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2017 SPEAKERS
SPEAKERBIOGRAPHIES
Saeed Aminzadeh, Chief Executive Officer, 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.

Medicare Star Ratings
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.

Medicare Star Ratings
Suzanne (Sue) Brown, RN, MS, MPA, Vice President for Medicare Stars and Quality Improvement, WellMed

Suzanne (Sue) Brown, RN, MS, MPA has joined WellMed as Vice President for Medicare Stars and Quality Improvement. She was formerly Quality Lead at Anthem’s Amerigroup Iowa where she helped stand up a de novo health plan with almost 200,000 members its first day of operations. Her responsibilities comprised of NCQA Accreditation including HEDIS and CAHPS, Grievance and Appeals, Quality of Care, Critical Incidents, quality-related member and provider outreach and interventions for members in traditional Medicaid, waiver programs, Long Term Services and Supports, Integrated Health Homes and Dual Eligibles. Before joining Anthem, Sue was the Director of the Medicare Stars Quality Improvement Program at Excellus Health Plan in Rochester, New York. Over the years, Sue has managed programs, people and projects in health plans (Medicare and Medicaid Managed Care, quality improvement, care management, software implementation and medical policy implementation), Home Health and Hospice (responsible for compliance, quality and education), academic research (psychosocial research and clinical trials), and hospitals (cross-continuum critical pathway implementation). In addition to Bachelor and Masters Degrees in nursing, Sue has a Master's in Public Administration, is a certified Project Management Professional (PMP) and a Lean Six Sigma Black Belt.

Medicare Star Ratings
Puneet Budhiraja ASA MAAA, Medicare / Chief Actuary, Capital District Physicians' Health Plan, Inc.

Puneet has been working in healthcare industry as an actuary for last 9 years. He has experience working for both the consulting and insurance side of the business. Puneet is currently working as Medicare / Chief Actuary for CDPHP (Capital District Physicians' Health Plan) as the lead actuary for Medicare and Medicaid business. Puneet has worked on wide variety of projects including pricing, reserving, product development, market surveys, and predictive modeling.

Puneet holds an Electrical Engineering degree and went to New Mexico State University to do his masters in Electrical engineering. In NMSU he became aware of Actuarial profession and decided to be an actuary

Medicare Star Ratings
Michelle Coberly, Manager, Medicare Compliance & Quality, Priority Health

Medicare Star Ratings
Robert Gofourth, Vice President Operational Strategy and Performance, BlueCross BlueShield of North Carolina

Robert has more than 25 years of operations and risk management experience across a variety of industries including insurance, mortgage banking, government enterprise, and outsourcing. In 2014, Robert accepted the position of Vice President of Operational Strategy and Performance at BlueCross BlueShield of North Carolina, Robert is responsible for the divisional Strategy, Innovation, Quality, Compliance, Analytics, and Process Improvement programs.

Robert has been a certified Six Sigma Master Black Belt since 1999. After earning his M.B.A., he applied a combination of process improvement and operational knowledge to drive quality, reduce cost and improve efficiency to the benefit of several companies. Prior to joining BCBSNC, he was with Citizens Property Insurance Corporation, a government entity acting as the insurer of last resort for the State of Florida. Robert first held the position of Vice President of Operations, improving performance levels which could compete with private enterprise. His final position at Citizens was Vice President of Enterprise Risk Management. As the corporate officer in charge of risk, he utilized his knowledge of process improvement and operations to develop and deploy the company’s risk program which ultimately helped the company in achieving its mission and strategic goals.

The ultimate vision Robert has for operations as a whole is to utilize predictive and prescriptive analytics in conjunction with performance data coupled with Key Risk Indicators. By applying this model, operations can move to the next level through a predictive approach and deliver unsurpassed value to the Enterprise.

When not working, he enjoys traveling and volunteering. Kidznotes is an organization that is near and dear to his heart. This passion is derived from seeing children, families and community develop and evolve. Robert completed his first book in 2016 becoming a best-selling author in 2017.

Medicare Star Ratings
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

Medicare Star Ratings
David L. Larsen RN, MHA, Director, Quality Improvement, SelectHealth

David L. Larsen has been the Director of Quality Improvement for SelectHealth in Salt Lake City, Utah for the past 25 years and has worked for Intermountain Healthcare for 32 years. SelectHealth is a mixed model HMO with more than 650,000 commercial, 90,000 Medicaid, 35,000 Medicare advantage and 10,000 CHIP members in Utah and Idaho. Intermountain Healthcare is an integrated health care delivery system with 23 hospitals and over 1500 employed physicians.

As the Director of Quality Improvement, David has responsibilities for oversight of the Medicare Advantage Stars program for which SelectHealth received a 4.5 Star rating in 2015; maintaining NCQA accreditation, SelectHealth is currently accredited with a Commendable rating; as well as, HEDIS performance measurement, public reporting (transparency) and disease management. David was a past co-chair of America's Health Insurance Plans Subcommittee on Accreditation and Industry Standards.

David has also been responsible for the oversight and development of chronic disease registries, performance measurement and web based reporting systems, quality improvement pay for performance incentives for physicians, and direct patient improvement interventions related to chronic illnesses including patient adherence monitoring, reminders and incentive programs.

David led initiatives that were successful in applying for and receiving the 2001 American Association of Health Plans National Exemplary Practice Program Award for Diabetes, the 2002 George W. Merck Quality Award for cholesterol management, the 2002 American Association of Health Plans Innovations in Immunizations Award and the 2003 Best Provider Engagement Initiative Award from the Disease Management Association of America.

Medicare Star Ratings
Jordan Mauer, Executive Vice President of Marketing and Engagement, NovuHealth

Jordan is Executive Vice President of Marketing & Operations at Novu. In this role, he develops and leads the company's marketing and brand initiatives, as well as the end-to-end management of member-facing operations. With more than 15 years of senior marketing leadership experience, Jordan brings a passion for analytics, loyalty operations and engagement, as well as strategic energy to Novu.

Medicare Star Ratings
Michael Meadows, Founder, Product Strategy and Delivery, Hyperlift

Spanning a wide range of operational and marketing leadership roles, Michael has helped both high and low performing health plans, successfully driving improved and sustainable Medicare Stars results. His extensive experience both client side and as a consultant has given him a unique perspective of where challenges exist, fueling Hyperlift’s product strategy and selection of premier partners.

Medicare Star Ratings
Gabriel L. Medley, MHA, MBA, Vice President, Quality and Risk Revenue, Gateway Health

Gabe Medley brings over 15 years of progressive healthcare experience leading diverse multidisciplinary teams and projects in the most challenging settings to achievement. Gabe’s background includes a combination of healthcare, business, and data analytic leadership roles and is currently serving as the Vice President of Quality and Risk Revenue for Gateway HealthSM headquartered in Pittsburgh, PA. He is the executive owner and department head for all quality improvement and risk adjustment related activities covering the Medicare and Medicaid populations in six states. Prior to Gateway, Gabe’s previous professional experience includes Sr. Director of Quality and Risk Revenue (Gateway Health), Director of Risk Revenue, Manager of Risk Adjustment Program (Horizon Blue Cross Blue Shield of NJ), Manager of Healthcare Data Analytics (Inovalon Inc.), Senior Manager of Patient Access (Military Health System, National Capital Region), and Captain (Medical Service Corps, U.S. Army). Gabe’s education includes the following: Master of Science in Healthcare Administration (MHA) and a Master of Business Administration (MBA) from the University of Maryland University College in Adelphi, Maryland; Bachelor of Science in Psychology with a minor in Military Science from Grambling State University in Grambling, Louisiana

Medicare Star Ratings
Rajesh Munjuluri ASA MAAA, Medicare Actuary, Capital District Physicians' Health Plan, Inc.

Raj is a Member of the American Academy of Actuaries with over 12 years of health actuarial experience working with insurers as well as with consulting firms. During the course of his actuarial career, he has consulted with insurers on Medicare bid development and on risk adjustment. Additionally, he has consulted with providers in the development of risk sharing arrangements, alternative payment design and evaluation of bundled payment contracts.

Raj has an MBA from New Mexico State University and a Bachelor of Science in Mechanical Engineering from Bangalore University, India.

Medicare Star Ratings
Luis Cerda Polanco, Medicare Stars Program Director, MCS Healthcare Holdings LLC

Luis has been working at MCS Healthcare in San Juan, Puerto Rico for the past 6 years. During this time he had experience as a Business Analyst and as a PDE Specialist in the Pharmacy department, and then as the Medicare Stars Program Manager. Luis has been the Medicare Stars Program Director for the past two years, and he is currently in charge of developing and implementing strategies to help achieve the company’s goals for the Stars Ratings Program. MCS Healthcare is one of the five main Medicare Advantage healthcare plans in Puerto Rico and currently has the second largest membership in this sector with a 35% of market share. Since Luis joined the Medicare Stars Program, MCS Healthcare improved its overall Stars performance from 3.0 to 4.0 stars. For Stars 2017, MCS Healthcare achieved 4.0 stars overall and a 4.5 stars result for the HEDIS measures, the highest in Puerto Rico so far. His focus has been primarily on shifting the company’s orientation towards a Stars-driven path, working closely with primary care providers, understanding members’ needs, and developing a strong analytical foundation for strategies. Luis graduated from the University of Puerto Rico with a Master’s degree in Economics. His research interests are mostly investments and health economics. Previous work experience include working as an investment analyst for a private firm where he focused on the healthcare and technology sectors.

Medicare Star Ratings
Allyson Y. Schwartz, former member of the U.S. House of Representatives, President & CEO, Better Medicare Alliance

Allyson Y. Schwartz, a former member of the U.S. House of Representatives from Pennsylvania who served from 2005-2015, is a nationally recognized leader on health care issues. Throughout her professional life she has worked on issues such as affordability, prevention, primary care, coordinated care, and increased access to coverage.

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 powerful Ways and Means committee in her second term, and served as a senior member of the Budget Committee. In both capacities, Schwartz was a strong advocate for Medicare. She was the leader in Congress on physician payment reform to encourage value over volume, supported research, innovation, and use of technology to improve quality, efficiency, and contain costs.

Schwartz was instrumental in the passage of landmark health reform legislation, authoring key provisions such as the ban on pre-existing condition exclusions for children and increased access to primary care.

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, Senior Fellow for Health Policy at the Center for American Progress, and Co-Chair of the Bipartisan Policy Center Health and Housing Task Force.

Schwartz earned a B.A. from Simmons College, and a Master of Social Service (MSS) from Bryn Mawr College. She is married, has two grown sons, a daughter-in-law, and a 2 ½-year-old granddaughter.

Medicare Star Ratings
Melissa Smith, Vice President, Star Ratings, Gorman Health Group

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

Medicare Star Ratings
Mindy D. Smith, BSPharm, R.Ph., Vice President of Pharmacy Practice Innovation, PrescribeWellness

Smith joined PrescribeWellness as the Vice President of Pharmacy Practice Innovation in August 2015 where she works to drive the adaption of pharmacist patient care services. PrescribeWellness offers innovative technological solutions designed to make it easier for pharmacists to manage patient care services by improving patient adherence, building customer loyalty and providing extended services via the appointment-based model. PrescribeWellness solutions have been proven to improve a patient’s adherence to their medication and the pharmacy’s ratings in various performance measures.

Prior to joining PrescribeWellness in August 2015, Mindy Smith served as the Executive Director of the American Pharmacists Association Foundation from 2011 to 2015. Smith was appointed as chief executive officer of the Arizona Pharmacy Alliance in 2006 and served in that role for five years. Previous to her service in Arizona, Smith served as the executive director of the Wyoming Pharmacy Association from 2003-2006.

The first seven years of her career, Smith practiced in community pharmacy settings as well as spend six years practicing in health systems where she was awarded the Health-System Clinical Pharmacist of the Year in 2001 for helping establish an anticoagulation patient care service through collaborative practice. She holds two clinical certificates in diabetes and anticoagulation, and was ACLS (Advanced Cardiac Life Support) certified during her tenure at the hospital. She also holds a certificate in Professional Fundraising from Boston University’s Center for Professional Education.

Mindy Smith earned both a Bachelor of Science in Zoology-Physiology from the University of Wyoming in 1995 and a Bachelor of Science in Pharmacy in 1998 from the University of Wyoming School of Pharmacy. Smith serves on the National Alliance of State Pharmacy Associations (NASPA) associate board and the Alliance for Patient Medication Safety. Smith also serves on the board the Alliance for Integrated Medication Management.

Medicare Star Ratings
Donna Sutton, Healthcare Informatics, Director of Medicare Star Quality Programs, SCAN Health Plan

Donna Sutton, Healthcare Informatics, Director of Medicare Star Quality Programs at SCAN Health Plan Donna received her MBA from the University of Southern California (USC) and is a Certified Master Black Belt in Six Sigma. She has over 14 years of experience managing and conducting process improvement projects. Her most recent experience prior to SCAN includes various process improvement roles at OptumInsight and OptumRx. Her responsibilities at SCAN include managing the deployment of and providing oversight over SCAN’s 5 Star programs and interventions.

Medicare Star Ratings
Daniel Weaver, Director of Programs, Government Quality, 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

Medicare Star Ratings
John Mark Willis, M.Ed., Senior Director-Star Operations, Cigna-HealthSpring

John has worked in managed care for over 18years 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 Senior Director 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.

Medicare Star Ratings
Deb Zeh, Director of Quality Provider Performance, UPMC Health Plan, Pittsburgh, Pennsylvania

Deb Zeh is the Director of Quality Provider Performance at the UPMC Health Plan in Pittsburgh, Pennsylvania. Deb has over 16 year’s experience in the health care insurance industry accompanied by her many years of clinical nursing experience. Her insurance experience includes quality improvement, quality auditing, fraud and abuse investigations, clinical account management, provider relations with a lead role in supporting the Physician Network in the Regional Extension Center Initiative and extensive experience in all aspects of HEDIS operations. Her current role consists of supporting the network providers and hospitals in developing and implementing quality initiatives to support the Physician Pay for Performance Quality Programs. A key role is providing education to the Provider Network surrounding Quality Initiatives which are inclusive of the CMS STARS and HEDIS measures.

Medicare Star Ratings
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