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Patricia Wilson is the founder and sole
owner of Associates & Wilson, Inc. Until May 1995, Pat
was National Practice Leader for Retiree Health Care at
Foster Higgins.
Pat’s work in pharmacy management
has changed the market: Her work has caused the
industry to change its view of itself – from selling
drugs at discounted prices to:
- Covering products and services that meet insured or
ERISA plan requirements – safe and effective for
the individual’s conditions, in accordance with
accepted practice guidelines, etc., and
- Managing drugs to reduce medical costs and improve patient
care.
Pat has influenced drug programs
covering millions of lives: Selected experiences
include:
- Creating RFPs for plan sponsors who want pharmacy benefit
managers (PBM) to capture more patient-specific data through
patient profiles and other data feed mechanisms. The data
allow sponsors and their health managers to target information,
reward, reinforcement, etc. to specific patients –
a concept she’s coined “focused wellness.”
- Drafting “show me” questions on concurrent
DUR messaging and evaluating vendor responses. One goal
was to show PBMs that problems exist with the industry
standards, particularly for seniors. New studies showed
problems for children and Pat has been on the case of
improving pediatric edits for two years. Today, many are
working on something of a “solution.”
- Reviewing PBM contracts and negotiating new terms for
health plans and employers. Some unique approaches used
in the negotiating process produced the best results in
the marketplace. These financial savings were unrelated
to a client’s purchasing clout.
- Redesigning employer drug plans with the goal of reducing
hospital admissions and lengths of stay.
- Designing campaigns to provide “things of value”
supporting self-management of specific conditions including
hypertension, ulcers and cholesterol, to name a few.
- Designing initiatives focusing on the safety of two
anti-psychotic medications. Concerns included users twice
as likely to develop Type 2 diabetes drugs, most commonly
prescribed by non-psychiatrists for non-FDA approved indications,
increased risk of cardiac death, and more expensive than
conventional equally effective anti-psychotic drugs. Prescribing
physicians were contacted. Detailed planning and a “convince
with the evidence” approach paid off - 50% of physicians
accepted the suggestions for change.
- Developing generic incentive programs to take advantage
of cost savings from the brand medication losing patent
protection. These programs typically include healthy lifestyle
information promoting alternatives to drugs.
- Reviewing and revising standard PBM offerings for concurrent
and retrospective DUR and the prior authorization criteria
to eliminate ineligible claims, improper dosing, drugs
ineffective for an individual patient and other examples
of “might as well” healthcare.
- Evaluating drug formulary construction and the decision-making
process of the Pharmacy & Therapeutics committee and
the PBMs contracting department concerning the balancing
of three selection criteria - efficacy, safety and cost.
Reviewing formularies and the bias in developing them
tells you who you are dealing with and how to protect
the plan and its members.
Selected wellness/training projects
include:
- Consulting on staff professional development programs.
Projects are diverse, ranging from helping consultants
listen to and communicate with customers, to improving
project management skills. This is relevant because improving
drug compliance or changing unhealthy habits or supporting
individuals in managing their diseases requires developing
campaigns to modify behavior through awareness, understanding,
reward, reinforcement, etc. These are the same elements
Pat uses in developing campaigns to build skills in health
plan members or in helping pharmacists improve their consultative
skills.
- Designing initiatives for stress management for an employer
in the throws of downsizing.
- Working with health/food product manufacturers to provide
coupons for health products as reward and reinforcement
elements in focused wellness and disease prevention campaigns.
While the focus of Associates & Wilson
is managing the dispensing of pharmaceuticals, wellness,
and disease management programs, Pat, as a previous pension
actuary that received a healthcare transplant, has past
experience in consulting to retirement communities which
case manage and self insure long-term care - home health,
personal and skilled care. Services included community population
projections, changing health consumption patterns of the
elderly, and determining appropriate liability for the contractually
guaranteed long-term care and drug benefits.
Pat is viewed as an authoritative
source on pharmacy and medical management. Her name often
appears in the media: Pat has testified before
Congress and the Financial Accounting Standards Board on
both pension and healthcare issues. She has chaired many
national conferences on topics ranging from disease to drug
formulary management. She appears on national radio and
television shows such as NPR’s Marketplace
and the Wall Street Journal Report, addressing
a wide range of topics. Because of her drug focus, she’s
frequently quoted on topics ranging from the acquisition
of PBMs to managing drugs under national health care proposals.
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