Operations

Carol Dunn

September 28, 2020

Carol Dunn is a hunter on the policy and restriction team at MMIT. She finds information on new-to-market drugs on insurer websites, so that health providers can utilize the information to ensure patient access. Dunn tracks down what barriers are in place to these drugs, such as step therapy, specific indications or prior authorizations. That information is then triple-checked by our teams, ending up in the hands of providers who prescribe those new drugs.

What do you do,

Carol Dunn is a hunter on the policy and restriction team at MMIT. She finds information on new-to-market drugs on insurer websites, so that health providers can utilize the information to ensure patient access. Dunn tracks down what barriers are in place to these drugs, such as step therapy, specific indications or prior authorizations. That information is then triple-checked by our teams, ending up in the hands of providers who prescribe those new drugs.

What do you do, in your own words?

I’m in the PAR department, and PAR stands for policy and restriction. It’s not a client facing role, but rather, behind the scenes. I go to the controller websites, which are where insurers like UnitedHealthcare and Aetna store their pharmacy data. The information we collect then creates policies for these medications, information like details on what’s required in order to prescribe the medications.

So I’m at the beginning of the market access puzzle. I find [the data] and I pass it on to the policy team, and they go in and assess that everything is correct. Then that information gets put into Analytics, where the providers can find the documents for what they’re looking for.

We have our team meetings every couple of weeks. Our managers will bring us up to speed on anything that’s new that we need to be aware of, like certain FDA indications that are approved for certain drugs, and not for other drugs. As they find out [new information], we find out. The main thing is sharing of information.

What’s your day to day like?

Right now, I am finding new indications for botulism drugs. That’s my project for the next couple of days. I’m looking at four different drugs right now that all came out with new indications For Botox, one of the new indications is called blepharospasm, which is spasms of the eyelids. The other is chronic sialorrhea, which is chronic drooling. I’m going to the controller websites now to look for criteria for Botox that says that insurers will cover it for these two indications.

There are more than 150 different controller sites, so normally a new project like this will take about three days.

What are some of the common challenges of your role?

My drugs, they’re brand new, they’ve just been approved by the FDA and released. And there’s hardly any information to find on them, so you really, really, really have to go hunt deep. It’s really challenging to go in there and find what you can find, because it’s hidden behind the scenes

But if it’s a medical benefit drug — these are drugs that are provider-administered, like intravenously or through injection — they have more stringent requirements and more restrictions to get the drugs. Trying to find that information is tricky. Sometimes I might not find actual criteria, but we might be able to find proof that it is a medical benefit drug, and that’s enough to create a policy to provide to the prescribers.

What’s been your biggest victory with the company so far?

[Most of my projects are] already mapped out for me. When I get assigned these drugs, there’s already a process that’s been put in place by another department that tells me where to go and what to do. And then I might go to the controller sites, but when I get there, I can’t find what I need.

But I like to dig deeper. When I can find reliable resources on my own, things that were not mapped out for me, I submit my findings to the powers-that-be. If it ends up getting approved, that gets incorporated into the official hunting process. When I’m able to find something that wasn’t provided to me, that’s like a “woo-hoo” moment for me.

What changes are you seeing in the industry that clients should be aware of?

A lot of the insurer websites are starting to batten down the hatches. Some of the nice, beautiful websites that we used to be able to use to find data, they’re locking it down. We can only get in there now with special provider portals.

Also, you might go to the website and it might say, ‘This site has formulary data,’ which means it’s where the drug lives, and it might have prior prioritization forms that are needed. But I’ll go in and open up a page, and there’s nothing there. You have to dig deep to make sure that you find it, and see if really does exist. If it doesn’t exist, you give it up.

What do you like about working at MMIT?

The management, upper level management, is just fantastic. They are all employee-driven, and employee-sensitive as far as our welfare and our safety. And they are very accessible. You can go to this director, go to the office and say hello, and sit down and just start talking.

What do you like to do outside of work?

Well, yesterday was my birthday, and I took my first social outing since March! [We] went to Great Adventure Safari Park in New Jersey and saw lions, tigers and bears…oh my!

Life outside of work has pretty much slowed down for me. I am 64 and married 43 years. At this point in my life, I am much more into being with my family and I’m looking forward to times [when] we’ll be able to get together.

Other than that, I really enjoy cooking. And, since the Parx casino is about 30 minutes away, we enjoy occasional trips there.

Jim Scacco

July 27, 2020

Jim Scacco is the vice president of services at MMIT. He is responsible for product implementation and client support for the organization’s health plan, specialty pharmacy and electronic prescribing businesses. Scacco oversees several of MMIT’s key solutions, such as Formulary Navigator, specialty pharmacy surveys and electronic prescribing data tools.

What do you do, in your own words?

My team and I are responsible for partnering with our clients in key business areas and ensuring they not only understand how to use our tools,

Jim Scacco is the vice president of services at MMIT. He is responsible for product implementation and client support for the organization’s health plan, specialty pharmacy and electronic prescribing businesses. Scacco oversees several of MMIT’s key solutions, such as Formulary Navigator, specialty pharmacy surveys and electronic prescribing data tools.

What do you do, in your own words?

My team and I are responsible for partnering with our clients in key business areas and ensuring they not only understand how to use our tools, but also understand how to leverage them throughout their organization to gain the most value. We are often asked to play a subject matter expert role and act as an industry knowledge source for our payer partners. I also work with the product and technology teams to help them understand client needs and evolve the MMIT tools to better support our client base.

How did you join the company? What in your background brought you to health care?

Earlier in my career, I worked with several members of the leadership team at MMIT, where we were successful in growing and transforming another company to become an industry leader. Back in 2012, those individuals contacted me regarding a new endeavor with a small company called Managed Market Insights and Technology. At that time, they needed someone to help lead and transform the technology group, which seemed like an exciting opportunity. Prior to this, I had led IT organizations for large insurance companies for much of my career, so I had a solid health care foundation at the time. Coming to MMIT to help grow and transform this company seemed like a natural fit.

I led the technology group at MMIT for several years but found myself enjoying the customer interaction part of my position. This led me to move into my current role, where I am tasked with providing an infrastructure that enables high-level support and services to our client base while also identifying ways to evolve our products to continue to lead the industry.

What’s your day to day like?

Every day is a bit different and is dependent on our client needs and industry trends. The one constant is our focus on providing superior support and services for roughly 100 clients, all of which have unique business challenges. During times of new regulatory changes, I spend time researching and understanding those changes and their effect on our customers. Then I engage key stakeholders within our existing and prospective clients to partner on unique ways of solving nuanced business needs. These discussions often focus on new business processes, federal and state regulations and approaches to the ever-changing formulary landscape. From an internal standpoint, I partner with our sales and product leaders to provide insights around industry trends and how this connects to customer needs.

What are some of the larger projects you’re working on?

Every year there are regulatory changes or new offerings in the Medicare and Medicaid businesses. These changes result in enhancements to our products and processes. An example of this is our current project to support regulatory changes for 2021 Medicare offerings. Once product enhancements are completed, we work with our clients to ensure they understand how to efficiently leverage those enhancements to meet government filing and regulatory needs. Another large project is the addition of medical formulary management to our Formulary Navigator tool. There seems to be a growing trend in the industry to have more formality and processes around managing medical drug lists. Partnering with clients and gaining their feedback is paramount to the success of this new offering. Finally, in our electronic prescribing business unit, we are migrating our electronic provider client base to the latest version of our data feeds so they can gain more value from recent enhancements.

What are some of the common challenges of your role?

Understanding, reacting to and communicating the ever-changing federal and state requirements for formulary management and publishing is a challenge for the industry. States are defining more complex and differing requirements at a more rapid pace than in prior years. At the federal level, CMS is requiring more overall management and options, which translates to more formulary oversight and offerings from payers. All this regulatory change requires us to be more diligent in synthesizing these trends, while also being very agile in addressing it so we can meet our payer client needs. Mergers and acquisitions in the health plan space is another challenge. The formulary landscape is constantly changing, especially after a merger or acquisition. Understanding new priorities and being able to react and provide efficient solutions to changing requirements is always a challenge. Creating flexible products that meet a variety of client needs and constantly learning about industry trends and changes has helped us greatly through these challenges.

What’s a common issue you help clients with?

As I said before, one of the most common issues we see with clients is their ability to understand the ever-changing regulatory environment. Most payers have groups that research new legal regulatory requirements, but many times that information does not filter down to the individuals doing the actual formulary management in a way that translates into process changes. In general, payers may be hesitant to directly meet with competing payers and discuss approaches to new requirements, so each company is challenged with coming up with their own solutions to problems. We regularly discuss challenges and solutions with our clients, and as such, can act as a knowledge base hub. Having these discussions allows us to fully understand new regulatory and industry trend requirements from a broad perspective, and provide software solutions, knowledge and processes changes resulting in optimal value to our clients.

What does MMIT do, in your own words?

MMIT is a complex and growing company with several different products geared toward satisfying our client’s needs. At its root, I think our mission statement really gets to the core of what we do: MMIT smooths access to therapies. If you look at our offerings, and the general driving focus of all our teams, this is what we are trying to accomplish through several industry verticals. In the payer vertical, this means helping health plans efficiently manage formularies, satisfy claims and communicate with members and healthcare providers so individuals can get access to the therapies they need.

What do you like to do outside of work?

Spending time with my family, first and foremost. I have two daughters, one in college and one who just graduated. Although we have been states apart for a few years due to college, we try and find as much time as possible to be together. The beach is our favorite place, and we spend a lot of time “down the shore” in New Jersey all year round. When I am not with the family, I also enjoy boating and saltwater fishing. There is never a bad day on the water!

by Brooke McDonald

Jayne Hornung

December 23, 2019

Jayne Hornung is the vice president of pharmacy and medical programs at MMIT. She is MMIT’s clinical subject matter expert, and conducts ongoing research of new indication and policy data while helping the client experience team gain expertise on clinical knowledge. She creates MMIT’s clinical perspectives for all current indications and helped develop the Policies and Restrictions (PAR) data platform. Prior to joining MMIT, Hornung was a medical information scientist at AstraZeneca, a clinical pharmacist at Cancer Treatment Centers of America and Home Solutions Infusion Services,

Jayne Hornung is the vice president of pharmacy and medical programs at MMIT. She is MMIT’s clinical subject matter expert, and conducts ongoing research of new indication and policy data while helping the client experience team gain expertise on clinical knowledge. She creates MMIT’s clinical perspectives for all current indications and helped develop the Policies and Restrictions (PAR) data platform. Prior to joining MMIT, Hornung was a medical information scientist at AstraZeneca, a clinical pharmacist at Cancer Treatment Centers of America and Home Solutions Infusion Services, and owned and operated an independent pharmacy until 2006. She is a registered pharmacist in the state of Pennsylvania.

Q: What’s your day to day like?

On top of developing our oncology product, the client experience team comes to me when they have clinical questions that clients are posing to them. In addition, the operations team asks questions about how to assess policies when they are unsure. So I answer a lot of questions about our data and how our clients can find the answers to their business questions through our data. On a daily basis, I create the workbooks [a comprehensive view of an indication, including the drug market basket and pipeline products] for the clinical content in our data and find what’s important in the policies that’s relevant to our clients and that we should be exposing in our data.

Q: You pioneered some of the internship programs at MMIT. How did that come about and how have those programs grown?

We needed some additional clinical support when we were growing for short term sprints. I had remembered when I was in pharmacy school, we had a lot of opportunities to go and work at different companies, and I thought, “Well, why can’t people come here and learn, because this is an interesting experience!” How drugs are covered by a plan and why they’re covered or not is not taught in pharmacy school, but it’s very much a part of everyday life for a pharmacist. We developed three programs with Philadelphia-area schools. This small level of involvement helps recruit students, so they understand what we do when they get here. If they have interest, they can reach out to me.

I believe as we grow, we’re going to need more clinicians here. As these students who’ve had experiences here graduate, we’re keeping in touch with them so when we have openings, they can apply.

Q: What are some of the other larger projects you’re working on?

We are currently trying to create as many oncology indications as possible and a new Advanced Oncology Analytics platform. Right now, I have eight students working for me remotely who are researching oncology indications so we can get the data into the database quickly and we can stand up our oncology offering as soon as possible.

Q: What clinical areas should clients be keeping an eye on?

Oncology is the area that has not truly been managed by health plans, and it’s where drug approvals are growing exponentially year over year. The criteria is also the most complex that we’ll see in policies, so there’s a real need in the industry for pharma companies and doctors to understand how those are managed, so their patients can get access.

Q: Are there any big industry trends that clients should be looking out for?

I don’t think it’s a shift that clients aren’t aware of, but I think as the cost of drugs go up and health plans need to manage those costs, our client success leads are getting questions every day about how the policies are changing, and how payers are changing their policies to respond to the high cost of drugs, and to more oncology drugs being in the market. Those are the big questions that everybody is watching to see what happens over the next few years, specifically in oncology because there’s so much growth there.

Q: How is MMIT poised to help with the current trends we’re seeing in market access?

Since we sit in a unique position between the payers, providers and pharma, we can expose the policy data so doctors understand what pathway they need to follow for patients to get access to the appropriate therapy at the appropriate place in treatment. Pharmaceutical manufacturers can make sure that they’re doing everything they can for patients to get access to the medications that are available on the market. As far as our provider network, we push all of this information out to providers. It’s important that we sit where we can be transparent with all of this information.

Q: What’s your favorite part of your job?

Every day is new. Every day is different questions, it’s never ever the same and it’s not boring. I love the variety in it, there’s always a new indication to stand up, there’s always a new workbook to build. So that and the education part of it are my two favorite things.

Q: What do you like to do outside of work?

We own a boat, so we go boating almost every weekend when the weather’s nice. I like to travel, and we go boating everywhere, the Chesapeake, Delaware, and my daughter lives in Miami, so we love to go there too. I also love to craft, so I knit and crochet, you name it. I’m a crafter, or “maker” as they call them now.

by Carina Belles

Bob Lombardi

November 21, 2019

Bob Lombardi is the director of policies and restrictions (PAR) data operations at MMIT. Lombardi joined MMIT five years ago as a contractor to aid in the development of MMIT’s Medicare project. From there, he was brought on as a full-time employee where he has worked as a project manager, team manager and director. As the director of PAR operations, Lombardi oversees the day-to-day aspects of all PAR data updates and has played an integral role in launching MMIT’s payer data team.

Bob Lombardi is the director of policies and restrictions (PAR) data operations at MMIT. Lombardi joined MMIT five years ago as a contractor to aid in the development of MMIT’s Medicare project. From there, he was brought on as a full-time employee where he has worked as a project manager, team manager and director. As the director of PAR operations, Lombardi oversees the day-to-day aspects of all PAR data updates and has played an integral role in launching MMIT’s payer data team.

How did you join the company?

My education is in astrophysics and aerospace engineering. I spent the first eight years of my career building satellites for Lockheed Martin. When the plant closed and I was offered relocation, I decided not to move because I wanted to start a family. I made a big career change coming to MMIT, but the many opportunities and recognition of hard work that embodies this company’s culture has been rewarding.

What’s a typical day like for you?

I spend a lot of my day solving problems and answering questions. I oversee the managers of the different PAR teams and make sure they have everything they need to be successful. A lot of that is helping clear any blocking issues for them, but it also includes giving them tools and metrics to keep the teams organized and productive. I also do a lot of thinking, as I am responsible for helping design our operational processes and plan for what’s upcoming.

Can you describe how the data teams you manage fit into the company?

I oversee the PAR segment of the data operations, which is made up of several different teams. Our cycle team maintains our data and ensures it’s timely. Our new indications and prototype teams are focused on building newly sold indications and ensuring they become operational. The new-to-market team is focused on high profile drugs that have recently launched or will be launching into the market.

Can you describe the process for new employees coming onto the team? How they start out as temps, move into a full-time role, and advance within the company?

We strive to put people in the best position to succeed and grow within the company. As people grow into new positions, we often will backfill their role with a temp. Our temps are given the opportunity to learn our data and processes and eventually perhaps find their opportunities within the company.

We have several examples of people who started as temps and have moved up in the company. I’m one of them. I started as a contractor about five years ago. My first task was to build a process for the Medicare project and that turned into a project manager role, which turned into a manager role, which turned into a director role.

What are some of the larger projects you’re working on?

We’ve been working over the last six months to establish our payer data backbone, and we’ve built a team that is a mix of new temps and experienced employees to maintain that data. Their main purpose is to research and find new formularies and plans and make updates to our payer data structure based on their findings. We’ve recently introduced managed care organizations (MCOs) into our dataset, and the payer data team is responsible for maintaining the payer hierarchy as well. They’ll also be staying on top of some of the bigger merger and acquisition activity that is expected to occur in 2020.

What’s been your biggest victory with a client or the company in general so far?

The success of PAR has been a big victory. I started by managing the precursor to PAR when it became operational, but that process was project-based and not scalable. We analyzed the data and the processes and came up with a way to execute more efficiently. I helped design the data structure, tools, and team. The success of those efforts and our ability to evolve PAR has provided a lot of value for the business and our clients.

What’s your favorite part of your job?

There are a lot of fun aspects to my job, but the people I work with are my favorite. I work with so many talented people at each level who are all working hard toward the same goals.

What are the challenges of your role?

The pace at which the company is growing tends to create new challenges for operations, often in the form of adjusting or creating processes, tools and teams. Solving these challenges requires being creative, flexible and fast.

What do you like to do outside of work?

I have two small kids at home, and my life outside here is about enjoying my family. We like to travel and to cook, and when we can, try different local cuisine. We love just getting out with the kids and watching them grow up.