Rebecca Ballou Regional Sales Leader, Southeast Region
Amplifon Hearing Health Care
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.
James is an Actuary in the Tampa office of Milliman. He joined the firm in 2014.
James’ experience covers a wide range of healthcare topics including pricing and new plan design for both Medicare Advantage as well as Commercial ACA compliant Individual and Small Group plans. James’ Medicare Advantage experience includes extensive medical claims data analytics with an emphasis on comparison with national trends and managed care benchmarks. James also has extensive experience in financial reporting, reserving, and year-end opinion work.
Prior to joining Milliman, James spent over ten years working for state and local government overseeing budgeting, compliance, financial reporting and forecasting, while honing his leadership, management and technical actuarial skills. James is a graduate of RPI with a BS in Management. James also earned his MBA from Georgia State University with a concentration in Risk Management.
Mary Jo Coyne, BSN, RN, CCM SNP – High Risk Manager – SouthEast Region
Mary Jo Coyne has worked in the healthcare industry, with a focus on Managed Care over the past 25 years. Mary Jo considers herself an upbeat, people-oriented and energetic clinical operations professional. Mary Jo has led diverse cross-functional departmental teams in both Medicaid and Medicare.
Mary Jo is currently a Manager at Cigna, providing leadership for the SNP Medicare Advantage Care Management Team, within the SE Region.
Mary Jo has led the development, implementation, and strategic day-to-day administration of clinical operations in a variety of clinical functions, including utilization review, case management and disease management, with a focus on transition of care and quality metrics.
Mary Jo is a team player who strives to build strong relationships at all levels. Her passion is to coach and mentor associates to perform at their highest levels. She leads by example, striving to be fair, firm and consistent while setting the standard for hard work, flexibility and team success.
Ryan Davis Medicare Market & Operations, Senior Manager
Ryan Davis is a Medicare aficionado who has over twelve years of wide-ranging managed care experience. Ryan has previously consulted CVS Health with marketing activities in support of their Medicare PDP product, ensured compliant benefit administration, and maintained healthy relationships having worked in Account Management with the country’s largest Pharmacy Benefit Manager Express Scripts (formerly Medco), and has overseen multiple Part D clinical programs for a regional integrated health plan with over 90,000 Medicare enrollees. Today as a Sr. Manager of Medicare Market & Operations with Centene he is responsible for building up a new-to-market Medicare plan in Washington state.
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.
Jim Egan is Vice President of Health Plan Sales for WEX Health. Jim works with new and existing health plan partners to deploy solutions that best complement and enhance health plans’ core offerings. Jim has 25 years of healthcare experience in operations and sales for health plans, administrators and solution providers.
Rafael has over 35 years of experience in the auto, liability, no-fault, and workers’ compensation insurance industries. He has written extensively on liability, workers’ compensation, social security, and Medicare/Medicaid issues. He has also taught these subject matters at several law schools and medical schools in Florida. He lectures throughout the country on all aspects of Medicare and Medicaid compliance, including Mandatory Insurer Reporting, Conditional Payment Resolution, Medicare Set Asides, MSA Post Settlement Administration, Medicaid Third Party Lien Reimbursement, and Special Needs Trusts.
Over the last 30 years, Rafael has been recognized by City of Tampa Mayor Pam Iorio and Hillsborough County Commissioner Ronda Storm for his work on behalf of the Hispanic community in Tampa and Hillsborough County. He was awarded the Governors Appreciation Award by Governors Bob Martinez and Jeb Bush for his work in improving Florida’s workers compensation system. He was awarded the Governors Leadership Award by Governor Charlie Crist for his work in improving Florida’s Medicaid system. He was awarded Florida’s Distinguished Service Award by US Senator Mel Martinez for his work and advocacy to improve the US Social Security disability system. He has also been awarded the Presidential National Service Award by President George W. Bush for his work on improving the Medicare Secondary Payer system through the addition of the Mandatory Insurer Reporting process, and by President Back Obama for his work and support of the Affordable Care Act.
Recently, WorkCompCentral CEO Kristen Chavez presented Rafael with the Magna Comp Laude Award with Great Honor for his willingness to share his knowledge, experience, and scholastic work with the country’s workers compensation community. Also RISE CEO Ellen Wofford honored Rafael with the RISE Distinguished Service Award for his many years of leadership, scholarship, and professionalism in educating the thousands of professionals who have attended his numerous Medicare and Medicaid programs. And International Association of Industrial Accidents Boards and Commissions President Evelyn McGill awarded Rafael its President’s Award for his leadership and service to the international workers compensation community.
Rafael is active on social media. He is owner and manager of several LinkedIn groups, including Medicare and Medicaid Compliance (8,500 members), Medicare Mandatory Reporting, Medicare Conditional Payments, Medicare Set Aside Allocations, Medicare Set Aside Administration (3,500 members), Florida Workers Compensation (2,500 members), Social Security Benefits (1,500 members), Hispanic Issues and Demographics (500 members), and Affordable Care Act Compliance (250 members). Rafael is also active on Twitter with 2,000 followers and Facebook with 2,000 friends.
Born in Havana, Cuba, Rafael and his family escaped communism to Madrid, Spain, and ultimate immigrated to the US. He owes everything he has achieved to his mother, Miriam Lera. Her love and sacrifice have allowed him to live in freedom, succeed and prosper. Rafael graduated from Miami Senior High School, received his Bachelor of Science degree from the University of Florida and his Jurisprudence Doctorate degree from the Florida State University. He lives in Lithia, Florida with the love of his life, his wife Lisa, and his greatest pride, his two sons, Alex and Andres.
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.
Matthew Hayes, FSA, MAAA Principal and Consulting Actuary
Matthew is a Principal and Consulting Actuary in the Tampa office of Milliman. He joined the firm in 2016.
Matthew’s experience includes 18 years in the actuarial field working in both the health and life sectors.
Matthew’s expertise lies in all areas of the pharmaceutical space including formulary and rebate analysis, competitive analytics, network analysis, policy research, PBM analysis, benefit design, reimbursement and Part D pricing. Matthew has written extensively on the impact of regulatory and legislative changes to pharmaceutical pricing for both Medicare Part B and Part D medications. Matthew works with many stakeholders in the pharmaceutical space including payers, PBMs, manufacturers, and other advocacy organizations.
Matthew also has extensive experience in Medicare Advantage pricing, research, experience analysis, and regulatory & compliance review.
Prior to joining Milliman, Matthew spent seven years at a large national insurer spearheading the development of new Medicare Part D products and the introduction of a quality-based pharmacy network. While there, Matthew helped lead to more than double PDP membership and become the largest plan sponsor for PDP membership.
Matthew is a graduate of the University of Louisville with a BS in Mathematics and a concentration in Actuarial Science.
Andy Higgins Director, Product Development, Senior Markets
With close to 20 years of experience in Healthcare, Andy has worked for large payers and PBM’s in a variety of product, marketing and strategy roles. His primary focus has been on B2C and B2B2C solution designs that are profitable, scalable and valuable to clients, members and/or patients.
As Director of Product Strategy at Highmark BCBS, Andy’s team develops and manages Medicare Advantage, Prescription Drug and Medigap product portfolios in PA, WV, DE and NY. Innovative Medicare Advantage supplemental benefits are a key area of focus and his team has doubled the number of new benefits offered over the past 3 years.
Prior to joining Highmark, Andy spent over 8 years at CVS Health in product development, management & innovation roles. His responsibilities included P&L ownership of over a dozen B2B2C clinical products, driving solutions through all phases of the product lifecycle, from assessing early-stage concepts to scaling across a 60M-member book of government, fully insured and ASO clients. Early in his career, Andy held marketing, technology and strategy roles in Medicare and Pharmacy departments at Cigna and Aetna.
Andy graduated with an MBA from the University of Massachusetts and a BA in Economics from Westfield State University. He’s a native of Springfield, MA and now lives with his wife and 2 children in Pittsburgh, PA.
Dani is a Senior Medicare Product Manager for Regence (Cambia Health Solutions). She has been working within the health insurance industry since 2005.
Dani has been working primarily with Medicare products since 2014, with a focus on Medicare Advantage plans. Regence covers the four states of Washington, Oregon, Idaho and Utah, and includes HMO, PPO, and PDP types of plans. Dani has an MBA from George Fox University, and a BA from Willamette University. Prior roles in the health insurance industry include sales, marketing communication, benefit management, and product management. She has worked with all lines of business including large group, small group, individual, and government programs, as well as ancillary products such as dental, vision, and hearing products.
Sion Hughes Consultant, Market and Provider Strategy
Wakely Consulting Group, LLC
Sion Hughes has 10 years of experience in Medicare Advantage. In his current position at HealthPlus of Michigan,Sion is responsible for the development, marketing, and management of its Medicare productline. Under Sion’s leadership, the Health Plus product line has grown an average of 10.8% per year while maintaining one of the highest quality rated plans in the State of Michigan. Prior to Joining HealthPlus of Michigan, Sion worked in the roles of Sales and Program Oversight and BlueCross BlueShield of Michigan where he gained insight to all of the operational areas that are required to operate a Medicare Advantage program.
Naomi Irvin is a California native who began calling North Carolina home in 2006. She earned her BSBA with a Management concentration and MBA with a Marketing certificate from East Carolina University (ECU). With nearly 15 years of health insurance experience, Naomi supports Government Markets at Blue Cross and Blue Shield of North Carolina as Chief of Staff. In that role she is focused on providing strategic alignment, accountability, communications, and enablement.
Having participated in Leadership North Carolina’s 2020-2021 cohort, Naomi has taken on the role of Program Chair for the 2021-2022 cohort and sits on the Leadership North Carolina board of Directors.
When not working, Naomi enjoys spending time with her kids (Josh, Hayley, and Milena) and pup (Juliet Bean). Josh is a senior at ECU, Hayley is a rising Junior at Elon University, and Milena is a 5th grader. One of the most rewarding things Naomi does with her family is volunteering with the Inter-Faith Food Shuttle and KABOOM!. A devourer and collector of books, Naomi retreats to her home office and packed bookshelves when she needs a break.
Pamela is an Actuary in the Tampa office of Milliman. She joined the firm in 2017.
Pamela’s has several years of experience in the actuarial field working in the pension, life insurance, and healthcare sectors. During the last 10 years, she has focused in the healthcare sector with an emphasis in managed care. Since she joined Milliman, Pamela has successfully assisted numerous clients throughout their MAPD and PDP bid development process. Pamela has extensive experience in Medicare Advantage financial reporting, pricing employer group waiver plans, formulary analysis, and development of pricing models.
Prior to joining Milliman, Pamela spent 5 years at a large Medicare Advantage organization honing her leadership and project management skills.
Dr. Stuart Levine is currently an Operating Partner for Chicago Pacific Founders specializing in Care Model Innovation supporting current companies as well as founding new companies in this arena. Dr. Levine is on the board/ executive advisor of a number of health care companies including Exsel (Health care IT), P3 (PCP led global risk medical IPA), Atrio (Medicare Advantage Plan), MyCare (global risk PCP led medical group) WellBe Senior Health (Home Care for the chronically ill and frail), Windstone Behavioral (BH medical group), VIM (health care IT), Luna (PT) and HealthMap (CKD chronic care), and VillageMD (primary care global risk). He is also a Founder of agilon health and previously worked as the Chief Medical and Innovation Officer for Agilon Health, a physician group and IPA platform providing integrated and coordinated care in multiple geographies powered by advanced technology. Dr. Levine is also the Director/ Chief Physician Strategist at Google Health.
Kelsey McNamara, MPH, is a public health professional with experience in digital health, behavioral interventions, and obesity-related chronic diseases. As the Director of Research at Papa, she evaluates the clinical and economic impact that Papa has on members. Prior to joining Papa, McNamara held research and strategy positions at Omada Health, Google, and the Harvard Center for Work, Health and Wellbeing.
Rajesh Munjuluri is an actuary with Capital District Physicians Health plan in NewYork. He has over 15 years of experience as a Health Actuary and has extensive experience in developing MAPD bids and in designing and evaluatingvalue-basedcontracts 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 asaCMS desk reviewer for Medicare bids.
Tim Murray, FSA, MAAA Director and Senior Consulting Actuary
Wakely Consulting Group, LLC
Tim Murray, FSA, MAAA, is a Director and Senior Consulting Actuary and leads Wakely’s New York office. He joined the firm in 2017 and has worked as a health actuary for more than sixteen years. Over the course of his career, Tim has consulted to and served health plans on matters of pricing strategy, product design, forecasting, financial reporting and reserving, and Merger & Acquisition due diligence. Prior to joining Wakely, Tim spent nearly 7 years at Deloitte Consulting, supporting extensive audit support of major health plan clients. Tim also spent 4.5 years leading the actuarial forecasting and budgeting functions of a Medicare Advantage-focused health plan. Immediately preceding Wakely, Tim spent nearly 2 years at J.P. Morgan in an equity research role covering publicly traded managed care and health care facility stocks, providing investment/industry guidance to institutional investors.
Hannah Neylon Manager, Government Products and Relations
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 also manages the Network Health Political Action Committee (NH PAC).
Hannah is a graduate of Loyola University Chicago and the John Felice Rome Center. In her free time she volunteers for a variety of nonprofit organizations including the American Heart Association and Feeding America, and can most often be found trying to keep a lid on things with her three young children.
Hank Osowski, a Founding Member and Managing Partner of Strategic Health Group, is an experienced health care executive and strategist who has provided leadership to commercial, Medicare and Medicaid health plans for more than three decades. He has led several engagements for the firm’s clients on the key challenges of Medicare and Medicaid Managed Care programs in diverse markets, such as California, Wisconsin, Michigan, Illinois, New Mexico, Florida, Texas, West Virginia and Hawaii. He has also provided leadership to more than a dozen client plan development undertakings for commercial, Medicare Advantage and Medicaid business startups in multiple states.
A frequent speaker and resource on critical issues facing the Medicare and Medicaid programs, including the opportunities for strengthening a Medicare Advantage plan’s market position, the challenges of supporting programs for the Dual Eligible populations, as well as the principles for structuring effective long term care programs. His insights on some of the challenges facing the healthcare industry have been published in “Managed Care”, “Healthcare Marketing Report”, “Managed Care Contracting & Reimbursement Advisor”, “Payers and Providers” and “Becker’s Hospital Review” among other publications.
Formerly the senior vice president of corporate development for SCAN Health Plan, Hank was a key member of the senior leadership team that turned the company around from a “near death experience” into an exceptionally strong financial position and one of the largest nonprofit Medicare Advantage plans in the country. He led SCAN’s expansion into seven additional California counties and as well as its first out-of-state expansion into Arizona where Hank then served as CEO of SCAN Health Plan Arizona and SCAN Long Term Care. He has also led the organization’s strategic planning efforts and initiated an innovation development regimen to seek improvements in care coordination practices and future care outcome protocols.
Prior to SCAN, Hank served as a Principal in a national health care consulting organization providing a range of strategic, financial and development services for health plans, physician groups and hospitals. He also served as vice president International Operations for American Family Life Assurance Corporation where he directed the development of start-up operations in the United Kingdom, Germany and Italy, as well as the financial turnaround of the company’s Canadian operations.
Hank began his California career as a member of the senior management team responsible for the turnaround and financial survival of Blue Cross of California. In this capacity, Hank led the financial improvement of the individual and small group division and provided leadership to the organization’s strategic planning efforts.
Tom Pelegrin Senior Vice President and 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 bachelor’s degree from the University of South Florida and remains an active member of their alumni association.
Dr. Anthony Perry is the Chief Clinical Officer at Duo Health. By background he is a geriatric medicine physician practicing at Rush University Medical Center in Chicago IL for over 30 years.
In conjunction with his practice he served in a variety of leadership roles at Rush. Notably, he served as the Division Chief for Geriatric Medicine and Palliative Care, Chief Medical Officer for Rush University Medical Group and Vice President for Population Health. Within that last role, he was instrumental in the development of the Medical Home Network ACO, an innovative partnership across hospitals and FQHCs dedicated to successfully providing at risk care to Medicaid recipients in Chicago.
His final role at Rush was heading the Rush Ambulatory Transformation Center. In that role his scope ranged from ‘bricks to clicks’ - delivering modern clinical programs through integration of bricks and mortar, operations and digital to augment the experience and quality of care.
He serves as an associate professor at Rush with faculty appointments in the Department of Internal Medicine and Health Systems Management.
Dr. Perry serves on the boards of RRF Foundation for Aging (a leading grantmaking organization committed to improving lives of older adults) and AgeOptions (the Suburban Chicago Area Agency on Aging).
He brings that background in advancing models of care to Duo Health, which is a new type of medical group focused on transforming care for persons with chronic kidney disease.
Jessica Sanders Manager and Government Programs Product Consultant
Blue Cross Blue Cross Blue Shield of Michigan
15 years’ experience working on government programs for the largest health insurer in the state of Michigan. Experience creating and managing products for Affordable Care Act compliance. commercial business, Medicare Advantage as well as Medicaid. Currently managing the Healthy Kids Dental Medicaid program which covers over 300,000 members and growing at Blue Cross Blue Shield of Michigan. Received undergraduate degree from Michigan State University. Earned an MBA from Wayne State University. Wife and mother of 5 boys.
Hans is also the President and CEO of Hans Wiik Health Group, LLC – a Colorado based consulting group that focuses on assisting providers, payers, and employers on guidance and strategies around ACO development and performance, clinical integration, care coordination, population health management, value based benefit design, employee wellness, medication therapy management and overall performance improvement in healthcare quality and cost reduction.
Hans was the President and CEO of the Centura Health Integrated Physician Network (iPN) from 2008-2014. The iPN was formed in 2004 when a small group of independent practices and physicians in the North Denver and Boulder area of Colorado began implementation of a common/enterprise wide EHR to drive quality and clinical performance improvement as one of the first clinically integrated networks of independent practices in the nation. In six years, the iPN grew to over 260 providers represented in 25 different multi-specialty practices across 45 separate practice sites. Over 120 of these providers are primary care physicians, all certified by the NCQA as Level 3 Patient Centered Medical Home providers, the largest number in Colorado.
It is partnered and sponsored by Colorado’s largest not for profit healthcare system – Centura Health. Practices include both primary care and specialty practices, including a large Federally Qualified Health Center – Clinica Family Health Services practicing in 5 locations. Practices currently include Family Practice, Internal Medicine, Ob-Gyn, General Surgery, Neurosurgery, Orthopedics, Pulmonology, Cardiology, and Reconstructive Plastic Surgery. The practices are integrated through population based quality initiatives, benchmarking for quality and patient satisfaction and sharing of best practices.
The iPN supported its many members in single signature payer contracting, IT/EHR and CQI implementation and support, quality performance reporting and analytics, care coordination and also provided a variety of MSO services to help improve practice financial performance and productivity. As a developing ACO in the Colorado market, it has negotiated and implemented several payer and employer agreements, with included shared savings and quality metrics integral to annual performance objectives.
Hans has a BS degree in Pharmacy, an MHA and MPH from the University of California,
Berkeley and has been a long standing Fellow in the American College of Healthcare Executives. (FACHE)
He has over 40 years of experience in healthcare, serving as a COO and CEO in hospitals
in California, Oregon and Colorado. He previously served as President and CEO of Health Future, a consortium of 30+ hospitals and health care systems in Oregon, and also as the President for the VHA Mountain States region after his various hospital CEO positions. He consults nationally working with hospitals, physician groups and large employers for promoting healthier workforces and improving clinical, financial and managed care performance, with emphasis to new models of healthcare delivery and payment.