2019 Speakers

Harvard Pilgrim Health Care

Gaurishankar Chandrashekhar

Director Revenue Management
Tufts Health Plan

Debra A. Corbett

Program Director, Senior Products Clinical Services Strategy
SCAN Health Plan

Michelle Fujii

Manager, Medicare Star Quality
Omnicell, Inc.

Mark Gregory, RPh

Director, Population Health Division
Livongo

Stephanie Gutendorf

Vice President of Medicare Growth and Strategy
Florida Blue

Aldiana Krizanovic, MPH, CPH

Senior Health Policy Consultant for Federal Government Relations
Select Health

David L. Larsen RN, MHA

Director, Quality Improvement
Molina Healthcare

Donovan Lemelin

Director of Operations, Medicare Pharmacy
BCBSAZ Advantage

James Lewis III

Vice President of Quality/STAR & Risk Revenue Programs
Capital BlueCross

Susan Lira

Manager, Plan Performance & Improvement
Martin’s Point Health Care

Karen Manning

Director Strategic Quality Programs, Interim Director Medicare Revenue Operations
Geisinger

Maria Welch

Senior Wellness Specialist, Steele Institute for Innovation
Clover Health

Erica Pham

Deputy General Counsel and Head of Government Affairs
UPMC Health Plan

Tim Plank

Manager of CMS Encounter Data
Vatica Health

Dr. Hassan Rifaat

Chief Executive Officer
Axion Contact

Christine Swan

VP of Call Center Operations
Hyperlift, Inc.

Mick Twomey

President and Chief Operating Officer
Excellus BlueCross BlueShield

Alyssa M. Tutino, PharmD

Quality Improvement Clinical Pharmacist
Aetna

Dr. Tracey Veal, PhD, MBA

Sr. Director, Strategic Programs
Gateway Health

Dan Weaver

Vice President, Stars Quality
CareSource

Karen VanZant

Vice President, Executive Director, Life Services
UPMC Health Plan

Debra J. Zeh BSN, RN

Sr. Director, Quality Improvement, Provider Performance
Highmark

Olga Ziegler

Vice President, Revenue Program Management
Speakers Biographies


Gaurishankar Chandrashekhar

Director Revenue Management
Harvard Pilgrim Health Care

Gaurish Chandrashekhar is the Director of Revenue Management within the Finance organization at Harvard Pilgrim Health Care. He assumed this role in September of 2013 and was tasked with the responsibility of developing and leading a team to pursue risk adjustment revenue opportunities for Harvard Pilgrim’s Medicare and Commercial lines of business. He has successfully helped the organization to implement best-in-class and effective prospective and retrospective revenue programs. His responsibilities include providing routine guidance to Finance Leadership and Market Team P&L Leaders on risk revenue for better plan pricing alignment. He joined Harvard Pilgrim in 2001 as a Sr. Analyst and grew through the ranks to the position of Manager, Pricing Applications. In his current role as Director of Revenue Management, he reports to the SVP & Chief Actuary. He routinely collaborates with Quality, Care Management and Network teams for deeper revenue impact on cross-functional programs.

Gaurish has regularly presented at RISE Conferences in California (May 2018) and in Florida (Nov 2018) on diverse topics. He has also presented at the Medicare Risk Adjustment Revenue Management conference in February 2018 on Medicare Prospective and Retrospective Risk Analytics and was a featured panelist at the Inovalon Client Congress in 2016.

Gaurish is an alumnus of The Partnership Program’s Next Generation Executive. Gaurish graduated from Southern New Hampshire University (previously New Hampshire College) in 1999 with a Master’s in Computer Information Systems. Prior to immigrating to the United States, he completed his Bachelors in Engineering from University of Mumbai in 1994 and his MBA in Finance from ITM, Mumbai in 1998.

Outside of his day job, Gaurish is a professional percussionist and actively performs, records and teaches.

Debra A. Corbett

Program Director, Senior Products Clinical Services Strategy
Tufts Health Plan

Debra A Corbett is the Program Director for Senior Products Clinical Services Strategy for Tufts Health Plan, a multi-year 5 CMS Star Plan. In that capacity, she manages a number of Clinical Stars Quality Improvement Campaigns as well as the Chronic Care Improvement Program (CCIP), Performance Improvement Projects (PIP) and Quality Improvement Projects (QIP) and the Dual Special Needs Program (SNP) Model of Care. Ms. Corbett has more than 20 years of experience in the managed care industry; serving predominately as senior administrator for quality and/or care management in several Health Plans. She has also provided consultation services for more than 10 years.

Michelle Fujii

Manager, Medicare Star Quality
SCAN Health Plan

Michelle received her MHA from California State University, Long Beach (CSULB) and is a certified Project Management Professional (PMP). She has over 9 years of experience in managed care. Prior to SCAN, she held quality improvement roles at HealthCare Partners Medical Group in California. Her responsibilities at SCAN include managing the operations of the 5-Star program and its initiatives.

Mark Gregory, RPh

Director, Population Health Division
Omnicell, Inc.

Mr. Gregory joined Omnicell in July 2014. Most recently Senior Vice President of Store Operations previously Vice President of Pharmacy and Government Relations for Kerr Drug, Inc based in Raleigh, North Carolina. Responsibilities included all store operations, oversight of pharmacy systems and automation, managed care contracting, store support, pharmacy administration, operational policies and procedures, patient care and compliance programs, university relationships and government affairs activities. He also served as Kerr Drug’s Privacy Officer and Chairman of Kerr Drug’s PAC.

Mark Gregory graduated in 1982 from Ohio Northern University and in October 2011 was awarded a Distinguished Alumni Award. He was a practicing pharmacist for 11 years when he assumed corporate positions as Manager of Pharmacy Systems and Third Party Programs at Thrift Drug Company in Pittsburgh, PA. After the acquisition of Thrift Drug by the Eckerd Corporation, Mark worked for a brief period of time in pharmacy operations for Eckerd.

Other pharmacy involvement include: Past President of North Carolina Association of Pharmacists, Past Chairman Executive Committee North Carolina Retail Merchants Association, Member and Past Chair of NACDS Policy Council, Past Chairman of the Board of Visitors for Campbell University School of Pharmacy, Past Chairman Board of Advisors MUSC School of Pharmacy, Board member of the University of North Carolina School of Pharmacy Board of Advisors, Board member of Wingate University School of Pharmacy Advisors and immediate past Facilitating Chair for Coalition for Community Pharmacy Action (CCPA).

Stephanie Gutendorf

Vice President of Medicare Growth and Strategy
Livongo

Stephanie Gutendorf is Vice President of Medicare Growth and Strategy at Livongo.  In this role, she partners with health plans, providers and CMS to empower Medicare beneficiaries with chronic conditions live healthier lives.  Previously, Stephanie has had held business development and strategy roles at The Advisory Board Company (OptumHealth) and held a healthcare policy position at the Global Health Council where she focused on the development of the President’s Emergency Plan for HIV/AIDS Relief (PEPFAR). In her time at The Advisory Board, Stephanie created and launched several provider sponsored health plans, focused on HCC revenue capture, and partnered with several regional and national health plans to deploy engagement strategies to support STARS and closing gaps in care.

Aldiana Krizanovic, MPH, CPH

Senior Health Policy Consultant for Federal Government Relations
Florida Blue

Aldiana Krizanovic is the Senior Health Policy Consultant for Federal Government Relations at Florida Blue. In her prior role she served as a Health Policy Analyst for the Florida Blue Center for Health Policy. She holds a Master's in Public Health with a concentration in Health Policy from the University of North Florida. She specializes in Medicare regulation, with a focus on Medicare Advantage and Part D. In her role she monitors and analyzes Medicare regulatory changes and their impact to the business. Aldiana is passionate about advancing development of health policy that improves access to care for vulnerable populations, decreases cost of care, and improves individual's quality of life. She serves as an advisor to the Age-Friendly Public Health System Advisory Committee led by Trust for America's Health and the John A. Hartford Foundation.

David L. Larsen RN, MHA

Director, Quality Improvement
Select Health

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.

Donovan Lemelin

Director of Operations, Medicare Pharmacy
Molina Healthcare

Donovan is the Analytics Director for the Medicare Pharmacy team for Molina Healthcare, Long Beach, California. He oversees clinical pharmacy initiatives from both an operational and data perspective that span MTM services, adherence, interventions for STAR and HEDIS metrics, and corporate quality improvement projects. He is actively involved in outcomes research within Molina Healthcare. His areas of expertise include Medicare Stars, medication adherence, and pharmacy process improvement.

Donovan has developed innovative ways to address patient targeting. In 2014, he created a revolutionary model to identify members at risk of poor medication adherence. Today, he has expanded on that targeting model in an attempt to further drive improved medication adherence. Through his expertise, Molina also has a predictive model that projects STAR results prior to their publication by CMS.

Donovan has a Master's degree in the Science of Management, which was preceded by a Bachelor of Science degree in Actuarial Science.

James Lewis III

Vice President of Quality/STAR & Risk Revenue Programs
BCBSAZ Advantage

James Lewis III has a very diverse background on both the hospital and payer sides of the healthcare realm working at regional health plans and systems all over the United States. He has a passion for Healthcare Quality and the holistic approach to meeting the needs of the Medicare population and aspires to meet that standards of a community servant. When not discussing RAF, STARS or HCC’s he is coaching and mentoring youth through faith-based sports leagues or hosting his Sunday Night sports-talk radio show on Phoenix’s NBC Sports Radio affiliate KDUS.

Susan Lira

Manager, Plan Performance & Improvement
Capital BlueCross

Sue Lira has worked in healthcare for over 30 years. Her background in both clinical and case management of cardiac surgery patients provided overview of the challenges to providing cost effective quality care. Sue transferred her skills to the health insurance industry where she worked in utilization and case management until finally settling into a position in quality management. Over the past 18 years, she has seen the changes in healthcare delivery and quality leading to the emphasis on prevention and outcomes driven management and measurement. Sue has worked with multidisciplinary teams to improve HEDIS rates via supplemental data, increased hybrid collection rates, and focused, multi-tiered, measure specific interventions.

Karen Manning

Director Strategic Quality Programs, Interim Director Medicare Revenue Operations
Martin’s Point Health Care

Karen Manning is the Director Strategic Quality Programs and Medicare Revenue Operations for Martin’s Point Health Care in Portland Maine. She is a Registered Nurse with 20 years of healthcare experience, spending the last 8 years working in managed care. Her responsibilities include Quality Improvement, HEDIS, Stars, Accreditation, Quality of Care and Delegation Oversight. She is also responsible for Medicare Revenue work, including Retrospective, Prospective, Quality and Compliance. This has presented an opportunity to create strategic integration between quality and revenue functions in the organization.
Karen has experience with Medicare, USFHP, Medicaid, SNP and Commercial lines of business. Her interest is in developing high performing teams and implementing quality improvement initiatives for key performance indicators. This work has resulted in the achievement of a 5 Star Rating from CMS and Excellent Accreditation from NCQA.

Maria Welch

Senior Wellness Specialist, Steele Institute for Innovation
Geisinger

Maria Welch is a Senior Wellness Specialist at the Geisinger Steele Institute for Innovation. Maria specializes in the coordination and management of programs addressing social determinants of health across the Geisinger clinical enterprise and community partners. Maria’s role also includes a strong focus on food insecurity where she supports operations and educational programs at the Geisinger Fresh Food Farmacy, a clinical program focusing on “food-as-medicine”. Prior to this role, Maria managed chronic disease programs and developed, implemented and evaluated wellness programs for Medicare, Medicaid and community populations within Geisinger's service area. She is also a Master Trainer and instructor for many of the chronic disease programs offered by Geisinger. A native of Pennsylvania, Maria earned her B.S. in Biology from Juniata College and her M.P.H. from West Chester University of Pennsylvania.

Erica Pham

Deputy General Counsel and Head of Government Affairs
Clover Health

Erica Pham currently serves as Clover Health’s Deputy General Counsel, Head of Government Affairs, and Corporate Secretary. At Clover, Erica oversees day-to-day legal and regulatory matters, including government affairs, growth, IP, corporate and clinical matters, to name a few. Prior to Clover, Erica served as Counsel, Government Relations at Kaiser Permanente and worked for CMS. At CMS, Erica was Special Assistant to the Deputy Administrator and Director, CCIIO, where she advised the Director on key policies for implementing the Affordable Care Act. Erica received her J.D. from the University of California, Hastings College of the Law, and her B.A. in Public Health from Johns Hopkins University.

Tim Plank

Manager of CMS Encounter Data
UPMC Health Plan

Tim Plank is the Manager of CMS Encounter Data for UPMC Health Plan in Pittsburgh, Pennsylvania. Tim has fourteen years of experience working in healthcare finance and operations, eight of those years being in Medicare Advantage Risk Adjustment. In his current role, Tim is responsible for Medicare Encounter Data Submission, RAPS Data Submission, monitoring and reviewing EDGE Data Submission, and Risk Adjustment Analytics for Medicare and ACA lines of business. A key role involves reviewing and reconciling data from both RAPS and Encounter Data to ensure accurate submissions as well as maximum revenue potential.

Dr. Hassan Rifaat

Chief Executive Officer
Vatica Health

Dr. Rifaat has served as the Chief Executive Officer at Vatica Health since February 2014 and is responsible for all company activities. He has more than 25 years of experience in the health care industry and has consistently demonstrated high performance in compliance, quality, and profitability in the businesses he has managed. Dr. Rifaat was previously the Chief Executive Officer of Windsor Health Group, a Medicare Advantage and Supplement insurance carrier based in Nashville, TN, with over 300,000 covered members; the company was sold to WellCare in 2013. He also served on the Board of Directors of Outcomes Health Information Solutions, where he previously served as the Chief Operating Officer. Outcomes Health was a privately held business in Alpharetta, GA, offering medical record retrieval and clinical abstraction services for risk adjustment revenue and managed care quality ratings; the company was sold to Altegra in 2014. Dr. Rifaat has also served as the SVP, Eastern Region for Coventry Health Care where he managed seven health plans serving more than 1.5 million Commercial, Medicare, and Medicaid members in 11 states. He has also held senior executive positions at Humana, Inc., where he served a Regional CEO for Illinois and the Southeast Region and the Market President for Louisiana. Dr. Rifaat is a graduate of the University of Virginia School of Medicine and Harvard University, where he was an All-American player on the national championship rugby team.

Christine Swan

VP of Call Center Operations
Axion Contact

Christine Swan is a multidisciplinary Senior Executive with a proven track record In strategic planning, call center operations, adult learning content training, as well as organizational development. Possessing more than 20 years in business planning and performance, Christine has been responsible for Axion Contact’s healthcare services since 2012. A recognized leader in the healthcare industry for her commitment to designing, implementing and executing high quality campaigns that improve STAR ratings, HEDIS/HOS scores and the overall member experience.

Mick Twomey

President and Chief Operating Officer
Hyperlift, Inc.

As Hyperlift’s Chief Operating Officer, Mick oversees all aspects of product design and customer experience. His background includes a mix of leadership roles in global management consulting firms and founder roles in entrepreneurial digital ventures. Since Hyperlift’s inception, Mick has been a regular speaker at Medicare Advantage conferences with a focus on Stars improvement. Mick has worked with Stars teams at organizations of all sizes and performance levels. From single contact plans with less than 5,000 members to large multi-state plans with millions of members – Mick’s focus is to collaboratively work with Stars teams to gain a deep understanding of their unique situation and help create an operating model that drives sustainable results.

Hyperlift’s position on driving sustainable results in a Stars environment is combining the right internal resources and infrastructure, with the right approach for year-round management, and the tools and technology to support it.

Hyperlift offers a technology-enabled approach designed to reduce risk and improve results by combining a sophisticated suite of Stars technology solutions, with leading intervention identification expertise, and the knowledge and expertise of the internal Stars team. The approach is tailored to each plan and facilitated by Hyperlift’s experienced team to enable transparency across the organization and limit the time required for Stars leaders.

Alyssa M. Tutino, PharmD

Quality Improvement Clinical Pharmacist
Excellus BlueCross BlueShield

Alyssa Tutino is a Quality Improvement Clinical Pharmacist at Excellus BlueCross BlueShield. Since joining Excellus in 2015, her primary role has been to support the Medicare Stars program- which has consistently achieved 4 Stars or greater across its MAPD and PDP plans. She is responsible for developing and implementing innovative quality improvement programs related to Medicare Part D Star measures including medication adherence. Additionally, Alyssa has worked on initiatives to reduce high risk medication use in the elderly, promote statin use in patients with diabetes and provide clinical support and oversight for Excellus’ Medication Therapy Management (MTM) program. Alyssa received her PharmD from St. John Fisher College in Rochester, NY and completed a post-graduate residency at Buffalo Medical Group and the University at Buffalo. She has completed advanced training in delivering medication therapy management services from the American Pharmacists Association.

Dr. Tracey Veal, PhD, MBA

Sr. Director, Strategic Programs
Aetna

Dr. Tracey Veal has over 30 years in the health care industry and a distinctive career. She was awarded Aetna’s highest honor, the Chairman’s Award and was also an Aetna Silver Award in 2016. Tracey serves as Aetna’s Senior Director of Strategic Programs for Aetna’s Star/Quality, Risk Adjustment and Operations for Medicare in the Western U.S. In an interim role, she also managed West Region Commercial Risk Adjustment during the initial implementation of the Accountable Care Act for Aetna.

Tracey rejoined Aetna from Kaiser Permanente’s Government Programs in 2014 where she focused on sustaining and improving an over 90% Medicare Advantage group retention rate and supported transitioning seniors turning 65 into the plan. During her prior tenure at Aetna, Tracey was instrumental in expanding Medicare in California and 14 other states, in addition to building key provider relationships and leveraging affinity partnerships-- positioning Aetna as # 1 or #2 in key states assigned. Previously, Tracey was a hospital administrator for Aurora Behavioral Health, and Dignity Health Systems. She also worked in a variety of managerial roles for United Health (Secure Horizons) and Allergan Pharmaceuticals supporting growth.

Tracey has an MBA with a concentration in marketing and holds a doctorate in health administration with a concentration in leadership. Active in the community, she served on community boards and was a former Chair of the Board for American Diabetes Association-Greater Los Angeles. She is a sought after speaker and a member of several healthcare organizations, including the Healthcare Financial Management Association, the American Hospital Association Society for Healthcare Planning and Market Development, and the National Association of Health Services Executives. She resides in Pasadena, California and has been married for nearly 30 years to a retired Navy Captain based in Hilton San Diego Resort & Spa, San Diego, California, California.

Tracey received various awards throughout her career including Cambridge Who’s Who Lifetime Membership and Professional of the Year, National Association of Women Business Owners Community Service Award, and Los Angeles Business Journal Nominee for Woman of the Year, Catholic Healthcare West Values in Action Award, and a City of Los Angeles commendation for service to seniors.

Dan Weaver

Vice President, Stars Quality
Gateway Health

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.

Karen VanZant

Vice President, Executive Director, Life Services
CareSource

Karin VanZant is the Vice President of Integrated Community Partnerships at CareSource. Since 2015, Mrs. VanZant oversees the work of Social Determinants of Health at CareSource and the full integration into the Population Health Model. Specifically, Mrs. VanZant has built the JobConnect Program - a workforce development program that assists CareSource members to enter into full-time, permanent employment. In 2015, JobConnect started in Ohio and has expanded to Indiana and Georgia as of 2017. Karin is currently working on food access and food insecurity pilots; in addition to establishing housing partnerships as a part of the SDOH integration into Population Health.

Prior to joining CareSource, Karin was the co-founder and Executive Director of Think Tank, Inc. For ten years as this organization’s leader, Karin assisted the team to live out the mission of equipping and facilitating collaboration among people and organizations seeking ways to promote greater connectedness and a more thriving community.

Karin VanZant has a MPA in Public Administration (2008) and a BA in Social Work (1998) from Wright State University. Karin is certified in various curriculums that address comprehensive poverty issues in the United States. She has helped author presentations and curriculum for use within nonprofit, business and faith based organizations seeking to become relevant and holistic in their approach to poverty alleviation.

Mrs. VanZant is an Adjunct Professor at Antioch Midwest University and Wright State University on a variety of subjects including US Hunger and Poverty, Introduction to Human Services, Grant Writing, Leading Change, Coaching as Management, Holistic Case Management and Emotional Intelligence. She lives in Springfield, Ohio with her husband and her son.

Debra J. Zeh BSN, RN

Sr. Director, Quality Improvement, Provider Performance
UPMC Health Plan

Deb Zeh is the Senior Director of Quality Provider Performance at the UPMC Health Plan in Pittsburgh, Pennsylvania. Deb has over 17 years’ experience in the health care insurance industry accompanied by her many years of clinical nursing experience. Her current role consists of supporting the network providers 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. Deb’s 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.

Olga Ziegler

Vice President, Revenue Program Management
Highmark

Olga Ziegler serves as Vice President of Revenue Program Management for Highmark Inc., which proudly offers Medicare Advantage and ACA health insurance coverage to 400,000 members. Olga oversees the collection and submission of Risk Adjustment data to the Centers for Medicare and Medicaid Services (CMS) and is responsible for physician education and care gap closure programs. Before devoting her work to Highmark, Olga served as a Senior Managing Consultant in the Health Analytics practice at Berkley Research Group (BRG) where she specialized in providing advisory and analytical services to health care clients. Additionally, Olga is a Certified Risk Adjustment Coder (CRC) and has over 15 years in the managed care industry having worked for health plans including Universal and Coventry. In her free time, Olga enjoys traveling and spending time with her family.