Medicare Coverage Determinations compliance issues

Assisted a mid-size PBM turnaround their performance issues in the Medicare coverage determination process, by providing consulting expertise for evaluation of best in class prior authorization technology, implemented process improvements in the prior authorization call center and developed quality oversight procedures to improve the quality and timeliness of coverage determinations.  

Operations turnaround

A small clinical services and technology company engaged Leslie to evaluate and improve operations.  Over a period of 2 years, Leslie was able to reduce operational costs and increase sales resulting in 200% margin improvement.

PBM contract renegotiation

Analysis of a large Medicaid plan identified a higher than expected pharmacy spend and trend with little understanding of drivers or savings opportunities.   As a subject matter expert, Leslie was able to provide significant insight into the analysis and identify cost of care opportunities within the highly regulated environment.  The PBM contract was renegotiated and other changes implemented that resulted in more than $100M savings over the 4 years of the PBM contract.

Insourcing Pharmacy benefits

Led the pharmacy program for a state MCO and was one of the first programs in the country to move management of pharmacy benefits away from a national PBM to an internally managed program that included claims processing, formulary management, network management, rebate management and disease management programs.