Rise

Monday, August 28  ǀ  2:00pm - 4:00pm
Adapting to the Evolving Healthcare Landscape
A Discussion on Innovative Solutions to Deliver High-Value Care

Think Tank Hosted in Partnership With:

Thank you for participating in the RISE West Think Tank, hosted in partnership with Signify Health. We are proud to host thought leaders and industry experts for lively discussion and idea exchange on innovative solutions to deliver high-value care. Continue reading to learn more about who you will be interacting with during this valuable, invitation-only session.

MODERATOR
Heidi Schwarzwald, MD, MPH
Chief Medical Officer, Home & Community Services
Signify Health

In her role as Chief Medical Officer for Signify Health’s Home & Community Services business, Dr. Heidi Schwarzwald helps lead strategies related to the Signify Health clinician network, IHE governance, and new product development.
Prior to joining Signify Health, Dr. Schwarzwald held several roles with Aetna, including VP CMO of Provider Network and Deputy CMO for Aetna Better Health, leading the population health team. She was honored to receive the CVS Health CEO Award in 2021. Prior to joining Aetna in October 2019, Dr. Schwarzwald served as the Chief Medical Officer for Texas Children’s Health Plan and Associate Vice Chair for Community Pediatrics for Baylor College of Medicine.
Dr. Schwarzwald is a board-certified pediatrician and a fellow in the American Academy of Pediatrics. She received her undergraduate degree from Harvard University, her medical degree from the University of Cincinnati College of Medicine and completed a pediatric residency at Baylor College of Medicine in Houston Texas. She completed her Master’s in Public Health at the University of Texas School of Public Health in Houston Texas.
Dr. Schwarzwald lives in Houston Texas with her husband and two children.

MODERATOR
Rachel Hiatt
Vice President, Product Management
Signify Health

In her role as Vice President, Product Management for Signify Health’s Clinical Documentation products, Rachel Hiatt helps lead strategies related to member visits and new product development. Prior to joining Signify Health, Rachel focused on ambulatory care for the Centricity products within GE Healthcare. She led teams for clinical and revenue cycle product updates for Meaningful Use adoption, ePrescribing of controlled substances, and ICD-10 conversion. She also launched a new
multi-language EMR with the International Olympic Committee for the 2018 Winter Olympics.

Rachel has an undergraduate degree in Biology from the University of North Texas and a Master’s in English also from the University of North Texas. Rachel lives in Dallas Texas with her husband and son.

Vandna Bhrany
Vice President, HEDIS Strategy & Analytics
Amerihealth Caritas

Vandna Pandita, MPH is the Vice President of HEDIS® Strategy and Analytics for the AmeriHealth Caritas Family of Companies [ACFC].  In her role, Vandna is leverages her experience in quality and risk adjustment operations to support members and providers as it relates to performance reporting and the member and provider experience.  Her area of influence spans analytics, plan operations and digital integration of data and processes in the transition to interoperability. 

Prior to AmeriHealth, Vandna has worked for several national health plans, including Aetna, several Blue Cross Blue Shield plans, the Blue Cross Blue Shield Association and Centene.  She has successfully led several health plans through NCQA Accreditation, managed HEDIS® reporting, improvement and outreach, and helped develop and implement a successful provider profiling and performance measurement program.  In addition to her health plan experience, Vandna managed Risk Adjustment Client Operations for Evolent Health, is a former certified HEDIS® Compliance Auditor and led project management and client solutions for a retrieval, abstraction/coding and analytics vendor supporting health plans and provider groups in their efforts to optimize revenue and improve quality within their populations.

Vandna attended the University of California at Berkeley as an undergraduate and received her Master’s in Public Health from the University of California at Los Angeles.

Vandna has moved from coast to coast, spending the better part of the last 25 years working on her southern drawl in Atlanta, Georgia.  These days you can find her running the streets of Atlanta, cooking for friends or working on her newest hobby, making wobbly pottery. 

John Barkley
Vice President, Enterprise Risk Adjustment & Data Integrity
EmblemHealth/ConnectiCare

John Barkley is the Vice President of Enterprise Risk Adjustment and Data Integrity for Emblem
and ConnectiCare. John has been with the enterprise for ten years leading ConnectiCare and now Enterprise Risk Adjustment function.
Prior to joining Emblem John was with Aetna for twenty-one years with the last six years in the risk adjustment space. John has been an attendee and presenter at RISE events for several years now. When not executing risk adjustment activities he enjoys kayaking, biking and fishing on Cape Cod, Massachusetts where he lives.

Stacy Coggeshall
Vice President of Risk Adjustment
Fallon Health 

Stacy Coggeshall is a healthcare executive with a clinical background specializing in Government programs, strategy development and operational execution.
Stacy has been in health care for 22 years, primarily focused on Risk Adjustment and Value Based Care for over 15 years. She is currently serving the position of Vice President, Risk Adjustment, for Fallon Health in Worcester, MA. Stacy started her career as a transplant nurse at Johns Hopkins Hospital. After receiving her Master degrees, she worked in the Program Integrity Group at the Centers for Medicare and Medicaid Services. From there she has worked in Organizations such as Tufts Health Plan, Optum and Iora Primary care building Risk Adjustment departments, managing prospective programs, building program strategies and setting up coding and clinical documentation integrity teams.
Stacy holds a Bachelor of Science in Business Management and Marketing from Cornell; a Bachelor of Science in Nursing from Johns Hopkins University School of Nursing; a Masters of Business Administration and Masters of Science in Nursing from Johns Hopkins University.

Mark Dabney
Director, Risk Adjustment
Community Health Plan of Washington

Mark Dabney is the Director of Risk Adjustment at the not-for-profit healthplan Community Health Plan of Washington (CHPW), supporting risk adjustment operations, submissions, and analysis for Medicare, ACA, and Medicaid lines of business.   He has over 16 years of experience in risk adjustment programs and over 20 years of health care industry experience spanning a wide spectrum, from call center representative to supporting the implementation of the ACA program for millions of members across Kaiser Permanente, including serving as risk adjustment lead for Medicare, Medicaid, and ACA programs in the Mid-Atlantic States.  Prior to joining CHPW in late 2021, he helped implement risk adjustment operations and value-based programs at kidney care provider Somatus, driving revenue bearing care assessment partnerships.   

Outside of work, Mark and his wife enjoy pub trivia nights and board games.  Mark is an avid music and movie buff, and tolerable musician and home recording fan.  He lives in the Seattle area. 

Rika Kari
Vice President, Medical Economics and Risk
Horizon Blue Cross Blue Shield of New Jersey

Rika Kari, has 18 years of progressive experience in the health insurance field. He currently serves as VP of Medical Economics and Risk Adjustment at Horizon BCBS, where he oversees a risk adjustment operations for 1.5 million members and provider cost and medical trend management for 3.5 million commercial and government programs members.

He previously held the position of Divisional VP, Government Business Solutions at HCSC. While at HCSC, Rika leveraged his strong financial and analytical background, rising through the company in several roles, including in Financial Planning and Analytics, Risk and Revenue Optimization, Enterprise Analytics, Provider Analytics, and IT. Rika’s experience included the strategic and operational execution for over two million ACA and MA individual members.

Rika holds his Masters of Business Administration from Southern Methodist University and received his Bachelors in Economics and Finance from UT Dallas. He is married with three daughters—ages 3, 5, and 8—and has three dogs at home.

Mikal Sutton
Managing Director Medicaid
Blue Cross Blue Shield Association

Mikal Sutton is Managing Director of Medicaid policy for the Blue Cross Blue Shield Association (BCBSA), a national federation of thirty-four independent, community-based and locally operated Blue Cross and Blue Shield (BCBS) companies. BCBSA covers 114 million lives across all lines of business in the U.S. and Puerto Rico. Twenty-four of the BCBSA Plans operate a Medicaid program in twenty-nine states and Puerto Rico with more that twelve million Medicaid members. 

With almost 15 years of experience Sutton has collaborated with state and local agencies, organizations, and external stakeholders to build substantive policy solutions. Sutton oversees detailed Medicaid policy analysis and strategies to support BCBS companies, in collaboration with BCBSA’s legislative, regulatory, research and modeling teams. Since joining the Association in 2020, Sutton has worked on regulatory and policy development on a wide variety of program issue areas including maternal health, social determinants of health, long-term services and supports, expansion of Medicaid and the Public Health Emergency unwinding. 

Sutton has worked on Medicaid policy in Illinois, policy initiatives with the Illinois Department on Aging and as a director of grant operations for a Robert Wood Johnson Foundation grant focused on growing the nursing pipeline in Illinois. Sutton has a master’s degree in political studies and a bachelor’s degree in communications from the University of Illinois at Springfield. 

An Illinois native, Sutton earned a bachelor’s degree in communications and master’s degree in political studies from the University of Illinois, Springfield. She enjoys outdoor activities, listening to music and traveling with her family.

Mandvi Tandon
Director of Medicaid Quality & Risk Adjustment
HealthCare Partners

• Internal Risk Adjustment SME to Business Operations.
• Identification of internal operational gaps and development of new processes to ensure proper ownership and accountability.
• Identified, evaluated, and implemented technological solutions: web-based tracker to streamline departmental and interdepartmental workflows to improve efficiency and provide higher outcomes.
• Develop and implement risk adjustment strategies, programs, and initiatives to enhance documentation accuracy and improve estimated ROI by 10%.
• Driving changes to align risk adjustment goals with the company strategic objectives of the organization by creating retrospective and prospective strategies in improving RAF.
• Provide leadership and guidance to team members, fostering a culture of continuous improvement and professional development.
• RISE West- Panel Discussion Speaker on Best Practices Provider Engagement & RA strategies-August 2023

Adrian White
VP, Quality Operations, Clinical Safety & Patient Experience
Southwestern Health Resources

Adrian is an influential, people-centric executive who bridges gaps and drives results across clinical, safety, quality, and patient experience workflows through cross-functional collaboration, emotionally intelligent people management, and business acumen. He received his nursing degree from the Royal College of Surgeons in Ireland, an MBA from University College Dublin, and is a Certified Professional in Patient Safety (CPPS) and in Patient Experience (CPXP). He has been active in the areas of Clinical Care, Quality, Safety, Accreditation and Patient Engagement for over 20 years, having worked at St. James’s Hospital in Dublin and Mayo Clinic Health System in Minnesota before joining UT Southwestern in Texas in 2013. He is currently employed by Southwestern Health Resources (SWHR), as the VP for Quality Operations, Patient Experience and Clinical Safety. SWHR blends the strengths of University of Texas Southwestern Medical Center and Texas Health Resources; includes a network of 29 hospital locations and more than 5,000 physicians, committed to being the national leader in population health. Adrian’s role focuses on strategies to develop, deploy and sustain comprehensive programs across the multi-specialty SWHR Clinically Integrated Network, leading the strategic direction of this large-scale matrixed organization.

Helen Veet, DNP, RN
Director of Quality Management
AmeriHealth Caritas

Helen Veet DNP, RN is the Director of Quality Management for AmeriHealth Caritas Pennsylvania and Keystone First Medicaid Plans. Helen specializes in the Medicaid quality programs, assist with HEDIS project collection, and has a passion for healthcare quality. She has a background in cardiac and orthopedic clinical nursing as well as Healthcare Systems Leadership. In her role at AmeriHealth Caritas Pennsylvania and Keystone First, she overees the Community Health Navigator team, Community Outreach Team, and the Quality of Care Nurse team. She enjoys country line dancing and traveling the world with her family.

Kiran Rangarajan
Chief Government Programs Revenue Officer
Blue Cross & Blue Shield of Rhode Island

Kiran Rangarajan is an accomplished leader in the Risk Adjustment domain with extensive experience in government programs and has worked for payors, provider groups, and vendor partners. Currently, he serves as the Chief Government Program Revenue Officer at BCBS Rhode Island developing strategic initiatives, managing operations, and driving revenue for the organization. Prior to BCBSRI, Kiran has worked for United Group, Southwestern Health Resources, North Texas Specialty Physicians, Inovalon, and Anthem successfully navigating the complexities of the health care industry and driving revenue optimization and operational efficiency.  

Kiran Rangarajan has a PhD from Missouri University of Science and Technology in Engineering Management focusing on managing high-risk projects and implementing effective solutions. Kiran continues to be at the forefront of industry trends with an innovative mindset and ability to identify growth opportunities and implementing effective and sustainable solutions.  

Mia Bell
Sr. Manager, Medicare & Commercial Risk Adjustment
Blue Cross Blue Shield of Massachusetts

Mia was born and raised in Baton Rouge, Louisiana. She is married with 3 children with a career in healthcare. Mia’s has more than 20 years in the healthcare industry in the areas of Risk Adjustment, Quality, Value Base Contracting and Provider Relations. She is currently a Sr. Manager of Risk Adjustment Operations for Blue Cross Blue Shield of Massachusetts, where she works to improve medical record collection, oversee risk adjustment coding, and manages member programs to close quality gaps. In her spare time, Mia works with up-and-coming healthcare professionals to educate and train in the areas of Medical Billing and Coding, understanding quality measures and positive impacts of quality care provided to members. As an Innovator and agent for change within healthcare, Mia has helped many health plans restructure and realign their Risk Adjustment & STARS programs by helping each adapt to new technology to help improve program success and ultimately drive quality of care and reduce the cost of care.  

Outside of healthcare, Mia is a published author, Mentor and Coach and is active in community and faith based organizations in her hometown of Baton Rouge, Louisiana. 

Terence Tanue
Insights Analyst
Blue Cross Blue Shield of North Carolina

Lyle Hill
Risk Adjustment and STARS Adviser
Health Care Services Corporation

Lyle Hill’s health plan experience began with Kaiser Permanente and has included work with national, regional and provider sponsored for profit and not-for-profit health plans.  Within those health plans he’s worked in commercial, federal, Medicaid and most recently Medicare Advantage lines of business.

During a 10+ year career at Kaiser Permanente, Lyle served as Director of Membership Accounting, Director of Claims Adjudication and Director of Business Systems Administration.  Lyle again worked 10+ years at HealthSpring, a publicly traded firm (NYSE:HS) which was acquired by Cigna (NYSE:CI).  At Cigna/HealthSpring, Lyle served as VP of Medicare Data Quality Operations, leading all aspects of risk adjustment operations from 2007 to 2015.  Lyle also served as Director of IT Strategy, VP of Application Development and Chief Information Officer for HealthSpring, serving as CIO when HealthSpring opened for trading on the NYSE in 2006.

More recently Lyle served as VP and GM for Commercial and Medicare Operations at Centauri Health Solutions, leading the dual eligibility and risk adjustment lines of business until leaving in 2022.  Lyle currently consults for Health Care Services Corporation, supporting the risk adjustment and Quality teams in the Medicare Advantage business line.

Jenni Monfils
AVP, Risk Adjustment Coding and Compliance
Bright HealthCare

Jenni Monfils, CPC, CDEO, CRC has over 20 years of healthcare experience in revenue cycle, coding, and documentation improvement. She is an accomplished risk adjustment professional with extensive experience in both the Medicare and HHS HCC coding. Jenni specializes in developing provider risk adjustment education and HCC quality oversight programs to ensure compliance. She has project managed HHS-RADV audits, Medicare Advantage Contract Level RADV audits and Part C Improper Payment Measure (National RADV) audits. Jenni demonstrates effective leadership and innovative problem-solving skills to plan and execute the necessary oversight in the ever-changing risk adjustment space.

Clarence Grant
VP Provider Relations
Transcarent

Libby Mathai
Director, Risk Adjustment Analytics
Elevance Health

At Elevance Health, I've been a Data Analytics lead facilitating the architecture and building of Medicaid Risk Adjustment platforms. I currently lead the Risk Adjustment Innovation and Development team.

 We work in close collaboration with our Medicaid and Commercial Analytics teams supporting the following main business initiatives:

1. Retrospective Risk Adjustment (Document additional conditions in claims that existed at the time of a previous encounter for risk transfer revenue)
2. Prospective Risk Adjustment (Prompt a member/provider encounter in the future to assess for conditions not yet documented to close gaps. New claims with those conditions diagnosed will result from prospective targeting)

Core functions of my team:

• Technical consultation for RAA Commercial and Medicaid Operations teams.
• Platform Development including Claims, Provider, Membership Data Extraction from Elevance data repositories, and building risk scoring engines and models.
• Platform Operations including monthly refreshes to meet deliverables for retrospective and prospective targeting campaigns, score reconciliation etc.
• Provide Development Lifecycle Environment for the Risk Adjustment team that includes Release Management/Issue Management/Version control tools administration for the RAA team.

Prior to Elevance Health, I was with UnitedHealth Group and Optum for 13 years and worked in UW, Actuarial, Health Care Economics and Clinical Solutions teams.

Matt Coury
Title
AllCare IPA

Sarah Baggs
Title
Blue Cross Blue Shield of Alabama