Kadija Abounit

Experience

Engagement Delivery/Program Implementation

• Supporting second largest national employer with management of end-to-end sourcing and implementation of a new healthcare informatics solution and sunset of legacy system. This five-year program is a large endeavor ($14M annual budget) that involves multiple vendors and resulted in the implementation of several new applications for end users.

• Efficiently implemented program and process improvement initiatives on behalf of managed care and Pharmacy Benefit Manager (PBM) clients

• Designed and managed the implementation of fraud, waste and abuse (FWA) detection program and pharmacy audits for a health plan cooperative that resulted in the identification of $3.7 million in avoidable FWA costs. Performed root cause analysis and recommended actions for health plan to address and remediate identified issues

Clinical Strategy

• Collaborated to develop multiple innovative and value-based healthcare programs to manage the health of members across business segments for a large payer in the Mid-Atlantic Region.

• 5-Star Ratings and Medication Adherence:

  • Conducted in-depth review of 5-Star Rating scorecards (Part D and Part C) and worked collaboratively with Quality Assurance team to identify areas of improvement

  • Assisted with the development of strategies and programs to improve HEDIS measures and Medication Adherence

  • Served as primary liaison for building alliances and strategic partnerships with third-party organization and vendors

• Specialty Pharmacy:

  • Performed competitive analysis, which identified external and internal resources to manage the Specialty Pharmacy benefit

  • Developed and documented customized disease-specific SOPs and process workflows for implementation of clinical programs

  • The Specialty Pharmacy Program impacts more than 70,000 members with complex conditions (e.g., multiple sclerosis) and is expected to reduce healthcare costs by $60 million annually

• Fraud, Waste and Abuse:

  • Developed Opioid Management Program to maximize the benefits of prescription opioids for members with legitimate needs while curbing prescription drug abuse

  • Collaborated with Compliance and Audit Subject Matter Expert to develop Fraud, Waste and Abuse (FWA) analytical services by designing client-specific algorithms to detect, prevent and correct FWA activities

  • Served as Clinical Advisor on medical-related and FWA analyses

Research and Evaluation

• Biomedical Research:

  • Developed and conducted multiple research projects in private and public organizations including the Food and Drug Administration (FDA). Pre-clinical studies aimed at identifying potential therapeutic targets and elucidating their role in the pathogenesis of ischemia-related diseases (e.g., stroke, myocardial infarction and breast cancer). Additionally, therapeutic agents (small molecules and recombinant proteins) were produced in house and analyzed for their efficacy and safety in vitro and in vivo models of the disease of interest. Results from those studies were published in peer-reviewed journals

  • Contributed to the discussion on regulation and safety of biological products at the FDA (Center for Biologics Evaluation and Research) and collaborated with scientists to establish Material Transfer Agreements, Cooperative Research and Development Agreements with third-party institutions

• Public Policy Research:

  • Collaborated with the national evaluator of the Bundled Payment for Care Improvement Model 1 program ran by Centre for Medicare and Medicaid Services Innovation Centre (CMMI)

  • Supported evaluation of “Test Beds” implemented by NHS England

  • Managed the completion of a retrospective study to determine impact of Cardiac Contractility Modulation treatment on mortality and hospitalization rates and costs in Medicare patients with severe to moderate Heart Failure

  • Developed comparative effectiveness research (CER) studies for funding by the Patient Centered Outcomes Research Institute (PCORI)