Medicare Star Ratings: Key Steps to Prepare for Changes in 2014 and 2015

Speakers

KRISTIAN J. MARQUEZ, CFA is vice president of the Clinical & Quality Outcomes (C&QO) department at Inovalon, Inc., a leading health care technology solutions company that focuses on health care data analytics and improvement in clinical and quality outcomes, care management and financial performance throughout the health care industry and community. In this role, he oversees Inovalon product and technology solutions for client engagements that span 50 U.S. states, the District of Columbia and Puerto Rico. His leadership has been a key driver in the successful development of several Inovalon products including CCS Advantage, HEDIS Advantage and Star Advantage. He has also been responsible for several key facets of product execution and innovation that have resulted in the successful launch and implementation of new commercial, Medicaid and Medicare technology solutions for many of the largest U.S. health plans. Mr. Marquez brings in-depth knowledge of various quality management programs, such as CMS’ Star Ratings methodology and NCQA’s HEDIS and state reporting requirements. Mr. Marquez has been recognized as a national thought leader in health care quality measurement, improvement and reporting, and has served on numerous committees and speaker panels for leading industry associations and forums. Earlier in his career, he held a number of senior roles in accounting and investment management services. He earned a Bachelor of Science degree in General Engineering from the United States Naval Academy and also holds the Chartered Financial Analyst designation.

APRIL GOSS is senior manager, healthcare operations at Inovalon. She is responsible for facilitating a comprehensive root cause analysis process focused on cross-functional efficiencies within a health plan’s operational departments that support CMS Star Rating and Health Plan Management System Display Page Measures, as well as for providing effective administrative recommendations in support of Inovalon’s Star Advantage solution. Prior to joining Inovalon, Ms. Goss held successive regional director positions for more than 15 years within the healthcare industry at organizations that include Kaiser Permanente, MAMSI and Dental Benefit Providers. As a strategic administrator, she was accountable for the day-to-day operations in various departments, managed annual budgets up to $9 million, and led staffs of up to 130 union and non-union employees. Ms. Goss led the stabilization of under-performing departments including member services, provider relations and contracting, and contract and benefit administration, and Claims Administration. At Kaiser Permanente, Ms. Goss also launched new employer client services and case installation departments focused on cross-functional end-to-end process improvements.

Moderator: Jill Brown, executive editor of AIS

Designed Especially For

• Health plan CEOs, CFOs, chief operating officers, government affairs and compliance directors, marketing executives, medical and clinical services managers, directors of provider relations, contracting executives, product directors, accountants and actuaries.
• Hospital and medical group CEOs, CFOs, administrators and directors of managed care contracting
• Pharmaceutical company and PBM executives
• Insurance agents, brokers and third-party administrators
• Health information technology company executives and marketing directors
• Attorneys, consultants and actuaries

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