Mark joins Bright from QualChoice Health Plan Services where he spent 5 years as the Vice President of STARs and Quality and was accountable for the strategy and execution of CMS Star quality rating initiatives across all Medicare Advantage (MA) plans. During his tenure, Mark helped launch QualChoice’s first 4 STAR plan as well as help facilitate the sale of QualChoice’s largest MA contract to Premera Blue Cross. Prior to QualChoice, Mark spent 9 years at Humana, most recently in their STARs program, where he was accountable for reporting and analytics and worked closely with senior leaders and other key stakeholders to determine and prioritize STARs initiatives targeted to providers and members. During his tenure, Mark helped lead Humana from 0% of members in 4-star rated plans to over 90% of members in 4-star rated plans, driving over $900M in incremental revenue. Mark has also spent time in public accounting and the financial services industry and has also taught at local universities in the Louisville, KY area. Mark earned his MBA from Bellarmine University in Louisville, with a concentration in entrepreneurial studies.Mark is based in Louisville, where he lives with his wife Kirsten and their three children; son Hudson, son Luke, and daughter Julia. Mark spends much of his free time playing guitar and as head coach of his son’s middle school basketball team, but also enjoys running, swimming, and has been known to participate in the Ironman from time to time.
Matthew Anderson, MD is a father, husband and Family Physician living in Arizona. He serves as Innovation Lead and division Medical Director for Banner Health.
Since joining Banner in 2018, Matt has been an active member of the AZBio Government Affairs Committee.
“By providing Primary Care medical services to my patients in Arizona, I have seen the many of the inefficiencies and difficulties within our healthcare system. My training at Mayo Clinic taught me what it means to put the patient first and that focus has stayed with me for every patient encounter. Recently I completed an MBA program at the WP Carey School of Business. My goal is to take the foundation I have in good quality medical care and combine that with an understanding of the economics of healthcare to use technology to create a better, safer and healthier medical system.”
Derek Bergsten was sworn in as the tenth Chief of the Rockford Fire Department on November 14, 2008. As Fire Chief, Derek has led the Department through a time of positive change, brining the organization from a time of “this is how it has always been done” to using data-driven performance based approach. Derek supports building strong relationships within the community to create community collaboration. After joining the department, Chief Bergsten continued to further his education obtaining both an Associates of Science and an Associates of Fire Science from Rock Valley College, a Bachelor in Business and Organizational Development from Western Illinois University and a Master of Public Administration from Northern Illinois University. In addition to many specialized fire certifications, he is also the first member of the Rockford Fire Department to graduate from the Executive Fire Officer Program of the National Fire Academy and Naval Post Graduate School-Homeland Security Exectuive Leaders Program. Chief Bergsten is also designated as a Chief Fire Officer and Chief EMS Officer and Training Officer from the Center for Public Safety Excellence. The Department is 1 of 14 Departments nationally to be dual accredited by CPSE and CAAS. Besides all of his duties first as a firefighter and now as Fire Chief, Bergsten finds time to serve as a volunteer for Alignment Rockford and Transform Rockford. And last, but certainly not least, he is happily married to Christine and the father of three children; Alexandra-22, Sophie-17 and Jackson-16.
Antonette Buenavides Director of Risk Adjustment Programs & Audit
SCAN Health Plan
As the Director of Risk Adjustment, Programs & Audit at SCAN Health Plan, Antonette is responsible for the overall performance of Risk Adjustment in her organization. In this capacity, she oversees all risk adjustment audits including those that are mandated by the state and the federal government. Antonette has 15 years of solid healthcare experience in the Medicare and commercial lines of business.
Stephanie D. Conners, MBA, BSN, RN, NEA-BC serves as Executive Vice President and Chief Operating Officer for Jefferson Health, an integrated and complex academic-community health system serving the Philadelphia and southern New Jersey communities. Ms. Conners joined the Jefferson Health leadership team in September 2018 and leads its fourteen acute care hospitals, one long term care facility, and multiple ambulatory, diagnostic, and urgent care centres across both states. Jefferson is one of the most complex and fastest growing health systems in the country, employing more than 32,000 individuals and generating greater than $5 Billion in annual revenue. Ms. Conners is a well-respected senior Healthcare Executive with over 25 years of extensive healthcare experience and a proven track record of excellence in driving the highest safety, service, and quality while maintaining operational and fiscal rigor. Prior to joining Jefferson Health, Ms. Conners served as the Senior Executive Vice President, Chief Operating Officer and System Chief Nursing Officer at Cooper University Health Care/The Cooper Health System. During her career, she has held significant operational and nursing leadership positions at Robert Wood Johnson University and Hahnemann University Hospital/Tenet. Ms. Conners was named the youngest Chief Nursing Officer across the country when appointed Chief Nursing Officer for Hahnemann University where she served for more than a decade. Ms. Conners earned her MBA at Eastern University and her Bachelor of Science in Nursing from Villanova University. She completed a Johnson & Johnson/Wharton Fellowship in Management for Nurse Executives at the University of Pennsylvania and is also a certified Six Sigma Black Belt. Ms. Conners is a past recipient of Modern Healthcare’s “Up and Comer” award. Ms. Conners is passionate about healthcare and has dedicated her life to driving excellence in the organizations she leads and providing high quality care to her community.
Sean Creighton serves as vice president for Federal Policy at Humana, a leading health care firm. Sean provides leadership in the development and implementation of federal policy strategy. Prior to Humana, Sean works for 3 years as Managing Director and head of policy analytics at Avalere, a premier consulting firm focused on health care. Sean led projects in a number of key areas, Part D reform, risk adjustment and RADV, and analysis of Medicare Advantage performance relative to FFS on cost, quality and utilization. Sean also spent 2 years as SVP for risk adjustment product at Verisk Health (now Cotiviti) working on data aggregation, coding, and submission products for Medicare and the commercial market to ensure appropriate revenue and elevate performance.
Before joining Verisk Health, Creighton was the deputy group director of the Payment Policy and Financial Management Group in the CMS Center for Consumer Information and Insurance Oversight. He also served as the director of the division of Payment Policy and Risk Adjustment in the Medicare Plan Payment Group in the Center for Medicare.
While at CMS, Creighton was responsible for payment policy and operations for both private marketplace and Medicare plans. Notable accomplishments include developing and implementing a system to make advance premium-tax credit and cost-sharing reduction subsidy payments to marketplace issuers under the Affordable Care Act; developing and implementing Parts C and D risk adjustment models; and serving as the sponsor and chief architect of the Medicare Encounter Data System (EDS).
Creighton holds a Bachelor of Arts degree in European studies from the University of Limerick, a Higher Diploma in Statistics from Trinity College, Dublin, a Master of Science degree in Sociology from the London School of Economics, and conducted doctoral research at Indiana University, Bloomington. He has won numerous awards for development and implementation of risk adjustment and payment models.
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 P4P and FWA strategic teams. Prior to her position with Paramount she had 19 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 graduated from the University of Toledo with a Bachelors of Science in Health Information Management and will graduate with her Masters of Business in Healthcare Systems Management from the University of Toledo in December 2015. 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 certified ICD-10 trainer through AHIMA.Deb is blessed with one awesome husband of 24 years, three amazing children (one son-in-law), and one adorable grandson who all fill her life with a lot of joy, a little mischief, and a whole bunch of love.
A farmer by birth and biologist by training, for the past two years Will Dukes has been the Director of Business Development for iCare Intelligence, a firm dedicated to Provider Engagement in Value Based Care. A former teacher of the year in one of the largest public school districts in the nation, Will’s advanced degrees in Education and Communication and Master’s in Global Business Administration has enabled him to lead communication campaigns and change initiatives in a variety of industries. Now in healthcare, Will’s unique experience and background allows him to combine skills in systems approach, data analysis, and education to improve communications not only between iCare and their payer clients, but between payers and providers as well. In his free time, will enjoys wood turning and amusing his wife by serving as a life-sized karate dummy for his two wonderful children.
Michelle Duran Practice Transformation Facilitator
Hill Physicians Medical Group
Michelle Duran is Practice Transformation Facilitator at Hill Physicians Medical Group (HPMG). HPMG is the largest network of independent providers in Northern California with more than 4,000 physicians. Michelle has worked at HPMG for over 12 years and supports the network to improve healthcare processes and outcomes, including delivery of wellness and preventive services. She is dedicated to advancing the quality and efficiency of healthcare at HPMG by creating scalable, measurable improvement that focuses on patient care and provider engagement. During the COVID-19 pandemic she is advising and assisting the physicians of the HPMG network in transitioning into telehealth services to insure they continue to deliver high quality health care services to their patients.Michelle holds two American Academy of Professional Coders (AAPC) certifications, Certified Professional Coder and Certified Risk Adjustment Coder as well as BS in Business Management from University of Phoenix. Michelle is a member of AAPC and past Membership Development Officer of her local AAPC chapter. Michelle recently participated in CMS sponsored California Quality Collaborative (CQC) four-year practice transformation initiative to improve measures of cost, quality and patient experience.
Kathleen is a pioneer in bringing the best of consumer marketing and data-driven methodologies to healthcare to motivate better health decisions. As Co-Founder and Managing Director of Engagys, Kathleen leverages the best of behavioral economics, the latest in evidence-based communications combined with the insights from over a billion consumer interactions in health to help healthcare organizations close the last mile of consumer engagement. She consults on all topics related to consumer engagement and experience for the top healthcare organizations in the country.
Kathleen has been recently named as a consultant to the first ever FDA Patient Engagement Advisory Committee (PEAC). She received Stevie awards for highlighting opportunities for improving the lives of people with chronic conditions. She speaks regularly on the national stage on many topics including: driving consumer health engagement, creating better consumer experience in healthcare, and using data to drive consumer behavior.
Kathleen also participates in various healthcare advisory boards, including HealthComp’s Consumer Experience Advisory Board, Linkwell Health’s Marketing Advisory Board and RISE’s Consumer Engagement Advisory Board
Kathleen spent the first twenty years of her career in brand marketing at leading consumer marketing organizations, including General Mills and P&G. Additionally, she was a Vice President at Digitas, one of the leading direct marketing firms in the country. Kathleen has an undergraduate degree from the University of New Hampshire and an MBA from the Kellogg School at Northwestern.
Colleen Giantasio Director of Ambulatory Clinical Documentation Quality Improvement
Mount Sinai Health System
Colleen Gianatasio CPC, CPC-P, CPMA, CPC-I, CRC, CCS, CCDS-O has over 20 years of experience in all aspects of the business of healthcare. As Director of Ambulatory CDQI for Mount Sinai Health Care Partners she is responsible for provider engagement and clinical documentation improvement for accurate coding. 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 is President - elect of the AAPC National Advisory Board.
Brent Gleeson is a Navy SEAL combat veteran with multiple combat tours to Iraq and Africa. Upon leaving SEAL Team 5, Brent turned his discipline and battlefield lessons to the world of business and has become an award-winning entrepreneur, bestselling author, and acclaimed speaker on topics ranging from resilience, mental toughness, leadership and building high-performance teams to culture, and organizational transformation. Brent is the Founder and CEO of TakingPoint Leadership, a progressive leadership and organizational development consulting firm with a focus on business transformation and building high-performance cultures. Brent was named a Top 10 CEO by Entrepreneur Magazine in 2013. Brent holds degrees in finance and economics from Southern Methodist University, certificates in English and History from Oxford University in England and a graduate business degree from the University of San Diego. He is the bestselling author of TakingPoint: A Navy SEAL’s 10 Fail-Safe Principles for Leading Through Change, which was a #1 New Release on Amazon in Organizational Change and Business Structural Adjustment. Brent latest book, Embrace the Suck: The Navy SEAL Way to an Extraordinary Life, publishes on December 22, 2020.
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.
Eric Harman has been board certified in Family Medicine since 2000 and a member of Mountain Region Family Medicine (MRFM) in Kingsport, TN, since 2002. Presently Dr Harman serves as MRFM's IT Committee Chairman and board President. He is a graduate of University of Maryland College Park and East Tennessee State University College of Medicine. He has been active in population health improvement projects through committee work with Highlands Physicians IPA, Qualuable ACO, and through MRFM’s participation in Medicare Advantage shared savings programs. He enjoys spending time with his wife and 3 kids in his spare time and also travelling.
Dominic Henriques Vice President of Performance Improvement
Prominence Health Plan
Dominic currently serves as Vice President of Performance Improvement at Prominence Health Plan; he oversees all risk adjustment, quality improvement and medical management operations for the plan. Dominic is a process-oriented leader with a passion for staff development and technologies that improve workflow efficiency. Prior to his role at Prominence, he held various roles at OptumCare working with Western market care delivery organizations to optimize their risk adjustment and quality improvement operations. Dominic earned his Bachelor’s degree in Psychology from the University of Nevada, Reno and his Master of Healthcare Administration from the University of Nevada, Las Vegas. He currently lives in Reno, NV with his wife, two kids (4 and 2 yrs) and enjoys running competitively on the weekends.
Dr. Stephen Klasko President and Chief Executive Officer
Thomas Jefferson University and Jefferson Health
Dr. Stephen Klasko is an advocate for a transformation of health care and higher education. He has been a pioneer in using technology to build health assurance, not just sick care. As President and CEO of Philadelphia-based Thomas Jefferson University and Jefferson Health since 2013, he has led one of the nation’s fastest growing academic health institutions based on his vision of re-imagining health care and higher education. Under his leadership, Jefferson Health expanded from three hospitals to 14. His 2017 merger of Thomas Jefferson University with Philadelphia University created a pre-eminent professional university that includes fashion, design, architecture and health. In 2020, he was named the first Distinguished Fellow of the World Economic Forum, and will co-chair the WEF Board of Stewards for The Future of the Digital Economy and New Value Creation. In 2020, he has published two books: Un-Healthcare: From Sick Care to Health Assurance, with Hemant Taneja. And Patient No Longer: Why Healthcare Must Deliver the Care Experience that Consumers Want and Expect. His best-selling 2018 book is titled, Bless This Mess: A Picture Story of Healthcare in America. President Klasko has served as dean of two medical colleges, and leader of three academic health enterprises before becoming President and CEO at Jefferson. For three years he has been listed among the Top 100 most influential people by Modern Healthcare - in 2018 he tied for #2. His work on healthcare in a digital economy includes his 2009 colloboration with Apple Inc on digital media in healthcare, the 2012 building of one of the nation's largest medical simulation centers (CAMLS), and the development at Jefferson of his vision of "healthcare with no address." He is working with several digital health companies on the vision of "health assurance," using new technology to keep people well, instead of waiting to provide sick care.
Elissa Langley is an accomplished health care professional with thirty plus years of payor, provider, and consulting experience, Ms. Langley is the Vice President, Chief Operating Officer for Triad HealthCare Network (“THN”) of the Cone Health System. Her responsibilities include assisting with the development, implementation, and operation of THN, an Accountable Care Organization (“ACO”) in the Piedmont Triad area of North Carolina. She is currently responsible for THN’s operations, which includes managing over 185,000 covered lives. She oversees contracting with all Payers for THN’s shared savings/risk arrangements, including the Next Generation ACO Program. Additionally, she managed the implementation of a Medicare Advantage Risk Agreement with Humana and North Texas Specialty Physicians and was instrumental in the development of Cone’s Medicare Advantage Plan called HealthTeam Advantage. Previously, Ms. Langley has worked for managed care plans such as Humana and Aetna as a Network Manager. She was part of the initial U.S. Healthcare expansion team into Atlanta, Georgia, which grew to over 100,000 members in its first year of operation. Ms. Langley holds a Master of Healthcare Administration degree from Duke University and a Bachelor of Science degree in Zoology from Duke University. Ms. Langley is currently a member of the Policy Committee for the National Association of ACO’s (NAACOs) and is THN’s representative on the Next Generation ACO Coalition. She is a Board Member of Mental Health Greensboro and Proficient Health.
Teaching yoga since 2006, Kim Larkin was trained at OM Yoga Center in New York City and has also studied restorative yoga, experiential anatomy, prenatal yoga, and chair yoga. She teaches a range of students and abilities and especially enjoys introducing yoga to new students. Offering clear instruction and a lighthearted approach, her classes usually include some meditation and breathing exercises in addition to the yoga postures. An avid traveler, Kim leads yoga retreats and adventures around the world. Wherever she travels, she is continually awed and inspired by our interconnectedness and similarities, while at the same time values how our differences make the world a richer and more vibrant place. Her motivation as a retreat leader is to share heart-opening cultural exchanges and adventures with other curious beings. You can find details for upcoming 2021 retreats at www.kimlarkinyoga.com.
Tom Lutzow is the President/CEO of Independent Care Health Plan (iCare). iCare began as a research and demonstration program for SSI-Medicaid managed care in 1992, funded by CMS. iCare is a joint venture between Humana and a local Milwaukee rehabilitation agency. Tom was an original architect of this initiative, has served on iCare’s Board of Directors since its inception, and assumed the position of President/CEO in 2008.Independent Care serves individuals who are impoverished, have substantial multiple-morbid conditions, and frequently suffer from mental health or behavioral challenges. Seventy-five percent (75%) of iCare’s SSI members are below age 65. Fifty-five percent of iCare members have behavioral or mental health co-morbidities. iCare operates two dually eligible Special Needs Plan (D-SNP) with more than 7,000 members, a fully integrated Special Needs Plan (FIDESNP), an SSI-Medicaid and BadgerCare plan. iCare’s Special Needs Plans serve members with highly complex conditions who are 100% poor and 68% disabled, regarded by CMS as among the most difficult to serve individuals. iCare is rated by CMS as a 4.0-Star plan based on its Part C and Part D performance measures.Tom has an MBA awarded by Keller Graduate School of Management and received his PhD from Marquette University. He is an advocate for improved Medicare and Medicaid integration.
Senior Manager of Enterprise Risk Adjustment, HCC Coding and Quality Assurance
Donna Malone Senior Manager of Enterprise Risk Adjustment, HCC Coding and Quality Assurance
Tufts Health Plan
Donna has been on the job with the Tufts Health Plan in their enterprise risk adjustment division since August 2014, and is responsible for audit and coding review and provider education (CDI) management, development and implementation of department and vendor policies and procedures, government audits (CMS-RADV, HHS-RADV Audits), coding team performance management and provider education development and management.
Additionally, Donna serves at the MassBay Community College in Framingham, where she has been an advisor / professor for 16 years. Her specialty area is the Medical Coding Certificate and Medical Office Administration Program.
Prior to Tufts Health Plan, Donna worked for Blue Cross Blue Shield of Massachusetts as an HCC Professional Audit III for four years. Earlier, she worked for AM B Care for 9 years and Maine Medical Center.
Donna is frequently an invited speaker at RISE conferences. Additionally, she has contributed significantly to the design and implementation on both in-person workshops and the online courses offered by the RISE Institute. She is chair of the faculty and provides coaching, mentoring, and development support to the national faculty under contract with RISE. Whenever RISE implements an on-site training program on HCC coding and documentation, Donna is the first-person RISE turns to for the teaching role.
Jason McDaniel Vice President, Risk Adjustment and Quality
Healthcare Partners Nevada
Jason McDaniel has over a decade of experience as a healthcare leader in provider, payer, and government operations and is currently the Vice President of Risk Adjustment and Quality for Healthcare Partners (HCP), one of the largest healthcare providers in the Southwest. In partnership with the Medical Director of Risk Adjustment and Quality, Jason has direct oversight of quality nurses, CDI nurse reviewers, value-based care focused nurse practitioners, medical coders, vendor relationships, and all other aspects of risk adjustment and quality prospective and retrospective operations.Prior to his time at HCP, Jason was the Risk Adjustment Operations Director at Banner Health in Arizona. As a senior leader, he directed multiple teams in establishing the Banner Health risk adjustment and quality program as well as overseeing a pivotal segment of the integration of Banner Physician Hospital Organization and Arizona Integrated Physicians.Jason spent 6 years at Cigna Healthcare of Arizona as the Medical Coding Manager and Medical Business Trainer as part of both medical group and payer operations. During his time at Cigna, Jason helped develop risk stratification and social determinants of health criteria, an internal point of care solution for population health and Medicare Advantage metrics and an extensive provider education program.Jason has been a Certified Professional Coder since 2006. He earned his Bachelor's Degree in Healthcare Administration from the University of Phoenix and his Master's Degree in Healthcare Innovation from Arizona State University.
John E. McDonough, DrPH, MPA is Professor of Public Health Practice in the Department of Health Policy & Management at the Harvard T.H. Chan School of Public Health and Director of Executive and Continuing Professional Education. In 2010, he was the Joan H. Tisch Distinguished Fellow in Public Health at Hunter College in New York City. Between 2008 and 2010, he served as a Senior Advisor on National Health Reform to the U.S. Senate Committee on Health, Education, Labor and Pensions where he worked on the development and passage of the Affordable Care Act. Between 2003 and 2008, he served as Executive Director of Health Care for All, Massachusetts’ leading consumer health advocacy organization, where he played a key role in passage and implementation of the 2006 Massachusetts health reform law. Between 1998 and 2003, he was an Associate Professor at the Heller School at Brandeis University and a Senior Associate at the Schneider Institute for Health Policy. From 1985 to 1997, he served as a member of the Massachusetts House of Representatives where he co-chaired the Joint Committee on Health Care. His articles have appeared in Health Affairs, the New England Journal of Medicine and other journals. He has written three books, Inside National Health Reform, published in September 2011 by the University of California Press and the Milbank Fund, Experiencing Politics: A Legislator’s Stories of Government and Health Care by the University of California Press and the Milbank Fund in 2000, and Interests, Ideas, and Deregulation: The Fate of Hospital Rate Setting by the University of Michigan Press in 1998. He received a doctorate in public health in 1996 from the School of Public Health at the University of Michigan and a master’s in public administration from the John F. Kennedy School of Government at Harvard in 1990.
Gabriel McGlamery Senior Health Care Policy Consultant
Florida Blue Center for Health Policy
Gabriel McGlamery is in charge of Federal regulatory policy for Florida Blue’s individual market business. This means analyzing, influencing, and general problemsolving for the insurer covering roughly 10% of Marketplace enrollment. Prior to joining Florida Blue in 2012, Gabriel helped develop the rules for the ACA at HHS and graduated with honors from the University of Connecticut School of Law.
Dave is a strong leader with 14+ years of experience in Revenue and Clinical Outcomes Program Development and Management in various healthcare environments (Plans, MG/IPA, Academic, and Consulting). Proven record of success in optimizing Operations, PE / Investor Meetings, Maintaining Compliance, Recovering / Maximizing Revenue, Enhancing Clinical Quality and Developing Software and Custom Analytics. Specialties: RA / HCC, Pay for Performance (P4P), CMS Stars Program, NCQA HEDIS, Off‐shore Software Product Development, HOS, CAS, NCQA Accreditation, Physician Profiling, Encounter Programs, Contract and Claims Analytics. Previously, Dave served as an independent consultant to health plans, was Corporate VP, Operations(Revenue and Quality) at InnovaCare Health. He has also performed as Sr. Consultant, Risk Adjustment and Health Plan Operations for Dynamic Healthcare Systems, and in other roles with health plans.
Vice President of Public Policy and External Relations
Frank Micciche Vice President of Public Policy and External Relations
Frank Micciche is NCQA’s vice president of Public Policy and External Relations. In this position, he directs NCQA’s relations with Congress, federal agencies and the states, as well as NCQA’s work with employers, associations, corporate sponsors and the media.Micciche was formerly the Vice President for Partnerships and Coalitions at the Campaign to Fix the Debt, a nonpartisan collaboration of prominent public and private sector leaders and more than 350,000 grassroots supporters working to address the nation’s fiscal imbalance. Prior to this position, he was a Senior Advisor on health reform at McKenna, Long & Aldridge, LLP and worked for the New America Foundation think tank.Micciche’s service in the public sector includes his time as a legislative director for the House Minority Leader in Massachusetts and as a federal liaison for Governor John Engler of Michigan. He served for four years as the Director of State-Federal Relations for Governor Mitt Romney (R-MA), where he led the Commonwealth’s Washington, DC, office and advised the governor on federal policy issues, with a focus on health care reform.Micciche holds a master’s degree in public policy from the John F. Kennedy School of Government at Harvard University, and a bachelor’s degree in political science from Tufts University.
Dr. Marc Milstein specializes in taking the leading science research on health and happiness and presents it in a way that entertains, educates and empowers his audience to live better. His presentations provide science based solutions to keep the brain healthy, boost productivity and maximize longevity. He earned both his Ph.D. in Biological Chemistry and his Bachelor of Science in Molecular, Cellular, and Developmental Biology from UCLA. Dr. Milstein has conducted research on topics including genetics, cancer biology, and neuroscience, and his work has been published in multiple scientific journals. Dr. Milstein has been quoted breaking down and analyzing the latest research in popular press such as USA Today, Huffington Post and Weight Watchers Magazine. Dr. Milstein has also been featured on TV's "Dr. Oz" show explaining the latest science breakthroughs that improve our life.
Jenni has over 18 years of healthcare experience. Her expertise spans many areas including professional medical coding, revenue cycle processes, documentation improvement, compliance and risk adjustment. Jenni is currently the Risk Adjustment Coding Manager for a nonprofit healthcare plan in Minnesota that provides Medicare Advantage, Medicaid and ACA Exchange products. Her primary responsibility is the compliance oversight of the plans risk adjustment activities and project lead for all risk adjustment audits.
Joyce Nuesca, MD, MBA, MAS, CPE,
Regional Medical Director, Provider Partnership, Healthcare Quality and Affordability (HCQA)
Joyce Nuesca, MD, MBA, MAS, CPE, Regional Medical Director, Provider Partnership, Healthcare Quality and Affordability (HCQA)
Blue Shield of California
Dr. Joyce Nuesca is a board certified and licensed physician executive for 15 years who is passionate about value based health care delivery and payer-provider partnerships. She is currently a Regional Medical Director at BlueShield of California where she is accountable for the regional provider network population health strategy and performance. She leads teams in engaging providers ensuring collaborative partnerships and alignment on clinical and quality programs to support transformation and innovation and improve total cost of care. Part of her role is to ensure access of care and improve patient satisfaction. She is also involved in the development and implementation of new care models and new payments models.
Dr. Nuesca is a Primary Care Physician who subspecialized in Obstetrics and Women’s Health. She worked closely with providers in the clinics and hospitals as a Medical Director and Chief Medical Officer. As a physician leader in the clinics, she executed clinical and operational improvement and transformation like behavioral health -primary care integration, expansion of clinical services, redesigned care management and quality programs and implementation of electronic healthcare record and quality management data platform. She was also the Chief Medical Officer of Oregon Health COOP and oversaw the functions of medical management, was involved in network management and provider relations and development of quality management strategy. Dr. Nuesca finished her residency at Beth Israel Medical Center in New York City and fellowship in Obstetrics and Women’s’ Health at USC Keck School of Medicine. She also completed a Masters in Business Administration in Healthcare at UCI Paul Mirage Business School and currently completing her Masters in Applied Science in Population Health Management at Johns Hopkins University School of Public Health.
Dawn Peterson is the Director of Risk Adjustment Operations for Martin’s Point Health Care. Dawn has sixteen years of experience on the business side of medicine having worked with health systems in the Midwest, Pacific Northwest, and New England. Professional positions Dawn has served are various and include communication, auditing, education, billing and coding, and leadership for professional fee for service, risk adjustment, care management, HEDIS and population health.
Lou is currently the Senior Vice president of sales for Apixio Inc. Apixio is a Silicon Valley healthcare technology organization focusing on transformative HCC Coding technology enabling the review of thousands of EMR & PDF charts utilizing natural language processing, machine learning & linguistic pattern analysis.
Prior to joining Apixio, Lou was the vice president of sales for risk adjustment & quality solutions with Optum working closely with Medicare, Medicaid and Commercial Health plans throughout the country. Lou lives in Boston with his wife and has two great kids.
Tina Tressler Manager of Coding and Chart Operations
Prominence Health Plan
Tina Kim Tressler is the Manager of Coding and Chart Operations for Prominence Health Plan in Reno, NV. She is originally from New Jersey where she obtained her Bachelor’s Degree in English at Rutgers University. She started her career in New Jersey as a Certified Professional Coder and Medical Biller in 2010 and managed and oversaw all billing and coding operations for a multimillion dollar medical billing company for four years before transitioning to Nevada. Tina joined Prominence Health Plan as their very first ever Risk Adjustment Coder and second member of the Risk Adjustment Department, which has now grown to 18 members. At Prominence Health Plan, Tina supports various initiatives from Risk Adjustment to STARS and HEDIS by managing the Risk Adjustment Coding Department and the Chart Operations Team who retrieves thousands of records each year from across the provider network. She has successfully trained new Risk Adjustment Coders while also learning and training HEDIS abstraction. She has also successfully lead the RADV Audit since 2017. Tina Kim currently resides in Sparks, NV with her husband, Dennis Tressler, and dog, Nutello.
Yamilet Truex Manager for Risk Adjustment Data Analytics
Yamilet has over 22 years of experience in the managed care industry, both in health plan systems and care delivery, as well as 14 years of experience working in Medicare Advantage business processes. Her in-depth knowledge of Affordable Care Act (ACA) risk adjustment data management and Edge Server submissions have made her an invaluable piece of the Customer Success team at Pulse8. Her comprehensive background covers end-to-end aspects of Medicare Advantage RAPS and EDPS submissions, claims processing, and payments.
Kristen Viviano Manager, Risk Adjustment Coding Operations
Capital District Physicians’ Health Plan
Kristen Viviano has more than 10 years of experience in healthcare, working with both payers and providers in various roles and holds a Bachelor of Science degree in Health Information Management. As the Manager of Risk Adjustment Coding Operations for Capital District Physician’s Health Plan, Viviano leads a team of 14 auditors, chart retrievers, and professional coders. Viviano also oversees operations for a team of 10 international coders. She is involved with coordinating chart retrievals both internally and with multiple vendors. She enjoys learning about new technology and how that could apply and benefit the risk adjustment coding process.
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.
As Director of Coding Services for Centauri Health Solutions, Monica Watson has over 15 years of handson experience in coding, auditing, operations, and leadership for providers, facilities, and health plans. Ms. Watson has created and maintained best practices for correct coding, has designed and implemented audit programs, including CMS‐RADV, HHS‐RADV, Inpatient DRG, Outpatient OPPS, and Due Diligence. Monica has also assisted in designing and implementing new coding and auditing software. Ms. Watson holds a Bachelor’s degree in Health Information Management from the University of Cincinnati and serves on the AHIMA Practice Council for Clinical Terminology and Classification.
Anna Wetherbee has 15 years experience in the healthcare industry, in both start up and large integrated systems. In her current role, Anna leads strategy execution for Blue Shield of California programs in clinical quality, risk adjustment, population health, and clinical data infrastructure transformation. She is passionate about creating measurable change in the healthcare industry to improve quality, access and sustainability. Anna holds a Master of Business Administration, and certifications as a Project Management Professional and Lean Black Belt.
David Weathington is the Senior Vice President of Health Plan Operations for Clover Health, where he is responsible for ensuring operational effectiveness across key clinical and administrative functions including utilization management, in-home care, risk adjustment, STARs, quality improvement, customer experience, enrollment and claims. Prior to joining Clover, David served as Senior Vice President of Payer Strategy for Continuum Health, a physician enablement company that facilitated fair and transparent relationships between health plans and independent physicians. Before that, he served in a variety of health plan leadership positions with CIGNA-HealthSpring and Johns Hopkins Health Care. David has a BS in Psychology from University of Notre Dame, an MS in Clinical Psychology from Loyola College, Maryland and an MBA from Johns Hopkins University.
Daniel Weaver Vice President, Medicare & Medicaid Quality Programs
Gateway Health Plan
After 15 years at a BPO, Dan served as the Director of Programs at Highmark, Inc. where he led Stars programs for over 5 years before joining the Gateway Health team to establish a Stars Quality program focused on delivering 4.0+ Stars. Dan assumed responsibility for HEDIS, Quality Improvement, and Risk Adjustment programs across all lines of business at Gateway Health in 2018. In 2019, Gateway Health’s Medicaid program improved to a 4.0 Accreditation rating and 4.0 Medicare Star Rating.
Howard Weiss currently works in the Government Affairs & Policy Department at EmblemHealth, a nonprofit health plan headquartered in New York City serving 3.2 million enrollees in New York, Connecticut, and Massachusetts. Weiss is responsible for analyzing federal and state legislation and regulation across all business areas and developing advocacy to support EmblemHealth’s goals. Prior to joining EmblemHealth in October 2016, Weiss worked at America’s Health Insurance Plans (AHIP) in Washington, DC for more than 15 years, focusing on Medicare Advantage, Part D, and Medicaid policy. Weiss received a BA in Political Science from the University of Michigan and an MA in Public Policy from the University of Chicago, both many years ago.