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Management Bios
Kimberly Ply McDonough, Pharm.D. Dr. Kimberly McDonough is the President and Founder of Advanced Pharmacy Concepts. She has twenty-five years of administrative experience in a variety of pharmacy venues including managed care, hospital, and long term care. As president of APC, Dr. McDonough has participated in and/or supervised PBM contract negotiations, pharmacy clinical management activities, provider support, drug utilization analysis and management, and quality assurance. Recognized as a thought leader in the industry, she has testified on healthcare issues before hearings on behalf of U.S. Representatives of Congress, state legislative oversight committees, other state administrative organizations, and professional organizations. Prior to establishing Advanced Pharmacy Concepts, Dr. McDonough managed pharmacy utilization and quality assessment programs for Harvard Community Health Plan’s New England Division and for MIM Corporation, a national pharmacy benefit management company. She also has clinical and management experience as the Vice President of Pharmacy Systems, Inc., a hospital pharmacy management company. She has served as Director of Pharmacy for hospitals in New York and Indiana. Dr. McDonough is a graduate of the Purdue University School of Pharmacy. She has served as the chair of the Rhode Island Drug Utilization Review Board and Academy of Managed Care Pharmacy’s Legislative Committee and Strategic Marketing Committees. She has also served on the American Pharmaceutical Association’s STAT Committee for Payment Reform, AMCP’s Leadership Committee, and AMCP’s Committee for the development of Pharmacy’s Framework for the 21th Century. Dr. McDonough is the author of the National Pharmacy Council’s Summary of Pharmacy Quality Measures. She is currently a member of the Dean’s Advisory Committee for the University of Rhode Island and is a Board member for the Rhode Island Pharmacist Association. Dr. McDonough is the recipient of the 2007 Rhode Island Small Business Entrepreneur of the Year Award. She has also received the 2006 Rhode Island Minority Business of the Year, the Elan Pharmaceutical / Rhode Island Pharmacists’ Innovation in Pharmacy Practice Award., and the Baxter Award for Innovations in HealthCare. She has been recognized by the Rhode Island Business and Professional Women for her commitment to women in business. She is a past recipient of the Harvard Community Health Care prestigious Diamond Award.Michael G. Pirri Mr. Pirri joined Advanced Pharmacy Concepts in 2002. He is an industry expert on pharmaceutical pricing and co-payment design, and has 12 years of experience as an analyst and problem solver, working with complex databases of pharmaceutical and long term care claims. As the Director of Analytical Services for Advanced Pharmacy Concepts, Mr. Pirri has directed more than 50 comprehensive PBM audits for clients that range from Fortune 500 employers to one of the largest Blue Cross Blue Shield plans in the country. Mr. Pirri and his auditing team have conducted comprehensive, on-site rebate audits of major PBMs. The Analytical Services department’s additional responsibilities include client reporting and interpretation as well as managing APC’s information systems capabilities. Prior to joining APC, Mr. Pirri held the position of Manager of Analytical Services with PharmaCare, the PBM and specialty pharmacy subsidiary of CVS Corporation. During his two plus years with PharmaCare, Mr. Pirri led a group of analysts with responsibility for sampling large pharmaceutical databases, analyzing savings realized as a result of PharmaCare cost containment strategies and programs, and communicating these results to existing and potential clients. Prior to PharmaCare, Mr. Pirri spent six years as the Director of Market Research and Patient Outcomes at Mariner Health Care, the leading provider of sub-acute and long term care services in the United States. Mr. Pirri’s responsibilities at Mariner included analyzing patient outcome data associated with Mariner’s clinical pathways and using the information to assess efficacy and to manage census. Mr. Pirri holds a Bachelors degree in Mathematics from the University of Rhode Island.Mary Tafuri Ross Ms. Ross has over twenty years’ experience in the health care field, including ten years working for PBMs. At APC she is Director of the Consulting and Clinical departments and is responsible for projects that include projecting pharmacy costs, evaluating new methods of benefit delivery, evaluating ROI of benefit design features, developing Best Practices in pharmacy benefits, benchmarking contract terms, and conducting RFPs. Ms. Ross has advised health plans, benefit groups and employers on pharmacy benefit issues and has analyzed benefits, claims data, and contracts. Prior to joining APC, Ms. Ross held the position of Director, Pharmaceutical Contracting with PharmaCare, the PBM and specialty pharmacy subsidiary of CVS Corporation. At PharmaCare, Ms. Ross negotiated rebate and specialty drug purchase contracts and also reorganized the drug utilization review department. She also negotiated rebate contracts for MIM Corporation, another national PBM. Ms. Ross has worked in hospital administration as planning director and in the health insurance industry. Ms. Ross has presented at the RxSuccess Summit in Omaha on fraud and abuse in pharmacy services, and at the Employers Health Coalition of Ohio on pharmaceutical pricing. Ms. Ross holds a Master of Business Administration degree from the University of Rhode Island and a Bachelor of Science degree in Biology from Providence College.Nancy Hayden Joining our company in 2002, Ms. Hayden brings more than a decade of healthcare industry experience. Ms. Hayden manages the audit department and has performed over 25 audits of both rebate programs and claims adjudication while working for Advanced Pharmacy Concepts. Her knowledge of the industry and her proficient work has gained Ms. Hayden the trust and respect of external contacts (both at the client and the PBM) while performing audits. Because of her in-depth knowledge of rebate programs and claims adjudication, Ms. Hayden is able to identify genuine problems in a timely manner and communicate the issues effectively to the PBM and clients. Ms. Hayden began her career at one of the country’s largest healthcare group purchasing organizations, AmeriNet. As a contract auditor for AmeriNet, Ms. Hayden’s primary role was to ensure that AmeriNet’s clients were receiving appropriate pricing as specified in their contracts with various manufacturers and distributors. Ms. Hayden also worked for CVS Corporation’s PBM subsidiary, PharmaCare. While performing a variety of analytical, auditing, and programming roles for PharmaCare’s rebate contracting department, Ms. Hayden attained a thorough knowledge of the PBM industry and pharmacy claim adjudication practices. Negotiation and implementation of manufacturer rebate contracts was also part of Ms. Hayden’s responsibilities while employed by PharmaCare. Ms. Hayden earned a Master of Arts in Management in 1995 from Salve Regina University in Newport, Rhode Island. Andrea Luisi, Pharm.D. Dr. Luisi has been with APC since 2005. She currently is the Manager of CMS Consulting at APC. Dr. Luisi is responsible for coordinating the Part D audits with CMS and Booz Allen Hamilton, as well as supervising the benefit analysts at APC and Booz Allen conducting Part D audits. In 2005 and 2006 Dr. Luisi was a reviewer in the Medicare Part D Formulary Review Project. Previously, she was a Clinical Associate Professor of Pharmacy at the University of Rhode Island College of Pharmacy. Dr. Luisi holds a Doctor of Pharmacy degree from the University of Rhode Island. |