Director of Population Health Services, Cental Ohio Primary Care
Khrista Achtermann is the Executive Director of Columbus - agilon and the Director of Population Health Services at Central Ohio Primary Care. She received her undergraduate degree from Marietta College in International Business Management & International Leadership Studies.. Khrista received a Masters in Health Administration from Ohio University. She spent 9 years at Nationwide Children's Hospital leading system improvement for Supply Chain then serving as Business Manager for their ACO at-risk for 330,000 children in 34 counties in Ohio. Since moving to Central Ohio Primary Care, Khrista has built out a robust PMO and formalized program management of population health services supporting the management of their 400,000 patients. Khrista continues to take inspiration for her work in at-risk organizations from seeing the impacts of healthcare transformation on patients, providers, staff and the broader community.
PaHua leads the Risk Adjustment Program Integrity team at Devoted Health. She previously helped lead the implementation of new risk payment models, provider data exchange, and provider success at Devoted Health. She completed her Master in Public Policy at the Harvard Kennedy School, where she concentrated in political and economic development. Her thesis with the World Health Organization focused on the use of quality metrics towards measuring Universal Health Coverage (UHC) in the context of population aging. Prior to Harvard Kennedy School, PaHua was the Director of Policy and Regulatory Affairs at Molina Healthcare, executing projects on Medicaid transformation and managing a team responsible for assessing the business impact of federal rules on Molina’s claims and revenue-generating lines of business.
Associate Director, Value Capture Strategy & Analytics
Rafi Cices Associate Director, Value Capture Strategy & Analytics
Rafi Cices is the Associate Director of Strategy and Analytics within the Value Capture team at Oscar Health. He manages a team that is responsible for the submission of encounter data to CMS, prospective gap reporting/closure and retrospective chart collection. Prior to joining Oscar Health, Rafi was a Manager for Medicare Operations and Development for Caremount Medical where he oversaw the organization's performance of Medicare value based contracts. He has an MBA from the Johnson Business School at Cornell University and an undergraduate degree in Finance from Rutgers University.
Wynda Clayton is a Risk Adjustment Manager at Providence Health Plans in Beaverton, OR. She received her Health Information Degree from College of Saint Mary’s, her BS in Health Care Management from Bellevue University and her MS from Clarkson College. Wynda has been in the health care field for over 25 years with experience on all phases from compliance to billing and reimbursement to coding to Quality Assurance to being a RADV Auditor to risk adjustment and providing physician education. Wynda is very enthusiastic and loves basketball, traveling and helping those unfortunate. To help is not always meaning to give, but it also means to teach others how to make a difference in their lives. Currently Wynda resides in Portland, OR with her husband Kevin. She can be contacted at Wynda.Clayton@providence.org.
Laura Cooley, PhD Senior Director of Education and Outreach
Academy of Communication in Healthcare
Laura Cooley, PhD, humanizes healthcare through her contributions to education and outreach for The Academy of Communication in Healthcare. She serves as Editor-in-Chief for The Journal of Patient Experience, an open-access, indexed, SAGE publication, dedicated to presenting advances and applications that impact the patient and provider experience. Additionally, she holds a faculty appointment at Vanderbilt University School of Medicine where she contributes to the Center for Effective Health Communication. In her primary role with ACH, Dr. Cooley leads strategic efforts to develop and deliver customized communication skills training programs designed to enhance patient experience in partnership with organizations such as: Stanford Healthcare, Yale New Haven Hospital, Northwell Health, Adventist Health, Texas Children's Hospital, Baylor Scott & White, & many more. As a leader for The Academy of Communication in Healthcare for the past 8 years and recent editor of a book on the topic (Communication Rx: Transforming Healthcare Through Relationship-Centered Communication) Dr. Cooley is uniquely positioned to discuss the impact of technology on communication and relationships among patients and providers.
Deb joined Paramount Healthcare in May 2013 and manages the Medicare, Medicaid, and Commercial Marketplace Risk Management Program. Additionally, she is a member of Paramount’s STARS/HEDIS/Medicaid Performance Improvement teams. Prior to her position with Paramount she had 21 years’ experience working with the State of Ohio workers’ compensation program, both for the government and a contracted managed care organizations. She came to Paramount with extensive knowledge in medical coding, provider billing and education, Medicare payment methodologies, quality assurance, and regulatory compliance. Deb attended The University of Toledo for both her undergraduate and graduate degrees and currently holds a Masters of Business Administration with major in Healthcare Systems Management. She is an active member of the American Health Information Management Association (AHIMA) and is a Registered Health Information Administrator (RHIA), Certified Coding Specialist, physician based (CCS-P), and an AHIMA-approved ICD10-CM Trainer. Deb is also an active member of the America Academy of Professional Coders (AAPC) and is a Certified Risk Adjustment Coder (CRC). Also, Deb is a member of RISE and holds certificates as a Risk Adjustment Practitioner (RAP) and Advanced HCC Auditor (AHCCA). Deb is blessed with one awesome husband of 29 years, three amazing children (one son-in-law), two adorable grandsons, and three beautiful granddaughters who all fill her life with a lot of joy, a little mischief, and a whole bunch of love. In her spare time, Deb volunteers at her church as a Team Captain in the Youth Ministry, is Board Member of the University of Toledo Health Information Administration Advisory Board, Health and Human Services Alumni Affiliate at The University of Toledo, and Health Information Technology Advisory Committee at Owens Community College.
Shannon Decker Vice President of Clinical Performance
Brown & Toland
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.
Eric oversees data analytics and reporting across all Advantmed solutions. He brings over 10 years of experience in healthcare that includes actuarial work, provider engagement, and risk adjustment leadership. Thru his extensive experience at both health plans and vendors, Eric understands the value of providing data that is actionable, nuanced, and trustworthy. He is focused on building these qualities into all solutions at Advantmed. His past experience includes roles at Priority Health and Cigna health plans as well as Pulse8 where he directed the provider-facing solutions and played key roles across all analytics.
Mark Ishimatsu Director of Enterprise Risk Adjustment
Director of Enterprise Risk Adjustment Strategies and Initiatives at L.A. Care Health Plan. Rebuilding and developing new programs to ensure L.A. Care’s risk adjustment strategic approach has the flexibility and operational capabilities to address the modern challenges facing the industry.
California farm boy with extensive healthcare industry experience applying behavioral economic perspectives to help address business objectives in health plans, hospitals, and medical groups. This includes building and improving business operations in risk adjustment, clinical operations, claims operations, large scale capital planning projects, product development, and marketing. Having worked both on the client and vendor sides of analytics services has led to development of a clear and broad vision to the challenges facing the industry, developing solutions, and communicating the best approaches to achieve business objectives.
Married to a wonderful wife who is a physician with whom rarely, if ever, discuss work. Two adult children whose resumes outshine both parents. Also, an unhealthy obsession with golf and fly fishing that only serve as major distractions to an otherwise unremarkably simple life of exploring the artistic offerings of innovative restaurants and chefs around the country.
Dr. Khan is a 20-year veteran of the software and healthcare industries. He is a serial entrepreneur who has been developing advanced technologies and cutting-edge software since the mid 90s. Over the years he has led teams that have developed technology and applications for Disease Surveillance, Artificial Intelligence, Quality Management, Analytics, Care Management and Cost and Utilization Management. He has had a particular interest in helping providers and patients transition from Fee-for-Service to Value Based Care. These efforts have won numerous awards over the years including best Decision Support System for ACOs (Blackbook) and Top 100 AI companies. Previously Dr. Khan founded and had successful exits from KeyCommerce (1997 – 2004), DiagnosisOne (2005 – 2012) and was CEO of Alere Analytics (2012 – 2015).
Kathy Lyall is the Vice President of Specialty Programs for U.S. Medical Management (USMM), headquartered in Troy, MI. USMM, through their affiliates Visiting Physicians (VPA) House Calls and VPA In- Home Assessments, Pinnacle Senior Care, Grace/Comfort Hospice and The Home DME, provides value based care for the sickest 5% of patients in their homes.
Kathy is responsible for the development and implementation of the Risk Adjustment In-Home Assessment (IHA) business, including oversight of credentialing, enrollment, claims payment, and coding quality assurance. She is involved in the strategic planning and execution of risk adjustment projects with multiple payers including individual market launches, vendor selections, network retention, implementation of new offerings, data integrity, and attaining goals. She is also responsible for vendor oversight management of multiple IHA Risk Adjustment vendors, providing services nationally and completing over 100,000 assessments annually. Additionally, she oversees approximately 200 Nurse Practitioners who conduct In-Home Assessments in 5 states. Notable accomplishments include: Creating and implementing an outbound and inbound call center to support Specialty Programs, managing the development of the Lab2U business which grew 100% under her leadership, and serving as an Executive Sponsor for a Value Stream Analysis (VSA) and subsequent process improvement events for Specialty Programs.
She served as the Associate Vice President - Health Plan Operations at Molina Healthcare where she was responsible for leading multidisciplinary teams of professionals to optimize the success of the organization’s strategic goals. She managed operations to support multiple product lines including Medicaid, Medicare Advantage, MI Health Link (dual Medicare / Medicaid), and ACA Marketplace. Notable accomplishments included: leading process improvements resulting in mass adjudication of claims rate increase to 86% through auto solutions, developing the Molina Michigan Vendor and FDR monitoring and oversight program for the thirty-two vendor contracts serving all product lines, and operational owner responsible for the implementation of Molina Dental Services for Molina Medicaid and Healthy Michigan Plan members ensuring that the operational infrastructure was in place to achieve health plan goals and compliance resulting in $5.2 million in savings.
Kathy has also served as the Director - Vendor Oversight Management and Operations for Fidelis SecureCare of Michigan, the Manager - Integrated Care for HAP Midwest Health Plan, and Project Manager and formerly Marketing/Intake Manager for Center for Senior Independence (CSI-PACE).
Kathy has a MSA, Health Services Administration from Central Michigan University and a Bachelor of Arts in Political Science/Business and Communications from the University of Michigan – Dearborn. She is currently serving on the Board of Directors for the Area Agency on Aging 1B in Michigan. She has over 25 years of operations, administrative, and negotiating experience across multiple organizations.
Donna Malone, CPC, CRC
, AAPC Approved Instructor, AHCCA, RAP Director Clinical Documentation and Quality Improvement (CDQI),
Donna Malone, CPC, CRC , AAPC Approved Instructor, AHCCA, RAP Director Clinical Documentation and Quality Improvement (CDQI),
Mount Sinai Hospital System
Donna has been on the job with the Tufts Health Plan in their senior products division since August 2014, and is responsible for audit and coding review management, development and implementation of department and vendor policies and procedures, simulation RADV Audits for preparedness, coding team performance management and provider education development and management. Additionally, Donna serves at the MassBay Community College in Framingham, where she has been an advisor / professor for nearly 10 years. Her specialty area is the Medical Coding Certificate and Medical Office Administration Program.
Prior to Tufts Health Plan, Donna worked for Blue Cross Blue Shield of Massachusetts as an HCC Professional Audit III for four years. Earlier, she worked for AM B Care for 9 years and Maine Medical Center.
J.D., Sr. Health Policy Consultant, Government Relations
Jennifer Monfils Director, Risk Adjustment Coding and Compliance
Jenni has over 18 years of healthcare experience. Her expertise spans many areas including professional medical coding, revenue cycle processes, documentation improvement, compliance and risk adjustment. Jenni is currently the Risk Adjustment Coding Manager for a nonprofit healthcare plan in Minnesota that provides Medicare Advantage, Medicaid and ACA Exchange products. Her primary responsibility is the compliance oversight of the plans risk adjustment activities and project lead for all risk adjustment audits.
Actuary for Sentara Health Plans. Joined Sentara/Optima Health in May 2019, focusing on Risk Adjustment. Prior to Optima Health, he worked for a consulting firm focusing primarily on evaluation of CMS’ CMMI payment delivery models and rate-setting for a state Medicaid managed care program.
Sony Naing MSN, FNP-C, RN, Family Nurse Practitioner,
Providence-Axminster Medical Group
Sony Naing, N.P., is a Board-Certified Nurse Practitioner specializing in Family Medicine and a member of the American Association of Nurse Practitioners.
“My philosophy of care is to provide compassionate, up-to-date, and honest care for all patients by integrating knowledge, holistic, and best practices. Everyone deserves a chance at a healthy lifestyle, and I strive to provide the utmost quality care while examining and treating the person as a whole. I enjoy working in medicine because it allows me the opportunity to treat and manage a patient’s illness while working with the individual or family to improve health outcomes.”
Outside of working with patients in the primary care setting, Naing is also heavily involved in Risk Adjustment in the Primary Care setting. At PMA, she has developed the Prospective Chart Review Process, EPIC’s HCC Best Practice Advisory Toolbar, logics for HCC data mining, provider education during the onboarding period for novice providers and monthly webinars for seasoned providers. She is heavily involved in creating improved and compliance workflows to ease the providers’ workload.
Naing is also involved in various committees within PMA, including the Adult Medicine Committee, APC Committee, PMA, LA Regional Risk Adjustment Committee, HCC Technology Committee, and the Onboarding Committee. She is also happy to share her knowledge with others.
Naing earned her nursing degree/credential at the University of California Los Angeles (UCLA/CSULA). You can find her providing outstanding care to her patients at PMI Wateridge Primary and Specialty Care.
Thomas Nasadoski Director, Risk Adjustment and Recovery
Tom Nasadoski is currently serving as the Director, Risk Adjustment and Recovery after being named Manager, Risk Adjustment in February, 2011. In this position, he oversees managing the Medicare Advantage, Commercial, and Medicaid risk adjustment initiatives and CMS reimbursement to the plan. Tom has built a Risk Adjustment unit at CDPHP consisting of over 30 internal staff with 7 specific job titles.
Carlos Rodriguez IMG, Senior Medical Risk Adjustment Analyst
Aegis Clinics MRA Manager
Carlos Rodriguez is a Medical Research Analyst who is employed by Aegis Medical Group. For the past two years, He has worked on ensuring patients are taken care of in their entirety. This includes but is not limited to reviewing medical records for accurate coding and documentation, developing training materials, and the education of providers and their support staff.
Carlos is passionate about healthcare because he has always loved medical research and finding better ways to treat patients and maintain them with health. He always tries to give his best with providing premium healthcare to every patient.
Carlos graduated from Universidad Americana, Nicaragua. It was here that he obtained his Doctor of Medicine. Soon there after, he completed his internship with the Hospital Jose Nieborosky, Boaco Nicaragua as Chief of Interns.
In his spare time, Carlos enjoys spending time with his family, following up with formula 1 races, and playing soccer. Although he was born in California, raised in Nicaragua, he currently calls central Florida home. He shares this home in the sunshine state with his loving wife, Paola, and new born son, Lucas.
Jennifer Ross, MHA Director of Revenue Cycle Management
Aegis Medical Group
As the Director of Revenue Cycle Management at Aegis Medical Group and Primary Care Alliance Jennifer leads multiple teams focused on pursuing risk adjustment revenue opportunities. She began her career with Premier Medical Associates and Paradigm ACO, gaining unparalleled experience in the compliance space, while also establishing herself as a respected manager of clinical operations. With her move to Aegis Medical Group in 2019, Jennifer began working closely with physicians and support staff on coding and documentation guidelines. She is well versed in cross- functional collaboration programs which enabled her to build a successful prospective and retrospective auditing team comprised of International Medical Graduates( IMGs). Jennifer then started a premium billing company, claims and ancillary service department. She has since developed a successful training presentation that was recently accepted by the University of Texas School of Medicine for CME credits. She has also developed an interactive learning session for providers to understand Medicare payment methodologies. Jennifer believes that it takes a village to raise RAF. She continues to educate on the importance of physician, support staff, health plan and patient collaboration. She is a highly analytical professional combining more than 15 years of experience in medical office operations and the Medicare Advantage workspace.
MSN with 10 years’ experience in Medicare, Medicaid, and Marketplace Managed Care with proven success in Risk Adjustment. Confirmed track record in operations, program management and process improvement. Demonstrates effective leadership, innovative problem solving techniques, and goal oriented focus to execute business objectives and meet performance expectations. Designed and coordinated all team activities including provider education, training, auditing, data mining, and data analysis to steer program success and achieve performance metrics.
Erik is responsible for the delivery of onshore and offshore coding services, record retrieval, IT infrastructure, and compliance. His knowledge in engineering, finance, and operations enables him to continuously improve performance and operational transparency for clients. He has over 10 years’ experience managing outsourced centers, and substantive backgrounds in investment banking and technology. Erik has a BS in Biomedical Engineering from Johns Hopkins University and an MBA from NYU Stern.
MPH, Chief Data Scientist and VP, Product Analytics,
Ashby Wolfe MD, MPP, MPH, Regional Chief Medical Officer
Centers for Medicare & Medicaid Services
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).