Michael S. Adelberg
Kim Barrus, MSN, BSCIS, RN, PMP
Lynn Deguzman, Pharm.D., BCGP
Julianne Eckert RN BSN, CCM, CMCN, ACMP
Dr. Nathan Estrada
Jamie Galbreath, PhD, MPH, CHES
David Kirkus, PharmD
Dean Koskinas, PharmD
Dena Miller, RN MSN
Patricia Powers, PharmD, BCPS
Michael S. Adelberg
Mike Adelberg leads the Healthcare Strategy Practice at Faegre Baker Daniels Consulting.
He has 25 years progressive healthcare industry and government experience in Medicare,
Medicaid and commercial health insurance. Mike spent fifteen years at 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) where he oversaw most of the functions of the federally-run
health insurance exchanges; serving as the Director of Medicare Advantage Operations, where he supervised
the annual cycle for review and award of Medicare Advantage bids and contracts, developed CMS’s operational policy,
and led the monitoring of Medicare Advantage contractors; and serving as the associate regional administrator for
Medicare operations (Chicago Region) and the director of education and assistance programs. Mike gained private sector
experience as vice president of product development and government affairs for the Universal American Corporation,
a multi-state health insurer which operated Medicare Advantage and Medicaid health plans (subsequently acquired by Wellcare).
He has also led or co-led health policy studies published in Health Affairs and The American Journal of Managed Care. Mike speaks and publishes frequently on healthcare topics and has served on numerous advisory committees. He’s been quoted in the Washington Post, New York Times, Modern Healthcare, NPR, and other leading media. In his spare time, Mike is an author. He’s written three novels, a history book, several scholarly journal articles, and over sixty book reviews.
Cindy Aguglia is the Medicare Stars & quality manager at The Health Plan (THP), one of the
largest locally managed care organizations in West Virginia. They offer a complete line of
managed care products and services, including Medicare Advantage plans that provide
coverage to West Virginia and eastern Ohio. Cindy has worked in the health insurance space
for over 30 years, holding various positions in sales, operations, Medicare compliance, quality,
and appeals. Prior to joining THP in March 2021, Cindy was the Medicare Stars administrator
for almost nine years at the Capital District Physician’s Health Plan (CDPHP) in upstate New
York, where she used her expertise in Stars to achieve a 5-star rating for their PPO plan.
As THP’s Medicare Stars & quality manager, Cindy is responsible for the growth and development of the Stars program. She provides training to new staff on the importance of achieving high star ratings, she collaborates with vendors to improve member engagement and designs and initiates campaigns to increase Star ratings. To accomplish this, she facilitates and participates in many cross functional teams within THP.
Kim Barrus, MSN, BSCIS, RN, PMP
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
Kim Barrus began her career with SelectHealth 26 years ago and has worked in a variety of capacities in that time. She developed 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 1,240 participating providers at 222 participating clinics. Kim is currently the Director of Clinical Outcomes Management and has oversight for quality, medical home, NCQA accreditation, HEDIS and CMS Stars.
Sam is a Stars Program Specialist at Priority Health, headquartered in Grand Rapids, Michigan. In her role she is responsible for developing and executing on strategies that increase member engagement and enhance member experience for a population of more than 200k Medicare Advantage members. Sam is passionate about making the complex world of health care engaging and easy-to-understand for beneficiaries. She collaborates with teams across the organization to drive CAHPS scores and help members access the care they need, when and where they need it.
With a background in Human Computer Interaction, Louise brings a design-oriented approach to leadership and product development. She has 15+ years of experience as a design, product, and technology leader serving enterprise clients across the healthcare, finance, retail, and supply chain industries. Prior to joining Icario, Louise held several leadership positions in multiple San Francisco based data and engineering-focused companies including Addepar, Alloy.ai, and Nuna. Louise holds a masters degree from Carnegie Mellon University in Human Computer Interaction.
Amanda Calvert is a Medicare Clinical Program Manager with Blue Shield of California. Blue Shield of California is a nonprofit health plan serving 150,000 Medicare members. She has led Medicare provider incentive strategies since 2017, driving provider performance improvement and building relationships between Blue Shield and its Medicare providers. Her approach is public health and data-driven, balancing enterprise and provider priorities. Calvert is a Southern California native with a BS from UCLA and an MPH from USC.
Evelyn Chojnacki, MPH
Evelyn joined SWORD Health in September 2021 bringing over 16 years of Health Plan experience having served clients and members across multiple roles and responsibilities. Building on deep experience rooted in employer group client management, health care program development, market deployment and sales strategy, she serves as the Director of Health Plan Product Strategy for SWORD Health.
Evelyn’s philosophy is focused on delivering the best outcome for the user, defined as the health plan, employer or member/beneficiary. This includes clinical effectiveness, access and convenience of when and where care is received, and improved bottom line - cost. Her motivation for joining SWORD was driven by an appreciation for the growing role of virtual care delivery in the healthcare ecosystem and the belief that physical movement is a freedom that we should all preserve and cherish.
Evelyn obtained her BBA in Healthcare Management from Marshall University and an MPH from UNC-Greensboro.
A high performing strategy and operations leader, Anthony Davis is the Managing Director for quality and accreditation services at Health Management Associates
He has extensive experience driving and achieving results across quality, value-based reimbursement, risk, project management and development, most recently serving as senior director of Quality, Regulatory, and Strategy with UPMC Health Plan. While there, he led quality, regulatory, credentialing and data/analytic operations with a team supporting insured members in Pennsylvania. He also designed all quality, regulatory, strategy and intervention programs for NCQA, state, and federal required compliance/performance activities.
Anthony’s experience with quality improvement expands beyond NCQA and includes long-term services and supports, Stars ratings, and Healthcare Effectiveness Data and Information Set (HEDIS) review highlighted by his previous work as director of quality improvement programs with Molina Healthcare. He also has served as a consultant and surveyor for NCQA. In addition to quality work, he has led diverse teams that support business operations, risk adjustment, quality, contracting, clinical, provider, and information technology services. His background and previous work includes quality projects and leadership at United Healthcare, Optum, Molina, and several other large health plan and care delivery systems.
Anthony earned a Master of Public Health in healthcare administration and a Bachelor of Science in medical anthropology, both from Oregon State University. In addition, he has taught quality improvement and clinical leadership as an associate professor at George Washington University.
Lynn Deguzman, Pharm.D., BCGP
Dr. Lynn Deguzman received her BS Chemistry/Biology from St. Mary’s College of
California and Pharm.D. from the University of California SF School of Pharmacy. She
has served as the Clinical Operations Manager at Kaiser Permanente Northern
California since 2011. She leads the Pharmacy Medicare Stars program which includes
the Medicare Part D Medication Therapy Management, Medication Adherence, SUPD,
Pharmacy New Member and Polypharmacy/ Deprescribing.
She has been an active PQA and AMCP member and is on PQA’s Quality Metric Expert Panel and AMCP’s MTM Advisory Board. She was identified as a Technical Expert for the Center for Medicare Services (CMS) Medication Therapy Management (MTM) Technical Expert Panel (TEP) Member group. She was invited as a subject member expert member for the Lown Institute’s Polypharmacy project. She has collaborated with the Institute Healthcare Improvement (IHI) to share her work in Polypharmacy and Deprescribing.
Julianne Eckert RN BSN, CCM, CMCN, ACMP
Julianne Eckert is the Director of Quality Improvement at Clover Health, a healthcare
company using technology to improve health outcomes, where she is responsible for
creating an organizational data driven innovative strategy that breaks the traditional
model of healthcare to make it easier for providers and patients to deliver and receive
She has spent her life using her personal and career experiences to help drive her mission as a patient advocate by driving health plan quality improvement strategy to prevent vulnerable populations from falling through the cracks by designing data and forward thinking programs that enable patients to easily navigate the complex matrices of healthcare and insurance. As a Registered Nurse (RN), daughter, mother and friend, she has seen first hand how people find it difficult in understanding how to care for themselves in a way that helps optimize their health outcomes or understanding their insurance benefits. She understands and has worked closely in designing strategies that bring care to patients in an easy and consumable format which breaks the traditional model of the patient seeking out the doctor for care. While her focus is on preventative care and ensuring safe and successful transitions through the care continuum, she also heavily focuses on improving patient experience with their health plan, providers and the services that they receive.
She understands that there is no single strategy that works for everyone and may even look different from one county to the next, so she continues to drive herself and her teams using root causal analysis and data driven insights to better understand populations and their unique needs to provide the most comprehensive program that touches every patient, not just “most” patients. She has sweeping subject matter experience in CMS innovation models, Stars program, NCQA HEDIS/CAHPS, health equity, as well as, national and international leadership in driving laser focused strategies to improve health plan performance and member outcomes/experience.
She received her Bachelor’s in Nursing at Barnes Jewish Goldfarb College of Nursing and is currently completing her MBA at University of Texas. She holds multiple certifications in Organizational Change Management, Case Management and also Managed Care. She is an avid mentor and career coach believing it is her mission to develop our next generation of leaders.
Julianne is currently in Austin, Texas where she lives with her husband raising their two young daughters.
Dr. Nathan Estrada
Dr. Nathan Estrada is the VP of Clinical for Nymbl Science and subject matter expert on older adult balance training and fall prevention. He is a physical therapist by training and received his Doctorate in Physical Therapy from University of Colorado Denver Health Science Center, where he also received the Hubert J. Levy Humanitarian Award in 2007. Professionally, he has worked in outpatient orthopedics, sports medicine and home health where he developed a passion for helping older adults participate more fully in life. He was the program manager for Senior Living at Bayada Home, where he focused on older adult population health. Dr. Estrada believes we have bought into the lie that aging is less and that health decline is somehow a normal expectation of aging. He is validating that empowerment will always yield better results than fear and that healthcare should be fun. He believes we can do better to meet the needs of older adults by combining human connection with technology to impact results at a population level. His primary mission is to bring lasting solutions to older adults to meet the greatest anxiety points of aging, beginning with falls.
Michael A. Farina, R Ph., MBA joined CDPHP in 2019 and is currently the Director of Health Care Quality In this role, he has primary responsibility for the HEDIS hybrid abstraction process, day to day operational aspects of the quality department. Michael earned a Bachelor of Science degree from Albany College of Pharmacy and a masters of Business Administration from Union College. Michael is a registered pharmacist in New York State.
Dana Friedman is Assistant Director of Performance Improvement at Elderplan/
HomeFirst, an HMO plan with Medicare and Medicaid plan offerings, which is part of
the Metropolitan Jewish Health System. Dana has managed the Plan’s partnership with
HealthCrowd to leverage digital outreach to communicate with its members on a variety
of health awareness and member engagement campaigns.
Dana is an experienced public health professional with over 15 years’ background in quantitative research, project management, statistics, and program evaluation.
She is a graduate of the City University of New York with a Masters in Public Health.
Jamie Galbreath, PhD, MPH, CHES
Jamie Galbreath is the Quality Improvement Associate Director for UCare where she provides
oversight and manages the HEDIS chart abstraction team, NCQA Accreditation (both Health
Plan and Health Equity Accreditation), Star Ratings (Medicare, Marketplace and Medicaid), and
regulatory quality improvement projects. Additionally, she leads clinical and public health
performance improvement projects designed to improve member health outcomes.
Jamie has received her doctorate in Public Health with a specialization in Community Health Promotion and Education from Walden University. She also has her Master’s degree in Public Health from Walden University and Bachelors of Science degree in Community Health Education from the University of Minnesota Duluth. She has completed a certificate program from St. Thomas University in Health Care Management. Further, she is a Certified Health Education Specialist and a member of the Minnesota Society for Public Health Education and the Minnesota Public Health Association. Jamie has almost ten years of health care industry work experience and 18 years of experience working in the mental health and substance use field.
Lindsey Giglio is the Manager for the rapidly growing Medicare Advantage Stars program at BlueCross BlueShield of South Carolina. In her role, she leads the work of provider engagement, medical record collection and provides clinical input on Stars activities. She has developed a successful track record of building provider partnerships and has played a key role in the year-over-year increases in MA provider Star scores resulting in better health outcomes for MA members. Prior to her role with Medicare Stars, she implemented the Medicare Advantage Transition of Care program for BlueCross BlueShield of South Carolina Care Management team.
As a Registered Nurse, Lindsey holds a Bachelor’s degree from the University of South Carolina. She currently resides in Lexington, South Carolina with her husband, baseball loving son, and ballerina daughter.
Leslie Groves is the Head of Marketing for HealthCrowd. In this role she is responsible
for overall strategy and success of the marketing and communications program including
digital marketing; brand messaging; content marketing; media relations; event
management; and overall brand management.
She has a Master of Art in Organizational Leadership from The Graduate Institute and a Master of Science in Research, Evaluation and Measurement from Southern Connecticut State University.
Anna Hall is an experienced clinical pharmacist by training and a pioneer in building MTM programs and STAR Ratings/HEDIS measure improvement intervention programs for prominent national prescription plan sponsors. At Enhanced Medication Services, Anna oversees strategic partnerships, contracting of clinical services, and program compliance. Over the past 10 years she has worked to develop interactive training programs designed to teach technicians and pharmacists how to engage patients in medication therapy management and encourage adherence through the provision of multi-modal interventions and motivational interviewing. Anna serves in national roles for both PQA and AMCP to influence MTM innovation and consensus and contributes to the national strategy to improve effectiveness of MTM and quality improvement programs.
As Director of Government Programs, James Haskins ensures that HealthMine’s products and solutions have a strong positive impact on clients’ performance by acting as a subject matter expert on government programs including Medicare Advantage, Medicaid, and ACA/Commercial.
Prior to his role at HealthMine, James led a team to raise plan ratings from 2.5 stars to 3.5 stars. Today, James leverages his boots-on-the-ground experience coupled with an in-depth knowledge of Medicare Star Ratings, medical record review, HEDIS®, and data analytics to direct the development and implementation of new product initiatives, including product enhancements.
A forever-learner and thorough researcher, James is HealthMine’s go-to resource for what’s up and coming in the healthcare space. He is passionate about leveraging technology and advanced analytics to engage members in their health care.
James graduated from the University of Michigan with a Bachelor’s in Chemistry and a Master’s in Public Health. He has lived in Michigan for twenty years and currently resides in the city of Detroit. When he isn’t researching government policy and procedures, James enjoys playing Nintendo, jumping on a Peloton ride, and planning his next trip to Disney world.
Shaila has more than twenty years of professional experience, the majority in
customer experience strategy within the health care industry. Shaila currently
serves as Principal for Mergence Advisors, where she has developed strategy and
change management for STARS initiatives. Prior to Mergence Advisors, Shaila
worked for Independence Blue Cross as the Customer Experience Executive,
where she redefined the customer experience and related health care reporting and
communications. She is an expert in CAHPS implementation, having authored
several blogs and podcasts about STARS and CAHPS.
In her consulting practice, Shaila focusing on data that tells the “story” behind the numbers. She has led initiatives to analyze large quantities of data and extract key conclusions for better focus on goals, priorities and cross functional impacts. In addition, Shaila has led several transformational change initiatives and believes that communications are key to making any transformation successful. As such, she has created innovative and engaging change management plans that build acceptance and consensus. Shaila believes that health care is going through an exciting transformation and is one of the most dynamic and rapidly changing industries we have today.
Shaila serves on a number of boards, including Trinity Health, Serviam Girls’ Academy, The Grand Opera House of Delaware, The Better Business Bureau of Delaware, and the Ronald McDonald House of Delaware.
Haley Kesler is the manager of the Medicare Star Ratings program for Health Alliance, a vertically integrated health system with Carle that provides coverage in Illinois, Indiana, Iowa, Washington, and North Carolina. She brings several years of experience in the healthcare field with a focus data analytics and process improvement.
Haley holds a Bachelor of Science degree in Health Administration from the University of Illinois Urbana-Champaign. In her current role, she facilitates and coordinates the Star Ratings program for Health Alliance’s Medicare Advantage products. Haley and her team have continued to expand their use of predictive analytics in conjunction with collaboration amongst internal teams and external provider partners to continue their journey towards 5 stars for their Medicare Advantage products.
David Kirkus, PharmD
As a Director, Consulting Services for EnlivenHealth™, David advises the company on building and enhancing solutions that meet the evolving demands of retail pharmacy partners. David is lauded for his 20-year history of developing and implementing innovative strategies and solutions in the retail pharmacy industry. Prior to joining EnlivenHealth™, David served as a pharmacy executive at Publix Super Markets with a tenure of over 18 years. He earned his Doctor of Pharmacy from the University of Georgia.
Dean Koskinas, PharmD
Dean is a seasoned clinical pharmacist that has spent the last 7 years designing and overseeing medication therapy management and quality intervention program operations. Through residency training and experiential opportunities over the past 7 years, Dean has experienced wide exposure to various practice models of quality intervention services. Dean has worked to directly manage teams of pharmacists and technicians and work with EMS clients directly to operationalize all programs. Dean is a subject matter expert in quality clinical intervention execution, meeting volume expectations, and Medicare program requirements that impact the delivery of MTM and quality services. Dean is also a subject matter expert in overcoming barriers to member and provider engagement in clinical services. He has trained hundreds of pharmacists and technicians in motivational interviewing and overcoming resistance to participation in services.
Ms. Leo oversees the overall performance, strategic direction and product development for Cigna Healthspring's Medicare products. Prior to joining Cigna, she worked for Aetna, where she was most recently was the National Head for Medicare Advantage product and strategy.
Previously, Ms. Leo held leadership roles at Aetna in national contracting, network contracting, operations and dental. She has an MBA from St. Joseph's University and lives in Philadelphia with her husband and daughter.
Dr. Henry Mahncke is the CEO of Posit Science. He joined Posit Science at its inception in 2003 as Vice President of Research & Outcomes, where he led the first large-scale clinical trials of a publicly available cognitive training program. He became CEO of Posit Science in 2011. Previously, he served as consultant at McKinsey focused on health care and video games, and then as a science and technology advisor to the British government. Dr. Mahncke earned his PhD in Neuroscience at the University of California, San Francisco.
Mallory provides clinical leadership in the quality department over various population health and quality programs including condition management, wellness, NCQA, HEDIS, clinical appeals review, and Stars. In addition, Mallory works with the clinical integration team to ensure members are receiving the right care at the right place and the right time.
Mallory graduated from UW-Green Bay and is a registered nurse with background in long term care and nursing administration. She lives in the Fox Valley with her husband and three children. She enjoys reading and spending time watching her kids sporting events
Enam Noor has15+ years of analytics and digital marketing experience to include customer acquisition, retention, and win-back. Proven solutions for Kaiser Permanente, La Quinta, Dickies, Johns Hopkins Healthcare, Magellan, Highmark, Masterbrand, Target, and other prominent industry leading brands. Successfully architected several multi-million dollar campaign automation to improve ROI. Gartner CRM Excellence Award Winning Member Engagement Campaign. Multi year customer engagement automation resulted in $300M+ gained revenue for a Healthcare Client.
Dwight Pattison is a Consultant at Healthmine with over twenty years of healthcare industry experience focused on healthcare quality management, performance improvement, data analytics, and reporting.
Fueled by a strong background in Medicare and Medicaid reporting and regulatory compliance, Dwight has directly led MCOs in achieving significant performance improvement results across numerous markets and product lines. He has consulted dozens of plans on improving their HEDIS® and Star Ratings programs. He has also served as the National Director of HEDIS for a leading organization where he was responsible for HEDIS and CAHPS© performance reporting and analytics, as well as supporting 18 health plans’ Medicaid and special needs plans quality reporting requirements.
Prior to his role as a Consultant, Dwight held numerous positions as a Director of Quality Improvement for multiple markets in the managed care industry. In these roles, he implemented member and provider outreach programs focused on targeting vulnerable populations and providing member engagement tools.
As an integral part of the Healthmine Consulting and Professional Services team, Dwight provides strategic guidance on process improvements for managed care organizations, provider groups, and ancillary services organizations. He continually uses his expertise in reporting, data capture, and analytics to evaluate programs, develop teams, and improve performance in Star Ratings, HEDIS, CAHPS and HOS surveys, and NCQA accreditations. Dwight also routinely performs mock readiness audits of Special Needs Plan Model of Care (SNP-MOC) and Coordinated Care Quality Improvement Program Effectiveness (CCQIPE).
Cynthia Pawley-Martin is a Senior Consultant at Healthmine. She brings a wealth of expertise from her long-tenured career as a healthcare quality improvement professional, where she has provided expertise to health plans and provider practices in a wide range of areas including Quality Improvement, the Centers for Medicare & Medicaid Services Quality Bonus Programs, Star Ratings, Quality Rating System (QRS), and Patient Centered Medical Home (PCMH). Cynthia is a Registered Nurse (RN) certified in Healthcare Quality with more than twenty years of experience in the healthcare industry. Her areas of expertise include CMS regulatory requirements (Quality/Star Ratings/Physician Quality Reporting System (PQRS), HEDIS®, CAHPS, HOS, Models of Care (MOCs), and providing support for Patient-Centered Medical Home (PCMH) and PQRS.
Cynthia has consulted with dozens of Medicare Advantage plans on their Star Ratings programs and comes with a solid record of success leading and supporting Quality Improvement programs across healthcare delivery systems, including health plans and large physician practices. Her leadership skills allow her to effectively communicate across all organizational levels and enables those teams to reach consensus among diverse stakeholders to deliver better services for the healthcare clients.
Cynthia has not only guided plans in CMS quality program assessment, implementation, organizational design, and MOC development, she has also supported provider groups in obtaining and maintaining PCMH recognition.
Prior to her consultant roles, Cynthia served as Director of Star Ratings for a leading organization and has held numerous positions in Quality and managing HEDIS® for multiple products in the managed care arena.
Patricia Powers, PharmD, BCPS
Patricia Powers, PharmD, BCPS is a director of Clinical Services at Mosaic Pharmacy Service. She is responsible for the development and delivery of clinical services
for medically complex patients. Prior to Mosaic, Dr. Powers worked for Kaiser Permanente, Mid-Atlantic Region to provide clinical pharmacy services striving to provide
high quality population-based care while maintaining affordability. She has experience in health informatics, drug utilization and formulary management, development of
clinical pharmacy services, and direct patient care.
Dr. Powers holds a Doctor of Pharmacy and Bachelor of Science from the Ohio State University. She completed a residency in Ambulatory Care/Community Pharmacy with the Medical College of Virginia (VCU)/Richmond Apothecaries. She is a Board‐Certified Pharmacotherapy Specialist (BCPS).
Konark is healthcare executive with 15 plus years of experience in healthcare strategy, creating clinical, member centric solutions which helps organizations to increase revenue, decrease costs and improving operational effectiveness by addressing people, processes and technology across every aspect of the healthcare payer lifecycle.
Currently as a Director of Product Strategy and Development within Gateway Healthplan he focuses on strategizing, designing and implementing innovative and transformative programs that support Gateway’s members throughout their journey to self reliance while positioning Gateway to be at forefront in the industry. He and his team contributes to support growth, value based payments, clinical and quality (HEDIS, Stars) programs and outcomes.
A former retail pharmacist, Dr. Michael Rea founded Rx Savings Solutions in 2008 after routinely witnessing consumers struggle to pay for medications. His research on behalf of patients uncovered ways to find equivalent therapies at lower costs, which became the foundation of the company’s, groundbreaking technology. Throughout his career, Michael has studied the pharmacy industry and its pricing practices at all levels of the supply chain. His time with a large pharmacy benefit manager provided invaluable experience and insight for developing Rx Savings Solutions’ patented transparency solution. A graduate of the Creighton University School of Pharmacy, he is a sought-after speaker and thought leader on pharmacy, healthcare and entrepreneurship.
Lisette is Decision Point’s Director of Client Analytics and is responsible for overseeing the design, development, and delivery of data-driven solutions based on the unique needs of Decision Point’s customers. Lisette brings her training in health informatics and her experience in healthcare quality, self-reported outcomes, care management, and clinical operations from the provider and payer settings to understand healthcare organizations' needs and deliver actionable recommendations.
Melissa Smith is the Executive Vice President of Consulting and Professional Services at Healthmine, bringing over 25 years of experience in Star Ratings, strategy, sales, and marketing for health plans, providers, pharmacy benefit managers, and industry vendors. Melissa has extensive experience developing strategic and tactical solutions to meet client needs and 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.
Most recently, Melissa was Senior Vice President of Sales, Marketing, Strategy and Stars at Gorman Health Group. She is a well-known thought leader and healthcare strategist with proven success developing enterprise-wide solutions to improve Star Ratings, quality performance, health outcomes, and the member experience. Melissa’s team helps clients improve performance within quality ratings systems, evaluate market dynamics and opportunities, optimize distribution channels, and support our clients’ strategic planning needs.
Prior to Gorman Health Group, Melissa served in a leadership capacity at Cigna-HealthSpring. Before working in Medicare Advantage and 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 unique access to healthcare strategy, quality performance, revenue optimization, and more.
Kimberly Swanson leads 5 Star and top-ranked quality programs at Network Health. She is accountable for the performance the Quality Health Integration (QHI), Member Wellness, Disease Management, Credentialing and Population Health Support Services Departments. Kimberly develops innovative member and provider interventions and population health programs that support the success of Network Health’s quality programs, MLR initiatives, and value-based care initiatives. Kimberly is responsible for the integration of quality, performance improvement and member satisfaction initiatives across Health Plan operations. Kimberly works with Network Health’s senior leadership on clinical integration operations and value-based care initiatives with provider systems to drive performance improvement that will have a positive impact for internal and external customers.
Prior to joining Network Health, Kimberly served in several positions with Valence Health in Chicago, Illinois, most recently as Manager of Consulting Services. Kimberly also worked with APS Healthcare and the New York City Department of Health and Mental Hygiene. She has more than a decade of experience in the health care and health insurance industries.
Kimberly is a graduate of Vanderbilt University and holds a Master of Public Administration from the Robert F. Wagner School of Public Service at New York University.
Mohammed is a technology industry veteran with extensive experience in delivering innovative technology solutions. He has driven more than 50 different applications and product development initiatives with 45,000+ hours of solution design and technical oversight. Under his leadership, Simplify Healthcare established itself as a market leader in its space.