2018 Speakers

Priority Health

Reva Sheehan

Sr. Improvement Specialist – Medicare Quality
Harvard Pilgrim Health Care

Noreen Hurley

Program Manager, Star Quality & Performance
Cigna-HealthSpring

John Mark Willis, M.Ed.

Senior Director-Star Operations
Health Alliance

Kena Hahn

Director Medicare Stars & Health Improvement
Anthem

David Burianek

Vice President, Clinical Quality Management
Commonwealth Care Alliance

Lauren Easton

Senior Director, Behavioral Health
SelectHealth

Kim Barrus

Medical Home Manager
Cambia Health Solutions

Marnie Frasier, CPC CRC

Medicare Provider Training & Education Specialist
Gateway Health, Highmark

Dan Weaver

Vice President, Stars Quality, Formerly Director of Program Management, Government Business, Quality Improvement
Cambia Health Solutions

Kellee Mills, CPC

Medicare Provider Performance Manager
Excellus BlueCross BlueShield

Jeffrey Ledgerwood, PharmD, BCGP

Medicare Clinical Pharmacist
Capital BlueCross

Susan Lira

Manager, Plan Performance & Improvement
UCare

JESSICA ASSEFA

Medicare Stars Program Manager
The Health Plan

Valerie Ogilbee

Director, Quality Analytics
Tufts Health Plan

Debra A Corbett

Program Director, Senior Products Clinical Services Strategy
MCS Healthcare Holdings, LLC

Linda Lee

Vice President of Quality Improvement
Capital District Physicians’ Health Plan

Cynthia Aguglia

Medicare Stars Administrator
Anthem

Kathy Rowerdink MPH, MBA

Director, Clinical Strategy
Gorman Health Group, LLC

MELISSA SMITH

Vice President, Star Ratings
Health Sun Health Plans

Karen W. Connolly, RN

Senior VP/QI and Accreditation
Carrot Health

Kurt Waltenbaugh

CEO
mPulse Mobile

Chris Nicholson

Co-founder and CEO
Speakers Biographies


Reva Sheehan

Sr. Improvement Specialist – Medicare Quality
Priority Health

Reva Sheehan, Sr. Improvement Specialist in Medicare Quality at Priority Health. With over 10 years in healthcare, Reva has overseen operations of several long term care pharmacies and compound labs prior to joining the Senior Markets team at Priority Health where she transitioned from Part D Pharmacy Operations to Medicare Quality.

Noreen Hurley

Program Manager, Star Quality & Performance
Harvard Pilgrim Health Care

Noreen has spent her career in the healthcare arena. She blends operational, strategic and technology perspectives as well as payer and provider expertise to lead major initiatives and strategies. She started in hospital operations and was Director of the Admitting & Registration department in the New England Deaconess Hospital, a Harvard teaching hospital in Boston. Transitioning to IT, she implemented the EMPI (Enterprise Master Patient Index) when the Deaconess merged with the Beth Israel Hospital to form what is now the Beth Israel Deaconess Medical Center. From there she moved to the vendor world and ran implementations of EMPI's, HL7 integrations and HIPAA EDI transactions for SeeBeyond Technologies.
Most recently, she has focused on the payer space. She started and oversaw the Star program at Tufts Health Plan, as well as working in IT, developing a senior products PMO and managing the member call center. Moving back to technology, she developed data driven solutions in the healthcare space while working at Informatica. Her current role is developing the Star program at Harvard Pilgrim Health Care, which has recently re-entered the Medicare Advantage market. As a leader in the Clinical Informatics Division, the program focuses on leveraging non-traditional data and analytics to craft targeted initiatives to improve performance in the Star program and the Harvard Pilgrim Stride product

John Mark Willis, M.Ed.

Senior Director-Star Operations
Cigna-HealthSpring

John has worked in managed care for over 18 years and has spent the past 10 years with Cigna-HealthSpring in various roles. He has served as a clinical trainer, Director of Quality Improvement, Star Director-Central Region and currently serves as the Vice President of Star Operations for all Cigna-HealthSpring markets. John has a bachelor's degree in Social Work and a master's in education with a focus on Community Development. Prior to coming to Cigna-HealthSpring he worked for Tricare, Alabama Psychiatric Services, and United Healthcare. John is very passionate about customer engagement, promoting quality outcomes for customers, and developing strategic and innovative programs to improve the Star Rating for Cigna-HealthSpring.

Kena Hahn

Director Medicare Stars & Health Improvement
Health Alliance

Kena Hahn is the Director of the Medicare Star Ratings program for Health Alliance, a vertically integrated health system with Carle that provides coverage to Illinois, Indiana, Iowa, and parts of Washington state. Prior to this Kena served as a Patient Experience Advisor at Carle where she was responsible for the education and improvement efforts with all staff and physicians to improve CG CAHPS scores for Carle’s ambulatory clinics. She brings over 14 years of experience in the healthcare field with focus on patient/member experience and process improvement. c In her current roll, Kena has responsibility for the facilitation and coordination of the Star Ratings program for Health Alliance’s Medicare Advantage products. In 2016 the organization was at a 4.5 Star Rating and they are currently working towards becoming a 5 Star plan.
In addition to her Bachelor of Science degrees in Biology and Marketing, Kena also has her Master’s in Health Administration degree. The ultimate vision she has for the Stars program is to utilize predictive analytics in conjunction with collaboration from the entire health plan organization and provider partners to reach and sustain a 5 star Medicare Advantage products.

David Burianek

Vice President, Clinical Quality Management
Anthem

Lauren Easton

Senior Director, Behavioral Health
Commonwealth Care Alliance

For over a decade, Lauren Easton, LICSW, has served as a Behavioral Health leader for Commonwealth Care Alliance (CCA). Over the years and in various roles, Lauren has been largely responsible for developing CCA's behavioral health integration across its care models, for creating a responsive network, and for creating many innovative programs, including CCA’s Crisis Stabilization Units. Lauren embraced the integration of behavioral health and medical care long before the concept became "trendy." She has made behavioral health integration a hallmark of program development throughout her professional life.
In her current role, Lauren is responsible for the oversight of CCA's behavioral health services, delivered through its network of behavioral health providers and internal behavioral health specialists to CCA's 22,000+ members. She is responsible for assisting clinical leadership in improving the level of integration of Primary Care and behavioral health services for CCA members and for guiding network development, cost management, and quality improvement activities. She oversees the Behavioral Health development and expansion of the One Care program and Senior Care Option Program, paying particular attention to the significant mental health needs of this population.
Lauren holds a master's degree from Simmons College School of Social Work. She also attended Boston University and the University of Massachusetts, where she completed a double Major in psychology and education.

Kim Barrus

Medical Home Manager
SelectHealth

Kim is a registered nurse who received her Bachelor of Science in Computer Information Systems from Columbia College of Missouri, and her Bachelor of Science in Nursing and Master of Science in Nursing from Western Governors University. She also maintains a Project Management Professional (PMP) certification from the Project Management Institute (PMI).
Kim Barrus began her career with SelectHealth 23 years ago and has worked in a variety of capacities in that time. Her current focus has been on the development and management of the SelectHealth Advanced Primary Care (a.k.a., patient centered medical home) program and supporting department. Kim facilitated the initial pilots of the program in 2010. Today the program has 1,085 participating providers at 200 participating clinics.

Marnie Frasier, CPC CRC

Medicare Provider Training & Education Specialist
Cambia Health Solutions

Marnie is the Medicare Provider Educator and Training Specialist for Cambia Health Solutions. She has worked a variety of healthcare roles in the past 18 years including claims, billing manager, risk adjustment coder, auditing, and HEDIS abstractor. In her current role she oversees a team of coders reviewing the Stars quality gaps and performs monthly training and audits. Her expertise is Medicare Quality Gaps and Education.

Dan Weaver

Vice President, Stars Quality,
Gateway Health,
Formerly Director of Program Management, Government Business, Quality Improvement,
Highmark

Daniel Weaver is an established leader with extensive experience developing and implementing intervention strategies to improve Medicare Stars performance. With demonstrated success with innovative intervention programs, Daniel's team has consistently delivered market-leading performance and forward-thinking engagement with providers and members.

Kellee Mills, CPC

Medicare Provider Performance Manager
Cambia Health Solutions

Kellee is a certified professional coder, and began her career in healthcare working for a variety of physician groups, including a multi-specialty clinic and a group of cardiovascular surgeons. She moved to Medical Service Bureau of Idaho, now part of Cambia Health Solutions (Regence) in 1989 as a provider network consultant, contracting and educating provider groups and hospitals. She joined the Government Program team at Cambia four years ago as a Medicare Provider Performance Manager, educating clinics across the four Regence states on the MedAdvantage Quality Incentive Program, which includes quality measures, risk adjustment, and HCC diagnosis care gaps. She is an Idaho native with two grown daughters.

Jeffrey Ledgerwood, PharmD, BCGP

Medicare Clinical Pharmacist
Excellus BlueCross BlueShield

Jeffrey Ledgerwood has taken his experience and success from almost seventeen years in community pharmacy and applied it to his work on Medicare Star improvement for Excellus Health Plan in Rochester, NY. Excellus Health Plan has consistently been a high performing Health Plan achieving 4 STAR or better in both the MAPD and PDP space. As a Medicare Clinical Pharmacist, Jeffrey supports the development, implementation, and execution of quality improvement initiatives aimed at boosting Medicare Star ratings. In addition to his work on Medication Adherence, in the 3 years that Jeffrey has been at Excellus he has created and offered clinical insight on numerous projects related to both Part C and Part D Star measures focusing on topics including Rheumatoid Arthritis, Osteoporosis, Heart Failure, Medication Reconciliation, and Statin Use in Diabetics. Jeffrey holds a Doctor of Pharmacy from Massachusetts College of Pharmacy and Health Sciences, and is recognized by the Board of Pharmacy Specialties as a Certified Geriatric Pharmacist.

Susan Lira

Manager, Plan Performance & Improvement
Capital BlueCross

Sue Lira has worked in healthcare for over 30 years. Her background in both clinical and case management of cardiac surgery patients provided overview of the challenges to providing cost effective quality care. Sue transferred her skills to the health insurance industry where she worked in utilization and case management until finally settling into a position in quality management. Over the past 18 years, she has seen the changes in healthcare delivery and quality leading to the emphasis on prevention and outcomes driven management and measurement. Sue has worked with multidisciplinary teams to improve HEDIS rates via supplemental data, increased hybrid collection rates, and focused, multi-tiered, measure specific interventions.

JESSICA ASSEFA

Medicare Stars Program Manager
UCare

Jessica Assefa has been the Manager of the Medicare Star Ratings program for UCare,an independent, nonprofit health plan that provides coverage to Minnesotans, for the past two years. Prior to this Jessica served on UCare's Clinical Compliance team where she was responsible for the trainingand oversight of UCare's delegated care coordination entities. In her current roll, Jessica has responsibility for the facilitation and coordination of the Star Ratings program for UCare's four Medicare Advantage and Dual Eligible products..UCare's Medicare Advantage product, UCare for Seniors rated "Excellent" by NCQA, has maintained a 4.5 Star Rating, and is very close to becoming a 5 Star plan. UCare's Medicare portfolio also includes: Minnesota Senior Health Options (MSHO), a D-SNP plan that combines Medicare and Medical Assistance benefits/services for low income Seniors, EssentiaCare - a Medicare Advantage plan from Essentia Health (a local care system) and UCare, andUCare Connect + Medicare - (Special Needs Basic Care) a plan that combines the benefits/services of Medicare and Medical Assistance for Minnesotans with certified disabilities ages 18 to 64. In addition to her managed care experience, Jessica brings over 20 years of nursing experience in the states of MN, IN and NY working extensively with the geriatric and disabled populations.

Valerie Ogilbee

Director, Quality Analytics
The Health Plan

Valerie joined The Health Plan in April 2001 as an intern. She worked in the QI Department for several years prior to being transferred to the Finance Department. As a health data analyst, Valerie completed a variety of projects including contract analysis, financial analysis, and reinsurance reporting. Valerie has implemented software programs for fraud, waste and abuse identification and predictive modeling and provider profiling. She served as the manager of health economics in the Business Intelligence Unit prior to assuming her current role as Quality Analytics Director. Valerie is responsible for working with staff to analyze data relevant to The Health Plan's various quality initiatives. Through analysis of data, she works with the quality improvement teams on the development and implementation of programs aimed at improving the quality of care and service provided to members. She is also responsible for HEDIS reporting, Medicare data projects and member outreach efforts. Valerie received a Bachelor of Science Healthcare Administration degree from Ohio University in June 2001. While working at The Health Plan, Valerie earned a Master of Public Health degree from West Virginia University in 2006. In December 2015, she completed the University of California, Davis Healthcare Analytics Certificate Program.

Debra A Corbett

Program Director, Senior Products Clinical Services Strategy
Tufts Health Plan

Debra A Corbett is the Program Director for Senior Products Clinical Services Strategy for Tufts Health Plan, a multi-year 5 CMS Star Plan. In that capacity, she manages a number of Clinical Stars Quality Improvement Campaigns as well as the Chronic Care Improvement Program (CCIP), Performance Improvement Projects (PIP) and Quality Improvement Projects (QIP) and the Dual Special Needs Program (SNP) Model of Care. Ms. Corbett has more than 20 years of experience in the managed care industry; serving predominately as senior administrator for quality and/or care management in several Health Plans. She has also provided consultation services for more than 10 years.

Linda Lee

Vice President of Quality Improvement
MCS Healthcare Holdings, LLC

Linda Lee possesses 29 years of experience in the Healthcare industry. She began working at MCS, a Puerto Rico Health Plan, in February 2011, as Vice President of Quality Improvement. As part of her responsibilities, Linda provides oversight and structure for continuous quality improvement. She also oversees all Quality Improvement activities including the Model of Care, the Special Needs Program, Accreditation, and HEDIS. Linda has implemented and promoted strategies that have resulted in significant improvement of her business unit and for MCS in general. Linda holds a bachelor's degree in Mathematics and Applied Sciences from the University of California (UCLA) and has studied Econometrics at the Master's level at California State University Fullerton (CSUF). Linda is part of professional associations such as the Fellow Life Management Institute (FLMI), the Health Insurance Association of America (HIAA) and the Insurance Institute of America (IIA), and she is a lifetime member of Worldwide Who's Who of Executives & Professionals. In her spare time, she enjoys travelling, gardening, and spending time with her family and dachshund.

Cynthia Aguglia

Medicare Stars Administrator
Capital District Physicians’ Health Plan

Cindy Aguglia is the Medicare Stars Administrator at Capital District Physician’s Health Plan (CDPHP) in Albany, NY. Cindy has worked in the health insurance space for over 30 years, holding various positions in sales, operations, Medicare compliance, and appeals.

As the Medicare Stars administrator, Cindy is responsible for the oversight of the 48 star measures and develops yearly campaigns to increase these ratings. To accomplish this, she facilitates and participates in many cross-functional teams.

Having a background in appeals, Cindy also assists the appeals and complaints department by performing weekly and monthly oversight of their determinations.

Kathy Rowerdink MPH, MBA

Director, Clinical Strategy
Anthem

Kathryn Rowerdink works in the Anthem’s Clinical Strategy & Programs organization, focused on enterprise wide strategies and solutions. In her position, she leads the end to end strategies for diabetes, Social Determinants of Health and healthcare disparities. Her role combines elements of innovation, value, quality, and consumer centricity to develop leading clinical solutions.

Her Anthem career spans multiple departments that developed leadership skills in community health initiatives & partnerships, clinical program development and management, National Accounts product and clinical model strategies. Ms. Rowerdink graduated with her master’s degree in public health from California State University, Northridge and earned her master’s degree in business administration from Pepperdine University. She continues her education obtaining her certification in design thinking and finishing the Anthem leadership development program.

MELISSA SMITH

Vice President, Star Ratings
Gorman Health Group, LLC

Melissa Smith is Vice President of Stars at Gorman Health Group. In this role, she helps health plans, providers, PBMs, and industry vendors improve their performance within quality ratings systems such as Star Ratings within Medicare Advantage, Quality Rating System (QRS) within the Health Insurance Marketplace, Healthcare Effectiveness Data and Information Set (HEDIS®), Consumer Assessment of Healthcare Providers and Systems (CAHPS®), etc. She brings more than 20 years of healthcare experience to GHG, with more than five years at Cigna-HealthSpring working with Star Ratings among national MA and Part D plans. Melissa has extensive experience developing strategic and tactical solutions to maximize performance on the full spectrum of quality measures. Melissa also has a strong background of building productive partnerships across internal teams and with external vendors to improve performance on clinical, medication, patient survey, and administrative quality measures. Before working with quality ratings systems, Melissa was an Associate Director at Vanderbilt University Medical Center. Melissa received her degree from Purdue University and began her career at KPMG, LLP. Melissa's unique background of business process, regulatory compliance, and healthcare quality offers our clients the opportunity to maximize quality performance and revenues. Medicare Star Ratings

Karen W. Connolly, RN

Senior VP/QI and Accreditation
Health Sun Health Plans

Karen Connolly, RN, a health care professional, has over 40 years of extensive experiences in operational leadership in health care quality delivery and management including quality management and improvement in health care. She has been involved in nursing and hospital administration and in operational leadership with the health plan industry to include QI, accreditation attainment, HEDIS, health information, contract administration, risk management and strategic planning. Her expertise and experiences in quality improvement activities have included activities in both the hospital and ambulatory settings and interfacing with a number of external agencies in the promotion of quality and in the use of data to increase access to care and to increase the quality of health care delivery systems. She has worked consultatively in the health plan community with Medicaid Advantage, Medicaid, and Commercial health plans in the areas of compliance, QI, operational leadership, accreditation achievement, key metrics, and HEDIS with emphasis with the CMS Medicare Advantage Stars Program for over 14 years. She has facilitated strategic planning sessions and performed analytical evaluation, database management, and quality improvement of key performance indicators that have resulted in statistically significant improvements impacting health outcomes particularly focused in the health plan that has resulted in impacting star ratings including the achievement of a 5 Star Rating from CMS. Ms. Connolly has worked with organizations throughout the country in the achievement and continued compliance with accreditation with NCQA, AAAHC, and The Joint Commission.
Ms. Connolly has been an accreditation surveyor with the Accreditation Association for Health Care Administration (AAAHC) since 1998 and serves as faculty for AAAHC educational programs. Ms. Connolly serves as the Chair of AAAHC's Health Plan Advisory Committee and is a member of AAAHC's Standards and Survey Process Committee. She has served on a number of other committees, workgroups and task forces for AAAHC that have included the Medical Home Advisory Committee, the Task Force on Quality Improvement, the Task Force for Primary Care, and workgroups for Patient Center Medical Home and Scoring Methodology. She currently serves on 2 CMS national technical expert panels on Quality Improvement Strategies and the Quality Reporting System in conjunction with the Affordance Care Act. She is an under-graduate of DePauw University School of Nursing in Indiana and did her graduate studies at Oakland University and University of Michigan in Michigan.

Saeed Aminzadeh

CEO
Decision Point Healthcare Solutions

Saeed founded Decision Point with the mission of improving health plan clinical, financial and operational performance through informed, data-driven predictions on strategic decisions. He has more than 25 years of health information technology experience, with a track record of developing innovative approaches to solve complex business problems. He has held key senior management positions at Eliza Corporation, Ingenix (currently Optum), IHCIS and ProVentive, where led high-performing teams focused creative uses of technology for practical problem-solving. Saeed is a graduate of The Johns Hopkins University with a BA in Economics.

Kurt Waltenbaugh

CEO
Carrot Health

Kurt is a serial entrepreneur who has built successful analytic solutions, products and companies in the healthcare, retail, manufacturing, education/credentialing and fundraising industries. His previous companies were sold to Oracle and Pearson Education. Most recently, Kurt was responsible for Product Strategy at Optum, Inc. (UnitedHealth), building data analytic businesses for the Provider, Payer and Employer markets.

Chris Nicholson

Co-founder and CEO
mPulse Mobile

Chris Nicholson has over 20 years of experience in healthcare and digital technology from working in Fortune 100 companies to dynamic startups. As CEO, he leads the company vision of creating a new approach to healthcare communications. Chris previously spent over a decade in strategic leadership roles at Humana, including VP and COO of Wellness, and led Humana’s Strategic consultancy division. His focus for mPulse Mobile is to drive improved health outcomes and business efficiencies through Star Ratings-Focused Mobile Solutions by creating lasting partnerships with industry leaders and demonstrating proven ability to deliver outcomes for health plans.