Rebekah Dube

Clinical and operations executive leading strategy for Central Maine Healthcare’s accountable care organization (ACO), programs to improve value-based contract performance, pharmacy, primary care, behavioral health, community health programs, and health equity.

• Developed and executed the strategy and operations of the accountable care organization and population health programs to optimize value-based contract performance.
• Directed inpatient and ambulatory pharmacy programs, resulting in improved pharmacy expense trends, specialty pharmacy growth, and cross-system integration of pharmacy services.
• Developed and implemented a primary care strategy and operations, including the growth of primary care volume by 10%, improvement of provider productivity, and improved care coordination.
• Led cross-system initiatives to improve colorectal and breast cancer screening rates, Medicare Annual Wellness Visit rates, and A1c control for Central Maine Healthcare primary care patients.
• Formulated and carried out programs for behavioral health, community health, and health equity.
• Advisor and partner to Human Resources and Senior Leadership teams in the assessment and implementation of new medical and pharmacy benefits for Central Maine Healthcare team members.

Led clinical, operations, analytical, and regulatory leadership for the Central Maine Accountable Care Organization and the integration of quality, care coordination, and value-based care initiatives at Central Maine Healthcare and with non-employed ACO participating providers.

• Established and managed a central team of nurses, pharmacists, medical assistants, analysts, and administrative staff to support clinical program initiatives and improve value-based contract performance.
• Led a system-wide hospital readmission reduction initiative, resulting in a 15% improvement in the readmission rate.
• Coordinated efforts with the Central Maine ACO Board, the executive leadership of Central Maine Healthcare, and leaders of other ACO participating providers to determine ACO and value-based care priorities and goals.
• Guided performance improvement activities to manage cost, utilization, and drive quality improvement in alignment with measures in the Medicare Shared Savings Program, and other payer ACO risk contracts.
• Managed the implementation of an integrated population health system to provide increased access to actionable data and reporting, and to drive improved cost of care management, quality improvement, and complete and accurate CMS-HCC risk score capture.

Directed integration and strategy for pharmacy, quality improvement, population health, Medicare risk adjustment programs, and provider engagement.

• Directed strategic planning and activities to drive the performance of pharmacy benefits, pharmacy operations, clinical programs, and cost management for Medicare Part D, US Family Health Plan programs, and onsite retail and mail order pharmacies.
• Led the strategy and execution of Health Plan Quality programs, including Star Ratings, HEDIS, NCQA accreditation, CAHPS, and other CMS and Defense Health Agency requirements.
• Defined strategic priorities for the Medicare Risk Adjustment program.
• Directed medical management clinical programs and operations, including Medical Directors and Medical Economics, to improve the quality of care and the cost of care management.
• Collaborated with Martin’s Point Primary Care Delivery System and ACO partners to enhance performance on quality, risk adjustment, and cost of care measures.
• Developed market strategies and executed performance improvement initiatives to drive Medicare Advantage program profitability.

Led the growth, market positioning, financial performance, and management of Medicare Advantage product lines, Medicare operations, star ratings and pharmacy programs.

• Formulated product and market strategies to meet growth and financial performance goals.
• Directed and advised the Medicare star ratings program, consistently achieving 4.5- and 5-star ratings.
• Facilitated the growth of Medicare Advantage membership by more than 20,000 through effective product and bid development.
• Led the Pharmacy Services division for Medicare Part D and the US Family Health Plan, including operational and clinical programs, Pharmacy Benefit Manager oversight, and onsite pharmacies – achieved a strongly improved appropriate utilization and lower-than-industry-average pharmacy cost trends.
• Directed Medicare Health Plan customer operations, including member services, sales, grievances and appeals, and enrollment, to achieve consistent 5-Star customer satisfaction scores and an industry-leading retention rate.
• Interim Vice President of Medical Management (July 2015 - February 2017) - responsible for strategic development and management of care/utilization management operations and programs, as well as provider network management, value-based contracting, and relationship management.

Oversaw critical strategic programs for Martin’s Point’s Medicare Advantage plans, including product and benefit design, performance, and Medicare star ratings, as well as all Martin’s Point Medicare and USFHP pharmacy programs.

• Created market-leading Medicare Advantage and Part D benefit designs through the annual Medicare bid, product, and benefit design process.
• Spearheaded the creation of the organization’s star rating strategy and program, achieving 4.5- and 5-star performance.
• Managed the relationship with the contracted Pharmacy Benefits Manager (PBM) to drive clinical and financial performance for all Health Plan lines of business, as well as to ensure compliance with CMS and Department of Defense regulations.
• Developed a preferred pharmacy strategy for Medicare Advantage plans that resulted in a 30% increase in volume shift.
• Collaborated with University of New England to establish Maine's inaugural Community Pharmacy Residency Program.
• Spearheaded continuous quality and process improvement projects across various departments with Lean practices.

Led all Pharmacy Health Plan operations, clinical programs, onsite pharmacies, and provider care delivery sites.

• Designed programs to enhance pharmaceutical utilization for clinical and cost effectiveness.
• Developed programs and processes to ensure compliance with all contractual obligations and requirements for the Department of Defense and Medicare Part D, including rejected claims, clinical decision-making, and other oversight methodologies and processes, and performed clinical appropriateness drug reviews for health plan prior authorization requests and appeals.
• Oversaw relationship with the contracted Pharmacy Benefits Manager (PBM).
• Led management and rollout of pharmacy benefits for a commercial, small employer, innovative health plan.
• Served as the organizational lead on drug information questions, clinical initiatives, benefit design and interpretation, and claims processing issues.
• Developed and managed pharmacy health plan budgets
• Managed and coordinated the preceptor program for the School of Pharmacy rotations across all Martin’s Point Pharmacy locations.

Responsible for developing and executing clinical initiatives and programs for medication and formulary management, and serving as a liaison between the pharmacy and the medical care team.

• Analyzed and recommended changes for physician prescribing in order to improve outcomes, reduce costs, improve quality, and manage financial risk.
• Conducted clinical drug reviews for health plan prior authorization, and appeals requests.
• Served as an onsite resource for Martin’s Point physicians, pharmacists, and other clinical staff on drug information questions, clinical initiatives, benefit design and interpretation, and claims processing issues.
• Served as the primary preceptor for the School of Pharmacy rotations.

Responsible for building and strengthening relationships with physician groups and practices throughout the state of Maine to educate and improve clinically effective, cost-effective pharmacy management.

• Implemented disease-specific programs aimed at improving medication prescription standards.
• Provided physicians with unbiased clinical drug information, formulary, generic, benefit updates, new drug reviews, and group/individual data analysis to identify target areas for improvement.

Responsible for the clinical and business success of onsite wellness/disease management testing services and programs, immunization awareness and delivery, medication reviews for assisted living facilities served by the pharmacy, and precepting students and other faculty appointment activities for the Bernard J. Dunn School of Pharmacy.

Participated in all aspects of retail pharmacy practice, including prescription order review, entry and dispensing, patient counseling, communication with physicians, supervision of, and communication with technicians and interns, third-party reimbursement, review of allergy and interaction data, and resolution of patient issues.