Rise

Josh Benner, PharmD, ScD President and CEO

RxAnte

Josh Benner is Founder, President, and CEO of RxAnte, a pioneering provider of advanced analytics, patented technology, and high-touch pharmacy services that get more from medicines. The company’s solutions increase quality scores and lower costs by improving prescription drug use in medically complex and vulnerable populations. A leading voice on medication adherence, Dr. Benner’s award-winning research and numerous publications have shed new light on the problem of non-adherence and identified promising approaches to improving it.

Prior to RxAnte, Dr. Benner was Fellow and Managing Director at the Brookings Institution’s Engelberg Center for Health Care Reform where he focused on medical technology policy. Prior to Brookings, Dr. Benner was principal at ValueMedics Research, an analytic and consulting services firm. Following the sale of ValueMedics to IMS Health in 2007, he served as senior principal in health economics and outcomes research and global lead for medication adherence at IMS (now IQVIA).

Dr. Benner received his Doctor of Pharmacy degree from Drake University and his Doctor of Science in health policy and management from the Harvard University School of Public Health. He was a post-doctoral fellow in health services research at the Brigham and Women’s Hospital Department of Pharmacoepidemiology and Pharmacoeconomics. Dr. Benner is currently a member of the Health Policy and Management Executive Council at the Harvard T.H. Chan School of Public Health, and an Entrepreneur in Residence at the Harvard i-lab.

Kurt Cegielski Senior Vice President, Client Success

Revel-Health

As SVP of Client Success at Revel, Kurt brings more than 20 years of experience in key leadership roles within the healthcare industry. Prior to joining Revel, 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 as well as worked closely with other key market influencers 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. His ability to help bring leadership and vision to diverse groups of people has offered him a unique perspective on people, especially with start-ups and high growth stage companies. Kurt has a passion for organizational mission and values and the unique competitive advantage a strong culture can bring to any company.

Michelle D. Chang Director, Network Quality

SCAN Health

Michelle has over 10 years of quality improvement experience in managed care. Prior to SCAN, she held roles in both the provider group and health plan settings. Since joining SCAN, Michelle has held various roles in quality improvement, including leading the 5-Star team to deploy member and provider interventions. Her most recent role at SCAN has been as Director, Network Quality. Her key responsibility is to drive performance improvement and quality initiatives with the provider groups.

Michelle received her MHA from California State University, Long Beach (CSULB) and is a certified Project Management Professional (PMP).

Margaret Ciancetta Senior Quality Business Analyst

Pulse8

Marge is a Sr. Business Analyst on Pulse8’s Qualit8 team with a decade of healthcare experience.  She specializes in new customer implementations and product enhancements. Prior to joining Pulse8, Marge’s recent roles included several positions at UPMC Health Plan where her responsibilities encompassed reporting of Commercial, Medicare and Medicaid products for the HEDIS, Five-Star, QRS and PQA programs.

Marge’s skillset spans the Quality spectrum, including measure building and reporting, BI dashboard creation, data analysis, requirements gathering and documentation, Medical Record tool population/extraction, and IDSS submissions.

Marge earned her BS in Information Technology from Penn State.

Paul Cotton Director, Federal Affairs

NCQA

Paul Cotton is the National Committee for Quality Assurance Director of Federal Affairs. He works with Congress, the Administration and other stakeholders to improve health care quality. Previously he was a lobbyist for AARP on Medicare, Medicaid, CHIP, health reform, health IT and quality improvement issues. He has also worked at the Center for Medicare & Medicaid Services as Hearings & Policy Presentation Director in the Office of Legislation, and as a journalist for publications including the Journal of the American Medical Association.

Ryan Davis Manager, Pharmacy Medicare Programs

Kaiser Permanente

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.

Matthew Dinh, PharmD Director, Pharmacy Quality & 5 Star

SCAN Health Plan

Matt began his pharmacist career in the community, working as a pharmacist in retail-based settings. While his first love is working directly with patients, he quickly discovered an interest and desire in caring for them at a much larger scale. For the past eight years, Matt has worked as a managed care pharmacist focusing on quality in various settings inclusive of a medical group, pharmacy benefits manager, and health plans. At SCAN, he leads a team of pharmacists that develop clinical programs designed to maximize health outcomes. He remains dedicated to improving the quality and efficiency of healthcare, and hopes to continue growing collaboration with providers and other healthcare leaders to ensure that SCAN members remain healthy and independent.

Matt received his Bachelor of Arts from the University of California, Riverside and his Doctor of Pharmacy at the University of Southern California.

David Dodge Medicare Stars Program Director, Government Programs

Cambia Health Solutions

Ryan Dodson Regional Manager, Risk Adjustment

Molina Healthcare

His background is in management and operational processes for 15 years, and began working in the Risk Adjustment arena 12 years ago. Ryan has proven himself by helping Medical Groups raise their RAF scores to their proper levels. He directed the movement of a 10,000 member group up 43% over a two year period, and an 1800 member group up 53% in the first year. Ryan achieves these results through chart documentation audits, provider and staff documentation training, and provider relationship building. In his most current role Ryan works with multiple groups to optimize their RAF score, while at the same time achieving CMS 5 Star quality. Ryan explains to these groups that getting their RAF score to the correct level will not only drive revenue, but it will also lead to better patient care with improved documentation habits. Ryan is a Certified Risk Adjustment Coder (CRC) credential through the AAPC.

Michelle Duran, CPC, CRC, CDEO Practice Transformation Facilitator

Hill Physicians Medical Group

Michelle Duran is Practice Transformation Facilitator at Hill Physicians Medical Group (HPMG). HPMG is the largest network of independent providers in Northern California with more than 4,000 physicians. Michelle has worked at HPMG for over 12 years and supports the network to improve healthcare processes and outcomes, including delivery of wellness and preventive services. She is dedicated to advancing the quality and efficiency of healthcare at HPMG by creating scalable, measurable improvement that focuses on patient care and provider engagement. During the COVID-19 pandemic she is advising and assisting the physicians of the HPMG network in transitioning into telehealth services to insure they continue to deliver high quality health care services to their patients.Michelle holds two American Academy of Professional Coders (AAPC) certifications, Certified Professional Coder and Certified Risk Adjustment Coder as well as BS in Business Management from University of Phoenix. Michelle is a member of AAPC and past Membership Development Officer of her local AAPC chapter. Michelle recently participated in CMS sponsored California Quality Collaborative (CQC) four-year practice transformation initiative to improve measures of cost, quality and patient experience.

Kathleen Ellmore Managing Director

Engagys

Kathleen is a pioneer in bringing the best of consumer marketing and data-driven methodologies to healthcare to motivate better health decisions.  As Managing Director of Engagys, Kathleen leverages the best of behavioral economics, the latest in evidence-based communications combined with the insights from over a billion consumer interactions in health to help healthcare organizations close the last mile of consumer engagement.

Kathleen has been recently named as a consultant to the first ever FDA Patient Engagement Advisory Committee (PEAC). She received Stevie awards for highlighting opportunities for improving the lives of people with chronic conditions. She speaks regularly on the national stage on many topics including: driving consumer health engagement, creating better consumer experience in healthcare, motivating and inspiring consumers, and using data to drive consumer behavior. Kathleen is not just a healthcare consumer expert, she’s a healthcare consumer. Her daughter has cerebral palsy; thus Kathleen lives daily the complexity of today’s healthcare system.

Kathleen spent the first twenty years of her career in brand marketing at leading consumer marketing organizations, including General Mills and P&G.   Additionally, Kathleen was a Vice President at Digitas, one of the leading direct marketing firms in the country.   Kathleen has an undergraduate degree from the University of New Hampshire and an MBA from the Kellogg School at Northwestern.

https://www.linkedin.com/in/kellmore. Twitter handle: @kellmore1

Kathleen Faulk General Manager, Government Programs

Regence

Ana Handshuh RISE Revenue & Quality Community Chair, Principal

CAT5 Strategies

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.

Sara Hansen Director of Quality & Clinical Risk Services

Avera Health Plans & DAKOTACARE

Sara has more than 12 years experience in health care, including 5 years in managed care. Prior to joining Avera Health Plans in 2016, she held the role of Health Educator on the delivery side. Since joining Avera Health Plans, Sara has held various roles in Population Health Services, primarily overseeing risk adjustment operations. Her most recent role with Avera Health Plans has been as Director of Quality & Clinical Risk Services, where her key responsibility is to drive quality improvement with alignment of quality and risk adjustment operations.

Sara received her Master's Degree from South Dakota State University and her Bachelor's Degree from the University of South Dakota.

Tejaswita Karve, Ph.D. Director, Quality Improvement

Johns Hopkins HealthCare

Tejaswita Karve is the Director of Medicare STARS with the Johns Hopkins Health System. She has previously held roles at several Fortune 500 companies, including Accenture and CVS Health, as well as with Presbyterian Healthcare Services and most recently at UPMC Health Plan in Pittsburgh.

Karve holds a Ph.D. in Biochemistry and Cellular & Molecular Biology from Georgetown University.

Kate Rollins Senior Vice President, Population Health and Clinical Innovations

Gorman Health Group

Kate Rollins, MSN, RN, is the Senior Vice President of Population Health Management and Clinical Innovations. In this role, she is responsible for leading GHG’s efforts to define and advance the next generation of population health management and clinical innovation. Kate is a Clinical Nurse Specialist with expertise in oncology and infectious diseases, and a focus on caring for vulnerable populations. She brings over 20 years of experience in healthcare and health plan innovations to GHG, including clinical strategy development, program development, implementation, start up and ongoing operations, and performance management/evaluation. She has worked across many clinical settings and lines of business, including Medicare Advantage, Chronic Condition Special Needs Plans, Dual Special Needs Plans, Medicare Shared Savings Plans, Medicaid, Commercial/Employee, and Exchange.

Jay Scholes Director of Sales

Pulse8

Jay currently leads the sales efforts in the West region for Pulse8, a leader in the healthcare industry providing an integrated approach to supporting risk adjustment and quality programs for health plans and providers. 

Jay is an enthusiastic and energetic sales executive with deep rooted ties to the healthcare industry and over 20 years of experience in various roles and healthcare segments. Jay currently works with Medicare Advantage, Commercial, and Medicaid plans to help improve the overall care of members through strategic partnerships in an ongoing effort to improving health plan performance and profitability.

Reva Sheehan Government Programs Strategic Market Executive

mPulse Mobile

With more than 15 years’ industry experience ranging from long term care and compound pharmacy management to health plan quality and operations, Reva excels in engaging internal and external stakeholders to improve processes for optimal outcomes while keeping the member’s experience at the heart of every conversation.

Melissa Smith Executive Vice President, Consulting & 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.

John Suarez CEO and Founder

iCare Intelligence

John Suarez is the founder of iCare Intelligence. His extensive 2-decade background in both health care finance and information technology led him to design and develop the iCare Provider Engagement Platform to empower health plans and primary care providers to improve Quality of Care, reduce Cost of Care, and facilitate the transition to Value-Based Care. Improvement in processes and communication with providers result in better population health and CMS Star Ratings.

Kimberly Switlick Prose Vice President, Star & Risk Adjustment Center of Excellence

Blue Cross and Blue Shield Minnesota

• Strategy and analytics specialist with nearly 20 years of experience focused on strategic planning, strategic partnerships, data and analytics, and organizational transformation.
• Worked with global organizations in the public and private sector to design and implement sustainable and integrated programs that achieve business objectives and improve population health and wellness, particularly among underserved populations.

Rodolfo G. Velasco, MBA Healthcare Solutions Manager

Nagnoi

Mr. Velasco has over 15 years of leadership experience in the healthcare industry across various business areas and segments including Medicare Advantage, Medicaid and Commercial.  As a Stars Rating Director in a Medicare Advantage (MA) organization managing more than 170,000 MA lives, Rodolfo lead a multi-disciplinary team in developing business strategies and action plans, which lead to improved Quality Ratings consistently during his tenure.  Velasco has a Bachelor of Science in Marketing and International Studies from Indiana University, IN. He also earned an MBA in Health Sector Management and Policy from the University of Miami in Coral Gables, FL.

Rex Wallace Principal

Rex Wallace Consulting

Rex Wallace is the founder and principal of Rex Wallace Consulting, LLC, a firm that specializes in improving Star Ratings for Medicare Advantage health plans. Rex assesses plans and guides them in the development and implementation of-leading strategies to drive material Quality Improvement. Since its inception in 2017, RWC has helped multiple Medicare Advantage contracts achieve significant improvements in Star Ratings, including single-year full-Star improvements. Prior to launching RWC, Rex spent twenty-three years in strategic healthcare roles, with a strong focus on Medicare Advantage. Most recently, he led Stars for a large, multi-state plan that consistently achieved 4 and 4.5 Stars across its multiple contracts.

Daniel Weaver VP Medicare & Medicaid Quality Programs

Gateway Health Plan

Daniel Weaver is an established leader with extensive experience developing and implementing intervention strategies to improve Medicare Stars performance. With demonstrated success through innovative programs, Daniel led a Stars Quality team at Highmark for 6 years where they consistently delivered market-leading performance and forward-thinking engagement with providers and members.  Daniel moved to Gateway Health Plan to help an underperforming DSNP plan achieve 4 Stars, boost Quality Improvement performance across multiple State pay for performance programs, and expand Risk Adjustment programs.

Ashby Wolfe Chief Medical Officer, Regions VIII, IX & X

Centers for Medicare & Medicaid Services (CMS)

Dr. Ashby Wolfe is a board-certified family physician and serves as co-Chief Medical Officer for the Centers for Medicare & Medicaid Services (CMS) offices in Denver, San Francisco and Seattle. Dr. Wolfe has been based at CMS San Francisco since 2015, and now also supports the Denver and Seattle regional locations in her focus on the implementation of Medicare and Medicaid policy across the Western States and the Pacific Territories (AK, ID, OR, WA, AZ, CA, HI, NV, CO, MT, ND, SD, UT, WY, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands). As a senior medical advisor for CMS programs in the Western United States, she provides clinical expertise to the divisions of Medicare and Medicaid payment policy, quality improvement, survey operations, contracted health plans and serves as the principle liaison with the clinical community.
Dr. Wolfe completed her medical degree at Stony Brook School of Medicine in New York, and her residency training at the UC Davis Medical Center in Sacramento, California. She also holds a Masters of Public Policy and a Masters of Public Health from the University of California, Berkeley. Dr. Wolfe has practiced broad-scope family medicine in academic, integrated and community clinical settings over the course of her career and holds a particular interest in improving the quality and equity of care for underserved and low-income populations. She has published multiple articles on Medicare and Medicaid policy, and is a contributing author of the public health text, Prevention is Primary (Jossey-Bass).