Agenda – Day 2

Pamela is a senior healthcare consultant with the New York office of Milliman. She has a broad background in integrated delivery system administration and healthcare payment reform. She has worked in both clinical and payer settings and has extensive experience in alternative risk contract strategies. Pamela has particular expertise in analysis of healthcare claims and the development of episode-based payment definitions and benchmarking methodologies. Prior to joining Milliman, Pamela held a technical advisory role in the U.S. federal government. She was responsible for developing and implementing novel payment methodologies to transform healthcare delivery and payment nationwide. Previously, Pamela also worked in quality improvement at an academic medical center.

Erin Smith, is the Vice President of Policy and Government Affairs at naviHealth (www.naviHealth.us), a Cardinal Health Company, and an expert on payment and delivery innovation. She is deeply invested in monitoring how policies impact providers. Smith previously worked at CMS, more specifically with the Center for Medicare & Medicaid Innovation (CMMI), where she led the team that implemented the Bundled Payment for Care Improvement (BPCI) initiative and other bundled payment models. Before that, she worked for the World Health Organization.

David Mauzey is the General Manager the Optum Network Payment Innovation focused on enabling organizations to administer their value based programs and bundle based programs. Network Payment Innovation acts as a payment exchange service enabling the move from volume to value based contractual arrangements. Prior to joining Optum, David spent 17 years with ppoONE, a claim pricing and provider data management solution for preferred provider networks. Serving as both COO and CIO, David gained a great appreciation for finding the right operational and technical balance that align to organizational vision.

Cheri Zielinski is a Senior Director, Health Care Analytics Advisory Services at Optum. She is responsible for leading several of the Optum bundled payment initiatives; notably leading analytic and reporting efforts for two of the three Managed Care Organizations in the State of Tennessee’s Medicaid bundled program. Cheri has been involved in bundled programs for over four years.

Prior to this role, Cheri was the Product Director of the Optum Symmetry Suite. Her expertize includes over 17 years of Symmetry experience in both a Value Added Reseller and a direct licensing capacity for provider profiling, initiating Pay for Performance projects and community outreach. Cher’s experience also includes 2 years with a commercial health plan, 5 years in client support for a major Value Added Reseller and 2 years in a major consulting firm.

Dr. Chaudhry is an internal medicine physician and medical technologist whose expertise focuses on healthcare payment, clinical service redesign, and the use of data analytics to improve clinical and financial performance in healthcare. Prior to starting Tuple Health Dr. Chaudhry was a medical scientist at IBM Research where his work focused on using data analytics and information technology to drive innovation in healthcare. In addition to technology development, Dr. Chaudhry worked on developing IBM’s private and public sector business strategies for the healthcare industry. In this role, Dr. Chaudhry focused on developing the Watson technology for clinical practice. Dr. Chaudhry has worked in the Internal Medicine department at UCLA and as a research scientist at the RAND Corporation. He has provided expertise to the US Department of Health and Human Services and the Institute of Medicine and served on a working group of the President’s Council of Advisors on Science and Technology.

Kavita Patel is the Associate Chief Medical Officer and Medicare Director at Johns Hopkins Medicine, Sibley Hospital, responsible for the oversight of primary care transformation and population health in the outpatient setting. She is also a nonresident Senior Fellow at the Brookings Institution. Previously, she was a Fellow and Managing Director of Delivery System Reform and Clinical Transformation at the Engelberg Center for Health Care Reform in the Department of Economic Studies at the Brookings Institution. At the Institution, Dr. Patel is specifically working on helping health care systems understand how to transform their clinical environments to become more accountable for the care they provide as well as other aspects of health reform implementation. Dr. Patel also serves on the GAO Appointed Physician-Focused Payment Model Technical Advisory Committee (PTAC) which is charged with developing alternative payment models for Medicare as a result of the bipartisan, bicameral Medicare and CHIP Reauthorization Act (MACRA) which aims to accelerate the movement to value-based care.

As Chief Medical and Quality Officer for AMGA and President of AMGA Foundation, Dr. Penso leads best-practices learning collaboratives for the more than 400 member groups, research and benchmarking programs, and AMGA’s national hypertension campaign.

Prior to joining AMGA, Dr. Penso served as Medical Director, Continuum of Care for Sharp Rees-Stealy Medical Group (SRSMG) in San Diego. SRSMG was recognized as a top performing group in California’s Pay for Performance program every year since 2005.

Michael Ciarametaro joined the National Pharmaceutical Council (NPC) as the Director of Research in 2014. In this position, Mr. Ciarametaro plays a key role in developing and delivering NPC’s portfolio of health policy and health outcomes projects.

Mr. Ciarametaro has 16 years of health care industry experience with both pharmaceutical manufacturers and payers. Most recently, he was a senior research manager at Evidera, where he designed and led a wide variety of both qualitative and quanbititative studies across multiple health care industries and stakeholders. Mr. Ciarametaro’s work analyzed reimbursement and treatment patterns for drugs, biologicals and devices.

Prior to Evidera, he served as a financial analysis manager in support of P&T at WellPoint NextRx and as lead staff at Noblis, a nonprofit science, technology and strategy organization. Mr. Ciarametaro holds a Bachelor of Science from the University of Virginia and received his MBA from George Mason University.

Dr. Mecklenburg trained at Northwestern University Medical School, the University of Washington and the National Institutes of Health. At Virginia Mason he has served as Chief of Medicine and as a Board member. His publications include lead articles in the New England Journal of Medicine. His work with employers has been featured in the Wall Street Journal, LA Times, Health Affairs, Harvard Business Review (included in HBR’s 10 Must-Reads for 2017), by the Institute of Medicine and by the Institute for Healthcare Improvement. At Washington’s Bree Collaborative, he leads teams producing bundled payment models and warranties for high-cost surgeries.

Lisa serves as the Vice President of National Accounts and Federal Employee Program Operations. Lisa supports a culture of customer obsession across the leadership team she manages in her responsibility for overseeing all operation functional activities and staff to ensure effective integration of process.

During Lisa’s 35 year career with Premera, she has held several positions within operations including Director for Alaska Operations and Director of National Account Operations. The majority of her operations experience has been managing key National Accounts including some of the largest national accounts in the pacific northwest including Amazon, Microsoft, and Starbucks.

Marcia Peterson, is the Manager of Benefit Design and Strategy for the Washington State Health Care Authority’s Public Employee Benefits Program (PEB). The PEB program is responsible for purchasing and managing benefits for 350,000 state, county and local employees and their dependents within the state of Washington. Ms. Peterson is responsible for leading the organization’s strategic benefit design and the roll-out of innovative benefits designed to improve the health of PEB members. In addition, she manages the Wellness program for the state and oversees the decision support function. Prior to her current position, she was the Director of Strategy and Project Management for the Swedish Health System in Seattle, one of the premier providers of care in the state. In addition, she worked for more than a decade in the field of healthcare information technology where she led product development teams in designing user-centered software and web products.

Jay Sultan is a nationally recognized expert in payment reform. Mr. Sultan began work on implementing episodes for payment over 15 years ago and has authored two patents in payment bundling. He has participated in both commercial and the Centers for Medicare and Medicaid Services (CMS) payment bundling programs – for both retrospective and prospective episodes, and is currently working on one of the largest episode of care programs in the industry. Jay has served and/or still serves as subject matter expert in payment bundles to the CMS, several states, various non-profits (such as IHA), and over 100 payer and provider organizations.

Brittany Cunningham is the Director for the Episodes of Care office at Vanderbilt University Medical Center. Her past experience as the Quality and Patient Advisor in the Vanderbilt Heart and Vascular Institute for 7 years allowed her to gain experience working on implementing projects such as reducing readmissions, managing clinical registries and rolling out the Valve Surgery Bundle Initiaitve in 2014 with CMS. The Episodes of Care office is now leading out 20 state mandated episodes, 6 CMS bundles and several internal initiatives towards increasing quality and decreasing cost. Brittany is additionally trained in QI methodology including being a certified Six Sigma Black Belt.

C.J. Stimson is the Warburton-Jewett Fellow in Urologic Oncology at the James Buchanan Brady Urological Institute at Johns Hopkins Medical Institutions. He is active in the American Urological Association’s Public Policy Division, and is currently serving on the Legislative Affairs Committee, the Alternative Payment Model Workgroup, and co-chair of the Regulatory Workgroup. He served in the U.S. House of Representatives as a Health Policy Legislative Fellow to Republican and Democratic members, as well as the GOP Doctors Caucus.

Following his urologic oncology fellowship Dr. Stimson will be an Assistant Professor in the Department of Urologic Surgery at Vanderbilt University Medical Center, having concurrent appointments as the Medical Director of the Office of Episodes of Care in the Office of Population Health, and as Senior Advisor to the Chief Executive Officer, Vanderbilt Health System. He will also play a substantive role in federal health policy development as a Senior Advisor to the Front Office for the CMMI.

Lili Brillstein is the Director of Episodes of Care for the Market Innovations division of Horizon Blue Cross Blue Shield of New Jersey. She is responsible for the overall direction, strategy, design and oversight of the Episodes of Care/Bundled Payment Program. When Lili joined Horizon in January of 2013, the Episodes program was still in pilot and included only total hip and total knee replacement episodes. Under Lili’s leadership, the program has grown to include additional orthopaedic episodes, obstetrics and gynecology, GI, cardiology, oncology, and is the largest commercial Episodes program in the country. Lili also plays a leadership role in the advancement of Horizon’s PCMH, ACO and other value-based models.

Lili serves as an advisor to CMS and other organizations, nationally, on episodes of care and bundled payment development, and is a recognized thought leader in the advancement of the Episodes of Care model as a health care value strategy for specialty care.

Matt Civili is the Senior Director of Provider Management at Signature Medical Group, Inc. a multi-specialty group of 150 physicians in 17 specialties primarily located in St. Louis and Kansas City Missouri. Signature has 63 orthopedists providing services in all orthopedic subspecialties including total joint replacement, sports medicine and pediatric. Matt has over 17 years of business development experience within the insurance, pharmacy and healthcare markets. Matt presently oversees operations for Signature’s (Awardee Convener) Bundled Payment for Care Improvement program encompassing 2,000 orthopedic physicians and 50,000 clinical episodes throughout 26 states in 60 cities and is the largest voluntary national collaborative orthopedic bundled payment program.

Andrew Tessier is Business Development Director for Signature Medical Group, Inc., a multi-specialty group of 150 physicians in 17 specialties and almost 1,000 employees in St. Louis, Kansas City and rural Missouri. Signature has 63 orthopedists providing services in all orthopedic subspecialties including total joint replacement, sports medicine and pediatric. Over the past 15+ years, Andrew has worked in a variety of health care areas developing and managing physician group projects, information technology and commercial bundled payments. Most recently Andrew has focused on programs and opportunities within CMMI (Center for Medicare and Medicaid Innovation) including Signature’s Awardee Convener Bundled Payment for Care Improvement (BPCI) initiative. This program encompasses 2,000 orthopedic physicians and 50,000+ clinical episodes throughout 26 states in 60+ cities and totals $1.8 billion in Medicare costs.

Patty Fennell has over 30 years of nursing experience with expertise in clinical quality, performance improvement, case management, safety, and administrative areas. Mrs. Fennell is certified in Lean, healthcare quality (CPHQ), quality assurance and utilization review (FABQAURP), healthcare compliance (CHC), and is a licensed healthcare risk manager (LHRM). At Adventist Health System, Patty is the Corporate Director of Clinical Quality Improvement and the Operational Director for Bundled Payments. In her role. Patty is responsible for the System level quality initiatives, leading the Regulatory committee, and is the project lead for the mandated bundles. Prior to AHS, Patty worked as a QUEST Senior Performance Partner with Premier Healthcare alliance reviewing hospital and system level data to assist with outcome improvement. In addition, previous roles include Director of Case Management, Performance Improvement, Professional Services, and Patient Safety/Research Manager. Mrs. Fennell has extensive experience in healthcare quality, Case Management, resource utilization, readmissions and patient flow.

Chris Murphy is the Principal Healthcare Consultant for Premier’s Payer Partnerships with more diverse industry management experience, consulting expertise, and a strong hybrid skill-set encompassing leadership of fiscal, sales, and marketing operations and product management. With a unique combination of provider, payer, and vendor experience, Chris is recognized for providing visionary leadership in operations, marketing, finance, and product development. Being a leader and innovator of technology, healthcare trends, and the movement of pay-for-volume to pay-for-performance, he has extensive knowledge in the reimbursement space with a focus on bundled payments, episode performance programs, gainsharing, capitation, and many other areas of the payment spectrum.

Chris brings along with him knowledge in behavioral health, care management, provider relations, network management, practice and physician recruitment and management, revenue cycle offerings including credentialing and enrollment and electronic billing, NCQA accreditation, HEDIS measures, clearinghouse and TPA capabilities, contract negotiations and management in his historical book of business.

Justin Rock is a Director with Premier Performance Partners His background is in hospital operations and analytics with a special emphasis on Bundled Payment, value-based care models, clinical integration, and process improvement in the acute hospital setting. Prior to joining Premier, Justin was Executive Director, ACO with Valley Baptist Health System in South Texas. While at Valley Baptist, Justin led the first Model 4 Bundled Payment program in the nation. He later led the conversion of the Model 4 program into Model 2. He also developed the local Clinical Integration Network and MSSP ACO, wrote and received the Practice Transformation Network grant under the Transforming Clinical Practices Initiative, and developed Executive guidance materials on Medicare Innovation programs for Tenet Healthcare. Other positions held by Justin at Valley Baptist included Director of Operations Analytics, LEAN Process Improvement Specialist, and Customer Service Manager.

Win Whitcomb oversees all aspects of the clinical enterprise, and the intersection between clinical, technology, and business areas. Prior to joining Remedy, Dr. Whitcomb led the development and implementation of several bundled payment programs at Baystate Health in conjunction with its commercial health plan and the Center for Medicare and Medicaid Innovation. A practicing hospitalist for the past twenty years, Win has led the development of the hospitalist specialty since 1994, when he assumed leadership of the nation’s first 24/7 on-site hospitalist program. Dr. Whitcomb is cofounder and past president of the Society of Hospital Medicine, and has lectured widely, written numerous articles, and authored three books on the clinical and administrative aspects of hospital medicine. Dr. Whitcomb received hospital medicine’s most prestigious achievement award, the Master in Hospital Medicine, in April 2010. He is Assistant Professor of Medicine at the University of Massachusetts Medical School.

Adam Berry is the CEO of Summit Orthopedics, one of the Minnesota’s top orthopedic groups with surgeons practicing at over 30 clinics. Adam is making dramatic changes to the way orthopedic healthcare is delivered. Adam’s vision has led to tremendous growth, reinventing the joint replacement experience for patients through his management groundbreaking of two 65,000-square-foot destination specialty centers, increasing Summit’s geographic footprint, and revitalizing its organizational structure to decrease silos and add capacity. Adam is known for walking the halls with surgeons and staff to observe and explore how he can better serve the needs of each doctor and clinic.

Jack Drogt, MD is an orthopedic surgeon and President of Summit Orthopedics, an independent practice with 50+ physicians, 29 partners, and 850 employees. As an experienced leader, he was instrumental in creating a dynamic business model, assembling an experienced executive team, and organizing a successful sub-specialty based orthopedic surgical practice providing exemplary clinical and surgical care. He is recognized locally and regionally as a skilled sub-specialized hip and knee reconstruction surgeon. Dr. Drogt received his undergraduate degree at the University of Illinois, medical degree at Northwestern University Medical School. He is a Clinical Associate Professor at the University of Minnesota.

Paloma Izquierdo-Hernandez is the President and Chief Executive Officer of Urban Health Plan (UHP), a network of community health centers located in the South Bronx, Corona, Queens and Central Harlem. Under Ms. Izquierdo-Hernandez’ leadership, Urban Health Plan is today a first class health care organization.

Ms. Izquierdo-Hernandez has dedicated her professional life to eliminating health disparities and improving the lives of the people in the communities that she serves. She currently sits on both local and national boards including serving as the Secretary of the Board of Directors of the National Association of Community Health Centers.

Anthony Thompson is a Program Director for Empire Blue Cross Blue Shield Health Plus, the New York Medicaid Health Plan. In this role, he is responsible for the development, ongoing operations and client management of the Provider Collaboration Initiative which is Empire BCBS’ focus on DSRIP and value based arrangements. Prior to this position, Anthony worked with the legacy Amerigroup Corporation as the director of Marketing Operation Analytics. Anthony also has a significant background in financial analysis and reporting having spent years working for Warner Music and Deloitte as financial reporting analyst and staff auditor, respectively.

Dr. Berg is the National Lead of Government Healthcare Transformation, and member of the KPMG Global Health Center of Excellence. He currently leads the Delivery System Reform Incentive Program for the State of New York, including a comprehensive Value Based Payment Reform that CMS has embraced as ‘leading the nation’. Marc Berg was Professor of Social Medicine in the Department of Health Policy and Management of Erasmus University Rotterdam, and has been in leading health care consulting roles for over a decade. He has extensive experience with claims data and clinical data, played a leading role in the introduction of public performance measures on the quality and safety of hospital care, mental health care, nursing home care, and chronic care. He pioneered the introduction of measuring value of care for defined populations, working for both governments and public payers, building upon an integrated set of claims data, patient reported outcome measures and clinical data.

Mr. Fazio has successfully helped a variety of providers enter and implement the CMS BPCI initiative and OCM. Previously, Mr. Fazio was a senior consultant with Health Management Associates where he helped health plans, providers and states navigate healthcare payment reform. Prior to this, Mr. Fazio served as director of contracting for Boston Children’s Hospital where he managed the hospital’s $1.6 billion contracted book of business with local and national health plans. Mr. Fazio holds a bachelor’s degree in health management and policy from the University of New Hampshire.

Erich Mounce is the Chief Executive Officer of the West Clinic and the University of Tennessee West Cancer Center, one of the nations’ top rated community oncology practices. Mr. Mounce has been instrumental in the development and implementation of the West Clinic’s strategic vision and operational transformation to value based health care.

Mr. Mounce has a mix of both physician and hospital operational expertise. Previously, Mr. Mounce was the COO for Lakeside Comprehensive Healthcare. In addition, as the past President and CEO of Envision Healthcare Corporation, Mr. Mounce has served on numerous leadership and advisory boards. During his tenure with Envision, he was instrumental in the development of the DC Healthcare Alliance, a public private partnership to care for Washington, DC’s indigent population. Mr. Mounce has also participated in the direct leadership, acquisition and restructuring of numerous non-profit and for profit hospitals, physician owned medical groups IPAs, and managed care organizations.

Barry Russo has been with The Center since 2002. Barry has over 25 years of healthcare experience – he has worked in academic and community practices as well as academic and community hospitals. The Center for Cancer and Blood Disorders is a private community practice. The Center has 20 physicians, 8 Physician Extenders and 9 practice sites. The Center offers medical oncology, radiation oncology, hematology, gynecologic oncology, breast oncology surgery, stereotactic radiosurgery, integrative medicine, imaging, laboratory services and retail pharmacy.

Lindsay Jubelt, MD, MSc is the Senior Medical Director of Population Health at Mount Sinai Health System and Assistant Professor of Medicine in the Icahn School of Medicine. Dr. Jubelt leads clinical program redesign across the health system to promote high-quality, efficient healthcare services. In her work, she aims to strengthen the health system’s role as a learning laboratory to improve the quality and value of care provided to patients. She is also a practicing general internist for vulnerable patients at Mount Sinai Hospital.

Dr. Jubelt received her B.A. from the University of Pennsylvania her M.D. from Stony Brook University. She completed her internal medicine residency at the Massachusetts General Hospital followed by training in health services research via the Robert Wood Johnson Clinical Scholars Program at the University of Pennsylvania.

Jonathan Pearce is a healthcare finance and analytics strategist who assists providers and purchasers of healthcare services to make data driven decisions, and is the founder of Singletrack Analytics. In that position he assists healthcare providers to better utilize data analyses for financial and clinical management. He is currently helping more than 75 ACOs and bundled payment participants to compete on analytics, and utilize their data to guide their path in those programs. Jon is a Certified Public Accountant and holds an undergraduate degree in engineering and a MBA in finance. He also holds a Microsoft Certified IT Professional certification in business intelligence, and is a Fellow of the Healthcare Financial Management Association.

Kristen Daley is the Group Director of Value Based Programs for Centura Health, South Denver Operating Group. Kristen joined Centura Health in 2014 as the Director of Orthopedics at Porter Adventist Hospital. She brings a strong track record in the development of new programs and services, physician alignment, and thrives as a change architect for high impact operations and strategic projects. Prior to her roles at Centura Health, Kristen served for over 18 years as a consultant to hospitals nationwide in healthcare advisory services. Ms. Daley earned her bachelor’s degree in Biology from Dartmouth College.

Brenda Lewis is the Group Manager of Care Coordination for the South Denver, Colorado Operating Group of Centura Health. Brenda’s care coordination team assists to guide and support patients throughout post-acute episodes while ensuring quality and costeffective care. Brenda also provides oversight for Centura Health’s postacute network to ensure that the Centura hospitals and their preferred partners deliver quality coordinated care to patients. Brenda’s nursing experience includes twenty years in hospital Case Management and she holds both CCM and ACM case manager certifications.

David M. Glaser is a shareholder in Fredrikson & Byron’s Health Law Group. David assists clinics, hospitals, and other health care entities negotiate the maze of health care regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in health care regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David’s goal is to explain the government’s enforcement position and to analyze whether this position is supported by the law or represents government overreaching.

Adam Romney is a partner at Davis Wright Tremaine and works from the firm’s Seattle and Los Angeles offices. He supports health care providers on regulatory and reimbursement matters, Medicare and Medicaid issues, audits and payment disputes, developing telemedicine delivery models and areas of health care reform including accountable care, bundled payment and others. Adam has worked for the U.S. Department of Health and Human Services Office of General Counsel and Office of Medicare Hearing and Appeals, and also spent time as a legislative staffer specializing in Medicare and Medicaid policy.