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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.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Thomas Kravis, Chief Medical Officer, Chinese Community Health Plan

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
David L. Larsen RN, MHA, Director, Quality Improvement, SelectHealth

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.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Donna Malone, CPC, CRC, Sr. Manager Enterprise Risk Adjustment Coding, Quality Assurance & Provider Education, Tufts Health Plan

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Gabriel L. Medley, MHA, MBA, Vice President, Quality and Risk Revenue, Gateway Health

Gabe Medley brings over 15 years of progressive healthcare experience leading diverse multidisciplinary teams and projects in the most challenging settings to achievement. Gabe’s background includes a combination of healthcare, business, and data analytic leadership roles and is currently serving as the Vice President of Quality and Risk Revenue for Gateway HealthSM headquartered in Pittsburgh, PA. He is the executive owner and department head for all quality improvement and risk adjustment related activities covering the Medicare and Medicaid populations in six states. Prior to Gateway, Gabe’s previous professional experience includes Sr. Director of Quality and Risk Revenue (Gateway Health), Director of Risk Revenue, Manager of Risk Adjustment Program (Horizon Blue Cross Blue Shield of NJ), Manager of Healthcare Data Analytics (Inovalon Inc.), Senior Manager of Patient Access (Military Health System, National Capital Region), and Captain (Medical Service Corps, U.S. Army). Gabe’s education includes the following: Master of Science in Healthcare Administration (MHA) and a Master of Business Administration (MBA) from the University of Maryland University College in Adelphi, Maryland; Bachelor of Science in Psychology with a minor in Military Science from Grambling State University in Grambling, Louisiana

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Kim Romanski, Vice President of Government Programs, Quality & Analytics, United Health Group

Kim Romanski is an experienced health plan and pharmacy benefit manager (PBM) leader, focused on Government Programs Stars, Audit Support, HPMS reporting, and Data Analytics. She has a broad background in PBM Operations, Information Technology, Product Innovation, Portfolio Management, and Mergers and Acquisitions. She is a strategic and results-driven leader with 20+ years’ experience delivering innovative strategic change for leading organizations in the health care industry. Imaginative analytical, business, product, and market leader with unprecedented success in developing, launching, and managing product brands. Keen strategic planning, new business development, problem solving, and analytical skills. Expert in clarifying organizational vision and translating it into tactical plans that move projects forward, surpass corporate expectations, and deliver consistently strong ROI.

Since 2014, Kim has been part of United Health Group and in 2016 she was promoted to Vice President of Government Programs Quality and Analytics. Previously, Kim worked for Walgreeens between 2008 and 2014, serving as a strategic portfolio manager as well as a health care product innovation Senior Director that launched several new service lines for Walgreens. Prior to joining Walgreens Kim spearheaded and launched a successful new international global service line that was the first of its kind, allowing the College of American Pathologists to expand beyond existing product offering and to attract new clients. Kim gained the breadth of her experience as a management consultant at Deloitte as an information technology consultant as well as a mergers and acquisition consultant for health plans for over ten years to navigate the competitive and legislative landscape.

Kim holds a Bachelor of Science in Industrial Engineering, Summa Cum Laude from Northern Illinois University and a Master of Business Administration from the University of Michigan.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Michelle Tyra, Pharm.D., Manager, Government Programs Quality Initiatives, United Health Group

Michelle Tyra is Manager of Government Programs Quality Initiatives at UnitedHealth Group. In this role, she serves as a trusted advisor to the PBM’s Medicare Part D clients, providing the insights and the expertise to stay ahead of the curve and position the health plans for success. Outside of Star Ratings, she is also responsible for the company’s quality rating program strategy and roadmap for the other government program lines of business which includes Managed Medicaid and the Health Insurance Marketplace.

Prior to joining the Quality Initiatives team in 2015, Michelle managed the PBM’s Medicare Part D Level 3 Retrospective Drug Utilization Review (RDUR) program, the Acetaminophen Refill Monitoring program and the Concurrent Drug Utilization Review program. Furthermore, she has an extensive PBM background in specialty pharmacy, utilization management, transitional benefit, clinical program logic development, clinical operations, and coverage determinations.

Michelle attended the University of the Incarnate Word in San Antonio, TX where she graduated Summa Cum Laude with a Doctor of Pharmacy degree.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
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 San Diego, 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.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Dan Weaver, Director of Program Management, Government Business, Quality Improvement, Highmark

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

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
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.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings

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Medicare Risk Revenue Management, Plus  Quality and Star Ratings

Medicare Risk Revenue Management, Plus  Quality and Star Ratings