Rebecca Ballou is the Southeast Regional Sales Leader for Amplifon Hearing Health Care, where she ensures an exceptional sales and member retention experience through the development of strategic benefits for health plans. Previously, she devoted more than six years to working across a broad spectrum of health care, including positions in the hospital, integrated health system, provider, health plan and medical device settings. She’s especially passionate about enriching the connection between health plans and their members. Rebecca is a graduate of Eastern Illinois University, where she earned a bachelor’s degree in communications and business. She currently lives in Chicago.
Puneet Budhiraja Chief Actuary and Senior Vice President
Capital District Physicians Health Plan
Puneet Budhiraja joined CDPHP in 2013 and currently serves as senior vice president and chief actuary. In this role, he oversees the preparation and submission of all Commercial and Medicare rate filings. He is also responsible for creating new value-based initiatives and monitoring existing ones. Value-based programs allow CDPHP to partner with providers to attain the common goal of reducing overall health care costs while also improving quality.
Puneet has over 15 years of health care actuarial experience, working for insurance companies as well as consulting companies. Prior to joining CDPHP, Puneet worked as an actuary at Cigna Healthcare and was an actuarial consultant at Deloitte Consulting.
Puneet holds a Bachelor of Science in engineering and program in M.S. electrical engineering from New Mexico State University, N.M. Puneet graduated from the America’s Health Insurance Plans (AHIP) Executive Leadership Program (ELP) for healthcare executives. Puneet is a member of the Society of Actuaries and the American Academy of Actuaries. Puneet also serves as a committee member for the American Academy of Actuaries. Puneet has also peer-reviewed and published multiple papers for the Society of Actuaries journals.
Alex is a Consulting Actuary for Milliman where his main focus is assisting clients in developing their Medicare Part D bids. Prior to joining Milliman, Alex led the Medicare Part D actuarial team at Cigna where he was in charge of bid pricing as well as financial reporting. He has 13 years of experience in the healthcare industry both as a consultant for insurers and as a plan Actuary.
Kristy Croom Tucker Director of Member Experience & Acquisition
Kristy Croom Tucker is the Director of Member Experience & Acquisition for BayCare Health Plans, a subsidiary of BayCare Health System—the largest health system in the Tampa Bay area. BayCare Health Plans’ first insurance plan, BayCarePlus Medicare Advantage, began in January 2019, currently serves about 12,000 Medicare beneficiaries across four counties and is rated Five Stars by CMS for the 2022 plan year.
Kristy started at BayCare in 2011 as a hospital marketing manager and oversaw the marketing of four hospitals and the system-wide marketing of several key service lines, including cardiovascular services and neurosciences. In 2014, Kristy moved on to become the System Marketing Manager for Consumers for BayCare. In that role, she oversaw the marketing of BayCare’s extensive ambulatory division and the development and marketing of several mobile applications. Kristy also oversaw the development and launch of BayCare’s first brand campaign—Humanity at Work. Kristy transitioned to the health plan with the launch of BayCarePlus Medicare Advantage.
Prior to her role at BayCare, Kristy was Director of Communication for Rasmussen College. She holds a Bachelor’s and Master’s degree in Journalism from the University of Kansas. Rock chalk Jayhawk!
When she’s not thinking about branding, member experience and cost-per-acquisition, Kristy enjoys being the mom of two perfect angels, Gabriella and Sebastian. The Tucker family enjoys going on adventures, being outdoors, craft beers and traveling.
Omar joined Community Health Plan of Washington, CHPW, as the Director of Pharmacy in 2019 after sixteen years with Walgreens Co., where he led Specialty Pharmacy operations for the Pacific Northwest Region.
Omar has extensive experience in Specialty Pharmacy, Managed Care including government programs, and Clinical Pharmacy quality initiatives. Omar’s current role is focused on PBM relationship oversight, clinical pharmacy integration, and utilization management of medical and prescription drug benefits.
Omar received his Doctorate of Pharmacy Degree from the University of Washington in 2005 and continues to reside in the beautiful Pacific Northwest.
Dr. Shannon Decker is Vice President of Clinical Performance at Brown and Toland where she leads a department responsible for Clinical Quality Documentation (Risk Adjustment); Clinical Quality, Patient Experience & Population Health; Clinical Compliance, including Appeals & Grievance; and Clinical Data Management, including Encounter Data Management. She also serves as Brown & Toland's COVID-19 Taskforce leader. Dr. Decker has more than 20 years of experience in healthcare--15 of which include working with risk adjustment and Medicare. Dr. Decker has a PhD. in Interdisciplinary Studies, dual MBA degrees--in Finance and in Marketing, as well as an M.Ed. in Secondary Education and a M.Ed. in Administration and Leadership. Dr. Decker is on the faculty at Arizona State University and is also an associate professor of Higher Education & Adult Learning (HEAL) and chief methodologist for Walden and Capella Universities where she chairs and oversees the dissertations of doctoral students. An author of two books and several peer-reviewed articles, she consults in both the fields of healthcare and education. Her interests include the study of human behavior and how theories on motivation and learning may be brought to bear on population health management.
Donna Doebler AVP, Medicare SNP Product & Analytics
UPMC Health Plan, Inc.
Dr. Almario Doebler is the Associate Vice President of Medicare and SNP Product and Analytics at UPMC Health Plan. Dr. Almario Doebler leads the analytics and product strategy of the Medicare Advantage team. Her focus is in promoting health equity and understanding the social, community, and contextual factors that impact health outcomes, especially with the aging population.
Lauren is the founder & CEO of NourishedRx and a Medicare Advantage subject matter expert. She founded NourishedRx to support health plans’ efforts to address the most actionable and critical non-clinical needs of their members — nutrition and social isolation. Lauren formerly led the Medicare business at Oxford Health Plans and also served as a Principal at Leavitt Partners focused on Medicare. She has an MPH from Columbia University and a BA from the University of Virginia.
Lisa Franklin Manager, Government Products Lifecycle
CareFirst BlueCross BlueShield
Lisa Franklin is currently a Manager of the Government Products Lifecycle (strategy, design, management, and optimization) at CareFirst BlueCross BlueShield leading the overall product vision and strategy to launch and continuously improve both Individual Medicare Advantage plans (including Dual Special Needs) and Group Medicare Advantage plans in the Maryland, District of Columbia, and Northern Virginia areas. Her focus is managing a team that leads cross-functional discussions to meet milestones on the product roadmap towards the short and long-term strategic goals. Lisa previously worked at Johns Hopkins Healthcare in Maryland as Product Development Manager in a similar role. She has over 5 years of experience leading the Medicare Advantage Bid process at multiple organizations with a passion for ensuring that data is the driving force for every element of the product lifecycle. In her spare time, she enjoys spending time with her husband and corgi, Turbo, as well as spinning and shopping (more online now!).
Thomas works in the Tampa office of Wakely Consulting Group, LLC, an HMA Company. Since joining Wakely in 2013, Thomas has worked in areas, such as Medicare Advantage, Risk Adjustment, State rate filings, Management of Medicare Plan Benefit Packages (PBPs), Claim liability analysis, Diagnosis-related group rate analysis, Monthly reserves, and Contract Analysis.
Principal, CAT5 Strategies
Chair, The RISE Association, Quality & Revenue Community
Chair, The RISE Association, Quality & Revenue Community
Ana Handshuh, CHC, is a government programs executive with expertise in creating and implementing corporate programs for the healthcare industry. Ms. Handshuh is the Principal at CAT5 Strategies, a healthcare advisory practice specializing in Regulatory and Operational Compliance, Revenue Management, Communications, Quality, Care Management Programs, Benefit and Formulary Design, Program Bid Submission, Accreditation, and Technology Integration. She recently founded TRACSCOUT, a technology startup SaaS platform for managed care processes.
Her recent consultancy roles include conducting compliance risk assessments, performing Compliance Program Effectiveness audits, conducting FDR and PBM pre‐delegation audit, preparing for CMS program audit, and writing and implementing post‐audit corrective action plans. Ms. Handshuh has also assisted government program sponsors achieve higher Star ratings, create and implement care management programs, 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 is a member of the Health Care Compliance Association and is Certified in Healthcare Compliance by the Compliance Certification Board. Ana 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.
Ms. Handshuh previously served as the Vice President of Managed Care Services at Central Florida Inpatient Medicine (CFIM), providing leadership and strategy on CFIM projects with physicians, risk entities, hospital systems, and health plans. Prior to that assignment, she worked with Precision Healthcare Systems as their Vice President of Quality Improvement, leading the IPA’s collaborations with payers to implement Quality and Star Rating initiatives. Ms. Handshuh also served as the Director of Corporate Program Development at Physicians United Plan (PUP), leading the Medicare health plan’s Quality Management and Corporate Communications departments and spearheading the development of innovative integrated technology solutions to drive business excellence and Star Rating achievement. Prior to joining Physicians United Plan Ms. Handshuh was the founder of I-Six Creative. Under Ms. Handshuh’s vision and leadership, I-Six 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.
Ali has worked as an actuary at Milliman for over 6 years, the job which she accepted upon graduating college. In 2015, she graduated from Lehigh University with a Bachelor of Arts, double majoring in Mathematics and Economics with minors in Statistics and Actuarial Science. She attained her FSA in 2019.
Since joining Milliman, she has worked in a variety of different healthcare markets, but the majority of her time has been spent in the Medicare Advantage market. In particular, she has assisted various clients with the development of their Medicare Part C and Part D bids, desk review and audit assistance, Statements of Actuarial Opinion, Part D settlements, and feasibility studies, among others. Recently, she has also started helping drug manufacturer clients with assessing stakeholder impacts on proposed Part D legislation changes.
In her current role, she leads teams internally, overseeing technical staff to ensure quality and timely work product. She also trains her technical staff to understand the bid mechanics and modeling behind it. Recently, she also assisted with a firm-wide Medicare Part C 101 training, which taught new staff across Milliman the basics of Part C. She also is frequently engaged with her clients through leading calls, managing daily communications, and ensuring client satisfaction with timely and accurate results.
This is Ali's first industry conference, and she is excited to share her knowledge and expertise with others in the market.
Zain Jafri is Vice President, Innovation and Analytics for Pareto Intelligence. He is responsible for building new analytics capabilities and pursuing innovation opportunities at Pareto. He also oversees the development and commercialization of emerging products, while keeping an ear to the market and our clients’ needs to identify new problems to solve or how new features (e.g., machine learning, artificial intelligence) can enhance our current solutions.
David Koenig is a consulting actuary with the Milliman Seattle Health Practice. He has been with the firm since 2010. As a healthcare consultant, David works primarily with the Medicare and Medicaid markets. His clients include insurance companies and provider groups.
David’s experience as a healthcare consultant includes:
Medicare Advantage Part C and Part D bid preparation and support
CMS-HCC risk adjustment calculation, including Part C (both ESRD and non-ESRD) and Part D models
Provider risk-contracting support
Year-end statements of actuarial opinion and reserving
Hannah began her career working extensively in politics and state government before joining the health insurance industry. Since joining Network Health, Hannah has held positions covering the intersection of public relations, member experience, product planning, vendor management, government relations and community engagement. In her current role, Hannah focuses on Network Health’s Medicare Advantage and other government-sponsored health insurance products, as well as key commercial client products.
Hannah is a graduate of Loyola University Chicago and the John Felice Rome Center. She enjoys volunteering for a variety of nonprofit organizations including the American Heart Association and Feeding America, and can most often be found trying to control the chaos with her three young children.
Monica Pagels is a Senior Product Manager for Health Alliance Plan (HAP) in Detroit, Michigan. HAP is a regional health plan with HMO, PPO and SNP plans that serve over 70,000 Medicare lives in over 40 counties across the state of Michigan. HAP is a solution based health plan, providing meaningful benefits that support community needs, including aging in place, removing barriers to care and managing insecurities. Monica has been with HAP since 2017 and has worked in the health insurance field since 2009. Monica holds a Master of Science from Eastern Michigan University and a BS from Central Michigan University. She has extensive experience in Project Management, program design and improving health outcomes. She has worked with special populations and helped to create chronic condition management programs.
Tom Pelegrin Senior Vice President & Chief Revenue Officer
Convey Health Solutions
As Senior Vice President and Chief Revenue Officer Tom is responsible for Convey’s market growth, sales, business development, brand and marketing. Tom brings more than 25 years of sales and business development experience in the healthcare markets specifically related to payer technology and operations. Most recently, he was the Founder and CEO of MDInnovate, an organization focused on providing primary care services and improved patient care coordination through unique and innovative delivery models. Prior to this, Tom was a Partner with Optimity Advisors, a leading Washington, DC – based healthcare operations consulting firm where he provided subject matter expertise related to State and Federal Health Exchanges and payer enrollment and billing technology and operations. Tom also led the firm’s business development efforts and helped grow the firm into a multi-national operation with offices throughout the US and Europe. Prior to Optimity Advisors, Tom was Vice President of Enterprise Sales for Benefitfocus, a leading cloud-based benefits management technology provider. While at Benefitfocus Tom was instrumental at building and expanding Benefitfocus’ footprint within the payer markets and founded the government programs group, which was one of the earliest providers to serve the State and Federal Health Exchange marketplaces. Tom received his bachelors degree from the University of South Florida and remains an active member of their alumni association.
Vice President, Client Advisory & Business Development
Brandon Solomon Vice President, Client Advisory & Business Development
Convey Health Solutions and Pareto Intelligence
Brandon Solomon is Vice President, Client Advisory and Business Development for both Convey’s Supplemental Benefits Administration and Pareto Intelligence divisions. He is responsible for contributing to the strategic growth of the organization, both through setting and pursuing business development strategy, as well as ensuring our clients receive optimal value from our solutions and services. Brandon and his team support clients with robust analytics and technology solutions to set strategic direction, uncover actionable areas for improvement and achieve measurable outcomes.
Mike Spicer Director, Product Innovation & Research
Capital District Physicians' Health Plan
Mike leads the product innovation team of portfolio managers, researchers, and analysts at CDPHP in Albany, NY. Mike’s team is always seeking out new trends and disruptions in healthcare to enhance CDPHP’s product portfolio, running the gamut from digital health technologies to high deductible plans paired with HSAs. Mike is most interested in studying and utilizing consumer behavior trends in healthcare, including the choices people make, why they make those choices, and the influences required to help them make choices that are more appropriate. Originally from Syracuse, New York, Mike relocated for his post-secondary education, including a B.S. from Union College focused in Neuroscience and Quantitative Economics, as well as a master’s of Business Administration (M.B.A.) focused in Healthcare Management from Clarkson University. Mike now resides with his family and dachshunds in Latham while continuing to work on his golf game.
Ryan is a consulting actuary with the Atlanta office of Milliman. He first joined the firm’s Scottsdale, Arizona, office in 1994 and moved to the Atlanta office in 2004.
Ryan works with Blue Cross and Blue Shield Plans, HMOs, health insurance carriers, and provider organizations. He assists clients in developing and evaluating strategies in the commercial, Medicare, and Medicaid markets. His client activities include the following:
Pricing and rate development
Healthcare cost analysis and actuarial cost model development
Preparing regulatory rate filings
Developing provider reimbursement and risk-sharing arrangements
Analyzing feasibility of participating in Medicare and Medicaid programs
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.
Rex Wallace is the founder and principal of Rex Wallace Consulting, LLC, a firm that specializes in improving Star Ratings for Medicare Advantage health plans. Rex assesses plans and guides them in the development and implementation of-leading strategies to drive material Quality Improvement. Since its inception in 2017, RWC has helped multiple Medicare Advantage contracts achieve significant improvements in Star Ratings, including single-year full-Star improvements. Prior to launching RWC, Rex spent twenty-three years in strategic healthcare roles, with a strong focus on Medicare Advantage. Most recently, he led Stars for a large, multi-state plan that consistently achieved 4 and 4.5 Stars across its multiple contracts.
Dan Weaver EVP Product Operations and Stars Strategy
Daniel Weaver is the Executive Vice President of Product Operations and Stars Strategy at NationsBenefits, with nearly 25 years of experience in Operations and Star Ratings strategy. Daniel most recently served as VP, Government Quality Programs at Gateway Health, where he led the company to its first 4.5 Star Rating and an improved Medicaid NCQA Accreditation rating. In his career, Dan has overseen the development and implementation of many analytics-driven and customer-focused programs, and he advocates for continuous improvement and operational excellence philosophies for sustained success. In his new role with NationsBenefits, Daniel will drive strategic planning, facilitate execution, oversee product financial performance, manage operational performance across all products, and ensure strong internal controls are in place to enable efficiency in the growth of the business. Daniel will also help drive prospective and retrospective investigation into quality outcomes and customer engagement across the company’s distinct benefit management programs while continuing to innovate new solutions for health plan partners focused on growth and strong quality performance.
Andy Wheaton is the Pharmacy Department Manager for Network Health in Menasha, Wisconsin. Andy received his doctor of pharmacy from the University of Minnesota School of Pharmacy-Twin Cities College of Pharmacy in 2005. After graduation, he was a retail pharmacy manager at a national chain for 11 years. During this time, he also worked with various companies in workers’ compensation case reviews/consultations, long-term care, and Medication Therapy Management (MTM).
His current role focuses on Medicare BID, Medicare compliance, formulary management, Medicare Part C and Part D Stars/Quality Initiatives, and various clinical initiatives.
During his free time, he enjoys navigating organized chaos with his wife (Jess) and their three children (Ian-7, Tyson-10, and Maiya-12).