Blake Amos Customer Retention & Experience Director
Blake Amos is the Customer Retention & Experience Director at Cigna Medicare. In this role, he is the strategic lead for customer retention and the end-to-end customer experience, working across the organization to ensure a rich customer experience. Blake joined Cigna’s Managed Care Leadership Development Program nearly nine years ago, and has held positions of increasing responsibility, previously serving as the Director of Expansion and Business Readiness. In this role, he led the strategy and execution of Medicare Advantage new market and product expansions. Blake holds a bachelor’s degree in Business Administration from the University of Tennessee and an MBA from Belmont University.
Claudeen Barber, MSN, RN, CPHQ Director of Clinical Operations, Quality
Ascension Care Management
● Director of Clinical Operations, Quality, for Ascension Care Management (ACM), a population health and value-based service solution in Nashville, TN. ● Clinical and Operational Quality Professional with over 25 years health plan experience. ● Served five years as a Board Examiner for Tennessee Center for Performance Excellence (TNCPE) State Malcolm Baldrige Award and board certified as a ISO 9001 Internal Lead Auditor.
Karrie Baker is the Manager of HEDIS® on Premera’s Quality & Healthcare Performance team. She is responsible for the leadership of the HEDIS Program including ensuring an effective structure, accurate and timely HEDIS data submission, analysis and reporting; annual audit, and vendor oversight; Medical Record Review (MRR) to include retrieval, abstraction, and validation efforts, along with continuous quality improvements. She leads a team that includes analysts responsible for the following: Quality Measurement, Analytics, External Reporting and Submission, Quality Data Mining, Trending and Forecasting, Internal Reporting, and Quality Data Assurance and Optimization, for the lines of business offered by Premera. Karrie is also responsible for strategically approaching the intake of health information and collaborating closely with vendors and stakeholders to access this critical data most efficiently for a 360 view of our members health. Karrie has over 25 years of health plan experience and 9 years of direct HEDIS® experience.
Vice President of Quality and Clinical Integration
Elizabeth Benz Vice President of Quality and Clinical Integration
Elizabeth leads accreditation, appeals and grievances, condition management, credentialing, member wellness, provider informatics, quality health integration and CMS Stars areas for Network Health. Most recently she served as vice president government relations and product development, leading Network Health’s government relations activities, product design and supplemental benefit vendors. Prior to Network Health, Elizabeth served on the senior leadership team member at Molina Healthcare of Wisconsin and vice president of sales at Universal American.
Elizabeth received a bachelor of science in marketing and a bachelor of science in international relations from Syracuse University. She was named one of Milwaukee’s “40 under 40” in 2019 by the Milwaukee Business Journal. She currently serves as a board member for Luther Manor and Journey House, is a member of Impact 100 and serves on Tempo Milwaukee’s Professional Development Committee. Previous board and leadership roles include Wisconsin Women in Government and American Heart Association Go Red for Women Executive Leadership team.
Courtney Breece, is the Associate Vice President, product management for Inovalon. She serves as the product owner for the analytics capabilities of the Inovalon ONE® Platform, overseeing the overall product development and market launch of Inovalon's Converged Analytics solution that will add Risk Adjustment and Intervention Planning analytics to its industry-leading Quality Spectrum Insight™ (QSI-XL™) platform, the industry’s leading performance measurement reporting application. Prior to joining the Inovalon team in 2012, she acted as the assistant director of NCQA’s measure validation department and managed the Certified HEDIS® Compliance Audit (CHCA) Program.
In her roles at NCQA, she worked closely with auditors, health plans, and vendors to craft measure and audit policy. She served as NCQA’s contract director for CMS’ HEDIS® Medicare Reporting contract for the delivery of Medicare data used in CMS’ Five Star Health Plan Ratings program.
Jessica Columbus, LVN, CCS-P, CRC, CPHQ is currently the Associate Vice President of Stars and Risk Adjustment for Apex Health Solutions. Her expertise in physician performance engagement and value based care best practices are built on a foundation of more than 15 years experience in managed care focusing on end to end health plan operations related to Risk Adjustment and the CMS STAR Rating Program. She began her healthcare career in direct patient care as a Pediatric/NICU nurse and in 2005 took an opportunity at a managed care company in their Referral/Pre Cert Department where she was first exposed to quality and risk adjustment concepts. Once promoted into a leadership role that allowed her to own and create both risk adjustment and HEDIS programs from scratch she discovered those to be her true passion.
For 10 years her career has concentrated on innovative provider engagement strategies and implementing real world solutions that positively impact provider and contract performance. Her enterprise-wide physician education programs that aim to improve understanding of clinical documentation requirements have proven successful through accuracy of HCC recapture, increased year round closure of HEDIS gaps in care and strengthened positive health plan experiences among both providers and members. Prior to joining Apex in August of 2020, Jessica worked at Universal American/WellCare for 5 years as the Sr. Director of Quality Improvement directly overseeing all quality improvement programs, HEDIS/STARs operations and prospective risk adjustment activities for their Texas and Louisiana markets. During her tenure at WellCare she was able to consistently deliver solid Star Ratings for all contracts under her responsibility, including achieving a 4.5 STAR in 2019 for their flagship MAPD plan in Texas. Jessica’s continued career journey is centered on improving clinical outcomes for patients through advancing provider and payer partnerships that will revolutionize value
Micah Cost, PharmD, MS, is the CEO of the Pharmacy Quality Alliance (PQA). A seasoned health care association executive, Cost leads PQA’s work to improve medication safety, adherence and appropriate use. Previously, Cost was executive director of the Tennessee Pharmacists Association (TPA), representing pharmacists and pharmacy professionals across all practice settings in the state. Cost previously served in a variety of roles, including board president of the Alliance for Patient Medication Safety, chair of the American Pharmacists Association’s Policy Committee, a board member of the National Alliance of State Pharmacy Associations, and president of the Tennessee Society of Association Executives. Cost earned his doctor of pharmacy degree from the University of Tennessee Health Science Center College of Pharmacy and a master’s degree in pharmaceutical outcomes and health policy from the University of Florida.
For the past 30 years Mike has been working to improve the quality of care and patient experience in the US. He has held a variety of quality leadership roles with prominent payers such as Harvard Pilgrim, Aetna and UnitedHealth Group, played an important role in shaping measurement policy with NCQA, and most recently has been advancing the how health systems modernize data strategies and improve performance through technology with CitiusTech.
Dr. Jatin Dave, MD, MPH
Chief Medical Officer, MassHealth
Director, Office of Clinical Affairs, Commonwealth Medicine
Dr. Jatin Dave, MD, MPH Chief Medical Officer, MassHealth
Director, Office of Clinical Affairs, Commonwealth Medicine
In his dual medical leadership roles, Dr. Dave is the primary clinical liaison between MassHealth (Massachusetts Medicaid) and Commonwealth Medicine, emphasizing the close working relationship between the organizations. In addition to helping guide the leadership team in the Office of Clinical Affairs, Dr. Dave is a key part of the MassHealth executive team. As chief medical officer, he provides medical, clinical, policy, and strategic oversight of all health care services for MassHealth members and represents the program on clinical matters.
Dr. Dave joined Commonwealth Medicine and MassHealth from New England Quality Care Alliance, where he served as a chief medical officer, a member of the executive leadership team, quality committees, and the board of trustees. He is also a consultant for the palliative care team at Tufts Medical Center and is an assistant clinical professor of medicine with Tufts University School of Medicine. Prior to that, he served as medical director of geriatrics and Senior Care Options at Tufts Health Plan.
Previously, at Brigham and Women’s Hospital, Dr. Dave served as both a primary care physician and consultant geriatrician, as well as director of education. While there, he received the Geriatric Academic Career Award and the Clinical Innovation Award.
After his training in internal medicine at the University of Illinois College of Medicine, Dr. Dave completed a general internal medicine fellowship at New York University. Dr. Dave then completed a fellowship in geriatric medicine at Harvard University. He also received a master’s degree in public health from the Harvard School of Public Health and earned a bachelor's degree in medicine and in surgery at Gujarat University in Gujarat, India.
Anne Davis brings more than 20 years of healthcare experience to the Wellth team where she leads strategy across Government Markets. Her experience spans strategy development, managed care operations, population health, and quality improvement. For the last decade, Anne has been focused primarily on improving care & experience programs for managed Medicaid and Medicare Advantage beneficiaries. At Martin's Point Health Care, Anne led the Health Management team of nurses and social workers conducting utilization review and care management. Anne has worked with vendors such as Cotiviti, Eliza, Health Dialog as well as with health plans, health improvement organizations and nonprofits as a quality and evaluation consultant. At her core, Anne wants to support people in living well (safe, nourished, healthy).
Dr. Shannon Decker is the Vice President of Clinical Performance for Brown & Toland. Dr. Decker has more than 20 years of experience in healthcare--14 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.
His background is in management and operational processes for 15 years, and began working in the Risk Adjustment arena 12 years ago. Ryan has proven himself by helping Medical Groups raise their RAF scores to their proper levels. He directed the movement of a 10,000 member group up 43% over a two year period, and an 1800 member group up 53% in the first year. Ryan achieves these results through chart documentation audits, provider and staff documentation training, and provider relationship building. In his most current role Ryan works with multiple groups to optimize their RAF score, while at the same time achieving CMS 5 Star quality. Ryan explains to these groups that getting their RAF score to the correct level will not only drive revenue, but it will also lead to better patient care with improved documentation habits. Ryan is a Certified Risk Adjustment Coder (CRC) credential through the AAPC.
Thomas Dowdle Director of Quality Improvement & PHM Oversight
Thomas Dowdle is the Director of Quality Improvement and PHM Oversight at Cigna Medicare. In this role, he and his team lead the organizational strategy for HEDIS, Medical Record Review (MRR), Partnership for Quality (P4Q), Population Health Management, and Quality Improvement. Thomas joined Cigna through the Managed Care Leadership Development Program more than eleven years ago and has held various roles in Stars, Risk Adjustment, Quality, and HEDIS. He has been involved in HEDIS for Cigna since 2012 and has been a part of the Medicare and Medicaid HEDIS team in roles of advancing responsibility since 2016. Thomas holds a bachelor’s degree in Business Administration and Spanish as well as an MBA from the University of Alabama.
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.
Michel Faust is the Director for Performance Improvement with Presbyterian Health Plan of New Mexico. She has worked in the Managed Care space for the last 15 years in roles ranging from direct Care Management to Program Management across all lines of business government and commercial and has been working with Quality, HEDIS and MA Stars directly for the past four years with Presbyterian.
Jenna Fitcher is the Director of Quality Improvement at Vital Data Technology. With more than 10 years’ experience in healthcare, Fitcher is responsible for leading the development and deployment of best-in-class quality solutions to health plans nationwide to support their HEDIS, Star Ratings, and quality reporting initiatives. Previously, she's held HEDIS product management positions with Optum, Cotiviti, and Verisk Health.
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.
Phil brings more than two decades of healthcare leadership experience to his role as Chief Growth Officer, with expertise in developing and implementing shared-risk models. Before joining SameSky Health, Phil was the President and CEO of Leavitt Risk Partners. Prior to Leavitt Risk Partners, he held leadership roles at Rally Health, UnitedHealth Group, Optum, and Deloitte and Touche Consulting Group. Phil holds an MBA from Arizona State University and a bachelor’s in electrical engineering from Brigham Young University.
Josh Hetler is a customer-focused healthcare technology leader with ten years of experience in building software products to improve the workflows for healthcare professionals in value-based arrangements. During his tenure at DataLink, he onboarded two of the nation’s three largest Medicare Advantage health plans onto DataLink’s Evoke360 platform and increased user counts and managed users by over 100x. In addition to the exponential growth levels, he has worked with DataLink's Business Intelligence team and its contracted health plans to establish a platform ROI of 5:1 through clinical data connectivity, population health management, and risk analytics. While currently focused on Product Strategy and Business Intelligence, Josh has held various positions at DataLink across the product, growth, technology, and operations departments.
Kent Holdcroft is the Chief Growth Officer at Healthmine, bringing over 20 years of operational, consulting, and business development experience with healthcare technology providers to our team. Prior to Healthmine, Kent was CRO/Executive Vice President at AdhereHealth where he installed the teams and processes that led to record growth and innovation in product strategy. Before that, Kent had 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 received his Bachelor’s degree in Psychology from Miami University and Master’s in Counseling from the University of Toledo. In his free time, Kent serves on the Board of Directors at BrightStone, Inc., and resides outside of Nashville, TN with his two sons.
Katharine is the President of Healthy People, an NCQA-licensed HEDIS audit firm and CMS Data Validation firm. She is a member of NCQA’s Audit Methodology Panel and NCQA’s HEDIS Data Collection Advisory Panel. Katharine has been a Certified HEDIS® Compliance Auditor since 1998 and has directed more than two thousand HEDIS audits.
Previously, as CEO of the company Acumetrics, Katharine provided consultancy services to NCQA which helped their initial development and eventual launch of the NCQA Measure Certification Program.
Katharine is a frequent speaker at HEDIS conferences, including NCQA’s most recent Healthcare Quality Congress. She is featured on an NCQA podcast, discussing the HEDIS Electronic Clinical Data System Measures: https://blog.ncqa.org/inside-h...
She received her BA from Columbia University and her MPH from UC Berkeley School of Public Health. She is a member of the National Association for Healthcare Quality and is published in the fields of healthcare and public health.
Jenice James serves as a Senior Manager of Product Management for Inovalon’s Quality Spectrum suite of applications. Her primary duties include overall responsibility for the company’s QSI-XL HEDIS Quality Measurement application; including understanding customer and market needs through competitive research and analysis, deliverable tracking, and product release management, and marketing. Throughout her almost 11 year tenure at Inovalon, Jenice has also worked on a variety of Quality Measurement, Quality Improvement, and Risk Score Accuracy solutions including serving as product manager for the company’s HEDIS MRR activities, Natural Language Processing (NLPaaS) solution and integrating Risk Score gap generation within QSI-XL.
Prior to joining Inovalon, Jenice served in a variety of health care product management and research roles. Mrs. James earned a BA in Biology from the University of Virginia, a MS in Healthcare Administration from the University of Maryland University College, and a DrPh degree from Morgan State University.
Rachael Jones Senior Vice President, Performance Analytics & Quality
Rachael Jones is the Senior Vice President, Performance Analytics & Quality at Cotiviti, a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to deliver deep insight into the performance of the healthcare system. These insights uncover new opportunities for healthcare organizations to collaborate to improve their financial performance, reduce inefficiency, and improve healthcare quality. In her role, she has accountability for business unit strategy, product vision, team, and market impact for one of the company’s high-growth verticals, Performance Analytics &Quality, which allows health plans to move from simply reporting quality measures to driving the purchase, delivery, and utilization of higher value healthcare.
Prior to her current role, she was Vice President, Growth & Account Management for Anthem’s Diversified Business Group (DBG) division which is focused on delivering whole person care to radically transform the healthcare industry. She led a team that leveraged the commercial experience of Anthem, the nation’s largest Blue health plan, bringing strategic solutions to health plans across the country. Focusing on a range of health plan needs, these solutions offer critical insights on how to personalize and integrate care for those with complex and chronic conditions.
Backed by nearly two decades of health care and technology experience, Rachael is well recognized for her expertise in solution sales, delivery and product management, and as an innovator in cost-of-care and provider reimbursement strategies. Prior to her current role, she had financial oversight of payment innovation programs, as well as analytics product development that drove the shift from volume to value-based payment models.
Within the healthcare industry, Rachael has also held leadership roles at Healthfirst,LLC, where she served as Assistant Vice President of Financial Analysis, overseeing regulatory reporting, shared risk/ACO performance analysis and as a leader of the organization’s Data Governance/MDM programs. In addition, she was Director of Product Management for the TriZetto Group, where she helmed a $200 million expansion and new product and service launch for value-based care analytics.
Rachael earned her Bachelor of Science from Montclair State University and a Master of Public Administration from New York University. She is a member of PHAM, the Professional Academy for Healthcare Management.
Anna is the Executive Director for the Midlands region of inVio Health Network, a Clinically Integrated Network affiliated with Prisma Health, South Carolina’s largest non-profit healthcare system.
Anna has been with Prisma Health for 22 years and has served in several management roles during that time, including serving as the Director and then Vice President for the Prisma Health employed medical group in the Midlands prior to moving to her current role 10 years ago to develop and implement the Clinically Integrated Network in the Midlands.
Anna holds a Bachelor of Arts degree from Duke University and then her Masters in Health Administration from the University of South Carolina School of Public Health.
As Chief Experience Officer at FarmboxRx, Jenn Kerfoot is the head of Client and Member Experience Operations. In this role, Jenn leads the strategic planning, design, and implementation of initiatives that drive Member Satisfaction & Retention. Additionally, Jenn spearheads the Member Insights function using qualitative and advanced analytic approaches to understand the gaps in care and unmet needs of populations. Jenn has helped companies articulate and achieve success across several aspects of the healthcare space. As a military veteran, Jenn brings leadership and vision to diverse audiences, and offers a unique perspective within start-ups and high-growth stage companies. With a passion for organizational mission and values, as well as the unique competitive advantage of establishing a strong culture, Jenn works with all departments to streamline processes and programs that integrate the member experience into every aspect of the business.
Toni joined Medallia as Head of Clinical Healthcare Experience in August 2020.
Before joining Medallia, Toni spent over 30 years in healthcare. This time allowed her to serve and impact in many areas of patient, family and employee experiences. These areas include: bedside nursing, educator, manager, home care, medical practice, performance improvement at Novant Health, establishing a system patient experience program at Prisma Health and more recently Chief Patient Experience & Quality Officer at Medical Center Health System. These experiences helped her to have direct engagement with the many complex areas of healthcare and evaluate how to implement and sustain change.
Toni has her Bachelor’s in Nursing, Master’s in Business Administration and Patient Experience Certification through the Beryl Institute. She is a wife and mother to four adult children, two beautiful grandchildren and a cute little havapoo. She enjoys reading, crochet and cross stitch.
David serves as Senior Advisor, Payer Solutions at Press Ganey and has more than 30 years’ experience leading quality improvement at SelectHealth, the Utah-based health plan owned by Intermountain Healthcare. In his role, David focuses on payer thought leadership, advising clients on best practices and leading Press Ganey’s payer client council.
Under David’s leadership, SelectHealth earned a 5 Star rating and received 5 stars for all of the CAHPS measures for Stars 2022. With many years working at a “payvider” organization, David brings experienced perspective and possesses great appreciation for the necessary collaboration between payer and provider in terms of quality and patient experience.
Sean has worked at the intersection of managed care and government benefit programs for the past 19 years. He is responsible for BeneLynk’s product development, new business acquisition, and strategic growth initiatives. Prior to BeneLynk, Sean served as the President of Freedom Disability and Alpha Disability, one of the nation’s largest Social Security Disability and Veterans Advocacy companies. Before that, Sean served as Vice President, Sales for SSC Disability, providing government program benefit services for Managed Care Organizations.
He is recognized by the Social Security Administration as a non-attorney representative (EDPNA) and has personally represented claimants in hearings for Social Security Disability Insurance and Supplemental Security Income throughout the country.
Sean is an expert on a wide variety of government benefit programs and has been quoted in Bloomberg, Business Week, and other national publications. He regularly publishes articles on managed care and government benefits for BeneLynk’s blog.
Sean is a graduate of Middlebury College and has a master’s degree from Yale University.
Robert LoNigro, MD, MS
President, HealthCare Partners, MSO
EVP Health Care Operations, HealthCare Partners, IPA
Robert LoNigro, MD, MS President, HealthCare Partners, MSO
EVP Health Care Operations, HealthCare Partners, IPA
Bob currently serves as President and Chief Physician Executive for NYC based Health Care Partners, IPA and MSO covering the 5 boroughs of NYC and all of Long Island. He oversees the operation of over 1000 PCPs and 220,000 members through Value Based Full and Shared Risk contracts across all product lines. In 2020 he and HCP were recognized by NY Newsday as Leader of the Year and Best Place to Work among Long Island midsized companies.
His previous experience is across payer and provider organizations, having spent seven years with Centene Corporation as local CEO, regional CMO and national SVP. Prior to Centene he served for eight years as Medical Director at Tufts Health Plan in Boston, helping the organization achieve and maintain its status among the top three NCQA accredited health plans in the country.
As a provider, Dr. LoNigro 33 years of practice experience as a Board Certified Internal Medicine physician in both the Los Angeles and Boston managed care markets. In 1996 he co-founded the Primary Care, LLC PCP network in Boston which survives today as NEQCA, the New England Quality Care Alliance.
For 25 years he has remained in practice as an Internal Medicine consultant at McLean Hospital, Harvard’s Psychiatric teaching hospital. He attended Rutgers Medical School, completed a Medicine Residency through UCLA, and he holds a Master’s Degree in Engineering from Va Tech.
Emily McGrath Associate Director, Population Health
Emily McGrath has 14 years of experience in healthcare and serves as the Associate Director of Population Health Strategy at Humana. In her role, she leads innovation and product development strategy for social determinants of health, as a part of Humana’s Bold Goal/Office of Population Health. Emily has broad experience in integrating social determinants of health into benefits and healthcare delivery.
McGrath received a bachelor’s degree in Financial Economics from Centre College and a master’s in business administration from Bellarmine University.
Marlene McIntyre is the Vice President, Quality Solutions at Change Healthcare. Marlene’s nearly 30-year healthcare career started in clinical nursing, and after transitioning into administration, she became an deep SME leading strategic quality, risk, and population health programs in multiple sectors, including within the payer, large provider group, and integrated delivery network arenas. In her current role she is responsible for strategic initiatives in CHC’s retrieval and quality product verticals. Marlene joined Change Healthcare more than six years ago and has leveraged her extensive clinical and quality background in supporting Change Healthcare clients in HEDIS and risk adjustment services. Aside from work, Marlene enjoys travel and serves as Executive Director for a charitable foundation focused on serving under-served and at-risk communities here and abroad.
Ashley McNairy is a product director supporting Cotiviti's Quality Improvement solution suite. With more than 10 years’ experience in healthcare, her primary responsibility is the successful delivery of our quality solutions to ensure they meet clients’ needs in support of HEDIS, Star Ratings, and other quality reporting initiatives. She also works to deliver high value for our clinical data acquisition and retrieval services to ensure high retrieval rates, low turnaround times, and consistency in our retrieval workflows to decrease provider abrasion and improve customer experience in our projects enterprise wide.
David Meyer is a nationally recognized thought leader and change agent, with over 20 years of experience in healthcare commercial and government programs operations, data science, clinical outcomes, revenue and quality. He currently serves as the Senior Vice President of Health Outcomes and Informatics at NationsBenefits, where he is building-out the Research and Data Services unit of the company. In pervious roles, he has run revenue, quality and healthcare informatics for both regional and national health plans, spanning both Medicare Advantage and Commercial products. He has been a RISE Advisory Executive Board Member 12+ years, and is a frequently invited speaker at conferences and summits.
Vice President of Public Policy and External Relations
Frank Micciche Vice President of Public Policy and External Relations
Frank Micciche is NCQA’s vice president of Public Policy and External Relations. In this position, he directs NCQA’s relations with Congress, federal agencies and the states, as well as NCQA’s work with employers, associations, corporate sponsors and the media.Micciche was formerly the Vice President for Partnerships and Coalitions at the Campaign to Fix the Debt, a nonpartisan collaboration of prominent public and private sector leaders and more than 350,000 grassroots supporters working to address the nation’s fiscal imbalance. Prior to this position, he was a Senior Advisor on health reform at McKenna, Long & Aldridge, LLP and worked for the New America Foundation think tank.Micciche’s service in the public sector includes his time as a legislative director for the House Minority Leader in Massachusetts and as a federal liaison for Governor John Engler of Michigan. He served for four years as the Director of State-Federal Relations for Governor Mitt Romney (R-MA), where he led the Commonwealth’s Washington, DC, office and advised the governor on federal policy issues, with a focus on health care reform.Micciche holds a master’s degree in public policy from the John F. Kennedy School of Government at Harvard University, and a bachelor’s degree in political science from Tufts University.
Lyle Mioduszewski, RN Vice President, Population Health
Lyle Mioduszewski is Vice President of Population Health for Ciox Health, where he works with risk-bearing entities to understand the utility of social determinants of health factors, with the goal of improved and equitable outcomes for all individuals. With twenty years of experience throughout the health care continuum, Lyle has clinical expertise in emergency and trauma nursing of adults and pediatric populations, as well as cardiac catheterization and electrophysiology nursing. Lyle has been a leader in the health information technology and medical device industries with previous companies, including McKesson Corporation, PointClickCare (Collective Medical), and Zoll Medical. He is passionate about advancing value based care modalities, augmenting process relative to varying health literacies, care collaboration, interoperability, and influencing an end to the opioid epidemic through the use of innovative technologies.
As Senior Manager for Engagys, Shannon O’Connell leads projects that drive behavior change for health plans. She is especially focused on the Medicare population and populations that experience the barriers of social determinants of health. She has over a decade of experience in healthcare with a passion and focus on improving member and provider engagement with a C360 communications approach. Her expertise includes leading teams through producing and improving communications mapping, inventory, and taxonomy development, print to digital strategy, communications governance models, and campaign optimization.
At her previous role with Blue Cross Blue Shield of Massachusetts, Shannon managed communications strategy for the Member and Provider Communications unit. Her communications designs spanned 25 business units across the organization and impacted millions of members and tens of thousands of providers. From problem solving to end goals, Shannon draws on creativity and storytelling best practices she learned during her early career experience in television and documentary film production.
Noris has a Master's degree from the University of Miami and has spent her professional life in the healthcare industry, including academia, hospital and private sector settings. During her career in academia, Noris was intimately involved in research management as well as the management of graduate medical education.
Noris entered the arena of quality and value based care seven years ago, as a seasoned healthcare administrator. In this new role, Noris has been transforming the way medical practices understand quality and value based care with emphasis on moving from episodic care to life-based care. Noris strongly believes that empowering and educating patients and their caregivers is the key to quality care and healthier beneficiaries. When beneficiaries are educated about their health and made part of their care, they are empowered to make the right decision for themselves.
Noris is a firm believer that when an environment that promotes a culture of education, compliance, mutual respect is created, this becomes the driving force behind quality care, quality of life, stability or improvement of chronic conditions, and ultimately a reduction in healthcare costs.
Dr. Bahar Sedarati is a physician executive with diverse experience across the continuum of care, including private medical practice, medical group management, integrated delivery system, and the payers.
She is a national expert and a physician trainer in both inpatient and outpatient clinical documentation (CDI), Medicare risk adjustment (MRA) coding as well as utilization management (UM) with an MCG Utilization and Case Management Certification. Her niche is in training clinicians on harvesting data to achieve precision in chronic disease management, cost savings, excellence in quality measures and pay per performance.
Dr. Sedarati provides guidance on administrative and clinical excellence, work-flow efficacy and electronic health records proficiency. She has created intelligent and innovative tools assisting clinicians to succeed in the value-based care as well as the on-demand care spaces.
Dr. Sedarati has over two-decade of experience in education, and academic medicine. She is the author of multiple nationally and internationally recognized medical review books and is a faculty at university of California, Irvine, UCI.
Dr. Sedarati is Board Certified in Internal Medicine (ABIM), and the Fellow of Collage of Urgent Care Medicine. She is a Certified Physician Executive and holds Six Sigma black belt and green belt certificates.
She is currently the lead medical director of clinical performance & operation for the Desert Pacific Region in Humana. She oversees the market acute and post-acute authorizations requests, conducts peer quality audits and education for the market medical directors on coding, clinical documentation, benchmarking and quality measures such as inpatient admissions and hospital length of stay.
Kacey Serrano Director for Medicare Stars and Risk Adjustment
Arkansas Blue Cross Blue Shield
Kacey Serrano serves as the Director for Medicare Stars and Risk Adjustment for Arkansas Blue Cross Blue Shield. She is accountable for the management and execution of risk adjustment and quality strategies and improvement for ABCBS Medicare Advantage plans. Prior to joining ABCBS, Kacey has worked for other large national plans in Medicare Advantage Stars and Risk market strategy, provider engagement, and implementation of value-based arrangements. She is well-versed in risk adjustment and stars improvement execution and market plan development for both rural and large urban markets.
Kacey has Bachelor of Arts degrees in Biology and Psychology and a Master of Public Administration degree from the University of Arkansas. She also has her Certified Professional Coder and Certified Risk Coder designations from AAPC.
VP Government Programs Practice (Stars & Compliance)
Cherie Shortridge VP Government Programs Practice (Stars & Compliance)
Cherié Shortridge is the Vice President, Government Programs at FluidEdge Consulting with 15 years of health care industry experience. She is an experienced health plan executive, leading Medicare Advantage operations. Her deep expertise lies in Enrollment, Reconciliation, Premium Billing, Appeals & Grievances, Compliance, Audit, Stars, Health Plan Operations, and Process Improvement. She has a track record of proven success, leading organizations through strategic transitions such as Acquisition, Sanction Remediation, and System Implementations
Vice President, Medicare Advantage Stars and Risk Programs
Jason Sloan Vice President, Medicare Advantage Stars and Risk Programs
BlueCross and BlueShield of South Carolina
At BlueCross BlueShield of South Carolina Jason leads the strategic vision and implementation for Medicare Advantage quality improvement activities, risk adjustment procedures and value-based provider partnerships. Under Jason’s leadership the MA program has markedly increased quality outcomes by helping beneficiaries navigate the healthcare system and by establishing strong partnerships with local healthcare providers.
Jason has spent his career managing local and national Medicare Advantage quality programs along with experience in medical research and physical therapy health programs. He earned an MBA from the University of Notre Dame and a Masters in Biomedical Science from Midwestern University in Chicago. To stay well rounded Jason enjoys fishing with his kids and playing golf as often as possible.
I started my career in healthcare in 2007, working in the mental health field, cardiothoracic intensive care then in the emergency department of a level 1 trauma center. In 2017 I left bedside nursing to work for Martins Point Health Care as a CDI nurse/HEDIS reviewer, then as the HEDIS Administrator in 2018. I live in Gorham Maine with my husband, two children, and dogs that keep me busy.
Melissa Smith EVP Consulting and Professional Services
Melissa Smith is the Executive Vice President of Consulting and Professional Services at Healthmine and brings over 25 years of experience in Star Ratings, strategy, sales, and marketing for health plans, providers, pharmacy benefit managers, and industry vendors. She is a well-known thought leader and healthcare strategist with proven success developing enterprise-wide solutions to improve Star Ratings, quality performance, health outcomes, and the member experience.
Melissa has helped dozens of clients in a consulting capacity improve performance within HEDIS®, Star Ratings and other quality programs and helps clients evaluate market dynamics and opportunities, optimize distribution channels, and support our clients’ strategic planning needs.
Prior to entering the consulting industry, Melissa served in a leadership capacity at Cigna-HealthSpring where she led Star Ratings efforts for approximately 25 Medicare Advantage contracts.
Amber Smits Quality Revenue and Health Equity Program Manager
Amber Smits provides cross functional leadership in efforts relating to Network Health’s quality excellence and health equity strategy. She works with the clinical integration team and operations to ensure members are receiving the right care at the right place and the right time.
Amber joined Network Health three years ago, and previously served as a continuous improvement specialist. In this role, she led the strategy and execution of numerous large efforts impacting member experience.
Carissa brings over 15 years of healthcare experience on both the delivery and payer sides. She has proven outcomes streamlining and simplifying processes to improve the customer experience and reduce costs. A social worker by background, Carissa is a passionate clinician who understands the need for technology and innovation to scale the important work of improving the health and wellness of the community at large, one individual at a time.
Jeremy Stone Senior VP, Population Health Solutions
Jeremy Stone is an accomplished Business Development and Operations Executivewith a proven track record providing the vision, strategy, and leadership required to strengthen and grow client relationships in the highly competitive health care space. With extensive experience in human resources and business development roles, Jeremy excels as a facilitator of change initiatives to drive operational and organizational improvements and achieve and maintain industry leader status.
Currently, Jeremy is Senior Vice President at Everly Health, where he leads population health solutions, business development, and strategic client management. Prior to Everly Health, Jeremy served as Vice President, Payer Relations & Government Affairs at National Seating & Mobility, where he was responsible for the company’s network relationships with more than 1,000 health plans across the U.S. Jeremy has also held leadership roles with several successful health care organizations, including Aspire Health, Matrix Medical Network, and Healthways.
Jeremy earned a Master of Science Degree in Organization Development from Johns Hopkins University and a Bachelor of Business Administration Degree from Belmont University. He lives in Nashville, TN, and is married with twin 15-year-old daughters. He is a passionate soccer fan and loves cooking and traveling.
Jill Strassler, VP Solutions Management, Pulse8, is a dynamic healthcare executive focused on innovating the analytics and reporting solutions for Health Plans for Risk Adjustment, Quality and Value Based Care models. Jill brings expertise in developing novel solutions to address emerging and transformative change in the healthcare industry. Jill excels at delivering value across the ecosystem by increasing transparency and building connectivity among all stakeholders. Over her notable 20-year career, Jill has developed holistic member engagement and quality strategies for health plans. Prior to her focus in risk adjustment, she led solutions for molecular diagnostic utilization management and reimbursement. Jill received her BA in Psychology from The University of Chicago and received her MBA and MS in Management Information Systems from Boston University.
Michelle Thomsen VP Pop. Health Mgmt. & Plan Operations
30+ Years of Healthcare Industry Experience. Experienced health plan executive leading clinical program operations (CM, UM, DM, and Quality). Highly skilled in NCQA and URAC accreditation. Extensive knowledge in medical management program analysis, development and transformation.
Hyperlift was founded in 2017 with the expressed goal of changing how plans looked at Stars optimization and creating a repeatable model that could be ubiquitous across the industry. Through an action-oriented Stars Performance Scorecard, leading Stars experts, and a year-round technology-enabled approach, Hyperlift helps plans of all sizes and performance levels supercharge their Stars performance management.
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.
Dr. Ashby Wolfe is a board-certified family physician and serves as co-Chief Medical Officer for the Centers for Medicare & Medicaid Services (CMS) offices in Denver, San Francisco and Seattle. Dr. Wolfe has been based at CMS San Francisco since 2015, and now also supports the Denver and Seattle regional locations in her focus on the implementation of Medicare and Medicaid policy across the Western States and the Pacific Territories (AK, ID, OR, WA, AZ, CA, HI, NV, CO, MT, ND, SD, UT, WY, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands). As a senior medical advisor for CMS programs in the Western United States, she provides clinical expertise to the divisions of Medicare and Medicaid payment policy, quality improvement, survey operations, contracted health plans and serves as the principle liaison with the clinical community.
Dr. Wolfe completed her medical degree at Stony Brook School of Medicine in New York, and her residency training at the UC Davis Medical Center in Sacramento, California. She also holds a Masters of Public Policy and a Masters of Public Health from the University of California, Berkeley. Dr. Wolfe has practiced broad-scope family medicine in academic, integrated and community clinical settings over the course of her career and holds medical licenses in both the State of California and the State of Washington. She holds a particular interest in improving the quality and equity of care for underserved and low-income populations. She has published multiple articles on Medicare and Medicaid policy, and is a contributing author of the public health text, Prevention is Primary (Jossey-Bass).
Brent Zenobia is Chief Strategist for Novillus, a Portland-based startup focusing on innovative Risk Adjustment and Stars solutions for healthcare organizations. He has been part of the HL7/FHIR Da Vinci Project since 2018 and serves as a SME for several Da Vinci implementation guides as well as a lead SME for Risk Adjustment. The Da Vinci Project has named Brent as a Community Champion for 2021. Brent holds a Ph.D. in Systems Science/Engineering Management and MS in Software Engineering with over 37 years of experience in Medicare and ACA risk adjustment, Medicare Stars, quality metrics, value-based payment arrangements, and software engineering. Prior to Novillus he served as the Medicare and ACA business architect for Cambia Health Solutions, global software process improvement specialist for Sharp Labs and Intel, and taught numerous graduate courses in technology management and software engineering for OHSU and Portland State University.
His peer-reviewed paper “If You Build It, Will They Come? An Adoption Analysis of the HL7/FHIR/Da Vinci Healthcare Interoperability Stack” is in press and will be presented at the PICMET ‘22 conference in August.
Holly Zorz Team Lead Medicare, Quality improvement
Paramount Health Care
Holly Zorz is the Quality Improvement Team Lead, Medicare at Paramount Health Care. Paramount is a subsidiary of ProMedica Health System, an integrated health delivery system located primarily in Northern Ohio and SE Michigan.
Holly’s true passion and primary area of focus is the Medicare Advantage Stars program for which Paramount Elite has received a 4+ Star Rating for the past 8 years. She has been responsible for identification, development, and implementation of strategic programs focusing on Star Ratings since the program’s inception.
Holly enjoys working collaboratively with internal teams and external vendors to ensure the success of Paramount’s Stars program. She is the in-house expert on the Star program for all internal and external stakeholders. She provides education, understanding, and subject matter expertise regarding the measures throughout the organization.