2021 Speakers

The Health Plan

Cindy Aguglia

Medicare STARS & Quality Manager
Decision Point Healthcare Solutions

Saeed Aminzadeh

Chief Executive Officer
SelectHealth

Kim Barrus, MSN, BSCIS, RN, PMP

Director, Clinical Outcomes Management
Priority Health

Samantha Bartholomew

Stars Program Specialist
Oscar

Laura A. Breisch

VP of Value Capture
Blue Shield of California

Amanda Calvert

Medicare Clinical Program Manager
Icario

Kurt Cegielski

SVP, Client Success
Kaiser Permanente Northern California

Lynn Deguzman, Pharm.D., BCGP

Regional Clinical Operations Manager
Clover Health

Julianne Eckert RN BSN, CCM, CMCN, ACMP

Director of Quality Improvement
Capital District Physicians’ Health Plan

Michael Farina

Director Health Care Quality
BlueCross BlueShield of South Carolina

Lindsey Giglio

Program Manager
Oscar Health

Bryan Jones, MBA

Director of STARs
Clover Health

Shaila Kapur

Consultant
Health Alliance Medical Plans

Haley Kesler

Star Rating Manager
Cigna

CHRISTINE LEO

Vice President, Senior Products
Florida Blue

Dena Miller, RN MSN

VP Medicare Stars and Risk
Network Health

Mallory Mueller

Director Quality Health Integration
Gateway Health Plan

Konark Rana

Sr. Director – Strategy and Innovation
HealthMine

Melissa Smith

Executive Vice President, Consulting and Professional Services
Speakers Biographies


Cindy Aguglia

Medicare STARS & Quality Manager
The Health Plan

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.

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.

Kim Barrus, MSN, BSCIS, RN, PMP

Director, Clinical Outcomes Management
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 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.

Samantha Bartholomew

Stars Program Specialist
Priority Health

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.

Laura A. Breisch

VP of Value Capture
Oscar

Laura A. Breisch, MBA is the Vice President of Value Capture of Oscar Health, where she is responsible for performance improvement initiatives around Risk Adjustment, HEDIS and STARs for both Medicare Advantage and the Affordable Care Acts product lines. Laura joined Oscar in 2019 after spending 15 years at Health First Health Plans in Melbourne Florida, where she was responsible for regulatory operations, risk adjustment, HEDIS, STARs, NCQA and member engagement. During her career, the insurance industry went through numerous regulatory changes such as the Medicare Modernization Act and the Affordable Care Act where Laura was instrumental in implementing the Part D program, along with Exchange product lines. She also founded the Risk Adjustment program at Health First along while educating the industry on the importance of combining Risk Adjustment and HEDIS operations to better streamline processes and increase provider engagement.

Laura also worked for Blue Cross and Blue Shield of IL and Aon, where she worked in claims and underwriting. She has a Master of Business Administration degree from Florida Institute of Technology and earned her undergraduate degree in marketing and accounting from Marquette University. Laura also holds a Professional Academy for Health Care Management (PAHM) designation.

Amanda Calvert

Medicare Clinical Program Manager
Blue Shield of California

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.

Kurt Cegielski

SVP, Client Success
Icario

As SVP of Client Success at Icario, Kurt brings more than 20 years of experience in key leadership roles within the healthcare industry. Prior to joining Icario, Kurt was a Founder and member of the senior leadership team at RedBrick Health, an innovative start-up and high growth company in the well-being space. At RedBrick Health, Kurt led both the sales and the client success teams to help propel growth for the organization. Throughout his career, Kurt has helped clients articulate and realize success across many aspects of the healthcare space.

Lynn Deguzman, Pharm.D., BCGP

Regional Clinical Operations Manager
Kaiser Permanente Northern California

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

Director of Quality Improvement
Clover Health

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 healthcare.

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.

Michael Farina

Director Health Care 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.

Lindsey Giglio

Program Manager
BlueCross BlueShield of South Carolina

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.

Bryan Jones, MBA

Director of STARs
Oscar Health

Bryan Jones, MBA is the Director of STARs at Oscar Health, responsible for the performance and improvement of STAR ratings for both Medicare Advantage and Affordable Care Act lines of business. He joined Oscar Health in April of 2021 and spent the previous 5 years at Health First Health Plans in Melbourne, Florida. During his time at Health First Health Plans, Bryan was responsible for STARs and Accreditation for all lines of business, as well as member communications, experience, and servicing. He also founded a strategic member outreach department to positively affect member experience, STARS, and Risk Adjustment.

Previously, Bryan spent several years in the telecommunications industry, working at multiple major national companies, gaining experience in customer experience, contact center and operations management, project management, data analytics, and financial planning and analysis. He holds a Master of Business Administration degree from the University of Mount Olive in North Carolina.

Shaila Kapur

Consultant
Clover Health

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

Star Rating Manager
Health Alliance Medical Plans

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.

CHRISTINE LEO

Vice President, Senior Products
Cigna

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.

Dena Miller, RN MSN

VP Medicare Stars and Risk
Florida Blue

Mallory Mueller

Director Quality Health Integration
Network Health

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

Konark Rana

Sr. Director – Strategy and Innovation
Gateway Health Plan

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.

Melissa Smith

Executive Vice President, Consulting and Professional Services
HealthMine

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.