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Boosting Plan Performance: Improving Provider-Centric Risk Adjustment & Staying Compliant

Boosting Plan Performance: Improving Provider-Centric Risk Adjustment & Staying Compliant

Gregg Kimmer

President & CEO,
ATRIO Health Plans

A tenured leader with a history of building portfolios of success over the last decade, Gregg has experience in all aspects of Medicare Advantage, including finance, sales, marketing, product development, operations, care delivery, and strategic partnership development. After nearly seven years at Humana, where he was one of five Divisional CFOs and oversaw $1.4 billion in revenue, he became Chief Medicare Officer over the Great Lakes market at Aetna / CVS Health. During his four years in this role, he had full P&L responsibility and oversaw organic growth of 20k to 133k members.

Colleen Gianatasio

Director, Clinical
Documentation Integrity and
Coding Compliance, CDPHP

Colleen has over 20 years of experience in health insurance, including customer service, claims, quality, and coding. As Director, Clinical Documentation Integrity and Coding Compliance, Colleen’s primary responsibilities are provider engagement and clinical documentation improvement for accurate coding and reimbursement. Colleen specializes in developing innovative coding curricula and instruction to support compliance with federal guidelines and appropriate reimbursement processes.She is a certified AAPC instructor and enjoys teaching a variety of coding, documentation, and auditing classes. In addition, Colleen serves as President of the AAPC National Advisory Board.

Hassan Rifaat, MD

CEO, Vatica Health

Hassan has over 25 years of experience in leading healthcare organizations. He served as CEO of Windsor Health Group with 300,000+ members, held senior executive positions at Humana, and served as SVP at Coventry Health Care for over 1.5 million members across 11 states.

Michelle IIitch, MPH

Vice President of Network
Solutions and Value-Based
Programming,
Priority Health

In her role, Michelle is responsible for driving Priority Health’s Statewide network contracting strategy, operations and partnerships to improve quality and lower the cost of care for Priority Health members. Her role covers the entire provider network spectrum of providers from post-acute to physicians and health systems.

She has extensive experience in strategy, health plan mergers, ACO federal regulations, network development, risk-based contracting, population health IT data platforms, care management and process improvement.

Before joining Priority Health, Ilitch served in several roles in population health management, clinical integration, payer strategy, and ACO creation at Trinity Health.

In this capacity, she helped create ACOs in 14 markets nationally and concentrated within Southeast Michigan. Ilitch also held a role with Blue Cross Blue Shield (BCBSM)’s Physician Group Incentive Program (PGIP), where she oversaw the management of the pharmacy incentive program.

In addition, she is a Senior Lecturer at the University of Michigan School of Public Health, Health Management and Policy (HMP) department. Michelle earned a Master of Public Health (MPH) from the University of Washington and a B.A. from Albion College.

Frank Shipp, FACHE, MBA, RRT

Executive Director,
Johns Hopkins Clinical
Alliance, Johns Hopkins
Medicine

Frank currently serves as Executive Director of the Johns Hopkins Clinical Alliance, the clinically integrated network of Johns Hopkins Medicine. The network includes over 3,000 providers, consisting of both employed and independent practices.

Frank transitioned to value-based care after 25 years of hospital-based operations experience at organizations including New York Presbyterian, NYU Langone and Temple University Health System. During the past 9 years, Frank has held executive positions in a Payor-Provider Organization in NYC, Emblem Health, and has built a highly successful CIN over a five-year period in Northern New Jersey within the Valley Health System.

Frank completed his MBA at Fairleigh Dickinson University and is a certified Fellow of the American College of Healthcare Executives and a trained Black Belt in Lean Six Sigma from Villanova University.

Boosting Plan Performance: Improving Provider-Centric Risk Adjustment & Staying Compliant

Provider-centric risk adjustment and quality programs enable health plans to enjoy higher compliance, enhanced quality of care, improved risk score accuracy, higher Star and quality ratings and better financial performance.

Learn how your plan can empower physicians to proactively close care gaps and maintain compliant record documentation.

  • Learn best practices for provider-centric risk adjustment programs.
  • Avoid common pitfalls in designing a program.
  • Benefits of SDOH interventions

Gregg Kimmer

President & CEO,
ATRIO Health Plans

Colleen Gianatasio

Director, Clinical
Documentation Integrity and
Coding Compliance, CDPHP

Hassan Rifaat, MD

CEO, Vatica Health

Michelle IIitch, MPH

Vice President of Network
Solutions and Value-Based
Programming,
Priority Health

Frank Shipp, FACHE, MBA, RRT

Executive Director,
Johns Hopkins Clinical
Alliance, Johns Hopkins
Medicine

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