Faculty – Medicare Conference 2018

Cyndi Alexander, BSN, MHA, CPHQ
Vice President of Quality and Star Ratings Improvement, PHARMMD

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Cyndi Alexander, a Certified Professional in Healthcare Quality (CPHQ) through the National Association for Healthcare Quality, brings PharmMD more than 20 years of healthcare expertise in her oversight role for clinical, quality and Star Ratings improvement. PharmMD’s track record in this growing field reflects her impact.

Cyndi’s’ previous experience includes oversight of regulatory compliance and Joint Commission quality metrics for St. Thomas’ multi-hospital system. Cyndi was also responsible for quality, Star metrics, regulatory compliance, and NCQA accreditation activities for the Sterling Life Insurance’s Windsor Health Plan. Her expertise in the coordination and integration of health plan activities enabled the plan to increase their overall Star Rating by one Star in less than three months.

Cyndi holds a BS in Nursing and an M.S. in Healthcare Administration from the University of Tennessee-Knoxville. Cyndi is a former Baldrige Award surveyor and currently sits on the advisory board for The National Committee for Quality Assurance (NCQA) SNP surveys.

Larry Baca

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Larry Baca is Director of Sales with Inter Valley Health Plan, a not-for-profit Medicare Advantage Plan. He has more than 20 years of experience in sales management with leading carriers, including United Healthcare and Blue Shield of California.

Paul R. Belton, RHIA, MHA, MBA, J.D., LL.M
Vice President of Corporate Compliance, Ethics and Privacy, SHARP HEALTHCARE

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Paul has served in the healthcare industry for the past thirty-three years at a number of healthcare systems and hospitals across the country. His line responsibility has included positions as Vice President of Ancillary Services and Assistant Vice President of Finance. He has a Master’s in Hospital Administration and a Master’s in Business Administration from Arizona State University. He also attended law school and has a Master’s in Health Law from Loyola University-Chicago School of Law.

After working with the American Hospital Association, Stanford University, and PricewaterhouseCoopers specializing in implementing corporate compliance programs, Paul has served the past nineteen years as Vice President of Corporate Compliance and Privacy with Sharp HealthCare in San Diego, CA. He is an active member of the Health Care Compliance Association, American College of Healthcare Executives, Healthcare Financial Management Association, Health Ethics Trust, American Health Information Management Association and the American Health Lawyers Association.

Joyce Chan, Vice President of Population Health Strategy, HEALTHFIRST CORPORATION

Joyce Chan
Vice President of Population Health Strategy, HEALTHFIRST

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Joyce Chan, MBA, is the Vice President of Population Health Strategy at Healthfirst, a not-for-profit managed care organization sponsored by major New York not-for-profit and public healthcare systems. She is responsible for using analytics, reporting and incentives to improve clinical quality and member satisfaction. Her role includes oversight of quality bonus programs and performance as well as provider quality. Prior to joining Healthfirst, Ms. Chan was a consultant in the Global Health Practice at Booz Allen Hamilton, where she advised providers, payers and pharmaceutical companies on strategy and operations. With a deep interest in reducing health disparities, she is an active contributor to a number of industry workgroups and speaks regularly with policymakers and regulatory agencies on this topic. Ms. Chan received a B.S. degree in chemical engineering and B.A. degree in Plan II Honors from The University of Texas at Austin, and she holds an MBA degree from the University of Michigan.

John Gorman
Founder and Executive Chairman, GORMAN HEALTH GROUP

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John Gorman is Founder and Executive Chairman at Gorman Health Group (GHG). In this role, he has led the development of the industry’s leading consulting practice and several entrepreneurial ventures in government health programs. John’s work focuses on Medicare, Medicaid, and Affordable Care Act strategy, 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 provides leadership and expert strategic, operational, and technology-based solutions in 21 years of continuous operations and growth. GHG has redefined solutions in risk adjustment, enrollment/eligibility/membership reconciliation, beneficiary marketing, sales agent compliance and management, and online training. The company also sources acquisitions and investments and assists due diligence teams for its clients and the investment community.

John speaks at dozens of industry and investment community conferences each year, reaching thousands of senior healthcare executives with his predictions about the evolving 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 the firm in 1996, John served as Assistant to the Director of Health Care Financing Administration’s 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 healthcare reform, John was chief lobbyist on healthcare financing issues for the National Association of Community Health Centers, an organization of federally-funded primary care clinics for the medically underserved. John’s career in Washington began as Press Secretary and Staff Director for U.S. Representative John Conyers, Jr. (D-MI), then-Chairman of the Government Operations Committee.

Thomas Graf
Chief Medical Officer and Vice President, HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY

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Thomas Graf, MD, FAAFP is Vice President and Chief Medical Officer for Horizon Blue Cross. He brings 25 years of experience in advancing healthcare delivery, reducing cost of care, and supporting continuous growth and performance improvement. Dr. Graf applies his deep understanding of economic, social, and regulatory issues with his clinical experience to align diverse stakeholders and build consensus around shared strategic and operational goals, bridging the unique perspectives provided by physicians, hospitals, payors, patients, and employers. He adeptly translates overarching strategies into targeted operational and performance improvement efforts to help organizations navigate through the evolving and turbulent landscape.

Prior to joining Horizon, he was National Director for Population Health for The Chartis Group helping dozens of provider systems and groups to create strategy and improve performance in driving quality to lower total cost of care and comprehensively care for populations. Prior to Chartis, Dr Graf served for nearly twelve years in various roles at Geisinger. In his final position there, Dr. Graf was the Chief Medical Officer for Population Health and Longitudinal Care Service Lines. There, he was responsible for the value re-engineering of the care continuum and other population health initiatives for Geisinger including the ACO portfolio, the Physician Group Practice, and PGP Transitions Demonstrations and Bundled Payments for Care Improvement. Operationally he had responsibility for the community practice, internal medicine, medical specialties, pediatrics, psychiatry, oncology, neurosciences, women’s health, and care continuum service lines across 22 counties in central and northeast Pennsylvania.

After graduating from University of Michigan Medical School and completing family medicine residency training at Henry Ford Health System in Detroit, Dr. Graf served on the faculty of the Henry Ford Family Practice Residency and was Director of the Southwest Georgia Family Practice Residency.

Leah Hirsch
Government Relations Director, Medicare, ANTHEM

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Leah joined Anthem in 2013 as a Government Relations Director focused on Executive Branch advocacy for the Medicare business.

Prior to joining WellPoint, she was an Associate at Booz Allen Hamilton and supporting The Center for Consumer Information and Insurance Oversight (CCIIO) within The Centers for Medicare and Medicaid Services (CMS). At Booz Allen, Leah focused her on efforts on the health insurance exchanges development and implementation.

Before joining Booz Allen, Leah was a Senior Legislative Representative at AARP specializing in health policy. Her role was to monitor and analyze healthcare laws and regulations as well as develop strategies. She focused on Medicare, Insurance Market Reform, Delivery System Reform, and Private Insurance Issues.

Leah has also held positions at Medical Group Management Association and Academic Family Medicine Advocacy Alliance where she focused Medicare-related issues.

Leah holds a Certificate of Health Policy from the George Washington University as well as a Master of Arts in Peace and Conflict Resolution from Arcadia University. In addition, she holds a Bachelor of Arts degree in Government and Politics and a Bachelor of Arts degree in Hearing and Speech Science from the University of Maryland.

Kent Holdcroft, M.A.
Chief Revenue Officer, PHARMMD

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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.

Leonard Kirschner, M.D., MPH
Former President, AARP ARIZONA


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Dr. Kirschner is Past President of AARP Arizona. He is a member of the Harvard School of Public Health Leadership Council and was a member of the 2011 AHA Committee on Research and the 2010 AHA Long Range Policy Committee. He is on the Board of Directors of Wickenburg Community Hospital. He is a member of the National Advisory Board on Improving Health Care Services for Seniors and People with Disabilities. He is a Trustee of the Arizona Perinatal Trust, a member of the Arizona State Medicaid Advisory Committee, the Arizona Health Improvement Plan, and Fighter Country Partnership. He was a member of the AHRQ Regional Expert Panel and the 2003 Citizens’ Task Force on the Maricopa County Health Care System. He is a past President of the Veterans Medical Leadership Council of the Carl T. Hayden VA Medical Center, and he served on the Board of the AzHHA from 1998 to 2005. He was a member of the AHA Regional Policy Board from 2000-2003 and 2007-2009; and was on the Board of the PMH Health Systems Strategy Group, 1994-2001; Del E. Webb Hospital, 2002-2008; and Sun Health, 2004-2008.

He retired as a Principal with William M. Mercer Inc., a global consulting firm, in 2001. During his tenure with the company, he provided consulting services to such diverse Medicaid programs as TennCare, MediCal and AHCCCS. Dr. Kirschner was Vice President, Health Care Initiatives, State Health Care, EDS, 1993 to 1999. During his six years with EDS, he provided consulting services to Medicaid programs, including business trips to all 50 states.

Dr. Kirschner was Director of the Arizona Health Care Cost Containment System (AHCCCS) from February 1987 until July 1993. This program provides healthcare to more than one million residents of the state. The prepaid model pioneered by Arizona is considered to be the most cost-effective means of providing quality health care to Medicaid beneficiaries. During his six years as AHCCCS Director, he represented the western states and Pacific territories on the Executive Committee of the State Medicaid Directors Association and chaired the Medicaid Managed Care Technical Advisory Group.

During the past 40 years, he has been an invited speaker at numerous conferences across the country speaking on the subjects of Medicaid, Medicare, managed care, behavioral health and health care reform. He was on the Advisory Committee of the National Managed Health Care Congress, a featured speaker of the Medical Leadership Forum, and co-author of “Medicaid Managed Care” in the Managed Health Care Handbook. He was the recipient of the 1994 Arizona Hospital and Healthcare Association’s Salisbury Award and the 1997 Arizona Department of Health Services and Arizona Medical Association’s Public Health Service Award. In 2006, he was awarded the Healthcare Lifetime Achievement Award by the Phoenix Business Journal and the Individual Leadership Award by WESTMARC.

Dr. Kirschner is a graduate of Williams College, Albany Medical College and the Harvard University School of Public Health. He is board certified by the American Board of Preventive Medicine and is a Fellow of the American College of Preventive Medicine and the Aerospace Medical Association.

Dr. Kirschner served on active duty in the United States Air Force for 22 years commanding five Air Force hospitals before retiring in 1985 as Commanding Officer of the USAF Hospital, Luke Air Force Base with the rank of Colonel. He spent 10 years at military medical facilities outside the United States, including assignments in Turkey, Japan, Vietnam, Thailand and Spain, and served four years as Director, Cadet Health Services at the USAF Academy. His military awards include the Legion of Merit, Bronze Star, Air Medal and Vietnam Service.

Sarah Kramer, M.D.
Chief Medical Information Officer, YUMA REGIONAL MEDICAL CENTER

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Dr. Sarah Kramer is a former family physician with over 30 years of clinical experience. She is currently the Chief Medical Information Officer of Yuma Regional Medical Center (YRMC). Prior to her career in Informatics, she acted in the role of Clinical Medical Director, and has had experience in the fields of Ambulatory Clinical Quality, worked for a well-known electronic health records vendor, and had a brief stint on the payor side. She has worked in a variety of different practice settings, including private practice, and an academic health center. She has acted as a physician leader for ICD-10 transition, as well as patient engagement through web-portals. Dr. Kramer is passionate about facilitating an ideal technology experience for busy physicians, and helping them get paid for what they do.

Christine Leo
Vice President, Senior Products, CIGNA

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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.

George N. Miller, Jr., MSHA, FACHE
President and Chief Executive Officer, THE LORETTO HOSPITAL

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George N. Miller, Jr. has over 30 years’ experience in healthcare related administrative and financial management.  Mr. Miller is very passionate about his profession and has served as the President/Chief Executive Officer of THE LORETTO HOSPITAL (TLH) in Chicago, IL since November 2017.  The Loretto Hospital is an acute care community hospital that serves over 33,000 patients each year from Chicago’s Austin and surrounding communities.  As a not-for-profit, community-focused health care provider, we offer a unique, patient-centered healthcare delivery system that promotes general wellness and education in the communities we serve. Through our partnerships with physicians, research institutions, area residents and local businesses, we strive daily to be your health care provider of choice.

Before coming to The Loretto Hospital Mr. Miller was President/CEO of CommUnityCare Health Center is the largest Federally Qualified Health Center (FQHC) healthcare provider in Texas and the 10th largest in America, has 24 locations, with over 321,000 patient visits annually, we have over 850 Team Members, including over 150 providers and a budget of over $105 Million.  CUC is a fully Integrated Delivery System (IDS), delivering care from the womb to the tomb or from birth to the hearse.

Before coming to CUC, Mr.  Miller was the Chief Executive Officer of the Okmulgee Memorial Hospital (OMH) in Okmulgee, OK, a full-service rural hospital.  Before coming to OMH, Mr. Miller served as the President/CEO of First Diversity Healthcare Group (FDHG), Springfield, OH, full-service firm that is committed to bringing quality healthcare professionals to Healthcare.  Before coming to Springfield, Mr. Miller served as the President /CEO of Provena St. Mary’s Hospital (PSMH) in Kankakee, IL.   CEO of CHRISTUS Jasper Memorial Hospital (CJMH) in Jasper, TX; President/CEO of Pecos County Memorial Hospital and Pecos County General Hospital in Fort Stockton and Iraan, TX; President/CEO of Twin Oaks Medical Center in Fort Worth, TX and Administrator/CEO of Newport News General Hospital.

Mr. Miller has won several awards, he led CMHP to the 2007 Premier One Source National Quality Award, where only 49 hospitals out of 4700 nationally earned this distinction.  Mr. Miller also led PSMH in and CJMH  to be selected as one of Solucient’s Top 100 Hospitals in America. In addition, PSMH also won the J.D. Powers Hospital of Distinction Award.

In 2008 he was appointed by President Bush to the Medicare Payment Advisory Commission (MedPAC) and reappointed in 2011 by President Obama. Mr. Miller was the National President of the National Rural Health Association for 2007, the largest rural trade association in America and the voice of rural healthcare.  Served on the Board of Directors of the American Hospital Association (AHA) for 2004-2006 the Board of Commissioners for the Joint Commission (TJC) from 2002-2004, served on the Board of Directors of the Texas Hospital Association (THA), and the Texas Organization of Rural and Community Hospitals. (TORCH).

In Austin, TX, Mr. Miller currently served on the Board of Directors of the Texas Hospital Association/Health Share.   He is on the Board of Directors and the Chair-Elect of the Texas Health Institute (THI) for 2018-2020.

Mr. Miller received a BS in Business Administration from Bowling Green State University in Bowling Green, Ohio and an MSHA in Health Services Administration, from Central Michigan University in Mount Pleasant, Michigan.  He is currently an Adjutant Professor of Health Services Administration for the Masters Program for CMU.  He is FACHE of the America Colleges of Healthcare Executives. Mr. Miller has given more than 200 speeches nationwide on healthcare including speaking at the White House and both Houses of Congress.  He also has been selected to give the commencement address for University and High School Graduations.

Mr. Miller has two beautiful girls, Brianna and Grace along with a son, George III (Trey).  The family is active members of their church.  He enjoys a host of activities along with most sports including being an avid golfer.

John O'Shea, M.D.
Surgeon and Senior Fellow, Center for Health Policy Studies, THE HERITAGE FOUNDATION

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John O’Shea is currently a practicing surgeon and Senior Fellow in the Center for Health Policy Studies at the Heritage Foundation in Washington, DC. Prior to taking his current position, he was a Visiting Scholar in Health Policy at the Brookings Institution. From 2011 to 2013, he served as a senior health policy advisor to the U.S. House Committee on Energy and Commerce, where he helped draft the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). He has a master’s in public administration from the Harvard Kennedy School and a master’s in history and sociology of science from the University of Pennsylvania.

Michael Olsen, MBA
Senior Director, Network Strategy and Contracting, BETH ISRAEL DEACONESS CARE ORGANIZATION

Michael Perez-Mesa
Division Director Managed Care, SAVASENIORCARE

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Michael Perez-Mesa is currently the Division Director of Managed Care for Sava Senior Care, a nationwide Skilled Nursing Facility Corporation with 207 locations in 22 States. He is responsible for the managed care contracting, business development and ACO relationships for over 100 SNF’s in 13 States.

Prior to working for Sava Senior Care, Michael worked for other Health Care companies, including Kindred, Vibra Healthcare, Trumpet Behavioral Health, and Cypress Healthcare Consultants. Other areas of expertise include business development and contracting for LTAC Hospitals, Behavioral Health Facilities, and Therapy. He also has experience in working with Managed Medicaid, the VA, and other Payor Sources.

Michael holds a B.S. Degree in Biology from Westminster College in Fulton, MO. He also has an MBA from the University of Colorado, in Boulder, CO. Michael currently resides in Lonetree, CO. In his spare time, he enjoys playing tennis and golf, and spending time with his wife and three children.

Jana Perry
Vice President, Strategy and Growth, HEALTH ALLIANCE MEDICAL PLANS

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Jana Perry began her duties as Vice President of Strategy and Growth in January 2015. Jana has been with Health Alliance since 1986, serving in a variety of leadership roles for claims, operations, member retention, customer service and Consumer and Employer Group sales and service. In her current role, Jana has overall responsibility for new business growth, net growth within and retention of existing clients, and development of a sustainable distribution system. Jana is accountable for the development of a sales strategy that is aligned with the organization’s short-term and long-term strategic plans and supports the market growth objectives of health system partners. Further responsibilities include assessing market trends and new product developments, applying these findings to the business of Health Alliance and overall responsibility for construction and implementation of product line adjustments. This position includes product line oversight for commercial employer group, Medicare, Exchange marketplace and Third Party Administrative Services.

Annamarie Rakes
Director, Quality Improvement and Stars, BLUECROSS BLUESHIELD OF TENNESSEE

H. Scott Sarran, M.D., M.M.
Senior Divisional Vice President, Chief Medical Officer, Government Programs, HEALTH CARE SERVICE CORPORATION

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H. Scott Sarran, M.D., is Divisional Senior Vice President and Chief Medical Officer, Government Programs, Health Care Service Corporation (HCSC). He is responsible for network strategy and oversight (including ACOs), medical management and quality for HCSC’s government programs in all five (IL, TX, NM, OK, MT) states. Dr. Sarran joined HCSC in 2008 as Chief Medical Officer for Blue Cross Blue Shield of Illinois.

Curtis Stubblefield

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Curt Stubblefield, the Director of Value Based Care for National HealthCare Corporation (NHC), [(NYSE MKT: NHC)].

An alumunus of the University of Tennessee Martin, (BA, Communications) Mr. Stubblefield’s career in health care began in 1985 in a small private home health agency. Over the course of the 31 years since then, Mr. Stubblefield has managed health care operations for both small, private companies and large, national corporations (Beverly Enterprises and Columbia-HCA).

His experience includes the development of startup companies for healthcare consulting, medical staff leasing and medical adult day care. He has worked in many aspects of healthcare, as a provider and a Medicare Advantage payer.

Mr. Stubblefield gives credit to excellent mentors who were strong leaders and shared their understanding of modeling for change. As a result, he has seen many professional sucesses in his field. Looking ahead, he hopes to have a positive impact with the changes in the industry.

David E. Swieskowski, M.D., MBA
President, MERCY ACO

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Dr. David E. Swieskowski, MD, MBA, is the Senior Vice President and Chief Accountable Care Officer at Mercy Health Network ACO, Iowa. He completed his graduation from University of Iowa College of Medicine. Dr. Swieskowski has led Mercy Health Network ACO’s quality initiatives in areas such as diabetes and hypertension that are now recognized as best-practice nationally. In addition to his clinical expertise in the areas of quality and safety, he has applied process improvement strategies to reduce operating costs. Dr. Swieskowski is a highly experienced doctor, with over 30 years of practice in the field and is affiliated with top rated hospitals.He has authored numerous articles on health IT, policy, medical practices, and administration that featured on various media channels, journals, etc.

Director of Coding Effectiveness, BON SECOURS HEALTH SYSTEM, INC.

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Ms. Tate is the Director of Coding Effectiveness for Bon Secours Health System, Inc. She has 20 years of experience in healthcare practice management, coding, and compliance, specializing in auditing and physician coding education. She is a doctoral candidate at the Medical University of South Carolina, having earned her Master in Health Administration in 2004 and her BS in Business Administration from the College of Charleston in 1986. Ms. Tate has been a Certified Professional Coder since 2000 and is also a Certified Professional Medical Auditor, with additional specialty coding credentials in evaluation and management and cardiology coding. She is a member of the American Academy of Professional Coders, the American Health Information Management Association, the Association of Clinical Documentation Improvement Specialists, and the Health Care Compliance Association.