2020 Speakers

Faegre Baker Daniels Consulting

Michael S. Adelberg

Principal & Lead, Healthcare Strategy Practice,
Formerly, Director of Medicare Advantage Operations, CMS
Humana

Caraline Coats

Vice President, Bold Goal & Population Health Strategy
SCAN Health Plan

Archie Dey

Director of Customer Experience Insights
Blue Shield of California

Torrie Fields, MPH

Senior Manager, Advanced Illness & Palliative Care, Healthcare Quality & Affordability
Premier Home Health Care Services

Jennifer Gentzlinger

Vice President, Strategic Development
UCare

Gregory A. Hanley, FACHE, CPHQ

Vice President, Quality Management & Pharmacy
Oscar Health

Amanda Hazer

Director of Population Health
Oscar Health Insurance

Kurt R. Herzer, MD, PhD, MSc

Director of Population Health
American Telemedicine Association

Megan S. Herber

Director, Faegre Baker Daniels Consulting, Policy Consultant
Harvard Pilgrim Health Care

Noreen Hurley

Program Manager, Star Quality & Performance
SummaCare Health Plan

Tracy Jones

Senior Compliance Coordinator
Cigna

Christine Leo

Vice President, Senior Products
Network Health

Gary Melis

Clinical Pharmacist
UnitedHealthcare

Kevin Moore

Vice President, Policy – Health and Human Services
HealthEdge

Harry Merkin

Vice President, Marketing
UPMC Health Plan

Angela Perri

Vice President, Strategic Alignment, Transformation & Consumer Innovation, (Business Transformation Office)
Martin’s Point Health Care

Dawn Peterson

Director of Risk Adjustment
Health Alliance Plan (HAP)

Lori Rund

Vice President, Product Management & Market Intelligence
Health New England

Amy Sepko

Medicare Program Manager
Capital District Physicians’ Health Plan

Michael Spicer

Director of Product Innovation & Research
Clover Health

Khoi Ta

Associate General Counsel
Health Alliance Medical Plan

Randy Walker

Vice President, Provider Network Management & Partnerships
Carrot Health

Kurt Waltenbaugh

CEO
Gateway Health

Dan Weaver

Vice President, Formerly Director of Program Management, Government Business, Quality Improvement, Highmark
Hyperlift

Ian Wolfman

CEO
Speakers Biographies


Michael S. Adelberg

Principal & Lead, Healthcare Strategy Practice,
Formerly, Director of Medicare Advantage Operations, CMS
Faegre Baker Daniels Consulting

Mike Adelberg leads the Healthcare Strategy Practice at Faegre Baker Daniels Consulting. He has 25 years progressive healthcare industry and government experience in Medicare, Medicaid and commercial health insurance. Mike spent fifteen years at the Centers for Medicare and Medicaid Services (CMS), including concurrently serving as the director of the Insurance Programs Group and the acting director of the Exchange Policy and Operations Group in the Center for Consumer Information and Insurance Oversight (CCIIO) where he oversaw most of the functions of the federally-run health insurance exchanges; serving as the Director of Medicare Advantage Operations, where he supervised the annual cycle for review and award of Medicare Advantage bids and contracts, developed CMS’s operational policy, and led the monitoring of Medicare Advantage contractors; and serving as the associate regional administrator for Medicare operations (Chicago Region) and the director of education and assistance programs. Mike gained private sector experience as vice president of product development and government affairs for the Universal American Corporation, a multi-state health insurer which operated Medicare Advantage and Medicaid health plans (subsequently acquired by Wellcare).

He has also led or co-led health policy studies published in Health Affairs and The American Journal of Managed Care. Mike speaks and publishes frequently on healthcare topics and has served on numerous advisory committees. He’s been quoted in the Washington Post, New York Times, Modern Healthcare, NPR, and other leading media. In his spare time, Mike is an author. He’s written three novels, a history book, several scholarly journal articles, and over sixty book reviews.

Caraline Coats

Vice President, Bold Goal & Population Health Strategy
Humana

Caraline Coats is Vice President of Humana’s Bold Goal and Population Health Strategy, leading Humana’s mission to help improve the health of the communities it serves by making it easier for people to achieve their best health.

Coats has been with Humana for over eleven years. She started as a Regional Director of Medicare Operations in Arizona and relocated to Florida, where she became the Vice President of Network Management and subsequently, the Regional Vice President of Network Management for the East Region. In her role before joining the Bold Goal team, Coats served as Vice President of Humana’s Value-Based Strategies, leading the organizational advancement of innovative payment models that enable Humana to support providers as population health managers in value-based care relationships.

Prior to Humana, Caraline was Vice President of Operations with a hospitalist company and Assistant Vice President of Managed Care for IASIS Healthcare in the Arizona and Nevada regions. She credits her understanding and experience working directly with physicians and hospitals for the opportunities she has had with Humana.

Caraline holds an undergraduate degree in biology and a Masters in Health Services Administration from the University of Michigan. She and her husband have two sons, Michael (4 years old) and Nicholas (3 years old). Outside of Humana, Caraline spends her time with family and enjoys running.

Archie Dey

Director of Customer Experience Insights
SCAN Health Plan

Archie Dey is accountable for Consumer Experience and Insights at SCAN Health Plan. In his current role, Archie leads the strategic planning, design and implementation of initiatives which drives Member Satisfaction, Net Promoter Score and Retention. Archie also acts as the Business Lead for implementing Artificial Intelligence to enable data informed decision making and strategy.

Archie has extensive healthcare experience with both Health Plan and Provider groups. He has lead enterprise efforts to create innovative programs focused on customer experience, enterprise transformation, Consumer insights and advanced analytics

Prior to SCAN, Archie has been a management consultant specializing in Strategy and Operations for the Healthcare Industry. Archie did his undergraduate in Mechanical Engineering and earned his MBA from USC Marshall School of Business.

Dawn Peterson

Director of Risk Adjustment
Martin’s Point Health Care

Dawn Peterson, Director of Risk Adjustment for Martin’s Point Health Care recently joined MPHC after completing fifteen years of service at another industry leading integrated health system on the clinical, hospital, and insurance sides of medicine. Professional positions Dawn has served are various and include communication, auditing, education, and billing, coding and leadership for professional fee for service, risk adjustment, care management and population health.

Gary Melis

Clinical Pharmacist
Network Health

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.

Kevin Moore

Vice President, Policy – Health and Human Services
UnitedHealthcare

Kevin Moore is the Vice President of Policy for Health and Human Services at UnitedHealthcare Community & State. UnitedHealthcare Community & State proudly serves nearly 6.4 million Medicaid members in 27 states, plus Washington D.C. UnitedHealthcare is a division of UnitedHealth Group (NYSE: UNH) which is a diversified health and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.

As Vice President of Health and Human Services, Kevin focuses on the development of sustainable interventions that improve the health of those we serve by identifying and addressing social, economic, workforce, transportation and nutritional barriers. Prior to this role, Kevin served as Senior Vice President of Medicaid Strategy for Aurora Health Care. Before joining Aurora Health Care, Kevin was appointed by Gov. Scott Walker to serve as Wisconsin’s Medicaid Director and Administrator of the Division of Health Care Access and Accountability in the Department of Health Services (DHS).

Kevin has served on a several boards and committees including the Waste, Fraud and Abuse Elimination Task Force, the State Council on Alcohol and Drug Abuse (SCAODA), and the Wisconsin Child Abuse and Neglect Board.

Kevin holds dual Bachelor of Science degrees in History and Political Science from the University of Wisconsin—Madison. He, his wife Heidi, and daughter Scout reside in Madison, WI.

Harry Merkin

Vice President, Marketing
HealthEdge

Harry Merkin has worked with both payers and providers through many dynamic changes in healthcare for a number of years. He is currently responsible for Marketing at HealthEdge, including product marketing, demand generation and thought leadership. He previously had similar responsibilities at Evariant and NaviNet and has collaborated with many transformative entities across the healthcare landscape. Harry has helped introduce and promote innovative enterprise software solutions that enable payers to improve their competitive effectiveness, as well as perform valuable communications between payers, providers, and consumers. He is a frequent speaker at industry conferences and forums and contributor to the 'Edge Report, the HealthEdge blog.

Torrie Fields, MPH

Senior Manager, Advanced Illness & Palliative Care, Healthcare Quality & Affordability
Blue Shield of California

Torrie leads the development and implementation of programs and processes at Blue Shield of California that work to improve the quality of life for individuals with serious illness and their families.

Torrie has led the development of highly successful palliative care initiatives including benefit design, case management, caregiver support, medical home development, and policy and engagement efforts. Prior to joining Blue Shield, Torrie worked as an applied health services researcher in a variety of settings, including health plans, health delivery systems, local and federal health departments, and in university research laboratories. She has extensive experience in health policy development and implementation. In addition to her work with Blue Shield of California, Torrie acts as a consultant and curriculum developer for The Center to Advance Palliative Care and California State University Palliative Care Institute.

Torrie holds a Master's in Public Health in health management and policy from the Oregon Master of Public Health Program at Oregon Health and Sciences University, a Certificate in Gerontology from Portland Community College, a Bachelor of Science degree in sociology from Portland State University, and a Bachelor of Arts degree in communication theory from University of California, San Diego.

Jennifer Gentzlinger

Vice President, Strategic Development
Premier Home Health Care Services

Jennifer joined Premier Home Health Care Services, Inc. in November of 2011 as an Operations Manager and in her time with the organization she has held multiple positions, including Office Administrator, Assistant Director of Operations, and AVP of Managed Care Services. Jennifer’s experience at Premier spans all service lines and includes launching new home care and care management initiatives in numerous geographic locations. In her current role as VP of Strategic Development, her focus is developing and implementing strategic growth plans that reflect the organization’s mission and vision. A graduate of the University of Rhode Island, Jennifer is currently pursuing a Master’s degree in Public Health.

Gregory A. Hanley, FACHE, CPHQ

Vice President, Quality Management & Pharmacy
UCare

Greg is the Vice President of Quality Management & Pharmacy for UCare. UCare serves over 400,000 members in Minnesota and Wisconsin. Greg provides oversight and direction for the CMS Star Ratings improvement program, HEDIS, CAHPS, HOS, QRS, QIS, NCQA Accreditation, member complaints, appeals, and grievance process, practitioner credentialing, and Pharmacy. UCare has had an Excellent NCQA Accreditation rating since 2014 and has a 4.5 Star Medicare Advantage plan.

Prior to joining UCare, Greg was the Midwest Regional Director of Quality Improvement at Coventry Health Care in Kansas City, MO. As such, he oversaw Coventry’s credentialing, NCQA Accreditation, CAHPS and quality of care, as well as its quality Committees and all quality improvement projects.

Greg retired from the Army in 2005 after a 21-year career as a Medical Service Corps Officer and in Psychological Operations. Greg is board certified by the American College of Healthcare Executives (ACHE) as a Fellow (FACHE) in health care management and a Certified Professional in Healthcare Quality (CPHQ). He earned a Bachelor of Arts degree from St. Cloud State University and a Master of Business Administration from Portland State University.

Amanda Hazer

Director of Population Health
Oscar Health

Amanda is the Director of Population Health at Oscar where she has been for 2 years. In that time, she has worn many hats at a fast paced and high growth health insurance company disrupting the member experience with a combination of a tailored concierge model, highly iterative and forward-thinking product offerings and a deep analytical foundation which is at the core of all that we do. Some of her favorite projects at Oscar include building our first procedural cost estimate tool, establishing a Social Determinant of Health (SDoH) program from scratch, bringing design thinking to the innovation process and building a team of incredibly thoughtful and passionate leaders in the organization. Prior to Oscar, Amanda worked at Pricewaterhouse Coopers' Health Industries Advisory focusing on helping clients in the R&D space. She got her MBA from Carnegie Mellon University where she focused on Management of Innovation and Product Development and patented a toddler feeding device. Before business school she worked at the Children's Hospital of Pittsburgh where she worked closely with researching physicians to get the grant money needed to continue their lifesaving work. In 2010, she got her Bachelor of Science degree from Allegheny College where she studied neuroscience and conducted cancer research focused on monitoring current patients' mood while supplementing with Omega-3 fatty acids.

Kurt R. Herzer, MD, PhD, MSc

Director of Population Health
Oscar Health Insurance

Kurt R. Herzer, MD, PhD, MSc, is the Director of Population Health at Oscar Health, a tech-focused health plan headquartered in New York City where he oversees the teams responsible for clinical prototyping and experimentation, clinical intervention design and scale, HEDIS/Stars, clinical transformation; and behavioral health.

Dr. Herzer’s academic research has included the role of vitamin A in reducing childhood mortality and blindness in developing countries as well as national assessments of healthcare quality and patient safety. He has co-authored dozens of journal papers and spoken or presented at numerous national or international conferences and meetings related to health care, patient safety, and disabilities. Dr. Herzer has previously worked in the Office of Health Reform in the Department of Health and Human Services in Washington DC during the Obama Administration and at the World Health Organization in Geneva, Switzerland.

He is a recipient of the Harry S. Truman Scholarship, honoring leadership and commitment to public service, as well as the Marshall Scholarship awarded by the British Government. Dr. Herzer is a graduate of Johns Hopkins University where he received his BA, MD, and PhD degrees and the University of Oxford where he received an MSc in social policy.

Megan S. Herber

Director, Faegre Baker Daniels Consulting, Policy Consultant
American Telemedicine Association

Megan Herber is a Director in the Health and Biosciences Practice at Faegre Baker Daniels Consulting. Megan partners with clients to analyze and develop strategies related to legislative and regulatory policy developments impacting the health care industry. Prior to joining Faegre Baker Daniels, Megan managed the House Energy and Commerce Committee health care portfolio for U.S. Rep. Doris Matsui (CA-06), most recently as Legislative Director. While pursuing her Master of Public Health, Megan served as health policy legislative fellow for former Sen. John Rockefeller IV (D-West Virginia). Prior to moving to D.C., Megan worked in hospital consulting in California, where she performed revenue cycle auditing and strategic advising. She leverages her in-depth understanding of the processes and pressure points that drive federal health care policy to help clients adapt and thrive in an ever-changing regulatory environment.

Megan is an expert on federal legislative health care policy, particularly policies that fall in the jurisdiction of the House Energy & Commerce Committee, including those that affect the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), the Substance Abuse and Mental Health Services Administration (SAMHSA) and other Department of Health and Human Services (HHS) agencies. She has particular subject matter expertise in digital health including Medicare telehealth policy, digital therapeutics, remote prescribing of controlled substances, software as a medical device, and electronic health record interoperability.

Noreen Hurley

Program Manager, Star Quality & Performance
Harvard Pilgrim Health Care

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

Michael Spicer

Director of Product Innovation & Research
Capital District Physicians’ Health Plan

Mike leads the product innovation team of portfolio managers, researchers, and analysts at CDPHP in Albany, NY. Mike’s team is always seeking out new trends and disruptions in healthcare to enhance CDPHP’s product portfolio, ranging the gamut from digital health technologies to high deductible plans paired with HSAs.

Mike is most interested in studying and utilizing consumer behavior trends in healthcare, including the choices people make, why they make those choices, and the influences required to help them make choices that are more appropriate.

Originally from Syracuse, New York, Mike relocated for his post-secondary education, including a B.S from Union College (NY) focused in Neuroscience and Quantitative Economics, as well as a Masters of Business Administration (M.B.A.) focused in Healthcare Management from Clarkson University. Mike now resides with his family and dachshunds in Latham while continuing to work on his golf game.

CHRISTINE LEO

Vice President, Senior Products
Cigna

Ms. Leo oversees the overall performance, strategic direction and product development for Cigna Healthspring's Medicare products. Prior to joining Cigna, she worked for Aetna, where she was most recently was the National Head for Medicare Advantage product and strategy.

Previously, Ms. Leo held leadership roles at Aetna in national contracting, network contracting, operations and dental. She has an MBA from St. Joseph's University and lives in Philadelphia with her husband and daughter.

Harry Merkin

Vice President, Marketing
HealthEdge

Harry Merkin has worked with both payers and providers through many dynamic changes in healthcare for a number of years. He is currently responsible for Marketing at HealthEdge, including product marketing, demand generation and thought leadership. He previously had similar responsibilities at Evariant and NaviNet and has collaborated with many transformative entities across the healthcare landscape. Harry has helped introduce and promote innovative enterprise software solutions that enable payers to improve their competitive effectiveness, as well as perform valuable communications between payers, providers, and consumers. He is a frequent speaker at industry conferences and forums and contributor to the 'Edge Report, the HealthEdge blog.

Tracy Jones

Senior Compliance Coordinator
SummaCare Health Plan

Tracy Jones is a Senior Compliance Coordinator for SummaCare Health Plan in Akron, Ohio. She has been with SummaCare for over 19 years and has a background in database management and operational process evaluation. Tracy is also responsible for the implementation of compliance initiatives such as dashboard reporting, policy management and internal compliance department over-sight.

Angela Perri

Vice President, Strategic Alignment, Transformation & Consumer Innovation, (Business Transformation Office)
UPMC Health Plan

Angela Perri oversees the Business Transformation Office, Organizational Performance and Project Management Office, Consumer Innovation, and the Medicare STARs program. She leads business alignment and prioritization initiatives overseeing strategic planning and multidisciplinary approaches for development and growth.

Angela has nearly 20 years of experience in managed health care and managed behavioral health care. Prior to joining UPMC, she served in executive leadership roles for several Fortune 100 organizations including UnitedHealth Group (Optum), Centene Corporation, and Amerigroup (an Anthem Company). She led development, strategic planning, and growth for Medicaid, Medicare Advantage and Special Needs Plans, and Commercial products designing and implementing population health management programs in numerous states.

Ms. Perri is recognized nationally as an expert on models of care for persons with Intellectual and Developmental Disabilities (IDD), Foster Care, Managed Long Term Services and Supports (LTSS) and integrated behavioral health. She also serves on the Board of Directors for Allegheny Family Network.

Lori Rund

Vice President, Product Management & Market Intelligence
Health Alliance Plan (HAP)

Lori Rund is the Vice President, Product Management and Market Intelligence at Health Alliance Plan, a managed care organization owned by the Henry Ford Health System in Detroit. Lori has over 25 years of health care experience in all aspects of the health care delivery system. In her current position, Lori is responsible for Government and Commercial product oversight and strategy. This includes the identification, concept building, researching and business case developments for new products, services and markets as well as management and oversight of HAP’s product portfolio. She also leads the market strategy and customer analytics functions to help the organization better understand industry trends and identify business opportunities. Prior to joining Health Alliance Plan, Lori was Director of Product Development and Market Intelligence at Health Alliance Medical Plans in Illinois and Director of Market Research and Strategy at Carle Health System, also in Illinois.

Amy Sepko

Medicare Program Manager
Health New England

Amy Sepko is the Medicare Program Manager at Health New England, a nonprofit health plan based in Springfield, Massachusetts. Amy has been in the health care industry for more than 15 years working alongside providers, auditing Long Term Care facilities and supporting and managing Health New England’s Medicare Advantage program. Amy’s primary focus as the Medicare Program Manager is assessing performance of existing products, developing and implementing new benefit and product design, and providing program and service management support for all programs.

Khoi Ta

Associate General Counsel
Clover Health

Khoi Ta is an Associate General Counsel at Clover Health, where he focuses on a variety of regulatory, corporate and transactional areas. At Clover, he provides advice on Medicare Advantage risk adjustment issues, complex regulatory compliance issues, operational matters and the structuring of new lines of business. Prior to Clover, Khoi practiced law at two international law firms, assisting hospital systems on the structuring and negotiation of healthcare transactions. He received his dual JD-MPA degree from UC Berkeley School of Law and Princeton University.

Randy Walker

Vice President, Provider Network Management & Partnerships
Health Alliance Medical Plan

Randy Walker is currently the VP of Provider Network Management and Partnerships for Health Alliance Medical Plan in Champaign Illinois. He joined the company in March 2018. Prior to joining Health Alliance, Walker was the State Director of Provider Contracting for Aetna Better Health of Michigan for two years. Walker’s responsibilities include negotiating complex, competitive contractual relationships with providers and developing and executing value based/ Alternative Payment Model (APM) contracts, designed to move care from volume to value.

Walker served as President of Walker and Associates Consulting, LLC from 2014 to March 2016. The firm specialized in helping companies establish and manage their provider delivery system, strategic planning for start -up and non-profit organizations as well project management for organizations looking to either evaluate or create a Diversity and Inclusion program. Through the education division; the firm helps develop mentoring programs, non-profit board training tools and manuals and temporary public and charter school teaching consulting support in the areas of general and special education. Before leaving Henry Ford Health System (HFHS) and Health Alliance Plan (HAP) in 2014, Walker held several executive positions. His positions included Corporate Vice President and Chief Diversity Officer (CDO) HFHS and Vice President of Operations at Henry Ford Hospital. At HAP he held positions the positions of Senior Vice President of

Health Care Management and Contracting, Associate Vice President, Corporate Alliances, Mergers and Acquisitions and Director of Contracting. He received a bachelor’s degree in Business Administration and MBA from Wayne State University.

Walker was recognized by Crain’s Detroit Business as one of 40 successful business people under the age of 40 (40 under 40) and Governor Grahholm also selected him in 2006 as mentor of the Year for the State of Michigan. Walker served, as a board member and past President for ‘100 Black Men of Greater Detroit’, and is a former board member of U of D Jesuit High School and Black Family Development Inc. Walker is a current board member of the Detroit Youth Violence Prevention Initiative (DYVPI) and Davison Holistic Inc., a non-profit focused on community development and empowerment.

He and his wife are residents of West Bloomfield, Michigan and have two sons, both graduates of U of D High School. His older son was a graduate of Hampton University with a degree in Accounting. The youngest son played Junior Hockey in Alaska for three years and is now a senior at Oakland University. Majoring in Information technology.

Kurt Waltenbaugh

CEO
Carrot Health

Kurt Waltenbaugh is CEO & Founder of Carrot Health, creator of Carrot MarketView: a cloud-based Healthcare Business Intelligence platform used to analyze data, generate reports and provide real-time insights into your population and market. Kurt is a serial entrepreneur who has built successful analytic solutions, products and companies in the healthcare, retail, manufacturing, education/credentialing and fundraising industries. His previous companies were sold to Oracle and Pearson Education. Most recently, Kurt was responsible for Product Strategy at Optum, Inc. (UnitedHealth), building data analytic businesses for the Provider, Payer and Employer markets.

Dan Weaver

Vice President, Stars Quality,
Gateway Health,
Formerly 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.

Ian Wolfman

CEO
Hyperlift

Sets Hyperlift's strategic direction, develops last partnerships and leads the sales team. From early-stage startups to the world’s most respected brands, Ian has more than two decades experience driving innovation across technology, healthcare, marketing and media organizations.