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LIST OF ATTENDEES
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Click here for attendees list.
Agenda Links: Preconference | Day 3
AGENDA: DAY II
THURSDAY, MAY 17, 2018
7:00 am
Registration Opens; Continental Breakfast in Exhibit Hall
MORNING PLENARY SESSION
8:15 am
Welcome and Introduction
Allyson Y. Schwartz
President and Chief Executive Officer, Better Medicare Alliance; Former Member (D/PA), US House of Representatives, Washington, DC (Chair)
President and Chief Executive Officer, Better Medicare Alliance; Former Member (D/PA), US House of Representatives, Washington, DC (Chair)
Allyson Y. Schwartz is President and CEO of the Better Medicare Alliance, a former member of the U.S. House of Representatives from Pennsylvania and a nationally recognized leader on health care issues. Having worked as a health service executive, Schwartz was elected to the Pennsylvania State Senate in 1990, serving 14 years until her election to Congress. In the state Senate, Schwartz was the driving force behind Pennsylvania’s CHIP program, which was a model for the federal CHIP program five years later. In Congress, Schwartz was appointed to the Ways and Means Committee and served as a senior member of the Budget Committee. Schwartz is a Distinguished Policy Fellow at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Visiting Fellow at the Penn Wharton Public Policy Initiative and Co-Chair of the Bipartisan Policy Center Health and Housing Task Force.
Jerry Penso, MD, MBA
President and Chief Executive Officer, AMGA; Former Medical Director, Continuum of Care, Sharp Rees-Stealy Medical Group, Washington, DC (Co-chair)
President and Chief Executive Officer, AMGA; Former Medical Director, Continuum of Care, Sharp Rees-Stealy Medical Group, Washington, DC (Co-chair)
Dr. Penso is president and chief executive officer at AMGA, a trade association that represents medical groups and other organized systems of care. Dr. Penso previously served as chief medical and quality officer for AMGA and president of AMGA Foundation.
Prior to joining AMGA, Dr. Penso served as medical director, continuum of care for Sharp Rees-Stealy Medical Group (SRSMG). In addition to his work at AMGA and SRSMG, Dr. Penso has served on the Integrated Healthcare Association Board of Directors, the California Cooperative Healthcare Reporting Initiative Executive Committee, and Board of Directors of the Behavioral Diabetes Institute, and chaired the Technical Quality Committee for California’s Pay for Performance program. He currently serves as chair of the Board of Directors of two AMGA subsidiaries, AMGA Analytics, and AMGA Consulting. Dr. Penso also serves on the board of the Pharmacy Quality Alliance.
Prior to joining AMGA, Dr. Penso served as medical director, continuum of care for Sharp Rees-Stealy Medical Group (SRSMG). In addition to his work at AMGA and SRSMG, Dr. Penso has served on the Integrated Healthcare Association Board of Directors, the California Cooperative Healthcare Reporting Initiative Executive Committee, and Board of Directors of the Behavioral Diabetes Institute, and chaired the Technical Quality Committee for California’s Pay for Performance program. He currently serves as chair of the Board of Directors of two AMGA subsidiaries, AMGA Analytics, and AMGA Consulting. Dr. Penso also serves on the board of the Pharmacy Quality Alliance.
8:30 am
Video Presentation: The Voices of Medicare Advantage
8:45 am
Keynote
Steve Nelson, MBA, MHSA
Chief Executive Officer, UnitedHealthCare Inc., Executive Vice President, UnitedHealth Group, Minnetonka, MN
Chief Executive Officer, UnitedHealthCare Inc., Executive Vice President, UnitedHealth Group, Minnetonka, MN
Steve Nelson is chief executive officer of UnitedHealthcare, a $160 billion division of UnitedHealth Group. In September 2017, he was named to the Office of the Chief Executive for UnitedHealth Group.
Previously Steve served as chief executive officer of UnitedHealthcare’s Medicare & Retirement business, a $65 billion division of UnitedHealthcare and the nation’s largest organization dedicated to seniors and Medicare beneficiaries. Other past roles included leading UnitedHealthcare’s Community & State business, an organization that delivers Medicaid solutions to 25 state governments and more than 5 million individuals, and leadership of the West Region of UnitedHealthcare’s Employer & Individual business. Before coming to UnitedHealthcare, Steve was president of the Eastern Region and Senior Products Division at HealthNet and served for 10 years in executive roles at the Henry Ford Health System.
Previously Steve served as chief executive officer of UnitedHealthcare’s Medicare & Retirement business, a $65 billion division of UnitedHealthcare and the nation’s largest organization dedicated to seniors and Medicare beneficiaries. Other past roles included leading UnitedHealthcare’s Community & State business, an organization that delivers Medicaid solutions to 25 state governments and more than 5 million individuals, and leadership of the West Region of UnitedHealthcare’s Employer & Individual business. Before coming to UnitedHealthcare, Steve was president of the Eastern Region and Senior Products Division at HealthNet and served for 10 years in executive roles at the Henry Ford Health System.
9:15 am
The Policies and Politics of Medicare Advantage
Joseph Antos, PhD
Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute (AEI); Former Assistant Director for Health and Human Resources, Congressional Budget Office (CBO), Washington, DC
Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute (AEI); Former Assistant Director for Health and Human Resources, Congressional Budget Office (CBO), Washington, DC
Joseph R. Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute and adjunct associate professor of emergency medicine at the George Washington University. He is the Vice-Chair of the Maryland Health Services Cost Review Commission, where he is serving a third term as a commissioner.
Previously, Dr. Antos was Assistant Director for Health and Human Resources at the Congressional Budget Office, and he held senior management positions in the U.S. Department of Health and Human Services, the Office of Management and Budget, and the President’s Council of Economic Advisers. His work focuses on the economics of health policy, including the Affordable Care Act, Medicare, the uninsured, and the overall reform of the health care system.
Previously, Dr. Antos was Assistant Director for Health and Human Resources at the Congressional Budget Office, and he held senior management positions in the U.S. Department of Health and Human Services, the Office of Management and Budget, and the President’s Council of Economic Advisers. His work focuses on the economics of health policy, including the Affordable Care Act, Medicare, the uninsured, and the overall reform of the health care system.
Melanie Egorin, PhD
Professional Staff, Committee on Ways and Means, US House of Representatives, Former Senior Health Policy Analyst, GAO, Washington, DC
Professional Staff, Committee on Ways and Means, US House of Representatives, Former Senior Health Policy Analyst, GAO, Washington, DC
Melanie Egorin has over 20 years of health policy experience almost 15 years in the federal government. Dr. Egorin currently serves as Democratic Deputy Staff Director, Subcommittee on Health, Committee on Ways and Means in the U.S. House of Representatives. She is the lead staff person for Affordable Care Act policy as well as Medicare Advantage, dualeligible beneficiaries, women’s health, and health tax issues. Prior to joining Ways and Means, Dr. Egorin was a Senior Analyst at the U.S. Government Accountability Office (GAO). Before moving to Washington D.C., she worked for the University of California Office of the President and taught at San Francisco State University.
Chris Jennings
President and Founder, Jennings Policy Strategies, Inc.; Former Deputy Assistant for Health Policy and Coordinator of Health Reform, The White House (Obama); Former Senior Health Advisor, The White House (Clinton), Washington, DC
President and Founder, Jennings Policy Strategies, Inc.; Former Deputy Assistant for Health Policy and Coordinator of Health Reform, The White House (Obama); Former Senior Health Advisor, The White House (Clinton), Washington, DC
Chris Jennings is a health policy veteran of the White House, the Congress and the private sector. Mr. Jennings is President of Jennings Policy Strategies (JPS), a nationally respected health care consulting firm committed to assisting foundations and other aligned stakeholders develop policies to ensure higher quality, more affordable health care. In January 2014, Mr. Jennings departed from his second tour of duty in the White House where he served as Senior Advisor to the President for Health Policy. He served in a similar capacity in the Clinton White House for eight years. From his positions, Mr. Jennings has helped pass, enact and implement the Affordable Care Act, the Children’s Health Insurance Program and numerous other health reforms. He served as the Deputy Director of the Special Committee on Aging for three Senators and led major reform efforts in the areas of long-term care, prescription drug coverage/cost containment, and rural health care.
Nicholas Uehlecke
Professional Staff Member (R), Subcommittee on Health, Committee on Ways and Means, US House of Representatives, Washington, DC
Professional Staff Member (R), Subcommittee on Health, Committee on Ways and Means, US House of Representatives, Washington, DC
Nick Uehlecke is a professional staff member for the House Committee on Ways and Means Subcommittee on Health majority staff. His portfolio includes Medicare Advantage & Part D policies as well as Medicare fraud and program integrity across the system. Nick has been with the Subcommittee since the start of 2011, prior to which he was an analyst for the Marwood Group in several fields including health care for nearly three years.
Dan Mendelson, MPP
President, Avalere Health; Former Associate Director for Health, Office of Management and Budget (OMB), Washington, DC (Moderator)
President, Avalere Health; Former Associate Director for Health, Office of Management and Budget (OMB), Washington, DC (Moderator)
Dan Mendelson is President of Avalere Health. He leads the firm’s operations and engages in data-driven strategic work for major clients in life sciences, managed care, and the provider sectors. Prior to founding Avalere in 2000, Dan served as Associate Director for Health at the White House Office of Management and Budget. Mr. Mendelson presently serves on the Board of Champions Oncology (CSBR) and is Executive in Residence at the Fuqua School of Business at Duke University. He previously served on the boards of Coventry Healthcare, PharMerica Corporation and HMS holdings. Dan speaks frequently and is often quoted in the media on business strategy and policy matters – often highlighting the outstanding analytic work of the Avalere staff.
10:00 am
Break
10:20 am
Star Ratings
Paul Cotton
Director of Federal Affairs, NCQA; Former AARP Senior Legislative Representative Lobbying Congress; Former Director, Office of Legislation, Center for Medicare and Medicaid Services, Washington, DC
Director of Federal Affairs, NCQA; Former AARP Senior Legislative Representative Lobbying Congress; Former Director, Office of Legislation, Center for Medicare and Medicaid Services, Washington, DC
Paul Cotton is the National Committee for Quality Assurance Director of Federal Affairs. He works with Congress, the Administration and other stakeholders to improve health care quality. Previously he was a lobbyist for AARP on Medicare, Medicaid, CHIP, health reform, health IT and quality improvement issues. He has also worked at the Center for Medicare & Medicaid Services as Hearings & Policy Presentation Director in the Office of Legislation, and as a journalist for publications including the Journal of the American Medical Association.
John Gorman
Founder and Executive Chairman, Gorman Health Group; Former Assistant to the Director of Health Care Financing Administration’s Office of Managed Care, HCFA, Washington, DC
Founder and Executive Chairman, Gorman Health Group; Former Assistant to the Director of Health Care Financing Administration’s Office of Managed Care, HCFA, Washington, DC
John Gorman is Founder & Executive Chairman at Gorman Health Group (GHG). In this role, he has led the development of the industry’s leading consulting practice and several entrepreneurial ventures in government health programs. John’s work focuses on Medicare, Medicaid, and Affordable Care Act strategy, governance, and turnaround of distressed health plans. Prior to founding the firm, John served as Assistant to the Director of Health Care Financing Administration’s Office of Managed Care, where he provided day-to-day management and served as the external liaison for the Medicare and Medicaid managed care programs. During the 1993 debate on national healthcare reform, John was chief lobbyist on healthcare financing issues for the National Association of Community Health Centers, an organization of federally-funded primary care clinics for the medically underserved. John’s career in Washington began as Press Secretary and Staff Director for U.S. Representative John Conyers, Jr. (D-MI), then Chairman of the Government Operations Committee.
Mark Newsom, MSc
Vice President, Public Policy Analysis, Humana; Former Director, Public Policy, CVS Health; Former Director, Division of Payment Reconciliation, CMS, Washington, DC
Vice President, Public Policy Analysis, Humana; Former Director, Public Policy, CVS Health; Former Director, Division of Payment Reconciliation, CMS, Washington, DC
Mark Newsom has 20 years of experience focusing on the intersection of health policy and business. He currently serves as Vice President of Public Policy Analysis at Humana, where he advises senior business executives on the policy environment and leads analysis of CMS regulations and guidance. Mark joined Humana in July 2015, after serving as a Director of Public Policy at CVS Health, where he focused on the pharmacy benefit manager (PBM) subsidiary and the Business Development /Merger and Acquisition team. Prior to CVS Health, Mark spent nearly 6 years at CMS, developing Medicare Advantage (MA) and Part D payment policies and operations. Mark also served two years as a senior policy analyst at the Congressional Research Service (CRS) and as Director of Medicare Policy and Compliance at Coventry.
Paul Wimer, MBA
Chief Innovation Officer, Tivity Health; Former Senior Principal, Clareo Partners, Franklin, TN
Chief Innovation Officer, Tivity Health; Former Senior Principal, Clareo Partners, Franklin, TN
As the Chief Experience Officer, Paul Wimer is responsible for driving member engagement and utilization of products and services, as well as brand and product marketing, product development, product management and strategic partnership development. Wimer joined Tivity Health in 2017 and brings more than 25 years of experience assisting companies, from start-ups to Fortune 100 businesses, with corporate strategy development in a variety of industries.
Prior to Tivity Health, Wimer was a senior principal at Clareo Partners, where he advised clients on strategic growth and corporate venture capital, and was a founding managing director at Topspin Partners, a New York-based venture capital and private equity firm, where he was responsible for all aspects of investing.
Prior to Tivity Health, Wimer was a senior principal at Clareo Partners, where he advised clients on strategic growth and corporate venture capital, and was a founding managing director at Topspin Partners, a New York-based venture capital and private equity firm, where he was responsible for all aspects of investing.
Susan Dentzer
President and Chief Executive Officer, NEHI (The Network for Excellence in Health Innovation), Analyst on Health Policy, The NewsHour, Former Editor, Health Affairs, Washington, DC (Moderator)
President and Chief Executive Officer, NEHI (The Network for Excellence in Health Innovation), Analyst on Health Policy, The NewsHour, Former Editor, Health Affairs, Washington, DC (Moderator)
Susan Dentzer is the President and Chief Executive Officer of the NEHI, the Network for Excellence in Health Innovation. a nonprofit, nonpartisan organization composed of more than 100 stakeholder organizations from across all key sectors of health and health care. Dentzer previously served as senior policy adviser to the Robert Wood Johnson Foundation. Prior to that, she was editor-in-chief of the journal Health Affairs, and, she served as the on-air Health Correspondent for the PBS NewsHour. Dentzer is an elected member of the National Academy of Medicine and the Council on Foreign Relations and a member of the Board of Directors of the International Rescue Committee; a member of the board of directors of Research!America; and a member of the board of directors of the Public Health Institute. She is a fellow of the National Academy of Social Insurance and the Hasting Center. She previously served as a public member of the American Board of Medical Specialties.
11:05 am
Trends and Value of Employer Group Waiver Plans
Fran Soistman, DHL
Executive Vice President and Head of Government Services, Aetna, Hartford, CT
Executive Vice President and Head of Government Services, Aetna, Hartford, CT
Fran Soistman is Executive Vice President of Aetna and President of the Government Services segment. He is responsible for driving growth in the company’s Medicare, Medicaid and Federal Employees Health Benefits Program. Prior to joining Aetna, he was Executive Vice President, Chief Operating Officer and co-founder of Jessamine Healthcare. Mr. Soistman has held several senior leadership positions at Coventry Health Care, including Executive Vice President for the Individual Consumer and Government Business Division. He was appointed by Governor Rendell to serve on the Pennsylvania Health Care Cost Containment Council. Mr. Soistman serves on multiple higher education boards, including the Towson University Board of Visitors, the University System of Maryland Foundation Board of Directors, and the Penn State University Presidential Leadership Board. In addition, he represents Aetna on the Healthcare Leadership Council the Healthcare Transformation Task Force and the Harvard Medical School Department of Health Care Policy Scientific Advisory Board.
11:15 am
Employer Group Waiver Plans
Cary Badger, MBA
Principal, HealthScape Advisors LLC; Former Corporate & Strategic Business Development and Marketing Leader, The Regence Group, Seattle, WA
Principal, HealthScape Advisors LLC; Former Corporate & Strategic Business Development and Marketing Leader, The Regence Group, Seattle, WA
Fran Soistman, DHL
Executive Vice President and Head of Government Services, Aetna, Hartford, CT
Executive Vice President and Head of Government Services, Aetna, Hartford, CT
Fran Soistman is Executive Vice President of Aetna and President of the Government Services segment. He is responsible for driving growth in the company’s Medicare, Medicaid and Federal Employees Health Benefits Program. Prior to joining Aetna, he was Executive Vice President, Chief Operating Officer and co-founder of Jessamine Healthcare. Mr. Soistman has held several senior leadership positions at Coventry Health Care, including Executive Vice President for the Individual Consumer and Government Business Division. He was appointed by Governor Rendell to serve on the Pennsylvania Health Care Cost Containment Council. Mr. Soistman serves on multiple higher education boards, including the Towson University Board of Visitors, the University System of Maryland Foundation Board of Directors, and the Penn State University Presidential Leadership Board. In addition, he represents Aetna on the Healthcare Leadership Council the Healthcare Transformation Task Force and the Harvard Medical School Department of Health Care Policy Scientific Advisory Board.
Thomas E. Hutchinson, MPA
Strategic Advisor, EBG Advisors; Former Director, Medicare Plan Payment Group, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Baltimore, MD (Moderator)
Strategic Advisor, EBG Advisors; Former Director, Medicare Plan Payment Group, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Baltimore, MD (Moderator)
Thomas Hutchinson is a Strategic Advisor for EBG Advisors, Inc. He has more than 25 years of experience in both the private sector and in federal service implementing programs and policies directly affecting Medicare and Medicaid beneficiaries. Mr. Hutchinson advises clients on a wide range of payment policy and operations issues relating to the Centers for Medicare and Medicaid Services (CMS).
Prior to his joining EBG Advisors in this business advisory role, Mr. Hutchinson served as the director of the Medicare Plan Payment Group at CMS, where he was responsible for all aspects of annual Medicare payments to Part C (Medicare Advantage) and Part D (drug) plans, totaling approximately $160 billion.
Mr. Hutchinson provided essential technical assistance to Congressional staff in drafting the Affordable Care Act (ACA) regarding changes in the Medicare Advantage payment methodology. His knowledge was sought by HHS executives responsible for implementing the ACA, particularly with regard to payment and plan design.
Prior to his joining EBG Advisors in this business advisory role, Mr. Hutchinson served as the director of the Medicare Plan Payment Group at CMS, where he was responsible for all aspects of annual Medicare payments to Part C (Medicare Advantage) and Part D (drug) plans, totaling approximately $160 billion.
Mr. Hutchinson provided essential technical assistance to Congressional staff in drafting the Affordable Care Act (ACA) regarding changes in the Medicare Advantage payment methodology. His knowledge was sought by HHS executives responsible for implementing the ACA, particularly with regard to payment and plan design.
NETWORKING LUNCHEON AND PRESENTATION
12:00 pm
Networking Luncheon and Presentation
12:15 pm
Medical Groups and MA Plans: What Do Groups Need to Succeed
Beth Honan, MHA
Chief Contracting Officer, Atrius Health, Former Vice President Contracting, Harvard Vanguard Medical Associates, Boston, MA
Chief Contracting Officer, Atrius Health, Former Vice President Contracting, Harvard Vanguard Medical Associates, Boston, MA
Beth Honan, Chief Contracting Officer, is responsible for leading Atrius Health’s overall health plan contracting strategy, negotiations, contract performance and relationship management efforts. Additionally Beth oversees Atrius Health’s contracting initiatives in support of key hospital and other provider partnerships. This work involves monitoring contract performance and implementing improvement initiatives, developing new approaches to alternative financial arrangements, identifying strategic business opportunities and aligning incentives through innovative contracting models between Atrius Health and its’ key health plan and hospital partners. Beth joined Harvard Vanguard in 2000 as Assistant Vice President of Contracting. Prior to that, Beth served in various leadership roles including Regional Director for Tufts Health Plan – Rhode Island, Director of Contracting at Lowell General Hospital and Executive Director of the Lowell General Physician Hospital Organization. Beth’s responsibilities have included network development, provider contracting, business development, strategic planning, provider operations and provider engagement.
Tricia Nguyen, MD, MBA
Chief Medical Officer, Inova, CEO, Commonwealth Health Network, Former President, Texas Health Population Health, Education & Innovation Center, Former CMO, Banner Health Network and CMO, Blue Cross Blue Shield of Kansas City, Washington, DC
Chief Medical Officer, Inova, CEO, Commonwealth Health Network, Former President, Texas Health Population Health, Education & Innovation Center, Former CMO, Banner Health Network and CMO, Blue Cross Blue Shield of Kansas City, Washington, DC
Dr. Nguyen is currently with Inova Health System as CEO, Commonwealth Health Network (Inova’s Tri-State -VA, MD and DC) Clinically Integrated. The Network contracts with insurers and employers to deliver value -healthcare through better clinical coordination, effective care management models and reducing unnecessary utilization of healthcare services.
Dr. Nguyen has more than 20 years of experience in healthcare. Dr. Nguyen has a broad range of experience working with health systems and networks (Banner Health, Texas Health Resources) and payers (Humana and Blue Cross Blue Shield), all focused on establishing the foundations for population health and outcomes-based reimbursement. She has worked as an emergency medicine physician, a clinical leader in hospital settings and as an executive champion for improving the health and well-being of the people in the community.
Dr. Nguyen has more than 20 years of experience in healthcare. Dr. Nguyen has a broad range of experience working with health systems and networks (Banner Health, Texas Health Resources) and payers (Humana and Blue Cross Blue Shield), all focused on establishing the foundations for population health and outcomes-based reimbursement. She has worked as an emergency medicine physician, a clinical leader in hospital settings and as an executive champion for improving the health and well-being of the people in the community.
Aric Sharp, MHA, CMPE, FACHE
Vice President, Accountable Care, UnityPoint Health Accountable Care Organization; Former Chief Executive Officer, Quincy Medical Group, Des Moines, IA
Vice President, Accountable Care, UnityPoint Health Accountable Care Organization; Former Chief Executive Officer, Quincy Medical Group, Des Moines, IA
Aric Sharp is the VP of Accountable Care for UnityPoint Health. He helps lead UnityPoint Health Partners a 7,500+ physician ACO with over 350,000 attributed lives including being one of the largest Next Generation Model ACO programs in the country. Mr. Sharp currently serves on the Board of Directors for the American Medical Group Association. He is a past Chair of the AMGA Public Policy Committee and past Board Member of the AMGA-Political Action Committee. Prior to joining UnityPoint Health, Sharp served as the CEO of Quincy Medical Group and in various roles with The Iowa Clinic, P.C. He has over 20 years of experience leading multispecialty group practices, is a Fellow in the American College of Healthcare Executives and a Certified Medical Practice Executive.
Jerry Penso, MD, MBA
President and Chief Executive Officer, AMGA; Former Medical Director, Continuum of Care, Sharp Rees-Stealy Medical Group, Washington, DC (Moderator)
President and Chief Executive Officer, AMGA; Former Medical Director, Continuum of Care, Sharp Rees-Stealy Medical Group, Washington, DC (Moderator)
Dr. Penso is president and chief executive officer at AMGA, a trade association that represents medical groups and other organized systems of care. Dr. Penso previously served as chief medical and quality officer for AMGA and president of AMGA Foundation.
Prior to joining AMGA, Dr. Penso served as medical director, continuum of care for Sharp Rees-Stealy Medical Group (SRSMG). In addition to his work at AMGA and SRSMG, Dr. Penso has served on the Integrated Healthcare Association Board of Directors, the California Cooperative Healthcare Reporting Initiative Executive Committee, and Board of Directors of the Behavioral Diabetes Institute, and chaired the Technical Quality Committee for California’s Pay for Performance program. He currently serves as chair of the Board of Directors of two AMGA subsidiaries, AMGA Analytics, and AMGA Consulting. Dr. Penso also serves on the board of the Pharmacy Quality Alliance.
Prior to joining AMGA, Dr. Penso served as medical director, continuum of care for Sharp Rees-Stealy Medical Group (SRSMG). In addition to his work at AMGA and SRSMG, Dr. Penso has served on the Integrated Healthcare Association Board of Directors, the California Cooperative Healthcare Reporting Initiative Executive Committee, and Board of Directors of the Behavioral Diabetes Institute, and chaired the Technical Quality Committee for California’s Pay for Performance program. He currently serves as chair of the Board of Directors of two AMGA subsidiaries, AMGA Analytics, and AMGA Consulting. Dr. Penso also serves on the board of the Pharmacy Quality Alliance.
AFTERNOON MINI SUMMITS GROUP I: 1:15 pm – 2:15 pm
Mini Summit I: Medicare Advantage Value-Based Insurance Design
1:15 pm
Introductions, Panel Discussion and Q&A
Adam Finkelstein, JD, MPH
Counsel, Manatt Health; Former Health Insurance Specialist, Centers for Medicare and Medicaid Services, US Department of Health and Human Services; Former Counsel, Aetna, Washington, DC
Counsel, Manatt Health; Former Health Insurance Specialist, Centers for Medicare and Medicaid Services, US Department of Health and Human Services; Former Counsel, Aetna, Washington, DC
Adam Finkelstein is counsel with Manatt Health in the Washington, D.C., office.
Prior to joining Manatt, Adam served as a health insurance specialist at the CMS Center for Medicare and Medicaid Innovation. There, he led the Medicare Advantage Value-Based Insurance Design model test, an innovative test of benefit flexibilities for Medicare Advantage and Medicare Part D enrollees.
Adam has served as counsel for a national insurer, supporting its Medicaid and CHIP business lines. He held lead legal responsibility for the company’s Medicaid managed care provider relationships, and in that role he built new provider networks, developed strategies for implementing value-based provider contracting and established approaches for managed care contracts with long-term services and supports providers. Adam began his career as an associate in the commercial litigation group of a Philadelphia-based law firm.
Prior to joining Manatt, Adam served as a health insurance specialist at the CMS Center for Medicare and Medicaid Innovation. There, he led the Medicare Advantage Value-Based Insurance Design model test, an innovative test of benefit flexibilities for Medicare Advantage and Medicare Part D enrollees.
Adam has served as counsel for a national insurer, supporting its Medicaid and CHIP business lines. He held lead legal responsibility for the company’s Medicaid managed care provider relationships, and in that role he built new provider networks, developed strategies for implementing value-based provider contracting and established approaches for managed care contracts with long-term services and supports providers. Adam began his career as an associate in the commercial litigation group of a Philadelphia-based law firm.
Stephen Z. Jenkins, MPP
Lead, Medicare Advantage Value-Based Insurance Design Model, Centers for Medicare and Medicaid Services, US Department of Health and Human Services; Former Associate, Health Policy, Finance Committee, United States Senate, Alexandria, VA
Lead, Medicare Advantage Value-Based Insurance Design Model, Centers for Medicare and Medicaid Services, US Department of Health and Human Services; Former Associate, Health Policy, Finance Committee, United States Senate, Alexandria, VA
Stephen Jenkins is the Medicare Advantage Value-Based Insurance Design (VBID) Model Lead for the Center for Medicare and Medicaid Innovation (CMMI). Prior to working on VBID, he served as the Model Lead of the ACO Investment Model and the Advance Payment Model. Before joining CMMI, he spent time working on health policy for the United States Senate – Finance Committee.
Greg A. Jones, MS
Government Affairs, Public Policy, Aetna; Former Group Director, Part C, D and Program Integrity Analysis Group, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Washington, DC
Government Affairs, Public Policy, Aetna; Former Group Director, Part C, D and Program Integrity Analysis Group, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Washington, DC
Helene Weinraub, MPH
Vice President, UPMC Health Plan; President, W Squared Health: Medicare Strategic Consultants; Former Senior Vice President, Senior Products, Highmark Blue Cross Blue Shield, Pittsburgh, PA
Vice President, UPMC Health Plan; President, W Squared Health: Medicare Strategic Consultants; Former Senior Vice President, Senior Products, Highmark Blue Cross Blue Shield, Pittsburgh, PA
Ms. Weinraub oversees the overall performance, strategic direction, and program development for UPMC Health Plan’s Medicare products. Prior to joining UPMC, she led a national consulting firm, W Squared Health, specializing in Medicare Advantage and Dual products. Previously, Ms. Weinraub has taught strategic management at the University of Pittsburgh and held senior leadership positions at Highmark Blue Cross Blue Shield and Metropolitan Jewish Geriatric Health System in Brooklyn, NY. She has also served on the Governor’s Intergovernmental Council on Long Term Care.
A. Mark Fendrick, MD
Professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management; Policy Director, Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, MI (Moderator)
Professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management; Policy Director, Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, MI (Moderator)
Mark Fendrick, is a Professor of Internal Medicine in the School of Medicine and a Professor of Health Management and Policy in the School of Public Health at the University of Michigan. Dr. Fendrick conceptualized and coined the term Value-Based Insurance Design (V-BID) and currently directs the V-BID Center at the University of Michigan. Dr. Fendrick is an elected member of the National Academy of Medicine (formerly IOM), serves on the Medicare Coverage Advisory Committee, and has been invited to present testimony before the U.S. Senate Committee on Health, Education, Labor and Pensions, the U.S. House of Representatives Ways and Means Subcommittee on Health, and the U.S. Senate Committee on Armed Services Subcommittee on Personnel. He is also a member of the Institute for Healthcare Policy and Innovation at the University of Michigan, where he remains clinically active in the practice of general internal medicine.
Mini Summit II: Family Caregivers and Patient Engagement
1:15 pm
Introductions, Panel Discussion and Q&A
R. Shawn Martin
Senior Vice President of Advocacy, Practice Advancement and Policy, AAFP; Former Director of Government Relations, American Osteopathic Association, Washington, DC
Senior Vice President of Advocacy, Practice Advancement and Policy, AAFP; Former Director of Government Relations, American Osteopathic Association, Washington, DC
Shawn Martin, senior vice president, advocacy, practice advancement and policy at the AAFP, is responsible for overseeing the AAFP Division of Government Relations and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care in Washington, DC, as well as the Division of Practice Advancement.
Prior to joining AAFP, Martin served as director of government relations and health policy and director of socioeconomic affairs at the American Osteopathic Association, director of government relations and health policy, director of socioeconomic affairs and deputy director of government relations and director of congressional affairs
Martin has served on multiple boards, including National Quality Assurance Coalition Patient Centered Medical Home Advisory Board, Agency for Healthcare Research and Quality Practice Transformation Advisory Board, Hospital and Facilities Accreditation Program Patient-Centered Medical Home Advisory Panel. He has served as chair of the Health Coalition on Liability and Access and is an active member of the Patient Centered Primary Care Collaborative.
Prior to joining AAFP, Martin served as director of government relations and health policy and director of socioeconomic affairs at the American Osteopathic Association, director of government relations and health policy, director of socioeconomic affairs and deputy director of government relations and director of congressional affairs
Martin has served on multiple boards, including National Quality Assurance Coalition Patient Centered Medical Home Advisory Board, Agency for Healthcare Research and Quality Practice Transformation Advisory Board, Hospital and Facilities Accreditation Program Patient-Centered Medical Home Advisory Panel. He has served as chair of the Health Coalition on Liability and Access and is an active member of the Patient Centered Primary Care Collaborative.
Megan O’Reilly, JD
Director, Federal Health & Family, AARP, Washington, DC
Director, Federal Health & Family, AARP, Washington, DC
Thomas Riley
President and CEO, SeniorLink, Boston, MA
President and CEO, SeniorLink, Boston, MA
As CEO of Seniorlink, Tom brings his vision and expertise to the next generation of innovative care, and is committed to enriching the lives of caregivers and their families. Tom is particularly focused on expanding Seniorlink’s reach with technology designed specifically for caregivers, their care teams and professional supports. Tom brings more than three decades of leadership experience in health care services and proprietary education. He was a board member and interim Chairman/CEO of Brown schools, which provides specialized residential treatment and education programs for at-risk youth. Tom was also CEO of Care Advantage, a provider of high-cost case management services, and he served as CFO and CEO of MENTOR.
C. Grace Whiting, JD
President and Chief Executive Officer, National Alliance for Caregiving; Former Advocacy and Communications Director, Leaders Engaged on Alzheimer’s Disease, Bethesda, MD (Moderator)
President and Chief Executive Officer, National Alliance for Caregiving; Former Advocacy and Communications Director, Leaders Engaged on Alzheimer’s Disease, Bethesda, MD (Moderator)
Grace Whiting is the President and Chief Executive Officer at the Alliance, where she continues her tenure from previous roles including Chief Operating Officer and the Director of Strategic Partnerships. Ms. Whiting led the launch of the Caregiving in the U.S. 2015 report with AARP and directed the first national study of rare disease caregiving with Global Genes. She has contributed to several national reports on caregiving, including Caregiving in the U.S. 2015 with AARP, Cancer Caregiving in the U.S. with the National Cancer Institute and Cancer Support Community, and Dementia Caregiving in the U.S. with the Alzheimer’s Association. In addition to her work at the Alliance, Ms. Whiting has served as the Advocacy and Communications Director at Leaders Engaged on Alzheimer’s Disease (LEAD Coalition) and as the Director of Strategic Initiatives & Communications and as the Special Assistant to the Executive Director at the Alliance for Home Health Quality and Innovation in Washington, D.C.
Mini Summit III: Medicare Advantage and Health Outcomes
1:15 pm
Introductions, Panel Discussion and Q&A
Shawn Bishop, MPP
Vice President, Controlling Health Care Costs and Advancing Medicare, The Commonwealth Fund; Former Professional Staff Member, US Senate Finance Committee, Washington, DC
Vice President, Controlling Health Care Costs and Advancing Medicare, The Commonwealth Fund; Former Professional Staff Member, US Senate Finance Committee, Washington, DC
Shawn Bishop joined The Commonwealth Fund in 2016 as vice president for the Controlling Health Care Costs program, which monitors and analyzes spending in both the public and private health care sectors, and Advancing Medicare, which identifies ways in which the Medicare program can serve its beneficiaries more effectively and efficiently. Previously, she provided strategic consulting related to Medicare and the Affordable Care Act, including policy development and outreach to Congress and the administration. Bishop earlier served as senior vice president of research for the Marwood Group, offering financial services firms and others analysis of political, legislative, and regulatory environments, and as professional staff with the U.S. Senate Finance Committee.
Gaurov Dayal, MD
President, New Markets and Chief Growth Officer, ChenMed; Former Senior Vice President, Lumeris; Former President, Interim CEO, and SVP, SSM Health Care System, Miami, FL
President, New Markets and Chief Growth Officer, ChenMed; Former Senior Vice President, Lumeris; Former President, Interim CEO, and SVP, SSM Health Care System, Miami, FL
Dr. Dayal is President, New Markets and Chief Growth Officer at ChenMed where he leads operations for new markets and is responsible for ChenMed’s national expansion. Gaurov has wide-ranging experience in population health and physician group, health plan and hospital operations. Prior to joining ChenMed, Gaurov was a Senior Vice President at Lumeris. Earlier, at SSM Health Care, he served as the first Chief Medical Officer, Interim CEO for SSM Wisconsin Hospitals and President of Health Care Delivery, Finance and Integration. At SSM he was responsible for leading the transformation from a traditional volume-based provider to a value-based system which included the successful acquisition and successful integration of Dean Clinic and Dean Health plan- the largest HMO in Southern Wisconsin. Prior to SSM he served as the first Chief Medical Officer for Adventist Health Care and President of the Adventist Medical Group, founder of a hospitalist group and as a strategy consultant for McKinsey and Co.
Christie Teigland, PhD
Vice President, Advanced Analytics, Avalere Health; Former Senior Director, Statistical Research, Inovalon, Washington, DC
Vice President, Advanced Analytics, Avalere Health; Former Senior Director, Statistical Research, Inovalon, Washington, DC
Christie Teigland, Vice President of Advanced Analytics at Avalere Health, is expert in the design and implementation of statistical studies focused on comparative effectiveness, predictive analytics, and performance measure development. Prior to joining Avalere, she served as Senior Director of Statistical Research at Inovalon. In 2017 she received a large grant from the Commonwealth Fund to evaluate the high risk, high cost Medicare Advantage population. Dr. Teigland serves on the National Quality Forum (NQF) Disparities Standing Committee and newly formed NQF Scientific Methods Panel. She was appointed to the NQF Quality Innovation Expert Panel on the Impact of Social Determinants of HealthShe also serves on various panels with the Pharmacy Quality Alliance (PQA) including their Quality Metrics Expert Panel. Previously, Dr. Teigland was Director of Research for the New York Foundation for Long Term Care. She has served on CMS expert and national panels.
Allyson Y. Schwartz
President and Chief Executive Officer, Better Medicare Alliance; Former Member (D/PA), US House of Representatives, Washington, DC (Moderator)
President and Chief Executive Officer, Better Medicare Alliance; Former Member (D/PA), US House of Representatives, Washington, DC (Moderator)
Allyson Y. Schwartz is President and CEO of the Better Medicare Alliance, a former member of the U.S. House of Representatives from Pennsylvania and a nationally recognized leader on health care issues. Having worked as a health service executive, Schwartz was elected to the Pennsylvania State Senate in 1990, serving 14 years until her election to Congress. In the state Senate, Schwartz was the driving force behind Pennsylvania’s CHIP program, which was a model for the federal CHIP program five years later. In Congress, Schwartz was appointed to the Ways and Means Committee and served as a senior member of the Budget Committee. Schwartz is a Distinguished Policy Fellow at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Visiting Fellow at the Penn Wharton Public Policy Initiative and Co-Chair of the Bipartisan Policy Center Health and Housing Task Force.
Mini Summit IV: Provider-Sponsored and Plan-Provider Joint Ventured Medicare Advantage Plans
1:15 pm
Introductions, Panel Discussion and Q&A
Allan Baumgarten, MA, JD
Principal, Allan Baumgarten, LLC; Co-author, New Provider-Sponsored Health Plans: Joint Ventures Are Now the Preferred Strategy (Health Affairs Blog, February 23, 2018), Minneapolis, MN
Principal, Allan Baumgarten, LLC; Co-author, New Provider-Sponsored Health Plans: Joint Ventures Are Now the Preferred Strategy (Health Affairs Blog, February 23, 2018), Minneapolis, MN
Allan Baumgarten is an independent analyst and consultant whose work focuses on health care policy, finance and local market strategies. For nearly 30 years, he has published Minnesota Health Market Review, a nationally recognized annual report analyzing key trends and competitive strategies for health plans and provider systems in that market. With support from health care conversion foundations, he also prepared market studies for Arizona, California and Kentucky. He consults to a variety of organizations to help them analyze the market competition and policy issues they face and to develop business strategies to meet the challenges of dynamic markets and health reform. Before establishing his health care practice, he was the Research Director of the Citizens League in Minneapolis and Principal Evaluator and Staff Attorney in the Legislative Auditor’s Office in St. Paul. He has chaired the Jewish Community Foundation of Minneapolis and the Public Policy and Legislation Committee of United Jewish Communities.
Steve Neorr, MBA
Senior Vice President, Cone Health, Chief Administrative Officer, Triad HealthCare Network, President, HealthTeam Advantage, Greensboro, NC
Senior Vice President, Cone Health, Chief Administrative Officer, Triad HealthCare Network, President, HealthTeam Advantage, Greensboro, NC
Steve Neorr currently serves as Senior Vice President/Chief Administrative Officer of Triad HealthCare Network (THN), the Accountable Care Organization (ACO) affiliated with Cone Health, and Chief Executive Officer of HealthTeam Advantage (HTA), Cone’s provider-led Medicare Advantage health plan. His responsibilities include all activities, operations and strategic planning for both THN and HTA. Mr. Neorr previously served as Senior Consultant at WayPoint Health Care Advisors. Prior to WayPoint, Mr. Neorr served as Chief Operating Officer of a 140-physician multi-specialty medical group practice located in Dallas/Fort Worth. He has worked in healthcare and with physicians for over 20 years. Mr. Neorr serves on the Board of the Greensboro Science Center, CAPG and various advisory committees for the North Carolina Medical Society and North Carolina Hospital Association. In addition, Mr. Neorr is a Past President of the North Texas Association of Medical Administrators and Past President of the Fort Worth Medical Group Administrators Association.
Scott R. Seymour, ASA
Executive Director, Head of Provider Collaboration and Performance, Aetna Medicare, Atlanta, GA
Executive Director, Head of Provider Collaboration and Performance, Aetna Medicare, Atlanta, GA
Scott Seymour is the Executive Director of Medicare Provider Collaboration and Performance for Aetna. With extensive real-world experience in the evolving healthcare environment, he has developed, executed, and implemented many projects that are essential to migrating from fee-for-service medicine to outcomes-based models. Scott oversees Aetna Medicare’s value-based programs which are designed to provide outcome-based financial incentives for improving clinical quality, healthcare utilization, and member experience. These programs include progressive incentive models that range from upside shared savings to downside risk models, and novel product-based relationships jointly owned by provider groups and Aetna aimed at meeting providers where they are in the value-based continuum. He has obtained the Associate of the Society of Actuaries designation and brings over 19 years of actuarial experience and managed care experience across the areas of healthcare finance, risk management and pricing in the health sector.
Joseph F. Damore, FACHE
Vice President, Population Health Management, Premier Inc., Washington, DC (Moderator)
Vice President, Population Health Management, Premier Inc., Washington, DC (Moderator)
Joseph Damore is Vice President of Population Health Management (PHM) at Premier, Inc. He is responsible for assisting physician groups, hospitals and health systems, health plans, and integrated health systems in implementing population health management arrangements, including Accountable Care Organizations.
Prior to joining Premier, Mr. Damore served as the President/CEO of Mission Health System in Asheville, NC and Sparrow Health System in Lansing, MI from. He also served in leadership positions with the Greenville Hospital System (SC) and the Sisters of Mercy Health Corporation (now Trinity Health). He also has served in numerous voluntary roles including Chair of the Board of Directors of the Alumni Association of The Ohio State University and on the Boards of both the North Carolina and Michigan Hospital Associations. He also served on the Board of Directors of the National Alliance for the Advancing not for profit Health care.
Prior to joining Premier, Mr. Damore served as the President/CEO of Mission Health System in Asheville, NC and Sparrow Health System in Lansing, MI from. He also served in leadership positions with the Greenville Hospital System (SC) and the Sisters of Mercy Health Corporation (now Trinity Health). He also has served in numerous voluntary roles including Chair of the Board of Directors of the Alumni Association of The Ohio State University and on the Boards of both the North Carolina and Michigan Hospital Associations. He also served on the Board of Directors of the National Alliance for the Advancing not for profit Health care.
2:15 pm
Transition Break
AFTERNOON MINI SUMMITS GROUP II: 2:30 pm – 3:30 pm
Mini Summit V: Special Needs Plans
2:30 pm
Introductions, Panel Discussion and Q&A
G. Lawrence Atkins, PhD
Executive Director, Long-Term Quality Alliance; Principal, Health Policy Concepts, LLC; President, National Academy of Social Insurance; Former Staff Director, Commission on Long-Term Care, Washington, DC
Executive Director, Long-Term Quality Alliance; Principal, Health Policy Concepts, LLC; President, National Academy of Social Insurance; Former Staff Director, Commission on Long-Term Care, Washington, DC
Dr. Atkins is Executive Director of the Long-Term Quality Alliance, and Executive Director of the National MLTSS Health Plan Association in Washington, DC. He is a Board member and immediate past-President of the National Academy of Social Insurance. He was recently the Staff Director of the federal Commission on Long-Term Care, which issued its final report in September 2013. Prior to that, he was Executive Director, U.S. Public Policy at the global pharmaceutical manufacturer Merck. Dr. Atkins is a veteran of more than 40 years of health and social policy analysis, policy development, and legislative representation at the local, state, and federal levels.
Michele Lepore
President, East Region, Optum Care Services, Complex Care; Former Plan President, UnitedHealthcare Community Plan, MA, Boston, MA
President, East Region, Optum Care Services, Complex Care; Former Plan President, UnitedHealthcare Community Plan, MA, Boston, MA
Michele Lepore joined UnitedHealth Group (UHG) in 2009 serving as Plan President for UnitedHealthcare Community and State- Massachusetts, responsible for one of the nation’s original FIDESNP’s. Currently she is President, East Region for OptumCare (a division of UHG), where she oversees several eastern state sites operating special needs plans, inclusive of ISNP and DSNP programs.
Previously, Michele was Chief Operating Officer for Boston Medical Center HealthNet Plan, (BMCHP) Massachusetts’ leading state wide managed care organization for uninsured and low-income populations. Michele also held several positions in health industry related organizations, such as Bankers Life and Casualty in Chicago, IL, Henry Ford Health System (HFHS) and Health Alliance Plan in Detroit, MI. During her tenure with HFHS, Michele implemented one of the original PACE demonstration sites in the nation and served on the board of the National Chronic Care Consortium.
Michele is currently a SNP Alliance board member.
Previously, Michele was Chief Operating Officer for Boston Medical Center HealthNet Plan, (BMCHP) Massachusetts’ leading state wide managed care organization for uninsured and low-income populations. Michele also held several positions in health industry related organizations, such as Bankers Life and Casualty in Chicago, IL, Henry Ford Health System (HFHS) and Health Alliance Plan in Detroit, MI. During her tenure with HFHS, Michele implemented one of the original PACE demonstration sites in the nation and served on the board of the National Chronic Care Consortium.
Michele is currently a SNP Alliance board member.
John G. Lovelace, MS
President, UPMC for You, Inc.; President, Government Programs and Individual Advantage, UPMC Health Plan; Board Chair, Association of Community Affiliated Plans (ACAP), Pittsburgh, PA
President, UPMC for You, Inc.; President, Government Programs and Individual Advantage, UPMC Health Plan; Board Chair, Association of Community Affiliated Plans (ACAP), Pittsburgh, PA
John Lovelace serves as Present of Government Programs for UPMC Health Plan; in this position he is responsible for the Medicaid, Medicare Advantage, MA Special Needs Plans, Children’s Health Insurance Program, Managed Long Term Services and Supports programs at UPMC Health Plan, as well as operations of the FFM Individual and Small Group coverage. In this role, he has overseen many changes and innovations in the delivery and financing of health care. He is active in national trade associations and advocacy groups as well as many regional and local nonprofit boards.
Cheryl Phillips, MD
President and Chief Executive Officer, SNP Alliance; Former Senior Vice President, Public Policy and Health Services, LeadingAge, Washington, DC (Moderator)
President and Chief Executive Officer, SNP Alliance; Former Senior Vice President, Public Policy and Health Services, LeadingAge, Washington, DC (Moderator)
Cheryl Phillips is the President and CEO of the Special Needs Plans Alliance. Prior to this she was the Senior VP for Public Policy and Health Services at LeadingAge. She has also served as the Chief Medical Officer of On Lok Lifeways, and the Medical Director for Senior Services and Chronic Disease Management, for the Sutter Health System. As a fellowship-trained geriatrician her clinical practice focused on nursing homes and the long-term care continuum.
Dr. Phillips is a past president of the American Geriatrics Society and past president of the American Medical Directors Association. She continues to serve on multiple technical advisory groups for chronic care, nursing home quality and home and community-based services and has provided multiple testimonies to the U.S. Congress. She served as a primary care health policy fellow under Secretary Tommy Thompson. Dr. Phillips is on the Board of Directors of the SCAN Foundation.
Dr. Phillips is a past president of the American Geriatrics Society and past president of the American Medical Directors Association. She continues to serve on multiple technical advisory groups for chronic care, nursing home quality and home and community-based services and has provided multiple testimonies to the U.S. Congress. She served as a primary care health policy fellow under Secretary Tommy Thompson. Dr. Phillips is on the Board of Directors of the SCAN Foundation.
Mini Summit VI: Incentivizing Providers to Help Plans Improve Their Star Ratings
2:30 pm
Introductions, Panel Discussion and Q&A
Joyce Chan, MBA
Vice President, Medicare Product, Healthfirst, New York, NY
Vice President, Medicare Product, Healthfirst, New York, NY
Joyce Chan is the Vice President of Medicare Product at Healthfirst, a notfor-profit provider-sponsored health insurance company serving more than 1.3 million members in downstate New York. She leads product strategy, design, and management for Medicare, driving performance and ensuring that members receive the highest quality and experience of care. Prior to joining Healthfirst, Ms. Chan was a consultant in the Global Health Practice at Booz Allen Hamilton, where she advised providers, payers, and pharmaceutical companies on strategy and operations. Ms. Chan has a deep interest in reducing health disparities; she is an active contributor to industry workgroups and speaks regularly with policymakers and regulatory agencies on this topic.
Robb Cohen, MBA
Retired Health Care Executive and Philanthropist/Volunteer; Former Co-founder and Senior Executive, XLHealth/United HealthCare; Former CEO, Advanced Health Collaborative, Baltimore, MD
Retired Health Care Executive and Philanthropist/Volunteer; Former Co-founder and Senior Executive, XLHealth/United HealthCare; Former CEO, Advanced Health Collaborative, Baltimore, MD
Mr. Cohen is currently a community volunteer, serving on several non-profit Boards. He was a Co-Founder & Senior Executive of XLHealth, which was founded as a diabetes disease management company, became the nation’s leading Medicare Advantage Chronic Special Needs Plan, and was acquired by United Healthcare. Robb was part of the founding management team in 1998, and stayed through the sale to United in 2012.
Robb was an advisor to the State of Maryland on the design of the Maryland hospital payment system, and was also the former / founding CEO of Advanced Health Collaborative, a network that includes 7 health systems with 10 hospitals. Robb was also the CEO of and a founding partner of Phoenix HealthCare Consulting.
Robb has payer, provider, investment banking, and consulting experience.
Robb was an advisor to the State of Maryland on the design of the Maryland hospital payment system, and was also the former / founding CEO of Advanced Health Collaborative, a network that includes 7 health systems with 10 hospitals. Robb was also the CEO of and a founding partner of Phoenix HealthCare Consulting.
Robb has payer, provider, investment banking, and consulting experience.
Ghita Worcester
Senior Vice President, Public Affairs and Marketing, UCare Minnesota; Former Director of Policy and Operations, University Affiliated Family Physicians (UAFP), Minneapolis, MN
Senior Vice President, Public Affairs and Marketing, UCare Minnesota; Former Director of Policy and Operations, University Affiliated Family Physicians (UAFP), Minneapolis, MN
Ghita Worcester brings more than 35 years of health care management experience to her role as Senior Vice President, Public Affairs and Chief Marketing Officer. She provides strategic direction for marketing, business development and strategy, public relations, legislative, regulatory, government programs, provider relations, and community outreach activities. Before joining UCare, Worcester served as Director of Policy and Operations for Minneapolis-based University Affiliated Family Physicians (UAFP), the management company that started UCare in 1984. Before that, she worked for 13 years in a community-based family medicine residency program operated by the University of Minnesota Department of Family Practice. Worcester has significant legislative and public policy experience at both the state and federal level on health care reform, and Medicare and Medicaid policy. In 2015, Worcester was recognized with a Women in Business Award by the Minneapolis/St. Paul Business Journal and, in 2018, received a Women’s Health Leadership TRUST Courage Award.
James Gutman, MS, MBA
Former Vice President and Managing Editor, Atlantic Information Services; Former Editor, Medicare Advantage News, Laurel, MD (Moderator)
Former Vice President and Managing Editor, Atlantic Information Services; Former Editor, Medicare Advantage News, Laurel, MD (Moderator)
James Gutman is an Adjunct faculty member in the writing department at University of Maryland University College. Previously, he was the Vice President and Managing Editor of the Atlantic Information Services, Inc. where he wrote and edited the Medicare Advantage News and oversaw Health Reform Week and was in charge of developing new print and online publications related to health reform and developing. Mr. Gutman is President and Chief Executive Officer Business Information Services, Inc. Previously, he was Associate Director of Communication Services of the National Association of Securities Dealers and Editorial Director of the Washington Business Information, Inc.
Mr. Gutman has served as Editor of many publications including McGraw-Hill Inc., the Baltimore Business Journal, Milwaukee Sentinel and the Baltimore Sun. He has won multiple professional awards for reporting.
He is currently and is a Member of the Association of Health Care Journalists and the Society of American Business Editors.
Mr. Gutman has served as Editor of many publications including McGraw-Hill Inc., the Baltimore Business Journal, Milwaukee Sentinel and the Baltimore Sun. He has won multiple professional awards for reporting.
He is currently and is a Member of the Association of Health Care Journalists and the Society of American Business Editors.
Mini Summit VII: New Changes in Medicare Advantage Telehealth
2:30 pm
Introductions, Panel Discussion and Q&A
Latoya Thomas
Director, State Policy Resource Center, American Telemedicine Association; Former Associate Director of Government Affairs, National Association for Home Care and Hospice, Washington, DC
Director, State Policy Resource Center, American Telemedicine Association; Former Associate Director of Government Affairs, National Association for Home Care and Hospice, Washington, DC
Latoya Thomas is the Director, State Policy Resource Center for the American Telemedicine Association and has a deep expertise in shaping statutory and regulatory policies nationwide that facilitate better delivery of care, cost reduction, internet connectivity and transparency between consumers, providers and insurers. She has spoken extensively on matters involving virtual care including testimony before legislative and regulatory bodies, and works with ATA members, affiliates, and state officials on legislative and regulatory issues affecting the use and deployment of telehealth services. Prior to joining the ATA, Latoya worked as an Associate Director of Government Affairs for the National Association for Home Care and Hospice. She served as Research and Communications Strategist for the National HIT Collaborative for the Underserved (NHIT) to promote their core message of using health IT as a tool to reduce health disparities, and improve patient engagement and access to care. Latoya is a Howard University alumna.
Jim Yocum
Senior Vice President, Connecture; Former Executive Vice President, DRX, Inc., Los Angeles, CA
Senior Vice President, Connecture; Former Executive Vice President, DRX, Inc., Los Angeles, CA
Jim Yocum is Senior Vice President of Connecture/DRX, and manages its Federal Markets unit. In this role, Jim originated and implemented the longstanding healthcare exchange, the Medicare Part D Plan Compare tools and Online Enrollment Center on Medicare.gov. Jim joined DRX from Acacia Capital Partners, an advisory firm to private equity investors. Before Acacia, he co-founded Korn-Ferry’s Futurestep at idealab and was its VP of Business Development. Before his entrepreneurial ventures, Jim was a consultant with McKinsey & Company where he served media firms, financial institutions, and healthcare payors. Jim joined McKinsey from Standard Chartered Bank and was an automotive engineer in his early career with NOK.
Gary Capistrant, MA
President, Capistrant Consulting; Former Chief Policy Officer, American Telemedicine Association; Former Director, Congressional Relations, American Health Care Association; Former Staff Director, State Medicaid Directors Association; Former Health Legislative Assistant, Rep. Jim Corman, Washington, DC (Moderator)
President, Capistrant Consulting; Former Chief Policy Officer, American Telemedicine Association; Former Director, Congressional Relations, American Health Care Association; Former Staff Director, State Medicaid Directors Association; Former Health Legislative Assistant, Rep. Jim Corman, Washington, DC (Moderator)
Gary Capistrant is focused on advancing consumer health tech tools, including telehealth, artificial intelligence, online patient empowerment, broadband, 5G, and IoT. His involvement is consulting and speaking about coverage and reimbursement, especially with value-based payments, and advising about investment strategy. His expertise in health policy is based on over 40 years’ experience with Medicare, Medicaid, and other federal health matters. His knowledge of health policy has lead him to become a trusted advisor to associations, innovative health providers and health investment analysts. Previously, he was the Chief Policy Officer for the American Telemedicine Association. He is also the former Director of Congressional Relations for the American Health Care Association, Staff Director of the State Medicaid Directors Association and Health Legislative Assistant for a former senior member of the House Committee on Ways and Means.
Mini Summit VIII: Educating Your Patients on the Difference Between Original Medicare and Medicare Advantage & What Do You Really Know About Your Health Care Coverage?
2:30 pm
Educating Your Patients on the Difference Between Original Medicare and Medicare Advantage
Georgeann Pizzi
Partner, MassMedia Health, Henderson, NV
Partner, MassMedia Health, Henderson, NV
Georgeann Pizzi: As one of MassMedia Health’s chief marketing strategists, Georgeann spearheads strategic planning initiatives for a number of clients, ensuring collaboration across the agency’s disciplines to deliver meaningful insights and integrated campaigns that drive business results. Georgeann has extensive experience focused on brand growth and patient acquisition initiatives for independent physician groups, specialty practices and nonprofit organizations. Her leadership has helped shape numerous award-winning marketing and communications campaigns for local, regional and national healthcare companies.
Prior to joining MassMedia Health, Georgeann served on the brand marketing team that opened and launched the M Resort Spa Casino.
Prior to joining MassMedia Health, Georgeann served on the brand marketing team that opened and launched the M Resort Spa Casino.
Brooke Snelling
Director, MassMedia Health, Henderson, NV
Director, MassMedia Health, Henderson, NV
Brooke Snelling serves as the Group Account Director of Healthcare with more than a decade of experience in marketing and brand development. Brooke manages integrated healthcare-focused account teams to deliver strategic results-driven marketing campaigns. Prior to joining MassMedia, Brooke served as a director of marketing where she managed a department focused on creative services, product launches, brand development and advertising.
3:00 pm
What Do You Really Know About Your Health Care Coverage?
Christine Ferguson, JD
President, Leverage Global Consulting, Inc.; Former Executive Director, HealthSource RI, Providence, RI
President, Leverage Global Consulting, Inc.; Former Executive Director, HealthSource RI, Providence, RI
Christine Ferguson is Principal of Leverage Global Consulting. She has served as a Director on the Corporate Boards of two Health Insurance Companies; in key leadership positions with three Governors; as US Senate Staff; and as a consultant and advisor to private and non-profit executives, the Congressional Budget Office, The Institute of Medicine, Centers for Medicare and Medicaid Services, and numerous state and national organizations. Under her leadership, RI initially took a unique approach to build a health insurance exchange (HSRI) which was recognized as one of 7 global examples of innovation and disruption in health care by the Imperial College of London and the WISH Foundation. In 2015, she co-founded Leverage with two primary goals – to provide comprehensive support for leaders and decision makers in a time of uncertainty and dynamic change; and to develop and bring to market on the ground solutions that bridge the gap between business and technology.
3:30 pm
Transition Break
AFTERNOON MINI SUMMITS GROUP III: 3:45 pm – 4:45 pm
Mini Summit IX: Pharmaceutical Issues: Managing Costs and Improving Member Outcomes
3:45 pm
Introductions, Panel Discussion and Q&A
Paul Heldman
Managing Partner, Heldman Simpson Partners LLC, Washington, DC
Managing Partner, Heldman Simpson Partners LLC, Washington, DC
Drawing on more than 20 years of experience in health policy, Paul Heldman specializes in translating legislative developments and policy changes – specifically for government health insurance programs, the Food and Drug Administration, pharmaceuticals, medical devices, US health spending, health-care legislation and national elections – for the investment community.
Prior to forming Heldman Simpson Partners LLC, Paul ran the health-care team at Potomac Research Group. Paul previously spent a combined eight years at Citigroup Investment Research and Schwab Soundview Washington Research Group, where he developed a committed following of investors who participated in his weekly research calls, health-care policy conferences, and other investor/policy maker events.
Mr. Heldman honed his information-gathering skills early in his career as a reporter for Bloomberg Business News, covering the impact of policy decisions on publicly traded health-related companies.
Prior to forming Heldman Simpson Partners LLC, Paul ran the health-care team at Potomac Research Group. Paul previously spent a combined eight years at Citigroup Investment Research and Schwab Soundview Washington Research Group, where he developed a committed following of investors who participated in his weekly research calls, health-care policy conferences, and other investor/policy maker events.
Mr. Heldman honed his information-gathering skills early in his career as a reporter for Bloomberg Business News, covering the impact of policy decisions on publicly traded health-related companies.
Kat Wolf Khachatourian, PharmD, MBA
Vice President – Strategic Care Transformation, QualChoice Health Plan; Former Vice President-Pharmacy Services, Strategy, Vendor Oversight, Catholic Health Initiatives; Seattle, WA
Vice President – Strategic Care Transformation, QualChoice Health Plan; Former Vice President-Pharmacy Services, Strategy, Vendor Oversight, Catholic Health Initiatives; Seattle, WA
Dr. Katherine (“Kat”) Wolf Khachatourian is the Vice President of Care Transformation for Qualchoice Health Plan Services, Inc., overseeing multiple regional Medicare contracts and their delegated entities. In her current role, Dr. Wolf is tasked with clinical program development and decision making, quality program development, strategy deployment, contracting decisions, and delegated function compliance for all Medicare Advantage contracts within her organization. Dr. Wolf spent the first 11 years of her pharmacy career working in a community pharmacy setting. Dr. Wolf further serves AMCP in her roles as committee member, Washington State Advocacy Coordinator, participant, and contributor to AMCP initiatives locally and nationally, most recently in the Partnership for Pre-Approval Information Exchange development and Congressional briefings. In 2017, Dr. Wolf received a four-year appointment to the Washington (WA) State Pharmacy Quality Assurance Commission, the pharmacy rule-making and enforcement division of the WA State Department of Health, where she serves on the Technology and Opioid Use Sub-Committees.
Marissa Schlaifer, MS
Principal, Schlaifer & Associates, LLC; Former Head of Policy, CVS Health; Former Pharmacy Affairs Director, Academy of Managed Care Pharmacy, Washington, DC
Principal, Schlaifer & Associates, LLC; Former Head of Policy, CVS Health; Former Pharmacy Affairs Director, Academy of Managed Care Pharmacy, Washington, DC
Marissa Schlaifer works as an independent consultant, assisting businesses, professional associations, trade associations with health care policy analysis, issue advocacy, practice advancement and business development. Marissa has 30 years of experience in both the managed care pharmacy and community pharmacy segments of the profession.
Most recently, Marissa served as the Head of Policy at CVS Health. Marissa led the team responsible for creating policy positions that help shape the laws and regulations impacting CVS Health business, and she also served as a key contact with federal agencies.
Marissa currently serves on the National Quality Forum Measure Application Partnership Coordinating Committee, representing AMCP, and co-chairs the MAP Medicaid Adult workgroup. Prior to joining AMCP, Marissa was Healthy Outcomes Director at H-E-B Grocery Company. In addition, Marissa worked for PacifiCare of Texas and Prescription Solutions (now OptumRx) as a clinical pharmacist, and for Eckerd Drug Company as a pharmacy manager and regional manager for managed care sales.
Most recently, Marissa served as the Head of Policy at CVS Health. Marissa led the team responsible for creating policy positions that help shape the laws and regulations impacting CVS Health business, and she also served as a key contact with federal agencies.
Marissa currently serves on the National Quality Forum Measure Application Partnership Coordinating Committee, representing AMCP, and co-chairs the MAP Medicaid Adult workgroup. Prior to joining AMCP, Marissa was Healthy Outcomes Director at H-E-B Grocery Company. In addition, Marissa worked for PacifiCare of Texas and Prescription Solutions (now OptumRx) as a clinical pharmacist, and for Eckerd Drug Company as a pharmacy manager and regional manager for managed care sales.
Babette S. Edgar, PharmD, MBA, FAMCP
Principal, BluePeak Advisors; Former President, Government Services, CatalystRx; Former Vice President, Clinical Business Development, Caremark/AdvancePCS; Former Director, Division of Finance and Operations, Medicare Drug Benefit Group, CMS, Baltimore, MD (Moderator)
Principal, BluePeak Advisors; Former President, Government Services, CatalystRx; Former Vice President, Clinical Business Development, Caremark/AdvancePCS; Former Director, Division of Finance and Operations, Medicare Drug Benefit Group, CMS, Baltimore, MD (Moderator)
Babette Edgar is a Principal at BluePeak Advisors (BPA). Babette has been in the managed care industry for over 25 years and advises health plans, pharmacy benefit management companies and pharmaceutical companies on Medicare and managed care strategies, operational and compliance issues. Prior to starting her own firm, Babette worked at CatalystRx, where she was President, Government Services and ran the Medicare business for the fourth largest PBM. Babette was the Director of the Division of Finance and Operations for the Medicare Drug Benefit Group at the Centers for Medicare and Medicaid (CMS). Previous to her term at CMS, Babette was Vice President, Clinical Business Development at Caremark/AdvancePCS, where she directed sales, account management and product development for a multi-milliondollar disease management product line. Babette also previously served as Director of Clinical Services for Advance Paradigm. She is the Immediate Past President of the Academy of Managed Care Pharmacy.
Mini Summit X: The Future of Programs for Dual Eligibles
3:45 pm
Introductions, Panel Discussion and Q&A
Christine Aguiar Lynch
Vice President of Medicare and Managed Long-Term Services and Supports, Association for Community Affiliated Plans (ACAP); Former Senior Policy Analyst, Medicare Payment Advisory Commission, Washington, DC
Vice President of Medicare and Managed Long-Term Services and Supports, Association for Community Affiliated Plans (ACAP); Former Senior Policy Analyst, Medicare Payment Advisory Commission, Washington, DC
Jack Rollins, MPH
Senior Policy Analyst, National Association of Medicaid Directors (NAMD), Washington, DC
Senior Policy Analyst, National Association of Medicaid Directors (NAMD), Washington, DC
Jack Rollins joined NAMD in April 2014. He is responsible for the association’s policy work, including analysis of legislation and regulations impacting the Medicaid program, convening Medicaid Directors and their staffs to identify and build consensus around policy objectives, and articulating members’ consensus positions via comment letters and other communications to federal policymakers and Medicaid stakeholders. In his time at NAMD, Jack has focused specifically on the areas of Medicaid prescription drug coverage, managed care, and long-term services and supports. Prior to joining NAMD, Jack interned at a safety net hospital association, a small lobbying firm specializing in healthcare issues, and performed policy work for a nonprofit organization of women state legislators.
Ghita Worcester
Senior Vice President, Public Affairs and Marketing, UCare Minnesota; Former Director of Policy and Operations, University Affiliated Family Physicians (UAFP), Minneapolis, MN
Senior Vice President, Public Affairs and Marketing, UCare Minnesota; Former Director of Policy and Operations, University Affiliated Family Physicians (UAFP), Minneapolis, MN
Ghita Worcester brings more than 35 years of health care management experience to her role as Senior Vice President, Public Affairs and Chief Marketing Officer. She provides strategic direction for marketing, business development and strategy, public relations, legislative, regulatory, government programs, provider relations, and community outreach activities. Before joining UCare, Worcester served as Director of Policy and Operations for Minneapolis-based University Affiliated Family Physicians (UAFP), the management company that started UCare in 1984. Before that, she worked for 13 years in a community-based family medicine residency program operated by the University of Minnesota Department of Family Practice. Worcester has significant legislative and public policy experience at both the state and federal level on health care reform, and Medicare and Medicaid policy. In 2015, Worcester was recognized with a Women in Business Award by the Minneapolis/St. Paul Business Journal and, in 2018, received a Women’s Health Leadership TRUST Courage Award.
Lois Simon, MPH
Executive Vice President, Policy and Programs, Seniorlink; Founder and Principal, L. Simon Solutions LLC; Former President and Co-founder, Commonwealth Care Alliance, Boston, MA (Moderator)
Executive Vice President, Policy and Programs, Seniorlink; Founder and Principal, L. Simon Solutions LLC; Former President and Co-founder, Commonwealth Care Alliance, Boston, MA (Moderator)
Lois Simon is the Executive Vice President of Policy and Programs at SeniorLink, a national caregiving company providing care collaboration solutions that leverage human touch and technology to truly integrate and activate consumers, caregivers, payers and providers to deliver person and family centered care resulting in better outcomes at lower costs. Prior to joining Seniorlink, Lois was the Co-Founder and former President of Commonwealth Care Alliance. Lois served in a variety of government positions, most notably as the Director of Long Term Care for the Massachusetts Medicaid program and as the Assistant Secretary of the State Unit on Aging. She went on to serve as Senior Vice President and Regional General Manager for The Mentor Network. Lois served as Chief Operating Officer at the East Boston Neighborhood Health Center. She also served on the executive leadership team as the Vice President for Care Delivery at Neighborhood Health Plan.
Mini Summit XI: Network Optimization and Assessment
3:45 pm
Introductions, Panel Discussion and Q&A
Kelley Ordonio, MPA
Health Insurance Specialist, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Baltimore, MD
Health Insurance Specialist, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Baltimore, MD
Mrs. Ordonio has been employed by CMS from March 2013 to the present as a Health Insurance Specialist in the Division of Medicare Advantage Operations in the Medicare Drug and Health Plan Contract Administration Group in the Center for Medicare. In her current position, she is a subject matter expert on network Adequacy. She also leads the Exception Review team of subject matter experts within CMS whose role it is to collaborate and continue to work to improve our network adequacy standards.
Theresa Wachter, MA
Health Insurance Specialist, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Baltimore, MD
Health Insurance Specialist, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Baltimore, MD
Ms. Wachter has been employed by CMS from January 2015-present as a Health Insurance Specialist in the Division of Policy, Analysis, and Planning in the Medicare Drug and Health Plan Contract Administration Group in the Center for Medicare. In her current position, she develops policies for Medicare Advantage health plans, and her primary subject matter expertise is network adequacy policy. Ms. Wachter participates in the annual exceptions review activities, and she recently played a key role in the planning and implementation of the new triennial network review process for 2018.
Helene Weinraub, MPH
Vice President, UPMC Health Plan; President, W Squared Health: Medicare Strategic Consultants; Former Senior Vice President, Senior Products, Highmark Blue Cross Blue Shield, Pittsburgh, PA
Vice President, UPMC Health Plan; President, W Squared Health: Medicare Strategic Consultants; Former Senior Vice President, Senior Products, Highmark Blue Cross Blue Shield, Pittsburgh, PA
Ms. Weinraub oversees the overall performance, strategic direction, and program development for UPMC Health Plan’s Medicare products. Prior to joining UPMC, she led a national consulting firm, W Squared Health, specializing in Medicare Advantage and Dual products. Previously, Ms. Weinraub has taught strategic management at the University of Pittsburgh and held senior leadership positions at Highmark Blue Cross Blue Shield and Metropolitan Jewish Geriatric Health System in Brooklyn, NY. She has also served on the Governor’s Intergovernmental Council on Long Term Care.
John Weis
Co-founder and Chief Executive Officer, Quest Analytics, LLC, Appleton, WI
Co-founder and Chief Executive Officer, Quest Analytics, LLC, Appleton, WI
John P. Weis is President, CEO and Co-Founder of Quest Analytics LLC. From pioneering the industry’s first accessibility tools to building Quest Analytics as the industry-leading Network Access, Adequacy and Accuracy solutions partner, John has brought visionary network adequacy solutions to market for more than a decade. Through his leadership, Quest Analytics has developed partnerships with Federal, State and commercial markets evolving the idea of simple access standards to comprehensive automated solutions that connect the dots between Network Adequacy and Data Accuracy.
Michael S. Adelberg
Principal, FaegreBD Consulting; Former Director, Medicare Advantage Operations; Former Director, Insurance Programs Group; Former Acting Director, Exchange Policy and Operations Group, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Washington, DC (Moderator)
Principal, FaegreBD Consulting; Former Director, Medicare Advantage Operations; Former Director, Insurance Programs Group; Former Acting Director, Exchange Policy and Operations Group, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Washington, DC (Moderator)
Mike Adelberg is a Principal with Faegre Baker Daniels Consulting. He has 25 years progressive experience with Medicare, Medicaid and the Health Insurance Exchanges. Previously, Mike held several senior positions within the Centers for Medicare and Medicaid Services (CMS), including concurrently serving as the director of the Insurance Programs Group and the acting director of the Exchange Policy and Operations Group in the Center for Consumer Information and Insurance Oversight (CCIIO). Prior to that, Mike was the Director of Medicare Advantage Operations. His other senior roles at CMS included serving as the associate regional administrator for Medicare operations (Chicago Region) and the director of education and assistance programs. Mike gained private sector experience while serving as vice president of product development and government affairs with a medium-sized Medicare Advantage organization. Mike also co-led a successful health policy and program evaluation practice.
Mini Summit XII: Medicare Advantage APMs: How Plans and Groups Are Paying Doctors Downstream
3:45 pm
Introductions, Panel Discussion and Q&A
Glen Bogner, MBA
Chief Operating Officer for Coordinated Regional Care, Prospect Medical Holdings; Former Regional Vice President, Molina Healthcare, Baltimore, MD
Chief Operating Officer for Coordinated Regional Care, Prospect Medical Holdings; Former Regional Vice President, Molina Healthcare, Baltimore, MD
Sasha Dhall
Vice President, Risk Performance and Growth, AppleCare Medical Group, A Part of OptumCare, Lynwood, CA
Vice President, Risk Performance and Growth, AppleCare Medical Group, A Part of OptumCare, Lynwood, CA
Sasha Dhall currently serves as the Vice President, Risk Performance and Growth at AppleCare Medical Group in Los Angeles. She oversees AppleCare’s risk arrangements, staff-model clinics and health policy strategy. Additionally, she is responsible for membership growth and retention, with an emphasis on member experience.
Scott W. Disch, MPH
President and Chief Executive Officer, SolveMed Consulting, LLC, Cold Spring, NY
President and Chief Executive Officer, SolveMed Consulting, LLC, Cold Spring, NY
Scott Disch has been working in acute care hospitals and ambulatory health networks for the past twenty years, of which the latter thirteen have been focused on administration and operational management of risk-bearing physician practices, strategic growth initiatives, population health / risk contract management and development of physician financial and service contractual relationships. In his various roles within Physician Services, he has garnered experience in revenue cycle management, managed care and value-based risk contracting, physician recruitment, integration, and on-boarding, detailed medical practice operations, and day-to-day adherence to quality outcomes, process efficiency and throughput in the ambulatory setting.
Peter J. Kelly, MBA
Senior Director of Development, CareMount Medical; Executive Director, CareMount ACO LLC, New York, NY
Senior Director of Development, CareMount Medical; Executive Director, CareMount ACO LLC, New York, NY
Peter Kelly leads business development efforts at CareMount Medical PC, the largest independent multi-specialty medical group in New York State. Mr. Kelly also serves as the Executive Director of CareMount ACO LLC, the CareMount physicians’ new managed care subsidiary focused on performance under risk-based Government Programs contracts. Previously, Mr. Kelly previously served as Executive Director of Market Operations at Universal American Corp., a Medicare Advantage and ACO insurance company, and as a senior manager at Avalere Health in Washington DC.
Margaret Peterson
Director of Federal Affairs, America’s Physician Groups, Washington, DC (Moderator)
Director of Federal Affairs, America’s Physician Groups, Washington, DC (Moderator)
Margaret Peterson serves as the Director of Federal Affairs at America’s Physician Groups. In this capacity, Margaret works to promote the organization’s federal advocacy and policy objectives including increasing access to value-based, coordinated care through regulatory and legislative avenues. This role centers around building relationships and encouraging educational opportunities with Members of Congress and Congressional staff, Executive Branch staff, and health policy leaders. Margaret also directs the induvial advocacy program, APG Advocates, which encourages members to become more involved in public policy and the legislative process. Immediately prior to joining Affairs at America’s Physician Groups, Margaret served on the health policy team for Senator Joni Ernst focusing on a number of legislative priorities including ACA reform and MACRA implementation.
4:45 pm
Transition Break
AFTERNOON MINI SUMMITS GROUP IV: 5:00 pm – 6:00 pm
Mini Summit XIII: Marketing Issues: Taking Advantage of New Regulatory Flexibility
5:00 pm
Introductions, Panel Discussion and Q&A
Michael S. Adelberg
Principal, FaegreBD Consulting; Former Director, Medicare Advantage Operations; Former Director, Insurance Programs Group; Former Acting Director, Exchange Policy and Operations Group, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Washington, DC
Principal, FaegreBD Consulting; Former Director, Medicare Advantage Operations; Former Director, Insurance Programs Group; Former Acting Director, Exchange Policy and Operations Group, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, Washington, DC
Mike Adelberg is a Principal with Faegre Baker Daniels Consulting. He has 25 years progressive experience with Medicare, Medicaid and the Health Insurance Exchanges. Previously, Mike held several senior positions within the Centers for Medicare and Medicaid Services (CMS), including concurrently serving as the director of the Insurance Programs Group and the acting director of the Exchange Policy and Operations Group in the Center for Consumer Information and Insurance Oversight (CCIIO). Prior to that, Mike was the Director of Medicare Advantage Operations. His other senior roles at CMS included serving as the associate regional administrator for Medicare operations (Chicago Region) and the director of education and assistance programs. Mike gained private sector experience while serving as vice president of product development and government affairs with a medium-sized Medicare Advantage organization. Mike also co-led a successful health policy and program evaluation practice.
Kelli Back, JD
Attorney, Law Offices of Kelli Back, Washington, DC
Attorney, Law Offices of Kelli Back, Washington, DC
Since 1992, Ms. Back has assisted managed care organizations, health care providers and their representative associations in legal and policy issues. First, as Federal Programs Counsel for the American Managed Care and Review Association, she worked closely with the Centers for Medicare & Medicaid Services (CMS) and the U.S. Office of Personnel Management in addition providing technical support to Committee staff in both the House and the Senate. Then, as the Senior Policy Associate at the Group Health Association of America (now known as America’s Health Insurance Plans), she continued providing legislative support and working with CMS, while focusing on substantive policy analysis regarding Medicare and Medicaid managed care. In October 1995, Ms. Back began working with the Law Offices of Mark S. Joffe, providing legal, policy and business advice regarding managed care to its clients. In January 2018, Ms. Back began her own firm with the same practice focus.
Matt Feret, MHA
Chief Sales Officer and Executive Director, Medicare, Aetna; Former Divisional Vice President for Medicare Sales Strategy, HCSC; Former Marketing Director (National), Medicare, CVS, Chicago, IL
Chief Sales Officer and Executive Director, Medicare, Aetna; Former Divisional Vice President for Medicare Sales Strategy, HCSC; Former Marketing Director (National), Medicare, CVS, Chicago, IL
Lindsay Resnick, MHA
Executive Vice President, Wunderman Health, Chicago, IL (Moderator)
Executive Vice President, Wunderman Health, Chicago, IL (Moderator)
Mini Summit XIV: Encounter Data System Developments
5:00 pm
Introductions, Panel Discussion and Q&A
Sean Creighton, MsC
Vice President, Avalere Health; Former Deputy Group Director, Payment Policy and Financial Management Group; Former Director, Payment Policy and Risk Adjustment, Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Washington, DC
Vice President, Avalere Health; Former Deputy Group Director, Payment Policy and Financial Management Group; Former Director, Payment Policy and Risk Adjustment, Centers for Medicare & Medicaid Services, US Department of Health and Human Services, Washington, DC
Sean Creighton, Vice President at Avalere Health, is responsible for leading advisory services work tied to Medicare Advantage (MA), risk adjustment, and related issues. His extensive experience with claims data and application of Avalere’s modeling and analytics functions enable him to advise clients on their strategic goals. Prior to Avalere, Sean was a Senior Vice President at Verscend Technologies, where he led the development and management of risk adjustment products. Prior to that, he spent 15 years at the Centers for Medicare & Medicaid Services (CMS), leading the policy development and implementation of major public programs.
David Meyer
Vice President of Risk Adjustment, SCAN Health Plan; Former Corporate Vice President, Operations, InnovaCare Health, Anaheim, CA
Vice President of Risk Adjustment, SCAN Health Plan; Former Corporate Vice President, Operations, InnovaCare Health, Anaheim, CA
David P. Meyer: Strong leader with 14+ years of experience in Revenue and Clinical Outcomes Program Development and Management in various healthcare environments (Plans, MG/IPA, Academic, and Consulting). Proven record of success in optimizing Operations, PE / Investor Meetings, Maintaining Compliance, Recovering / Maximizing Revenue, Enhancing Clinical Quality and Developing Software and Custom Analytics.
Specialties: RA / HCC, Pay for Performance (P4P), CMS Stars Program, NCQA HEDIS, Off-shore Software Product Development, HOS, CAS, NCQA Accreditation, Physician Profiling, Encounter Programs, Contract and Claims Analytics.
Previously, Dave served as an independent consultant to healthplans, was Corporate VP, Operations (Revenue and Quality) at InnovaCare Health. He has also performed as Sr. Consultant, Risk Adjustment and Health Plan Operations for Dynamic Healthcare Systems, and in other roles with healthplans.
Specialties: RA / HCC, Pay for Performance (P4P), CMS Stars Program, NCQA HEDIS, Off-shore Software Product Development, HOS, CAS, NCQA Accreditation, Physician Profiling, Encounter Programs, Contract and Claims Analytics.
Previously, Dave served as an independent consultant to healthplans, was Corporate VP, Operations (Revenue and Quality) at InnovaCare Health. He has also performed as Sr. Consultant, Risk Adjustment and Health Plan Operations for Dynamic Healthcare Systems, and in other roles with healthplans.
Lynn F. Dong, FSA, MAAA
Principal and Consulting Actuary, Milliman, Inc., Seattle, WA (Moderator)
Principal and Consulting Actuary, Milliman, Inc., Seattle, WA (Moderator)
Lynn Dong is Principal and Consulting Actuary with Milliman, Inc. and has over 20 years of healthcare actuarial experience and consults extensively with provider organizations and commercial and Medicare health plans. She has significant experience in evaluating risk-based contacts and alternative payment models for provider organizations. Lynn serves on Milliman’s Health Research Board and is deeply involved in the research and development of multiple components of Milliman’s Health Cost Guidelines.
MINI Summit XV: Managing the Opioid Challenge
5:00 pm
Introductions, Panel Discussion and Q&A
Eric Bailly, MA
Business Solutions Director, Anthem, Inc., Moorhead, MN
Business Solutions Director, Anthem, Inc., Moorhead, MN
Eric Bailly is currently a Business Solutions Director at Anthem, Inc. In his 10th year at Anthem, Eric’s role is focused on the enterprise substance use disorder strategy, with a recent emphasis on the enterprise opioid strategy.
Eric is a Licensed Professional Counselor in the states of ND and CO, and is a Licensed Alcohol and Drug Counselor in the state of MN. Eric has worked as a behavioral health clinician in several settings including Outpatient Substance Use Disorder treatment services at both Kaiser Permanente and the Jefferson County Department of Health and Environment, both in the Denver, CO metro area.
Eric is a Licensed Professional Counselor in the states of ND and CO, and is a Licensed Alcohol and Drug Counselor in the state of MN. Eric has worked as a behavioral health clinician in several settings including Outpatient Substance Use Disorder treatment services at both Kaiser Permanente and the Jefferson County Department of Health and Environment, both in the Denver, CO metro area.
Pamela Greenberg, MPP
President and Chief Executive Officer, Association for Behavioral Health and Wellness (ABHW); Former Deputy Director, AHIP, Washington, DC
President and Chief Executive Officer, Association for Behavioral Health and Wellness (ABHW); Former Deputy Director, AHIP, Washington, DC
Pamela Greenberg is the President and CEO of the Association for Behavioral Health and Wellness (ABHW); she joined the organization in 1998. ABHW is the leading association working to raise awareness, reduce stigma, and advance federal policy to improve mental health and addiction care.
Pamela serves on the Editorial Board of the Bloomberg BNA Health Insurance Report and is a liaison to the National Committee for Quality Assurance Standards Committee. She also serves on the Advisory Board of Landmark Health and the InnovaTel Telepsychiatry’s Strategic Advisory Board. She was the Chair of the Coalition for Fairness in Mental Illness Coverage and served as President of The College for Behavioral Health Leadership.
Prior to joining ABHW Pamela was the Deputy Director of Federal Affairs for America’s Health Insurance Plans (AHIP). Before joining AHIP Ms. Greenberg was a Legislative Assistant at Capitol Associates, a healthcare consulting firm in Washington, D.C.
Pamela serves on the Editorial Board of the Bloomberg BNA Health Insurance Report and is a liaison to the National Committee for Quality Assurance Standards Committee. She also serves on the Advisory Board of Landmark Health and the InnovaTel Telepsychiatry’s Strategic Advisory Board. She was the Chair of the Coalition for Fairness in Mental Illness Coverage and served as President of The College for Behavioral Health Leadership.
Prior to joining ABHW Pamela was the Deputy Director of Federal Affairs for America’s Health Insurance Plans (AHIP). Before joining AHIP Ms. Greenberg was a Legislative Assistant at Capitol Associates, a healthcare consulting firm in Washington, D.C.
Monique Yohanan, MD, MPH
Director, State Government Relations, MCG, San Francisco, CA
Director, State Government Relations, MCG, San Francisco, CA
Monique Yohanan is the Director for State Government Relations for MCG, a Hearst Health company. Previously she served as the Senior Physician Editor and Subject Matter Expert in Behavioral Health at MCG. She trained in Internal Medicine and Geriatrics in the Harvard and Stanford systems, respectively. She has held faculty appointments at UCSF and Stanford and was a Medical Director in Extended Care at the VA Palo Alto Health Care System. She has given numerous invited Grand Rounds and talks at the annual APA meeting, as well as other national and state psychiatric meetings. Most recently she has become involved in the development of national accreditation standards for Mental Health Parity.
Mesfin Tegenu
President, PerformRx, Philadelphia, PA (Moderator)
President, PerformRx, Philadelphia, PA (Moderator)
Mesfin Tegenu is the president of PerformRx, LLC, one of the nation’s leading URAC-accredited pharmacy benefit management organizations. A clinical pharmacist and executive with more than 25 years of experience, Mr. Tegenu’s vision has resulted in the development of leading-edge pharmacy benefit solutions that enable health plans to improve patient outcomes while reducing costs. Mr. Tegenu spearheaded the creation of PerformRx after successfully developing a comprehensive in-house pharmacy benefit management program for a national provider of managed care services. Leveraging the clinical expertise that has driven PerformRx’s continued success; Mr. Tegenu has directed the development of PerformSpecialty LLC, a new specialty pharmaceutical care management and fulfillment company providing services for those with complex illnesses. Mr. Tegenu is active in the community and currently serves on the board of multiple civic organizations.
MINI Summit XVI: Palliative Care and Hospice
5:00 pm
Introductions, Panel Discussion and Q&A
Mollie Gurian, JD, MPH
Chief Strategy Officer, National Partnership for Hospice Innovation, Washington, DC
Chief Strategy Officer, National Partnership for Hospice Innovation, Washington, DC
Mollie Gurian oversees the day-to-day strategy and public policy priorities for the National Partnership for Hospice Innovation, a collaborative for over 50 not-for-profit, community-integrated hospice and palliative care providers. In this role, she provides strategic guidance, in-depth policy analysis, regulatory interpretation, and coalition leadership across a broad range of projects and innovative strategic priorities for NPHI. More broadly, she is deeply engaged in work in advanced illness and hospice care development and modernization with particular emphasis on integrating community-based providers into overall health system delivery transformation.
Originally from New York City, Mollie attended law school and public health school at the University of Minnesota earning both a J.D. and an M.P.H. in Public Health Administration and Policy as well as a B.A. from Carleton College. As part of her graduate work, she completed her masters’ thesis on the Medicare Hospice Benefit.Excellence in Assisted Living and as a volunteer with the DC chapter of Aging 2.0.
Originally from New York City, Mollie attended law school and public health school at the University of Minnesota earning both a J.D. and an M.P.H. in Public Health Administration and Policy as well as a B.A. from Carleton College. As part of her graduate work, she completed her masters’ thesis on the Medicare Hospice Benefit.Excellence in Assisted Living and as a volunteer with the DC chapter of Aging 2.0.
Zinnia Ng Harrison, MHS
Vice President of Innovation & Inclusion, National Hospice and Palliative Care Organization; Former Division Director of Health Care Payment Models, Patient Care Models Group, Centers for Medicare & Medicaid Services, Washington, DC
Vice President of Innovation & Inclusion, National Hospice and Palliative Care Organization; Former Division Director of Health Care Payment Models, Patient Care Models Group, Centers for Medicare & Medicaid Services, Washington, DC
Zinnia Ng Harrison joined the National Hospice and Palliative Care Organization in as Vice President of Innovation and Inclusion to collaborate with diverse stakeholders to design and implement sustainable care delivery and payment models that increase high quality care to a broad cross-section of patients and families. With 15 years of health program and policy experience, Mrs. Harrison began her federal career at the Health Resource and Service Administration’s Bureau of Primary Health Care. She served in the Centers for Medicare & Medicaid Services, Center for Medicare, Chronic Care Policy Group and contributed to a diverse portfolio of payment policy issues related to institutional post-acute care settings, home health, and hospice. In late 2015, she joined the Center for Medicare and Medicaid Innovation as the Director of Division of Health Care Payment Models.
Peter Stein, MA
Director of Government Affairs, Better Medicare Alliance; Former Senior Policy Advisor, US Senator Rick Santorum, Washington, DC (Moderator)
Director of Government Affairs, Better Medicare Alliance; Former Senior Policy Advisor, US Senator Rick Santorum, Washington, DC (Moderator)
6:00 pm
Adjournment and Networking Reception
Agenda Links: Preconference | Day 3