Rise

Nebeyou Abebe Senior Vice President of Social Determinants of Health

Highmark Health

Nebeyou Abebe is the senior vice president of social determinants of health (SDoH) for Highmark Health, a $27 billion national health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pennsylvania, Highmark Health’s 44,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses including Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, enGen, and Helion.

Social Determinants of Health (SDOH) are the conditions in which people live, work, learn, and play that can impact up to 80% of an individuals’ health outcomes before the healthcare system can intervene. Mr. Abebe brings nearly 20 years of experience leading SDOH, population health, and employee health and well-being initiatives for public and private sector organizations.

In his role at Highmark Health, Mr. Abebe leads an SDOH team that spans across the enterprise and forges close ties with the communities in Pennsylvania, West Virginia, Delaware, and New York, uncovering non-clinical opportunities to improve the health and well-being of members and the region at large.

Highmark Health focuses on the confluence of medical and non-medical drivers of poor health outcomes, with a primary goal to identify and effectively address barriers to health.

Before joining Highmark Health, Mr. Abebe served as global vice president of health and well-being for Sodexo Group, where he guided SDOH, population health and employee wellness for all Sodexo business segments impacting more than 425,000 employees and 100 million consumers. While at Sodexo Group, Mr. Abebe developed initiatives that addressed food insecurity, housing, transportation, and workforce development in partnership with community-based organizations.

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.

Charles Baker MHA, MSW, CHC, Vice President Compliance Solutions,

ATTAC Consulting Group

Mital Brahmbhatt, MHA, LMSW Director, Health Management

Memorial Hermann

Mital Brahmbhatt has 19 years of a variety of health care experiences. She has been able to effectively develop, promote and implement programs around population health and care coordination, and focused on adding value to the healthcare journey. She earned her Masters of Social Work at the University of Houston. Mital started her career as a pediatric oncology social worker at Texas Children’s Hospital. Upon receiving her Masters in Healthcare Administration from Texas Woman’s University, she then moved into impactful positions where she was charged with overseeing the operations of intensive care units, then to building a new psychosocial division for the largest pediatric cancer center, to building the STAR Kids Medicaid program for a health plan and helping to develop how care coordination from payer to hospital to the community positively impacts the patient journey. She strives to be a change agent in all the roles she sits in, professionally and personally. Mital believes in paying it forward and volunteers her time and knowledge to 4 different non-profit agencies in and around Houston, Tx.

Currently, Mital is the Director of Health Management for Memorial Hermann’s Population Health Service Organization and is an adjunct professor at Texas Woman’s University. Her teams focus on providing wrap-around care coordination in the ambulatory space to approximately 400 thousand ACO attributed lives, building and developing innovative workflows related to value-based care, complex case management, transitional case management, community care coordination, HEDIS preventative/wellness initiatives, remote patient monitoring, pharmacy, and overall population health strategies. Her purpose is to be an innovative and passionate thought-leader who is driven to support patients, their families and providers across their health journey and continues to be an advocate for those in need.

Jeremy Cale Browning, MBA, CPC, CRC Director – CDE Performance Management

Ochsner Health Network (OHN)

Cale Browning, MBA, CPC, CRC is the Director of Clinical Documentation Excellence & Risk Adjustment for Ochsner Health Network, the Value-Based Care division of Ochsner. Cale has nearly 10 years of experience in Risk Adjustment in various roles such as Risk Adjustment Coder, MRA Frontline Lead, Manager of Risk Adjustment Education, and Director of Revenue Cycle on both the payer and provider side of healthcare. Cale started at Ochsner in October of 2020 as a Risk Adjustment Performance Improvement Manager tasked with building out the necessary Key Performance Indicators (KPIs), dashboards, and educational material for Executive Leadership then absorbed the Clinical Documentation Excellence Team in February of 2022. Since that time, Cale and the CDE Leadership Team have designed and implemented a state-of-the-art Ambulatory / Outpatient CDI Program that supports Primary Care and Specialty service lines with proven success within the first year, subsequently presenting their vision at several conferences and work groups since.

Jeanine Bumford, CPC, CRC Director of Risk Adjustment Operations

Christus Health

As Director of Risk Adjustment Operations, Jeannine Bumford has successfully planned, designed, and overseen the business and strategic objectives in creating and optimizing a Risk Adjustment Program. Her team has effectively managed all risk adjustment programs pertinent to Medicare, Medicare Advantage, and ACA lines of business. Jeannine's extensive experience in risk adjustment, spanning over twelve years, has significantly improved provider engagement, finance, HCC coding, RADV audits, and data submissions. She holds certifications for Professional Coder (CPC) and Risk Coder (CRC).

Renee Cline, RN, MSN, CNML Manager of Practice Coordination

Inspira

Renee Cline, RN, MSN, CNML. -Manager of Practice Coordination.  Oversees Medicare Annual Wellness Visit Nurse Program and the practice coordination team.  Her team works to outreach, schedule and complete MAWV for all the nearly 8,000 lives that make up our Medicare patient population with Signify.  Her team also helps with the pre-visit prep that helps the office’s workflow such as preventative screening result and medical record requests.   Renee has been a nurse for over 9 years and has experience in Magnet, Nursing Leadership, Shared Governance at both unit and system levels, IRB level Research.  She has her Master’s in Nursing Leadership and is a Certified Nurse Manager & Leader. 

Jessica Columbus Risk Adjustment Industry Consultant

Memorial Hermann

Jessica Columbus, LVN, CCS-P, CRC, CPHQ is currently the Vice President of Value Based Care for Apex Health Solutions. Her expertise in physician performance engagement and value-based care best practices are built on a foundation of more than 18 years’ experience in managed care focusing on end-to-end health plan operations related to Risk Adjustment and the CMS Star Rating Program. 

She began her healthcare career in direct patient care as a Pediatric/NICU nurse and in 2005 took an opportunity at a managed care company in their Referral/Pre-Cert Department where she was first exposed to quality and risk adjustment concepts. Once promoted into a leadership role that allowed her to own and create both risk adjustment and HEDIS programs from scratch she discovered those to be her true passion.

For 15 years her career has concentrated on innovative provider engagement strategies and implementing real world solutions that positively impact provider and contract performance. Her enterprise-wide physician education programs that aim to improve understanding of clinical documentation requirements have proven successful through accuracy of HCC recapture, increased year-round closure of HEDIS gaps in care and strengthened positive health plan experiences among both providers and members. 

Prior to joining Apex in August of 2020, Jessica worked at Universal American/WellCare for 6 years as the Sr. Director of Quality Improvement directly overseeing all quality improvement programs, HEDIS, Stars operations and prospective risk adjustment activities for their Texas and Louisiana markets. During her tenure at WellCare she was able to consistently deliver solid Star Ratings for all contracts under her responsibility, including achieving a 4.5 STAR in 2019 for their flagship MAPD plan in Texas.  Jessica’s continued career journey is centered on improving clinical outcomes for patients through advancing provider and payer partnerships that will revolutionize value-based care. 

Jessica enjoys spending her free time traveling with her husband Brandon and their 3 daughters (Gabriella, Alexis and Jordan) in Houston Texas. 

Mark Dabney Director, Risk Adjustment

Community Health Plan of Washington

Mark Dabney is the Director of Risk Adjustment at the not-for-profit healthplan Community Health Plan of Washington (CHPW), supporting risk adjustment operations, submissions, and analysis for Medicare, ACA, and Medicaid lines of business.   He has over 16 years of experience in risk adjustment programs and over 20 years of health care industry experience spanning a wide spectrum, from call center representative to supporting the implementation of the ACA program for millions of members across Kaiser Permanente, including serving as risk adjustment lead for Medicare, Medicaid, and ACA programs in the Mid-Atlantic States.  Prior to joining CHPW in late 2021, he helped implement risk adjustment operations and value-based programs at kidney care provider Somatus, driving revenue bearing care assessment partnerships.   

Outside of work, Mark and his wife enjoy pub trivia nights and board games.  Mark is an avid music and movie buff, and tolerable musician and home recording fan.  He lives in the Seattle area. 

Greg Dadlez VP, Value-Based Performance

Ochsner Health Network

In his role as vice president of value-based performance, Greg is charged with driving Ochsner and its partners to maximize returns on capitated, risk-based and pay for performance agreements. He works across Ochsner Health Network to develop and scale projects impacting cost, utilization, documentation, and quality.  Greg leads the strategy, population health, documentation exellence, and performance improvement teams.

Omar Daoud Senior Director of Pharmacy

Community Health Plan of Washington

Omar Daoud Senior Director of Pharmacy
Community Health Plan of Washington

Omar joined Community Health Plan of Washington, CHPW, as the Director of Pharmacy in 2019 after sixteen years with Walgreens Co., where he led Specialty Pharmacy operations for the Pacific Northwest Region. 

Omar has extensive experience in Specialty Pharmacy, Managed Care including government programs, and Clinical Pharmacy quality initiatives. Omar’s current role is focused on PBM relationship oversight, clinical pharmacy integration, and utilization management of medical and prescription drug benefits. 

Omar received his Doctorate of Pharmacy Degree from the University of Washington in 2005 and continues to reside in the beautiful Pacific Northwest.

Dr. Shannon I. Decker Principal

VBC One

Dr. Shannon Decker is principal 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 20 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 20 years of experience in healthcare--15 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 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, and a prolific national public speaker, her interests include the study of human behavior and how theories on motivation and learning may be brought to bear on population health management.

Jennifer Dietz Director, Health Care Fraud Division

Defense Health Agency (OIG)

Ms. Dietz has served with the Defense Health Agency in a variety of roles including Contracting Officer’s Representative for the TRICARE West region contract, Technical Representative for Claims, and Health Care Fraud Specialist.  She has extensive experience in the TRICARE program to include oversight, implementation of changes, contract proposal review and negotiation, and leading transition activities for the T2017 TRICARE West contract.  She is an Assistant Inspector General, and currently leads the Health Care Fraud Division under the DHA-Office of the Inspector General, responsible for safeguarding the healthcare benefits for 9.6 million TRICARE beneficiaries from medical fraud, waste and abuse.

Prior to coming to the Defense Health Agency in 2007, she worked for the Department of Labor developing, investigating and adjudicating worker compensation claims and at the Veterans Administration processing domestic and foreign claims. 

Jennifer has a variety of leadership experience, including the civilian co-chair of the Making Health Plans Great workgroup, establishing a mentoring program within DHA, participating on the NHCAA Healthcare Inequity working group, Healthcare Artificial Intelligence working group, Boot Camp instructor and conference committee.  She is the Past President of Arapahoe County Quilt Guild and an avid quilter.  She has presented at numerous national conferences on organizational bias, cross-functional communication and fraud schemes, and has published several articles on TRICARE fraud.

Ms. Dietz holds a Master of Science Degree in Criminology from Regis University, a Master of Science in Government Information Leadership from the National Defense University, and a Master of Science in Leadership with Brookings Executive Education in partnership with Washington University in St. Louis.  Ms. Dietz is an Accredited Healthcare Fraud Investigator, Certified in Healthcare Compliance, a Certified Fraud Examiner, and a Certified Yoga Teacher (265hr).

She resides in Denver, Colorado with her husband, two sons and a household of pets including many chickens.

Ryan Dodson Chief Operating Officer/Co-Founder

New Vision Healthcare Solutions

His background is in management and operational processes for 15 years, and began working in the Risk Adjustment arena 12 years ago. Ryan has proven himself by helping Medical Groups raise their RAF scores to their proper levels. He directed the movement of a 10,000 member group up 43% over a two year period, and an 1800 member group up 53% in the first year. Ryan achieves these results through chart documentation audits, provider and staff documentation training, and provider relationship building. In his most current role Ryan works with multiple groups to optimize their RAF score, while at the same time achieving CMS 5 Star quality. Ryan explains to these groups that getting their RAF score to the correct level will not only drive revenue, but it will also lead to better patient care with improved documentation habits. Ryan is a Certified Risk Adjustment Coder (CRC) credential through the AAPC.

Tina Dueringer CEO, Principal Advisor

Dueringer Advisors, Inc

Tina Dueringer, BSN, RN, CCM, PCC, is the CEO and Principal Advisor at Dueringer Advisors Inc., a distinguished consulting firm dedicated to supporting health plans, vendors, and leaders in the health insurance and provider sectors. With a robust background spanning Medicare Advantage, Medicaid, Duals, ACA, and commercial markets, Tina brings extensive expertise in care management, utilization management, clinical quality, Model of Care development, Stars ratings, HEDIS measures, and accreditation standards such as NCQA and URAC.

Tina's career is marked by strategic insights into health plan operations, including strategic planning, joint ventures, partnerships, delegated relationships, and the advancement of value-based care models. She is deeply committed to advancing Health Equity, Population Health, and integrated care initiatives across the industry.

Previously, Tina served as Vice President of Clinical Quality and Stars at Rebellis Group, specializing in Medicare Advantage and government consulting. Her leadership journey includes pivotal roles at Cityblock, Blue Cross Blue Shield of Arizona, and the Wisconsin Department of Health Services, Medicaid Policy Division.

Tina earned her Bachelor of Science in Nursing and holds a post-graduate certification in Population Care Coordination from Duke University. She is also a Board-Certified Case Manager (CCM), underscoring her dedication to enhancing healthcare delivery and outcomes through comprehensive care coordination strategies.

Julianne Eckert Senior Director, Clinical Quality Programs

Clover Health

Julianne Eckert is the Senior Director of Clinical Quality Programs at Clover Health, a physician enablement company focused on seniors who have historically lacked access to affordable, high-quality healthcare. She is responsible for creating an innovative  data driven strategy that breaks the traditional model of healthcare to make it easier for providers and patients to deliver and receive healthcare.   

She has spent her life using her personal and clinical career experiences to help drive her mission as a patient advocate by leading health plan quality improvement strategies to prevent vulnerable populations from falling through the cracks with data stories and forward thinking programs which enable patients to easily navigate the complex matrices of healthcare and insurance. She has sweeping subject matter experience in CMS Innovation models, Stars QI programming, NCQA HEDIS/CAHPS/HOS, health equity, as well as, national and international leadership in driving laser focused strategies to improve health plan performance and member outcomes/experience.

She has held multiple Board Advisory roles and currently serves on the Board of Advisors for curriculum development for Pace University’s Design Thinking Executive Program which meets high academic standards, with a challenging interdisciplinary curriculum designed to prepare top executives to solve real-world challenges in designing innovative practices. She holds multiple certifications in Organizational Change Management, Case Management and also Managed Care.  She is an avid mentor and career coach believing it is her mission to develop our next generation of leaders.

Kathleen Ellmore Cofounder & Managing Partner

Engagys

As Managing Partner of Engagys, Kathleen Ellmore brings the best of consumer marketing and data-driven methodologies to healthcare to motivate better health decisions.  Prior to founding Engagys, Kathleen led the consumer engagement consulting practice for Silverlink for 12 years leveraging Silverlink's data repository of over a billion consumer health interactions, the best of behavioral economics and the latest in clinical research to help health plans and PBMs close the last mile of consumer engagement. 

Kathleen is an award-winning engagement expert who speaks regularly on the national stage on many topics including: driving consumer health engagement, creating better consumer experience in healthcare, motivating and inspiring consumers, and using data to drive consumer behavior. She has been recently named as a consultant to the first ever FDA Patient Engagement Advisory Committee (PEAC). 

Kathleen has an undergraduate degree from the University of New Hampshire and an MBA from the Kellogg School at Northwestern.  

Mary Feliz Manager, Risk Adjustment Consulting

Pareto Intelligence

Mary brings over 14 years of healthcare experience and over 9 years of experience focusing on the risk adjustment space. She is an MD by training with a broad medical background as well as a certified risk adjustment coder.

Mary worked closely with Clinical Documentation Improvement programs focusing on the implementation, provider education, chart reviews ensuring the overall success of these programs across hundreds of independent practices and hospitals in NYC. In addition, Mary has developed materials and implemented training programs for providers focusing on the importance of proper documentation for prospective capture of chronic conditions in the Medicare Advantage population.

In her current role, Mary is an integral member of the Risk Adjustment Consulting team at Pareto Intelligence. She focuses on providing guidance on prospective programs, coding guidelines, HCC compliance, and developing provider training materials.

Suzzane Fredrick Gruszka National Director of Value-Based Optimization

Sanitas USA

Suzanne Frederick Gruszka, MAS, RN, CCM, LSSMBB, is the National Director of Value-Based Optimization at Sanitas USA, where she has led the expansion of the Population Health Management Service Organization (PHSO) to 50,000 members. Her innovative strategies in value-based care have generated significant cost savings and improved health outcomes, earning her accolades for excellence in care transformation. With a distinguished career spanning over two decades, Suzanne has been recognized for her achievements in managing high-performing teams and implementing successful value-based and accountable care programs. Her previous roles include impactful leadership at Guidewell Health and Orlando Health, where she drove efficiencies and enhanced care quality, further establishing her reputation as a leader in healthcare management.

Pam Galley SVP/Area Manager Diablo Service Area

Kaiser Permanente

Pamela Galley has over two decades of healthcare leadership where she has been pivotal in advancing health equity and wellness for broad and diverse populations.

Pamela joined Kaiser Foundation Hospitals and Health Plan in 2004, advancing through progressive leadership roles and currently serves as the Senior Vice President and Area Manager for the Diablo Service Area. Pamela previously served as Vice President, Continuum of Care for the Mid-Atlantic States and Northern California Region.

As Vice President, Continuum of Care, Pamela created systematic opportunities for Kaiser Permanente to grow as a leading community health consortium. In partnership with executive leaders across regions, she developed and drove the vision for care across the continuum, cultivated a strong partner base, and led large-scale initiatives as a valued partner.

Known for her strategic vision, Pamela has spearheaded collaborations across care delivery and operations, significantly contributing to Kaiser Permanente's growth and community health initiatives.

In her current role, Pamela serves as the primary chief administrator for the largest service area in Kaiser Permanente Northern California overseeing 3,500 employees and health care for nearly half a million members. Pamela is focused on optimizing performance quality, service, and affordability as key drivers for high levels of customer satisfaction and member growth and retention.

Pamela has consistently established deep trust and integrity among employees, leadership, and stakeholders. Serving as a strong senior-level coach and team leader, she has built top-caliber teams and mentored leaders to think factually and strategically.

She holds MA and BA degrees from Chapman University and completed Harvard Business School's Executive Leadership Program in 2023. Pamela also serves on the Walnut Creek Chamber of Commerce & Visitors Bureau Board of Directors, exemplifying her commitment to community and organizational excellence.

Kim Geidel VP of Risk Adjustment

Priority Health

Colleen Gianatasio Director Clinical Documentation Integrity and Coding Compliance 

Capital District Physician’s Health Plan (CDPHP) 

Colleen Gianatasio CPC, CPCO, CRC, CDEO, CPC-P, CPMA, CPPM, CCS, CCDS-O, and AAPC Approved Instructor has over 20 years of experience in the health insurance field. She has experience in customer service, claims, quality, and coding. As Director, Clinical Documentation Integrity and Coding Compliance, Colleen’s primary responsibilities are provider engagement and clinical documentation improvement for accurate coding and reimbursement. Colleen specializes in developing innovative coding curriculum and instruction to support compliance with federal guidelines and appropriate reimbursement processes. She is a certified AAPC instructor and enjoys teaching a variety of coding, documentation, and auditing classes. Colleen serves as President of the AAPC National Advisory Board.

RaeAnn Grossman

Medicare Advantage Industry Expert

RaeAnn Grossman joins us today as a health care innovator and strategic thought leader. RaeAnn has over 25 years of experience in healthcare working at health plans, provider organizations, and adjacent supporting health services and solutions companies. RaeAnn is a subject matter expert in Medicare Advantage, Duals, SNPs, MSSP, Medicaid, and other governmental programs. While at BCBSAZ and HealthNet, she led the provider strategy, network engagement, redesigned the reimbursement pillars, and built national care pathways for complex conditions. While working with Gorman Health Group, RaeAnn built Medicare Advantage plans and 17 ACOs, plus tech-enabled services, and drove turnarounds with an incredible team of network, operations, risk adjustment, and quality consultants. She has reimagined risk adjustment, moving it from retrospective to prospective and concurrent strategies. She has integrated risk, quality, and care throughout her career to drive the greatest impact with the most efficiency. She built Signify and Datavant. At Cotiviti, she turned around a $750M risk adjustment, quality, network, clinical, and consumer organization. RaeAnn is a transformative leader in innovation and is a completely purpose-driven healthcare executive. Now at Luna, RaeAnn continues to innovate in-home, in-person care, as Luna strives to lower the total cost of care, improve outcomes, and impact risk adjustment scores. RaeAnn is dedicated to improving health literacy and creating better access to and better navigation for a comprehensive network for social needs. In short, every day she focuses on simplifying healthcare and bettering the health status of all populations.

Ana Handshuh Principal

CAT5 Strategies

Ana Handshuh, Principal at CAT5 Strategies, is a government programs executive with expertise in creating and implementing corporate programs for the healthcare industry. Her background includes Quality, Core Measures, Care Management, Benefit Design and Bid Submission, Accreditation, Regulatory Compliance, Revenue Management, Communications, Community-based Care Management Programs and Technology Integration. Ms. Handshuh currently serves on the Board of the Resource Initiative and Society for Education (RISE), the preeminent national professional association dedicated to managed and accountable care financing and delivery. She is a sought after speaker on the national healthcare circuit in the areas of Quality, Star Ratings, Care Management, Member and Provider Engagement, and Revenue Management. Her recent consultancy roles have included assisting organizations create programs to address the unmet care management needs in the highest risk strata of membership, document their processes and procedures, achieve accreditation status, design and submit government program bids, institute corporate-wide programs and create communications strategies and materials. She possesses sophisticated business acumen with the ability to build consensus with cross-functional groups to accomplish corporate goals. Ms. Handshuh served as the Vice President of Managed Care Services at Central Florida Inpatient Medicine (CFIM). In this role, she provided leadership and strategy on CFIM projects and collaborations with physicians, risk entities, hospital health care systems, and health plans. CFIM is the largest Hospitalist group in Central Florida, with 70 providers discharging over 50,000 patients annually from multiple hospitals across two health care delivery systems and 24 skilled nursing facilities. At CFIM Ms. Handshuh previously served as the Vice President of Operations. Prior to those assignments, she worked with Precision Healthcare Systems as their Vice President of Quality Improvement. In that capacity, she led the IPA’s Quality efforts and collaborated with payers on implementing programs to move the needle on Quality and Star Rating initiatives. Ms. Handshuh also served as the Director of Corporate Program Development at Physicians United Plan. In this role, she led the Quality Management and Corporate Communications departments and spearheaded the development of innovative integrated technology solutions to drive business excellence and Star Rating achievement initiatives. For the past fifteen years Ms. Handshuh has taken an active role in redefining and implementing changes that have led to improvements and greater efficiency within Government programs and healthcare delivery. Prior to joining Physicians United Plan Ms. Handshuh was the founder of I-Six Creative. Under Ms. Handshuh’s vision and leadership, I-Six Creative provided expertise in the areas of managed Medicare benefit design, MSO/IPA operations, provider network strategy, new market launches, technology integration, corporate communications and quality improvement. 

Liz Haynes MSN, RN, CCM DVP, Risk Adjustment & Stars Government Programs

Blue Cross and Blue Shield of Kansas City

Liz Haynes is the DVP of Risk Adjustment & Stars- Government Programs at Blue Cross and Blue Shield of Kansas City (Blue KC). In this role, Liz leads provider engagement and the operations, oversight, strategic direction of Risk Adjustment and Star functions for Blue KC’s Medicare Advantage and Affordable Care Act health plans. These government-sponsored lines of business contribute significantly to Blue KC’s mission to provide affordable access to healthcare.  Liz has an extensive background in healthcare with experience ranging from bedside nursing to provider engagement on behalf of national payers. Prior to joining Blue KC in 2018, Liz served for seven years in Risk & Quality at Optum Insight and eleven years with BJC HealthCare. Liz is a respected expert in Government Programs Provider Engagement, Stars and Risk Adjustment.  She manages comprehensive solutions for overall contract performance and is actively involved in several healthcare initiatives bridging health care and health insurance.  She has experience with taking several Medicare Advantage contracts to 4 Star. Liz was named as the 2023 recipient of RISE’s prestigious quality award for advancing the lives of America's seniors through clinical leadership and policy vision. Liz earned both a Bachelor & Master of Nursing from Chamberlain University with an emphasis in Informatics.

Jennifer Holman Director of Risk Adjustment

Centene Corporation

Carrie Horn MSHA, BBA, RN, CCDS, CCDS-O, CRC, CPC System Director Outpatient Clinical Documentation Integrity

Baylor Scott & White Health

Carrie Horn, MSHA, BBA, RN, CCDS, CCDS-O, CRCR, CPC is the system director for Outpatient CDI at Baylor Scott & White Health in Texas.  She has 27 years of experience across pediatrics, med-surg/renal, ICU and Level 1 surgical trauma nursing.  Prior to joining BSWH as the Outpatient CDI Director in 2022, she spent the last 14 years building and leading high quality, cost-effective adult and pediatric programs while standardizing process improvement across inpatient and ambulatory CDI and Utilization Management operations at a Level 1 academic medical system in Michigan.  She expanded and transformed Inpatient CDI from 3 facilities to 13 facilities, and created Outpatient CDI and Provider CDI Education departments in 2015. She has expertise in developing, monitoring, and auditing compliant Inpatient and Outpatient CDI infrastructure, risk adjustment, provider coding education, clinical denials, and post-payment audits. Her leadership fosters relationships to support full burden of illness documentation and coding capture across the health system and health plan. She continues to serve the ACDIS community as a member of the Leadership Council and has presented at ACDIS, MACDIS, MHIMA, AHIMA, RISE, Risk Adjustment Innovations Summit, the ACDIS Outpatient Symposium, EPIC UGM, 3M, and the ACDIS exhibit hall.

Mary Inman Partner in Whistleblower Practice Group

Constantine Cannon

Mary Inman is a partner in Constantine Cannon’s London and San Francisco Offices. After 20+ years representing whistleblowers in the U.S., she moved to London in July 2017 for four years to launch the firm’s international whistleblower practice and now splits her time between the London and San Francisco offices. She specializes in representing whistleblowers from the U.S., U.K., Europe and worldwide under the American whistleblower reward programs, including the federal and various state False Claims Acts and the SEC, CFTC, IRS, DOT and Treasury Department AML and sanctions whistleblower programs. Ms. Inman’s efforts to export the American whistleblower programs to the United Kingdom, including her efforts on behalf of a successful British whistleblower, were featured in a recent New York Times article “Law Firm Sees Britain as Hunting Ground for U.S. Whistleblower Cases.”  Ms. Inman’s successful representation of three whistleblowers exposing risk adjustment fraud in the Medicare Advantage program was featured in the February 4, 2019 issue of the New Yorker magazine in an article entitled “The Personal Toll of Whistle-Blowing.” Ms. Inman represents renowned SEC whistleblower Tyler Shultz who exposed the now infamous Silicon Valley blood testing start-up Theranos, and regularly speaks on lessons to be learned from this scandal surrounding corporate governance.    

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.

Amy Jack Risk Adjustment Coding Manager

SelectHealth

Amy Jack is the Risk Adjustment Coding Manager at Select Health. She has honed her expertise in Risk Adjustment documentation and coding for more than a decade by earning a Health Information Management Bachelor's degree from Weber State University, along with her credentials of Registered Health Information Administrator, Certified Coding Associate and Certified Risk Adjustment Coder.

For the past eight years, Amy has grown a dedicated team of Risk Adjustment coding specialists and has led them to be the standard-bearers of ethical and compliant Risk Adjustment coding. She thrives in her role as a mentor and team leader. She takes delight in sharing knowledge about coding and documentation best practices with Providers and their staff, and her expertise has led her to be a sought-after presenter at industry events.

Ekaette Joseph-Isang Principal Consultant

Ritebridge

Dr. Ekaette Joseph-Isang is a subject matter expert in population health and value-based care with over 20 years combined experience in payor-provider strategy.

Her expertise cuts across population health, risk adjustment, healthcare quality, and healthcare innovation. Her specialty is in serving as a bridge between payers and providers and supporting  organizations in getting their providers the tools,  resources, and education that they need to stay competitive and efficient in the value based care space.

She is certified across multiple professional organizations in the risk adjustment, CDI, coding, and healthcare quality and is highly sought after for healthcare strategy and operations consulting.”

Karen Marie Joswick President/CEO

Benevolence Health

Karen Marie Joswick, MHA, is the Founder and President of Benevolence Health. With over 20 years in healthcare, including health system executive leadership roles, she is a recognized thought leader in payment innovation and health system operations.

Karen's expertise spans value-based care, clinical program growth, and technology integration across various payer models: Medicare, Medicaid, and commercial plans. She holds multiple professional certifications in health IT and clinical informatics, serves as a faculty member at Jefferson University, and has been on the Board of Directors for the National Association of ACOs. As an advisor to VC/PE capital firms, she brings her expertise to guide investment decisions in promising startups and emerging technologies. 

Her most cherished roles are those of wife, mother, and daughter. Having navigated the health delivery system professionally and personally, she possesses a unique perspective on healthcare challenges. This firsthand experience fuels her passion for improving healthcare accessibility and quality for all.

https://www.linkedin.com/in/kmjoswick/

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 brings her deep understanding of the complexities and nuances within the Medicare Advantage & Value-Based Care landscape to their work at DUOS, where they lead business development, go-to-market strategy, and marketing. By leveraging data-driven insights and market intelligence, they spearhead the development of tailored products and services that cater to the unique needs of Medicare Advantage plans and deliver unparalleled value to clients and beneficiaries alike; previous leadership roles include FarmboxRx, Excelera Health, and NationsBenefits. Beyond her role at DUOS, Jenn actively contributes to the industry's progress as a thought leader leveraging expertise and advocacy for innovative healthcare practices to enhance healthcare accessibility and quality.

Mansoor Khan, SC.D. CEO

Persivia Inc.

Dr. Mansoor 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. 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).

David Knight Executive Director

California Community Action Partnership Association (CalCAPA)

David Knight is the Executive Director for the California Community Action Partnership Association (CalCAPA). CalCAPA is a state association that represents 60 Community Action Agencies. CalCAPA is a part of the national Community Action Network that consists of over a thousand agencies covering 98% of the United States.

David’s experience includes 20 years of non-profit management including 16 years in Community Action & Head Start management. He began his career in community action in Pikeville, KY as a business service representative under the WIA (Workforce Investment Act), then a special projects coordinator in the American Recovery and Reinvestment Act, and then to Community Services Director under the Community Services Block Grant (CSBG). At the age of 29, David became the youngest executive director in Arkansas state history as the Executive Director for Pine Bluff Jefferson County EOC. David also worked with the National Association for Community Services Programs (NASCSP) out of Washington, D.C. as the Community Services Director for the entire US before becoming the Executive Vice President & Chief Operating Officer for Hinds County Human Resource Agency in Jackson, Mississippi.

He received his Bachelor of Science in Social Work in August 2004 from the University of Mississippi and is a nationally certified Results Oriented Management & Accountability (ROMA) Master Trainer in which he trains Community Action Agencies all over the United States. He also holds a certificate in Public Management and Leadership from the Institute of Government at Jackson State University.

Andrew Lockhart CEO

Fathom

Andrew Lockhart is CEO of Fathom, the leader in autonomous coding. Fathom applies cutting-edge deep learning to produce complete risk-adjustment coding results with zero human intervention. Fathom partners with leading health plans, managed care organizations, and health systems.

Andrew is a recognized industry expert, having published dozens of articles in leading industry publications such as Healthcare Business Today and HIT Consultant, while earning awards such as Slice of Healthcare's Top Digital Health Leader in 2023. He has presented to healthcare executives at Becker's, Google, Healthcare Finance Institute, and Health Innovation Roundtable, among other engagements. Andrew earned his MBA from Stanford University and his BA from the University of Toronto.

Nate Lucena CSO

Rex Wallace Consulting, LLC

Nate Lucena is the Chief Strategy & Analytics Officer for Rex Wallace Consulting, where he specializes in helping health plans achieve their Quality Improvement performance goals through data-driven and equity-focused strategies. He began his career spending over a decade in academic research, specializing in the neural bases of schizophrenia, brain aging, Alzheimer’s Disease and human cognition. Nate has been published in the Journal of Clinical and Experimental Neuropsychology and Frontiers in Integrative Neuroscience, and regularly presented research findings at industry conferences.

Nate shifted into a managed care career at Centene Corporation, where he built and led an Enterprise Quality Analytics and Data Science team specializing in data strategy, QI initiative outcomes studies, member-level predictive modeling of experience and clinical outcomes, and performance forecasting. Additionally, he was the key analytics lead in the development of an award-winning QI Health Equity Analysis Model, incorporating stratified reporting and advanced statistical modeling to help health plans identify health disparities and drivers in HEDIS and CAHPS. He went on to lead Ratings Improvement Strategy, National Vendor Management, and Quality RFP/Business Development for Medicare, Medicaid, and Marketplace lines of business.

Core to Nate’s work across the academic and corporate sectors is a deep commitment to creating diverse workplaces rooted in equity and inclusion through measurable action. His commitment is evidenced by leadership roles in the Washington University LGBT Advisory Board, co-creator and leader of the SafeZones training program for faculty and staff departments, co-Presidency of Centene’s cPRIDE employee inclusion group, and participation in numerous equity-focused community groups. This equity focus is the primary lens through which he helps managed care organizations bring disparity reduction to the forefront of their QI strategic focus.

Nate has Master’s degrees in Experimental Psychology and Cognitive Neuroscience/Aging from the College of William & Mary and Washington University in St. Louis.

Donna Malone CPC, CRC, AAPC Approved Instructor, AHCCA, RAP  Director Risk Capture, Population Health Management  

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

DeAnna Minus-Vincent President & CEO

The D-velopment Group, Inc.

DeAnna Minus-Vincent has tackled the toughest issues plaguing our country today—equity, poverty, housing, health, and education, just to name a few.  DeAnna has created programs that move individuals along their pathway, but believes that the most sustainable change happens when we work across sectors to re-engineer fractured systems; in so doing we can exponentially impact the lives of many and create sustainable change.  DeAnna is noted for not just programmatic and policy prowess, but for scaling organizations—she has transformed entities and dramatically increased revenue, service regions, as well as product mix.

Drawing from a broad range of lived and learned experiences, DeAnna Minus-Vincent serves as the Founder and Managing Partner of The Outcomes Architect, a strategic advisory firm that works across sectors to optimize leadership, leverage relationships, and gather insights to improve organizational results with an aim to develop efficient and cost-effective solutions that empower companies and the communities they serve. Immediately prior to this role, DeAnna served as Executive Vice President, and inaugural Chief Social Justice and Accountability Officer for RWJBarnabas Health where she was charged with addressing the social drivers of health and developing organizational change. She has also worked as the Chief Engagement Officer at Benefits Data Trust (BDT), a national social change organization and the Assistant Commissioner for the New Jersey Department of Community Affairs.

DeAnna serves as an advisor for many national and local entities, as well as on the Board of Trustees for the Corporation for Supportive Housing. DeAnna has been recognized for her success in business, equity, and health care. Most recently, Ms. Minus-Vincent was recognized by the NJ Chamber of Commerce for her innovative business practices.

DeAnna received a Master of Public Administration from Rutgers University, and a Bachelor of Arts in sociology from Morgan State University, a historically Black university. DeAnna is currently pursuing a Doctorate in Business Administration with a concentration in Leadership and Innovation.  Born and raised in Trenton, New Jersey, DeAnna lives in Lumberton with her husband, Daryl and daughter, Darynn.

Jenni Monfils AVP, Risk and Quality Provider Engagement Education

Molina Healthcare Inc.

Jenni Monfils, CPC, CDEO, CRC has over 20 years of healthcare experience in revenue cycle, coding, and documentation improvement. She is an accomplished risk adjustment professional with extensive experience in both the Medicare and HHS HCC model. Jenni specializes in developing provider risk adjustment education and HCC quality oversight programs to ensure compliance. She has project managed HHS-RADV audits, Medicare Advantage Contract Level RADV audits and Part C Improper Payment Measure (National RADV) audits. Jenni demonstrates effective leadership and innovative problem-solving skills to plan and execute the necessary oversight in the everchanging risk adjustment space.

Erin Montgomery COO

Porter

Erin brings over 30 years of healthcare experience to our leadership team. As a former Chief Operating Officer in the healthcare sector, she excels in coordinating teams, optimizing organizational performance, and driving growth in competitive environments. Erin possesses expertise in government programs, specifically risk adjustment, HCC coding, and submissions.Rooted in her experience as a nurse in the US Army, Erin's passion for patient care has driven her career, marked by significant contributions to healthcare technology startups over the past nine years. Her diverse healthcare background, combined with a relentless work ethic and adeptness in relationship-building, positions her to drive operational excellence at Porter.

Kenneth Persaud CEO

White-Wilson Medical Center, P.A.

Dr. Kenneth Persaud is nationally recognized thought leader and change agent with over two decades of experience with increasing responsibility across healthcare sectors, in creating, scaling and operating businesses to achieve optimized healthcare outcomes. Ken is a healthcare executive with a history of setting strategic direction and bringing together high caliber teams to execute on business growth, while maintaining focus on people first corporate cultures. Ken entered health administration after practicing as a primary care provider, this combination of a provider perspective with business acumen have provided vision, unique insight and problem-solving advantages beneficial in today’s rapidly evolving healthcare arena.  Ken earned a BS from the Rochester Institute of Technology, and his medical degree from the University of Mexico Medical College. During his free time Ken can be found enjoying the outdoors alongside his wife of 18 yrs or courtside cheering on their son or daughter.

Kristen Phillips Associate Vice President

Lifepoint Health

Kristen Phillips is AVP of Population Health Strategic Operations at Lifepoint Health, overseeing the 8 AdvantagePoint clinically integrated networks across the US. She has specific expertise in value-based payment models and quality measures, care workflow optimizations, and change management.

Prior to joining Lifepoint in 2022, Kristen worked as a value-based care consultant, advising large health systems and academic medical centers on their Medicare and Medicare Advantage value-based contracting and population health initiatives. She led multiple VBC transformation projects, including the roll-out of new care navigation programs, implementation of Medicare’s Primary Care First model, and optimization plans for value-based contract strategy.

Dr. Seun Ross Executive Director, Health Equity

Independence Blue Cross

Seun Ross is the Executive Director Health Equity at Independence Blue Cross. She has responsibility for crafting and implementing the strategy to achieve health justice for all Independence members and the communities they live in. Through her leadership, IBC has established condition specific goals to reduce inequities and has formed a Regional Coalition to Eliminate Race Based Medicine that includes all the health systems in the PA5 and contiguous counties. Her career has centered around systems innovation, health policy, public health interventions, healthcare reform and addressing equity.

Dr. Ross is a published author, most recently as a committee member of the National Academies of Medicine-Medications for Opioid Use Disorder Saves Lives; the Robert Wood Johnson Foundation-Advance Practice Nursing Leadership: a Global Perspective; and the American Nurse Credentialing Center- The Doctor of Nursing Practice and the Executive Role. She has lectured on many topics within her research interests, which include health equity, SDOH, healthcare policy, and evidence based practice. She received The Coppin State University Healthcare Award from the Helene Fuld School of Nursing, the Women of Achievement Award from the Philadelphia Tribune and the Health Equity in Business Award from March of Dimes-Philadelphia.

Dr. Ross earned her Bachelor’s degree and Master’s Degree from Coppin State University and her Doctoral Degree from Chatham University. She is a member of the board of directors for Childrens Crisis Trauma Center (CCTC), March of Dimes (Philadelphia/South Jersey), and MontCo Mommas. She is a member of the University Science Center Health Innovation Council, and the Academy of Healthcare Executives; and holds certifications as a family nurse practitioner.

Laura Sheriff Contracting Risk Adjustment Specialist

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.

Melissa Smith Founder

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.

Liz Soltan Associate

Whistleblower Partners

Liz Soltan is an associate at Whistleblower Partners LLP, a boutique law firm dedicated to representing whistleblowers under the various U.S. whistleblower reward programs.  She is a member of the case team working side-by-side with DOJ on United States ex rel. Poehling v. UnitedHealth Group, Inc., a pioneering Medicare Advantage risk adjustment fraud case launched by Whistleblower Partners’ whistleblower client. In addition to her work on healthcare-related matters under the False Claims Act, she helps whistleblowers bring tips to government agencies (SEC, CFTC, FinCEN) regarding financial fraud, money laundering, and sanctions evasion.

Sunita E. Varghees, MD VP, Physician Documentation

Baylor Scott & White Health

Dr. Sunita Varghees serves as System VP of Clinical Documentation Integrity for Baylor Scott and White Healthcare in Texas. Dr. Varghees began her career in Hospital Medicine at Scott & White Memorial Hospital in Temple, Texas, and later went on to become Division Director of that group. She moved into the Quality/Physician Documentation space in 2014 for the legacy Scott and White clinics and hospitals, allowing her to understand the intersection and interdependence of quality and provider documentation.

Dr. Varghees received her bachelor and medical degrees from Texas A&M University and completed an internal medicine residency at Scott & White in Temple Texas. She also holds a PhD in Bacterial Pathogenesis from Texas A&M HSC.

Doug Wackowski Vice President, Prospective Service Solutions

Advantmed

Doug oversees Advantmed’s Prospective Service Solutions and brings 20 years of extensive operations and technology experience leading successful member and provider engagement programs. Through collaboration with Advantmed’s Business Development and Operations teams, he brings innovative solutions to our clients, achieves client objectives, and standardizes Advantmed’s offerings while optimizing the client and member experience.

Prior to Advantmed, Doug held several leadership positions with Change Healthcare, Inovalon and CBay Systems and Services. He holds a Master’s in Business Administration from Point Park University, a Master’s in Project Management from George Washington University, and a Bachelor’s in Accounting from Indiana University of Pennsylvania.

Rex Wallace Principal

Rex Wallace Consulting, LLC 

Rex is a Quality Improvement expert who helps health plans achieve higher quality, operational excellence, and more meaningful engagement with all stakeholders.  o Prior to founding RWC, Rex was a health plan leader accountable for Star Ratings, Medicare operations, and the member experience for a multi-state, 100,000+ member plan. He led the turnaround of all nine contracts from 3.5 Stars to either 4 or 4.5 Stars through enhanced data-enabled engagement with the organization, its members, and its providers. Rex has 30 years of industry experience leading functions such as member retention, market analysis, customer service, and operational improvement. 

Lesley Weir Senior Director, Solutions Strategy

Veradigm

Lesley Weir, Senior Director, Solutions Strategy at Veradigm, has over 30 years’ experience in the Medicare Managed Care industry, with specific expertise in operations, risk adjustment and quality improvement. She has a demonstrated track record of assisting health plans in meeting operational and revenue goals, as well as developing innovative strategies to improve member’s health and experience. Prior to her role at Veradigm, she held various leadership positions at multiple provider-owned Medicare Managed Care Health Plans and a large national plan.  She also spent six years working in the vendor space supporting Medicare Advantage plans across the country with their risk adjustment and quality programs.

Rebecca Welling Vice President Risk Adjustment

Intermountain Health

Rebecca Welling is the VP of Risk Adjustment for Intermountain Health.  Her team oversees all risk adjustment programs pertinent to Medicare, Medicaid and ACA lines of business.  Rebecca brings 18 years of risk adjustment experience through provider engagement, strategy, finance, HCC coding, RADV audits and encounter data submissions.   Rebecca’s primary focus is to ensure risk adjustment is performed through ethical, compliant, and comprehensive workflows.  Rebecca works closely with Alliance of Community Health plan to help develop policy recommendations for CMS. 

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.

Nicole Wright, MSN, RN, CBN Director of Clinical Coordination

Inspira

Nicole Wright, RN, MSN, CBN. -Director of Clinical Coordination.  Oversees all clinical coordination & strategic planning for the Access Management and clinical lane opportunities withing the ambulatory practices at Inspira Medical Group.  Nicole is a nurse for over 19 years and has experience in Nursing Leadership, Peer Review, Quality, Accreditation management, and Clinical Navigation.  She has her Master’s in nursing education and is a Certified Bariatric Nurse. 

Rebecca Yanniello Vice President, Population Health 

Regal Medical Group

Becca Yanniello is a passionate and skilled leader in population health management. She holds a Master of Public Health degree and a certificate in Population and Reproductive Health from UCLA Fielding School of Public Health and dual bachelor’s degrees in psychology and Italian from the University of Southern California. She is currently the Vice President of Population Health at Regal Medical Group, a leading managed care organization in Southern California. Prior to that, she worked in the government and non-profit sectors, developing, implementing and overseeing health programs and services for vulnerable populations. Becca recently published A Kids Book About Public Health (A Kids Co) in 2023.

Michelle Zilisch Director of Product Management

Episource

Michelle Zilisch is the Director, Product Solutions at Episource. With over 25 years of experience in adult education training and 18 years in the healthcare industry, Michelle has established herself as a leader in training and implementing various healthcare systems. Throughout her career, Michelle has successfully led training and implementations for provider and facility EMR/EHR systems, Health Information Exchanges, hospital time and attendance systems, capital purchasing/budgeting software, and Medicare Advantage, Medicaid, and ACA Risk Adjustment and Quality software and service solutions for health plans and provider groups. Michelle's expertise lies in Risk Adjustment and Quality, where she has focused on intervention identification, coding, submissions, audit mitigation, and clinical documentation improvements through knowledge management. She is passionate about improving efficiencies, engaging customers, and ensuring compliance management. Michelle holds a Master of Arts in Curriculum and Instruction: Educational Technology from the University of Northern Iowa.