Erika Bower, PharmD, BCACP
David L. Larsen RN, MHA
Toc Soneoulay-Gillespie, MSW
Lisa Wigfield, RN, BSN, CCM, CRC, CDEO
Debra J. Zeh BSN, RN
Belinda Zhang, PhD, MHA
Jessica Assefa is the Senior Director of Star Ratings at Gorman Health Group (GHG). In this role she provides expertise to health plans regarding Quality Improvement (QI), the Centers for Medicare & Medicaid (CMS) Services Quality Bonus Programs (QBP) and Star Ratings. Jessica is an accomplished nurse and brings clients over twenty years of diverse experience and achievement in managed care, quality improvement and clinical care in addition to strong Medicare, Medicaid, Marketplace and Dual-Special Needs Plans (D-SNP) programs knowledge.
Prior to joining Gorman Health group, Jessica led the Medicare, Marketplace and Medicaid Star Ratings Programs and Quality Ratings Systems (QRS) for an independent, nonprofit health plan in the state of Minnesota, successfully achieving 4, 4.5 and 5 Star Ratings for the plan’s multiple Medicare and Marketplace contracts and product lines. Her managed care experience expands into the areas of Clinical Compliance, including training and oversight of internal and delegated care coordination entities for Medicare Advantage and Dual-Special Needs Plans (D-SNP).
For the past several years, Jessica has been asked to speak at multiple, national health care, quality and managed care conferences on the topics of Star Ratings, social determinants of health, health plan operations and beneficiary experience, among other topics.
In addition to her managed care experience, Jessica brings years of clinical knowledge, patient-care and nursing experience in the states of Minnesota, Indiana and New York, working extensively with the geriatric and disabled populations in nursing home, school, clinic and home-care settings in a variety of roles including Director of Clinical Education, Manager of Alzheimer’s & Memory Care and Minimum Data Set (MDS) coordination.
Erika Bower, PharmD, BCACP
Erika Bower is a Clinical Pharmacist at UCare in Minnesota and is the subject matter expert for pharmacy quality measures and Medication Therapy Management (MTM). She received her doctorate of pharmacy degree from North Dakota State University and completed two years of residency training at Hennepin County Medical Center in Minneapolis (PGY-1 Pharmacy Practice & PGY-2 Ambulatory Care). She is board certified in ambulatory care pharmacy practice. Prior to working for UCare, Erika practiced MTM in a Family Practice Clinic and started a new clinic at the HealthEast Pain Center, specializing in pain management from a multi-disciplinary team approach. Her primary interests are promoting public health initiatives for safe and effective use of medications, pharmacy quality, and MTM.
Amanda Calvert is a collaborative team player passionate about asking the right questions and vigorously pursuing answers that will improve the health of vulnerable populations. She comes from a public health background and has spent the last eight years in the managed care environment working in government programs. For the last three years, she’s been a Clinical Program Manager at Blue Shield of CA, focusing on the Medicare Star Program. She has been a key player in projects such as Blue Shield of CA’s Medicare provider incentive program and acts as a liaison between provider groups and the health plan.
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.
For over a decade, Lauren Easton, LICSW, has served as a Behavioral Health leader for Commonwealth Care Alliance (CCA). Over the years and in various roles, Lauren has been largely responsible for developing CCA's behavioral health integration across its care models, for creating a responsive network, and for creating many innovative programs, including CCA’s Crisis Stabilization Units.
Lauren embraced the integration of behavioral health and medical care long before the concept became "trendy." She has made behavioral health integration a hallmark of program development throughout her professional life.
In her current role, Lauren is responsible for the oversight of CCA's behavioral health services, delivered through its network of behavioral health providers and internal behavioral health specialists to CCA's 22,000+ members. She is responsible for assisting clinical leadership in improving the level of integration of Primary Care and behavioral health services for CCA members and for guiding network development, cost management, and quality improvement activities. She oversees the Behavioral Health development and expansion of the One Care program and Senior Care Option Program, paying particular attention to the significant mental health needs of this population.
Lauren holds a master's degree from Simmons College School of Social Work. She also attended Boston University and the University of Massachusetts, where she completed a double Major in psychology and education.
Josh is the Medicare Stars Programs Manager at Martin’s Point Health Care in Portland, Maine. His company’s PPO contract reached 5-stars for the first time in 2020 and his HMO contract has achieved 5-stars five times since 2010, most recently in 2019.
In his role Josh is responsible for identification, development, and implementation of quality improvement initiatives to maintain and improve health plan quality measures, specifically Medicare Star Ratings.
Prior to his health care career Josh worked for several branches of the Walt Disney Company, including many years in production management at Walt Disney Animation Studios in Burbank, Calif. Josh has an MBA in Marketing from the American University in Dubai and a Master of Science in Health Communication from Boston University. He lives in Portland with his wife and eight-year-old daughter.
Savannah Gonsalves, RN-BSN, MHA is the Quality Manager at Hometown Health in Reno, Nevada. She took this role in December of 2017. Her background includes a nursing career in telemetry, specialty practice management, and clinical informatics. Savannah received her first bachelors in Health Information & Informatics Management in 2008 from Boise State University and her Nursing degree in 2011. Quality and patient care are her passion, but administration is her strength, which led her into administrative roles that allowed her to improve the care for patients not only on the hospital floor, but within the entire healthcare system. In her role as a Clinical Nursing Informatics Specialist, she worked directly on ACO initiatives through collaboration with providers, workflow standardization, and EMR technology enhancements to improve quality metrics for a non-profit integrated health care delivery system. This experience lead her to her current role at Hometown Health. Her responsibilities include developing innovative ways to increase clinical quality metrics, improve member experience, and provider engagement.
Kena Hahn is the Director of the Medicare Star Ratings program for Health Alliance, a vertically integrated health system with Carle that provides coverage to Illinois, Indiana, Iowa, and parts of Washington state. Prior to this Kena served as a Patient Experience Advisor at Carle where she was responsible for the education and improvement efforts with all staff and physicians to improve CG CAHPS scores for Carle’s ambulatory clinics. She brings over 14 years of experience in the healthcare field with focus on patient/member experience and process improvement.
In her current roll, Kena has responsibility for the facilitation and coordination of the Star Ratings program for Health Alliance’s Medicare Advantage products. In 2016 the organization was at a 4.5 Star Rating and they are currently working towards becoming a 5 Star plan.
In addition to her Bachelor of Science degrees in Biology and Marketing, Kena also has her Master’s in Health Administration degree. The ultimate vision she has for the Stars program is to utilize predictive analytics in conjunction with collaboration from the entire health plan organization and provider partners to reach and sustain a 5 star Medicare Advantage products.
Noreen has spent her career in the healthcare arena. She blends operational, strategic and technology perspectives as well as payer and provider expertise to lead major initiatives and strategies. She started in hospital operations and was Director of the Admitting & Registration department in the New England Deaconess Hospital, a Harvard teaching hospital in Boston. Transitioning to IT, she implemented the EMPI (Enterprise Master Patient Index) when the Deaconess merged with the Beth Israel Hospital to form what is now the Beth Israel Deaconess Medical Center. From there she moved to the vendor world and ran implementations of EMPI's, HL7 integrations and HIPAA EDI transactions for SeeBeyond Technologies.
Most recently, she has focused on the payer space. She started and oversaw the Star program at Tufts Health Plan, as well as working in IT, developing a senior products PMO and managing the member call center. Moving back to technology, she developed data driven solutions in the healthcare space while working at Informatica. Her current role is developing the Star program at Harvard Pilgrim Health Care, which has recently re-entered the Medicare Advantage market. As a leader in the Clinical Informatics Division, the program focuses on leveraging non-traditional data and analytics to craft targeted initiatives to improve performance in the Star program and the Harvard Pilgrim Stride product
David L. Larsen RN, MHA
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.
Rene’ Mack is an accomplished program manager who has spent 14 years of her career in Managed Care and the last 5 with Blue Shield of CA as a senior clinical program manager. As part of her responsibilities, Rene’ established and continues to manage Blue Shield’s Medicare Star Provider Engagement Program. This program works with more than 30 delegated provider organizations on an ongoing basis to better understand and positively influence the measures that comprise Medicare Star ratings. As part of their engagement strategy, Rene’ and her team of clinical program managers use data to develop and implement tactical and/or clinical programs that are individualized to a provider groups’ needs and objectives. The goal of these efforts is to drive continual performance improvement for the health plan’s provider partners, and improved quality of care for Blue Shield’s Medicare population.
Having a Bachelor Degree in Biology and a Master Degree in Business Administration guided me to start working in the health care industry since 2005. I have had exposure to numerous operational and administrative positions. These prior experiences was a great preparation that leads me to focus on my passion that is Star Ratings, HEDIS and Quality Improvement. I have been lucky enough to work in this field since 2011. My mission is to support and lead operational activities to reflect the excellent quality of care we provide. The past few years I have been dedicated to increase Cigna HealthSpring of Florida overall Star Ratings to the Medicare’s highest rating: 5 Stars on 2019.
Brian May is the Manager of Risk Adjustment at Hometown Health in Reno, Nevada. He started working at Hometown Health in May of 2014 and moved into a Risk Adjustment Analyst role in June 2016, before becoming the Supervisor and now Manager. He received his Bachelor of Science for Business Administration – Finance from CA State University, Chico in 2007. With a passion for data and analytics, Brian has been focused on improving processes and developing strategies to support risk adjustment initiatives for Hometown Health’s Medicare Advantage and ACA lines of business.
Gary Melis is a Clinical Pharmacist for the past six years at Network Health, a local health insurance provider in Northeast and Southeast Wisconsin. He is currently one of two pharmacists involved making MTM calls in-house. His responsibilities also involve NCQA, pharmacy appeals, P&T Committee, Member and Provider relations. Gary's also has experience as pharmacy manager for a national long term care company, pharmacy manager for retail pharmacy chain, and Pharmacy Director for a National Health Care provider. He has also been a pharmacy instructor at local medical college family practice clinic.
Cynthia Pawley-Martin is a Senior Clinical Consultant at Gorman Health Group (GHG). In this role, she provides expertise to health plans and provider practices regarding Quality Improvement (QI), the Centers for Medicare & Medicaid Services (CMS) Quality Bonus Programs, Quality Rating System (QRS), and Star Ratings. Cynthia is a Registered Nurse (RN) certified in Healthcare Quality and brings GHG clients more than 15 years of experience in the healthcare industry. Her areas of expertise include CMS regulatory requirements (Quality/Star Ratings/Physician Quality Reporting System (PQRS), Healthcare Effectiveness Data and Information Set (HEDIS®), Consumer Assessment of Healthcare Providers and Systems (CAHPS®), Health Outcomes Survey (HOS), Models of Care (MOCs), and providing support for Patient-Centered Medical Home (PCMH) and PQRS.
Cynthia comes with a solid record of success leading and supporting QI programs across healthcare delivery systems, including health plans and large physician practices. Her leadership skills allow her to effectively communicate across all organizational levels and enables those teams to reach consensus among diverse stakeholders to deliver better services for GHG healthcare clients.
While at GHG, Cynthia has guided plans in CMS quality program assessment, implementation, organizational design, and MOC development. She has also supported provider groups in obtaining PCMH recognition.
Prior to joining GHG, Cynthia served as Director of Star Ratings for a leading organization and has held numerous positions in Quality and managing HEDIS® for multiple products in the managed care arena. ,
Tim Plank is the Director of Government Revenue for UPMC Health Plan in Pittsburgh, Pennsylvania. Tim has fifteen years of experience working in healthcare finance and operations, nine 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.
Reva Sheehan, Sr. Improvement Specialist in Medicare Quality at Priority Health. With over 10 years in healthcare, Reva has overseen operations of several long term care pharmacies and compound labs prior to joining the Senior Markets team at Priority Health where she transitioned from Part D Pharmacy Operations to Medicare Quality.
Melissa Smith is Senior Vice President of Stars & Strategy at Gorman Health Group. In this role, she is responsible for leading a team of experts to support the needs of health plans, providers, Pharmacy Benefit Managers, and industry vendors in their pursuit of success. Melissa’s team helps clients improve performance within quality ratings systems such as Star Ratings, improve health outcomes and the member experience, evaluate market dynamics and opportunities, optimize distribution channels, and supports client’s strategic planning needs.
Melissa has served the many clients of Gorman Health Group for five years, and brings 25 years of healthcare experience to clients, including more than five years serving in a leadership capacity at Cigna-HealthSpring. 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.
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 and revenue optimization.
Toc Soneoulay-Gillespie, MSW
Toc Soneoulay-Gillespie has over 20 years of experience working with and advocating for refugees and immigrants. As a 1.5 generation refugee, she brings a unique perspective for understanding the strengths and complexities of this community. She holds a bachelor’s degree in Anthropology/Sociology from Eastern Oregon University and a Master of Social Work from the University of Alaska Anchorage. As an interpreter, consultant, trainer, and community organizer, she believes strongly in raising awareness about meaningful language access and when introduced with humility, can reshape the narratives of historically under-served limited English proficient communities and ultimately transform systems. Ms. Soneoulay-Gillespie serves as a commissioner on the Oregon Commission on Asian Pacific Islander Affairs and in her current role as the Social Services Manager at CareOregon, she continues to be a fierce advocate, promoting health equity across the healthcare network.
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.
Robyn is Registered Respiratory Therapist and clinical coordinator at Saint Elizabeth Hospital, Ascension. Her services in the past 17 years include acute care for all ages, DME homecare, cardiac and pulmonary rehab, and patient education/advocacy. She provides personalized management and education to individuals with chronic lung disease. Robyn has a special interest in working with those who have COPD and are wanting to live life to the fullest. Her responsibilities are to provide a proactive condition management program that is designed to help members and participants of Network Health avoid flare-ups, control symptoms and potentially improve their lung conditions.
Lisa Wigfield, RN, BSN, CCM, CRC, CDEO
Lisa Wigfield is no stranger to the Health Insurance Industry having spent the past18 years as a Care Manager and Risk Adjustment Manager for Priority Health. She piloted and in turn created an in- office strategy focused on Risk Adjustment, HEDIS measures, and Stars.
Lisa is a Registered Nurse and holds a Diploma of Nursing from St Clair College and a Bachelor of Science Degree from the University of Windsor. In addition she holds several certifications including: Certified Case Manager (CCM), Certified Risk Adjustment Coder (CRC) and Certified Documentation Expert Outpatient (CDEO).
Sarah Winski is the HEDIS Director for Gateway Health Plan, a Medicaid and Medicare health plan in Pittsburgh, PA. She is responsible for HEDIS and state quality based metrics, including the medical record review process. Sarah has over 18 years’ experience in Medicaid and Medicare HEDIS reporting, including work at both regional and national health plans.
Jennifer Wong is the Director of Stars and Clinical Performance at Blue Cross Blue Shield of New Jersey. She received her Bachelor’s degree from the University of CA, Los Angeles and her Executive Masters of Health Administration from George Washington University. In her current role, she is responsible for enterprise wide quality improvement efforts which includes provider quality transformation, quality data exchange, performance reporting, pay for performance programs, and member engagement and satisfaction programs. In her free time, she enjoys traveling with her family and trying new cuisines.
Debra J. Zeh BSN, RN
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.
Belinda Zhang, PhD, MHA
Belinda is the chief quality officer at CareFirst Blue Cross Blue Shield Community Health Plans DC (formerly known as Trusted Health Plan DC). Prior to that, she was in charge of quality improvement programs for five lines of businesses at Johns Hopkins HealthCare, including one of the largest MCOs in Maryland – Priority Partners. Before working on the health plan side, she coordinated quality improvement efforts on the health care delivery side at three different health systems, including Mayo Clinic (Rochester, MN), Baylor Health Care System (Dallas, TX), and University of Missouri Health Care (Columbia, MO). She holds a PhD in Industrial Engineering, and a MHA degree from University of Missouri – Columbia. She has great passion in improvement of health care for all people in different communities
Staci lives for a challenge in all aspects of her life; always
being drawn to pilot programs, people with innovative ideas,
and newly developed positions that give her the opportunity
to explore new approaches addressing old challenges.
Staci began her zest for professional challenges as far back as the mid 90’s when accepting a position in a pilot Outpatient Unit within a local hospital that planned to take a new approach to cardiac care, then moving on to independent ownership of a franchise in dire straits. She relocated and found herself entering the insurance arena after life took a turn. She has held a variety of positions over the last 20 plus years, including ones with large health plans, independent brokerage firms, small businesses looking to grow, and finally with BlueCross BlueShield of Tennessee. Under the leadership and partnership of equally creative people, she has found an atmosphere that can drive change through creative thinking. She believes that success is possible when people are willing to push away from the norm, break down internal silos and try something new. There is only one direction – forward!