James C Rhodes
Crestwood,USA
Summary
Professional with extensive experience in founding and managing businesses, demonstrating exceptional leadership and strategic planning capabilities. Proven track record in creating and implementing effective business strategies, fostering team collaboration, and driving growth. Known for adaptability and results-focused approach, excelling in dynamic and fast-paced environments.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Enterprise Director Opioid Mitigation Strategies
Humana
01.2019 - Current
- Accountable for Humana’s enterprise strategy surrounding the opioid epidemic
- Lead Humana’s Opioid Enterprise Task force
- >54% reduction of Opioid overutilizers (>90MME)
- >58% reduction of concurrent use of Opioids and Benzodiazepines
- >25% distribution of Naloxone for at risk opioid utilizers according to CDC guidelines
- Developed holistic adherence program for Medication Assisted Therapy (>80% PDC)
- Accountable for Humana’s Star Measure – Combination use of Opioids and Benzodiazepines
- First year bounsable MY 2025 reduced measure performance YOY 168 basis points
- 141 basis points lower than acumen average for all MAPD plans
Founder, CEO
St. Matthews Community Pharmacy PLLC, St. Matthews Specialty Pharmacy PLLC
01.2013 - 01.2021
- Independent Pharmacy
- Vivitrol/MAT injection clinic program- >800 monthly monitored patients
- In Home Medication Management (73 monthly patients)
- Vaccine Clinic
- Integrated Health promotion (>$225,000 in annual sales)
- Specialty Pharmacy ($14M revenue annually 2016, 2017, 2018)
- ACHC , URAC and PCAB accredited
- Care Coordination program
- >7 Collaborative Care programs for Dermatology, HepatitisC, HIV, Vivitrol
- Utilized 3 PSAOs (Mckesson/Health Mart; Epic for Traditional medications, Pharmacy First for Specialty pharmacy medications)
- Grew from 3-19 employees, licensed in 4 states, Revenue grew from $600,000 -$19M
- Responsible for contract negotiations, direct manufacturer purchase agreements (4), data contracts (1), Financial reporting, Filing compliance, 2 remodels, accreditation, business planning and growth
- 1st KORE grant independent Pharmacy participant
- Improve access to Narcan (>700 Rx in 7 months)
- Per protocol Vivitrol program (Pharmacist lead Vivitrol program for under or uninsured)
- Clia waiver lab program that tests – Urinalysis, Pregnancy, naloxone tolerance
- Kentucky board approved protocols for vaccination, opioid use disorder, Flu, Strep
Director- Pharmacy Patient Safety Programs and MTM Business Solutions
Humana
01.2014 - 01.2019
- Accountable for quality- 15 CMS Pharmacy Star measures for Humana’s MAPD population, PDP, Medicaid and Exchange business
- Grown from $6.5 to $10M budget to improve quality measures
- 2014 >90% of membership in 4 Star or above for Pharmacy measures
- 2015 >95% of membership in 4 Star or above for Pharmacy measures
- 2016 >80% of membership in 4 Star or above for Pharmacy measures
- 2017 >84% of membership in 4 Star or above (Humana leads all competitors Minus Kaiser in Patient Safety measures (Med Adh, SUPD, CMR)
- Clinical programs that include
- Medication Adherence – contributes >$1M in trend savings annually
- Drug Utilization Review and Adverse Drug Events – contributes >2% lift in appropriate medication utilization annually and reduced ADE by 10% YOY
- Patient Safety (including gaps in care)- consistent 5 Stars in HRM for 3+ years
- Medication Therapy Management-2016 >140,000 completed CMRs in MAPD 2018 goal of 85% (over 200,000 CMRs)
- Developed clinical measures and clinical support for Quality Network through DIR Program- contributing >$400M in retained fees (2017,2018) while increasing Quality over 200 basis points in percentile fashion
- Vendor relationships
- Pharmacy Quality Solutions (quality metric solutions and measure testing)
- Welltok, Eliza (VAT solutions for retail and Mail)
- OutcomesMTM, SinfoniaRx, Mirixa
- Convergyes (Live agent member outreach)
- Enhanced Medication Services (Live agent (PharmD, CPhT) to member/Provider outreach)
- Conduent (Live agent (Physicians) to member/Provider outreach)
- Walgreen’s – Kansas City partners in Primary Care consortium
- Walmart- Direct Connect and Clinical programs (SinfoniaRx)
- Opioid strategy business and clinical leader- reduced MME >250 PMPM 45% while also reducing average MME by 36% in two years, Double threat reduction >25% YOY
- Caregiver strategy – implemented clinical programs for caregivers of Alzheimer disease
- Drug Management Care Coordination program- implementing Part B step therapy clinical Program for eligible members to receive rebate % for completing 3 step program
- Business owner for IT solution that coordinates Point of Prescribing and Point of Sale
- $40M investment to drive 20% ADE reduction via Prescribers
- Drive channel management for prescription delivery
- Real time benefits that drive channel management to preferred pharmacies and therapeutic alternative
Founder, CFO
Commons Community Pharmacy
01.2011 - 01.2016
- Independent Pharmacy
- Non Sterile Compounding (40/day)
- In Home Medication Management (55 monthly patients)
- Vaccine clinic
- Integrated Health promotion (>$150,000 in sales)
- Specialty Pharmacy ($58M revenue)
- Grew from 5 – 55 employees; licensed in 23 states; Revenue grew from $1.2M to $63M
- Responsible for contract negotiations, direct manufacturer purchase agreements (10), data contracts (2), Financial reporting, Filing compliance, 3 remodels
RxHealth Management LLC, Board of Managers
01.2009 - 01.2016
- Medication Therapy Management company in Kentucky
- Serviced Group Medicare and Medicaid patients
- Developed clinical services director who owned operations and account management
- Developed and Reviewed RFPs for software vendors that have MTM technology
- Network Expansion (developed plans that expanded KYs network from 200 to 750 stores)
- Kentucky State Legislation for non-dispensing pharmacies- advised on language that would allow pharmacists to beable to perform MTM without being tied to a physical store.
Strategic Consultant: Provider based pharmacy solutions
Humana
01.2013 - 01.2014
Strategic Consultant: Durable Medical Equipment Business Category Manager
Humana Pharmacy Solutions, Humana Inc.
01.2011 - 01.2013
- New business Expansion – Diabetes Supplies Humana and Non-Humana sales
- Consult on strategic partnerships for Diabetes Self-Management and Medical Nutrition Education
- Developed subcontractor for backend fulfillment for additional lines of Durable Medical Equipment
- Consult on OTC eCommerce expansion; developed wellness bundles, coupon strategy, marketing strategy
- Contributing Editor Humana Active Outlook Magazine Medical Advisory Board
Manager: Formulary and Utilization Management
Humana Pharmacy Solutions
01.2008 - 01.2011
- Chair of National Pharmacy and Therapeutics Committee
- Formulary and utilization management operations
- Responsible for CMS audits and URAC accreditation
- Pharmacy benefit and specialty consultation
- Managed team >15 professionals that included Operations Pharmacists, Clinical Pharmacists, process managers and analysts
- Clinical liaison for mergers and acquisitions
Manager: Pharmacy and Therapeutics Committee
Humana Inc.
01.2007 - 01.2008
- Responsible for daily clinical and formulary operations
- Utilization Management Policy
- Pipeline surveillance
- Trend Management
- Clinical programs
- Member impact mitigation strategies
- Drug Information
- Expedited Case Reviews
- Oversee national formularies for all lines of business
- Clinical communications strategy
- Department consisted of >7 professionals that included Pharmacists and analysts
Clinical Pharmacy Advisor: Pharmacy and Therapeutics Committee
Humana Inc.
01.2006 - 01.2007
- Developed Utilization Management Policies
- Clinical Pharmacy and Therapeutics Monograph and therapeutic class reviews
- Pipeline and Trend evaluation management
- Responsible for Regional Medical director quality reviews and education
Clinical Pharmacist
Humana Clinical Pharmacy Review, Humana Inc.
01.2005 - 01.2006
- Responsible for clinical review of utilization management exceptions
- Responsible for utilization management policies and procedures
Pharmacy Manager
Walgreen’s Pharmacy- Paducah, KY.
01.2004 - 01.2005
- Supervised Pharmacy department
- Enforced Administrative policies and procedures
- Managed >10 Pharmacist and technicians for 24 hour store (147,000 annual Rxs)
Pharmacist
Walgreen’s Pharmacy- Paducah, KY.
01.2004 - 01.2004
- Responsible for pharmacist dispensing and clinical services
Pharmacy Development Manager
Rite Aid Pharmacy- Western Kentucky
01.2003 - 01.2004
- Manage Prescription department Operations for 20 Pharmacies
- Inventory management
- Sales expectation
- Process enforcement
- Profitability
- Recruiting and maintaining work force
- Acquisitions
- 6 Independents
- 2 CVS
- 2 New store openings
- 5 Remodels
Pharmacy Manager
Rite Aid Pharmacy –Frankfort, KY.
01.2003 - 01.2003
- Supervised Pharmacy department
- Enforced Administrative policies and procedures
- Managed >6 Pharmacist and technicians for 24 hour store (90,000 Annual Rx’s)
Staff Pharmacist
Rite Aid Pharmacy-Elizabethtown, KY.
01.2002 - 01.2003
- Responsible for pharmacist dispensing and clinical services
Education
Master of Business Administration -
Sullivan University
01.2007
Doctor of Pharmacy - undefined
University of Kentucky
01.2002
Skills
- Goal setting
- Team leadership
- Contract negotiation
- Business administration
- Policies and procedures development
- Strategic thinking
- Revenue development
- Partnership building
Websites
Affiliations
- Pharmacy Quality Alliance- Invited Board guest and SAP Participant 2015-2019
- Commission for Certification in Geriatric Pharmacy (CGP) Board 2013-2016
- American Red Cross Blood Donor Board 2012-2015
- Academy of Managed Care Pharmacy
- Membership Committee 2011-2013
- Kentucky Pharmacist Association
- Chairman 2011-2012
- President 2010-2011
- President-Elect 2009-2010
- Speaker of the House of Delegates 2008-2009
- Vice-Speaker of the House of Delegates 2007-2008
- Kentucky Pharmacy Education Research Foundation
- Board of Directors 2007-2012
- Jefferson County Association of Pharmacist-
- President 2007-2008
- President-Elect 2006-2007
- Board of Governors 2005-2006
- American College of Clinical Pharmacy
- University of Kentucky Fellows Society
- University of Kentucky Alumni Association Life Member
- Kappa Psi Pharmaceutical Fraternity Graduate Chapter
Certification
- Board Certified Pharmacotherapy Specialist 2007-2021
- Certified Geriatric Pharmacist 2012-2017
- Registered Pharmacist, Kentucky 2002-Present
- Registered Pharmacist, Ohio 2007-Present
- Registered Pharmacist, Arizona 2008-Present
- Registered Pharmacist, Tennessee 2002-2006
- American Pharmacist’s Association Immunization Training 2002-Certificate
- Diabetes Patient Care Specialty Training Program 2003-Certificate
- Pharmaceutical Care for Patients with Diabetes 2011-Certificate
- Pain Management Certificate Program ASHP 2020-Certificate
- Opioid Stewardship Certificate Program ASHP 2023-Certificate
Publications / Poster Presentations
- Alpert C, Schwab P, Stevens L, Vaccaro J, Rhodes C, Johnson S Evaluation of Pharmacist-led Intervention for Patients Flagged for High Morphine Milligram Equivalents (MME) Poster Presentation Academy of Managed Care Pharmacy Annual Conference March 28- April 1 2022 (manuscript publication pending)
- Ferries E, Racsa P, Seuhs B, Brizzel B, Rhodes C Removal of Prior Authorization for Medication-Assisted Treatment: Impact on Opioid Use and Policy Implications Poster presentation Academy Health Research Conference June 13-16, 2020 (manuscript publication pending)
- Rhodes, C Three Reason for Non Adherence Managed Healthcare Executive July 2017
- Chiang J, Schwab P McCulloch, R, Brooks P, Happe L, Rhodes C Impact of a Retrospective Drug Utilization Review Program on Changing Opioid Prescribing Behavior. Research in Social and Administrative Pharmacy 14(5):e7-e8. May 2018
Consulting
- Dissertation Committee Member- Vaishnavi Tata PhD Candidate; Comorbid Burden of Depression Among Patients with Opioid Use Disorder Undergoing Buprenorphine Therapy – University of Houston College of Pharmacy 2022-2024
- National Quality Foundation – Measure Incubator – Appropriate Pain Management Strategy. Charge to develop post-surgical opioid and non-opioid quality improvements. 2018-Present
- National Quality Foundation – Opioid Technical Expert Panel. Charge to develop Opioid related quality measures to improve care and health related outcomes. 2019 to Present
- KPMG – Overutilization Monitoring System Technical Expert Panel. Charge to re-evaluate and contemporize the Medicare Part D Overutilization Monitoring System as part of a multifaceted response to address the growing problem of overuse and abuse of opioid analgesics. 2019-Present
- PCMA- Opioids workgroup 2019-Present
- IHI (Institute for Healthcare Improvement) OSUD workgroup 2020-Present
Timeline
Enterprise Director Opioid Mitigation Strategies
Humana
01.2019 - Current
Director- Pharmacy Patient Safety Programs and MTM Business Solutions
Humana
01.2014 - 01.2019
Founder, CEO
St. Matthews Community Pharmacy PLLC, St. Matthews Specialty Pharmacy PLLC
01.2013 - 01.2021
Strategic Consultant: Provider based pharmacy solutions
Humana
01.2013 - 01.2014
Founder, CFO
Commons Community Pharmacy
01.2011 - 01.2016
Strategic Consultant: Durable Medical Equipment Business Category Manager
Humana Pharmacy Solutions, Humana Inc.
01.2011 - 01.2013
RxHealth Management LLC, Board of Managers
01.2009 - 01.2016
Manager: Formulary and Utilization Management
Humana Pharmacy Solutions
01.2008 - 01.2011
Manager: Pharmacy and Therapeutics Committee
Humana Inc.
01.2007 - 01.2008
Clinical Pharmacy Advisor: Pharmacy and Therapeutics Committee
Humana Inc.
01.2006 - 01.2007
Clinical Pharmacist
Humana Clinical Pharmacy Review, Humana Inc.
01.2005 - 01.2006
Pharmacy Manager
Walgreen’s Pharmacy- Paducah, KY.
01.2004 - 01.2005
Pharmacist
Walgreen’s Pharmacy- Paducah, KY.
01.2004 - 01.2004
Pharmacy Development Manager
Rite Aid Pharmacy- Western Kentucky
01.2003 - 01.2004
Pharmacy Manager
Rite Aid Pharmacy –Frankfort, KY.
01.2003 - 01.2003
Staff Pharmacist
Rite Aid Pharmacy-Elizabethtown, KY.
01.2002 - 01.2003
Doctor of Pharmacy - undefined
University of Kentucky
Master of Business Administration -
Sullivan University