Mike Adelberg leads the Healthcare Strategy Practice at Faegre Baker Daniels Consulting. He has 25 years progressive healthcare industry and government experience in Medicare, Medicaid and commercial health insurance. Among other projects, Mike co-leads a 33-health plan consortium focused on improving plan benefits and a 19-health plan consortium focused on improving provider networks. Mike spent fifteen years at the Centers for Medicare and Medicaid Services (CMS), including concurrently serving as the director of the Insurance Programs Group and the acting director of the Exchange Policy and Operations Group in the Center for Consumer Information and Insurance Oversight (CCIIO) several ACA programs; serving as the Director of Medicare Advantage Operations, where he supervised the annual cycle for review and award of Medicare Advantage bids and contracts, developed CMS’s operational policy, and led the monitoring of Medicare Advantage contractors; and serving as the associate regional administrator for Medicare operations (Chicago Region) and the director of education and assistance programs. Mike gained private sector experience as vice president of product development and government affairs for the Universal American Corporation, a multi-state health insurer which operated Medicare Advantage and Medicaid health plans (subsequently acquired by Wellcare).
Mike has also led or co-led health policy studies published in Health Affairs and The American Journal of Managed Care. He speaks and publishes frequently on healthcare topics, has served on numerous advisory committees, and has earned two foundation grants. He’s been quoted in the Washington Post, New York Times, Modern Healthcare, NPR, and other leading media. In his spare time, Mike is an author. He’s written three novels, a history book, several scholarly journal articles, and over sixty book reviews.
A Southern California native, Andres Aguirre specializes in Quality Improvement and has spent his entire professional career helping health plans of all shapes and sizes strengthen their programs. He got his start in the Commercial health plan world, spending five years with Kaiser Southern California Permanente Medical Group before joining Health Net of California. Andres spent the next 14 years focused on Medicaid, first in Hawaii and later in the San Francisco Bay Area. It was during his time in San Francisco when Andres began working with Cotiviti (Tiermed). He would go on to join Sharp Health Plan and re-enter the Commercial world. Today Andres serves as the Director of Quality Improvement where he's helped Sharp achieve 5 Stars as a Medicare plan and 5 Stars as a Covered California / Exchange plan.
Krutika Amin Associate Director for Program on the ACA
Kaiser Family Foundation
Krutika Amin is an Associate Director at KFF for the Program on the ACA, where she conducts economic and policy research on the Affordable Care Act (ACA) and its effects on private insurers and enrollees. Krutika is also an Associate Director of the Peterson-Kaiser Health System Tracker Project, a partnership of the Peterson Center on Healthcare and KFF aimed at monitoring the performance of the U.S. health system over time and in relation to other large, high-income countries.
Ed Baker is Of Counsel in the Washington, DC office of Constantine Cannon LLP, where he advocates on behalf of whistleblowers seeking to address fraud against government programs, including Medicare Advantage. He specializes in the representation of whistleblowers in healthcare fraud cases under state and federal False Claims Acts. Prior to joining Constantine Cannon, Mr. Baker was an AUSA in the Eastern District of California, where he was the Civil Healthcare Fraud Coordinator and Elder Justice Coordinator. He previously prosecuted criminal and civil healthcare fraud cases as the Director of the Medicaid Fraud Control Unit within the Vermont AG's Office. He began his professional career in commercial litigation at a Boston law firm, where he focused on government enforcement defense.
Amanda Banister, CPC Manager of Provider Engagement
Veradigm Payer Solutions (formerly Pulse8)
Amanda Banister is a Manager of Provider Engagement for Veradigm Payer Solutions (formerly known as Pulse8). She has over 25 years of healthcare experience, including 15 years of practice administration for both private practice and regional healthcare systems. Amanda has extensive experience coaching teams in the implementation of process and quality improvement activities. She has worked directly with Providers and their teams to improve their care coordination, population health management and risk stratification efforts as well as improvements in documentation and accurate coding related to HCC's and HEDIS quality scores including 5 Star and Part D measures. Amanda is a Lean Six Sigma in HealthCare Green Belt, a Certified Clinical Microsystems Coach and a Certified Professional Coder.
MHA, BSN, RN Executive Officer, Population Health & Quality
Lauren Barca MHA, BSN, RN Executive Officer, Population Health & Quality
UnitedHealthcare Community Plan of Tennessee
Lauren Barca serves as the Executive Officer for Population Health, & Quality at UnitedHealthcare Community Plan of Tennessee. Lauren has dedicated 20 years to the health care industry and is passionate about ensuring the quality of care for economically disadvantaged and medically underserved populations, particularly moms and babies. Over last ten years with UnitedHealthcare, she has been accountable for state and national clinical programs. Prior to UnitedHealthcare, Lauren spent four years in state government, including the State Medicaid Agency, TennCare. Lauren resides in Nashville, Tennessee, with her family and enjoys attending sporting events and volunteering with community organizations.
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 large provider groups, 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. Stephen is one of the leading attorneys in the country on the law and legal challenges to the use of statistical sampling and extrapolation in the review and analysis of health care claims and has served as an expert witness in this arena. 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).
Austin is a Client Advisory Manager at Pareto Intelligence, focused on the implementation and delivery of Pareto's solutions as well as ongoing industry advisory to various healthcare clients. His combined engineering and business backgrounds allows him to bring an analytical approach to solving problems and supporting revenue management improvement activities for clients.
Brendan Brown is the Director of Research at the Green & Healthy Homes Initiative where since 2011 he has led the public health research on childhood lead poisoning, asthma, aging in place, non-energy benefits, and housing-related health outcomes. Most recently as the project manager for the three-year EPA Indoor Environments Program grant, he led the National Initiative for Asthma Reimbursement, where in 2017-2021 he supervised the delivery of technical assistance to 11 sites in the business development cohort and 10 sites awarded reimbursement support technical assistance. The goal of the initiative supported the growth of new or existing business partnerships to develop comprehensive asthma home visiting programs that deliver environmental health services, and by engaging health care payers assisted in obtaining reimbursement for services.
Currently, in partnership with Blue Cross Blue Shield of North Carolina, he is GHHI’s Director of the Fall Prevention Program responsible in the planning phase for the recruitment of the service provider partners in the four priority geographic areas, program design, and advising on the evaluation plan. During the implementation phase he is overseeing the training, pilot implementation, performance management, data collection, and quality assurance. He is also the Principal Investigator leading the evaluation of the Enhanced Stepping On program that is a partnership between Molina and People Working Cooperatively in Cincinnati, Ohio. Mr. Brown is currently a co-investigator and lead evaluator on two other home injury prevention program evaluations. He is co-investigator on a HUD-funded (2021-2023) Healthy Homes Technical Study “Preventing Injuries to Children Through Home Safety Audits and Modifications” with the Johns Hopkins Center for Injury Research and Policy. The implementation study is designed to evaluate the use of Child Housing Assessment for a Safe Environment (CHASE) in preventing child home injury. He is also a co-investigator and lead evaluator on GHHI’s evaluation of Habitat For Humanity’s CAPABLE plus Home Modification program in Memphis, TN.
Dawn Carter is a Director of Product Strategy at Centauri Health Solutions, LLC. Her career in healthcare spans 26 years, which most recently includes extensive experience in developing revenue integrity and quality software solutions, with a focus on encounter management and risk adjustment solutions for Medicare Advantage, Medicaid and Commercial health plans. Prior to that, her experience spans all domains of health care including health plan and provider systems administration, and healthcare applications development. Her experience also includes multiple teaching engagements in medical administration, billing and coding. Dawn holds a Bachelor’s degree in Business Administration. She is a passionate and prolific industry speaker, author, blogger and subject matter expert in claims, EDI management, and risk adjustment.
Suzanne Chipello joined Cedars-Sinai Medical Network in 2014 after completing her Master of Public Health degree at UCLA. She served as Project Manager, Executive Operations for Tom Gordon from 2014 – 2015 where she managed Health System deliverable timelines on behalf of the Medical Network, co-led the 2015 All Hands Meeting, Bi-Annual Physician Retreats and the Physician and Executive Leadership & Management Class series. Suzanne joined the Government Incentives Team as Manager in 2016 where she led the transition from Meaningful Use reporting to the MIPS program under MACRA, forecasting and supervising the program’s operational project rollout, resource allocation and financial viability. She managed vendor bidding and procurement and contract/consultant engagement, advised on regulatory legislative updates and authored organizational action plans. In her role within Revenue Cycle and Managed Care Operations, Suzanne led key initiatives throughout the Medical Network and beyond, developing the implementation of the Revenue Guardian program, leading the Professional Impact Committee, shepherding a new provider group Go-Live with Cedars-Sinai Medical Care Foundation, and leading special projects involving cross-functional teams in Managed Care, Revenue Cycle, Enterprise Information Services (EIS) and Network Management. In her most recent role as Director, Program Management, Suzanne oversees the functions and staff of the Project Management Office (PMO). She leads and is developing a best-in-class team of Program Managers who oversee high priority initiatives for the Medical Network, working alongside clinical and non-clinical operational teams, EIS technical partners, billing SMEs and compliance stakeholders, establishing and implementing best practices for the PMO delivering value-based outcomes. Suzanne graduated from Harvard College in 2009 with a degree in Economics.
Osato F. Chitou, Esq., MPH
NMOC Healthcare Compliance Consulting, LLC, d/b/a Compli by Osato
NMOC Healthcare Compliance Consulting, LLC, d/b/a Compli by Osato
Osato Chitou is the Principal Consultant for NMOC Healthcare Compliance Consulting, LLC, d/b/a Compli by Osato, where she provides legal and compliance services to the Payor, Provider, and Life Science Industries. Her prior roles include serving as the Chief Legal and Compliance Officer for a Private Equity backed MSO supporting Dermatology and Plastic Surgery practices across four states, in addition to serving as the Medicare Compliance Officer for several multi-state Payors that offered Medicaid, Medicare Advantage and Special Needs Plans. She has also served as the Compliance Officer for one of New Jersey’s largest urban teaching hospitals. Additionally, Ms. Chitou also worked for the State of New Jersey, within the Department of Human Services, and was charged with overseeing Managed Care Organizations market entry and exit including MCO applications, close-out activities, and procurement cycles. Ms. Chitou was also in private practice as an associate in the Healthcare & Healthcare Privacy practice groups at Moses & Singer LLP. While there, her areas of concentration included state and federal health privacy issues and regulatory compliance with HIPAA and HITECH. Ms. Chitou is admitted to practice law in New York, New Jersey, and the Supreme Court of the United States.
Wynda Clayton is a Risk Adjustment Manager at Providence Health Plans in Beaverton, OR. She received her Health Information Degree from College of Saint Mary’s, her BS in Health Care Management from Bellevue University and her MS from Clarkson College. Wynda has been in the health care field for over 25 years with experience on all phases from compliance to billing and reimbursement to coding to Quality Assurance to being a RADV Auditor to risk adjustment and providing physician education. Wynda is very enthusiastic and loves basketball, traveling and helping those unfortunate. To help is not always meaning to give, but it also means to teach others how to make a difference in their lives. Currently Wynda resides in Portland, OR with her husband Kevin. She can be contacted at Wynda.Clayton@providence.org.
Carmela Costiniuk, MHA Vice President of Population Health and Clinical Transformation
Catholic Medical Partners
Carmela Costiniuk is Vice President of Population Health and Clinical Transformation at Catholic Medical Partners, the largest network of independent practice physicians in Buffalo, NY, with nearly 900 physician members. She develops and implements population health and operational strategies and oversees the operations team, which provides direct support to physician practices to improve quality performance and care coordination across the health continuum.
A native of Canada, Carmela earned her Bachelor of Science degree in Occupational Therapy from the University of Toronto and her Masters in Health Services Administration from D’Youville University where she is currently completing her Doctoral Degree in Health Administration.
Carmela has held various administrative positions in home and community based care, acute care, long-term care, and the Local Health Integration Network (LHIN) Ontario Ministry of Health.
Deb Curry, MBA, RHIA, CCS-P, CRC, RAP, AHCCA Director Risk Adjustment & Recoveries
Paramount Healthcare/ProMedica Health System
Deb joined Paramount Healthcare in May 2013 and oversees the Risk Adjustment, Coordination of Benefits, and Subrogation departments. 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). Additionally, Deb is a 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 I. Decker, M.Ed., M.Ed., MBA, MBA, PhD. Principal
Dr. Shannon Decker is principal at VBC One, a consulting firm assisting physician groups, health plans and vendors maximize the performance of their value based contracts and offerings. Dr. Decker has more than 20 years experience in health care and most recently led teams in risk, quality, data and analytics, telehealth, COVID response and delegation compliance. Of her more than 20 years of experience in healthcare--15 include working with risk adjustment, quality and Medicare. Dr. Decker has a PhD. in Interdisciplinary Studies, dual MBA degrees--in Finance and in Marketing, as well as an M.Ed. in Secondary Education and a M.Ed. in Administration and Leadership. Dr. Decker is on the faculty at Arizona State University and is also an associate professor of Higher Education & Adult Learning (HEAL) and chief methodologist for Walden and Capella Universities where she chairs and oversees the dissertations of doctoral students. An author of two books and several peer-reviewed articles, and a prolific national public speaker, her interests include the study of human behavior and how theories on motivation and learning may be brought to bear on population health management.
I’m Meredith Diep, Sr. Manager Enterprise Risk Adjustment at LA Care Health Plan. I am motivated by opportunities to transform healthcare operational processes, defining tasks and achieving results.
I have over 20 years of operational experiences in encounter data and risk adjustment management. My key characteristics of vision, perseverance, being option oriented, analytic, helpfulness, and being open to change, enable me to lead and deliver organizational successes.
I enjoy traveling, exploring, and collecting local custom hand-made novelties.
His background is in management and operational processes for 15 years, and began working in the Risk Adjustment arena 12 years ago. Ryan has proven himself by helping Medical Groups raise their RAF scores to their proper levels. He directed the movement of a 10,000 member group up 43% over a two year period, and an 1800 member group up 53% in the first year. Ryan achieves these results through chart documentation audits, provider and staff documentation training, and provider relationship building. In his most current role Ryan works with multiple groups to optimize their RAF score, while at the same time achieving CMS 5 Star quality. Ryan explains to these groups that getting their RAF score to the correct level will not only drive revenue, but it will also lead to better patient care with improved documentation habits. Ryan is a Certified Risk Adjustment Coder (CRC) credential through the AAPC.
Dona Doran Program Director Risk Adjustment Operation
Cambia Health Solutions
As Program Director of Risk Adjustment Operations for Cambia Health Solutions, Dona is responsible for driving the tactical execution of the Medicare Advantage and ACA risk adjustment strategy and program management. Serving in the healthcare industry for over 15 years, Dona continues to focus on improving efficiencies, data accuracy, and compliant outcomes through operational excellence and strong vendor partnerships.
Julianne Eckert Senior Director of Clinical Quality Programs
Julianne Eckert is the Senior Director of Clinical Quality Programs at Clover Health, a physician enablement company focused on seniors who have historically lacked access to affordable, high-quality healthcare. She is responsible for creating an innovative data driven strategy that breaks the traditional model of healthcare to make it easier for providers and patients to deliver and receive healthcare.
She has spent her life using her personal and clinical career experiences to help drive her mission as a patient advocate by leading health plan quality improvement strategies to prevent vulnerable populations from falling through the cracks with data stories and forward thinking programs which enable patients to easily navigate the complex matrices of healthcare and insurance. She has sweeping subject matter experience in CMS Innovation models, Stars QI programming, NCQA HEDIS/CAHPS/HOS, health equity, as well as, national and international leadership in driving laser focused strategies to improve health plan performance and member outcomes/experience.
She has held multiple Board Advisory roles and currently serves on the Board of Advisors for curriculum development for Pace University’s Design Thinking Executive Program which meets high academic standards, with a challenging interdisciplinary curriculum designed to prepare top executives to solve real-world challenges in designing innovative practices. She holds multiple certifications in Organizational Change Management, Case Management and also Managed Care. She is an avid mentor and career coach believing it is her mission to develop our next generation of leaders.
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.
Eden Encarnacion MHA Director, Quality and Stars Program
Clever Care Health Plan
Eden Encarnacion, MHA is the Director of Quality and Star Programs at Clever Care Health Plan. Prior to joining Clever Care HP, her work primarily focused on quality improvement for Commercial, Medi-Cal and Medicare lines of businesses for 2 MSO’s in CA. A few achievements include year-over-year awards from Integrated Health Association (IHA) AMP Program for Most Improved Medical Group (for 4 IPAs) and improving an IPA from a 3 star to a 4.5 Star Performance. Her experience spans not only in quality but also in the areas of risk adjustment, claims, encounter data submission and overall improvement focused on strategic development and implementation of Value Based Performance Programs.
Ellen Fink-Samnick is an award-winning industry thought leader who empowers healthcare's transdisciplinary workforce. Known and highly respected as 'The Ethical Compass of Professional Case Management', she is a sought out professional speaker and author with hundreds of offerings and publications to her credit.
Ellen's work has achieved global acclaim. She is a national expert on the Social Determinants of Health and Mental Health, Workplace Bullying and Violence, Professional Ethics, Professional Case Management Practice, and Wholistic Case Management™. Her latest books include, The Essential Guide to Interprofessional Ethics for Healthcare Case Management, The Social Determinants of Health: Case Management's Next Frontier, End of Life Care for Case Management, and upcoming Social Determinants of Mental Health: The Essential Guide for Healthcare Case Management. Ellen is a panelist for Monitor Mondays and Talk Ten Tuesdays, plus contributor to RAC Monitor and ICD 10 Monitor. She also serves as moderator of Ellen’s Ethical LensTM on LinkedIn, consultant for the Case Management Institute, and moderator of their Case Managers Community. She is also the Lead for Rise Association’s Social Determinants of Health Community.
Ellen is a Licensed Clinical Social Worker, Board-certified Case Manager, Certified Clinical Trauma Professional, Certified Mental Health Integrative Medicine Provider, and Certified Rehabilitation Provider. Her academic affiliations include roles as subject matter expert for Western Governors University, and adjunct faculty for the University of Buffalo’s School of Social Work, and George Mason University’s Department of Social Work. She is also a Doctor in Behavioral Health candidate at Cummings Graduate Institute of Behavioral Health Studies.
Ellen's passion is evident across her varied roles as professional speaker, industry consultant, educator, blogger, continuing education content developer, accreditation specialist, clinical social work supervisor and professional mentor to the case management community. Her contributions transverse the industry’s professional associations and credentialing organizations. A past commissioner for the Commission for Case Manager Certification, and Chair of their Ethics and Professional Conduct Committee, member of the Board of Directors for the Case Management Society of America, Ellen serves on the editorial boards for the Professional Case Management Journal, Case Management Monthly, and RAC Monitor. More detailed information is available on her LinkedIn Profile.
Colleen Giantasio, CPC, CPC-P, CPMA, CPC-I, CRC
Director, Clinical Documentation Integrity and Coding Compliance
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.
WSJ Bestselling Book “Competing in the New World of Work”
WSJ Bestselling Book “Competing in the New World of Work”
Kian Gohar is Founder & CEO of Geolab, an innovation venture lab in Los Angeles that explores impact-driven innovation moonshots to tackle grand challenges. He is a master facilitator and has coached the CEO and leadership teams of over 50 companies in the Fortune 500 on topics as diverse as innovation, disruptive technologies, exponential thinking, the future of work, the future of mobility, and leadership.
Previously, Kian founded and was Executive Director of the world’s leading corporate innovation ecosystem, called the Innovation Partnership Program (IPP.biz), a joint venture of two of the world’s most advanced futurist organizations: the XPRIZE Foundation & Singularity University.
His 20-year innovation career spans venture capital, academia and startups around the world. Early in his career, he was a venture capitalist in the UK and China investing in early stage digital media companies, and was a Luce Scholar and faculty member at China’s leading business school.
Kian is passionate about the intersection of technology, society and policy. A sought-after public speaker, Kian has presented at the World Economic Forum, been featured on CNBC and Axios, delivered a popular TED talk, and co-authored a seminal report called “The Work Ahead” about the future of work. He speaks 5 languages, is a graduate of the Harvard Business School, the London School of Economics, and Northwestern.
Savannah Gonsalves, RN, BSN, MHA is the Director of Quality for Hometown Health. Savannah specializes is government regulatory quality programs and has a passion for population health. In her role at Hometown Health, she oversees the HEDIS and Stars, Appeals and Grievances, and Clinical Risk Adjustment teams. She enjoys hiking and camping with her family in the paradise that is Lake Tahoe.
"People who say it cannot be done should not interrupt those who are doing it." George Bernard Shaw.
EVP, Operations - Risk Adjustment, Population Health Management and Quality
RaeAnn Grossman EVP, Operations - Risk Adjustment, Population Health Management and Quality
As Executive Vice President of Operations for Population Health Management, Risk Adjustment, and Quality, RaeAnn is responsible for leadership and management oversight of financial performance and operations, as well as innovation, vision, strategic and business planning. In this capacity, she is reframing and accelerating the success and impact of Cotiviti’s industry-leading Risk Adjustment, Quality Network and Clinical, plus Consumer (Eliza) solutions focused on health plan success, health equity and outcomes, and provider performance. With her extensive track record of customer focus, value creation, along with government program and industry experience, Grossman drives the Cotiviti portfolio to improve financial and clinical metrics, reduce the cost of care, and create a landscape for health equity.
Grossman is a renowned industry expert in healthcare innovation and transformation, product strategy, partnership development, and risk adjustment and quality. She has more than 25 years of experience in executive roles at an array of organizations, including commercial and government health plans as well as medical groups, integrated hospital systems, startups, and physician hospital organizations. Most recently, she was President of Medicare Advantage/COO of Bright Health Plan, managing a multi-state Medicare Advantage plan. Prior to that she held C-suite roles at various healthcare technology and consulting firms for nearly two decades, including extensive time with Gorman Health Group, which the premier consulting firm for government-sponsored healthcare programs.
RaeAnn earned an MS in urban and regional planning from Florida State University, and a bachelor’s degree in environmental policy from University of Minnesota.
Ana Handshuh, Principal at CAT5 Strategies, is a government programs executive with expertise in creating and implementing corporate programs for the healthcare industry. Her background includes Quality, Core Measures, Care Management, Benefit Design and Bid Submission, Accreditation, Regulatory Compliance, Revenue Management, Communications, Community-based Care Management Programs and Technology Integration. Ms. Handshuh currently serves on the Board of the Resource Initiative and Society for Education (RISE), the preeminent national professional association dedicated to managed and accountable care financing and delivery. She is a sought after speaker on the national healthcare circuit in the areas of Quality, Star Ratings, Care Management, Member and Provider Engagement, and Revenue Management. Her recent consultancy roles have included assisting organizations create programs to address the unmet care management needs in the highest risk strata of membership, document their processes and procedures, achieve accreditation status, design and submit government program bids, institute corporate-wide programs and create communications strategies and materials. She possesses sophisticated business acumen with the ability to build consensus with cross-functional groups to accomplish corporate goals. Ms. Handshuh served as the Vice President of Managed Care Services at Central Florida Inpatient Medicine (CFIM). In this role, she provided leadership and strategy on CFIM projects and collaborations with physicians, risk entities, hospital health care systems, and health plans. CFIM is the largest Hospitalist group in Central Florida, with 70 providers discharging over 50,000 patients annually from multiple hospitals across two health care delivery systems and 24 skilled nursing facilities. At CFIM Ms. Handshuh previously served as the Vice President of Operations. Prior to those assignments, she worked with Precision Healthcare Systems as their Vice President of Quality Improvement. In that capacity, she led the IPA’s Quality efforts and collaborated with payers on implementing programs to move the needle on Quality and Star Rating initiatives. Ms. Handshuh also served as the Director of Corporate Program Development at Physicians United Plan. In this role, she led the Quality Management and Corporate Communications departments and spearheaded the development of innovative integrated technology solutions to drive business excellence and Star Rating achievement initiatives. For the past fifteen years Ms. Handshuh has taken an active role in redefining and implementing changes that have led to improvements and greater efficiency within Government programs and healthcare delivery. Prior to joining Physicians United Plan Ms. Handshuh was the founder of I-Six Creative. Under Ms. Handshuh’s vision and leadership, I-Six Creative provided expertise in the areas of managed Medicare benefit design, MSO/IPA operations, provider network strategy, new market launches, technology integration, corporate communications and quality improvement.
Leah Hannum Director of 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.
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.
Former Director, Enterprise Risk Adjustment Strategies/Initiatives
Mark Ishimatsu Former Director, Enterprise Risk Adjustment Strategies/Initiatives
L.A. Care Health Plan
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.
Katharine is the President of Healthy People, an NCQA-licensed HEDIS audit firm and CMS Data Validation firm. She is a member of NCQA’s Audit Methodology Panel and NCQA’s HEDIS Data Collection Advisory Panel. Katharine has been a Certified HEDIS® Compliance Auditor since 1998 and has directed more than two thousand HEDIS audits.
Previously, as CEO of the company Acumetrics, Katharine provided consultancy services to NCQA which helped their initial development and eventual launch of the NCQA Measure Certification Program.
Katharine is a frequent speaker at HEDIS conferences. She is featured on an NCQA podcast, discussing the HEDIS Electronic Clinical Data System Measures: https://blog.ncqa.org/inside-h...
She received her BA from Columbia University and her MPH from UC Berkeley School of Public Health. She is a member of the National Association for Healthcare Quality and is published in the fields of healthcare and public health.
As Chief Experience Officer at FarmboxRx, Jenn Kerfoot is the head of Client and Member Experience Operations. In this role, Jenn leads the strategic planning, design, and implementation of initiatives that drive Member Satisfaction & Retention. Additionally, Jenn spearheads the Member Insights function using qualitative and advanced analytic approaches to understand the gaps in care and unmet needs of populations. Jenn has helped companies articulate and achieve success across several aspects of the healthcare space. As a military veteran, Jenn brings leadership and vision to diverse audiences, and offers a unique perspective within start-ups and high-growth stage companies. With a passion for organizational mission and values, as well as the unique competitive advantage of establishing a strong culture, Jenn works with all departments to streamline processes and programs that integrate the member experience into every aspect of the business.
As the Senior Director for Quality, Patient Experience & Safety, Archana is responsible for the overall quality framework delivered under Walgreens Health. In her role, Archana works cross functionally across the organization to lead development of strategies, plans and operational processes to ensure compliance with value-based care arrangements. Archana brings over 15 years of leadership and operational experience across a portfolio of industry-leading businesses and services in healthcare quality, quality improvement, clinical quality outcomes and process improvement. She has a CPHQ as well as a Lean Six Sigma Black Belt.
Throughout her career, Archana has worked collaboratively with healthcare providers and administrators to provide standardized, patient-centric care and improve health & quality outcomes. This has become her area of focus as she operationalizes a comprehensive quality approach for Walgreens Health to further the company’s purpose to create more joyful lives through better health. As a transformational leader, Archana is passionate in her belief that a comprehensive, holistic, patient-centric model for care gap closures is needed - one that leverages the physical, virtual & digital sites of care, allows real-time access & availability to clinicians, focuses on health equity & SDOH and partners with payors to offer customized solutions for their population quality needs.
DeAnna L. Minus-Vincent, MPA Chief Social Justice & Accountability Officer
DeAnna Minus-Vincent is the Corporate Vice President, for the Social Impact and Community Investment practice at RWJBarnabas Health. In this role, DeAnna coordinates the housing and community development initiatives; oversees the planning, development and implementation of a system-wide universal social determinants of health (SDOH) screening that seeks to integrate social and behavioral factors into clinical settings; collaborates with local facilities to ensure adherence to social impact principles; identifies ways to use data and technology to track progress and enhance health outcomes; and she also serves as the departmental liaison to the departments of communications and development.
Before coming to RWJBarnabas Health, DeAnna served for more than seven years as the Chief Engagement Officer at Benefits Data Trust (BDT), a national social change organization, where she facilitated cross-sector partnerships, diversified the organization’s revenue streams and oversaw the organization’s strategic positioning. Additionally, she has served as the Assistant Commissioner for the New Jersey Department of Community Affairs in Trenton, where she oversaw the Division of Housing & Community Resources, Division on Women, Center on Hispanic Policy and several functional units.
Adding to her resume, DeAnna was the Director, Office of Institutional Advancement, at the Stuart Country Day School in Princeton, overseeing all development, public relations and communications functions and the Director of Planning and Development for the Central Jersey Family Health Consortium in North Brunswick where she analyzed birth certificate data to better understand maternal and child health outcomes and create programming to improve the lives of women, infants and children in New Jersey.
DeAnna serves on several national, statewide and local organizations, including as a board member for the Corporation for Supportive Housing and the Housing and Community Development Network of New Jersey, as well as a member of the national Healthy Food Community of Practice, New Jersey WIC Advisory Board, and NJ Alliance to End Hunger.
DeAnna received a Master of Public Administration from Rutgers University, and a Bachelor of Arts in sociology from Morgan State University. DeAnna is a native New Jerseyan and lives in Lumberton with her husband, Daryl and daughter, Darynn.
Erin oversees operations across all our solutions. With more than 25 years of healthcare experience, she is focused on delivering top quality solutions and superior services that exceed client expectations. Erin works cross-functionally to ensure that we continually innovate, enhance, and scale effectively to drive results. Prior to Advantmed, she served as chief operating officer at Pulse8 where she was responsible for interventions, coding, and submission operations and products. Erin also has extensive clinical, customer engagement, risk adjustment, and vendor management experience and has held roles at Health Risk Partners (now Cotiviti), Physicians United Plan, and Health First. Erin received her BS in Administration from Barry University and is both a Licensed Practical Nurse (LPN) and Certified Medical Coder (CPC).
Tom Nasadoski, MBA Vice President, Risk Adjustment
Tom Nasadoski is currently serving as the Director, Risk Adjustment and Recovery after being named Manager, Risk Adjustment in February, 2011. In this position, he oversees managing the Medicare Advantage, Commercial, and Medicaid risk adjustment initiatives and CMS reimbursement to the plan. Tom has built a Risk Adjustment unit at CDPHP consisting of over 30 internal staff with 7 specific job titles.
As Senior Manager for Engagys, Shannon O’Connell leads projects that drive behavior change for health plans. She is especially focused on the Medicare population and populations that experience the barriers of social determinants of health. She has over a decade of experience in healthcare with a passion and focus on improving member and provider engagement with a C360 communications approach. Her expertise includes leading teams through producing and improving communications mapping, inventory, and taxonomy development, print to digital strategy, communications governance models, and campaign optimization.
At her previous role with Blue Cross Blue Shield of Massachusetts, Shannon managed communications strategy for the Member and Provider Communications unit. Her communications designs spanned 25 business units across the organization and impacted millions of members and tens of thousands of providers. From problem solving to end goals, Shannon draws on creativity and storytelling best practices she learned during her early career experience in television and documentary film production.
Margaret Paroski, MD President & Chief Executive Office
Catholic Medical Partners
Dr. Paroski is the is the President & CEO and Chief Medical Officer of Catholic Medical Partners, an independent practice association with 900 physician members. A board certified neurologist, Dr. Paroski has held various administrative positions including Medical Director at Erie County Medical Center; Senior Associate Dean of Academic Affairs & Admissions and Interim Vice President of Health Affairs and Interim Dean at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo; and Executive Vice President and Chief Medical Officer at Kaleida Health.
She began her medical career at the Buffalo VA Medical Center and held hospital appointments at the Buffalo Psychiatric Center, Roswell Park Cancer Institute, Kaleida Health, and Erie County Medical Center. In addition to her clinical and leadership roles, Dr. Paroski has been a faculty member in the Neurology department at the Jacobs School of Medicine and Biomedical Sciences for the past 37 years.
As President & CEO and Chief Medical Officer of Catholic Medical Partners, Dr. Paroski leads clinical integration and standardization efforts and physician relations among the organization’s medical and specialty practices. She is also responsible for engaging physician members in population health initiatives and value based payment model adaptation.
Gregory Pastor Managing Director of Risk Adjustment Operations
Greg Pastor is Managing Director of Risk Adjustment Operations for Advantasure. Under his leadership, over 350 risk adjustment professionals drive client execution, customer value, and optimize plan revenue. Pastor's team is about to do this through a suite of risk adjustment services such as retrospective medical record retrieval and review, the industry leading prospective Provider Engagement Coordination (PEC) program, in home assessment services, as well as analytic insights for clients. This teams optimizes documentation accuracy for 850,000 members and $7Billion in risk adjusted revenue.
Pastor has previously served as Advantasure’s Regional General Manager for the New York market where his team was responsible for driving value for three health plan clients via 41 field operations staff to deliver prospective and retrospective Medicare Advantage solutions on behalf of 120,000 lives under management.
Prior to joining Advantasure in 2016, Pastor spent 19 years supporting value creation in a variety of roles like the Director of Revenue Strategy for Aetna’s Medicare Business Segment. Pastor’s team optimized program interventions that improved condition documentation generating $450Million of incremental revenue and managing a risk adjustment vendor model with $55Million in annual spending. Pastor has also held a variety of market and client facing roles in the US and UK driving advancements in the management of populations, resulting in improvements in the cost and quality of care.
Pastor holds a Master of Public Policy Degree from The College of William & Mary, as well as BA degrees in Economics and Political Science from the University of Colorado, Boulder.
Pritesh leads a team of Product Managers building innovative healthcare data, analytics and interoperability solutions for Apixio's value-based care capabilities. The team is hyper focused on architecting a scalable and sustainable interoperability network, while incorporating industry data exchange standards, advanced technology and patient care experience design in Apixio's solutions that help realize exceptional value for Apixio's customers. Pritesh comes with 15 years of healthcare strategy, product and technology experience in the managed care, pharmacy, healthcare IT and management consulting. His experience spans across creating new products from idea to launch and achieving product-market fit at scale, enhancing products portfolio to expand the customer base and engagement, designing and launching healthcare services.
Melanie A. Prince, MSN, BSN, RN, NE-BC, CCM, FAAN
Case Management Society of America, Retired Military Colonel - U.S. Airforce
Melanie A. Prince, MSN, BSN, RN, NE-BC, CCM, FAAN Former President
Case Management Society of America, Retired Military Colonel - U.S. Airforce
Melanie A. Prince, is the President of Case Management Society of America (CMSA). She served 30 years in the armed services, retiring in the rank of Colonel assigned to Headquarters Air Force where she was responsible for developing strategies to eliminate interpersonal violence in the military and advanced the Air Force Surgeon General’s global health care strategy.
Priya Radhakrishnan Chief Academic Officer, VP Health Equity
Dr. Priya Radhakrishnan, MD, FACP is a board-certified internist with an interest in treating patients with chronic complex illness and is a physician leader with extensive experience.
She is the Vice President for Health Equity and Chief Academic Officer at HonorHealth. She oversees the medical education programs at HonorHealth and Social Determinants of Health & Health Equity Initiatives at HonorHealth. She is a Clinical Professor of Medicine at University of Arizona College of Medicine-Phoenix.
Dr. Radhakrishnan has held several leadership positions. She is the current Governor for the Arizona chapter and the Chair Elect of the Board of Governors of the American College of Physicians. She was the Robert Craig Academic Chair of Internal Medicine at St. Joseph’s Hospital and Medical Center, Phoenix.
Dr. Radhakrishnan received her undergraduate medical degree at Calicut Medical College, India and completed her residency in Pathology at Trivandrum Medical College. She then completed her Internal Medicine residency at Lincoln Hospital and Mental Health Center and St. Francis Hospital. She has received certification in Quality Improvement through the Inter-Mountain Advanced Training Program and is currently an ACGME Health Equity fellow.
Dr. Radhakrishnan’ s clinical and research work with health care disparities, quality improvement, and medical education has been recognized locally and nationally. Under her leadership, HonorHealth was awarded the AAMC Curricular Innovation Award. She was the recipient of the SGIM’s Clinical Practice and Quality Innovation, ArMA Ruhe Award and Wallace A. Reed, M.D. Award, recognizing innovation in health care and the AIAMC 2019 Innovation Award . She was the physician advisor for the CMS Transforming Clinical Practice Initiative (TCPI) grant that impacted 2500 clinicians in Arizona.
Tom Rhodes Director of Payer Sales-Risk Adjustment
Tom Rhodes, Director of Sales-Payer Risk Adjustment at Wolters Kluwer, Health Language, has more than eighteen years of experience in the healthcare industry with in-depth knowledge in the risk adjustment, HEDIS, business process outsourcing, natural language processing, medical record retrieval and coding services space. Prior to joining Health Language, Tom held various healthcare IT sales and sales management roles specializing in risk adjustment, quality improvement/HEDIS, data analytics, clinical decision support solutions and services for Reveleer, Change Healthcare, Molina Healthcare, and Truven Health Analytics.
Tom holds an MBA in finance and healthcare administration from Northeastern University and a bachelor’s degree in psychology and behavioral science from the University of Wisconsin-Madison.
Sonja Rosen MD, FACP, AGSF Chief, Section of Geriatric Medicine, Dept of Medicine
Sonja Rosen serves as the Chief of Geriatrics for Cedars-Sinai and the Medical Director of Geriatrics for Cedars-Sinai Medical Care Foundation. Under her leadership, the Academic Section of Geriatric Medicine at Cedars-Sinai was created, with her serving as the Inaugural Chief. She is a Professor of Medicine at UCLA David Geffen School of Medicine. She is a Fellow of the American College of Physicians and a Fellow of the American Geriatrics Society. She was previously Chief of Geriatric Medicine at UCLA Medical Center, SM and Medical Director of UCLA Medical Center, SM Geriatric Inpatient Unit. Dr. Rosen completed her fellowship in Geriatric Medicine at UCLA, residency in Internal Medicine at Harbor-UCLA, and medical school at the University of Chicago Pritzker School of Medicine. She is board certified in Internal Medicine, Geriatric Medicine and Hospice & Palliative Care Medicine. Dr Rosen’s research and clinical interests include safe transitions of care and safe prescribing in older persons, geriatric co-management, delirium education, population health, Medicare Advantage population management, addressing social determinants of health and fall prevention. She has written multiple peer-reviewed articles and chapters on this work, as well as served as book editor, and given multiple national and international presentations. She has created and implemented numerous quality improvement programs to improve geriatric models of care and has championed Cedars-Sinai’s efforts to be recognized as an Age-Friendly Health System Committed to Care Excellence in 2020. She currently serves nationally on the American Geriatrics Society Quality & Performance Measurement Committee and the workshop planning committee on Advancing Diagnostic Excellence for Older Adults for the National Academies of Sciences, Engineering, and Medicine. She has also won numerous awards for her clinical care, including being selected by peers for Southern California Super Doctors and Los Angeles Magazine Top Doctors for consecutive years.
Dr. Rothman is a geriatrician with expertise in multi-facility, multi-state provider organizations, aging, geriatrics, post-acute care, palliative care, quality improvement, patient experience and physician engagement.
Dr. Rothman is currently the Chief Medical Officer of Signify Health, a leading provider of tech-enabled healthcare solutions that enable value-based care transformation, drive healthcare homeward and fill gaps in the social determinants of health. Prior to Signify he served as Senior Medical Officer at Aspire Healthcare where he oversaw Aspire’s centralized telephonic urgent care services, their TeleHealth advanced care planning services and led Model of Care 2.0 performance improvement efforts. Before Aspire Dr. Rothman was the Chief Medical Officer of Kindred Healthcare, Inc., at that time the nation’s largest provider of integrated post-acute care services. At Kindred Dr. Rothman oversaw medical affairs, physician engagement, quality and patient experience across Kindred’s 2,400+ locations in 45 states.
Prior to joining Kindred, Dr. Rothman directed post-acute medical services for the Kaiser Permanente San Francisco Medical Center and practiced geriatric, post-acute and palliative medicine with the Permanente Medical Group.
Dr. Rothman is a graduate of the New York University School of Medicine. He completed his internship and residency in Internal Medicine, as well as fellowships in Geriatric Medicine and Clinical Epidemiology at the Yale University School of Medicine. He is board certified in Internal Medicine, Geriatric Medicine, and Hospice & Palliative Medicine, and is a Certified Medical Director.
JoJuan Rowe, RHIT Manager of Medicare Risk Adjustment
Arkansas Blue Cross Blue Shield
Currently holds a degree in Health Information Management and an RHIT credential with AHIMA. 10 years of medical coding experience, 8 years with a specialization in HCC/Risk Adjustment Coding with a focus on Medicare Advantage plans. Has managed a Medicare Risk Adjustment quality audit team and currently is the Manager of Medicare Risk Adjustment at Arkansas Blue Cross Blue Shield. Continues to help others meet and exceed their goals while finding their way to success.
George G Sauers Chief Managed Care and Strategy Officer
Rockport Healthcare Services
George has a bachelor’s degree in Business Administration with a concentration in Finance from Millersville University of Pennsylvania. He has served in numerous positions starting at the entry level to his current C-Suite position. His background is broad encompassing many functional areas within the Managed Care Payer and Provider Space. These experiences include: Budget and Financial Analyst at Pennsylvania Blue Shield (now Highmark), Provider Relations and Network Develop Representative at Keystone Health Plan Central (HMO subsidiary of PA Blue Shield), Director of Provider Relations and Marketing, Integrated Health Services, Sr. Medicare Risk Manager and eventual Executive Director, IHS Senior Care, Area Vice President of Sales and Managed Care, Integrated Health Services, Vice President of Managed Care, SavaSeniorCare, and currently Chief Managed Care and Strategy Officer at Rockport Healthcare Services. In addition to his C-Suite Role at Rockport, he is the founder and President of Post-Acute Collaborative Partners.
William Schweitzer Associate, Platform Strategy and Solutions
Will supports solution design and product management for Episource, coordinating efforts across product and client services to drive data-based opportunities for payers and providers. Before obtaining his MBA, Will spent six years supporting research for the healthcare industry, at an expert network serving life sciences companies, and as a client success manager for an online provider of business intelligence tools. He holds an MBA from UCLA and a bachelor’s degree in neuroscience.
Anand Shah, MD, MS Vice President of Social Health
Anand Shah, MD, MS, is vice president of social health at Kaiser Permanente. In this role, Dr. Shah is responsible for developing and implementing Kaiser Permanente’s national social health strategy. His areas of focus include driving the adoption of standardized screening tools, scaling evidence-based interventions, and integrating into the organization’s electronic health record system a platform to connect members with social services and other community-based programs that alleviate food insecurity, homelessness, and other social needs. Dr. Shah is trained as an emergency physician with prior academic appointments at the University of Texas Southwestern, University of Pennsylvania, and Brown University. He completed his residency and chief residency in emergency medicine at Brown University and was a Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania, where he also earned a master’s degree in health policy research.
Gretchen Shanofsky is an independent consultant, collaborating with organizations looking to develop programs and services to improve health care cost and service outcomes. With extensive experience in health tech and insured products, she has held executive positions at Clover Health, Oscar Health, Satellite Healthcare, and United Healthcare. She is a population health enthusiast with interests in systems thinking, behavioral economics and solutions to address inequities in the health system, and in her spare time enjoys playing classical piano and crossfit workouts. Gretchen earned her Master of Applied Science degree in Population Health Management from The Johns Hopkins University Bloomberg School of Public Health and her Bachelor of Arts Degree in English and Science, Technology and Society from Pitzer College in Claremont, California.
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.
Erik is responsible for the delivery of onshore and offshore coding services, record retrieval, IT infrastructure, and compliance. His knowledge in engineering, finance, and operations enables him to continuously improve performance and operational transparency for clients. He has over ten years of experience managing outsourced centers and substantive backgrounds in investment banking and technology. Erik has a BS in Biomedical Engineering from Johns Hopkins University and an MBA from NYU Stern.
Amy Smith, RN, CCM, BHA, MBA is a Registered Nurse, currently with Sentara Health Plans as the Director of Provider Enablement. Amy has led the development of the Provider Enablement team and value-based transformation efforts. Amy is passionate about value-based care and has experience both on the payer side and also leading value based work on the primary care provide side. Most recent experience, serving as Director, Clinical Health Services for both Medicaid CCC Plus and Medallion with Aetna. Prior to that, she served in multiple leadership roles with organizations such as Anthem, Virginia Care Partners and Commonwealth Primary Care as the Director of Quality and Value-Based Care. Amy has deep experience building and implementing care delivery transformation programs from both the provider and payer organization perspective.
In her current role, she oversee's the continued evolution of Joint Operating Committees and is the key liaison to Sentara's VBC provider partners, working with them to prioritize intervention activities aimed at closing quality, cost and risk adjustment gaps, and improve the member experience to ensure joint success under our VBC models. In her spare time, she enjoys hiking, running, shopping and spending time with her boys.
Archita Sood, MD Dr. Sood is the Chief Medical Officer at Homebase Medical and leads the organization's commitment to providing comprehensive access to in-home care for vulnerable seniors. Prior to this she served on the clinical leadership team at CareMore Health. Her care delivery and Medicare Advantage experience has afforded her in-depth knowledge of complex disease and palliative care management, risk adjustment and the Medicare annual wellness visit. She received her medical degree from the State University of New York and completed her residency training at UCLA-Olive View Medical Center. She has also completed additional Palliative Care training through a proprietary training model at the University of Southern California.
Barry Stelmach is the Chief Financial Officer for Catholic Medical Partners, the largest network of independent practice physicians in Buffalo, NY, with nearly 900 physician members. He is responsible for the overall financial operations and leads payor negotiations for the organization. Barry also oversees the development and evaluation of risk contracts between payors and providers for all lines of business. He has played a significant role in preparing practices for the shift from fee-for-service to value-based care and risk-based contracts.
A native of Buffalo, NY Barry earned his undergraduate degrees in Accounting and Economics and a Master of Arts degree from the State University of New York at Buffalo.
Jill Strassler is the VP of Solutions Management at Veradigm Payer Solutions (formerly known as Pulse8). She is a dynamic healthcare executive focused on innovating the analytics and reporting solutions for Health Plans for Risk Adjustment, Quality and Value Based Care models. Jill brings expertise in developing novel solutions to address emerging and transformative change in the healthcare industry. Jill excels at delivering value across the ecosystem by increasing transparency and building connectivity among all stakeholders. Over her notable 20-year career, Jill has developed holistic member engagement and quality strategies for health plans. Prior to her focus in risk adjustment, she led solutions for molecular diagnostic utilization management and reimbursement. Jill received her BA in Psychology from The University of Chicago and received her MBA and MS in Management Information Systems from Boston University.
Elaine Taverna Senior Vice President, Risk Adjustment and Quality
With over 25 years’ experience, Elaine Taverna has spent the last 10 years improving revenue trend and lowering medical expense for healthcare providers and payers within the United States and throughout Michigan.
A career of success in health care
Elaine has overseen medical management, risk adjustment and quality programs, primarily within the government funded product sector.
As senior vice president of risk adjustment and quality for Advantasure, she is responsible for performance in revenue stream areas such as risk adjustment and quality five-star programs.
As the vice president of revenue management and risk adjustment at Health Alliance Plan of Michigan (HAP), a subsidiary of the Henry Ford Health System. Elaine led the evaluation, design and implementation of HAP and Henry Ford risk adjustment and provider performance programs for all government-funded revenue streams. She also designed and implemented a chronic care outpatient ambulatory program for Henry Ford Medical Group and, as director of government programs, developed a strategic plan to integrate physical and behavior health for members.
At Concerto Health in Detroit, a physician organization, Elaine served as the national director of care management - with responsibility for provider performance for risk adjustment, quality and cost containment - designing and overseeing care management programs, quality assurance initiatives and contract compliance.
Elaine also served as Meridian Health Plan’s national director of long-term care supports and services, administrating lines of business in three states with over 500k of membership; at Community Living Services (CLS) as the division director of long-term care services and business development; and, earlier, as CLS director of operations for its Personal Supports and Services Department.
Education in social work and health administration
A licensed registered social worker in Michigan, with 12 years of national consulting experience, Elaine earned a Master of Science degree in health administration from Central Michigan University and a Bachelor of Science in social work from Eastern Michigan University.
Dr. Ally Thomas is the Director of Medicare STARs within the Business Transformation Office. Utilizing her expertise in data analytics, measurement and accountability systems, she aims to drive quality improvement in Medicare to achieve a 4.5 STAR rating for the UPMC Health Plan and influence healthcare policy decisions for CMS STAR rating programs. Although new to the healthcare industry, Dr. Thomas brings a unique skill set from her experience as a measurement scientist and researcher in education and psychology. Most recently, in her role at the Learning Research and Development Center at the University of Pittsburgh, she worked with a team of researchers and the Tennessee Department of Education to develop a measurement system to drive math instructional improvement across the state of Tennessee. Dr. Thomas continues her academic work at the University of Pittsburgh as an instructor in the Ed.D. program where she teaches students how to use data analytics to drive improvement in their organization. Dr. Thomas received her Ph.D. in Educational Psychology with a specialization in Quantitative Methods in Education and Psychological Research from the Graduate Center, CUNY. As well as her M.A. in Psychology from San Diego State University and her B.A. in Psychology from Biola University.
Ashley Tyrner is the founder and CEO of FarmboxRx and Farmbox Direct. Ashley has gone from being a single mom on food stamps to the CEO of a national brand that aims to break down the social barriers of access to nutritious food. With a clear conviction that everyone deserves the right to eat healthy, Ashley works tirelessly to disrupt the food policy and healthcare space.
Tracey Veal, DrPHA, MBA Senior Advisory Consultant
LA County Public Health Department
Dr. Veal brings over 30+ years of healthcare collaborations, clinical operations, and marketing at health plans, providers, hospitals and pharmaceuticals. She currently serves Los Angeles County, the largest county in the U.S with over 10 million residents as a Department of Public Health Senior Advisor in the Vaccine Preventable Disease Control Program, leading the relaunch of the Immunization Coalition.
Previously she led Los Angeles County's Public Health COVID-19 Vaccine Equity Committee as an Executive Fellow with after consulting for non-profit and private equity firms during the pandemic. As a result of the Los Angeles County’s vaccine equity collaboration, 80% of all residents and 94% of seniors 65+ received at least one dose. Consequently Dr. Veal was chosen as one of the nation’s Top 100 Diversity Leaders by Modern Healthcare (September 2021) and a Public Health Hero by the Los Angeles County Department of Public Health. Currently she is the lead for relaunching the Immunization Coalition of Los Angeles County for community collaboration on improvement in overall vaccine education and uptake.
Prior to Public Health, she was Vice President at United Healthcare for Clinical Transformation after serving as Aetna’s Senior Director of Quality and Performance for the Western Region. During her tenure at Aetna, Dr. Veal was awarded Aetna’s highest honor, the Chairman’s Award for leadership excellence and impact. She developed and implemented quality and risk adjustment strategies, which were adopted nationally to reverse losses exceeding half a billion dollars. During her earlier tenure at Aetna, Tracey was a leader in Sales/Marketing and Operations expanding Medicare in California and 14 other states.
Dr. Veal rejoined Aetna from Kaiser’s National Program Office improving Medicare retiree member acquisition and 90%+retention rates, after a V.P. role at Dignity Health. She holds an MBA and doctorate in Public Health.
Kristopher Volrath Vice President, Field Products & Solutions
Mr. Volrath serves as the Vice President, Products and Services, and is responsible for product revenue, design, strategy, and product execution across multiple product portfolios, including Quality Spectrum®, Data Visualization and Reporting, and the Inovalon ONE® Platform. In this role, Mr. Volrath and his team partner with clients to provide deep insights into quality measurement, drive quality improvement strategy and execution, deliver integrated member and provider engagement solutions, analyze and visualize information for rapid consumption, and achieve meaningful quality outcomes for Medicare Advantage, state-based Medicaid, and Commercial Health Insurance Exchange plans. Mr. Volrath has more than 16 years of experience in fields of healthcare technology, commodities, financial services, software engineering, data analytics, enterprise architecture, and portfolio management, holding a variety of leadership positions responsible for product and technology strategy. Prior to joining Inovalon, Mr. Volrath worked for Constellation Energy, a leading national supplier of energy products and services, where he was responsible for multiple delivery groups leading complex program initiatives, executing upon mergers and acquisitions, and driving innovation. Mr. Volrath previously held positions focused on financial services and software engineering at Accenture and Legg Mason.Mr. Volrath received his bachelor’s degree in Management Information Systems with a concentration in Finance from Salisbury University’s Perdue School of Business in Salisbury, Maryland.
Susan Waterman, RHIT CCS CPC CRC Director of Risk Adjustment
Baylor 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.
Daniel Weaver EVP Product Operations and Stars Strategy
Daniel Weaver is an established leader with extensive experience developing and implementing intervention strategies to improve Medicare Stars performance. With demonstrated success through innovative programs, Daniel led a Stars Quality team at Highmark for 6 years where they consistently delivered market-leading performance and forward-thinking engagement with providers and members. Daniel moved to Gateway Health Plan to help an underperforming DSNP plan achieve 4 Stars, boost Quality Improvement performance across multiple State pay for performance programs, and expand Risk Adjustment programs.
Rick Whitted is the President & Chief Executive Officer at U.S. Hunger, a global nonprofit whose mission is feeding families today and uniting them to a healthier tomorrow. In total, U.S. Hunger (USH) has provided over 150 million meals to families in need. Before his appointment as CEO in March 2020, Rick served on USH’s board of directors. Rick has overseen the launch of several of the organization’s initiatives: expanding home delivery of fresh produce into its supply chain; aligning its Full Cart ®program with the government payor spaces; and, developing a SaaS solution that uses Predictive Analytics and Machine Learning to identify root causes of food insecurity in the U.S.
Rick is a graduate of Stetson University and Nova Southern University where he received a BA in Political Sciences/American Studies, and an MBA, Business Administration and Management, respectively.
Beth works closely with our customers to ensure we deliver solutions that support their strategic objectives and drive better healthcare outcomes. She brings more than 20 years of experience in healthcare technology, consulting, project management, and sales. Beth got her start in healthcare IT at Epic and has held leadership roles at Evergreen Healthcare Partners and healthfinch. An impassioned solution-oriented leader, Beth is committed to bringing our customers innovative solutions that reduce waste and enable greater access to care.