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Jessica Assefa, Medicare Stars Program Manager, UCare

Jessica Assefa has been the Manager of the Medicare Star Ratings program for UCare,an independent, nonprofit health plan that provides coverage to Minnesotans, for the past two years. Prior to this Jessica served on UCare’s Clinical Compliance team where she was responsible for the trainingand oversight of UCare’s delegated care coordination entities.

In her current roll, Jessica has responsibility for the facilitation and coordination of the Star Ratings program for UCare’s four Medicare Advantage and Dual Eligible products..UCare’s Medicare Advantage product, UCare for Seniors rated “Excellent” by NCQA, has maintained a 4.5 Star Rating, and is very close to becoming a 5 Star plan. UCare’s Medicare portfolio also includes: Minnesota Senior Health Options (MSHO), a D-SNP plan that combines Medicare and Medical Assistance benefits/services for low income Seniors, EssentiaCare – a Medicare Advantage plan from Essentia Health (a local care system) and UCare, andUCare Connect + Medicare – (Special Needs Basic Care) a plan that combines the benefits/services of Medicare and Medical Assistance for Minnesotans with certified disabilities ages 18 to 64.

In addition to her managed care experience, Jessica brings over 20 years of nursing experience in the states of MN, IN and NY working extensively with the geriatric and disabled populations.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Michael Brown-Hayes, Ph.D., Data Science Operations and Strategy, Cambia Health Solutions

Michael joined Cambia Health Solutions in September 2014, helping to build Cambia’s data science team and working with business partners to develop and implement a wide range of data-driven solutions.

In the last year and a half, the Cambia Data Science team has implemented models and solutions for a variety of areas including clinical predictive modeling, care coordination, member experience optimization, fraud, waste, and abuse identification, and a range of innovative solutions for Medicare Advantage and ACA revenue management, risk adjustment, and Stars.

Michael holds a Ph.D. in Physics from Dartmouth College. Prior to joining Cambia, he led several data science and analytics consulting efforts.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Tim Buxton, Director of Coding, Episource

Tim has been a certified coder (CPC, COC, CRC, CCS) for fifteen years and currently serves on the RISE HCC Coding Faculty Advisory Group. He possesses a Master’s degree in Business Administration with special emphasis on Healthcare Management and is a past chapter officer of the American Academy of Professional Coders (AAPC).

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Matt Davis, Stars Manager, The Health Plan

Matt Davis joined The Health Plan in January 2016 as the Medicare Quality Coordinator. He worked closely with the quality and finance teams to take over the risk adjustment functions for the organization. As the a coordinator, he was able to complete major RFP projects for The Health Plan to select new vendors for In-Home Assessments and Risk Adjustment functions. He recently took on the role of Stars Manager.

As the Stars Manager, Matt is responsible for overseeing the risk adjustment functions and outreach functions for the organization. He serves as the corporate liaison for risk adjustment and star ratings strategies. He works closely with the HEDIS team to optimize outreach strategies for the organization.

Matt received his Bachelor of Science Healthcare Administration degree from Ohio University in June 2002. He later attended the Wheeling School of Radiology where he received is Radiology certification in June 2006. Matt worked for several years in the radiology field before joining The Health Plan. He has also been a volunteer EMS/Firefighter for over 15 years.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Jane Elliott, Executive Director for Quality Management, Health Alliance

Jane Elliott is an experienced quality management professional known for her track record of getting results through creating and coaching teams to improve quality and service. She has extensive experience in quality improvement, performance management, process management, regulatory requirements, and team leadership. During her years at Health Alliance Medical Plans, Jane has led the plan in achieving and maintaining accreditation since 1996 and has been recognized by her organization for repeated success from The National Committee for Quality Assurance (NCQA) for two decades.

Jane distinguishes herself with a coaching/mentoring style that establishes trust among team members and peers. Her excellent communication skills and mission focus on care and service, repeatedly demonstrate her ability to develop and support innovative initiatives. As a proven quality professional in a health plan which is owned by a provider system, she has experience across the health care continuum and success in managed care for the commercial and Medicare populations totaling over 300,000 members.

Most recent performance evaluations indicate a cornerstone employee; clearly performs duties with a high level of competence; demonstrates discretionary effort constantly; very flexible yet seeks to understand opportunities and how they logically fit, which is admirable; teamwork far exceeds expectations and is a role model for others.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Ellen Harrison, MBA, RN, SVP Consulting & Market Strategy, Eliza Corporation

Ellen, a veteran in strategic planning and managed care operations, joined Eliza in February 2016 as the Market Strategy and Consulting lead responsible for shaping Eliza's offering to anticipate the diversified communication engagement needs of Medicaid, Medicare, Commercial, Disease Management, Pharmacy Benefit Manager and new markets.

She brings over 20 years of experience in strategic planning and managed care operations with demonstrated results leading teams to build and redesign health care products, provider incentive systems, and developing successful quality, cost, and utilization improvement programs for commercial and senior populations.

Previously, Ellen was the VP of Medical Management for Martin's Point Health Care. She directed care management, quality improvement and provider network strategy and contracting for the Tricare and Medicare Advantage products and coordinated integrated population health management resources for the MPHC medical practices. During her tenure, Martin's Point achieved NCQA accreditation and a Medicare Advantage 5 Star rating for 2 consecutive years. Previous senior roles included COO of Network for Regional Healthcare Improvement Organization (NHRI), a grant funded member organization which facilitates regional quality improvement programs across the country through private and government funding, VP of Shared Decision Making Products at a national disease management firm, Sr. Vice President of HMOs for Trigon Blue Cross and Blue Shield, Virginia and Vice President and General Manager for CIGNA Healthcare of Connecticut. This year, Ellen will serve on a CMS Technical Expert Panel for Medicare Advantage care coordination measure development.

Ellen is a registered nurse with a BS in Nursing from Syracuse University and an MBA with a concentration in healthcare from the University of Connecticut.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Dr. Amy Helwig, Vice President, Quality Improvement and Performance, (UPMC) University of Pittsburgh Medical Center Insurance Services Division

Dr. Amy Helwig currently serves as Vice President, Quality Improvement and Performance at the University of Pittsburgh Medical Center Insurance Services Division where she leads quality operations for population health, patient experience and alternative payment programs. Dr. Helwig is recognized nationally for developing innovative programs in quality, safety and Health IT to drive value and improve patient outcomes. Previously, Dr. Helwig served as Deputy Director of the Center for Quality Improvement and Patient Safety, the premier resource for the nation’s quality and safety community, at the Agency for Healthcare Research and Quality. As the Director, HIT Safety and Clinical Informatics and Acting Chief Medical Officer at the U.S. Office of the National Coordinator for Health Information Technology she guided national quality improvement and population health programs and promoted development of new policies for health IT safety and usability.

Dr. Helwig is board-certified in both clinical informatics and family medicine and a graduate of the Medical College of Wisconsin. She has also served as Associate Corporate Medical Director at Quad/Med, the medical division of Quad/Graphics, in Sussex, WI where she practiced family medicine and directed their unique multi-state health care and disease management system that offered on-site primary care clinics for employees and families of Quad/Graphics.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
David Larsen, 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, Sr. Manager Enterprise Risk Adjustment Coding, Quality Assurance & Provider Education, Tufts Health Plan


Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Jordan Mauer, Executive Vice President of Marketing and Engagement, NovuHealth

Jordan is Executive Vice President of Marketing & Operations at Novu. In this role, he develops and leads the company's marketing and brand initiatives, as well as the end-to-end management of member-facing operations. With more than 15 years of senior marketing leadership experience, Jordan brings a passion for analytics, loyalty operations and engagement, as well as strategic energy to Novu.

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
Valerie Ogilbee, Director, Quality Analytics, The Health Plan

Valerie joined The Health Plan in April 2001 as an intern. She worked in the QI Department for several years prior to being transferred to the Finance Department. As a health data analyst, Valerie completed a variety of projects including contract analysis, financial analysis, and reinsurance reporting. Valerie has implemented software programs for fraud, waste and abuse identification and predictive modeling and provider profiling. She served as the manager of health economics in the Business Intelligence Unit prior to assuming her current role as Quality Analytics Director.

Valerie is responsible for working with staff to analyze data relevant to The Health Plan’s various quality initiatives. Through analysis of data, she works with the quality improvement teams on the development and implementation of programs aimed at improving the quality of care and service provided to members. She is also responsible for HEDIS reporting, Medicare data projects and member outreach efforts.

Valerie received a Bachelor of Science Healthcare Administration degree from Ohio University in June 2001. While working at The Health Plan, Valerie earned a Master of Public Health degree from West Virginia University in 2006. In December 2015, she completed the University of California, Davis Healthcare Analytics Certificate Program.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Melanie Richey, Vice President of Clinical Solutions, Centauri Health Solutions

Highly accomplished and visionary healthcare decision maker with 20+ years of experience leading program development, process improvements and managing multi-disciplinary teams to positively impact the customer’s quality and experience of care. Expertise in the development and execution of strategic plans to achieve organizational goals, while meeting market and customer needs. Possess a unique understanding of both the clinical and systems aspects of the healthcare industry.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Tara A. Russo, MPH, CPC, CPMA, CRC, VP of Medicare Risk Adjustment and HEDIS Quality Initiatives, VP of Navigate Directorate, Island Doctors

Tara Russo is the Vice President of Medicare Risk Adjustment, HEDIS Quality Initiatives, and Navigate Directorate for Island Doctors, a provider organization (MSO) headquartered in St. Augustine, Florida. Under her leadership, Island Doctors has become a leading example in the industry. Island Doctors operates 26 wholly-owned offices in Alachua, Clay, Columbia, Duval, Escambia, Saint Johns, Santa Rosa, Flagler, Putnam and Volusia counties, as well as manage a network of 49 affiliate providers throughout these ten counties and around the Orlando area. Tara has also recently become CEO of Transformative Healthcare Consulting, LLC.

Prior to her current role, Tara previously worked as a financial analyst for Humana, Florida Hospital and Visiting Nurse Service of New York. Earlier, she was the Finance Manager for the Department of Medicine at Memorial Sloan-Kettering Cancer Center in New York. She has a Master of Public Health from Columbia University School of Public Health, and holds credentials as a CPC, CPMA, and CRC. She is a member of the American College of Health Care Executives, NAMAS, and AAPC.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Jessica Smith, Vice President, Healthcare Analytics & Risk Adjustment Solutions, Gorman Health Group

Jessica Smith is Vice President, Healthcare Analytics & Risk Adjustment Solutions at Gorman Health Group (GHG). In this role, she is responsible for the execution and oversight of risk adjustment consulting services for managed care, provider practice, and commercial market clients and leading and integrating cross-functional teams to ensure superior performance outcomes related to risk adjustment operations.

Jessica brings GHG clients more than 10 years of experience as one of the nation’s leading experts on risk adjustment knowledge that bridges the gap between Medicare and commercial risk adjustment. She has experience developing strategies, initiatives, and end-to-end support for risk adjustment operations. Major emphasis is placed on warehouse development to support Affordable Care Act (ACA) deliverables and analyses.

Prior to joining the GHG team, Jessica led health plan efforts to implement commercial risk adjustment operations and technical support. In this role, Jessica was responsible for the overall strategy, design, and performance of the risk adjustment program. She led a cross-functional technical team of data analysts, solution architects, developers, testers, and business colleagues to implement all ACA data needs throughout the organization.

In addition to risk adjustment, Jessica also brings strong experience developing and operationalizing data governance, cost share reduction operations, regulatory compliance, and vendor management. For the past decade, she has been focused on public-private healthcare market interactions, all in the context of an ongoing analysis of key financial and public policy trends as they impact profitability in the industry. Jessica is passionate about the healthcare industry and delivering quality care to all members.

Jessica received her Bachelor of Science degree from the University of South Florida.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Melissa Smith, Vice President, Star Ratings, Gorman Health Group

Melissa Smith is Vice President of Stars at Gorman Health Group. In this role, she helps health plans, providers, PBMs, and industry vendors improve their performance within quality ratings systems such as Star Ratings within Medicare Advantage, Quality Rating System (QRS) within the Health Insurance Marketplace, Healthcare Effectiveness Data and Information Set (HEDIS®), Consumer Assessment of Healthcare Providers and Systems (CAHPS®), etc. She brings more than 20 years of healthcare experience to GHG, with more than five years at Cigna-HealthSpring working with Star Ratings among national MA and Part D plans. Melissa has extensive experience developing strategic and tactical solutions to maximize performance on the full spectrum of quality measures. Melissa also has 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.

Before working with 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 the opportunity to maximize quality performance and revenues. Medicare Star Ratings

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Kristine Walhof, MBA, MHA, Program Director, Medicare Star Ratings, Cambia Health Solutions

Kristine received a Bachelor's of Business Administration from Pacific Lutheran University in Tacoma, Washington, and a MHA and MBA from the University of Missouri – Columbia. Kristine has over 20 years of professional experience throughout the health care industry, including health care consulting, large and small group benefit design, long-term care, executive recruiting, and provider contracting. Kristine joined Cambia in 2012 and currently serves as the program director for the Medicare Star Ratings program across our plans in Oregon, Washington, Utah and Idaho.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Rex Wallace, Principal, Rex Wallace Consulting, LLC (RWC)

Through his consulting firm, Rex helps health plans achieve higher Star Ratings, resulting in improved outcomes, experiences, and quality of life for their members.

Before forming RWC in February 2017, Rex spent 22 years in various leadership and consulting roles in the healthcare industry, including positions with Cambia Health Solutions, Universal American, CIGNA, Mercer, and Aon Consulting. Most recently, Rex was the Vice President of Integrated Member Experience at Cambia Health Solutions, where he oversaw Star Ratings, Medicare operations, and the member experience. Under Rex's leadership, Cambia improved from 3.5 to either 4 or 4.5 Stars on every Medicare Advantage contract.

Rex earned his MBA from the University of Arkansas and his BS in Management from Arkansas State University.

Medicare Risk Revenue Management, Plus  Quality and Star Ratings
Brent Zenobia, Ph.D., Senior Business Architect for Medicare and ACA, Cambia Health Solutions

Brent Zenobia is a Senior Business Architect with Regence Blue Cross Blue Shield in Portland Oregon, with focus on innovative solutions for Medicare Advantage and ACA risk adjustment, revenue management, and Stars.

Brent has over 35 years of technical experience in the field of software engineering. During his 8 years at Regence he has led business analyst, systems analyst, and IT development teams in the Medicare Advantage and Medicare Part D space. Prior to Regence he served as chief software architect and process improvement specialist for Sharp, Intel, Hewlett Packard, Nortel Networks, and several smaller firms.

Brent holds a Ph.D. in Systems Science/Engineering Management and a Masters in Software Engineering, and has taught graduate courses for Oregon Health and Sciences University, Portland State University, and the Oregon Graduate Institute.

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

Medicare Risk Revenue Management, Plus  Quality and Star Ratings

Medicare Risk Revenue Management, Plus  Quality and Star Ratings

Medicare Risk Revenue Management, Plus  Quality and Star Ratings