A health-tech executive with a two-decade track record of leading product teams with revolutionary, rather than evolutionary innovation. An engaged team member who contributes with enthusiasm and a relentless focus on delighting end users. Highly experienced in CMS compliance, SDOH/HRA/PROM data collection/analytics, engagement, retention, healthfin, EHR, provider support, D-SNPs and health equity.
PlanAllies™ helps FMOs health insurance plans and ACOs improve member literacy, satisfaction and retention. In spite of $5 billion spent on patient engagement each year, member churn with Medicare Advantage plans now exceeds 10%. A $43 million annual problem.
While many health plans struggle with 25%+ rapid disenrollment, high-touch brokers often experience <5% churn with the same Medicare Advantage plans. PlanAllies™ enables FMO and insurance plan call centers to quickly scale up seasonal campaigns as technology acts as a virtual assistant, supplementing call center agents’ subject matter expertise. Reacting to conversations, technology prompts reps to introduce plan benefits in the context of the member’s lifestyle and aspirations. This concierge engagement delivers plan literacy, benefit utilization, member satisfaction and retention metrics typically only seen from brokers.
Applicable for onboarding, data collection and retention campaigns, PlanAllies™is available in over a dozen languages and includes a fully translated summary of benefits for each health plan. Tech-enabled, conversational engagement is ideally suited to special needs members and underserved populations who are often not digital.
Lowering short-term disenrollment delivers a strong ROI. The annual cost of a call center rep’s PlanAllies seat is more than paid for by the first plan member who is prevented from churning out.
Pilots and A/B testing are simple and inexpensive.
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- Virginia Premier. Kwame is responsible for Medicare, Medicaid, and Exchange Risk Adjustment operations, member and provider engagement, and vendor management. Kwame has a lot of Healthcare analytics experience, specifically in the Medicare and Medicaid arena. Prior to joining Virginia Premier, Kwame worked at Molina Medicaid Solutions, Verisk Health, and IntegriGuard LLC.
Kwame holds an Executive 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 certified.
Su Bajaj, a seasoned executive in value-based healthcare, is the current Chief Technology Officer at Yuvo Health. Throughout her career, she has demonstrated leadership in steering technology solutions for MA and Medicaid health plans, ACOs, Provider Groups, and patients. At Episource LLC, she headed the development of a successful SaaS platform and a team to support it, driving significant growth. Her acumen in incorporating public healthcare policy into product features proved crucial at multiple organizations, including Family Health Network (a Medicaid Plan). She is a supporter of women-led start-ups. She lives in Houston, TX with her husband and three sons.
John M. Barkley
Vice President, Enterprise Risk Adjustment & Data Integrity
John M. Barkley Vice President, Enterprise Risk Adjustment & Data Integrity
John Barkley is the Vice President of Enterprise Risk Adjustment and Data Integrity for Emblem and ConnectiCare. John has been with the enterprise for ten years leading ConnectiCare and now Enterprise Risk Adjustment function. Prior to joining Emblem John was with Aetna for twenty-one years with the last six years in the risk adjustment space. John has been an attendee and presenter at RISE events for several years now. When not executing risk adjustment activities he enjoys kayaking, biking and fishing on Cape Cod, Massachusetts where he lives.
As ReferWell’s Chief Revenue Officer, Chad Baugh oversees all revenue-generating activities for the company, including sales, marketing, product pricing and customer strategy.
His more than 20-year career in healthcare includes revenue management at Teladoc Health, where he delivered triple digit revenue growth within the large and midsize health plan market segment. He has served in leadership roles at Best Doctors, Edifecs, Allscripts, dbMotion and GE Healthcare.
Chad holds an MBA in Strategy, Finance and Entrepreneurship from the University of Chicago Booth School of Business. He is a Veteran of the United States Marine Corps.
Mia Bell Sr. Manager, Medicare & Commercial Risk Adjustment
Blue Cross Blue Shield of Massachusetts
Mia was born and raised in Baton Rouge, Louisiana. She is married with 3 children with a career in healthcare. Mia’s has more than 20 years in the healthcare industry in the areas of Risk Adjustment, Quality, Value Base Contracting and Provider Relations. She is currently a Sr. Manager of Risk Adjustment Operations for Blue Cross Blue Shield of Massachusetts, where she works to improve medical record collection, oversee risk adjustment coding, and manages member programs to close quality gaps. In her spare time, Mia works with up-and-coming healthcare professionals to educate and train in the areas of Medical Billing and Coding, understanding quality measures and positive impacts of quality care provided to members. As an Innovator and agent for change within healthcare, Mia has helped many health plans restructure and realign their Risk Adjustment & STARS programs by helping each adapt to new technology to help improve program success and ultimately drive quality of care and reduce the cost of care.
Outside of healthcare, Mia is a published author, Mentor and Coach and is active in community and faith based organizations in her hometown of Baton Rouge, Louisiana.
Born into a hard-working family that has always given back to their community, Dr. Benjamin eagerly went to medical school to fulfill his life’s dream: to make a difference by serving the community in which he grew up – Rochdale Village in Jamaica, Queens. As Chief Medical Officer at Joseph P. Addabbo, he enjoys the balance of patient care and having a meaningful voice in important decision-making. Dr. Benjamin earned a Bachelor of Science from The City College of New York, as well as an MD from Ross University School of Medicine, and is trained in Internal Medicine.
ACD Physician Assistant, SCMG Internal Medicine APC Lead
Kaitlyn Bertrand ACD Physician Assistant, SCMG Internal Medicine APC Lead
Since joining Scripps Clinic Medical Group in 2018, Kaitlyn has excelled in direct patient care within the internal medicine department. She was appointed as the Internal Medicine APC lead in 2021. In this role, Kaitlyn successfully oversees a team of 35+ Nurse Practitioners (NPs) and Physician Assistants (PAs), ensuring optimal patient outcomes and fostering a collaborative work environment.
In the spring of 2022, Kaitlyn transitioned to the Risk Adjustment program at Scripps, specifically focusing on the Accurate Coding and Documentation Program. As a member of this initiative, she trains and supports clinicians across the Scripps primary care system in best practices for coding and documentation practices to help improve accuracy and compliance, enhance patient care, and improve reimbursement for the organization.
In 2022 she became a certified Epic Physician Builder to help improve proficiency in utilizing Epic electronic health record (EHR) systems to optimize workflows and enhance patient care delivery.
Kaitlyn's contributions extend beyond training and support. With her team, she has helped successfully launch three Annual Health Assessment Clinics, facilitating comprehensive wellness evaluations for patients. Additionally, she worked on developing and implementing an optimized standard workflow for Medicare wellness visits, streamlining processes and improving efficiency.
Passionate about quality improvement, Kaitlyn actively participates in workgroups aimed at enhancing various quality metrics. Her involvement in initiatives targeting breast cancer screenings, cervical cancer screenings, hypertension, and diabetes.
Vandna Pandita, MPH is the Vice President of HEDIS® Strategy and Analytics for the AmeriHealth Caritas Family of Companies [ACFC]. In her role, Vandna is leverages her experience in quality and risk adjustment operations to support members and providers as it relates to performance reporting and the member and provider experience. Her area of influence spans analytics, plan operations and digital integration of data and processes in the transition to interoperability.
Prior to AmeriHealth, Vandna has worked for several national health plans, including Aetna, several Blue Cross Blue Shield plans, the Blue Cross Blue Shield Association and Centene. She has successfully led several health plans through NCQA Accreditation, managed HEDIS® reporting, improvement and outreach, and helped develop and implement a successful provider profiling and performance measurement program. In addition to her health plan experience, Vandna managed Risk Adjustment Client Operations for Evolent Health, is a former certified HEDIS® Compliance Auditor and led project management and client solutions for a retrieval, abstraction/coding and analytics vendor supporting health plans and provider groups in their efforts to optimize revenue and improve quality within their populations.
Vandna attended the University of California at Berkeley as an undergraduate and received her Master’s in Public Health from the University of California at Los Angeles.
Vandna has moved from coast to coast, spending the better part of the last 25 years working on her southern drawl in Atlanta, Georgia. These days you can find her running the streets of Atlanta, cooking for friends or working on her newest hobby, making wobbly pottery.
Stephen Bittinger Health Care Audit & Integrity Partner
Stephen Bittinger is a partner in the firm's Charleston and Washington, DC offices. He is a member of the health care/FDA practice group. Stephen focuses his practice on health care reimbursement compliance, defense and litigation, with an emphasis on government and private payer disputes on behalf of providers, suppliers, and manufacturers involved in the U.S. health care system nationally and from abroad. He has extensive experience representing large provider groups, home health agencies, medical facilities, ancillary service providers, medical labs, revenue cycle management companies, and drug and device manufacturers in matters including Medicare and Medicaid audits, private payer audits, federal regulatory termination and exclusion proceedings, False Claims Act defense, and health care revenue disputes. Stephen is one of the leading attorneys in the country on the law regarding the use of statistical sampling and extrapolation in the review and analysis of health care claims. He has served as an expert witness regarding federal reimbursement law in civil and criminal proceedings. Stephen has represented many providers with federal agency matters, including the Centers for Medicare and Medicaid Services (CMS) Center for Program Integrity (CPI), the Department of Health and Human Services Office of Inspector General (HHS-OIG), the Department of Veteran Affairs (VA), and Health Care Fraud division of the Department of Justice (DOJ).
John Boerstler Chief Veterans Experience Officer, Veterans Experience Office (VEO)
Department of Veterans Affairs
John W. Boerstler was sworn-in on February 16, 2021, as the Chief Veterans Experience Officer at the Department of Veterans Affairs (VA). In this role, John will provide oversight of the projects and programs housed within the VEO and work collaboratively within VA’s leadership to help achieve greater access and outcomes for Veterans, their families, caregivers and survivors. Prior to his current position, he served as the Chief Executive Officer of Combined Arms which helped unite collaborative methodology and technology in order to more effectively connect Veterans to government and non-profit services. John is a recipient of both the Eisenhower and Marshall Memorial Fellowships, having travelled to the UK, France, Denmark, Israel, Bosnia, Hungary and Ukraine to write comparative papers on their military transition systems. As the first Marshall Prize recipient, John completed a 3-year project in Ukraine to assist in the development of their Ministry of Veterans Affairs – the first of its kind in Europe. John is a native Texan who served honorably in the U.S. Marine Corps from 1999-2007 as a non-commissioned officer and infantry unit leader, including one combat tour in support of Operation Iraqi Freedom from 2004-2005 and Operation Natural Fire in the Republic of Kenya in 2006.
Ezekiel Brooks is the Chief Technology Officer at U.S. Hunger (formerly Feeding Children Everywhere), a global nonprofit 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.
Ezekiel has 30+ years of experience designing, developing, and implementing software solutions for companies in medical, entertainment, military, retail, and nonprofit organizations. He has built software solutions for Fortune 500 companies such as Disney, Sony-Ericsson, and NCR. He is now focused on fighting Hunger and Food Insecurity alongside U.S. Hunger.
Ezekiel attended North Carolina State University where he studied Electrical Engineering. He has been married 27 years to his loving wife, Monica, and together they have raised 3 daughters in Central Florida.
Heather Bullock Director, Risk Adjustment Process and Operations
Horizon Blue Cross Blue Shield of New Jersey
Heather Bullock is the Director of Risk Adjustment Process and Operations at Horizon Blue Cross Blue Shield of New Jersey. A dedicated risk adjustment executive with a passion for optimizing revenue and ensuring compliance, Heather leads end-to-end risk adjustment operations, encompassing vendor management, coding and compliance, provider engagement, member engagement, and long-term strategy.
Prior to her role at Horizon, she held several roles supporting a newly developed risk adjustment department, building financial planning and analysis for ACA, and supporting Government Programs for multiple states and lines of business at HCSC.
Heather holds Bachelor's in Social Work from the University of Mary Hardin-Baylor. When she's not working, she enjoys exploring NYC with her husband, drinking too much coffee, and making terrible costumes for her two cats.
Vice President Medicare & FEP Quality Improvement Performance
Gerri Cash Vice President Medicare & FEP Quality Improvement Performance
Gerri Cash is the Vice President Medicare and FEP Quality Improvement Performance at Blue Cross Blue Shield of Arizona. With a focused expertiseto Stars/Quality and Member Experience, Gerri is getting member the care and making it easy. Whether member or provider facing activities, the member is always the center of decision making process.
Wynda Clayton is a Risk Adjustment Director at Providence Health Plans in Beaverton, OR. She received her Health Information Degree from College of Saint Mary’s, her BS in Health Care Management from Bellevue University and her MS from Clarkson College. Wynda has been in the health care field for over 25 years with experience on all phases from compliance to billing and reimbursement to coding to Quality Assurance to being a RADV Auditor to risk adjustment and providing physician education. Wynda is very enthusiastic and loves basketball, traveling and helping those unfortunate. To help is not always meaning to give, but it also means to teach others how to make a difference in their lives. Currently Wynda resides in Portland, OR with her husband Kevin. She can be contacted at Wynda.Clayton@providence.org.
Jennifer joined Aetna in 2022 and brings over 10 years of government programs experience. She is focused on partnering with value-based clinicians to identify the full burden of illness to cover the cost of health care. Previously, she worked in digital product management role curating clinical workflows to meet Medicare Advantage, Medicaid and Affordable Care Act patient's needs. Jennifer is passionate, annoyingly positive and eager to collaborate for improved health outcomes.
In Jennifer's free time, you can find her on the golf course, playing tennis, or riding her bike. She enjoys spending time with her husband, two daughters and wiener dog.
Jennifer holds a masters in public administration from Arizona State University.
Phil Collins is a seasoned professional with extensive experience in the managed care industry. As the Senior Director of Quality at FarmboxRx, he plays a pivotal role in overseeing performance analytics and collaborating with health plans to develop and implement quality improvement strategies in programmatic design.
With a career spanning over 12 years, Phil has honed his expertise within MCO’s, including prominent names like Molina Healthcare and Atrio Health plan. During his tenure, he specialized in HEDIS measures, bringing in-depth knowledge and understanding of these essential quality metrics. He has actively participated in the chart review and data collection processes for Hybrid measures, ensuring accurate and comprehensive data analysis to support decision-making and performance evaluation.
A skilled analyst, Phil excels in producing reports that highlight current and projected HEDIS and CMS rates. These reports provide invaluable insights into the performance of health plans, enabling strategic decision-making to achieve higher HEDIS scores and Star Ratings.
Debbie is the SVP of risk adjustment and quality at Signify Health, bringing 35 years of healthcare experience to her role. With a focused expertise in Risk adjustment and Stars/quality, Debbie is widely recognized as an industry expert in these areas. Debbie has deep knowledge of multiple risk adjustment algorithms, data submission requirements, RADV/HRADV, as well as the regulatory environment that Medicare Advantage, Medicaid, and ACA operate within and around. At Signify, Debbie helps guide our clinical roadmap with a focus on accurate and appropriate documentation to support diagnostic capture, and has executive responsibility over our Coding and CDI teams.
Ms. Cornejo- Burke is Director of Quality Improvement at WellCare Health Plans of New Jersey. In her professional capacity Ms. Cornejo- Burke leads a team of quality improvement professionals and oversees NCQA accreditation, regulatory compliance, risk management, patient safety, quality assurance, provider relations and performance improvement strategies throughout the WellCare Health Plans territory. A Master level Licensed Social Worker with over 30 years of professional experience, Ms. Cornejo- Burke is passionate about the health care industry and takes pride in ensuring consistent high quality and safety of health care services for patients, providers, and communities at large. Born and raised in New Jersey, Ms. Cornejo-Burke is English/Spanish bilingual. In her spare time Ms. Cornejo enjoys yoga, walking and spending time with her family and friends.
Vice President, Population Health and Clinical Transformation
Carmela Costiniuk Vice President, Population Health and Clinical Transformation
Catholic Medical Partners
Carmela Costiniuk is Vice President of Population Health and Clinical Transformation at Catholic Medical Partners, the largest network of independent practice physicians in Buffalo, NY, with nearly 900 physician members. She develops and implements population health and operational strategies and oversees the operations team, which provides direct support to physician practices to improve quality performance and care coordination across the health continuum.
A native of Canada, Carmela earned her Bachelor of Science degree in Occupational Therapy from the University of Toronto and her Masters in Health Services Administration from D’Youville University where she is currently completing her Doctoral Degree in Health Administration.
Carmela has held various administrative positions in home and community based care, acute care, long-term care, and the Local Health Integration Network (LHIN) Ontario Ministry of Health.
Keslie joined BeneLynk 4 years ago bringing over 25 years of comprehensive managed care and healthcare technology experience. Previously, Keslie spent 13 years as Vice President of Sales at Change Healthcare and its predecessor companies Altegra Health and Social Service Coordinators, helping plans improve risk-adjusted revenue and quality performance scores through social care programs including dual advocacy, Medicaid retention, and health education campaigns. Earlier in her career, Keslie led marketing for both commercial and Medicare plans, with a focus on provider risk-sharing payment models tied to quality and member surveys. Keslie's passion lies in working on strategies thatput members at the center, are efficient and meaningful while ensuring her clients are provided with the services to drive accurate risk-adjusted and quality performance revenue.
In Keslie’s free time she volunteers at the local shelter and enjoys fishing.
Keslie holds a B.S. in Business Administration from Regis University in Denver, CO, and attended the MBA/Masters in Healthcare Administration program at Sacred Heart University in Fairfield, CT.
John has over 25 years of entrepreneurial and executive experience in the healthcare space, building relationships across major, national health plans and large regional healthcare systems. John’s newest venture, Porter, designed to reach beyond standard home interventions, is the only quality stars and risk adjustment-focused care coordination program. John previously founded Pulse8, a healthcare analytics and technology company delivering complete visibility into the efficacy of risk adjustment and quality management programs, and led them to a successful acquisition by a publicly traded health IT company. John was recently granted a patent by the United States Patent and Trademark Office for a method and apparatus for risk adjustment.
Deb Curry Director, Risk Adjustment & Recoveries Actuarial Services
Deb joined Paramount Healthcare in May 2013 and manages the Medicare, Medicaid, and Commercial Marketplace Risk Management Program. Additionally, she is a member of Paramount’s STARS/HEDIS/Medicaid Performance Improvement teams. Prior to her position with Paramount she had 21 years’ experience working with the State of Ohio workers’ compensation program, both for the government and a contracted managed care organizations. She came to Paramount with extensive knowledge in medical coding, provider billing and education, Medicare payment methodologies, quality assurance, and regulatory compliance. Deb attended The University of Toledo for both her undergraduate and graduate degrees and currently holds a Masters of Business Administration with major in Healthcare Systems Management. She is an active member of the American Health Information Management Association (AHIMA) and is a Registered Health Information Administrator (RHIA), Certified Coding Specialist, physician based (CCS-P), and an AHIMA-approved ICD10-CM Trainer. Deb is also an active member of the America Academy of Professional Coders (AAPC) and is a Certified Risk Adjustment Coder (CRC). Also, Deb is a member of RISE and holds certificates as a Risk Adjustment Practitioner (RAP) and Advanced HCC Auditor (AHCCA). Deb is blessed with one awesome husband of 29 years, three amazing children (one son-in-law), two adorable grandsons, and three beautiful granddaughters who all fill her life with a lot of joy, a little mischief, and a whole bunch of love. In her spare time, Deb volunteers at her church as a Team Captain in the Youth Ministry, is Board Member of the University of Toledo Health Information Administration Advisory Board, Health and Human Services Alumni Affiliate at The University of Toledo, and Health Information Technology Advisory Committee at Owens Community College.
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.
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.
Greg Demske is a partner in Goodwin’s Complex Litigation & Dispute Resolution and Healthcare practices. He advises healthcare and life sciences companies on healthcare compliance, transactions, regulatory issues, and government enforcement matters. Prior to joining Goodwin, Greg served from 2012 to 2022 as Chief Counsel to the Inspector General, Department of Health and Human Services (HHS), where he led the provision of all legal services and advice for the HHS Office of Inspector General (OIG), including all aspects of: representation of HHS in False Claims Act cases involving HHS (including Medicare and Medicaid); exclusions from participation in Federal health care programs; Corporate Integrity Agreements; civil monetary penalties; self-disclosures to OIG; Anti-Kickback Statute safe harbor regulations and advisory opinions; compliance guidance to the healthcare industry; and legal advice to OIG on audits, evaluations, and investigations. Prior to becoming Chief Counsel, Greg served in a variety of management and staff positions in OIG and received multiple awards, including the Attorney General’s Award for Fraud Prevention and the HHS Secretary’s Award for Distinguished Service. Greg received a bachelor’s degree from Miami University and a law degree from Ohio State University.
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.
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.
Rhonda is the Senior Manager of Data Analytics working with Elevate Quality Insights at Advantmed. Her clinical nursing experience includes critical care nursing in the ICU and ED, home health nursing, and Chronic Care Management. Recognizing the increasing frequency of ED and Home Health Care utilization by the same patients, Rhonda shifted to a healthcare quality focus. Rhonda has spent the last 8 years supporting patients, providers and health plans with significant experience in HEDIS and Quality Improvement. Rhonda’s health plan experience as the manager of HEDIS and Risk Adjustment departments on the payer side helps bring the clinical perspective to the technical needs of Quality. She joined the Advantmed team to use that experience to help clients balance clinical, clinical documentation, and data requirements to ultimately provide the best care possible for every patient. She is currently based in Marion County, FL and spends her free time with her husband, family, and their precious dogs Creek and River.
Grant Gaillard leads the Strategic Growth team at Vim, which specializes in connecting data to EHR workflows at scale for leading payers and physician enablement organizations. Throughout his 15+ years in healthcare, Grant has worked at the intersection of healthcare and technology, partnering directly with providers, payers, and executives to provide innovative and easy-to-use solutions to complex problems. He brings his extensive leadership experience to Vim, which has translated to a rapid expansion of the Vim provider network over the past 2 years. His focus is now on partnering with payer and physician enablement organizations to solve the “last mile” problem which exists across disparate EHR systems.
Grant resides in Greenville, South Carolina, along with his wife and three children. He earned his Bachelor of Science degree from Clemson University, and is an avid fitness and healthcare enthusiast.
Director Clinical Documentation Integrity and Coding Compliance
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.
Brett has been with Centene Corporation for 5+ years, where his roles have led to successful startups and transition of several health plans focused on supporting risk adjustment at both the corporate and health plan level across Medicare, Medicaid and ACA lines of business. He came to managed care from an extensive career in contract manufacturing of OTC & Nutritional products with robust experience in process development, business management, procurement and sales.
As Director of Risk Adjustment at Peach State Health Plan in Georgia. Brett leads risk adjustment operations, and strategy throughout the plan working interdepartmentally and cross functionally with providers, corporate and vendor partners. He and his team drive success and stand out as examples across Centene Corporation.
Savannah Gonsalves, RN, BSN, MHA is the Director of Quality for Hometown Health. Savannah specializes is regulatory quality programs, including MIPS, ACO, and HEDIS and has a passion for population health. She has an extensive background in clinical informatics as well and uses this to integrate quality into clinician workflows effectively and efficiently. In her role at Hometown Health, she oversees the HEDIS/Stars and Appeals and Grievances. She enjoys hiking and camping with her family in the paradise that is Lake Tahoe.
“People who say it cannot be done should not interrupt those who are doing it” George Bernard Shaw.
Music has always played an important role in Sal Gonzalez’s life. He grew up in the impoverished neighborhood of East Los Angeles, and as a teenager, music kept him out of trouble. So did his decision to serve in the U.S. Marine Corps after the terrorist attacks on September 11, 2001. “That tragedy inspired me to join the military,” says Sal. “The fact that I come from a family of immigrants also made me want to join. I wanted to give back for all this country has given us.” Sal enlisted in the infantry and was assigned to the 2nd Battalion, 5th Marines. In 2004, he was a machine gunner in Ramadi, Iraq, when his truck was hit by an improvised explosive device (IED). The blast left Sal with a traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and ultimately caused him to lose his left leg below the knee. “Losing a leg is tough,” says Sal. “But the invisible wounds — PTSD and the brain injury — were even tougher.” While he was still in a Maryland hospital, Sal received a Wounded Warrior Project® (WWP) backpack full of comfort items and a promise that if he needed anything, WWP would be there to help. That gesture meant a lot to Sal, and once he got out of the hospital, he decided to get more involved. One of his first events with WWP was a multi-day mental health workshop called Project Odyssey® — and it changed his life. Despite his injury, he was able to rock climb with the group; and it proved he could still do anything he set his mind to. “Wounded Warrior Project helped change my whole mentality,” says Sal. “Instead of feeling sorry for myself and letting the loss of my fellow marines consume me, I wanted to thrive. I wanted to live a happy, important, impactful life in memory of the warriors who didn’t make it home.” With WWP by his side, Sal set out to help as many warriors as possible by sharing his experience and encouraging them to seek help. He also continued playing music — not only to process his own emotions and continue his recovery, but also to inspire other injured veterans to continue living their lives. “Having music as a tool for my recovery, I was able to let go of a lot of pain,” says Sal. “It kept me going. It’s my life. It’s who I am, and I want to show other warriors that it’s possible to follow your dreams and be normal.” Sal remains grounded in his passion to help other warriors, even as his music career hits new highs. His talent has started to earn him national attention, including appearances on NBC’s “America’s Got Talent” and the television show “Nashville.” He also released his first EP, “Heroes,” in 2020. While many musicians strive to become famous, Sal is happy with his life right now. “I get to play music for a living,” says Sal. “I’m able to support my awesome wife and son by doing something I love. For most musicians, that’s living the dream.”
Jonathon Graham Director, Opargo Business Operations
Jonathon Graham is an accomplished professional who joined Opargo, LLC as Vice President of Operations in 2018 and now serves as Director of Business Operations for Opargo at Veradigm. With over two decades of experience in Healthcare Information Technology, he brings a unique blend of skills and expertise to his role.
Throughout his career, Jonathon has excelled in various technical positions, starting as a desktop support technician at a small services company and progressing to the esteemed position of Chief Information Officer for the largest private Orthopedics and Sports Medicine Practice in North Texas. In addition to his technical roles, he has also made significant contributions in business development within the Managed Services and medical software domains. Jonathon's extensive knowledge and industry insights have created opportunities to speak at numerous Healthcare-related trade conferences across Texas.
Originally from Texas, Jonathon takes pride in his Texan roots. Prior to his career in the healthcare industry, he served as a United States Marine, demonstrating his commitment to service and discipline. Furthermore, he has cherished his role as a dedicated husband of 23 years, a loving father to three amazing children and a doting grandfather to his young grandson.
Jonathon Graham's remarkable background and multifaceted expertise make him an invaluable asset to Veradigm and a respected figure within the healthcare community.
Danielle Green Experienced Health Care Perspective
U.S. Army Veteran
Ordinarily, high-level NCAA basketball players don’t join the military after graduating from college — but Danielle Green is far from ordinary. Her call to serve others became her driving force after her Division-One basketball career, and in 2004 she found herself on top of a rooftop in Iraq – injured – and praying she would survive. Luckily, she did, as her passion for serving others has led her to help countless people over the last 17 years. She’s counseled warriors in mental health, aided in veterans’ transition to civilian life, and now travels the country to share her powerful story in the hope that more veterans will reach out for the help they need. Please join me in welcoming a true all-star in the veteran community – a woman who has dedicated her life in service of others – Danielle Green.
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 providedexpertise in the areas of managed Medicare benefit design, MSO/IPA operations, provider network strategy, new market launches, technology integration, corporate communications and quality improvement.
Mary Inman Partner in Whistleblower Practice Group
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 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 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.
Jaye Johnston is a transformative and accomplished healthcare executive currently serving as the Vice President of Stars Operations at Clover Health, a physician enablement company focused on seniors who have historically lacked access to affordable, high-quality healthcare.
With a healthcare career spanning over two decades, she has leveraged her early experience at the frontlines of patient care and transitioned to roles driving systemic change. Over the years, she has developed deep expertise in elevating the quality of care through initiatives that make a meaningful impact and continue to reshape the healthcare landscape, leaving an indelible mark on the industry and improving lives.
Rika Kari Vice President, Medical Economics and Risk
Horizon Blue Cross Blue Shield of New Jersey
Rika Kari, has 18 years of progressive experience in the health insurance field. He currently serves as VP of Medical Economics and Risk Adjustment at Horizon BCBS, where he oversees a risk adjustment operations for 1.5 million members and provider cost and medical trend management for 3.5 million commercial and government programs members.
He previously held the position of Divisional VP, Government Business Solutions at HCSC. While at HCSC, Rika leveraged his strong financial and analytical background, rising through the company in several roles, including in Financial Planning and Analytics, Risk and Revenue Optimization, Enterprise Analytics, Provider Analytics, and IT. Rika’s experience included the strategic and operational execution for over two million ACA and MA individual members.
Rika holds his Masters of Business Administration from Southern Methodist University and received his Bachelors in Economics and Finance from UT Dallas. He is married with three daughters—ages 3, 5, and 8—and has three dogs at home.
Dr. Kim is the Chief Medical Officer of Long Island Select Healthcare (LISH). He joins LISH with 14 years of clinical practice focused on improving provider satisfaction and engagement while also driving a more consistent focus on the patient experience. Dr. Kim is proficient in medical Spanish and is experienced in taking care of LGBTQ patient populations. He is a graduate of the University of Pennsylvania School of Medicine and is double board-certified in Internal Medicine and Infectious Diseases.
With over 20 years in Healthcare, Allison leads Southeast Medical Group’s Northern Division, where she is responsible for the performance of 20+ clinics in multiple states. Her tenure at SEMG spans over a decade where she started as a practice manager at a single site and then expanded to a Director over multiple locations until she was promoted to Division VP in 2022.
She leads through a strong collaboration with the 60+ health care providers in her division to ensure high-quality patient care while also serving as a mentor to her Regional Directors and Practice Managers. Allison also serves as the key liaison between SEMG's clinic operations and its Population Health team where she integrates new VBC initiatives into the daily workflow of her clinics.
Allison holds a Bachelor of Healthcare Administration from Monmouth University and is an AAPC professional coder.
Bre Krebs is an integral part of Apixio as she oversees the relationships and supports the services delivered to Apixio’s clients. With over 20 years in healthcare, Bre has a strong understanding of the core components that drive customer success and uses this ability to work with external vendors and cross-functionally to ensure business deliverables and client needs are aligned. Prior to joining Apixio in 2015, Bre was a VP of Development at Quirk Healthcare Solutions, where she created, trained, and mentored technical teams in India, Ukraine, Mexico, and the United States to provide development services and support for clients and internal software solutions for Quirk Healthcare. At Muir Medical Group IPA, Bre provided technical leadership to identify areas for system improvements and ensure projects met customer expectations and budget parameters. Bre holds a Bachelor of Arts degree in Sociology from the University of Oregon.
Donna Malone Director Ambulatory Clinical Documentation Quality Improvement (CDQI)
Mount Sinai Health System
Donna Malone, CPC, CRC, CRC-I, AHCCA, RAP: Director Ambulatory Clinical Documentation Quality Improvement (CDQI) with Mount Sinai Health System, Adjunct Professor with MassBay Community College, Chair of the RISE Risk Adjustment Academy HCC Coding Faculty Advisory Group and President of the Watertown AAPC Chapter
Previously, she worked for Tufts Health Plan in their enterprise risk adjustment division for seven years with as Director Enterprise Risk Adjustment Coding and Provider Education, and was responsible for audit and coding review management, development and implementation of department and vendor policies and procedures, development of provider and coding training materials, implementation of provider system education and process review, government audits (CMS RADV, HHS RADV, OIG), coding team performance management.
Additionally, Donna serves at the MassBay Community College in Framingham, where she has been an advisor and adjunct professor currently in her 17th year. Her specialty area is the Medical Coding and Medical Office Administration Programs. Prior to Tufts Health Plan, Donna worked for ENJOIN as the Director of Ambulatory CDI – Risk Adjustment, Blue Cross Blue Shield of Massachusetts as an HCC Professional Audit III for four years. Earlier, she worked for AM B Care for 9 years and other healthcare settings previously. Donna also has served as Education Officer (2016) and President (2017 – current) for the AAPC chapter in Watertown, MA.
Donna speaks nationally for RISE, AAPC and AHIMA
Sr. Clinical Advisor, Risk Assessment Lead Risk Adjustment Nurse Practitioner
Kathryn “Katie” McLaughlin, DNP, FNP-BC, is the Senior Clinical Advisor in Risk Assessment at Scripps Clinic in San Diego, CA. As a Doctorally prepared Nurse Practitioner certified as an Epic Physician Builder and Risk Adjustment Provider, McLaughlin leads the ambulatory clinicians in Best Practice documentation and data integrity. Having over 16 years of clinical experience, including the last 5 within a population health leadership role, McLaughlin has bridged the gap between the clinician and the coding auditor by designing and training tools and workflows that both support providers and improve patient care. Contact her at KathrynMcLaughlinDNP@gmail.com.
Jenni Monfils AVP, Risk Adjustment Coding and Compliance
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 coding. 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 ever-changing risk adjustment space.
Nick Morrison Perspective on Access to Care in Rural Areas
U.S. Marine Corps Reserve Veteran
Nick Morrison’s Humvee was hit by improvised explosive devices on two separate occasions while he was deployed to Iraq with the U.S. Marine Corps. But it was a vehicle he wasn’t in that is responsible for the severity of his post-traumatic stress disorder (PTSD) and survivor’s guilt. He was just 500 meters behind that vehicle when it was blown to pieces, killing four of the occupants. He and his unit then faced the grim task of collecting the dead and cleaning up the debris. “On any other given day, I should have been in that vehicle,” Nick says. “That was a really hard thing for me to wrap my mind around — I felt like I cheated death and that I needed to pay for it or it was going to catch up with me. I felt guilty that I came home and they did not.” Nick’s experience overseas was plagued by an enemy he could not see. When he came home, he felt like he was still looking for the enemy. “Eventually, I think I made people at home the enemy,” Nick says. “I made stangers on the street the enemy, I made my friends the enemy, and then my family.” As his PTSD symptoms became more severe, his life began to unravel. Unchecked emotions led to uncontrolled crying and emotional outbursts. He couldn’t sleep and was drinking heavily. He isolated himself and, at times, stopped speaking. For the next fifteen years, Nick received various types of mental health therapy, but he credits treatment he received through the Wounded Warrior Project® Warrior Care Network® with providing the help he needed to get his life back. The three-week, intensive outpatient program gave Nick the information and opportunity to start developing new habits while participating in group sessions with other warriors. “We are indoctrinated within this military culture,” Nick says. “We get rewarded together. We get punished together. We got to deploy together and we come home together, hopefully. So, why not heal together?” Today, Nick draws on his own personal experiences to be a mentor for other warriors. “I know how hard this journey has been for me and I know there are others out there going through the same things who may give up,” Nick says. “I feel a compulsion and a drive to help other veterans figure out the things I have slowly learned so they, too, can begin to heal.”
Margaret Paroski President & CEO and Chief Medical Officer
Catholic Medical Partners
Dr. Paroski is the is the President & CEO and Chief Medical Officer of Catholic Medical Partners, an independent practice association with 900 physician members. A board certified neurologist, Dr. Paroski has held various administrative positions including Medical Director at Erie County Medical Center; Senior Associate Dean of Academic Affairs & Admissions and Interim Vice President of Health Affairs and Interim Dean at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo; and Executive Vice President and Chief Medical Officer at Kaleida Health.
She began her medical career at the Buffalo VA Medical Center and held hospital appointments at the Buffalo Psychiatric Center, Roswell Park Cancer Institute, Kaleida Health, and Erie County Medical Center. In addition to her clinical and leadership roles, Dr. Paroski has been a faculty member in the Neurology department at the Jacobs School of Medicine and Biomedical Sciences for the past 37 years.
As President & CEO and Chief Medical Officer of Catholic Medical Partners, Dr. Paroski leads clinical integration and standardization efforts and physician relations among the organization’s medical and specialty practices. She is also responsible for engaging physician members in population health initiatives and value based payment model adaptation.
Matt Peterson is a seasoned leader in healthcare technology with over two decades of experience. Currently serving as the Chief Operating Officer at Ciox Health, he leverages his expertise in risk adjustment and quality operations to empower Payer organizations in advancing their Risk Adjustment and Quality programs. His influence spans chart retrieval, coding operations, and vital digital integration, driving the transition towards interoperability. Prior to joining Ciox, Matt spent six years at Verisk Health in executive roles, overseeing retrieval operations and leading the client services division. With an extensive background, he also served as the Chief Operating Officer at Workforce Solutions, Inc. for almost a decade, demonstrating a talent for cost-effective HR management outsourcing, employee benefits, and payroll solutions. Residing in Phoenix, Arizona, Matt remains at the forefront of shaping the trajectory of healthcare technology.
Eric Pfleger Senior Vice President, Population Health
Southeast Primary Care Partners
Eric has 20+ years of healthcare industry experience, with the last decade focused exclusively on value-based care. He joined SPCP in 2022 to lead its value-based care strategy and operations. In his role, he is accountable for program performance across 40,000+ attributed Medicare and Commercial lives, VBC contracting, clinical partnerships, and working closely with physicians to deploy an organizational-wide care model.
Before joining SPCP, Eric spent 6 years at DaVita in its Integrated Care division where he had several leadership roles, including developing ACO partnerships with health systems, managing a team of 100+ care managers and support staff, and developing a brand new VBC collaboration platform with community nephrologists. Prior to DaVita, he spent nearly ten years in healthcare strategy consulting, where he worked with health systems and health plans at both the national and regional level to develop growth strategies, VBC strategies, and stand up new ACOs and provider-plan partnership models.
Subbu Ramalingam Vice President Quality, Stars and Risk Adjustment
CareFirst BlueCross BlueShield
Subbu Ramalingam is the Vice President of Enterprise Quality Stars and Risk Adjustment for CareFirst. Subbu & his team’s role is to drive the enterprise & community-wide actions for risk adjustment and quality/star improvements for CareFirst, a mission-focused & the largest not-for-profit organization in the mid-Atlantic region. He is a data-savvy & results-focused business leader with nearly two decades of experience driving growth, value, and outcomes in the Financial Services & Healthcare system. His charitable work includes serving in board positions for multiple organizations supporting mindfulness & global health.
Kiran Rangarajan Chief Government Programs Revenue Officer
Blue Cross & Blue Shield of Rhode Island
Kiran Rangarajan is an accomplished leader in the Risk Adjustment domain with extensive experience in government programs and has worked for payors, provider groups, and vendor partners. Currently, he serves as the Chief Government Program Revenue Officer at BCBS Rhode Island developing strategic initiatives, managing operations, and driving revenue for the organization. Prior to BCBSRI, Kiran has worked for United Group, Southwestern Health Resources, North Texas Specialty Physicians, Inovalon, and Anthem successfully navigating the complexities of the health care industry and driving revenue optimization and operational efficiency.
Kiran Rangarajan has a PhD from Missouri University of Science and Technology in Engineering Management focusing on managing high-risk projects and implementing effective solutions. Kiran continues to be at the forefront of industry trends with an innovative mindset and ability to identify growth opportunities and implementing effective and sustainable solutions.
Dean Ratzlaff Director - Actuary/Revenue Management
Sentara Health Plans
Dean brings the perspective of an Actuary to risk adjustment. Prior to working in Risk Adjustment he did Medicare Advantage bids, set various accounting items, and was extensively involved in ACA pricing.
He has over a decade of Risk Adjustment experience that spans Medicare, Medicaid and ACA. He has worked in risk adjustment at both for-profit and non-profit insurers.
After years of doing chart reviews off the side of his desk, he convinced his company to create a risk adjustment department that has since grown to over 16 people. His experience building a risk adjustment department spans hiring, RFPs, communicating to executives, forecasting, HEDIS collaboration, writing regulatory opinions, and much more.
He has conducted ACA RADVs since the beginning, often giving CMS suggestions for how to improve the program. As of BY2021 he has 7 years across multiple HIOS IDs in all 3 risk pools without a single outlier in any HCC group.
In MA risk adjustment he welcomes oversight improvements. It safeguards taxpayer money and helps level the playing field for all MAOs.
Dean’s RISE presentations pair in-depth understanding with practical tips, spanning both theory and application.
Syed Rizvi Director of Risk Adjustment & Vendor Operations
Southwestern Health Resources
Syed Rizvi, MHA, CPC – Syed is a dedicated healthcare leader focused on the ever-evolving value based care landscape for over 10 years. He has worked with large provider groups and payors to help increase quality and mitigate costs, giving him a unique and comprehensive approach to managing care. By utilizing data to tell a clear story and provide insights for innovation, Syed has built strategies to tackle some of the most complex healthcare topics including risk adjustment, hospital contracting, HEDIS Quality improvement, and provider/vendor relations. Syed is currently serving as Director of Risk Adjustment submissions at Southwestern Health Resources, and has also lead teams around strategy, quality, and provider network.
John Romans is the co-founder and CEO of Biomedix, LLC, a privately held company dedicated to advancing care models leveraging healthcare IT and diagnostic technology.
John has pursued his goal of improving healthcare through collaboration. In 2006, John led Biomedix as a founding member of the national P.A.D. Coalition and sponsoring partner of the American Podiatric Medical Association. In 2010, John Romans was invited by CA Governor Arnold Schwarzenegger to participate in the California P.A.D. Task Force and was named E&Y Entrepreneur of the Year in the Upper Midwest Region. John received the APMA Executive Director's Award as well as an honorary degree from the New York College of Podiatric Medicine in recognition of his dedication to the advancement of podiatric medicine. John currently serves on the board of the Heart Health Foundation and Dare to C.A.R.E., a nonprofit organization that promotes awareness of vascular disease, and is a past board member the Association of Black Cardiologists (ABC), an organization that strives to reduce disparities in cardiovascular health, as well as the Science Museum of Minnesota.
John received his BA from Williams College and MBA from Wharton. He has been a founding principal in several technology-based ventures with a track record of developing and implementing innovative business models in emerging telecom, energy and healthcare markets. John and his wife live in Saint Paul and are the proud parents of four children.
Kimberly Rykaczewski Content Management Manager– Medical Terminology
Wolters Kluwer, Health Language
Kimberly manages a team focused on providing data quality solutions by monitoring regulatory coding content and providing diagnostic and procedural mapping sets.
She has over 20 years of healthcare experience in the areas of nursing, case management, utilization review, overpayment recovery, vendor management, coding and billing, risk adjustment, and regulatory compliance. One of the biggest rewards of her profession is bringing providers and payors together to achieve regulatory and coding compliance.
Kimberly holds a Bachelor’s of Science in Nursing and is an AAPC certified professional and risk adjustment coder.
Eric Shapiro is a Principal of Risk Adjustment at Pareto Intelligence. He is responsible for the execution and oversight of risk adjustment consulting initiatives across government and state-sponsored programs (Medicare, Medicaid, and ACA).
Eric brings over 18 years of healthcare experience to Pareto, working closely with health plans, health services organizations, and independent physician associations. Eric has worked directly for NYU Langone Health, Healthfirst NY, Optum and CIOX Health. Eric holds a Bachelor of Science in Public Health from Indiana University with a concentration in Health Administration as well as a Master of Public Administration from New York University with a specialization in Healthcare Policy and Management.
Eric has extensive insight into risk adjustment activities including RA program design, clinical data acquisition, HCC coding operations, clinical documentation improvement strategy, RAF analytics, value-based care programming, encounter data submissions process, premium integrity and HCC/RADV compliance.
Laura Sheriff, RN, MSN, is currently working as Vice President Operations, Risk Adjustment for Southwestern Health Resources (SWHR). She also works as a consultant with physician groups and health plans to capitalize on risk adjustment performance and operations. Laura is an MSN with >13 years’ experience in Medicare, Medicaid, and Marketplace Managed Care and has led teams in risk, quality, telehealth, and population health analytics. Laura demonstrates effective leadership, innovative problem-solving techniques, and goal-oriented focus to execute business objectives and meet performance metrics. Laura has designed and coordinated activities including provider education, training, auditing, data mining, and data analysis to direct program success. Laura has a Master’s in Nursing Education and is also a certified professional coder and a certified risk coder. Laura is also a frequent speaker for RISE, a best-in-class organization for all things related to accountable care and government healthcare reform.
Becky Simmons, RN, BSN, is the Stars Program Manager for Security Health Plan. As a healthcare professional, Becky has been helping to improve the quality of care for patients and communities for more than 20 years. At Security Health Plan, Becky leads strategic management of Star ratings and other value-based performance strategies across the organization, including HOS, QHP CAHPS, MCAHPS and HEDIS CAHPS.
Meghan is a Vice President, Product Management at Signify Health (recently acquired by CVS) working on healthcare technology and solutions for patients in the home. Prior to Signify Health, Meghan was the Head of Product and Operations at 100Plus (acquired by Connect America), one of the first health technology startups to develop remote patient monitoring solutions to better connect patients with their primary care provider for care management services. Before 100Plus, she was a Product Leader at Amazon Lab126 working on emerging products and Alexa enabled smart home devices. She's passionate about creating new products, technologies and services by identifying customer needs, developing trust and driving results through cross functional teams. She holds an MBA from UC Berkeley Haas and Masters in Mechanical Engineering from UC Berkeley.
Director, Risk Adjustment & Value-based Care Program operations & Compliance
Khush Singh Director, Risk Adjustment & Value-based Care Program operations & Compliance
Granite GRC Consulting
Khush Singh is a trained clinician and experienced healthcare executive with 18+ years of combined HIM and Medicare experience. Khush has served in several senior leadership roles within risk adjustment teams at Medicare Advantage health plans and overseeing Medicare, Medicaid, and commercial risk adjustment efforts. In his current role as Director of Risk Adjustment and Value-based Care Operations and Compliance at Granite GRC Consulting, Khush leads focused engagements providing expertise in risk adjustment operations, healthcare data analytics, HCC coding, and operational compliance components of Medicare’s Part C and Part D. He has led a variety of projects, including RA operations and process improvement; prep for RADV audits; retrospective chart retrieval campaigns; provider and coder education; structuring and optimizing RA programs within MSOs and IPAs; due diligence audits supporting mergers and acquisitions by private equity firms; and analyses of encounter data submissions. Khush has worked with entities ranging from an EMR company, risk adjustment vendors for NLP and advanced HCC analytics, billing and coding, revenue cycle management entities, MAOs, and ACOs. He regularly engages with physician practices focused on managed care, providing HCC coding and documentation education to providers. He has helped several clients optimize their HCC coding recapture and CDI workflows, resolve RAPS and EDPS submission-related problems, and help them with their clinical documentation improvement process to recapture appropriate & accurate HCC risk scores. Khush Singh regularly speaks at national and regional conferences for AAPC, and other conferences, on topics related to Risk Adjustment, HCC coding, RADV audit compliance, MAO operations, and technology solutions for managed care focused on patient-centric RA and quality of care. Khush serves on the AAPC National and Regional Conference Education Committee.
Archita Sood, MD Dr. Sood is the Chief Medical Officer at Homebase Medical and leads the organization's commitment to providing comprehensive access to in-home care for vulnerable seniors. Prior to this she served on the clinical leadership team at CareMore Health. Her care delivery and Medicare Advantage experience has afforded her in-depth knowledge of complex disease and palliative care management, risk adjustment and the Medicare annual wellness visit. She received her medical degree from the State University of New York and completed her residency training at UCLA-Olive View Medical Center. She has also completed additional Palliative Care training through a proprietary training model at the University of Southern California.
Barry Stelmach is the Chief Financial Officer for Catholic Medical Partners, the largest network of independent practice physicians in Buffalo, NY, with nearly 900 physician members. He is responsible for the overall financial operations and leads payor negotiations for the organization. Barry also oversees the development and evaluation of risk contracts between payors and providers for all lines of business. He has played a significant role in preparing practices for the shift from fee-for-service to value-based care and risk-based contracts.
A native of Buffalo, NY Barry earned his undergraduate degrees in Accounting and Economics and a Master of Arts degree from the State University of New York at Buffalo.
Vice President of Business Development Patient Pattern
Ian Strand Vice President of Business Development Patient Pattern
Ian has 18 years’ experience in healthcare operations, both as a provider and a payer. Ian began his career as a Nursing Home Administrator, specializing in Post-Acute Rehab, opening new facilities and improving quality outcomes. It was there that he became passionate about improving quality of care and services through aligning the goals of providers, payers, and the patient.
In 2016, Ian took on the role of operations lead to launch and manage AgeRight Advantage, the first provider-owned I-SNP in the state of Oregon and created a medical group of Physicians and Advanced Practice Clinicians to provide on-site medical care to patients living in over 40 facilities of varying levels of care. Ian helped develop operational models and risk-based contracts that blended traditional fee-for-service requirements with the focus on superior quality outcomes and care management needed to be successful in Value-based care.
In 2021 Ian transitioned to Patient Pattern, a technology company that provides Care Management and Clinical Documentation solutions to Payers and Provider Groups that share risk on the clinical outcomes of their members and patients. As Vice President of Health Plan Business Development, Ian provides a consultative sales approach to operators who are seeking to be successful in the world of Value-Based Healthcare. Patient Pattern was fully acquired by PointClickCare in 2023 with the goal of enhancing the tools and services provided operators in long-term care who are taking risk on patient outcomes.
Jill Strassler, VP Solutions Management, Veradigm Payer Solutions (formerly Pulse8), is a dynamic healthcare executive focused on innovating the analytics and reporting solutions for Health Plans for Risk Adjustment, Quality and Value Based Care models. Jill brings expertise in developing novel solutions to address emerging and transformative change in the healthcare industry. Jill excels at delivering value across the ecosystem by increasing transparency and building connectivity among all stakeholders. Over her notable 20-year career, Jill has developed holistic member engagement and quality strategies for health plans. Prior to her focus in risk adjustment, she led solutions for molecular diagnostic utilization management and reimbursement. Jill received her BA in Psychology from The University of Chicago and received her MBA and MS in Management Information Systems from Boston University.
Mikal Sutton is Managing Director of Medicaid policy for the Blue Cross Blue Shield Association (BCBSA), a national federation of thirty-four independent, community-based and locally operated Blue Cross and Blue Shield (BCBS) companies. BCBSA covers 114 million lives across all lines of business in the U.S. and Puerto Rico. Twenty-four of the BCBSA Plans operate a Medicaid program in twenty-nine states and Puerto Rico with more that twelve million Medicaid members.
With almost 15 years of experience Sutton has collaborated with state and local agencies, organizations, and external stakeholders to build substantive policy solutions. Sutton oversees detailed Medicaid policy analysis and strategies to support BCBS companies, in collaboration with BCBSA’s legislative, regulatory, research and modeling teams. Since joining the Association in 2020, Sutton has worked on regulatory and policy development on a wide variety of program issue areas including maternal health, social determinants of health, long-term services and supports, expansion of Medicaid and the Public Health Emergency unwinding.
Sutton has worked on Medicaid policy in Illinois, policy initiatives with the Illinois Department on Aging and as a director of grant operations for a Robert Wood Johnson Foundation grant focused on growing the nursing pipeline in Illinois. Sutton has a master’s degree in political studies and a bachelor’s degree in communications from the University of Illinois at Springfield.
An Illinois native, Sutton earned a bachelor’s degree in communications and master’s degree in political studies from the University of Illinois, Springfield. She enjoys outdoor activities, listening to music and traveling with her family.
Department of Health and Human Services (HHS), Office of Inspector General (OIG)
Megan Tinker is the Chief of Staff of the Department of Health and Human Services (HHS), Office of Inspector General (OIG). She works closely with the Inspector General to develop and support a high-level vision, enhance OIG’s oversight, and promote the efforts of OIG’s highly skilled workforce, including auditors, agents, attorneys, and evaluators.
As the Chief of Staff, Ms. Tinker serves as the Deputy Inspector General for OIG’s Immediate Office, where she oversees OIG’s Office of Congressional Affairs, Office of Communications, and Office of Operations. Under Ms. Tinker’s leadership, OIG builds and strengthens relationships with legislative partners, amplifies OIG’s impact through constructive collaboration with the media, and ensures consistent levels of excellence in its internal processes and delivery of oversight products. Additionally, Ms. Tinker represents OIG leadership in cross cutting efforts involving HHS, OIG partners, other Government agencies, and external stakeholders.
Ms. Tinker joined OIG in 2004 as a Senior Associate Counsel in the Office of Counsel to the Inspector General (OCIG). During her tenure with OCIG, Ms. Tinker assumed increasingly important leadership responsibilities, including a role as the Senior Advisor for Legal Affairs from 2016 to 2020. From 2021 to 2023, Ms. Tinker served in the Office of Audit Services as an Assistant Inspector General, where she furthered her impressive track record by conceiving and spearheading innovative, collaborative, and high-impact work for OIG and the IG community.
Prior to OIG, Ms. Tinker was in the private practice of law and worked for several years as a congressional oversight staffer. Ms. Tinker graduated cum laude from American University Washington College of Law and with honors from the University of Richmond.
NFL Network Analyst, Hall of Fame Running Back, MVP and 5x Pro Bowl Selection
LaDainian Tomlinson NFL Network Analyst, Hall of Fame Running Back, MVP and 5x Pro Bowl Selection
NFL legend LaDainian Tomlinson, or "L.T.", has achieved iconic status both on and off the field while overcoming seemingly insurmountable odds along his journey of success; despite being overlooked for factors like size, durability, and collegiate level competition he persevered to become a triple Hall-of-Famer in College and NFL, an NFL MVP recipient and 2006 Walter Payton Man of The Year Award winner.
His compassion is evident in founding the Touching Lives Foundation in 2004 which works tirelessly for those less fortunate across numerous civic initiatives - from awarding scholarship money through grants to creating cultural awareness programs with US Veterans organizations.
Furthermore, L.T.'s work ethic even extends into social entrepreneurship where he leads many successful ventures such as the Tomlinson Center, 3SIXT Culture Management Software, LT21 Sports aimed at developing high production cultures within low socio-economic school districts via leadership development, mentor coaching sessions with students and staff that ultimately improved attendance by 12%, reduced recidivism rates by 61% whilst boosting academic performance scores to 18%!
Rising job market gaps will be filled thanks to Mr. Tomlinson’s' workforce program for tutoring, community engagement, and career experiences aligning corporations with students who must develop appropriate skills necessary to meet global employment challenges head on...providing opportunities for both our companies and students to ensure America’s future is intact.
Director of Operations, Condition Management and Documentation, Enterprise Population Health
Jessica Vaughn Director of Operations, Condition Management and Documentation, Enterprise Population Health
Advocate Aurora Health
A nurse of 26 years, Jessica has 12 years of CDI experience in both inpatient and ambulatory settings. She joined Advocate Health in 2022, where she leads a large multidisciplinary team focused on ambulatory documentation for risk adjustment and quality gap closure, as well as teams focused on Population Health initiatives including patient outreach, comprehensive care, and revenue cycle management.
Jessica is a leader in the industry, having previously created and led ambulatory CDI initiatives for Atrium Health Wake Forest Baptist in Winston-Salem, NC and Norwood in Austin, Texas. She has spoken at multiple conferences, authored articles, received ACDIS’s Professional Achievement Award and helped write both the original study guide and the initial CCDS-O certification exam. She has held clinical certifications in oncology, chemo and biotherapy, and AHIMA’s approved ICD-10 CM/PCS trainer.
Jessica completed her Doctor of Nursing Practice in Executive Leadership at Duke University and believes in empowering interprofessional teams to improve patient care.
DNP, RN, Director of Quality Management
AmeriHealth Caritas Pennsylvania and Keystone First
Helen Veet DNP, RN, Director of Quality Management
AmeriHealth Caritas Pennsylvania and Keystone First
Helen Veet DNP, RN is the Director of Quality Management for AmeriHealth Caritas Pennsylvania and Keystone First Medicaid Plans. Helen specializes in the Medicaid quality programs, assist with HEDIS project collection, and has a passion for healthcare quality. She has a background in cardiac and orthopedic clinical nursing as well as Healthcare Systems Leadership. In her role at AmeriHealth Caritas Pennsylvania and Keystone First, she overees the Community Health Navigator team, Community Outreach Team, and the Quality of Care Nurse team. She enjoys country line dancing and traveling the world with her family.
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 is a Quality Improvement expert who helps health plans achieve higher quality, operational excellence, and more meaningful engagement with all stakeholders. oPrior 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.
As BeneLynk’s Chief Product Officer, Terry synthesizes the voice of the customer, market feedback, elements of technical design with regulatory requirements and emerging trends to execute a meaningful/aggressive roadmap, drive innovation to a vision, maximize growth and customer success. Terry has more than 30 years of health care leadership experience with a proven history of integrating industry expertise, leadership, creativity, and collaboration to drive excellence in solution innovation, operational execution, and organizational improvement. Innovation, collaboration, and customer success has been the center piece in each of leadership positions Terry has successfully performed in such companies as McKesson, UnitedHealth Group, Change Healthcare, Apixio/Centene and now BeneLynk.
Terry has been recognized for his focus on these core tenants; Innovation, Collaboration, Customer Success). In 2012 Terry was awarded an OptumInsight Innovation award in recognition of his leadership on the Care Pattern Analysis solution. This innovation would enable clinicians and medical directors to conduct meaningful coaching discussions with providers that would reduce cost by decreasing and, in some cases, eliminating the variations in care.
In 2013, the Certified HEDIS solution, for which Terry provided Product Management leadership, was the recipient of the Gartner award for demonstrating best practices in dashboard design for HEDIS reporting. In addition, in 2013 Terry was the recipient of the 2013 Optum Innovation Leadership Shadow Award which recognizes individuals who consistently support Optum’s innovation culture in their daily work and inspire innovation in others through their leadership shadow. Sponsored three quality management solution patents as co-inventor.
In 2020 and 2021 Terry was directly responsible for designing, developing, and integrated two new solutions into the Apixio portfolio, accounting for over $3 million of revenue in just the first seven months of their release.
Terry earned his Bachelor of Arts degree from the University of Montana – Missoula and completed the Post-Baccalaureate Pre-Professional Health Science Program (Pre-Med) at Loyola University of Chicago.
Jon Wasson, a seasoned healthcare executive, is passionate about using data-driven strategies to revolutionize healthcare delivery. With over 20 years of enterprise technology experience, including 10 years in healthcare, he has a remarkable track record of successfully bridging the gap between data, interoperability, and analytics. Jon's expertise includes healthcare SaaS, interoperability, integration (EMR, HIE, API, HL7, FHIR, etc.), data analytics and reporting, AI/NLP, and digital solutions (point-of-care, portals, search engines, etc.). His thought leadership in healthcare is widely recognized, as evidenced by his prominent presence in conferences, panels, and publications like CEO World Magazine. He advocates for interoperability and data-driven innovation, inspiring professionals to embrace transformative technologies and harness data as a powerful tool to elevate patient care quality.
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.
Adrian White VP, Quality Operations, Clinical Safety & Patient Experience
Southwestern Health Resources
Adrian is an influential, people-centric executive who bridges gaps and drives results across clinical, safety, quality, and patient experience workflows through cross-functional collaboration, emotionally intelligent people management, and business acumen. He received his nursing degree from the Royal College of Surgeons in Ireland, an MBA from University College Dublin, and is a Certified Professional in Patient Safety (CPPS) and in Patient Experience (CPXP). He has been active in the areas of Clinical Care, Quality, Safety, Accreditation and Patient Engagement for over 20 years, having worked at St. James’s Hospital in Dublin and Mayo Clinic Health System in Minnesota before joining UT Southwestern in Texas in 2013. He is currently employed by Southwestern Health Resources (SWHR), as the VP for Quality Operations, Patient Experience and Clinical Safety. SWHR blends the strengths of University of Texas Southwestern Medical Center and Texas Health Resources; includes a network of 29 hospital locations and more than 5,000 physicians, committed to being the national leader in population health. Adrian’s role focuses on strategies to develop, deploy and sustain comprehensive programs across the multi-specialty SWHR Clinically Integrated Network, leading the strategic direction of this large-scale matrixed organization.
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.
Essence Williams serves as Head of Risk Adjustment for Yuvo Health. She has been a registered nurse for just shy of 20 years, spending the first decade at the bedside in critical care and the latter decade solely in the Risk Adjustment documentation and coding space. Essence is passionate about people and is adamant that healthcare should be a right for all. She joined Yuvo primarily because the mission and values between herself and the organization aligned beautifully. She is confident that this very necessary work can and will be done. Essence holds a BSN from St. Petersburg College, and an MHA from Ashford University. She lives in Brandon, FL with her son (Josiah) and her daughter (Kai).
Aaron Winkel is a Senior Solutions Manager and Product Owner for Veradigm’s Risk Adjustment Analytics product suite. He has over 25 years of experience in the health care industry. Prior to his 7+ years at Veradigm (formerly Pulse8), he spent over 10 years at a health plan in Portland, OR in various leadership roles. As the Manager of the Analytics team, Aaron focused on Utilization metrics, Cost trends, opportunities for savings initiatives, Medicare bids, and oversaw all Risk Adjustment activities. He began his career as a Healthcare Analyst for a medical group that assumed financial risk for their patients by doing managed care. He received his Bachelor of Science in Statistics from Brigham Young University.
Mike Zeli has over 20 years of Healthcare experience w/ 10+ years in risk adjustment with an emphasis on Medicare Advantage. After starting a career as an Acturarial Analyst, he was able to adapt his technical and analytical experience to the world of Risk Adjustment. His experiences range from managing RAF coding production, estimating risk adjusted financial accruals, managing vendor relationships, coordinating RAPs and EDS processes, In home assessments, and other prospective CDI programs.
He is currently the Executive Director of Risk Adjustment and Quality for AdventHealth. This role leverages prior health plan experience to educate primary care providers on the importance of risk adjustment and coding to the highest level of specificity.
Beth works closely with our customers to ensure we deliver solutions that support their strategic objectives and drive better healthcare outcomes. She brings more than 20 years of experience in healthcare technology, consulting, project management, and sales. Beth got her start in healthcare IT at Epic and has held leadership roles at Evergreen Healthcare PArtners and healthfinch. An impassioned solution-oriented leader, Beth is committed to bringing our customers innovative solutions that reduce waste and enable greater access to care.