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Session Speakers
Ruth Galyon, RN
Director, Specialty Care Management Team
HCSC/Health Care Management – BCBSIL
Breakout Session: Monday 2:30 PM
Ruth Galyon is the Director of the Specialty Care Management Team in the Medical Management Department of Blue Cross Blue Shield of Illinois. She has been with HCSC/BCBSIL for more than 5 years and worked in all areas of Medical Management, such as Utilization Management and Case Management, as well as the implementation of our Disease Management Program. She also implemented the pilot program for our Personal Health Manager. Before joining BCBSIL, she had many years experience in Pediatrics, Med/Surgical, OB and Nursery, Orthopedics, and home care. Ms. Galyon has been in the managed care industry since 1995 and worked within Precert/PreAuth, Utilization Management, Disease Management, and Case Management for various companies. In her current position at BCBSIL, she manages Case Management, Transplant, High-Risk OB and client-specific programs. She has been part of the Integrated Total Health Management (ITHM) project since its inception in 2005 as the Case Management Lead to facilitate and provide oversight for the integration of all Case Management workflow process across all four Health plans. In 2006, she became a member of the Core Team, which provided oversight for the implementation of the Care Planner Web platform, as well as an Enterprise Workflow process across HCSC (NM, OK, IL, and TX).
Cynthia Hallam, BSN, MBA
Divisional Director of Clinical Operations
BCBS of Louisiana
Breakout Session: Tuesday 11:15 AM
Cynthia Hallam is Divisional Director of Care Management and Medical Informatics at Blue Cross and Blue Shield of Louisiana. Previously she worked for Aetna as Clinical Director, Medicare Programs. Prior to joining Aetna, Ms. Hallam was AVP, Managed Care for CIGNA HealthCare. Ms. Hallam holds a masters degree in business administration and is a licensed registered nurse.
Nancy Skinner, RN, CCM
President
Riverside HealthCare Consulting
Breakout Session: Tuesday 2:50 PM
Session Repeats: Wednesday 8:30 AM
Although her healthcare education has a foundation in both acute and post acute nursing, Nancy has for the past 20 years primarily served as a case manager, case management supervisor and national case management trainer and educator. While her case management career has included a variety of practice settings including managed care, home health care and education, she most values her ability to advance case management education. In her current position, Nancy serves as Principal Consultant for Riverside HealthCare Consulting. In her role at Riverside HealthCare Consulting, Nancy develops programs for payors and providers, which reflect the state of the science of case management and other related medical management strategies. Additionally, she also advances educational opportunities for case managers through her role as an Adjunct Faculty Member for the University of Southern Indiana Case Management Program.
In 1998, Nancy was honored as the Illinois Case Manager of the Year and in 2002, she was named the CMSA National Case Manager of the Year. She has been active in CMSA at both the local and national level including serving as a National Officer of CMSA from 1995 to 2000 and 2004 to 2007. She has also assisted CMSA in developing programs that have advanced case management education including primary authorship of twelve Case Management Resource Paths™. Nancy has served on several case management advisory boards including the Commission/URAC Case Management Advisory Committee, CDC Case Management External Workgroup, American Society of Consultant Pharmacists Research and Education Foundation 2002 Thrombosis Prevention and Management Education Program and Traineeship Planning Committee, the National Managed Healthcare Conference Advisory Board, the Coalition to Prevent DVT, the MC Biologics Advisory Group and the National Transition of Care Coalition.
Michelle Milcarek, RN
Manager-Clinical Technology, Product Interface
HCSC/Health Care Management – BCBSIL
Breakout Session: Monday 2:30 PM
Michelle is a Manager in the Medical Management Department of Blue Cross Blue Shield of Illinois. She has been with HCSC/BCBSIL for 10 years and brings with her many years of clinical, supervisory and managed care experience. Prior to her joining the ITHM (Integrated Total Health Management) Project in 2005 as a Core Team member, her primary responsibilities included project management oversight of the Medical Management’s software system in the development, design, and rollout of system enhancements and new application for BCBSIL PPO/POS book of business. Her role as Core Team member focused on ensuring the ITHM software application would be able to support the business requirements and workflow processes of all plans under HCSC (TX/OK/IL/NM) utilizing a single software platform supporting the "Enterprise Approach" of doing business across all plans to support both end users as well as our external customers. She received her nursing degree from Purdue University-Calumet.
John Semmens, MD
Healthcare Management Consultant, Collaborative Care
Milliman
Breakout Session: Monday 2:30 PM
John is currently a healthcare management consultant in the Indianapolis office of Milliman. He joined the firm in 1996.
John has over 30 years of experience in various aspects of both private practice and managed care. He practiced internal medicine in Phoenix, Arizona from 1972 to 1997. He is a founder of a primary-care-based multi-specialty group that grew to a 50-physician practice under his leadership. John was also co-founder of an HMO that was subsequently acquired by United
Healthcare and he served as National Medical Director of disease management at United Healthcare prior to joining Milliman.
John’s special interests include managing both capitation and fee-for-service through efficient use of clinical resources, development of disease management programs, evidence-based guideline implementation, and physician change management. He has extensive experience in evaluating the efficiency of healthcare delivery at the hospital and physician provider level. Evaluation of healthcare delivery includes extensive experience doing clinical chart reviews to evaluate the efficiency, resource use, quality and appropriateness of care in the inpatient and outpatient setting. At the health plan level he has extensive experience in assessing medical management, making recommendations for change and assisting in the implementation of those changes. Other interests and experience include clinical support of Milliman’s Individual and Small Group Medical Underwriting Guidelines. John has held appointments as an Assistant Professor of Medicine at the University of Minnesota School of Medicine and Clinical Instructor of Medicine at the University of Arizona School of Medicine.
Beth Heinz, MSW
Senior Director, Best Care Best Experience
Regions Hospital
Breakout Session: Monday 3:30 PM
Beth Heinz has more than 15 years of healthcare experience in hospital systems involved in Psychiatric Care, Care Management, Palliative Care, Utilization Management, Compliant Documentation Programs and Quality. Ms. Heinz graduated with a BA from the University of Minnesota, an MSW from the University of Michigan, and currently is a candidate for an MHA from the Carlson School of Management, University of Minnesota.
She has held a wide variety of both clinical and management positions in several hospitals in Michigan and Minnesota. She now is the Senior Director of Regions Hospital-Health Partners in St. Paul, Minnesota responsible for Best Care, Best Experience-improving the patient experience, Quality, Palliative Care, Date and Measurement, Care Management, Utilization Management, and Complementary Care. As such, she influences quality metrics, strategic organization planning, and project management. In recent Care Management improvement work, she partnered with Dr. Howard Epstein, Medical Director of Care Management, focusing efforts in decreasing delays. Ms. Heinz is an active member in the American Care Management Association, IHI Collaborative, and Institute for Clinical Systems Improvement.
Anthony Watts, BS
System Analyst
BCBS of Tennessee
Breakout Session: Tuesday 1:30 PM
Anthony Watts is a Systems Analyst who has been with BCBST for 10 years. His primary role is application and software support for the various Provider and Utilization Management systems. His responsibilities include software implementations, upgrades and maintenance. He currently serves as the Information Systems project lead for Care Guidelines implementations, upgrades and updates. Anthony graduated with a Bachelor of Science in Computer Information Systems from Alabama A&M University.
LaShonda Swoope, RN
Healthcare Services Coordinator
BCBS of Tennessee
Breakout Session: Tuesday 1:30 PM
LaShonda Swoope is a Registered Nurse who has worked with BCBST for five years. She currently works in the Commercial Training Department as the lead Training Coordinator. During the implementation of the Care Guidelines, her primary responsibilities included testing the guidelines, implementing the guidelines into the systems, training the end users whenever new editions are implemented or updates are received and maintaining the necessary training tools for the end users.
Melissa Vaughn
Medical Policy Specialist
BCBS of Tennessee
Breakout Session: Tuesday 1:30 PM
Melissa Vaughn is a Medical Policy Specialist for BlueCross BlueShield of Tennessee. Her primary responsibilities include providing technical support regarding various systems and software applications, maintains and updates BlueCross BlueShield of Tennessee Web sites, and provides project management support including the BlueCross BlueShield of Tennessee Modified Milliman Care Guidelines® project.
Kathleen Vinson, RN, BSN
Program Manager Clinical Resources
BCBS of Tennessee
Breakout Session: Tuesday 1:30 PM
Kathleen Vinson is a Program Manager Clinical Resources for BlueCross BlueShield of Tennessee. Her primary responsibilities includes researching and developing medical policies, the BlueCross BlueShield of Tennessee Modified Milliman Care Guidelines® process, which includes research and development of the Modified Milliman Care Guidelines®, the review and approval process, and implementation of the guidelines. Kathleen also developed and coordinates the Medical Policy and Modified Milliman Care Guidelines® Provider Appeals Process. Kathleen serves as the Milliman liaison for BlueCross BlueShield of Tennessee, coordinating continuing Milliman education. Kathleen graduated with a Bachelor of Science in Nursing from the University of Tennessee at Chattanooga.
Jean E. Range, MS, RN, CPHQ
Executive Director
The Joint Commission
Breakout Session: Monday 1:30 PM
Jean Range is Executive Director for the Disease-Specific Care Certification at The Joint Commission. In this role, she oversees all certification activities related to disease management services, including the development of standards and review processes.
Ms. Range has 27 years of nursing, management and consulting experience in the healthcare industry. She most recently served as senior vice president for Clinical Operations at ParadigmHealth Corporation in Deerfield, Ill., a national disease management provider.
Ms. Range is a certified professional in Healthcare Quality and she holds a certificate in Six Sigma Black Belt from Villanova University. She earned her master’s degree in Human Resource Management and Industrial Relations from Loyola University Chicago and her bachelor’s degree in nursing from Rush University in Chicago.
Barbara Wood, RN, BSN, MBA
Associate Director, Care Management
Group Health Cooperative
Breakout Session: Monday 11:15 AM
Barbara Wood has extensive ambulatory care and care management experience, both in FFS and non-profit. She has worked for Group Health Cooperative for 18 years, with the last 14 years in Utilization or Care Management. She has been a team member for the implementation of several successful care management programs at Group Health. She has a passion for developing the right approach to care management and believes that care management can help reform healthcare.
Stephanie Thompson, RN, BS, MS, CCM, CPUR
Manager Core Team Lead
BCBS of New Mexico
Breakout Session: Monday 2:30 PM
Mrs. Thompson received her RN from Riverside White Cross School of Nursing, and her Bachelor of Science and Master of Health Service Administration degrees from the University of St. Francis. She has been with Blue Cross Blue Shield of New Mexico for 18 years. Before joining Blue Cross she worked in labor and delivery, office nursing and home health care. In her current position, she manages nurses in Utilization, Case, and Disease Management. She joined the Integrated Total Health Management (ITHM) development and design team for Health Care Services Corporation (HCSC) in 2005, and was appointed Core Team Lead in 2006. The Core Team has provided oversight for implementation of the CarePlanner Web® platform for HCSC in NM, OK, IL and TX. Mrs. Thompson's Clinical specialty is Maternal Health. She is a board member for Life Options Academy, a residential program for teenage mothers.
John Cowman, BSc Physio, MSc Research
Director
Havering PCT
Breakout Session: Monday 3:30 PM
John Cowman qualified as a physiotherapist in his hometown of Dublin, Ireland, in 1995 and continued his studies, gaining qualifications in statistics and psychology and a Masters Degree in Research in 1998. He lectured in Research Methodology and Statistics at Trinity College, then secured the role of research physiotherapist at Kings College Hospital, London, and was a key team member on international drug trials with Strong Memorial in New York and the Gulf War Syndrome Trial with the Ministry of Defence. He recently enjoyed a year’s scholarship at the Saïd Business School at Oxford University as one of thirteen individuals sponsored by the Department of Health to study Social Entrepreneurship. He now holds the post of Associate Director of Business Development in Havering Primary Care Trust. His current role requires him to assess new models of service delivery, and he has been the assigned project manager for the implementation of the Milliman Care Guidelines within the Trust.
Howard R. Epstein, M.D.
Medical Director, Care Management and Palliative Care
Regions Hospital
Breakout Session: Monday 3:30 PM
Howard Epstein is Medical Director of Palliative Care and Care Management at Regions Hospital in St. Paul and former Associate Medical Director of Hospice of the Lakes at HealthPartners. Dr. Epstein received his undergraduate and medical degrees from Washington University in St. Louis. After completing his Residency in Internal Medicine at the University of Minnesota, he joined the teaching faculty at Regions Hospital and helped establish their hospital medicine program. He is a Clinical Assistant Professor of Medicine at the University of Minnesota, and is a faculty member of its Palliative Care Leadership Center. Dr. Epstein has given numerous lectures locally and nationally on Bioethics, Palliative and End-of-Life Care, and Care Management. He serves as Chair of the Committee for Evidence-Based Practice at the Institute for Clinical Systems Improvement, and is the workgroup leader for ICSI’s recently released Palliative Care Guideline. Dr. Epstein is the Chair of the Society of Hospital Medicine’s (SHM) Palliative Care Task Force, and has served as a member of the SHM Ethics Committee since 2001. Dr. Epstein was recognized for his many efforts to improve the quality of care for hospitalized patients with SHM’s 2006 National Award for Clinical Excellence.
Ginnean Quisenberry, RN, MSN, MS
Nurse Consultant, PHMMD
TRICARE Management Activity (TMA/HA)
Breakout Session: Monday 2:30 PM
Ms. Ginnean Quisenberry is a Senior Policy Analyst for the Medical Management Programs in the Office of Chief Medical Officer, TRICARE Management Activity. She is a subject matter expert in Medical Management, and serves as a liaison to the Services, TRICARE Regional Offices, and Managed Care Support Contractors. Ms. Quisenberry also participates in Population Health initiatives and implementation activities.
Prior to joining the TRICARE Management Activity, Ms. Quisenberry served in various administrative and clinical roles within the TRICARE arena. She served as a TRICARE Service Center Manager, on-site Utilization Management coordinator, MTF Case Manager, and as an on-site Referral Management specialist. Ms. Quisenberry has also served as a clinical coordinator within the civilian managed care sector, and has military service experience as an Air Force Flight Nurse. As an AD family member and TRICARE beneficiary Ms. Quisenberry is dedicated to improving services to the TRICARE beneficiary population as a whole.
Andrea Werner, MSW, CICSW
Director, Bellin Heart and Vascular Center
Bellin Memorial Hospital
Breakout Session: Monday 11:15 AM
Andrea Werner is the strategic and operational senior leader for all heart and vascular services at Bellin Health. Andrea has a background in social work and is the former manager of Care Management. Most recently, Andrea has been trained as an Improvement Advisor with the Institute for Healthcare Improvement. Andrea leads her business through the lens of continuous quality improvement.
Peggy Shaw, RN, BSN
Team Leader of Care Management CHP
Community Health Plan
Breakout Session: Monday 3:30 PM
Peggy Shaw, RN, BSN, works for Community Health Plan (CHP) in St. Joseph, MO, one of the first beta sites to use the new CareWebQI program. Peggy will explain the process that CHP went through to implement CareWebQI, and how the variance tracking and web-based interactions have been beneficial in implementing changes to the organization’s health plan.
Rebecca Perez, RN, CCM, CPUR, CPUM
Health Services Coordinator
Carpenters' Health and Welfare Trust Fund of St. Louis
Breakout Session: Tuesday 11:15 AM
Rebecca has 16 years of clinical experience in the acute care setting. Areas of practice included medical/surgical, cardiology and oncology. She began her career as a case manager late in 1992, specializing in case management of the oncology and transplant patient, eventually taking a position with the Carpenters’ Health and Welfare Trust Funds in 1997. Responsibilities include administration of the extensive Care Management Program, establishing and administering disease management programs, supervision of utilization management by network providers, direct contracting for health services, utilization management of directly contracted PHO, and coordination of services and education for union carpenters and floor layers. She has also served on several drug-testing committees for the construction industry in both Missouri and Illinois, assisting with the policy and procedure draft of the Southwestern Illinois Building Trades Drug Task Force, and design and implementation of the Carpenters’ District Council of Greater St. Louis and Vicinity Drug Testing Program.
Giselle Caron, BHSC
Team Leader
Mater Health Services Brisbane Limited
Breakout Session: Tuesday 1:30 PM
Giselle Caron has worked in a range of settings in the public and private sectors, both interstate and locally. Giselle’s twelve years of clinical experience includes medical and surgical nursing, specializing in Gynecology and Women’s Health. In the non-clinical setting, Giselle’s experience over the last seven years includes management and coordination roles in Clinical Information, Carepaths, Variance Analysis and Project Management. Giselle has completed her Certificate IV in Workplace Assessment and Training, as well as various Leadership and Change Management Courses. She is currently working towards her Advanced Diploma of Business Management. Giselle’s role for the last three years has been that of Team Leader for the Exceptional Models of Care Program within the Clinical Safety and Quality Unit of Mater Health Services.
James Tan, MD, MPH, MBA, CPE
SVP, National Medical Director
AMERIGROUP Corporation
Breakout Session: Tuesday 2:50 PM
James Tan is a National Medical Director at AMERIGROUP Corporation, a managed care organization that focuses on government-sponsored programs. In this capacity, Dr. Tan oversees Clinical Quality Management and Disease Management Programs. He is also involved in development of new products for the organization. During the past two years, he led AMERIGROUP in achieving NCQA accreditation for the eight Disease Management programs and one of the health plans. Before this, Dr. Tan served as a physician executive in medical groups, hospital, and health plan settings. He is a graduate of Loma Linda University (MD and MPH), and University of Redlands (MBA), and is a Certified Physician Executive (CPE).
Matthew Fitzgerald, DrPH
Senior Director, Science and Quality
American College of Cardiology
Breakout Session: Wednesday 8:30 AM
Dr. Matthew Fitzgerald is currently the Senior Director for Science and Quality at the American College of Cardiology, where he oversees the production of Clinical Practice Guidelines, Data Standards, Performance Measures, Appropriateness Criteria and other policy documents, as well as running quality alliances which includes national quality campaigns, including the Door to Balloon Time Quality Alliance, in which more than 930 hospitals are currently participating. Before coming to the ACC, Dr. Fitzgerald served as the Chief Scientist and Quality Officer at the Delmarva Foundation for Medical Care, where he led more than 100 clinical quality improvement projects in all clinical topics across the spectrum of clinical settings. Dr. Fitzgerald is a 1997 graduate of IHC's Healthcare Delivery Improvement Training Program, and holds a Doctorate in Environmental Health from the Johns Hopkins University.
Betsy Stumpf, BSN
Project Manager - Provider Service Center/ UM
Kaiser Permanente Mid-Atlantic
Breakout Session: Monday 11:15 AM
Betsy Stumpf has been with Kaiser Permanente since 1984, as an Advice nurse, a Clinic nurse, and in Utilization Management. Her Utilization Management (UM) roles include Inpatient Utilization Review and Discharge Planning, as well as Geriatric Case Management. She is a Certified Case Manager through CCM. Currently Betsy is a Compliance Program Manager with UM, though is more focused on the systems side of things. There is one more class left before she obtains her Master's Degree in Technology Management. She has helped Kaiser through a Referral Management system implementation, which included the Milliman CareGuideQI® interface. Betsy has worked with Milliman Care Guidelines to design a process to report on Inpatient Variances in which Kaiser Permanente felt that they could gain the most improvements on Inpatient Utilization.
Beth Malchetske, MBA, RHIA
Director, Health Information Services / Project Manager, Collaborative Care Transformation
ThedaCare, Inc
Breakout Session: Monday 1:30 PM
Beth Malchetske is the Director for Health Information Services at two of four ThedaCare hospitals, and is currently on assignment as a project manager for the organization’s collaborative care transformation journey. Lean concepts were used extensively in the redesign and implementation of a pilot medical unit testing the new model of care delivery. Beth's experience also includes knowledge and experience with EMR systems, intraoperable data exchange, compliance, and legislative processes. Additional experience includes utilization review, quality management, and risk management, cancer registry, and reimbursement systems. Beth also has a Masters in Business Administration, and has more than 20 years of health care experience.
John Schaller, MD, MPH
Medical Director
Schaller Anderson of Arizona, Inc.
Breakout Session: Monday 1:30 PM
Session Repeats: Tuesday 11:15 AM
Dr. John Schaller is a medical director within the corporate medical management department of Schaller Anderson and has been with the organization for 6 years. The department is responsible for the development and oversight of all medical management programs for health plans administered by Schaller Anderson. Schaller Anderson manages Medicaid health plans and commercial health plans for self insured employers in eight different states.
Schaller Anderson, which was recently acquired by Aetna, was founded 20 years ago by Dr. Donald Schaller, John’s uncle, and Joe Anderson. They were the administrators of the Arizona Health Cost Containment System, Arizona’s Medicaid program, from 1982 to 1986.
Prior to joining Schaller Anderson, Dr. John Schaller was a partner for seven years with a multi-specialty group, SHARP Mission Park Medical Group in San Diego, CA. He practiced occupational medicine and internal medicine. Prior to this, he was a medical director for Exxon Company, USA in Houston, TX for three years where he held several different positions.
Dr. John Schaller holds the following degrees: Bachelor of Science from the University of Southern California, Medical Doctor from the University of Arizona College of Medicine, and Masters in Public Health from San Diego State University. He is board certified in internal medicine, occupational medicine, and general preventive medicine.
John Robinson, MD, PhD
Consultant
John W. Robinson, M.D., Ph.D., LLC
Breakout Session: Wednesday 8:30 AM
John W. Robinson, MD, PhD, is a healthcare management and statistical consultant. He is board-certified in psychiatry and holds doctoral degrees in both biostatistics and health policy and management. He previously served as chief medical officer of a managed behavioral healthcare organization and is currently a Faculty Associate at the Johns Hopkins University Bloomberg School of Public Health, where he teaches outcomes and effectiveness research methods. Areas in which he has published research include healthcare cost prediction, risk adjustment, provider profiling, predictive data mining, and the recognition and management of behavioral health problems in primary care.
David Evans, MD
Senior Medical Director
ActiveHealth Management
Breakout Session: Monday 1:30 PM
Session Repeats: Tuesday 11:15 AM
Dr. Evans joined innovative, technology-driven ActiveHealth Management in 2003. He is a current member of ActiveHealth's clinical R&D team and has responsibilities across several of ActiveHealth's evidence-based products, including Care Considerations, Informed Care Management (disease management), UM, CM, and Maternity programs. Dr. Evans is Board-certified in Internal Medicine, and has additional training in medical acupuncture. Before joining ActiveHealth, he served 11 years in various clinical and administrative roles at Kaiser Permanente Mid-Atlantic States. Dr. Evans received his Bachelor's degree from Rice University, Houston, his medical degree from the University of Texas Health Science Center, San Antonio, and his post-graduate training from the Sinai Hospital-John's Hopkins system, Baltimore.
Dianne Beaven, RN, BSN, MS
Compliance and Program Manager
Kaiser Permanente
Breakout Session: Monday 11:15 AM
Experience:
18 years of Critical Care experience
2 years as Hospital Educator
4 years of Home Care, Manager of Utilization Review
11 years of managed care experience as Manager in clinical settings, and as UM
Education:
St. Vincent’s Hospital School of Nursing, NYC, NY—nursing diploma
Old Dominion University, Norfolk, Va.—BSN in nursing
University of Maryland University College, College Park, Md.---MS in Administration (Health Care)
Jamie Dunham, MS, BSN, RN
Business Unit Manager, Collaborative Care
ThedaCare, Inc.
Breakout Session: Monday 1:30 PM
Jamie Dunham is the Business Unit Manager for ThedaCare’s Research and Development Unit that opened at Appleton Medical Center on February 19, 2007, described as Collaborative Care. Previous management positions include Nursing Unit Manager for a Medical Services Unit at Appleton Medical Center, and Cardiac/Orthopedic Unit at Theda Clark Medical Center. Earlier, Jamie worked primarily in education as a Staff Development Educator in the Surgical, Pediatric and Neurology Service lines, and as a Community Health Educator for the Hospital Division. Jamie holds a Bachelor of Science Degree in Nursing and a Masters Degree in Organizational Leadership and Quality.
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