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Danielle Nelson

FWA Program Manager
PacificSource Health Plan

Danielle M. Nelson graduated from the University of Missouri with a Bachelor of Science in Criminology and Criminal Justice. In 2017, she received a Master of Arts in Management and Leadership from Webster University.

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Danielle Nelson

FWA Program Manager
PacificSource Health Plan

Danielle Nelson

FWA Program Manager
PacificSource Health Plan

Danielle M. Nelson graduated from the University of Missouri with a Bachelor of Science in Criminology and Criminal Justice. In 2017, she received a Master of Arts in Management and Leadership from Webster University.

Prior to joining for PacificSource Health Plans (PacificSource) as the Fraud, Waste and Abuse Program Manager in 2022, Ms. Nelson spent seven years working in Special Investigations Units (SIU) of varying sizes at both for-profit and not-for profit organizations, allowing her to gain experience in investigating fraud for government-funded programs, ACA, FEHB, and commercial lines of business. Before moving into fraud investigations in health care, Ms. Nelson spent 15 years in finance, working in consumer lending and back-office operations.

Ms. Nelson is a member of the Association of Certified Fraud Examiners, the St. Louis Chapter of ACFE, and National Health Care Anti-Fraud Association (NHCAA) and a participant with the Healthcare Fraud Prevention Partnership (HFPP).

Learn how one health plan worked to implement both primary care capitation and global capitation in their market.  The healthplan will explain how they leveraged their provider relationships to develop capitation models, configured their systems to pay capitation and were able to deepen the collaboration with providers.

1. Learn how to leverage your system capabilities and data to implement capitation.

2. Explore better strategies to collaborate with providers implementing payment change.

3. Understand how to measure success under a capitated contract.

Track 1: Advanced Payment Integrity Function

Author:

Cathy Newman

Managing Director Value-Based Strategy
Blue Cross Blue Shield of Rhode Island

Cathy Newman is the Managing Director of Value-Based strategy for Blue Cross Blue Shield of Rhode Island.  Her experience in the healthcare industry spans over twenty years working for both large integrated providers, small IPAs, and health plans.  In her ten years with Blue Cross, she has worked to advance value-based opportunities from pay for performance to full-risk global capitation models.  She is passionate about her work and has been able to develop more collaborative and meaningful relationships with providers throughout the state of Rhode Island.

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Cathy Newman

Managing Director Value-Based Strategy
Blue Cross Blue Shield of Rhode Island

Cathy Newman is the Managing Director of Value-Based strategy for Blue Cross Blue Shield of Rhode Island.  Her experience in the healthcare industry spans over twenty years working for both large integrated providers, small IPAs, and health plans.  In her ten years with Blue Cross, she has worked to advance value-based opportunities from pay for performance to full-risk global capitation models.  She is passionate about her work and has been able to develop more collaborative and meaningful relationships with providers throughout the state of Rhode Island.

  1. Understand the role of payers, providers, CMS, and PBMs in effectively combatting pharmacy fraud.
  2. Learn strategies for identifying fraudulent prescriptions and reducing waste through collaborative efforts.
  3. Explore ways to establish effective communication networks between these groups to prevent duplicate claims.

Author:

Michael Devine

Director Special Investigations Unit
L.A Care
... read more

Michael Devine

Director Special Investigations Unit
L.A Care
  1. Gain insights into the effects of regulatory changes on payment and revenue integrity operations.
  2. Learn the impact of innovations, such as automation, on the work of these organisations and how they will improve processes.
  3. Discuss strategies for cost containment while still accounting for the need to reduce provider abrasion in the evolving regulatory landscape.

Author:

Dale Carr

Director
Missouri Medicaid Audit and Compliance (MMAC)

Dale Carr currently serves as Director of the Missouri Medicaid Audit & Compliance (MMAC) unit, which
has overall responsibility for Medicaid program integrity efforts. Dale has worked for the State of
Missouri since 2011. Director Carr was previously a Police Officer in Fallon, NV; an Investigator for the
U.S. Office of Special Counsel; and a Supervisory Special Agent with the Coast Guard Investigative
Service. Dale holds a Bachelor’s degree in Administration of Criminal Justice and is a graduate of the

158th Session of the FBI National Academy.

... read more

Dale Carr

Director
Missouri Medicaid Audit and Compliance (MMAC)

Dale Carr currently serves as Director of the Missouri Medicaid Audit & Compliance (MMAC) unit, which
has overall responsibility for Medicaid program integrity efforts. Dale has worked for the State of
Missouri since 2011. Director Carr was previously a Police Officer in Fallon, NV; an Investigator for the
U.S. Office of Special Counsel; and a Supervisory Special Agent with the Coast Guard Investigative
Service. Dale holds a Bachelor’s degree in Administration of Criminal Justice and is a graduate of the

158th Session of the FBI National Academy.

Author:

Drew Satriano

Vice President of Payment Integrity
Highmark Health

Drew Satriano, a seasoned professional with an MBA, CPA, CFE, and JD, brings extensive expertise in payment integrity, accounting, auditing, and legal matters within regulated environments. Notably, he has spearheaded innovative initiatives resulting in a 968% increase in savings since 2014. His recent focus includes leveraging AI and technology for enhanced accuracy and efficiency in provider payment processes.

... read more

Drew Satriano

Vice President of Payment Integrity
Highmark Health

Drew Satriano, a seasoned professional with an MBA, CPA, CFE, and JD, brings extensive expertise in payment integrity, accounting, auditing, and legal matters within regulated environments. Notably, he has spearheaded innovative initiatives resulting in a 968% increase in savings since 2014. His recent focus includes leveraging AI and technology for enhanced accuracy and efficiency in provider payment processes.

 

Paolo Woods-Wyatt

CEO
Tails.com

Paolo Woods-Wyatt

CEO
Tails.com

Paolo Woods-Wyatt

CEO
Tails.com
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