About Michael J Baldzicki, CRCM Executive Vice President, Growth & Strategy, AscellaHealth
As an Executive of Growth & Strategy for AscellaHealth, Mike leads Market Access, Business Development & Corporate Strategy for Specialty / Infusion Pharmacy Segments, he provides business strategies of all portfolio management. Within his roles, he ensures the success of the widest variety of strategic projects across departmental segments, applies strategic business development, contract negotiations, network development, marketing & outreach strategies, and other business development initiatives that cultivate opportunities that affect client segments. Identify pressing market factors and drive strategic business strategy for all facets related to the specialty market. With more than 21+ years of specialty pharmacy, pharmaceutical and biotech industry experience, including roles in national and regional managed markets, specialty supply channels, sales management and specialty brand management, Mr. Baldzicki offers strategic insight into specialty pharmacy trends, distribution, contracting, reimbursement, and the application of health outcomes and economic evidence to prove value proposition. He is a recognized leader in the specialty pharmaceutical market for developing and implementing key payer and specialty pharmacy agreements that result in documented savings for specialty market segments.
AscellaHealth, a national specialty pharmacy benefit manager (SPBMTM), serving commercial, Medicare and Medicaid segments, offers high quality prescription drug benefit management services. Complemented by other customizable services, such as carved-out specialty pharmacy services and cost-savings programs, AscellaHealth provides a unique, proprietary service portfolio. Visit www.ascellahealth.com.
Medical Travel Today (MTT): How do you see AscellaHealth participating in this new marketplace, given the “new normal,” the pandemic, economic woes and all the issues currently confronting employers and payers?
Mike Baldzicki (MB): AscellaHealth is already at the forefront of the industry, not only with our business model, especially regarding operational interoperability and with healthcare markets and costs, but also with the COVID-19 pandemic.
Since its inception, AscellaHealth has been a virtual model, which has allowed us to remain flexible about customization with our clients and in terms of managing networks, vendors and partners. We don’t own anything, from the pharmacy perspective, but continue to leverage our networks, ensuring cost and quality of service that we deploy in the clinical programs for our partners.
Based upon the dynamics of healthcare markets, it’s almost business as usual, simply because we’re used to these types of venues and pathways and customize accordingly. Our model fits where healthcare is going and the need to adapt to technology. We have proprietary platforms already in place with clients and are adding to that. We also focus on telehealth and deploy our programs in high touch therapies, like hemophilia or immune globulins.
MTT: What differentiates AscellaHealth in the marketplace as opposed to a traditional PBM?
MB: We haven’t lost sight that we started as and remain a full PBM organization, but we’re not always able to compete against the large PBMs that have a full scale of retail mail entities, like CVS or Walgreens, across the country.
On the specialty pharmacy side, we are competitive, not only from a price standpoint but also with our executive leadership team. We focus on becoming a true specialty PBM, specialty pharmacy and medical RX benefit administrator, with an array of pharmacists, physicians and executive staff who think the traditional model is broken. Traditional PBMs and pharmacies in the specialty space have not contained costs in these high cost therapies.
We continue to see utilization and costs go up, price tags continue to be increased by manufacturers and the employers and TPAs are now saying ‘enough is enough.’ They are now willing to disrupt this area.
What we’ve deployed as a solution meets the market need based on our true focus of being a specialty PBM to administer not only a cost savings initiative, but also streamline efficient clinical interventions and therapy optimization programs beyond unit costs. Most PBMs only look at unit costs for products.
Our specialty pharmacy carve-out is a solution based on looking at the total cost of a claim, benefit design, utilization management, disease management, clinical management and the patient’s overall wellness.
MTT: Tell us about the upcoming educational webinar series that you have planned. How did that evolve and how is it going?
MB: There’s a difference in how you manage specialty pharmacy and traditional drugs versus the medical side, such as infusion and subcutaneous injectable products. Based upon our market position, we have attracted a lineup of some of the nation’s most respected thought leaders from diverse areas of healthcare and the specialty pharmacy industry, including chief medical officers, large TPA executives, employer coalition leaders and key health marketing professionals.
Here’s the registration link: https://www.ascellahealth.com/events.
Episode 1: “Specialty Market Trends and the Market Place Realities for Pharmacy Benefit Managers (PBMs)”, June 25, 1:00 p.m. EST (60 min.), will explore specialty drugs as the greater percentage of drug spend, limited distribution drugs (LDDs) leading to greater emphasis on network management, cost of products, quality of service and clinical programs.
- Kevin Cast, Partner, ArchBow Consulting Group
- Dean Erhardt, MBA, D2 Consulting
- Randy Falkenrath, Principal/Founder, Epiphany Solutions LLC
- Robert Shelley, CEO/Founder, LeafHealth
Episode 2: “Evolution of the PBM Business Model for Specialty Medical Rx,” Aug. 27, 1:00 p.m. EST (60 min.), will examine new solutions of a streamlined PBM model that uses data analytics to improve adherence, patient outcomes and manage the total cost of the claim.
- Bruce Flunker, President, EBSO/90’Degrees
- Robert Shelley, CEO/Founder, LeafHealth
- David W. West, CLU, CEBS, Director, Corporate Development, Group and Pension Administrators, Inc. (GPA)
Episode 3: “Revolution: Leading Approaches to Transform Healthcare in Specialty Medical Rx Management,” Nov. 12, 1:00 p.m. (60 min.), will look at the promotion of biosimilar adoption, interrogating treatment adjustments from a patient-centered perspective and actively communicating with the complete specialty Rx chain, including providers, specialty pharmacies, employers, hospital systems and payers, for better results.
- Jeffrey Hogan, Northeast Regional Manager, Rogers Benefit Group
- Scott Howell, D.O., MPH&TM, Chief Medical Officer, CPE to Advisory Board: Clinical Specialist, and Healthcare Expert
- Brian Klepper, Ph.D., Principal, Worksite Health Advisors
- Cheryl Larson, President and CEO, Midwest Business Group on Health
For this series, we are partnering with Leaf Health, a consulting benefit entity, and will look at real world scenarios to provide insights.
MTT: Tell us a little bit about yourself and how you got involved in this industry.
MB: I’ve been in this sector for about 21 years and have experience with every segment of the pharmacy pharma diamond, from sales and distribution to private equity, specialty pharmacy therapies and PBM.
MTT: If you had to point to a key goal for this coming year, what would it be?
MB: To continue to get our message out there that we’re a boutique PBM focused on specialty pharmacy. Our growth in this area is based upon operations and interoperability as clients continue to leverage our technology applications, proprietary tools and cost modeling to help employers and the ASO market segments of TPAs.
We are passionate about solving solutions for a broken model. Employers, TPAs and hospital systems are facing a storm of price inflation around specialty drugs, particularly with the genotype and ultra-orphan drug price tags of up to $5 million. No one can manage these bills.
We have a track record and can provide real life scenarios of cost savings that will disrupt the market.
MTT: Because we’re reaching an international audience, I’d like to ask if you have any interest in the global market?
We are exploring it and have some books of business in the Puerto Rico market segment, but we are exploring in South America for different opportunities in business development other than European or Canadian markets within our business model of specialty PBM in the United States.
MTT: Would the medical travel for pharmaceuticals be part of that?
MB: Yes, and we are talking to certain entities that are already focused on medical travel and cost savings and looking at ways to streamline the member experience and journey across these high cost drugs, particularly in the Caribbean or Columbia markets where it is already being done. We’re very receptive to meeting with organizations that are already doing medical travel and willing to partner with us to help employers, hospital systems and TPAs to contain costs.