Performance Management For The C-Suite: An Executive Briefing
For management teams of health and human service organizations, the game has changed when it comes to success and
long-term sustainability. Managers need to navigate integrated care, consolidation, value-based reimbursement, emerging
technologies, declining reimbursement, new competitors, and a more consumer-driven industry.
In this emerging landscape, success is dependent on managing performance. But performance is now multidimensional and managers need to manage performance on five levels.
- The performance requirements of their contracts and a wide range of accrediting and quality organizations
- Consumer experience optimizing
- Optimizing referrals and speed consumer access to services
- Clinical excellence – services must be delivered consistently and with high value in terms of cost and outcomes
- Management teams need to manage their finances – from revenue and margins, to unit costs and productivity, to value-based reimbursement optimization
In this session, join Monica E. Oss, the chief executive officer of OPEN MINDS and Carol Clayton, Ph.D., the Chief, Translational Neuroscience, of Relias for a briefing on the current state of performance measures and performance management – and an update on their new performance management initiative.
Monica E. Oss
Monica E. Oss, M.S., Chief Executive Officer and Senior Associate, is the founder of OPEN MINDS. For the past three decades, Ms. Oss has led the OPEN MINDS team and its research on health and human service market trends and its national consulting practice. Ms. Oss is well known for her numerous books and articles focused on the strategic and marketing implications of the evolving health and human service field. She has unique expertise in payer financing models, provider rate setting, and service pricing. She has led numerous engagements with state Medicaid plans, county governments, private insurers, managed care programs, service provider organizations, technology vendors, neurotechnology, and pharmaceutical organizations, and investment banking firms – with a focus on the implications of financing changes on delivery system design.
Carol Clayton, Ph.D.
Dr. Carol Clayton is a licensed, psychologist with 30 years of health care experience in the public and private sector, including non-profit and private practice work. Prior to joining OPEN MINDS as a Senior Consultant, she retired as the Translational Neuroscientist for Relias, where she specialized in health care solutions targeting workforce development and population health outcome improvement. Before joining Relias, Dr. Clayton was the CEO of Care Management Technologies, a health IT data analytics company. She also served as the Executive Director of the NC Council of Community Programs from 2000-2006. The NC Council is the predecessor organization to i2i.
Tech Budgeting For Integrated Care & Value-Based Reimbursement
Sponsored by Qualifacts Systems, Inc.
Providers are becoming more aware of and involved with new reimbursement models. While many can build the internal
talent and resources needed to win in the VBR world, technology often seems a barrier that are difficult to overcome. The
executives, who often have no technical background, are faced with expensive choices that will require focus and effort to
implement. In this session we will explore questions that providers have about their technology decisions:
- How can they determine if they can afford these options?
- What are alternative options if they can’t afford technology at this time?
- Which options will bring the best return?
- Are there some that can be delayed?
- How can they allocate internal resources to tech projects without overwhelming their staff?
In this session we will explore building a plan that helps executives make choices with confidence, manage them financially, and overcoming VBR’s most challenging task, the development of an EHR systems that can optimize results.
Ray Wolfe, J.D.
Raymond “Ray” Wolfe, J.D. brings over 40 years of experience in the health and human services sector to the OPEN MINDS team. Mr. Wolfe currently serves as a Senior Associate, a position in which he utilizes his expertise to successfully lead varying projects for OPEN MINDS. His areas of expertise include financial analysis and management, mergers and acquisitions, performance improvement, and strategic planning.
Before joining OPEN MINDS, Mr. Wolfe served in a 22 year tenure with Pittsburgh Mercy Health System in Pittsburgh, Pennsylvania. Most recently, Mr. Wolfe served as the organization’s Chief Operating Officer (COO) where he was responsible for oversight of all system operations, strategic planning, and performance management. Under his direction Pittsburgh Mercy achieved over $850K in value-based reimbursement contract quality bonus awards, integrated three organizations through merger/acquisition, and adopted a new performance management program for managers.
Before acting as Pittsburgh Mercy’s COO, Mr. Wolfe served as the organization’s Chief Financial Officer (CFO) and was responsible for the development of internal costing methodologies, contract rate negotiations, and financial forecasting activities. In addition, he coordinated an integrated care program with local partner hospitals to develop a series of diversion and respite programs, as well as, specialized primary care, integrated care management and high utilizer teams, while maintaining 15 straight years profitability.
Mr. Wolfe was promoted to CFO after serving as the Director of Fiscal and Information Security/Compliance for the health system. In this role, he was responsible for managing the transition of service contracts from fee-for-service (FFS), leading all compliance activities, and implementing a next generation electronic health record (EHR) system.
Prior to his time at Pittsburgh Mercy Health System, Mr. Wolfe served as Chief Fiscal Officer with the Summit Center for Human Development in Clarksburg, West Virginia, where he was responsible for reporting and budgeting functions and preparing Summit Center’s programs for FFS billing.
Previously, Mr. Wolfe served in billing and collections for two Pennsylvania-based hospitals. First, as an Accounts Receivables Manager for Brownsville General Hospital in Brownsville, PA, where he managed the accounting and billing system transition systems. Later as a Patient Account Manager for St. Francis Medical Center in Pittsburgh, PA, where he improved collections to hit 95% rate through the implementation of new billing software and department reorganization.
Prior to working in the health and human services market, Mr. Wolfe spent five years practicing as a Lawyer with at Law Offices of Arch A. Moore in Moundsville, WV. In this role he provided general legal practice, created and established bylaws for multiple corporation, and handled West Virginia licensing of first vision insurance plan.
Mr. Wolfe earned his Juris Doctor from the West Virginia University School of Law in Morgantown, WV and his Bachelor’s degree with a focus in Political Science and Sociology from West Liberty University, in Wheeling, WV, where he graduated Magna Cum Laude.
What Does It Take To Be A Center Of Excellence? The Changing Market Role For Specialty Provider Organizations
Centers of Excellence (COEs) have been a strategy to promote quality and achieve healthcare cost savings for a variety of medical conditions for some time. COEs leverage pre-defined quality and cost measures to form a narrow network with benefits that reward consumers to use the most effective, high value treatment providers. While this approach has been in place for over a dozen years in physical health services, this is a relatively new approach for conditions related to behavioral health and substance use. In this session, we will hear from payers on how they are designing and implementing COEs tied to behavioral health conditions including reimbursement approaches, selection criteria, impact on consumer quality outcomes and healthcare cost savings. We will also hear from provider organizations that have earned COE status on their experiences including best practices and lessons learned.
Deb Adler
Deb Adler brings more than 20 years of experience in executive health care roles, serving in a variety of capacities including network executive, quality management executive and chief operating officer, to the OPEN MINDS team.
Her consultant work with OPEN MINDS spans a broad range of customers (provider organizations, payors and government programs) and topics, including: collaborative care models/medical behavioral integration, provider network functions– contracting, network designs/tiering, recruitment, telehealth network implementation, and strategic planning. In addition, Ms. Adler has a special interest in helping technology-enabled providers in “go-to-market” strategies and streamlining network functions.
Since entering the managed behavioral health care field, she has become an industry-recognized leader in value-based contracting and alternative payment models. An innovator known for her ability to execute results, she has facilitated network designs and benefit plan approaches that achieve both quality outcomes and healthcare cost savings.
Before joining OPEN MINDS, Ms. Adler served as Senior Vice President of Network Strategy for Optum (now UnitedHealth Group) where she was responsible for behavioral health network development, contracting, and strategy for over 185,000 providers. In this role she developed the largest, performance-tiered behavioral health network, largest telemental health network, and largest medication assisted treatment (MAT) network. She was also responsible for implementing network initiatives to promote medical/behavioral integration, improve member outcomes, and reduce total cost of care through collaborative care models.
Prior to joining Optum/UnitedHealth, Ms. Adler spent over 12 years with ValueOptions, Inc. (now Beacon Options) where she held a variety of senior leadership roles including, Executive Vice President of National Networks; Chief Executive Officer, Health Plan Division; Vice President, Network Operations; Executive Director, Corporate Quality Management; and Executive Director, Quality & Information Systems. She was responsible for quality management and coordinated NCQA and URAC accreditation efforts.
Ms. Adler spent her early career in health care quality, serving as a quality director in two state-run psychiatric centers.
Ms. Adler received her Master’s degree in educational psychology and evaluation from Catholic University of America and is a Certified Professional in Health Care Quality (CPHQ).
Erin Boyd
Erin Boyd is the Behavioral Network Strategy, Solutions and Program Director for Cigna Behavioral. Ms. Boyd is responsible for network marketing and communications, developing network strategy and overseeing network programs, and solutions to drive innovation, cost-savings, improved outcomes, and better care for Cigna customers. Ms. Boyd has been with Cigna for three years and provides a unique perspective to this role having most recently served as Senior Director of Business Development and Marketing for a behavioral hospital system. In addition, she has 20 years of experience in medical healthcare communications, marketing, public relations, and strategic planning.
Pablo McCabe, LCSW
Bio Coming Soon!
Debra Nussbaum, Ph.D., LCSW
Deb started with Optum in 2009 as Director of Clinical Operations. In 2013, Deb moved into national role as a Sr. Director of Behavioral Health Product. Deb is a co-founder and clinical lead for Optum's national substance use disorder (SUD) initiatives. Deb has successfully championed many projects within Optum designed to improve member access to evidence based services, the development of the nation's largest MAT network and the 24/7 SUD helpline and live chat capabilities.
Debra's clinical background has been primarily in substance use services in progressive leadership roles managing and developing treatment programs aimed at improving outcomes in addiction treatment services. Deb has a PhD in organizational psychology and is LCSW licensed in Florida and in New York.
Rethinking Revenue Cycle Management: How To Optimize Operations For A Value-Driven World
In a value-driven world, one of the most important changes organizations have to make is expanding their revenue cycle management model. To facilitate an effective transition away from fee-for-service reimbursement structures, focus must be placed on revenue cycle management strategies that support fee-for-service while facilitating the transition to new payment models. Provider organizations that understand how to manage costs, while delivering quality service and better outcomes, will be in the best positioned to thrive.
In this session, attendees will learn about how to broaden their thinking on revenue cycle management and how to optimize their revenue cycle for value-based reimbursement.
Joseph P. Naughton-Travers, EdM
Joseph P. Naughton-Travers, Ed.M., Senior Associate, has more than 30 years of experience in the health and human service field. In this tenure as senior associate with OPEN MINDS since 1998, he has served as lead of dozens of client initiatives, served as editor of OPEN MINDS publications, and is the author of many groundbreaking articles and presentations.
Mr. Naughton-Travers brings to OPEN MINDS a broad range of experiences in private and public sector delivery of behavioral health and social services. He started his career as a behavioral health clinician, working in both child welfare and community mental health clinic settings. Subsequently, Mr. Naughton-Travers held a senior business operations management position for a psychiatric hospital system and its community mental health clinics. Later, he was vice president of a firm specializing in information systems and billing and receivables management for community-based mental health programs.
Since joining OPEN MINDS, Mr. Naughton-Travers has developed business solutions for provider and professional organizations, state and county government, technology companies, and venture capital firms. His primary areas of expertise include strategic planning and metrics-based management, electronic health record (EHR) and technology selection and implementation, operations improvement, and corporate compliance. For the past decade, more than half of his consulting practice has focused on aiding organizations in technology selection and implementation, including all aspects of strategic technology planning, functional specifications development, request for proposal development, vendor selection, and contracting.
He has written numerous articles, including “Winning the Human Resource Wars: Tried, True and New Strategies for Behavioral Health and Social Service Organizations,” “Five Pillars of Management Competency,” “Data Driven Decision Making: Moving to an Organizational Measurement Culture,” “Survival of the Smartest: What is Your Organization’s Information Literacy IQ?,” and “Strategic Human Resource Management: Aligning Compensation with Employee Performance and Organizational Strategy.” Mr. Naughton-Travers is also a nationally recognized speaker, having conducted hundreds of executive and professional executive training events around the nation.
Mr. Naughton-Travers received his Bachelor’s degree from Miami University of Ohio and his Masters’ of Education in Counseling Psychology from Boston University.
Vanessa R. Lane, MBA
Vanessa Lane is the Director of Revenue Cycle Management at Grafton Integrated Health Network. She has over twenty years of experience in the healthcare field. Ms. Lane has experience managing accounts receivable, contracting, admissions, authorizations and front desk functions in a healthcare setting. She also has extensive experience in working with multiple state Medicaid systems to develop and implement policy changes. Additionally, she has participated in multiple teams in the selection, implementation, and use of multiple Electronic Health Record Systems.
Prior to working at Grafton, Ms. Lane was the Manager of Accounts Receivable for the Center for Behavioral Health at Centerstone. In this position, she managed the revenue cycle through multiple Electronic Health Record Implementations and several mergers between Non-Profit CMHCs.
Ms. Lane received her MBA with a Healthcare Administration focus from Indiana Wesleyan University. She received a Bachelor of Science degree in Business Management from Indiana Wesleyan University.
Managing Specialty Populations With Payer & Provider Collaboration
Sponsored by Netsmart
The need to collaborate and identify gaps in care is vital to improve outcomes for complex and diverse populations. Thriving Minds funds and oversees a safety net of services for Miami-Dade and Monroe County Florida. They use a data-driven, client-centric approach to care coordination to effectively track outcomes and ensure those in need receive the right services. Technology and data sharing are imperative to the success of Thriving Minds network of exceptional providers.
Join Dr. Newcomer, President and CEO of Thriving Minds and Julie Hiett, Senior Director of Population Health, to learn about new and innovative approaches to successfully leverage technology to manage priority populations, drive outcomes and enable collaboration across providers and payers.
Julie Hiett, MSW
Julie Hiett is Sr. Director of Population Health Management, providing Netsmart clients with expertise and population health solutions that enable them to collect and analyze authorized patient data across the healthcare continuum, and use it to improve clinical outcomes and lower the cost of care.
Previously, Julie was Netsmart’s Practice Director, Consulting, managing the implementation teams for Netsmart care coordination, population health, addiction management and public health solutions. Julie works closely with Netsmart’s product, development and consulting teams, driving these multi-functional teams to implement small and large-scale projects. She has led multiple state-wide rollouts involving care coordination across social services, I/DD, behavioral health and primary care populations.
Prior to joining Netsmart, Julie held a variety of positions with ScriptPro, a pharmacy software company, including leading large-scale projects for the Department of Veterans Administration, Department of Defense and Indian Health Services. She also has 8+ years of experience in the social services and social work arena, including both child and adult mental health, mentoring and advocacy at community mental health centers and multiple non-profit organizations.
Julie has a bachelor’s degree in Family Studies & Human Services from Kansas State University and a master’s degree in Social Work from Wichita State University.
John W. Newcomer, M.D.
John W. Newcomer, M.D., is President and CEO of Thriving Mind South Florida, a non-profit organization overseeing safety-net mental health and substance-abuse services for Miami-Dade and Monroe counties, with annual funding of more than $110 million from Florida's Department of Children and Families as well as other federal, state, local, and private sources. Dr. Newcomer is also an Adjunct Professor of Psychiatry at Washington University School of Medicine in St. Louis. He previously served as Vice Dean for the medical school and Vice President for Research at Florida Atlantic University, and prior to that was Senior Associate Dean for Clinical Research at the University of Miami Miller School of Medicine. During more than two decades at Washington University, he served in leadership positions related to the National Institutes of Health (NIH) funded General Clinical Research Center, the Clinical Translational Science Award and the Center for Clinical Studies. Dr. Newcomer has been a Principal Investigator on grants funded through the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration (SAMHSA) for more than years. In the public sector he was Chair of the Medicaid Drug Utilization Review Board for the State of Missouri for 13 years. In 2014 he was named to the Thomson Reuters list of "Highly Cited Researchers" in the field of psychiatry.
Bridging The Gap Between Employee Experience & Financial Sustainability
Sponsored by DATIS HR Cloud
Your organization is its workforce, and can be the difference between success and failure. Taking care of your employees first has increasingly become not just a best practice, but an industry standard. But how can we strike the right balance between a focus on employees and the financial requirements of keeping your organization running? In this session, Erik Marsh, CEO of DATIS, will explore how these two seemingly conflicting priorities are actually more related than they appear at first glance. Join us as we explore the building blocks for developing a successful workforce management strategy that works for both your people and your organization.
Erik Marsh
As the President and CEO of DATIS HR Cloud, Erik Marsh is focused on delivering value, productivity, and efficiencies for nonprofit organizations through Human Capital Management software. Erik graduated from Indiana University, Bloomington with a B.S. in Finance. After graduation, Erik worked for 5 years in various financial roles before joining Oracle, where he worked for 15 years. With over 20 years of experience in finance and software, Erik combines this knowledge to help organizations implement best-in-class technology that drives innovation and growth.
The ABC’s Of Reporting: The Value Of Reporting To Multiple Payers Simultaneously
Sponsored by Streamline Healthcare Solutions
The demands for additional data from payers continues to grow. As this market shift occurs, the burden on organizations to capture and report outcomes data becomes an unwieldy target. When it comes to reporting outcome measures, it is essential to know how to incorporate this process into your daily workflows so you are retrieving quality data from your Electronic Health Record (EHR). In this valuable learning session, Katie Morrow, LBSW, MPA, VP of Compliance will discuss the outcome measure requirements of major reimbursement models overlap with one another and how you can take advantage of this to maximize reimbursement. We will discuss how to reduce the burden on the staff responsible for capturing this data and tools for adapting your reporting as the behavioral health reimbursement process evolves.
In this session, attendees will learn how to:
- Reduce your administrative oversight by knowing how the reporting requirements across payers overlap and how to take advantage of these overlaps
- Identify the important factors and considerations when implementing new reporting techniques.
- Leverage the data you are collecting for payers to improve your organization’s services and performance
Katie Morrow
Katie Morrow is a Licensed Bachelor’s Social Worker with seven years’ experience in the clinical field. In her clinical experience she was a Case Manager for adults with mental illness and developmental disabilities. After receiving a Master’s Degree in Public Administration, she transitioned to also doing quality improvement tasks as a Performance Improvement Clinician, which included coordination of The Joint Commission and State audit reviews, data analysis of the electronic health record data, and staff training for her agency on the use of Streamline products. She began working directly for Streamline in August of 2011. With Streamline, Katie has been the project manager on several implementations as well as providing training and support to Streamline’s customers.
Population Health Management For The Complex Consumer Market: How To Utilize Data To Coordinate Services Across The Care Continuum
Data is the key for care coordination, but many organizations struggle with what data is needed and how to effectively leverage this data. To understand the risks their consumers are facing and in order to provide effective services that best meet their consumers’ needs, providers must gather a variety of data, clinical and financial, from a number of different types of providers and sources. Combing these data sources into a single actionable record is paramount to improving care and outcomes for individuals.
In this session, we will hear from executives of organizations with experience bringing together disparate types data and how they are utilizing this data for care coordination.
James Stewart
James Stewart brings to OPEN MINDS more than 20 years of experience in the healthcare field. Mr. Stewart has helped develop and modify health care plans and benefits, retirement plans and benefits, and paid time off (PTO) plans for multiple behavioral healthcare providers. He has also had an integral role in program development and business planning for new strategic business lines. Additionally, he has led multiple teams in the selection, implementation, and use of multiple electronic health record (EHR) systems at several behavioral health care entities.
Mr. Stewart currently serves as the Chief Executive Officer at Grafton Integrated Health Network. He previously served as the Executive Vice President, Chief Administrative Officer, where he was responsible for the supervision of the Finance Departments, Contracting (both payer and vendor), Information Technology, Human Resources, Risk Management, Facilities Department, The Infant and Toddler Program, and the Education Department. He has participated and enabled the expansion of services through the acquisition of facilities and extension of the organization’s IT/HR network into Florida and West Virginia in the United States and also in Australia. Mr. Steward also spearheaded the process of developing and implementing a new paperless EHR, as well as a new accounting software that integrated with the electronic clinical record and billing system.
Prior to working at Grafton, Mr. Stewart was the Chief Financial Officer for the Center for Behavioral Health at Centerstone. In this position, he managed the coordination of a multi-disciplinary team through development and implementation of a Davies Award Winning Electronic Health Record. He developed new clinical programs to meet identified locality needs and established a merger between Non-Profit CMHC’s, which crossed state boundaries.
Mr. Stewart received his MBA with a Healthcare Administration focus from Indiana Wesleyan University. He received a Bachelor of Science degree in Accounting from the University of Kentucky.
Cathy Lipton, M.D., CMD
Cathy Lipton, M.D., CMD, is on the Corporate Medical Director team for Optum Complex Care Management (CCM), and has been affiliated with UnitedHealth Group since the original Evercare demonstration program expanded to Atlanta, Georgia, in the 1990’s. Optum’s clinical models of care support UnitedHealthcare’s Institutional (nursing home) and Dual (community-based) Special Needs Plans (SNPs) as well as the Post Acute care needs for other Medicare and private health plans. Optum’s programs focus on strong collaboration between Advanced Practice Clinicians (APCs) and Primary Care Physicians (PCPs) to enhance primary care for vulnerable populations.
Dr. Lipton has lived in Atlanta, Georgia, since the time she attended Medical School at Emory University as well as completing both her Internal Medicine Residency and Geriatric Fellowship programs there. Following training she worked at Emory’s Geriatric campus for a number of years in the clinical and academic arenas, including providing the medical direction for Emory’s skilled and intermediate care nursing facilities. Dr. Lipton has been a Certified Medical Director since 1997. She moved into an Adjunct Clinical capacity with Emory once she formally affiliated with UnitedHealth Group. Prior to her regional role, Dr. Lipton served as the Optum Market Medical Director for Georgia for many years, during which time the market provided clinical expertise in a variety of health plans including Institutional, Dual, and Chronic SNPs, as well as an End Stage Renal Disease pilot with CMS. She earned an innovation award for a telepsychiatry pilot program in 2013.
Dr. Lipton has twice been President, and is presently a long-standing Board member, of the Georgia Medical Directors Association, Georgia’s chapter of the Society for Post-Acute and Long Term Care (formerly AMDA). She sits on the Georgia Medical Care Foundation Nursing Home Quality Initiative Advisory Board, and has served on the American Health Care Association's Clinical Practice Committee and Professional Development Workgroup. Dr. Lipton’s interests include improved access to quality behavioral health care for under served populations, medical-behavioral integration, telemedicine, and remote monitoring technologies.
Dianne Shaffer, LMSW
Dianne Shaffer has worked for Integrated Services of Kalamazoo (ISK) since November 2012, first as a Program Manager for Youth and Families and now as Director of Systems Development. In her role as Director of Systems Development, she serves in a leadership capacity to develop, promote and support the ISK relationship with Health Care systems in the county serving as a primary contact with health care organizations, facilitating and assisting with planning initiatives that support the integration of primary and behavioral health care. Dianne also assists with grant writing, program development and implementation. Prior to ISK, Dianne was the Executive Director of Advocacy Services for Kids (ASK). During her tenure with ASK, she was involved in the implementation of federal SAMHSA grants in both Kalamazoo and Kent Counties, and provided trainings on family-driven, youth-guided mental health services at the local, state, and national levels. After earning a Master of Social Work degree from Western Michigan University (WMU) in 1997, Dianne served families in Kalamazoo and Southwest Michigan for 10 years prior to moving into administrative roles.
Sarah Green, RN, BSN, MBA, HCS-D, COS-D
Sarah Green has over 10 years of leadership and management experience and clinical nursing experience in the healthcare industry. She works as Senior Integrated Healthcare Specialist at Southwest Michigan Behavioral Health (SWMBH) where she completes and oversees coordination of high-risk members with managed care plans and providers. Sarah is also integral in development and management of integrated care projects at SWMBH.
She has experience in behavioral health managed care, public policy involvement, care management, project development and implementation, home health care nursing, home health consultation, case management, hospice and hospital floor nursing (including medical-surgical and labor and delivery). Her passion is in improving patient outcomes (including quality of life and person-centered goals), project development and implementation, efficient operational structures, regulation compliance, process-flow development and implementation, and improving efficiency.
Sarah received a Master of Business Administration from Grand Valley State University in Grand Rapids, MI and a Bachelor of Science in Nursing from Western Michigan University in Kalamazoo, Michigan.
Key Performance Indicators For Value-Based Care: How To Use Performance Metrics To Build A Value Proposition For Health Plans
More competition and more value-based reimbursement (VBR) are making performance metrics more important than ever for health and human service organizations. Finding the right performance metrics to demonstrate value to health plans has been a big challenge for many executive teams.
One method of metrics-based management is the development of a key performance indicator (KPI) system. An effective KPI system captures financial and non-financial measures, and is driven by structured data based upon an organization’s strategic objectives. This session will discuss the steps to developing applicable measures and the use of these measures for building a value proposition for health plans. We will also hear case study presentations from organizations that have developed performance metrics and have used them to create a strategy for successfully working with health plans.
Deb Adler
Deb Adler brings more than 20 years of experience in executive health care roles, serving in a variety of capacities including network executive, quality management executive and chief operating officer, to the OPEN MINDS team.
Her consultant work with OPEN MINDS spans a broad range of customers (provider organizations, payors and government programs) and topics, including: collaborative care models/medical behavioral integration, provider network functions– contracting, network designs/tiering, recruitment, telehealth network implementation, and strategic planning. In addition, Ms. Adler has a special interest in helping technology-enabled providers in “go-to-market” strategies and streamlining network functions.
Since entering the managed behavioral health care field, she has become an industry-recognized leader in value-based contracting and alternative payment models. An innovator known for her ability to execute results, she has facilitated network designs and benefit plan approaches that achieve both quality outcomes and healthcare cost savings.
Before joining OPEN MINDS, Ms. Adler served as Senior Vice President of Network Strategy for Optum (now UnitedHealth Group) where she was responsible for behavioral health network development, contracting, and strategy for over 185,000 providers. In this role she developed the largest, performance-tiered behavioral health network, largest telemental health network, and largest medication assisted treatment (MAT) network. She was also responsible for implementing network initiatives to promote medical/behavioral integration, improve member outcomes, and reduce total cost of care through collaborative care models.
Prior to joining Optum/UnitedHealth, Ms. Adler spent over 12 years with ValueOptions, Inc. (now Beacon Options) where she held a variety of senior leadership roles including, Executive Vice President of National Networks; Chief Executive Officer, Health Plan Division; Vice President, Network Operations; Executive Director, Corporate Quality Management; and Executive Director, Quality & Information Systems. She was responsible for quality management and coordinated NCQA and URAC accreditation efforts.
Ms. Adler spent her early career in health care quality, serving as a quality director in two state-run psychiatric centers.
Ms. Adler received her Master’s degree in educational psychology and evaluation from Catholic University of America and is a Certified Professional in Health Care Quality (CPHQ).
Stan Monroe, J.D.
Stan Monroe is a co-founder, President and General Counsel of MindPath Care Centers, the largest outpatient behavioral health company in North Carolina, and among the top few in America. Mr. Monroe was CEO of MindPath (formerly Carolina Partners in Mental HealthCare) for twenty four years prior to a sale to private equity in 2018. He is currently serving on MindPath's Board of Directors with private equity co-investors (River Cities Capital Fund). Mr Monroe has a JD degree and has had an active law license for 26 years, with experience in business, contracting, commercial real estate, health care delivery and management. He is a leader of the movement in NC/USA toward value based care, especially in integrating behavioral health into the medical continuum with the goal of improving health outcomes while decreasing total health care costs.
Ashley Sandoval
The Payer Perspective: An OPEN MINDS Forum On The Performance Management Metrics That Health Plans Are Looking For From Providers
As reimbursement shifts to value-based models, health care providers continue to ask how payers define value and what metrics prove that their investments in consumer care result in better outcomes and the reduction in or avoidance of unnecessary health care costs. Join us for a straightforward discussion with health plan representatives who will share organizational strategies for measuring and rewarding success with value-based reimbursement models.
Ray Wolfe, J.D.
Raymond “Ray” Wolfe, J.D. brings over 40 years of experience in the health and human services sector to the OPEN MINDS team. Mr. Wolfe currently serves as a Senior Associate, a position in which he utilizes his expertise to successfully lead varying projects for OPEN MINDS. His areas of expertise include financial analysis and management, mergers and acquisitions, performance improvement, and strategic planning.
Before joining OPEN MINDS, Mr. Wolfe served in a 22 year tenure with Pittsburgh Mercy Health System in Pittsburgh, Pennsylvania. Most recently, Mr. Wolfe served as the organization’s Chief Operating Officer (COO) where he was responsible for oversight of all system operations, strategic planning, and performance management. Under his direction Pittsburgh Mercy achieved over $850K in value-based reimbursement contract quality bonus awards, integrated three organizations through merger/acquisition, and adopted a new performance management program for managers.
Before acting as Pittsburgh Mercy’s COO, Mr. Wolfe served as the organization’s Chief Financial Officer (CFO) and was responsible for the development of internal costing methodologies, contract rate negotiations, and financial forecasting activities. In addition, he coordinated an integrated care program with local partner hospitals to develop a series of diversion and respite programs, as well as, specialized primary care, integrated care management and high utilizer teams, while maintaining 15 straight years profitability.
Mr. Wolfe was promoted to CFO after serving as the Director of Fiscal and Information Security/Compliance for the health system. In this role, he was responsible for managing the transition of service contracts from fee-for-service (FFS), leading all compliance activities, and implementing a next generation electronic health record (EHR) system.
Prior to his time at Pittsburgh Mercy Health System, Mr. Wolfe served as Chief Fiscal Officer with the Summit Center for Human Development in Clarksburg, West Virginia, where he was responsible for reporting and budgeting functions and preparing Summit Center’s programs for FFS billing.
Previously, Mr. Wolfe served in billing and collections for two Pennsylvania-based hospitals. First, as an Accounts Receivables Manager for Brownsville General Hospital in Brownsville, PA, where he managed the accounting and billing system transition systems. Later as a Patient Account Manager for St. Francis Medical Center in Pittsburgh, PA, where he improved collections to hit 95% rate through the implementation of new billing software and department reorganization.
Prior to working in the health and human services market, Mr. Wolfe spent five years practicing as a Lawyer with at Law Offices of Arch A. Moore in Moundsville, WV. In this role he provided general legal practice, created and established bylaws for multiple corporation, and handled West Virginia licensing of first vision insurance plan.
Mr. Wolfe earned his Juris Doctor from the West Virginia University School of Law in Morgantown, WV and his Bachelor’s degree with a focus in Political Science and Sociology from West Liberty University, in Wheeling, WV, where he graduated Magna Cum Laude.
Lori Fertall, MBA
Lori Fertall is the Director of Value-Based Programs at Community Care Behavioral Health, a non-profit behavioral health managed care organization that is part of the Insurance Services Division of UPMC headquartered in Pittsburgh, Pennsylvania. In this position, she is responsible for the creation, management, and evaluation of value-based purchasing arrangements across the enterprise. Previously, Lori served as Community Care’s Director of Quality Management for 11 years. In that role, she implemented quality management programs and performance improvement projects across the company and its provider networks.
Prior to joining Community Care, Lori worked at various health and human service agencies. In her previous positions, she created new programs and service lines and implemented and managed behavioral health programs.
Lori earned a Master’s Degree in Business Administration from Point Park University and a Bachelor’s Degree in Social Work and Women’s Studies from West Virginia University. She also earn a Lean Six-Sigma Green Belt from UPMC.
Cathy Lipton, M.D., CMD
Cathy Lipton, M.D., CMD, is on the Corporate Medical Director team for Optum Complex Care Management (CCM), and has been affiliated with UnitedHealth Group since the original Evercare demonstration program expanded to Atlanta, Georgia, in the 1990’s. Optum’s clinical models of care support UnitedHealthcare’s Institutional (nursing home) and Dual (community-based) Special Needs Plans (SNPs) as well as the Post Acute care needs for other Medicare and private health plans. Optum’s programs focus on strong collaboration between Advanced Practice Clinicians (APCs) and Primary Care Physicians (PCPs) to enhance primary care for vulnerable populations.
Dr. Lipton has lived in Atlanta, Georgia, since the time she attended Medical School at Emory University as well as completing both her Internal Medicine Residency and Geriatric Fellowship programs there. Following training she worked at Emory’s Geriatric campus for a number of years in the clinical and academic arenas, including providing the medical direction for Emory’s skilled and intermediate care nursing facilities. Dr. Lipton has been a Certified Medical Director since 1997. She moved into an Adjunct Clinical capacity with Emory once she formally affiliated with UnitedHealth Group. Prior to her regional role, Dr. Lipton served as the Optum Market Medical Director for Georgia for many years, during which time the market provided clinical expertise in a variety of health plans including Institutional, Dual, and Chronic SNPs, as well as an End Stage Renal Disease pilot with CMS. She earned an innovation award for a telepsychiatry pilot program in 2013.
Dr. Lipton has twice been President, and is presently a long-standing Board member, of the Georgia Medical Directors Association, Georgia’s chapter of the Society for Post-Acute and Long Term Care (formerly AMDA). She sits on the Georgia Medical Care Foundation Nursing Home Quality Initiative Advisory Board, and has served on the American Health Care Association's Clinical Practice Committee and Professional Development Workgroup. Dr. Lipton’s interests include improved access to quality behavioral health care for under served populations, medical-behavioral integration, telemedicine, and remote monitoring technologies.
Susanna Kramer, MA
Susanna Kramer has been working in behavioral health program development and evaluation for over 15 years. She currently serves as Director of Performance Evaluation with Community Behavioral Health (CBH), Philadelphia County's Behavioral Health Medicaid Managed Care Organization. Since coming to CBH in August 2014, she has overseen program evaluation initiatives such as pay-for-performance and value-based purchasing. Prior to joining CBH, Ms. Kramer worked at Drexel University's Center for Nonviolence and Social Justice in developing trauma-informed systems of care and the University of Pennsylvania's Center for Mental Health Policy and Services Research in evaluating public behavioral health systems. She has worked clinically with children in Philadelphia and with adults in a day treatment program in Portland, Oregon. She holds a Masters degree in Clinical Psychology from West Chester University and a Bachelor of Fine Arts degree from the University of Pennsylvania.
Melissa Nichols, MHA
Melissa has more than 20 years’ experience in managed care with a focus on network management and payer contracting strategies. In her current role as Vice President Market Operations Development, she is responsible for the operational development of specialized population models to include support of clinical models and payer strategies. She has led both physical and behavioral health network activities within the Medicaid and Medicare space while working for many of the large managed care organizations. Her focus during the past 10 years has included the development of integrated care models, the development of risk contract models for behavioral health, and increasing access to care through comprehensive telehealth models and incentive programs. Most recently, she led the network and operational implementation in a provider sponsored health plan for IDD and SMI membership. She holds a Bachelor of Science degree in Psychology and a Master’s degree in Healthcare Administration.
Bridging The Gap Between Mind & Body Through Integrated Technology
Sponsored by Streamline Healthcare Solutions
Health care providers and government officials understand that an individual’s mental health is just as important as his or her physical health and how closely the two are related. The holistic approach to care has, and continues to improve the overall well-being of clients and provides benefits to the providers and payers. Kevin Sullivan, Director of Client Solutions with Streamline will demonstrate how SmartCare, Streamline’s fully web-based Electronic Health Record, incorporates documentation for both behavioral health and primary care to create a complete, fully integrated client record.
Join us and learn how SmartCare’s intuitive platform will support your organization and the clients you serve now and in the future!
Kevin Sullivan
Kevin joins Streamline with over 25 years of healthcare experience. He worked in direct client care positions in both mental health and substance use, as well as inpatient and outpatient settings. For the latter part of the 1990’s, Kevin managed the admissions department at the Betty Ford Center. Beginning in 2000, Kevin’s focus shifted from direct client care to working more behind the scenes on the technical side of behavioral healthcare systems; supporting the systems that enable clinicians and support staff to do their work more efficiently. Kevin continued working with healthcare software, implementing solutions for small agencies all the way up to large county applications. Kevin holds a Bachelor of Arts in Psychology and Master’s Degree in Computer Science.
Technology: How Much Is Enough? An Executive Discussion Group
How much should your organization be spending on technology? What kind of tech staffing do you need? Join this facilitated discussion group with OPEN MINDS Senior Associate Joe Naughton-Travers to learn more about managing technology - rather than having it manage you. We'll be asking discussion group participants to share the framework for their organization's technology - software, hardware, budgets, and staffing - as well as their future plans for optimizing their tech investments and tech operations.
Joseph P. Naughton-Travers, EdM
Joseph P. Naughton-Travers, Ed.M., Senior Associate, has more than 30 years of experience in the health and human service field. In this tenure as senior associate with OPEN MINDS since 1998, he has served as lead of dozens of client initiatives, served as editor of OPEN MINDS publications, and is the author of many groundbreaking articles and presentations.
Mr. Naughton-Travers brings to OPEN MINDS a broad range of experiences in private and public sector delivery of behavioral health and social services. He started his career as a behavioral health clinician, working in both child welfare and community mental health clinic settings. Subsequently, Mr. Naughton-Travers held a senior business operations management position for a psychiatric hospital system and its community mental health clinics. Later, he was vice president of a firm specializing in information systems and billing and receivables management for community-based mental health programs.
Since joining OPEN MINDS, Mr. Naughton-Travers has developed business solutions for provider and professional organizations, state and county government, technology companies, and venture capital firms. His primary areas of expertise include strategic planning and metrics-based management, electronic health record (EHR) and technology selection and implementation, operations improvement, and corporate compliance. For the past decade, more than half of his consulting practice has focused on aiding organizations in technology selection and implementation, including all aspects of strategic technology planning, functional specifications development, request for proposal development, vendor selection, and contracting.
He has written numerous articles, including “Winning the Human Resource Wars: Tried, True and New Strategies for Behavioral Health and Social Service Organizations,” “Five Pillars of Management Competency,” “Data Driven Decision Making: Moving to an Organizational Measurement Culture,” “Survival of the Smartest: What is Your Organization’s Information Literacy IQ?,” and “Strategic Human Resource Management: Aligning Compensation with Employee Performance and Organizational Strategy.” Mr. Naughton-Travers is also a nationally recognized speaker, having conducted hundreds of executive and professional executive training events around the nation.
Mr. Naughton-Travers received his Bachelor’s degree from Miami University of Ohio and his Masters’ of Education in Counseling Psychology from Boston University.
Lean Six Sigma & Operational Efficiencies In Healthcare
Sponsored by TenEleven Group
During this session, Dr. Singh will detail Lean Six Sigma, which is a process improvement methodology designed to eliminate problems, remove waste and inefficiency, and improve working conditions to provide a better response to customers' needs. Topics will include paths to cost reduction; value-added and non-value-added activities; batch vs. continuous flow and other compelling business principles.
Arvin Singh, MBA, MPH, MHL, LSSGB, PhD.c
Arvin Singh is a dynamic, collaborative, multi-site leader who hails from Indiana and developed his vocational and academic skills in the DC/East Coast region. He is a graduate from the George Washington University, where he received his Master in Public Health (MPH); a graduate from Penn State, where he received his Master in Business Administration (MBA); a graduate from Brown University,where he received his Master in Healthcare Leadership (MHL); a graduate from Harvard, where he obtained his Master Level Certificate in Negotiation, and is currently enrolled/pursuing his Doctoral Degree in Public Health (PhD). In addition, Arvin is an active member of the American College of Healthcare Executives (ACHE) and is 6 months away from qualifying for his Fellowship (FACHE). His professional accomplishments started at Indiana State, within Americorps, where he led teams to several disaster areas [JoplinTornado and the BP Oil Spill disasters].
He moved to DC shortly after and worked at Congress on the Affordable Care Act; the Department of Health and Human Services (HHS) at the Center for Medicaid and Medicare Services (CMS); the Pentagon overseeing reforms at the Defense Health Headquarters Agency (DHHQ), and the White House - directly under the Obama Administration overseeing the healthcare initiative for children (Let’s MoveCampaign) - achieving invaluable experience in healthcare policy, politics, economics, trade, and so forth. In order to gain a deeper understanding of healthcare/hospital operations, he moved to Baltimore and led Johns Hopkins through significant, innovative changes - such as their new partnership with RoundTrip & Lyft for patient transportation. It was here where Arvin also obtained his Lean, 6-Sigma Green Belt with the Johns Hopkins Armstrong Institute – expanding his knowledge base in eliminating waste and streamlining healthcare operations. In 2018, Arvin moved to New Orleans with his wife, a medical doctor in the Neurology field.
In his role at OHL as Chief Operations Officer, Arvin oversees day-to-day operations of the Agency, ensures Agency policies and procedures are enforced, leads expansion/acquisition/construction efforts over the new multi-million dollar facilities, and works with the Chief Executive Officer to provide staff support and guidance.
Lastly, Arvin is an avid community supporter. As a 32nd Degree Scottish Rite Freemason and active member of his DC-based lodge, he donates his time and effort towards giving back to cities which have blossomed him into the leader he is today (including New Orleans based Freemason lodges). In his free-time he enjoys an active life-style and plays basketball & tennis, enjoys flying Cessna planes,drone piloting and video-graphing, chess, computer building/technology, politics, and is an at home garage inventor.
The Future Of Residential Treatment: How Technology & Innovative Program Models Are Redefining Service Delivery Models
Residential treatment continues to have an important and evolving place in the continuum of care for patients with complex needs. Join us to learn how provider organizations are turning to technology to improve both the quality and efficiency of care.
This session will focus on:
- The changing residential treatment landscape
- Different technologies that are re-defining service models
- How organizations have created innovative solutions for residential programs
John F. Talbot, Ph.D.
John F. Talbot, Ph.D., Advisory Board Member, has more than 30 years of experience in all aspects of healthcare, including upper management, consultation, education, direct clinical work, and serving as the president of a non-profit board. Dr. Talbot has provided consultation, training and operational assistance to behavioral health providers, nonprofit organizations, and managed care organizations across the country. His areas of focus for consultation and training include strategic planning, the development of successful strategic alliances, board development, organizational reengineering, operations management, management and leadership development, and change management. He is currently Vice President of Integration Development at Jefferson Center for Mental Health in Denver, Colorado.
Prior to his current position, Dr. Talbot served as the President of a network of agencies providing care to children and families. The innovative work of Colorado Care Management received national recognition, including participation in a Federal IV-E waiver study that demonstrated measurable superior clinical outcomes. In his role with Colorado Care Management, Dr. Talbot also led the development of a coalition of Colorado business executives to address the issues of providing care to abused and neglected children, and the establishment of a nationwide purchasing cooperative for non-profits. Dr. Talbot’s previous experience included serving as the Director of the Master of Health Systems Program, and Associate Dean of University College at the University of Denver. He also held senior management positions at Mount Airy Psychiatric Center in Denver, Colorado.
Dr. Talbot has been a featured speaker at a number of national and state venues including the National Council Community Behavioral Health, Mental Health Corporations of America, the American Association of Residential Treatment Centers, the Medical Group Management Association, the Colorado Behavioral Health Council, the Mental Health Council of Arkansas, the New Jersey Association of Mental Health Agencies, and the Florida Behavioral Health Council.
Dr. Talbot is the former publisher and editor of Today’s Healthcare Manager, a newsletter focusing on leadership and management skills for healthcare managers, and has written numerous articles, manuals, and book chapters. His volunteer work includes serving as the President of the Board of Human Services Inc. in Colorado.
John Stupak
Mr. Stupak is the Chairman of Sequel Youth and Family Services and has more than 40 years experience in the behavioral health industry. Mr. Stupak is the former Board Chair of the National Association for Behavioral Healthcare. Prior to becoming Sequel's Chairman, Mr. Stupak held several roles at Sequel including Chief Executive Officer, Chief Operating Officer, and Chief Administrative Officer. Before joining Sequel, he worked for NHS Human Services, a large and diversified provider of behavioral health and human services. In addition to NHS, Mr. Stupak worked in an executive capacity for the Mentor Network. He graduated from Temple University with a master's degree from the School of Social Administration with a concentration in planning, research, and evaluation.
Marianne Birmingham, MS, CMUP
Marianne Birmingham is the Regional Director of Compliance and Quality for Sequel Youth & Family Services' Child Welfare Division. She has been with Sequel since 2010, starting as a Direct Care Employee, then rising through the ranks to where she is today. During her tenure with Sequel, Marianne has spearheaded several initiatives that leaned heavily on the successful adoption of new technologies that aimed to reduce the company's overall risk while increasing performance - including the development of Sequel's new proprietary mobile healthcare application, myPANDA, and 5 years of successfully attesting Meaningful Use, up to and including Stage 3. Marianne is an exceptional employee who has received several honors at Sequel, including Sequel's most prestigious "HIPP Award", an award given to the employee who most exemplifies Sequel's core values and beliefs. Marianne graduated Magna Cum Laude with her Bachelor of Arts from Western Michigan University and Cum Laude honors with her Master of Science in Psychology from Capella University. She also holds her Certified Meaningful Use Professional certification.
Theresa Jenkinson
Theresa joined Inglis in February 2018 as Vice President of Strategic Initiatives. She focuses on enhancing and developing new lines of business that will support individuals with complex disabilities throughout Philadelphia and further the ongoing sustainability and impact of the organization.
Theresa oversees Inglis’ community-based services located out of the Inglis Innovation Center, including Adapted Technology Services. She also leads Strategic Planning efforts, Marketing and Communications (Internal and External), Business Development and the execution of major projects that require interdepartmental coordination.
Before joining Inglis, Theresa spent almost nine years at Resources for Human Development (RHD), a national and diversified human services organization, holding progressively responsible positions beginning with program director of a nonprofit Incubator consisting of 38 start-ups, and concluding her tenure as Director of Strategic Initiatives. Prior to RHD, Theresa held communications and strategic planning roles at Coro New York Leadership Center and Acumen Fund in New York City, washingtonpost.org in D.C., and Princeton University's Alumnicorps Program. She is also spent five years as an Adjunct Professor of Human Services at Harcum College.
The Integration Imperative: What You Need To Know & Do To Remain Relevant
The health care landscape continues to shift - shaped by payer preference for integration, the shift to reimbursement for value, consumerism, and technology. This evolution has changed the key strategic question for executive teams of specialty provider organizations - is your organization relevant? Will it continue to be relevant?
The question is shaped by the two ends of the service delivery continuum. Are you positioned to participate in increasingly 'integrated' systems? Do you have a clearly defined specialty and are you 'best of breed' in that specialty? The answer to these questions lies in the numbers. Do your outcomes demonstrate good consumer health and efficient service utilization? Do consumers find your services convenient to use with a great experience? Are you a 'good deal', financially speaking?
Learn how executive teams are answering these questions - and managing to better value in the closing keynote address of Monica E. Oss, the CEO and Founder of OPEN MINDS. In her closing, she will focus on the current status of performance and performance management, the strategic implications of building a data-driven organization, and how to use performance data to craft a sustainable future strategy.
Monica E. Oss
Monica E. Oss, M.S., Chief Executive Officer and Senior Associate, is the founder of OPEN MINDS. For the past three decades, Ms. Oss has led the OPEN MINDS team and its research on health and human service market trends and its national consulting practice. Ms. Oss is well known for her numerous books and articles focused on the strategic and marketing implications of the evolving health and human service field. She has unique expertise in payer financing models, provider rate setting, and service pricing. She has led numerous engagements with state Medicaid plans, county governments, private insurers, managed care programs, service provider organizations, technology vendors, neurotechnology, and pharmaceutical organizations, and investment banking firms – with a focus on the implications of financing changes on delivery system design.