Rise

Christpher Aguwa Executive Vice President Head of Growth and Business Development

Cityblock Health

Christopher N. Aguwa is Executive Vice President, Head of Growth and Business Development at Cityblock Health, a provider of advanced primary care services inclusive of primary, behavioral, and social care for low income and underserved communities based in New York with subsidiaries across the US. In his role, Chris leads the Growth office and the execution of the company’s value-based care arrangements with health plans. His responsibilities also include product development, business development, and strategy.

Mr. Aguwa also served as Vice President of Payor Partnerships and Strategy at DaVita, an industry leading kidney dialysis provider and kidney care management company where he was responsible for growing their Integrated Kidney Care business. Mr. Aguwa has also held Corporate and Business Development roles at both Aetna (a CVS Health Company) and Evolent Health where he oversaw extensive deal flow evaluating transformative mergers & acquisitions, joint ventures, and corporate venture capital investments; most notably the sale of Aetna to CVS Health, creation of the Allina|Aetna joint venture health plan, investment in AbleTo and the creation of the Evolent ACO.

Previous to building a career in healthcare, Mr. Aguwa was an attorney for over five years with a primary focus on real estate securities litigation.

Mr. Aguwa earned his M.B.A. from Oxford University Saïd Business School, J.D. from Howard University and B.A. from the University of Michigan.

Lisa Barrett Vice President, Member Navigation Solutions

UnitedHealthcare

Lisa Barrett is the vice president of Member Engagement for UnitedHealthcare’s My Community Connections organization. In this role, Lisa is responsible for the program management, development, advancement and implementation of an industry-leading sustainable model to standardize and use non-traditional data elements and innovative partnerships to improve health outcomes at scale. As part of this work, social barriers are addressed by “leading with help” not only to assist the member, but also as a lead generator for revenue. In 2021, the MCC “leading with help” model generated over $400M in revenue for UnitedHealthcare. In addition, Lisa is responsible for the design, development, and expansion of UnitedHealthcare’s National Veterans Program. She is also responsible for member outreach to “close the loop” on social referrals made to community- based organizations.

Lisa is well known within UnitedHealthcare for turning concepts into effective and efficient programs. In 2011, she pioneered a program for vendor management strategies that was adopted company-wide as a best practice. In addition, her work in the social determinants of health (SDoH) arena was the first of its kind with the Arizona Medicaid population. Lisa was instrumental in standing up a consumer-facing facility in 2015 serving over 15,000 under-served community residents per month with food, housing, employment and financial assistance. The community center is recognized as a model of a successful collaboration between for-profit, not-for-profit and governmental agencies.

Lisa leads the ground-breaking effort to identify and more holistically serve UnitedHealthcare’s veteran member population. The National Veterans Program strives to help veteran members get the most from their health plan. The program uses NSP’s award-winning social determinants of health (SDoH) data model to identify veterans among the UnitedHealthcare member population. Since January 2017, the program has identified more than 1M veterans and a subset of over 350,000 who receive care from the Veterans Healthcare Administration (VHA) and therefore, outside the UHC network. By identifying veteran members, we can provide better care coordination, care management, care-gap closure and social services referrals – which address SDoH barriers to good health and health care. Lisa was instrumental in the alliance agreement between UnitedHealthcare and The American Legion.

Lisa has more than 30 years of experience spanning finance, business development, operations, account management and relationship management. Lisa brings a broad range of analytical skills as well as health care operational experience to her role and has held various leadership positions in healthcare operations during the course of her career.

Prior to joining UnitedHealthcare, Lisa held executive finance positions with diverse companies outside of the healthcare industry. She has led a broad range of operations and strategic objectives including growth management, mergers and acquisitions, and financial operations.

Barrett earned a Bachelor’s of Business Administration in accounting from the University of Georgia. She is also a Certified Public Accountant and a licensed Realtor®. Lisa has been awarded several accolades while at UnitedHealthcare, including the prestigious Innovation Award. She has served on the board of several community nonprofit organizations.

Kim Barrus Director Clinical and Outcomes Management

SelectHealth

Kim is a registered nurse who received her Bachelor of Science in Computer Information Systems from Columbia College of Missouri, and her Bachelor of Science in Nursing and Master of Science in Nursing from Western Governors University. She also maintains a Project Management Professional (PMP) certification from the Project Management Institute (PMI).  Kim Barrus began her career with SelectHealth 28 years ago and has worked in a variety of capacities in that time.  SelectHealth insurance plan covers just over a million lives in Utah, Idaho and Nevada.  She is currently the Director of Clinical and Outcomes Management leading the health plan quality outcomes strategy and four teams that have responsibility for Health Plan Quality Operations, Provider Quality Performance, NCQA accreditation, HEDIS and CMS Stars.

Anna Basevich VP of Enterprise Partnerships

Arcadia

Kate Beck AVP, Health Information Exchange

Healthfirst

Kate Beck joined Healthfirst in 2019 as the Director of the Healthfirst Health Information Exchange (HIE). In her current role, Kate leads a team focused on growing the Healthfirst HIE by expanding the data available through the HIE as well as growing the utilization of HIE data and supporting Care Management and Clinical Quality initiatives. Kate Beck has worked in information technology for over 20 years focusing on life sciences, retail services and most recently healthcare. Prior to her role at Healthfirst, Kate held positions at the New York Care Information Gateway, The Visiting Nurse Service of New York and the NYC Department of Health & Mental Hygiene.
Healthfirst is a provider-sponsored health insurance company that serves more than 1.7 million members in downstate New York. Healthfirst offers top quality Medicaid, Medicare Advantage, Child Health Plus, Managed Long Term Care plans and commercial products.

Keith Bruns Senior Director Business Development

InComm Healthcare

Keith focuses on healthcare and consumer loyalty engagements at InComm.   His work borrows on over 25 years of experience in this space, working with clients that include Humana, Aetna, Amerihealth Caritas, AT&T, Essilor, Abbott Laboratories, and Bright Health.  Common to his work at each client has been a focus on increasing engagement, loyalty,  realizing desired behaviors, and improving efficiencies in the distribution of benefits, rewards and incentives.

Matt Caminiti Sr. Principal Solutions Engineer

Inovalon

Matt Caminiti, Sr. Principal Solutions Engineer, is responsible for planning, operations, design, modeling, and coordination of the Inovalon solutions across the healthcare landscape. Mr. Caminiti’s experience bringing risk adjustment, quality improvement and other solutions to health plans and health systems is essential to their effective program execution. Mr. Caminiti has focused on public policy and its impact on businesses for more than a decade, including appearances as a subject matter expert at industry-leading healthcare conferences. In addition, Mr. Caminiti previously discussed policy issues on Bloomberg Television, Bloomberg.com, Federal News Radio, and in front of the Maryland State Legislature. He has a Master of Business Administration in Finance and International Business from Loyola University, Maryland, and a Bachelor of Arts degree from Boston College.

Biggs Cannon Senior Managing Director, Health Solutions Practice

FTI Consulting

Anna Carley Senior Director- CRM, Payer Solutions

GeBBS Healthcare Solutions

Anna Carley, RHIT, has worked in risk adjustment and quality improvement for going on 10 years. She is Senior Director, Client Relations at GeBBS Healthcare Solutions, a risk adjustment service and technology partner, and is the relationship holder between the client and GeBBS. 

Anna has worked in different aspects of risk adjustment, such as the payer side of working at UnitedHealthcare at developing the risk adjustment strategy, and by working on the provider side of building risk adjustment, quality, and pharmacy programs at Stanford Health Care. 

Anna Carley, RHIT lives in Austin, Texas with her husband and two daughters, Penelope, and Valerie. When Anna isn’t working hard at GeBBS Healthcare Solutions, you’ll find her spending time with her family and two dogs, Sampson and Dodger. 

Dawn Carter, BSBA, CPC, CRC, CPMA, CDEO, CPCO, CSPO Director, Product Strategy, AAPC Fellow

Centauri Health Solutions

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.

Evelyn Chojnacki MPH, Director, Health Plan Strategy

Sword Health

Evelyn Chojnacki brings an extensive health plan background to Sword Health with over 19 years’ experience serving clients and members. This includes client management, health care program development, vendor assessment and integrations, market deployment and strategy.

Evelyn joined Sword in early 2021 and remains focused on advocating for the needs of health plan partners while supporting the advancement of virtual care across the industry. This means promoting solutions positioned to deliver impactful clinical results and equitable member access to convenient care - all while tackling escalating healthcare costs. 

Outside of work, Evelyn is an active outdoor and travel enthusiast.

Jason Christ, JD Attorney

Epstein Becker Green

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.

Nicole Clarke Luck Chief Development and Commercial Officer, Principal

Apex Health

Nicole is the Chief Development and Commercial Officer for Apex Health Solutions and brings over 20 years of healthcare and finance experience to the company. Nicole is responsible for commercial strategy, revenue and product growth for Apex.

Prior to joining Apex, Nicole spent twelve years at Memorial Hermann Health System where she led finance and strategic initiatives for its physician enterprise including spearheading its value-based care transformation.

As a vital member of the physician leadership team, Nicole made significant contributions through development and implementation of strategic plans to enhance quality outcomes and expand population health initiatives across Memorial Hermann’s clinically integrated network, accountable care organization and population health services organization. She established performance-based incentives models which have distributed over $200M in incentives. She also oversaw Memorial Hermann’s highly successful Medicare Shared Savings Program which generated over $3 60M in total share savings and $151M in earned performance payments. Most notably Nicole established the Population Health Services Organization for Memorial Hermann designed to support system value based care initiatives, physicians both independent and employed as well as employers through multidisciplinary care coordination, analytics, wellness and pharmacy support. Nicole also developed Unity Health Partners, a risk bearing joint venture between Memorial Hermann, Apex, and physicians which was the first health care collaborative in the state of Texas.

Prior to Nicole’s tenure at Memorial Hermann, Nicole spent 6 years working in private equity focused on the healthcare sector and was an active member of the investment committee. Nicole also spent time in investment banking within the healthcare sector.
Outside of Apex, Nicole enjoys spending time with her husband and two boys playing golf and snow skiing.

Nicole earned a Bachelor of Science, Healthcare Administration / Business degree from James Madison University and holds and Executive Healthcare Certificate from Rice University.

Deborah Coakley Ed.D., MBA, Director, Risk Adjustment Programs – Operations

Baylor Scott & White Health Plan

Dr. Deborah Coakley is the Director of Risk Adjustment Programs Operations at Baylor Scott & White Health Plan. Dr. Coakley brings more than 25 years of healthcare experience in her role. Of her 25 years of experience in healthcare, 16 years include Risk Adjustment submissions, operations and reporting for Medicare, ACA, and Medicaid. Dr. Coakley has an Ed.D. in Organizational Leadership with an Emphasis in Organization Development. She has dual MBA degrees, in Finance and Project Management.

With a focused expertise in Risk Adjustment Operations, Dr. Coakley is widely recognized as an industry expert in this area. Dr. Coakley has deep knowledge of multiple risk adjustment algorithms, data submission requirements, as well as the regulatory environment that includes Medicare Advantage, ACA, and Medicaid operations.

Dr. Coakley is responsible for the effective and efficient operation of all processes designed to ensure a successful Medicare & ACA Risk Adjustment program. She led the development, implementation and oversight of Risk Adjustment staff, vendors, and strategies to ensure complete and accurate risk adjusted revenue. Risk Adjustment strategies included submission activities, vendor oversight, and data validation.

Dr. Coakley manages the day-to-day operational workflow, dealing with the design and developments of risk adjustment for the Medicare and ACA as well as generating policies and procedures to govern all aspects of the Risk Adjustment operations workflow process. Oversees Risk Adjustment initiatives as well as provides oversight for process improvement. Ensures proper compliance with regulatory agencies and ensures data integrity through research and issue resolution.

Blaine Collins Regional Inspector General, Office of Evaluation and Inspections  

Office of Inspector General   U.S. Department of Health and Human Services (HHS)

Blaine Collins is the Regional Inspector General of the Office of Evaluation and Inspections’ San Francisco office, as part of the Office of Inspector General, U.S. Department of Health and Human Services (HHS).  The teams that he leads conduct national program evaluations on a range of issues effecting various HHS programs, including the Medicare Advantage program.   He received a Master’s of Public Affairs from the University of Texas at Dallas.

Debbie Conboy SVP, Risk Adjustment and Quality

Signify

Debbie is the SVP of risk adjustment and quality at Signify Health, bringing 35 years of healthcare experience to her role. With a focused expertise in Risk adjustment and Stars/quality, Debbie is widely recognized as an industry expert in these areas and an often sought after speaker at industry conferences.  Debbie has deep knowledge of multiple risk adjustment algorithms, data submission requirements, RADV/HRADV, as well as the regulatory environment that Medicare Advantage, Medicaid, and ACA operate within and around.  

Carmela Costiniuk B.Sc. OT, MHA, D. EdD (C), Vice President, Population Health and Clinical Transformation

Catholic Medical Partners

Carmela Costiniuk is Vice President of Population Health and Clinical Transformation at Catholic Medical Partners, the largest network of independent practice physicians in Buffalo, NY, with nearly 900 physician members. She develops and implements population health and operational strategies and oversees the operations team, which provides direct support to physician practices to improve quality performance and care coordination across the health continuum.

A native of Canada, Carmela earned her Bachelor of Science degree in Occupational Therapy from the University of Toronto and her Masters in Health Services Administration from D’Youville University where she is currently completing her Doctoral Degree in Health Administration.

Carmela has held various administrative positions in home and community based care, acute care, long-term care, and the Local Health Integration Network (LHIN) Ontario Ministry of Health. 

Patrick Coulson Senior Vice President, Sales and Marketing 

Allymar Health Solutions

Sean Creighton RISE Policy

Expert Contributor

Sean Creighton serves in Avalere’s Policy practice, focusing on Medicare Advantage (MA) and Part D reform, risk adjustment, and analysis of healthcare quality and utilization.

In recent projects, Sean has helped MA plans obtain regulatory flexibility linked to enhanced benefits for members, access medical loss ratio flexibilities during the pandemic, improve bid gain/loss margin rules, and rationalize network requirements for dialysis centers. He led successful policy discussions with the Centers for Medicare & Medicaid Services (CMS) aimed at maintaining high quality of care for patients with end-stage renal disease while also reducing dialysis center network adequacy requirements, which restricted provider competition. Sean has also helped MA plans safeguard patient access by negotiating line-of-business requirements with CMS’s Office of the Actuary.

Before joining Avalere, Sean served as vice president for federal policy at Humana, working on industry initiatives related to COVID-19 and leading development and implementation of federal policy strategy. He worked as senior vice president for revenue integrity and risk adjustment product lines at Verscend (now Cotiviti) focusing on data aggregation, medical coding, and submission products for Medicare and the commercial market. Previously, Sean served as deputy group director of CMS’s Center for Consumer Information and Insurance Oversight’s Payment Policy and Financial Management Group and directed the CMS division of Payment Policy and Risk Adjustment in the Medicare Plan Payment Group, where he developed and implemented risk adjustment models for Medicare Parts C and D. Sean also served as chief architect of CMS’s Medicare Encounter Data System.

John Criswell Founder, CEO, Chairman

Porter

John has over 25 years of entrepreneurial and executive experience in the healthcare space, building relationships across major, national health plans and large regional healthcare systems. John’s newest venture, Porter, designed to reach beyond standard home interventions, is the only quality stars and risk adjustment-focused care coordination program. John previously founded Pulse8, a healthcare analytics and technology company delivering complete visibility into the efficacy of risk adjustment and quality management programs, and led them to a successful acquisition by a publicly traded health IT company. John was recently granted a patent by the United States Patent and Trademark Office for a method and apparatus for risk adjustment.

Deniese Crittenden, RN, MSN, MHA, BSW, CRC VIce President, Risk Adjustment Strategy and Solutions

Reveleer

Deniese Crittenden is the Vice President, Risk Adjustment Strategy and Solutions at Reveleer. Deniese brings more than 18 years of experience in the Medicare/Medicaid industry as well as more than 31 years of healthcare experience as a Registered Nurse and a Geriatric Social Worker.  Among many things, Deniese provides gap analysis, assessment, design, and implementation in managed care risk-adjustment activities. Deniese has extended experience across all operational areas of Risk Adjustment for Payors and Providers and provides a unique perspective having worked for both Provider and Payer organizations.

Dr. Shannon Decker, M.Ed., MBA, PhD. Principal

VBC One

Dr. Shannon Decker is principal at VBC One, a consulting firm assisting physician groups, health plans and vendors maximize the performance of their value based contracts and offerings.  Dr. Decker has more than 20 years experience in health care and most recently led teams in risk, quality, data and analytics, telehealth, COVID response and delegation compliance.  Of her more than 20 years of experience in healthcare--15 include working with risk adjustment, quality 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, and a prolific national public speaker, her interests include the study of human behavior and how theories on motivation and learning may be brought to bear on population health management.

Dave DeHommel Managing Director of Risk Adjustment

BCBS Michigan

Mohamed Diab Chief Executive Officer, Accountable Care Organization

CVS Health

Mohamed has more than 25 years of experience leading, growing, and advising regional and national payers, integrated health care systems, academic medical centers and big pharma.

As CEO of the CVS Health (Fortune 4 Company) Accountable Care Organization (ACO).  Mohamed is responsible for the development of value-based care strategies, oversight of the clinical and financial model design, and successful execution of the program. 

Dr. Diab is a Physician by training and received his MBA from St. John’s University in NY.

Prior to his role with the CVS Health ACO, Mohamed:

Led the payor-agnostic population health management solutions for CVS/Aetna as President and Chief Executive Officer of ActiveHealth Management and Health Data Management Solutions (HDMS). In this role, he delivered personalized health care management, health lifestyle and wellness programs to 25M+ people through the utilization of unique analytics, digital assets and health care insights.

Served as a Principal in PwC’s Health Industries Advisory practice where he led the population health strategy and service offering for health systems. He also provided consultative services to various payers and health systems to develop and execute successful population health strategies.

Ran all medical management and pharmacy benefit operations at two large regional plans in New York and New Jersey, overseeing. Development and implementation of medical policies as well as the execution of the utilization management, case management and disease management programs.

Worked with various health systems and physician groups nationally on value-based care models ranging from pay for performance to joint ventures between payers and providers with the goal to improve the quality of care and reduce waste.

Julianne Eckert RN BSN, CCM, CMCN, ACMP, Senior Director, Clinical Quality Programs 

Clover Health

Julianne Eckert is the Senior Director of Clinical Quality Programs at Clover Health, a physician enablement company focused on seniors who have historically lacked access to affordable, high-quality healthcare. She is responsible for creating an innovative  data driven strategy that breaks the traditional model of healthcare to make it easier for providers and patients to deliver and receive healthcare.   

She has spent her life using her personal and clinical career experiences to help drive her mission as a patient advocate by leading health plan quality improvement strategies to prevent vulnerable populations from falling through the cracks with data stories and forward thinking programs which enable patients to easily navigate the complex matrices of healthcare and insurance. She has sweeping subject matter experience in CMS Innovation models, Stars QI programming, NCQA HEDIS/CAHPS/HOS, health equity, as well as, national and international leadership in driving laser focused strategies to improve health plan performance and member outcomes/experience.

She has held multiple Board Advisory roles and currently serves on the Board of Advisors for curriculum development for Pace University’s Design Thinking Executive Program which meets high academic standards, with a challenging interdisciplinary curriculum designed to prepare top executives to solve real-world challenges in designing innovative practices. She holds multiple certifications in Organizational Change Management, Case Management and also Managed Care.  She is an avid mentor and career coach believing it is her mission to develop our next generation of leaders.

Dave Etling Senior Vice President & General Manager

InComm Healthcare

Dave Etling was InComm Payments' 40th employee (20+ years) and has held various leadership positions, including business development, sales, product management, merchant services. Dave uses his broad knowledge of InComm Payments' technologies and services to establish deep and mutually beneficial business relationships with our customers that extend far beyond the basic delivery of stored-value cards into reward points redemption directly at retail POS, single-use digital coupons for specific retail SKU redemption and card-based, by-SKU affinity promotions. He has been a key asset to InComm Payments' growth over many years by improving product partner acquisition and successful retail launches of products for major industry leaders.

Kathleen Faulk SVP & General Manager, Government Programs

Regence Blue Cross Blue Shield

As senior vice president and general manager of government programs, Kathleen Faulk leads the growth, operations, and finances of government programs with accountability for the overall performance of Regence’s Medicare and Federal Employee Programs (FEP) lines of business and other government contracts. She owns 2.5 billion P & L for these lines of business.
Her work includes oversight of our risk adjustment and Stars area, which supports both Medicare and the individual market and collaborates closely with our clinical and provider teams. Kathleen is an executive liaison with external agencies such as Centers for Medicare & Medicaid Services (CMS), FEP Director's Office and America's Health Insurance Plans (AHIP).
She came to Regence in 2017 with a rich career built around commercial and government program health plans with experience from finance to network to medical economics. Before Regence, Kathleen served as the central region president for Humana, where she led membership growth and revenue optimization efforts within their Medicare Advantage business and oversaw risk adjustment, Stars, medical management, and value-based provider agreements. She has also held executive roles at Excellus BlueCross BlueShield in New York managing claims, customer service, membership and provider network strategy and development. Kathleen’s experience spans 30+ years in the health plan industry.
Kathleen received her bachelor's degrees in accounting and finance at Houston Baptist University and her master's degree in strategic leadership from Roberts Wesleyan College.

Mark Filiault VP Payer Sales

Edifecs

Ellen Fink-Samnick DBH, MSW, LCSW, ACSW, CCM, CCTP, CRP

EFS Supervision Strategies, LLC

Dr. Ellen Fink-Samnick is an award-winning industry entrepreneur who empowers healthcare's interprofessional workforce. She is a subject matter expert on Ethics, Health Equity and Quality, Integrated Care, Interprofessional Teams, Professional Case Management, and Trauma-informed Leadership. Her latest books include The Essential Guide to Interprofessional Ethics for Healthcare Case Management 1^st edition, The Social Determinants of Health: Case Management's Next Frontier, End of Life Care for Case Management, and upcoming Social Determinants of Mental Health: Advancing Wholistic Practice Excellence.

Dr. Fink-Samnick has a Doctorate in Behavioral Health with specialization in Health Equity, Integrated Care, Quality, Leadership, and Trauma-Informed Practice, She is a Licensed Clinical Social Worker, Board-certified Case Manager, and Certified Clinical Trauma Professional, as well as a member of the academic honor society, Delta Epsilon Tau.

Dr. Fink-Samnick serves the industry through a variety of roles with academic appointments at Cummings Graduate Institute of Behavioral Health Studies, George Mason University’s College of Public Health, and the University of Buffalo School of Social Work. She is a clinical supervision trainer and instructor for the National Association of Social Workers of Virginia and Metro DC, lead for Rise Association’s Social Determinants of Health Community, moderator of Ellen’s Ethical Lens^TM on LinkedIn, and author of the blog, Ellen’s Interprofessional Insights. She is also a consultant for the Case Management Institute and moderator of their Case Managers Community.

Dr. Fink-Samnick is known for her fierce professional voice. Along with leadership and committee roles across credentialing entities and professional associations, she has served on the Gravity Project and the National Coalition for Social Work and Health. She is a board consultant to the American Association of Doctors of Behavioral Health, and editorial board member for the Professional Case Management Journal, and Case Management Monthly. Further information is available on her LinkedIn Profile.

Wilson Gabbard Vice President, Quality and Condition Management, Enterprise Population Health

Advocate Health

Wilson Gabbard is the Vice President of Quality and Condition Management for Advocate Health, the 5^th largest not-for-profit, integrated health system in the United States and a national leader in population health. Mr. Gabbard joined Advocate in 2020 where he is responsible for CIN and medical group quality across over 1.3M value based lives and risk adjustment strategy for over $3 billion in system risk-based revenue.  This includes responsibility for operationalizing programs for a portfolio of joint-ventures, fully delegated capitation, upside/downside risk, shared savings and pay for performance contracts.  Previously, he spent seven years leading population health operations for UNC Health Care where he was responsible for strategy and operations during their transition from fee-for-service to value-based reimbursement. The UNC population health services team grew from two to over 200 team members during his seven-year tenure. Prior to joining UNC, he led regional operations for primary and specialty care practices and regional emergency and hospitalist service lines for Vidant Medical Group. Mr. Gabbard received his Bachelor and Master of Business Administration degrees from Morehead State University and is a Fellow of the American College of Healthcare Executives (FACHE).

Joe Gabler Chief Revenue Officer

Solutran

Troy Garland Senior Vice President of Clinical and Quality Operations

Equality Health

Troy is the Senior Vice President of Clinical and Quality Operations for Equality Health focusing improving health and eliminating health disparities for all individuals.  Within this area, he is responsible for physical and behavioral health clinical operations, care management services, member engagement, quality improvement and risk adjustment.  

With over 28 years of nursing and healthcare experience Troy Garland has been a bedside nurse, hospital executive, Medicare, Medicaid, Marketplace, ACO executive and innovation transformation consultant.  Troy has expertise in inpatient, outpatient, and ambulatory areas within both commercial and governmental organizations.  Within these roles, Troy has expertise in leadership, operations, population health management, innovative process design, group facilitation, speaking, patient engagement, and clinical application of technology.  

Troy received his Bachelors in nursing from Gustavus Adolphus College, MN.   He received his Masters in Business Administration and Healthcare Management from University of Phoenix.

Colleen Gianatasio Clinical Documentation Integrity and Coding Compliance

Capital District Physician’s Health Plan (CDPHP)

Colleen Gianatasio CPC, CPCO, CRC, CDEO, CPC-P, CPMA, CPPM, CCS, CCDS-O, and AAPC Approved Instructor has over 20 years of experience in the health insurance field. She has experience in customer service, claims, quality, and coding. As Director, Clinical Documentation Integrity and Coding Compliance, Colleen’s primary responsibilities are provider engagement and clinical documentation improvement for accurate coding and reimbursement. 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 of the AAPC National Advisory Board.

Greg Gierer Vice President of Policy and Research

Better Medicare Alliance

Greg Gierer, MPP, joined the Better Medicare Alliance as Vice President of Policy and Research in September 2021, bringing nearly 25 years of policy and advocacy experience to the role.
His post at Better Medicare Alliance follows leadership roles with some of the nation’s leading health care associations including the Pharmaceutical Research (PhRMA) and Manufacturers of America and the Blue Cross and Blue Shield Association (BCBSA). Greg most recently served as Senior Vice President for Policy at America’s Health Insurance Plans (AHIP). He began his career on Capitol Hill as an aide to U.S. Senator Christopher J. Dodd (D-CT).
Greg is a graduate of Providence College and earned his master's degree in public policy (MPP) from Georgetown University. He also served on the Cancer Support Community’s Cancer Policy Institute Advisory Board.
A Connecticut native, Greg resides in Leesburg, Virginia with his wife and three children.

Garth Graham Director and Global Head of Healthcare and Public Health

Google/YouTube at Alphabet, Inc.

Christi A. Grimm Inspector General

Office of Inspector General, Department of Health and Human Services

The Honorable Christi A. Grimm was sworn in as the sixth Inspector General of the U.S. Department of Health and Human Services (HHS) on February 22, 2022, following her nomination by the President and confirmation by the U.S. Senate. As the head of the HHS Office of Inspector General (OIG), she leads an independent and objective organization of more than 1,600 auditors, evaluators, investigators, data analysts, attorneys, and management professionals who carry out OIG’s mission to protect the integrity of HHS programs as well as the health and welfare of the people they serve. Ms. Grimm is responsible for the oversight of more than 100 programs administered by HHS agencies such as the Centers for Medicare & Medicaid Services, Administration for Children and Families, Centers for Disease Control and Prevention, Food and Drug Administration, and National Institutes of Health. Collectively, taxpayers usually devote approximately $1.5 trillion a year to these programs. In 2021, including COVID-19 relief funding, HHS was responsible for a total of $2.4 trillion in spending. Since the onset of the COVID-19 pandemic, HHS-OIG is responsible for oversight of the HHS-COVID-19 response and relief efforts. Ms. Grimm represents HHS-OIG on the Pandemic Response Accountability Committee (PRAC) and leads PRAC’s Health Care Subgroup.

Beginning in January 2020 until her appointment as Inspector General, Ms. Grimm served as Principal Deputy Inspector General Performing Duties of the Inspector General.

Ms. Grimm brings two decades of leadership and expertise in providing oversight of health and human services programs. She is a leading expert in program integrity issues related to HHS programs, with particular emphasis on health and safety in care provided in home and community-based settings, in hospitals and nursing homes, and in facilities serving unaccompanied children under HHS’s Office of Refugee Resettlement. Ms. Grimm regularly engages with Government partners, national professional associations, and the private sector. She elevates accessibility and understanding of OIG work through articles on a range of topics, including medical identity theft, deleterious effects of elevated risk scores in Medicare managed care, and commercial influences on electronic health records. Ms. Grimm is a frequent speaker at educational programs and before Congress and the media.

Ms. Grimm began her career with OIG in 1999 as an evaluator in OIG’s Office of Evaluation and Inspections and later served in a variety of management roles, including Chief of Staff and Deputy Inspector General for the Immediate Office. As an evaluator, she designed and conducted groundbreaking work to improve quality and safety in hospitals, stop unqualified providers from enrolling in Medicare and Medicaid, and improve the process for appealing Medicare payment decisions.

Ms. Grimm holds a Master of Public Administration from New York University and a Bachelor of Arts from the University of Colorado, Denver. She is a graduate of Harvard University’s Kennedy School of Senior Managers in Government. Ms. Grimm has received the Secretary’s Award for Excellence in Management and the Council of the Inspectors General on Integrity and Efficiency Award for Excellence in Management
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RaeAnn Grossman EVP, Operations - Risk Adjustment, Population Health Management, and Quality

Cotiviti, Inc.

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.

Maya Gumatay-Marmo MPH, Director, Data Analysis, Quality Improvement

Health Net

Maya Gumatay-Marmo is the Quality Improvement Director for Data Analytics at Health Net of California. She has over 15 years of experience as a healthcare data scientist, serving the health plan’s population of over 2 million Commercial, Medicare and Medicaid beneficiaries. She oversees a team of data scientists who provide predictive models, develop innovative strategies, and support Quality Improvement programs, all geared towards improving health outcomes and patient satisfaction, with a focus on health equality and education.

Ana Handshuh Principal

CAT5 Strategies

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.

Michael Hasbany EVP, Customer Success and Commercialization

Inovalon

Liz Haynes DVP, Risk Adjustment & Stars- Government Programs

Blue Cross and Blue Shield of Kansas City

Liz Haynes is the DVP of Risk Adjustment & Stars- Government Programs at Blue Cross and Blue Shield of Kansas City (Blue KC). In this role, Liz leads provider engagement and the operations, oversight, strategic direction of Risk Adjustment and Star functions for Blue KC’s Medicare Advantage and Affordable Care Act health plans. These government-sponsored lines of business contribute significantly to Blue KC’s mission to provide affordable access to healthcare.  Liz has an extensive background in healthcare with experience ranging from bedside nursing to provider engagement on behalf of national payers. Prior to joining Blue KC in 2018, Liz served for seven years in Risk & Quality at Optum Insight and eleven years with BJC HealthCare. Liz is a respected expert in Government Programs Provider Engagement, Stars and Risk Adjustment.  She manages comprehensive solutions for overall contract performance and is actively involved in several healthcare initiatives bridging health care and health insurance.  She has experience with taking several Medicare Advantage contracts to 4 Star.  Liz earned both a Bachelor & Master of Nursing from Chamberlain University with an emphasis in Informatics.

Kevin Healy CEO

Allymar Health Solutions

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. 

James Hereford Chief Executive Officer

M Health Fairview

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.

Josh Hetler Chief Operating Officer

DataLink Software

Josh is a customer-focused, healthcare technology leader with over ten years of experience in building software products to improve the workflows for healthcare professionals in value-based arrangements. At DataLink, he has held management, director and vice president positions, successfully building strategies that impact customer adoption and engagement. He has been instrumental in the growth of the Evoke360 platform development and the innovation of new products and solutions to support value-based care.

Previously he served in Sales with a medical device start-up and he began his career in education. Josh earned a bachelor’s degree from the University of Florida.

Brett Hickman Strategic Advisor

Modivcare

Brett Hickman is a Strategic Advisor with Modivcare. Prior to joining Modivcare as Chief Commercial Officer, Hickman was Chief Growth Officer for Cityblock Health, a leader in making healthcare accessible and affordable to the country’s most vulnerable populations. He has held various executive leadership roles at Optum and ProVenture, an Aetna subsidiary for joint venture provider-sponsored health plans, and is a retired partner of PricewaterhouseCoopers LLP.

Hickman graduated with a Bachelor of Arts in Economics from DePauw University and a Master of Business Administration from the University of Indianapolis

Adam Higman DHA, FACHE, Partner, Strategic Consulting

Press Ganey

Adam is a healthcare leader with national experience in healthcare quality, strategic planning, analytics and performance improvement. He has management and consulting experience leading engagements focused on clinical redesign and performance improvement for more than 75 healthcare organizations throughout the United States. Adam has also worked with health organizations for a variety of growth-focused projects including projection analysis, short-/long-term strategic planning, and new product/service planning and operationalization. His planning experience includes system planning around demographic states and population health initiatives.

He serves currently as a Partner/SVP for Press Ganey, one of the largest healthcare, measurement analytics and advisory firms in the country. He has responsibility for Press Ganey’s member experience and payer consulting, as well as strategic initiatives for provider clients around patient, workforce and operational redesign.

Craig Hittle SVP Health Plans

Kaia Health

Craig leads Kaia’s growth and sales initiatives in the US for the national and regional payer/provider channel, focused on driving visibility and adoption of Kaia’s world class digital therapies. He is passionate about practical and transformational solutions and democratizing accessible, affordable, quality health care. Craig brings 22 years of diverse health care experience and expertise in business development, market/product growth and innovation, transactions and valuation, performance improvement and executive leadership. Prior to joining Kaia, Craig was SVP and Market Head for Lumeris and Essence Healthcare, a national leader in population health enablement and Medicare Advantage, responsible for revenue growth, strategic partnerships with leading health systems, providers and payers, and growth of its MA business unit. He earned a BS from Purdue University, an MBA from Indiana University Kelley School of Business and is a Certified Valuation Analyst (CVA). Craig is an avid sports fan, enjoys traveling, reading, and outdoor adventures, and resides in Indianapolis, Indiana with his wife and three children.

Jennifer Holman LPN, CRC, Director Risk Adjustment

Centene Corporation

Kaleb Holt Medicare Program Director

SelectHealth

Kaleb began his career in health insurance in 1999 when he first joined the SelectHealth customer service team. He has worked in claims, provider relations, coverage policy management, product management, product development, and pretty much anything else they would let him get his hands on. In 2011, while Kaleb was working in Product Development, he had the opportunity to lead the feasibility analysis for SelectHealth to enter the Medicare Advantage space. When the decision was made for SelectHealth to launch an MA plan, Kaleb enthusiastically joined the team and has never looked back. Medicare Advantage has been an incredibly challenging and rewarding field and he isn’t sure he could ever leave it. Kaleb has been described by himself and work colleagues as a true Medicare Advantage nerd, which essentially just means he is really fun at parties.

The only thing better than Kaleb’s work life is his personal life that he is fortunate to share with his wife and best friend, Sarah Jean. They will celebrate their second anniversary this coming June, and yes Sarah Jean was very understanding that they could not get married in May because you can’t work in Medicare Advantage and go on a honeymoon right before the bids are due. They have four children in total. Two have moved out of the house and launched their own exciting lives, and two are shared part time with their other parents. All four are very funny, smart, and kind. None yet show any inclination for Medicare Advantage, but there is still time. They like to watch movies, go on picnics, and take the occasional road trip when they can get everyone together.

Scott Howell D.O., MPH&TM, CPE, Chief Innovations Officer

Semler Scientific, Inc.

Dr. Scott Howell has been in various executive positions within health plans, delegated medical groups, direct-care delivery and healthcare policy for 30 years.  Dr. Howell is currently the Chief Innovation Officer at Semler Scientific and assists as medical director for the AIDS Healthcare Foundation Positive Healthcare Partners, a specialty C-SPN health plan. 

Dr. Howell is board certified in Family Practice, Preventative Medicine and Public Health and Addiction Medicine with a Masters in Economics from the University of Miami, Master in Public Health and Tropical Medicine (MPH&TM) from Tulane University, a Masters in Business Administration (MBA) from California State University Fresno. 

Dr. Howell served the military for 25 years with his last assignment in the Office of Secretary of Defense (OSD) at the Department of Defense Inspector General (DoDIG), Special Plans and Operations (SPO) concentrating on the Wounded Warrior Program, BioAssurity, and Ebola Outbreak Assessments.

Dr. Howell has published peer-reviewed articles in both disciplines finance and medicine. 

Gene Huang Executive Chairman

Referwell

Gene has a 30+ year career building health care businesses, focusing on health services companies, health plans, provider organizations and most recently payment reform and value-based care initiatives. Gene managed home health care and home IV therapy businesses, was chief operating officer of OptiCare Eye Health and was president and chief development officer of a multi-state physician home visit company that was sold to CIGNA.

In the health plan sector, he built the Medicare Advantage business from startup to an $850 million unit of Oxford Health Plans in the CT/NY/NJ market, was CEO of Citrus HealthCare in Tampa in a turnaround/ownership transition, ran the Medicare Advantage plan for HealthNet of the Northeast, built Chronic Special Needs Plans for Aveta and ran the nationwide 24-hour nurse line for IntraCorp/CIGNA HealthCare. From 2013 to 2018, Gene led the post-acute business for Remedy Partners, the largest player in the CMS Bundled Payment for Care Improvement program, generating substantial savings for Medicare, surpluses for SNF partners and returns for investors.

Gene has been on the ReferWell Board since 2015 and in his role as executive chairman, works on behalf of the Board with the CEO and his team to develop significant payer relationships and key strategic partnerships to maximize enterprise value. Gene holds a bachelor’s degree in chemistry from Cornell University and Masters in the Management of Technology from Massachusetts Institute of Technology.

Nikki Hungate MS, MHA Director, Medicare & Gov't Programs Product Strategy

MVP Health Care

Nikki Hungate, a long-time resident of the Western New York region, currently serves as the Senior Leader of Medicare & Government Programs Product Strategy at MVP Health Care. Utilizing the 17 years of experience in the health plan industry she is accountable for leading a team of product innovators that create and deliver a suite of high-quality government products that address the needs of the community in a customer-centric fashion, placing emphasis on those populations that are most vulnerable and underserved. Nikki holds a Bachelor and Master of Science in Health Administration from Roberts Wesleyan College. She is currently an Executive Leadership doctoral candidate at the University of Charleston. Nikki has a passion for sharing knowledge, and also serves as an adjunct professor in the health sciences degree programs at Monroe Community College and Roberts Wesleyan College. In her free time, she volunteers as fundraising coordinator for the local Vietnam Veterans of America chapter in Rochester, NY.

Leo Janze Head of Data Engineering, NLP

Change Healthcare

Leo Janze is a technologist and NLP subject matter expert who is passionate about how patient data can be leveraged to improve patient outcomes and healthcare operations.

As Head of AI Data Engineering at Change Healthcare, Leo leads the design and development of a fully managed Healthcare AI solution, including patient data extraction services and applications. This solution is bringing Risk adjustment coding, HEDIS abstraction, payment adjudication and clinical decision support to another level of efficiency and customer delight.

Prior to Change Healthcare Leo was Vice President of Engineering at Apixio where he led teams to gain insights from medical records. Prior to Apixio, he led engineering and product management teams at multiple startups and Fortune 500 companies.

Leo is a speaker on opportunities and challenges of leveraging Artificial Intelligence in Healthcare..

He received his master's degree in Computer Science from the University of Uppsala, holds several patents, and is a graduate of the Engineering Leadership Program at UC Berkeley.

Troy Jelinek Chief Commercial Officer

Icario

Ashish Kachru CEO

DataLink Software

Ashish is an industry visionary with more than 20 years of healthcare technology and executive leadership experience. As the Chief Executive Officer of DataLink, he leads the strategic direction of the organization and drives future innovation to enable high-quality, cost-effective, value-based care. Previously, Ashish was the Chief Executive Officer of Altruista Health, a leading healthcare technology company he founded to provide care management solutions to payers impacting better health outcomes for millions of members. 

Ashish has been widely recognized for his entrepreneurship and leadership in healthcare and most recently was voted Best Tech Leader in Washington, DC in the 2021 Timmy Awards. He was named a Top 25 CEO by the Northern Virginia Technology Council two years in a row (2020 and 2019) and one of the Top 10 Emerging Healthcare Leaders in 2018 by Managed Healthcare Executive magazine. He also received the prestigious EY Entrepreneur of The Year® Award in the health category in the Mid-Atlantic region in 2017. 

Ashish serves on the board of the Department of Medical Assistance Services, the agency that administers Medicaid programs in the Commonwealth of Virginia. He is also a member of the Young Presidents’ Organization. Ashish earned a bachelor’s degree in engineering from NIT Bhopal in India, a master’s degree in nanotechnology from the University of North Carolina and an MBA from the University of Chicago Booth School of Business.

Jenn Kerfoot Chief Experience Officer

FarmboxRx

As Chief Experience Officer at FarmboxRx, Jenn Kerfoot is the head of Client and Member Experience Operations. In this role, Jenn leads the strategic planning, design, and implementation of initiatives that drive Member Satisfaction & Retention. Additionally, Jenn spearheads the Member Insights function using qualitative and advanced analytic approaches to understand the gaps in care and unmet needs of populations. Jenn has helped companies articulate and achieve success across several aspects of the healthcare space. As a military veteran, Jenn brings leadership and vision to diverse audiences, and offers a unique perspective within start-ups and high-growth stage companies. With a passion for organizational mission and values, as well as the unique competitive advantage of establishing a strong culture, Jenn works with all departments to streamline processes and programs that integrate the member experience into every aspect of the business.

Autumn Kerr AVP, Clinical Quality

Healthfirst

Autumn Kerr has been with Healthfirst since 2007, most recently as AVP, Clinical Quality. In this role she serves as the subject matter expert for HEDIS and provider engagement for quality activities. She leverages these areas of expertise exploring new and innovative ways to close care gaps both within her organization and with provider partners. In her tenure, Healthfirst has been awarded 4 Stars from CMS multiple times and routinely in the top performing Medicaid plans in New York State. Autumn has worked in healthcare for 20 years on both the payor and payee side.

Healthfirst is a provider-sponsored health insurance company that serves more than 1.7 million members in downstate New York. Healthfirst offers top quality Medicaid, Medicare Advantage, Child Health Plus, Managed Long Term Care plans and commercial products.

Gregg Kimmer CEO

ATRIO

Effective August 1, 2022, ATRIO’s new President and CEO is Gregg Kimmer.  All of Gregg’s experience in healthcare has been in Medicare Advantage, and until ATRIO, it has all been in the Midwest, with Chicago serving as the anchor geography.  After nearly 7 years at Humana, where he was 1 of 5 Divisional CFOs and oversaw $1.4 billion in revenue, he became Chief Medicare Officer over the Great Lakes market at Aetna / CVS Health.  During his 4 years in this role, he had full P&L responsibility and oversaw organic growth of 20k to 133k members.  

Gregg is originally from Nashville, TN.  Without a doubt, what he enjoys most is spending time with his family.   

Daphne Klausner Plan President

Honest Medical Group

I have been privileged to serve the senior population for over 25 years, and most recently within the largest city in America with the highest amount of poverty. While it was home to some of the world’s best hospitals and doctors, the people who needed us most were struggling. Despite everyone’s best intentions and hard work, the state of the system was highly fragmented. When we decided to test a new model of care, where a health plan collaborated with doctors, we saw great things happen.

David Larsen Senior Advisor Payor Solutions

Press Ganey

David L. Larsen has been the Director of Quality Improvement for SelectHealth in Salt La¬ke City, Utah for the past 31 years and has worked for Intermountain Healthcare for 38 years. SelectHealth is a mixed model HMO with more than 900,000 members in Utah, Idaho and Nevada. Intermountain Healthcare is an integrated health care delivery system with 23 hospitals and over 1500 employed physicians.

As the Director of Quality Improvement, David has responsibilities for oversight of the Medicare Advantage Stars program for which SelectHealth received a 4.5 Star rating in 2020 and 4 Star rating in 2021, maintaining NCQA accreditation; HEDIS performance measurement; CAHPS measurement and reporting, public reporting (transparency) and population health.

David has also been responsible for the oversight and development of chronic disease registries, performance measurement and web based reporting systems, quality improvement pay for performance incentives for providers, and direct patient improvement interventions related to chronic illnesses including patient adherence monitoring, reminders and incentive programs.

Sean Libby President

BeneLynk

Sean has worked at the intersection of managed care and government benefit programs for the past 20 years. He is responsible for BeneLynk’s product development, new business acquisition, and strategic growth initiatives. Prior to BeneLynk, Sean served as the President of Freedom Disability and Alpha Disability, one of the nation’s largest Social Security Disability and Veterans Advocacy companies. Before that, Sean served as Vice President, Sales for SSC Disability, providing government program benefit services for Managed Care Organizations. 

He is recognized by the Social Security Administration as a non-attorney representative (EDPNA) and has personally represented claimants in hearings for Social Security Disability Insurance and Supplemental Security Income throughout the country. 

Sean is an expert on a wide variety of government benefit programs and has been quoted in Bloomberg, Business Week, and other national publications. He regularly publishes articles on managed care and government benefits for BeneLynk’s blog. 

Sean is a graduate of Middlebury College and has a master’s degree from Yale University. 

Paul G. Linder, MD

Paul G. Linder and Associates PC

Paul G. Linder, MD, is a primary care physician, internist and small business owner in Pittsburgh, Pa. He has operated a solo practice since 1991. He also serves as clinical director at Biolife Plasmapheresis Center in Braddock and was a visiting professor and clinical lecturer at Washington and Jefferson College in Washington, Pa. He earned a bachelor’s degree in biology from Brandeis University and a doctorate in medicine from Milton S. Hershey Medical Center. Dr. Linder completed his residency in internal medicine at West Penn Hospital in Pittsburgh and is board certified in internal medicine. He and his wife, Mary Anne, have three children.

Robert London Medical Director, Senior Consultant

Semler Scientific, Inc.

Dr. Robert (Bob) London is President of SciconHealth, a boutique consulting firm which provides services to corporations focused on healthcare technology, biomedical, pharma, and population health programs. Clients include Semler Scientific, Hologic, Nirvana Health, BetterNight, Averhealth, and Boston Scientific.  He has been a President, Chief Operating Officer (COO), and Chief Medical Officer (CMO) in both private and public rapidly growing companies and has deep expertise in payer operations, pharmacy, managing MLR, biomedical research, healthcare technology, and medical informatics.

Dr. London is a national thought leader in leveraging technology to improve quality and reduce medical costs from the Payer perspective.  From 2014 thru 2021, he was the Chief Medical Officer for WellCare’s South Carolina Health Plans. He also worked 2020-2021 as Chief Medical Officer for the SC Centene book of business including all Medicare, Exchange and Medicaid membership.  In these role his span of control included overseeing the medical services and quality results for WellCare Medicaid and Medicare plans in the state: including medical leadership for the effective care integration of pharmacy operations, utilization/case/disease management activities and quality improvement. He reported to WellCare’s state leader for South Carolina. In addition to his market role, Dr. London led a number of corporate projects involving informatics, artificial intelligence, Obstetrics/NICU and IT related RFP’s.

Prior to WellCare, London was the national medical director for Walgreens and led the clinical solutions group in the health and wellness business segment. Preceding to that, he served as the general manager of ikaSystems, a leader in enterprise software for the payer sector. He has also served as the chief development officer for D2Hawkeye, a provider of medical data reporting and analytics solutions, and chief clinical officer for TriZetto, a public health care information technology company. Earlier in his career, London led health care management for Anthem Blue Cross and Blue Shield’s (WellPoint) Western region. He has also served as corporate chief medical officer at CNA Insurance Company, chief operating officer for United Healthcare’s mid-Atlantic region, and chief medical officer at NYLCare Health Plans. Dr. London did his executive training while at Kaiser Permanente’s Mid-Atlantic Region and was the lead of Maternal-Child Care for the Mid-Atlantic Market.

London has served on the faculty of the Johns Hopkins School of Medicine, the University of Colorado MBA program, and the South Carolina School of Medicine. He holds degrees from George Washington University and University of Maryland School of Medicine, is board certified in obstetrics and gynecology, and is a fellow of the American College of Obstetricians and Gynecologists.

Donna Malone CPC, CRC, CRC-I, AHCCA, RAP AAPC National Advisory Board Director Ambulatory CDQI Clinical Documentation Quality Improvement "

Mount Sinai

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 17^th 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.

Donna speaks nationally for RISE, AAPC and AHIMA

Matthew Markham Director, Business Development

Wolters Kluwer, Health Language

Matt Markham supports Wolters Kluwer, Health Language as a Business Development Manager working to help payers, providers, and health IT vendors to improve their healthcare data quality. He has worked with some of the leading healthcare organizations, providing insights and strategic guidance to help improve their operational effectiveness, analytics, and ultimately better healthcare experience for their patients and members.

Matt graduated from Brigham Young University with a Bachelors in Business Communications, and is currently an MBA candidate at the University of Colorado, Denver.

Lisa Marshall Manager, Alternative Payment Strategies

Driscoll Health Plan

Lisa has a bachelor’s degree in Business Administration with a minor in Contract Management in Acquisitions from University of Maryland and an MBA from Texas A&M with emphasis in business analytics. She is currently working on obtaining her Project Management Professional (PMP) certification.

Lisa has had the unique opportunity of following her husband through his 28-year naval career living all over the country and overseas. That nomadic lifestyle allowed her the opportunity to work in healthcare in a variety of capacities. Her 25 years of healthcare experience includes national commercial carriers, managed care organizations, physician offices, hospitals (including Department of Defense (DoD) military treatment facilities) and in a variety of capacities. She ran my own business for many years consulting for physicians working closely with family practice, therapy, and behavioral health. Lisa has a significant understanding of the impact that business decisions have on these organizations.

Driscoll Health System (DHS) is a non-profit health system in south Texas.  DHS supports a predominantly pediatric population of 270,000 members across 24 counties with communities that can be significantly remote. Driscoll Health System has multiple clinics across their service delivery area with more than 30 medical and surgical specialties. Driscoll has the only free-standing children’s hospital in South Texas and is building a second free standing hospital in McAllen, Texas scheduled to open in the fall of 2023.

Currently, Lisa’s team runs a 113M dollar Alternative Payment Program for Driscoll Health Plan which impacts approximately 71% of their contract business.

Melissa McVaugh, MSN-LM, RN, CPC Director Clinical Programs

Mountain Health CO-OP

With over 20 years of diversified experience, Melissa McVaugh is a proven leader in the healthcare industry.

Melissa is a foundational part of the Mountain Health Co-Op, where she serves as the Director of Clinical Programs. In this pivotal role, Melissa oversees clinical operations, including risk adjustment, medical management, and claims/payment integrity for three states.

Using her deep operational knowledge, she has leveraged her nearly 20 years of experience to improve risk scores, quality metrics, member and provider experience, and outreach.

By focusing on the relationships between data, quality, and risk adjustment, Melissa has put her Master’s Degree and CPC to good use. Her passion for member-driven care has led Mountain Health Co-Op to adopt many signature benefits available to all members, like access to zero-cost insulins, heart medications, anti-depressants, and more. Melissa was applauded by the Co-Op for helping implement a 24/7 telehealth option that proved to be life-changing during the pandemic.

Over the years, her strengths at Mountain Health Co-Op have garnered recognition for the success of the risk adjustment program. Strategic changes to associated programs generated results that exceeded National benchmarks.

A proven leader in her field, Melissa’s professional experiences include consulting services, auditing, coding, and mentoring graduate nursing students and new leaders.
________________________________________

Gabriel Medley Vice President, Risk Adjustment & Analytics

Blue Cross Blue Shield of Michigan

Gabe Medley brings over 22 years of progressive healthcare experience leading diverse multidisciplinary teams and projects to successful outcomes. Gabe’s background includes a combination of healthcare, business, and data analytic leadership roles with his most recent role serving as VP, Risk Adjustment and Analytics at BCBSM. In his current role, Gabe manages risk adjustment, HEDIS/quality improvement, and analytic reporting programs for the Medicare product line.

Prior to Emblem Health, Gabe’s previous experience included roles as Vice President of Provider Network and Population Health at Emblem Health headquartered in NYC, NY; start-up health plan (Iowa Total Care) for Centene Corporation as VP - Quality Improvement; progressive leadership roles at Highmark Wholecare (fka. Gateway Health) culminating as VP - Quality and Risk Adjustment, Manager - Risk Adjustment Programs (Horizon Blue Cross Blue Shield of NJ), Manager of Healthcare Data Analytics (Inovalon Inc.); Senior Manager of Patient Access (Military Health System, National Capital Region); and active-duty service as a Captain in the U.S. Army (Medical Service Corps).

Gabe’s education includes the following: Master of Science in Healthcare Administration (MHA) and a Master of Business Administration (MBA) from the University of Maryland Global Campus in Adelphi, Maryland; Bachelor of Science in Psychology with a minor in Military Science from Grambling State University in Grambling, Louisiana. In his spare time, Gabe enjoys working out, traveling, and spending time with family and friends.

David Meyer Chief Customer Officer, Applied Research Works

COZEVA

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.

Lyle Mioduszewski Vice President of Population Health

Ciox Health

Lyle Mioduszewski is Vice President of Population Health for Ciox Health, where he works with risk-bearing entities to understand the utility of social determinants of health factors, with the goal of improved and equitable outcomes for all individuals. With twenty years of experience throughout the health care continuum, Lyle has clinical expertise in emergency and trauma nursing of adults and pediatric populations, as well as cardiac catheterization and electrophysiology nursing. Lyle has been a leader in the health information technology and medical device industries with previous companies, including McKesson Corporation, PointClickCare (Collective Medical), and Zoll Medical. He is passionate about advancing value based care modalities, augmenting process relative to varying health literacies, care collaboration, interoperability, and influencing an end to the opioid epidemic through the use of innovative technologies.  

Erin Montgomery Chief Operating Officer

Advantmed

P.J. Morris MHA, Manager, Risk Adjustment Operations & Analytics

Fallon Health

P.J. Morris, MHA, has worked in risk adjustment for almost 6 years. Currently, he is the Manager of Risk Adjustment Operations & Analytics at Fallon Health, a health insurance plan in central Massachusetts. 

P.J. has previously worked at Tufts Health Plan in different areas of health insurance for over 10 years. This experience includes Membership Operations, Provider Network Contracting, and Finance. He also has worked on the provider side at UMass Memorial Healthcare in the Finance department.  

A former college athlete, P.J. Morris, MHA, lives in Massachusetts with his wife Susannah and daughter, Sydney. When P.J. isn’t working hard at Fallon Health, you’ll find him watching sports, mentoring youth from his church, or enjoying a local craft brewery.

James Murray VP, Clinical Informatics and Interoperability

CVS Health/Aetna

Jim Murray is Vice President, Clinical Informatics and Interoperability at CVS Health.  CVS Health is America’s leading health solutions company headquartered in Woonsocket, RI.  At CVS Health, Jim is responsible for the strategy related to clinical data management, systems, configuration of provider workflow, and interoperability of clinical data.  In this role Jim sets the enterprise strategy and vision for clinical systems and interoperability, including the electronic medical records system, population health management platform and other complementary systems that support patient health as well as provider efficiency.  Jim is also responsible for vendor and affiliate relationships and represents CVS Health to provide solutions and guidance to key partners. 

Jim also served as VP, Information Technology for CVS MinuteClinic and was responsible for the EHR as well as medical record data exchange for over 1,100 retail-based clinics across the US.  Mr. Murray has been at the forefront of enabling disparate systems to share medical records and improve the continuity of care. 

Mr. Murray serves on the Board of Directors for Carequality.  He has served as adjunct faculty at Harvard University T. H. Chan School of Public Health.  He holds Master of Science in Medical Informatics from Northwestern University and a Bachelor of Arts in Economics from the University of Nebraska.

Michael Nemeth MSM-RMI, AVP, Revenue Program Management                          

Blue Cross Blue Shield of North Carolina

Mike Nemeth offers three decades of extraordinary success in a series of high level roles at top tier companies that include Blue Cross Blue Shield of North Carolina, Florida Blue, and SS&C Health.

Mike’s invaluable expertise and broad business range have powered a history of developing successful process improvements that drive productivity, reliability, and client satisfaction. Such traits have consistently enabled Mike to achieve an impressive command of the skills needed to manage ongoing business planning processes
while developing strategies to meet future challenges.

Upon being named as Associate Vice President of Revenue Management for Blue Cross Blue Shield of North Carolina, Mike builds the risk adjustment strategy and leads the Risk Revenue Program to strengthen the organization’s market competitiveness within Medicare Advantage HMO/PPO, Experience Health HMO, D-SNP, ACA u65, and ACA small groups. Mr. Nemeth has dedicated himself and his vision as a leader who engages in projects with an “All-In” attitude.

Prior to assuming the role of Associate Vice President of Revenue Management for Blue Cross Blue Shield of North Carolina, Mike achieved over two decades of experience driving positive outcomes across Operations Management, Risk Adjustment Programs, Team Management, Product Development, and Process Improvement in multiple roles with Florida Blue and SS&C Health.

Combining his proven business instinct with an unprecedented disciplinary work ethic, Mike has continuously exceeded expectations in high stake environments within Blue Cross Blue Shield of North Carolina, Florida Blue and SS&C Health positioning himself as a key member of each company and a driving force for growth.

Mike holds a Master of Science Degree in Risk Management and Insurance from Florida State University as well as a Bachelor of Science Degree in Business Development and Leadership from Jacksonville University.

Lynne Newson Vice-President, Medicare Strategy

BCBSMA

Lynne is currently Vice-President, Medicare Strategy, responsible for the Medicare Stars program, Revenue Management, Medicare Compliance, and the Overall Medicare Segment Strategy.  Prior to this position, Lynne was the Medicare Compliance Officer at BCBSMA, responsible for the Medicare Compliance Program for BCBSMA’s Medicare Advantage and Prescription Drug Plan Contracts.

Prior to her work at BCBSMA, she worked at Blue Cross Blue Shield of Rhode Island (BCBSRI) as the Director of Government Programs. Lynne started her career in Washington, DC at the Department of Health and Human Service’s Budget office, where she was lead analyst on Medicare Physician Payment Policy and Medicare Risk Plan Policies and Regulations.  Her career also included a period as a Senior Policy Analyst in the Washington, DC based Office of Policy and Representation at the Blue Cross Blue Shield Association.

Lynne received a Master's degree in Public Policy from Duke University and a Bachelor of Arts degree from Bowdoin College

Khanh Nguyen Chief Executive Office

Cozeva

• Khanh has a Doctorate from the University of California San Francisco, School of Pharmacy, and has over 15 years of experience in creative 
•  payer-provider collaborations. Her leadership around care innovations, social determinants of health and health disparities, patient engagement, system integrations for enhanced point-of-care solutions, and provider incentive programs broke new ground in California’s 
•  sophisticated managed-care environment.  

Roy Oaks Senior Director, Data Analytics

Driscoll Health Plan

Roy Oaks is the Senior Director for Driscoll Health System and serves as a servant leader for all departments within the health plan, with primary leadership responsibilities for the Alternative Payment Strategies, Data Analytics and Medical Economics.

Prior to joining Driscoll Health System, Roy worked for Humana and the University of Michigan Health Systems where he played a key role in promoting new and innovative approaches to analytics with C Suite and senior level decision makers. These experiences have contributed to his expertise in Medicaid and Medicare with focus on medical economics, network development, utilization management with growth in the areas of Risk, and Population Health including quality and social determinants of health.

Prior to becoming a leader within the health care industry, Roy served as Hospital Corpsman with direct support of the United States Marine Corps with the Fleet Marine Force’s II and III Expeditionary forces serving in multiple conflicts and peacekeeping missions throughout the world. Over a 30-year career he was awarded with some of our nation’s top military honors.

He received his education from the University of Michigan with a master’s degrees in Public Administration and bachelor’s degrees in Healthcare Administration and Mathematics.

Roy and his wife have a strong passion in helping children throughout the world. When not working, Roy and his wife are board members & helpers of a private magnet school where they work to provide free tuition and other resources for worthy students to attend. They are also involved in multiple other philanthropic work which supports their friends and family throughout the world. These missions along with the mission of Driscoll Health System and Plan have continued to motivate Roy to keep moving forward in his career and his personal life.

Nigel Ohrenstein President

Kaia Health

Nigel is passionate about transformational solutions that improve cost and quality of care. Most recently, he was the co-founder of Lumeris, helping to build Lumeris into the leading Value Based Care Company and operator of Essence Healthcare, the Five Star rated Medicare Advantage plan. Prior to Lumeris, Nigel led the Medicare business at Express Scripts. He has a BA and MA from the University of Cambridge.

Nationally recognized as a thought leader in healthcare, Nigel is excited to democratize healthcare and through Kaia Health make clinically proven digital therapies available to patients anywhere and at any time.

When not working, Nigel can be found running, traveling, spending time with family and watching Liverpool FC.

Milissia Olberding Associate Director, Risk Adjustment & Revenue

UCare

My name is Milissia Olberding I am the Associate Director of Risk Adjustment and Revenue for UCare. I have been in the managed care space for over 16 years with a focus on leading risk adjustment and revenue reporting including: strategic modeling, projections, and encounter data submissions oversight across all lines of business.

UCare is an NCQA accredited independent, nonprofit health plan serving Minnesota and western Wisconsin through programs such as Medicare, Medicaid, Dual and SNP’s we strive to live our mission of improving the health of our members through innovative services and partnerships across communities. Thanks to strong collaboration, UCare delivers measurably high-quality care to every one of our members.

Lynne Padilla Vice President of Risk Adjustment Solutions

Change Healthcare

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.  

Wayne Pan MD, PhD, MBA, Medical Director

Banner Health

Dr. Pan has served as a member of the board of directors of Semler Scientific, Inc since May 2014. He has over 20 years of broad healthcare industry experience from clinical medicine, to managed care, health information technology and biotechnology. Dr. Pan is currently medical director at Banner Health, Insurance Division, responsible for all of Banner’s Medicare Programs, including HMO, PPO and D-SNP. Prior to Banner, from June 2021 to May 2022, he was co-founder and chief medical officer of Salusive, Inc., a technology-enabled healthcare services company, based in Emeryville, CA, providing chronic care management and remote patient monitoring services to help physicians manage older adults with chronic conditions, leveraging a proprietary NLP/AI platform that enhances the effectiveness of clinical coaches in real-time as they connect with their patients.

From May 2018 to June 2021, he was employed by BioMarin Pharmaceutical Inc., a biotechnology company based in Novato, CA, initially as a medical director in Global Medical Affairs, functioning as the Global Medical Lead for products in development and marketed products treating the mucopolysaccharidoses (MPS) diseases, Morquio A (MPS IVA), Maroteaux-Lamy (MPS VI) and Sanfilippo B (MPS IIIB) syndromes. In January 2021 he moved to the Product Portfolio Development organization as a director, core team leader supporting the PKU gene therapy program. He is also a part-time medical director at San Francisco Health Plan, since May 2014, responsible for utilization management, appeals and grievances and quality improvement programs. From April 2016 to February 2018, he was a medical director in Quality of Care and Health Economics and Outcomes Research, US Medical Affairs at Genentech, Inc., a biotechnology company based in South San Francisco. From April 2015 to April 2016, Dr. Pan served as the chief medical officer at Applied Research Works, a healthcare software technology company based in Palo Alto, offering health plans and integrated delivery systems, a cloud-based platform providing timely, actionable clinical data to providers at the point of care.

From October 2014 to April 2015, Dr. Pan served as medical director in the technology group of Clover Health Labs, a start-up integrated healthcare delivery system based on the East Coast that includes a hospital system, a medical group and affiliated independent physicians, and a Medicare and Medicaid health plan. From June 2014 to April 2015 he served as the chief medical officer at Santa Clara County IPA (SCCIPA), a large independent physician association in Santa Clara County, California with 800 multi-specialty physicians with 80,000 covered lives in commercial (HMO/ACO) and Medicare Advantage (HMO/ACO) programs. From August 2012 to May 2014 Dr. Pan served as chief medical officer at Thrasys, Inc., a global healthcare technology company that provides a cloud-based platform upon which healthcare delivery systems and provider organizations can build high quality, person centered accountable care communities.

Between October 2010 and July 2012, Dr. Pan was concurrently the chief medical informatics officer for Health Access Solutions, a health care software development company and chief medical officer of Pacific Partners Management Services, Inc., a medical management services company serving medical groups in northern California with over 50,000 covered lives. Prior to that, between September 2009 and February 2010, he served as chief medical officer for Affinity Medical Solutions, LLC, a medical management services organization serving independent physicians association clients and managing commercial and Medicare Advantage members. Dr. Pan has also served as chief medical officer between June 2008 and August 2009 for Alameda Alliance for Health, a local initiative health plan with Medicaid, Medicare Advantage Dual Eligible SNP and IHSS plans, and as an advisory chief medical officer at a data analytics start-up focused on big data issues in healthcare in 2007-2008. Dr. Pan holds an M.B.A. from The Wharton School, University of Pennsylvania and an M.D. and Ph.D. from the Mt. Sinai School of Medicine, and a B.S. in Biology from Johns Hopkins University.

Vandna Pandita Vice President, HEDIS Strategy & Analytics

AmeriHealth Caritas

Vandna Pandita, MPH is the Vice President of HEDIS® Strategy and Analytics for the AmeriHealth Caritas Family of Companies [ACFC].  In her role, Vandna is leverages her experience in quality and risk adjustment operations to support members and providers as it relates to performance reporting and the member and provider experience.  Her area of influence spans analytics, plan operations and digital integration of data and processes in the transition to interoperability. 

Prior to AmeriHealth, Vandna has worked for several national health plans, including Aetna, several Blue Cross Blue Shield plans, the Blue Cross Blue Shield Association and Centene.  She has successfully led several health plans through NCQA Accreditation, managed HEDIS® reporting, improvement and outreach, and helped develop and implement a successful provider profiling and performance measurement program.  In addition to her health plan experience, Vandna managed Risk Adjustment Client Operations for Evolent Health, is a former certified HEDIS® Compliance Auditor and led project management and client solutions for a retrieval, abstraction/coding and analytics vendor supporting health plans and provider groups in their efforts to optimize revenue and improve quality within their populations.

Vandna attended the University of California at Berkeley as an undergraduate and received her Master’s in Public Health from the University of California at Los Angeles.

Vandna has moved from coast to coast, spending the better part of the last 25 years working on her southern drawl in Atlanta, Georgia.  These days you can find her running the streets of Atlanta, cooking for friends or working on her newest hobby, making wobbly pottery. 

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. 

Manoj Pawar Chief Medical Officer

Mutual of Omaha

Manoj Pawar, MD is Chief Medical Officer at Mutual of Omaha, where he leads both the Health Outcomes and Value-Based Innovation team as well as Mutual of Omaha’s Medicare Prescription Drug Plans business. As a seasoned physician executive with roots in primary care and public health, he is passionate about seeking ways to improve health outcomes and affordability for populations.

Over his career, he has led risk-bearing medical groups, health systems, population health organizations (IPAs, ACOs, CINs), and health plans at the regional and national level.

Dr. Pawar graduated from Northwestern University with a degree in Biochemistry, Molecular, and Cellular Biology. He studied Medicine at McGill University in Montreal, completed his internship and residency in family medicine at University of Colorado, and completed his masters at the School Public Health and Tropical Medicine Tulane University, where he was inducted into the Delta Omega public health honor society.

Schawn Pedersen, CPC Director, Coding and Quality Compliance

Matrix Medical Network

Schawn Pedersen has over 25 years of health are experience specializing in physician billing, coding, education, policies and procedure development, regulatory compliance, and reimbursement. As a consultant, she worked with multi-specialty physician practices to perform chart audits and to develop compliance plans, education, and training. She has provided coding education and training on OIG documentation guidelines, developed and implemented training programs specifically designed to address coding and compliance issues as well as conducted patient relations workshops for providers and staff.  Over the last twelve years, Schawn has focused her career in the Risk Adjustment space. In her role at Matrix as the Director of Coding and Quality Compliance, Schawn is responsible for a department of coders, auditors, and the computer aided coding teams. She as developed internal metrics to drive production and accuracy which has positioned Matrix as a leader in accuracy not only for Risk Adjusting diagnosis codes, but also for CPT and CPTII capture to support HEDIS gaps in care.

Matt Plack VP for Innovation and New Solution Strategy

Apixio

As VP for Innovation and New Solution Strategy at Apixio, Matt Plack utilizes his 25 years of healthcare IT expertise to solve critical business problems for payers and providers through Apixio's machine learning (ML) platform. Beginning with McKesson (now Change Healthcare) and Siemens Medical Solutions (now Cerner/Oracle), Matt's career arc has taken him from Product Management and Marketing roles with large healthcare IT organizations to customer-focused sales roles with mid-to-late stage startups like MEDecision and Apixio. His specific areas of domain expertise include revenue cycle, population health, utilization management, and the use of ML to improve risk adjustment coding and quality measure abstracting for improved business outcomes.

Lisa Pouncey Director Product Management, Data Transformation and Submissions

Veradigm

Melanie Prince MSN, BSN, NE-BC, CCM, FCM, FAAN, President/CEO

MAPyourWAY, LLC

Melanie A. Prince, is the President of Case Management Society of America (CMSA).  She served 30 years in the armed services, retiring in the rank of Colonel assigned to Headquarters Air Force where she was responsible for developing strategies to eliminate interpersonal violence in the military and advanced the Air Force Surgeon General’s global health care strategy. 

Sundar Ramalingam Senior Manager of Government Programs

AvMed Health Plans

As a Senior Manager of Government Programs, Sundar Ramalingam leads a vibrant team of associates at AvMed Health Plans in Miami for Risk adjustment operations. As a Clinician, Sundar brings more than 20 years of health care experience in the Medicare and ACA lines of business.

Seth Ravine Senior Vice President

Modivcare

Seth Ravine joined Modivcare in September 2021 as Senior Vice President of Strategic Solutions by way of the company’s acquisition of VRI, an industry-leading provider of remote patient monitoring solutions. As head of the company’s cross-functional Mobility, Home and innovation strategy, Ravine is a mission-driven executive with a proven track record of delivering results and a passion for driving the best capabilities and services to the vulnerable members of the healthcare community.

Before he joined Modivcare, Ravine served as the Senior Vice President of Sales at VRI and held previous senior leadership roles, including Chief Revenue Officer at Acclaris, a Wills Towers Company, and Senior Vice President of Sales and founding team member of Silverlink Communications.

Ravine holds a Bachelor of Science from the University of Vermont.

Jacqualine Reid Social Science Research Analyst , Office of Evaluation and Inspections

Office of Inspector General   U.S. Department of Health and Human Services (HHS)

Jacqualine Reid is a Social Science Research Analyst in the Office of Inspector General, U.S. Department of Health and Human Services (HHS). She conducts national program evaluations on a range of issues effecting various HHS programs, including the Medicare Advantage program. She received her Ph.D. in Anthropology from American University.

Tom Rhodes Director – Payer Sales, Risk Adjustment

Wolters Kluwer, Health Language

Tom Rhodes, Director of Sales-Payer Risk Adjustment at Wolters Kluwer, Health Language, has more than eighteen years of experience in the healthcare industry with in-depth knowledge in the risk adjustment, HEDIS, business process outsourcing, natural language processing, medical record retrieval and coding services space. Prior to joining Health Language, Tom held various healthcare IT sales and sales management roles specializing in risk adjustment, quality improvement/HEDIS, data analytics, clinical decision support solutions and services for Reveleer, Change Healthcare, Molina Healthcare, and Truven Health Analytics. 

Tom holds an MBA in finance and healthcare administration from Northeastern University and a bachelor’s degree in psychology and behavioral science from the University of Wisconsin-Madison.

Hassan Rifaat Chief Executive Officer

Vatica Health

Hassan Rifaat, MD, is chief executive officer at Vatica Health and has more than 25 years of experience in the healthcare industry. Dr. Rifaat was previously chief executive officer of Windsor Health Group, a Medicare Advantage and supplemental insurance carrier based in Nashville, Tenn., with over 300,000 covered members. He served as chief operating officer at Outcomes Health Information Solutions and was senior vice president, eastern region, for Coventry Health Care. At Coventry, he managed seven health plans serving more than 1.5 million commercial, Medicare and Medicaid members in 11 states. He held senior executive positions at Humana, Inc., including regional CEO for Illinois and the southeast region and market president for Louisiana. Dr. Rifaat is a graduate of the University of Virginia School of Medicine and Harvard University, where he was an All-American player on the national rugby team.  

Francesca Rinaldo SVP, Clinical Product & Innovation

Sharecare

Francesca Rinaldo, MD, PhD, is SVP of Clinical Product and Innovation at Sharecare. She is a physician-scientist with expertise in clinical research and healthcare delivery innovation. Her role at Sharecare focuses on creating, implementing and scaling care models and technology for healthcare delivery and research. She is a subject matter expert in Aging and Late Life, and her clinical interests are strongly rooted in health services and technology aimed at improving the health of the rapidly aging global population.

Melissa Ritz SVP Client Success

Advantmed

Jennie Roberts Senior VP, Quality and Clinical Modernization

UnitedHealthcare

Jennie Roberts is Senior Vice President of Quality & Clinical Modernization for UnitedHealthcare. As a leading insurer serving more than 54 million people across the full spectrum of health benefit programs for individuals, employers and Medicare and Medicaid beneficiaries, UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting health and wellness needs, and sustaining trusted relationships with care providers. 

As Senior Vice President of Quality & Clinical Modernization, Jennie Roberts leads end-to-end strategy and drives effectiveness for programs impacting HEDIS and STARs results. This includes aligning the right program, the right population and the right resources for each market and health plan to help achieve targeted HEDIS and population outcomes. 

Since joining UnitedHealth Group in 2006, Ms. Roberts has held executive roles throughout the organization, including leading hospice and long-term care delivery teams, national clinical call centers and Medicaid program oversight. 

Ms. Roberts has retained a focus on patient care outcomes during her clinical practice and throughout her business career. Prior to joining UnitedHealth Group, she served in leadership positions including Director of Business Development with Independent Care Health Plan, Director of Health Operations for Assurant Health and Assistant Vice President of Managed care for United Heartland Inc. 

A graduate of Alverno College, Ms. Roberts holds a bachelor’s degree in Nursing and Biology and received her Master of Business Administration degree from the University of Phoenix.

Samantha Rodgers CPC, CRC, Provider Coding & Education Implementation Manager

Premera

Samantha Rodgers began her career in healthcare over 20 years ago as a volunteer educator in her local public health department.  Since then, she has worked in a variety of settings, including not-for-profit healthcare organizations, private medical practices, and payers.  While working for a payer as a certified medical coder, Samantha was introduced to risk adjustment, and soon after, become a certified risk adjustment coder and provider educator.  Samantha has continued her work as a risk adjustment coder and provider educator and currently leads a team of four coders at Premera Blue Cross.

Steve Romary MBA, PMP – Director, Risk Revenue and Strategy

Highmark

Steve Romary serves as Director of Risk Revenue and Strategy for Highmark, which proudly offers Medicare Advantage and ACA health insurance coverage to 600,000 members across PA, DE, WV, and NY.  Steve oversees the strategic vision, implementation, and execution of Risk Adjustment clinical gap closure programs.  Before devoting his work to Highmark, Steve provided technology delivery services as a consultant for an information technology firm.  Steve’s technology and health care experiences align to support innovative solutions that meet payer and provider needs.  In his free time, Steve enjoys travel, golf, and spending time with his family.

Lynda Rowe Senior Advisor, Value-based Markets

Intersystems

Ms. Lynda Rowe, Senior Advisor for Value-Based Markets at InterSystems is a subject matter expert around the shift to value-based payment models. She shares her expertise with customers and the industry through speaking engagements and published pieces. For the past two decades, Lynda has held senior-level positions in health information technology. She’s worked for payers, health systems, start-ups, vendors and the federal government. Prior to her role at InterSystems she was an executive in the health market at Booz Allen Hamilton, where she led a number of consulting projects for the Centers for Medicare and Medicaid and the Office of the National Coordinator within HHS. She provided leadership for quality measurement, health information technology use and adoption, health information exchange, interoperability and standards. She continues to be active in a number of national efforts including the HL7 Da Vinci project.

Aria Sameni Vice President of Growth and Strategy

Optum

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.

Craig Savage President & General Manager, Payer

Inovalon

Craig Savage serves as the President and General Manager of Inovalon’s Payer business, providing a portfolio of industry-leading cloud-based SaaS platform solutions empowering data-driven healthcare for a wide array of health plan and payer organizations. In this role, Craig leads and is responsible for the management, product portfolio, sales, delivery, operations, client success, and overall performance of Inovalon’ payer business.

Prior to joining Inovalon, Craig was a senior executive at Optum, Inc., a division of UnitedHealth Group, reporting to the Optum Insight CEO, where he served as Senior Vice President responsible for the global payer consulting organization. In this role, Craig oversaw a team of more than 1,000 personnel serving an extensive portfolio of health plan customers across six areas of Risk Management & Growth, Government Programs, Health Management & Operations, Payer Technology, Professional Staffing, and Payer Digital. Prior to his role at Optum, Craig served as Partner and Managing Director for the Health & Public Sector for Accenture, LLP where he directed the practice focused on payers and providers across Accenture’s key pillars of Enterprise Operations, Clinical Excellence, Growth and Innovation, Analytics, and Digital Health. Prior to joining Accenture in 2013, Craig had served in senior rolls at PWC Strategy& as Principal and Director of Global Healthcare, STS Capital Partners, Videre, Inc., and McKinsey & Company.

Craig graduated with a Bachelor of Science in Computer Science from the University of Maryland and has undertaken multiple postgraduate executive development programs at the University of Pennsylvania’s Wharton School of Business, Harvard Business School, and Southern Methodist University.

Kelley Scott, MSN, FNP-c Nurse Practitioner

Providence St Joes

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.

Eric Segal Sr. Director of Platform Strategy and Solutions

Episource

As Director of Platform Strategy and Solutions, Eric is at the intersection of Product, Operations, and Client Services with a focus on the development and execution of innovative healthcare solutions. He has a background in mobile technology and served as an Emergency Medical Technician in South Los Angeles. Eric holds a BA from Lehigh University and an MBA from the USC Marshall School of Business.

Reva Sheehan Sr. Director of Customer Insights

mPulse Mobile

Sheehan is an experienced government programs subject matter expert with more than 15 years of industry experience ranging from long-term care and compound pharmacy management to health plan quality and operations, previously leading Medicare 5-Star Quality initiatives at Priority Health. She is tasked with enhancing mPulse’s support of government plans through technology, relationships, and subject matter expertise.

Laura Sheriff, RN, MSN Vice President Operations, Risk Adjustment

Southwestern Health Resources (SWHR) 

Laura Sheriff, RN, MSN, is currently working as Vice President Operations, Risk Adjustment for Southwestern Health Resources (SWHR).  She also works as a consultant with physician groups and health plans to capitalize on risk adjustment performance and operations.  Laura is an MSN with >13 years’ experience in Medicare, Medicaid, and Marketplace Managed Care and has led teams in risk, quality, telehealth, and population health analytics.  Laura demonstrates effective leadership, innovative problem-solving techniques, and goal-oriented focus to execute business objectives and meet performance metrics.  Laura has designed and coordinated activities including provider education, training, auditing, data mining, and data analysis to direct program success.  Laura has a Master’s in Nursing Education and is also a certified professional coder and a certified risk coder.   Laura is also a frequent speaker for RISE, a best-in-class organization for all things related to accountable care and government healthcare reform.

Dr. David Shulkin Ninth Secretary, US Department of Veteran Affairs-Shulkin

Solutions, LLC

The Honorable Dr. David J. Shulkin was the ninth Secretary of the US Department of Veterans Affairs in the Trump Administration and VA’s Under Secretary of Health in the Obama Administration.  As such, Secretary Shulkin was the only member of the Cabinet to have served both Presidents and to have been confirmed by the US Senate by a vote of 100-0.  

As Secretary, Dr. Shulkin represented the 21 million American veterans and was responsible for the nation’s largest integrated health care system with over 1,200 sites of care, serving over 9 million Veterans. VA is also the nation’s largest provider of graduate medical education and major contributor of medical research and provides veterans with disability payments, education through the GI bill, home loans, and runs a national cemetery system.

Secretary Shulkin is a widely respected healthcare executive having served as chief executive of leading hospitals and health systems including Beth Israel in New York City, Morristown Medical Center in Northern NJ, and currently advises leading health systems.  Secretary Shulkin has held numerous physician leadership roles including the Chief Medical Officer of the University of Pennsylvania Health System, the Hospital of the University of Pennsylvania, Temple University Hospital, and the Medical College of Pennsylvania Hospital. Secretary Shulkin has held academic positions including the Chairman of Medicine and Vice Dean at Drexel University School of Medicine.  As an entrepreneur, he founded and served as the Chairman and CEO of DoctorQuality one of the first consumer orientated sources of information for quality and safety in healthcare.  Secretary Shulkin has served on boards of managed care companies, technology companies, and health care organizations.  He now works with healthcare organizations that are leading the transformation of medicine around the world. 

Secretary Shulkin is a board-certified internist. He received his medical degree from the Medical College of Pennsylvania, his internship at Yale University School of Medicine, and a residency and Fellowship in General Medicine at the University of Pittsburgh Presbyterian Medical Center. He received advanced training in outcomes research and economics as a Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania.

Over his career Secretary Shulkin has been named  “One Hundred Most Influential People in American Healthcare” by Modern Healthcare.  He continues to advocate on behalf of the country’s veterans by serving on the board of numerous nonprofits that serve veterans, is the host of the popular Policy Vets Podscast,  and is the author of the recent book, “It Shouldn’t Be This Hard to Serve Your Country: Our Broken Government and the Plight of Veterans”.

Follow @DavidShulkin

Melissa Smith EVP, Consulting & Professional Services

Healthmine

Melissa Smith is the Executive Vice President of Consulting and Professional Services at HealthMine, bringing over 25 years of experience in Star Ratings, strategy, sales, and marketing for health plans, providers, pharmacy benefit managers, and industry vendors. Melissa has extensive experience developing strategic and tactical solutions to meet client needs and a strong background of building productive partnerships across internal teams and with external vendors to improve performance on clinical, medication, patient survey, and administrative quality measures.

Most recently, Melissa was Senior Vice President of Sales, Marketing, Strategy and Stars at Gorman Health Group. She is a well-known thought leader and healthcare strategist with proven success developing enterprise-wide solutions to improve Star Ratings, quality performance, health outcomes, and the member experience. Melissa’s team helps clients improve performance within quality ratings systems, evaluate market dynamics and opportunities, optimize distribution channels, and support our clients’ strategic planning needs.

Prior to Gorman Health Group, Melissa served in a leadership capacity at Cigna-HealthSpring. Before working in Medicare Advantage and quality ratings systems, Melissa was an Associate Director at Vanderbilt University Medical Center. Melissa received her degree from Purdue University and began her career at KPMG, LLP. Melissa’s unique background of business process, regulatory compliance, and healthcare quality offers our clients unique access to healthcare strategy, quality performance, revenue optimization, and more.

Alyson Spencer Sr. Director, Clinical Quality

Blue Shield of California

Alyson Spencer joined Blue Shield of California in 2018 as the Senior Director for Clinical Quality Improvement where she oversees multiple quality programs across commercial, Medicare, and Medicaid (Medi-Cal). Alyson has direct leadership over Blue Shield’s clinical quality measurements functions including member expierence programs.

Alyson is a healthcare industry leader with over 16 years of experience she is driven by the conviction that everyone should have access to high-quality affordable healthcare. Alyson is focused on closing healthcare access gaps and improve quality measures, through identifying new ways to incentivize high-quality care for members by linking providers payment to savings and quality outcomes as well as engaging members in their health.

Prior to joining Blue Shield Alyson built and implemented Quality Improvement Programs, ensuring Accreditation and regulatory requirements are met in multiple states and has driven improvements from both a provider, hospital, and health plan perspective.

Alyson holds a B.S., Business Administration, is a certified specialist in business intelligence (CSBI) and will be obtaining her M.S., Healthcare Administration, June 2023.

Will Stabler Executive Vice President, Payer Solutions 

GeBBS Healthcare Solutions

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.

Jill Strassler VP Product Management, Payer Analytics

Veradigm

Scott Stratton MPH, Chief Data Scientist & VP Industry Development

Veradigm

Scott Stratton, Pulse8's 5th employee, is the Chief Data Scientist and leads the Industry Development team within Business Development at Pulse8/Veradigm. He is an industry leader in the design, development, and adoption of innovative analytic products.

He has won a number of awards such as Computerworld's Global Best Practices in Business Intelligence and Analytics, the URAC award for applying Six-Sigma analytics to reduce diabetes medication errors, Creative Excellence Award from the International Foundation of Employee Benefit Plans for the nation's first urban CHIP program.

His background includes hospitals, managed care, Pharma, PBM, regulatory, and start ups. At Yale he studied under the creators of DRs and worked on the development of RUGs for long-term care reimbursement. His application for a Method And Apparatus For Risk Adjustment is currently pending with the US Patent and

Trademark Office.

Mikal Sutton Managing Director, Medicaid

Blue Cross Blue Shield Association

Mikal Sutton is Managing Director of Medicaid policy for the Blue Cross Blue Shield Association (BCBSA), a national federation of thirty-four independent, community-based and locally operated Blue Cross and Blue Shield (BCBS) companies. BCBSA covers 114 million lives across all lines of business in the U.S. and Puerto Rico. Twenty-four of the BCBSA Plans operate a Medicaid program in twenty-nine states and Puerto Rico with more that twelve million Medicaid members. 

With almost 15 years of experience Sutton has collaborated with state and local agencies, organizations, and external stakeholders to build substantive policy solutions. Sutton oversees detailed Medicaid policy analysis and strategies to support BCBS companies, in collaboration with BCBSA’s legislative, regulatory, research and modeling teams. Since joining the Association in 2020, Sutton has worked on regulatory and policy development on a wide variety of program issue areas including maternal health, social determinants of health, long-term services and supports, expansion of Medicaid and the Public Health Emergency unwinding. 

Sutton has worked on Medicaid policy in Illinois, policy initiatives with the Illinois Department on Aging and as a director of grant operations for a Robert Wood Johnson Foundation grant focused on growing the nursing pipeline in Illinois. Sutton has a master’s degree in political studies and a bachelor’s degree in communications from the University of Illinois at Springfield. 

An Illinois native, Sutton earned a bachelor’s degree in communications and master’s degree in political studies from the University of Illinois, Springfield. She enjoys outdoor activities, listening to music and traveling with her family.

Elaine Taverna Senior Vice President for Risk Adjustment and Quality

Advantasure

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. 

Ally Thomas Ph.D., AVP, Quality Improvement

UPMC Health Plan

Megan Tinker Chief of Staff

Office of Inspector General   U.S. Department of Health and Human Services (HHS)

Megan Tinker is Senior Advisor for Legal Affairs for the Office of Counsel to the Inspector General, U.S. Department of Health and Human Services. She advises the OIG on jurisdiction and oversight issues under the IG Act, and health care fraud and compliance matters, including Medicaid, Medicare and grant programs. Ms. Tinker is responsible for executive level direction and oversight on highly complex and sensitive matters for which the Office of Counsel provides legal advice and representation to OIG officials. This includes a wide range of issues dealing with fraud, waste, and abuse in HHS programs and grants.

Ms. Tinker has testified before Congress, and spoken to the Health Care Compliance Association, Association of Government Accountants, Association of Healthcare Internal Auditors, and American Health Lawyers Association. Ms. Tinker provides training on multiple topics including OIG jurisdiction and authorities. Ms. Tinker is also a guest lecturer at the American University, Washington College of Law, Health Law Program. Ms. Tinker graduated cum laude from American University, Washington College of Law and with honors from University of Richmond.

Elissa Toder VP, Quality Improvement Strategy & Solutions

Reveleer

Elissa Toder, Vice President of Quality Improvement Strategy and Solutions has worked in managed care for over 16 years as a former Staff Vice President of Quality Improvement.

Siva Tunga Chief Product Officer

Invent Health

For the past 19 years, Siva has excelled in developing successful healthcare products focused on risk adjustment, value-based care analytics, and encounter data workflow management. He has extensive experience working with various risk adjustment models and developing solutions for risk analytics.

Currently, Siva is fully committed to driving operational efficiency in risk adjustment and quality programs across all business lines. To achieve this objective, he employs cutting-edge reporting tools, advanced analytics, and streamlined workflow engines. Siva's ultimate goal is to optimize healthcare delivery and outcomes by implementing innovative solutions that enhance data-driven decision-making processes.

Jessica Wack-Alexander MBA, Program Manager, Health Care Services

Providence Health Plan

Within her role, Jessica works in close partnership with leaders throughout Providence Health Plan to support and lead key initiatives that enhance operational efficiency, manage medical expense, improve quality for members, shepherd process improvement, and coordination of data analysis and evaluation. Jessica has been in health care for nearly 10 years and is an expert in implementing and managing programs focused on improving health care delivery and quality. Jessica received both her Bachelor's of Science and her Master's of Business Administration from Oregon State University.

Susan Waterman Trainer, Director, Risk Adjustment

Baylor Scott & White

As Director of Risk Adjustment, Susan Waterman has been empowered to plan, design, and oversee business and strategic coding and education objectives to optimize the Risk Adjustment Department . Responsible for ensuring the accuracy of risk adjustment payment, while successfully managing activities related to Medicare Advantage, DSNP, ACA, and HIX 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.

Bruce Waugaman Risk Adjustment Leader

EmblemHealth

Bruce has been a part of the EmblemHeatlh group for over six years, and currently serves as a lead in the Risk Adjustment Provider Engagement area.  Prior to joining EmblemHealth, Bruce worked in multiple areas of the healthcare industry, including various local and national payors, vendors, and external consulting positions. While dedicating more than 12 years in the risk adjustment arena, Bruce has taken immense pride in delivering engagement expertise and building new relationships.

Bruce has made his home in the New York City area for over 25 years, after originating from the Pittsburgh area in Pennsylvania. In his spare time, Bruce enjoys going on hiking excursions with his son and has a love of travel. He also looks forward to meeting new people and learning new things. Following the presentation, Bruce can be reached at BWaugaman@emblemhealth.com.

Scott Weiner Director, Government Programs

Sentara

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.

Meghan West Sr. Manager Product Management, Clinical Data Exchange

Veradigm

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.

George Witwer CEO

Cavo Health

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.

Michelle Zilisch Director, Product Management

Ciox Health

Michelle Zilisch serves as Director, Product Management at Ciox Health/Datavant. With more than 20 years in adult education training experience and 16 years healthcare, Michelle has led the training and implementations for provider and facility EMR/EHR systems, Health Information Exchanges, hospital time and attendance systems, capital purchasing/budgeting software, and Medicare Advantage, Medicaid and ACA Risk Adjustment and Quality software and services solutions for health plans. Her career in Risk Adjustment and Quality has focused on intervention identification, coding, submissions, and clinical documentation improvements through knowledge management, improving efficiencies, customer engagement, and compliance management. Michelle has a Master of Arts in Curriculum and Instruction: Educational Technology from University of Northern Iowa and enjoys spending her free time in the kitchen cooking and baking for family, friends, and colleagues.