The 14^th Medicare Stars, HEDIS^®, Quality & Risk Summit

Kim Barrus MSN, BSCIS, RN, PMP,

Director, Clinical Outcomes Management,

SelectHealth

Kim is a registered nurse who received her Bachelor of Science in Computer Information Systems from Columbia College of Missouri, and her Bachelor of Science in Nursing and Master of Science in Nursing from Western Governors University. She also maintains a Project Management Professional (PMP) certification from the Project Management Institute (PMI). Kim Barrus began her career with SelectHealth 26 years ago and has worked in a variety of capacities in that time. She developed the SelectHealth Advanced Primary Care (a.k.a., patient centered medical home) program and supporting department. Kim facilitated the initial pilots of the program in 2010. Today the program has 1,240 participating providers at 222 participating clinics. Kim is currently the Director of Clinical Outcomes Management and has oversight for quality, medical home, NCQA accreditation, HEDIS and CMS Stars.

Jennifer Callahan,

President and CEO,

ATRIO Health Plans

Melissa (Missy) Skelton Duke, PharmD, MS, BCPS, FAPhA

Executive Director, Medicare Quality and Stars Strategy

Banner Health

Missy Skelton Duke is the Executive Director of Quality and Medicare Stars Strategy at Banner Health. In this role, she builds the strategic vision and strategies that optimize Banner Health Plans’ Medicare Advantage Star Rating. In this role, she drives alignment across complex provider networks, provider aggregators, population health services organizations, and health plan departments to provide the highest quality health care and service to their Medicare Advantage HMO, PPO, and Dual-Eligible members. Prior to this role, Missy served as the Executive Director of Population Health Pharmacy Solutions and Ambulatory Pharmacy Services and Senior Director of Specialty and Home Delivery Pharmacy Services at Banner Health. She has also served as the Clinical Pharmacy Services Manager for Intermountain Healthcare, where she was responsible for the growth and development of clinical services, collaborative pharmacy practice agreements, and professional development and competency assessment.

Missy has been active in pharmacy advocacy issues throughout her entire pharmacy career. She has served in numerous pharmacy leadership and advocacy roles at the state and national level, most recently serving as APhA Speaker of the House of Delegates.

She received her Doctor of Pharmacy degree from the University Of New Mexico College Of Pharmacy in 2008, and a Master of Science degree in Health Policy and Pharmacotherapy Outcomes Research from the University of Utah. She completed a 24-month residency program in Health-System Pharmacy Administration from Intermountain Healthcare in June of 2010.

Josh Edwards

Stars Program Senior Manager

Devoted Health

Jamie Galbreath, PhD, MPH, CHES,

Quality and Population Health Director,

UCare

Jamie Galbreath is the Quality and Population Health Director for UCare with a background in public health and mental health. She has been at UCare for 13 years and has 21 years of experience working with individuals who have severe and persistent mental illness (SPMI) and substance use disorders. As the Quality and Population Health Director, she provides oversight and manages the HEDIS chart retrieval and abstraction team, NCQA Accreditation (both Health Plan and Health Equity Accreditation), Star Ratings (Medicare, Marketplace, and Medicaid), Population Health, Quality Improvement and Health Improvement Teams. She ensures regulatory oversight on quality improvement projects and supports leading clinical and public health initiatives designed to improve member health outcomes.

Jamie has received her doctorate in Public Health with a specialization in Community Health Promotion and Education from Walden University. She also has her Master’s degree in Public Health from Walden University and Bachelors of Science degree in Community Health Education from the University of Minnesota Duluth. She has completed a mini-MBA certificate program from St. Thomas University in Health Care Management. Further, she is a Certified Health Education Specialist and a member of the Minnesota Society for Public Health Education and the Minnesota Public Health Association. Jamie is a Board member for Touchstone Mental Health and serves on the Public Health Advisory Board for St. Catherine’s University.

Brendan Generelli,

Director of Medicare Stars & Quality,

Johns Hopkins Health Plan

Brendan Generelli is Director of Medicare Stars & Quality at Johns Hopkins Health Plan. Prior to joining JHHP, Brendan was the Senior Program Manager for Stars and Quality at Blue Cross Blue Shield of Rhode Island, where he led them to achieving a 5 Star rating on multiple contracts in back to back years. Brendan has a deep passion for member experience, is a leading voice in the health equity space, and is always striving to improve the quality of care for Medicare Advantage beneficiaries.

Renee Golderman

Senior Vice President and Chief Quality Officer

Capital District Physicians’ Health Plan

With more than 30 years of progressive experience in the health care industry, Renée S. Golderman, MS, RN, NE-BC, is the Senior Vice President and Chief Quality Officer at CDPHP. In this role, Golderman provides the strategic leadership needed to design, implement, and manage quality improvement programs at CDPHP, and is responsible for the plan being named a 5 Star plan by the Centers for Medicare and Medicaid Services (CMS). Golderman was recently named as one of the Top 100 Women Leaders in New York by Women We Admire.

Golderman is responsible for directing HEDIS,QARR, NCQA, and Medicare Stars initiatives at CDPHP, which includes collaboration among Medicare risk, medical management, care management and network providers to drive innovative initiatives to improve quality outcomes and ensure member satisfaction. She has led health care transformation initiatives, including tools for population health and clinical integration strategies, and assists in design and operational aspects of primary care incentive programs.

Golderman is skilled at fostering relationships while executing on strategic plans to drive quality outcomes focused on the Quadruple Aim. Golderman demonstrates sound understanding of and has broad experience with hospital operations, health care finances, board responsibilities, physician relations, and knowledge of how all entities are interdependent, along with current knowledge of the trends and challenges in health care.

Prior to joining CDPHP, Golderman has held various positions in the health care industry and has a record of accomplishments in a range of health care settings, including both the clinical and administrative aspects of inpatient and outpatient care, quality and risk management, hospital and primary care business operations, as well as health plan leadership and administration. Golderman has served as the director of nursing for Seton Health System, part of the Ascension Health System where she was a recipient of the NYSNA Nursing Excellence Award in Administration/Management. In addition, she held clinical management positions at New England Baptist Hospital in Boston, Mass., and New Britain General Hospital in New Britain, Conn. She has also served as a clinical educator for The Eddy in Troy, N.Y.

Golderman earned a Bachelor of Science degree in nursing from SUNY Buffalo, and a Master of Science degree in health care management from Rensselaer Polytechnic Institute. Golderman is a nurse executive-board certified, by the American Nurses Credentialing Center (ANCC), and is a member of the National Association for Healthcare Quality.

Nilda González, MPH, HIA, CHC, MHP, HCSA

VP Quality Management & Stars

MMM Holdings

With over two decades of experience in the insurance and healthcare industry, NILDA GONZÁLEZ has built a career marked by her passion for innovation and her commitment to member and patient well-being. She has worked in key areas such as sales and marketing, operations, customer service, and quality standing out for her ability to lead transformative projects.

Throughout her career, González has been a driving force behind programs that have revolutionized the MMM member experience promoting strong provider collaboration. Among the initiatives she has been part of are the Members Clubs, including support groups for caregivers and mental health, the MMM Mobile App for beneficiaries, and the Office Advantage program, for provider offices staff.

Since 2012, she has focused her work on strategic planning and the development of initiatives aimed at improving Medicare Star Ratings. Under her leadership, she has achieved the optimization of clinical and non-clinical processes and operations, the creation of new technological and administrative tools, and the strengthening of communications with medical providers, among other growth outcomes.

González is an expert in areas such as the Medicare care model, health quality development, care coordination, HEDIS clinical guidelines, benefit design, and federal program regulations. Her career has positioned her as an important voice on care trends for Medicare and Medicaid populations, as well as on health system innovations. She is a strong advocate for better funding for federal program beneficiaries in Puerto Rico, leading to the inclusion of the island into the rightful participation of double quality bonus for Medicare beneficiaries.

Holding a bachelor’s degree in Business Administration from the University of Puerto Rico and a master’s degree in Public Health with a concentration in Gerontology from the Medical Sciences Campus, González combines her academic training with professional designations such as Health Insurance Associate, Certified Healthcare Consultant, Managed Healthcare Professional, and Healthcare Customer Service Associate.

Tara C. Griffin,

Director, Analytics Consulting,

Health Care Service Corporation (HCSC)

Director, Analytics Consulting at Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma, and Texas. (Health Care Service Corporation: HCSC) Focus on HEDIS rate improvement. Conducts data-driven oversight and expansion of HEDIS analytics, data loading, data accuracy and data solutions for Commercial, Exchange, Federal Employee Program, Medicaid, and Medicare products. Works as part of a Data Analyst and Data Engineer team to grow machine learning. Significant contributions toward enhancing Provider Specialty Types within HEDIS mapping to differentiate specialists within Federally Qualified Health Centers, as well as expansion of Certified Nurse Specialists, Prenatal Care, Behavior Health, and Primary Care Providers across each product. Before this appointment, launched HEDIS performance improvement workgroups, as well as integrated member experience strategies for adult and child behavioral health, women’s health, transitions of care and assessed policy/procedures within clinical programs to meet NCQA accreditation requirements.

Tamara Migut,

Director of Quality Improvement,

Health Alliance Medical Plans

Pooja Naithani,

Vice President Risk Adjustment & Quality,

Clever Care Health Plan

Danie Paul,

Senior Manager,

Point32Health

Caroline Paes Leme Pires,

Care Consultant Sr.- Medicare Quality, East Region,

Elevance Health

Caroline Pires is an experienced Care Consultant in NY with a comprehensive background in Population Health and Change Management in healthcare. In my current role I have proven ability to implement value-based quality programs, strategize based on market trends, and collaborate with various stakeholders for effective resource allocation to support quality and cost improvement. She leverage her strong skills in data analysis to provide targeted solutions for HEDIS stars and CAHPS enhancement. In her free time she loves to play and dance with her daughter, read and try diferent cusines.

Dan Weaver,

Senior Vice President, Stars & Quality,

Zing Health

Daniel Weaver recently joined Zing Health, a tech-forward health plan based in Chicago, as the Senior Vice President of Stars and Quality. With over 25 years of experience in Operations and Star Ratings strategy, Daniel has previously served as VP, Government Quality Programs at Highmark Wholecare (formerly Gateway Health Plan) and Director of Stars Programs at Highmark Health, helping both organizations achieve and maintain their first 4.5 Star Ratings. In his career, Dan has overseen the development and implementation of many analytics-driven and beneficiary-focused programs, has adopted continuous improvement and operational excellence philosophies for sustained success, and embraces innovation focused on overcoming socioeconomic barriers to achieving health equity and optimal quality outcomes. In his new role with Zing Health, Daniel will focus on implementing a high-performing Stars infrastructure to support the organization’s rapid growth with a focus on servicing special needs members in several states.

John Willis,

Vice President, Quality and Clinical Integration,

Network Health

Daniel Weaver recently joined Zing Health, a tech-forward health plan based in Chicago, as the Senior Vice President of Stars and Quality. With over 25 years of experience in Operations and Star Ratings strategy, Daniel has previously served as VP, Government Quality Programs at Highmark Wholecare (formerly Gateway Health Plan) and Director of Stars Programs at Highmark Health, helping both organizations achieve and maintain their first 4.5 Star Ratings. In his career, Dan has overseen the development and implementation of many analytics-driven and beneficiary-focused programs, has adopted continuous improvement and operational excellence philosophies for sustained success, and embraces innovation focused on overcoming socioeconomic barriers to achieving health equity and optimal quality outcomes. In his new role with Zing Health, Daniel will focus on implementing a high-performing Stars infrastructure to support the organization’s rapid growth with a focus on servicing special needs members in several states.

Saeed Aminzadeh,

Chief Product Officer,

DecisionPoint by mPulse

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.

Keslie Crichton,

Chief Sales Officer,

BeneLynk

Keslie is the Chief Sales Officer for BeneLynk. In her role, she is not only responsible for new business development but also works on innovative partnerships to improve outreach strategies and health outcomes for our client’s members. At the core of BeneLynk’s services, Keslie and her team work to identify, document, and solve members' social determinants of health (SDoH) challenges by “leading with help.” This increases BeneLynk’s engagement rates across our integrated services while also providing our clients with crucial information they need to deliver care and improve their quality metrics. 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. 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.

Brian Heacox – VP,

Product & Engagement,

mPulse

As Vice President of Product overseeing mPulse's Engagement & Analytics solutions, he is continuously assessing opportunities for improved member targeting and personalized messaging. Brian has a particular focus on developing and enhancing solutions that lower medical and administrative spend within the healthcare space.

Rebecca Jacobson,

CEO,

Astrata

Dr. Rebecca Jacobson is the visionary co-founder, CEO, and President of Astrata, a groundbreaking digital quality company revolutionizing healthcare measurement. With over 25 years of experience as both a physician and informaticist, she is at the forefront of the shift to value-based care. A pioneer in Natural Language Processing, Dr. Jacobson previously served as Vice President of Analytics at UPMC Enterprises and as a Professor of Biomedical Informatics at the University of Pittsburgh School of Medicine. An elected fellow of the American College of Medical Informatics, she actively contributes to the National Quality Forum's AI in Quality Measures Technical Expert Panel and the NCQA Industry Council, shaping the future of healthcare quality.

Reid Kiser,

Founder and CEO,

Kiser Healthcare Solutions, LLC

Reid is the founder and CEO of Kiser Healthcare Solutions, LLC, where he leverages 25 years of experience in healthcare leadership to address critical challenges in quality and performance measurement. His expertise spans a broad range of areas, including the development, implementation, and reporting of healthcare quality measures, as well as data collection, analysis, and electronic healthcare data exchange. He is also skilled in strategic planning and product development within the healthcare sector. Reid's extensive career includes significant national leadership roles. He served as the Director of the Division of Quality Measurement at the Centers for Medicare & Medicaid Services (CMS), where he provided technical guidance and oversaw the development and maintenance of quality measures for various CMS programs. Prior to CMS, he held leadership positions such as Senior Vice President for Performance Measurement and Research at the Pharmacy Quality Alliance (PQA), General Manager of Quality Spectrum at Inovalon, Director of Research and Measurement at the Council for Affordable Quality Healthcare (CAQH), National Director for Clinical Excellence Special Projects and Reporting at UnitedHealthcare, and Director of HEDIS Policy and Manager of HEDIS, CAHPS, and HOS Data Collection at the National Committee for Quality Assurance (NCQA).

Throughout his career, Reid has been actively involved in industry expert panels and committees focused on quality measurement and data analytics. He has also presented at numerous public meetings and industry conferences, sharing his insights and expertise on behalf of his employers and clients. His recent work at CMS emphasized advancing healthcare quality through technology, including digital quality measurement, while ensuring alignment with legislative mandates, CMS program priorities, and regulatory requirements.

Subbu Ramalingam,

Managing Director,

Attac Consulting Group (ACG)

Strategy & execution consulting leader driving performance in healthcare quality, 5-star rating, risk adjustment, and cost results for healthcare organizations. Former VP of health plans handling Medicare, Medicaid, ACA and Commercial plans.

Dan Ready,

Director, Business Development,

DecisionPoint by mPulse

Dan leads business development and strategic partnerships at mPulse, leveraging over a decade of experience in advancing data-driven, consumer-focused solutions. In his current role, Dan partners with healthcare organizations to identify opportunities for innovation, aligning cutting-edge technologies with business objectives. His work focuses on fostering collaboration and designing strategies that personalize consumer engagement, streamline operational efficiencies, and drive measurable improvements in business performance.

Reva Sheehan,

– Sr. Director, Customer Insights,

mPulse

Reva has more than 15 years’ industry experience ranging from long term care and compound pharmacy management to health plan operations and quality. As an avid collaborator, Reva engages internal and external stakeholders to improve processes for optimal outcomes while keeping the member’s experience at the heart of every conversation.

Melissa Smith,

Founder and Senior Advisor,

Newton Smith Group

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.

Rebecca Yarish,

Senior Manager,

ProspHire

Rebecca is a Senior Manager at ProspHire, a national management consulting firm dedicated exclusively to healthcare. She specializes in delivery and execution within the Payor Space, with a strong focus on Medicare Advantage and Stars Performance Improvement. Leveraging a data-driven approach, Rebecca helps clients assess their current performance, identify key opportunities, and develop sustainable improvement programs to enhance Star Ratings and drive long-term success.

Amber Smits,

Manager, Strategic Initiatives and Health Equity,

Network Health

Ally Thomas, Ph.D.,

Associate Vice President, Quality Improvement,

UPMC Health Plan

Ally Thomas, Ph.D. is the Associate Vice President of Quality Improvement at UPMC Health Plan. She oversees several teams including Medicare STARs, Quality Data and Analytics, Community-Based Quality Programs, Member Experience and Operational Excellence, and Program Development and Innovation.

Dr. Thomas joined UPMC Health Plan in 2018 to build a newly formed Medicare STARs analytic team. One year later, in addition to the analytics, she was asked to build the overall Medicare STARs program. This new program resulted in UPMC Health Plan earning their first 5-STAR Rating for the 2022 STAR Rating Year and maintaining that 5-STAR for the 2023 STAR Rating Year. In 2021, Dr. Thomas was asked to expand these best practices to enhance Quality across the business as Associate Vice President of Quality Improvement.

Dr. Thomas is also responsible for leading the development of several innovative programs including the Medicare Faith & Wellness Program and partnering with Astrata (www.astrata.co ) to advance the use of Natural Language Processing to enhance the development and impact of various interventions.

Prior to joining UPMC Health Plan, Dr. Thomas worked as a researcher in psychology and education. Specializing in program design and evaluation, statistics, measurement science, survey design, social cognition, learning and instruction, and accountability programs. During this time, she collaborated on several contracts and multi-million-dollar NSF grants with the City University of New York and the University of Pittsburgh.

Dr. Thomas received her Ph.D. in Educational Psychology with a specialization in Quantitative Methods in Education and Psychological Research from the Graduate Center, CUNY.  As well as her M.A. in Psychology from San Diego State University and her B.A. in Psychology from Biola University.