Duke-Robert J. Margolis, MD, Center for Health Policy
David Anderson is a research associate at the Duke University Margolis Center for Health Policy. His research focus is on applying my pragmatic expertise gained during my industry experience with large claims data sets for Medicaid, Medicare Advantage and Medicare fee for service and employer sponsored insurance claims analysis. His current research interests are in the individual market insurer strategy and consumer buying choice structures as well as palliative care payment reform options at the end of life. He has been published in the New York Times, JAMA-Internal Medicine, Health Services Research, Journal of Health Policy, Politics and Law, Journal of Symptom and Pain Management as well as numerous op-eds and Health Affairs blogs.
Su Bajaj Vice President of Product and Payer Solutions
Suhas built extensive solutions for payors, including ACOs, Medicaid, MA, and the ACA exchange. She uses technology to integrate Revenue Programs with Quality and Care Management while maintaining a dedication to adding value to the beneficiary's experience with the health plan through those solutions.Suhas aBachelors in Economicsfrom Northeastern University in Boston, MA and is a Six Sigma Yellow Belt.
Dr. Allysceaeioun D. Britt is a public health practitioner with more than 20 years of public service in local and state government with focus on population health engagement to address social determinants health for Medicaid populations. She has led initiatives for State Medicaid expansion and continuous enrollment (Oklahoma), state enrollment assistance program for pregnant Medicaid eligible women within local rural and metropolitan health departments and a statewide expansion, integration and sustainability of an evidence-based smoking cessation program targeted for pregnant women (Tennessee). She also serves as an adjunct professor at Trevecca Nazarene University Skinner School of Business Education and Technology -Health Care Leadership Program. She is the founder of IMPAACT Health which provides support to community-based organizations by creating innovative models which promote, advocate and advance a community’s health for tomorrow.
When she is not working or teaching, she enjoys serving in her community and promoting health as an activity member of Lake Providence Missionary Baptist Church Health Ministry; member of Kappa Lambda Omega Chapter of Alpha Kappa Alpha Sorority, Incorporated Health Committee and an active member of the Music City (TN) Chapter of The Links, Incorporated Health and Human Services Facet.
She holds a Bachelor of Science in Biology from Florida State University, Masters of Public Health – Health Care Administration and Policy from University of Oklahoma Health Sciences Center and Doctorate in Public Health – Community Health from Walden University.
In her free time, she enjoys singing in her church choir, playing the piano and traveling with her family.
Tim has over 15 years of professional experience in health care operations and regulatory risk management. A strategic and forward-thinking business executive, Tim has a proven track record of success in risk adjustment operations, coding and documentation programs, regulatory compliance, and consulting and business advisory services. Throughout his career, Tim has demonstrated effectiveness as a leader with an ability to build and coach teams that deliver integrated and optimal results.
In his current role as National Vice President for DaVita Medical Group (DMG), Tim is responsible for the national strategy, development, and implementation of programs focused on comprehensive health assessment and quality, coding documentation improvement, and revenue accuracy. In this capacity, Tim is responsible for the oversight of six geographic markets and a growing national infrastructure, focused on DMG’s Medicare Advantage patient population.
Previously, Tim served as the Compliance Officer for DMG, Vice President of Compliance for DaVita Kidney Care, and was a management consultant with PricewaterhouseCoopers’ Health Care Practice
Dr. Burroughs serves as Dean of the College for Public Health and Social Justice at Saint Louis University (SLU). In his current role he leads a unique college that combines a School of Public Health and School of Social Work with highly ranked programs in Urban Planning, Criminology and Criminal Justice, and Health Administration. This multidisciplinary college is home to more than 1200 students, 60 faculty and 11,000 alumni working together to address the significant health and social challenges facing society today. Dr. Burroughs’ career has spanned academic, corporate, and consulting worlds, and has been dedicated to improving health outcomes through advanced analytics, health interventions and translation of research into health policy. Prior to joining SLU, he was the Director of Performance Measurement for BJC Health System in St. Louis where he designed and led online surveillance and reporting systems that served more than 2,000 health system managers. He has consulted for organizations such as Harvard’s Beth Israel Deaconess Medical Center, Presbyterian Healthcare and Princeton University Health Services on the design of clinical surveillance systems and has led training for the Institute for Healthcare Improvement. He was also the co-founder of a surveying company that provided business intelligence to international corporations including Emerson, Monsanto, Sprint, Anheuser Busch, and Hyatt Hotels. Throughout his career, he has spent extensive time advising corporate leadership on organizational performance, market position and strategies for strengthening performance. Dr. Burroughs holds graduate degrees in mathematical statistics and psychology from Southern Illinois University and Washington University. His research has been funded by the NIH, VA, private foundations and corporations. He is the author of more than 90 peer-reviewed articles and book chapters and serves on numerous committees and boards.
Deb joined Paramount Healthcare in May 2013 and manages the Medicare, Medicaid, and Commercial Marketplace Risk Management Program. Additionally, she is a member of Paramount’s STARS/HEDIS/Medicaid P4P and FWA strategic teams. Prior to her position with Paramount she had 19 years’ experience working with the State of Ohio workers’ compensation program, both for the government and a contracted managed care organizations. She came to Paramount with extensive knowledge in medical coding, provider billing and education, Medicare payment methodologies, quality assurance, and regulatory compliance.
Deb graduated from the University of Toledo with a Bachelors of Science in Health Information Management and will graduate with her Masters of Business in Healthcare Systems Management from the University of Toledo in December 2015. She is an active member of the American Health Information Management Association (AHIMA) and is a Registered Health Information Administrator (RHIA), Certified Coding Specialist, physician based (CCS-P), and certified ICD-10 trainer through AHIMA.
Deb is blessed with one awesome husband of 24 years, three amazing children (one son-in-law), and one adorable grandson who all fill her life with a lot of joy, a little mischief, and a whole bunch of love.
Jeff De Los Reyes
AVP, Product Operations, Analytics and Reporting, Government & State Sponsored Programs
Jeff De Los Reyes AVP, Product Operations, Analytics and Reporting, Government & State Sponsored Programs
Jeff De Los Reyes has over 15 years of experience in the healthcare industry including more than 8 years leading risk adjustment strategy and operations at both health plan and provider organizations. In his current role, he leads Risk Adjustment and Revenue Management across EmblemHealth for Government and State Sponsored programs for Medicare Advantage, Medicaid and ACA.
Prior to his role at EmblemHealth, Jeff worked at Optum in the Risk, Quality and Network Solutions business, where he was responsible for driving product and program strategy for both retrospective and prospective risk adjustment solutions. Jeff also held roles at Optum Advisory in the Risk Adjustment practice area, were he helped clients develop and execute their risk adjustment strategies.
Dr. Shannon I. Decker is the Executive Director of Risk Adjustment for NAMM California, Primecare, Part of OptumCare. Dr. Decker has more than 15 years of experience in healthcare, 11 of which include working with Risk Adjustment and Medicare. Dr. Decker has a PhD. in Interdisciplinary Studies, a dual MBA, one in Finance, the other in Marketing, as well as an M.Ed. in Secondary Education and a M.Ed. in Administration and Leadership. Dr. Decker is also an Associate Professor of Higher Education and Adult Learning (HEAL) and Chief Methodologist for Walden University where she chairs and oversees the dissertations of doctoral students. An author of two books as well as several peer reviewed articles, she consults in both the fields of healthcare and education. Her interests include the study of human behavior and how theories on motivation and learning may be brought to bear on population health management.
MHA, Senior Vice President and Chief Operating Officer
Mr. William J. DeMarco is President and CEO of Pendulum HealthCare Development Corporation. He created Pendulum Health based upon 40 years of executive and consulting experience in health care delivery research, design, development and management. He earned his early credentials working with several health plans in the competitive St. Paul/Minneapolis marketplace in 1975. He was involved in developing both government health system solutions for Medicaid and Medicare and also working with employers.
Mr. DeMarco gained national recognition in working with physicians and building physician relationships with payers which led to his leadership in developing many physician owned enterprises including Health Plans, ACOs and Physician Hospital Joint Ventures.
Authoring several papers on RBRVS, he received many invitations to Medical Societies and Hospital Associations as well as commendation from the White House for his early work in Alternative Payment Models. He was also recognized for his work in Managed Care strategy development by the Health Care Financial Management Association and received a Follomer Award for his work in advanced Managed Care contracting.
Based on the consistent effort to bring purchasers and physicians together in a mutually beneficial reimbursement framework, Mr. DeMarco assisted a broad variety of health systems, employers and over a dozen newly forming ACOs. His work has led in the development and expansion of provider sponsored health plans in 30 states and the Commonwealth of Puerto Rico.
Recognizing the need for comprehensive management services for emerging Clinically Integrated Networks, he founded Pendulum HealthCare Development Corporation in 2001 as the resource to support health care enterprises through their evolution into value based care. He holds degrees in behavioral science and a Masters in health care from DePaul University and is author of 7 books and over 100 articles on care design and management.
David DiGiuseppe Vice President of Healthcare Economics
Community Health Plan of Washington
David DiGiuseppe is the Vice President of Healthcare Economics at Community Health Plan of Washington (CHPW), a not-for-profit health plan serving 260,000 Medicaid managed care and Medicare Advantage members in Washington State. David’s expertise includes integrated managed care, population health, healthcare financing and value-based purchasing. Prior to joining CHPW, David worked for the University of Washington’s Child Health Institute conducting outcomes research on a wide range of child health issues.
As Managing Director of Engagys, Kathleen brings the best of consumer marketing and data-driven methodologies to healthcare to motivate better health decisions. Engagys is a healthcare consultancy lasered focused on consumer engagement and experience. Prior to founding Engagys, Kathleen led the consumer engagement consulting practice for Silverlink for 12 years leveraging Silverlink's data repository of over a billion consumer health interactions, the best of behavioral economics and the latest in clinical research to help health plans and PBMs close the last mile of consumer engagement.
Kathleen is an award-winning, high energy, engagement expert with over twenty-five years of experience. She speaks regularly on the national stage on many topics including: driving consumer health engagement, creating better consumer experience in healthcare, motivating and inspiring consumers, and using data to drive consumer behavior. She has been recently named as a consultant to the first ever FDA Patient Engagement Advisory Committee (PEAC).
Kathleen is frequently quoted in both national and trade press. Her bylines have appeared in Executive Insights, Predictive Modeling News, and AHIP Smart Brief. She recently received two Stevie awards, Maverick of the Year, Silver 2015 and Innovator of the Year, Bronze, 2016, for highlighting the greatest challenges and opportunities for improving the lives of people who are afflicted with chronic conditions.
Kathleen spent the first twenty years of her career in brand marketing at leading consumer marketing organizations, including General Mills and P&G. Additionally, Kathleen was a Vice President at Digitas, one of the leading direct marketing firms in the country. She also spent many years in marketing at various consumer, technology and media companies throughout the Boston area. Kathleen has an undergraduate degree from the University of New Hampshire and an MBA from the Kellogg School at Northwestern.
Stacy Garrett-Ray, MD, MPH, MBA Vice President, Medical Director, Population Health Services Organization, President, Quality Care Network
University of Maryland Medical System
Stacy Garrett-Ray, MD, MPH, MBA is the Vice President/Medical Director of the University of Maryland Medical System’s Population Health Services Organization and President of both the University of Maryland Quality Care Network and Transform Health MD. Dr. Garrett-Ray’s responsibilities include leading, planning, development, and execution of value-based, population health initiatives and innovations for multiple populations (approx. 100K commercial, federal, self-insured patients) with over $1B in medical costs. She received her Bachelor of Science degree with a Biology major and Women’s Studies minor from the University of Richmond where she was a Cigna Scholar, her medical degree from the University of Maryland School of Medicine, her family medicine residency at the University of Maryland Dept. of Family and Community Medicine where she served as chief resident. She received her MPH and MBA from Johns Hopkins Bloomberg School of Public Health. Previously, Dr. Garrett-Ray also served as the medical director of the Baltimore City Cancer Program of University of Maryland Greenebaum Cancer Center which provided cancer screening, treatment and diagnostic services to low-income residents of Baltimore. In 2010, Dr. Garrett-Ray was directly appointed to service as the national Deputy Director of Comprehensive Women’s Health for the Veterans Health Administration and later held other leadership positions to support VA Senior Leadership including serving as the Deputy Director of the Office of Strategic Integration. Her responsibilities included overseeing the operations of the Integrated Health Operating Portfolio nationally for VHA with a budget of approximately ¾ of $1 billion which included Patient Aligned Care Teams, Women’s Health, Telehealth, Virtual Care Non-Telehealth, Non-Institutional Long Term Care, Specialty, Patient Centered Care, Systems Redesign, GAO High Risk, Access to Care initiatives, and later VA Pulse.
Risk Adjustment Quality and Education Program Manager
Colleen Gianatasio Risk Adjustment Quality and Education Program Manager
Capital District Physicians’ Health Plan
Colleen Gianatasio CPC, CPC-P, CPMA, CPC-I, CRC has 18 years of experience in the health insurance field. She has experience in customer service, claims, quality and coding. As Risk Adjustment Quality and Education Program Manager for Capital District Physician’s Health Plan (CDPHP) Colleen’s primary responsibilities are provider engagement and clinical documentation improvement for accurate coding. Colleen specializes in developing innovative coding curriculum and instruction to support compliance with federal guidelines and appropriate reimbursement processes. She is a certified AAPC instructor and enjoys teaching a variety of coding, documentation and auditing classes. Colleen serves as President-Elect of the AAPC National Advisory Board.
Renee Golderman Senior Vice President of Health Care Quality
Capital District Physicians’ Health Plan
Renée S. Golderman, MS, RN, NE-BC joined CDPHP in 2007 and currently serves as senior vice president of health care quality. In this role, she leads the design, implementation, and management of a quality improvement program focused on providing CDPHP members with efficient, cost-effective, and timely care. Renée also oversees credentialing and appeals. With more than 30 years of progressive experience in the health care industry, Renee is also responsible for directing HEDIS, NCQA, and Medicare Stars initiatives, which includes collaboration among Medicare risk, medical management, and network providers to drive innovative initiatives to improve quality outcomes and ensure member satisfaction with their health care. She has led health care transformation initiatives, including tools for population health and clinical integration strategies, and assists in design and operational aspects of primary care incentive programs.
Renee served as the director of nursing for Seton Health System, part of the Ascension Health System where she was a recipient of the NYSNA Nursing Excellence Award in Administration/Management. In addition, she held clinical management positions at New England Baptist Hospital in Boston, Mass., and New Britain General Hospital in New Britain, Conn. She also served as a clinical educator for The Eddy in Troy, N.Y. Renee earned a Bachelor of Science degree in nursing from SUNY Buffalo, and a Master of Science degree in health care management from Rensselaer Polytechnic Institute. Renée is an executive-board certified nurse by the American Nurses Credentialing Center (ANCC) and is a member of the New York Organization of Nurse Executives (NYONE).
Ms. Grossman is one of the nation’s foremost experts on Medicare Advantage, Medicaid, and Commercial physician engagement, risk adjustment, quality, HEDIS success strategies, and moving to value and risk reimbursement. She is a thought leader in healthcare business strategy and product development. Her expertise extends to provider enablement and engagement, HEDIS, STARS, QRS, analytic design, care impact, and best practices implementation. She has a wide variety of healthcare experience at organizations that include health plans, medical groups, Physician Hospital Organizations (PHOs), start-ups, integrated hospital systems, and the Institute of Health Professionals Education.
Ms. Grossman has held executive positions that encompass her areas of expertise which include: Hierarchical Condition Category (HCC) and Medicaid risk adjustment, network alignment and management, executive client relationship management, predictive and reimbursement modeling, MLR strategies and implementation, business development, strategic planning, building Centers of Excellence, acute and chronic care pathway creation, and product development and marketing for healthcare companies.
Before joining DataLink, she held executive roles with ArroHealth, Gorman Health Group, CenseoHealth, and Optum. Over the past fifteen years, Ms. Grossman has been a founding partner in three risk adjustment, quality, and cost of care reduction companies focusing on Medicare Advantage, ACA, and Medicaid. Prior to that, Ms. Grossman served as Health Net of Arizona’s Vice President of Network Strategy and Development, as well as serving in roles at Scottsdale PHO and Blue Cross Blue Shield of Arizona. She holds a Master of Science in healthcare planning from Florida State University.
Michael Hasbany is Executive Vice President, World Wide Sales at Inovalon. The Inovalon Technologies family of businesses provide the essential Healthcare software, analytics and advanced professional services for organizations. The company services customers of all sizes across Providers, Health Plans, Specialty Pharma to Life Sciences with the industry’s most comprehensive and innovative portfolio.
Michael brings more than 28 years of experience in technology sales, management and marketing. Michael leads an organization focused on attracting, retaining and expanding corporate customers by guiding their IT transformation. Prior to assuming his current role, Michael led Texas Enterprise Sales at DELL. In this role, Michael worked with DELL’s Global Alliances group, Providers, System Integrators, Outsourcers, OEMs, Industry Sales, and Market Development.
Michael is a 18-year veteran of DELL. Prior to joining Dell, he served for five years as Vice President and General Manager of the Brinkmann Corporation’s Americas Retial Division. Michael has also held key executive leadership and sales management positions at several smaller companies. He holds a Bachelor of Science degree in Computer Science from the Arizona State University as well as an MBA from the SMU Cox School of Business.
Eric has been involved in healthcare financial analytics since 2011 where he worked in the actuarial department of a regional health plan in Michigan. There he developed the financial models to assess pricing implications of risk adjustment changes and initiatives for both MA and ACA lines of business. Additionally, he supported the provider network with analytics and reporting to help them be successful in their contracts. It was in those contract negotiations that Eric gained a passion for helping providers succeed as the market shifts to alternative payment models.
Since joining Pulse8 in 2015, Eric has been involved in supporting customers with their risk adjustment initiatives, building financial models, and enhancing inferencing engines. Today he leads the provider solutions team at Pulse8, building tools to enable provider organizations to better manage medical expenditures and risk adjustment for their APM contracts.
Eric graduated with a BS in Mathematics from Grand Valley State University. He lives in West Michigan with his wife and two young boys, where they enjoy the sandy shores and beautiful sunsets of Lake Michigan.
Amy Nguyen Howell, MD, MBA FAAFP Chief Medical Officer
America’s Physician Groups
Dr. Amy Nguyen Howell is a practicing family practice physician at Cedars-Sinai Medical Network. She leads the clinical and educational programs as the Chief Medical Officer at America’s Physician Groups (APG) and supports the advocacy and leadership pillars of excellence at APG through legislative and networking events throughout the country. She serves a member of CMS’ Technical Expert Panel (TEP) for the MACRA Measurement Development Program for the Quality Payment Program (QPP) and on CMS’ TEP for the Medicare Advantage (MA) Star Ratings Program, and she is a leader on the Population Based Payment Workgroup, as part of the Healthcare Payment Learning and Action Network (LAN), recommending national guidelines for an effective population-based payment model. Dr. Nguyen actively serves on the Measures Application Partnership (MAP) Clinician Workgroup, providing input to the Coordinating Committee at the National Quality Forum (NQF) on matters related to the selection and coordination of measures for clinicians, particularly in the office setting. Additionally, she sits on the steering committee of the Core Quality Measures Collaborative and chairs the Patient Experience/ Patient Reported Outcomes (PROs) Core Measure Set Workgroup, while also participating on the ACO/PCMH and Pediatric Workgroups, setting national core measures for these specialties. Further, she contributes to the Population Health Management, Clinical Programs, and Patient-Centered Specialty Practice Advisory Committees at the National Committee for Quality Assurance (NCQA), which provides guidance on provider quality measures and requirements. By participating on these national committees, she offers guidance, structure and strategy around innovation, quality and technology to risk-based coordinated care delivery models, focusing on payment reform and integrated person-centric care. Also, Dr. Nguyen is an adjunct faculty member at University Southern California (USC) Sol Price School of Public Policy and teaches Quality of Care for the Master’s in health administration (MHA) program. She serves as member of the Steering Committee at the California Quality Collaborative (CQC) of the Pacific Business Group on Health (PBGH). Also, Dr. Nguyen serves as a member on the Steering Committee at the California Maternal Quality Care Collaborative (CMQCC) and is an active member of the Alternative Payment Model Infrastructure (APMI) Taskforce, part of Healthcare Information Management Systems Society (HIMSS). These national and regional committees provide structure for an innovative coordinated delivery model focused on payment reform and integrated person-centric care. She has most recently served as the Chief Medical Officer at Easy Choice Health Plan, a WellCare Company, where she oversaw clinical direction of medical services within appeals and grievances, care management, utilization management and quality improvement for 56,000 Medicare patients and 16,000 SNP members. Dr. Nguyen has extensive managed care experience overseeing revenue, quality and cost savings for over 500,000 lives in Commercial, Medicaid and Medicare lines of businesses with responsibility for profit/loss budget of over 700 million dollars. She has built strategic partnerships between medical groups, hospitals, external vendors and sales, especially in the areas of Advanced Illness Management, Care Coordination, Dual Eligibles, Quality Improvement and Practice Transformation.
Brooke Ivey joined Bloom as a phone agent in 2007. Since then, she has steadily moved up the ranks to become the leader of Bloom's business development team. Brooke is a natural people person who loves to make connections among her contacts and share new information and ideas. Her expertise in Medicare sales and call center campaigns make her a valuable asset to both Bloom and its clients.
With a constant ear to the ground, Brooke identifies issues and needs in the health insurance industry and works to solve them. She has represented Bloom at industry events, presented numerous webinars, and written about the health insurance industry for a variety of publications and websites. Her mission is to improve lives through stronger networks and better tools.
Associate Vice President of Product Management & Strategy
Judy Kang Associate Vice President of Product Management & Strategy
Judy Kang is the VP of New Markets and Ventures at Healthfirst, a not-for-profit provider-sponsored health insurance company serving more than 1.3 million members in downstate New York. She currently leads the development of Medicare product management and strategy for the approximately 160,000 Medicare members Healthfirst serves as well as initiatives to incubate and implement new business concepts supporting the entire organization. Prior to her role at Healthfirst, Judy was a Healthcare consultant with a focus on the employer health and welfare industry. She holds a BS from New York University and an MBA from the Wharton School at the University of Pennsylvania.
Senior Vice President – Risk Adjustment and Coding Operations
Carey Ketelsen Senior Vice President – Risk Adjustment and Coding Operations
Carey Ketelsen, Senior Vice President of Risk Adjustment and Coding Operations at Ciox Health is an accomplished senior healthcare leader with a strong commitment to innovation and performance. For the past 18 years, Carey has been a trusted advisor dedicated to providing exceptional service to her clients and a catalyst for change. She excels at utilizing non-traditional methods and leveraging data analytics to uncover hidden opportunities to optimize revenue and maximize profits. Prior to joining Ciox, Carey was the Executive Director at GlobalHealth and Senior Operations Manager at Zotec Partners where she spearheaded programs in Risk Adjustment, Quality Improvement, cost containment, and revenue optimization.
William Kinsman Senior Manager of Product Innovation
William Kinsman, Senior Manager of Product Innovation, manages Inovalon’s Artificial Intelligence team and the implementation of their products. In his first year at Inovalon, Mr. Kinsman has made it his goal to bring clinicians and this technology together by leading the development of the advanced natural language processing algorithms presently in Inovalon’s product offerings. He collaborates with Professors and Doctorial candidates from the University of Maryland and the New Jersey Institute of Technology to bridge the gap in healthcare data extraction and develop never before seen approaches in patient-centric healthcare, with a focus on patient gap detection and intervention optimization.
Mr. Kinsman has over 6 years of experience in the construction of machine learning algorithms. Prior to joining Inovalon, he led the development of several novel language processing algorithms as a contractor at the National Security Agency, but also has previous work experience as a developer at a high frequency trading firm and as an engineer at NASA. He received his Bachelor’s degree from Clarkson University in mechanical engineering prior to years of research in electrical materials research at Penn State University.
John M. Kirk recently retired from a 16-year term as the founding CEO of Pioneer Medical Group, a multispecialty medical group in the Los Angeles area. He also served as CEO of Eagle Business Performance Services, a medical management company organized as a joint venture with the McKesson Corporation. He was a member of Board of Directors of the California Association of Physician Groups for over ten years, most recently serving as the Vice-Chair of its Public Policy Committee. After having been retired from Pioneer for fourteen months, he was called back to duty as CEO in June, 2018, due to the resignation of his successor. He “re-retired” ten months later.
His prior experience includes service as CEO of a four-hospital system in New Mexico, Medical Group CEO/COO responsibilities in San Diego and Fort Worth, Board membership in a private equity-funded hospital corporation, as the principal of a consulting firm, and in the private practice of law.
Kirk is a decorated veteran of the Vietnam War. He holds an AB from the Johns Hopkins University and a JD (cum laude) from the University of New Mexico.
Donna Malone CPC, CRC, Senior Manager of Enterprise Risk Adjustment, HCC Coding and Quality Assurance
Tufts Health Plan
Donna has been on the job with the Tufts Health Plan in their senior products division since August 2014, and is responsible for audit and coding review management, development and implementation of department and vendor policies and procedures, simulation RADV Audits for preparedness, coding team performance management and provider education development and management. Additionally, Donna serves at the MassBay Community College in Framingham, where she has been an advisor / professor for nearly 10 years. Her specialty area is the Medical Coding Certificate and Medical Office Administration Program.
Prior to Tufts Health Plan, Donna worked for Blue Cross Blue Shield of Massachusetts as an HCC Professional Audit III for four years. Earlier, she worked for AM B Care for 9 years and Maine Medical Center.
Ms. Marta has been with Inovalon since 2008 and serves as the Senior Director of Quality.In this role, she is responsible for coding and abstraction oversight for all clinical review staff, and also oversees the Quality Clinical Review Team, which is responsible for performing client audits and monitoring quality oversight.
Ms. Marta began her career in the early 1990s in patient care and later hospital management in both Maternal/Child Health and Adult Critical Care.She has also held positions with Spacelabs Medical/General Electric as a Clinical Application Specialist and later as a Project Manager, and has provided utilization management training and coding education in the role of Corporate Clinical Trainer for a national health plan.
Ms. Marta maintains an active RN license from the state of Maryland and received her BSN from Georgetown University in Washington, DC.
J. Gabriel McGlamery J.D. Senior HCR Policy Consultant
Florida Blue Center for Health Policy
Gabriel McGlamery is in charge of Federal regulatory policy for Florida Blue’s individual market business. This means analyzing, influencing, and general problemsolving for the insurer covering roughly 10% of Marketplace enrollment. Prior to joining Florida Blue in 2012, Gabriel helped develop the rules for the ACA at HHS and graduated with honors from the University of Connecticut School of Law.
Dave is a strong leader with 14+ years of experience in Revenue and Clinical Outcomes Program Development and Management in various healthcare environments (Plans, MG/IPA, Academic, and Consulting). Proven record of success in optimizing Operations, PE / Investor Meetings, Maintaining Compliance, Recovering / Maximizing Revenue, Enhancing Clinical Quality and Developing Software and Custom Analytics.
Specialties: RA / HCC, Pay for Performance (P4P), CMS Stars Program, NCQA HEDIS, Off‐shore Software Product Development, HOS, CAS, NCQA Accreditation, Physician Profiling, Encounter Programs, Contract and Claims Analytics.
Previously, Dave served as an independent consultant to healthplans, was Corporate VP, Operations (Revenue and Quality) at InnovaCare Health. He has also performed as Sr. Consultant, Risk Adjustment and Health Plan Operations for Dynamic Healthcare Systems, and in other roles with healthplans.
Creagh Milford, DO MPH, FACOI is a physician executive who serves as the Chief Medical Officer for Healthcare Highways, a healthcare innovation company based in Dallas, Texas. He has a passion for improving healthcare, specializing in population health management, healthcare informatics, analytics, and innovation.
Dr. Milford has held several C-suite positions. Recently, he served as the Chief Executive Officer of FullWell, a population health management services company, which was sold in 2017. Previously, Dr. Milford served as the system-wide division president of population health services of Mercy Health. He served as Assistant Chief Medical Information Officer for Massachusetts General Physician Organization (MGPO) and Massachusetts General Hospital (MGH), a Harvard teaching hospital. He also served as Associate Medical Director for Population Health Management at Partners Healthcare, a Boston-based health system founded by MGH and Brigham and Women’s Hospital.
Dr. Milford remains engaged in national health policy. He was nominated as a Fellow of the National Academies of Medicine, where he participated on the Board on Population Health. He has also held positions within the Centers for Medicare and Medicaid Services and the Department of Health and Human Services Office of the National Coordinator for Health IT, focusing on federal policy for value-based purchasing and health IT.
He earned his bachelor’s degree from the University of Colorado at Boulder and his D.O. degree from the Chicago College of Osteopathic Medicine at Midwestern University. Following a residency at the University of Chicago-North Shore and a fellowship in Health Management and Policy at Massachusetts General Hospital, he earned a master’s degree in Health Management and Policy from the Harvard School of Public Health, where he continues to serve as a guest lecturer.
Greg Pastor Managing Director of Risk Adjustment Operations
Greg Pastor is Managing Director of Risk Adjustment Operations for Advantasure. Under his leadership, 200+ risk adjustment professionals drive client execution, customer value, and optimize plan revenue through a suite of risk adjustment services such as retrospective medical record retrieval and review, the industry leading prospective Provider Engagement Coordination (PEC) program, in home assessment services, as well as analytic insights for clients.
Mr. Pastor had previous served as Advantasure’s Regional General Manager for the New York market where his team was responsible for driving value for three health plan clients via 41 field operations staff delivering prospective and retrospective Medicare Advantage solutions on behalf of 120,000 lives under management.
Prior to joining Advantasure in 2016, Mr. Pastor spent 19 years supporting value creation in a variety of roles at Aetna, Inc. As Director of Revenue Strategy for Aetna’s Medicare Business Segment Mr. Pastor’s team optimized program interventions that improved condition documentation generating $450M of incremental revenue and managing risk adjustment vendor model with $55M in annual spending. Mr. Pastor also held a variety of market and client facing roles in the US and UK driving advancements in the management of populations, resulting in improvements in the cost and quality of care.
Mr. Pastor has his Master of Public Policy Degree from The College of William & Mary as well as BA Degrees in Economics and Politic Science from the University of Colorado – Boulder.
FDNY Chief and Highest-Ranking Firefighter to Survive the World Trade Center Collapse
Richard Picciotto FDNY Chief and Highest-Ranking Firefighter to Survive the World Trade Center Collapse
Author of “Last Man Down”
The highest-ranking firefighter to survive the World Trade Center collapse, and the last fireman to escape the devastation, Richard "Pitch" Picciotto was on a stairwell between the sixth and seventh floors of the North Tower when it collapsed on September 11, 2001. An FDNY battalion commander, his is the harrowing true story of an American hero who thought nothing of himself and gave nearly everything for others during one of our nation's darkest hours.
Rodney Reider Managing Partner and CEO Strategic Advisor
Rodney D. Reider, President and CEO of RDR Solutions, has over 25 years of experience working in the healthcare industry specializing in providing strategic guidance to a diverse group, encompassing both providers and vendors.
An International Scholar twice-over, Rodney has a thirst for knowledge and a drive to explore, create and support innovative solutions within the healthcare space that make a lasting impact on the quality of patient care.
Rodney’s career began at Irvine Medical Center as Director of Program Development and Operations in 1991. He quickly moved into hospital administration as COO of Saddleback Memorial Medical Center in Laguna Hills, California. Since then he has provided strategic leadership and oversight for eight other hospitals throughout the United States. Rodney’s most recent provider-side post was as president and CEO of Saint Alphonsus Health System, a five-hospital system with $972M in annual net revenue, with 500 physicians and advanced practitioners, 21 joint ventures, 88 clinics and a 2,500-physician clinically integrated network serving residents in Southwest Idaho and Eastern Oregon.
Rodney is an international thought leader, having the honor to speak and moderate conferences from New York City to Tel Aviv, Israel. He also serves as a Healthcare Advisor and International Healthcare Services Ambassador for the Young Jewish Professionals of New York.
Always seeking to make an impact on the community in which he lives, Rodney has served on dozens of boards of directors, and foundations, receiving such honors as Honorary Commander of the Idaho National Guard, CEO of Influence from the State of Idaho, and a Fellow in the American College of Healthcare Executives.
Rodney earned a bachelor of arts degree from Chapman University; an MBA in finance and marketing from Loma Linda University; a master of science degree in Physiology from California State Polytechnic University; and a master of arts degree and Doctorate from Harrison Middleton University.
In addition to his role as President and CEO of RDR Solutions, Rodney is currently a Consultant for CoSourcing Partners and Partner for KA-Ventures, a global company that identifies, accelerates and deploys technologies that improve patient care and operational efficiency.
Janine has been with UnitedHealthcare-Nevada since 2010 and has over 18 years of experience in Quality and Performance Improvement. Currently Janine oversees the Quality, Strategy and Performance Operations team for the UnitedHealthcare Nevada market. As well as the Health Education & Wellness and Disease Management departments.
As a long-term quality operations administrator working in the health care industry, Janine is highly skilled in performance improvement, analytical skills and strategic planning.
Her HEDIS® tenure and subject matter expertise has helped to develop and deploy a unique operational performance model that has helped not only develop a successful internal operations team, but driven marked improvement in HEDIS® ratings for all lines of business.
Janine is an expert in all aspects of HEDIS® and NCQA audit requirements.
Janine is a strong-willed success driven professional, who possesses an exceptional determination to get the job done.
When she is not at work, she enjoys spending time with her family, working out and traveling.
Janine welcomes you to reach out to her via firstname.lastname@example.org or on LinkedIn.
Adele Towers MD MPH FACP, Director of Risk Adjustment
Dr. Towers is the Director of Risk Adjustment for UPMC Enterprises, and is also a geriatrician on the faculty at the University of Pittsburgh. At UPMC Enterprises, she is directly involved in the development of healthcare related technology, with emphasis on use of Natural Language Processing (NLP) for Risk Adjustment coding and use of Clinical Analytics to optimize clinical performance. Prior to this role, she has served as the Medical Director for Health Information Management at UPMC with responsibility for Clinical Documentation Improvement as well as inpatient coding denials and appeals. She has been on the faculty in the Division of Geriatric Medicine at the University of Pittsburgh for over 25 years, and continues to see patients at the Benedum Geriatric Center in UPMC. She is the former Medical Staff President at UPMC Presbyterian, and her prior positions have been as Vice Chair for Quality Improvement and Patient Safety for the Department of Medicine, Medical Director of UPMC Home Health, Medical Director of the Benedum Geriatric Center and Medical Director of Primary Care at the Western Psychiatric Institute and Clinic. Dr. Towers has presented the experience at UPMC with use of NLP and Clinical Analytics at multiple regional and national conferences.
For more than 20 years, Stephen Shapiro has presented his provocative strategies on innovation culture and collaboration to audiences in over 40 countries. During his 15-year tenure with the consulting firm Accenture, he led a 20,000-person innovation practice. He is the author of five books, including “Best Practices Are Stupid,” which was named the best innovation and creativity book of 2011. He has been featured in Newsweek, Entrepreneur Magazine, SUCCESS Magazine, The Wall Street Journal, ABC News, and CNBC. Clients include 3M, P&G, Nike, Marriott, Honda, Johnson & Johnson, Microsoft, NASA, USAA, Fidelity Investments, and GE.
Laura Sheriff, RN, MSN, CPC, CRC Regional Director, Risk Adjustment
Molina Healthcare, Inc.
Laura leads a dynamic Risk Adjustment Team, managing the day to day operations for Medicare and Marketplace members. She has a proven track record of maximizing risk scores. Laura designs and coordinates all team activities which focus on provider education, training, auditing, data mining, and data analysis to steer program success and achieve performance metrics. Laura is familiar with developing strategies for seeing high risk members utilizing technical dashboards, auditing processes, and working 1:1 with local vendors. Additionally she identifies end-to-end processes and prioritizes interventions to correct known weaknesses. Laura also provides support to corporate compliance efforts for RADV audits for both lines of business. She collaborates with business partners and develops best practices, and shares them with other health plans.
She has over 20 years of varied clinical nursing practice experience including more than ten years of Clinical Coding Certification practice. Laura is a Master’s prepared nurse, who also maintains her CPC and CRC through the AAPC.
Mallory Sheth Director of Strategy and Transformation
Sharp Health Plan
Mallory Sheth is Director of Strategy and Transformation at Sharp Health Plan. In addition to annual strategic planning, she oversees enterprise-wide strategic initiatives including Sharp Health Plan’s risk adjustment program.
Prior to joining Sharp, Mallory consulted for health organizations as a leader in Accenture’s data and analytics strategy group. She also spent five years with Acumen, LLC, designing data-focused monitoring and evaluation programs for the Centers for Medicare and Medicaid Services (CMS) and other government health agencies. Mallory received her Bachelor of Arts from Stanford University, and Masters in Operations Research from the Massachusetts Institute of Technology.
Lou is currently the Senior Vice President of Sales for Apixio Inc. Apixio is a Silicon Valleyhealthcare technology organization focusing on transformative HCC Coding technology enabling the review of thousands of EMR & PDF charts utilizing natural language processing, machine learning & linguistic pattern analysis. Prior to joining Apixio, Lou was the vice president of sales for risk adjustment & quality solutions with Optum working closely with Medicare, Medicaid and Commercial Health plans throughout the country. Lou lives in Boston with his wife and has two great kids.
Kathleen Stillo, MBA
President and Chief Operations Officer, Clinical Redesign Community & State,
Kathleen Stillo, MBA President and Chief Operations Officer, Clinical Redesign Community & State,
Kathleen Stillo is the President & COO of the Clinical Redesign team at UnitedHealthcare within the Medicaid line of business. This team includes myConnections,™ which is UnitedHealthcare’s program to help low-income individuals and families access essential social services that are the gateway to better health, and TeamMD, an innovative home-based primary and complex care program. The team cares for more than 5,000 of United’s most medically and socially complex members.
Kathy leads Finance, Strategy, Clinical and Housing Operations, IT/EHR, Post-Launch Markets, Training & Replication, Legal, and Marketing Communications. Her team is focused on implementing innovative care delivery models which incorporate social determinants of health, for better care at lower cost for our most vulnerable populations.
Prior to joining UnitedHealthcare, Kathy co-led the Adult Health and Urban Health Institutes at Cooper Hospital in Camden, NJ. Adult Health is a $265M business unit serving 365k patient visits/year across primary care, behavioral health, and medical specialties. The Urban Health Institute, a $6M business unit dedicated to medically and socially vulnerable populations, develops innovative care delivery models including addiction clinics, nurse-led protocols, an Ambulatory ICU, and complex care services which has resulted in a 58% decrease in deficit. Kathy previously led strategic consulting teams for Bristol-Myers Squibb and Reuters. While at Cooper, she was also a member of the Board of Directors of the Camden Coalition of Healthcare Providers.
Kathy earned her B.A. from Bowdoin College and M.B.A from Columbia Business School.
Kimberly Swanson Vice President of Quality & Clinical Integration
Kimberly Swanson is responsible for developing and leading Network Health’s quality improvement program and maintaining quality standards consistent with NCQA, CMS Star ratings and other regulatory agencies. She oversees and implements innovative quality strategies to improve the health of members and improve care delivery and coordination across Network Health’s broad network of providers. Kimberly also manages Network Health’s appeals and grievances department. Prior to joining Network Health, Kimberly served in a number of positions with Valence Health in Chicago, Illinois, most recently as Manager of Consulting Services and Interim Director of Operations at Community Care Partners. Kimberly has also worked with APS Healthcare and the New York City Department of Health and Mental Hygiene. She has more than a decade of experience in the health care and health insurance industries. Kimberly specializes in strategic development for quality improvement and value-based care, population health management administration and health plan process and operational improvement. Kimberly is a graduate of Vanderbilt University and also holds a Master of Public Administration from the Robert F. Wagner School of Public Service at New York University. She is a member of the American College of Healthcare Executives.
Dr. Dirk Wales has been the Chief Medical Officer of HealthSpring, a Medicare Advantage HMO for the last several years. Prior to that, he was the Senior Medical Director for Texas HealthSpring for several years. He has worked as a senior officer in other managed care companies prior to HealthSpring. He is an internist by training and practiced for several years on the West Coast. His areas of interest are dual diagnosis patients, chronic pain and emotional concerns in a physical setting.
Dr. Wales graduated from Wright State University with both an MD and Psy.D.. He did his residency and a chief residency at Northwestern University in Chicago, Il. He holds a BS from Emory University.
As Director of Risk Adjustment, Susan Waterman has been empowered to plan, design and oversee business and strategic objectives in creating and optimizing a Risk Adjustment Department responsible for ensuring the accuracy of risk adjustment payments while successfully managing all activities related to Medicare Advantage, ACA and Exchange Risk Adjusted lines of business. In that capacity Susan directed department changes that resulted in multi‐million dollar gains in ACA Risk Adjustment, brought all chart review activity in‐house saving 500K per year in vendor coding fees, and partnered with the hospital CDI/Quality Physicians to create an Outpatient CDI Department focused on documentation quality, Risk Adjustment activities and clinic training for 1,200 providers.
A proven leader in her field, Susan’s professional experience includes coding and compliance management, auditing and provider training, system management, and consulting services.
For over ten years, MattWallaerthas been applying behavioral science to practical problems, from startup exits to the Fortune 500. and is currently the healthcare industry’s first Chief Behavioral Officer at Clover Health, a Medicare Advantage plan changing the model of insurance by changing behavior. He’s given hundreds of talks on the science of behavior change and is the author of Start at the End, which details how anyone can become a behavioral scientist by making behavior their outcome and science their process. His side projects consistently focus on the unrepresented, like GetRaised.com, which has helped underpaid women ask for and earn over $2.3B in salary increases.
Terry Ward is SVP of Solutions, where he leads the development of new payer-facing products. Prior toApixio, he served as VP of Product Management, Reporting and Analytics at Change Healthcare, and worked at UnitedHealth Group for 14 years, most recently as Vice President of Network Data Strategies
Anna Wetherbee has 15 years experience in the healthcare industry, in both start up and large integrated systems. In her current role, Anna leads strategy execution for Blue Shield of California programs in clinical quality, risk adjustment, population health, and clinical data infrastructure transformation. She is passionate about creating measurable change in the healthcare industry to improve quality, access and sustainability. Anna holds a Master of Business Administration, and certifications as a Project Management Professional and Lean Black Belt.
Josh Weisbrod currently serves as the Vice President – Risk Adjustment at Network Health in Menasha, WI. He brings over 20 years of health insurance, healthcare analytic and human service experience to Network Health. Josh specializes in government programs, health plan operations, risk adjustment and data analytics. Prior to his work at Network Health, he served as Director of Government Programs for a regional Wisconsin health plan serving the state’s Medicare, Medicaid and Marketplace participants. Josh previously served as the Director of Operations for the Wisconsin Health Insurance Risk-Sharing Plan (HIRSP), the state’s high-risk insurance plan. HIRSP also administered the federal high-risk insurance plan in Wisconsin prior to the implementation of the Affordable Care act. Josh has taught part-time at the college level for over 11 years and has extensive experience training health insurance and human service professionals.
Senior Director of Quality & Value Based Care
University of Maryland Medical System & UM Quality Care Network
Karen Wilding Senior Director of Quality & Value Based Care
University of Maryland Medical System & UM Quality Care Network
Karen Marie Wilding is the corporate Senior Director of Quality & Value-based Care with the University of Maryland Medical System (UMMS).
Karen is responsible for driving value based care efforts across acute and ambulatory care settings from revenue cycle optimization thru integrated care coordination. She works with commercial and government payers; facilitating work streams that are a growing 100M+ in annual quality / payment portfolio for the system.
In addition to her system-wide responsibilities, she leads major operating divisions for both the University of Maryland Quality Care Network (UMQCN) and UM Transform Health MD (Care Transformation Organization), within the organization’s clinically integrated network. Karen’s team provides state-wide support to clinicians and healthcare entities in the areas of quality, practice transformation, risk adjustment, health IT, data & analytics and federal policy/programs. Collectively, they are supporting over 1B in care for the state of Maryland and over 100,000 patients. Karen serves as an affiliate compliance officer, ensuring the emerging population health programs have a robust compliance program wrapped around them.
She was previously the Director of Operations for the enterprise Information & Technology Department at UMMS and has worked in Health IT for over fourteen years for both small and large organizations. She has completed hundreds of implementations, adding to her experience within all aspects of healthcare technology.
Karen is soon ending her two-year term as President of Maryland Chapter of HIMSS. With over 2000 members, the current board has advanced programming beyond traditional educational sessions and now specializes in executive engagement as well as diversity in health IT. Over the last two years, vendor partnerships have doubled, allowing expansion of programming for one of the largest chapters in the country. She has been an active member since 2011.
In fall 2017, she achieved board certification as a Certified Healthcare Chief Information Officer (CHCIO) with the College of Healthcare Information Management Executives (CHIME). In spring 2018, she was inducted as a Fellow of the Health Information Management Systems Society (FHIMSS) for her continued leadership and dedication to the industry and community at large. Karen has held an adjunct faculty appointment with the Community College of Baltimore County (CCBC) in the Health Information Technology Program since 2010.
She attended The George Washington University in Washington D.C and holds a Master’s certificate in Value-based Care from The Johns Hopkins University and Normandale CC. She resides near Annapolis, with her husband and three children.
Robin Wilson Senior Business Analyst, Risk Adjustment
WellMed Medical Management, Inc.
Robin has over 15 years of IT and health care experience including Claims and Risk Adjustment. Her prior experience includes working for health care providers and insurance companies in a variety of roles and support for IT and business including EDI Manager, Audit, Medical Billing, Cash Posting, Eligibility and Provider Management. She has expertise in EDI transactions including 837 (Professional and Institutional), 835, 999, 277CA, 270 and 271. In her current role she supports the functions and drives process improvements for the Submission of Risk Adjustment data for WellMed. She holds a Bachelor in Business Administration Information Systems from the University of Texas at San Antonio.
Director of Risk Adjustment, Stars and Provider Engagement
Debbie Conboy is the Director of Risk Adjustment and Quality Strategy at Arcadia. Debbie has over 30 years of experience at Blue Cross Blue Shield of Massachusetts, with the last 11 years focused on directing Risk Adjustment strategy and operations across all lines of business. She brings her extensive knowledge to Arcadia to lead the Risk Adjustment and Quality product suite.
Debbie works collaboratively across the Arcadia organization to ensure that our Risk Adjustment/STARs/Quality suite of products meets and exceeds our customer expectations and continues to position Arcadia as the industry leader in population health management.