Rise

Reza Alavi Founder - Quintuple Aim

Partner - ClinX Academy

Kwame Appiah-Yeboah Director, Risk Adjustment and Revenue Management

SENTARA HEALTH PLAN

Kwame Appiah-Yeboah is Director of Risk Adjustment and Revenue Management at Sentara Health Plans (SHP). Kwame is responsible for Medicare, Medicaid, and Health Exchange Risk Adjustment operations.   Prior to joining SHP, Kwame worked at Molina Medicaid Solutions, Verisk Health, and IntegriGuard LLC.

Kwame holds an MBA from Virginia Commonwealth University, Ph.D. in Agricultural Economics from the University of Kentucky, and a Masters in Economics from Iowa State. Finally, Kwame has a Lean Six Sigma Black Belt certification issued by Virginia Tech and is CRC and CPC certified.

Kaitlin Bates Manager, ARHOME Quality

Arkansas Blue Cross and Blue Shield

Kaitlin Bates, PharmD, is the Manager for ARHOME Quality at Arkansas Blue Cross and Blue Shield, where she spearheads Medicaid quality metric strategy and drives initiatives for Arkansas’s Medicaid expansion program. Leading member and provider engagement, she collaborates with interdisciplinary teams and vendors to enhance operational efficiency and achieve strategic excellence, improving quality of care while reducing utilization and costs for the Medicaid population.

A passionate advocate for innovative healthcare solutions, Kaitlin develops value-based pharmacy programs targeting chronic condition management and contraceptive access to expand care for ABCBS members. Her leadership in leveraging AI-powered two-way texting has transformed engagement with hard-to-reach populations, fostering meaningful connections and improving health outcomes.

Kaitlin earned her Doctor of Pharmacy from the University of Arkansas for Medical Sciences. Previously, as a clinical pharmacist, she forged a partnership with a major health system to integrate pharmacists into primary care clinics, managing chronic conditions like diabetes and driving measurable improvements in quality metrics and cost savings.

Charlotte Black Principal

Oak HC/FT

Charlotte Black, a Principal at Oak HC/FT, joined the firm in 2021 and focuses on growth equity and early-stage venture opportunities in healthcare.

Charlotte serves as a Board Member at Remodel Health and a Board Observer at Bloom, Harmony Cares, Imagine Pediatrics, Indigo, Reveleer, Rialtic, and Trovo Health.

Earlier in her career, Charlotte was a Senior Associate at Lightyear Capital, where she focused on healthcare financial services investment opportunities. She has also held roles at MBF Healthcare Partners and Piper Jaffray.

Charlotte has been named to the Rising Stars of Venture Capital (Business Insider). She also serves on the Board of Directors for Phaidon.

Charlotte received a Bachelor of Arts degree from University of Chicago.

Gail Blacklock Chief Compliance Officer

Elite Health Plan

Gail’s experience includes 25 plus years working in health care as a compliance officer and consultant in the Medcare arena. As an experienced Compliance Officer for health plans her approach to compliance involves dedication of the entire organization and helping companies develop compliance and operational strategies. This top-down organizational approach ensures support and accountability from each staff member and assists the Compliance Department with implementation and management of the Plan’s Program.  Gail’s responsibilities include implementing federal and state regulations, licensing/applications, risk assessments, work plans, compliance programs, monitoring, auditing & oversight programs for health plans and delegated entities; lead and resolution on FWA incidents; training on FWA, HIPAA, and compliance, and operations and IT Systems implementation. 

Bennett Borden Founding Partner and CEO

Clarion AI Partners

Bennett B. Borden is a globally recognized authority on the legal, technological and policy implications of artificial intelligence. As a partner and Chief Data Scientist in Big Law, he has worked in machine learning and AI for 25 years. Bennett is an expert on AI regulation and compliance, and founded Clarion AI Partners to help all organizations harness the transformative power of AI.

Josh Brezovar Senior Actuarial Analyst

Milliman IntelliScript

Laura Carroll

Lived experience expert, Rural storyteller, Social drivers of health champion

Laura Carroll is a patient family partner that focuses on integrated healthcare, social determinants/ drivers of health (SDOH), and complex care in rural Colorado and the United States. A natural storyteller, she openly shares real life experiences and challenges from her own life and community with corporations and agencies to facilitate better physical, mental, and social healthcare for all.

Laura is the president of the State of Colorado Medicaid Medical Services Board, and also serves on the Nourish Colorado Advisory Board, Kyruus Health’s Patient and Family Advisory Council, The Center to Advance Consumer Partnership’s Consumer Advisory Panel, the Camden Coalition's INSPIRE Core Team and the Colorado Blueprint to End Hunger's Community Voice Commitee. She enjoys bringing her down to earth approach to speaking engagements, facilitated panels, and research projects nationwide.

Laura lives in a small agricultural community of less than 1,500 people where she volunteers with the Colorado Master Gardeners, gleans produce for local food pantries with UpRoot Colorado, and explores the wilderness with her husband, son, and little dog, Mari.

Judy Chappell

Arkansas Blue Cross and Blue Shield

The Honorable Christi A. Grimm Former Inspector General

U.S. Department of Health and Human Services

Christi A. Grimm is a nationally recognized expert in health care oversight, program integrity, and organizational leadership, with more than 25 years of experience driving accountability, innovation, and performance in the nation’s largest health and human services programs. As the sixth Inspector General of the U.S. Department of Health and Human Services (HHS), she led independent oversight of up to $2 trillion in annual HHS expenditures, spanning Medicare, Medicaid (including managed care), public health, biomedical research, and social services.

Ms. Grimm is deeply knowledgeable about the complexities of managed care and value-based models, home- and community-based services, nursing home and hospital oversight, and fraud schemes targeting federal programs and their enrollees. She has been a trusted advisor to C-suite executives, legislators, and agency heads on emerging risks, health care technology and data use, disaster preparedness, grants and contracts, and strategies to strengthen program efficiency while protecting beneficiaries and taxpayers.

As Inspector General, Ms. Grimm directed a workforce of 1,600 professionals, combining advanced analytics, cutting-edge investigations, and robust law enforcement partnerships to detect and prevent waste, fraud, and abuse. She championed actionable insights through audits, evaluations, fraud alerts, and congressional testimony to drive measurable improvements in program operations and stakeholder trust.

Prior to her appointment as Inspector General, Ms. Grimm held senior leadership roles at HHS OIG, including Principal Deputy Inspector General, Deputy Inspector General, and Chief of Staff. She was also a statutory member of the Pandemic Response Accountability Committee, providing independent oversight of pandemic relief funding across the federal government.

Ms. Grimm holds a Master of Public Administration from New York University, a Bachelor of Arts from the University of Colorado Denver, and is a graduate of Harvard Kennedy School’s Senior Managers in Government program. Under her leadership, HHS OIG was consistently ranked among the best places to work in the federal government. In 2024, Modern Healthcare named Ms. Grimm one of the Top Women Leaders in Healthcare.

Rafi Cices Head of BOI, Coding & Billing

CityBlock

Rafi Cices is the Head of Risk Adjustment, Coding and Billing function at CityBlock Health, a tech-driven healthcare provider for those in underserved communities. Prior to joining Cityblock, Rafi led the Risk Adjustment strategy and analytics at Oscar Health for Medicare and ACA lines of business.  

Rafi has experience managing an organization's performance in value based contracts where he successfully implemented contracts with insurers and CMS when he worked at Caremount Medical. He has an undergraduate degree in finance from Rutgers University and an EMBA from the Johnson Business School at Cornell University.

Alan Coker

Lived experience expert and Board member

Informed by his lived experience undergoing two major operations and receiving homecare following discharge, Alan Coker advocates for better consumer experience, patient rights, and support of the healthcare workforce. He is particularly passionate about helping people with mental health challenges and has a deep love for the deaf community. Alan serves in a variety of roles related to healthcare, health equity, mental health, substance abuse, suicide prevention, and patients' rights. He is a member of the Husky Advisory Workgroup, the CFAC Consumer Family Advisory Council, Connecticut's Ahead Advisory Committee, Certificated Community Behavioral Health Clinics Steering Committee, the INSPIRE Core Team, and serves as a Board Member for Advocacy Unlimited and Amplify of CT (formerly North Central Mental Health Agency). When he isn't busy serving in advocacy and advising roles, Alan loves writing poetry and songs and relaxing through music.

Melissa Cornejo-Burke, LSW Director, Quality Improvement

Fidelis Care

Melissa Cornejo- Burke is the Director of Quality Improvement at WellCare Health Plans of New Jersey.  In this role, she leads a team of quality improvement professionals and is responsible for NCQA accreditation, regulatory compliance, risk management, patient safety, quality assurance, provider and member engagement, member satisfaction, and the development and implementation of performance improvement strategies.

A master level licensed social worker with over 30 years of professional experience, Mrs. Cornejo- Burke is deeply passionate about the health care industry.  She is committed to promoting high quality, safe, and equitable health care services for patients, providers, in the communities she services.

Born and raised in New Jersey, Mrs. Cornejo-Burke is bilingual in English and Spanish. In her spare time, she enjoys practicing yoga, taking long walks and spending quality time with her family and friends. 

Deb Curry Risk Adjustment Programs Director

Medical Mutual

Deb joined Paramount Healthcare in May 2013, which was bought by Medical Mutual of Ohio in 2024, and oversees the Risk Adjustment, Coordination of Benefits, and Subrogation departments.

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 Documentation Integrity Practitioner (CDIP), and Certified Coding Specialist, physician based (CCS-P). Deb is also an active member of the America Academy of Professional Coders (AAPC) and is a Certified Risk Adjustment Coder (CRC). Additionally, Deb is a member of RISE and holds certificates as a Risk Adjustment Practitioner (RAP) and Advanced HCC Auditor (AHCCA).

Deb is a Board Member of the University of Toledo Health Information Administration Advisory Board and Health

Aaron DeBoer MBA, Executive Vice President

Honest Health

After spending over two decades in the health care industry, I’ve seen both the successes and failures of our system. I strongly advocate for a better model that benefits both physicians and patients. My passion lies in promoting value-based care, which I believe has the potential to greatly improve our health care delivery system.

Dr. Shannon Decker CEO

VBC One

Dr. Shannon Decker is Founder & CEO at VBC One, a consulting firm assisting physician groups, health plans and vendors maximize the performance of their value based contracts and offerings. Dr. Decker has more than 25 years experience in health care and most recently led teams in risk, quality, data and analytics, telehealth, COVID response and delegation compliance. Of her more than 25 years of experience in healthcare--17 include working with risk adjustment, quality 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 in the social and behavioral sciences 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, and a prolific national public speaker, her interests include the study of human behavior and how social and behavioral theories may be brought to bear in value based care and population health management as a whole.

Jennifer Del Villar VP, Operations

Elite Health Plan

Jennifer Del Villar has over 30 years experience working in the health care industry. A good portion of that time has focused on serving in operations and as a Medicare Compliance Officer for both start-up and established Medicare Advantage Prescription Drug. Jennifer’s current role includes leadership over numerous operational processes, systems, and teams to ensure they are compliant, effective, and strategic. Jennifer’s motos she follows daily are that “compliance is everyone’s responsibility” and “everything we do touches a member.”

Jennifer holds a Certification in Healthcare Compliance (CHC) through the Health Care Compliance Association and a Professional Academy for Healthcare Management (PHAM) certification from AHIP.

Tina Dueringer, BSN, RN, CCM, PCC CEO, Principal Advisor

Dueringer Advisors, Inc.

Tina Dueringer is a board-certified nurse strategist and the CEO of Dueringer Advisors Inc., a nationally respected consulting firm serving health plans, providers, private equity, and healthcare innovators. With deep expertise spanning Medicare Advantage, Medicaid, Duals, ACA, and commercial markets, Tina brings over two decades of clinical and operational leadership to the most complex corners of the healthcare industry.

As Principal Advisor, Tina partners with executives, boards, and investors to architect scalable strategies that drive growth, compliance, and care transformation. Her advisory focus includes Stars performance, risk adjustment, population health, delegated entity management, joint ventures, M&A strategy, and AI-driven health system redesign. Whether guiding payer-provider integration or decoding regulatory landmines, Tina is known for turning complexity into competitive advantage.

Previously, Tina served as Vice President of Clinical Quality & Stars at Rebellis Group and held senior leadership roles at Cityblock Health, Blue Cross Blue Shield of Arizona, and the Wisconsin Department of Health Services. Her work has shaped policy, built infrastructure, and improved outcomes at every level of care delivery.

Tina holds a Bachelor of Science in Nursing and a post-graduate certification in Population Care Coordination from Duke University. She is a Board-Certified Case Manager (CCM) and a certified professional in care coordination (PCC), with a strong foundation in regulatory compliance, quality strategy, and health equity.

Harlan Edlin

Reveleer

John Farley Chief Medical Officer

Complete Health

As a fourth-generation physician and founder of a large primary-care practice, Dr. John Farley has been working for more than 20 years to improve the way physicians practice medicine with a focus on improving health outcomes. In addition to being President of Birmingham Internal Medicine Associates, Dr. Farley has also served as Medical Director for Ascension / St. Vincent’s Birmingham primary-care clinics. As Chief Medical Officer, Dr. Farley oversees all Complete Health programs related to quality patient care.

Rafat Fields Founder & CEO

Powered To Rise ®

Rafat Fields is a strategist, advocate, and founder of Powered to Rise, an organization dedicated to building digital advocacy platforms that empower mission-driven healthcare leaders and changemakers. By integrating digital marketing strategy software with proven brand-building frameworks, she helps leaders amplify their voices, grow their influence, and drive systemic change. With a focus on advocacy, brand strategy, and health policy education, Rafat ensures that grassroots innovators gain visibility in the rooms where policies are shaped and resources are distributed. Her work bridges the gap between frontline impact and decision-making power—because advocacy isn’t just about being heard; it’s about creating access, influence, and sustainability.

Carrie Graham Research Professor and Director, Medicare Policy Initiative

Georgetown University

Carrie Graham, Ph.D. is a Research Professor and the Director of the Medicare Policy Initiative at Georgetown’s Center on Health Insurance Reform (CHIR) where she oversees a portfolio of policy analysis, research and technical assistance for policymakers on Medicare Advantage and original Medicare. Previously she was the Director of Aging and Disability Policy at the Center for Health Care Strategies. She also holds an Adjunct Professor appointment at the University of California, San Francisco, Institute for Health and Aging.

Dr. Graham has been working in the field of aging research, health policy, and evaluation research for over 25 years, including evaluating California’s Dual Financial Alignment Initiative and other efforts to expand managed care delivery systems for older adults and people with disabilities. In 2018-2019 she worked as a Health and Aging Policy Fellow in the U.S. House of Representatives, Committee on Ways and Means on Medicare oversight and legislation for post- acute care, surprise billing, and price negotiations for Part D prescription drugs. In 2020 she acted as consultant to California in the development of the state’s Master Plan for Aging; and subsequently provided technical assistance for over 20 states developing their own multisector plans for aging. Dr. Graham holds a doctorate in medical sociology from UCSF and a master’s degree in gerontological studies from the Scripps Gerontology Center at Miami University. She obtained her bachelor’s degree from University of California, San Diego in sociology and African studies.

Katharine Iskrant President

Healthy People, Inc.

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. 

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.

Jacop Jung VP Risk Adjustment

Intermountain Health, PCSS

Jacop Jung has over 25 years of experience in the health care industry, leading HIM, Compliance Coding, Data Quality, Finance, Contracting, UM, Claims, Risk Adjustment, and Clinical Quality teams across multiple integrated delivery networks. His mission driven passion of “helping people live the healthiest lives possible” comes alive through data driven, coordinated, proactive care.

In his current role as the VP of Risk Adjustment, Jacop leads enterprise-wide strategies to improve the health of members in the Nevada, Utah, and Colorado markets. Jacop is a firm believer that risk adjustment, with humble beginnings as a prospective payment model, has developed into a clinical care model to help enrollees live longer and healthier.

Prior to Intermountain Health, Jacop worked with large integrated delivery networks such as Kaiser Permanente and Providence Health. In each of these organizations, Jacop focused on purpose over performance. The purpose of STARs quality is not about closing measures but screening and managing diseases. The purpose of risk adjustment suspecting is not to fully report the risk burden, but to early identify diseases and prevent or delay disease progression. Organizations that first focus on purpose will outperform.

Carolyn Kapustij Senior Advisor for Managed Care

HHS Office of Inspector General 

Carolyn Kapustij serves as a Senior Advisor for Managed Care at the Office of Inspector General (OIG) for the Department of Health and Human Services.  At OIG, she develops and leads enterprise-wide strategies to oversee Medicare Advantage and Medicaid Managed Care programs.  She previously worked at the Centers for Medicare and Medicaid Services (CMS) and oversaw the improper payment measures for Medicare Part C and Part D, developed program integrity activities for the Federally Facilitated Exchanges, and developed payment policy for MA and Medicare Part D plans. She holds a Master of Public Health from the University of Michigan.

Jenn Kerfoot Chief Strategy and Growth Officer

DUOS

Jenn is a visionary healthcare leader with deep expertise in Medicare Advantage and Value-Based Care. She leverages her extensive background in healthcare policy, regulation, and business development to drive strategic growth and innovation at DUOS, developing tailored solutions that meet the evolving needs of Medicare Advantage plans. A seasoned podcast host, Jenn regularly explores critical issues like the looming threat of Medicare insolvency, the challenges of financing care for an aging population, the impact of rising healthcare costs, and disparities in care access. With previous leadership roles at FarmboxRx, Excelera Health, and NationsBenefits, Jenn has a proven track record of navigating complex healthcare regulations and aligning strategies with market demands. Beyond her executive role, she is a recognized thought leader and advocate for progressive healthcare practices, advising venture capital and private equity firms on investments in transformative healthcare solutions. Jenn’s pragmatic optimism and relentless problem-solving approach are key to her success in fostering collaboration and pushing the boundaries of what’s possible in healthcare.

Rachel Kern SVP

First Trust Capital Partners

Rachel Kern is the Senior Vice President at First Trust Capital Partners (FTCP) based in Franklin, Tennessee and Managing Director at A1 Health Ventures. She has been with FTCP since November 2016 and has led investments in a diverse range of healthcare technology and services companies, including Predict Health, Vynca, Third Eye Health, and PipCare.

Prior to joining FTCP, Rachel worked as an analyst at Healthcare Growth Partners (HGP), where she provided strategic and financial advisory services to healthcare technology companies. Before her time at HGP, she served as a Legislative Assistant to an Illinois State Senator.

In addition to her work at FTCP and A1 Health Ventures, Rachel serves on the boards of several private companies, including Conversio Health, ReferralPoint, Sonara, SendARide, PipCare, Predict Health, and Third Eye Health. She is also a member of the Finance and Audit Committee for Ray Graham, a nonprofit that provides person-centered services for people with disabilities and their families and serves as a President and board member for the Mid-America Healthcare Investors Network.

Rachel earned a BA from the University of Dallas. In her free time, she enjoys outdoor activities, as well as playing golf and tennis.

Rachel Klein Executive Director Medicare

Kaiser Permanente

Christina Latterell-Loganimoce Sr. Director, Leader of Medicare STARs

Blue Shield of California

Christina Latterell-Loganimoce is a transformational healthcare executive with over 17 years of experience leading enterprise-wide quality improvement, operational strategy, and patient-centered initiatives across both payer and provider landscapes. She currently serves as Senior Director of Medicare Quality (Stars) at Blue Shield of California, where she leads Stars strategy and analytics to improve performance and compliance across the organization's California footprint.

A dynamic and entrepreneurial leader, Christina has built and scaled cross-functional teams and integrated platforms to drive quality outcomes and operational excellence. Her work has consistently helped organizations achieve top-tier Medicare performance and navigate the complexities of value-based care delivery.

Christina combines strategic insight with technical fluency, having led EPIC EHR integrations, machine learning implementations, and real-time analytics initiatives. She is equally committed to embedding empathy and consumer voice into healthcare experiences, driving engagement and satisfaction across diverse populations.

She is the creator and host of Rising Star(tups) in Medicare, a podcast exploring innovation, leadership, and real-world stories from emerging disruptors in the Medicare and value-based care space. Known in that space as the “Star Whisperer,” Christina brings clarity and candor to the often-complex world of Medicare performance and policy. She is also in the early stages of developing Social Lift Off, a mission-driven initiative designed to support youth transitioning out of foster care, reflecting her deep commitment to social impact and her entrepreneurial drive to turn vision into action.

In partnership with the University of Edinburgh, Christina recently conducted original research exploring how clinical coding practices impact NHS Scotland’s digital health strategy. This experience deepened her commitment to evidence-based policy and international health system transformation. She also holds a Master of Science in Management and Leadership from Pepperdine University.

At Rise West, Christina shares insights from her journey as an innovator, strategist, and founder committed to reshaping the future of Medicare through data, creativity, and bold, people-centered leadership.

Sarah Lechner SVP, Chief of External Affairs

Hackensack Meridian Health

Sarah Lechner is a seasoned healthcare executive currently serving as Senior Vice President and Chief of External Affairs at Hackensack Meridian Health since November 2020, after previously holding the position of Senior Vice President for Policy Development and Government Affairs at RWJBarnabas Health. With extensive experience in legal counsel and government affairs, Lechner served as General Counsel for the New Jersey Hospital Association, advising on compliance and regulatory issues within the healthcare sector. Prior to that, Lechner was Deputy General Counsel for the NJ Senate Democratic Office, managing legislative matters related to banking and consumer affairs. A foundational legal career includes roles as an Associate at Lum, Drasco & Positan and as a Law Clerk for Hon. Erminie L. Conley in the Appellate Division of the Superior Court of New Jersey. Lechner holds a Bachelor’s degree in Political Science from The George Washington University and a Juris Doctor from Rutgers Law School.

Gregory LeGrow Executive Director, Payer Market Strategy

athenahealth

Greg LeGrow leads payer product strategy at athenahealth. He is a seasoned professional with over 30 years of experience in the healthcare industry with demonstrated success in strategy development, program leadership, operations and technology deployment.

He is passionate about enabling innovation and supporting the collaboration and data exchange among payers and providers required for successful value-based care.

Item 53 PharmD, MHCDS, BCACP Senior Vice President, Strategic Initiatives

Community Care Physicians

Stephanie Lobosco-Navarro is the Senior Vice President of Strategic Initiatives and the Executive for Aurora Community Care ACO REACH, at Community Care Physicians. In this role she works closely with a multidisciplinary team on program development, quality improvement, growth opportunities and community, state and national partnerships. Stephanie is an integral part of building and executing strategic payer contracts, inclusive of value-based care arrangements. She has experience working and leading across professional disciplines and creating best practices for quality care initiatives, healthcare utilization and trends analysis, population health and developing the successful bridge between clinical and business strategy. Stephanie has spent her early career as a clinical professor and ambulatory practice pharmacist and has since transitioned her professional focus to healthcare leadership for the past 15+ years. She is well versed and passionate about value-based programs, design and healthcare change.

Stephanie earned her Doctor of Pharmacy degree from the Massachusetts College of Pharmacy and Health Sciences in Boston, MA as well as a Masters in Health Care Delivery Science through the Tuck School of Business and the Geisel School of Medicine at Dartmouth College.

Donna Malone Director, Risk Capture

Mass General Brigham

Donna Malone, CPC, CRC, AAPC Approved Instructor, AHCCA, RAP, RISE Fellow: Director Risk Adjustment with Mass General Brigham in MA, Adjunct Professor with MassBay Community College, Chair of the RISE Risk Adjustment Academy HCC Coding Faculty Advisory Group as well as content developer RISE designations and workshops, and 2022-2025 AAPC National Advisory Board. Donna has over 28 years’ experience (Payer, Provider System and Vendor) in healthcare with primary focus on Value-Based Care.

Donna has also served as President of the Watertown AAPC Chapter (2017-2022) and Education officer (2016)

Donna speaks nationally for RISE, AAPC and AHIMA

She also received the 2021 MaHIMA Champion Award

Ann Maxwell Deputy Inspector General for Evaluation and Inspections

HHS Office of Inspector General 

Ann Maxwell is the Deputy Inspector General for Evaluation and Inspections in the Department of Health and Human Services (HHS) Office of Inspector General. As the head of the Office of Evaluation and Inspections (OEI), she leads more than 150 professionals who provide objective, reliable, data-driven evidence to HHS, Congress, and the public on significant issues. Ms. Maxwell leads the office in producing results-oriented evaluations that provide valuable insights into the efficiency and effectiveness of HHS programs as well as offer actionable recommendations to drive positive change in HHS programs so that they can better serve and protect the American people. Ms. Maxwell also leads OEI in its oversight of the State Medicaid Fraud Control Units (MFCUs), which investigate and prosecute providers for Medicaid fraud as well as for abuse and neglect of patients in health care facilities. In fiscal year 2021, the MFCU grant program recovered $1.7 billion—a return of $5 for every $1 invested.

Ms. Maxwell’s two decades of leadership and evaluation expertise have resulted in significant improvements in HHS programs and protected millions of people. For example, under her leadership, OEI helped drive down inappropriate prescribing and utilization of prescription opioids in Medicare, accomplishing this by way of Congressional testimony, more than a dozen evaluation reports, an analytic toolkit, and referrals to law enforcement and HHS. She has also directed a variety of OIG-wide multidisciplinary teams—consisting of evaluators, auditors, lawyers, investigators, and data scientists—to accomplish high-profile, consequential oversight and drive positive change in numerous HHS programs. These programs include Medicare; Medicaid; emergency response, including the COVID-19 response; oversight of food and drugs; and child welfare programs such as Head Start, foster care, and the program for unaccompanied children who cross the southern border.

Ms. Maxwell began her career with OIG in 1997 as an evaluator in the Chicago regional office, where she rose to serve in a variety of leadership roles, including Regional Inspector General. Leading the Chicago regional office, Ms. Maxwell focused significant efforts on evaluating prescription drug benefits under Medicare, Medicaid, and the 340B Drug Pricing Program. This work led to substantial savings for Medicaid and strengthened protections for providers who serve underinsured and uninsured patients. Ms. Maxwell also served as Assistant Inspector General for 8 years before taking the helm as Deputy Inspector General.

Ms. Maxwell holds a Master of Social Work from the University of Chicago and a Bachelor of Arts in Sociology and Economics from Kalamazoo College, Michigan. Ms. Maxwell has received numerous OIG awards, including the Thomas D. Morris Leadership Award for her leadership, program knowledge, and analytical abilities, and the Bronze Medal for her exemplary leadership. She has also received numerous awards for excellence in evaluation from the Council of the Inspectors General on Integrity and Efficiency, including the inspector general community’s highest honor — the Alexander Hamilton Award for protecting the safety and welfare of migrant children in HHS custody.

Cathy McClain Gordon Managing Partner & CEO

4E Health Care Ventures, LLC

Cathy McClain Gordon provides strategic leadership of 4E Healthcare Ventures, as the CEO & Managing Consultant. Her expertise includes over 25 years of experience across the healthcare industry, including as a liaison with commercial insurance programs, namely the Health Insurance eXchange, and government-sponsored programs including: Medicare Advantage, Medicaid, and TRICARE. Assessing and transforming health care operations is her specialty, and she ably engages with clients to establish  process controls for monitoring regulatory compliance, ensure quality management, steward provider network contracting and maintenance, roll out systems, and conduct general business development.

She maintains extensive knowledge of  all core health plan and physician group functional areas, specifically: Utilization Management, Quality Improvement, Provider Data Management, Claims, Appeals & Grievances, Fraud, Waste & Abuse, and Credentialing. She leverages this knowledge to provide expert advice on health plan operations and physician group management. Cathy works collaboratively to rapidly assess the current state of operations, establish an actionable roadmap, and deliver  appropriate, timely, and cost-effective solutions to both managing financial risk, and optimizing care.

Consistently, Cathy has been a dynamic resource person, equipping clients with the necessary  skills to achieve operational efficiency and comply with relevant policies and regulations. Whether it is guiding a firm through the launch of new service offerings,  the development and deployment of successful risk adjustment strategies, or performing routine delegation oversight and monitoring, she is able to set clients apart. In addition to developing care coordination models, and executing provider network incentive models, she furnishes clients with quality improvement strategies to meet a variety of different health plan quality measures including the Centers for Medicare & Medicaid Services, Healthcare Effectiveness Data Information Set, and those applicable to a particular state.

Prior to founding 4E Healthcare Ventures, LLC, Cathy served in leadership roles at other well recognized health plans. This included leading the Health Care Service Corporation (HCSC) and Anthem Alliance’s network contracting team, to identify and target providers for the new product offering, TRICARE Region 2 & 5. This offering served Illinois, Michigan, Wisconsin, Indiana, Kentucky, and Ohio. As the Regional Network Manager, she successfully implemented network adequacy requirements across all partner states, and transitioned the market from HCSC to Anthem Alliance with 97% retention of the provider network.

Other notable positions held include the Vice President for Commercial and Medicaid Products, at Optum’s Collaborative Care’s subsidiary North American Medical Management (NAMM). Here, she directly managed the provider networks for eleven provider sponsored organizations, and launched a network for a newly formed independent physician association. Her role also included managing revenue opportunities for each of the clients, through pursuing additional health plan contracts and increasing quality bonus earnings from the health plan.

Additionally, Cathy led an Illinois multi-health plan provider engagement initiative through the Illinois E-prescribing Collaborative to increase adoption of electronic prescriptions, with the aim to reduce medication errors, while increasing provider experience and compliance with generic prescribing, and ultimately fostering brand loyalty with the respective health plans. Through her leadership and partnership with industry stakeholders, the initiative won the Surescripts Award for “Most Improved State” in just two years! Further, generic and formulary prescribing rates increased by 10-15% across health plans, as a result of this effort.

Cathy holds a Master of Health Administration (M.H.A.), as well as a Bachelor of Arts (B.A.) in Psychology from Governors State University, and is an alumni of the competitive America’s Health Insurance Plans (AHIP) Leadership Development Program. She is a current member of the Advisory Cloud Board Directory, a network of executives which provides advisory services through the Board of Directors at public and private firms.

Scott Migdole Assistant Clinical Professor

Yale University School of Medicine

Mr. Migdole is the Chief Operating Officer of Yale Behavioral Health and the Yale Group on Workforce Development. He is also an Assistant Clinical Professor in the Department of Psychiatry at the Yale School of Medicine. His responsibilities include administering a large mental health services contract for pre-adjudicated youth, crisis services, vocational programming for persons with severe mental illness, outpatient mental health and substance abuse services and managing the implementation of the Supervision Competency Development Initiative.

He has long focused on the development of the behavioral health workforce and how to help staff translate administrative requirements into clinical practice. This has included working with clinical and rehabilitation staff in the development of behaviorally driven, medically necessary treatment plan within a model based on the stages of change. His model has helped professionals and paraprofessionals alike to utilize a behaviorally-driven, structured, stage by stage treatment planning process with children, families and adults.

Over the past four years, Mr. Migdole has worked on developing a supervision model consistent with the needs of the public sector. This has included providing training and consultation throughout Connecticut for the Department of Mental Health and Addiction Services, Connecticut Department of Corrections, Department of Children and Families and Connecticut Valley Hospital. He has also worked with the District of Columbia’s Department of Mental Health to provide supervision training and consultation to public sector agencies throughout the DC area.

Mr. Migdole has collaborated on various publications including “Graduate Education and Training for Contemporary Behavioral Health Practice” in Administration and Policy in Mental Health, “Mental Health in Juvenile Detention Facilities: A Review” in The Journal of the American Academy of Psychiatry and the Law, “Providing Competency Training to Clinical Supervisors through an Interactional Supervision Approach”, in Research on Social Work Practice and “Exploring New Frontiers: Recovery Oriented Peer Support Programming in a Psychiatric Emergency Department”, in the Journal of Psychiatric Rehabilitation. He also recently completed a term as a contributing editor for “Compliance Watch,” a quarterly newsletter published through the National Council for Community Behavioral Healthcare.

Abby Miller Levy Managing Partner

Prime Time Partners

Abby has spent her career helping businesses and consumer brands grow as an operator, entrepreneur and advisor, most notably in the wellness sector. Prior to Primetime Partners, Abby was a senior executive at SoulCycle, where she oversaw business development and new digital products. Abby has also been a Founder herself, teaming with Arianna Huffington as the Founding President of Thrive Global, a behavior change technology company focused on employee productivity and wellness. Abby began her career at McKinsey & Company then led product development at OXO International. She is a graduate of Princeton University and Harvard Business School.

Melissa Newton Smith Founder, Senior Advisor

Newton Smith Group

For more than a decade, Melissa Smith has been at the forefront of leading Medicare Advantage and Star Ratings teams. As the founder of Newton Smith Group and a Senior Advisor to Oliver Wyman, Melissa is a widely recognized thought leader and healthcare strategist. Her proven track record of success lies in developing comprehensive enterprise-wide solutions that enhance Star Ratings, quality performance, health outcomes, and the overall member experience.

Melissa excels in crafting strategic and tactical solutions to meet client needs, forging productive partnerships across internal teams and external vendors, and improving performance on various quality measures.  Her unique background in business, finance, regulatory compliance, and healthcare quality provides clients unparalleled access to healthcare strategy, quality performance, and revenue optimization.

As the former Chief Consulting Officer at Healthmine and Senior Vice President at Gorman Health Group, Melissa's leadership spans across prestigious organizations like Cigna-HealthSpring and Vanderbilt University Medical Center. Graduating from Purdue University, Melissa began her career at KPMG, LLP and is a Certified Public Accountant.

Neil Patil Health Policy Director, The Medicare Policy Initiative

Georgetown University

Neil Patil is a Senior Fellow and the Policy Director at the Medicare Policy Initiative at Georgetown’s Center on Health Insurance Reform (CHIR). He conducts policy analysis and provides technical assistance to policymakers on Medicare Advantage issues.

Prior to joining CHIR, Neil was a Senior Analyst at the Centers for Medicare & Medicaid Services Office of Legislation, where he provided technical assistance to Congress on issues related to Medicare Advantage and the Medicare Drug Price Negotiation Program. In this role, he served as the lead analyst on Medicare Advantage issues. He was also instrumental in supporting the passage and early implementation of Medicare drug pricing policies included in the Inflation Reduction Act. Neil has also served as the Legislative Assistant/Clerk in the U.S. House of Representatives, Committee on Ways and Means and as a Policy Associate for the U.S. Senate Committee on Finance. In these roles, his work has focused on issues related to Medicare reform, drug pricing, nursing home oversight, health equity, as well as other Medicare issues.

Neil holds a Master of Public Policy from Georgetown University’s McCourt School of Public Policy and a Bachelor of Arts in Economics from Xavier University.

Kali Peterson Director of Policy and Programs

The SCAN Foundation

Kali Peterson serves as the Director of Policy and Programs at The SCAN Foundation. In this role, she oversees a grant portfolio focused on long-term care financing and advancing person-centered and integrated care for complex care populations. Kali’s experience includes project management, public administration, and policy analysis with the United Nation’s Department of Economic and Social Affairs, the 2005 White House Conference on Aging, and the VA Geriatric Research, Education and Clinical Center.

Kali holds a joint Master of Science in Gerontology from the USC Davis School of Gerontology and a Master of Public Administration from the USC Price School of Public Policy. She also completed a bachelor’s degree in Mass Communications at the University of California, Berkeley. Kali enjoys photography, Pilates, and traveling with her husband and twin sons.

Kevin Pierce FSA, MAAA, Senior Consuting Actuary

Milliman

Kelley Scott Manager, Risk Adjustment Clinical Programs

Providence

Kelley is a board-certified Nurse Practitioner with over 30 years of experience in healthcare, playing a key role in driving departmental success. She is a recognized subject matter expert within the Providence system, specializing in value-based care and risk adjustment programs. For the past 12 years, Kelley has developed comprehensive HCC training content focused on proper coding, documentation, and best practices for physicians and APPs. She has successfully led large-scale HCC training initiatives across teams in all regions. As the chair of the HCC Technology Committee, Kelley collaborates with vendors to enhance the clinical application of technology in risk adjustment, ensuring seamless workflows that support both coding and provider efficiency. Additionally, she oversees the clinical operations of a telehealth program, advancing accessibility and closing gaps in patient care.

Laura Sheriff

Risk Adjustment Consultant

Laura Sheriff is a highly experienced and skilled professional in the healthcare industry, with a wealth of knowledge and expertise in risk adjustment, quality improvement, and population health analytics. With her background in Medicare, Medicaid, and Marketplace Managed Care, as well as her leadership abilities and certifications as a professional coder and risk coder, Laura brings a unique set of skills to her consulting work with physician groups and health plans.

Jason Silberberg Partner

Frier Levitt

Jason Silberberg is a partner in Frier Levitt’s Healthcare Litigation section and co-chairs the firm’s value-based care litigation group.

Jason has experience handling a wide range of healthcare and life sciences litigation and regulatory matters affecting clients in various sectors, but currently focuses his practice on helping clients in the value-based care space with strategic litigation and pre-litigation-based solutions to commercial disputes. Jason counsels accountable care organizations (ACOs), patient-centered medical homes, clinically integrated networks (CINs), and healthcare data analytics vendors in resolving conflicts with payers, including Medicare Advantage Organizations and Managed Medicaid plans. Jason also regularly represents clients in False Claims Act matters and provider-agency disputes under state and federal Administrative Procedure Acts.

Prior to joining Frier Levitt as an associate in 2014, Jason worked for several years as a Deputy Attorney General in the New Jersey Attorney General’s Office, Banking & Insurance Section, where he civilly prosecuted healthcare providers, insurance producers, and insurance carriers for violations of the state Fraud and Producer Acts. He also has authored several amicus curiae briefs on novel questions of law concerning the interpretation of healthcare and insurance related statutes.

Dionne Stalling

Lived experience expert and Founder/Executive Director

With over a decade of formal advocacy experience and a lifetime of lived experience, Dionne L. Stalling is a beacon of empowerment and resilience in the realm of health advocacy. As the Founder and Executive Director of Rare and Black, her life's work is dedicated to amplifying the voices and experiences of Black individuals navigating the complex landscape of rare diseases. Dionne brings an unwavering commitment to inclusivity and justice and is a driving force behind initiatives that strive to ensure equitable healthcare access for all. As a living testament to her mission, Dionne courageously battles not just one, but nine rare conditions with grace and determination. Her journey as a health advocate is deeply personal, stemming from her own experiences navigating a healthcare system often fraught with disparities and neglect. Beyond her role with Rare and Black, Dionne is a former Washington University Community Research Fellow, alumni of the Camden Coalition’s National Consumer Scholars program, Consumer Advisory Council member with the Center to Advance Consumer Partnership, and serves as a principal at Athari Strategies, a pioneering health equity consulting firm. In all she does, Dionne leverages her wealth of experience and expertise to drive meaningful change on a systemic level, working collaboratively with organizations to dismantle barriers and foster inclusive healthcare practices.

Anthony Thompson Senior Vice President, Healthcare Network Strategy

CDPHP

Chris Towner Manager, Risk Adjustment Analytics

Providence

Chris leads Providence's enterprise Risk Adjustment Analytics program, transforming complex healthcare data into strategic advantage for Medicare Advantage and ACA populations. Over his decade at Providence, Chris has pioneered predictive models and intuitive dashboards that have measurably improved HCC capture accuracy, fortified audit readiness, which has had a positive impact on revenue integrity.

As a bridge between technical innovation and clinical practice, Chris directs a high-performing team who translate sophisticated analytics into actionable insights. His solutions prioritize provider efficiency, while proving that robust risk adjustment programs can enhance both financial performance and clinical workflow.

A recognized thought leader in healthcare analytics, Chris champions practical, scalable approaches to risk adjustment that respect provider time while maximizing program impact. He actively develops the next generation of healthcare analysts and is a sought-after speaker on building sustainable risk adjustment programs in complex health systems.

Susan Waterman Director, Risk Adjustment

Baylor, Scott and White Health Plan

As Director of Risk Adjustment, Susan Waterman has been empowered to plan, design and oversee business and strategic objectives in creating and optimizing a Risk Adjustment Department responsible for ensuring the accuracy of risk adjustment payments while successfully managing all activities related to Medicare Advantage, ACA and Exchange Risk Adjusted lines of business. In that capacity Susan directed department changes that resulted in multi-million dollar gains in Risk Adjustment, brought all chart review activity in-house, and partnered with the hospital CDI/Quality Physicians to create an Outpatient CDI Department focused on documentation quality, Risk Adjustment activities and clinic training.

A proven leader in her field, Susan’s professional experience includes coding and compliance management, auditing and provider training, system management, and consulting services.

Amanda Watkins Director, Coding / CDI Operations

Cityblock

Chad Wege VP & Head of Product, Risk Adjustment

Datavant

Rick Whitted CEO

U.S. Hunger

Rick Whitted is the President & Chief Executive Officer at U.S. Hunger, a global nonprofit whose mission is feeding families today and uniting them to a healthier tomorrow. In total, U.S. Hunger (USH) has provided over 150 million meals to families in need. Before his appointment as CEO in March 2020, Rick served on USH’s board of directors. Rick has overseen the launch of several of the organization’s initiatives: expanding home delivery of fresh produce into its supply chain; aligning its Full Cart® program with the Centers for Medicare/Medicaid Services’ (CMS) health equity framework; and, developing a cloud based SaaS solution that uses A.I. and Machine Learning to identify root causes of food insecurity in the U.S. and provide real-time actionable intelligence on social determinants of health (SDOH). Rick is a graduate of Stetson University and Nova Southern University where he received a BA in Political Sciences/American Studies, and an MBA, Business Administration and Management, respectively. Prior to joining USH, he spent 27 multi-faceted years in banking; focusing on small business, government and non-profit banking. He is also an accomplished author and speaker with expertise in leadership, workplace culture and individual and team development.

Shannon Wilson Vice President of Population Health and Health Equity

Priority Health

Shannon Wilson is the first-ever vice president of population health and health equity for Priority Health, a Michigan-based health plan. In her role, she is responsible for the growth and development of Priority Health’s population health strategy, inclusive of health plan quality. Wilson also has oversight for health equity efforts, ensuring that achieving health equity is foundational to all health plan functions. To complement this work, Wilson serves as the executive director of the Total Health Care Foundation, a charitable organization committed to addressing social needs and determinants in southeast Michigan.

Wilson is a public health leader who has devoted her career to studying the intersection between health and race. She is focused on improving health care experiences for vulnerable populations and improving health and well-being for all residents across the state of Michigan.

Ari Yampolsky Founding Partner

Whistleblower Partners

Ari Yampolsky is a partner at Whistleblower Partners in San Francisco. He has represented whistleblowers under every major whistleblower-reward law for more than a decade. In his False Claims Act practice, Ari has successfully represented individuals exposing healthcare fraud, procurement fraud, and customs fraud. Ari’s cases include ground-breaking state False Claims Act lawsuits against four wireless carriers that resulted in a $138 million settlement. Ari also represents whistleblowers with claims under every reward program run by a federal agency. Ari has helped secure millions of dollars in awards for several financial-fraud whistleblowers under the SEC’s program. Ari and his colleagues also obtained a $24.3 million reward for a former Hyundai safety engineer, the first-ever whistleblower award made by the federal auto-safety regulator. 

Previously, Ari was a law clerk for the Honorable Jane Branstetter Stranch of the U.S. Court of Appeals for the Sixth Circuit and the Honorable Kevin Hunter Sharp of the U.S. District Court for the Middle District of Tennessee. Ari graduated magna cum laude from the University of California, Irvine School of Law, where he was a member of the inaugural class. Between college and law school, Ari worked for the Service Employees International Union, helping long-term-care employees organize unions and ensure government funds were used to support living-wage jobs.