What helps investment managers market their funds? Aaron is a Senior Consulting Actuary at Wakely. He began working as a health actuary in 2001 and joined the firm in 2017. Since 2012 Aaron has been working with many types and configurations of provider organizations. He has focused specifically on the CMS sponsored value based programs during most of that time. He has worked with provider organizations to help them quantify their risk, model their future financial outcomes, identify clinical intervention opportunities, and manage all aspects of their value based contracts to help achieve clinical, quality, and financial goals.
Prior to his work with risk-bearing provider organizations he has worked with employers on contribution setting and plan design for current and retiree medical benefit plans, priced individual major medical insurance for a multi-state insurer, and valued hospital and physician PPO contracts.
Aaron is an Associate of the Society of Actuaries and a member of the American Academy of Actuaries. He graduated from Brigham Young University with a Bachelor of Science in Statistics.
Lili Brillstein is a nationally recognized thought leader in the advancement of Episodes of Care as a value-based approach for specialty care. She is the Director of Specialty Care Value Based Models for Horizon Blue Cross Blue Shield of New Jersey, and, under her leadership, has built the largest program for commercially insured patients in the country.
Lili is responsible for the overall direction, strategy, design and oversight of the Horizon Episodes of Care/Bundled Payment Program. When Lili joined Horizon in January of 2013, the Episodes program was still in pilot and included only total hip and total knee replacement episodes. The program has grown to include additional orthopaedic episodes (including low back/laminectomy, shoulder replacement, knee arthroscopy), obstetrics and gynecology, GI (including an IBD episode with a fully integrated behavioral health component), cardiology, oncology, and substance use disorder.
Lili is a passionate advocate of Episodes of Care/Bundled Payments as a strategy to successfully migrate from fee for service to quality- & value-based models that rewards providers for excellent outcomes and patient experience, while reducing the overall cost of healthcare.
Lili is a guest lecturer on episodes of care/bundled payments at the Harvard Business School working under Michael Porter, and has co-authored several peer-reviewed articles on the subject of Episodes. In addition, Lili has served as an Advisor to CMS on bundled payments, and is on the Advisory Boards of the US Women’s Health Alliance and the Quality Cancer Care Alliance; both national coalitions focused on advancing value based care to improve quality and cost of care delivery.
Lili’s expertise at cultivating functionally collaborative relationships between payers and providers across the full continuum of health care has allowed not only the pillars of the triple aim to be achieved, but the spirit of the relationships to shift from one of adversaries to one of collaborators.
Karla Richardson is the Director of Value Based Care at University of Toledo Physicians, LLC (UTP), a 300+ multi-specialty group affiliated with the University of Toledo, College of Medicine. She also services as the chair of the quality sub-committee for Ohio’s Care Innovation and Community Improvement Program. She transitioned to her current role at UTP after serving as the Director of Analytics and Information Systems at the same organization for more than half a decade. In her role overseeing Value Based programs within the health system, Karla guides the practice through the development and implementation of numerous initiatives, such as ambulatory care management and quality metric reporting and process improvement. Her work has helped UTP achieve successful outcomes for MIPS, Meaningful Use, CPC+, and others, resulting in millions in quality-related revenue for the Practice. Before joining University of Toledo Physicians in 2011, Karla gained valuable experience working as a consultant for McKesson Provider Technologies. While there, she oversaw software implementation for hospitals around the country, and helped redesign McKesson’s Encounter Reporting Course. Her data analysis knowledge and experience date back even farther, with positions at University of Toledo Medical Center , the Florida Healthcare Purchasing Cooperative, as well as the Agency for Healthcare Administration, where she oversaw the development of one of the first statewide discharge datasets in the country. When she isn’t leading the practice through the latest quality projects, Karla devotes much of her personal time to Community Theater, spending time with her three adult children, and creating stained-glass artwork.
Sion Hughes Consultant, Market and Provider Strategy
Wakely Consulting Group
Sion Hughes has over 15 years of healthcare experience with time spent in both the provider and payer space. He has worked for payers such as Blue Cross Blue Shield of Michigan and HealthPlus of Michigan primarily focused on Medicare Advantage. Sion's Medicare Advantage experience includes product development/management, compliance/program oversight, and marketing/sales. During Sion’s career on the provider side, he worked for Trinity Health as the Director of Regulated Products. His responsibilities included organic growth of lives in the system for Medicare and Medicaid lines of business. Additionally, Sion was responsible for analyzing and negotiating alternative payment model arrangements with payers. Currently, Sion works for Wakely where he provides consulting services for market strategy, benefit designs, contract negotiation support, and profitable growth drivers through advanced analytics.
Karen Wilding Senior Director of Quality & Value Based Care
University of Maryland Medical System
Karen Marie Wilding is the corporate Senior Director of Quality & Value-based Care with the University of Maryland Medical System (UMMS). Karen is responsible for driving value based care efforts across acute and ambulatory care settings from revenue cycle optimization thru integrated care coordination. She works with commercial and government payers; facilitating work streams that are a growing 100M+ in annual quality / payment portfolio for the system.
In addition to her system-wide responsibilities, she leads major operating divisions for both the University of Maryland Quality Care Network (UMQCN) and UM Transform Health MD (Care Transformation Organization), within the organization’s clinically integrated network. Karen’s team provides state-wide support to clinicians and healthcare entities in the areas of quality, practice transformation, risk adjustment, health IT, data & analytics and federal policy/programs. Collectively, they are supporting over 1B in care for the state of Maryland and over 100,000 patients. Karen serves as an affiliate compliance officer, ensuring the emerging population health programs have a robust compliance program wrapped around them.
She was previously the Director of Operations for the enterprise Information & Technology Department at UMMS and has worked in Health IT for over fourteen years for both small and large organizations. She has completed hundreds of implementations, adding to her experience within all aspects of healthcare technology.
Karen is soon ending her two-year term as President of Maryland Chapter of HIMSS. With over 2000 members, the current board has advanced programming beyond traditional educational sessions and now specializes in executive engagement as well as diversity in health IT. Over the last two years, vendor partnerships have doubled, allowing expansion of programming for one of the largest chapters in the country. She has been an active member since 2011.
In fall 2017, she achieved board certification as a Certified Healthcare Chief Information Officer (CHCIO) with the College of Healthcare Information Management Executives (CHIME). In spring 2018, she was inducted as a Fellow of the Health Information Management Systems Society (FHIMSS) for her continued leadership and dedication to the industry and community at large. Karen has held an adjunct faculty appointment with the Community College of Baltimore County (CCBC) in the Health Information Technology Program since 2010.
She attended The George Washington University in Washington D.C and holds a Master’s certificate in Value-based Care from The Johns Hopkins University and Normandale CC. She resides near Annapolis, with her husband and three children.
Jon Swisher is the Director of Solution Development for Kiriworks, a leading provider of information and process management solutions that optimize and transform today's business. He has worked as a trusted advisor with both healthcare providers and insurers for close to a decade – utilizing software solutions to drive innovation and process improvement. This includes designing enterprise-class case management platforms, integrating with industry leading EMRs and developing technology roadmaps for the interconnected healthcare ecosystem.
Dr Kenneth Persaud has dedicated his career building and leading vertically integrated healthcare delivery models; focusing on re-design, equitable care, physician compensation, global capitation and population management. Dr Persaud is the CEO of Visualize Health, based in Franklin, Tennessee. Visualize Health is a healthcare management and population health technology company, which supports best practices of medicine, using our reach, scale and stability to transform healthcare. Visualize Health delivers solutions to physician networks and payers, helping foster self-sufficiency by creating sustainable revenue models while transitioning to value-based programs, and preparing for risk based reimbursement. Visualize Health enables value-based adoption, and the improvement of health outcomes. Over his career Dr Persaud has held leadership positions in healthcare organizations which accelerate performance and create value for patients, health plans, physicians, hospital systems and investors. Dr Persaud earned a Bachelor’s of Science from the Rochester Institute of Technology, NY and completed his post graduate training at the University of Mexico, School of Medicine.
Denise Patriaco, RN, APN, is the Regional Director for Care Coordination for the Hackensack Alliance ACO and Hackensack Meridian Health (HMH) Network located in New Jersey. She is responsible for providing leadership, planning, and managing the outcomes of the Care Coordination team along with multiple other administrative, financial and educational responsibilities. Denise’s focus is on providing high level care coordination for patients through a high touch and high technological approach, as well as supervising the population management initiatives. Denise initially created, and now guides the development of the HMH initiatives on transitional care team development, continuous quality improvement and provider satisfaction. The Hackensack Alliance ACO has achieved shared savings each year since conception, receiving over 150 million. Earlier in her career Denise’s work on quality improvement assisted Hackensack University Medical Center in securing the Robert Wood Johnson’s “Perusing Perfection Grant “ - a $20.9 million Six Sigma type national demonstration program. The intent was to show that system-wide efforts are feasible and can set new benchmarks for healthcare quality and safety. Thirteen health care organizations from the US and Europe designed, tested, and implemented changes in strategy, structure, and key processes, supported by IHI faculty and with frequent contact with each other in a collaborative learning model.
Denise holds a master’s degree in Nursing from Pace University and is ANCC certified as a family nurse practitioner. She attended Duke University in 2012 for the Population Care Coordinator Program and later became a guest speaker for the program. Denise also owns and manages an aesthetic practice in New York.
Chief of Primary Care and Value Based Health and Professor
Elizabeth Jacobs Chief of Primary Care and Value Based Health and Professor
University of Texas
Elizabeth A. Jacobs is chief of primary care and value-based health and a professor of medicine and population health at Dell Medical School. She also serves as associate chair for research in the Department of Internal Medicine.
Prior to joining Dell Medical School, she was a professor of medicine and population health sciences and vice chair for health services research in the Department of Medicine at the University of Wisconsin School of Medicine and Public Health. She attended medical school at the University of California at San Francisco and trained as a general internist at Brigham and Women’s Hospital in Boston. She completed a Robert Wood Johnson Clinical Scholars fellowship and a master’s in public policy at the University of Chicago.
Her research focus has been investigating disparities in health care, specifically in minority populations. She is recognized as an expert on developing accessible and culturally competent care for diverse populations, and her research has been supported through funding from the National Institutes of Health, the Robert Wood Johnson Foundation, The California Endowment and the Patient-Centered Outcomes Research Institute.
Stuart Levine Chief Medical and Innovation Officer
Agilon Health/ Medical Innovations
In addition to his work at agilon health, Stuart serves as the Chief Physician Advisor to Google Brain/Health Research as well as an Assistant Clinical Professor Internal Medicine/Psychiatry at UCLA and Stanford University School of Medicine. He previously served in a variety of executive roles at HealthCare Partners, SCAN Health Plan, Heritage Provider Network and Blue Shield California. In these roles, he was responsible for various clinical, strategic and operational initiatives. Stuart graduated from the University of Illinois College of Medicine at Chicago as a James Scholar, holds a Master’s degree in Healthcare Administration from George Washington University and fellowships from CHCF, UCSF and Stanford.
As CEO of the Michigan Clinic, a healthcare provider holding company, and Principal at CHM Corp, an advisory services firm, Ethan sourced, financed, structured, and executed numerous healthcare deals culminating in a multi-hospital health care system. Prototypical transactions include the acquisition of hospitals and diagnostic imaging center, restructure of provider divisions, expansion of a rehabilitation and physical therapy center, merger of clinical practices, and affiliations with physician practice groups, a research institute and a medical school. Ethan is a frequent conference speaker and panelist, with particular interest in current healthcare industry trends. He also sits on the Board of Directors and management committees of several health care providers.
Robert Jordan is Geisinger’s director of market advancement and growth, where he leads business development, direct to employer contracting, provider relations and merger and acquisition efforts. He has been a member of the Geisinger family for ten years holding numerous positions including roles in Geisinger Health Plan - the integrated delivery system's insurance arm, revenue management, market research, strategic planning and business development. Robert played a key role in advancing Geisinger’s newly inked joint ventures with Highmark and St. Luke’s University Health Network, and is responsible for the continued expansion of Geisinger’s Destination Care travel surgery program. Robert holds a master of science degree in healthcare administration and a bachelor of science degree in business administration, both from King’s College in Wilkes-Barre Pennsylvania. Outside of work, Robert enjoys spending time with his wife, son and two Siberian huskies. He is also an avid outdoor enthusiast, mountain biker, runner and practitioner of Brazilian jiu-jitsu.
Manager Medical Economics & Innovations, Enterprise Population Health
Stacy Garrett-Ray, MD, MPH, MBA is the Vice President / Medical Director of the University of Maryland Medical System’s Population Health Services Organization (PHSO) and President of both the University of Maryland Quality Care Network (UMQCN) and Transform Health MD. Dr. Garrett-Ray’s responsibilities include leading the planning, development and execution of value-based, population health initiatives and innovations for multiple populations (approx. 100,000 commercial, federal, self-insured patients) with over $1B in medical costs. She received her Bachelor of Science degree with a Biology major and Women’s Studies minor from the University of Richmond where she was a Cigna Scholar, medical degree from the University Of Maryland School of Medicine, her family medicine residency at the University of Maryland Dept. of Family and Community Medicine where she served as chief resident. She received her MPH and MBA from Bloomberg School of Public Health in 2005. Previous Dr. Garrett-Ray also served as the medical director of the Baltimore City Cancer Program of University of Maryland Greenebaum Cancer Center which provided cancer screening, treatment and diagnostic services to low-income residents of Baltimore City. In 2010, Dr. Garrett-Ray was directly appointed to service as the national Deputy Director of Comprehensive Women’s Health for the Veterans Health Administration and later held other leadership positions to support VA Senior Leadership including serving as the Deputy Director of the Office of Strategic Integration. Her responsibilities included overseeing the operations of the Integrated Health Operating Portfolio nationally for VHA with a budget of approximately ¾ of $1 billion which included Patient Aligned Care Teams, Women’s Health, Telehealth, Virtual Care Non-Telehealth, Non-Institutional Long Term Care, Specialty, Patient Centered Care, Systems Redesign, GAO High Risk, Access to Care initiatives, and later VA Pulse. As a board certified family physician, Dr. Garrett-Ray continues to practice primary care in Glen Burnie.
Kendall Payne Director of Independent Review Division
Spine Care Partners, LLC
Experienced chiropractic physician that has owned and operated a solo practice for 17 yrs specializing in spine related disorders, sports injuries and wellness. Has consulted with multiple hospital systems as well as insurance companies. Is a national speaker speaking focusing on evidence-based, patient centered care, care coordination, medical necessity and documentation. A 2001 graduate of Cleveland Chiropractic College He has over 17 years of clinical and consulting experience.
Hans Wiik is an experienced healthcare strategist. He sees the details in the big picture and delivers clinically integrated accountable solutions that improve quality and lowers healthcare costs for employers and insurers, working with hospitals and aligned physician groups that increases the overall value of care for our patient communities.
Hans’ combination of healthcare leadership positions and his long-standing clinical background as a pharmacist allows him to understand medication therapy management (MTM), medication reconciliation, medication adherence, providing clients a variety of added perspectives from the ground floor to the corner office, and several floors in between.
This unique point of view allows Hans to see solutions among the silos. Where others are committed to competition, Hans brings insight, intelligence, and community based strategies that go beyond the typical healthcare discussions to find common ground between groups who previously believed they had competing interests.
For example, co-locating behavioral health and integrating pharmacists into the primary care setting are key parts of Hans Wiik’s vision. Also, clinical information, data analytics, validated patient registries, benchmarking, and better coordination among all providers is critical for long-term success for the triple aim of healthcare (improved cost and quality and a better patient experience).
Hans has recently embarked on a new vision and challenge as President and CEO of the Hans Wiik Health Group, LLC – a Colorado-based consulting group that will focus on assisting providers, payers, and employers on guidance and strategies around ACO development and performance, clinical integration, care coordination, co-location of behavioral health and pharmacists in the primary care setting, population health management, value based benefit design, that leads to overall performance improvement in healthcare quality, cost reduction, and better outcomes.
From 2008-2014, Hans was the President and CEO of the Centura Health Integrated Physician Network (iPN). The iPN was formed in 2004 when a group of independent practices and physicians in the North Denver metropolitan area began implementing a common/enterprise-wide EHR to improve the quality of clinical performance and care. This adoption of a common EHR made the iPN one of the first clinically integrated networks of independent practices in the nation. The iPN currently has over 260 providers represented in 25 different multi-specialty practices across 45 separate practice sites. Over 120 of these providers are primary care providers (PCPs) — all certified by the NCQA as Level 3 Patient Centered Medical Home (PCMH) providers. This is the largest group of PCPs with Level 3 NCQA- and PCMH-designation in Colorado.
The iPN is sponsored by (and partners with) Colorado’s largest not-for-profit healthcare system – Centura Health. Practices include both primary care and specialty practices, including a large, successful Federally Qualified Health Center (FQHC) – Clinica Family Health Services, which has 5 clinic locations.
Practices currently include Family Practice, Internal Medicine, Ob-Gyn, General Surgery, Neurosurgery, Orthopedics, Pulmonology, Cardiology, and Reconstructive Plastic Surgery. The practices are integrated through a series of population-based quality initiatives, which focus on quality of care, patient satisfaction, and the sharing of best practices.tient communities.
Director of Reimbursement Strategy and Value Based Care
Dave Wirka Director of Reimbursement Strategy and Value Based Care
Blue Cross and Blue Shield of Nebraska
David Wirka is the Director of Network Innovation at Blue Cross and Blue Shield of Nebraska where he oversees $3 Billion in annual provider reimbursement. He was instrumental in the development of BCBS of Nebraska’s Patient Centered Medical Home and Accountable Care Organization (ACO) Programs – currently involving over 2,500 primary care practitioners and 400,000 members. He serves as an adjunct faculty member at Nebraska Methodist College and is on the advisory board of the University of Nebraska Medical Center’s Master of Health Administration (MHA) program. David is also a Registered Respiratory Therapist and a past member of the Saunders Medical Center board of directors.
David holds an undergraduate degree from Missouri State University and a master’s degree in Health Services Administration from Southwest Baptist University.
Jeff Micklos is the Executive Director of the Health Care Transformation Task Force. An attorney by training, Jeff is the former Executive Vice President, Management, Compliance, & General Counsel of the Federation of American Hospitals, a national trade association representing investor-owned hospitals, and a former Partner in the Health Law Department of the international law firm of Foley & Lardner LLP. Mr. Micklos began his career as a litigator and regulatory counsel for the Health Care Financing Administration, U.S. Department of Health and Human Services, and also served in the Office of General Counsel of the Social Security Administration.
Jeff is a graduate of the Columbus School of Law, The Catholic University of America, and received a Bachelor Arts Degree from Villanova University. He resides in Washington, DC with his wife, Monica, and their four children.
Ralph Tang, President, MD/VA IPA, WellCare Health Plans / Collaborative Health Systems, spearheads the company’s growth strategy and execution to deliver Value Based Care via a risk bearing-capable population health MSO, including episodes of care/bundled payments.He focuses on value-based contracting and health care delivery partnerships with Primary Care-led IPAs/CINs and related Preferred Provider Networks of specialists and acute/post-acute care providers—to better serve Medicare, Medicaid and Commercial beneficiaries/members.
Prior to WellCare/CHS, Ralph served as CEO & President of Partners In Care, New Jersey—a multi-entity physician organization, comprising an 18-year-old population health MSO and a 650-provider IPA, which sponsored multiple Medicare and Commercial ACOs. As chief executive, Ralph led and re-structured the organization to deliver better health, better care at lower costs—serving CMS, Health Plans, and Self-Funded Employers.
Ralph was formerly Senior VP, Solution Marketing for MEDecision.He spearheaded related Product Marketing and Partnering for the industry-leading provider of VBC care management technology solutions, comprising software, services, and content/analytics, serving Payers, Providers, and Patients.
In 2014, Ralph was named NJBIZ “New Jersey Health Care 50”. Ralph holds an MBA from Harvard Business School.
Ebony C. Gilbert is a behavioral health professional – turned – Director of Network Relations for a state managed care organization. Her scope of duties range from design and implementation of alternate payment methods to developing overall strategy for network transformation. Through partnership with state agencies and collaboration with community health providers, Ebony has influenced change at multiple levels in the field of value-based reimbursement. Over the course of a decade, Ebony has managed to hire and develop a cross functional team that has used top notch execution to balance financial goals with quality performance. The collective efforts of Ebony’s team have resulted in over 50% of the market spend flowing through value-based agreements tied to total cost performance, process, and health outcomes, which has resulted in a 20% improvement in quality metrics.
Ebony proudly serves on the board of a large FQHC and also teaches in the social work department for Austin Peay State University in Clarksville, Tennessee.
Ebony earned BSW and MSW degrees from Florida A&M University. She is also a temporary dropout from a doctoral program.
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. Her expertise extends to provider enablement and engagement, HEDIS, STARS, QRS, analytic design, care impact, and best practices implementation. She has a wide variety of healthcare experience at organizations that include health plans, medical groups, Physician Hospital Organizations (PHOs), start-ups, integrated hospital systems, and the Institute of Health Professionals Education. 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. Before joining DataLink, she held executive roles with ArroHealth, Gorman Health Group, CenseoHealth, and Optum. Over the past fifteen years, Ms. Grossman has been a founding partner in three risk adjustment, quality, and cost of care reduction companies focusing on Medicare Advantage, ACA, and Medicaid. Prior to that, Ms. Grossman served as Health Net of Arizona’s Vice President of Network Strategy and Development, as well as serving in roles at Scottsdale PHO and Blue Cross Blue Shield of Arizona. She holds a Master of Science in healthcare planning from Florida State University.
Certified Management Consultant ( CMC) in Health care specializing in new health care ventures and growth strategies. Primary work is in feasibility and design work for communities to build and own their own organized health care delivery system of care. These include Accountable Care Organizations and Patient Centered Medical Homes.
Experience in helping employers and providers to build local community based cooperatives/coalitions, benchmarking consortiums, data coalitions. These represent recent projects.
International work in government policy on health reform and managed care as well as negotiated networks for larger employers with overseas workers. Work experience on 3 continents including Latin America, Asia and Eastern Europe.
Strategy development for new products and services, occupational medicine, woman's centers, wellness program, new benefits, benefit design advice on coverage changes, benefit communication strategies, employer custom network development of private ACO.
Development of high performance specialty networks and Medical homes in Primary care, Neurology, Radiology, Orthopedics, Cardiac, Behavioral health care.
Liz is a senior consulting actuary at Wakely Consulting Group. She joined the firm in May 2017 and has more than 20 years of actuarial consulting experience. Liz’s expertise lies in value-based reimbursement, claims bundling, ACO contract reconciliation, data warehousing and analytics and cost benchmarks. Her focus in this area began in 2001 with the majority of her time since then spent on establishing best practice standards and strategic positioning for her clients. Her clients include several of the national carriers, ACOs, jumbo-sized employers, and provider organizations. Liz’s responsibilities have ranged from lead consultant to expert witness to independent actuarial review. Additionally, she manages the Wakely Grouper Tool used to categorize and track clients’ utilization and cost data and Wakely’s Medicare Repricer Tool. Liz is a Fellow in the Society of Actuaries and a Member of the American Academy of Actuaries. She holds a BBA in Actuarial Science from Georgia State University.