Rise

Kevin Agatstein Consultant

Sharecare

Reza Alavi MD, MHS, MBA Faculty

Johns Hopkins Medicine

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.

Diana Allen PhD, CEO

The SSI Group

Diana Allen is a healthcare finance leader with more than 35 years’ experience in healthcare provider and payer services. Serving as the CEO of The SSI Group, she is focused on augmenting the company’s service and solutions, drawing on her experience in business development, quality improvement, and strategic direction. Prior to joining SSI, Diana honed her revenue cycle skills with companies such as GE Healthcare, McKesson Corporation, and Harvard Medical Faculty Physicians. Diana holds a doctorate from Colorado Technical University in Healthcare Administration Leadership and a master’s degree in healthcare administration from Cambridge College.

Jessica Assefa President and Senior Consultant 

Ameropia Advisors, LLC

Jessica Assefa is a seasoned healthcare executive and nationally recognized expert in Medicare Advantage Star Ratings and quality improvement. With over two decades of experience, she is the President and Senior Consultant at Ameropia Advisors, LLC, where she helps health plans optimize performance and achieve higher Star Ratings.

Jessica’s expertise spans Medicare, Medicaid, Marketplace, and dual-eligible programs, with a proven track record of guiding contracts to 4- and 5-Star ratings nationwide. She has held senior leadership roles on the Medicare Advantage payer side, including Chief Quality Officer and Senior Director of Star Ratings, where she led strategic planning, quality improvement initiatives, and operational execution for local, regional, and national health plans. Her work has driven measurable improvements in HEDIS, medication adherence, CAHPS, HOS, provider engagement, value-based care, and overall health plan performance.

Jessica’s healthcare career began on the provider side, where she held leadership positions in geriatric and disability care. As a nurse, she developed a deep, firsthand understanding of patient needs, healthcare delivery, and quality improvement—insights that now shape her strategic approach.

Her unique experience across both payer and provider sectors gives her an unmatched perspective on healthcare quality, regulatory strategy, and Star Ratings success. Jessica is a trusted advisor known for delivering data-driven, results-oriented solutions that drive meaningful improvements in healthcare quality and outcomes.

Aurelious Bankston Information Technology (IT) Director

SOUTH TEXAS RENAL CARE GROUP

Aurelious Bankston is the IT Director at South Texas Renal Care Group and LASO Health, bringing over 14 years of experience in healthcare IT to ensure the seamless operation of critical IT infrastructure that supports patient care. With expertise in computer science, network administration, and naval architecture, Aurelious offers a unique perspective on optimizing healthcare technology to improve clinical workflows and operational efficiency.

Passionate about leadership and mentorship, Aurelious fosters a culture of innovation and collaboration within the IT team. Focused on implementing high-quality, secure, and scalable IT solutions, he is dedicated to enhancing business processes and ultimately improving patient outcomes.

John Barkley Vice President, Enterprise Risk Adjustment & Data Integrity

Emblem Health / ConnectiCare

John Barkley is the Vice President of Risk Adjustment and Data Integrity for Emblem Health. Emblem Health is one of the nation’s largest nonprofit health insurers, with 3.2 million members and an 80 year legacy serving New York’s communities. Emblem family of companies includes ConnecitCare, Advantage Care Physicians Group and Well Spark Health.

John is responsible for all risk adjustment operations, submissions and data integrity activities for Emblem and ConnectiCare. He has been with Emblem for 13 years and prior to that 21 years with Aetna in various financial roles, including leading risk adjustment operations.

John started his career as a CPA working for Deloitte. John has been an attendee and presenter at many RISE conferences over the years. When not executing risk adjustment operations John enjoys boating, kayaking and fishing on Cape Cod Massachusetts where he lives.

Sharon Barnicle Executive Director

Springhill Medical Center

Sharon Barnicle is a experienced multi-departmental Executive Director with a specialization in Health Information Management with a demonstrated history of working in the hospital & health care industry. Sharon is a Registered Health Information Administrator (RHIA) and a Certified Revenue Cycle Representative (CRCR). With over six years of experience at Springhill Medical Center in oversight of Patient Financial Services, HIM and Case Management.

Steven Berkow Senior Advisor, Value-Based Markets

InterSystems

Steven Berkow leads efforts across InterSystems to ensure our technology and wrap-around services support plans, providers, and other customer organizations in advancing value-based care. He brings to this role a passion for improving healthcare, backed by over two decades of experience as an executive and GM for both payer and provider organizations.

Before joining InterSystems, Steven launched SaaS-based businesses at OptumInsight, managed the Advisory Board’s best-practice memberships for health system executives, and led Press Ganey’s solutions for clinician engagement and workforce productivity. He also worked at UnitedHealth Group’s Center for Health Care Research, where he evaluated population health needs, emerging technologies, and value-based care initiatives to inform national and state-level policy.

Henish Bhansali MD, FACP, Chief Medical Officer

Medical Home Network

Dr. Henish Bhansali is a leader and executive in value-based care, with expertise in care model design and delivery, strategy and operations, data and analytics, and population health management. He serves as the Chief Medical Officer of Medical Home Network (MHN), caring for 300,000+ Medicaid and Medicare patients served by Federally Qualified Health Centers (FQHCs) across eight states in both urban and rural geographies within Medicaid and Medicare (MSSP, ACO REACH, D-SNP, MA).

Dr. Bhansali trained in internal medicine at Washington University/Barnes-Jewish Hospital (WU-BJH) where he led WU-BJH's readmission reduction program. In 2011, WU-BJH was amongst the bottom 10 hospitals in the US for readmissions. As the Director of the 'Stay Healthy Outpatient Program’, Dr. Bhansali led a multidisciplinary team of medical social workers, behavioral health specialists, care managers, pharmacists, EMTs, and a geriatrician to reduce WU-BJH's readmissions. He also served as a primary care consultant for Independence Center, optimizing primary care for Medicaid patients with serious mental illness (SMI). He also practiced as a PCP and precepted internal medicine residents at Affinia, an FQHC. He further directed WU’s Global Health Program, leading resident education and program development in Bhutan, Guatemala, Nicaragua, Ethiopia, Honduras, Japan, and Eritrea.

Dr. Bhansali spent the next five years as an Associate Program Director for the University of Chicago’s Internal Medicine Program where he co-directed the outpatient residency training. He trained fifty-one residents annually in evidence-based medicine, social determinants of health, the ‘medical home’ model, and advanced care planning alongside caring for four thousand Medicaid and undocumented patients. He created NorthShore’s Global Health Program curating mutually beneficial experiences at a hospital in Port au Prince, Haiti. He directed Medical Grand Rounds for five years, recruiting nationally recognized speakers to further both GME and CME for 200+ conferences.

Dr. Bhansali joined Oak Street Health in 2018 where he learned the operational constructs of Medicare Advantage (MA). As Medical Director, he and his team served an 80% dual-eligible population with a 10% prevalence of homelessness. He transitioned to a national role as the Vice President and National Medical Director of Care Navigation, structuring specialty and diagnostic care navigation for 100,000+ MA patients across 22 states. He also curated a high-performance specialty network and integrated e-consults to reduce part B spend and improve physician engagement with collaborative specialty care.

Dr. Bhansali joined Duly Health and Care (FKA DuPage Medical Group) in 2021 as their Senior Vice President of Medicare Advantage (MA) where he was responsible for total cost of care, HEDIS/STARS performance, and payor relationships. This included global strategy and operations for MA and ACO REACH, compensation structure design, care model design, and compliance for 700+ physicians caring for 2.1 million patients across four states. He was the end-to-end product owner of MA and ACO REACH, managing 90K full risk lives and a $840M budget.

Dr. Bhansali has been formally trained in Value-Based Care by Dr. Michael Porter at the Harvard Business School and has an appointment with the University of Illinois as an Adjunct Professor teaching population health servicing for their Master of Healthcare Administration program. He serves on NAACOS’ Education Committee and Board of Directors, is a Fellow of the American College of Physicians, a member of the AOA Medical Honor Society, a 2024 Presidential Leadership Scholar, an Economic Club of Chicago member, was inducted in 2024 to the Payment Technical Advisory Committee reporting to the Secretary of Health and Human Services, and is Board Certified in both Internal and Obesity medicine.

Dr. Bhansali lives with his wife, a Chicago Public Schools Pre-K teacher and advocate for education equity, and their two loving and mischievous sons and one courageously kind daughter, in Chicago.

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.

Jeffrey Blomgren Director of Engineering

The SSI Group

Jeff is a 25-year analytics and data warehouse expert, working in data aggregation and reporting in the ASC space for 15 years.  He has been deeply involved in the NCAQ DCS Early Adopter program since 2023.  In addition, he has been the data architect and director of SSI’s efforts to provide NCAQ Quality Improvement metrics and analytics, working with SSI’s data partner KONZA.  Jeff has a Bachelor of Business Administration from the University of Oklahoma.

Frederick Bloom, MD President

Guthrie Medical Group

Frederick Bloom, MD, MMM is chief population health officer of Guthrie Clinic. The Guthrie Clinic is a rural integrated health system in the northern tier of central Pennsylvania and the southern tier of upstate New York. The Guthrie Clinic includes four hospitals in the region and the 470 provider Guthrie Medical Group.

Dr. Bloom served as the president of the medical group and currently is a practicing family medicine physician. He joined Guthrie in 2014 from Geisinger Health System where he worked for 28 years in increasing roles of physician leadership.

Dr. Bloom graduated from Hahnemann Medical College in Philadelphia, Pennsylvania and subsequently did his Family Medicine Residency at Saint Vincent Health Care Center in Erie, Pennsylvania. Dr. Bloom also earned his Master of Medical Management at Tulane University in New Orleans, LA.  

Dr. Bloom is a frequent national speaker and author of numerous peer review articles on high value health care. He serves on the CAPG Board, the National Committee for Quality Assurance (NCQA) Recognition Review Oversight Committee and was the former chairperson of the American Medical Group Association Quality Council.

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.

Erika Bowen PhD

Patient Representative

Erika Bowen, PhD is the Executive Director for the Patient and Family Resource Center/Patient Family Advisory Councils (PFAC) at University Health in San Antonio, TX. Dr. Bowen earned her PhD from the University of the Incarnate Word in San Antonio, TX. Her main research interest is the study of interprofessional collaborative practice models within the scope of patient- and family-centered care. Dr. Bowen has presented and published her research at various national and local conferences. She holds a dual faculty appointment at UT Health San Antonio in the School of Nursing and at the Long School of Medicine in the Department of Family and Community Medicine.

She also serves as an Adjunct Faculty member at the University of the Incarnate Word within the School of Professional Studies, where she teaches classes in Organizational Leadership, Organizational Development, and Leadership Ethics. Dr. Bowen received a Master’s in Communication and a Bachelor of Arts degree in Communications from the University of the Incarnate Word in San Antonio, TX.

Dr. Bowen is passionate about empowering patients, families, and caregivers to find their voice through advocacy, support programs, and educational initiatives that encourage them to share their stories to inspire others and improve care. When she is not working, she enjoys spending time with her husband, Chris, and supporting their kiddos, Colt (15 y/o) and Kate (13 y/o), play baseball, softball, football, and basketball.

Leticia Bresnahan MBA

Patient Representative

Leticia Bresnahan, MBA  is a 40 year resident of San Antonio, Texas in which she and her husband, Roger, raised her three children.  She was very involved in their school PTA’s and served on the North East Independent School District as a trustee, vice-president and president from 2008-2016.  She currently serves on the Region 20 Educational Service Center Board of Directors as it’s Vice-President.  

From 2008 to 2024, she worked at the University of Texas Health Science Center at San Antonio, School of Medicine as a project coordinator for the Center for Patient Safety and then as the Director of Continuing Medical Education until her retirement in 2024.  She was very involved in the Texas Association for Continuing Medical Education and the Society of Continuing Medical Education for many years.  She also serves on University Health’s Patient Family Advisory Committee (PFAC.) since 2002. As a PFAC member she is a member of the Inpatient Patient Family Advisory Council (PFAC) and the Bioethics Committee. 

Her personal experience with breast cancer in 2023 has given her an even more empathetic perspective on patient care, making her contributions even more meaningful.

She graduated from St. Louis University in 1982 and The University of Texas at San Antonio in 1988.

Jodi Bucholz MSW, Director Ambulatory Case Management

Populance

Jodi Buchholz, LMSW Clinical and Macro, CCM, is the Director of Ambulatory Case Management at Populance, a population health services organization and subsidiary of Henry Ford Health. The eight years prior to that, she was the Director of Integrated Case Management in the Population Health Management department for Henry Ford Health supporting primary care and specialty practices until transitioning to Populance. Jodi directs a diverse case management team which includes nurses, social workers, population health coordinators and health specialists. They provide support for multiple populations in a variety of settings including those embedded in primary care.

Prior to her leadership role with Henry Ford, Jodi was a social worker with Ascension Detroit starting in the inpatient setting and transitioning to the ambulatory space. Over the last 13 years, she has successfully led multiple teams to meet state and system initiatives including Michigan Primary Care Transformation Project, State Innovation Model, social drivers of health screening and intervention, system wide integration of case management that included inpatient, ambulatory and specialty, and Epic redesign. When she is not working in health care, Jodi teaches at Wayne State School of Social Work and supports students from Michigan State University School of Social Work.  Jodi graduated with her master’s in social work from Wayne State University (WSU).

Paul Burke Chief Product Officer

Reveleer

Cory Busse VP, Strategy & Sales Enablement

Icario

Cory Busse is the Vice President of Strategy at Icario. With nearly 30 years of healthcare industry experience working for payers, PBMs, pharmaceutical and medical device companies, Cory helps health plans optimize (and maximize) engagement with hard-to-reach member populations to improve quality, enhance member satisfaction and manage costs. 

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   

As one of the first and few attorneys focused on risk adjustment in Medicare Advantage (MA) plans, Jason has transformed how clients organize, monitor, and ultimately defend their programs. He creates new business opportunities and best practices for risk-bearing provider groups, plans, and vendors.

As enforcement and regulation of risk adjustment and the FCA escalates, Jason anticipates threats. He devises balanced and compliant approaches that address his clients’ greatest exposures: coding fidelity, clinical effectiveness, oversight, and consistency in best industry practices. From program assessment to testing and corrective actions, Jason shows clients how to close the compliance gap.

Michael Clark President & Chief Growth Officer

RAAPID

Wynda Clayton Consultant, Risk Adjustment

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.

Sean Creighton Former CMS Managing Director

Avalere Health

Sean Creighton serves in Avalere’s Policy practice, focusing on Medicare Advantage (MA) and Part D reform, risk adjustment, and analysis of healthcare quality and utilization.

In recent projects, Sean has worked on key MA initiatives including changes to MA rate setting, risk adjustment models, Stars, Utilization Management, and Marketing.  He continues to serve as a trusted advisor to MA plan leadership on MA Part C and D payment policy, risk adjustment modeling and encounter data.  Additionally, he leads operational focused projects assessing and improving risk adjustment operations, data aggregation, and data submissions.

Before rejoining Avalere, Sean served as vice president for federal policy at Humana, working on industry initiatives related to COVID-19 and leading development and implementation of federal policy strategy.  Sean helped MA plans obtain regulatory flexibility for provision of enhanced benefits for members, access medical loss ratio flexibilities during the pandemic, improve bid gain/loss margin rules, and rationalize network requirements for dialysis centers. He led successful policy discussions with the Centers for Medicare & Medicaid Services (CMS) aimed at maintaining high quality of care for patients with end-stage renal disease while also reducing dialysis center network adequacy requirements, which restricted provider competition.

He worked as senior vice president for revenue integrity and risk adjustment product lines at Verscend (now Cotiviti) focusing on data aggregation, medical coding, and submission products for Medicare and the commercial market. Previously, Sean served as deputy group director of CMS’s Center for Consumer Information and Insurance Oversight’s Payment Policy and Financial Management Group and directed the CMS division of Payment Policy and Risk Adjustment in the Medicare Plan Payment Group, where he developed and implemented risk adjustment models for Medicare Parts C and D. Sean also served as chief architect of CMS’s Medicare Encounter Data System.

Sean holds a bachelor’s degree in European studies from the University of Limerick, a higher diploma in statistics from Trinity College, Dublin, and a master’s degree in sociology from the London School of Economics. He conducted doctoral research at Indiana University, Bloomington, and has won various awards for development and implementation of risk adjustment and payment models.

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, which was bought by Medical Mutual of Ohio in 2024, and oversees the Risk Adjustment, Coordination of Benefits, and Subrogation departments.

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

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

Deb is a Board Member of the University of Toledo Health Information Administration Advisory Board and Health Information Technology Advisory Committee at Owens Community College.

Mark Dabney Director, Risk Adjustment

Community Health Plan of Washington

Mark Dabney is the Director of Risk Adjustment at the not-for-profit health plan Community Health Plan of Washington (CHPW), supporting risk adjustment operations & initiatives, submissions, and data analysis for Medicare, ACA, and Medicaid lines of business.  He has 20 years of experience in risk adjustment programs and almost 25 years of health care industry experience spanning a wide spectrum, from call center representative to supporting the implementation of the ACA program for millions of members across Kaiser Permanente, including serving as risk adjustment lead for Medicare, Medicaid, and ACA programs in the Mid-Atlantic States.  Prior to joining CHPW in late 2021, he helped implement risk adjustment operations and value-based programs at Somatus, driving revenue bearing care assessment partnerships. 

Outside of work, Mark and his wife enjoy pub trivia nights and board games.  He is an avid music and movie buff, and is currently fascinated by playing guitar and building custom guitar pedals.  He lives in the Seattle area.

Yvonne Daugherty Global Head of Industries

Ushur

Yvonne brings more than 30 years of experience in healthcare via leadership roles in marketing and communications, including 6 years at UnitedHealthcare in marketing, broker, employee and member communications. Throughout her career, she has specialized in more effective and influential communications that drive engagement, better experiences and better outcomes. Yvonne leads healthcare strategy and go to market at Ushur, serving as the bridge between the business and the market. She is also Ushur’s subject matter expert for member engagement and activation best practices, guiding clients around the world on implementing more effective omnichannel B2B and B2C communication.

As a care navigator and family caregiver, she also has a personal passion for health equity and accessibility, as well as reducing friction and complexity for those who are navigating the healthcare system.

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

Hemanth Doma is a healthcare technology professional with a strong commitment to improving patient outcomes. Currently serving as AVP of Product for Converged Outreach and Converged Vaccine Adherence, he oversees all product management aspects. He led the successful launch of Inovalon's value-based care reporting platform, now known as Converged Provider Enablement, and developed key components for Converged Data Insights and Healthcare Data Lake. Hemanth began his journey at Inovalon in 2010, specializing in healthcare data analytics for Quality Improvement. Prior to Inovalon, he gained experience at tech giants like IBM and RedHat. He holds an MBA from the University of North Carolina and a bachelor's in Computer Science from Bangalore University. With a passion for healthcare technology innovation, Hemanth is dedicated to enhancing healthcare delivery through data-driven solutions.

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.

Rebecca Elhassid

Secure Exchange Solutions

Rebecca is an experienced, mission-driven healthcare technology executive committed to helping health plans unlock the value of holistic data while maximizing providers’ health IT investments so that they can focus on what they do best – caring for patients. Under Rebecca’s leadership, the enterprise team drives collaboration with health plans, providers, and health information technology leaders striving to improve meaningful health information exchange. Before joining the world of healthcare technology, Rebecca led marketing and product development for international software and consumer product companies.

Kathryn Eshelman MD, MPH, VP, Medical Informatics

Inovalon

Dr. Eshelman oversees the development of Inovalon’s clinical toolsets, delivering provider-decision solutions that are patient specific at the point of care. Dr. Eshelman’s medical and clinical experience play a significant role in the design and development of Inovalon’s medical informatics product lines, which gather and rapidly process large amounts of patient and provider data to deliver insights and actionable solutions to the point of care.

Prior to this role, Dr. Eshelman served as Inovalon’s Senior Medical Director, where she was responsible for the provision and maintenance of best-practice and evidence-based standards across all clinical product lines. In this role, she played an integral role in the design of Inovalon’s data-driven encounter support solution, as well as its healthcare data analytics and individualized insights product.

For more than 20 years, Dr. Eshelman has held clinical, evidence-based, and data-driven positions across a variety of healthcare institutions. Prior to joining Inovalon, Dr. Eshelman served as an assistant professor in the internal medicine department at the University of Maryland, where she supervised residents in inpatient and outpatient internal medicine. Previously, she worked in underserved medicine on the Navajo Indian Reservation and as a primary care physician and director of the Diabetes Collaborative at the Family Health Center of Baltimore.

Dr. Eshelman graduated summa cum laude from Lafayette College with a degree in biochemistry. She received her medical degree, graduating with honors, and Master of Public Health, magna cum laude, from George Washington University, where she was elected into the medical honor society Alpha Omega Alpha. Dr. Eshelman completed her residency in internal medicine at the University of Pennsylvania Health System in Philadelphia. In addition to being board certified in Internal Medicine, Dr. Eshelman is also board certified in Clinical Informatics.

Amy Frankowski, MD Clinical Leader

Optum

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

Value Based Care Expert

Colleen Gianatasio CPC, CPCO, CRC, CDEO, CPC-P, CPMA, CPPM, CCS, CCDS-O, CHC, AHFI, and AAPC Approved Instructor is a strategic value-based care expert with over 20 years of experience in the health care field. Colleen specializes in supporting healthcare programs by ensuring compliance with federal guidelines and appropriate reimbursement processes. Colleen is known for driving program integrity and cost savings, increasing provider engagement and developing innovative coding curriculum. Colleen served as President of the AAPC National Advisory Board for the 2022-2025 term.

Jeff Grant Former Operations Director

Center for Consumer Information and Insurance Oversight at Centers for Medicare & Medicaid Services

Jeff Grant is the President and Founder of Schedule F Healthcare Strategies, a consulting practice specializing in federal health programs, health information technology, and government contracting.  He is currently using Schedule F as a platform to place wrongfully terminated civil servants in private sector jobs.  Jeff has over 30 years of experience as an entrepreneurial manager of major health programs in the Federal sector, leading the implementation of Affordable Care Act, Medicare Advantage and Medicare Prescription Drug Benefit payment policies, operations, and systems.  He also gained valuable private sector experience at Health Risk Partners, LLC, supporting Medicare Advantage plans in revenue strategy, risk adjustment and enrollment reconciliation.  Jeff most recently served as the Operations Director in the Center for Consumer Information and Insurance Oversight, leading 600 Federal staff and thousands of contracted personnel to support the enrollment of millions of Americans in private health insurance coverage and the provision of protections from surprise medical bills.  Jeff has a BA in History from the University of Michigan and a Masters of Public Administration from the George Washington University. He is a retired Navy Reservist with 22 years of service.

RaeAnn Grossman

Medicare Advantage Expert

RaeAnn Grossman joins us today as a health care innovator, strategic thought leader and premier healthcare operator. RaeAnn has over 25 years of experience in healthcare working at health plans, provider organizations, and tech-enabled solutions companies. RaeAnn is a subject matter expert in Medicare Advantage, Duals, SNPs, MSSP, Medicaid, and other governmental programs.

While at BCBSAZ and Centene, she led the provider strategy, network management, VBC contracting, provider engagement, redesigned payment integrity, and built national care pathways for complex conditions. , plus the hospitalist program that still exists today.

While working with Gorman Health Group, RaeAnn built over 22 Medicare Advantage plans and 17 ACOs, plus tech-enabled solutions, and drove turnarounds with an incredible team of network, operations, risk adjustment, and quality consultants. She has reimagined risk adjustment, moving it from retrospective to prospective and concurrent strategies. She has integrated risk, quality, and care throughout her career to drive the greatest impact with the most efficiency. She built Signify and Datavant. At Cotiviti, she turned around a $550M risk adjustment, quality, network, clinical, and consumer organization business unit.

RaeAnn is a transformative leader in innovation and is a completely purpose-driven healthcare executive. Now at HLTHWorks as CEO, RaeAnn continues to drive organizational transformation, build global workforce to compliment the challenge jobs of care delivery and responding to government regulatory changes. In short, every day RaeAnn focuses on simplifying healthcare, driving greater value, and bettering the health status of all populations

Ana Handshuh Principal

CAT5 Strategies

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

Luke Hansen MD, MHS, Chief Medical Officer

Arcadia

Luke Hansen, MD, MHS, is the Chief Medical Officer at Arcadia, a healthcare data platform company. He provides clinical and healthcare operational expertise to the company's internal teams and builds relationships with external stakeholders, particularly clinical executives and clinicians at Arcadia’s customers. He also contributes to strategic planning efforts and the company’s product roadmap by integrating emerging clinical evidence and technologies.

Before joining Arcadia, Dr. Hansen led the clinician organization for Homeward Health, a population health enablement company focusing on access and outcomes for rural Americans. He previously served at United Health Group as the Illinois Market Medicare Advantage Chief Medical Officer and a Senior Medical Director for Population Health at Optum. Dr. Hansen has also held health system roles as a Population Health Chief Medical Officer, including medical directorship over capitated risk-based contracts and a MSSP ACO.

Dr. Hansen’s career is driven by a desire to improve the healthcare system and a passion for improving the quality and efficiency of care delivery and clinical outcomes. Throughout his career, he has maintained an active clinical practice and teaching positions at Northwestern University and the University of Illinois.

Dr. Hansen holds a bachelor's degree in American studies from Yale College, a Doctor of Medicine degree from Loyola University Stritch School of Medicine, and a master's degree in health sciences from Yale University School of Medicine. He lives in Chicago with his wife and three children. In his free time, Dr. Hansen enjoys reading, writing, backpacking, and traveling.

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 Vice President, Quality, Stars and Risk Adjustment

CareFirst BlueCross BlueShield

Liz Haynes is the Vice President of Quality, Stars and Risk Adjustment for CareFirst Blue Cross BlueShield (CareFirst), one of the nation's largest not-for-profit healthcare organizations. In this role, Liz proposes innovative solutions bridging healthcare and health insurance. She is passionate about comprehensive quality of care, including the ongoing assessment and evaluation of chronic conditions at the plan and provider level, while accomplishing her mission of advancing affordable access to healthcare with accurately reflected revenue.

With expertise in Medicare Advantage and Affordable Care Act health plans, Liz has an extensive background in healthcare with experience ranging from bedside nursing to provider engagement on behalf of national payers. Prior to joining CareFirst, Liz was the Divisional Vice President of Risk Adjustment & Stars - Government Programs at Blue Cross and Blue Shield of Kansas City (Blue KC), where she led provider engagement and the operations, oversight and strategic direction of Risk Adjustment and Star functions for Blue KC's Medicare Advantage and Affordable Care Act health plans. Liz served for seven years in Risk & Quality at Optum Insight and eleven years with BJC HealthCare. Liz is a respected Government Programs Provider Engagement, Stars and Risk Adjustment expert. She manages comprehensive solutions for overall contract performance and is actively involved in several initiatives to deliver quality healthcare.

Liz has experience taking several Medicare Advantage contracts to 4 Star and was named the 2023 recipient of RISE's prestigious Martin L. Block award for advancing the lives of America's seniors through clinical leadership and policy vision. Liz earned both her B.S. and M.S. in Nursing from Chamberlain University with an emphasis in Informatics, making her a visionary in storing, processing, communicating and using results-oriented data to serve members while "future-proofing" the business.

Jennifer Holman Senior Director, Risk Adjustment Program Oversight

Centene

Bill Horn Chief Commercial Officer, Payer

Datavant

Bill Horn, Chief Commercial Officer (CCO) for Payer at Datavant, brings over 30 years of healthcare leadership experience focused on clinical data exchange and interoperability.

Since joining Datavant in 2015, Bill has been instrumental in the company's transformation into the premier clinical data acquisition and insights solution provider in the marketplace.  Previously, Bill served in senior sales roles at RelayHealth (McKesson) and Nuance, pioneering solutions connecting healthcare decision-makers with critical data. In 2024, he founded the Clinical Data Leadership Council to partner with leading health insurance data leaders in addressing pressing interoperability challenges across the industry.

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. 

Amit Jindal SVP, Healthcare & Private Equity

Ciklum

With 29 years of experience in the healthcare industry, Amit Jindal is dedicated to transforming health outcomes through the strategic application of AI, digital technologies, and intelligent automation. His expertise spans the entire healthcare ecosystem, focusing on enhancing care quality and patient experience while driving efficiencies to reduce costs. At Ciklum, Amit leads the charge in partnering with clients to deliver innovative solutions that make a meaningful impact on healthcare delivery and operations.

Mike Jones President & General Manager, Payer

Inovalon

Mike Jones serves as President & General Manager of the payer division at Inovalon. With over 29 years of experience in the industry, he maintains a strong commitment to the improvement of healthcare economics and outcomes and leads with a unique blend of strategic vision and operational expertise.

Prior to Inovalon, Mike was Vice President and General Manager at Nuance, a healthcare AI provider that was acquired by Microsoft in 2022. Before Nuance, he served as CEO of Cantata Health LLC, a Revenue Cycle Management and Electronic Medical Records software provider that was successfully spun out from NTTDATA.

Dr. Summerpal Kahlon Chief Medical Officer

Edifecs

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.

Amir Keren Senior Vice President of Payer Solutions'

Datavant

Amir Keren, SVP Payer Solutions at Datavant, brings over 20 years of healthcare technology leadership experience focused on clinical data interoperability and analytics. 

Since joining Datavant in 2017, Amir has driven innovation in healthcare data solutions, previously serving in several roles including Chief Technology Officer, Head of Payer product, and Chief Innovation officer. Earlier, as CIO at ArroHealth, he developed technology platforms serving hundreds of healthcare clients. Amir specializes in emerging technologies including NLP, machine learning, and AI to solve clinical data challenges across the healthcare ecosystem. He holds dual MBA degrees from Schulich School of Business and Tel Aviv University, and a Computer Science BSc from Bar-Ilan University.

Marilee Klock MBA, CPC, CRC, Senior Director, Diagnosis Accuracy Program

Guidehealth

Marilee started her career as an observation and surgical overnight coder with the Revenue Management department at Geisinger in 2008. In 2011, she decided to make a move to the insurance side of things and took on the role of Risk Adjustment Coder. While at Geisinger, Marilee held positions such as HCC analyst, Lead- Risk Adjustment Educator, Manager of Clinical Transformation and Director of Coding Operations. During COVID, she decided to leave Geisinger and transition to a more national level role. Over the past few years she has spent time building national level CDI programs, working in large HCC coding contract work, and VBC operations at a health plan. In her most recent role, she is the Senior Director of the Diagnosis Accuracy program at Guidehealth.

Marilee is a Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC) through the American Academy of Professional Coders (AAPC). Through her career, non-coding opportunities have presented themselves as well. Marilee is a Certified Business Analyst, carries a SQL Programming Skills Certification, and has a Green Belt in Lean/Six Sigma. Marilee attained a Bachelor’s degree in Management in 2015 and a Master’s in Business Administration in early 2017. In 2019, she decided to go back to school for an additional Bachelor's degree in Human Resources Management. 

In her free time, Marilee enjoys camping and boating on the Susquehanna river with her family and friends. Marilee grew up in rural Pennsylvania and plans to never leave the area! Her entire family of over 500 people (mostly) all live within a 25-30 mile radius. She has a total of 4 children, and they are always keeping her busy and on her toes. 

Susan Kopp Director, Provider Network Analytics

MVP Health Care

Susan Kopp is a strategic and results-oriented healthcare leader with extensive experience in leading clinical transformation and EHR implementation efforts. She holds an MBA, a BSN, and is a registered nurse.

Currently, Susan serves as the Director of Provider Analytics Innovation and Delivery at MVP. In this role, she is responsible for overseeing the team that supports provider analytics, including high-value health and population health analytics.

Prior to joining MVP, Susan served as a technology executive at Albany Medical Center. She provided direction and oversight related to strategic decision-making, collaborated with key clinical and non-clinical stakeholders to successfully execute and implement care management and analytics solutions for the Medicaid Delivery System Reform Incentive Payment (DSRIP) program. Her background also includes roles in Clinical Informatics, Utilization Management, and Case Management.

Susan's professional journey is marked by her ability to lead and mentor others, her strong analytical and conceptual skills, and her commitment to enhancing healthcare delivery. She is known for her problem-solving abilities, organizational skills, and her dedication to meeting aggressive timelines while ensuring quality delivery.

Outside of work, Susan enjoys Peloton, Hot Yoga and spending time with her husband, two daughters and dog, Roy Kent!

Tom Kornfield

MAST Health Policy Solutions

Mr. Kornfield is a leading national expert on Medicare Advantage risk adjustment and payment policy with more than 25 years of public and private sector experience. He spent 10 years at the Centers for Medicare and Medicaid Services (CMS) in a variety of roles tied to health plan payment and risk adjustment, where he was the technical lead on risk adjustment and for the annual rate notice would contribute technical sections on the payment methodologies for Medicare Advantage plans. He led the development of the 2014 and 2015 annual Medicare Advantage rate announcement.  In addition, he has worked extensively with the risk adjustment model, served on expert panels, presented on risk adjustment policy in multiple webinars and conferences, developed impacts of changes to the model, and conducted training on both risk adjustment and Medicare Advantage payment for industry. Since his time at CMS, he has been a consultant with Avalere and as the Vice President of Medicare Policy for AHIP. He currently runs his own consulting firm, MAST Health Policy Solutions, which supports a wide range of healthcare clients on Medicare policy.

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

Matt McClasky Executive Vice President

Fusion Advantage

Dr. Marie McCormack, MD Division Chief of Primary Care

Renown Medical Group

Dr. Marie M. McCormack has 30 plus years’ experience as a Family Medicine physician. She has been in a leadership position for the last 10 years working with all the changes that come down the pike for healthcare. She graduated from University of Nevada-Reno School of Medicine and says it is the best job she has ever had. Prior to medicine, she spent 10 years in the Federal Government fighting wildland fires.

Melissa McVaugh AVP Clinical Operations

Mountain Health CO-OP

With over 20 years of diversified experience, Melissa McVaugh is a proven leader in the healthcare industry.  

Melissa is a foundational part of the Mountain Health Co-Op, where she serves as the Director of Clinical Operations. In this pivotal role, Melissa oversees clinical operations, including risk adjustment, medical management, claims and payment integrity for three states.

Using her deep operational knowledge, she has leveraged her nearly 20 years of experience to improve risk scores, quality metrics, member and provider experience, and outreach.

By focusing on the relationships between data, quality, and risk adjustment, Melissa has put her knowledge to good use. Her passion for member-driven care has led Mountain Health Co-Op to adopt many signature benefits available to all members, like access to zero-cost insulins, heart medications, anti-depressants, and more. Melissa was applauded by the Co-Op for helping implement a 24/7 telehealth option that proved to be life-changing during the pandemic.

Over the years, her strengths at Mountain Health Co-Op have garnered recognition for the success of the risk adjustment program. Strategic changes to associated programs generated results that exceeded National benchmarks.

A proven leader in her field, Melissa’s professional experiences include consulting services, auditing, coding, and mentoring graduate nursing students and new leaders.

Miranda Meunier, NP Vice President of Clinical Services

Greater Good Health

A native of Montana, Miranda has focused her professional career on improving health of older adults in Montana.  After receiving a BSN from St. Olaf College in Minnesota in 2002, Miranda moved to Seattle and worked at a community hospital there before moving to North Carolina to purse a Master’s in Nursing program as a Hartford Foundation Scholar at Duke University, which she completed in 2008.  She is specialized as a Gerontological Nurse Practitioner, focusing exclusively on the care of older adults. Miranda worked for the Geriatrics Department at Billings Clinic for nearly 15 years where she also served as the Chief of Advanced Practice, overseeing the professional practice of NPs and PAs across Billings Clinic. Since 2023, she has been working as VP of Care Services with Greater Good Health, a senior-focused primary care organization. With this role she oversees the professional practice of the providers along with quality and  documentation programs.

David Meyer Medicare Advantage Expert

Kim Miller D.C., CPC, CEDC, CRC, Government Programs Clinical Coordinator, SR.

Blue Cross Blue Shield of Kansas City

Kim Miller is the Senior clinical coordinator at Blue Cross Blue Shield of Kansas City (Blue KC).  Kim is responsible for engaging with provider groups in the surrounding Kansas City area to ensure Blue KC members are receiving the highest quality of care by promoting preventative care and enhanced chronic condition assessment and management.

Starting her healthcare journey as a chiropractor Kim owned and operated a small chiropractic practice allowing her to gain insight into the provider’s view from proper documentation to coding and billing, to filing claims and even credentialing.  During this time, she moonlighted as a certified coder.  Prior to joining Blue KC, Kim became the proud mother of three beautiful children, one of whom is medically complex.  This experience allowed Kim to gain an empathetic view of Blue KC’s members.  She later joined the University of Kansas Health systems in 2017 to assist with successfully operationalizing and implementing emergency department coding and billing that had been outsourced the previous 20 years all while overseeing the psychiatry and radiation oncology coding and billing operations.

Kim gained her doctorate degree in 2003 from Cleveland Chiropractic College followed by many certificates through the AAPC. She has been a Certified Professional Coder (CPC) since 2007 and obtained her Certified Emergency Department (CEDC) certificate in 2009 and her Certified Risk Adjustment Coder (CRC) certificate in 2022.  Kim has a unique empathetic 360-degree view of the insurance industry that has led to many successes at Blue KC and in her career.   

Katrina Miller Parrish M.D., FAAFP, Chief Medical Officer, President

SSI/Patient.com

Dr. Parrish is a Family Physician and Clinical Informaticist who currently is GAO appointee to HITAC for ASTP. Formerly, she was Physician Director, Clinical Informatics for Humana and Chief for Quality and Informatics at L.A. Care Health Plan. In her various roles, she has led efforts increasing patient empowerment, interoperability, population health, regulatory and accreditation scores, optimizing data governance, analytics, data science, provider, group and facility performance, health assessments and risk stratification. She also served as Clinical Information Systems Medical Director for Adventist Health, West where she facilitated CPOE implementation at 19 hospitals and hundreds of clinics with multiple EMR-based Lean workflows, education and communication processes focused on provider user experience. She trained in Quality Management through the American Association of Physician Leadership (AAPL), is a GE Change Agent Plus. She is Fellow of the American Board of Family Medicine and Diplomate of the American Board of Preventive Medicine – Clinical Informatics Specialty. She was an Assistant Professor through USC’s Keck School of Medicine. Her BA is from Reed College in Portland, OR, MD from EVMS in Norfolk, Virginia and residency was at UCLA-Westwood.

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.

Jessica Muratore Healthcare Expert

Muratore Advisory Services, LLC

Jessica Muratore transitioned from civil litigation to healthcare, leveraging her legal expertise to navigate CMS, Medicare Advantage, and Medicaid regulations. Over the past 2.5 years, she has advised payers, vendors, and investors on Medicare Stars, Medicaid pay-for-performance, and quality improvement strategies. Previously, she held executive roles at MVP Health Care and Centene, managing national market strategy, quality compliance, and operations for 38 health plans. Her hands-on experience uniquely equips her to deliver impactful solutions.

Brian Murtha Senior Director, Digital Initiatives

Centene

Brian is Senior Director, Digital Initiatives. 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

Michelle Nelson Senior Vice President of Risk Adjustment

Illumed

Swati Patel AVP, Product Development

GeBBS Healthcare Solutions

Brandon Piersant Chief Marketing Officer

American Logistics

For the last 6 years, Brandon has overseen all of the marketing and communications for American Logistics, an industry-leading technology-enabled services company known for delivering high-quality transportation management for healthcare payors and systems nationwide. With over 20 years of leading marketing teams for technology companies in the automotive and healthcare verticals, he empowers brands through cross-functional, departmental support to ensure alignment internally and leverages the amazing work, people and stories that make a difference. His executive acumen with M&A and business transformations was integral in multiple successful organizations’ exits. Brandon’s award-winning creativity has elevated brands to differentiate themselves uniquely, emphasizing people, products, and technology. He currently resides with his wife and 5 children in Southern California, enjoys ocean activities and is active with leadership roles in community-based organizations.

Chris Punzalan Director, Financial Analysis

Caloptima Health

Chris Punzalan is the Director of Financial Analysis at CalOptima Health, a County Organized Health System that offers programs including Medicaid managed care plan, D-SNP, and PACE for low-income families and people with disabilities in Orange County. 

Chris has been working in healthcare finance roles for 18 years specializing in Medicare risk adjustment, CMS stars, and analytics. At CalOptima, his team is responsible for risk adjustment analytics, internal coding audits, quality incentive programs, and support of new operational initiatives. Chris is committed to streamline processes and develop long-term solutions through strategic planning and analysis to improve member experiences and achieve better health outcomes. 

Hassan Rifaat, MD CEO

Vatica Health

Hassan Rifaat, MD, is chief executive officer at Vatica Health and has more than 25 years of experience in the healthcare industry. Dr. Rifaat was previously chief executive officer of Windsor Health Group, a Medicare Advantage and supplemental insurance carrier based in Nashville, Tenn., with over 300,000 covered members. He served as chief operating officer at Outcomes Health Information Solutions and was senior vice president, eastern region, for Coventry Health Care. At Coventry, he managed seven health plans serving more than 1.5 million commercial, Medicare and Medicaid members in 11 states. He held senior executive positions at Humana, Inc., including regional CEO for Illinois and the southeast region and market president for Louisiana. Dr. Rifaat is a graduate of the University of Virginia School of Medicine and Harvard University, where he was an All-American player on the national rugby team.

Jenny Ritchie Area Vice President Sales, East

Veradigm

Jenny Ritchie is an accomplished senior business development executive with over 30 years’ experience in healthcare technology. She is a trusted advisor working with senior and C-suite executives in health plans and risk bearing entities across government and commercial lines of business. Her focus has been in the solution areas of prospective and retrospective risk adjustment, data and analytics, prospective care gap closure at the point of care, medical record chart retrieval and HCC risk adjustment coding, Medicare STARS, HEDIS reporting, EDS submissions for MA, ACA, and Medicaid, population health, predictive modeling, and payment integrity. She began her career at Blue Cross Blue Shield of Georgia and holds a Bachelor of Science degree in Marketing from Clemson University.

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.

Crystal Sawyer Associate Director, Process Improvement

Humana

Crystal leads the Process Improvement & Facilitation team serving Humana KY Medicaid, a retail product for KY Medicaid recipients. She joined KY MCD in October 2019 supporting implementation and standing up the market. Prior to KY MCD, Crystal has held several progressive leadership roles within Humana at Home Medicare and Humana Ohio Demo (Medicare/Medicaid).

She is focused on advancing the Medicaid strategy with a deep understanding of how organization capabilities are related across departments within the market, shared services, corporate, and national teams. She is responsible for supporting the health service team’s clinical operations including physical and behavioral health care management, population health management, quality improvement, and physical and behavioral health utilization management. Crystal and her team created a process improvement, vendor management, and facilitation mission that focuses on the leader, new hire, and member experience. Identifying opportunities to initiate operational change to make it easy for the associates serving our members while also improving results. Some key large project implementations include the Health Risk Assessment and automated business rules, Predictive models and ER Diversion, DEBUT and RxConnect applications.

Crystal graduated with a Masters of Science in Nursing with a focus of Education from Walden University.  In her spare time, she enjoys spending it with her husband (Matt) and 2 girls (Luna, Aurora) traveling or staying local and joining their community at local music, art, and food events.

Andrew Schwab Founder & CEO

Platform Government Strategies

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.

Nehal Shah CEO, DataOrb, CTO

RAAPID

Reva Sheehan Sr. Director of Customer Insights

mPulse

Sr. Director of Customer Insights, mPulse

Reva Sheehan is the Senior Director of Customer Insights at mPulse, a company specializing in digital solutions for the healthcare industry. 

With over 15 years of experience in health plan operations, Medicare quality, long-term care, and compound pharmacy management, Reva is dedicated to enhancing member experiences and outcomes.  

In her role at mPulse, Reva focuses on leveraging data-driven insights to improve healthcare consumer experiences. She has been instrumental in developing strategies to navigate changes in Medicare Star Ratings and has shared her expertise through webinars and industry events.

LinkedIn URL: https://www.linkedin.com/in/reva-sheehan-2625ab177

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.

Rohit Shinde Vice President

Healow

Mr. Shinde founded the Payer-Provider interoperability platform, known as healow Insights, at healow, LLC. Under his guidance, healow Insights has been instrumental in facilitating a seamless transition for both Payers and Providers toward Value Based Care. Over the past 8 years, he has successfully led teams in delivering innovative data exchange solutions and services that empower Providers to reduce administrative burden while enhancing the quality of care and outcomes for Patients. Simultaneously, Payers benefit from reduced healthcare cost and improved engagement with Providers and Members.

Before embarking on the healow Insights journey, he has over 11 years of experience in bridging the gap between technology and healthcare delivery. During this time, he spearheaded various business units focused on critical areas such as Electronic Health Records (EHRs), Health Information Exchanges (HIEs), Clinical Registries, and Professional Services. He is also an active member of the HL7 DaVinci Project operating committee, contributing to the advancement of healthcare interoperability standards.

Melissa Smith Founder

Newton Smith

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

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

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

Jenny Smith Market Strategy

Consultant

With more than a decade of experience in Medicare Advantage and health insurance, Jenny Smith has built a reputation for turning complex market data into clear, actionable strategies that drive business growth. She has led major initiatives at organizations like Blue Cross Blue Shield and Wellabe, where she developed market intelligence frameworks, optimized business performance, and spearheaded strategic transitions that delivered measurable impact.

A proven leader in navigating evolving regulatory landscapes, Jenny specializes in aligning cross-functional teams, translating data into market-driven decisions, and operationalizing strategies that enhance both financial and customer outcomes. She brings a fresh perspective on how organizations can stay competitive amid shifting markets and increasing member expectations.

Branka Sustic Vice President, Risk & Quality Solutions

Cotiviti, Inc.

Branka provides leadership and oversight into product and business development, client program management, and strategy to assist health plans in meeting their quality and risk adjustment goals, optimization of revenue, and risk mitigation.  

She is a leader with more than two decades of healthcare experience, blending a strong customer service and analytic foundation with experience leading change management throughout her career. Branka is known for creating and establishing operational and support plans leading to increased client satisfaction and performance.

Shannon Thorpe DNP, RN, CNL, SVP

Sharecare/CareLinx 

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.

Dan Weaver Senior Vice President, Stars & Quality

Zing Health

Daniel Weaver recently became the Senior Vice President of Stars and Quality at Zing Health. With over 25 years of experience in Operations and Star Ratings strategy, Daniel has previously served as VP, Government Quality Programs at Gateway Health and Director of Stars Programs at Highmark Health, helping both organizations achieve and maintain their first 4.5 Star Ratings. In his career, Dan has overseen the development and implementation of many analytics-driven and customer-focused programs, and he advocates for continuous improvement and operational excellence philosophies for sustained success. In his new role with Zing Health, Daniel will focus on implementing a high-performing Stars infrastructure to support the organization’s rapid growth with a focus on servicing special needs members in several states.

Josh Weisbrod Risk Adjustment and Payment Integrity

Network Health

Mr. Weisbrod currently serves as the Vice President – Risk Adjustment and Payment Integrity at Network Health in Menasha, WI.  Mr. Weisbrod brings over 25 years of health insurance, healthcare analytic and human service experience to Network Health.  Mr. Weisbrod specializes in government programs, health plan operations, risk adjustment, payment integrity and data analytics.  Prior to his work at Network Health, Mr. Weisbrod served as Director of Government Programs for a regional Wisconsin health plan serving the state’s Medicare, Medicaid and Marketplace participants.  Mr. Weisbrod previously served as the Director of Operations for the Wisconsin Health Insurance Risk-Sharing Plan (HIRSP), the state’s high-risk insurance plan.  HIRSP also administered the federal high-risk insurance plan in Wisconsin prior to the implementation of the Affordable Care act. 

Mr. Weisbrod has taught part-time at the college level for over 11 years and has extensive experience training health insurance and human service professionals. 

Josh lives in Neenah, WI with his wife and three teenage sons. 

Rick Whitted President & CEO

U.S. Hunger

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

Matt Yancisin Chief Financial Officer

Alterwood Health

Matt is the Chief Financial Officer of Alterwood Health, Inc., a Medicare Advantage MCO that launched operations in Maryland in 2022 and current serves over 9,500 members. Matt directs the accounting, finance, human resources and risk adjustment functions for the organization. Prior to joining Alterwood Heath, he served as the Chief Financial Officer of Riverside Health, Inc. a Maryland Medicaid and Medicare Advantage organization with over $450 million in annual revenue before it was sold to a local hospital system.  Prior to that, Matt was the Chief Financial Officer of several enterprise technology companies.  Matt began his career with Arthur Andersen LLP.

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.