Drug Store News.

Brian Peltz, RPh

Brian is a Consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.

Brian has over 40 years of experience in Hospital and Health System Administration, Pharmacy practice and Managed Care. Brian has served as the Senior Executive of 3 Detroit area hospitals representing Acute Care, Long Term Acute Care, Specialty Surgical, and Ambulatory Surgery. He is the past Director of Pharmacy at two prominent Health Plans in Southeast Michigan. He has also held the position of Vice President of Clinical Services, overseeing operations of Medicaid, Medicare, and Dual Eligible lines of business.

Most recently, he has lead the Medicaid Strategy for Tabula Rasa Healthcare as their Vice President of Medicaid Solutions, engaging multiple states in understanding and improving their risk of Medication Adverse Events and impacts on patient outcomes and overall costs of care. Brian has also served as the Managing Principal for the Government Programs & Services division of MedImpact Healthcare Systems where he was responsible for the Medicaid and Marketplace lines of business. This included setting strategic direction, financial forecasting and budgeting, oversight of support teams, understanding legislation and regulation, client facing Subject Matter Experts, Sales and Marketing activities. He developed and served as Chair of the organization’s Drug Use Review Board and operationalized a successful Medicaid Encounter platform.

Brian holds a Bachelor of Science in Pharmacy and a Master of Science in Hospital Pharmacy Administration, both from Wayne State University in Detroit, MI. He is a Life Fellow of the American College of Healthcare Executives and a Fellow of the Academy of Health Management.

Brian Butler, PharmD, MBA

Brian is a senior consultant with The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.

Brian has over twenty years of executive experience in employee benefits and managed care, with specialization in pharmacy benefits and drug pricing. As a licensed pharmacist, Brian has been an advocate for improving health outcomes and affordability across a variety of diverse health care roles. Brian currently advises clients pursuant to drug pricing and pharmacy benefit management.

Brian held leadership positions with an array of health care-related organizations including startups and three, Fortune 15 companies including Cigna and CVS Health. At Cigna, Brian managed national account clients with total organizational revenue of $2.5B across 1.5M commercial members.

Brian currently volunteers with the Junior Achievement of Iowa. He was a member of Cigna’s Gold Circle for two years and was awarded the Dale Carnegie Highest Award for Achievement.

Brian holds a PharmD and a Master of Business Administration from Drake University in Des Moines, IA.

Perry Cohen

Perry is co-founder and Chief Executive Officer of The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.

Perry has more than 45 years of experience with managed care, and during that time has worked for local, regional, and national health plans. A pharmacist by training, he created a pharmacy benefit management (PBM) company for Aetna in the early 1990s. Over the years he has developed relationships with hundreds of decision-makers in the United States healthcare system and has assisted more than 200 companies in selling their products and services to payors.

Additionally, Perry practiced in community, hospital, and long-term care pharmacy in California and oversaw the operations of 50 community pharmacies in nine states. Perry is a co-founder, past president, and fellow of the Academy of Managed Care Pharmacy (AMCP), a member of the Drug Topics Editorial Advisory Board and Managed Healthcare Executive Editorial Advisory Board. He has lectured and written extensively on the role of pharmacy benefit management in healthcare.

Perry holds a Bachelor of Science degree in Pharmacy and a Doctor of Pharmacy degree from University of the Pacific in Stockton, California. He completed an administrative clerkship at the Food and Drug Administration in Rockville, Maryland. His clinical training was performed at Tripler Army Medical Center in Honolulu, Hawaii.

Susan Hogue, MPM, RPh

Susan is a Senior Consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.

Through collaboration with payers, providers, and manufacturers, Susan has over 40 years of leadership experience driving growth for innovative and cutting-edge programs to enhance quality, improve outcomes, and lower the cost of care. Her accountabilities have included business development, account management, sales enablement, product strategy, and clinical operations. She maintains numerous relationships with national and regional healthcare decision-makers and channel partners across the United States healthcare system.

Most recently, Susan has advanced payer programs related to member engagement, improved Star Ratings and quality measures, and reduced adverse drug events as Area Vice President of Business Development at Tabula Rasa HealthCare. Previously, Susan spent 17 years in various leadership roles, including Managing Director and Vice President, Health Systems and Payer Relations for MedStart, a point-of-care medication adherence platform that originated at MedVantx, Inc. and was later acquired by QPharma, Inc.

A pharmacist by training, Susan held various positions at the UPMC Health System for over 14 years, including Director of Pharmaceutical Services, Director of Therapeutic Services, and Assistant Vice President of Business Development. Susan also served as Executive Director of the Physician Hospital Organization (PHO) for four UPMC Hospitals. The PHO physician membership eventually transitioned to become the provider network when the UPMC Health Plan was launched.

Susan holds a Bachelor of Science in Pharmacy from the University of Pittsburgh, in Pittsburgh, PA, a Master of Public Management from Carnegie Mellon University, in Pittsburgh, PA, and a Sales Growth Certificate from eCornell, in Ithaca, NY.

John Vazquez, MD

Dr. John Vazquez is a Physician Consultant with TPG International Health Academy (TPG-IHA). TPG-IHA has hosted educational programs for senior healthcare executives for 25+ years, holding week-long Educational Summits in over 30 countries across the globe. The Academy is powered by three pillars: education, networking, and cultural immersion.

Dr. Vazquez is a Physician Executive with extensive CMO and Healthcare Management experience who has spent his career serving the underserved communities in some of the most industry-challenged healthcare delivery organizations. HIs skills in teamwork, strategy, quality, safety, business development, turnaround, and a commitment to education have led to Dr. Vazquez’s long-term success.

Dr. Vazquez spent the last 17 years at Sinai Health System, Chicago’s largest private healthcare system serving vulnerable communities, and with over $1 billion of revenues. Dr. Vazquez led the physician group through numerous projects and endeavors. He was the physician lead on philanthropy for the system, EMR and telemedicine implementations as well as numerous physician practice acquisitions and a large hospital merger. During his work as a physician leader for Sinai Chicago, the system saw a year-over-year improvement in the bottom line from a loss of $42 million to a profit of $10.7 million and an improved EBIDA from a negative $14.8 million to a positive $33.8 million. Dr. Vazquez assisted to increase philanthropic giving from a baseline of $2.3 million annually to $10.9 million.

Dr. Vazquez is currently Professor of Anesthesia at University of Illinois in Chicago. Besides leadership roles as Chief Medical Officer and Chair of Anesthesia, he has been Medical Director of the anesthesia service line and operating rooms at three hospitals, residency site coordinator for University of Illinois and Program Director for the Midwest School of Nurse Anesthesia. Dr. Vazquez is active in state and national physician organizations and governance bodies. He has built strong teams and strategic relationships with many companies building partners both in and out of healthcare.

Dr. Vazquez has served on several boards. As an entrepreneur at heart, he has helped shepherd companies to growth and acquisition. He is driven by the opportunity to bring innovation while improving health and wellness. On a global scale, Dr. Vazquez has been a US delegate for years with TPG International Health Academy visiting 4 countries to date with the mission to share strategies to improve global healthcare.

Dr. Vazquez holds a Doctor of Medicine degree from University of the Illinois in Chicago, Illinois and Is Board Certified in Anesthesia.

James Notaro, RPh, PhD

Jim is Senior Consultant with The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.

With extensive experience in the managed care industry, he has served as Director of Ancillary Clinical Services and Manager of Pharmacy Services for Univera Health Care, and Director of Managed Care Programs/Research & Development for Centrus, an Albany-based prescription benefit management company.

In 2000, Jim founded and grew CSS Health into one of the nation’s three largest medication therapy management software and service providers. At CSS Health, Jim was the product visionary for MTMPath a unique medication management SaaS software platform that has been used in over 120 health plans, self-insured employer groups, PBMs and ACOs to manage drug utilization at a population level.

Throughout his career, Jim’s career has been focused on small to medium sized venture and private funded start-ups in the health tech space.

Jim is a graduate of Albany College of Pharmacy; he holds a Master’s degree in health administration from Union College and a PhD in Operations Research from the University of North Carolina at Chapel Hill. He is a licensed pharmacist in both New York and North Carolina.

Dan Leonard

Dan is a senior consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.

With over 20 years of management of associations at the highest levels Dan Leonard has had a unique 360-degree view of the healthcare ecosystem in America from the payor, innovative and generic pharma, and patient perspectives. Leonard is the founder of Granite Capitol Consulting where he works with corporations, nonprofit associations, and professional societies in the healthcare space on strategic planning, advocacy, policy, and public affairs.

From 2020 to 2022 Leonard served as the President and Chief Executive Officer of the Association for Accessible Medicines (AAM), the nation’s trade association for the makers of generic and biosimilar medicines which fill 9 out of 10 prescriptions in the United States. Prior to joining AAM, Leonard served as President and Chief Executive Officer of the National Pharmaceutical Council (NPC), which sponsors and conducts research on a number of critical health policy issues. During his 12 years as CEO, NPC played a leadership role in the evolving areas of pharmaceutical value assessment, value-based contracting, and the importance of maintaining a robust innovation ecosystem.

Prior to his time in the pharmaceutical space, Leonard was an executive responsible for Public Affairs and Advocacy at one of the nation’s leading payor organizations America’s Health Insurance Plans (AHIP), the trade association representing companies providing health insurance coverage in the United States. He also served for six years on the Board of Directors of the National Health Council, whose core membership includes the nation’s leading patient organizations.

Before entering the Washington association community Leonard developed significant experience in politics and government, including time spent in presidential campaigns, leading communications at the National Republican Congressional Committee (NRCC) and serving as a Chief of Staff for a member of the Congressional leadership. Early in his career, Leonard worked as a television news reporter covering presidential primary politics in his home state of New Hampshire. He also worked in newsrooms in Boston, Pittsburgh, and Vermont.

Leonard has a bachelor’s degree in journalism from Marietta College in Marietta, Ohio, where he currently serves on the Board of Trustees, and he received a master’s degree in Government from the Johns Hopkins University.

Susan Ito, PharmD

Dr. Susan Ito is Senior Consultant with The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.

Dr. Ito is an accomplished healthcare executive and pharmacist with over 30 years of experience in client relations management and clinical pharmacy serving a diverse portfolio of managed care organizations, commercial employer clients, health plans, and pharmacy benefit management consultants. She is currently a partner with Swenson Pharmacy Advisors and a consultant for SH Advisors. Her focus is on pharmacy benefit management, clinical pharmacy services, health, and wellness.

Her experience was garnered in leadership positions that included two major pharmacy benefit managers – OptumRx and Express Scripts. Her responsibilities included strategic development, account management, client/consultant education for formulary management, utilization management, pharmacy trend management, and specialty benefit management. Prior to her pharmacy benefit management service, Susan held positions with Blue Cross of California. She also served in both the retail and hospital practice settings prior to moving into corporate healthcare management roles.

Susan received her Doctor of Pharmacy degree from the University of Southern California (USC). She completed a postdoctoral American Society of Health-System Pharmacists (ASHP) accredited residency in Ambulatory Care at USC in conjunction with the United States Department of Veterans Affairs. She is a member of the Academy of Managed Care Pharmacy (AMCP) and served as Chairman for the AMCP Public Policy Committee from 2022 – 2023. She currently serves on the Legislative and Regulatory Action Committee for AMCP. In 2023, Dr. Ito was awarded the AMCP Advocate of the Year Award. Dr. Ito is based in Gainesville, Florida.

Gaston Bernstein

Gaston is a Senior Consultant with The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.

He is an accomplished c-suite healthcare executive with experience in client management, market access, product development, contracting and business development. He has over 30 years of broad healthcare experience and is recognized for developing long-term relationships with internal and external customers built on exceptional service and execution. Gaston also has a working knowledge of medical and pharmacy benefits, pharmaceutical trade relations and employer programs.

During his career, Gaston has worked for several pharmacy benefit management companies (e.g., NDC/HealthTrans, ProVantage, Rescription, ValueRX, Welldyne), specialty pharmacies (e.g., CoramRx, Eversana, HealthDyne, ivpcare specialty pharmacy, priority healthcare), specialty infusion companies (e.g., Soleo Health, Coram Healthcare and Amerita Specialty Infusion) and pharmaceutical companies (e.g., Schering-Plough, William H. Rorer)

Gaston holds a Bachelor of Science degree from the University of California at Irvine and Master of Business Administration degree from the University of Southern California.

Sue Scheid

Sue is a senior consultant for The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.

Sue is an executive in the PBM industry with deep experience representing some of the largest US payors. Leadership roles have included accountability for the entire scope of manufacturer relationships including rebate competitiveness, supply chain strategies and optimizing overall value. She is passionate about affordability, value-based outcomes and building capabilities to execute strategies leading to better health outcomes and lower cost of care.

Sue brings expertise in rebate and innovative contracting, including value-based or outcomes agreements. Most recent experience in bidding and pricing optics brings significant value as they are critical components in formulary strategies and achieving growth targets. Recognized as a strategic thinker, she has an in-depth understanding of formulary development, pricing strategies, and innovative contracts that leads to effective total cost of care management, minimal patient disruption, and a competitive edge.

Sue’s areas of expertise include working collaboratively with pharmaceutical manufacturers on market access strategies – offering a payor perspective on value-based agreements, and innovative contracting.

Sue currently works at Scheid Services, LLC as the founder and principal. Past roles have included Vice President, Trade Relations at Prime Therapeutics and the Head of Manufacturer Relations at Aetna.

Sue has her Bachelor of Science degree in Biology from the University of Minnesota.

Gayle Dichter, RPh, MBA

Gayle is a Senior Consultant with TPG Data Services (TPG-DS). TPG-DS and our team of senior healthcare and clinical consultants are transforming the way providers and payors monitor healthcare information to control costs and enhance efficiencies.

Gayle is an innovative, caring, and pragmatic clinician who leverages business acumen and strategic vision to create realistic solutions that optimize member care and improve outcomes while also delivering an ROI. She has been effective in working with both internal and external stakeholders to build consensus and create long-term strategies that are both practical and pioneering at the same time. Gayle’s expertise in government programs (Medicare including duals, and Managed Medicaid) allows her to effectively incorporate regulatory requirements into processes without losing site of the goal. She has a special interest in transitions of care, medication concordance, care management, value-based contracting, elderly care, and behavioral health.

Gayle most recently served at the Vice President of Integrated Care Strategies at Neighborhood Health Plan of Rhode Island (NHPRI). In this role, she created the clinical strategy that aligned with the plan’s 5-year strategic plan which was integral to answering the Medicaid RFI. She also served as a clinical lead for care management, creating a comprehensive review with recommendations and managed the relationship with the Medicaid accountable care organizations, enabling them to both meet state requirements and successfully navigate their risk contracts.

Gayle has been a trail blazer in the managed care pharmacy world. In addition to successfully building and then running the pharmacy departments for several health plans, Gayle worked with CMS and her MTM provider to initiate a medication synchronization program (then a new concept) that was coordinated with MTM and specialized packaging (services widely used and accepted today). Gayle served on then RI Governor Raimondo’s committee to improve the use of opioids as well as Rhode Island’s Utilization Review Board. Gayle was also part of a successful academic detailing program and has spent time in the PBM space, long-term care pharmacy, and has extensive experience in the retail pharmacy business.

She has held senior leadership positions at Superior Health Plan, Core Health, LLC/Health Alliance Connect, Senior Whole Health, BMC Healthnet Plan, Bridgeview Pharmacy, Merck-Medco Managed Care, and Insta-care Pharmacy Services. She has been active with the Association of Managed Care Pharmacy (AMCP) and served as a preceptor Northeastern University School of Pharmacy.

Gayle holds a BA in Psychology and Sociology from Brandeis University, a BS in Pharmacy from Massachusetts College of Pharmacy and Allied Health, and an MBA in Marketing from Bentley College. She has a current pharmacy license in Massachusetts and Rhode Island.

Nancy Dickau

Nancy is a Senior Vice President with The Pharmacy Group, responsible for all financial aspects of the TPG Family of Companies, as well as operational matters. She joined The Pharmacy Group in March 2012, in addition to performing the overall financial management she evaluates project profitability and pricing, manages cash flow, analyzes financial performance, and makes financial recommendations. Additionally, she handles HR functions, and frequently is involved in client contracting.

Prior to her career in finance, she spent over a decade in the Information Technology department at The Travelers Insurance Company during the 80’s. During her tenure, she held multiple technical and analytical positions, including software design, development, and implementation.

Nancy received her BS in Business Administration from the University of Connecticut. She currently resides in South Glastonbury, Connecticut with her husband, and enjoys spending time with her three grandchildren. Her hobbies include spending time with her family at their cottage in Rhode Island, boating, walking, gardening, and reading.

Jeff Carlisle

Jeff joined The Pharmacy Group (TPG) in August 2008 to support its administrative functions. Over the years he has taken on additional responsibilities including marketing initiatives, client communications, and general web support. As a vice president Jeff is primarily responsible for attendee recruitment for all TPG activities, from the planning and strategy of recruitment to the execution and oversight of those initiatives.

Jeff also handles administrative functions for TPG International Health Academy (TPG-IHA) and TPG National Payor Roundtable (TPG-NPRT). He works in several areas of the TPG Family of companies including registration and attendee administration, hotel and audio-visual coordination, on-site meeting management, publications, website maintenance and graphic design, grant research and writing and budgeting.

In addition to his business career, Jeff has over 15 years of teaching experience in martial arts schools around Connecticut. He was the program manager for the state’s top performance martial arts school where he was responsible for student enrollments, curriculum design, and class management on a daily basis. He also had the honor of competing on the nation’s #1 ranked martial arts team for three years. He also founded central Connecticut’s premiere fitness kickboxing school where he designed classes, created social media content and marketing initiatives, and helped manage employee training.

Jeff attended the University of Connecticut and graduated in 2007 with a BA in English. He currently resides in Bolivia, North Carolina. His hobbies include rock climbing, rucking, reading, writing, and supporting Arsenal FC.

Jim Smeeding, RPh, MBA

Jim is President of TPG National Payor Roundtable (TPG-NPRT), an educational company that brings healthcare industry product and service offerings to managed care decision makers. Education and access are the key attributes TPG-NPRT offers client customers and payor medical decision makers leading to improved adoption and reimbursement for products and services.

He is the former executive director of the National Association of Specialty Pharmacy (NASP). He is also a founder of the Center for Pharmacoeconomic Studies at the University of Texas College of Pharmacy. His research interests are in applied pharmacoeconomics, digital health, systems integration, and managed care. Over the past 48 years, his practice orientation has been in hospital pharmacy, clinical services design, home infusion therapy, managed care services, drug development, pharmaceutical marketing, and disease management. He has authored more that 85 peer-reviewed publications and has given hundreds of presentations.

Within Professional organizations, Jim has served at the state, national, and global level. He is an original founder of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) and their third president. ISPOR now exceeds 50,000 members with chapters on every continent and within all major countries.

He has worked with all major pharmaceutical companies. He is the founder and president of Indication Biosciences an early-stage drug discovery company that is examining the use of CBD with statin agents to safely lower lipid anomalies. He was the Executive Vice President and founder of Engaged Media, a technology driven patient engagement solution, used in multiple pharmaceutical copay programs that was purchased in May of 2018. He is also active in other Cannabis-based Medicines (CBM) and research as a founder of CannaPharma Rx and Member of the BOD of Allied Health (ALID), as well as Vice President of Pharmacy and Chief Scientific Officer.

Jim has a pharmacy degree from the University of Buffalo and an MBA from the University of Texas.

Winston Wong, PharmD

Winston Wong is a Senior Consultant with The Pharmacy Group (TPG). TPG provides consulting services to healthcare service, information technology, and pharmaceutical companies to grow revenue and improve the financial performance of their products and services.

Winston Wong, PharmD, is the President of the W-Squared Group. The W-Squared Group is committed to assist healthcare innovators develop their value statement and launching their technology in the government and commercial marketplace. Dr. Wong is also the current Editor-In-Chief for the Journal of Clinical Pathways, a journal committed to providing high-quality educational and informational articles as well as presenting original health economic outcomes research data to an audience of interested in utilizing clinical pathways as a tool to move towards value-based care.

Throughout his 30-year career in the pharmacy industry, he has been repeatedly recognized for his
clinical and business innovations. Dr. Wong’s accomplishments start with his leading of two separate
hospital pharmacy departments “out of the basement”, to having a more active clinical role in patient care areas. This new role of the hospital pharmacist was then implemented on a regional basis through his work accomplished at the Southern New England Region of VHA, then the largest Group Purchasing Organization in the United States. His entry into managed care was in 1994, joining United HealthCare, where he developed the first Senior Prescription Benefit offering, which was in place until the CMS Medicare Part D benefit was implemented in 2006.

As the Associate Vice President of Pharmacy Management at CareFirst BlueCross BlueShield, Dr. Wong was responsible for the development, implementation, and administration of the prescription benefit, including formulary development, contracting, including the Medicare Part D prescription benefit. He was instrumental in the development and implementation of a pharmacist driven Medication Therapy Management (MTM) program that has been recognized by CMS, and many national organizations in the Part D benefit. Dr. Wong implemented one of the first successful network-based oncology clinical pathway program where oncologists collaborated with the health plan to develop and maintain clinical pathways for common cancer types. The model was expanded into rheumatology and gastroenterology, as well as serving as a model for many oncology managements programs today.

Dr. Wong was named as one of the Top 100 Healthcare Leaders in 2018 in June 2019, and one of the Top 100 Healthcare Visionaries in 2020 in January 2021 by the International Forum on Advancement in Healthcare.

He earned his PharmD degree in 1981 from the University of the Pacific in Stockton, California, and completed a General Residency at the University of Nebraska Hospital and Clinics in Omaha, Nebraska.

Rich Balest, BS

Rich Balest has served as a health industry consultant utilizing over 25 years of experience in data mining, data modeling, data warehousing, and information delivery. Rich has comprehensive experience analyzing detailed claims and eligibility from CMS, insurance companies, and managed care organizations including prescription benefit managers (PBM), and account and medical record detailed patient data from hospital patient accounting systems, clinical ancillary systems, and professional and institutional billing systems.

Rich has supported the actuarial departments of health plans projecting the impact on provider payments resulting from amended contracts, measuring prescription drug trends, preparing Medicare Part D bids, and developing process specifications for the actuarial analytic platform.

On behalf of several consulting firms, Rich has supported the pharmacy practices on client engagements measuring the administrative and financial performance of employer sponsored prescription drug benefit plans as defined by the contractual arrangements with the PBMs. For PBM clients, Rich completed Medicare Part D process assessments and specialty network assessments.

Education

BS, Economics, Pennsylvania State University

Marjorie Zimmerman, MS, BS Pharm

Marjorie Pestel Zimmerman, MS, BS Pharm, is a registered pharmacist with diverse experience in the healthcare industry. During her practice in a large tertiary care center, she held numerous positions, including decentralized clinical pharmacist and Assistant Director of Operations within the pharmacy department. As a consultant for a psychiatric hospital, she performed medical staff drug usage evaluations and led patient medication groups.

Marjorie has experience as the Director of Pharmacy for a home-infusion company that managed a broad range of diseases and has multiple-years’ experience in the medical communications/education industry. At a managed care communications company, she researched, designed and developed products, including sales training, advisory boards, symposia, disease state management, and communications programs.
After focusing on managed care, Marjorie joined a medical education company, where she held various positions within account services and new business development. Her responsibilities included developing and managing educational plans that included publications and advocacy development as well as promotional and CME programs.

Marjorie served as editor of a business strategy publication that focused on devices, diagnostics and drugs in development. Researching and writing about new drugs in development including biosimilars is an area of interest. Additionally she has worked with several health plans and employer groups distributing and evaluating RFPS for PBM selections as well as determining PBM performance relative to the existing contracts.

Education

BS, University of Nebraska Medical Center College of Pharmacy
MS, University of Missouri at Kansas City

Professional Affiliations and Accomplishments

Member, Academy of Managed Care Pharmacy
Member, American Society of Health-System Pharmacists
Prepared dossiers using the Academy of Managed Care Pharmacy Format for Formulary Submissions

Leon Edelsack, MBA, BS

In August 2015, Leon Edelsack became the President of TPG Healthcare Consulting (TPG-HC) and also serves as the president of TPG-HC’s sister company, TPG Data Services (TPG-DS), a position he has held since 2009.

With over 30 years of extensive business experience, including six years managing TPG-DS, Leon brings a well-rounded background to the company. As the president of TPG-DS, he led account management efforts and successfully maintained the client base. He also was instrumental in the development of new data analytic products/services geared to effectively meet the needs of today’s health plans.

Leon’s previous professional experience includes in-depth expertise in information technology (IT), sales and marketing at Fortune 500 companies and new start-ups. During his career, Leon has held management positions in sales, account management, market/product development, strategic planning/business development, mergers and acquisitions and venture capital investing. His IT experience encompasses a number of industries, including manufacturing, government, professional services, broadcasting, insurance and healthcare.

Prior to joining TPG Data Services, Leon was the President and Founder of a state-of-the-art multimedia gaming company. He also spent 20 years with Westinghouse, growing his division into a global communications solutions provider with over $100 million in annual revenue. Additional experience includes overseeing the operations of three data centers for a company providing business process outsourcing services to Fortune 500 clients.

Board and Advisor Appointments

Advisor to the Management Game Board, Tepper School of Business at Carnegie Mellon University
Board Member, Squirrel Hill Urban Coalition

Education and Training

BS, Political Science and Psychology, Reed College, Portland, OR
MBA, Tepper School of Business at Carnegie Mellon University, Pittsburgh, PA
Continuing Education Online Courses, Healthcare Infomatics
Professional Culinary Certificate from L’Academie de Cuisine, Washington, DC

Published Works
Leon has been published in several periodicals, including Managed Healthcare Executive.

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