Michael Clift Director of Stars Strategy and Analytics
Mike Clift currently serves as the Director of Stars Strategy and Analytics for Cigna-HealthSpring. He has extensive Commercial and Medicare Advantage experience including leading provider engagement and clinical quality programs, system and process implementations, local / national Star rating programs, and driving health plan network strategy and operations.
Jim has over 22 years’ experience in developing customer engagement solutions that help clients drive valued behavior and engagement with their brands. He has focused his attention over last decade developing an expertise in healthcare and designing solutions that reward members with incentives for taking an active role in their health care decisions.
Jim partners with clients to understand their member lifecycle and build solutions that support their goals. His solutions are fueled by Entertainment’s best-in-class offers, which are selected based on the lifestyles, geographies and demographics of the target audience. Jim helps shape these offers into print, digital and mobile programs for acquisition, loyalty, retention and to reward desired behaviors.
In the Medicare space, Jim focuses on offers and delivery methods that work best with the senior demographic. He has helped Medicare Advantage companies reach a variety of goals, like encouraging wellness visits, risk assessments and preventative screenings. Improvements like these can lead to higher Star Ratings and increased bonus payments for clients, as well as healthier lifestyles and program satisfaction for their members.
Kristen has 4 years of progressive experience with Cigna-HealthSpring. After completing the Managed Care Rotational Leadership Program, she served as the Coordinator of Stars Operations for the Georgia and Carolinas region before moving on to her current role as Stars Operations Lead for the Arizona region based in Phoenix, Arizona. Kristen earned her undergraduate degree in business from the University of North Carolina at Chapel Hill and is currently working toward a graduate degree in Business Administration from the University of Hartford. She enjoys learning about and executing on ways to help provider offices improve the quality of care delivered to their patients every day. Becoming knowledgeable about the Star Ratings program in order to provide this quality care is an area of focus she is especially interested in.
Risk Adjustment Quality and Education Program Manager
Colleen Gianatasio Risk Adjustment Quality and Education Program Manager
Colleen Gianatasio MHS, CPC, CPC-P, CPMA, CPC-I, CRC, CCS has nearly 20 years of experience in the health insurance field. She has experience in customer service, claims, quality and coding. As Risk Adjustment Quality and Education Program Manager for Capital District Physician’s Health Plan (CDPHP) Colleen’s primary responsibilities are provider engagement and clinical documentation improvement for accurate coding. Colleen specializes in developing innovative coding curriculum and instruction to support compliance with federal guidelines and appropriate reimbursement processes. She is a certified AAPC instructor and enjoys teaching a variety of coding, documentation and auditing classes. Colleen serves as President-Elect of the AAPC National Advisory Board.
Kari Hadley Senior Director, Quality Product Solutions
Kari Hadley is the product owner for Pulse8’s Qualit8 (Quality Analytics) solution, which supports all quality metrics including HEDIS®, Medicare Advantage 5-Star, and QRS. Kari has worked in the health care industry for over 20 years and has a wide range of experience from Healthcare Education and Disease Management to NCQA Accreditation, HEDIS® measurement, and Risk Adjustment.
Prior to joining Pulse8, Kari worked for Molina Healthcare, Inc., as the Manager of Medicaid and Marketplace Risk Adjustment. Kari started her career in 1995 as a Health Educator at provider and hospital locations. In 1997, she joined QualMed/Molina Healthcare, where she worked as the Manager of Preventive Care and HEDIS®. In 2001, Kari began working for a Non-Profit Health Care Organization, where she oversaw health care access initiatives and community programs. By 2010, Kari returned to overseeing Quality programs within a health plan and managed HEDIS® for a large commercial carrier, before returning to Molina in 2013.
Kari earned her Bachelor of Science degree in Health Education and Nutrition from Idaho State University.
Jennifer Hawkins Director, Health Plan Quality Assurance
Jennifer Hawkins has lead the CareOregon Advantage Star Ratings Program since 2016, and, under her leadership the plan’s star rating has stabilized after a marked decrease in 2015. Jennifer has implemented a robust Stars governance structure and cultivated a culture of accountability, framed by continuous improvement processes, to streamline the work and achieve results. Jennifer currently serves as the Director, Clinical Integration, for CareOregon, a non-profit organization that provides health plan services to over 280,000 Oregonians covered by Medicaid and Medicare Advantage. She is responsible for directing the integration and execution of network and clinical strategy, including the Medicare stars program, for CareOregon’s Portland Metro region, which includes the majority of CareOregon’s members.
Jennifer joined CareOregon in 2014 and has twelve years of experience in quality, performance improvement, and behavioral health administration. With a bachelor’s degree in Accounting (Philadelphia University) and a Master in Social Work (San Diego State University), Jennifer has a unique combination of numbers savvy and relationship management that has allowed her to successfully build and cultivate cross-functional teams that are required for stars success across a large enterprise.
Cindy Aguglia is the Medicare Stars Administrator at Capital District Physician’s Health Plan (CDPHP) in Albany, NY. Cindy has worked in the health insurance space for over 30 years, holding various positions in sales, operations, Medicare compliance, and appeals.
As the Medicare Stars administrator, Cindy is responsible for the oversight of the 48 star measures and develops yearly campaigns to increase these ratings. To accomplish this, she facilitates and participates in many cross-functional teams throughout the organization.
David L. Larsen has been the Director of Quality Improvement for SelectHealth in Salt Lake City, Utah for the past 26 years and has worked for Intermountain Healthcare for 33 years. SelectHealth is a mixed model HMO with more than 750,000 commercial, 100,000 Medicaid, 38,000 Medicare advantage and 10,000 CHIP members in Utah and Idaho. Intermountain Healthcare is an integrated health care delivery system with 23 hospitals and over 1500 employed physicians.
As the Director of Quality Improvement, David has responsibilities for oversight of the Medicare Advantage Stars program for which SelectHealth received a 4.5 Star rating in 2015 and 3.5 rating in 2016; maintaining NCQA accreditation, SelectHealth is currently accredited with a Commendable rating; as well as, HEDIS performance measurement, public reporting (transparency) and disease management. David was a past co-chair of America’s Health Insurance Plans Subcommittee on Accreditation and Industry Standards.
David has also been responsible for the oversight and development of chronic disease registries, performance measurement and web based reporting systems, quality improvement pay for performance incentives for physicians, and direct patient improvement interventions related to chronic illnesses including patient adherence monitoring, reminders and incentive programs
As Project Professional for Chronic Condition Management, Melanie is responsible for developing SCAN Health Plan’s approach to addressing chronic conditions. In this capacity, she monitors and oversees the development and execution of activities to improve health and quality outcomes of plan members, and supports provider partners in implementation of relevant programs.
Melanie is an industry veteran with more than 25 years of experience in healthcare. She joined SCAN in 2004 and previously served as project manager within SCAN’s Geriatric Practice Innovation team, as well as in SCAN’s CMS Star Ratings program. In addition, Melanie was adjunct professor at California State University, Long beach in the Gerontology Department from 2011 – 2014. Prior to working at SCAN, Melanie held a broad range of management positions with SmileCare Family Dentistry, PacifiCare Health Systems and FHP Healthcare.
Melanie received her MBA from Pepperdine University and holds a Master of Science degree in Gerontology from California State University, Long Beach. She also holds a PMP certification from the Project Management Institute.
Executive Director, Enterprise Quality and Accreditation
Terri Kitchen Executive Director, Enterprise Quality and Accreditation
Blue Cross Blue Shield Illinois
Terri Kitchen is the Executive Director of Enterprise Quality & Accreditation for Health Care Service Corporation (BCBS of IL, TX, NM, OK, MT). In 2005, she obtained and MBA from University of Chicago. Following her education, Terri consulted with Deloitte for top tier health plans such as HCSC, Anthem and Humana. During her tenure as a consultant, Terri gained deep knowledge around health plan data analytics and operations. In 2013, she was offered a position at HCSC in Analytics and Information Management. Today Terri is responsible for the five-state’s clinical quality regulatory reporting, quality analytics and the development of HCSC’s provider facing performance measurement.
Cynthia Weiss Director of Quality, Accreditation and Wellness
AvMed Health Plans
Cynthia (Cindy) Weiss is a registered nurse with decades of experience in the healthcare field. As the Director of Quality, Accreditation and Wellness, Cindy has been able to leverage her knowledge and experience of both quality improvement and wellness and behavior change to create a successful member engagement program that drives quality improvement and preventive health. Prior to working at AvMed, Cindy held senior-level positions at Jackson Health Systems within their health plan and hospital system.
Christine Gage is an experienced senior marketing strategist with a demonstrated history of developing and managing loyalty and engagement solutions across several industries, including healthcare. In her role as Sr. Program Performance Strategist at NovuHealth, Christine helps evaluate and optimize the performance of client engagement programs to ensure they’re meeting key objectives.
Prior to NovuHealth, Christine held senior-level positions at AT&T, Carlson Marketing Worldwide and The Lacek Group, helping clients like Best Buy, Coca-Cola, Kodak, Petco, Staples and Time Warner design, launch and manage successful consumer loyalty and engagement initiatives.
Paul Cotton is the National Committee for Quality Assurance Director of Federal Affairs. He works with Congress, the Administration and other stakeholders to improve health care quality. Previously he was a lobbyist for AARP on Medicare, Medicaid, CHIP, health reform, health IT and quality improvement issues. He has also worked at the Center for Medicare & Medicaid Services as Hearings & Policy Presentation Director in the Office of Legislation, and as a journalist for publications including the Journal of the American Medical Association.
Fran Johnson is the Director, Quality Management at BlueCross BlueShield of North Carolina where she previously served as Director, Care Management. Fran’s current responsibilities include the Medicare Stars Program, NCQA Accreditation, Clinical Data Exchange, Commercial HEDIS, Provider Quality Contracting and other quality initiatives.
Prior to her tenure at BCBSNC, Fran held several executive and managerial roles in health care including Executive Director, Vice President and CEO. Embracing the core values of integrity, innovation and process improvement, Fran has built a reputation for developing skilled, nimble, goal-oriented teams. She has successfully led change in various capacities including entity reorganizations and strategic plan development and implementation.
Some of Fran’s accomplishments include the creation and establishment of primary care practices, the formation of a Hospice Foundation supporting end-of-life care, successfully leading a large healthcare provider through Chapter 11 protection including reorganization and restructuring and the development of quality improvement programs implemented state and nationwide, to name a few.
Fran holds a Masters of Business Administration degree with a concentration in health care management and is a Registered Nurse.
In her free time, Fran enjoys spending time with her family including 4 dogs and 3 parrots.
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 healthplans, 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 healthplans.
Clinical Pharmacist for the past eight years at Network Health, a local health insurance provider in Northeast and Southeast Wisconsin. I am currently one of three pharmacists involved making MTM calls in-house. My responsibilities also involve NCQA, pharmacy appeals, P&T Committee, Member and Provider relations.
Gary’s also has experience as pharmacy manager for a national long term care company, pharmacy manager for retail pharmacy chain, and Pharmacy Director for a National Health Care provider. He has also been a pharmacy instructor at local medical college family practice clinic.
Amy Salls serves as Director of Population Health Strategy for SS&C Health, where she is responsible for developing analytic approaches and distributing Web-based reporting software used by managed care organizations. Her responsibilities include the company’s revenue and quality analytics and decision support products -- DSTHS RiskAnalyzer™ and DSTHS CareAnalyzer® -- and The Johns Hopkins University ACG® System.
With more than 25 years of experience in data analysis and healthcare informatics, Ms. Salls has particular expertise in the application of predictive modeling tools for care management, underwriting, and Medicaid rate setting. During her career, she has gained extensive experience in customizing and evaluating predictive models to support specific populations and applications.
Before joining SS&C, Ms. Salls served as Director, Decision Support, for CSC, a global leader in next-generation IT services and solutions. She previously worked with APM/CSC Healthcare and MediQual.
Ms. Salls earned a BS in Mathematics from the University of Massachusetts, and an MBA from Assumption College.
Director of Continuous Improvement, Quality, and Compliance
Ahmed Ayad Director of Continuous Improvement, Quality, and Compliance
Blue Cross and Blue Shield of North Carolina
Ahmed Ayad is an accomplished speaker, consultant, professor, and Master Black with over 18 years of driving transformative change using the Lean Six Sigma methodology. Ahmed Ayad currently serves as the Director of Quality, Compliance, and Continuous Improvement at Blue Cross and Blue Shield of North Carolina. He has previously led quality and continuous improvement at Cancer Treatment Centers of America and the American Red Cross.
His qualifications include a Bachelor of Science from North Carolina State University and a Masters in Business Administration from Aspen University.
Ahmed is also a certified Master Black Belt from Arizona State University and holds an Executive Leadership certificate from Northwestern University. He is also a certified Project Manager (PMP) and has served as an Adjunct professor in Lean Six Sigma courses for 8 years with Drexel University and Wesleyan College.
Director of Quality Improvement and Risk Adjustment
Dominic Henriques Director of Quality Improvement and Risk Adjustment
Prominence Health Plan
Dominic currently serves as Director of Performance Improvement at Prominence Health Plan and has been with the plan since mid-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, two kids (3 and 1 yrs) and enjoys running competitively on the weekends.
Dr. Daniel Castillo is Chief Medical Officer for Matrix Medical Network, providing overall clinical leadership to the company’s growing suite of home and mobile based clinical services. Dr. Castillo is a respected healthcare expert and physician executive with more than 10 years of experience providing thought leadership, vision and strategy to drive transformational clinical solutions. Most recently, Dr. Castillo served as chief executive officer with WiserCare; a healthcare IT, analytics, and shared decision making company. Dr. Castillo is board certified in emergency medicine and continues to work clinical shifts in busy EDs. He has a Doctorate of Medicine from the Medical College of Wisconsin and an MBA from the University of Chicago Booth School of Business.
Jennifer Pereur is VP of Solutions at Apixio, where she leads the development of new provider-focused products. She brings brings 20 years of expertise in creating and managing government programs for risk-bearing provider groups, most recently at Hill Physicians Medical Group.
As VP of Clinical Solutions, Melanie Richey brings more than 20 years of deep HEDIS-specific experience, as well as an overall expertise in quality management strategies, regulatory compliance, operations and product development. Her experience includes commercial, Medicare and indigent programs, as well as care delivery re-design.
Prior to joining Centauri Health Solutions, Ms. Richey served as the senior director, Quality Solutions for Verisk Health, leading all aspects of quality management and improvement products for
commercial, Medicaid, Medicare and QHP clients. Prior to joining Verisk Health, Ms. Richey was responsible for launching and expanding a network model quality management program for Kaiser Permanente Colorado. During her tenure at Kaiser Permanente, Ms. Richey oversaw a broad range of network operations for the organization including risk adjustment, disease management, accreditation and regulatory compliance, wellness and pay for performance programs.
Ms. Richey holds a master’s degree in Business Administration from the University of Phoenix and a bachelor’s degree in Nursing from Wright State University.
Jose Diaz-Luna is the Vice President of Pharmacy at Trusted Health Plan in Washington, DC. He received his pharmacy degree from St. John’s University College of Pharmacy and Allied Health Professions. Jose is a proud veteran of the US Army Medical Corps. During his career Jose has worked in both clinical and managerial positions as Pharmacist in Charge, Pharmacy District Manager, and Director of Pharmacy, and Vice President of Pharmacy. Jose has practiced pharmacy in a varied setting including hospital, retail, long term care, compounding and managed care. Jose is Adjunct Faculty at Howard University College of Pharmacy. Jose was selected as the Howard University Administrative APPE Preceptor of the year in 2015 and received the Washington DC Pharmacy Association Excellence in Innovation award in October 2015. Jose is an active member of the Academy of Managed Care Pharmacy and the American Society of Consultant Pharmacies.
Director of Quality Programs and Medicare Strategy
Anne Davis Director of Quality Programs and Medicare Strategy
Anne Davis joined HMS in 2018 as the Director of Quality Programs & Medicare Strategy where she primarily focuses on the Total Population Management market. Anne was the Director of Health Management at Martin’s Point Healthcare, a Medicare Advantage five-star plan in Portland, Maine, where she directed the care management, utilization review, chronic & wellness programs for 70,000 health plan members. In addition to directing the care management activities, Anne directed a significant portion of MPHC’s NCQA accreditation and managed the population health team supporting the plan’s primary care practices. Anne has been working as a consultant since 2015, focused on HEDIS and Stars, quality programming, and reporting & evaluation.
Ms. Grossman is one of the nation’s foremost experts on Medicare Advantage, Medicaid, and Commercial physician engagement, risk adjustment, quality, HEDIS success strategies, and moving to value and risk reimbursement. She is a thought leader in healthcare business strategy and product development. Ms. Grossman has held executive positions that encompass her areas of expertise which include: Hierarchical Condition Category (HCC) and Medicaid risk adjustment, network alignment and management, executive client relationship management, predictive and reimbursement modeling, MLR strategies and implementation, business development, strategic planning, building Centers of Excellence, acute and chronic care pathway creation, and product development and marketing for healthcare companies.
Nadia Ince-Lovelace Director, Enterprise Quality – STARS Program
Nadia Ince-Lovelace, RN, BSN MBA has been with CareSource since April 2019 as the Director, Enterprise Quality Program-STARS. She resides in Cleveland, Ohio with her family. Nadia has seventeen years’ experience working as a clinician, administrator and executive leader to improve qualitative care delivered to members. Her current team drives quality metrics across multiple states – Ohio, Indian, Kentucky, Georgia and West Virginia; and product lines – Medicare Advantage, My Care and Marketplace.
Vicki Schwab Enterprise Quality Business Operations Manager
Vicki Schwab has been with CareSource since October of 2014 where she has utilized her skill set across the organization including her current position as the Enterprise Quality Business Operations Manager. She is the Business Owner of the CareSource/Matrix Medical Network relationship managing the In-Home Health Assessment/Quality Visit (HHA) program. The HHA program covers four products mixed throughout five states where Matrix performs in-home visits to complete Risk Adjustment Assessments and Quality Visits for Gap In Care closure for CareSource members. Vicki is a certified Project Management Professional (PMP) and Six Sigma Lean Expert. She earned her BS in Business Management from Urbana University.
Carmen has worked her entire professional life focusing on services and programs that increase the independence of people living in the community with disabilities. Early in her career Carmen managed the Adult Day Center at Care Wisconsin where she focused on having a program that provided quality day services with an emphasis on independence and dignity for all members. In following years Carmen worked to build a Medicare and Medicaid Grievances and Appeals program at Care Wisconsin. She is passionate about seeing that member rights are protected and that members have the best possible experience. In her current role as Member Rights Manager, Carmen oversees the Member Rights Department at Care Wisconsin. This includes Member Satisfaction Surveys, Member Experience, CAHPS/HOS surveys, and Grievances and Appeals. As a result of working with Care Wisconsin members for over 20 years, Carmen has developed a broad base of member experience expertise. Using this expertise, Care Wisconsin works to continually improve the health and satisfaction of members in Medicare programs.
• Health Data Decisions • Founder and CEO • 25 years in health data management • Prior work experience in multiple Blues, Harvard Pilgrim, Optum and independent consulting firms • Expert in HEDIS, STARS, Risk Adjustment, Predictive Analytics and Data Validation
Dr. Nilasena is the Chief Medical Officer for the U.S. Centers for Medicare & Medicaid Services’ Dallas Regional Office. He has been with the agency since 1995. He is the regional lead for the agency’s Value-Based Purchasing initiatives, including quality reporting and pay for performance programs in hospitals, ambulatory surgical centers and ambulatory care settings. He is also a lead contact for the HITECH EHR Incentive Programs and the Quality Payment Program (QPP) and is also part of the regional team implementing the Health Insurance Marketplace. Dr. Nilasena has been the CMS lead for national quality improvement efforts in acute myocardial infarction, heart failure and stroke. He has served as a clinical and technical consultant to Quality Improvement Organizations and End Stage Renal Disease Networks in CMS Region 6.
Dr. Nilasena received his medical degree from the University of Texas Health Sciences Center at San Antonio. Following an internship in internal medicine at the Oklahoma University Health Science Center, he completed a two-year research fellowship in immunology at the Oklahoma Medical Research Foundation. He completed residency training in general preventive medicine and public health and a fellowship in general internal medicine and medical informatics at the Veterans Affairs Medical Center in Salt Lake City, UT. Dr. Nilasena has masters of science degrees in both public health and medical informatics from the University of Utah. He is board certified in general preventive medicine/public health.
Senior Vice President of Strategy, Product & Marketing
Eugenia Ross Senior Vice President of Strategy, Product & Marketing
Eugenia ("Gennie") Ross serves as Senior Vice President of Strategy, Product & Marketing for Ciox Health. Gennie focuses on helping clients implement solutions to increase efficiencies and generate the best outcomes for their members and their business. She manages strategic initiatives and drives Ciox's market leadership in the use of advanced technologies for data aggregation, extraction and management. Prior to Ciox, Gennie was an Associate Partner at McKinsey & Company, where she led strategy for healthcare clients. Gennie holds an MBA from the Wharton School at the University of Pennsylvania and an MA in International Economic Policy from American University in Washington, DC.