Rich Appel has been with Cigna for over 23 years. He has held roles within eligibility, IT, Special Investigations and Compliance through his career. Rich is currently a Project Manager at Cigna supporting cross functional initiatives within the Senior Segment.
Jeff Baker is a Senior Consultant with BluePeak Advisors and has been actively engaged in the Medicare Part D industry since 2007. Jeff has over 15 years of management experience and his expertise includes a comprehensive insight into the Medicare Part D claim adjudication environment, Medicare payment methodologies, and a solid aptitude to interpret and articulate new and existing Medicare guidance.
Jeff has a proven track record of leading operational and technical teams to achieve defined goals within the complex Medicare environment. Jeff has an extensive background in managing and analyzing large data sets and has developed solutions to effectively monitor and manage Part D claim adjudication functions and Part D financials. Jeff has partnered with Part D plans in performing in-depth analysis into their claims and PDE data to identify areas of non-compliance as well as developing compliant solutions to remediate issues while optimizing plan reimbursements.
Within BluePeak Advisors, Jeff has collaborated with various health plans and Pharmacy Benefit Managers (PBMs) to test and validate several complex Medicare Part D adjudication functions including formulary administration, plan benefit, CMS subsidies, pharma discounts, and transition of care logic. Using his experience of claims processing and formulary administration, Jeff has supported numerous program audits and has conducted several validation and mock audits with his primary expertise in Part D Formulary Administration (FA).
Prior to BluePeak Advisors, Jeff worked for a large PBM where he became a program manager over several Part D programs including PDE reporting, CMS required reporting, and claim reprocessing. Jeff then set out to start a new Employer Group Waiver Plan (EGWP) where he managed several key financial and operational functions including underwriting EGWP premiums, budget management, and developing solutions to remediate any adjudication, formulary or PDE issues.
Jeff currently resides in San Diego, California and holds a Bachelor of Arts in Psychology from California State University, San Marcos.
Gail Blacklock is Director of Compliance/Compliance Officer for Inter Valley Health Plan located in Pomona, CA. Gail’s experience includes 20 plus years working in health care administration. Inter Valley Health Plan is a not-for-profit Medicare Advantage Prescription Drug Plan “only” - with 20,000 members and devoted to giving back to the communities it has served for 40 years.
Inter Valley’s approach to compliance involves dedication of the entire organization. This top-down organizational approach ensures support and accountability from each staff member and assists the Compliance Department with implementation and management of the Plan’s Compliance Program.
As Compliance Officer, Gail’s responsibilities include implementing federal and state regulations and ensuring the protection of members’ rights and access to MAPD benefits. Gail leads training programs to educate on compliance, fraud, waste and abuse, HIPAA, and Section 1557. Compliance monitors and audits the health plan and multiple delegated first tier, downstream, and related entities. Compliance, working as the Plan’s Special Investigations Unit, also investigates and resolves reported incidents of non-compliance and potential fraud, waste, and abuse within the health plan and health care system.
Ryan is a Medicare aficionado with over eleven years of experience having been employed by some of the country’s largest managed care entities. Since 2014, Ryan’s responsibilities include oversight of Part D benefit implementation, claims adjudication, the Medication Therapy Management Program, and the Opioid Over-utilization Program for a health plan with over 90,000 Medicare enrollees. Ryan background is comprised of Medicare centric roles with some of the country's largest Pharmacy Benefit Managers. As a Senior Consultant with CVS/Caremark, he managed cross-functional initiatives related post sanction remediation efforts for member communications. At Express Scripts (formerly Medco Health Solutions) Ryan operated as the point-of-contact for multiple Medicare employer group plans to ensure successful benefit administration and client satisfaction.
Babette S. Edgar, Pharm.D., MBA, FAMCP is a Principal at BluePeak Advisors (BPA). Babette has been in the managed care industry for over 25 years and advises health plans, pharmacy benefit management companies and pharmaceutical companies on Medicare and managed care strategies, operational and compliance issues. Throughout her tenure, Babette has conducted and supported numerous audits with her primary expertise in Part D Coverage Determinations, Appeals and Grievances (CDAG).
Prior to starting her own firm, Babette worked at CatalystRx, where she was President, Government Services and ran the Medicare business for the fourth largest PBM. Babette was the Director of the Division of Finance and Operations for the Medicare Drug Benefit Group at the Centers for Medicare and Medicaid (CMS), where she directed building and implementing the formulary and benefit design review processes for the Part D drug benefit. She oversaw the CMS Part D team that developed the agency’s marketing guidelines and marketing models, and conducted oversight of the marketing review process. Babette also directed CMS operations for reviewing and monitoring the licensure and solvency of Part D plan sponsors, assisted in developing transition guidance for Part D plans with patients migrating from Medicaid or other benefits; and provided input into the Part D regulations and other subregulatory guidance from a managed care pharmacy perspective.
Previous to her term at CMS, Babette was Vice President, Clinical Business Development at Caremark/AdvancePCS, where she directed sales, account management and product development for a multi-million-dollar disease management product line. She oversaw 16 premier accounts, including Blue Cross plans, managed health plans, Medicare/Medicaid, third party administrators and large and small employers. Babette previously served as Director of Clinical Services for Advance Paradigm, where she ran the P and T process, developed physician and patient education materials, performed academic detailing, and managed the clinical team responsible for developing clinical content and clinical strategy. She also performed business development for specialty services in the Theracom division.
Babette has authored many articles in peer-reviewed journals, and has been a speaker at many national meetings, conferences and symposia. She is the Immediate Past President of the Academy of Managed Care Pharmacy and is a national thought leader in topics related to managed care pharmacy, Medicare strategy and value-based pharmaceutical care.
Scott Fries Executive Vice President, Pharmacy Solutions
Scott Fries joined Pulse8 to accelerate the launch of Pulse8’s pharmacy program management solution that aims to provide customers with a clear path to better financial performance, improved operations, and portability of their pharmacy management programs through a sophisticated platform of reporting, benchmarking, and analytics. He brings the expertise and knowledge needed to position Pulse8 as the only objective partner available in the industry that can support the health plan’s evolving relationship with PBMs, pharmaceutical manufacturers, pharmacy networks, prescribers, and patients.
Scott is known as a thoughtful innovator with broad leadership skills and a strong track record of developing and managing finance, operations, and client facing teams. Scott brings 30 years of financial, operations, and government programs experience, including roles of Chief Financial Officer of a national Medicare Advantage and Medicaid managed care organization, Senior Vice President of Government Programs of a top-tier PBM serving BCBS clients, and Chief Operating Officer of the same PBM’s specialty and mail pharmacies. He also has extensive experience as an Executive Consultant, where he assisted health plans with navigating the changing landscape in the areas of risk adjustment, clinical and quality programs, and provider incentives.
Scott earned his Bachelor of Business Administration from the University of Wisconsin, Eau Claire, and his Masters of Business Administration from the University of Minnesota.
Ana Handshuh, Principal at CAT5 Strategies, is a government programs executive with expertise in creating and implementing corporate programs for the healthcare industry. Her background includes Quality, Core Measures, Care Management, Benefit Design and Bid Submission, Accreditation, Regulatory Compliance, Revenue Management, Communications, Community-based Care Management Programs and Technology Integration. Ms. Handshuh currently serves on the Board of the Resource Initiative and Society for Education (RISE), the preeminent national professional association dedicated to managed and accountable care financing and delivery. She is a sought after speaker on the national healthcare circuit in the areas of Quality, Star Ratings, Care Management, Member and Provider Engagement, and Revenue Management. Her recent consultancy roles have included assisting organizations create programs to address the unmet care management needs in the highest risk strata of membership, document their processes and procedures, achieve accreditation status, design and submit government program bids, institute corporate-wide programs and create communications strategies and materials. She possesses sophisticated business acumen with the ability to build consensus with cross-functional groups to accomplish corporate goals. Ms. Handshuh served as the Vice President of Managed Care Services at Central Florida Inpatient Medicine (CFIM). In this role, she provided leadership and strategy on CFIM projects and collaborations with physicians, risk entities, hospital health care systems, and health plans. CFIM is the largest Hospitalist group in Central Florida, with 70 providers discharging over 50,000 patients annually from multiple hospitals across two health care delivery systems and 24 skilled nursing facilities. At CFIM Ms. Handshuh previously served as the Vice President of Operations. Prior to those assignments, she worked with Precision Healthcare Systems as their Vice President of Quality Improvement. In that capacity, she led the IPA’s Quality efforts and collaborated with payers on implementing programs to move the needle on Quality and Star Rating initiatives. Ms. Handshuh also served as the Director of Corporate Program Development at Physicians United Plan. In this role, she led the Quality Management and Corporate Communications departments and spearheaded the development of innovative integrated technology solutions to drive business excellence and Star Rating achievement initiatives. For the past fifteen years Ms. Handshuh has taken an active role in redefining and implementing changes that have led to improvements and greater efficiency within Government programs and healthcare delivery. Prior to joining Physicians United Plan Ms. Handshuh was the founder of I-Six Creative. Under Ms. Handshuh’s vision and leadership, I-Six Creative provided expertise in the areas of managed Medicare benefit design, MSO/IPA operations, provider network strategy, new market launches, technology integration, corporate communications and quality improvement.
Julie Lappas advises health care clients of all types on a variety of regulatory, compliance and reimbursement matters. She focuses her practice on counseling pharmacies, pharmacy benefit managers, hospitals and provider-owned health plans on a wide range of pharmacy and managed care issues.
Prior to joining Hall Render, Julie served as legal counsel to a large, national pharmacy benefit manager. She leverages this experience to assist pharmacies, PBMs, hospitals and other health care providers in preparing and negotiating complex pharmacy, PBM, payer and drug supplier agreements, advising on pharmacy and prescription drug discount card licensure and compliance requirements and providing practical counsel on fraud and abuse and HIPAA privacy matters. Julie works closely with clients to address regulatory and compliance issues related to participation in Medicare Advantage and Medicare Part D, including requirements applicable to first tier, downstream and related entities. Julie has assisted providers and vertically integrated organizations with the development of provider-sponsored health plans and narrow networks. This work involves the preparation of necessary service and provider agreements and advising on issues related to network development, licensing and any willing provider laws.
Julie writes frequently on managed care, PBM and pharmacy matters and is an active member of the American Health Lawyers Association. She is a graduate of The George Washington University Law School and worked as a pharmaceutical sales representative for a Fortune 500 pharmaceutical manufacturer prior to beginning her legal career.
Julie Moses is a Compliance Monitoring Consultant for BlueCross BlueShield of Tennessee. In this role, Julie is an integrated resource to the Medicare Part D Pharmacy team for monitoring and CMS guidance interpretation. Julie began her career with BlueCross in 1997, and in addition to experience in Compliance as a dedicated resource for both Medicare Part D and the Affordable Care Act monitoring, she has also worked as a Senior Field Auditor for Medicare Part A Cost Report audits for providers across the nation, for Riverbend Government Benefits Administrator, the former Medicare Intermediary for the state of Tennessee. In addition, Julie spent time in the Medicaid division, BlueCare Tennessee, gaining experience in the area of Quality Management.
Julie has a Bachelor of Science in Accounting from the University of Tennessee, Chattanooga, a Masters of Business Administration from Bryan College and is Certified in Healthcare Compliance (CHC) by the Health Care Compliance Association.
Marita Nazarian received her undergraduate degree from University of California Los Angeles and her doctorate in pharmacy from University of Southern California. She has over 18 years of healthcare experience and has held Senior Manager and Director roles in Pharmacy and Compliance departments in manage care settings.
Marita is currently the Director of Delegation Oversight at L.A. Care Health Plan. L.A. Care Health Plan serves nearly 2.2 million members in Los Angeles County, making it the largest publicly operated health plan in the nation. At her current role she manages all delegation oversight audits to ensure their compliance with company policies and guidance from all applicable regulatory agencies. She manages corrective action plans, correction action plan validation and monitoring for Providers, Independent Practice Associations, Physician Provider Groups, Plan Partners, PBM and other first tier, downstream and related entities.
Prior to her current role, she was the Director of Pharmacy Compliance, where she oversaw managing all external and internal audits to conclusion, designing PBM oversight program, managing Pharmacy compliance program analysis, plan partner oversight program as well as conducting risk assessments.
Tammy is currently Audit and Operational Lead, Compliance and Risk Management for Humana Healthcare Services. Tammy holds certifications in both Managed Healthcare and Process Management. With Humana, Tammy has held multiple roles in auditing, clinical operations process management, business development, pharmacy benefits management (PBM) operations, and compliance related to the Medicare Advantage and Part D benefits with expertise in Prescription Drug Events (PDE). Tammy is currently responsible for all audit management and oversight related to Humana Pharmacy Solutions for all lines of business (i.e. Medicare, Medicaid, Commercial) as well as all operational compliance issues.
Dan Piessens leads RevealRx as CEO. RevealRx serves health plans and PBMs that want to see the full scope of their pharmacy claim data and centralized service-enabled claims analysis.
Having 20 years of experience in the software industry, Dan has lead teams to build enterprise applications in the transportation, insurance, and healthcare industries. Prior to leading RevealRx, Dan served as VP of Product Development and CISO for Tricast LLC, where the pilot for RevealRx was started.
Dan holds a MS-Computing from Marquette University. In his free time you can find him spending time with wife and three children in Milwaukee, WI.
Ashley Smith Manager of Pharmacy Services, Senior Care Options
Boston Medical Center HealthNet Plan
Ashley Smith serves as the Manager of Pharmacy Service for Boston Medical Center HealthNet Plan located in Boston, MA. In this role, Ashley oversees the operations, implementation, Part D PBM oversight, and ongoing management of BMC HealthNet's Medicare Dual Special Needs Plan's pharmacy benefit. Ashley serves as a cross-functional resource for plan operations, finance, compliance, and clinical departments.
Over the last 6 years, Ashley has held various managed care positions focused primarily on the management of Medicaid and Medicare populations. Ashley received her Doctor of Pharmacy degree from Northeastern University in Boston, MA, maintains a Board of Pharmacy Specialty in geriatrics, and is currently pursuing an MBA in Healthcare Management.
Koren Stevenson Director of Contracts and Compliance
Center for Elders' Independence
Koren Stevenson is an attorney with fifteen years’ experience in program administration, quality control, compliance, and investigations prior to joining CEI’s management team after moving to the Bay Area in 2017. She began her government career with the US Department of Agriculture as a USDA/1890 National Scholar and completed rotations in the national office, a regional office, and a state field office. While at USDA she worked with the Program Accountability Division of the nation’s largest nutrition assistance program. She was a member of the team that received the Secretary’s Honors Award in 2007 for their work in reducing the national payment error rate. She left USDA to begin her legal career as a criminal prosecutor in New York City. In addition to her experience with USDA, Koren is also well versed in Title II and Title XVI of the Social Security Act, having handled social security claims. She has also reviewed appeals arising out of termination of Medicaid benefits.
The policy analysis and research skills she has acquired in a variety of government and business settings serve her well in her role leading CEI’s many compliance and contracting functions. She is excited about working with CEI and serving East Bay seniors.
Prior to joining CEI, Koren was a private practice attorney in Washington, DC. Koren received her Juris Doctor degree at Georgetown University Law Center in Washington, DC, and a Bachelor’s degree from Florida A&M University. Koren lives with her family in Oakland and loves exploring the Bay area in her free time.
Jessica Vander Zanden directs Network Health’s efforts in compliance and member privacy, grievance and appeals and Internal Audit. She has over 10 years of leadership experience in the areas of compliance, privacy, corporate integrity, project manage and process improvement.
Prior to joining the executive team, Jessica previously served in a number of other roles at Network Health, including Director of Compliance and Culture, Compliance Director, Director of Medicare Compliance and Star Quality and Manage of Medicare Social Services and Special Needs Plan.
Jessica is a graduate of the University of Wisconsin – Oshkosh and holds a Masters of Social Work from University of Wisconsin – Milwaukee and a Masters in Organizational Business and Business Leadership from Silver Lake College in Manitowoc, WI. She holds certifications in Health Care Compliance from the Health Care Compliance Association, Strategic Decision and Risk Management from Stanford University and Gerontology from the University of Wisconsin – Milwaukee. She holds a current Wisconsin license as an Advance Practice Social Worker and is also a Six Sigma Green Belt and a certified Gallup Strengths Coach.
Director, Compliance and Risk Management | Healthcare Services
Brian Wehneman Director, Compliance and Risk Management | Healthcare Services
Brian is currently Director, Risk Management and Compliance for Humana Healthcare Services. Brian is a registered pharmacist with experience in pharmacy benefits management (PBM) operations, pharmacy transaction standards development, pharmacy claim auditing for fraud, waste and abuse, and compliance related to the Medicare Advantage and Part D benefits. With Humana, Brian has held multiple roles involving pharmacy network contracting, pharmacy auditing, fraud waste and abuse investigation, and risk management and compliance for coverage determinations and formulary administration.
Pete oversees the sales, client development, and marketing efforts at RevealRx. RevealRx serves health plans and PBMs that want to see the full scope of their pharmacy claim data and centralized service-enabled claims analysis.
He has more than 20 years of experience specializing in client development and strategic IT partnerships. Prior to joining RevealRx, Pete worked for several Fortune 500 companies, spanning: healthcare technology, financial services, and digital & print marketing. Most recently, Pete managed client experience and operations for Tricast, a professional services company providing PBM rebate audits, mock program audits, and coverage determination audits among other services.
Pete is a Wisconsin native, avid Brewers, Packers and Bucks fan, and lives in the greater Milwaukee area with his wife and three children (9, 5 and 2). When not working you can find Pete enjoying all the outdoor activities southeastern Wisconsin has to offer.