Acknowledged as one of the most engaging and crowd-pleasing speakers in the world of neuroscience, Dr. Medina is a developmental molecular biologist, researcher, professor and the author of ten books. His New York Times bestseller, Brain Rules: 12 Principles for Surviving at Work, Home and School has been celebrated as the standard handbook on understanding the brain and optimizing its performance. Brain Rules has been translated into more than 20 languages and selected as a textbook at numerous universities. Dr. Medina’s focus is on the genes behind brain development and psychiatric conditions. He has spent most of his professional life as an analytical research consultant, working primarily in the biotechnology and pharmaceutical industries on research related to mental health. He also consults with hospitals and healthcare facilities on designing brain-healthy environments that reduce staff stress and improve patient outcomes. Recently, he expanded his interest in how the brain interacts with environments to office spaces, teaming up with award-winning architecture firm NBBJ.
Dr. Medina is an Affiliate Professor of Bio engineering at the University of Washington School of Medicine. He is also the Founding Director of the Talaris Research Institute studying how infants encode and process information at the cognitive, cellular and molecular level. Dr. Medina’s extensive study of the developing brain at different stages of life resulted in his most recent book, Attack of the Teenage Brain! Understanding and Supporting the Weird and Wonderful Adolescent Learner. He is also the author of Brain Rules for Baby and Brain Rules for Aging Well.
Su Bajaj is Episource’s Senior Vice President of Product Development. Su has built extensive solutions for payers, including ACOs, Medicaid, MA, and the ACA exchange. She uses technology to integrate Revenue Programs with Quality and Care Management while maintaining a dedication to adding value to the beneficiary's experience with the health plan through those solutions. Su has a Bachelors in Economics from Northeastern University in Boston, MA and is a Six Sigma Yellow Belt.
Chad Brooker is an Associate Principal at Avalere Health, an Inovalon Company. Chad advises clients on the short- and long-term impacts of federal and state regulations and legislation and healthcare-related litigation on their business strategy and advocacy priorities. He has special expertise in health care regulatory compliance and product innovation in the insured, self-insured, and Medicare markets. Prior to joining Avalere, Chad was regulatory counsel and manager of Policy and Strategy for Connecticut’s Health Insurance Exchange, Access Health CT. In this role, he provided legal counsel to exchange leadership and insurance plan executives around coverage design, risk adjustment, strategic initiatives, federal and state insurance and Medicaid compliance, and healthcare related tax laws. Prior to that, Chad served as a health insurance specialist in the Exchange Policy Operations Group at the Centers for Consumer Information and Insurance Oversight where he wrote Affordable Care Act (ACA) related regulations and advised exchanges and health plans on ACA implementation and issuer certification.Chad has a JD with certifications in health law and business law from the University of Maryland School of Law and a BS in economics and mathematics and a BA in political science and policy studies from Syracuse University.
MD, MPH, MBA, CRC, Chief Quality and Risk Adjustment Officer
Karl Brown MD, MPH, MBA, CRC, Chief Quality and Risk Adjustment Officer
HealthCare Partners, IPA
Dr. Karl Brown is a healthcare leader with 20 years of extensive experience working in both outpatient and inpatient settings, as well as in operational management of hospitals, outpatient facilities, and health plans. Dr. Brown served as Molina Healthcare’s Chief Medical Officer of Utah and Idaho. During his tenure, he was the Corporate Medical Director of Risk Adjustment, Coding, and Auditing, overseeing these enterprise-wide teams. Dr. Brown began his health plan experience as the medical director of risk adjustment in the Utah market. Highly regarded for data-driven initiatives resulting in improved patient outcomes, enhanced safety measures, strategic cost reductions, and increased revenue capture, Dr. Brown is a process-focused motivator dedicated to continuous improvement.
His extensive experience includes risk adjustment for Medicare, Medicaid, and Marketplace; safety, protocol standardization, and promoting and instituting Electronic Health Records (EHR) usage; utilization and case management; revenue capture; CMS audits and improved core measures; prior authorizations; grievances and appeals; compliance; Stars, HEDIS; and improving Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores. Dr. Brown earned his MD from Wayne State University, his MPH in Epidemiology and his MBA from the University of Michigan.
Shelley Collins Director of Clinical Quality Improvement
Shelley Collins RN BSN CHCQM
Director, Clinical Quality Improvement for Blue Cross Blue Shield Nebraska
As Director of Clinical Quality Improvement, Shelley is responsible for oversight of the quality improvement program strategy, value-based contract quality metrics, HEDIS measurement and Medicare STARS performance. Prior to joining Blue Cross Blue Shield Nebraska Shelley served as a Director of Quality Management with Aetna.
Shelley obtained her RN from St. Luke’s School of Nursing and a Bachelor of Science in Nursing from Briar Cliff College. Shelley has her certification in Health Care Quality Management (CHCQM) and is a member of the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP).
Debbie Conboy Director of Risk Adjustment and Quality Strategy
Debbie leads risk adjustment and quality product strategy at Arcadia, bringing 30 years of experience to her role. For the last 11 years Debbie directed risk adjustment strategy and operations across all lines of business for Blue Cross Blue Shield of Massachusetts, a pioneer and leader in value-based contracts. At BCBSMA Debbie led risk adjustment initiatives that resulted in $50 million in revenue. Debbie is widely recognized as an expert in the area of Risk Adjustment and is a frequent speaker at industry conferences. Debbie’s experience gives her a deep understanding of risk adjustment algorithms, RAPS and EDPS submissions, RADV and HRADV, as well as the many different methodologies used to ensure accurate and appropriate diagnosis capture.
David is responsible for leading analytic efforts for Cotiviti as well as new market facing solutions. He works closely with the Product, Consulting, Data Operations, and Client Engagement teams to ensure that Cotiviti’s proprietary analytics help our clients meet their business objectives and remain relevant in the industry.
Prior to joining Cotiviti, David was the chief analytic officer at Press Ganey. He was responsible for building a set of analytic products that allowed hospitals and provider groups to enhance patient experience, solidify their reimbursements, and identify areas for process improvement and revenue enhancements. David also previously served as SVP of consumer segmentation and engagement strategies at Health Dialog, where he was responsible for building and implementing strategies that targeted, activated, and engaged members related to their specific health conditions.
David holds a B.A. in Business Administration and Sociology from Northern Michigan University and a M.A./Ph.D. in Sociology from the University of Delaware. He also served for four years in the United States Air Force.
Paul Cotton is the National Committee for Quality Assurance Director of Federal Affairs. He works with Congress, the Administration and other stakeholders to improve health care quality. Previously he was a lobbyist for AARP on Medicare, Medicaid, CHIP, health reform, health IT and quality improvement issues. He has also worked at the Center for Medicare & Medicaid Services as Hearings & Policy Presentation Director in the Office of Legislation, and as a journalist for publications including the Journal of the American Medical Association.
Kathleen is a clinician who started her career as an Emergency Room and Intensive Care Respiratory Care Practitioner in a 360-bed hospital in the California Bay Area in 1993. She transitioned her career to HEDIS, Quality and Accreditation in 1998. She has a proven track record of driving HEDIS improvement and engaging FQHC and provider partners in quality improvement. She has extensive experience in Northern California Medicaid Plans.
•20 years’ experience in Quality
•15 years’ experience in HEDIS improvement
•8 years’ experience with NCQA Health Plan Accreditation
Kathleen has also worked with many of the large HEDIS vendor products and enjoys partnering with vendors to find innovative approaches to closing gaps in care.
Director of the Division of Risk Adjustment Operations
Kelly Drury Director of the Division of Risk Adjustment Operations
Centers for Medicare & Medicaid Services (CMS)
Kelly Drury serves as the in the Payment Policy and Financial Management Group at the Center for Consumer Information & Insurance Oversight (CCIIO) within the Centers for Medicare & Medicaid Services (CMS). Kelly leads the permanent risk adjustment program and RADV operations responsible for ensuring the integrity of billions of dollars across the individual and small group market. She has also published original research and led the first ever prescription drug integration into the risk adjustment model: “Incorporating Prescription Drugs into Affordable Care Act Risk Adjustment” in Medical Care, January 2020 and “A Comparison of Health Risk and Costs Across Private Insurance Markets” in Medical Care, January 2020. Since joining CCIIO in May 2012, Kelly has focused mainly on risk adjustment policy and operations, including risk adjustment data validation. Prior to CCIIO, Kelly worked on home health payment policy in the Center for Medicare and in financial services at Legg Mason. Kelly has an undergraduate degree from the University of Maryland and an MBA in finance and management from Johns Hopkins University.
Senior Vice President, Clinical Performance and Compliance
Scott Filiault is the Chief Revenue Officer of Pulse8, a cutting-edge healthcare technology and data analytics company focused on delivering the highest financial impact by providing an unprecedented view into risk adjustment for health plans with Commercial, Medicare Advantage and Long-Term Care populations. Scott leads Pulse8’s sales efforts by focusing on new business development, and assists in the company’s business strategy and future channel opportunities.
Prior to joining Pulse8, Scott served as Vice President of Sales for Matrix Medical Network, the nation’s leader in prospective assessments. He was instrumental in the company’s growth and is recognized as one of the Industry’s leading executives.
In addition to his Managed care experience, he has led and developed sales and marketing strategies for the Medical Device field and the Institutional/Hospital markets. He is also credited with improving health plan performance and profitability through effective, state-of-the-art care management programs, risk adjustment services, and data-driven strategies.
Scott has served as National Director of Sales, working with both HIX and Medicare Advantage plans. He helped develop and deliver the marketing strategy for a predictive modeling company and the identification and stratification of members for case and disease management. In addition, Scott planned and implemented the Managed Care Training Program for the New York City Managed Medicaid initiative.
Scott has international experience where he helped develop and market software programs that measure cognitive function for neurological conditions such as Alzheimer's and Parkinson's diseases, MS, and schizophrenia.
Ellen Fink-Samnick is an award-winning industry thought leader who empowers healthcare's transdisciplinary workforce. Known and highly respected as 'The Ethical Compass of Professional Case Management', she is a sought out professional speaker and author with hundreds of offerings and publications to her credit.
Ellen's work has achieved global acclaim. She is a national expert on the Social Determinants of Health, Workplace Bullying and Violence, Professional Ethics, Professional Case Management Practice, and Wholistic Case Management™. Her latest books include, The Essential Guide to Interprofessional Ethics for Healthcare Case Management and The Social Determinants of Health: Case Management's Next Frontier, both through HCPro. Ellen is a panelist for Monitor Mondays and Talk Ten Tuesdays, plus contributor to RAC Monitor and ICD 10 Monitor. She also serves as moderator of Ellen’s Ethical LensTM on LinkedIn, a consultant for the Case Management Institute, and a moderator of their Case Managers Community. Ellen’s academic affiliations include roles as subject matter expert for Western Governors University, and adjunct faculty for the University of Buffalo’s School of Social Work, and George Mason University’s Department of Social Work.
Ellen's passion is evident across her varied roles as professional speaker, industry consultant, educator, blogger, continuing education content developer, accreditation specialist, clinical social work supervisor and professional mentor to the case management community. Her contributions transverse the industry’s professional associations and credentialing organizations. A past commissioner for the Commission for Case Manager Certification, and Chair of their Ethics and Professional Conduct Committee, Ellen currently serves on the Board of Directors for the Case Management Society of America, the editorial boards for the Professional Case Management Journal and RAC Monitor, and the Council of Advisors and Founders for Reverberation 5.0 (a collective for women over 50 in the workforce). More detailed information is available on her LinkedIn Profile.
Colleen Gianatasio CPC, CPC-P, CPMA, CPC-I, CRC, CCS, CCDS-O has over 20 years of experience in all aspects of the business of healthcare. As Director of Ambulatory CDQI for Mount Sinai Health Care Partners she is responsible for provider engagement and clinical documentation improvement for accurate coding. Colleen specializes in developing innovative coding curriculum and instruction to support compliance with federal guidelines and appropriate reimbursement processes. She is a certified AAPC instructor and enjoys teaching a variety of coding, documentation and auditing classes. Colleen is President - elect of the AAPC National Advisory Board.
Ana Handshuh, Principal at CAT5 Strategies, is a government programs executive with expertise in creating and implementing corporate programs for the healthcare industry. Her background includes Quality, Core Measures, Care Management, Benefit Design and Bid Submission, Accreditation, Regulatory Compliance, Revenue Management, Communications, Community-based Care Management Programs and Technology Integration. Ms. Handshuh currently serves on the Board of the Resource Initiative and Society for Education (RISE), the preeminent national professional association dedicated to managed and accountable care financing and delivery. She is a sought after speaker on the national healthcare circuit in the areas of Quality, Star Ratings, Care Management, Member and Provider Engagement, and Revenue Management. Her recent consultancy roles have included assisting organizations create programs to address the unmet care management needs in the highest risk strata of membership, document their processes and procedures, achieve accreditation status, design and submit government program bids, institute corporate-wide programs and create communications strategies and materials. She possesses sophisticated business acumen with the ability to build consensus with cross-functional groups to accomplish corporate goals. Ms. Handshuh served as the Vice President of Managed Care Services at Central Florida Inpatient Medicine (CFIM). In this role, she provided leadership and strategy on CFIM projects and collaborations with physicians, risk entities, hospital health care systems, and health plans. CFIM is the largest Hospitalist group in Central Florida, with 70 providers discharging over 50,000 patients annually from multiple hospitals across two health care delivery systems and 24 skilled nursing facilities. At CFIM Ms. Handshuh previously served as the Vice President of Operations. Prior to those assignments, she worked with Precision Healthcare Systems as their Vice President of Quality Improvement. In that capacity, she led the IPA’s Quality efforts and collaborated with payers on implementing programs to move the needle on Quality and Star Rating initiatives. Ms. Handshuh also served as the Director of Corporate Program Development at Physicians United Plan. In this role, she led the Quality Management and Corporate Communications departments and spearheaded the development of innovative integrated technology solutions to drive business excellence and Star Rating achievement initiatives. For the past fifteen years Ms. Handshuh has taken an active role in redefining and implementing changes that have led to improvements and greater efficiency within Government programs and healthcare delivery. Prior to joining Physicians United Plan Ms. Handshuh was the founder of I-Six Creative. Under Ms. Handshuh’s vision and leadership, I-Six Creative provided expertise in the areas of managed Medicare benefit design, MSO/IPA operations, provider network strategy, new market launches, technology integration, corporate communications and quality improvement.
From humble beginnings in South Central Los Angeles, to life as an imprisoned drug dealer, and then as an award-winning celebrity chef and best-selling author, Jeff is a role model for anyone who needs the encouragement to reinvent their life. Since he discovered his passion and gift for cooking in the unlikeliest of places – prison – Jeff has completely turned his life around, and today serves as a popular and powerful voice for self-transformation.
The creator of Food Network's reality series, The Chef Jeff Project, host of Family Style with Chef Jeff, and the star of the nationally syndicated series, Flip My Food with Chef Jeff, he is also the best-selling author of two books.
From overcoming hardship to identifying one’s personal talents, Jeff reveals his hard-knock yet transformative life lessons and the secrets to rising above and realizing your potential. His dynamic and engaging presentations help audiences discover their hidden business aptitudes, make life-changing decisions, and gain a new foothold on the ladder to success.
Inspiring Celebrity Chef, Star of Flip My Food with Chef Jeff & Author of If You Can See It, You Can Be It
Yogi Hernandez Suarez, MD, MBA, FACOG Vice Provost for Population Health and Well-being
Florida International University
Dr. Yogi Hernandez Suarez is Founding Vice Provost for Population Health and Well-being at Florida International University. As one of South Florida’s anchor institutions, FIU plays a central role in generating, sharing, and implementing knowledge that promotes health and well-being. FIU endeavors to graduate students who are responsible for their own health and who support and advocate for the health of their community. Answering directly to the Provost, Dr. Hernandez Suarez works collaboratively and across disciplines to incorporate health promotion and literacy into all aspects of student culture, administration, operations, and academic mandates. She is also Associate Dean for Clinical and Community Affairs in the Herbert Wertheim College of Medicine and serves as a strategic consultant to FIU’s community-based Academic Health Center. Dr. Hernandez Suarez has been a physician leader in Miami for almost 20 years, with positions in private, public, academic, and hospital settings. Her first role in leadership was in the Jackson Health System where she advanced to serve as Chief Administrative Officer of Ambulatory Services. Imprinted by her time in the safety net, she has spent her career building value for patients, providers, and learners through public- private partnerships, inclusive practice models, and community relationships. Most recently, Dr. Hernandez Suarez was Vice President for Clinical Innovation for Conviva Care Solutions, a managed care subsidiary of Humana, Inc. where she led population health management for 250,000 seniors in a full risk model. She has received multiple awards for her leadership and was recently elected to the International Women’s Forum for her impact in healthcare. Born and raised in New York City, she attended Swarthmore College and the Johns Hopkins University School of Medicine. She trained in Obstetrics and Gynecology at the University of Iowa Hospital and Clinics. She holds a Master of Business Administration with specialization in Health Administration and Policy from the University of Miami. Dr. Hernandez Suarez is a first generation Cuban American whose parents came to New York in 1961. She is married to Dr. Jeffrey D. Simmons. They are the parents of twins, Gabriela and David. David is autistic; his journey fuels her unrelenting passion for the inclusion and well-being of special populations.
Kent joined AdhereHealth in 2013, bringing over a decade of operational, consulting, and business development experience for the healthcare technology industry. Kent’s leadership at AdhereHealth includes business development, strategic partnerships and product strategy.
Kent came to AdhereHealth following multiple successes with AIM Healthcare (now a part of Optum, a United Health Group, Inc. company), rising to National Director as it expanded into new markets. Kent was a key player in Optum’s growth strategy representing solutions for both providers, managed care and government entities.
Actively involved in the community, Kent currently serves on the Board of Directors at BrightStone, Inc., as well as on the Board of Directors with the Tennessee Crohn’s and Colitis Foundation. Kent holds a BA in Psychology from the Miami University and a MA in Counseling from The University of Toledo.
Jennifer Hunt Administrative Director Actuarial Services
Jennifer Hunt is the Administrative Director of Actuarial Services at Paramount Healthcare in Maumee, Ohio. Paramount is part of the ProMedica Health System headquartered in Toledo, Ohio. She has worked at Paramount for 20 years in a variety of roles including underwriting and analytics. In her current role, she is responsible for Actuarial Services including commercial rate filings and the Medicare and QHP Bids, Underwriting for group and individual business, Reinsurance for ceded coverage as well as ESL products, Product Development, Business Analytics and Insight team as well as Risk Adjustment for Commercial, Medicare, and Medicaid. Jennifer earned her degree in Economics from Denison University. She previously worked on the sales and service side of property and casualty insurance. She routinely volunteers in her community.
As the Vice President of Quality for Advantasure, Erica Krieger is responsible for deploying industry-leading initiatives and driving success through Stars strategy development, program implementation and performance management which are complemented by overseeing prospective HEDIS gap identification and HEDIS administration services. Prior to joining Advantasure, Erica held a variety of roles at Blue Cross Blue Shield of Michigan, including roles focused on continuous improvement, strategic informatics, and customer reporting.
Erica earned a Bachelor of Science and Engineering in Industrial & Operations Engineering, a Master of Science in Industrial and Systems Engineering, and a Master of Business Administration – all from University of Michigan.
Lynn M. Kryfke Executive Director, Health Plan Clinical Services
Children's Community Health Plan
Lynn Kryfke is the Executive Director of Health Plan Clinical Services at Children’s Community Health Plan which serves members in Medicaid, Marketplace and Commercial products. In her role she has oversight of Quality Improvement, Utilization Management, Case Management, Accreditation and Risk Adjustment. Lynn obtained a Bachelors of Science in Nursing at UW- Milwaukee and Master’s Degree from Marquette University in Healthcare Systems Leadership. She has held leadership positions in the clinical setting and managed care for over 20 years. She has worked with the Medicaid population most of her career beginning with pregnant women and their infants and now with responsibility for the health’s plan Medicaid, Marketplace and Commercial populations. Lynn is passionate about recognizing the significance and availability of Services for the population the health plan serves.
Social Science Research Analyst for Evaluation and Inspections
Office of Inspector General U.S. Department of Health and Human Services (HHS)
San Le Social Science Research Analyst for Evaluation and Inspections
Office of Inspector General U.S. Department of Health and Human Services (HHS)
San Le is a Social Science Research Analyst for Evaluation and Inspections in the Office of Inspector General, U.S. Department of Health and Human Services (HHS). She has conducted evaluations on issues relating to HHS programs, such as payment rates in the Child Care and Development Fund and risk adjustment in Medicare Advantage. She received her Bachelor of Arts in Health and Societies from the University of Pennsylvania, and a Master of Public Health from Emory University.
Jacob LeRoy, MSA, is a Project Manager within the Quality Improvement Department at Children’s Community Health Plan in Milwaukee. He holds a Bachelor’s degree in Health Care Administration and a Master’s of Science in Management – Accounting from the University of Wisconsin-Milwaukee. He is currently responsible for the submission, analysis and planning for HEDIS, which includes the Medicaid, Marketplace and Commercial Product lines. Additionally, he has been able to use his analytical background and develop a way to measure provider performance within the health plan. Jacob is responsible for the calculation of quality and financial metrics for value-based contracts with providers. He also worked as a Quality Analyst where he implemented analytical tools to help develop and track health plan initiatives.
Jimmy is a risk adjustment industry thought leader and conference speaker who has been helping health plans nationwide to better understand and formulate their risk adjustment strategy for the past 10 years. He currently serves as Vice President of Risk Analytics at Change Healthcare supporting the Medicare, Medicaid, and Commercial ACA lines of business, with a focus on analytics, strategy and innovation across the company. Jimmy is an expert in risk scoring models and risk adjustment methodology, and he is a graduate of the University of Pennsylvania.
Donna Malone, CPC, CRC, CRC-I
AAPC Approved Instructor, Director of Enterprise Risk Adjustment: Coding and Provider Education (CDI)
Donna Malone, CPC, CRC, CRC-I AAPC Approved Instructor, Director of Enterprise Risk Adjustment: Coding and Provider Education (CDI)
Tufts Health Plan
Donna has been on the job with the Tufts Health Plan in their senior products division since August 2014, and is responsible for audit and coding review management, development and implementation of department and vendor policies and procedures, simulation RADV Audits for preparedness, coding team performance management and provider education development and management. Additionally, Donna serves at the MassBay Community College in Framingham, where she has been an advisor / professor for nearly 10 years. Her specialty area is the Medical Coding Certificate and Medical Office Administration Program.
Prior to Tufts Health Plan, Donna worked for Blue Cross Blue Shield of Massachusetts as an HCC Professional Audit III for four years. Earlier, she worked for AM B Care for 9 years and Maine Medical Center.
Allison Massari knows that you have the power to transform lives. As an advocate for both patient and provider, Massari has an intimate understanding of the demands and challenges of the medical profession, and compelling authority to address the delicate nature of patient-centered care. She experienced firsthand the critical value of receiving personalized health care from committed, empathetic providers after surviving two life-threatening car accidents, one where she suffered second and third degree burns on over 50% of her body.
In addition, raised by her father, a surgeon, and her mother, a nurse, Allison was mentored in the world of medicine from an early age. Captivated by her father’s compassionate work, she shadowed him in his practice, and also worked in hospitals and medical office settings. Allison’s riveting and courageous journey from absolute loss to a triumphant and hope-filled life, addresses sensitive topics, shining light on the provider’s immense value to a patient who is suffering, and helping to reinvigorate employees and heal burnout in the workplace.
Jason McDaniel Vice President, Risk Adjustment and Quality
Healthcare Partners Nevada
Jason McDaniel has over a decade of experience as a healthcare leader in provider, payer, and government operations and is currently the Vice President of Risk Adjustment and Quality for Healthcare Partners (HCP), one of the largest healthcare providers in the Southwest. In partnership with the Medical Director of Risk Adjustment and Quality, Jason has direct oversight of quality nurses, CDI nurse reviewers, value-based care focused nurse practitioners, medical coders, vendor relationships, and all other aspects of risk adjustment and quality prospective and retrospective operations. Prior to his time at HCP, Jason was the Risk Adjustment Operations Director at Banner Health in Arizona. As a senior leader, he directed multiple teams in establishing the Banner Health risk adjustment and quality program as well as overseeing a pivotal segment of the integration of Banner Physician Hospital Organization and Arizona Integrated Physicians. Jason spent 6 years at Cigna Healthcare of Arizona as the Medical Coding Manager and Medical Business Trainer as part of both medical group and payer operations. During his time at Cigna, Jason helped develop risk stratification and social determinants of health criteria, an internal point of care solution for population health and Medicare Advantage metrics and an extensive provider education program. Jason has been a Certified Professional Coder since 2006. He earned his Bachelor's Degree in Healthcare Administration from the University of Phoenix and his Master's Degree in Healthcare Innovation from Arizona State University.
Dave is a strong leader with 14+ years of experience in Revenue and Clinical Outcomes Program Development and Management in various healthcare environments (Plans, MG/IPA, Academic, and Consulting). Proven record of success in optimizing Operations, PE / Investor Meetings, Maintaining Compliance, Recovering / Maximizing Revenue, Enhancing Clinical Quality and Developing Software and Custom Analytics. Specialties: RA / HCC, Pay for Performance (P4P), CMS Stars Program, NCQA HEDIS, Off‐shore Software Product Development, HOS, CAS, NCQA Accreditation, Physician Profiling, Encounter Programs, Contract and Claims Analytics. Previously, Dave served as an independent consultant to health plans, was Corporate VP, Operations(Revenue and Quality) at InnovaCare Health. He has also performed as Sr. Consultant, Risk Adjustment and Health Plan Operations for Dynamic Healthcare Systems, and in other roles with health plans.
As a co-founder of Centauri Health Solutions, Michelle Miller brings deep expertise in risk adjustment, information technology and data analytics. Her experience includes a broad healthcare background across payer and provider spaces, including Medicare Advantage, radiology benefit management, post-acute care, and renal dialysis revenue cycle management.
Before helping to found Centauri, Michelle served as Cigna-HealthSpring’s VP of Risk Adjustment Services, leading all aspects of risk adjustment efforts for Medicare Advantage. Prior to her risk adjustment role, she held various IT leadership positions within the organization.
Michelle’s previous experience includes leadership positions with Geriatrix, as VP of Information Systems (prior to becoming Inspiris) –and serving as VP of Information Systems for MedSolutions during its strategic pivot from outpatient imaging to a leading radiology benefit management company.
Michelle holds a Master’s degree in Biomedical Engineering from Vanderbilt University and a Bachelor’s in Electrical and Computer Engineering from New Mexico State University.
Michelle was named the 2019 CTO of the Year by the Greater Nashville Technology Council.
Dr. Eddie Ortiz earned his medical degree and his specialty in Family Medicine from the University of Puerto Rico Medical School. He is the CEO of International Medical Card, Inc. and he oversees the operation and business development of IMC, First Medical Health Plan’s TPA. IMC is responsible for the Provider Network Administration for both lines of business (Commercial and Medicaid), including Contracting, Credentialing, Recredentialing, Claims Management, and Risk Adjustment Models, among other delegated functions. Previously, Dr. Ortiz was the Vice President of Medical Affairs for First Medical Health Plan and responsible for the corporate medical management and quality programs to ensure the provision of proven effective care to nearly 600,000 medical members around the island. During the time as VP of Medical Affairs, Dr. Ortiz had responsibilities in all First Medical’s lines of business; Commercial, Medicare Advantage and Medicaid. Prior to joining First Medical, Dr. Ortiz served as Medical Advisor and Medical Director in McKesson PR, Humana Health Plan PR, and Amedisys, Inc. He was also Vice President of Medical Affairs in MCS.
ABC News Veteran, Creator & Host, "What Would You Do?"
John Quiñones ABC News Veteran, Creator & Host, "What Would You Do?"
Combining a moving life story, an exceptional career, incomparable insights, and a powerful presence, John Quiñones has emerged as one of the most inspiring keynotes in the speaking world today. His moving presentations focus on his odds-defying journey, celebrate the life-changing power of education, champion the Latino American Dream, and provide thought-provoking insights into human nature and ethical behavior.
A lifetime of “never taking no for an answer” took Quiñones from migrant farm work and poverty to more than 30 years at ABC News and the anchor desk at 20/20 and Primetime. Along the way, he broke through barriers, won the highest accolades, and became a role model for many.
Known for truly connecting with audiences and leaving them uplifted and inspired, Quiñones delivers a powerful message of believing in one’s self, never giving up, and always, always doing the right thing. As host and creator of What Would You Do?, the highly-rated, hidden camera ethical dilemma newsmagazine, Quiñones has literally become “the face of doing the right thing” to millions of fans. It’s a role that he has enthusiastically embraced off camera, with a popular book and keynote presentations that challenge both business and general audiences to examine the What Would You Do? moments we face every day. This work and his many achievements were recently recognized with honorary Doctorate degrees from Davis & Elkins College in West Virginia and Utah Valley University.
Social Science Research Analyst
Office of Inspector General U.S. Department of Health and Human Services (HHS)
Office of Inspector General U.S. Department of Health and Human Services (HHS)
Jacqualine Reid is a Social Science Research Analyst in the Office of Inspector General, U.S. Department of Health and Human Services (HHS). She conducts national program evaluations on a range of issues effecting various HHS programs, including the Medicare Advantage program. She received her Ph.D. in Anthropology from American University.
Laura leads a dynamic Risk Adjustment Team, managing the day to day operations for Medicare and Marketplace members. She has a proven track record of maximizing risk scores. Laura designs and coordinates all team activities which focus on provider education, training, auditing, data mining, and data analysis to steer program success and achieve performance metrics. Laura is familiar with developing strategies for seeing high risk members utilizing technical dashboards, auditing processes, and working 1:1 with local vendors. Additionally she identifies end-to-end processes and prioritizes interventions to correct known weaknesses. Laura also provides support to corporate compliance efforts for RADV audits for both lines of business. She collaborates with business partners and develops best practices, and shares them with other health plans.
She has over 20 years of varied clinical nursing practice experience including more than ten years of Clinical Coding Certification practice. Laura is a Master’s prepared nurse, who also maintains her CPC and CRC through the AAPC.
Brandon Solomon VP of Client Advisory & Business Development
Brandon Solomon is Vice President and co-leader of Pareto’s Client Advisory and Business Development teams. He is responsible for contributing to the strategic growth of the organization, both through setting and pursuing Pareto’s business development strategy, as well as ensuring our clients receive optimal value from our solutions and services. Brandon and his team support clients with robust analytics and technology solutions to set strategic direction, uncover actionable areas for improvement and achieve measurable outcomes.
Brandon has been with Pareto since its inception, and before that, worked with health plan and provider organizations to solve their strategic, financial, operational and compliance challenges at Pareto’s sister company, HealthScape Advisors. He has deep expertise in regulated markets (e.g., MA, ACA, Medicaid) and has designed, implemented and run over a dozen operational divisions for health plans operating in these lines of business. Brandon’s advisory work has led to the identification, development and advancement of multiple Pareto solutions and capabilities to date, including continued expansion into the risk-bearing provider through solutions to achieve complete and accurate revenue capture.
Brandon is a frequent speaker at industry events, including RISE conferences, and has been published in HFMA’s magazine and Bloomberg. He earned his bachelor’s degree in economics from Indiana University.
Scott Stratton Chief Data Scientist & VP, Product Analytics
Scott Stratton is an industry leader in the design and development of analytic products and technologies that demonstrably improve health care quality and financial results. Scott joined Pulse8 in 2013 and is the chief architect of Pulse8’s predictive models, clinical inferencing logic, and Dynamic Intervention Planning, for which two patents are pending.
Senior Vice President of Innovation and Data Strategies
Eric Sullivan Senior Vice President of Innovation and Data Strategies
Mr. Sullivan serves as Senior Vice President of Innovation and Data Strategies at Inovalon, supporting the innovation towards new product and technology solutions and providing executive leadership over all data integration, management, and governance programs as well as the MORE2 Registry® data asset.
For more than 25 years, Mr. Sullivan has been leading clinical innovation and data-driven solutions in a variety of roles in the healthcare sector—with a keen focus on developing data-driven models to transform healthcare by improving quality, outcomes, and efficiency. He has held leadership positions in some of the nation’s largest health plans including UnitedHealthcare and led teams in the clinical care setting to deliver patient-centered, patient specific health care. His current role advances patient-precision analytics by leveraging big data technologies, Natural Language Processing (NLP), interoperability and real-time clinical data patient profiling. Mr. Sullivan received his M.S. in Health Care Administration as well as an M.B.A from the University of Maryland. Mr. Sullivan also holds a B.S. in Neurobiology from the University of Maryland College Park.
Deputy Group Director of Payment Policy and Financial Management
Erin Sutton Deputy Group Director of Payment Policy and Financial Management
Erin Sutton is the Deputy Group Director of Payment Policy and Financial Management at CMS. She oversees dynamic marketplace policy and data related to the implementation of premium stabilization programs for the individual and small group market both off and on exchange, including the permanent risk adjustment and risk adjustment data validation program and payments to health plans. Ms. Sutton has more than ten years of leadership experience in CMS including directing bundled payments programs in the Center for Medicare and Medicaid Innovation and as a special assistant across fee-for-service, Medicare Advantage/Part D. She was also the division director for the first ever nationwide insurance program for those with pre-existing conditions before the Exchanges were implemented. She has also worked as a senior analyst in the legislative office in CMS and on rotation at the Office of Management and Budget in the Medicare Branch. She has also worked at a large health plan, post-acute care trade association, patient organizations and for various clients in health care consulting. She is a graduate of the University of Tennessee and George Washington University’s Milken Institute of Public Health and has recently published the following article with her colleagues: “A Comparison of Health Risk and Costs Across Private Insurance Markets” in Medical Care, January 2020.
Senior Advisor for Legal Affairs
Office of Counsel to the Inspector General Office of Inspector General U.S. Department of Health and Human Services (HHS)
Office of Counsel to the Inspector General Office of Inspector General U.S. Department of Health and Human Services (HHS)
Megan Tinker is Senior Advisor for Legal Affairs for the Office of Counsel to the Inspector General, U.S. Department of Health and Human Services. She advises the OIG on jurisdiction and oversight issues under the IG Act, and health care fraud and compliance matters, including Medicaid, Medicare and grant programs. Ms. Tinker is responsible for executive level direction and oversight on highly complex and sensitive matters for which the Office of Counsel provides legal advice and representation to OIG officials. This includes a wide range of issues dealing with fraud, waste, and abuse in HHS programs and grants.
Ms. Tinker has testified before Congress, and spoken to the Health Care Compliance Association, Association of Government Accountants, Association of Healthcare Internal Auditors, and American Health Lawyers Association. Ms. Tinker provides training on multiple topics including OIG jurisdiction and authorities. Ms. Tinker is also a guest lecturer at the American University, Washington College of Law, Health Law Program. Ms. Tinker graduated cum laude from American University, Washington College of Law and with honors from University of Richmond.
As Director of Risk Adjustment, Susan Waterman has been empowered to plan, design and oversee business and strategic objectives in creating and optimizing a Risk Adjustment Department responsible for ensuring the accuracy of risk adjustment payments while successfully managing all activities related to Medicare Advantage, ACA and Exchange Risk Adjusted lines of business. In that capacity Susan directed department changes that resulted in multi-million dollar gains in ACA Risk Adjustment, brought all chart review activity in-house saving 500K per year in vendor coding fees, and partnered with the hospital CDI/Quality Physicians to create an Outpatient CDI Department focused on documentation quality, Risk Adjustment activities and clinic training for 1,200 providers.
A proven leader in her field, Susan’s professional experience includes coding and compliance management, auditing and provider training, system management, and consulting services.
After 15 years at a BPO, Dan served as the Director of Programs at Highmark, Inc. where he led Stars programs for over 5 years before joining the Gateway Health team to establish a Stars Quality program focused on delivering 4.0+ Stars. Dan assumed responsibility for HEDIS, Quality Improvement, and Risk Adjustment programs across all lines of business at Gateway Health in 2018. In 2019, Gateway Health’s Medicaid program improved to a 4.0 Accreditation rating and 4.0 Medicare Star Rating.
Josh Weisbrod currently serves as the Vice President – Risk Adjustment at Network Health in Menasha, WI. He brings over 20 years of health insurance, healthcare analytic and human service experience to Network Health. Josh specializes in government programs, health plan operations, risk adjustment and data analytics. Prior to his work at Network Health, he served as Director of Government Programs for a regional Wisconsin health plan serving the state’s Medicare, Medicaid and Marketplace participants. Josh previously served as the Director of Operations for the Wisconsin Health Insurance Risk-Sharing Plan (HIRSP), the state’s high-risk insurance plan. HIRSP also administered the federal high-risk insurance plan in Wisconsin prior to the implementation of the Affordable Care act. Josh has taught part-time at the college level for over 11 years and has extensive experience training health insurance and human service professionals.
Director of Risk Adjustment Programs and Portfolio Management
Alan Whittington Director of Risk Adjustment Programs and Portfolio Management
Alan leads prospective risk adjustment programs for Highmark’s MA and ACA members. Originally from Scotland, Alan has made a home in Pittsburgh after living in South Korea where he met his wife. Alan has focused his career on developing and deploying software solutions to improve user experience across a number of disciplines, including asset management, information risk management, human resources, and most recently healthcare. In his role as Director of Risk Adjustment Programs and Portfolio Management, Alan enjoys finding elegant, straightforward solutions to complex problems. He’s committed to finding ways to simplify risk adjustment activity for providers, practices, and internal business partners.
Paul L. Wilder, Executive Director of CommonWell Health Alliance, is leading the organization as it enters a new chapter in its pursuit of empowering clinicians, practitioners and individuals with interoperability services via its robust, nationwide network. With more than two decades of experience in health IT, Paul has held various roles focusing on imaging, clinical informatics, and interoperability.Prior to joining CommonWell, Paul was Vice President of Strategy & Business Development for Philips Interoperability Solutions. He also spent close to 10 years with one of the largest regional HIE networks in the world, the New York eHealth Collaborative (NYeC)—serving as its Chief Information Officer, Vice President of Product Management and Program Director for NYeC’s Regional Extension Center. During his time with the NYeC, he helped nearly 10,000 primary care providers attest to Meaningful Use and solidified the state’s status as one of the national leaders in health IT adoption. Each role enabled him to work and hear directly from providers and end-users of Electronic Health Records (EHRs)—which gives him an important perspective as a leader in health IT adoption and execution.Prior to joining the NYeC, Paul spent more than a decade in health care with a focus on information technologies at McKesson, Fujifilm Medical Systems and GE Healthcare. Paul is passionate about transforming our health care delivery system nationwide.Paul received his Master of Business Administration from New York University with a concentration in Finance and Operations. Paul also holds two bachelor’s degrees from the University of Pennsylvania – one from the College of Arts and Sciences in Economics and the other from the School of Engineering and Applied Science in Biomedical Science. He lives in the New York area with his wife, two daughters and their newest family member, their dog Penny.