Jay Baker Senior Vice President – Data Management and Analytics
Jay joined Advantmed in 2015 and is currently responsible for Advantmed’s analytical engines and Data Management services. Prior to joining Advantmed, Jay was responsible for the ACA risk adjustment strategy and execution for UnitedHealth Group’s Optum division. His accomplishments included standing up an end-to-end service offering and exceeding revenue goals for the first two years of the program. As one of the founders of Dynamic Healthcare Systems, he was responsible for the original design for each of their 10 Medicare Advantage software modules. Jay is an ACA and Medicare Advantage industry leader and expert in policy, compliance, systems, and plans operations.
Dr. Allysceaeioun D. Britt
Associate Vice President of Faculty Affairs and Development and Assistant Professor in the School of Graduate Studies and Research
Dr. Allysceaeioun D. Britt Associate Vice President of Faculty Affairs and Development and Assistant Professor in the School of Graduate Studies and Research
Meharry Medical College
Dr. Allysceaeioun D. Britt is the Associate Vice President of Faculty Affairs and Development and Assistant Professor in the School of Graduate Studies and Research at Meharry Medical College. She previously served as the Director of Strategic Initiatives and Quality Assurance at the Tennessee Department of Health where she was responsible for the oversight and strategic alignment of Maternal Child Health and Chronic Disease programs to advance population health efforts. She has led innovative initiatives targeting TennCare (Medicaid) and CoverKids(SCHIP) which include the design and implementation of the TennCare (Medicaid) and CoverKids enrollment assistance program for pregnant eligible women within local rural and metropolitan health departments, the statewide expansion, integration and sustainability of an evidence-based smoking cessation program targeted for pregnant women and established an agency Maternity Collaborative to engage TennCare (Medicaid) Managed Care Organizations to improve engagement and care coordination of TennCare enrollees served through TDH public health programs. Dr. Britt has more than 20 years of public health experience with research interest in public health and healthcare administration and policy for Medicaid populations, program development and evaluation, population health engagement with a focus on social determinants health and vaccine-preventable diseases. She also serves as an adjunct professor at Trevecca Nazarene University Skinner School of Business Education and Technology -Health Care Leadership Program. When she is not working or teaching, she enjoys serving in her community and promoting health as an activity member of Lake Providence Missionary Baptist Church Health Ministry; member of Kappa Lambda Omega Chapter of Alpha Kappa Alpha Sorority, Incorporated Health Committee and an active member of the Music City (TN) Chapter of The Links, Incorporated Health and Human Services Facet. She holds a Bachelor of Science in Biology from Florida State University, Masters of Public Health – Health Care Administration and Policy from University of Oklahoma Health Sciences Center and Doctorate in Public Health – Community Health from Walden University. In her free time, she enjoys singing in her church choir, playing the piano and traveling with her family.
Dr. Brodsky serves as Vice President of Enterprise Population Informatics for Advocate Aurora Health. In this role, he helps ensure that the electronic health record supports Population Health’s clinical and business goals.Prior to joining AdvocateAurora in 2016, Dr. Brodsky served a similar role for 10 years at Kaiser Washington in Seattle.
Puneet Budhiraja is the Chief Actuary and Senior Vice President at Capital District Physicians’ Health Plan in NY.
He manages the Medicaid, Medicare and Commercial lines of business and is responsible for pricing and the design and implementation of value based contracts. Additionally, he has a key role in the development of analytics platforms in his organization. He is a member of the American Academy of Actuaries and an associate of the Society of Actuaries. He is also a member of two key sub-committees at the American Academy of Actuaries and regularly weighs in policy evaluations at the academy. He is a frequent speaker at various conferences and has authored multiple papers for the Society of Actuaries.
Biggs Cannon Senior Managing Director, Health Solutions
Biggs Cannon is a Senior Managing Director in the Health Solutions practice at FTI Consulting. He is based in Washington D.C.
Mr. Cannon has worked with managed care organizations, retail pharmacies, pharmaceutical companies, and government agencies where his areas of expertise include data compliance and process improvement, advanced database development and maintenance, advanced data querying and analysis, data mining and manipulation, quantitative analysis, project management and general litigation support.
Mr. Cannon has worked extensively with Medicare Advantage plans, helping identify potential compliance concerns while supporting and educating internal resources on appropriate ways to remediate identified issues. He has lead the identification, reconciliation and reprocessing of Medicare Advantage submissions to CMS as well as the quantification of potential repayments related to those reprocessed submissions. He has also led process improvement initiatives for these plans to put compliant policies and procedures in place in these organizations going forward.
Mr. Cannon has also worked with payor owned physician groups to support their Medicare Advantage submissions and help maximize their financial return. He has led efforts to review physician charts and determine historical risk within groups as well as provided guidance on steps to minimize risk going forward. He has also led efforts to identify erroneous submissions, assess solutions to remediate correctable submissions and calculate potential risk adjustment factor (“RAF”) lift related to the remediation efforts.
Mr. Cannon has supported several major managed care organizations, retail pharmacies and pharmaceutical companies through complex litigations and disclosures involving intensive data collection and analysis. During these engagements he has worked with various members within the client organizations to gather systems information, identify and collect key data elements, and perform analysis on this data using various platforms.
Mr. Cannon holds an MBA along with a BS in Neuroscience from The College of William & Mary.
Shelley Collins Director of Clinical Quality Improvement
Shelley Collins RN BSN CHCQM
Director, Clinical Quality Improvement for Blue Cross Blue Shield Nebraska
As Director of Clinical Quality Improvement, Shelley is responsible for oversight of the quality improvement program strategy, value-based contract quality metrics, HEDIS measurement and Medicare STARS performance. Prior to joining Blue Cross Blue Shield Nebraska Shelley served as a Director of Quality Management with Aetna.
Shelley obtained her RN from St. Luke’s School of Nursing and a Bachelor of Science in Nursing from Briar Cliff College. Shelley has her certification in Health Care Quality Management (CHCQM) and is a member of the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP).
David is responsible for leading analytic efforts for Cotiviti as well as new market facing solutions. He works closely with the Product, Consulting, Data Operations, and Client Engagement teams to ensure that Cotiviti’s proprietary analytics help our clients meet their business objectives and remain relevant in the industry.
Prior to joining Cotiviti, David was the chief analytic officer at Press Ganey. He was responsible for building a set of analytic products that allowed hospitals and provider groups to enhance patient experience, solidify their reimbursements, and identify areas for process improvement and revenue enhancements. David also previously served as SVP of consumer segmentation and engagement strategies at Health Dialog, where he was responsible for building and implementing strategies that targeted, activated, and engaged members related to their specific health conditions.
David holds a B.A. in Business Administration and Sociology from Northern Michigan University and a M.A./Ph.D. in Sociology from the University of Delaware. He also served for four years in the United States Air Force.
Patrick Coulson is a successful healthcare executive with more than 20 years’ experience leading healthcare sales with expertise in risk adjustment and member engagement. He brings a proven success record in hyper-growth organizations, doubling revenue year after year for multiple years. Patrick’s sales and management experience includes health insurance, disease management, and provider industries. He is particularly adept at C-level new business sales, new product launches, sale force recruitment and training.Patrick’s healthcare career is focused around Medicare and Medicaid. His career began with skilled nursing facilities and home health agencies. Early on in his career he started a new home health agency in Phoenix, AZ. As the healthcare industry adopted disease management, Patrick began managing sales for disease management programs including diabetes, end-stage renal disease and coronary artery disease. Patrick had the opportunity to help start and manage one oft he first Medicare Advantage Chronic Special Needs plans. After the Special Needs Plan, Patrick began managing sales in the HCC risk adjustment revenue industry for Medicare Advantage plans as well medical cost containment programs for Medicare Advantage, Medicaid, and commercial health plans.The provider, disease management, and Medicare Advantage experience provides a greater understanding of what health plans do well and where vendor partnerships can result in greater success for the health plan and its members.
As Executive Vice President at Cognisight, Christine D’Amico is responsible for all corporate operations, including product and business development. Having previously served as Vice President of Business Development for Rochester Regional Health, she has over a decade of leadership experience and a consistent track record of exceptional performance with start-up, expansion, turnaround, and growth initiatives in healthcare, technology, and consumer sectors. Her entrepreneurial and visionary leadership has consistently provided a platform for developing and leading high performing teams that are laser-focused on client satisfaction, efficiency, and outcomes.
At Cognisight, Christine was instrumental in developing our IVA solution during the pilot year and worked closely with the entire team to ensure roles and responsibilities were clearly defined and aligned to a master work plan. She continues to work with both clients and internal resources to develop and improve operations and client relations while developing new business opportunities.
Christine earned her BS in Organizational Management at Roberts Wesleyan College.
Shannon Decker Vice President of Clinical Performance
Brown and Toland
Dr. Shannon Decker is Vice President of Clinical Performance for Brown and Toland. Dr. Decker has more than 19 years of experience in healthcare--13 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.
As Chief Administrative Officer, Dr. Desai oversees Advantmed’s operations and clinical leadership, ensuring the effective execution and evolution of our solutions and services. Dr. Desai brings more than 40 years of healthcare management, clinical, and leadership experience to Advantmed, including 25 years practicing internal and emergency medicine and 17 years in senior healthcare management positions within large health plans and at risk medical groups. His extensive background helps inform and drive forward thinking, realistic solutions that meet the needs of Advantmed’s growing client roster. He is board certified in internal medicine, is a Fellow of the American College of Emergency Physicians, and holds a management degree in healthcare administration from California Lutheran University.
Senior Vice President, Clinical Performance and Compliance
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, 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 and The Social Determinants of Health: Case Management's Next Frontier, both through HCPro. 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, a consultant for the Case Management Institute, and a moderator of their Case Managers Community. Ellen’s 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.
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, Ellen currently serves on the Board of Directors for the Case Management Society of America, the editorial boards for the Professional Case Management Journal and RAC Monitor, and the Council of Advisors and Founders for Reverberation 5.0 (a collective for women over 50 in the workforce). More detailed information is available on her LinkedIn Profile.
For more than two decades, Cathy has directed Quality programs and lead accreditation efforts including collaboration with health plan systems and providers; quality initiatives, management of the health plan quality departments, NCQA accreditation and STARs program; credentialing, performance analysis and reporting as well as other strategic quality initiatives.
As the Director of Quality at Health Plan of San Joaquin, Cathy is a motivated visionary leader with proven ability to effect organizational change; development of clinical quality improvement teams for multiple settings, hospitals, integrated healthcare system, medical practices and managed care organizations. NCQA and HEDIS expertise with demonstrated results. Her expertise with Medicaid managed care enables her to lead for HPSJ in the area of development and implementation of quality initiatives, NCQA accreditation, performance outcome analysis, HEDIS, credentialing as well as grievances and appeals.
Merrill Friedman Senior Director Disability Policy Engagement
Merrill Friedman leads the Disability Policy Engagement team and advocacy strategy for Anthem, a leading health benefits company serving nearly 71 million people nationwide through its affiliates. She works collaboratively with consumers, advocates and stakeholders to ensure the diverse interests and preferences of older adults, individuals with disabilities, and children, adolescents and young adults involved in child welfare programs inform Anthem’s health benefits approaches and related initiatives. Ms. Friedman also advances the integration of the independent living philosophy, principles of selfdetermination and the National Advisory Board (NAB) on Improving Health Care Services for Older Adults and People with Disabilities' six foundational principles throughout these programs, as well as Anthem’s member interactions and business practices. In addition, she leads strategic partnerships with national and local organizations to advance the development of inclusive public policy. Previously, Ms. Friedman was interim director at a nonprofit foster care agency serving children and adolescents who experienced severe neglect and physical abuse. She also served as president and chief executive officer of a private organization that owned and operated residential treatment facilities, group homes and home and community based services in several states for adolescents with mental health, substance use disorders and/or intellectual disabilities.
Ms. Friedman is a nationally recognized leader in Medicaid, LTSS and health services that reflect the needs and interests of older adults, people with disabilities and children and adolescents. Health program expertise includes social determinants/influencers of health, foster care, mental health and substance use, intellectual and developmental disabilities, and justice involvement. Her extensive experience in program development, strategy, new business growth and operations management informs the innovation and development of home and community based services and capacity building.
Ms. Friedman has served on numerous national boards and commissions. She was appointed by President Barack Obama to the President’s Committee for People with Intellectual Disabilities. Currently,
Ms. Friedman serves on the board of directors for Family Voices, the National MLTSS Association, the Long-Term Quality Alliance (LTQA) and is a member of the National Academy of Social Insurance (NASI) and the NASUAD MLTSS Institute Advisory Board.
Wayne Gibson Senior Managing Director, Health Solutions
Wayne Gibson is a Senior Managing Director at FTI Consulting and is based in Washington, DC. He is part pf the Health Solutions segment. He has 20 years of experience applying economic and financial modeling, data‐intensive analysis, and complex claims analyses across numerous industries and in a variety of operational, dispute and compliance matters.
He has assisted health plans, providers, pharmaceutical manufacturers and PBMs with in a variety of matter types including operational improvement and compliance consulting, nationwide class‐action litigation, Medicare and Medicaid false claims and sales and marketing investigations, investigations by other government agencies, and arbitration matters. Significant types of matters Mr. Gibson has worked on include:
Risk Adjustment Operational Improvement and Compliance Assessments – assisted Medicare Advantage plans, ACA exchange‐based plans, trading partners/vendors, and providers under risk contracts in an end to end assessment and redesign of work flows and data flows, policies and procedures, controls, reporting and forecasting related to their Medicare Advantage and risk adjusted populations. Has also performed reviews of systems and programming logic used to filter encounters to assess compliance with Medicare Advantage and Managed Medicaid requirements. Has worked with clients to develop and implement interim and ‘bridge’ applications that provided added functionality in managing populations subject to risk adjustment. Has supported plans in RADV and other regulatory reviews.Has assisted in contractual disputes regarding payments from health plans to provider groups under shared risk agreements.
Medicare and Medicaid Investigations ‐ assisted a variety of clients including health plans, pharmaceutical manufacturers, institutional providers, diagnostic lab testing companies, and their outside counsel in responding to governmental investigations and in conducting internal investigations related to Medicaid and Medicare false claims and fraud and abuse issues as well as how these issues may impact statutory and SEC reporting. These investigations encompass issues such as reimbursement, pricing, Medical Loss Ratios and cost reporting, and sales and marketing. As part of these investigations has assisted clients and their counsel in discussions with the DOJ, OIG, state Medicaid and regulatory agencies, and the SEC. Compliance and Operational Reviews – assisted a variety of clients with compliance reviews related to Medicare Advantage, Fee for Service Medicare and Medicaid programs. He has also performed other contractually‐mandated reviews, and operational assessments of controls, data and information systems, and relationships with third parties/sub‐contractors.
Litigation and Commercial Disputes (Healthcare and Other Industries) – assisted a variety of clients and their outside counsel in defense of nationwide class‐action matters, federal and state court litigation, international arbitration, and arbitration and mediation matters. Has developed and submitted expert reports on damages in a number of forums and has testified in arbitrations.
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.
From humble beginnings in South Central Los Angeles, to life as an imprisoned drug dealer, and then as an award-winning celebrity chef and best-selling author, Jeff is a role model for anyone who needs the encouragement to reinvent their life. Since he discovered his passion and gift for cooking in the unlikeliest of places – prison – Jeff has completely turned his life around, and today serves as a popular and powerful voice for self-transformation.
The creator of Food Network's reality series, The Chef Jeff Project, host of Family Style with Chef Jeff, and the star of the nationally syndicated series, Flip My Food with Chef Jeff, he is also the best-selling author of two books.
From overcoming hardship to identifying one’s personal talents, Jeff reveals his hard-knock yet transformative life lessons and the secrets to rising above and realizing your potential. His dynamic and engaging presentations help audiences discover their hidden business aptitudes, make life-changing decisions, and gain a new foothold on the ladder to success.
Inspiring Celebrity Chef, Star of Flip My Food with Chef Jeff & Author of If You Can See It, You Can Be It
Dominic Henriques Vice President of Performance Improvement
Prominence Health Plan
Dominic currently serves as Vice President of Performance Improvement at Prominence Health Plan and has been with the plan since 2017. 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 is a process-oriented leader with a passion for staff development, analytics, and technologies that improve workflow efficiency. 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 children and enjoys running competitively on the weekends.
Kent joined AdhereHealth in 2013, bringing over a decade of operational, consulting, and business development experience for the healthcare technology industry. Kent’s leadership at AdhereHealth includes business development, strategic partnerships and product strategy.
Kent came to AdhereHealth following multiple successes with AIM Healthcare (now a part of Optum, a United Health Group, Inc. company), rising to National Director as it expanded into new markets. Kent was a key player in Optum’s growth strategy representing solutions for both providers, managed care and government entities.
Actively involved in the community, Kent currently serves on the Board of Directors at BrightStone, Inc., as well as on the Board of Directors with the Tennessee Crohn’s and Colitis Foundation. Kent holds a BA in Psychology from the Miami University and a MA in Counseling from The University of Toledo.
Jennifer Houlihan Vice President of Value-Based Care and Population
Wake Forest Baptist Health
Jennifer is the Vice President of Primary Care and Population Health for Wake Forest Baptist Health focused on operational and financial performance in value-based arrangements, engagement with community partners, and serving as a liaison with Public Health Sciences to lead and support the journey to high value care.
Previous to joining Wake Forest Jennifer was responsible for leading the University of Vermont (UVM) Health Network’s transformation to value through improving quality and lowering costs. In this role she implemented an interdisciplinary collaborative leadership model for quality in partnership with the CMO, CNO and Chief Experience Officer to support quality accountability and improvement at the patient care unit level; launched a Transitions of Care and Care Management initiative to align the Network’s population health and performance goals under Vermont’s All Payer CMS Waiver; and led the development of an integrated network- wide quality and population health strategy to support full transformation into a shared service.
With 20+ years as an experienced healthcare leader in both payer and provider environments, Jennifer’s role is to understand and connect the health care continuum, data and operations which includes the development of organizational capabilities needed to implement and sustain population health management along with community engagement to minimize care fragmentation and reduce costs.
Jennifer earned a Master's in Planning from Florida State University with an emphasis in Health
Policy and a Master’s Certificate of Population Health at Thomas Jefferson University.
Jennifer Hunt Administrative Director Actuarial Services
Jennifer Hunt is the Administrative Director of Actuarial Services at Paramount Healthcare in Maumee, Ohio. Paramount is part of the ProMedica Health System headquartered in Toledo, Ohio. She has worked at Paramount for 20 years in a variety of roles including underwriting and analytics. In her current role, she is responsible for Actuarial Services including commercial rate filings and the Medicare and QHP Bids, Underwriting for group and individual business, Reinsurance for ceded coverage as well as ESL products, Product Development, Business Analytics and Insight team as well as Risk Adjustment for Commercial, Medicare, and Medicaid. Jennifer earned her degree in Economics from Denison University. She previously worked on the sales and service side of property and casualty insurance. She routinely volunteers in her community.
She has been with Geisinger Health System for 12 years. She started as an observation and surgical overnight coder with the Revenue Management department in 2008. In 2011, she decided to make a move to the insurance side of things and took on the role of Risk Adjustment Coder. Since then, Marilee has held positions such as HCC analyst, Lead- Risk Adjustment Educator, and Manager of Clinical Transformation before promoting to her current role as Director of Coding Operations for Geisinger.
Marilee is a Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC) through the American Academy of Professional Coders (AAPC). Through her years at Geisinger, non-coding opportunities have presented themselves as well. Marilee is a Certified Business Analyst, carries a SQL Programming Skills Certification, and has a Green Belt in Lean/Six Sigma. Marilee also attained a Bachelor’s degree in Management in 2015 and a Master’s in Business Administration in early 2017.
As the Vice President of Quality for Advantasure, Erica Krieger is responsible for deploying industry-leading initiatives and driving success through Stars strategy development, program implementation and performance management which are complemented by overseeing prospective HEDIS gap identification and HEDIS administration services. Prior to joining Advantasure, Erica held a variety of roles at Blue Cross Blue Shield of Michigan, including roles focused on continuous improvement, strategic informatics, and customer reporting.
Erica earned a Bachelor of Science and Engineering in Industrial & Operations Engineering, a Master of Science in Industrial and Systems Engineering, and a Master of Business Administration – all from University of Michigan.
Lynn M. Kryfke Executive Director, Health Plan Clinical Services
Children's 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.
Jimmy is a risk adjustment industry thought leader and conference speaker who has been helping health plans nationwide to better understand and formulate their risk adjustment strategy for the past 10 years. He currently serves as Vice President of Risk Analytics at Change Healthcare supporting the Medicare, Medicaid, and Commercial ACA lines of business, with a focus on analytics, strategy and innovation across the company. Jimmy is an expert in risk scoring models and risk adjustment methodology, and he is a graduate of the University of Pennsylvania.
San Le Social Science Research Analyst for Evaluation and Inspections
Office of Inspector General U.S. Department of Health and Human Services (HHS)
San Le is a Social Science Research Analyst for Evaluation and Inspections in the Office of Inspector General, U.S. Department of Health and Human Services (HHS). She has conducted evaluations on issues relating to HHS programs, such as payment rates in the Child Care and Development Fund and risk adjustment in Medicare Advantage. She received her Bachelor of Arts in Health and Societies from the University of Pennsylvania, and a Master of Public Health from Emory University.
Donna Malone Director of Enterprise Risk Adjustment: Coding and Provider Education (CDI)
Tufts Health Plan
Donna has been on the job with the Tufts Health Plan in their senior products division since August 2014, and is responsible for audit and coding review management, development and implementation of department and vendor policies and procedures, simulation RADV Audits for preparedness, coding team performance management and provider education development and management. Additionally, Donna serves at the MassBay Community College in Framingham, where she has been an advisor / professor for nearly 10 years. Her specialty area is the Medical Coding Certificate and Medical Office Administration Program.
Prior to Tufts Health Plan, Donna worked for Blue Cross Blue Shield of Massachusetts as an HCC Professional Audit III for four years. Earlier, she worked for AM B Care for 9 years and Maine Medical Center.
TERESA A. MASON is a Member of the Firm in the Health Care and Life Sciences practice, in the Washington, DC, office of Epstein Becker Green. She concentrates in health care fraud and abuse, risk adjustment coding and payment, government investigations, and health regulatory counseling.
Defends a variety of health care entities against federal and state government investigations related to health care fraud and abuse arising under the False Claims Act, the Anti-Kickback Statute, physician self-referral laws, and other state and federal fraud statutes
Conducts internal investigations related to health care fraud and counsels clients on self-disclosures
Negotiates settlement agreements and corporate integrity agreements in connection with state and federal investigations
Counsels clients—including plans, vendors, and providers—regarding Medicare Part C risk adjustment, including false claims defense, self-disclosures related to overpayment, enforcement counseling, risk adjustment program review, RAD-V preparedness, coding/documentation guidance, and compliance with Medicare regulations
Assists Medicare Advantage Organizations with CMS program audits, responses to imposition of civil monetary penalties and/or sanctions, and implementation of program changes
Assists hospitals and health systems with disclosing or responding to non-compliance with Medicare Conditions of Participation, including EMTALA violations
Designs institutional policies, procedures, and compliance documents
Advises clients on legal and regulatory compliance matters arising under Medicare, Medicaid, and other third-party reimbursement programs.
Prior to joining Epstein Becker Green, Ms. Mason worked as a registered nurse in emergency medicine, pediatric oncology, and bone marrow transplantation. She also served as a medical analyst at a boutique litigation firm in the District of Columbia, where she was responsible for researching and analyzing medical information for attorneys who were defending major pharmaceutical companies in class action litigation.
Allison Massari knows that you have the power to transform lives. As an advocate for both patient and provider, Massari has an intimate understanding of the demands and challenges of the medical profession, and compelling authority to address the delicate nature of patient-centered care. She experienced firsthand the critical value of receiving personalized health care from committed, empathetic providers after surviving two life-threatening car accidents, one where she suffered second and third degree burns on over 50% of her body.
In addition, raised by her father, a surgeon, and her mother, a nurse, Allison was mentored in the world of medicine from an early age. Captivated by her father’s compassionate work, she shadowed him in his practice, and also worked in hospitals and medical office settings. Allison’s riveting and courageous journey from absolute loss to a triumphant and hope-filled life, addresses sensitive topics, shining light on the provider’s immense value to a patient who is suffering, and helping to reinvigorate employees and heal burnout in the workplace.
Jason McDaniel Vice President, Risk Adjustment and Quality
Healthcare Partners Nevada
Jason McDaniel has over a decade of experience as a healthcare leader in provider, payer, and government operations and is currently the Vice President of Risk Adjustment and Quality for Healthcare Partners (HCP), one of the largest healthcare providers in the Southwest. In partnership with the Medical Director of Risk Adjustment and Quality, Jason has direct oversight of quality nurses, CDI nurse reviewers, value-based care focused nurse practitioners, medical coders, vendor relationships, and all other aspects of risk adjustment and quality prospective and retrospective operations. Prior to his time at HCP, Jason was the Risk Adjustment Operations Director at Banner Health in Arizona. As a senior leader, he directed multiple teams in establishing the Banner Health risk adjustment and quality program as well as overseeing a pivotal segment of the integration of Banner Physician Hospital Organization and Arizona Integrated Physicians. Jason spent 6 years at Cigna Healthcare of Arizona as the Medical Coding Manager and Medical Business Trainer as part of both medical group and payer operations. During his time at Cigna, Jason helped develop risk stratification and social determinants of health criteria, an internal point of care solution for population health and Medicare Advantage metrics and an extensive provider education program. Jason has been a Certified Professional Coder since 2006. He earned his Bachelor's Degree in Healthcare Administration from the University of Phoenix and his Master's Degree in Healthcare Innovation from Arizona State University.
Debra McGill is the Senior Director of Population Health at Maine Medical Partners, a division of MaineHealth. She has served for over seven years in a distinguished leadership role, representing Maine’s largest physician management organization. Working with system and organizational leaders, Debra has provided the vision, strategy and operational planning for Maine Medical Partners’ Population Health and Care Coordination Program. She has worked to drive program activities across the continuum of care and within various pay for performance contract requirements, including fee-for-service, shared savings and risk-based agreements. Debra has written for several publications, on topics including Tools of Population Health Management, and A Population Health Approach to Clinical Social Work with Complex Patients in Primary Care. She received her Master of Science in Population Health from Thomas Jefferson University, and a Bachelor of Science degree in Nursing. Her experience as a registered nurse and care manager has shaped her vision to understand, preserve and improve the health of patients and the communities that she serves.
Gabriel McGlamery is in charge of Federal regulatory policy for Florida Blue’s individual market business. This means analyzing, influencing, and general problemsolving for the insurer covering roughly 10% of Marketplace enrollment. Prior to joining Florida Blue in 2012, Gabriel helped develop the rules for the ACA at HHS and graduated with honors from the University of Connecticut School of Law.
Acknowledged as one of the most engaging and crowd-pleasing speakers in the world of neuroscience, Dr. Medina is a developmental molecular biologist, researcher, professor and the author of ten books. His New York Times bestseller, Brain Rules: 12 Principles for Surviving at Work, Home and School has been celebrated as the standard handbook on understanding the brain and optimizing its performance. Brain Rules has been translated into more than 20 languages and selected as a textbook at numerous universities. Dr. Medina’s focus is on the genes behind brain development and psychiatric conditions. He has spent most of his professional life as an analytical research consultant, working primarily in the biotechnology and pharmaceutical industries on research related to mental health. He also consults with hospitals and healthcare facilities on designing brain-healthy environments that reduce staff stress and improve patient outcomes. Recently, he expanded his interest in how the brain interacts with environments to office spaces, teaming up with award-winning architecture firm NBBJ.
Dr. Medina is an Affiliate Professor of Bio engineering at the University of Washington School of Medicine. He is also the Founding Director of the Talaris Research Institute studying how infants encode and process information at the cognitive, cellular and molecular level. Dr. Medina’s extensive study of the developing brain at different stages of life resulted in his most recent book, Attack of the Teenage Brain! Understanding and Supporting the Weird and Wonderful Adolescent Learner. He is also the author of Brain Rules for Baby and Brain Rules for Aging Well.
Kyle Mendez, MBA, is Director of Quality Operations at Landmark. Kyle is responsible for building Landmark’s qualityprogram, andhas introduced quality initiatives such as point-of-care testing, training programs, and a care-gap closure module in Landmark’s EMR. Kyle has over 15 years of experience working for managed care organizations, health plans, and medical groups. Kyle achieved his Master of Business Administration, with a concentration in healthcare, from the University of California, Irvine.
Dave is a strong leader with 14+ years of experience in Revenue and Clinical Outcomes Program Development and Management in various healthcare environments (Plans, MG/IPA, Academic, and Consulting). Proven record of success in optimizing Operations, PE / Investor Meetings, Maintaining Compliance, Recovering / Maximizing Revenue, Enhancing Clinical Quality and Developing Software and Custom Analytics. Specialties: RA / HCC, Pay for Performance (P4P), CMS Stars Program, NCQA HEDIS, Off‐shore Software Product Development, HOS, CAS, NCQA Accreditation, Physician Profiling, Encounter Programs, Contract and Claims Analytics. Previously, Dave served as an independent consultant to health plans, was Corporate VP, Operations(Revenue and Quality) at InnovaCare Health. He has also performed as Sr. Consultant, Risk Adjustment and Health Plan Operations for Dynamic Healthcare Systems, and in other roles with health plans.
As a co-founder of Centauri Health Solutions, Michelle Miller brings deep expertise in risk adjustment, information technology and data analytics. Her experience includes a broad healthcare background across payer and provider spaces, including Medicare Advantage, radiology benefit management, post-acute care, and renal dialysis revenue cycle management.
Before helping to found Centauri, Michelle served as Cigna-HealthSpring’s VP of Risk Adjustment Services, leading all aspects of risk adjustment efforts for Medicare Advantage. Prior to her risk adjustment role, she held various IT leadership positions within the organization.
Michelle’s previous experience includes leadership positions with Geriatrix, as VP of Information Systems (prior to becoming Inspiris) –and serving as VP of Information Systems for MedSolutions during its strategic pivot from outpatient imaging to a leading radiology benefit management company.
Michelle holds a Master’s degree in Biomedical Engineering from Vanderbilt University and a Bachelor’s in Electrical and Computer Engineering from New Mexico State University.
Michelle was named the 2019 CTO of the Year by the Greater Nashville Technology Council.
Annie Miyazaki-Grant is the SVP, Chief Compliance & Privacy Officer for the Visiting Nurse Service of New York (VNSNY), the largest not-for-profit home health care organization in the U.S. VNSNY has a D-SNP (MAP and FIDA), NYS Medicaid Long-Term Care, and HIV/SNP Special Needs Health Plan. VNSNY also provides certified home health, licensed home care, mental health, and hospice services throughout New York. Annie oversees VNSNY’s Compliance, HIPAA Privacy, Risk, and Internal Audit Programs, leading a large team focused on providing strategic advice to leadership and being a partner to all staff in providing high quality services while maintaining the highest standards of ethics, integrity, and regulatory adherence. Annie partners with the Legal team on all major government audits, government investigations, and major litigations. She has extensive experience in responding to health plan and provider external units, including RADV; leading a best practice Compliance & HIPAA Program; managing leadership and Board reporting; and the daily problem-solving required to ensure VNSNY maintains its strong reputation as a nationally-recognized gold standard health plan and provider. Annie has particular expertise as an attorney in advising companies in the long term care and post-acute arena, currently as VNSNY’s Compliance Officer, as well as in her prior position as associate at Arent Fox LLP, where she represented long term care providers across the country.
Jenni has over 18 years of healthcare experience. Her expertise spans many areas including professional medical coding, revenue cycle processes, documentation improvement, compliance and risk adjustment. Jenni is currently the Risk Adjustment Coding Manager for a nonprofit healthcare plan in Minnesota that provides Medicare Advantage, Medicaid and ACA Exchange products. Her primary responsibility is the compliance oversight of the plans risk adjustment activities and project lead for all risk adjustment audits.
Kevin Mowll is responsible for building and driving the RISE association, creating a better value for members, creating education and training, industry collaboration, as well as expanding and enhancing our conference offerings.
Prior to joining RISE, Kevin was Vice President for Senior Products with the Tufts Health Plan in Boston. He was responsible for sales, marketing, product development, business performance and strategic planning for the strategic business unit that had annual revenues of $1 B. Kevin has a diverse background and an expertise in Medicare health plans. His expertise centers on:
• Consumer‐driven product design and value segmentation • Growth‐oriented product development and implementation • Market‐based sales strategy and execution • Strategic planning and business development • Optimization of sales channel distribution models
Earlier, Kevin was the Vice President, Medicare Products, for Capital District Physicians’ Health Plan in Albany, New York, when the Medicare Advantage membership grew from 12,000 to 30,000, including both individual and group retiree business. This growth was achieved through product portfolio and geographic expansion, development of the sales and distribution system and other strategic initiatives. Originally, from Southern California, Kevin worked for both PacifiCare Health Plans and CIGNA Healthplans. At PacifiCare (acquired in 2005 by United Healthcare), Kevin led the development and launch of multiple products and conducted service area expansions for health plans, led a multi‐functional national franchise team for start‐up Medicare health plans, and ran the California business unit provider network management department. At CIGNA, Kevin was the healthcare center administrator of staff model offices in Long Beach and Torrance, California, as well as regional manager, and Regional Director for IPA model plan development. A speaker at national conferences on Medicare Advantage business themes, Kevin has also chaired several events. He founded a professional social networking group on LinkedIn called Medicare Advantage Healthplan Colleagues, focused on educating and sharing best practices by developing a virtual community with shared interests and concerns. The group attracted over 18,000 members from across the country.
Kevin is married and has three adult children, and now lives in the Santa Barbara area in California.
Rajesh Munjuluri is an actuary with Capital District Physicians Health plan in NY. He has over 15 years of experience as a Health Actuary and has extensive experience in developing MAPD bids and in designing and in evaluating value based contracts for health plans and healthcare provider organizations. He has served both health plans and reputed consulting firms which allows him to appreciate different points of view. He has also served as CMS desk reviewer for Medicare bids.
Raj is a member of the American Academy of Actuaries and an Associate of the Society of Actuaries. He is a frequent speaker and has co-authored various articles for the Society of Actuaries.
Christine Palermo Medical Director, Patient Financial Services
Virginia Mason Medical Center
Christine Palermo is a physician at Virginia Mason Medical Center where she practices internal medicine primary care and also concurrently serves as the Medical Director and lead Physician Advisor over the Revenue Cycle. In her Physician Advisor capacity, she uses her training as a Certified Professional Coder with the American Academy of Professional Coders to help implement enterprise wide initiatives for ICD10 and Risk Adjustment Coding with a focus on provider education and Value Based Purchasing. She received her Doctor of Medicine with Honors 2008 from the University of Hawai’i, and Bachelors of Science in Biochemistry in 2002 from the University of Washington. She also currently serves on the Board of Trustees for the Washington State Medical Association, the Health Economics Committee for the Washington State Washington Health Alliance and is a Fellow for the American College of Physicians.
He has more than twelve years of experience. The majority of his focus is on custom software development in the health insurance industry, covering claims processing, contract pricing, and provider reimbursement systems. Michael also has experience in financial process and system design and implementation projects, data warehousing, business intelligence, legacy systems to ERP process and data integration, and shared service center implementations including work in the utility, consumer package goods, and public sector industries. Prior to joining Baker Tilly in 2003, Michael worked in the consulting practice of a global professional services firm.
Kenneth Persaud, is the Director of Network Management and Medicare Risk Adjustment at Physicians United Plan, a Medicare Advantage HMO in Orlando Florida. Physicians United Plan has ~20,000 enrollees. Kenneth’s focus at Physicians United Plan has included provider network development, medicare risk adjustment, clinical programs development, and regulatory accreditation oversight. Prior to joining Physicians United Plan, Kenneth served as the Vice President of Health Services at one of the largest full risk managed care IPA’s in South Florida, where his responsibilities included utilization management, case management, medicare risk adjustment and development of provider education programs. Kenneth has held executive positions and served as a consultant for 10+ years with managed care IPAs and health plans. Kenneth began his career as a primary care physician, serving a rural medicare population in a full risk IPA setting. Kenneth holds a B.S. in Biology / Molecular Biology from the Rochester Institute of Technology in Rochester, NY and completed his post graduate studies at the National Autonomous University of Mexico, School of Medicine.
Harshith is primarily responsible for new product development and global operations at Episource. Prior to joining Episource, he was in the investment banking industry, focusing on M&A, restructuring, and capital markets assignments. He has worked for a range of global institutions, including Moelis & Co., Bain & Co., and Bear, Stearns & Co. Harshith earned his Bachelors at Tulane University, and an MBA from the Wharton School.
Sarah Ramsey Director, Documentation and Coding Director
Virginia Mason Medical Center
Sarah Ramsey serves as Director of Documentation and Coding at Virginia Mason Medical Center. She has 12 years of healthcare coding and compliance experience. She has accountability for both the professional and inpatient coding teams and has helped to lead organizational wide initiatives, such as the implementation of ICD-10 and creation of a risk adjustment program. She has a Master’s in Business Administration and a Bachelor’s of Arts in Political Science from Marshall University. She also holds both the CPC and CRC credentials through the AAPC.
SVP of Government Programs & Strategic Initiatives
Office of Inspector General U.S. Department of Health and Human Services (HHS)
Jacqualine Reid is a Social Science Research Analyst in the Office of Inspector General, U.S. Department of Health and Human Services (HHS). She conducts national program evaluations on a range of issues effecting various HHS programs, including the Medicare Advantage program. She received her Ph.D. in Anthropology from American University.
He has more than 25 years of experience in the health care industry and has consistently demonstrated high performance in compliance, quality, and profitability in the businesses he has managed. Dr. Rifaat was previously the Chief Executive Officer of Windsor Health Group, a Medicare Advantage and Supplement insurance carrier based in Nashville, TN, with over 300,000 covered members; the company was sold to WellCare in 2013. He also served on the Board of Directors of Outcomes Health Information Solutions, where he previously served as the Chief Operating Officer. Outcomes Health was a privately held business in Alpharetta, GA, offering medical record retrieval and clinical abstraction services for risk adjustment revenue and managed care quality ratings; the company was sold to Altegra in 2014. Dr. Rifaat has also served as the SVP, Eastern Region for Coventry Health Care where he managed seven health plans serving more than 1.5 million Commercial, Medicare, and Medicaid members in 11 states. He has also held senior executive positions at Humana, Inc., where he served a Regional CEO for Illinois and the Southeast Region and the Market President for Louisiana.
Dr. Rifaat is a graduate of the University of Virginia School of Medicine and Harvard University, where he was an All-American player on the national championship rugby team.
Sarah Rittman has 17 years’ experience working within the care industry, holding leadership positions in marketing, care management, product development, corporate strategy, analytics and risk management organizations
Currently, Sarah leads a number of Baker Tilly teams delivering multi-year engagements with regional and national health plan clients, provider organizations and integrated health systems - with heavy emphasis on:
Medicare Advantage and ACA Risk Adjustment operations, analytics and financial reconciliation and forecasting
Medicaid strategy and program development
Population health strategy, program design, platform implementation and analytics
Consumer, member and patient engagement, with extensive experience in strategy development, capability definition, system design & implementation, analytics and overall program effectiveness measurement and improvement
Large-scale integrated clinical and claims / administrative data and analytics initiatives – being deployed in pursuit of transparent population health and value based care strategies
Senior Vice President of Population Health Management
Stephen Rosenthal Senior Vice President of Population Health Management
Montefiore Health System
Senior Vice President, Population Health; Montefiore Health System President, Montefiore Care Management Company (CMO), LLCStephen Rosenthal is the Senior Vice President, Population Health Management for Montefiore’s Integrated Delivery System and President of the CMO The Care Management Company, LLC (CMO), a wholly owned for-profit subsidiary of the Montefiore Health System. Mr. Rosenthal has been a leader in the development of programs and initiatives in Care Management interventions. These programs are currently serving over 400,000 individuals in value based arrangements, which include frail and vulnerable populations that have supported the growth of Montefiore’s Integrated Delivery System. The Montefiore Health System includes over 6,000+ providers including, physicians, primary care providers, its Home Health Agency, Rehabilitation Facility and ten (10) Acute Care Hospitals. Mr. Rosenthal as Vice President of Montefiore’s Professional Services, developed and managed Montefiore’s Faculty Practice of over 1,000 employed physicians. He has developed over a half a million square feet of ambulatory practice programs and played the leadership role in the initial implementation of Montefiore’s Ambulatory Clinical Information Systems. Mr. Rosenthal also spent a number of years practicing as a Clinical Audiologist. Stephen Rosenthal holds a Master’s Degree in Science, as well as, a Masters of Business Administration in Finance and Management Information Systems, from Brooklyn College and Pace University, respectively. He is an Associate in the Department of Epidemiology and Social Medicine of the Albert Einstein College of Medicine and a Fellow of the New York Academy of Medicine.
Before starting TAVHealth, Jamo founded and led Medical Present Value, a revenue cycle company (now Experian Healthcare [EXPN]) and PTRX, a pharmacy benefit management company (now UnitedHealth Group [UNH]). Prior to his entrepreneurial career, Jamo practiced as a cardiac anesthesiologist. He is the current chair of the Texas Biomedical Research Institute and former chair of the Texas Property and Casualty Guaranty Association. He received his MD from UT Southwestern, a MBA from UT Austin, and trained at Mass General.
Daniel Sergile Deputy Chief Information Security Officer
Daniel Sergile is a 25-year veteran in the information technology field. For the last 19 years, he has been dedicated solely to information security. During that time, he has started up information security programs in multiple sectors of business to include the banking and telecommunications sectors. Mr. Sergile built the information security program at Cox Communications. He has secured companies globally to include Canon Europa and Rabobank International. Before coming to CiOX, he built the security program for CertusBank as their CISO. Mr. Sergile is also a veteran of the United States Army and held the additional duty as an information systems security officer.
Mayank Shah, MD, MBA, FAAFP, currently serves as the chief medical officer for Alegis Care, a complete, in-home population health and clinical services company dedicated to serving the diverse needs of patients, providers and health plans. Alegis Care works side-by-side with patients in the comfort of their home to deliver direct patient care, comprehensive health assessment services and targeted chronic condition programs.
Dr. Shah is the former chief medical officer at Presence Health Partners where he led the organization through successful changes, including adopting the Quality Payment Program and achieving shared savings in the Medicare Shared Savings Program.
Additionally, Dr. Shah has served in many roles within hospital-based, clinic-based and independent physician organizations and is an experienced educator and faculty member in family medicine and palliative care. He has developed and implemented a model of care that focuses on provider engagement leading to increased adoption of population health and value-based care concepts within provider groups. He is passionate about quality improvement and has worked on several practice transformation projects with the Illinois Academy of Family Medicine.
Laura leads a dynamic Risk Adjustment Team, managing the day to day operations for Medicare and Marketplace members. She has a proven track record of maximizing risk scores. Laura designs and coordinates all team activities which focus on provider education, training, auditing, data mining, and data analysis to steer program success and achieve performance metrics. Laura is familiar with developing strategies for seeing high risk members utilizing technical dashboards, auditing processes, and working 1:1 with local vendors. Additionally she identifies end-to-end processes and prioritizes interventions to correct known weaknesses. Laura also provides support to corporate compliance efforts for RADV audits for both lines of business. She collaborates with business partners and develops best practices, and shares them with other health plans.
She has over 20 years of varied clinical nursing practice experience including more than ten years of Clinical Coding Certification practice. Laura is a Master’s prepared nurse, who also maintains her CPC and CRC through the AAPC.
Scott Stratton Chief Data Scientist & VP, Product Analytics
Scott Stratton is an industry leader in the design and development of analytic products and technologies that demonstrably improve health care quality and financial results. Scott joined Pulse8 in 2013 and is the chief architect of Pulse8’s predictive models, clinical inferencing logic, and Dynamic Intervention Planning, for which two patents are pending.
Senior Vice President of Innovation and Data Strategies
Eric Sullivan Senior Vice President of Innovation and Data Strategies
Mr. Sullivan serves as Senior Vice President of Innovation and Data Strategies at Inovalon, supporting the innovation towards new product and technology solutions and providing executive leadership over all data integration, management, and governance programs as well as the MORE2 Registry® data asset.
For more than 25 years, Mr. Sullivan has been leading clinical innovation and data-driven solutions in a variety of roles in the healthcare sector—with a keen focus on developing data-driven models to transform healthcare by improving quality, outcomes, and efficiency. He has held leadership positions in some of the nation’s largest health plans including UnitedHealthcare and led teams in the clinical care setting to deliver patient-centered, patient specific health care. His current role advances patient-precision analytics by leveraging big data technologies, Natural Language Processing (NLP), interoperability and real-time clinical data patient profiling. Mr. Sullivan received his M.S. in Health Care Administration as well as an M.B.A from the University of Maryland. Mr. Sullivan also holds a B.S. in Neurobiology from the University of Maryland College Park.
Ralph Tang currently serves as President, MD/VA IPA, WellCare Health Plans / Collaborative Health Systems. In this role, he spearheads the company’s growth initiatives in Value Based Care via risk bearing-capable Population Health MSO, including bundled payments/episodes of care. Ralph’s work focuses on Value-Based Contracting and Health Care Delivery in partnership with Primary Care-led CINs/IPAs and related Preferred Provider Networks of specialists and acute/post-acute care providers—to deliver better health, better care at lower costs for Medicare, Medicaid and Commercial patients.
Ralph formerly served as CEO & President of Partners In Care, New Jersey—an 18-year-old multi-entity physician-owned organization—comprising a population health MSO, a 650-provider IPA/CIN, and multiple Medicare and Commercial ACOs. Ralph led and re-structured the organization to deliver better health, better care at lower costs for patients, members and beneficiaries of CMS, Health Plans, and Self-Funded Employers.
Ralph’s executive experience also includes leadership of PCMH eHealth development with Patient Centered Primary Care Collaborative (PCPCC), a pioneer of PCMH as well as its industry advocacy group. Ralph was formerly Senior VP, Solution Marketing (& Strategic Partnerships) for MEDecision, a Digital Health IT care coordination and management company and subsidiary of HCSC Health Plans (2018) serving ~15 million members.
Ralph is passionate about healthcare transformation from “Volume to Value.” He is a thought leader and speaks frequently in various industry forums on reforms challenges and opportunities, such as payor transformation, payor/provider partnerships, primary care-led healthcare transformation and value-based contracting and health care delivery. These forums include(d) World Health Care Congress, ACO and Payer Leadership Summit, RISE Summit, Payer/Provider Partnership Summit, Innovations in Healthcare Contracting & Network Development Conference, PCMH/Integrated Behavioral Health Summit, Health IMPACT, and Healthcare Payers Transformation Assembly.
In 2014, Ralph was named NJBIZ “New Jersey Health Care 50.” He holds an MBA from Harvard Business School, complemented with its executive program on “Transforming Health Care Delivery” focused on value-based strategy and execution.
Senior Advisor for Legal Affairs
Office of Counsel to the Inspector General Office of Inspector General U.S. Department of Health and Human Services (HHS)
Office of Counsel to the Inspector General Office of Inspector General U.S. Department of Health and Human Services (HHS)
Megan Tinker is Senior Advisor for Legal Affairs for the Office of Counsel to the Inspector General, U.S. Department of Health and Human Services. She advises the OIG on jurisdiction and oversight issues under the IG Act, and health care fraud and compliance matters, including Medicaid, Medicare and grant programs. Ms. Tinker is responsible for executive level direction and oversight on highly complex and sensitive matters for which the Office of Counsel provides legal advice and representation to OIG officials. This includes a wide range of issues dealing with fraud, waste, and abuse in HHS programs and grants.
Ms. Tinker has testified before Congress, and spoken to the Health Care Compliance Association, Association of Government Accountants, Association of Healthcare Internal Auditors, and American Health Lawyers Association. Ms. Tinker provides training on multiple topics including OIG jurisdiction and authorities. Ms. Tinker is also a guest lecturer at the American University, Washington College of Law, Health Law Program. Ms. Tinker graduated cum laude from American University, Washington College of Law and with honors from University of Richmond.
Kris has been leading the operational side of the Geisinger Health Plan Risk Adjustment program since 2007. In this role, she oversees four critical components to a successful risk adjustment program, including retrospective review/auditing; chart retrieval; compliance; and Risk Adjustment Education/Training. She’s been the catalyst and visionary within her health plan to migrate from a primarily vendor-driven solution to a nearly all in-house solution. Her team has grown from 3 to 73 employees, including Master’s-prepared leadership staff, Highly-skilled Coders, Boot-camp trained Educators and two Registered Nurses. Kris holds a Bachelor of Science degree in Business Administration/Accounting from Bloomsburg University.
Jessica is the Manager of Outpatient Clinical Documentation Excellence at Wake Forest Baptist Health, a nationally recognized academic organization in Winston-Salem, NC, with over 2800 providers and greater than 3.5 million outpatient visits yearly. She has over eight years of Clinical Documentation Improvement experience, in both the inpatient and outpatient settings, and is an active member of the NC chapter and National ACDIS. She is a certified clinical documentation specialist inpatient/outpatient, and a certified risk-adjustment coder, as well as a previous AHIMA approved ICD-10-CM/PCS trainer. Jessica has a diverse 23 years of nursing experience in acute care and ambulatory settings, holds a Master’s degree in executive leadership and is a member of Sigma Theta Tau International Honor Society of Nursing.
Over the past five years, she has helped create and lead the Outpatient Clinical Documentation Excellence program at Wake Forest Baptist Health, structuring processes to accurately reflect risk-adjustment of the population served. Honors and awards include receiving the 2016 ACDIS CDI Professional Achievement Award, multiple speaking engagements, authorships, and most recently a member of the CCDS-O certification exam and study guide publication committees.
Kristen Viviano Manager, Risk Adjustment Coding Operations
Capital Districts Physicians’ Health Plan
Kristen Viviano has more than 10 years of experience in healthcare, working with both payers and providers in various roles and holds a Bachelor of Science degree in Health Information Management. As the Manager of Risk Adjustment Coding Operations for Capital District Physician’s Health Plan, Viviano leads a team of 14 auditors, chart retrievers, and professional coders. Viviano also oversees operations for a team of 10 international coders. She is involved with coordinating chart retrievals both internally and with multiple vendors. She enjoys learning about new technology and how that could apply and benefit the risk adjustment coding process.
As Director of Risk Adjustment, Susan Waterman has been empowered to plan, design and oversee business and strategic objectives in creating and optimizing a Risk Adjustment Department responsible for ensuring the accuracy of risk adjustment payments while successfully managing all activities related to Medicare Advantage, ACA and Exchange Risk Adjusted lines of business. In that capacity Susan directed department changes that resulted in multi-million dollar gains in ACA Risk Adjustment, brought all chart review activity in-house saving 500K per year in vendor coding fees, and partnered with the hospital CDI/Quality Physicians to create an Outpatient CDI Department focused on documentation quality, Risk Adjustment activities and clinic training for 1,200 providers.
A proven leader in her field, Susan’s professional experience includes coding and compliance management, auditing and provider training, system management, and consulting services.
After 15 years at a BPO, Dan served as the Director of Programs at Highmark, Inc. where he led Stars programs for over 5 years before joining the Gateway Health team to establish a Stars Quality program focused on delivering 4.0+ Stars. Dan assumed responsibility for HEDIS, Quality Improvement, and Risk Adjustment programs across all lines of business at Gateway Health in 2018. In 2019, Gateway Health’s Medicaid program improved to a 4.0 Accreditation rating and 4.0 Medicare Star Rating.
Steve is an expert on leading, building and developing commercial enterprises in order to drive rapid growth and accelerate speed to market. With a focus on healthcare - particularly technology, mobile and clinical platforms - Steve’s extensive execution experience allows businesses to quickly build strategic partnerships, support growth, and scale operations.
I have been in the medical field 40 years. I have worked in doctor’s offices starting as a receptionist and working my way up to Office Manager and Administrator for Primary Care as well as a few different specialties. I have been coding since the 80’s but became a CPC (Certified Professional Coder) in 2003. I also am a CPC‐I (Certified Professional Coding Instructor), CPMA (Certified Professional Medical Auditor) and CHCCS (Certified HCC Specialist). I am also an ICD‐10 certified trainer. I have been in management for 25 years and the last 13 years have been working for Medicare Advantage Health plans as Director Risk Adjustment Audit and Education. I now have my own consulting business, Susan Wyatt HealthCare Consulting Inc. My specialty is educating clinicians, coders etc. on the Medicare Risk Adjustment HCC model. I focus on the clinicians to educate them on proper documentation and coding for ICD‐10 diagnoses as it relates to HCC. I also do focus chart audits for Risk Adjustment HCC with analysis and educational feedback to the clinician. I have experience with RADV’s as well. ICD‐10 tools is a specialty of mine as well.
Courtney Yeakel is a results-driven leader with a progressive track record of technical and managerial successes with complex government risk-adjustment and payment programs. Courtney joined Pulse8 in 2015 bringing nearly a decade of experience in government program’s health insurance, Courtney led enterprise-wide corporate initiatives focusing on the health plan’s risk adjustment strategy at both the federal and state levels. She was responsible for the execution and oversight of Medicare, Medicaid, and ACA encounter data submissions, intervention strategies, and financial reporting. Courtney has developed and led cross-functional operational teams to ensure both compliance and accurate revenue management.
Prior to joining the Pulse8 team, in addition to risk adjustment, Courtney focused on the analysis of multiple data sets within government programs, including Medicare Secondary Payer, Prescription Drug Event data, federal & state payment reconciliations, cost share reduction, and data governance initiatives. Under her direction, the programs experienced significant process improvements that yielded substantial financial returns for the health plan by lowering administrative costs while increasing quality.
Courtney is Lean Six Sigma-certified and a graduate of St. John Fisher College with a Bachelor of Arts in Economics, along with a Master of Business Administration degree from Penn State University.