Michael Adelberg Principal

Faegre Drinker Consulting

Jill Alessi Vice President of Healthcare Operations

Blue Cross of Idaho

Jill Alessi, RN, BSN, MHA is the Vice President of Healthcare Operations for Blue Cross of Idaho. She has responsibility over the clinical teams that support their membership with wellbeing, care management, utilization management, and condition support.  Jill has oversight of quality initiatives for Blue Cross of Idaho related to CMS Medicare Advantage Star’s Measures, HEDIS and NCQA accreditation.  She works closely with her teams to support quality of care and preventative health initiatives as well as care coordination for Medicare/Medicaid duals membership in Idaho.  She is a registered nurse with over 15 years of patient care experience in a Level One Trauma Academic Medical Center.  Her health plan experience extends over 15 years with support of members in commercial and government lines of business.  She has been with Blue Cross of Idaho for five years and is a strong advocate for the support of members in their healthcare journey.  

Rick Alexsonshk, PAHM Director Risk Adjustment

SummaCare

Richard K Alexsonshk is the the Director of Risk Adjustment Unit for SummaCare, where he evaluates, develops and implements innovative solutions dealing with Risk Adjustment for both the retrospective chart review process as well as all prospective services. Under his guidance, SummaCare has achieved a blended approach of developing internal tools and best-in-class vendors to augment the medical chart review process. He also coordinates all development activities with the medical review nurses and outside vendors to make sure the products that are deployed meet the needs of the user community. 

Edward Baker Of Counsel

Constantine Cannon

Edward Baker is Counsel in Constantine Cannon’s Washington, D.C. office.  Mr. Baker represents a broad range of whistleblowers and has extensive experience with healthcare fraud cases under the federal False Claims Act and comparable state laws. Prior to joining Constantine Cannon, Mr. Baker was an Assistant U.S. Attorney in the Eastern District of California for four years where he worked on affirmative civil enforcement cases and was the Healthcare Fraud Coordinator for the district.  He previously served as the Director of the Vermont Medicaid Fraud Control Unit, prosecuting civil and criminal Medicaid fraud cases.  He began his professional career on the defense side in Boston, representing pharmaceutical executives and companies under government investigation

Jonah Berger International Bestselling Author of Contagious, Invisible Influence, and The Catalyst Professor

Wharton School at the University of Pennsylvania

Jonah Berger is a Marketing Professor at the Wharton School at the University of Pennsylvania, an internationally bestselling author, and a world‐renowned expert on change, influence, word of mouth, natural language processing, consumer behavior, and how products, ideas, and behaviors catch on. He has published over 50 articles in top-tier academic journals, teaches Wharton’s highest rated online course, and popular accounts of his work often appear in places like The New York Times, Wall Street Journal, and Harvard Business Review. Over a million copies of his books, Contagious, Invisible Influence, and The Catalyst: How to Change Anyone’s Mind are in print in over 35 countries around the world. Berger often keynotes major conferences and events like SXSW and Cannes Lions, advises various early stage companies, and consults for organizations like Apple, Google, Nike, Amazon, GE, 3M, and The Gates Foundation.

Mark Bigelow Vice President

EXL

Mark Bigelow is EXL's Vice President, Risk Adjustment and is in charge of guiding and shaping product strategy around risk adjustment. Mark has over 14 years of industry expertise in the Healthcare space holding various leadership positions in Finance, Corporate Strategy and Risk Adjustment in Government-sponsored and Commercial payor environments.

In the Risk Adjustment space, Mark has led teams that have developed proprietary predictive analytics algorithms, automated regulatory submissions to achieve 99%+ acceptance rates across all LOBs and developed provider and member engagement strategies that have made significant improvements to risk score accuracy.

Mark has an MBA in Finance and Strategy from the University of Washington and a Bachelor's degree in Economics from Brigham Young University.

Stephen Bittinger Health Care Audit & Integrity Partner

K&L Gates, LLP

Stephen Bittinger is a partner in the firm's Charleston and Washington, DC offices. He is a member of the health care/FDA practice group. Stephen focuses his practice on health care reimbursement compliance, defense and litigation, with an emphasis on government and private payer disputes on behalf of providers, suppliers, and manufacturers involved in the health care system with the United States and abroad. He has extensive experience representing inpatient and outpatient providers, hospices, home health agencies, medical facilities, ancillary service providers, medical labs, revenue cycle management companies, and drug and device manufacturers in matters including Medicare and Medicaid audits, private payer audits, federal regulatory termination and exclusion proceedings, False Claims Act defense, and health care revenue disputes. In addition, he has experience advising clients on defending and appealing government and private payor audits and has worked collaboratively with government regulators and health care provider associations across the United States. Stephen has represented many providers with federal agency matters, including the Centers for Medicare and Medicaid Services (CMS) Center for Program Integrity (CPI), the Department of Health and Human Services Office of Inspector General (HHS-OIG), the Department of Veteran Affairs (VA), and Health Care Fraud division of the Department of Justice (DOJ).

Archie Block SVP, Analytics and Insights

Signify Health

As the SVP, Analytics and Insights at Signify Health, Archie Block leads a team focused on providing deep insights into program outcomes/design, and analytics that facilitate risk adjustment and drive success. He brings to this role over a decade of experience assisting health plans, risk-bearing medical groups, and clinical networks with their risk adjustment programs and program strategies.  With a background in technology, security, and data analytics, Archie has extensive expertise in risk adjustment program design, performance measurement, member segmentation, program optimization, and program analysis. He earned his Bachelor’s in Computer Information Systems from the University of North Texas and also holds numerous technology certifications.  

Jim Bohnsack Senior Vice President & Chief Strategy Officer

TransUnion Healthcare

Jim Bohnsack is responsible for driving growth through sales, partnerships, new solution development and acquisitions for TransUnion Healthcare. Jim has spent his entire 20-year career focused on various aspects of the healthcare industry. His experience ranges from strategy to process, services to technology and health systems to corporations.

Prior to returning to TransUnion Healthcare, Jim served as the President and Chief Financial Officer for Strivant Health, a private-equity backed physician revenue cycle management company based in Dallas, Texas, and as Senior Vice President of Provider Growth for CIOX Health, a New Mountain Capital portfolio company. Throughout his career in the healthcare industry, Jim has held various leadership positions at Conifer Health Solutions, TransUnion Healthcare, Deloitte and Ernst & Young.

Jim holds a bachelor‘s degree in business administration and a master’s degree in healthcare administration from Trinity University in San Antonio, TX

Laura Breisch VP of Value Capture

Oscar Health

Laura A. Breisch, MBA is the Vice President of Value Capture of Oscar Health, where she is responsible for performance improvement initiatives around Risk Adjustment, HEDIS and STARs for both Medicare Advantage and the Affordable Care Acts product lines. Laura joined Oscar in 2019 after spending 15 years at Health First Health Plans in Melbourne Florida, where she was responsible for regulatory operations, risk adjustment, HEDIS, STARs, NCQA and member engagement. During her career, the insurance industry went through numerous regulatory changes such as the Medicare Modernization Act and the Affordable Care Act where Laura was instrumental in implementing the Part D program, along with Exchange product lines. She also founded the Risk Adjustment program at Health First along while educating the industry on the importance of combining Risk Adjustment and HEDIS operations to better streamline processes and increase provider engagement.

Laura also worked for Blue Cross and Blue Shield of IL and Aon, where she worked in claims and underwriting. She has a Master of Business Administration degree from Florida Institute of Technology and earned her undergraduate degree in marketing and accounting from Marquette University. Laura also holds a Professional Academy for Health Care Management (PAHM) designation.

Meleah Bridgeford Director, Risk Adjustment Analytics

Episource

Jessica Columbus AVP, STARs & Risk Adjustment

Memorial Hermann Health Plan

Jessica Columbus, LVN, CCS-P, CRC, CPHQ is currently the Associate Vice President of Stars and Risk Adjustment for Apex Health Solutions. Her expertise in physician performance engagement and value based care best practices are built on a foundation of more than 15 years experience in managed care focusing on end to end health plan operations related to Risk Adjustment and the CMS STAR Rating Program. 

She began her healthcare career in direct patient care as a Pediatric/NICU nurse and in 2005 took an opportunity at a managed care company in their Referral/Pre Cert Department where she was first exposed to quality and risk adjustment concepts. Once promoted into a leadership role that allowed her to own and create both risk adjustment and HEDIS programs from scratch she discovered those to be her true passion.

For 10 years her career has concentrated on innovative provider engagement strategies and implementing real world solutions that positively impact provider and contract performance. Her enterprise-wide physician education programs that aim to improve understanding of clinical documentation requirements have proven successful through accuracy of HCC recapture, increased year round closure of HEDIS gaps in care and strengthened positive health plan experiences among both providers and members. 

Prior to joining Apex in August of 2020, Jessica worked at Universal American/WellCare for 5 years as the Sr. Director of Quality Improvement directly overseeing all quality improvement programs, HEDIS/STARs operations and prospective risk adjustment activities for their Texas and Louisiana markets. During her tenure at WellCare she was able to consistently deliver solid Star Ratings for all contracts under her responsibility, including achieving a 4.5 STAR in 2019 for their flagship MAPD plan in Texas.  Jessica’s continued career journey is centered on improving clinical outcomes for patients through advancing provider and payer partnerships that will revolutionize value based care. 

Jessica enjoys spending her free time traveling or binge watching new Netflix releases with her husband Brandon and their 3 daughters (Gabriella, Alexis and Jordan) in Houston Texas. 

Patrick Coulson Chief Growth Officer

Advantasure

Patrick Coulson has more than 25 years of experience leading healthcare sales, specializing in early-stage companies, new product launches and C-level new business sales. With expertise in Medicare Advantage, risk adjustment, technology services and member engagement, he has a record of enhancing start-up organizations – doubling revenue year-over-year, in many cases.

Prior to joining Emerging Markets as Advantasure’s Chief Growth Officer, Coulson served as Senior Vice President of Business Development for engagement services company Integra ServiceConnect. Within two years, Coulson helped triple the client base and double the annual revenue. He was previously Vice President of Sales for medical cost management company MedSolutions, where he was responsible for Medicare Advantage sales nationwide.

Sean Creighton Vice President, Risk Adjustment Policy

Humana

Sean Creighton serves as vice president for Federal Policy at Humana, a leading health care firm. Sean provides leadership in the development and implementation of federal policy strategy. Prior to Humana, Sean works for 3 years as Managing Director and head of policy analytics at Avalere, a premier consulting firm focused on health care. Sean led projects in a number of key areas, Part D reform, risk adjustment and RADV, and analysis of Medicare Advantage performance relative to FFS on cost, quality and utilization. Sean also spent 2 years as SVP for risk adjustment product at Verisk Health (now Cotiviti) working on data aggregation, coding, and submission products for Medicare and the commercial market to ensure appropriate revenue and elevate performance.

Before joining Verisk Health, Creighton was the deputy group director of the Payment Policy and Financial Management Group in the CMS Center for Consumer Information and Insurance Oversight. He also served as the director of the division of Payment Policy and Risk Adjustment in the Medicare Plan Payment Group in the Center for Medicare.

While at CMS, Creighton was responsible for payment policy and operations for both private marketplace and Medicare plans. Notable accomplishments include developing and implementing a system to make advance premium-tax credit and cost-sharing reduction subsidy payments to marketplace issuers under the Affordable Care Act; developing and implementing Parts C and D risk adjustment models; and serving as the sponsor and chief architect of the Medicare Encounter Data System (EDS).

Creighton holds a Bachelor of Arts degree in European studies from the University of Limerick, a Higher Diploma in Statistics from Trinity College, Dublin, a Master of Science degree in Sociology from the London School of Economics, and conducted doctoral research at Indiana University, Bloomington. He has won numerous awards for development and implementation of risk adjustment and payment models.

Deb Curry Manager, Risk Adjustment

ProMedica

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 Performance Improvement teams. Prior to her position with Paramount she had 21 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 attended The University of Toledo for both her undergraduate and graduate degrees and currently holds a Masters of Business Administration with major in Healthcare Systems Management. 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 an AHIMA-approved ICD10-CM Trainer. Deb is also an active member of the America Academy of Professional Coders (AAPC) and is a Certified Risk Adjustment Coder (CRC). Also, Deb is a member of RISE and holds certificates as a Risk Adjustment Practitioner (RAP) and Advanced HCC Auditor (AHCCA). Deb is blessed with one awesome husband of 29 years, three amazing children (one son-in-law), two adorable grandsons, and three beautiful granddaughters who all fill her life with a lot of joy, a little mischief, and a whole bunch of love. In her spare time, Deb volunteers at her church as a Team Captain in the Youth Ministry, is Board Member of the University of Toledo Health Information Administration Advisory Board, Health and Human Services Alumni Affiliate at The University of Toledo, and Health Information Technology Advisory Committee at Owens Community College.

Dr. Shannon Decker Vice President, Clinical Performance

Brown & Toland Physicians

Dr. Shannon Decker is Vice President of Clinical Performance at Brown and Toland where she leads a department responsible for Clinical Quality Documentation (Risk Adjustment); Clinical Quality, Patient Experience & Population Health; Clinical Compliance, including Appeals & Grievance; and Clinical Data Management, including Encounter Data Management. She also serves as Brown & Toland's COVID-19 Taskforce leader. Dr. Decker has more than 20 years of experience in healthcare--15 of which include working with risk adjustment and Medicare. Dr. Decker has a PhD. in Interdisciplinary Studies, dual MBA degrees--in Finance and in Marketing, as well as an M.Ed. in Secondary Education and a M.Ed. in Administration and Leadership. Dr. Decker is on the faculty at Arizona State University and is also an associate professor of Higher Education & Adult Learning (HEAL) and chief methodologist for Walden and Capella Universities where she chairs and oversees the dissertations of doctoral students. An author of two books and several peer-reviewed articles, she consults in both the fields of healthcare and education. Her interests include the study of human behavior and how theories on motivation and learning may be brought to bear on population health management.

Archie Dey Director of Consumer Experience and Insights

SCAN Health

Kathleen Ellmore Managing Director

Engagys

Kathleen is a pioneer in bringing the best of consumer marketing and data-driven methodologies to healthcare to motivate better health decisions. As Co-Founder and Managing Director of Engagys, Kathleen leverages the best of behavioral economics, the latest in evidence-based communications combined with the insights from over a billion consumer interactions in health to help healthcare organizations close the last mile of consumer engagement. She consults on all topics related to consumer engagement and experience for the top healthcare organizations in the country.

Kathleen has been recently named as a consultant to the first ever FDA Patient Engagement Advisory Committee (PEAC). She received Stevie awards for highlighting opportunities for improving the lives of people with chronic conditions. She speaks regularly on the national stage on many topics including: driving consumer health engagement, creating better consumer experience in healthcare, and using data to drive consumer behavior.

Kathleen also participates in various healthcare advisory boards, including HealthComp’s Consumer Experience Advisory Board, Linkwell Health’s Marketing Advisory Board and RISE’s Consumer Engagement Advisory Board

Kathleen spent the first twenty years of her career in brand marketing at leading consumer marketing organizations, including General Mills and P&G. Additionally, she was a Vice President at Digitas, one of the leading direct marketing firms in the country. Kathleen has an undergraduate degree from the University of New Hampshire and an MBA from the Kellogg School at Northwestern.

Andy Ellner Founder

Firefly Health

Scott Filiault Co-President

Pulse8

Scott led the sales efforts that grew the largest prospective risk adjustment vendor in the Medicare Advantage space, eventually leading to the acquisition of the firm at a significant multiple of EBITDA. 

Scott is a tireless sales and business development leader with C-level contacts at most health plans in the country.  Scott has served as National Director of Sales, working with both Commercial and Medicare Advantage plans.  He was responsible for improving health plan performance and profitability through effective, state-of-the-art care management programs, consulting services, and data-driven strategies.  Scott helped develop and deliver the marketing strategy for a predictive modeling company and the identification and stratification of members for a case and disease management vendor.  In addition, he planned and implemented the Managed Care Training Program for the New York City Managed Medicaid initiative.

Scott has international experience, when he helped develop and market software programs that measure cognitive function for neurological conditions such as Alzheimer's and Parkinson's diseases, MS, and schizophrenia.

Janette Gacaferi Assistant Director Risk Adjustment

Regence Cambia

Janette Gacaferi leads the Government Programs Risk Adjustment team for Cambia Health Solutions. She is a results-driven leader with a strong track record of operational and managerial successes. With over a decade of experience and rooted ties in the healthcare industry, Janette has led both provider and health plan strategies for complete and compliant outcomes. She is currently responsible for the strategic and operational execution of Medicare Advantage and ACA risk adjustment across Cambia’s four state region. Janette is a graduate of Wayne State University with a Bachelors of Science in Business Administration, along with a Masters of Business Administration with a concentration in strategic operations from Walsh College.

Colleen Gianatasio

Devoted Health

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, Chief Quality Officer

CDPHP®

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 National Association for Health Care Qualit

Marc Goldwein Senior Vice President and Senior Policy Director

Committee for a Responsible Federal Budget

Marc Goldwein is the Senior Vice President and Senior Policy Director for the Committee for a Responsible Federal Budget, where he guides and conducts research on a wide array of topics related to fiscal policy and the federal budget. He is frequently quoted in a number of major media outlets and works regularly with Members of Congress and their staffs on budget-related issues.

In 2010, Marc served as Associate Director of the National Commission on Fiscal Responsibility and Reform (The Fiscal Commission), and in 2011 he was a senior budget analyst on the Joint Select Committee on Deficit Reduction (The Super Committee).  He has also conducted research for the Government Accountability Office, the World Bank, the Historian's Office at the Social Security Administration, and the Institute of Governmental Studies at UC Berkeley. In addition to his work at the Committee, Marc teaches economics at the University of California DC and at Johns Hopkins University, where he was the 2013 recipient of Excellence in Teaching Award. In 2011, Marc was featured in the Forbes "30 Under 30" list for Law & Policy. Contact him at goldwein@crfb.org and find him on Twitter at @MarcGoldwein.

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.

Leah Hannum Director, Government Funding Operations

Blue Cross of Idaho

As Director of Government Funding, Leah Hannum played a pivotal role in the planning, creation, oversight and strategic objectives of risk adjustment department at Blue Cross of Idaho. She is responsible for overseeing activities related to Medicare and ACA risk adjustment programs in support of payment accuracy. With 15+ years’ experience in government programs, Leah’s current focus is to understand and connect the health plan’s risk adjustment accuracy needs with efficient provider workflows for improved patient outcomes.

Sara Hansen Director of Quality & Clinical Risk Services

Avera Health Plans

Sara has more than 12 years experience in health care, including 5 years in managed care. Prior to joining Avera Health Plans in 2016, she held the role of Health Educator on the delivery side. Since joining Avera Health Plans, Sara has held various roles in Population Health Services, primarily overseeing risk adjustment operations. Her most recent role with Avera Health Plans has been as Director of Quality & Clinical Risk Services, where her key responsibility is to drive quality improvement with alignment of quality and risk adjustment operations.

Sara received her Master's Degree from South Dakota State University and her Bachelor's Degree from the University of South Dakota.

Randy Harwell

United States Attorney’s Office, Middle District of Florida

Randy Harwell has been a civil attorney in the Middle District of Florida since 2004, and has served as a supervisor in the Civil Division for that district since 2011.  In that capacity, he manages the work of twenty-six civil AUSAs in four offices located all over central Florida.  Mr. Harwell also personally handles civil white collar fraud cases in the nation’s busiest whistleblower docket, and has earned the most prestigious awards conferred by the Department of Justice (Special Commendation for Outstanding Service to the Civil Division, 2013 and 2020), the Department of Health and Human Services Inspector General (Cooperative Achievement Award), and the Taxpayers Against Fraud (Integrity in Government Award).  Prior to joining the United States Attorney’s Office, Mr. Harwell served for fourteen years as a trial attorney in the Commercial Litigation Branch of the United States Department of Justice, Civil Division. 

Dominic Henriques Vice President of Performance Improvement

Prominence Health Plan

Dominic currently serves as Vice President of Performance Improvement at Prominence Health Plan; he oversees all risk adjustment, quality improvement, and medical management operations for the plan. Dominic is a process-oriented leader with a passion for staff development and technologies that improve workflow efficiency. Prior to his role at Prominence, he held various roles at OptumCare working with Western market care delivery organizations to optimize their risk adjustment and quality improvement operations. Dominic earned his Bachelor’s degree in Psychology from the University of Nevada, Reno, and his Master of Healthcare Administration from the University of Nevada, Las Vegas. He currently lives in Reno, NV, with his wife and two kids (5 and 3 yrs), and enjoys running competitively on the weekends.

Mary Inman Partner

Constantine Cannon

Mary Inman is a partner in Constantine Cannon’s London and San Francisco Offices. After 20+ years representing whistleblowers in the U.S., she moved to London in July 2017 for four years to launch the firm’s international whistleblower practice and now splits her time between the London and San Francisco offices. She specializes in representing whistleblowers from the U.S., U.K., Europe and worldwide under the American whistleblower reward programs, including the federal and various state False Claims Acts and the SEC, CFTC, IRS, DOT and new Treasury Department AML whistleblower programs. Ms. Inman’s efforts to export the American whistleblower programs to the United Kingdom, including her efforts on behalf of a successful British whistleblower, were featured in a recent New York Times article “Law Firm Sees Britain as Hunting Ground for U.S. Whistleblower Cases.”  Ms. Inman’s successful representation of three whistleblowers exposing risk adjustment fraud in the Medicare Advantage program was featured in the February 4, 2019 issue of the New Yorker magazine in an article entitled “The Personal Toll of Whistle-Blowing.” Ms. Inman represents renowned SEC whistleblower Tyler Shultz who exposed the now infamous Silicon Valley blood testing start-up Theranos, and regularly speaks on lessons to be learned from this scandal surrounding corporate governance.   

Naomi Irvin Director, Divisional Compliance, Sales, Marketing & Communications

BCBS NC

Naomi Irvin is a California native who relocated to North Carolina in 2006. She earned her undergraduate degree (BSBA with a Management concentration) from East Carolina University (ECU), graduating Magna Cum Laude. Subsequently, she completed her MBA (with a Marketing Certificate) at ECU on full academic scholarship.

With over a decade of health insurance experience, Naomi currently leads a team of Compliance Consultants within the Sales, Marketing and Communications division of Blue Cross and Blue Shield of North Carolina.

At home, Naomi has 3 children (an ECU Sophomore, a high school senior, and a second grader) and two dogs. In her free time she enjoys reading and collecting books.

Mark Ishimatsu Director of Enterprise Risk Adjustment

L.A. Care

Director of Enterprise Risk Adjustment Strategies and Initiatives at L.A. Care Health Plan. Rebuilding and developing new programs to ensure L.A. Care’s risk adjustment strategic approach has the flexibility and operational capabilities to address the modern challenges facing the industry.

California farm boy with extensive healthcare industry experience applying behavioral economic perspectives to help address business objectives in health plans, hospitals, and medical groups. This includes building and improving business operations in risk adjustment, clinical operations, claims operations, large scale capital planning projects, product development, and marketing. Having worked both on the client and vendor sides of analytics services has led to development of a clear and broad vision to the challenges facing the industry, developing solutions, and communicating the best approaches to achieve business objectives.

Married to a wonderful wife who is a physician with whom rarely, if ever, discuss work. Two adult children whose resumes outshine both parents. Also, an unhealthy obsession with golf and fly fishing that only serve as major distractions to an otherwise unremarkably simple life of exploring the artistic offerings of innovative restaurants and chefs around the country.

Jeslie Jacobs Divisional Vice President, Provider Performance, Provider Analytics, Reporting and Connectivity

Blue Cross Blue Shield of Illinois

Jeslie Jacob currently serves as Divisional Vice President of Provider Analytics, Reporting & Connectivity at Blue Cross and Blue Shield of Illinois (BCBSIL). In this role, he is responsible for developing and executing the organization’s strategies to enable the adoption of enhanced reporting, analytics, and data exchange capabilities to improve health outcomes, reduce costs, and enhance the quality of care for more than 16 million members across five states.

Tejaswita Karve, Ph.D. Former Director, Quality Improvement

Johns Hopkins Health System

Tejaswita Karve is the former Director of Medicare STARS with the Johns Hopkins Health System. She has previously held roles at several Fortune 500 companies, including Accenture and CVS Health, as well as with Presbyterian Healthcare Services and most recently at UPMC Health Plan in Pittsburgh.

Karve holds a Ph.D. in Biochemistry and Cellular & Molecular Biology from Georgetown University.

Amir Keren Ciox Chief Technology Officer

CIOX Health

Michael Klotz Managing Consultant

MK Advisory Services LLC

Michael is a Healthcare IT consultant, innovator, 3x entrepreneur and seasoned executive. His current consulting work is in streamlining healthcare data operations for payers as well as product and go-to-market strategy for HIT vendors with a special focus on the rapidly progressing 'digital transformation' that will affect many stakeholders in US healthcare.

Michael started his HIT journey in 2008. After selling his first company, an IT consulting company, he recognized the potential for innovation and automation in Medical Records Review (MRR) started Health Data Vision (now Reveleer). He transformed it from a tech-enabled services company into a SaaS company, raised $10M in venture capital and led the company through aggressive early-stage growth.

In 2017, Michael left his company to start his 2nd consulting firm and set out to systematically explore the ‘clinical data ecosystem’ – exactly how clinical data flows between providers, payers, patients and other stakeholders.

In addition to ongoing research, he has been leading strategic consulting engagements with a large EMR company, patient-facing app companies, HIT vendors and health plans. He has also been very closely engaged with NCQA, HL7 and ONC to understand exactly how each organization would shape policy, standards and technology towards a future with digital quality measures and standardized interoperability.

Over the last 20, Michael has founded and built three successful companies. He continues to apply his entrepreneurial experience working with startups and a private equity company to help launch HIT companies with a meaningful impact on improving the delivery of healthcare while lowering costs.

Before becoming an entrepreneur, Michael implemented ERP and ecommerce solutions with an emphasis on process & workflow automation and optimization.

He is a frequent speaker at industry events and a guest lecturer at the Pepperdine Graziadio Graduate School of Business. Michael holds a business degree from USC and a degree in Electrical Engineering from the HTL Innsbruck in his native Austria.

Lynn Kryfke Executive Director, Health Plan Clinical Services,

Children & Community Health Plan

Lynn Kryfke is the Executive Director of Health Plan Clinical Services at Children’s Community Health Plan which serves members in Medicaid, Marketplace and Commercial products. In her role she has oversight of Quality Improvement, Utilization Management, Case Management, Accreditation and Risk Adjustment. Lynn obtained a Bachelors of Science in Nursing at UW- Milwaukee and Master’s Degree from Marquette University in Healthcare Systems Leadership. She has held leadership positions in the clinical setting and managed care for over 20 years. She has worked with the Medicaid population most of her career beginning with pregnant women and their infants and now with responsibility for the health’s plan Medicaid, Marketplace and Commercial populations. Lynn is passionate about recognizing the significance and availability of Services for the population the health plan serves.

Andy Kumar Vice President of Product

Ciox Health

Andy Kumar is a healthcare executive with fifteen years of experience partnering with payers and large health systems to build, implement, and scale value-based care products for Medicare Advantage, Managed Medicaid, and commercial populations. As an experienced product strategist, Andy has a proven track record growing businesses via product development.

Andy Kumar currently serves as Vice President of Product & Strategy at Ciox. In this position, he leads a cross-company team focused on planning and design for Ciox products at all stages of the product life cycle with the ultimate goal of driving innovation and improving outcomes for customers. With his experience, Andy has a proven track record in driving product innovation, generating growth and improving margins for Fortune 15 organizations and emerging growth companies. In this role, he is responsible for all aspects of product management under the health plan business.

Prior to joining Ciox, Andy lead product at numerous startups specializing in NLP-based risk adjustment solutions. He led the growth of the product portfolio, achieving a consistent increase in bookings year over year. Prior to this, he was involved in McKesson’s lead market initiative around interoperability and served as one of the founding product leaders for the CommonWell Health Alliance initiative. He holds a Master of Business Administration degree from Arizona State University and a Bachelor of Computer Engineering degree from the University of Arizona.

David Larsen Director of Quality Improvement

SelectHealth

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.

Bryan Lee Vice President of Solutions

Apixio

Bryan is a seasoned Healthcare Executive with over 30 years’ experience working with Payers and Providers focused in Government Programs, operations, compliance and payment practices. He possesses a deep understanding of how to build, implement and leverage technology to achieve performance improvement. He as built successful teams focused on providing comprehensive business process and compliance management solutions for Medicare Advantage, Medicaid and Commercial Marketplace health plans. His expertise in CMS transaction processing and regulatory requirements has led to the successful design and implementation of dynamic rules-based healthcare analytic solutions.

He has significant P&L management experience with a track record of business growth and profit improvements. He has been successful in leading multi-year, multi-million dollar projects, operational consolidations as well as continuous improvement initiatives that achieve bottom-line results. Bryan has driven change with his leadership style stressing expectations that align with business goals. This, coupled with unwavering accountability at every level of the organization, results in the achievement of the desired cultural and financial results.

James Lewis Former VP of Risk and Quality; Principal Owner

BCBS of Arizona Advantage; Paragon 7ven Studios & Consulting Group

James Lewis III is the Owner/President of Paragon 7ven Studios & Consulting Group, which has the core competencies of influencing healthcare media while assisting managed care plans with their strategic approach to Medicare/Medicaid product lines.  A graduate of Oakwood University in Huntsville, AL, his experience spans over 15 years at various levels of responsibility for Quality, Clinical Operations, Wellness, Risk Adjustment and STAR Rating initiatives.  James is also the host of “The” Lance Jay Radio Network, a nationally syndicated radio platform airing from WVOL 1470AM in Nashville, TN.  This daily program blends popular culture with a focus on the executive lens of healthcare policy and strategy and is televised on Roku and AppleTV. 

“The” Lance Jay Radio Network has recently signed a deal with Urban One in Washington D.C. for affiliate expansion and will be spearheading healthcare marketing and vaccination campaigns in minority communities with this new partnership. In his spare time, James works with F.H. Jenkins Preparatory School, a local private academy in Nashville where he serves as the Athletic Director and leads their external strategy for branding and fundraising.  He has a passion for community and just hopes to humbly contribute to society.

Richard Lieberman Chief Data Scientist

Mile High Healthcare Consulting/Cortex Analytics

Richard Lieberman is the founder and Chief Data Scientist of Mile High Healthcare Consulting and its affiliated software development enterprise, Cortex Analytics.  Cortex Analytics builds software solutions while Mile High Healthcare Consulting provides strategic consulting to Medicaid managed care organizations, Medicare-Advantage health plans, Exchange issuers, ACOs, and risk-bearing provider groups. Mr. Lieberman is one of the nation's leading experts on risk adjustment, quality measurement, and predictive analytics.  Since 1991, he has been active in the design and implementation of risk adjustment models and risk-adjusted payment systems for commercial, Medicare, and Medicaid payers.    Mr. Lieberman possesses in-depth understanding of Medicare, Medicaid and Affordable Care Act statutes, regulations, and policies.  He synthesizes these with insights obtained from the health services research literature, a background as a health care provider and clinical trials researcher, and from operational interactions with a variety of managed care entities.  He applies this knowledge and experience to risk adjustment revenue optimization strategies, quality measurement/quality improvement activities, provider profiling, provider reimbursement strategies, and information systems design.  Since 2017, Mile High and Richard Lieberman have garnered numerous insights from working with ACOs that contract privately with payer organizations.  We have seen up close how asymmetrical information between payer and ACO as well as limited understanding by both payer and ACO often result in less than desirable financial outcomes. 

Richard Lieberman Chief Data Scientist

Cortex Analytics/Mile High Healthcare Consulting

Richard Lieberman is the founder and Chief Data Scientist of Mile High Healthcare Consulting and its affiliated software development enterprise, Cortex Analytics. Cortex Analytics builds software solutions while Mile High Healthcare Consulting provides strategic consulting to Medicaid managed care organizations, Medicare-Advantage health plans, Exchange issuers, ACOs, and risk-bearing provider groups. Mr. Lieberman is one of the nation's leading experts on risk adjustment, quality measurement, and predictive analytics. Since 1991, he has been active in the design and implementation of risk adjustment models and risk-adjusted payment systems for commercial, Medicare, and Medicaid payers. Mr. Lieberman possesses in-depth understanding of Medicare, Medicaid and Affordable Care Act statutes, regulations, and policies. He synthesizes these with insights obtained from the health services research literature, a background as a health care provider and clinical trials researcher, and from operational interactions with a variety of managed care entities. He applies this knowledge and experience to risk adjustment revenue optimization strategies, quality measurement/quality improvement activities, provider profiling, provider reimbursement strategies, and information systems design. Since 2017, Mile High and Richard Lieberman have garnered numerous insights from working with ACOs that contract privately with payer organizations. We have seen up close how asymmetrical information between payer and ACO as well as limited understanding by both payer and ACO often result in less than desirable financial outcomes.

Rick Liu VP, Risk Adjustment

SCAN Health Plan

Rick has worked in the healthcare industry for over twenty years, providing decision support to both health plans and provider groups, and joined SCAN in 2018. As part of the Healthcare Informatics team, Rick is responsible for risk adjustment operations and analytics for one of the largest not-for-profit Medicare Advantage health plans in the nation. Prior to joining SCAN, he also served as an analytics leader at HealthCare Partners Medical Group, and at agilon health.

Jim Loehr Co-Founder

Johnson & Johnson Human Performance Institute

Dr. Jim Loehr is a co-founder of the Human Performance Institute, a world-renowned performance psychologist and author of 17 books including his most recent, Leading with Character. He also co-authored the national bestseller The Power of Full Engagement. Dr. Loehr’s ground-breaking, science-based energy management training system has achieved world-wide recognition and has been chronicled in leading national publications including the Harvard Business Review, Business Week, Fortune, Newsweek, Time, US News and World Report, Success, Fast Company and Omni. He has appeared on NBC’s Today Show, ABC’s Nightline, The CBS Evening News, The CBS Morning News, and the Oprah Winfrey Show. From his more than 35 years of experience and applied research, Dr. Loehr believes the single most important factor in successful achievement, personal fulfillment and life satisfaction is the strength of one’s character. He strongly contends that character strength can be built in the same way that muscle strength is built through energy investment. Dr. Loehr has worked with hundreds of world-class performers from the arenas of sport, business, medicine and law enforcement including Fortune 100 executives, FBI Hostage Rescue Teams, and military Special Forces. A sampling of his elite clients from the world of sport include: golfers Mark O’Meara, Justin Rose, and Daniel Berger; tennis players Jim Courier, Monica Seles, and Arantxa Sanchez-Vicario; boxer Ray Mancini; hockey players Eric Lindros and Mike Richter; and Olympic gold medal speed skater Dan Jansen. Dr. Loehr has been inducted into two Hall of Fames, was a pioneer in the application of psychology to human performance, has received numerous sport science and coaching awards and has lectured world-wide on his performance technology. Dr. Loehr is currently applying his insights regarding character to youth. He possesses a masters and doctorate in psychology and is a full member of the American Psychological Association. The Human Performance Institute’s training is the result of decades of proprietary research and working with elite performers. The Institute’s training draws on the sciences of performance psychology, exercise physiology and nutrition to create lifelong behavior change. By training to expand and manage energy levels both personally and professionally, performers ignite their full potential in high stress arenas

Donna Malone, CPC, CRC, CRC-I, AHCCA, RAP AAPC Approved Instructor Director of Ambulatory Clinical Documentation Quality Improvement

Mount Sinai Health System

Donna Malone, CPC, CRC, CRC-I, AHCCA, RAP: Director Ambulatory Clinical Documentation Quality Improvement (CDQI) with Mount Sinai Health System,  Adjunct Professor with MassBay Community College, Chair of the RISE Risk Adjustment Academy HCC Coding Faculty Advisory Group and President of the Watertown AAPC Chapter

Previously, she worked for Tufts Health Plan in their enterprise risk adjustment division for seven years with as  Director Enterprise Risk Adjustment Coding and Provider Education, and was responsible for audit and coding review management, development and implementation of department and vendor policies and procedures, development of provider and coding training materials, implementation of provider system education and process review, government audits (CMS RADV, HHS RADV, OIG), coding team performance management. 

Additionally, Donna serves at the MassBay Community College in Framingham, where she has been an advisor and adjunct professor currently in her 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

Brian McLane Sr. Director, Market Intelligence, Analytics & Product Solutions

Priority Health

Brian McLane is the Senior Director for Market Intelligence, Market Analytics and Digital Products at Priority Health. Brian’s teams provide the organization with corporate and line of business intelligence and measurement. His teams also lead efforts related to Priority Health’s member portals and transparency tools.

In his work, Brian’s goal is to simplify the complex world of health care through the use of data and analytics to engage members in their health care decisions.

Brian has more than 15 years of experience in health care and 30 years of experience in management roles. He holds a Master of Business Administration from Northwood University and a Bachelor of History from Michigan State University.

Andy McMahon Vice President, Health and Human Services Policy

UnitedHealthcare Community & State

Andy McMahon is the Vice President of Health and Human Services Policy at UnitedHealthcare Community & State. UnitedHealthcare Community & State proudly serves nearly 6.4 million Medicaid members in 31 states, plus Washington D.C. UnitedHealthcare is a division of UnitedHealth Group, a health and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.


In his current role, Andy focuses on integrating and collaborating across an array of public systems to provide better care at lower costs for populations with complex health needs. Andy works with UnitedHealthcare’s Medicaid managed care plans and the myConnections™ team, employing a multi-pronged strategy including policy/systems reform, partnership building, impact investments, and data analytics to better support our members. Andy’s programmatic portfolio includes work in affordable and supportive housing, human services, justice-involved populations and child welfare.


Prior to joining UnitedHealthcare, Andy worked at the Corporation for Supportive Housing (CSH) for 15 years, most recently as the Vice President for Policy and External Affairs. At CSH, Andy led an array of national, state, and local efforts to align systems and integrate resources to create supportive housing opportunities for vulnerable populations. Andy also led CSH's work to develop Pay for Success and impact investing models for supportive housing.


Prior to CSH, Andy held positions in both state and local government, as a lobbyist for state housing and community development agencies in Washington, D.C., and helped found and was the first executive director of a non-profit housing organization in Minnesota.

Dr. Christie McMullen Adult Learning Expert & Author

Learning Can Stick

Dr. Christie L. McMullen spent the last 20+ years as an educator but has spent her entire life as a learner. Christie trains adults to be better at what they do so that every interaction is memorable. She loves making people laugh while they learn and recognized early on that evoking emotion increases retention of information. She transitioned from teaching high school to teaching adults early in her career and has worked with adult learners in many settings. Whether training educators, business leaders, medical personnel, or her own children, she knows that learning sticks when it is safe, logical, fun, and memorable. She might even convince you that adults need stickers too.

Christie has been happily married for 23 years and is the mother to 20 year old twins. She loves working out and bettering herself in mind, body, and spirit. Whether talking to people one on one or in group settings she manages to get her participants to learn and grow in every circumstance. She has been a teacher, assistant principal, mentor, program specialist, associate area director, trainer, and life-long learner, giving her a unique and diverse perspective on the training, teaching, and learning world.

David Meyer Member

RISE Policy Committee

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.

Vivian Nava-Schellinger Director, Partnerships & Network Activation

NCOA

Vivian Nava-Schellinger, a proud Tejana, originally from the U.S.-Mexico border community of El Paso, Texas, is an organizer at heart. She has utilized her legal training to efficiently and successfully merge business strategy, development, organizational management, and health policy to ensure that all communities have access to the information they need to make informed decisions about their health and economic security.

Before her tenure at the National Council on Aging (NCOA), Nava-Schellinger, worked in the private sector on the development and design of large-scale reimbursement patient assistance programs for low-income adults. Additionally, she worked in development and strategic partnerships at Enroll America, a nonprofit aimed at connecting individuals to health coverage under the Affordable Care Act. At NCOA, she leads the organization’s engagement with national and community partners, to include senior centers focusing on low-income older adults, with a commitment to connecting the organization to diverse groups and coalitions working towards achieving greater economic and health equity for all older adults. Throughout the pandemic, Nava-Schellinger, has lead numerous initiatives around equity in aging – from digital engagement around financial security, coalitions to drive the impact of safety net programs for older adults, and the organization’s COVID 19 vaccine and education efforts with partners in communities across the country in order to help professionals in aging, older adults, caregivers, and their families to benefit from the ability for the aging network to be a more equitable vehicle for change.

Vivian is a graduate of the University of Texas at El Paso, with a Bachelor of Arts in Political Science and Legal Reasoning, a Master’s of Science in National Security Studies, and a Juris Doctorate from the Sandra Day O’Connor College of Law at Arizona State University, in Phoenix, Arizona.

Vivian enjoys running, hiking, cooking, and spending time with husband Jake and dogs Fernie, Phil-Chepito, and Nacho.

Andrey Otrovsky Former Chief Medical Officer; Managing Partner

US Medicaid Program; Social Innovation Ventures

Dr. Andrey Ostrovsky was the former Chief Medical Officer of the US Medicaid program. He is the Managing Partner at Social Innovation Ventures where he invests in and advises companies and non-profits dedicated to eliminating disparities. He also advises federal and state regulators on how to incorporate human centered design into policy making. He previously operated a series of methadone clinics in Baltimore, Maryland. Prior to working on the front line of the opioid use disorder crisis, he served as the Chief Medical Officer for the Center for Medicaid and CHIP Services, the nation's largest health insurer, where he advocated to protect the program against several legislative efforts to significantly dismantle the program. He also led efforts to streamline Medicaid and make it more customer-centric. Before leading the Medicaid program, he co-founded the software company, Care at Hand, an evidence-based predictive analytics platform that used insights of non-medical staff to prevent aging people from being hospitalized. Care at Hand was acquired in 2016 by Mindoula Health. Before Care at Hand, Dr. Ostrovsky led teams at the World Health Organization, United States Senate, and San Francisco Health Department toward health system strengthening. Dr. Ostrovsky has served on several boards and committees dedicated to behavioral health, interoperability standards, quality measurement, and home and community based services including the National Academies of Medicine, National Quality Forum, Institute for Healthcare Improvement, and the Commonwealth Fund.

Andrey holds a Medical Doctorate and undergraduate degrees in Chemistry and Psychology Magna cum Laude from Boston University and is a member of Phi Beta Kappa. Andrey completed his pediatrics residency training in the Boston Combined Residency Program at Boston Medical Center and Boston Children's Hospital where he was a clinical instructor at Harvard Medical School. He is currently teaching faculty and attending physician at Children's National Medical Center.

Akash Patel Chief Executive Officer

Advantmed

Akash Patel is the co-founder and CEO of Advantmed. In 2005, Akash and Jignesh Patel founded the company with a vision of helping managed care organizations optimize risk adjustment scores and quality improvement. Prior to launching Advantmed, Akash served as Chief Financial Officer for medical record retrieval, consumer electronics, and business process outsourcing organizations. In addition to his work at Advantmed, Akash serves on the board for Aluratek, a digital technology company.  

Akash holds a Bachelor of Arts degree in Business from California Polytechnic State University of Pomona and is a Certified Public Account (CPA) in the State of California. In his free time, he enjoys traveling, sports, and spending time with his family. 

Ashley Perry Chief Solutions Officer

Socially Determined

Ashley Perry serves as Chief Solutions Officer for Socially Determined. In this capacity, she leads the company’s Strategic Solutions Group with responsibility for market-facing activities, including business development, account management, and client success. Her work focuses on improving the health of communities and the performance of health care organizations by addressing Social Determinants of Health (SDOH) risks that impact health care utilization, costs, and outcomes. Ashley leads a multidisciplinary team of analysts, consultants, and subject matter experts that translate analytic insights generated by Socially Determined’s SocialScape^Ò risk intelligence platform into quantifiable business and community impact for clients and the populations they serve. 

Ashley is a public health practitioner and researcher by training and an experienced management consultant whose career has bridged health care and public health. Prior to joining Socially Determined, she helped build and scale successful population health consulting practices for the Premier Healthcare Alliance and Kaufman Hall & Associates. Earlier in her career, Ashley led research and programmatic initiatives for organizations ranging from an academic research center to a network of federally qualified health centers. She also designed, implemented, and evaluated health promotion interventions for the country’s largest local health department.

Ashley holds a Bachelor’s degree from Duke University and a Master’s degree in Public Health from Columbia. She is a Certified Public Health professional, serves on the National Board of Public Health Examiners, and is a frequent speaker at national conferences on topics related to community health, advancing health equity, and assessing and addressing SDOH risk.

Jonathan Porter Assistant United States Attorney

United States Attorney’s Office Southern District of Georgia

Jonathan is an Assistant United States Attorney in the Savannah Office of the United States Attorney’s Office for the Southern District of Georgia. Jonathan is cross-designated to represent the United States in both criminal and civil cases in district court, and also serves as the Southern District of Georgia’s criminal and civil health care fraud coordinator, as well as the Affirmative Civil Enforcement (ACE) Coordinator. Now in his fifth year with the United States Attorney’s Office, Jonathan’s main focus is investigations involving health care providers. Jonathan graduated from Furman University and received his law degree from Emory University.

Jennifer Ross Director of Risk Adjustment Compliance Programs

Aegis Medical Group

Jennifer Ross is the Director of Revenue Cycle Management for Primary Care Alliance, ACO and Aegis Medical Group. She began her career with Premier Medical Associates and Paradigm ACO, gaining unparalleled experience in the compliance space, while also establishing herself as a respected manager of clinical operations. She is widely known for her compliance, documentation, and Medicare risk adjustment expertise. She is a highly analytical professional combining more than 15 years of experience in medical office operations and the Medicare Advantage workspace.

Steve Sanders Vice President, Platform Strategy and Business Development

Veradigm

Steve joined Allscripts in November 1999 and currently leads the Veradigm business development, platform strategy, and partner management functions. He has over 25 years’ experience with technology and healthcare IT firms leading product management, sales, marketing, and operations teams during his career.  Steve is certified in product management and a past recipient of the Allscripts Circle of Excellence Award (2007) and the Allscripts CLEAR Leadership Award (2011).

Steve received his B.B.A in Finance from James Madison University.  He lives in Mechanicsville, VA with his wife, Christy, and his daughter, Carsen (17).  In his free time, Steve enjoys outdoor water sports and coaching.  He is active in board and advisory roles with local youth recreation programs and other volunteer organizations.

Daniel Sands, MD, MPH, FACMI Chief Medical Officer

Diameter Health

Dr. Danny Sands is passionate about healthcare transformation. A practicing physician with training and experience in clinical informatics, Dr. Sands has worked in a variety of capacities in the healthcare IT industry for over 25 years. He spent almost 14 years doing clinical informatics at Beth Israel Deaconess Medical Center, where he developed and implemented innovative systems to improve clinical care delivery and patient engagement, including clinical decision support systems, an EHR, and one of the nation’s first patient portals. This was followed by leadership positions including Cisco, Zix Corporation, and others.

Dr. Sands is the recipient of numerous healthcare honors, including recognition in 2009 by HealthLeaders Magazine as one of “20 People Who Make Healthcare Better.” He is the co-author, with e-Patient Dave deBronkart, of Let Patients Help.

Dr. Sands has earned degrees from Brown University, Ohio State University, Harvard School of Public Health, and trained at Boston City Hospital and Boston’s Beth Israel Hospital.

Dr. Sands holds an academic appointment at Harvard Medical School and maintains a primary care practice at Beth Israel Deaconess Medical Center in which he makes extensive use of health IT—much of which he helped to introduce. In addition to practicing, Dr. Sands works with a number of innovative companies and is a co-founder and the chief advocacy officer of the Society for Participatory Medicine. He is a popular speaker and consultant, blogs at DrDannySands.com and tweets as @DrDannySands.

William Sarraille Partner

Sidley Austin LLP

Michael Schopke Chief Growth Officer

DataLink Software

Darren Schulte, MD President of Advanced Technology

Centene Corporation

Darren Schulte, MD, is President of Advanced Technology at Centene Corporation. Prior to Centene, Darren served as CEO of Apixio, which was acquired by Centene in 2020. Before joining Apixio, Darren served in executive leadership roles at Alere Health as well as Anvita Health and Resolution Health, both of which were acquired by national payers. Darren is a nationally recognized speaker on the topics of healthcare analytics and quality improvement, and he is the co-inventor of 6 US patents. Darren received his BS degree from Berkeley, his MPP degree from Harvard, and his MD from Stanford.

Kelley Scott 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 Director, 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.

Laura Sheriff Risk Adjustment Specialist

MSN with 10 years’ experience in Medicare, Medicaid, and Marketplace Managed Care with proven success in Risk Adjustment. Confirmed track record in operations, program management and process improvement. Demonstrates effective leadership, innovative problem solving techniques, and goal oriented focus to execute business objectives and meet performance expectations. Designed and coordinated all team activities including provider education, training, auditing, data mining, and data analysis to steer program success and achieve performance metrics.

Melissa Smith EVP of 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.

Mikal Sutton Managing Director, Medicaid Policy

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 35 independent, community-based and locally operated Blue Cross and Blue Shield (BCBS) companies. Today, one in three Americans is covered by the Blue System.
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 BCBSA 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 and expansion of Medicaid.
Prior to joining BCBSA, Sutton worked in Medicaid Managed Care with Blue Cross Blue Shield Illinois and Cigna HealthSpring working on issues for managed care with state government and provider groups 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.

Amir Sweha Chief Medical Officer

Hill Physicians Medical Group

Amir Sweha, MD, is board-certified in Family Medicine and has been a member of Hill Physicians since 1996. He has been the Chief Medical Officer for Hill Physicians Medical Group since 2016. Previously, he served as a Hill Physicians board member and served on several Hill Physicians governance committees. He also held leadership roles as Chief Medical Officer/Vice President of Medical Affairs and Chief of Staff at Dignity Health, President and CEO of Mercy Faculty Practice Medical Group and Program Director of Dignity Health Methodist Hospital Family Practice Residency Program. He has been a Professor of Family Medicine at California Northstate University and a Clinical Associate Professor at University of Southern California, Keck School of Medicine. Dr. Sweha completed his Fellowship training at University of California San Francisco and his residency training at University of California Davis.

Elaine Taverna Senior Vice President 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 AVP, Quality Improvement

UPMC Health Plan

Karin VanZant Vice President, National SDOH Strategy

CareSource

Karin VanZant is the Vice President of Integrated Community Partnerships at CareSource. Since 2015, Mrs. VanZant oversees the work of Social Determinants of Health at CareSource and the full integration into the Population Health Model. Specifically, Mrs. VanZant has built the Life Services strategy, CareSource’s brand of SDOH partnerships, programs and pilots. The first and largest program of Life Services is JobConnect™ - a workforce development program that assists CareSource members to enter into full-time, permanent employment. In 2015, JobConnect™ started in Ohio and expanded to Indiana and Georgia Medicaid Markets as of 2017. Karin leads a team that is currently working on hunger and housing strategies as a part of Life Services. Prior to joining CareSource, Karin was the co-founder and Executive Director of Think Tank, Inc. For ten years as this organization’s leader, Karin assisted the team to live out the mission of equipping and facilitating collaboration among people and organizations seeking ways to promote greater connectedness and a more thriving community.


Karin VanZant has a MPA in Public Administration (2008) and a BA in Social Work (1998) from Wright State University. Karin is certified in various curriculums that address comprehensive poverty issues in the United States. She has helped author presentations and curriculum for use within nonprofit, business and faith-based organizations seeking to become relevant and holistic in their approach to poverty alleviation. Mrs. VanZant is an Adjunct Professor at Antioch Midwest University and Wright State University on a variety of subjects including US Hunger and Poverty, Justice and Equity, Introduction to Human Services, Grant Writing, Leading Change, Coaching as Management, Holistic Case Management and Emotional Intelligence. She lives in Springfield, Ohio with her husband and two boxer dogs.

April Vogelsang, RN, MS SVP, Chief Clinical Integration Officer

Health Alliance Medical Plans

April Vogelsang, RN, MS, currently serves as the System Senior Vice President & Chief Clinical Integration Officer at Health Alliance Medical Plans & Carle Health, having worked in the Carle system since 2006. She has provided progressive health service leadership since 1996, including leading program development and transformation of population health within a vertically integrated health system. Skilled at aligning cultures, organizational structures, and incentives to ensure success within value-based payment arrangements. Adapted and scaled Population Health model as the organization evolved to include an Accountable Care Organization (ACO) and Clinically Integrated Network. She provides strategic and operational oversight for integrated enterprise strategy for Population Health and Health Alliance Clinical Operations (Case Management, Health Coaching and Prevention/Wellness, Utilization Management, Quality Services, Pharmacy, and Risk Adjustment Solutions), including the Stratum Med Accountable Care Organization.

She holds a Master of Science in Health Services Administration, and is a member of the American College of Healthcare Executives (ACHE), America’s Health Insurance Plans (AHIP), the Alliance of Community Health Plans (ACHP) and Illinois Organization of Nurse Leaders. Additionally she serves on the Board of Directors for CIMRO and Great Plains Quality Innovation Network. She has contributed to local and national publications (Journal of Managed Care Nursing) and presented at numerous national conferences.

Max Voldman Attorney

Constantine Cannon

Max Voldman is an associate in Constantine Cannon’s Washington, DC office. Mr. Voldman’s practice is focused on representing whistleblowers under the federal False Claims Act and numerous state law equivalents, and the whistleblower programs of the Internal Revenue Service, Securities and Exchange Commission, Commodity Futures Trading Commission, and Department of Transportation. Max was selected to the Washington, DC Super Lawyers Rising Stars list in 2019.

Mr. Voldman has particular experience in combatting fraud in the healthcare industry. He is part of the legal team pursuing a qui tam case against UnitedHealth Group alleging the nation’s largest Medicare Advantage Organization submitted false claims for payment to the Medicare Program by improperly inflating its members’ risk scores. Mr. Voldman also has experience analyzing complex data sets, developing  damages models, and assisting with statistical analyses. He has also published numerous articles on issues of healthcare law, whistleblower programs, and environmental issues.

Mr. Voldman also represented a former Vice President of Visiting Nurse Service of New York, one of the nation’s largest home health care agencies, in a federal False Claims Act suit alleging the company defrauded Medicare and Medicaid by routinely failing to provide patients the care prescribed by their doctors. In Summer 2020, Visiting Nurse Services of New York agreed to pay $57 million to resolve these allegations.

Mr. Voldman received his J.D. from Georgetown University Law Center. During law school, Mr. Voldman served as a research assistant on taxation to Professor John Brooks and as the Symposium Editor for the Journal of Law and Public Policy.

Prior to law school, Mr. Voldman completed his undergraduate studies at the University of Illinois, where he was a member of the Mathematics Honors Society and graduated with a degree in Actuarial Science and a Minor in Business. Mr. Voldman also worked in State Farm’s actuarial science department and coached the debate team for a high school in Illinois, including one team that won the State Championship.

Mr. Voldman is fluent in Russian and admitted to practice in the State of Illinois, the District of Columbia, the United States District Court for the District of Columbia, and the United States District Court for the District of Colorado.

Tiffany Wandy Executive Director, Clinically Integrated Network

LifeBridge Health

Tiffany Wandy is the Executive Director of the 1,500+ provider Clinically Integrated Network for LifeBridge Health, a $2.5B regional health care organization based in northwest Baltimore and its surrounding counties. Her scope includes oversight of the health system’s performance in a range of commercial, Medicaid, and Medicare value-based care programs comprising over 125,000 lives, as well as physician recruitment for both facility and ambulatory settings across the health system. Her team manages the claims data, analytics, and visualization of data to determine and implement best practices for quality improvement and cost reduction and leads a wide range of provider engagement, operations optimization, and primary care innovation initiatives.  Prior to joining LifeBridge, Tiffany was a Senior Data Analyst and Lead Program Consultant for the CareFirst Patient-Centered Medical Home (PCMH) program, where she served as an advisor to primary care providers on best practices relating to the implementation of coordinated care delivery models. Tiffany holds an MBA from the Johns Hopkins Carey Business School and an MPH from the Johns Hopkins Bloomberg School of Public Health. 

Terry Ward Senior Vice President of Solutions

Apixio

Terry Ward is SVP of Solutions, where he leads the development of new payer-facing products. Prior to Apixio, 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.

Denise Warzel Science Program Analyst; International Convenor

National Cancer Institute; WG2 Metadata Standards Working Group

As a science program analyst at the National Cancer Institute. Beginning in 2000, Denise envisioned a novel approach for semantically annotating data dictionary entries with standard terminology and later led the design and development of the NCI Cancer Data Standards Registry and Repository (caDSR) where NCI currently creates and maintains common data element standards, data models, and case report forms linked to standard terminology concepts. These resources are made available for use in designing data collection programs with common meaning and data validation rules, helping achieve the vision interoperable data across disparate research project. Her work was noticed in 2009 and she was invited to become the Convenor for ISO/JTC1/SC32/WG2 Data Management and Interchange, Metadata Standards helping to influence development of international standards for recording and registering data element standards. Denise is now focusing on expanding its services to address a broader spectrum of services around harmonization and transformation to support the NCI Cancer Research Data Commons and other data repository projects. She co-led a special NIH initiative beginning in 2020 around harmonizing and standardizing COVID common data elements across the NIH. The creation of semantic data resources are in line with her interests in leveraging machine readable descriptions of data to increase organizational understanding and usage of research data. Prior to joining NCI, Denise worked for the International Business Machines where her involvement in data mining in the retail industry led her to NCI to help build infrastructure to enable using cancer data in similar ways to improve patient outcomes.

Susan Waterman Director of Risk Adjustment

Scott and White Health Plan

As Director of Risk Adjustment, Susan Waterman has been empowered to plan, design and oversee business and strategic objectives in creating and optimizing a Risk Adjustment Department responsible for ensuring the accuracy of risk adjustment payments while successfully managing all activities related to Medicare Advantage, ACA and Exchange Risk Adjusted lines of business. In that capacity Susan directed department changes that resulted in multi-million dollar gains in Risk Adjustment, brought all chart review activity in-house, and partnered with the hospital CDI/Quality Physicians to create an Outpatient CDI Department focused on documentation quality, Risk Adjustment activities and clinic training.

A proven leader in her field, Susan’s professional experience includes coding and compliance management, auditing and provider training, system management, and consulting services.

Scott Weiner Director, Government Programs

Virginia Premier

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.

Steve Wiggington CEO

Icario

Steve Wigginton is CEO of Icario, responsible for the overall strategy, growth, and operations of the company. Previously the CEO of NovuHealth, Steve became the CEO of Icario in 2020 following NovuHealth’s merger with Revel. Steve has a 25-year track record of driving growth, culture, and innovation in healthcare and is passionate about creating a better experience for members, patients, and providers.

Steve came to Icario from Sutter Health | Aetna, a 50/50 joint venture between Aetna, a CVS Health company, and Sutter Health, a not-for-profit integrated health delivery system in northern California. There, he served as the joint venture’s first CEO, responsible for launching an innovative health insurance business, delivering best-in-class clinical care, and driving breakthrough consumer and member experiences.

Before that, Steve served as CEO of Valence Health, where he led and grew the business following its acquisition by Evolent Health, doubling revenues and scaling operations internationally. Prior to the Valence acquisition, Steve was the chief development officer at Evolent Health, responsible for driving growth, partnerships, and the brand. Additional leadership roles in technology-driven care management, physician practice management, and healthcare supply chain businesses round out Steve’s experience.

Steve holds a bachelor’s and master’s degree of business administration from Indiana University, Kelley School of Business. In his free time, Steve is an avid cyclist, traveler, and concertgoer. He and his wife, an award-winning OB/Gyn, have four beautiful children.

Baligh Yehia Senior Vice President; President

Ascension; Ascension Medical Group

Baligh Yehia, MD, MPP, FACP, is Senior Vice President, Ascension, and President, Ascension Medical Group. In this role, Dr. Yehia is focused on clinician engagement, well-being, and development and advancing AMG’s care model portfolio and virtual care strategy. Previously, Dr. Yehia led enterprise-wide initiatives to improve community health and clinical integration at Johns Hopkins Medicine and served as the first Deputy Under Secretary for Health for Community Care at the U.S. Department of Veterans Affairs (VA).  

A nationally recognized expert in health disparities and HIV medicine, Dr. Yehia has published over 150 articles, abstracts and chapters in leading journals. Dr. Yehia received his bachelor and medical degrees from the University of Florida, completed internal medicine residency at Johns Hopkins Hospital, and infectious diseases fellowship at the Hospital of the University of Pennsylvania. He also holds a Masters in Public Policy from Princeton University and Masters of Science in Health Policy Research from the University of Pennsylvania.  

Stephanie Zeiber, MPA, PA-C APP Programs Manager for Value Based Care

Sentara Family Medicine Physicians

As a physician assistant, Ms. Zeiber works collaboratively with the team of medical professionals at Sentara Family Medicine Physicians to provide comprehensive care to her patients. She is a compassionate primary care provider and has particular interests in preventative care, women's health, and diabetes management. Ms. Zeiber has a passion for educating others and encourages patients to partner with her in their healthcare journey.
Ms. Zeiber also has previous experience as a registered nurse in the emergency department, serves as Advanced Practice Provider Program Manager for Value Based Care, and is a member of the Advanced Practice Provider Council and the Compliance and Regulatory Education Advisory Committee within her organization.
She is happily married and enjoys spending time at the beach, running, cycling, reading, & her Labrador Retriever.
Education:
MPA - Eastern Virginia Medical School, MPA
BSN - Old Dominion University
Professional Organizations:
American Academy of Physician Assistants
Virginia Academy of Physician Assistants