Eden Anne Encarnacion, MHA
Camille Clarke-Smith, EdD, MS, CHES, CPT
Abby Hoffman, R.N.
Moraima Rios Gonzalez
Becky Simmons, RN, BSN
Stephen P. Winn, CPHQ
Saeed founded Decision Point with the mission of improving health plan clinical, financial and operational performance through informed, data-driven predictions on strategic decisions. He has more than 25 years of health information technology experience, with a track record of developing innovative approaches to solve complex business problems. He has held key senior management positions at Eliza Corporation, Ingenix (currently Optum), IHCIS and ProVentive, where led high- performing teams focused creative uses of technology for practical problem-solving. Saeed is a graduate of The Johns Hopkins University with a BA in Economics.
Eden Anne Encarnacion, MHA
Eden Encarnacion, MHA is currently the Sr. Manager, HEDIS for Medicare Stars Program at Blue Shield CA. She manages the member and provider-facing engagement programs to drive improvements in HEDIS performance. She has 8 plus years of experience leading Quality Improvement programs across multiple Lines of Business in both provider and payer settings. Her experience includes Risk Adjustment, Encounter Data Submission, and Member Experience (CAHPS, HOS). In her previous role as Director, Quality and Medicare Stars for Clever Care Health Plan, she led the development and implementation of the provider incentive program, transitions of care program, and multiple initiatives across HEDIS, Pharmacy, and CAHPS measures. Her previous roles also include Director of Quality Improvement and Physician Operations at Tenet Healthcare. In this capacity, she worked directly with multiple provider groups as well as with various health plans to manage end-to-end efforts and oversee performance on value-based care programs focused on Quality and Risk Adjustment improvement.
Jessica Assefa provides expertise to health plans regarding Quality Improvement, CMS’s Quality Bonus Programs, 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) knowledge. Prior to joining the Convey family of companies, Jessica led the Medicare, Marketplace and Medicaid Star Ratings Programs and Quality Ratings Systems for an independent, nonprofit health plan in Minnesota, successfully achieving 4-, 4.5- and 5-Star Ratings for multiple Medicare and Marketplace contracts and product lines. Her managed care experience expands into Clinical Compliance, including training and oversight of care coordination entities for Medicare Advantage and D-SNP.
Michael is a public policy expert with more than 15 years of working with federal policymakers and lawmakers to advance regulatory and legislative activities. He previously served as a senior policy advisor at the Department of Health and Human Services Office of the Secretary, attorney with the Office of Management and Budget, and as a law clerk at the US Department of Labor and Health Policy Associate with the Senate Finance Committee.
Chayla Beason is the Director of Medicare Advantage Clinical Data Strategy & Execution at Blue Cross Blue Shield of Michigan. She is responsible for consulting with business executives and enterprise partners to set the strategic direction and execute on the strategy to drive cost, process and operational efficiencies related to data acquisition, connectivity & EHR use, enablement & innovative solutions, interoperability and health information management for Medicare Advantage.
Andrew is the Medicare Stars Practice Leader at ProspHire, a national management consulting firm exclusively dedicated to healthcare. Specializing in delivery and execution, Andrew’s work has focused on the Payor Space supporting clients with go-to-market strategic planning, new product development, growth and transformation activities, post-acquisition integration efforts, and other strategic initiatives for MCOs. One of his key areas of expertise is Medicare Stars where he takes a lead role in guiding health plans through the program, enabling long-term sustainable success. He has a passion for staying at the forefront of policy changes, regulatory changes, and trends related to managed care, particularly in context to the Medicare Stars Program. Being an emerging thought leader in the field, he actively engages with new developments and industry changes, positioning himself and ProspHire as leaders in healthcare consulting.
Katie Capadona is the Risk Adjustment Revenue Manager for Security Health Plan. In this role she is responsible for implementing and maintaining end-to-end risk adjustment strategies for the organizations ACA, Medicaid, and Medicare programs. Prior to joining Security Health Plan, Katie led the Medicare risk adjustment strategy for a Wisconsin based FIDE-SNP/DSNP program for over 15 years. During her tenure there she worked closely with the IT, Quality, and Provider Education to develop a cohesive approach to Medicare Stars and Risk Adjustment that created operational efficiencies, improved provider engagement, and increased revenue.
Tyler Chancellor is a Program Manager in the Quality Improvement Department at UPMC Health Plan. In 2021, Tyler joined the Medicare STARs and Quality Team leveraging his experience in health and wellness to enhance member experience. Tyler’s expertise in health and wellness helps support the Medicare Faith and Wellness Program to be more targeted with Medicare STARs gap closures. By supporting the initiative developed by Dr. Camille Clarke-Smith, Tyler strives to promote healthy equity for members and provide access to care for those who may be at risk.
Camille Clarke-Smith, EdD, MS, CHES, CPT
Dr. Camille Clarke-Smith is a Program Director in the Quality Improvement Department at UPMC Health Plan. Dr. Clarke-Smith created and currently leads the Medicare Faith and Wellness Program, originally launched as the Medicare Healthy Church Challenge in 2019 that engages Faith-Based Organizations’ Medicare beneficiaries. The program focuses on enhancing health outcomes in communities, enhance member satisfaction, and contribute to higher quality ratings for Medicare STARs.
Dr. Clarke-Smith is also the host of the UPMC Health Plan micro-cast: Health Break. Outside of UPMC Health Plan, Dr. Clarke-Smith is the founder of the non-profit organization T.H.A.W (Transforming the Health of African American Women) Inc. Dr. Clarke-Smith earned a BS in Psychology and Sociology, MS in Exercise Science, and an EdD in health and physical activity from the University of Pittsburgh and is currently pursuing her MSW at Carlow University.
Keslie brings a long history of strong execution and delivery for integrated solutions across risk adjustment, quality performance and eligibility and enrollment solutions in both Medicare and Medicaid.
At BeneLynk, Keslie is responsible for driving enterprise growth and innovative partnerships to improve outreach strategies and health outcomes for our client’s members. Keslie works closely with BeneLynk’s product team to offer differentiated services and capabilities to maintain its market leader position.
Keslie has worked in managed care for over 25 years with a focus on SDoH solutions that improve members lives but also provide a return on investment for our clients. Keslie's passion lies in working on strategies that put members at the center while ensuring we deliver accurate risk-adjusted revenue, quality performance, and member retention.
Prior to joining BeneLynk, Keslie served as Vice President, Sales, and Account Management at Change Healthcare (formerly Altegra Health/Social Service Coordinators). Keslie holds a B.S. in Business Administration from Regis University and worked toward her MBA and Masters in Healthcare Administration at Sacred Heart University in Fairfield, CT.
Omar joined Community Health Plan of Washington, CHPW, as the Director of Pharmacy in 2019 after sixteen years with Walgreens Co., where he led Specialty Pharmacy operations for the Pacific Northwest Region.
Omar has extensive experience in Specialty Pharmacy, Managed Care including government programs, and Clinical Pharmacy quality initiatives. Omar’s current role is focused on PBM relationship oversight, clinical pharmacy integration, and utilization management of medical and prescription drug benefits. Omar received his Doctorate of Pharmacy Degree from the University of Washington in 2005 and continues to reside in the beautiful Pacific Northwest.
Michael A. Farina, R Ph., MBA joined CDPHP in 2019 and is currently the Director of Health Care Quality In this role, he has primary responsibility for the HEDIS hybrid abstraction process, day to day operational aspects of the quality department. Michael earned a Bachelor of Science degree from Albany College of Pharmacy and a masters of Business Administration from Union College. Michael is a registered pharmacist in New York State.
Brendan Generelli is the Senior Program Manager for Stars and Quality at Blue Cross Blue Shield of Rhode Island. In his 11 years at BCBSRI, Brendan has had a variety of roles ranging from Customer Service to Operations to Strategy, but has always maintained focus on member and provider experience. Under his management of the 5 Star program, BCBSRI became the first and only plan available to all Rhode Islanders to achieve a 5 Star rating and now has repeated that rating in back to back years.
Giuliano is the Medicare Program Manager for at Elevance Health, covering the Connecticut Market . In his role he facilitates programs to align with external stakeholders performance goals as it pertains to Stars, HEDIS, Risk Adjustment and CAHPS, while ensuring that patients are getting the care they need. Giuliano has been involved in healthcare quality improvement for over 8 years, priding himself in fostering great relationships to ensure a successful collaboration. In his free time he enjoys golfing and teaching cycling classes as - spinning instructor.
Tamara Khachikyan is the Operational Program Manager at Blue Shield of California. Tamara’s current role focuses on providing strategic direction, oversight, and management of the Medicare Member Engagement programs, aiming to improve Medicare Stars performance. The effectiveness of the programs she leads and oversees is not only reflected in the health outcomes of the members but also the improvement in quality metrics. Prior to joining Blue Shield of California, she was a Senior Consultant at Kaiser Permanente who successfully managed the health plan’s NCQA Accreditation. With her substantial expertise in quality improvement, project management, and consulting, Tamara understands the quality and value of healthcare services.
Tamara is the Director of Quality Management for Health Alliance, a subsidiary of Carle Health. Carle, a Vertically Integrated Health System, encompasses hospitals, physicians, outpatient and wellness divisions, as well as the health plan. She has been in her role since 2019. In Tamara’s role, she has oversight of the Health Alliance quality improvement program, HEDIS data collection and reporting, and Member/Provider Resolutions.
She brings over 23 years of experience in the healthcare field at Carle Health with focus on patient/member experience, data collection and analytics, and process improvement. <
In addition to her Bachelor of Science degree in Pharmacy from Midwestern University Chicago College of Pharmacy, Tamara is also a Certified Professional in Healthcare Quality from the Healthcare Quality Certification Commission.
Jenna Pinnelle is the Medicare Program Manager for the state of Maine at Elevance Health. In her current role she manages and coordinates the development of provider programs related to Stars, HEDIS , Risk Adjustment and CAHPS. She has been involved in healthcare quality improvement for over 10 years and has a passion for elevating patient outcomes and experience throughout the healthcare continuum. In her free time she enjoys exploring the outdoors through surfing, hiking, and snowshoeing.
Moraima Rios Gonzalez
10+ years of experience in the healthcare industry specifically focused on Medicare Advantage Stars Rating, public policy, and compliance. Currently serving as the subject matter expert on Stars Rating Methodology and its related data sources. Responsible for leading analyses used to establish effective Stars strategies and initiatives impacting HEDIS, Operational, Member Experience among other measures. During my tenure MCS became the first Medicare Advantage Plan in Puerto Rico to attain 5 stars.
Completed my Dr. PH in Health System Analysis and Management from the University of Puerto Rico on 2016 and a Credential in Public Leadership from Harvard University on 2021.
Sabrina Zerzouri is a Senior Program Manager of Medicare Quality at Point32Health where she is responsible for Medicare Star performance oversight and quality improvement. Her background in Public Health has contributed greatly to her success in developing creative strategies to address clinical and member experience quality gaps in healthcare today. She has developed successful provider engagement programs, actionable and informed reporting, and creative tactical solutions to overcome performance barriers. She believes in the power of data to address disparities in health equity and to improve health outcomes. Sabrina is active in professional organizations and is currently a Board Member for the New England Association of Healthcare Quality and a participant in the Boston Chamber of Commerce Women’s Leadership Program, Class of 2024.
Nazanin is a Manager of Health Data Exchange Adoption and Analytics Consulting at Health Care Service Corporation which operates Blue Cross and Blue Shield® Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. Nazanin’s current role at HCSC focuses on building core capabilities for a real-time bi-directional health data exchange. Nazanin’s work involves strategic and operational activities in acquiring health data to facilitate treatment, payment, and operations. She is also responsible for the adoption, value realization, and analytics needed to drive the Health Data Exchange program at HCSC. Prior to HCSC, Nazanin worked in an administrative role at Northwestern Medicine’s Feinberg School of Medicine in their outcomes transplant research group. Nazanin earned her bachelor’s degree in psychology from the University of Illinois at Chicago and holds a certificate in Leadership Principles from Harvard Business School Online. She is currently pursuing her Master of Science in Health Informatics with a focus on Healthcare Administration at Northwestern University. Nazanin has over a decade of combined healthcare and health insurance experience. Nazanin has a passion for solving healthcare’s biggest challenges and improving patient outcomes by using technology and data.
An expert in multiple aspects of CMS star ratings and quality, Kim is a strategic minded healthcare
executive, committed to creativity and innovation in every aspect of health care.
Kim has almost 30 years of extensive experience focused on quality management stars, accreditation and process improvement, inclusive of Six Sigma projects in the national health plan industry. Working for several of the largest US health plans for extended periods, she has designed and implemented roadmaps and tactical strategies designed to improve performance, increase member engagement and yield greater returns. Her experience includes working in local, regional, and national leadership roles and experience with Medicaid, Medicare and Commercial lines of business.
She has led efforts not only with health plans but also with other partners such as providers assisting in strategic design to maximize the efficiencies between payor and providers. Additionally, she has direct experience in 14 states/markets overseeing all aspects of quality, HEDIS/CAHPS/HOS as well as Risk Adjustment.
Kim has excelled in developing strategies to achieve outcomes on multiple aspects of quality, operations and network areas. Her outcomes have included being the recipient of the 5 Star Award for being the first plan in a national MCO to achieve the coveted 5-star rating, receiving the Executive Development Program nomination and incremental increases in the number of plans achieving their star goal from 42% to 67% within 2 years in another national Medicare plan.
For more than a decade, Melissa Smith has been at the forefront of leading Medicare Advantage and Star Ratings teams. As the founder of Newton Smith Group and a Senior Advisor to Oliver Wyman, Melissa is a widely recognized thought leader and healthcare strategist. Her proven track record of success lies in developing comprehensive enterprise-wide solutions that enhance Star Ratings, quality performance, health outcomes, and the overall member experience.
Melissa excels in crafting strategic and tactical solutions to meet client needs, forging productive partnerships across internal teams and external vendors, and improving performance on various quality measures. Her unique background in business, finance, regulatory compliance, and healthcare quality provides clients unparalleled access to healthcare strategy, quality performance, and revenue optimization.
As the former Chief Consulting Officer at Healthmine and Senior Vice President at Gorman Health Group, Melissa's leadership spans across prestigious organizations like Cigna-HealthSpring and Vanderbilt University Medical Center. Graduating from Purdue University, Melissa began her career at KPMG, LLP and is a Certified Public Accountant.
Stephen P. Winn, CPHQ
Stephen Winn is the Senior Director for Quality at the Mid-Atlantic Permanente Medical Group, a large multi-specialty medical group based in the Mid-Atlantic, and oversees Quality Program reporting, including HEDIS. With more than a decade of experience, he focuses on building programs, systems, and workflows that promote the delivery of high-quality care and accurate reporting.
Prior to working in Healthcare, he was an International Economist at the U.S. Department of Treasury.