Alena M. Baquet-Simpson
Catherine Macpherson, MS, RDN
Linda S. Ellis, MD, MJ, MA, VP
Mike Reha, CEBS
Puneet Budhiraja ASA MAAA
Rajesh Munjuluri ASA MAAA
Adam Mintz is the VP of Sales and Retention for Gateway Health. In this role he is responsible for developing and closing enrollment leads for the MCO's Medicare plans, as well as managing program to attract and retain current Medicaid members.
A tenured healthcare professional with 25 years in the managed care industry, Adam began his career in 1992 with New York based US healthcare. Over the ensuing years, Adam held senior leadership positions with some of the larger payers in the nation while maintaining a strong focus on government healthcare programs.
The major focus of Adam's career has been helping healthcare organizations to grow both membership and revenue while actively promoting their brand. His successes include helping to launch three new health plans and position them to significantly increase their market share.
With a background that includes deep experience in both commercial and government insurance programs, Adam is among an elite group of sales and marketing professional who can speak to all lines of consumer health insurance. His expertise includes a wide knowledge of both Medicaid and Medicare, especially Dual Special Needs plans (DSNP), programs.
Adam resides in New Jersey with his wife and two teenage children.
Alena M. Baquet-Simpson
Dr. Baquet-Simpson is a Senior Director, Medical Health Services. She drives quality and
efficiency outcomes for Medicare membership in value-based contracts and leads the
performance improvement efforts of our talented nurse program manager team. Alena also works
closely with the clinical services teams on the case management model for Aetna Medicare
members to enhance engagement at both the member and provider level. She works with the
Aetna team to ensure that services provided are aligned with Aetna's mission and vision and
that they are consistent with industry standards of practice.
Dr. Baquet-Simpson earned her bachelors degree from Loyola Marymount University (Los Angeles, Calif.), and then proceeded to earn her medical degree with honors at Meharry Medical College (Nashville, Tenn.). She is board certified in Family Medicine. Dr. Baquet-Simpson has 30 years of Medical Management experience, as well as 12 years of experience in clinical practice.
Dr. Baquet-Simpson joined Coventry Health Care as Corporate Senior Medical Director in 2011 and then transitioned to the Aetna Medicare team in 2013. Prior to joining Coventry and Aetna, Dr. Baquet-Simpson served as Staff VP, Medical Director for Anthem where she was responsible for case management. Before Anthem, Dr. Baquet-Simpson served as Medical Director of the Office of Managed Care for the Los Angeles County Department of Health Services. She also previously served as Medical Director for the Antelope Valley Cluster (which included hospital, public health clinic and rehabilitation services), and as Chief of Family Medicine at High Desert Hospital, both in Lancaster, California. Dr. Baquet-Simpson also previously served as the Director of Residency Training and Clinical Services for the Department of Family Medicine at the King-Drew Medical Center in Los Angeles.
Catherine Macpherson, MS, RDN
Catherine is a senior leader in healthcare product strategy and product management. She is a product innovation leader who has launched successful multi-channel, consumer-focused, technology-enabled health, wellness and condition management products at leading healthcare companies and organizations. Catherine is the VP of Product Strategy and Development and Chief Nutrition Officer for PurFoods, the leading national provider of home-delivered meals that allow people to recover and age at home. She also served as Vice President over the Medication Adherence and Immunizations businesses at Walgreens, led Healthcare Product Strategy at WebMD and managed health and wellness products and programs for Ceridian, the National Institutes of Health and the American Institute for Cancer Research. Catherine earned her Masters of Science degree in Human Nutrition from the University of Minnesota and her BA from the University of Michigan. She is a Registered Dietitian and has training and expertise in product management, behavior change, weight management, tobacco cessation, medication adherence, health coaching, disease management and culinary arts.
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.
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.
Dr. Mihale has 20+ years of experience working directly with Executive Management teams, Quality Improvement Committees and Risk Bearing Entities to promote improved operations and clinical outcomes. He focuses on promoting the best outcomes, the highest member satisfaction and the most appropriate costs of care. Dr. Mihale, is the Chief Medical Officer of a Berkshire Hathaway company, the Medical Director for the MRA Department of a large Medicare Advantage Plan and Medical Advisor to the leading Care Coordination company in the US. He served as the CMS Physician Champion for ICD-10 in Florida, founded two Managed Care Companies and has served as Chief Medical Officer/Medical Director to more than 15 companies. Dr. Mihale's unique strengths and experience include:
Donna Sutton, Healthcare Informatics, Director of Medicare Star Quality Programs at SCAN Health Plan Donna received her MBA from the University of Southern California (USC) and is a Certified Master Black Belt in Six Sigma. She has over 14 years of experience managing and conducting process improvement projects. Her most recent experience prior to SCAN includes various process improvement roles at OptumInsight and OptumRx. Her responsibilities at SCAN include managing the deployment of and providing oversight over SCAN's 5 Star programs and interventions.
Donovan is the Analytics Director for the Medicare Pharmacy team for Molina Healthcare, Long Beach, California. He oversees clinical pharmacy initiatives from both an operational and data perspective that span MTM services, adherence, interventions for STAR and HEDIS metrics, and corporate quality improvement projects. He is actively involved in outcomes research within Molina Healthcare. His areas of expertise include Medicare Stars, medication adherence, and pharmacy process improvement.
Donovan has developed innovative ways to address patient targeting. In 2014, he created a revolutionary model to identify members at risk of poor medication adherence. Today, he has expanded on that targeting model in an attempt to further drive improved medication adherence. Through his expertise, Molina also has a predictive model that projects STAR results prior to their publication by CMS.
Donovan has a Master's degree in the Science of Management, which was preceded by a Bachelor of Science degree in Actuarial Science.
Worked in the health care industry for almost 15 years. The majority of that time was spent in the pharmacology field. Then transitioned to the health IT and health informatics field for the past 3 years and has a passion for driving innovation in the healthcare industry.
Harry 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 and providers, and allow providers to effectively collaborate with patients and consumers as well as with each other. He is a frequent speaker at industry conferences and forums and contributor to the 'Edge Report, the HealthEdge blog.
Jim is the Senior Director of Product Development at the Cleveland Clinic. In his role, he has responsibility for collaboration with health plans. For 2018, he and his team have launched a co- branded Humana | Cleveland Clinic Medicare Advantage HMO and D-SNP products, as well as a Cleveland Clinic + Oscar health plan for the individual market.
Jim also oversees the Cleveland Clinic's Direct to Employer products, including Centers of Excellence, Wellness and Executive Health.
He joined the Cleveland Clinic from Blue Cross Blue Shield of Michigan where he was responsibe for the Medicare Supplement, Medicare Advantage PPO and Part D prescription drug lines of business. Prior to that, Jim worked at Anthem in Los Angeles where he held a variety of management positions, including, most recently, Vice President of Product Innovation.
Mr. McMahon is a graduate of the University of Michigan in Ann Arbor. Outside work, he work enjoys gardening and travel.
Jared currently oversees the Client Experience program at Burgess. Combining his Medicare and industry expertise and passion for elevated customer service, Jared ensures every client's needs are heard and provides hands-on service to help them find the right solution. Since joining Burgess in 2011, he has helped clients navigate the intricacies of the healthcare system. He has a history of effectively serving the nation's top 50 health plans and premier health organizations, and has led product management, client experience and business development programs at Burgess.
An expert in operational performance and excellence, Jenny has over 15 years of experience developing and implementing innovative operational strategies to improve overall business performance and utilization. As a founding partner, Jenny has led engagements for clients in the Health Insurance and Insurance Brokerage industries. Her functional expertise includes customer service, correspondence, claims, medical management, enrollment, brokerage servicing, policy management, underwriting operations, requirements development, and information technology.
working in collaboration with executives and their teams, Jenny focuses on developing strategic recommendations at make a positive impact on the customer experience by vastly improving internal processes and management.
Jeny has led instructional design teams, developed member centric operating models and best in industry training and skills development programs. Effective in both off- and on-shore projects, Jenny has experience handling aggressive ramp up timelines including 30-day implementations. A recognized Project Management Professional (PMP), Certified Professional in Learning and Performance (CPLP), And a Lectora Certified Advanced Author, an eLearning development tool. Jenny was member of the Honor's Program at Babson College and holds a bachelor of science in Business Administration
Jessica Assefa has been the Manager of the Medicare Star Ratings program for UCare,an independent, nonprofit health plan that provides coverage to Minnesotans, for the past two years. Prior to this Jessica served on UCare's Clinical Compliance team where she was responsible for the trainingand oversight of UCare's delegated care coordination entities.
In her current roll, Jessica has responsibility for the facilitation and coordination of the Star Ratings program for UCare's four Medicare Advantage and Dual Eligible products..UCare's Medicare Advantage product, UCare for Seniors rated "Excellent" by NCQA, has maintained a 4.5 Star Rating, and is very close to becoming a 5 Star plan. UCare's Medicare portfolio also includes: Minnesota Senior Health Options (MSHO), a D-SNP plan that combines Medicare and Medical Assistance benefits/services for low income Seniors, EssentiaCare - a Medicare Advantage plan from Essentia Health (a local care system) and UCare, andUCare Connect + Medicare - (Special Needs Basic Care) a plan that combines the benefits/services of Medicare and Medical Assistance for Minnesotans with certified disabilities ages 18 to 64.
In addition to her managed care experience, Jessica brings over 20 years of nursing experience in the states of MN, IN and NY working extensively with the geriatric and disabled populations.
John Gorman is Founder and Executive Chairman at Gorman Health Group (GHG). In this role, he has led the development and launch of several entrepreneurial ventures in both software and business process outsourcing in government health programs. John's work focuses on government health programs strategy, cultural transformation within health care companies, governance, and turnaround of distressed health plans. John brings GHG clients more than 25 years of experience in government-sponsored health program strategy, compliance and operations.
GHG has become the leading professional services and solutions firm for government-sponsored health care, providing leadership and expert strategic, operational, and technology-based solutions in nearly twenty years of continuous operations and growth. Under the mantra of "better to be new than improved," GHG has redefined solutions in risk adjustment, enrollment/eligibility/membership reconciliation, beneficiary marketing, sales agent compliance and management, and online training. The company now pursues several ventures annually, and sources acquisitions and investments for multiple private equity firms.
John speaks at dozens of industry and investment community conferences each year, reaching thousands of senior health care executives with his predictions about the evolving government-sponsored managed care market. He is regularly quoted in the trade press and national media, including The New York Times and The Wall Street Journal, and serves on the editorial advisory boards of several industry publications.
Prior to founding his own company in 1996, John served as Assistant to the Director of Health Care Financing Administration's (HCFA) Office of Managed Care, where he provided day-to-day management, and served as the external liaison for the Medicare and Medicaid managed care programs. During the 1993 debate on national health care reform, John was chief lobbyist on health care financing issues for the National Association of Community Health Centers, an organization of Federally-funded primary care clinics for the medically underserved. Prior to that, John served as Press Secretary and Staff Director for U.S. Representative John Conyers, Jr. (D-MI), then-Chairman of the Government Operations Committee.
John W. Halsey, Vice President, Payer Development, Turn-Key Health, is a healthcare executive with 20+ years of experience helping organizations drive revenue by strategically assessing opportunities, developing marketing strategies and executing on sales.
Previously, he served as a managing partner at AXON Strategy. He has also held business development and management leadership positions at Real Time Medicare Data, MDLIVE, Inc., and Teladoc.
John is a member of the AHIP Foundation, American Telemedicine Association, ACO Development Group, the Institute for HealthCare Consumerism, MCO Executives, Urology Health Foundation and the MacJannet Foundation. He holds a bachelor's degree in History from the University of Alabama at Birmingham
Dr. Harding is currently the Senior Medical Director of Senior products comprising a population of over 100,000 Medicare and Retiree members at Tufts Health Plan in Massachusetts. Prior to this position, he was at Touchstone Health Partnership, where he served as Vice President for Health Services. Prior to that he was Chief Medical Officer of the Fallon Clinic in Worcester, MA, a multi‐specialty group practice with over 300 practitioners, and held several different positions at FHP in California, a multi‐faceted health care company with HMO, medical group, and hospital businesses. He also continues his role as a physician reviewer for the National Committee on Quality Assurance (NCQA). He brings over 25 years of experience in medical management.
Dr. Harding received his bachelor's degree and his degree in medicine from Boston University and he is board certified in internal medicine and geriatric medicine. He also has been certified by the ABMM and ABQAURP, and is a Fellow of the American College of Physician Executives. Dr. Harding has previously taught Internal Medicine at the University of California, Irvine, School of Medicine; the University of Massachusetts Medical School in Worcester and in Uganda and South Africa.
Jordan is Executive Vice President of Marketing & Operations at Novu. In this role, he develops and leads the company's marketing and brand initiatives, as well as the end-to-end management of member-facing operations. With more than 15 years of senior marketing leadership experience, Jordan brings a passion for analytics, loyalty operations and engagement, as well as strategic energy to Novu.
Kent Holdcroft joined PharmMD in March 2013, bringing over a decade of operational, consulting, and sales experience in the healthcare technology and services industry. His leadership at PharmMD has quickly expanded well beyond the management of business development, client negotiations, and relationships, taking on integral roles in marketing operations and product development. His charismatic personality is helping shape the culture of this rapidly growing team.
"PharmMD holds the potential to be a game-changer," comments Holdcroft. "This team is focused on being the market innovator as emerging regulatory requirements position our solutions to return millions of dollars to our customers, reducing cost, and building healthier lives."
Holdcroft came to PharmMD following multiple successes with AIM Healthcare (now a part of Optum, a United Health Group, Inc. company), rising to National Director as it expanded into new markets. He was a key player as a part of Optum's growth strategy representing all of Optum's provider-facing solutions. He managed healthcare accounts in the community hospital, academic medical center, integrated delivery network, as well as a variety of managed care plans and government settings. Actively involved in the community, Holdcroft currently serves on the Board of Directors at BrightStone, Inc., and as a Stephen Minister. Holdcroft holds a BA in Psychology from the Miami University and a MA in Counseling from The University of Toledo.
Keri is the Medicare Compliance Officer and Director of Medicare Compliance for Providence Health Assurance in Beaverton, Oregon. She has over 20 years of Compliance experience in the Medicare industry, as well as a broad range of healthcare experience throughout her career. She has built a Medicare Compliance Program from the ground up and has a passion for doing so. She has been with Providence for over 14 years.
Kristine Walhof, MBA, MHA,
Kristine received a Bachelor's of Business Administration from Pacific Lutheran University in Tacoma, Washington, and a MHA and MBA from the University of Missouri - Columbia. Kristine has over 20 years of professional experience throughout the health care industry, including health care consulting, large and small group benefit design, long-term care, executive recruiting, and provider contracting. Kristine joined Cambia in 2012 and currently serves as the program director for the Medicare Star Ratings program across our plans in Oregon, Washington, Utah and Idaho.
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.
Larry's professional career within the healthcare industry has focused on the delivery, transformation, performance and measurement of healthcare services relative to cost, quality and utilization. He has served in executive, leadership, and consultative roles supporting provider-sponsored organizations, managed care entities, and insurers. His healthcare experience spans 30 years with functional expertise that includes -
- Physician-hospital network and ACO performance strategy formation and execution
- Value based reimbursement and financial risk arrangement development and management
- Triple Aim implementation and measurement
- Provider Organization governance and operations management
- Managed care organization, insurer, and payer contract negotiations
- Private label product creation and implementation
- Healthcare budget development, financial analysis and reporting - inclusive of capitation management
- Care management leadership
- Patient Centered Medical Home/PCP management and practice transformation
Larry has earned an MBA from the University of Detroit with a concentration in Finance and International Economics. Additionally, he has completed graduate studies at Wayne State University in Healthcare and Labor Economics, and Econometrics.
Leah insists a great digital program is akin to great theater. You need a good script, excellent talent, a sound platform, and a compelling story. She should know. Before becoming an expert in the fine alchemy of the Web-and other electronic wizardry, she was an actress. Armed with a theatre degree from USC, she moved to New York to join her fellow performers behind the footlights, and continued studying acting as she climbed the corporate ladder in healthcare communications. Then, the promise of even more creativity drew her into amassing an impressive fifteen-year track record in digital marketing, helping clients build their brand and business with a strong Web presence. Rest assured, if it's online performance you're after, Leah is always in character.
Linda S. Ellis, MD, MJ, MA, VP
Dr. Linda Ellis is Chief Medical Officer at Independent Care Health Plan in Milwaukee, WI, serving dually eligible Medicare and Medicaid beneficiaries, all of whom are at or below 100% of the federal poverty level. Dr. Ellis is responsible for utilization and disease management, population health initiatives, and oversight of medical and pharmacy services. Dr. Ellis is board certified in Anatomic, Clinical, and Pediatric Pathology, and has served as an academic pathologist for over 20 years. While in practice, Dr. Ellis completed a master's of jurisprudence degree in health law and policy at Loyola University Chicago School of Law and a master's of arts degree in bioethics and health policy, also at Loyola University Chicago, at the Neiswanger Institute for Bioethics and Health Policy. The unique interrelationship of medicine, law, and ethics fuels her passion in promoting access opportunities and ethical health care delivery and practice for vulnerable populations, including dual eligibles.
Lisa is the Director of Payment Integrity for Providence Health Assurance/Providence Health Plan in Beaverton, OR. Lisa has a Master's Degree in Healthcare Business Leadership. She is a Certified Professional Coder (CPC) since 1996 and a Fellow in the American College of Medical Practice Executives (FACMPE) since 2008. She has had the good fortune to spend much of her over 23 year healthcare career educating colleagues on coding, revenue cycle improvement and compliance. She has a broad range of healthcare experiences in small physician's clinics, multi-practice medical/surgical practices, a large teaching hospital, compliance consulting, and a medium-size health plan. Lisa is a national speaker at conferences and seminars regarding healthcare reimbursement, and coding skills.
Melissa Smith is Vice President of Stars at Gorman Health Group. In this role, she helps health plans, providers, PBMs, and industry vendors improve their performance within quality ratings systems such as Star Ratings within Medicare Advantage, Quality Rating System (QRS) within the Health Insurance Marketplace, Healthcare Effectiveness Data and Information Set (HEDIS®), Consumer Assessment of Healthcare Providers and Systems (CAHPS®), etc. She brings more than 20 years of healthcare experience to GHG, with more than five years at Cigna-HealthSpring working with Star Ratings among national MA and Part D plans. Melissa has extensive experience developing strategic and tactical solutions to maximize performance on the full spectrum of quality measures. Melissa also has a strong background of building productive partnerships across internal teams and with external vendors to improve performance on clinical, medication, patient survey, and administrative quality measures. Before working with quality ratings systems, Melissa was an Associate Director at Vanderbilt University Medical Center. Melissa received her degree from Purdue University and began her career at KPMG, LLP. Melissa's unique background of business process, regulatory compliance, and healthcare quality offers our clients the opportunity to maximize quality performance and revenues. Medicare Star Ratings
Dr Parkinson is the Senior Medical Director overseeing employer health and productivity strategies for UPMC Health Plan and WorkPartners. Mike is a Past President of the American College of Preventive Medicine, the national medical specialty society of physicians trained in and committed to health promotion, disease prevention and systems-based approaches to improving health and health care. He formerly was EVP, Chief Health and Medical Officer of Lumenos, a pioneer of consumer-directed health plans and a subsidiary of Wellpoint. A retired Air Force colonel, he served as associate director of medical programs and resources in the Office of the Surgeon General where he was responsible for policy and planning for over 2 million beneficiaries, 70 facilities and a $4 billion budget. While assigned to the US Public Health Service, he provided oversight of federal programs in public health, geriatrics and preventive medicine training. He served on the Institute of Medicine (IOM) Committee on NASA employee health programs, and as faculty for the 14-cities Robert Wood Johnson Foundation 'Aligning Forces for Quality' project. He is a member of the Policy Committee of the American Heart Association Great Rivers Affiliate, University of Iowa NIOSH Total Worker Health Center Advisory Board and the (DoD) Defense Health Board Healthcare Delivery Subcommittee. Mike has been appointed to the editorial boards of the American Journal of Preventive Medicine and the American Journal of Medical Quality. He obtained his AB from Cornell, MD from George Washington, family practice training at the UCLA and his MPH, preventive medicine residency and chief residency at Johns Hopkins.
Michelle is a Sr. Director Operations at HealthNet, a subsidiary of Centene. She has been with Health Net since September 2002, starting as a business analyst in Claims for process improvement/root cause and implementation processes, and worked with all departments for implementation of ACA, and is currently working with Centene operations for migration to Centene platforms. Michelle's current responsibilities include Pricing and Benefit configuration teams, Provider Data Maintenance team, and Mass Member Move units.
Mike Reha, CEBS
Mike Reha is director of sales and marketing for EPIC Hearing Healthcare, the leading provider of hearing care insurance in America. Reha has more than 20 years of experience in the hearing industry, ranging from serving as managing director for Qualitone, a subsidiary of Starkey Laboratories hearing aid manufacturing facility, to his current role directing strategic customer relationships and marketing initiatives for EPIC.
Founded in 1997, EPIC is the first in the country to provide access to hearing care as an ancillary or specialty benefit. With its extensive network of audiologists and hearing healthcare physicians, and distribution relationships with major hearing aid technology manufactures, EPIC is now the national leader in hearing healthcare, and the only organization to offer hearing as a fully insured indemnity plan. EPIC Hearing Service Plan (HSP) manages the process of referrals; professional services and diagnostics; access to all technology; and billing and collections for hearing care. In this manner, members throughout the country can be assured of standardized and consistent procedures for assessment and evaluation, technology selection, programming, and outcomes measurements. Reha leads contact with all third-party administrators, brokers, employer groups, insurance companies and Taft Hartley funds, through which EPIC HSP covers millions of lives.
With a concentration in human resources, Reha earned a bachelor of science in business administration from the University of St. Thomas in Minnesota and has a CEBS designation from the International Society of Certified Employee Benefits Specialists through The Wharton School of the University of Pennsylvania.
Currently working as Vice President of Freedom Health, Optimum Health, Beacon Health and AFCSC Health plan responsible for all the Revenue Management including develop plan benefits, Medicare Risk Adjustment, RAPS, Encounter, CSNP, Analytical, Revenue compliance monitoring and Successfully integration of other companies into Umbrella Organization. Joined Freedom Health since inception of the company and helps to achieve the 7 th fastest growing Private Company in USA as per INC 500.
Served as Executive Committee member of Chamber of Commerce and Professor at West bay Career University. Graduated Magna Cum Laude with MBA in Business/Finance, also served as President of Honor Society and President of Learning Society.
Proficient and well-known Public Speaker. Spoke at various conferences held by leading organizers in Healthcare Industry, including World Congress, Financial Research, RISE Group, World Research Group, Opal Group etc. on Medicare, Health Care Revenue Management and Compliance.
Nicole brings over 20 years of solution consulting to the healthcare practice for RR Donnelley. She is responsible for supporting health plans across the country to acquire, engage and retain members through efficient and effective communications. Well versed in all lines of business, Nicole is a valued advisor, status quo disruptor and an on-going source of valuable ideas to her health plan clients.
Nita is the Director of Program Oversight and Communications for Senior Health Services, a subsidiary of Blue Cross Blue Shield of Michigan. In her role, she has responsibility for oversight of Blue Cross' Medicare Advantage and Part D programs. Although the Michigan Blues are a single state health plan, they have the 6 th largest Medicare Advantage plan nationally because of the number of Michigan based employer groups. It provides health care coverage to half a million Medicare beneficiaries through its Medicare Advantage PPO, HMO, PFFS and PDP plans. During her lengthy career at the Michigan Blues, she's held a variety of leadership roles in compliance, communications, IT, training and provider relations. Nita sees her two main job responsibilities as balancing compliance with operational needs and to keep her executives out of orange jump suits. She is a graduate of Wayne State University in Detroit. Outside of work, she enjoys travel and doing things with her wife Jane and two dogs, Mario Banderas and Lorna Doone.
Puneet Budhiraja ASA MAAA
Puneet has been working in healthcare industry as an actuary for last 9 years. He has experience working for both the consulting and insurance side of the business. Puneet is currently working as Medicare / Chief Actuary for CDPHP (Capital District Physicians' Health Plan) as the lead actuary for Medicare and Medicaid business. Puneet has worked on wide variety of projects including pricing, reserving, product development, market surveys, and predictive modeling.
Puneet holds an Electrical Engineering degree and went to New Mexico State University to do his masters in Electrical engineering. In NMSU he became aware of Actuarial profession and decided to be an actuary
Dr. Piyush Gupta is the Regional Medical Officer of CareMore Health of Arizona, a Medicare Advantage health plan and delivery system with a focus on caring for the frailest populations by harnessing the power of teamwork to proactively manage their complex medical needs. CareMore Health provides care to over 100,000 Medicare and Medicaid beneficiaries across eight states, including Arizona, California, Nevada, Virginia, Tennessee, Iowa, Georgia, and Connecticut. As the Regional Medical Officer of CareMore Health in Arizona, Dr. Gupta leads the market in strategy, operations, and quality improvement. Prior to joining CareMore, Dr. Gupta was an attending physician at Kaiser Permanente where he also completed a fellowship in patient safety and quality improvement. He is board certified in internal medicine and trained in internal medicine at Brown University. Dr. Gupta received his medical degree from the University of Vermont and graduated with honors from Carnegie Mellon University with a bachelor's degree in biological sciences.
Rajesh Munjuluri ASA MAAA
Raj is a Member of the American Academy of Actuaries with over 12 years of health actuarial experience working with insurers as well as with consulting firms. During the course of his actuarial career, he has consulted with insurers on Medicare bid development and on risk adjustment. Additionally, he has consulted with providers in the development of risk sharing arrangements, alternative payment design and evaluation of bundled payment contracts.
Raj has an MBA from New Mexico State University and a Bachelor of Science in Mechanical Engineering from Bangalore University, India.
Rebekah Dube, Pharm.D., is Martin's Point's Vice President of Health Plan Clinical Programs where she oversees all aspects of pharmacy, medical management, risk adjustment, and quality for Martin's Point's Medicare Advantage and US Family Health Plan products. Prior to this role Rebekah held the title of VP, Senior Products at Martin's Point where she was responsible for the Medicare Advantage (Generations Advantage) line of business, including leading the continued growth, market positioning, and performance of Medicare programs and direct leadership of Part D, risk adjustment, star ratings, product development and performance and operational functions, including Member Services, Sales, Enrollment and Grievances & Appeals.
Rebekah joined Martin's Point in 2005 and has also held multiple roles within the organization, including Clinical Pharmacy Coordinator, Manager of Pharmacy Programs, Manager of Part D Operations, and Director of Medicare and Pharmacy Programs. Before joining Martin's Point she served as Clinical Account Pharmacist in the State of Maine for Anthem Prescription Management and Staff Pharmacist for CVS Pharmacy. Rebekah received her Doctor of Pharmacy from Southwestern Oklahoma State University and completed a post-graduate pharmacy residency at Leesburg Pharmacy and Shenandoah University.
Dr. Young is Senior Medical Director of Medicare for Florida Blue in Jacksonville, Florida. As Senior Medical Director for Medicare, Dr. Young provides strategic direction for Florida Blue's Government Programs to include growth and performance of the value based provider network, integration of Medicare programs including Medicare risk adjustment, HEDIS/Stars, and care management. He also provides clinical oversight of the Dual Eligible Special Needs and Chronic Condition Special Needs care management teams, as well as, compliance oversight for all Medicare lines of business.
Prior to joining Florida Blue in May of 2017, Dr. Young served as a medical director for a Medicare Medicaid Demonstration Plan with Select Health of South Carolina, and as a commercial UM medical Director for UnitedHealthcare.
Dr. Young is a board certified orthopedic surgeon with a subspecialty certificate in sports medicine. He was in clinical practice until 2014 and held positions with the University of Florida, a multi-physician orthopedic group, and his own solo practice. Dr. Young received his Medical Doctorate from the University of Texas-Southwestern, and his orthopedic training at the University of Pennsylvania and Duke University. Dr. Young also holds a Masters of Business Administration from the University of North Carolina Kenan-Flagler School of Business.
Sallie Prins is a career nurse and lifelong learner with longevity in managed care. For the past eleven years, Prins has been serving a range of individuals from the young disabled to the frail elderly in a Medicare Advantage Plan care management department. Her nursing background is varied, encompassing medical surgical nursing, provider liaison, quality, utilization and care management. For the past eight years she has been assuming leadership roles and has accountability for inpatient, post- acute and outpatient care management teams. Prins is dedicated to transforming the care model, to bring care management to the point of care at the inpatient and post-acute settings, as well as in homes. She also has oversight of the telephonic care management teams. Engaged in sharing knowledge, experience and passion, Prins promotes the triple aim of health care for our seniors and the generations to come. She has certifications in healthcare quality and as a geriatric resource nurse, and recently earned her masters of science in nursing leadership, health systems management. When not working, she enjoys the many adventures and activities available in "Pure Michigan" with her friends and family.
Scott calls the shots at our Agency Services unit, and has been the prime mover behind literally hundreds of programs serving some of the world's leading brands. He's known for pioneering the vertically integrated business model for a direct marketing agency and refining media integration techniques long before it was the norm. He's helped create some of the industry's most intelligent databases and closed-loop ROI reporting systems, too. Throughout his 26 years in the business, Scott has developed a diverse range of programs involving acquisition and retention, cross-sell, continuity, utilization, event and seminar marketing, plus lead generation and new product launches. He also admits to growing up on a farm, which is probably why cultivating client revenue streams comes so naturally to him.
Stuart Rosenblum is an entrepreneurial senior leader with a track record in growing profits
through connecting the dots to reveal opportunities and then executing innovative strategies
while leveraging relationships. His over 30 years of experience encompasses roles in Business
Development, Sales, Marketing and Finance across industries, including Healthcare, Financial
Services and Marketing Services.
In 2009, Rosenblum came to Anthem, Inc., a publicly traded health benefits company serving over 73 Million lives including over 40 million total medical members in affiliated health plans as a Blue Cross Blue Shield licensee in 14 States (California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin).Rosenblum and his team lead a program wherein they partner with Anthem Strategic Suppliers to deliver Best Practices and Cost Efficiencies to external Health Plan Companies. The portfolio of offerings has grown to over 50 suppliers offering capabilities for almost all Payer goods and services requirements.
Prior to joining Anthem, Rosenblum built, grew and exited his own businesses where he held various positions including President of a Marketing Services Company that provides end to end solutions from Strategic Plan Development, production and implementation for companies such as Disney, Dole Foods, and Target. Rosenblum worked as Executive Vice President, Operations and CFO of a Consumer Products Company that develops, manufactures and markets a variety of products primarily sold through Direct Response marketing efforts where he developed and managed the growth from $15 million to $250 million in 18 months. Rosenblum lives just outside of Los Angeles, with his wife, Andrea, and their dog, Rocky. He has 3 adult children and a new daughter through his oldest son's marriage and balances his time between a variety of different activities which include hiking and spending time cooking for his family and friends.
Vice President of Product Development has over 10 years of experience leading the development and delivery of healthcare technology solutions. Her prior experiences have included developing MA, MSSP/ACO, Medicaid and exchange ACA related applications. She has deep experience in building risk adjustment analytics, CMS EDS submissions, gain/risk share reporting, HEDIS reporting and taking health plans to the coveted 4 plus STAR rating.