10^th Annual Medicare Star Ratings & Quality Improvement Summit

Jennifer Callahan

Chief Operating Officer

ATRIO Health Plans

Jen Callahan is the Chief Operating Officer of ATRIO Health Plans. For the past 19 years, Jen has established herself as a trusted thought leader and helped shape the managed care industry with her innovative ideas and expertise. Jen has dedicated her career almost exclusively to managed care and is an industry leading expert in all areas of Medicare Advantage and Medicare Supplement programs.

Prior to joining ATRIO, she co-founded a field management organization, Keen Insurance Services, Inc. to create a provider-centric Medicare focused sales and distribution organization from the ground up. Prior to that, she held the position of Vice President, Medicare Product at Aetna, a CVS Health company where she oversaw the product development and implementation Aetna’s entire Medicare portfolio, contributing over $24 billion to Aetna’s revenue. Throughout her career, Jen has also held various leadership positions at Healthfirst, Inc. and Anthem, Inc. focused exclusively on Government sponsored business.

Jen received her Bachelor of Science degree from Fordham University and MBA from North Carolina State University. Jen currently resides in Waxhaw, a suburb of Charlotte, North Carolina with her husband, their three kids and fur baby, Vivi. Jen loves spending time with her family and friends and hosting them at their home.

Keslie Crichton

Chief Sales Officer

BeneLynk

Keslie is the Chief Sales Officer for Benelynk. In her role, she is not only responsible for new business development but also works on innovative partnerships to improve outreach strategies and health outcomes for our client’s members. At the core of BeneLynk’s services, Keslie and her team work to identify, document and solve member’s social determinant of health (SDoH) challenges by “leading with help”. This increases BeneLynk’s engagement rates across our integrated services while also providing our clients with crucial information they need to deliver care and improve their quality metrics.

Keslie has worked in managed care for over 25 years with a focus on SDoH solutions that improve members lives but also provide a return on investment for our clients. Keslie's passion lies in working on strategies that put members at the center while ensuring we deliver accurate risk-adjusted revenue, quality performance, and member retention.

Keslie holds a B.S. in Business Administration from Regis University and worked toward her MBA and Masters in Healthcare Administration at Sacred Heart University in Fairfield, CT.

Michael Farina

Vice President of Healthcare Quality

Capital District Physicians’ Health Plan

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.

Brendan Generelli

Lead Program Manager for Stars and Quality

Blue Cross Blue Shield of Rhode Island

Brendan Generelli is the Senior Program Manager for Stars and Quality at Blue Cross Blue Shield of Rhode Island. In his 11 years at BCBSRI, Brendan has had a variety of roles ranging from Customer Service to Operations to Strategy, but has always maintained focus on member and provider experience. Under his management of the 5 Star program, BCBSRI became the first and only plan available to all Rhode Islanders to achieve a 5 Star rating and now has repeated that rating in back to back years.

Kena Hahn, MHA

Director, Medicare Stars & Outpatient Care Coordination

Health Alliance

Kena Hahn is the Director of Medicare Stars and Outpatient Care Coordination for Health Alliance, a vertically integrated health system with Carle that provides coverage to Illinois, Indiana, Iowa, and parts of Washington state. She has 6 years of experience in star ratings including value based contracting, supplemental benefits design, vendor management and collaborates with other population health teams to drive improvement. Prior to working in the health plan industry, Kena served in a variety of roles in ambulatory operations with a focus on process improvement and overall patient experience. She brings over 19 years of experience in the healthcare field with a focus on Star ratings, patient/member experience and process improvement.

In her current role, Kena has responsibility for creating and implementing an overall strategy to improve Star Ratings for Health Alliance’s Medicare Advantage products as well as oversight for all Outpatient Care Coordination teams and the population health digital strategy at the health 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 key vendors, the entire health plan organization and provider partners to reach and sustain a five star rating for our Medicare Advantage products.

Jenna Horner

Director of Medicare Advantage Product Strategy

Cigna

Priyanka Jain

Vice President, Medicare Quality & Member Experience

Point32Health

Priyanka Jain leads the Medicare Star Quality and Member Experience program for Point32Health in Massachusetts (a not-for-profit formed from the combination of Tufts Health Plan and Harvard Pilgrim HealthCare). Tufts Medicare Preferred is the only HMO plan in Massachusetts, only plan in New England, that has earned 5 Stars 8 years in a row.

With more than 20+ years of healthcare experience, she started her journey as a dentist in India, received a Master’s in Health Education from Texas Woman’s University and a Master’s in Public Health with a concentration in Health Care Management and Policy from the Harvard School of Public Health.

Her background has served her well in building a bridge between the clinical and business world in her roles in Clinical Operations, Provider Performance, and Care Coordination at Partner’s Health Care and Beth Israel Lahey, large healthcare systems in Massachusetts.

Educate, Encourage, and Empower are the principles she firmly believes and adheres to in her professional endeavors. Mobilizing people around her to strive for excellence is the mantra that has shaped her and her organization’s remarkable 5 Star success.

She is mom to a 10 year old boy and lives with her family in Sharon, Massachusetts. In her spare time, she loves to learn languages, Mandarin is next on her list.

Leon W. Lead, AVP

Medicare Stars & Quality Improvement

Molina Healthcare

Leon Lead is an enthusiastic leader who is grateful for the opportunity to serve others. Leon is committed to improving access to care for our most vulnerable populations. Leon’s passion for improving access to care was molded by his mother and wife having different health outcomes due the zip codes in which they live. Leon serves as AVP of Stars & Quality Improvement for Molina Healthcare.

Leon has held numerous roles in the past 20 years ranging from an individual contributor to multiple leadership positions in both the private and public sectors of healthcare, behavioral health, child welfare, juvenile justice, and education.

Leon is a self-proclaimed “people helper” who lives in Arizona with his wife, two sons and two dogs.

Sara Lords

Medicare Stars Program Manager

Blue Cross of Idaho

Sara Lords is the Program Manager for Medicare Stars at Blue Cross of Idaho. She is responsible for the overall strategic vision, direction, and performance management for the organization. With over 10 years of healthcare experience, Sara also has her undergraduate degree in psychology from Boise State University and a Masters in Healthcare Administration and Management from Colorado State University.

Nate Lucena

Chief Strategy & Analytics Officer

Rex Wallace Consulting

Nate has Master’s degrees in Experimental Psychology and Cognitive Neuroscience/Aging from the College of William & Mary and Washington University in St. Louis where his research was funded by the American Psychological Association, the National Science Foundation, and the National Institute of Aging. He began his career with over a decade in academic research, specializing in the neural bases of schizophrenia, brain aging, Alzheimer’s Disease and human cognition. Nate has been published in the Journal of Clinical and Experimental Neuropsychology and Frontiers in Integrative Neuroscience.
Nate is currently the Chief Strategy & Analytics Officer for Rex Wallace Consulting, where he specializes in developing and executing data-driven and health equity-focused strategies to improve outcomes and reduce health disparities in government healthcare programs. He is an industry expert on health equity, health disparities, and inclusivity in government healthcare programs. He has served on the Health Equity Technical Expert Panel for the Pharmacy Quality Alliance, and at numerous speaking engagements at industry conferences across the country that focus on the complex intersections of race, sex, gender, and sexual orientation that impact access to safe, high-quality healthcare.
Prior to his current role, Nate held executive analytics and strategy roles at Centene Corporation, a Fortune 25 company headquartered in St. Louis. His executive roles included leadership over Enterprise Quality Analytics and Data Science, Chief of Staff and Vice President of Enterprise Quality Performance Improvement Strategy, and Quality Improvement Business Development for Medicare, Medicaid, and Marketplace lines of business delivering care to 1 in 15 Americans across all 50 states.

Shelly McCombs, MPH

Sr. Manager Quality Improvement Operations and Accreditation

Health New England

Shelly McCombs is the Sr. Manager, Quality Improvement Operations and Accreditation at Health New England. She joined the organization in 2017, under her leadership, the plan has achieved numerous milestones, including attaining and maintaining key accreditations and certifications. Shelly has served as the co-chair of the New England HEDIS Coalition in partnership with PressGaney from 2022-2023. In 2022, Shelly led Health New England’s journey to achieve NCQA Health Equity Accreditation. The plan achieved full NCQA Health Equity Accreditation, a 2024 Medicaid requirement, one year early and across all lines of business, just the second plan nationally to achieve that milestone.

She currently chairs the HNE Health Equity Committee and Medicaid BeHealthy Partnership Health Equity Committee. In addition to Health Equity Accreditation, Shelly and her team are proactively driving assessment and improvement as it relates to Medicare Stars upcoming Health Equity Index. Health New England is committed to the importance of Diversity, Equity, Inclusion and Belonging at the core of all values, processes, policies and programs, and Shelly serves as a charter member of the DEIB committee, contributing to company wide DEIB education and leadership programs.

Jenna Pinnelle

Medicare Program Manager, Maine

Elevance Health

Jenna Pinnelle is the Medicare Program Manager for the state of Maine at Elevance Health. In her current role she manages and coordinates the development of provider programs related to Stars, HEDIS , Risk Adjustment and CAHPS. She has been involved in healthcare quality improvement for over 10 years and has a passion for elevating patient outcomes and experience throughout the healthcare continuum. In her free time she enjoys exploring the outdoors through surfing, hiking, and snowshoeing.

Caroline Paes Leme Pires

Care Consultant Sr.- Medicare Quality, East Region

Elevance Health

Caroline Pires is an experienced Care Consultant in NY with a comprehensive background in Population Health and Change Management in healthcare. In my current role I have proven ability to implement value-based quality programs, strategize based on market trends, and collaborate with various stakeholders for effective resource allocation to support quality and cost improvement. She leverage her strong skills in data analysis to provide targeted solutions for HEDIS stars and CAHPS enhancement. In her free time she loves to play and dance with her daughter, read and try diferent cusines.

Mary A. Goble, MSN, RN

Director of Clinical Quality

Capital Health Plan

Kim Shell

Principal

Freedom Healthcare Consulting

An expert in multiple aspects of CMS star ratings and quality, Kim is a strategic minded healthcare executive, committed to creativity and innovation in every aspect of health care.

Kim has almost 30 years of extensive experience focused on quality management stars, accreditation and process improvement, inclusive of Six Sigma projects in the national health plan industry. Working for several of the largest US health plans for extended periods, she has designed and implemented roadmaps and tactical strategies designed to improve performance, increase member engagement and yield greater returns. Her experience includes working in local, regional, and national leadership roles and experience with Medicaid, Medicare and Commercial lines of business.

She has led efforts not only with health plans but also with other partners such as providers assisting in strategic design to maximize the efficiencies between payor and providers. Additionally, she has direct experience in 14 states/markets overseeing all aspects of quality, HEDIS/CAHPS/HOS as well as Risk Adjustment.

Kim has excelled in developing strategies to achieve outcomes on multiple aspects of quality, operations and network areas. Her outcomes have included being the recipient of the 5 Star Award for being the first plan in a national MCO to achieve the coveted 5-star rating, receiving the Executive Development Program nomination and incremental increases in the number of plans achieving their star goal from 42% to 67% within 2 years in another national Medicare plan.

Melissa Smith

Founder and Senior Advisor

Newton Smith Group

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

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

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

Jessica Thomas

Director of Quality

Independent Health

Rex Wallace

Principal & Founder,

Rex Wallace Consulting, LLC

Rex is a Quality Improvement expert who helps health plans achieve higher quality, operational excellence, and more meaningful engagement with all stakeholders. Prior to founding RWC, Rex was a health plan leader accountable for Star Ratings, Medicare operations, and the member experience for a multi-state, 100,000+ member plan. He led the turnaround of all nine contracts from 3.5 Stars to either 4 or 4.5 Stars through enhanced data-enabled engagement with the organization, its members, and its providers. Rex has 30 years of industry experience leading functions such as member retention, market analysis, customer service, and operational improvement.

Dan Weaver

Senior Vice President, Stars & Quality,

Zing Health

Daniel Weaver recently joined Zing Health, a tech-forward health plan based in Chicago, as the Senior Vice President of Stars and Quality. With over 25 years of experience in Operations and Star Ratings strategy, Daniel has previously served as VP, Government Quality Programs at Highmark Wholecare (formerly Gateway Health Plan) and Director of Stars Programs at Highmark Health, helping both organizations achieve and maintain their first 4.5 Star Ratings. In his career, Dan has overseen the development and implementation of many analytics-driven and beneficiary-focused programs, has adopted continuous improvement and operational excellence philosophies for sustained success, and embraces innovation focused on overcoming socioeconomic barriers to achieving health equity and optimal quality outcomes. In his new role with Zing Health, Daniel will focus on implementing a high-performing Stars infrastructure to support the organization’s rapid growth with a focus on servicing special needs members in several states.