Former President and CEO of America's Health Insurance Plans (AHIP)
and Former Administrator of the Centers for Medicare & Medicaid Services (CMS)
Looking Forward to Future Changes in Health and Human Services and Anticipating What’s Next for the Industry
A discussion with Marilyn Tavenner, hosted by Mediware CEO Bill Miller, featuring audience Q&A.
Agencies throughout the U.S. Department Health & Human Services continue to signal their increasing emphasis on delivering quality care. Most notably, the Centers for Medicare & Medicaid Services (CMS) are focusing on new value-based payment models. The trajectory of the health and human services industry affects the vital care you provide, and you need perspective to ensure your agency’s success for years to come. Marilyn Tavenner — former President and CEO of AHIP and Administrator of CMS — will give you that perspective at CareForum 2018. Join Marilyn for a forward-looking armchair discussion with audience Q&A, hosted by Mediware CEO Bill Miller. Marilyn will share her thoughts on what’s next for Medicare and Medicaid; how the 2018 political landscape in Washington will shape the industry; and how we can better connect community services and health care to help more people in need.
Keynote Speaker & Executive Coach
Oppositioning: One Surprising Strategy for Innovation and Differentiation
What can tiny houses, Spartan races, knuckleball pitchers, armless archers, Snapchat, unibrows, and Minecraft teach us about innovation and differentiation? We all know that innovation and differentiation are essential, but developing and implementing truly unique ideas seems very difficult, and most fail to become more creative and distinctive. The solution is surprisingly simple. A singular method for finding unconventional ideas that will dramatically improve your ability to stand out and produce an endless supply of original breakthroughs. You’ll go from unconventional to unforgettable to unstoppable.
Senior Policy Advisor for Corporation for Supportive Housing (CSH)
Former Deputy Assistant Secretary for Special Needs at the U.S. Department of Housing and Urban Development
Data with Purpose: Connecting Health and Social Issues to Help Communities Thrive
Health and social issues are deeply interconnected. Human services professionals know that a person’s presenting condition — whether it’s homelessness, addiction, or a health issue — is rarely a singular need with a singular solution. To find solutions that help individuals thrive, we need system-level thinking and planning, as well as innovation at every level of service. This kind of collaboration at scale requires intelligent, actionable data gathered from multiple sources. In this session, we will explore creative, multidisciplinary approaches to problem solving that can improve care across virtually any service setting.
President and Chief Experience Officer of Integrated Loyalty Systems
Creating Patient Loyalty by Providing Exceptional Patient Experiences
Patients today say they want to be treated as individuals and not just identified by their acuity or clinical ID number. They tell us that exceptional experiences occur when we consistently meet their expectations on what we provide (the clinical care side) while exceeding their expectations on how we provide it (the service side). In the highly competitive health care marketplace, patient experience is a top driver of patient loyalty and marketshare.
Healthcare Provider Solutions, Inc.
Melinda A. Gaboury is co-founder and Chief Executive Officer of Healthcare Provider Solutions, Inc. (HPS). Melinda Gaboury and Mark Cannon founded the company in April 2001 to provide financial, reimbursement, billing, operational and clinical consulting to the home care and hospice industries.
With more than 27 years in home care, Melinda has over 17 years of executive speaking and educating experience, including extensive day-to-day interaction with home care and hospice professionals. She routinely conducts Home Care and Hospice Reimbursement Workshops and speaks at state association meetings throughout the country. Melinda has profound experience in Medicare PPS training, billing, collections, case-mix calculations, chart reviews and due diligence. ZPIC, RA, ADR & TPE appeals with all Medicare MACs have become the forefront of Melinda’s current impact on the industry. She is currently serving on the NAHC/HHFMA Advisory Board as ex-officio and is Associate Director on the Home Care Association of Florida Board of Directors. Melinda is also the author of the Home Health Pocket Guide to OASIS-C2: A Reference Guide for Field Staff.
Melinda attended Cumberland University in Lebanon, Tennessee and received her Bachelor of Business Administration in Accounting. She began her career in 1991 with a large Tennessee based homecare chain as a staff accountant and later joined a national healthcare consulting firm as their Reimbursement Manager.
Prior to the inception of Medicare PPS, Melinda began researching, auditing and reviewing processes with OASIS, ICD-9 Coding and clinical documentation. She has developed and taught clinician and billing Medicare PPS Training and Hospice Training Workshops in a variety of venues. Melinda’s priority remains bridging the gap between clinical and financial issues in home health and hospice agencies. The one unique thing that Melinda brings to the industry is the development of very effective compliance education while being able to also teach the reimbursement aspect and how they are directly related.
Melinda has many years of firsthand experience in the following key areas:
* Medicare PPS Billing Training
* Medicare Hospice Billing Training
* Chart Reviews as a result of OIG Corporate Integrity Agreements
* Chart Reviews for Billing, ICD-10 Coding & OASIS Integrity Issues
* Coordination of Clinical and Financial Staff Communications
* Home Health PPS & Hospice Billing, Collections & Case Mix Calculations
* Medicare Revenue Recognition Models
* Operations Reviews and Process Improvement
* Due Diligence Procedures
* Staffing Pattern Analysis
* Management of a Medical Billing Department
* Financial Feasibility Studies/Certification Applications
* Correspondence and Appeals with Medicare Administrative Contractor
With extensive public health insurance program and healthcare safety net experience, Melinda Dutton helps clients—including state governments, provider groups and foundations—navigate the legal, regulatory and political challenges of the Affordable Care Act and programs such as Medicaid and CHIP.
With her robust experience in Medicaid, CHIP, marketplaces, delivery system transformation and payment reform, healthcare reform implementation is a significant focus of Melinda’s practice.
A frequent co-author and panelist on emerging trends in the field, Melinda also has served as a guest lecturer for health law and policy courses at colleges and universities, including New York University School of Law, Columbia Law School and New York Medical College. She was practitioner-in-residence at Saint Louis University School of Law.
Prior to joining Manatt, Melinda worked at the Children’s Defense Fund in New York. There, she helped develop and secure legislation expanding publicly funded health insurance programs for children. Her career in legal advocacy started in Brooklyn, where she helped establish a health law practice serving the borough’s low-income population.
Home Health Clinical Director
Home Health Strategic Management
Melissa Couty, RN, BSN, an innovative nurse consultant in the Home Health industry, is the Home Health Clinical Director for Home Health Strategic Management. Her decade of Home Health experience, 5 spent as the Director of Professional Services, has provided the expertise, insight and acumen about the rapidly changing home health industry. During her time as the Director of Professional Services, she accomplished a deficiency-free Joint Commission survey and a deficiency-free Department of Health and CMS survey. Melissa presents nationally on homecare industry changes and care models.
Southwest Missouri Project Manager
Institute for Community Alliances
Michael Tonarely is ICA’s Southwest Missouri Project Manager. As such he leads ICA’s HMIS services in Southwest Missouri, providing user training along with technical and analytical support to agencies in the Springfield Continuum of Care, the Joplin Continuum of Care and regions 8 & 9 of the Balance of State Continuum of Care. Prior to joining ICA in 2015, Michael worked for nearly a decade providing direct homeless services. He felt it was time to explore other options and learn more about the “back end” of homeless services. Since joining, he has seen how good data quality is just as important to assisting those in need as quality case management.
Director of Client Services
A graduate from the University of Massachusetts at Lowell with a Bachelor’s degree in Information Technology, Mike has over 20 years of experience in Healthcare technology and software products. Upon entering the Homecare industry in 1995, Mike has implemented enterprise software systems, and as Director of Information Technology, built compliant healthcare systems and infrastructure for large Homecare organizations. As Director of Client Services, Mike is currently responsible for driving excellence in customer care and implementation services for Mediware’s Home Care Solutions business.
MichRx Pharmacist Consulting Services, Inc
MichRx Pharmacist Consulting Services is a healthcare and training company providing state of the art Medication Therapy Management (MTM) and telehealth consulting with a focus on HIV Care, resulting in increased profits for our clients.
We create these results by focusing on the role of the pharmacist as a key healthcare provider, saving patients lives, improving outcomes and enhancing patient quality of life. The care provided is across all stakeholders such as pharmacists, physicians, third party payors, PBM’s and clinics.
Michelle Sherman founded MichRx Pharmacist Consulting Services, Inc. in 2005. MichRx Pharmacist Consulting Services, Inc. is a top provider of innovative services and solutions for Pharmacists who want to grow and expand their businesses and focus on specialty niche markets such as HIV/AIDS.
Michelle is an author, speaker, consultant and advisor and as a pharmacy entrepreneur and innovator, Michelle has developed a leading edge Medication Therapy Management program: Ubuntu Pharmacist Care Program saving lives and managing drug therapies and outcomes for people living with HIV.
Michelle is committed to advancing the recognition of pharmacists as key healthcare providers on a patients care team. To achieve this she has a non- profit organization The Center For Advanced Pharmacist Care, to further advance and recognize medication therapy management within the healthcare system.
Our team has a deep knowledge and understanding of HIV care, with expertise in growing profitable and compassionate HIV practices. We help our clients expand their businesses and grow their profits and HIV practices through MTM and the expanding role of the pharmacist as a healthcare provider.
Ms. Sherman is a nationally recognized HIV Specialist Pharmacist practicing in Orange County, California for over twenty five years. She has extensive experience and expertise with HIV medications, adherence and resistance issues, ADAP, CalOptima/Medi-Cal, Medicare Part D issues, 340B Programs, HIV Sensitivity issues and pharmacist care services for HIV infected individuals.
Ms. Sherman obtained her Bachelor of Pharmacy degree from the University of the Witwatersrand School of Pharmacy, Johannesburg South Africa. She moved to California in 1987 and has been involved in the HIV/AIDS community for over nineteen years. Ms. Sherman is also certified in the following areas: Dyslipidemia from American Pharmaceutical Association and Immunizations from the California Pharmacists Association, and has completed the American Society of Consultant Pharmacists HIV/AIDS Pharmacotherapy Traineeship, and is also a CHEK Holistic Lifestyle Coach and Certified Metabolic Typing Advisor l. Michelle is credentialed by AAHIVM as an HIV Pharmacist. Michelle has gone through the Advanced Practice Pharmacist Certification offered by California Pharmacists Association.
Ms. Sherman’s professional affiliations include the following:
American Pharmacists Association, California Pharmacists Association, Orange County Pharmacists Association, American Society of Consultant Pharmacists, the American Academy of HIV Medicine and South African Pharmaceutical Society, American Academy of HIV Medicine
Professional accomplishments include the following:
Pharmacist of the year for PayLess Drug Store- 1991, 1992 and 1993; Member of the Board of Directors of the Orange County Pharmacists Association since 1992 in the capacity of chairperson of the HIV Task Force; President- elect of the Orange County Pharmacists Association in 1995 and President in 1996; Local Pharmacy Association of the Year Award for 1996 awarded by the California Pharmacists Association and Orange County Pharmacists Association Dutch Hofstetter Community Service Award for 1999. Awarded the first Advancement of Pharmacy Specialties Award in February 2001 by the California Pharmacists Association. Nominated for Innovative Pharmacist of the year award for 2002 by the California Pharmacists Association, Certificate of Special Congressional recognition presented by Congresswoman Loretta Sanchez in 2004 & 2006, and Women who make a difference in Orange County with recognition from State Senator Joseph Dunn, the California State Assembly and Orange County Supervisor Lou Correa.
Ms. Sherman’s professional and community service is extensive and includes the following:
Volunteer at Shanti Orange County for over nineteen years; Currently Vice Chairman on Shanti OC Board of Directors, speaker and facilitator at numerous HIV Conferences and Continuing Education programs, Member of the City of Laguna Beach HIV Advisory Committee, Member of the Advisory Council- Cognitive Services Reimbursement for Pharmacists Caring for HIV/AIDS Patients- AIDS Drug Assistance Program, Member of California AIDS Drug
Assistance Program Medical Advisory Committee, and she is also an, Assistant Clinical Professor of Pharmacy, University of California San Francisco School of Pharmacy and Assistant Clinical Professor, University of California Irvine College of Medicine Volunteer Faculty.
Ms. Sherman has also participated in four California AIDS rides, two as a rider and two as a member of the medical crew as well as a Roadie on the AIDS Lifecycle.
Ms. Sherman has also participated in several research studies which have been posters at the XIIIth World AIDS Conference, Durban, South Africa 9-14 July 2000 and the 40th ICAAC Conference, Toronto, Canada September 17-20 2000. Study with CalOptima and UCSF School of Pharmacy - Evaluation of Antiretroviral Therapy in Patients Infected with HIV: A Pharmacy Claims Based Analysis, which was accepted for a poster presentation at the United States Conference on AIDS, September 20-22, 2002. Anaheim, CA
Abstract Presentation- "The Establishment of Pharmacist Consultation Services and Collaboration Between HIV Clinics and a Non Profit Pharmaceutical Care Center Specializing in HIV Care in Orange County California" at APhA 2004 Annual Meeting and Exposition, Seattle, WA March 27, 2004
Poster Presentation- HIV Pharmacist Consultation Services a Key Factor in HIV Continuum of Care and Improvements in Adherence, Quality of Life and Decreases in Healthcare Costs. NASP Annual Meeting Poster Poster #21, Washington DC September 18-20, 2017
She is the author of Saving Lives: The Role of The Pharmacist in HIV; Coauthor of the book: Care Your way To Insane Profits and Beat The Margin Game, and her book, Living Well With HIV. 6 Steps To Increased Vitality will be published in Fall 2018
Director of Product Management
Michelle Kerkstra is responsible for the strategic direction and product definition for Kinnser Hospice. She brings 7 years of software product management and development experience, all from innovative healthcare companies. Michelle holds two degrees in Bioengineering and Fine Art from Rice University.
Senior Technical Specialist
Mike Lindsay has more than 17 years of experience in HMIS and CoC implementation and is currently leading HMIS and CoC TA engagements in many communities to assist in advancing their CoCs and HMIS implementations. His experience is focused on data quality and monitoring, practical and strategic uses of data warehousing techniques, and supporting and growing regional HMIS collaborations. Prior to joining ICF, Mr. Lindsay worked for the Allegheny County Department of Human Services (ACDHS) in Pittsburgh, PA, for 10 years. While at ACDHS, he was the HMIS and CoC Administrator, leading the agency to develop a comprehensive cross-system HMIS integration. He directed HMIS data analysis to inform system redesign, and guided program development and performance evaluation.
Vice President of Product Management
Mike leads the effort to understand the needs of our Home Health Agency customers. The product management team works with customers and our extended team to build innovative solutions to issues faced by home health providers. Mike’s goal during CareForum 2018 is to meet as many Home Health providers as possible and learn more about the challenges they are looking to solve.
Clinical Lead, Provider Relations
Nikki graduated from the Marquette University Program in Physical Therapy with a Bachelor of Science in 1995 and has practiced full-time in urban, suburban, and rural private practices and hospital settings over the last two-plus decades. Her most recent clinical work, from 2005 until 2016 when she moved to Knoxville to join the FOTO team, was on staff at a critical access hospital in western Wisconsin. There, she was a full-time clinician and the “FOTO Superuser,” involved in all aspects of using FOTO in the daily practice, including implementation, training, improvement, and documentation. She was also a member of the hospital rehab services department’s documentation and regulatory committee. Her interest in outcomes, specifically FOTO, was piqued at a McKenzie conference in 2008 and FOTO was implemented at the facility in 2011. She was directly involved in all steps of the implementation process of FOTO, beta testing upgrades and therapist training in EMR software, voice recognition software testing and training, and FOTO-EMR integration and clinical application. She presented twice as a clinician user of FOTO at two separate annual national FOTO Outcomes Conference events, on the processes and phases of implementation and leveraging of data. She has also spoken at local, regional, and state venues in Wisconsin, Georgia, and Tennessee, presenting on outcomes and pelvic floor. She is a member of the American Physical Therapy Association, the Tennessee Physical Therapy Association, the APTA Health Policy Section, and the McKenzie Institute USA.
HMIS Program Coordinator
Pam Moseley is the Pima County HMIS Program Coordinator. She manages the Homeless Management Information System and Coordinated Entry database for the Tucson Pima Collaboration to End Homelessness. Pam has represented the HMIS Lead since 2011, when she also managed a family transitional housing program, HOPWA, ESG and FEMA funds for Pima County.
Clinical Consultant, Transfusion
Peggy Nemode has more than 30 years of experience in immunohematology in a hospital-based transfusion center, where she served as the blood bank manager and HCLL system administrator. Peggy has been with Mediware since 2008 and has been active in validation of new releases, site visits for post-assessments, product demonstrations, report customization, and BloodTrak Installs. Prior to Mediware, she was an adjunct professor for the MLT program at a community college for 11 years.
Powers Pyles Sutter & Verville, PC
Peter Thomas is a principal at Powers, Pyles, Sutter & Verville, located in Washington, D.C. His firm focuses on health care, education, and the law of tax-exempt organizations. Mr. Thomas has a federal law and legislative practice in the areas of health care and disability policy, Medicare coverage and reimbursement policy, medical rehabilitation services, devices and research, and vocational and community services and supports. He has served on a number of non-profit boards including the Center for International Rehabilitation/ Physicians against Land Mines, the Foundation for Physical Medicine and Rehabilitation, and the American Trauma Society (ATS). We welcome Peter Thomas to the stage.
PMB Precision Medical Billing, Inc
Petria Pierre is CEO/President and Founder of Precision Medical Billing (PMB), a leading provider of customized medical billing and auditing solutions for home health and hospice agencies, physicians, Durable Medical Equipment (DME) providers, Emergency Medical Services (EMS), and nursing homes across the U.S.
She has over 25 years of experience in the medical billing industry, and her expertise runs wide and deep. Petria founded PMB Precision Medical Billing, Inc. in 1995 and throughout her career, she has helped hundreds of private practitioners and healthcare organizations solve their billing challenges and recover millions of dollars in lost revenues. To date, she has personally performed more than 1000 audits and revenue recoveries nationwide. She regularly travels the country speaking at seminars, conferences, and industry events; additionally, she hosts a significant number of multi-day training programs designed to help other healthcare professionals improve their billing processes and outcomes. Petria is an active member of numerous state and national associations. For more information, visit: http://www.precisionmedicalbilling.com
Instructional Designer – Home Care Solutions CareTend/CPR+ - HCS Client Services
Phil Raynes has worked in the training industry as a Technical Writer and Instructional Designer for over 20 years. During his 15 years at Mediware, Phil has worked with the Home Care Client Services team and trainers to produce documentation along with instructional videos for CPR+ and CareTend. In addition to maintaining two training resource centers, Phil has help implement various web-based forums and mobile sites for the home care community, including the newly released Home Care Community web forum for Mediware HCS clients.
In addition to his daily job functions at Mediware, Phil works on video productions for his son's elementary school and web projects for a local church. He is also working on his first children's book based on a nighttime story he told to his daughter since she was a little girl.
Carla Cheatham Consulting Group, LLC
Rev. Dr. Carla Cheatham began her career in social services, with an M.A. in psychology, certification in crisis counseling, and a Ph.D. in health and kinesiology. After earning her M.Div., she served as a hospice spiritual caregiver and bereavement coordinator for a decade. Carla is a consultant, trainer, speaker, author, and blogger through her own Carla Cheatham Consulting Group, LLC; the section leader for NHPCOs Spiritual Caregiver Section and serves on their Ethics Advisory Committee; an adjunct faculty member at the Seminary of the Southwest, and an affiliate associate professor for the University of Maryland’s new M.S. in palliative care.
Dick Harmon is currently the SAMS Database Administrator for Iowa’s six Area Agencies on Aging. Dick has over 20 years’ experience in Database and Project Management. For the past 10 years prior to coming to the Iowa’s Aging Network, Dick Harmon worked for the Iowa Department on Aging as the SAMS Database Administrator. Prior to the Iowa Department on Aging, Dick Harmon worked for the Iowa Department of Public health and was the project manager for the development and implementation of the Iowa Trauma Care Delivery System that included development of the Iowa Trauma Registry, the Crash Outcome Data Evaluation System linking hospital records to motor vehicle crash records and implementing the data collection software for 120 hospitals and over 300 Emergency Medical Services providers.
Gawenda Seminars & Consulting
RICK GAWENDA, PT, is a licensed physical therapist with over 27 years of experience and currently serves as the founder and President of Gawenda Seminars & Consulting, Inc. He graduated with a Bachelor of Science degree in Physical Therapy from Wayne State University in Detroit, Michigan, in 1991. Mr. Gawenda is also Director of Finance for Kinetix Advanced Physical Therapy, a private practice with 2 locations.
He has provided valuable education and consulting to hospitals, private practices, skilled nursing facilities, and rehabilitation agencies in the areas of CPT coding, ICD-10 coding, billing, documentation compliance, revenue enhancement, practice management, and denial management as they relate to outpatient therapy services. Mr. Gawenda has presented nationally since 2004 and currently presents over 80 dates per year around the United States.
Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is a Past President of the Section on Health Policy & Administration of the APTA as well as a Past President of the Michigan Association of Medical Rehabilitation Program Administrators.
Mr. Gawenda is also the author of “The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials” and “Coding and Billing For Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes and Modifiers”.
Five Points Healthcare
Rob Radics is the CEO of Five Points Healthcare which he founded 2011. Five Points is a regional home health and hospice provider based in Atlanta, GA with operations in Alabama, Delaware, North Carolina, Pennsylvania, Tennessee and Virginia. He has spent his entire career in home health and hospice and over the past 20 years has held a variety of leadership roles with Gentiva Health Services, Healthfield, Inc. and Scottsdale Residential Care Investors. He holds a Bachelor of Business Administration from Appalachian State University and a Master of Health Services Administration from Arizona State University.
Hall, Render, Killian, Heath & Lyman, P.C.
For over 15 years, Robert W. Markette, Jr., CHC, HCS-C has focused his practice on representing home health, hospice, private duty and DME providers in all aspects of their operations. With more than a decade of experience in working with the these industries, Robert has developed a reputation for understanding the operational, compliance and legal/regulatory issues facing homecare providers.
In representing the homecare industry, Robert has assisted clients in a number of areas related to the operation of their business. He works with his client on issues related to Medicare/Medicaid compliance including surveys, responding to surveys, state and federal appeals of survey findings; payer issues, including appealing payer audit findings; HIPAA Compliance; Medicare and Medicaid fraud and abuse, including matters such as developing and implementing compliance programs, performing internal investigations and representing providers in external investigations and civil and criminal matters. Robert also assists clients with purchasing and selling home health, hospice and private duty agencies.
Because these providers depend heavily on their staff, Robert also addresses legal issues related to employment matters. This includes wage and hour compliance, responding to Department of Labor investigations, and litigating wage and hour disputes. Robert routinely provides guidance to his clients on HR matters, including assisting with preparing personnel manuals, guidance on discipline issues and similar matters. Robert also assists clients in responding to EEOC investigations and discrimination lawsuits and similar employment issues.
Robert is recognized for his expertise in this space and is a frequent speaker on home health, hospice and private duty matters across the country. Robert has presented to the American Health Lawyers Association, the National Association for Home Health and Hospice Care, DecisionHealth as well as other national speaking events and numerous state trade association conferences and continuing education sessions. Robert serves on both the Board of Medical Specialty Coding and Compliance and the Board of the Association for Home Care Compliance. Robert drafted the Second Edition of the Homecare Administrator's Field Guide and the Home Health Patient Rights Policy and Procedure Manual
Robert graduated from Hanover College with a degree in Computer Science and received his law degree from Indiana University School of Law in Bloomington, Indiana. Robert is a member of the American Health Lawyers Association, the Health Care Compliance Association and the Indiana and Oklahoma State Bar Association. Robert has been awarded the HCS-C credential signifying his knowledge and experience in home care compliance. Robert is also certified in health care compliance by the Health Care Compliance Board. Robert is admitted to practice in Indiana and Oklahoma.