Rise

Gaby Alcalá Founder and CEO

MAPA HealthCare

Gabrielena (Gaby) Alcala is a consultant with over 20 years of experience in the healthcare industry. She has worked with various organizations, from start-ups to large corporations. Her current focus is on helping organizations transition to value-based care. Gaby is passionate about assisting organizations in executing projects in an agile manner, improving processes, and making healthcare more patient-centered.

Gaby has worked with multiple organizations, including Iora Health, Community Care Cooperative (C3), CityBlock, Partners HealthCare (currently Mass General Brigham), BearingPoint (formerly KPMG Consulting), and The World Bank. Her work has included Medicare Advantage risk adjustment strategic planning and implementation, new business and program development, and operational system redesign.

With a great ability to swiftly adapt, she excels in managing complex projects, collaborating with stakeholders, inspiring teams, and consistently delivering positive outcomes in challenging environments.

She has an MA in Economics from the University of Michigan and a BA in Economics from Universidad Católica Andrés Bello in Venezuela. Gaby is fluent in English and Spanish, with intermediate proficiency in French.

Rachel Biblow Associate Editor of Strategy, Innovation, and Outcomes

Journal of Patient Experience

As a Healthcare Executive she relentlessly pursues better health, experience, and business outcomes. She facilitates transformational results by partnering with organizations to implement an outcomes-based experience model to achieve differentiated value.

As an expert advisor she partners with executive leaders and organizations to create clarity around strategic imperatives and intentional process design to achieve transformational outcomes. She most recently led as the Chief Experience Officer of JenCare, where she leveraged her experiences as a Partner & Senior Vice President at Press Ganey to create meaningful results across safety, quality, workforce engagement and patient experience.

Prior to Press Ganey, Rachel served at the Children’s Hospital of Philadelphia, leading the strategy and implementation of an enterprise-wide initiative to improve patient and family experience.

Rachel is widely recognized for her work advancing patient and family partnerships with health systems to drive value and quality outcomes. She is a founding leader of the National Pediatric Experience Collaborative formed in 2016. She is an international speaker on Experience, Culture, Patient & Family-Centered Care, Leadership Development, Organizational Dynamics and Change.

Kenya Boswell Senior Vice President, Community Affairs

Highmark Health

Kenya T. Boswell is the senior vice president of community affairs for Highmark Health, a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Ms. Boswell brings more than 20 years of leading community affairs, philanthropic and nonprofit management to the enterprise. Her role at Highmark Health involves overseeing community affairs for all markets in Pennsylvania, Delaware, West Virginia, and New York. This includes oversight of the Highmark Foundation, Highmark Inc. and its Blue-branded affiliates’ Highmark Bright Blue Futures charitable giving and community involvement program, Allegheny Health Network’s community giving and support of the Community Health Needs Assessments.

Before joining Highmark Health, Ms. Boswell served as the director of global impact citizenship at BNY Mellon, as well as the President for BNY Mellon Foundation of Southwestern PA. During her tenure at BNY Mellon, Kenya created a social innovation challenge that had a significant impact on under-resourced communities known as UpPrize. Ms. Boswell’s creation of UpPrize exceeded $2.5 million in investments, grants and technical assistance to social entrepreneurs and tech-startups.

Ms. Boswell earned her bachelor's degree in psychology from the University of Pittsburgh and her master's in nonprofit management from Robert Morris University. Her dedication to community service is evident in her board service at The Advanced Leadership Institute (TALI) and the Jefferson Regional Foundation. She also serves as a member of the Allegheny County Criminal Justice Reform Progress Panel at the University of Pittsburgh Institute of Politics and the Grants Distribution Committee for the Fred J. and Shirley H. Jordan Foundation

A strategic and results-oriented leader, Ms. Boswell focuses on aligning vision, goals, and resources to achieve high-impact, positive results, consistently demonstrating a commitment to advancing health equity and community well-being.

Paul Burke Chief Product Officer

Reveleer

Cory Busse VP, Strategy & Sales Enablement

Icario

Anna Carley RHIT, Senior Director - CRM, Payer Solutions

GeBBS Healthcare Solutions

With nearly a decade of dedicated experience in risk adjustment and quality improvement, Anna Carley, RHIT, stands as a seasoned professional in the healthcare industry. Currently serving as the Senior Director of Client Relations at GeBBS Healthcare Solutions, a leading risk adjustment service and technology partner, Anna plays a pivotal role as the primary liaison between clients and GeBBS.

Anna's expertise extends across various facets of risk adjustment, showcasing her comprehensive understanding of both payer and provider perspectives. During her tenure at UnitedHealthcare, she contributed significantly to the development of risk adjustment strategies. On the provider side, Anna made impactful contributions at Stanford Health Care, where she played a key role in establishing robust risk adjustment, quality, and pharmacy programs.

Residing in Austin, Texas, with her husband and three daughters—Penelope, Valerie, and Felicity—Anna Carley, RHIT, is not only a dedicated professional but also a loving family person. Beyond her commitments at GeBBS Healthcare Solutions, she values quality time with her family and two dogs, Sampson and Dodger.

Calvin Chou, MD, PhD Professor of Medicine at the University of California at San Francisco

Staff physician at the Veterans Affairs Health Care System in San Francisco

Calvin Chou, MD, PhD is Professor of Clinical Medicine at the University of California at San Francisco, and staff physician at the Veterans Affairs Health Care System in San Francisco. After undergraduate work at Yale, he received his PhD in microbiology and his MD at Columbia University, and subsequently completed residency training in internal medicine at UCSF.  As faculty with the Academy of Communication in Healthcare (ACH), he is recognized internationally for leading workshops in relationship-centered communication, feedback, conflict, and remediation in health professions education. Currently he is director of VALOR, a longitudinal program based at the VA that emphasizes humanistic clinical skill development for medical students. He also held the first endowed Academy Chair in the Scholarship of Teaching and Learning at UCSF.  He has delivered communication skills curricula for providers at health systems across the country, including Mayo Clinic, Cleveland Clinic, Stanford Health, NewYork Presbyterian, AdventHealth System, Wake Forest, and Texas Children’s Hospital, and internationally as well.  His research interests include assessment of curricular developments in clinical skills and clinical skills remediation, forces influencing feedback in health sciences education, and enhancing humanistic communication for interprofessional trainees.  A member of the UCSF Academy of Medical Educators since 2002, he has received numerous teaching awards at UCSF, including the Henry J. Kaiser Award for Excellence in Teaching in the Inpatient Setting, and two of ACH’s national awards, the 2019 Healthcare Communication Teaching Excellence Award, and the 2018 Lynn Payer Award for outstanding contributions to the literature on the theory, practice, and teaching of effective healthcare communication and related skills. He is co-editor of the books Remediation in Medical Education: A Midcourse Correction, and Communication Rx: Transforming Healthcare Through Relationship-Centered Communication.

Jason Christ Member of the Firm

Epstein Becker Green   

Kailey Collier Director of Quality Performance

Kern Health Systems

Kailey is the Director of Quality Performance for Kern Health Systems (KHS). She was born and raised in Bakersfield, California with a passion for the local community. She has been employed with KHS for more than eight years with responsibilities varying across MCAS/HEDIS, Grievances, Potential Quality Issues, and Site Reviews. Her prior clinical experience includes critical care nursing in the Emergency Department (ED), Case Management, Utilization Management, and more than ten years of Quality experience in the managed care setting for multiple lines of business. This is where she realized her passion for serving the local community of Kern County. As the Director of Quality for a managed Medi-Cal health plan, she supports the overall quality of care to members primarily who are poverty stricken, homeless, or gravely disabled. Kailey’s personal and professional mission is to support access to high quality and equitable care to the community she was born and raised in the Central Valley of California. Kailey holds a Bachelor’s of Science Degree in Nursing and is currently pursuing a Master’s Degree in Healthcare Administration. She enjoys reading, baking, and spending time with her husband and two daughters.

Laura Cooley PhD, Editor-in-Chief

Journal of Patient Experience

As Editor-in-Chief of the Journal of Patient Experience, she advocates for improved health and experience outcomes through evidence-based research and practice. As a mission-driven professional, she aims to drive value through strategic thought leadership, program development, and academic scholarship to improve patient experience outcomes. She provides consultative support and speaks at high-profile conferences as a recognized subject matter expert.

She most recently led The Academy of Communication in Healthcare, where she consistently partnered with C-Suite leaders to support the development and implementation of their Patient Experience strategies. She developed and managed a robust portfolio of healthcare enterprise affiliates.

Laura is Co-Editor for “Communication Rx: Transforming Healthcare through Communication and Relationships”, a popular book in the McGraw-Hill Professional Series.In her role as Editor-in-Chief at The Journal of Patient Experience (an open-access peer-reviewed academic publication) she leads a team dedicated to creating influential content focused on patient experience research and education.

John Criswell Founder, CEO, Chairman 

Porter

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 MBA, RHIA, CCS-P, CRC, Risk Adjustment Programs Director

Medical Mutual

Deb joined Paramount Healthcare in May 2013 and oversees the Risk Adjustment, Coordination of Benefits, and Subrogation departments.

Prior to her position with Paramount she had 21 years’ experience working with the State of Ohio workers’ compensation program, both for the government and a contracted managed care organizations. She came to Paramount with extensive knowledge in medical coding, provider billing and education, Medicare payment methodologies, quality assurance, and regulatory compliance.

Deb attended The University of Toledo for both her undergraduate and graduate degrees and currently holds a Masters of Business Administration with major in Healthcare Systems Management. She is an active member of the American Health Information Management Association (AHIMA) and is a Registered Health Information Administrator (RHIA) and Certified Coding Specialist, physician based (CCS-P). Deb is also an active member of the America Academy of Professional Coders (AAPC) and is a Certified Risk Adjustment Coder (CRC). Also, Deb is a member of RISE and holds certificates as a Risk Adjustment Practitioner (RAP) and Advanced HCC Auditor (AHCCA).

Additionally, Deb is a 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.

Shannon Decker Founder & CEO

VBC One

Dr. Shannon Decker is Founder & CEO at VBC One, a consulting firm assisting physician groups, health plans and vendors maximize the performance of their value based contracts and offerings. Dr. Decker has more than 25 years experience in health care and most recently led teams in risk, quality, data and analytics, telehealth, COVID response and delegation compliance. Of her more than 25 years of experience in healthcare--17 include working with risk adjustment, quality and Medicare. Dr. Decker has a PhD. in Interdisciplinary Studies, dual MBA degrees--in Finance and in Marketing, as well as an M.Ed. in Secondary Education and a M.Ed. in Administration and Leadership. Dr. Decker is on the faculty at Arizona State University and is also an associate professor in the social and behavioral sciences for Walden and Capella Universities where she chairs and oversees the dissertations of doctoral students. An author of two books and several peer-reviewed articles, and a prolific national public speaker, her interests include the study of human behavior and how social and behavioral theories may be brought to bear in value based care and population health management as a whole.

Hemanth Doma AVP, Product Management

Inovalon

Tina Dueringer CEO, Principal Advisor

Dueringer Advisors, Inc 

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

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

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

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

Donna Furlong RN Clinical Services Senior Director

Banner Medical Group

Donna Furlong is an RN, Clinical Services Senior Director for Banner Health. She started her career working in the acute arena as a rural health RN and then as a pediatric RN.  After moving to the ambulatory side Donna has worked as a vaccine nurse in an FQHC, served as a Public Health Director of Services and served the last 7 years with Banner Medical Group.  Donna also serves as a Board Member for The Arizona Partnership for Immunizations and often speaks as a vaccine expert both for Banner and the Arizona community.  As a cancer survivor she is incredibly passionate about health maintenance and patient experience and loves to speak on how these two things can save lives.

Colleen Gianatasio Director, Clinical Documentation Integrity and Coding Compliance  

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.

Denise Graeber SVP, Product Management

Signify Health

Jennifer Hawkes Manger of Member Engagement

Blue Cross of Idaho

Jennifer is a Manger of Member Engagement at Blue Cross of Idaho, for the previous 8 years she was a key player in vendor contracting, planning, developing, monitoring, and improving Medicare and ACA risk adjustment programs. She is responsible for the success of several risk adjustment prospective and retrospective programs. She brings over 27 years of experience in the health insurance, auditing and healthcare industries and holds certifications in professional and risk adjustment coding. She’s been focused on Risk Adjustment since 2017 and now has a tremendous opportunity to improve member health outcomes and create understanding. Her current focus is on strategic planning around member education and adoption of healthcare activities and collaboration with other stakeholders to combine efforts, eliminate duplication, map the member’s journey to maximize outcomes.

She is also passionate about bringing understanding, education, and awareness to managing type 1 diabetes and living an active love and laughter filled life.

Liz Haynes Risk Adjustment & Stars Government Programs

Blue Cross and Blue Shield of Kansas City

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

Jennifer Holman Director of Risk Adjustment Programs

Centene

Mary Inman Partner

Whistleblower Partners LLP

Mary Inman is a partner and co-founder of Whistleblower Partners LLP, a law firm dedicated to representing whistleblowers under the various U.S. whistleblower reward programs.  Mary and her colleagues have pioneered a series of successful whistleblower cases against prominent health insurers, hospitals, provider groups, and vendors under the False Claims Act alleging manipulation of the risk scores of Medicare Advantage patients.  Mary is a recognized expert and frequent author, commentator, and speaker on frauds in the healthcare industry, particularly those exposed by whistleblowers. 

BK Kajopaiye Risk Adjustment and STARS Manager

CareFirst BlueCross BlueShield

Biodun Kajopaiye better known as BK is a health care and fitness enthusiast, with over  20 years of experience as both a health care professional and a fitness and lifestyle coach. Born in Nigeria but raised in the Bay Area of Northern California BK has been guided by the wisdom of his father who always reminded him, "you make a living by what you receive, you make a life by what you give." These words have inspired BK to focus his education, and professional experiences to expose him to environments where he could nurture his love for health, fitness, medicine, care delivery so that he can contribute to the lives of others. BK received his undergraduate degree from Tufts University as a double major in Sociology and Community Health, received his master’s degree in health service administration from George Washington University. BK is a certified risk adjustment coder and has worked in various health professional spaces including Children's national medical center, Inova Health Systems, George Washington Medical faculty Associates, and Evolent Health. Currently BK is a Program Manager at CF Blue Cross Blue shield where he is the lead manager for Risk Adjustment on the Quality, STARS, and Risk Adjustment team.

Chris Lance Chief Product Officer

Edifecs

Margaret Larkins-Pettigrew, MD Chief Clinical Diversity, Equity and Inclusion Officer

Allegheny Health Network and Highmark Health

Margaret Larkins-Pettigrew, MD, MEd, MPPM, FACOG, is a Senior Vice President and the Chief Clinical Diversity, Equity and Inclusion Officer for Allegheny Health Network. She is also a professor and academic chair of Obstetrics & Gynecology at the Drexel University College of Medicine, which has a clinical campus affiliation with AHN.

As Chief Clinical DEI Officer, Dr. Larkins-Pettigrew’s role is to advance diversity and inclusion among the clinical and caregiving staff at AHN, and to advocate for equitable health outcomes among all patient populations by developing programs that target disparities in medical care. An internationally respected expert in cultural humility within the health care field, Dr. Larkins-Pettigrew has spent her career engaging marginalized communities and building programs that focus on promoting outcomes equity for vulnerable patients and mitigating socio-political barriers to care. She has a special interest in educating and empowering women, especially those pursuing careers in medicine.

Although Dr. Larkins-Pettigrew cares for all women in her general OB/GYN practice, she also focuses on providing care to women living in low- to middle-resource communities, with a clinical focus in the care of women living with HIV.

A native Pittsburgher, Dr. Larkins-Pettigrew returned to Pittsburgh in 2020 from Cleveland, Ohio where she led the Diversity, Equity and Inclusion programs for University Hospitals of Cleveland. There, she served as Chair & Director of the Center for Clinical Excellence and Diversity at University Hospitals as well as Dean of Students for Case Western Reserve University. Dr. Larkins-Pettigrew is the founder and current CEO and President of JUSTWONDOOR (Women and Newborns, Diversity, Outreach, Opportunity and Research), a program that aims to educate global medical providers through local and international health care collaborations.

Prior to receiving her medical degree from the University of Pittsburgh, she practiced as a critical care nurse, receiving her baccalaureate degree in nursing from the University of Pittsburgh, a master’s degree in education from California State University Los Angeles, an Adult Nurse Practitioner certification from California State University, Long Beach, and a master’s degree in public policy and management (International Affairs) from the University of Pittsburgh. She is also a veteran of the United States Navy, where she cared for active-duty members, veterans and their families.

Dr. Larkins-Pettigrew lectures frequently, regionally and internationally, on health issues relating to the wellness of women and strategies that advance diversity, equity and inclusion in healthcare. She is also the author of “The Colors of My Heart: Embracing My Blackness with History, Family, Fear and Faith,” a recently published autobiography.

Dr. Edward Likovich CEO

Nymbl

Edward Likovich, CEO of health-tech company Nymbl Science, is on a personal mission to empower older adults to live more freely through digital balance training. Hailing from Hermitage, PA, Ed earned three degrees from Harvard, including a PhD in applied physics. His career spans roles in J.P. Morgan's algorithmic trading group and his tenure as the CEO of GoodLux Technology, where he pioneered bright light therapy products for depression. Ed's expansive journey, from academia to cutting-edge digital health solutions, reflects his passion for making a meaningful impact in the world.

Helen Liu Pharm.D.

Health Plan Leader/Senior Consultant

Helen Liu, PharmD is a clinical pharmacist and healthcare leader with nearly three decades of experience driving clinical excellence, optimizing medication use, and improving patient outcomes across diverse healthcare settings. Drawing on her extensive background, Helen brings a unique blend of clinical expertise and strategic insight to her consulting practice, where she partners with organizations to enhance clinical operations, medication safety, and cost-effectiveness.

In her prior leadership roles, Helen spearheaded transformative pharmacy initiatives. At ATRIO Health Plans, she implemented a Pharmacy & Therapeutic Committee and developed a Part B Prior Authorization/Step Therapy Program, yielding $1.5 million in savings within the first year. She also led formulary analyses for Medicare submissions and crafted strategies to enhance Star quality measures. Her commitment to clinical integrity resulted in policies that ensured compliance with CMS regulations on critical medications, such as insulin B vs. D, hospice, and transplant drugs. During her seven-year tenure at Kaiser Permanente, Helen served as Regional Assistant Director and Drug Use Management leader, where she focused on optimizing medication use across the region. She played a pivotal role in delivering over $20 million in savings through inventory management and drug cost-saving initiatives, while also standardizing clinical practices to ensure consistent, evidence-based care. Her efforts in improving sterile compounding workflows and infusion clinic operations further solidified her reputation as a leader in clinical process improvement.

Now, as a consultant, Helen applies her vast clinical knowledge and operational experience to help healthcare organizations refine their pharmacy services, improve clinical outcomes, and achieve operational efficiencies. She remains dedicated to advancing clinical pharmacy practice and continues to advocate for the integration of cutting-edge clinical evidence to drive optimal patient care and achieve organizational goals.

Jimmy Liu VP, Analytics and MRR Solutions

Advantmed

Jimmy Liu is Vice President of Analytics and MRR Solutions at Advantmed. He has been helping health plans with their risk adjustment strategy across all lines of business for more than 15 years. Jimmy is a risk adjustment thought leader, conference speaker, and author of numerous white papers and articles. Jimmy started in consulting doing 10 years of application design and development for the financial services industry. He then spent the next 6 years at Independence Blue Cross in Philadelphia working on HIPAA EDI and eBusiness initiatives. He has designed and developed more than 20 large scale applications in his career, several of which became risk adjustment products. Jimmy has also spent more than 10 years doing risk analytics and developing suspecting algorithms that are used to create prospective and retrospective chase lists. Jimmy is a graduate of the University of Pennsylvania and lives in the greater Philadelphia area.

Andrew Lockhart CEO

Fathom

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

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

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

Mass General Brigham

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

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

Donna speaks nationally for RISE, AAPC and AHIMA

She also received the 2021 MaHIMA Champion Award

Melissa McVaugh AVP Clinical Operations

Mountain Health CO-OP

Dr. Robert Mirsky Former CMO

Aetna Medicare

Bob Mirsky, MD, MMM, FAAFP, is a seasoned physician executive with extensive health plan experience across Medicare, Medicaid, and commercial lines of business. Dr. Mirsky most recently served as Chief Medical Officer and Vice President of Medical Operations at Aetna Medicare (a CVSH Company). He has held leadership roles as CMO for North Shore-LIJ (Northwell) CareConnect Insurance Company, CMO for the Mid-Atlantic Region of Coventry Health Care, CMO Gateway Health Plan in Pittsburgh, Senior MD FloridaBlue, and CMO Tenet Health System Florida. Dr. Mirsky practiced family medicine for ten years in New York and Florida and completed his residency and chief residency at St. Joseph’s Medical Center in New York.

Brian Murtha Director of Risk Adjustment Digital Strategy

Centene

Brian is Director, Digital Strategy for Centene’s Risk Adjustment organization. His vision has helped to reshape Centene’s approach to clinical data exchange and establish a framework to execute at scale and with purpose. Today, his team leads all bidirectional EMR integration and clinical data management efforts, and contributes over 5m electronic charts to Centene’s medical record retrieval initiatives. Prior to working on interoperability, he engineered WellCare’s prospective program infrastructure.

He is a co-lead of the DaVinci Risk Adjustment IG, member of Apixio’s executive advisory council, and frequent collaborator with the industry’s largest EMRs to improve and expand their payer solutions.

When he’s not working, you may find him on the Gulf of Mexico chasing fish and catching a sunburn.

Barb Nelson Director of Clinical Services Optimization

Medica Health Plans

Teresa Ross

Whistleblower

Lori Rund Blue KC

Former VP Government Programs

Lori Rund is the former Vice President of Government Programs at Blue Cross and Blue Shield of Kansas City (Blue KC). Lori is responsible for the oversight and ongoing strategic direction for Blue KC’s Government Programs line of business, including Medicare, ACA, and Medicaid. She has been with Blue KC since November 2019. Prior to joining Blue KC, Lori worked nine years for the Henry Ford Health System health plan, HAP, as the Vice President for Product Management and Market Intelligence.  She has had an extensive career with 30+ years of experience within the healthcare industry. She is a member of the RISE Medicare Member Acquisition & Experience Advisory Board and member of the Girls on the Run Board of Greater Kansas City. Lori earned a Bachelor of Business Administration from Loyola University, New Orleans, Louisiana.

Heidi Schwarzwald Home & Community Services

Signify Health

Dr. Heidi Schwarzwald is the strategic advisor to Signify Health’s Network, Clinical and Product Teams on items related to clinician network, IHE governance, and new Product development. She was honored to receive the CEO Award in 2021.

Dr. Schwarzwald is a board-certified pediatrician and a fellow in the American Academy of Pediatrics. Dr. Schwarzwald has held several roles with Aetna, including VP CMO of Provider Network and Deputy CMO for Aetna Better Health, leading the population health team. Prior to joining Aetna in October 2019, Dr. Schwarzwald served as the Chief Medical Officer for Texas Children’s Health Plan and Associate Vice Chair for Community Pediatrics for Baylor College of Medicine.

She received her undergraduate degree from Harvard University, her medical degree from the University of Cincinnati College of Medicine and completed a pediatric residency at Baylor College of Medicine in Houston Texas. She completed her Master’s in Public Health at the University of Texas School of Public Health in Houston Texas.

Dr. Schwarzwald lives in Houston Texas with her husband and two children.

Eugene Scioscia, Jr., MD Chief Experience Officer

Allegheny Health Network

Dr. Scioscia has been a part of AHN and its family of hospitals for 35 years, working in leadership roles at both Allegheny General Hospital, where he served as chairman and residency training program director for the Department of Obstetrics and Gynecology, and West Penn Hospital, where he is past president of the medical staff. He is also past chair and program director of obstetrics-gynecology at Allegheny General Hospital, past president of the medical Staff at West Penn Hospital, and past vice chair of clinical operations with AHN’s obstetrics-gynecology department.

He continues to maintain his gynecology practice.

Under his leadership since 2018, AHN’s Patient Experience Office is building a system-wide culture of service excellence and superior patient communication, working closely with clinicians, hospital and institute leadership, and front-line staff across the network to meet and exceed patient and employee expectations.

Dr. Scioscia received his undergraduate degree from Duke University and his medical degree from the University of Pittsburgh’s School of Medicine. His post-graduate training comprises four years of residency at Yale-New Haven Medical Center, including two years as the center’s chief OBGYN resident.
Today, he is an adjunct clinical associate professor in obstetrics and gynecology at Temple University School of Medicine’s Pittsburgh Clinical Campus at AHN, and an assistant professor of Obstetrics and Gynecology Drexel University College of Medicine.

His professional affiliations include membership in the Pittsburgh Obstetrics/Gynecology Society (past president), and service as a fellow of the American College of Obstetrics and Gynecology. He also has served as an examiner for the American Board of Obstetrics and Gynecology.

Namita Seth Mohta M.D., Executive Editor

NEJM Catalyst Innovations in Care Delivery

Namita Seth Mohta is a physician executive with expertise in health care delivery transformation. As the Executive Editor for NEJM Catalyst Innovations in Care Delivery, she is part of the founding leadership team and has responsibility for content strategy and quality. Most recently, Dr. Mohta served as the Director of the Serious Illness Care Program (SICP) at Ariadne Labs, a health system innovation center at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. Dr. Mohta has been part of the founding Population Health and ACO leadership teams as Medical Director, Mass General Brigham and the New England Quality Care Alliance, both in Boston. Dr Mohta has worked with multiple start-ups, including PatientPing (now Bamboo Health), a digital health company, as their Physician Lead. She worked as a management consultant with the Boston Consulting Group prior to medical training. 

Dr. Mohta practices internal medicine as a Hospitalist at Brigham and Women’s Hospital. She is Associate Faculty at Ariadne Labs and Assistant Professor in the Department of Medicine at Harvard Medical School. She completed her Internal Medicine and Primary Care residency training at Brigham and Women’s Hospital. Dr. Mohta is a graduate of Yale College and Yale School of Medicine.

Laura Sheriff

Healthcare Expert

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

Amir St. Clair Vice President, Enterprise Risk Management

Advocate Health

Amir St. Clair, PhD., currently serves as Vice President of Enterprise Risk Management for Advocate Health. He leads the overall strategy and framework for identifying emerging risks, leading mitigation efforts, and enhancing business resilience in alignment with objectives set by the CEO and Board of Directors. Before joining Advocate Health, St. Clair was the Chief Resilience Officer at Emory University, responsible for designing and implementing resilience strategies to enhance the organization’s ability to adapt, innovate, and thrive amid emerging risks.

With senior leadership experience across higher education, academic medical, and healthcare organizations, St. Clair’s professional efforts have focused on optimizing risk strategy and scaling operational resilience to help large organizations navigate complex challenges and emerging threats. A recognized leader in enterprise risk and resilience, St. Clair is a frequent presenter at industry conferences, an active member of global risk associations, has published on crisis leadership and resilience strategies, and holds a PhD in Organizational Leadership.

Arati Swadi MBA, Vice President of Product

Optum

Arati Swadi has over 15 years of industry experience building healthcare products. She specializes in risk adjustment and quality, and worked at Inovalon, WebMD and Advantmed prior to joining Optum. Arati has an MBA degree from Purdue University and engineering from GIT, India.

Karl Ulfers Co-founder & CEO

DUOS

Karl is passionate about empowering older adults to have more freedom as they age because of his own experience helping his loved ones navigate their challenges of aging and struggling to find resources they need to age independently. He is leveraging his experiences as an early leader in digital health starting in 2006 at OptumHealth, part of UnitedHealth Group, and his more recent experience as the Chief Product Officer and then CEO of Rally Health to help DUOS establish a system of aging that makes it easy for older adults and caregivers to get access to the support they need.

“The time is now for a company like DUOS to exist. When you put together a team that is equally skilled, compassionate, tech-savvy and deeply entrenched in the healthcare space, it truly can change the world.”

Veronica Villalobos JD, VP DEI Strategy, Enterprise Equitable Health Institute

Highmark Health/ Allegheny Health Network

Veronica Villalobos, vice president of Highmark Health’s Enterprise Equitable Health Institute, joined the organization in 2020, having previously served as the principal deputy associate director at the U.S. Office of Personnel Management. She also served as chair of the U.S. Equal Employment Opportunity Commission's Federal Hispanic Work Group.

Ms. Villalobos’s leadership transcends administration, fostering the next generation of medical professionals and empowering employees. She leads AHN’s Young Scholars program, a 5-year pathway for Pittsburgh public school students interested in medicine. This program offers rising 8th graders summer internships at Allegheny General Hospital, year-round support, and guidance throughout their academic journey, culminating in assistance with college and medical school applications.

Her commitment to employee development is evident in the flourishing Business Resources Groups (BRGs) program, which has grown to include more than 3,500 employees. Ms. Villalobos champions initiatives such as "Invest in You," which empowers women through support and leadership training, and "Mentorship Matters," a programming series that fosters meaningful connections and growth opportunities. Through her dedication to nurturing future medical professionals and empowering employees, Ms. Villalobos is shaping a brighter future for Highmark Health, AHN, and the communities we serve.

Before joining AHN, Ms. Villalobos served over a decade within the U.S. Office of Personnel Management (OPM), most recently as Principal Deputy Associate Director of Employee Services division. Before that, she led OPM’s government-wide diversity effort. She was also appointed one of the first Honor Program Attorneys for the U.S. Equal Employment Opportunity Commission (EEOC), where she served as the Chair of the Federal Hispanic Work Group. She has spent decades opening doors for minoritized individuals by fighting institutional hiring biases, and by helping all voices to be heard and represented, first within the federal government and now in the health care industry.

Ms. Villalobos was born and raised in El Paso, Texas. She graduated from Saint Mary's College in South Bend, Indiana, in 1996 with a Bachelor of Arts degree in Political Science and Psychology. She subsequently earned her law degree from American University's Washington College of Law in Washington, D.C.

Max Voldman Partner

Whistleblower Partners LLP

Max Voldman is a partner at Whistleblower Partners. Max’s practice is focused on representing whistleblowers under the federal False Claims Act and numerous state law equivalents, and the whistleblower programs of the Internal Revenue Service, Securities and Exchange Commission, Commodity Futures Trading Commission, and Department of Transportation.

He is part of the legal team pursuing a qui tam case against UnitedHealth Group alleging the nation’s largest Medicare Advantage Organization submitted false claims for payment to the Medicare Program by improperly inflating its members’ risk scores. Max also has experience analyzing complex data sets, developing damages models, and assisting with statistical analyses. He has also published numerous articles on issues of healthcare law, whistleblower programs, and environmental issues.

Max received his J.D. from Georgetown University Law Center. During law school, Max served as a research assistant on taxation to Professor John Brooks and as the Symposium Editor for the Journal of Law and Public Policy. Prior to law school, Max completed his undergraduate studies at the University of Illinois, where he was a member of the Mathematics Honors Society and graduated with a degree in Actuarial Science and a Minor in Business.

Max worked in State Farm’s actuarial science department and coached the debate team for a high school in Illinois, including one team that won the State Championship. He is fluent in Russian. 

In his spare time, Max enjoys hiking, tennis, and is, unfortunately, a devoted fan of the Chicago Bears. 

Susan Waterman Trainer, Director, Risk Adjustment   

Baylor Scott & White

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.

Peter Watson, MD, MMM Chief Clinical Success Officer

Populance

Dr. Peter Watson serves as Chief Clinical Success Officer at Populance a part of Henry Ford Health.  He leads clinical strategic direction for population health services, overseeing 140 team members and supporting nearly 600,000 lives.  He has direct oversight of clinical success team members in various disciplines providing services in ambulatory case management, specialty condition support, transitional case management, post-acute care network/case management, supportive care management and utilization effectiveness.

Inclusive of his service to Populance, Dr. Watson has served Henry Ford Health for over 25 years. Prior to joining Populance, Dr. Watson spent nearly seven years in various executive leadership roles at Health Alliance Plan, Henry Ford Health’s integrated health plan, providing strategic leadership for HAP’s population health management operations, quality performance, and physician engagement. Prior to HAP, Dr. Watson oversaw the Henry Ford Medical Group Hospitalist Program for nearly 11 years – while working at Populance he continues to see patients as an Attending Hospitalist at several Henry Ford Health Hospitals. Dr. Watson has been deeply involved in residency education and research at Henry Ford, and has led clinical quality programs in inpatient safety, patient communication, and palliative care.  A native Detroiter, Dr. Watson graduated from Wayne State University School of Medicine and completed internal medicine residency and chief residency at Henry Ford Hospital.  He is certified by the American Board of Internal Medicine.  He also holds a Master of Medical Management degree from Carnegie Mellon University.  His state and national leadership positions have included serving on the Board of Trustees of the American Medical Association and key roles in the Michigan State Medical Society and the Society of Hospital Medicine.

Lesley Weir Senior Director, Solutions Strategy

Veradigm

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

Charlotte Yeh Former CMO

AARP

Dr. Yeh is a passionate advocate for healthcare transformation and healthy aging. Her career has spanned the industry: providers, payers, tech companies, nonprofits, and the government. Roles have included Chief Medical Officer, AARP Services Inc.; Regional Administrator, Centers for Medicare and Medicaid Services; and emergency department chief. Dr. Yeh received an MD from Northwestern University Medical School. She has extensive board experience and has garnered many honors for her work.

Michael Zeli Executive Director of Clinical Documentation Integrity PHSO

AdventHealth

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 Zuehlke Chief Customer Officer

Moxe Health

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.

Beth holds a BS from the University of Iowa and an MS from the University of Wisconsin-Madison.