Prince Baawuah Head of Medicare Advantage Solutions
Falcon Health
Prince Baawuah, DrPH, MPH, CSM® is a nationally recognized Medicare Advantage (MA) payment systems expert with 10+ years specializing in risk adjustment, encounter data, submissions, member and payment reconciliations. During his 7+ years at CMS's Medicare Plan Payment Group, he spearheaded operational policy and analytics for MA payments, leading critical initiatives in encounter data submissions, risk adjustment validation, and member-payment reconciliations. As Founder/CEO of HEALS Academy, he educates health plans and providers on end-to-end revenue recovery strategies, while at Falcon Health he pioneers AI-driven solutions for MA data submissions, reconciliations and payment accuracy.
A Johns Hopkins-trained health informatician, Dr. Baawuah revolutionized CMS's payment analytics by leading the development of the 2018 FedHealthIT Innovation Award-winning Encounter Data Dashboard (EDDA), which transformed how CMS resolves data submission and payment reconciliation issues for MA plans. His deep expertise spans the full MA payment lifecycle - from RAPS/EDS submissions to MARx report analysis (MAO-002/004, MORs, MMRs etc.) - making him a sought-after authority for plans and providers optimizing revenue integrity and compliance with understanding.
Suzanne Barone Clinical Manager, Risk Adjustment and Quality
VNS Health
Suzanne Barone is a highly experienced Registered Nurse and certified coder (CPC, CRC) with over 15 years of leadership in risk adjustment, clinical auditing, government revenue optimization, and healthcare compliance. With a Bachelor of Science in Nursing from Slippery Rock University and a robust background spanning UPMC Health Plan and VNS Health Plan, Suzanne has led cross-functional teams in medical record review, HCC coding, and government audit response.
At VNS Health Plan, Suzanne continues to lead coding and audit teams supporting Medicare and Medicaid compliance and building the retro and prospective audits. As Director of Government Revenue at UPMC Health Plan, she streamlined abstraction and retrieval processes, led enterprise RADV Medicare and HHS government audit strategies, for the ACA RADV audits delivering audit error rates consistently under 6%.
Her clinical foundation includes psychiatric and behavioral health nursing, along with progressive leadership roles in utilization review and quality assurance. Suzanne is licensed in Pennsylvania and New York and remains an active contributor to professional and philanthropic communities through Alpha Sigma Alpha Foundation.
Dr. Shannon Decker is Founder & CEO at VBC One, a consulting firm assisting physician groups, health plans and vendors maximize the performance of their value based contracts and offerings. Dr. Decker has more than 25 years experience in health care and most recently led teams in risk, quality, data and analytics, telehealth, COVID response and delegation compliance. Of her more than 25 years of experience in healthcare--17 include working with risk adjustment, quality and Medicare. Dr. Decker has a PhD. in Interdisciplinary Studies, dual MBA degrees--in Finance and in Marketing, as well as an M.Ed. in Secondary Education and a M.Ed. in Administration and Leadership. Dr. Decker is on the faculty at Arizona State University and is also an associate professor in the social and behavioral sciences for Walden and Capella Universities where she chairs and oversees the dissertations of doctoral students. An author of two books and several peer-reviewed articles, and a prolific national public speaker, her interests include the study of human behavior and how social and behavioral theories may be brought to bear in value based care and population health management as a whole.
David DeHommel is Vice President of Payer Strategies at Reveleer, bringing nearly 20 years of health plan leadership experience with a focus on advancing care for seniors and vulnerable populations. His background spans risk adjustment, revenue cycle, Stars, quality, analytics, and operations across Medicare Advantage, Medicaid, and ACA programs.
Prior to Reveleer, David served as Managing Director of Risk Adjustment at Blue Cross Blue Shield of Michigan and spent more than 16 years at Priority Health, part of Corewell Health’s integrated delivery network. He also held roles at Horizon BCBSNJ and Deloitte, where he began his career in assurance and advisory.
With 14 years of direct accountability for risk adjustment across multiple lines of business, David brings a cross-program perspective and a commitment to developing tools that empower clinicians and ensure patients receive the care they deserve.
David lives near Grand Rapids, Michigan. He’s been married for over 25 years and dedicates his time outside of healthcare to his family.
Penny Jefferson Manager of Coding and Clinical Documentation
University of California Davis Medical Center
Penny Jefferson entered the healthcare field 33 years ago as a medic in the US Army. Her extensive career spans a variety of roles, including CNA, LPN, RN, BSN, and MSN, with 14 years as a critical care nurse and 13 years of expertise in CDI. In 2019, Jefferson joined the Mayo Clinic as a concurrent CDI reviewer, quickly progressing to Supervisor of CDI in Rochester, MN. In December 2022, she transitioned to UC Davis Health as CDI Manager, where she continues to advance her leadership in CDI. Jefferson is a published author who has contributed to ACDIS, NAHRI, and ACPA. She actively serves on multiple committees, including the ACDIS Leadership Council, and she is the Chair of the ACDIS Regulatory Committee, the NAHRI Leadership Council, and the ACPA CDI Committee, where she holds the position of Assistant Co-Chair. Her diverse experience and dedication to the field have made her a recognized leader in healthcare documentation and CDI.
Ekaette Joseph-Isang Principal Consultant, Health Care Executive
RiteBridge Consultants
Dr. Ekaette Joseph-Isang is a subject matter expert in population health and value-based care with over 20 years combined experience in payor-provider strategy.
Her expertise cuts across population health, risk adjustment, healthcare quality, and healthcare innovation. Her specialty is in serving as a bridge between payers and providers and supporting organizations in getting their providers the tools, resources, and education that they need to stay competitive and efficient in the value based care space.
She is certified across multiple professional organizations in the risk adjustment, CDI, coding, and healthcare quality and is highly sought after for healthcare strategy and operations consulting.
Aldiana Krizanovic
Senior Health Policy Consultant, Federal Government Relations
Ann Maxwell Deputy Inspector General for Evaluation and Inspections
Office of Evaluation and Inspections
Ann Maxwell is the Deputy Inspector General for Evaluation and Inspections in the Department of Health and Human Services (HHS) Office of Inspector General. As the head of the Office of Evaluation and Inspections (OEI), she leads more than 150 professionals who provide objective, reliable, data-driven evidence to HHS, Congress, and the public on significant issues. Ms. Maxwell leads the office in producing results-oriented evaluations that provide valuable insights into the efficiency and effectiveness of HHS programs as well as offer actionable recommendations to drive positive change in HHS programs so that they can better serve and protect the American people. Ms. Maxwell also leads OEI in its oversight of the State Medicaid Fraud Control Units (MFCUs), which investigate and prosecute providers for Medicaid fraud as well as for abuse and neglect of patients in health care facilities. In fiscal year 2021, the MFCU grant program recovered $1.7 billion—a return of $5 for every $1 invested.
Ms. Maxwell’s two decades of leadership and evaluation expertise have resulted in significant improvements in HHS programs and protected millions of people. For example, under her leadership, OEI helped drive down inappropriate prescribing and utilization of prescription opioids in Medicare, accomplishing this by way of Congressional testimony, more than a dozen evaluation reports, an analytic toolkit, and referrals to law enforcement and HHS. She has also directed a variety of OIG-wide multidisciplinary teams—consisting of evaluators, auditors, lawyers, investigators, and data scientists— to accomplish high-profile, consequential oversight and drive positive change in numerous HHS programs. These programs include Medicare; Medicaid; emergency response, including the COVID-19 response; oversight of food and drugs; and child welfare programs such as Head Start, foster care, and the program for unaccompanied children who cross the southern border.
Ms. Maxwell began her career with OIG in 1997 as an evaluator in the Chicago regional office, where she rose to serve in a variety of leadership roles, including Regional Inspector General. Leading the Chicago regional office, Ms. Maxwell focused significant efforts on evaluating prescription drug benefits under Medicare, Medicaid, and the 340B Drug Pricing Program. This work led to substantial savings for Medicaid and strengthened protections for providers who serve underinsured and uninsured patients. Ms. Maxwell also served as Assistant Inspector General for 8 years before taking the helm as Deputy Inspector General.
Ms. Maxwell holds a Master of Social Work from the University of Chicago and a Bachelor of Arts in Sociology and Economics from Kalamazoo College, Michigan. Ms. Maxwell has received numerous OIG awards, including the Thomas D. Morris Leadership Award for her leadership, program knowledge, and analytical abilities, and the Bronze Medal for her exemplary leadership. She has also received numerous awards for excellence in evaluation from the Council of the Inspectors General on Integrity and Efficiency, including the inspector general community’s highest honor — the Alexander Hamilton Award for protecting the safety and welfare of migrant children in HHS custody.
Miranda Miller Director of Value Based Performance
Samaritan Health Services
Miranda Miller is the Director of Value-Based Performance for Samaritan Medical Group. She holds a master’s in health administration with a concentration in sustainability. Miranda started with Samaritan Health Plans in 2007 and transitioned to Director of Primary Care in the clinics in 2012. In August of 2022, Miranda accepted a position as the Director of Value-Based Care. She has previously served on the board for Corvallis Housing First and currently serves on the board for the Oregon Chapter of Women in Healthcare as the Sponsorship Chair and on the Oregon Chapter Planning Committee for American College of Healthcare Executives.
Miranda has three grown children and 2 grandchildren and has been married to her husband for 25-years. She enjoys spending time with family, camping, and traveling.
Brittany Poche Manager RADV and Stars Strategy Operations
LA Blue
Brittany is a dynamic and results-driven healthcare leader with over 15 years of experience in healthcare analytics and managed care. As a Manager of Risk Adjustment, she excels at transforming complex data into actionable insights that support strategic decision-making and operational excellence.
With a strong background in project management, Brittany has successfully led initiatives from concept to completion. She is adept at aligning business requirements with organizational goals to streamline processes, boost productivity, and reduce costs.
Brittany holds an MBA from Louisiana State University, complementing her technical expertise with strong business acumen. She is also a Certified Risk Adjustment Coder (CRC) and a Lean Six Sigma Green Belt, recognized for driving continuous improvement and enhancing compliance programs. Her leadership has led to measurable financial gains and significant process enhancements across cross-functional teams. Additionally, she holds a Health, Accident & Life Insurance license from the Louisiana Department of Insurance, underscoring her comprehensive understanding of the healthcare industry.
Syed Rizvi Director of Risk Adjustment and Vendor Operations
Southwestern Health Resources
Syed Rizvi, MHA, CPC – Syed is a dedicated healthcare leader focused on the ever-evolving value based care landscape for over 10 years. He has worked with large provider groups and payors to help increase quality and mitigate costs, giving him a unique and comprehensive approach to managing care. By utilizing data to tell a clear story and provide insights for innovation, Syed has built strategies to tackle some of the most complex healthcare topics including risk adjustment, hospital contracting, HEDIS Quality improvement, and provider/vendor relations. Syed is currently serving as Director of Risk Adjustment submissions at Southwestern Health Resources, and has also led teams around strategy, quality, and provider network.
