BluePeak’s team of highly trained and experienced consultants includes health care professionals who have worked at Centers for Medicare and Medicaid Services (CMS), health plans and Pharmacy Benefit Managers (PBMs). Our diverse team includes nurses, pharmacists, physicians, business and Information Technology (IT) professionals who bring real-life experience to our clients. Our seasoned Medicare and Medicaid subject matter experts and business managers understand the challenges facing plans, pharmacy benefit managers, pharmaceutical companies and other allied health businesses with resource limitations, systems issues, vendor oversight and the onslaught of daily CMS guidance and regulations.
Shannon Casey, MHA is the Area Senior Vice President at BluePeak Advisors, a division of Gallagher Benefit Services, Inc. Shannon has been in the managed care industry for over 20 years and works with health plans and Pharmacy Benefit Managers on Part D Operations, compliance, strategic planning and business development.
Prior to joining Blue Peak, Shannon was VP and General Manager for a large, national Prescription Drug Plan (PDP) with a heavy concentration on Employer Group Waiver Plans (EGWPs). Shannon spear-headed the launch and the successful creation of the PDP as a new business line for the company, handling all facets of start-up and subsequent management, from conceptualization to organizational design/business plan, policy/process development, Medicare approval, and initial sales. Shannon continued to manage the plan (including all aspects of plan operations, P&L, strategic planning, compliance and audit, PBM oversight, client relations and business development) for over 5 years.
While managing the plan, Shannon had extensive experience in leading and successfully responding to Medicare audits including CMS Program Audit, Low Income Subsidy (LIS) Readiness Audit, Transition Monitoring Program Audit (TMPA), Recovery Audit Contractor (RAC) Audit, and Financial Audit.
Prior to the PDP launch, Shannon was the Director of Medicare Strategy at a large, national PBM where she evaluated and launched products and services designed to satisfy existing and emerging regulatory requirements for MA-PD and PDP client operations. Some of her larger projects included managing the product lifecycle for a CMS Compliant Medication Therapy Management Program (MTMP) and e-prescribing program. In this role Shannon developed deep subject matter expertise in Medicare Part D requirements as well as the design of solutions to ensure plans remained compliant.
Before the inception of Medicare Part D, Shannon worked with hospitals and health plans with a focus on managed care contracting, Medicare Part A and B reimbursement methodologies and revenue cycle management. In this capacity, Shannon advised hospital clients on managed care contract analysis and negotiation of terms, detection and collection of underpayments by third party payers, as well as accurate and complete ICD coding and charge capture resulting in average client savings of $10M per project.
Babette S. Edgar, Pharm.D., MBA, FAMCP
Babette S. Edgar, Pharm.D., MBA, FAMCP is a founder of BluePeak Advisors, a division of Gallagher Benefits Services, Inc. Babette has been in the managed care industry for over 25 years and advises health plans, pharmacy benefit management companies and pharmaceutical companies on Medicare and managed care strategies, operational and compliance issues. She has been consulting for over 15 years.
Prior to starting her own firm, Babette worked at CatalystRx, where she was President, Government Services and ran the Medicare business for the fourth largest PBM. Babette was the Director of the Division of Finance and Operations for the Medicare Drug Benefit Group at the Centers for Medicare and Medicaid (CMS), where she directed building and implementing the formulary and benefit design review processes for the Part D drug benefit. She oversaw the CMS Part D team that developed the agency’s marketing guidelines and marketing models, and conducted oversight of the marketing review process. Babette also directed CMS operations for reviewing and monitoring the licensure and solvency of Part D plan sponsors, assisted in developing transition guidance for Part D plans with patients migrating from Medicaid or other benefits; and provided input into the Part D regulations and other subregulatory guidance from a managed care pharmacy perspective.
Previous to her term at CMS, Babette was Vice President, Clinical Business Development at Caremark/AdvancePCS, where she directed sales, account management and product development for a multi-million-dollar disease management product line. She oversaw 16 premier accounts, including Blue Cross plans, managed health plans, Medicare/Medicaid, third party administrators and large and small employers. Babette previously served as Director of Clinical Services for Advance Paradigm, where she ran the P and T process, developed physician and patient education materials, performed academic detailing, and managed the clinical team responsible for developing clinical content and clinical strategy. She also performed business development for specialty services in the Theracom division.
Babette has authored many articles in peer-reviewed journals, and has been an invited speaker at many national meetings, conferences and symposia. She is a Past President and a Fellow of the Academy of Managed Care Pharmacy and is a national thought leader in topics related to managed care pharmacy, Medicare compliance, operations and strategy and value-based pharmaceutical care.
Wendy Edwards, MPA, CHC, CHPC
Director of Internal Operations
Wendy Edwards, MPA, CHC, CHPC, is Director of Internal Operations at BluePeak Advisors, a division of Gallagher Benefit Services, Inc. Wendy is a seasoned healthcare executive with over twenty years of experience working in commercial, Medicare, Medicaid, and self-funded insurance arenas. Prior to becoming a consultant, Wendy was the President and Chief Executive Officer of a commercial and Medicare Advantage plan in Oregon and oversaw expansion applications to move to the national stage She maintained oversight over all executive duties and collaborated with board members and stakeholders alike to ensure that best practices are not only adhered to but also proactively sought out through an organizational culture of continuous improvement. Prior to this role Wendy was the company’s Chief Compliance Officer and HIPAA Privacy Officer and developed Fraud, Waste and Abuse (FWA) and Special Investigation Unit (SIU) teams. Since then, she served in several roles, including Chief Operating Officer and Executive Vice President. Wendy oversaw all compliance activity and exceeded financial and operational goals as the health plan leader. Wendy also served as the Director of Regulatory Affairs and Compliance officer for a regional health plan that operated Medicare, Medicaid, commercial and self-funded products.
Wendy started her career as a Critical Access Hospital Program Manager with the Office of Rural Health. Wendy then worked for the state of Oregon, first as Quality Improvement Coordinator and Medicaid Contract Administrator for all contracts. Wendy then served as the Actuarial Services Administrator where she was responsible for the biennial rate setting for the Oregon Health Plan, covering all Oregonians eligible for Medicaid. Wendy spent years as the Public Employees’ Benefit Board Director of Operations, where she served a diverse board made up of management and union representatives, to ensure the highest quality, lowest cost insurance for all State and University system employees.
Wendy earned her Master’s Degree in Public Administration: Health Administration from Portland State University and holds a Bachelor’s Degree in Health Care Administration from Oregon State University, Wendy is a certified Healthcare Privacy Compliance (CHPC) and Healthcare Compliance (CHC) professional.
Karen Mason, MBA
Director of Client Services
Karen Mason, MBA, is Director of Client Services at BluePeak Advisors, a division of Gallagher Benefits Services, Inc. Karen has been in the health care industry for over 20 years with experience in Medicare, Medicaid, Individual and Employer plans. Karen has extensive experience in CMS and other government requirements, specifically related to Contact Center and Appeals and Grievances. Within those areas, she has implemented new plans, assisted plans in turnaround efforts, and functioned as an operational leader.
At BluePeak, Karen is responsible for partnering with clients to find solutions to meet their key objectives and goals. Her firsthand experience leading health plan operations coupled with her knowledge in plan implementations, project management and process improvement allow Karen the ability to support a client from different angles to develop strong solutions and drive results.
Prior to BluePeak Advisors, Karen worked as a director supporting various clients with building new government health plans. Karen’s primary focus was implementing infrastructure and ensuring regulatory compliance for the plan Contact Center and Appeals and Grievances departments. In this role Karen also served as a consultant to existing plans who were not within regulatory requirements and assisted with remediation and the successful passing of validation audits.
As a Senior Director Karen took over running TPA operations of Appeals and Grievances and Contact Center for numerous health plans, overseeing over 400 employees who supported over 1 million plan members. Karen demonstrated a successful model of meeting or exceeding operational metrics, driving process improvements and staying on top of changing regulations. Karen successfully led her departments through numerous government audits and supported NCQA accreditation for the organization.
Karen has worked as a Black Belt Six Sigma Project Specialist , driving process improvement in various parts of the health plan space including Utilization Management, Population Health and CaseIt Management. Starting out as a Customer Service Representative within the Behavioral Health plan space, Karen keeps the member at heart as she navigates the complexities of health plan infrastructure and regulations, with a personal mission to make access to care simpler for people who need it.
Director of Account Management
Katie Carey is the Director of Account Management at Blue Peak Advisors, a division of Gallagher Benefits Services, Inc. Katie has spent the past 18 years supporting Medicare, Medicaid and Marketplace health plans for a national Pharmacy Benefit Management (PBM) provider. Katie has partnered with Health Plan leaders to support and develop the strategy for their pharmacy benefit and has a strong understanding of the complex business strategies in healthcare and the impact to the overall ecosystem.
Katie has been actively engaged in the Medicare industry since the inception of Part D in 2005. She partnered with health plan leaders to navigate the complexity of ensuring a compliant Part D benefit at its implementation in 2006. Since the start of Medicare Part D, Katie has worked with several Medicare health plans, Medicare start-up plans, and supported the expansion of Commercial Health Plans into the Medicare space. She provided expertise to plans on PBM contracting, operations, pricing, and programs required to support the pharmacy benefit for these regulated health plans. She has also fulfilled the role of consulting within the Pharmacy Benefit management space on development of Medicare programs to ensure the needs of health plans were delivered.
Katie currently resides in San Diego, California and holds a Bachelor of Health Science degree from Bowling Green State University in Ohio.
Senior Consultant, Part D Lead
Crescent Moore, PharmD, PhD is a Pharmacist and Senior Consultant, Part D Lead at BluePeak Advisors, a division of Gallagher Benefit Services, Inc. With 10 years of health policy and Medicare experience, Crescent lends her expertise in Part D operations, specifically coverage determinations, appeals, and grievances (CDAG), medication therapy management (MTM), overutilization management system (OMS)/drug management program (DMP), and formulary administration (FA) as well as Part D Stars strategy to clients.
Prior to joining BluePeak Advisors, Crescent worked as a director of clinical pharmacy at a managed care company where she was responsible for the strategic direction of the clinical pharmacy programs and initiatives for all lines of business. In her role, she successfully completed Medicare audits (program, timeliness, transition, and desk audits) as well as the transition of Medicare Part D coverage determinations and appeals from the pharmacy benefit manager to the health plan.
Crescent earned a Doctor of Philosophy degree and a Doctor of Pharmacy degree from the University of Tennessee and completed a health policy and association management residency at the Tennessee Pharmacists Association. She received a Bachelor of Science degree in Chemistry from Rhodes College.
Lisa Barker, MBA, BSN, RN, CCM
Senior Consultant, Part C Lead
Lisa B. Barker MBA, BSN, RN, CCM is a Senior Consultant, Part C Lead with BluePeak Advisors, a division of Gallagher Benefit Services, Inc. A Registered Nurse with over 21 years of health care experience, Lisa has more than 9 years of experience with Medicare Advantage Health Plans including operations management, compliance, delegation oversight, and providing consulting services.
Prior to joining BluePeak, Lisa has managed Utilization Management (UM) teams for Part C, developed UM vendor oversight programs, conducted risk assessments, performed mock audits for Coverage Determinations Appeals and Grievances, (CDAG) and Part C Organization, Determinations, Appeal and Grievances, (ODAG), participated in CMS audit remediation and validation for CDAG and ODAG conditions, performed pre-delegation, annual delegation oversight and validation audits for UM vendors, and participated in a CMS program audit for ODAG which resulted in no conditions attributable to the operational area within her purview as a Compliance Consultant. Lisa also has care coordinator and account management experience with an Institutional Special Needs Plan (I-SNP) where she conducted reviews for eligibility, analyzed and communicated performance monitoring results to key stakeholders and developed and implemented performance improvement plans to eliminate unnecessary utilization while maximizing care coordination and improving health outcomes. Additional health plan experience includes performing utilization and care management services for a national health plan in commercial and Medicaid lines of business, during which time the plan achieved URAC accreditation for Case Management and NCQA accreditation.
Prior to joining Blue Peak, Lisa served as a Senior Divisional Compliance Consultant for a Blue Cross Medicare AdvantageSM plan where she focused on UM delegation oversight. Through monthly program universe reviews, as well as, focused and annual file audits, Lisa identified any exposure to regulatory risk from vendor interpretation and implementation of guidance, as well as, developed and implemented processes to manage and mitigate those risk. Additional skills include policy and procedure development, process re-engineering and optimization, strategic alliances and relationship development.
Lisa received her MBA, Certificate in Health Care Management from East Carolina University, College of Business and holds a B.S. degree in Nursing from the University of North Carolina at Greensboro. She is licensed as a Registered Nurse in North Carolina and a Certified Case Manager (CCM).
Cheryl A. Wasserman, JD, CHC, CHPC
Senior Consultant, Compliance Lead
Cheryl A. Wasserman, JD, CHC, CHPC is a Senior Consultant, Compliance Lead at BluePeak Advisors, a division of Gallagher Benefit Services, Inc., with 28 years of experience in managed care, indemnity insurance and government programs (Medicare and Medicaid). She has a broad range of experience in regulatory compliance and healthcare operations, advising health plans and similarly regulated entities on compliance programs, auditing, delegate oversight, HIPAA privacy and security concerns, as well as day-to-day operational management concerns. Throughout her career, Cheryl has conducted and supported numerous audits with her primary expertise in Part C Organizational Determinations, Appeals, Grievances (ODAG), Compliance Program Effectiveness (CPE) and Medicare-Medicaid Plan Service Authorization Requests, Appeals and Grievances (MMP_SARAG).
Prior to consulting, Cheryl worked at several large Medicare and commercial health insurance payors. At Medical Card Systems, Inc. (MCS), she served as Vice President and Medicare Compliance Officer with responsibility for the Medicare Compliance Program, including Compliance Auditing and Monitoring, Delegation Oversight, Sales Oversight, and the Special Investigations / Fraud, Waste and Abuse function.
Previous to her position at MCS, Cheryl was Senior Director and Chief Privacy and Security Officer for WellCare, Inc. While at WellCare, she also served as a Director in the Claims Operations area, overseeing claims processing and adjustment functions for both the Medicare Advantage and Medicaid lines of business. Before joining WellCare, Cheryl was employed by HealthNow New York, Inc. serving in the roles of Senior Director for HIPAA Compliance, Director of Claims & Service, Director Special Services and Support (including Enrollment, Front End, Performance Guarantee Groups and Claims Quality) and Corporate BlueCard Executive.
Cheryl is a New York licensed attorney, and a member of the Health Care Compliance Association (HCCA), certified in both Health Care Compliance (CHC) and Health Care Privacy Compliance (CHPC).