Dan has been in the industry for 40 years. His business focus is on strategic relationships and solution architecture in the healthcare communications and at-home medical test kit fulfillment fields. Areas of expertise include applied information technology and the integration of medical testing and clinical communication and production fulfillment domains, alongside and within CMS, HIPAA and FDA regulatory compliance demands.
He obtained his Bachelor of Science in Printing Management from California State University Los Angeles in 1983, and then his MBA from the University of La Verne in La Verne California in 1995.
Dan is a member of the Health Care Compliance Association and serves as an adjunct professor at the University of La Verne teaching classes in the business impact of HIPAA.
Mike Adelberg leads the Healthcare Strategy Practice at Faegre Baker Daniels Consulting. He has 25 years progressive healthcare industry and government experience in Medicare, Medicaid and commercial health insurance. Among other projects, Mike co-leads a 33-health plan consortium focused on improving plan benefits and a 19-health plan consortium focused on improving provider networks. Mike spent fifteen years at the Centers for Medicare and Medicaid Services (CMS), including concurrently serving as the director of the Insurance Programs Group and the acting director of the Exchange Policy and Operations Group in the Center for Consumer Information and Insurance Oversight (CCIIO) several ACA programs; serving as the Director of Medicare Advantage Operations, where he supervised the annual cycle for review and award of Medicare Advantage bids and contracts, developed CMS’s operational policy, and led the monitoring of Medicare Advantage contractors; and serving as the associate regional administrator for Medicare operations (Chicago Region) and the director of education and assistance programs. Mike gained private sector experience as vice president of product development and government affairs for the Universal American Corporation, a multi-state health insurer which operated Medicare Advantage and Medicaid health plans (subsequently acquired by Wellcare).
Mike has also led or co-led health policy studies published in Health Affairs and The American Journal of Managed Care. He speaks and publishes frequently on healthcare topics, has served on numerous advisory committees, and has earned two foundation grants. He’s been quoted in the Washington Post, New York Times, Modern Healthcare, NPR, and other leading media. In his spare time, Mike is an author. He’s written three novels, a history book, several scholarly journal articles, and over sixty book reviews.
Edward Baker is Counsel in Constantine Cannon’s Washington, D.C. office. Mr. Baker represents a broad range of whistleblowers and has extensive experience with healthcare fraud cases under the federal False Claims Act and comparable state laws. He currently represents relators alleging FCA violations by MA and Medicaid managed care plans, health systems, and providers. Prior to joining Constantine Cannon, Mr. Baker was an Assistant U.S. Attorney in the Eastern District of California for four years where he worked on affirmative civil enforcement cases and was the Healthcare Fraud Coordinator for the district. He previously served as the Director of the Vermont Medicaid Fraud Control Unit, prosecuting civil and criminal Medicaid fraud cases. He began his professional career on the defense side in Boston, representing pharmaceutical executives and companies under government investigation.
John Barkley is the Vice President of Enterprise Risk Adjustment and Data Integrity for Emblem and ConnectiCare. John has been with the enterprise for ten years leading ConnectiCare and now Enterprise Risk Adjustment function. Prior to joining Emblem John was with Aetna for twenty-one years with the last six years in the risk adjustment space. John has been an attendee and presenter at RISE events for several years now. When not executing risk adjustment activities he enjoys kayaking, biking and fishing on Cape Cod, Massachusetts where he lives.
Nicholaos C. Bellos
MD, FIDSA, FACP Medical Director, Extended Care Svc Franchise
Nicholaos C. Bellos MD, FIDSA, FACP Medical Director, Extended Care Svc Franchise
Nicholaos Bellos, MD, is board-certified in internal medicine and infectious disease. Dr Bellos brings both deep clinical knowledge and executive leadership experience to the discussion, and has a passion for advancing positive outcomes for patients. His expertise includes delivering evidence-based, measurable healthcare solutions that contain costs, reduce hospital length of stay and readmissions, and cut down on hospital-acquired drug-resistant infections. Dr Bellos has maintained a private clinical practice for over 20 years and serves as national medical director for Extended Care Services at Quest Diagnostics. Previously, he was associate vice president of Medical Operations and Performance Management and Innovation at Tenet Health.
Courtney Breece, is the senior director, product management for Inovalon. She serves as the product owner for the analytics capabilities of the Inovalon ONE® Platform. Driving quality and measure improvements through big data processing, Breece oversees the technical development of Quality Spectrum Insight™ (QSI-XL™), the industry’s leading performance measurement reporting application; as well as measure content development, application support, implementation teams, and training programs. Prior to joining the Inovalon team in 2012, she acted as the assistant director of NCQA’s measure validation department and managed the Certified HEDIS® Compliance Audit (CHCA) Program.
In her roles at NCQA, she worked closely with auditors, health plans, and vendors to craft measure and audit policy. She served as NCQA’s contract director for CMS’ HEDIS® Medicare Reporting contract for the delivery of Medicare data used in CMS’ Five Star Health Plan Ratings program.
Dawn Carter is a Director of Product Strategy at Centauri Health Solutions, LLC. Her career in healthcare spans 26 years, which most recently includes extensive experience in developing revenue integrity and quality software solutions, with a focus on encounter management and risk adjustment solutions for Medicare Advantage, Medicaid and Commercial health plans. Prior to that, her experience spans all domains of health care including health plan and provider systems administration, and healthcare applications development. Her experience also includes multiple teaching engagements in medical administration, billing and coding. Dawn holds a Bachelor’s degree in Business Administration. She is a passionate and prolific industry speaker, author, blogger and subject matter expert in claims, EDI management, and risk adjustment.
Health care regulatory attorney Jason Christ extends his successful defense strategies in False Claims Act (FCA) actions by the government to safeguard clients’ Medicare Part C plan risk adjustment payment programs. As one of the first and few attorneys focused on risk adjustment in Medicare Advantage (MA) plans, Jason has transformed how clients organize, monitor, and ultimately defend their programs. He creates new business opportunities and best practices for risk-bearing provider groups, plans, and vendors.
As enforcement and regulation of risk adjustment and the FCA escalates, Jason anticipates threats. He devises balanced and compliant approaches that address his clients’ greatest exposures: coding fidelity, clinical effectiveness, oversight, and consistency in best industry practices. From program assessment to testing and corrective actions, Jason shows clients how to close the compliance gap.
Mr. Clement serves as Vice President of Products and Services and leads Inovalon’s quality interventions and integrated risk score accuracy programs which includes prospective, retrospective, and submissions. These solutions enable Inovalon’s client partners to drive meaningful improvements in risk score accuracy, member engagement and retention, quality, and financial performance. Mr. Clement maintains end-to-end responsibility for these products, from analytics and intervention strategy to intervention execution, data collection, and reporting. He has nearly 25 years of experience working in the payer and provider sectors.
Prior to this role, Mr. Clement served as Senior Director and General Manager of Inovalon’s quality improvement and integrated prospective risk adjustment solutions, where he maintained end-to-end responsibility for these products, from analytics and intervention strategy, through intervention execution, data collection, and reporting. Mr. Clement also previously served as Senior Director of Intervention Strategy Integration at Inovalon, where under his leadership Inovalon built new intervention channels including Inovalon owned member centers, as well as retail clinics nationwide and expanded operations to a nationwide footprint. In addition, Mr. Clement led the planning and development of Inovalon’s market-leading Member Engagement program.
Prior to joining Inovalon, Mr. Clement held various management consulting leadership roles at Booz Allen Hamilton, PricewaterhouseCoopers, and Accenture, where he oversaw teams providing strategic advisory services to large health plans, provider organizations, and government agencies. Mr. Clement has also served in various operating and strategic planning roles in large, integrated delivery systems including Johns Hopkins Medicine and Children’s Hospital Boston. Mr. Clement earned a Master of Business Administration from the University of Pennsylvania, Wharton School of Business and a Master of Public Health from the Harvard University School of Public Health.
Jessica Columbus, LVN, CCS-P, CRC, CPHQ is currently the Associate Vice President of Stars and Risk Adjustment for Apex Health Solutions. Her expertise in physician performance engagement and value based care best practices are built on a foundation of more than 15 years experience in managed care focusing on end to end health plan operations related to Risk Adjustment and the CMS STAR Rating Program.
She began her healthcare career in direct patient care as a Pediatric/NICU nurse and in 2005 took an opportunity at a managed care company in their Referral/Pre Cert Department where she was first exposed to quality and risk adjustment concepts. Once promoted into a leadership role that allowed her to own and create both risk adjustment and HEDIS programs from scratch she discovered those to be her true passion.
For 10 years her career has concentrated on innovative provider engagement strategies and implementing real world solutions that positively impact provider and contract performance. Her enterprise-wide physician education programs that aim to improve understanding of clinical documentation requirements have proven successful through accuracy of HCC recapture, increased year round closure of HEDIS gaps in care and strengthened positive health plan experiences among both providers and members.
Prior to joining Apex in August of 2020, Jessica worked at Universal American/WellCare for 5 years as the Sr. Director of Quality Improvement directly overseeing all quality improvement programs, HEDIS/STARs operations and prospective risk adjustment activities for their Texas and Louisiana markets. During her tenure at WellCare she was able to consistently deliver solid Star Ratings for all contracts under her responsibility, including achieving a 4.5 STAR in 2019 for their flagship MAPD plan in Texas. Jessica’s continued career journey is centered on improving clinical outcomes for patients through advancing provider and payer partnerships that will revolutionize value based care.
Jessica enjoys spending her free time traveling or binge watching new Netflix releases with her husband Brandon and their 3 daughters (Gabriella, Alexis and Jordan) in Houston Texas.
Former Director, Provider Compliance Group, Center for Program Integrity, CMS
Former Director, Provider Compliance Group, Center for Program Integrity, CMS
Melanie Combs-Dyer graduated from the University of Maryland School of Nursing and obtained her Master’s degree in Health Administration from Towson University. She retired from the Centers for Medicare & Medicaid Services (CMS) in January of 2020 after over 30 years of federal service. Most of Melanie’s years at CMS were spent in the Center for Program Integrity where she worked to reduce improper payments in the Medicare Fee-for-Service program. Melanie was a member of the Senior Executive Service at CMS and was instrumental in implementing many new initiatives including developing a large-scale national solution to allow providers to electronically submit medical record documentation to Medicare.
In 2017, the CMS Administrator chose Melanie to represent the Medicare FFS program on the Steering Committee of the Da Vinci project, a national a private-sector initiative that leverages HL7 Fast Healthcare Interoperability Resources (FHIR) to improve data sharing between healthcare providers and payers. During the following year, Melanie also led the creation of the Medicare FFS Documentation Requirement Lookup Service that uses the Da Vinci FHIR standards called coverage requirements discovery and documentation templates and rules. The DRLS service will allow providers to discover Medicare’s prior authorization and documentation requirements right from their EHR.
During her final year at CMS, Melanie served as Senior Advisor in the Office of the Administrator, Health Informatics Office where she continued to push to get health care data flowing using FHIR standards. She oversaw CMS’ first “Connect-a-thon” which saw hundreds of FHIR software developers descend upon the CMS central office in Baltimore to share code and create demonstrations of how payer and provider systems can be connected using FHIR-based Application Programming Interfaces.
After leaving CMS, Melanie became the Director of Innovation at Mettle Solutions, a Health Information Technology solutions company with expertise in interoperability standards and specifications, clinical quality measures, medical documentation exchange, and reducing improper payments at payers.
Laura Cooley, PhD Senior Director of Education and Outreach
Academy of Communication in Healthcare
Laura Cooley, PhD, humanizes healthcare through her contributions to education and outreach for The Academy of Communication in Healthcare. She serves as Editor-in-Chief for The Journal of Patient Experience, an open-access, indexed, SAGE publication, dedicated to presenting advances and applications that impact the patient and provider experience. Additionally, she holds a faculty appointment at Vanderbilt University School of Medicine where she contributes to the Center for Effective Health Communication. In her primary rolewith ACH, Dr. Cooley leads strategic efforts to develop and deliver customized communication skills training programs designed to enhance patient experience in partnership with organizations such as: Stanford Healthcare, Yale New Haven Hospital, Northwell Health, Adventist Health, Texas Children's Hospital, Baylor Scott & White, & many more. As a leader for The Academy of Communication in Healthcare for the past 8 years and recent editor of a book on the topic (Communication Rx: Transforming Healthcare Through Relationship-Centered Communication)Dr. Cooley is uniquely positioned to discuss the impact of technology on communication and relationships among patients and providers.
Patrick Coulson has more than 25 years of experience leading healthcare sales, specializing in early-stage companies, new product launches and C-level new business sales. With expertise in Medicare Advantage, risk adjustment, technology services and member engagement, he has a record of enhancing start-up organizations – doubling revenue year-over-year, in many cases.
Prior to joining Emerging Markets as Advantasure’s Chief Growth Officer, Coulson served as Senior Vice President of Business Development for engagement services company Integra ServiceConnect. Within two years, Coulson helped triple the client base and double the annual revenue. He was previously Vice President of Sales for medical cost management company MedSolutions, where he was responsible for Medicare Advantage sales nationwide.
Sean Creighton serves as managing director in the policy practice at Avalere, a premier consulting firm focused on health care. Creighton leads projects in a number of key areas, Medicare Advantage, Part D reform, risk adjustment and RADV, and analysis of healthcare quality and utilization. Creighton previously worked as vice president for Federal Policy at Humana, working on critical industry initiatives during COVID-19. At Humana, Creighton provided leadership in the development and implementation of federal policy strategy. Prior to Avalere and Humana, Creighton was Senior Vice President for the revenue integrity and risk adjustment product line at Verscend (now Cotiviti) working on data aggregation, coding, and submission products for Medicare and the commercial market to ensure appropriate revenue and elevate performance.
Before joining Verscend (now Cotiviti), Creighton was the deputy group director of the Payment Policy and Financial Management Group in the CMS Center for Consumer Information and Insurance Oversight. He also served as the director of the division of Payment Policy and Risk Adjustment in the Medicare Plan Payment Group in the Center for Medicare.
While at CMS, Creighton was responsible for payment policy and operations for both private marketplace and Medicare plans. Notable accomplishments include developing and implementing a system to make advance premium-tax credit and cost-sharing reduction subsidy payments to marketplace issuers under the Affordable Care Act; developing and implementing Parts C and D risk adjustment models; and serving as the sponsor and chief architect of the Medicare Encounter Data System (EDS).
Creighton holds a Bachelor of Arts degree in European studies from the University of Limerick, a Higher Diploma in Statistics from Trinity College, Dublin, a Master of Science degree in Sociology from the London School of Economics, and conducted doctoral research at Indiana University, Bloomington. He has won numerous awards for development and implementation of risk adjustment and payment models.
Shahyan Currimbhoy Vice President Product Management
Mr. Currimbhoy is an experienced healthcare executive and has led teams to create innovative product and services to drive growth. Mr. Currimbhoy is a seasoned product leader with experience in conceptualizing and launching new products to market and enhancing existing products. Prior to joining the Company, he was VP, Product Management at Healthline. Prior to that, Mr. Currimbhoy worked for Caradigm USA,LLC, Microsoft Corporation and Siemens Healthcare. He holds a master’s degree in Software Engineering from Carnegie Mellon and a bachelor’s degree in Computer Science from Cornell University.
Katy Davis, MBA, CPC, CPMA
Director, Risk Adjustment Coding Quality and Compliance
Katy Davis is a dynamic visionary leader with experience in coding compliance, auditing, and education. In her current role as Director of Risk Adjustment Coding Quality & Compliance, Katy leads the retrieval and coding projects for MMO’s Risk Adjustment department as well as provider education and contract management. She also drives initiatives for compliance as it relates to risk adjustment.
Katy began her career at Medical Mutual in 2015 as a Provider Risk Adjustment specialist and moved to the Manager of Risk Adjustment Coding creating the RA Coding team for MMO. She also moved into management of the RA Retrieval team implementing new processes and refining workflows. Prior to joining the company, Katy’s career included medical coding for provider groups and facilities as well as coding and documentation compliance auditing for The Ohio State University Physician’s Group.
Katy earned a Bachelor of Health Care Management and a Master of Business Administration from Ohio Christian University. She also has her Certified Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) credentials through the American Academy of Professional Coders (AAPC).
Dr. Shannon Decker, M.Ed., MBA, PhD. Vice President of Clinical Performance
Brown and Toland
Dr. Shannon Decker is Vice President of Clinical Performance at Brown and Toland where she leads a department responsible for Clinical Quality Documentation (Risk Adjustment); Clinical Quality, Patient Experience & Population Health; Clinical Compliance, including Appeals & Grievance; and Clinical Data Management, including Encounter Data Management. She also serves as Brown & Toland's COVID-19 Taskforce leader. Dr. Decker has more than 20 years of experience in healthcare--15 of which include working with risk adjustment and Medicare. Dr. Decker has a PhD. in Interdisciplinary Studies, dual MBA degrees--in Finance and in Marketing, as well as an M.Ed. in Secondary Education and a M.Ed. in Administration and Leadership. Dr. Decker is on the faculty at Arizona State University and is also an associate professor of Higher Education & Adult Learning (HEAL) and chief methodologist for Walden and Capella Universities where she chairs and oversees the dissertations of doctoral students. An author of two books and several peer-reviewed articles, she consults in both the fields of healthcare and education. Her interests include the study of human behavior and how theories on motivation and learning may be brought to bear on population health management.
The Chief Financial Officer (“CFO”) Roshan Desai has over 18 years’ experience in the healthcare industry. Mr. Desai has been with ATRIO since April 2021. Prior to his leadership role at ATRIO, Mr. Desai spent time in leadership positions at Gorman Health Group and Universal Health Care group. His responsibilities included managing the Medicare bid process, financial feasibility for new and expansion markets, budgeting and forecasting, maximizing operational performance, and oversight of all key Medicare financial reconciliations.
Art is an AHIP Fellow with 25 years of innovation and operational excellence experience while leading large teams in dispersed and highly matrixed organizations, such as Deloitte, Anthem, Horizon Blue Cross Blue Shield of New Jersey, Davita Healthcare Partners, and UnitedHealthcare. He joined Centrum Health from PopHealthCare, where he led the company’s prospective and retrospective risk adjustment operational programs including in-home assessments, data normalization and analytics, medical record acquisition, coding, and data submission for risk adjustment payment determination.
Laurin Dixon is the Lead Executive, Medicare Products at Arkansas Blue Cross and Blue Shield. In this role, she has day-to-day responsibility for all aspects of Medicare, including Medicare Advantage, Prescription Drug Plan, and Supplement. This includes accountability for strategic direction in product administration/operations, network development, revenue optimization, value-based contracting, risk adjustment, vendor management, pharmacy and medical trend results, and clinical quality/Stars. Laurin previously held Director roles in Medicare Stars and Pharmacy Quality at Arkansas BCBS and Humana. She completed an Executive Fellowship at the Pharmacy Quality Alliance after earning her Doctor of Pharmacy degree from the University of Mississippi.
Eden Encarnacion, MHA Director of Quality and Star Programs
Clever Care Health Plan
Eden Encarnacion, MHA is the Director of Quality and Star Programs at Clever Care Health Plan. Prior to joining Clever Care HP, her work primarily focused on quality improvement for Commercial, Medi-Cal and Medicare lines of businesses for 2MSO’sin CA. A few achievements include year-over-year awards from Integrated Health Association (IHA) AMP Program for Most Improved Medical Group (for 4 IPAs) and improving an IPA from a 3 star to a 4.5 Star Performance. Her experience spans not only in quality but also in the areas of risk adjustment, claims, encounter data submission and overall improvement focused on strategic development and implementation of Value Based Performance Programs.
Emma Ericksen, VP of Product, leads strategy and product development for Signify Health’s Social Determinants of Health products including the Care Advocate Model, Specialized Home and Community Solutions and Community Networks. She joined Signify Health with 13 years of healthcare payer experience, first joining UnitedHealthcare where she spent a majority of her time focused within Community & State’s Medicaid population, in a variety of roles from member engagement, new business implementation, clinical technology and lastly within the Social Determinants of Health program myConnections, leading community engagement, program operations, and data and technology strategy. Following that, Emma joined WellCare in 2018, leading the enterprise wide SDoH program Community Connections, including a social care coordination team, local community engagement teams, pilot innovation leaders and a data and technology team. This role focused on both Medicaid and Medicare populations, with a goal of developing, executing, measuring, and scaling innovation programs to support enterprise priorities and quantitatively measure the impact of social interventions.
Emma has a Master of Science in Applied Psychology, with a concentration in Industrial/Organizational Psychology and Program Evaluation. Emma resides in Minneapolis, Minnesota and in her free time enjoys traveling, spending time at her family cabin and trying new foods and restaurants.
Dave Etling Senior Vice President & General Manager
Dave is a recognized visionary within the prepaid industry, having established first to market multi-billion dollar categories in retail, including InComm’s digital content and gaming vertical. He was InComm’s fortieth employee and has held various positions, including executive management, business development, sales, product development and merchant services. Dave uses his broad knowledge of InComm’s technologies and services to establish deep and mutually beneficial business relationships with our customers. He has been a key asset to InComm’s growth over the past 20 years in improving product partner acquisition and successful retail launches of products for major industry leaders such as Apple, Google, Facebook, Microsoft, and Sony. Dave was previously the general manager of the InComm InCentives division and now InComm Healthcare.
Jonas Foit Senior Vice President, RQNC Analytics & Reporting
Jonas Foit has been developing and leading risk adjustment and quality analytics platforms and programs for over 15 years. He co-developed the first risk adjustment analytics platform to serve Payers and Providers and has since went on to lead industry-first programs in prospective risk adjustment, CMS 5-Star analytics, member and patient behavior data science, and value-based care. Jonas has worked for payers like Molina Healthcare and premiere vendors such as Inovalon, Ciox, and Pulse8. Jonas has a BS in computer information systems and a BA in management from Marietta College.
Jim leads marketing and product strategy efforts to create recognition, interest and demand for our newly combined organization’s commercial plans products and services offered across our 5 states. He oversees all commercial advertising, promotion, sponsorship and awareness across all media and other programs that support the division’s go-to-market strategies. In addition, Jim is responsible for product development and product effectiveness, sales administration.
Before joining Tufts Health Plan, Jim was senior vice president for business development and strategy for a health care strategy firm based in Houston TX. Prior to that, he spent 18 years in business development, marketing and product innovation roles, supporting all business segments within a regional BlueCross Blue Shield plan.
Jim holds a B.S. in business administration and marketing and an M.B.A. from the University of Rhode Island.
Colleen Gianatasio CPC, CPC-P, CPMA, CPC-I, CRC has 18 years of experience in the health insurance field. She has experience in customer service, claims, quality and coding. As Risk Adjustment Quality and Education Program Manager for Capital District Physician’s Health Plan (CDPHP) Colleen’s primary responsibilities are 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 serves as President-Elect of the AAPC National Advisory Board.
Wayne Gibson Senior Managing Director, Health Solutions
Wayne Gibson is a Senior Managing Director at FTI Consulting and is based in Washington, DC. He is part pf the Health Solutions segment. He has 20 years of experience applying economic and financial modeling, data‐intensive analysis, and complex claims analyses across numerous industries and in a variety of operational, dispute and compliance matters.
He has assisted health plans, providers, pharmaceutical manufacturers and PBMs with in a variety of matter types including operational improvement and compliance consulting, nationwide class‐action litigation, Medicare and Medicaid false claims and sales and marketing investigations, investigations by other government agencies, and arbitration matters. Significant types of matters Mr. Gibson has worked on include:
Risk Adjustment Operational Improvement and Compliance Assessments – assisted Medicare Advantage plans, ACA exchange‐based plans, trading partners/vendors, and providers under risk contracts in an end to end assessment and redesign of work flows and data flows, policies and procedures, controls, reporting and forecasting related to their Medicare Advantage and risk adjusted populations. Has also performed reviews of systems and programming logic used to filter encounters to assess compliance with Medicare Advantage and Managed Medicaid requirements. Has worked with clients to develop and implement interim and ‘bridge’ applications that provided added functionality in managing populations subject to risk adjustment. Has supported plans in RADV and other regulatory reviews. Has assisted in contractual disputes regarding payments from health plans to provider groups under shared risk agreements.
Medicare and Medicaid Investigations ‐ assisted a variety of clients including health plans, pharmaceutical manufacturers, institutional providers, diagnostic lab testing companies, and their outside counsel in responding to governmental investigations and in conducting internal investigations related to Medicaid and Medicare false claims and fraud and abuse issues as well as how these issues may impact statutory and SEC reporting. These investigations encompass issues such as reimbursement, pricing, Medical Loss Ratios and cost reporting, and sales and marketing. As part of these investigations has assisted clients and their counsel in discussions with the DOJ, OIG, state Medicaid and regulatory agencies, and the SEC.
Compliance and Operational Reviews – assisted a variety of clients with compliance reviews related to Medicare Advantage, Fee for Service Medicare and Medicaid programs. He has also performed other contractually‐mandated reviews, and operational assessments of controls, data and information systems, and relationships with third parties/sub‐contractors.
Litigation and Commercial Disputes (Healthcare and Other Industries) – assisted a variety of clients and their outside counsel in defense of nationwide class‐action matters, federal and state court litigation, international arbitration, and arbitration and mediation matters. Has developed and submitted expert reports on damages in a number of forums and has testified in arbitrations.
Steve Goldberg, MD, MBA
VP, Chief Health Officer, Medical Affairs & Diagnostic Services
By fusing customer service, six-sigma principles, and clinical knowledge, Mr. Gozleveli’s innovative approach to care coordination ventured into uncharted waters. As the pandemic created uncertainty and healthcare access became scarcer, Mr. Gozleveli established Innovative Medical Solutions LLC to expand delivery of efficient yet effective quality care outside of the family business’s full-risk primary care group practices.
Despite the challenges facing the industry, these outside-the-box solutions implemented within the groups practice of his family as well as for other clients quickly demonstrated the need for creating strategies for optimizing risk adjustment accuracy, continuous care coordination, and patient-provider-caregiver synergy. Although there are no “one size fits all” frameworks, the overlapping factors across the level of care spectrum allow these innovative processes to benefit a wide audience spanning from the patients to payors and everything in between.
Director, Medicare and ACA Risk Adjustment Programs and Analysis
Kevin Greer Director, Medicare and ACA Risk Adjustment Programs and Analysis
Kevin is the Director, Medicare and ACA Risk Adjustment Programs and Analysis, at AmeriHealth Caritas. In this role Kevin directs the development and implementation of risk accuracy strategies and reports key risk adjustment metrics. Kevin received an Economics degree from Rowan University.
EVP, Operations - Risk Adjustment, Population Health Management, and Quality
RaeAnn Grossman EVP, Operations - Risk Adjustment, Population Health Management, and Quality
As Executive Vice President of Operations for Population Health Management, Risk Adjustment, and Quality, RaeAnn is responsible for leadership and management oversight of financial performance and operations, as well as innovation, vision, strategic and business planning. In this capacity, she is reframing and accelerating the success and impact of Cotiviti’s industry-leading Risk Adjustment, Quality Network and Clinical, plus Consumer (Eliza) solutions focused on health plan success, health equity and outcomes, and provider performance. With her extensive track record of customer focus, value creation, along with government program and industry experience, Grossman drives the Cotiviti portfolio to improve financial and clinical metrics, reduce the cost of care, and create a landscape for health equity.
Grossman is a renowned industry expert in healthcare innovation and transformation, product strategy, partnership development, and risk adjustment and quality. She has more than 25 years of experience in executive roles at an array of organizations, including commercial and government health plans as well as medical groups, integrated hospital systems, startups, and physician hospital organizations. Most recently, she was President of Medicare Advantage/COO of Bright Health Plan, managing a multi-state Medicare Advantage plan. Prior to that she held C-suite roles at various healthcare technology and consulting firms for nearly two decades, including extensive time with Gorman Health Group, which the premier consulting firm for government-sponsored healthcare programs.
RaeAnn earned an MS in urban and regional planning from Florida State University, and a bachelor’s degree in environmental policy from University of Minnesota.
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.
As Director of Government Funding, Leah Hannum played a pivotal role in the planning, creation, oversight and strategic objectives of the risk adjustment department at Blue Cross of Idaho. She is responsible for overseeing activities related to Medicare and ACA risk adjustment programs in support of payment accuracy. With 15+ years’ experience in government programs, Leah’s current focus is to understand and connect the health plan’s risk adjustment accuracy needs with efficient provider workflows for improved patient outcomes.
Amber Harris, CPC, CRC Director of Risk Adjustment
MediGold is a MA only plan serving members in Ohio, Idaho, Iowa and New York. Amber leads the Risk Adjustment team, responsible for accurate coding and complete submissions to CMS. This department includes prospective and retrospective initiatives, auditing, analytics and EDPS submissions.
Erin is an internationally-recognized leader on the impact of authenticity in the workplace. She is the founder of b Authentic inc, where she’s leading a movement to eradicate the workplace of its BS and make it a fundamentally more authentic place. Erin is the best-selling author ofYou Do You(ish), a TEDx speaker, coach-sultant, and the co-host of an offbeat career and leadership podcast, b Cause with Erin & Nicole.
Her talks have reached hundreds of thousands of people and her thought leadership has been featured on ABC, CBS and published in Business Insider, Fast Company, Well+Good, among several others.
Erin spent her career “first half” working in the corporate world, where at the age of 42, she became the CEO of a large healthcare financial institution. In just three years, she took a struggling company and led a massive turnaround, tripling earnings and sending employee engagement skyrocketing. Her secret? Radical authenticity.
Erin holds a BBA in Statistics from Western Michigan University and an MBA in Finance and Marketing from the University of Connecticut. She is married to her husband, Manny, who she met while stumbling through (and failing) an early career in the Actuarial field. They have two children - Ella (13) and Mick (10). In Erin's free time you can find her coaching basketball, running, skiing, drinking wine in her fat pants, or dancing wherever you're not supposed to dance.
Kevin is the CEO of Allymar Health Solutions, a leading single platform, core administrative services organization built to assist health plans and risk bearing provider groups become more effective and efficient. Services include claims administration services such as claims adjudication, claims payment, members services, provider services, membership and billing as well as risk adjustment and Hedis services. Prior to taking on his current role Kevin has held several executive level positions at such organizations as Optum, Inspiris, Warm Health, Social Service Coordinators and The SilverSneakers Fitness Program.
This is the 14th year that Kevin has chaired the Rise Nashville event and is glad to be back.
Eric oversees data analytics and reporting across allAdvantmedsolutions. He brings over 10 years of experience in healthcare that includes actuarial work, provider engagement, and risk adjustment leadership. Through his extensive experience at both health plans and vendors, Eric understands the value of providing data that is actionable, nuanced, and trustworthy. He is focused on building these qualities into all solutions atAdvantmed. His experience includes roles at Priority Health and Cigna health plans as well as Pulse8 where he directed the provider-facing solutions and played key roles across all analytics.
James Hereford is President and Chief Executive Officer of Fairview Health Services. Based in Minneapolis, Minnesota, Fairview is a $6.5+ billion non-profit integrated health system affiliated with the University of Minnesota through our joint clinical enterprise, M Health Fairview. Fairview’s 34,000+ employees and 5,000+ system providers provide exceptional clinical care, from prevention of illness and injury to caring for the most complex medical conditions. Fairview has proudly served its communities for more than 150 years, and is the fourth largest employer in the State of Minnesota.
James provides strategic direction and ensures operational effectiveness for Fairview’s entire continuum of services, which is unmatched in the region. Following the integration of the HealthEast system in June 2017, Fairview is now one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center—serving the greater Twin Cities metro area and north-central Minnesota. Its broad continuum of care also includes 40+ primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, and an integrated provider network. Fairview also is a founding member of specialty pharmacy network Excelera and many other unique partnerships that advance our vision of driving a healthier future. In 2022, Fairview will open the Community Health and Wellness Hub in St. Paul, a first-of-its-kind center bringing together comprehensive services focused on addressing social risks.
Prior to joining Fairview, James served as chief operations officer at Stanford Health Care. Previous roles included chief operations officer at the Palo Alto Medical Foundation and a series of leadership roles with the Group Health Cooperative in Seattle.
James holds bachelor's and master's degrees in mathematics from Montana State University. He has taught courses with Stanford University’s Graduate School of Business, University of Washington’s Master of Health Administration program and The Ohio State University’s Masters of Business Operations Excellence program. He is a frequent writer and presenter on the topic of lean management systems and transformation.
Kent Holdcroft MA, Executive Vice President, Growth
Kent Holdcroft is the Executive Vice President of Growth at HealthMine, bringing over 15 years of operational, consulting, and business development experience with healthcare technology vendors to our team. Prior to HealthMine, Kent was Executive Vice President at AdhereHealth where he installed the teams and processes that led to record growth and innovation in product strategy. Before that, Kent had 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 received his Bachelor’s degree in Psychology from Miami University and Master’s in Counseling from the University of Toledo. In his free time, Kent serves on the Board of Directors at BrightStone, Inc., as well as with the Tennessee Crohn’s & Colitis Foundation.
Bill Horn serves as SVP Payer Growth for Ciox Health, leading sales and business development for the company’s Clinical Data Acquisition & Insights division. Since 2015, Bill has worked closely with health plans and their business partners to deploy & support best in class risk adjustment & quality programs. Collectively, Bill has over twenty-five years of healthcare sales and sales leadership experience, working with leading software and business processing outsourcing companies like RelayHealth, Nuance, and QuadraMed with a primary focus on clinical documentation, health information exchange, and interoperability solutions. He holds a Bachelor’s degree in Economics from University of Arizona.
RHIA, Vice President of Operations & Client Relations
Emmy Johnson RHIA, Vice President of Operations & Client Relations
GeBBS Healthcare Solutions
Emmy Johnson, RHIA is the VP of Operations & Client Relations at GeBBS Healthcare Solutions. She has two decades of experience in health information management, coding and revenue cycle operations. In her role she will focus on all HIM/Coding functions in addition to client relations management. In her previous roles she has been a critical leader for the establishment of goals/strategy, growth outcomes, and new service line development in addition to mergers and acquisitions and client engagement/satisfaction. She has been instrumental in the growth and success of top-tier hospital HIM and Coding operations in addition to consulting firms working with multiple hospital organizations on increasing overall revenue strategies and outcomes. In 2018, she was named as one of the Top 50 RCM Female Leaders to Know by Becker’s Hospital Review as well as leading WHIMA as their President for 2019-2020.
Vice President & General Manager, Clinical Quality and Revenue Integrity
Mike Jones Vice President & General Manager, Clinical Quality and Revenue Integrity
Mike holds a pivotal role in driving market acceptance and penetration of Nuance’s new Computer-Aided Physician Documentation guidance products, as well as growth of the company’s more mature Clinical Documentation Improvement and Coding portfolios.
Prior to Nuance, Mike led the healthcare technologies division of NTT DATA, a global Top 10 IT and healthcare business service provider. After a strong period of growth and a successful merger & acquisition transaction, Mike served as CEO of the newly formed post-acute care IT provider, Cantata Health Solutions.
Earlier in his career, Mike served as executive vice president and chief operating officer of CPSI, a provider of community hospital EMR software and services. Mike earned a B.S. in computer science the University of South Alabama. He has served for the past two decades as an advisory board member of the university’s School of Computing, driving its mission to prepare students for careers in technology.
Venkat Kavarthapu brings over 25 years of experience in technology leadership to his position as CEO at Edifecs. In various roles with the company over the last 12 years, Venkat has successfully built and scaled multiple product lines and led Edifecs’ services and product support business units. With the support of his global team, Venkat is focused on helping healthcare organizations collaborate on and exchange data, reduce operating costs, maintain compliance with industry regulations and accelerate adoption of alternative payment models through innovative software solutions.
Prior to joining Edifecs in 2009, Venkat launched his career in information technology, consulting and business process services with Wipro. Throughout his 10-year tenure at Wipro Venkat led program delivery and large customer engagements for global customers.
Venkat earned his bachelor’s degree in engineering and an MBA from the Indian Institute of Management.
Dr. Kilian serves as the Chief Medical Officer (CMO) for Inovalon. In this role, Dr. Kilian is responsible for the oversight of the medical directors of the Company, the clinical content and design of the Company’s software and analytics, and the clinical training, quality, policies, oversight and compliance of associated operations. For more than a decade, Dr. Kilian has led a team of clinical personnel who bring the latest best practices and evidence-based clinical standards to Inovalon’s products and services. Dr. Kilian is well known throughout the healthcare community as an expert on the application of data, software, and analytics to the benefit of clinical protocols, care guidelines, real-world healthcare clinical workflow, and regulatory policy guidelines adherence. Most recently, Dr. Kilian has been recognized with the Healthcare Business Women’s Association 2020 Luminary award.
Prior to joining Inovalon in 2007, Dr. Kilian was in clinical practice with Johns Hopkins Community Physicians, where she served as Medical Director with responsibilities including patient care, clinical training of medical students and residents, and clinical oversight of a multispecialty practice.
Dr. Kilian graduated summa cum laude from Washington and Lee University and earned her doctorate in medicine from Tufts University School of Medicine. She completed her residency in Internal Medicine at The Johns Hopkins Hospital in Baltimore, Maryland.
Managing Director, Member Solutions and Administration
Blue Cross Blue Shield of Michigan / Senior Health Services
Brian Krajewski Managing Director, Member Solutions and Administration
Blue Cross Blue Shield of Michigan / Senior Health Services
Brian is Managing Director, Customer Experience, Program Office and Business Administration at Blue Cross and Blue Shield of Michigan where he’s been instrumental in a significant increase in focus on operationalizing a renewed focus and improvements for member experience. Brian’s work is reflected in increased member satisfaction reflected in CAHPS, HOS, and other surveying score improvements and within the recent rise of the Medicare plans to 4.5 and 5 Star ratings.
During the 2020 COVID-19 pandemic period, Brian lead what is considered to be one of the most robust payor responses in the country. This work ensured that Blue Cross of Michigan’s 750,000 member Medicare population was properly supported and cared for during this difficult time. Brian lead teams that made hundreds of thousands of outbound calls, two rounds of direct to member care kits, food and grocery access, and provider liason efforts. This body of work was especially considerate of members who were determined to be facing food insecurities and social determinates of health challenges.
Brian’s professional background has significant experience in operational leadership in manufacturing, production, and supply chain businesses outside of health care. Brian brought that rigor to his role as Director of Global Engineering and Program Management at Atek Medical, a medical devices manufacturer. Following Atek, Brian transitioned to Priority Health, a State level payor with individual, group, and Medicare plans and their parent, Spectrum Health, the leading West Michigan provider system before moving to Blue Cross Blue Shield of Michigan’s Medicare business.
Sharon Kuhrt is an innovative healthcare leader with experience in health plan quality, acute, post-acute, and outpatient settings. She currently is the Manager of Quality Improvement at Priority Health in Grand Rapids Michigan. Here primary responsibility at Priority Health is the HEDIS Program. Sharon has 12 years of HEDIS experience in health plans, achieving 30% increase in HEDIS scores, leading to five-star results. Sharon also teaches graduate level health informatics, finance and marketing for Northeastern University, Simmons University, and University of New England. Sharon is an RN and holds a bachelor’s degree in nursing from Loretto Heights College, master’s degree in nursing from Regis University and doctorate in nursing from Northeastern University.
Chief Executive Officer
Cortex Analytics, Inc. / Mile High Healthcare Consulting, LLC
Cortex Analytics, Inc. / Mile High Healthcare Consulting, LLC
Richard Lieberman is the founder and Chief Executive Officer of Cortex Analytics, Inc. and Mile High Healthcare Consulting, LLC (MHHC). Cortex Analytics, Inc. builds software solutions while MHHC provides strategic consulting to Medicaid managed care organizations, Medicare-Advantage health plans, ACA issuers, ACOs, and risk-bearing provider groups. Mr. Lieberman is one of the nation's leading experts on risk adjustment, quality measurement, and predictive analytics. Since 1991, he has been active in the design and implementation of risk adjustment models and risk-adjusted payment systems for commercial, Medicare, and Medicaid payers.
Mr. Lieberman possesses in-depth understanding of Medicare, Medicaid and Affordable Care Act statutes, regulations, and policies. He synthesizes these with insights obtained from the health services research literature, a background as a health care provider and clinical trials researcher, and from operational interactions with a variety of managed care entities. He applies this knowledge and experience to risk adjustment revenue optimization strategies, quality measurement/quality improvement activities, provider profiling, provider reimbursement strategies, and information systems design.
Jimmy is a Risk Adjustment industry thought leader and conference speaker who has been helping health plans nationwide to formulate their risk adjustment strategy for the past 15 years. He is one of the original designers and developers of Change Healthcare’s risk adjustment products, including Risk View and Dx Gap Advisor. He also engages in strategic partnerships, client and sales support, consulting, and innovation across the company. He currently serves as Vice President of Risk Analytics Platform and is focused on migrating existing products to the new Change Healthcare corporate platform. Jimmy is an expert in risk scoring models and he is a graduate of the University of Pennsylvania.
Donna Malone, CPC, CRC, CRC-I, AHCCA, RAP
Director Clinical Documentation and Quality Improvement (CDQI),
Donna Malone, CPC, CRC, CRC-I, AHCCA, RAP Director Clinical Documentation and Quality Improvement (CDQI),
Mount Sinai Hospital System
Donna Malone, CPC, CRC, CRC-I, AHCCA, RAP: Director Ambulatory Clinical Documentation Quality Improvement (CDQI) with Mount Sinai Health System, Adjunct Professor with MassBay Community College, Chair of the RISE Risk Adjustment Academy HCC Coding Faculty Advisory Group and President of the Watertown AAPC Chapter
Previously, she worked for Tufts Health Plan in their enterprise risk adjustment division for seven years with as Director Enterprise Risk Adjustment Coding and Provider Education, and was responsible for audit and coding review management, development and implementation of department and vendor policies and procedures, development of provider and coding training materials, implementation of provider system education and process review, government audits (CMS RADV, HHS RADV, OIG), coding team performance management.
Additionally, Donna serves at the MassBay Community College in Framingham, where she has been an advisor and adjunct professor currently in her 17th year. Her specialty area is the Medical Coding and Medical Office Administration Programs. Prior to Tufts Health Plan, Donna worked for ENJOIN as the Director of Ambulatory CDI – Risk Adjustment, 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 other healthcare settings previously. Donna also has served as Education Officer (2016) and President (2017 – current) for the AAPC chapter in Watertown, MA.
Brian joined Chicago Pacific Founders (CPF) in April of 2021 bringing his 25 plus years' experience leading insight-driven enterprise transformations. Working across platforms, established portfolio companies and emerging start-ups, Brian is working with executive teams to deploy sophisticated analytics in support of informed strategic decisions.
Before joining CPF, Brian lead Analytics Transformation and the Knowledge Development agenda for McKinsey & Company globally, seeking to enhance our capacity to call upon cutting-edge analytics approaches in support of decision making in the C-suite and at every level of the business. His leadership role contributed to McKinsey being named the leading AI consultancy globally by Forrester (The Forrester Wave™ AI Consultancies Q1, 2021)
Before joining McKinsey, Brian worked at Accenture for 23 years, where he launched Accenture Analytics in 2009 and held several leadership roles the including the head of Financial Services Analytics and the head of Analytics Advisory Services, where he helped grow the Analytics practice to over 3,000 people by the end of 2016. In his role leading Accenture’s Analytics Advisory Services global practice of 500+ strategy and management consultants, Brian had responsibility for the firm’s Analytics offerings (a $3B+ business for Accenture) and the global analytics innovation agenda. He was the executive sponsor of the Accenture-MIT Analytics Research and Innovation Consortium partnership, a cross-industry network of chief analytics officers and he created the Financial Services Analytics alliance with the Stevens Institute of Technology.
Brian is a recognized Analytics thought leader and holds two patents for innovative applications in the areas of analytics and value management. He has written and published extensively (Harvard Business Review, Journal of Business Strategy, CFO, etc.) including the cover story in the July/August 2019 edition of the Harvard Business Review on the Building the AI-Powered Organization. Brian has also served as an adviser on two seminal best sellers in the Analytics field (Competing on Analytics and Analytics at Work) and in 2014 he co-authored a joint Accenture – MIT empirical research paper Winning with Analytics. He has been invited to speak at industry conferences on this topic (Conference Board, Economist Intelligence Unit, etc.) and led Accenture’s research around navigating economic downturns in 2002 and again in 2008.
Mr. McCarthy graduated from University College Cork, Ireland with a Bachelor of Science degree in Mathematics and Statistics (1H), and then completed his Masters of Science degree in Statistics (1H). Brian sits on the Advisory Board of the Center for Complex Systems and Enterprises at the Stevens Institute of Technology and is a member of the Board of Directors of Atlanta Symphony Orchestra.
Amy McDonough Managing Director and General Manager
Fitbit Health Solutions| Google
As the Managing Director and General Manager of Fitbit Health Solutions at Google, Amy leads the team working with employers, health plans and health systems to design solutions and programs focused on engagement, positive return on investment and health outcomes. Before her role, Amy took on several key positions leading Fitbit’s B2B efforts. Prior to Fitbit, Amy held strategic roles at CNET Networks, including Director of Audience and Content Development for the Community Division and Director of Strategic Partnerships for the Network. Amy has a bachelor’s degree from Merrimack College in Andover, MA and a Professional Certificate in Integrated Marketing Communications from the UC Berkeley Extension program.
Gabriel McGlamery Senior Health Care Policy Consultant
Florida Blue Center for Health Policy
Gabriel McGlamery is in charge of Federal regulatory policy for Florida Blue’s individual market business. This means analyzing, influencing, and general problemsolving for the insurer covering roughly 10% of Marketplace enrollment. Prior to joining Florida Blue in 2012, Gabriel helped develop the rules for the ACA at HHS and graduated with honors from the University of Connecticut School of Law.
David Meyer is a nationally recognized thought leader and change agent, with over 20 years of experience in healthcare commercial and government programs operations, data science, clinical outcomes, revenue and quality. He currently serves as the Senior Vice President of Health Outcomes and Informatics at NationsBenefits, where he is building-out the Research and Data Services unit of the company. In pervious roles, he has run revenue, quality and healthcare informatics for both regional and national health plans, spanning both Medicare Advantage and Commercial products. He has been a RISE Advisory Executive Board Member 12+ years, and is a frequently invited speaker at conferences and summits.
Vice President, Public Policy and External Relations
Frank Micciche Vice President, Public Policy and External Relations
Frank Micciche is NCQA’s vice president of Public Policy and External Relations. In this position, he directs NCQA’s relations with Congress, federal agencies and the states, as well as NCQA’s work with employers, associations, corporate sponsors and the media.Micciche was formerly the Vice President for Partnerships and Coalitions at the Campaign to Fix the Debt, a nonpartisan collaboration of prominent public and private sector leaders and more than 350,000 grassroots supporters working to address the nation’s fiscal imbalance. Prior to this position, he was a Senior Advisor on health reform at McKenna, Long & Aldridge, LLP and worked for the New America Foundation think tank.Micciche’s service in the public sector includes his time as a legislative director for the House Minority Leader in Massachusetts and as a federal liaison for Governor John Engler of Michigan. He served for four years as the Director of State-Federal Relations for Governor Mitt Romney (R-MA), where he led the Commonwealth’s Washington, DC, office and advised the governor on federal policy issues, with a focus on health care reform.Micciche holds a master’s degree in public policy from the John F. Kennedy School of Government at Harvard University, and a bachelor’s degree in political science from Tufts University.
Hannah Neylon Manager, Government Products and Relations
Hannah began her career working extensively in politics and state government before joining the health insurance industry. Since joining Network Health, Hannah has held positions covering the intersection of public relations, member experience, product planning, vendor management, government relations and community engagement. In her current role, Hannah focuses on Network Health’s Medicare Advantage and other government-sponsored health insurance products, as well as key commercial client products. Hannah also manages the Network Health Political Action Committee (NH PAC).
Hannah is a graduate of Loyola University Chicago and the John Felice Rome Center. In her free time she volunteers for a variety of nonprofit organizations including the American Heart Association and Feeding America, and can most often be found trying to keep a lid on things with her three young children.
Lynne Padilla Vice President of Risk Adjustment Solutions
Lynne is a Risk Adjustment coding healthcare leader with over 30 years’ experience in coding and quality solutions. Lynne’s focus over the past 10-years has been on leading Risk Adjustment coding operations and quality improvement where she led a large international team of coders and clinicians. Lynne’s subject matter expertise includes ICD-10, Medicare Advantage, HHS-HCC , CDPS and other state Medicaid Risk Adjustment models. In Lynne’s current role as VP of Risk Adjustment Solutions, Lynne is leading a team of clinicians and data science experts at Change Healthcare building and enhancing our products with AI-driven technology solutions.
Vandna Pandita, MPH is the Vice President of HEDIS® Strategy and Analytics for the AmeriHealth Caritas Family of Companies [ACFC]. In her role, Vandna oversees the full continuum of quality performance measurement from the acquisition of data to reporting and analytics for the enterprise, Medicaid Risk Adjustment and Clinical Solutions. Vandna works collaboratively with internal and external partners to ensure that the AmeriHealth Caritas Family of Companies is best positioned within the marketplace at the state and national level.
Kapil Parakh is a practicing cardiologist who serves as a Medical Lead at Google where he has pioneered partnerships with a range of organizations including the World Health Organization and the American Heart Association. Kapil previously worked on Google search to launch products that disseminate high-quality health information to over a billion people. Before Google, Kapil served as a White House Fellow and was the principal health advisor to the Secretary of Veterans Affairs. He is also the co-founder of an award-winning non-profit on health innovation. He was previously Director of Heart Failure at Johns Hopkins Bayview where he developed novel care delivery models. As a clinician-scientist he has published on psychosocial factors in heart disease. Kapil is board certified in Internal Medicine, Cardiology and Advanced Heart Failure and holds a MD, MPH and PhD. His book, Searching for Health, was published by Johns Hopkins Press.
Former Senior Advisor to the Secretary of HHS for Health Reform
Margaret Paroski, MD, MMM President & CEO and Chief Medical Officer
Catholic Medical Partners
Dr. Paroski is the is the President & CEO and Chief Medical Officer of Catholic Medical Partners, an independent practice association with 900 physician members. A board certified neurologist, Dr. Paroski has held various administrative positions including Medical Director at Erie County Medical Center; Senior Associate Dean of Academic Affairs & Admissions and Interim Vice President of Health Affairs and Interim Dean at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo; and Executive Vice President and Chief Medical Officer at Kaleida Health.
She began her medical career at the Buffalo VA Medical Center and held hospital appointments at the Buffalo Psychiatric Center, Roswell Park Cancer Institute, Kaleida Health, and Erie County Medical Center. In addition to her clinical and leadership roles, Dr. Paroski has been a faculty member in the Neurology department at the Jacobs School of Medicine and Biomedical Sciences for the past 37 years.
As President & CEO and Chief Medical Officer of Catholic Medical Partners, Dr. Paroski leads clinical integration and standardization efforts and physician relations among the organization’s medical and specialty practices. She is also responsible for engaging physician members in population health initiatives and value based payment model adaptation.
LMSW, FHELA, Dir, Clinical Design Community Health
Vinitha is responsible for leading Episource’s product strategy, design, and innovation. Her experience of over 20 years has spanned the healthcare ecosystem where she has defined, built, and managed product portfolios in the consumer, provider, payer, pharma, media, content, healthcare informatics, and analytics spaces. Her passion and strength lies in understanding the customer needs, aligning them to the organization's vision, and relentlessly executing against it to drivinge value for all stakeholders. Vinitha has a Master’s dDegree from the University of Minnesota and an undergraduate degree in Electronics and Communications Engineering from India.
Having grown up in Iowa, Dean decided to become an Actuary in 2004. In 2012 he attained the Fellows designation and now enjoys education continuously, year after year. Something about keeping a credential. His work in health insurance encompasses claim operations, provider credentialing, risk score optimization and a wide variety of Actuarial responsibilities. He has worked on most lines of business although is most familiar with Medicare Advantage, Individual and Small Group. Dean works as an Actuarial Director for Optima Health Plan, a provider-owned plan located in Virginia Beach, VA. His current focus is realizing Optima's risk adjustment function. His innate personality lends itself to copious information consumption and rigorous analytical approaches. He wonders why there are only seven levels of why when there's so much more to be understood.
Beth-Ann Roberts takes a vision and makes it a reality through sound market-based strategy, with a focus on profitable growth. Respected as a passionate, no-nonsense leader with a credible voice in decision making, she sees opportunities and works cross-functionally within the organization to develop and implement strategies that drive business advantage. She has a reputation for building a teamwork approach, breaking down barriers and eliminating silos.
As President of Commercial Business at Harvard Pilgrim Health Care/Tufts Health Plan — a $9.0 billion, non-profit health services company serving over two million members — Ms. Roberts oversees the five commercial markets. With more than 30 years’ experience in the health care market, she specializes in identifying synergies, establishing internal partnerships, leveraging talent and leading a team of over 350 staff to identify the most promising opportunities within Massachusetts, New Hampshire, Connecticut, Rhode Island and Maine. The careful balance of understanding the external market—including the products and services that drive successful business growth—and, optimizing the company’s strengths delivers winning solutions to the market.
Previously, as Senior Vice President for Harvard Pilgrim Regional Markets, Ms. Roberts led market-based strategy for New England, with direct responsibility for growing New Hampshire. Under her leadership, Harvard Pilgrim became the second-largest health plan in that state by entering new lines of business, forming unique partnerships and implementing a strategic approach to business development.
Ms. Roberts serves as Chair of the Board of Trustees for the RiverWoods Group and is a Board member of Benevera. In addition, the New Hampshire Business Review recognized her as an Outstanding Woman in Business in 2008, and in 2015 Business New Hampshire named her one of the top intriguing women of NH.
Ms. Roberts graduated in 1991 from Southern NH University with a bachelor’s degree in Business Administration and in 2010 received her MBA from Boston University.
Ms. Roberts and her husband Michael have two children, Branden and Bryanna. She raised her family in Londonderry, New Hampshire, and now resides in Waltham, Massachusetts, where she enjoys spending time outdoors with her family, and an active lifestyle that includes cycling, running, hiking and boating.
Aria Sameni leads the growth and strategy team responsible for interoperability and workflow optimization in Optum’s risk adjustment and quality solutions vertical. He holds a bachelor’s degree in Economics from the university of Minnesota and a master’s degree in Business Administration from the University of Florida. Aria brings over a decade of health care experience focused on risk adjustment and quality performance, including payer risk or gainshare modeling, care delivery collaborations, provider interoperability, prospective and retrospective program ideation and execution, and facilitating amongst payers, providers and vendors to drive informed care and better patient outcomes. This experience motivates his commitment to supporting payers in their goals to deliver improved health care solutions to their beneficiaries.
In his current role, Aria is honored to lead a team dedicated to helping providers succeed in risk and quality programs. Optum Risk & Quality Programs serve payers representing more than 6M members and engages with more than 13,000 providers nationwide.
Michael Schopke is the Chief Growth Officer at DataLink. In this role, he is responsible for the company’s overall growth strategies for its payor and provider technology and service solutions. Michael leads all facets of the company’s growth through its sales, strategic accounts, business development, marketing, and sales engineering departments. Prior to leading the Growth Office, he previously held both the CFO and COO roles where he led the finance and operations areas of the organization. Before joining DataLink, Michael founded and sold a healthcare technology start-up, and prior to that was the CFO & CGO of a healthcare network.
Kelley has been a board-certified Nurse Practitioner for over 20 years with experience in internal medicine, pulmonology, and healthcare administration. She has extensive knowledge about risk adjustment programs: MA, MSSP and ACOs. She has spent that last 9 years working with physicians, as well as NPs and PAs on proper coding, documentation, and best practices. She has led large HCC training initiatives across our teams in CA, Texas, Oregon, Montana, and Alaska. Kelley has worked closely with our vendors on the clinical application of HCCs from the coding and provider standpoints to ensure all workflows are seamless and effective. Kelley currently serves in a leadership role at Providence in the Risk Adjustment Programs division and has played a key role in the success of the department.
MSN with 10 years’ experience in Medicare, Medicaid, and Marketplace Managed Care with proven success in Risk Adjustment. Confirmed track record in operations, program management and process improvement. Demonstrates effective leadership, innovative problem solving techniques, and goal oriented focus to execute business objectives and meet performance expectations. Designed and coordinated all team activities including provider education, training, auditing, data mining, and data analysis to steer program success and achieve performance metrics.
Dr. William Shrank is Humana’s Chief Medical Officer (CMO). He leads the Integrated Health Solutions team that consists of several key clinical areas of the business. Dr. Shrank oversees Humana’s senior-focused, purpose driven, primary care organization, and guides the implementation of Humana’s integrated care delivery strategy, with an emphasis on advancing the company’s clinical capabilities. He launched Humana’s health equity department, Humana’s population health strategy (the Bold Goal), and the Humana Healthcare Research team. Across all divisions, Dr. Shrank promotes the idea of Humana as a learning organization and has dedicated his team to rapid learning – where meaningful insights are generated accurately and quickly, and enhance Humana’s ability to continually evolve to improve the health and health outcomes of those we serve. Dr. Shrank is a member of the Management Team, which sets the firm’s strategic direction, and reports and to President and Chief Executive Officer, Bruce Broussard. Additionally, Dr. Shrank serves on the Board of National Committee for Quality Assurance and is co-chair of the Clinical Transformation Taskforce for the Health Care Payment Learning and Action Network. Dr. Shrank joined Humana in April 2019 having previously been employed by the University of Pittsburgh Medical Center (UPMC) as CMO, Insurance Services Division from 2016 to 2019. At UPMC, Dr. Shrank was responsible for clinical operations, policy and quality for approximately 3.5 million members in government and commercial lines of business. Prior, Dr. Shrank served as SVP, Chief Scientific Officer, and CMO of Provider Innovation at CVS Health from 2013 to 2016. From 2011 to 2013, Dr. Shrank served as Director, Research and Rapid-Cycle Evaluation Group, for the Center for Medicare and Medicaid Innovation, part of the Centers for Medicaid and Medicare Services. Dr. Shrank began his career as a practicing physician with Brigham and Women’s Hospital and as an Assistant Professor at Harvard Medical School. Dr. Shrank completed his medical degree from Cornell University Medical College, his residency in internal medicine at Georgetown University and his fellowship in Health Policy Research at the University of California, Los Angeles. He also earned a Master of Science degree in Health Services from the University of California, Los Angeles and a Bachelor of Arts degree from Brown University.
Lisa Slattery Chief Strategy and Compliance Officer
Allymar Health Solution
Lisa Slattery serves as Chief Strategy and Compliance Officer for Allymar Health Solutions. With more than 25 years of executive leadership experience in health care operations, quality and compliance in hospitals, managed care plans and integrated delivery systems, she is excited to leverage her passion and expertise to support health plans and physician groups in driving optimal health and financial outcomes through data driven solutions.
Before joining Allymar, she served as Vice President of Operations at National Committee for Quality Assurance (NCQA) focused on the growth and delivery of all NCQA Accreditation and Recognition programs. Her experience also includes her role as Vice President of Enterprise Quality at Blue Cross Blue Shield of Tennessee, directing corporate clinical strategy and improving star ratings across the commercial, Medicare, and Medicaid lines of business. She has served as Chief Quality Officer of an integrated health system, Chief Quality and Compliance officer for a tech start up, and VP of Population Health and Quality for a community based 4.5 star plan.
A clinician at heart, Slattery began her career as a physical therapist, and is a graduate of the University of Florida and North Carolina State University
At BlueCross BlueShield of South Carolina Jason leads the strategic vision and implementation for Medicare Advantage quality improvement activities. Under Jason’s leadership the MA program has increased quality scores by ensuring that Medicare beneficiaries obtain needed care and by developing strong partnerships with local healthcare providers.
Jason has spent his career managing local and national Medicare Advantage quality programs along with experience in medical research and physical therapy health programs. He earned an MBA from the University of Notre Dame and a Masters in Biomedical Science from Midwestern University. To stay well rounded Jason enjoys fishing with his kids and playing golf as often as possible.
Manager, Risk Adjustment Submissions and Analytics
Mike Sloan Manager, Risk Adjustment Submissions and Analytics
Mike Sloan oversees the RAPS & EDPS submissions process for MediGold, a Medicare Advantage Plan. In his role, Mike is responsible for the complete, accurate, and timely submission of data to CMS. He manages the Encounter Resolution process to help improve risk score and revenue operations. Mike also collaborates with multiple vendors and large provider groups to capture necessary member data. His work ultimately helps create strategies for maximizing Risk Adjustment initiatives and operations.
Jennifer Spear Associate Director of Population Health
Jennifer Spear is a Population Health Strategy Lead with Humana’s population health team. Jennifer is in charge of executing interventions and programs that address food insecurity in Humana’s member population and the communities they serve. Additionally, she works closely with community partners, the clinical community and other partners to address the health related social needs, particularly food insecurity, of people, where they are receiving care. Spear previously led employee awareness strategies dedicated to raising awareness around the importance of social determinants of health and Healthy Days. Prior to her role working with food insecurity, Spear implemented member call programs that focused on Healthy Days assessments, which is how Humana is tracking progress toward its Bold Goal – that the communities it serves will be 20 percent healthier by 2020 and beyond.
Will Stabler has led Risk Adjustment, Quality and Payment Integrity revenue growth with companies such as Change Healthcare, Advantasure (BCBSM) and most recently at Discovery Health Partners (MultiPlan). Leading Sales, Marketing, Accountant Management and Product Management teams.
He was raised in a family of physicians; he grew up coding procedures and learning the business of medicine-and was formerly a certified coder. He was also part of the first wave of electronic claim processing and built a medical billing & consulting firm that assisted practices with building new facilities, CMS audits, billing, claims. human resource administration and general practice management.
Will has been laser focused on technology-enabled information/business/healthcare services and software with deep experience with providers, health plans and other risk-bearing entities. And is a sought after thought leader and as such delivers Key Notes, crafts commentary and often participates in industry panels and roundtables.
In prior roles, Will has been responsible for multinational new business development across an array of industries. He has extensive experience partnering with C-Suite peers and boards of directors across the entire range of the corporate life cycle from start-ups to middle market companies to billion-dollar multinationals. He has been responsible for P&L, market strategy development, and client solution planning for various regional, national and multinational markets and served as President, CEO and other CXO roles.
Josh Stern has a successful track record of leading sales teams and driving consistent growth in healthcare organizations. As an executive with HMS Holdings for nearly a decade, he led client relationships, new business development and go-to-market strategies for all commercial business line product suites. He started his career in investment banking in New York.
Rachel has 10+ years of experience working in public health and has extensive knowledge and experience with Minnesota’s quality landscape. At UCare Minnesota, Rachel leads the strategic plan and implementation of quality improvement activities influencing Star Ratings for UCare’s Medicare, Medicaid, and Exchange lines of businesses. A large part of her focus is on dual-eligible populations, across the age and disability spectrum. In her tenure, UCare has earned their first 5 out of 5 Star plan for 2022 Star Ratings. Rachel holds a Masters in Public Health from the University of Minnesota.
Jeremy Stone is an accomplished Business Development and Operations Executivewith a proven track record providing the vision, strategy, and leadership required to strengthen and grow client relationships in the highly competitive health care space. With extensive experience in human resources and business development roles, Jeremy excels as a facilitator of change initiatives to drive operational and organizational improvements and achieve and maintain industry leader status.
Currently, Jeremy is Senior Vice President at Everly Health, where he leads population health solutions, business development, and strategic client management. Prior to Everly Health, Jeremy served as Vice President, Payer Relations & Government Affairs at National Seating & Mobility, where he was responsible for the company’s network relationships with more than 1,000 health plans across the U.S. Jeremy has also held leadership roles with several successful health care organizations, including Aspire Health, Matrix Medical Network, and Healthways.
Jeremy earned a Master of Science Degree in Organization Development from Johns Hopkins University and a Bachelor of Business Administration Degree from Belmont University. He lives in Nashville, TN, and is married with twin 15-year-old daughters. He is a passionate soccer fan and loves cooking and traveling.
Anne Stowell Vice President Product Consumer Experience
Anne Stowell has served as Vice President of Consumer Experience at Signify Health since 2021. She is responsible for ensuring a best-in-class experience for members and patients who engage with the company’s in-home health evaluation services and for driving their overall satisfaction. Prior to this role, Anne led brand strategy, consumer experience, and consumer insights at Teladoc Health. Anne draws from a unique blend of brand, marketing, advertising, and product experience gained in senior roles while working on global brands such as Google, Coca-Cola, Sony, General Electric, and Johnson & Johnson. She was previously a consultant at Deloitte focused on health plan strategy and operations, and also led web product strategy at Empire BlueCross BlueShield.
Scott Stratton Chief Data Scientist, Business Development
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.
Prior to Pulse8, Scott co-founded a company supporting pay-for-performance in invasive cardiology and one of the first global fee/bundled payment companies. Before those, Scott had a key role with the first company to integrate all of a hospital’s quality-related functions (UM, QM, DRGs, Infection Control, Surgical Case Review, Credentialing). ComputerWorld tapped his RationalIQTM Fortune 100 product at Medco as one of two finalists in Global Best Practice in Business Intelligence and Analytics. His work on diabetes medication management won a URAC Six-Sigma award. He co-designed/deployed Pfizer’s global system for managing Phase II-IV clinical trials that is still in use after 15 years. The medical analytics function he built at Oxford was profiled by CIO magazine. He is proudest, however, of building the first urban-focused Child Health Plus program for 2,000 disadvantaged children in the Bronx, a model for the federal SCHIP program, which also received the Creative Excellence Award from the International Foundation of Employee Benefit Plans.
Jay Sultan leads the strategy development, innovation, market planning and strategic partnership initiatives for LexisNexis Risk Solutions Health Care. He is a healthcare IT expert on interoperability regulations and their impact on payers, providers, and other healthcare entities. Sultan is a healthcare industry veteran of more than 20 years. During his career, he has advised over 180 health plans and 50 delivery systems on value-based care, provider data management, healthcare analytics, clinical data use and interoperability. Prior to joining LexisNexis Risk Solutions, Sultan was vice president of healthcare innovation and strategy at Cognizant.
Alan is an experienced product management leader passionate about improving patient outcomes. In the past two decades, he has dedicated his time to delivering solutions across the healthcare landscape, serving patients, providers, payers, employers, and pharma/biotech manufacturers.
Senior Vice President for Risk Adjustment and Quality
Elaine Taverna Senior Vice President for Risk Adjustment and Quality
With over 25 years’ experience, Elaine Taverna has spent the last 10 years improving revenue trend and lowering medical expense for healthcare providers and payers within the United States and throughout Michigan.
A career of success in health care
Elaine has overseen medical management, risk adjustment and quality programs, primarily within the government funded product sector.
As senior vice president of risk adjustment and quality for Advantasure, she is responsible for performance in revenue stream areas such as risk adjustment and quality five-star programs.
As the vice president of revenue management and risk adjustment at Health Alliance Plan of Michigan (HAP), a subsidiary of the Henry Ford Health System. Elaine led the evaluation, design and implementation of HAP and Henry Ford risk adjustment and provider performance programs for all government-funded revenue streams. She also designed and implemented a chronic care outpatient ambulatory program for Henry Ford Medical Group and, as director of government programs, developed a strategic plan to integrate physical and behavior health for members.
At Concerto Health in Detroit, a physician organization, Elaine served as the national director of care management - with responsibility for provider performance for risk adjustment, quality and cost containment - designing and overseeing care management programs, quality assurance initiatives and contract compliance.
Elaine also served as Meridian Health Plan’s national director of long-term care supports and services, administrating lines of business in three states with over 500k of membership; at Community Living Services (CLS) as the division director of long-term care services and business development; and, earlier, as CLS director of operations for its Personal Supports and Services Department.
Education in social work and health administration
A licensed registered social worker in Michigan, with 12 years of national consulting experience, Elaine earned a Master of Science degree in health administration from Central Michigan University and a Bachelor of Science in social work from Eastern Michigan University.
Jill Tays RN, BSN, Director of Case Management, Coding, CDI
Magnolia Regional Health Center
Jill Tays RN, BSN, Director of Case Management at Magnolia Regional Health Center. I have been a nurse for over 20 years the last 3 of which I have managed the Coding Department, EMR Specialists, Case Management/ CDI Department. Experience in LEAN leadership, Meditech 6.1 EMR conversion, Strategic planning, Utilization Review, Med-Surgical, Transitional Care, Level II Rehab and Acute Care case management. Most recent CDI implementation of Clintegrity/ Triage for FY 18 resulted in a 3.5 million dollar impact for our organization. Our CM/CDI model was recently featured as a “Best Practice in Mid-Cycle Governance” by the Revenue Cycle Academy.
Ian Tong, MD leads all of Included Health's clinical care delivery, including clinical products and service lines, clinical quality, and practice performance of the clinical staff. Prior, he was Chief Resident of Stanford Internal Medicine and Co-Medical Director of the Arbor Free Clinic. Ian holds a BA from University of California at Berkeley and medical degree from The University of Chicago - Pritzker. He completed residency and Chief residency at Stanford Hospital and Clinics and is currently a Clinical Assistant Professor (Adjunct) at Stanford University Medical School. He’s board certified in Internal Medicine. Ian has dedicated his career to improving equity in, and access to, high quality care. He lives in the San Francisco Bay Area with his wife and three children.
Adele Towers, MD MPH FACP
Associate Professor of Medicine and Psychiatry, Director, Risk Adjustment
Adele Towers, MD MPH FACP Associate Professor of Medicine and Psychiatry, Director, Risk Adjustment
Dr. Towers is the Director of Risk Adjustment for UPMC Enterprises, and is also a geriatrician on the faculty at the University of Pittsburgh. At UPMC Enterprises, she is directly involved in the development of healthcare related technology, with emphasis on use of Natural Language Processing (NLP) for Risk Adjustment coding and use of Clinical Analytics to optimize clinical performance. Prior to this role, she has served as the Medical Director for Health Information Management at UPMC with responsibility for Clinical Documentation Improvement as well as inpatient coding denials and appeals. She has been on the faculty in the Division of Geriatric Medicine at the University of Pittsburgh for over 25 years and continues to see patients at the Benedum Geriatric Center in UPMC. She is the former Medical Staff President at UPMC Presbyterian, and her prior positions have been as Vice Chair for Quality Improvement and Patient Safety for the Department of Medicine, Medical Director of UPMC Home Health, Medical Director of the Benedum Geriatric Center and Medical Director of Primary Care at the Western Psychiatric Institute and Clinic. Dr. Towers has presented the experience at UPMC with use of NLP and Clinical Analytics at multiple regional and national conferences.
Ashley Tyrner is the founder and CEO of Farmbox Direct, FarmboxRx, and Harlow’s Harvest. Ashley has gone from being a single mom on food stamps to the CEO of a national brand that aims to reinvent the way the American healthcare system addresses the overwhelming number of chronic diet related diseases that plague our population today. With a clear conviction that all people should have access to healthy food, Ashley works tirelessly to disrupt the health and food policy space by making food as medicine accessible to all.
Since 2019 FarmboxRx has been disrupting the healthcare industry. As an extension of the Farmbox Direct mission, FarmboxRx focuses on proactive wellness by delivering Food as Medicine (FaM) nationwide in partnership with Medicaid and Medicare programs. This division of Farmbox was created to partner with health insurance plans by offering members a box of fresh fruits and vegetables as a means to help combat the most prominent Social Determinant of Health (SDOH) –food. FarmboxRx is a first-of-its-kind nutrition program that makes healthy eating accessible to members and includes curated educational content with wellness tips from experts and easy recipes in every box!
FarmboxRx is now available through participating Medicaid or Medicare programs as an Advantage Benefit, through Over the Counter (OTC) Network card benefits, or as a part of a plan's Healthy Food card benefit. Farmbox is dedicated to changing the way the healthcare system approaches member wellness and disease prevention by pioneering the food as medicine initiative across the country.
Ashley’s third company Harlow’s Harvest, which was recently acquired by Farmbox Brands, is re-inventing nutrition and food education for young, curious chefs. Harlow’s Harvest is developing a series of educational cooking kits as hands-on learning tools for families, children, teens, and young adults to teach critical life skills and promote a lifelong love of nutrition and healthy eating for those eligible under the Children’s Health Insurance Program (CHIP) and Medicaid.
Max Voldman is an associate in Constantine Cannon’s Washington, DC office. Mr. Voldman’s practice is focused on representing whistleblowers under the federal False Claims Act and numerous state law equivalents, and the whistleblower programs of the Internal Revenue Service, Securities and Exchange Commission, Commodity Futures Trading Commission, and Department of Transportation. Max was selected to the Washington, DC Super Lawyers Rising Stars list in 2019.
Mr. Voldman has particular experience in combatting fraud in the healthcare industry. He is part of the legal team pursuing a qui tam case against UnitedHealth Group alleging the nation’s largest Medicare Advantage Organization submitted false claims for payment to the Medicare Program by improperly inflating its members’ risk scores. Mr. Voldman also has experience analyzing complex data sets, developing damages models, and assisting with statistical analyses. He has also published numerous articles on issues of healthcare law, whistleblower programs, and environmental issues.
Mr. Voldman also represented a former Vice President of Visiting Nurse Service of New York, one of the nation’s largest home health care agencies, in a federal False Claims Act suit alleging the company defrauded Medicare and Medicaid by routinely failing to provide patients the care prescribed by their doctors. In Summer 2020, Visiting Nurse Services of New York agreed to pay $57 million to resolve these allegations.
Mr. Voldman received his J.D. from Georgetown University Law Center. During law school, Mr. Voldman served as a research assistant on taxation to Professor John Brooks and as the Symposium Editor for the Journal of Law and Public Policy.
Prior to law school, Mr. Voldman completed his undergraduate studies at the University of Illinois, where he was a member of the Mathematics Honors Society and graduated with a degree in Actuarial Science and a Minor in Business. Mr. Voldman also worked in State Farm’s actuarial science department and coached the debate team for a high school in Illinois, including one team that won the State Championship.
Mr. Voldman is fluent in Russian and admitted to practice in the State of Illinois, the District of Columbia, the United States District Court for the District of Columbia, and the United States District Court for the District of Colorado.
Milan has been serving as the Senior Vice President of Value Based care at MyCare Medical, a value based organization headquartered in Tampa, Florida. MyCare includes an MSO with employed and affiliated providers serving 28,000 Medicare Advantage beneficiaries, and a Medicare Direct Contracting Entity (DCE) serving 6,000 patients. He oversees the following departments: documentation, quality, contracting, and the MSO line of business. Prior to joining MyCare, Milan was the Senior Director of Business Development for four years at Family Physicians Group (FPG), a risk based primary care organization serving 25,000 Medicare Advantage Beneficiaries in Orlando, FL. At FPG Milan oversaw the sales, marketing, patient retention, and contracting departments. Milan has a Bachelor of Science in Business Administration from Babson College.
Kurt Waltenbaugh Senior Vice President Insights + Growth
Kurt Waltenbaugh is a dedicated entrepreneur with a career focused on the consumer: using data to predict and influence behavior. Understanding consumer behavior, Kurt has built successful analytic solutions, products, and companies in the healthcare, retail, education, and credentialing industries. His previous companies were sold to Oracle and Pearson Education. Kurt was responsible for product strategy at Optum, Inc. (UnitedHealth Group), building data analytic businesses for the provider, payer, and employer markets. Kurt founded and led as CEO of the consumer-health analytics company, Carrot Health. In August 2021 Carrot Health was acquired by Unite Us, the nation’s leading technology company connecting health and social services. Kurt joined the Unite Us team as Senior Vice President, Insights and Growth to work towards improving health nationwide. In his role, Kurt is passionate about shining the bright light of data to identify inequities, helping customers remove barriers which give everyone the opportunity for better health. When not working with customers, Kurt is with his wife, guiding their three children toward adulthood, and planning their next winter camping trek into Minnesota’s Boundary Waters (BWCAW).
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 Risk Adjustment, brought all chart review activity in-house, and partnered with the hospital CDI/Quality Physicians to create an Outpatient CDI Department focused on documentation quality, Risk Adjustment activities and clinic training.
A proven leader in her field, Susan’s professional experience includes coding and compliance management, auditing and provider training, system management, and consulting services.
Chad Wege is a successful and highly motivated agile technology product practitioner with a proven track record of solving complex challenges and driving results. As the Director of Product Management at Apixio, he is able to put into action his sound business acumen and extensive experience with product development. With 10+years of healthcare experience, Wege has a deep understanding in implementing and executing robust solutions that provide value and quality.
Scott is the Director of Government Programs at Sentara Health Plans. Prior to joining Sentara, Scott was the founder of Quadralytics, a data analytic, software, and finance consulting company. Previously, he was the Senior Vice President, Analytics and Strategy, EMSI HEALTH where he was focused on expanding the company’s HEDIS, Medicare Stars, Medicaid Risk Adjustment and data analytics offerings to better meet the needs of health plans and other clients. He has extensive executive-level and health-plan consulting experience, having held managed care, risk adjustment and data analytics positions for more than 20 years. He has a Master of Business Administration (MBA) from Seattle University and a bachelor’s degree in accounting from Central Washington University. He holds the Certified Risk Adjustment Coder (CRC) designation from AAPC and CMA and CFM from the Institute of Management Accountants. Scott served on the RISE Advisory Board and has been involved with RISE for many years.
Lesley Weir Chief Risk Adjustment and Quality Officer
ATRIO Health Plans
Lesley Weir, Chief Risk Adjustment and Quality Officer, has over 30 years’ experience in the Medicare Managed Care industry, with specific expertise in operations, risk adjustment and quality improvement. Lesley joined ATRIO in April 2021. She has a demonstrated track record of assisting health plans in meeting operational and revenue goals, as well as developing innovative strategies to improve member’s health and experience. Prior to her leadership role at ATRIO, she held various leadership positions at multiple provider-owned Medicare Managed Care Health Plans and a large national plan. She also spent six years working in the vendor space supporting Medicare Advantage plans across the country with their risk adjustment and quality programs.
Mr. Weisbrod currently serves as the Vice President – Risk Adjustment at Network Health in Menasha, WI. Mr. Weisbrod brings over 20 years of health insurance, healthcare analytic and human service experience to Network Health. Mr. Weisbrod specializes in government programs, health plan operations, risk adjustment and data analytics. Prior to his work at Network Health, Mr. Weisbrod served as Director of Government Programs for a regional Wisconsin health plan serving the state’s Medicare, Medicaid and Marketplace participants. Mr. Weisbrod 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.
Mr. Weisbrod has taught part-time at the college level for over 11 years and has extensive experience training health insurance and human service professionals.
Josh lives in Neenah, WI with his wife and three school aged children.
Rebecca Welling is the Associate Vice President for SelectHealth, a not for profit Health insurance company serving over one million lives in the Utah, Idaho and Nevada regions. SelectHealth Plan is part of Intermountain Health, the largest healthcare provider in the intermountain West. Rebecca’s responsibilities include oversight of all risk adjustment programs pertinent to Medicare, Medicaid and ACA lines of business with focus on physician coding education, coder training and clinical documentation initiatives. Rebecca directs a team of highly trained HCC coders and educators that perform retrospective, prospective and RADV audits for all government related lines of business. This work entails a thorough understanding of financial implications associated with an efficient and ethical risk adjustment program. In addition, Rebecca’s team oversee encounter data submissions, and analytical analysis of risk adjustment work. Rebecca also serves in a consultative role for Intermountain Health for risk adjustment related iniatiaves. Rebecca’s primary focuses is to ensure ethical, compliant and comprehensive risk adjustment programs.
Meghan West is an experienced Director of Financial Planning and Analysis with a demonstrated history of working in the Healthcare industry, specializing in Medicare Advantage and Quality Performance. She is highly skilled in Microsoft Excel, Customer Service, Managerial Finance, Strategic Planning, and Business Process Improvement.
Steve Wigginton is CEO of Icario, responsible for the overall strategy, growth, and operations of the company. Previously the CEO of NovuHealth, Steve became the CEO of Icario in 2020 following NovuHealth’s merger with Revel. Steve has a 25-year track record of driving growth, culture, and innovation in healthcare and is passionate about creating a better experience for members, patients, and providers.
Steve came to Icario from Sutter Health | Aetna, a 50/50 joint venture between Aetna, a CVS Health company, and Sutter Health, a not-for-profit integrated health delivery system in northern California. There, he served as the joint venture’s first CEO, responsible for launching an innovative health insurance business, delivering best-in-class clinical care, and driving breakthrough consumer and member experiences.
Before that, Steve served as CEO of Valence Health, where he led and grew the business following its acquisition by Evolent Health, doubling revenues and scaling operations internationally. Prior to the Valence acquisition, Steve was the chief development officer at Evolent Health, responsible for driving growth, partnerships, and the brand. Additional leadership roles in technology-driven care management, physician practice management, and healthcare supply chain businesses round out Steve’s experience.
Steve holds a bachelor’s and master’s degree of business administration from Indiana University, Kelley School of Business. In his free time, Steve is an avid cyclist, traveler, and concertgoer. He and his wife, an award-winning OB/Gyn, have four beautiful children.
George Witwer is the founder, Chairman, and Chief Executive Officer of Humanizing Technologies, Inc. He launched the company in 2000, with the goal to bring new technologies for structuring unstructured data to market. In 2017, Witwer led the team that developed Cavo Health for auto-coding electronic medical records. Today, Witwer continues to work closely with the company’s search science, search platform, and web interface teams to design new technologies and features for Cavo Health and other company products.
Megan Zakrewsky Director of Product, Clinical Data Exchange
Megan Zakrewsky is a dedicated and driven product director with nearly 15 years of diversified healthcare technology experience. As a certified project manager (PMP), she has a proven record of execution from concept to completion while maintaining distinguished client relationships. Megan is passionate about clinical data exchange and has a wide array of experience with EHRs, clinical workflows, and the complexities facing health information exchange. Her most recent roles have given her experience in health plan and payer workflow to support risk adjustment, quality measures, and HEDIS initiatives.