Summit Speakers
Miriam Atkins, MD, FACP
AO Multispecialty Clinic,
Community Oncology Alliance (COA)
Miriam Atkins, MD, FACP
SESSION
Monday, October 23, 2023; 7:30 – 8:30 PM
Dinner Discussion: Ensuring High-Quality Cancer Care for All: Innovating for the Future
About the Speaker
Dr. Atkins is a Medical Oncologist, physician owner and partner with AO Multispecialty Clinic (Augusta Oncology, P.C.). She joined the practice in 2000 when she moved to Augusta, GA from San Antonio, TX. Dr. Atkins completed her Fellowship in Hematology/Medical Oncology in 1996 at Brooke Army Medical Center, Fort Sam Houston, TX. She attained the rank of Major while serving 8 years in the United States Army. Prior to leaving the Army in 1998, she was the Associate Director of the Adult Bone Marrow Transplant Unit and a member of the Clinical Faculty at Brooke. Dr. Atkins worked at Texas Oncology, P.A. for two years before moving to Augusta, Georgia. Dr. Atkins is Board Certified in Medical Oncology.
Dr. Atkins grew up in Lanham, Maryland. She is an alumnus of Hampton University, Hampton, Virginia where she has an endowed scholarship in her name. She received her Doctor of Medicine from Eastern Virginia Medical School, Norfolk, Virginia. Prior to completing her residency in Internal Medicine and Fellowship at Brooke Army Medical Center, she did an internship in Internal Medicine at the Letterman Army Medical Center, Presidio of San Francisco, California.
Dr. Atkins is a member of The Links, Incorporated, Delta Sigma Theta Sorority, Women in Philanthropy of the CSRA, The Junior League of Augusta (Sustainer), American Society of Clinical Oncology, American Society of Hematology and the Georgia Society of Clinical Oncology.
Dr. Atkins frequently gives lectures to local community groups. She has a passion for maintaining community oncology and healthcare government reform. She is the President of the Community Oncology Alliance(COA), a national non-profit organization dedicated to advocating for physician-owned community oncology practices and the patients they serve. Dr. Atkins is also the President of the Medical Staff at Piedmont Hospital – Augusta. She has served on the Boards of the Patient Access Network Foundation, Child Enrichment, Inc., The Augusta Symphony and Augusta Preparatory Day School. As part of her medical practice, Dr. Atkins teaches medical students as an Assistant Clinical Professor of the University of Medicine and Health Sciences in St. Kitts and the American University of Antigua.
Dr. Atkins has received numerous awards. She earned Army Achievement Medal and the Meritorious Service Medal while in active duty. She was recognized as one of the Transformational Women in 2017 by Trinity C.M.E. Church and is the recipient of the 2023 Health Service Award given by the Augusta Branch of the NAACP.
Dr. Atkins enjoys the performing arts, traveling, reading John Grisham novels and spending time with her daughter, Schuyler. She is a competitive ballroom dancer with Ballroom in Motion.
Robert E. Baird, Jr., RN, MSA
National Cancer Treatment Alliance (NCTA)
Robert E. Baird, Jr., RN, MSA
SESSION
Monday, October 23, 2023; 12:50 – 1:45 PM
Multi-Stakeholder Collaboration to Optimize the Whole Person Cancer Journey
Tuesday, October 24, 2023; 8:15 – 9:00 AM
Participating in a CIN to Collaborate for Better Cancer Care
About the Speaker
Robert has extensive experience in healthcare management developing strategic plans and directing financial, operational, and clinical initiatives. He is currently the President of the National Cancer Treatment Alliance (NCTA) a national network of community oncology practices whose focus is to contract directly with health care purchasers for oncology services. Prior to joining NCTA Robert was the CEO of Dayton Physicians, where he merged 3 independent Physician practices (Medical Oncology/Radiation Oncology/Urology) to create a large multi-specialty practice. Robert received his Master of Science in Hospital and Health Service Administration from Central Michigan University, a Bachelor of Science in Education from Bowling Green State University, and a Nursing Degree from Excelsior College.
Robert is married with three children and enjoys traveling, hiking and spending time with family and friends.
Greg Baker, RPh
AffirmedRx
Greg Baker, RPh
SESSION
Tuesday, October 24, 2023; 9:05 – 9:55 AM
Show Me the Money! Alternative & Transparent PBMs
About the Speaker
As CEO, Greg Baker strategically develops AffirmedRx’s mission for drive better health, predictable costs and a partnership that puts employers in control. Greg has decades of experience in pharmacy as a Pharmacist, businessman, and entrepreneur. He leads AffirmedRx in three core areas: 1. Cost Transparency, 2. Data Control and 3. Patient Health improvement. He is passionate about creating a clinically-focused versus a financially-focused PBM.
At AffirmedRx, Greg leverages his prior experience working as the pharmacy lead for Premise Health, during which time he maintained the highest levels of operational efficiency, clinical excellence and customer service to provide value within the greater pharmacy healthcare ecosystem. Drawing from this experience, as well as time spent as Pharmacy Supervisor for Walgreens and Senior Pharmacy Consultant for Blue & Co., Greg listens to scores of employers across all industries to customize the highest quality clinical care solutions with the lowest costs for AffirmedRx customers. While in a previous role, Greg led a pharmacy organization that won the 2018 PBMI award for innovation and the 2019 APhA Pinnacle Award. He was also the first community pharmacist appointed by the HHS Secretary to the National Advisory Council for the Agency of Healthcare Research and Quality, where he further advanced the role of pharmacy to improve public health outcomes.
Greg Baker lives by the motto, “By employers, For employers,” in order to make AffirmedRx a nimble company in a large industry determined to do what is right for employers and the millions who work for them.
Sibel Blau, MD
Quality Cancer Care Alliance (QCCA)/Exigent Research,
Northwest Medical Specialties, PLLC
Sibel Blau, MD
SESSION
Monday, October 23, 2023; 12:30 – 12:45 PM
Day One – Welcome to PES
Monday, October 23, 2023; 1:50 – 2:35 PM
Is the EOM a Successor Model?
Tuesday, October 24, 2023; 8:00 – 8:10 AM
Day Two – Opening Remarks
Tuesday, October 24, 2023; 2:30 – 2:45 PM
Summit Wrap-Up & Observations
About the Speaker
Dr. Sibel Blau is a Hematologist and Oncologist with special interest and expertise in breast cancer, multiple myeloma and stem cell transplant.
She is the Medical Director at Northwest Medical Specialties, PLLC, where she also runs the clinical research and Precision Medicine program.
She is one of the founding members and the President/CEO of the Quality Cancer Care Alliance Network (QCCA) that is a national organization with a focus of value-based care, education, and research as well as Exigent Research, an innovative research network of independent practices throughout the US to provide high quality, accelerated and accessible research to the communities where patients are treated. She is a board member and past President of Washington State Medical Oncology Society (WSMOS). She is involved in multiple committees at national organizations like ASCO, COA, ACCC.
She is also a member of All4cure, which is a transparent platform for discussion between experts in myeloma, researchers, scientists and patients.
She is the founder and president of the Journey Fund which is a community-based, not-for-profit organization committed to cancer patients facing barriers that affect their treatment with donations and community resources that make it possible for us to assist cancer patients facing social, financial, or emotional obstacles, toward a courageous journey, with dignity.
Ronda Bowman, MHA, RN, OCN
American Society of Clinical Oncology (ASCO)
Ronda Bowman, MHA, RN, OCN
SESSION
Tuesday, October 24, 2023; 12:30 – 1:25 PM
The OMH & Patient-Centered Cancer Care Certification: Lessons Learned & a Path Forward
About the Speaker
Ronda Bowman joined ASCO in May 2018 and is the Sr. Director for ASCO Certification Programs in the Care Delivery Department. Ronda leads Patient-Centered Cancer Care initiatives focusing on high quality, safe, and equitable care delivery supporting overall care transformation to value-based care. She supports practice/health system and team member engagement through serving as the leader and surveyor for ASCO Certification Programs including Quality Oncology Practice Initiative (QOPI®) Certification and ASCO Patient-Centered Cancer Care Certification Programs. Ronda’s experience includes clinical leadership roles in both academic and community oncology settings. She has served in the development of quality patient care programs and participation in quality initiatives such as ASCO’s QOPI® Certification, Commission on Cancer Oncology Medical Home Certification, and CMMI Oncology Care Model. Ronda obtained her undergraduate nursing degree at Xavier University, Cincinnati Ohio and Master of Health Administration from the University of Cincinnati. Ronda is a member of the Oncology Nursing Society and an Oncology Certified Nurse OCN®. She is a frequent presenter and mentor sharing expertise in oncology patient care delivery and quality care initiatives.
Sunil Budhrani, MD, MPH, MBA
Capital Rx
Sunil Budhrani, MD, MPH, MBA
SESSION
Tuesday, October 24, 2023; 9:05 – 9:55 AM
Show Me the Money! Alternative & Transparent PBMs
About the Speaker
Dr. Sunil Budhrani is the Chief Innovation and Medical Officer at Capital Rx, where he is responsible for innovative clinical offerings and partnerships, expansion of JUDI® platform capabilities, enhanced pharmacy benefit management (PBM) and administration solutions, and continued success with membership growth. He is a Board-Certified Emergency Medicine Physician on the George Washington University School of Medicine faculty and has managed departments and practiced at several other leading institutions nationwide. Dr. Budhrani brings decades of experience as a physician executive to Capital Rx, having most recently served as the Chief Executive Officer of Innovation Health, a first-of-its-kind payer-provider partnership between CVS/Aetna and one of the largest health systems in the Washington DC Metropolitan Area, INOVA Health System. In addition to his roles in hospital settings, Dr. Budhrani also founded one of the first national end-to-end telemedicine solution companies, CareClix Telemedicine, and prior to that, a multi-sited, regional Urgent Care system, PrimeMed Urgent Care Systems. He also served as the first Chief Medical Officer of the Affordable Care Act health plan, Evergreen Health Care, for the State of Maryland.
Dr. Budhrani graduated with Honors from the University of Pennsylvania. He then completed his Medical Degree and a Master of Public Health at George Washington University, where he was a 2021 recipient of the School’s Distinguished Alumni Award for his exemplary service during the pandemic. He completed his residency training in Emergency Medicine at the Tufts University School of Medicine in Massachusetts and his MBA at the University of Baltimore.
Hillary Cavanagh
Center for Medicare & Medicaid Innovation (CMMI)
Hillary Cavanagh
SESSION
Monday, October 23, 2023; 1:50 – 2:35 PM
Is the EOM a Successor Model?
About the Speaker
Hillary Cavanagh is the Director of the Division of Ambulatory Payment Models at the Center for Medicare & Medicaid Innovation (CMMI). Hillary oversees the division’s work implementing physician specialty models including the Enhancing Oncology Model (EOM) and previously the Oncology Care Model (OCM). Hillary previously served as the model lead for the development of an alternative payment model to support high-quality oncology care. Previously, Hillary worked on the development of the International Pricing Index (IPI) Model and other alternative payment models focused on Part B drugs. She also worked in CMS’s Office of Legislation serving as a technical expert for the analysis of legislation relating to Medicare Part B coverage and payment policy issues. Hillary previously worked at Washington Council Ernst & Young providing legislative and regulatory strategic advisory services for health care clients and also worked at Avalere Health providing health policy and data analysis for health insurance companies, life sciences companies, and patient advocacy groups. Hillary earned her M.A. in health policy from the University of Chicago and her B.A. from the College of William and Mary.
Claire Cote
New England Cancer Specialists
Claire Cote
SESSION
Tuesday, October 24, 2023; 12:30 – 1:25 PM
The OMH & Patient-Centered Cancer Care Certification: Lessons Learned & a Path Forward
About the Speaker
Claire Cote is the Chief Operations Officer at New England Cancer Specialists (NECS), the largest independent oncology practice in New England and affiliate member of Dana Farber Cancer Institute. Claire has been with NECS for just over 5 years. Prior to joining NECS, Claire held various leadership roles in private practices and health systems such as CFO, Director Cardiovascular Operations, Director of Clinical Standardization, Director Care Integration and Vice President of Quality & Patient Experience. Claire has a Bachelor’s degree in Accounting, a Master’s Degree in Management and a Black Belt in Lean Six Sigma.
Claire was born in Northern Ireland and was diagnosed with ovarian cancer in 1986 at the age of 13. 10 years later, Claire moved to Boston where she met her husband – a Mainer. While working at NECS, Claire received a breast cancer diagnosis at the age of 48 and now shares her early detection stories with groups in an effort to save lives. Claire spends most of her free time watching her three daughters play field hockey in college and high school and planning her next trip to foreign climates.
Kim Czubaruk, JD
CancerCare
Kim Czubaruk, JD
SESSION
Tuesday, October 24, 2023; 11:05 – 11:55 AM
The Patient Impact of Alternative Funding Schemes
About the Speaker
Kim Czubaruk is an attorney with expertise in health policy who uses her prior experience in civil litigation and disability law to help improve patient care, coverage, and outcomes. As CanceCare’s Associate Vice President of Policy, Kim oversees the direction of CancerCare’s advocacy efforts by developing and implementing strategic branding, cultivating alliances, and advancing the organization’s national policy agenda. Kim earned her Juris Doctor from George Washington University Law School and her Bachelor of Arts degree in political science from Union College. Kim brings twenty-five plus years of non-profit experience and a commitment to driving meaningful patient-centered health policy solutions.
David Debono, MD
Carelon Medical Benefits Management
David Debono, MD
SESSION
Tuesday, October 24, 2023; 12:30 – 1:25 PM
The OMH & Patient-Centered Cancer Care Certification: Lessons Learned & a Path Forward
About the Speaker
David Debono is Oncology Medical Director for National Product Management for Carelon Medical Benefits Management. Carelon is a subsidiary of Elevance Health. He did his medical school education, internal medicine residency and hematology-oncology fellowship at Indiana University. He practiced hematology-oncology as a community practitioner in Illinois for 13 years. Upon moving to Detroit, Michigan, he practiced palliative medicine at Henry Ford Hospital and subsequently was the director of the Supportive Oncology program at Karmanos Cancer Center. He has been with Elevance Health for over 6 years, and previously was the National Medical Director for Oncology and Serious Illness for Elevance Health. His primary focus has been provider engagement within the oncology community as well as supporting efforts in palliative care. He has assisted in launching the Anthem Oncology Medical Home and has participated in the launch of the Oncology Medical Home Plus program. He has recently moved to Carelon where he will continue to support provider engagement within an over-arching value-based strategy. He has been supportive of the ASCO/COA Oncology Medical Home /APC4 program. In his free time he enjoys caring for his two year old grandson and cooking for friends and family.
Nicolas Ferreyros
Community Oncology Alliance (COA)
Nicolas Ferreyros
SESSION
Monday, October 23, 2023; 2:40 – 3:35 PM
Employer-Medicare Overlap: Benefits Landscape for Medicare Age Employees
About the Speaker
Nicolas Ferreyros is Managing Director of Policy, Advocacy, and Communications at the Community Oncology Alliance (COA), the only national organization dedicated solely to preserving and protecting local, affordable, and accessible cancer care.
A seasoned advocacy and communications strategist with nearly two decades of experience in health policy, Nick has a deep understanding of the people and processes that affect America’s health care system and has a knack for translating “wonky” policy into language and concepts that resonate with policymakers, providers, patients, and voters.
Nick has engaged in nearly every major recent health policy issue before Congress and regulatory agencies, including the Inflation Reduction Act, Affordable Care Act, 340B Program, Medicare reimbursement, and more. He has worked closely with policymakers on Capitol Hill, the White House, HHS, FDA, and NIH. Nick’s work has appeared in The New York Times, Washington Post, Wall Street Journal, USA Today, CBS Evening News, NPR, and other leading national news outlets.
Prior to joining COA, Nick was a Managing Supervisor at a boutique Washington, D.C. communications firm specializing in health care, science, and social issues. While there, he oversaw high-profile, award-winning campaigns for clients including the Robert Wood Johnson Foundation, American Board of Internal Medicine, Consumer Reports, and numerous federal agencies.
A native of Houston, Texas, Nick earned a bachelor’s degree in political science from McGill University in Montreal, Canada. He currently resides in New York City.
John Fox, MD
Illumina
John Fox, MD
SESSION
Monday, October 23, 2023; 3:40 – 4:35 PM
The Right Treatment for the Right Patient: Understanding Biomarkers & the Role They Play in Oncology
About the Speaker
John Fox, MD MHA, is current the Senior Medical Direct of the Americas, Market Access, for Illumina, where he is accountable for working with payers and employers to expand access to genomic testing and personalized medicine.
He served as the Associate Chief Medical Officer at Priority Health, a provider-sponsored health plan with over 1,200,000 members from 2000 through 2019. He was responsible for medical and pharmaceutical technology assessment, policy development, and physician pay-for-performance programs. He was also responsible for development of new programs, including shared decision making, digital therapeutics, advanced care planning, integrated specialty pharmacy program, surgical optimization initiatives, value-based benefit designs and contracts, oncology medical home programs, and personalized genomic medicine initiatives.
In June 2019 he became the Vice President of Clinical Transformation of Spectrum Health Systems, the parent company for Priority Health, and the Executive Medical Director for the West Michigan ACO, a clinical collaboration between Spectrum Health providers and Answer Health, the largest independent physicians organization in west Michigan.
Dr. Fox earned his BS in chemistry and biochemistry in 1983 from the University of Illinois, Urbana-Champaign. He was awarded his Doctor of Medicine Degree by the Johns Hopkins University School of Medicine in Baltimore, MD, in 1989. He completed his residency in pediatrics in 1992 and fellowship with the CDC’s Epidemic Intelligence Service in 1996. He was awarded a Master of Health Administration by the University of Wisconsin, Department of Preventive Medicine in 2000.
He is married to Kristine and has three children. His two sons, two brothers, and three nephews are Eagle Scouts and his daughter a Gold Award recipient. He is very committed to youth leadership development through the Boy Scouts of America. He continues to practice medicine in third world countries, including Honduras, and leads one to two trips there annually with his church. He helps keep nature nearby through the Land Conservancy of West Michigan where he serves as a work crew leader and on its board of directors. He’s a longtime volunteer with Habitat for Humanity and still has all ten fingers and toes.
Bo Gamble
Community Oncology Alliance (COA)
Bo Gamble
SESSION
Tuesday, October 24, 2023; 12:30 – 1:25 PM
The OMH & Patient-Centered Cancer Care Certification: Lessons Learned & a Path Forward
About the Speaker
Robert “Bo” Gamble joined the Community Oncology Alliance (COA) in May 2011. He supports COA’s Quality and Value initiatives and was active in the development and support of the original Oncology Medical Home (OMH) program. He is now working with ASCO for a new, and much improved, OMH program – also known as the ASCO Certified program. He devotes most of his time in assisting and supporting cancer care teams in this changing world of quality and value for cancer care. This effort includes monitoring and promoting reform models by different types of payers.
Mr. Gamble brings a diverse range of cancer practice expertise at the national and local levels. His extensive experience includes 13 years’ experience as administrator at a multi-physician, multi-location oncology practice. Prior to that he has served in various healthcare capacities including as an independent consultant for hospital business operations, national director of client support for a healthcare software company, and business office manager for a 300+ bed hospital.
Bobby Green, MD
Thyme Care
Bobby Green, MD
SESSION
Monday, October 23, 2023; 2:40 – 3:35 PM
Employer-Medicare Overlap: Benefits Landscape for Medicare Age Employees
About the Speaker
Bobby Green is a medical oncologist and Thyme Care’s Co-Founder, President and Chief Medical Officer. Thyme Care is the leading value-based cancer care partner, collaborating with payers and providers to transform the experience and outcomes for individuals living with cancer. Prior to joining Thyme Care, Bobby was the Chief Medical Officer at Flatiron Health. He practiced medical oncology in West Palm Beach, Florida at Palm Beach Cancer Institute (which became part of Florida Cancer Specialists) from 1999-2021.
Toni Gress
The US Oncology Network
Toni Gress
SESSION
Monday, October 23, 2023; 2:40 – 3:35 PM
Employer-Medicare Overlap: Benefits Landscape for Medicare Age Employees
About the Speaker
Toni Gress is the Commercial Value-Based Care Lead for the US Oncology Network. She supports The Network practices participation and performance in value-based commercial programs, from the time an opportunity is identified, through the analytical evaluation, implementation, and optimization phases. She has been with US Oncology for 7 years and moved into this current role from her position as VBC Program Portfolio Manager on the Transformation Team.
Prior to US Oncology, Toni was with Compass Oncology for 24 years in various roles including Implementation Manager and Practice Administrator. Her operational roles working to improve care delivery and patient experience sparked a passion for Value-Based Care.
Toni earned a BS in Business Management from Portland State University.
She resides in Vancouver, Washington.
Bret Jackson
Economic Alliance for Michigan
Bret Jackson
SESSION
Monday, October 23, 2023; 3:40 – 4:35 PM
The Right Treatment for the Right Patient: Understanding Biomarkers & the Role They Play in Oncology
About the Speaker
Bret Jackson is the President and CEO of the non-profit Economic Alliance for Michigan (EAM). Founded in 1982, the EAM is comprised of businesses and unions working together with one clear objective, the continued growth of Michigan’s economy by creating an atmosphere that inspires job growth and maintains Michigan’s competitiveness for attracting new companies and talent. EAM’s membership provides health benefits to an estimated 900,000 lives, creating a powerful voice in the health purchaser industry.
Bret began working at the EAM in 2007 as legislative director. In 2010, he was elected vice president and became the organization’s third president in January 2011. Bret oversees all EAM activities including policy development, research, education, administration, membership, and advocacy. He developed and manages the EAM Health Purchaser Forums, Oncology Symposium, and other various health purchaser roundtables.
With the EAM as The Leapfrog Group’s Regional Leader for Michigan, Bret is a leader in advocating for patient safety in the State of Michigan and completed The Leapfrog Group’s Bruce Bradley Fellowship in 2017. He serves as chair of the Health Policy Affinity Group and on the Board of Governors for the National Alliance of Healthcare Purchaser Coalitions. In 2020, Bret was appointed to the National Quality Forum Patient Safety Standing Committee.
Outside of EAM, Bret loves spending time with his family and is very active in the Detroit Curling Club. Email Bret at [email protected].
Scott Kruger, MD
Virginia Oncology Associates
Scott Kruger, MD, FACP
SESSION
Monday, October 23, 2023; 3:40 – 4:35 PM
The Right Treatment for the Right Patient: Understanding Biomarkers & the Role They Play in Oncology
About the Speaker
Dr. Kruger is a graduate of Jefferson Medical School in Philadelphia, PA. He served in the United States Army where he completed his internship and Internal Medicine residency at Walter Reed Army Medical Center in Washington, D.C. He completed a fellowship in Hematology/Oncology at Letterman Army Medical Center including studies in bone marrow transplant at the Hutchinson Cancer Research Center.
Dr. Kruger is board certified in Internal Medicine, Hematology and Medical Oncology. He served on numerous committees in both the U.S. and Europe, and has been awarded both military and civilian honors which include: the Meritorious Service Medal (two), Army Achievement Medal, the Commander’s Award for Excellence, and the National Red Cross Volunteer Award. Dr. Kruger has also been involved in clinical trials and research and has developed numerous presentations. Leukemia Lymphoma Society board member, Associate Professor of Medicine at EVMS and Chairman of the EVMS Institutional Review Board.
James Lee
Community Oncology Alliance (COA)
James Lee
SESSION
Tuesday, October 24, 2023; 10:10 – 11:00 AM
State-Level Successes: Local Policy Changes to Reduce Costs & Improve Care
About the Speaker
James Lee is senior manager of state regulation and policy at the Community Oncology Alliance (COA), the only national organization dedicated solely to preserving and protecting local, affordable, and accessible cancer care.
An experienced health care advocate at the state and federal levels, James has engaged in successful efforts to expand, clarify, and codify complex policy pertaining to Medicaid, telehealth and telemedicine, behavioral health, and pharmacy, just to name a few.
Prior to joining COA, James represented Legacy Community Health, one of the nation’s largest and fastest growing Federally Qualified Health Center systems, located in Southeast Texas. As manager of government relations at Legacy, he led strategic legislative campaigns with internal and external stakeholders. Producing public policy outcomes for more than 190,000 clients at 45 facilities, he served as a liaison to over 75 federal, state, and local policymakers.
James is a native of the U.S. border with Mexico, and was born and raised in the Rio Grande Valley, the most southern region of Texas. He earned a bachelor’s degree in political science from the University of Houston and now lives in Jersey City, New Jersey.
Jonathan E. Levitt, Esq.
Frier Levitt
Jonathan E. Levitt, Esq.
SESSION
Tuesday, October 24, 2023; 11:05 – 11:55 AM
The Patient Impact of Alternative Funding Schemes
About the Speaker
Jonathan Levitt, Esq. co-founded the national boutique healthcare law firm of Frier Levitt in 2000. Beginning with a 2003 national class action of pharmacies against a publicly traded Pharmacy Benefit Manager (PBM), Jonathan began his journey to understand all aspects of the drug supply chain. Jonathan was recently invited to testify before the U.S. Senate Committee on Finance during its hearing titled “Pharmacy Benefit Managers and the Prescription Drug Supply Chain: Impact on Patients and Taxpayers,” which took place on March 30, 2023. As a leading voice in the healthcare industry, Jonathan shared his valuable insights into the role of PBMs in the prescription drug supply chain.
During his testimony, he addressed many challenges faced by patients in accessing affordable medications, including concerns about the PBM rebate system, the need for greater transparency in PBM practices, and repercussions on patients, taxpayers, and independent pharmacies. The hearing can be viewed on finance.senate.gov/hearings.
Jonathan is a highly experienced trial attorney whose practice focuses on representing stakeholders in the drug supply chain, such as pharmacies, physician-dispensers, national provider associations, drug manufacturers, drug wholesalers, and plan sponsors. Jonathan prosecutes claims brought by these stakeholders against PBMs, often uncovering secretive PBM tactics used to hide funds through litigation. Additionally, he assists Self-Funded Plans with their pharmacy benefit design, utilizing his extensive skillset. Jonathan has tried numerous litigations or arbitrations involving Medicare Part D “Direct and Indirect Remuneration” (DIR) Fees. He represents state Medicaid systems conducting audits of PBMs. Clients count on Jonathan to challenge the one-sided contracts drafted by PBMs and level the playing field.
Jonathan is dedicated to pro bono and public service assignments, reflecting his commitment to serving the community.
Jonathan is admitted to practice in multiple states and before courts across the country and is Certified by the Supreme Court of New Jersey as a Civil Trial Attorney.
Relevant Matters
- Represented a publicly traded specialty pharmacy in a confidential arbitration against a major PBM. The arbitration resulted in an award of $20 million and a subsequent settlement exceeding that amount, that included prospective improved reimbursement rates. Frier Levitt’s team used its extensive knowledge of the federal Medicare Part D “Any Willing Provider” law and regulations, as well as their understanding of the PBM-specific contractual provisions.
- Secured a $9 million confidential settlement on behalf of a private equity-owned specialty pharmacy and returned the DIR Fees to the pharmacy client.
- Secured a $6.25 million arbitration win for a Medicare Part D Prescription Drug Plan (PDP) client by proving that the PBM neglected to reimburse the PDP for drug manufacturer rebates.
- Obtained a $3.7 million DIR Fee arbitration award on behalf of Mission Wellness, a female and minority-owned specialty pharmacy, against Caremark. Following a five-day hearing, Frier Levitt secured an arbitration award ordering the PBM to pay 100% of DIR Fees assessed on the pharmacy, the pharmacy’s costs, legal expenses, and interest.
- Obtained a $3.1 million arbitration award for a private equity owned specialty pharmacy client after a 5-day hearing against Caremark. The arbitrator awarded the specialty pharmacy damages for Caremark’s improper and unlawful assessment of DIR fees.
Education
- Legal: New York Law School, J.D., cum laude
- Articles Editor – New York Law School Law Review
- Undergraduate: Rutgers College, Rutgers University
Admissions
- State of New Jersey
- State of New York
- Commonwealth of Pennsylvania
- State of Missouri
- State of Arizona
- State of Texas
- Washington, D.C.
- Supreme Court of Illinois
- District of Columbia Court of Appeals
- U.S. District Court, District of Arizona
- U.S. District Court, District of Columbia
- U.S. District Court, District of New Jersey
- U.S. District Court, Southern and Eastern Districts of New York
- U.S. Court of Appeals, Third Circuit
- U.S. District Court, Eastern District of Michigan
- U.S. District Court, Eastern District of Missouri
- U.S. Supreme Court
Aaron Lyss, MBA
OneOncology
Aaron Lyss, MBA
SESSION
Monday, October 23, 2023; 1:50 – 2:35 PM
Is the EOM a Successor Model?
About the Speaker
Aaron Lyss is Senior Director of Payment and Policy Innovation for OneOncology, a national partnership of independent community oncology practices. Aaron’s role at OneOncology includes implementation of policy and advocacy strategies, and other initiatives related value-based care and risk-sharing payment models, including strategic planning and implementation support for CMMI’s Oncology Care Model and Enhancing Oncology Model, and development of similar commercial payer partnerships. He also serves on the board of directors for the Patient Advocate Foundation.
Prior to this role with OneOncology, Aaron was the Director of Strategy and Business Development for Tennessee Oncology, and prior to that served as healthcare policy specialist for the Association for the Advancement of Blood and Biotherapies.
Aaron earned his Master of Business Administration at the Vanderbilt University Owen Graduate School of Management, and his Bachelor of Arts degree at Washington University in St. Louis.
Richard Lewis Martin, III, MD, MPH
Tennessee Oncology
Richard Lewis Martin, III, MD, MPH
SESSION
Monday, October 23, 2023; 7:30 – 8:30 PM
Dinner Discussion: Ensuring High-Quality Cancer Care for All: Innovating for the Future
Tuesday, October 24, 2023; 1:30 – 2:25 PM
How Are We Moving the Needle on Health Equity?
About the Speaker
Dr. Richard Lewis Martin III, MD, MPH is a physician and Medical Director of Health Equity and Community Engagement with Tennessee Oncology, practicing in both Clarksville and Antioch, Tennessee. While not an organ focused specialist, Dr. Martin considers himself a specialist in treating diverse and socially complex patients. Dr. Martin also serves as President of Tennessee Oncology Practice Society (TOPS), the state affiliate of ACCC, where he is leading state efforts to advance patient and provider centered legislation on PBM and Prior Authorization Reform, Telehealth Reimbursement, and Women’s Reproductive Care. He also co-founded and serves on the steering committee for the Appalachian Community Cancer Alliance (ACCA) which seeks to bridge gaps in knowledge, resources, and communication between primary and sub-specialty providers in delivering cancer prevention and screening services. Dr. Martin also serves on COA’s Health Equity Committee.
Dr. Martin’s passion for health equity and caring for underserved populations stems from his initial experiences shadowing physicians in central Washington migrant farmworker clinics, and leading nutrition and exercise programming for low income East Boston Latino families through AmeriCorps. Dr. Martin completed his MPH in Epidemiology and Biostats from Oregon Health Sciences University and his medical school training at the University of Washington School of Medicine, where he sought out clinical rotations in Alaska and Wyoming to better understand rural healthcare delivery. Initially interested in HIV/Hepatitis medicine, Dr. Martin found his calling in Hematology/Oncology during his residency at the University of Wisconsin. During residency, he also discovered his passion for patient and provider advocacy, serving as resident board member of the American College of Physicians Wisconsin Chapter. Appreciating that mentorship and training are critical to advancing DEI, after his residency, Dr. Martin returned to his hometown community residency program for a one-year Teaching Fellowship.
Dr. Martin attended Vanderbilt University Medical Center for his Hematology/Oncology fellowship, where he completed his final year as chief fellow. After completing fellowship, he took a position as Assistant Professor of Medicine at Meharry Medical College, one of four HBCU medical schools in the United States, and tasked with providing oncology care for Middle Tennessee’s safety net hospital, Nashville General Hospital. At Meharry, Dr. Martin served as Co-Director of Clinical Oncology Trials, Sickle Cell Center Medical Director, and Cancer Liaison Physician for the Committee On Cancer. Hoping to build even broader state, regional, and national health equity networks, Dr. Martin joined Tennessee Oncology in 2022 where he now serves as Medical Director of Health Equity and Community Engagement.
When he is not eating, breathing, and sleeping health equity, Dr. Martin prides himself on being husband to his wife Juliana, dad to his son Santiago, and doggie dad to Guacamole. He also finds time to garden, attend Nashville soccer games, and is learning Spanish to keep up with his family.
Barbara L. McAneny, MD, FASCO, MACP
New Mexico Cancer Center
Barbara L. McAneny, MD, FASCO, MACP
SESSION
Tuesday, October 24, 2023; 9:05 – 9:55 AM
Show Me the Money! Alternative & Transparent PBMs
About the Speaker
Barbara L. McAneny, MD, a board-certified medical oncologist/hematologist from Albuquerque, N.M., became the 173rd president of the American Medical Association in June 2018. She has been a member of the AMA Board of Trustees between June 2010 and June 2020, serving as its chair in 2015–2016. Dr. McAneny is a fellow and former member of the board of directors of the American Society of Clinical Oncology (ASCO), a master of the American College of Physicians, and a past president of the New Mexico Medical Society (NMMS), the Greater Albuquerque Medical Association and the New Mexico chapter of the American College of Physicians. In addition, she has served as a member of the Community Oncology Alliance Board of Trustees and on the board of directors of the Cancer Center Business Summit. She became the delegate to the AMA from ASCO in 2002 and was elected to the AMA Council on Medical Service in 2003, serving as its chair in 2009–2010. Dr. McAneny is one of the founders and current chair of the board of the National Cancer Care Alliance, a group of independent practices collaborating to use innovation to deliver high-quality, high-value cancer care and to develop new alternative payment models based on sound data-driven principles. Prior to this, she was a founding member of Oncology Circle, a group of oncology practices using data to promote best practices. Dr. McAneny’s interest in using data to improve practice sustainability began when she was appointed to the Centers for Medicare & Medicaid Service’s Practicing Physicians Advisory Council, where she served from 2002 to 2006. In 2012 Dr. McAneny received a $19.8 million grant from the Centers for Medicare & Medicaid Innovation to demonstrate how oncology practices could use triage pathways to dramatically lower costs while improving outcomes. This award, named COME HOME (for Community Oncology Medical Home), later was incorporated into Medicare’s Oncology Care Model. Dr. McAneny also co-founded New Mexico Oncology Hematology Consultants Ltd. in 1987 with Clark Haskins, MD. A managing partner since 1999, she built New Mexico Cancer Center as the first physician-owned multi-disciplinary cancer center in the state with clinics in Albuquerque and Gallup. She also founded the New Mexico Cancer Center Foundation, which provides grants to help patients with nonmedical expenses. Dr. McAneny graduated magna cum laude from the University of Minnesota in 1973 and with honors from the University of Iowa College of Medicine in 1977. She completed her residency in internal medicine at the University of Iowa in 1980 and her fellowship in hematology/oncology at the University of New Mexico in 1983. She is married to Steven Kanig, MD.
Jeff Mortier
Farragut Partners
Jeff Mortier
SESSION
Monday, October 23, 2023; 4:40 – 5:35 PM
PBM Policy & Regulation Update: Latest From D.C. & Beyond
About the Speaker
Jeff Mortier brings over a decade of public policy expertise in the healthcare, energy, telecommunications, privacy, and data security arenas and is widely regarded as a trusted voice on Capitol Hill.
Jeff has extensive experience in providing strategic advice and lobbying and policy expertise to executives of fortune 500 companies, industry associations, and non-profit organizations.
Jeff also serves as the Executive Director of the 21st Century Privacy Coalition, where he represents major telecommunications and cable companies.
Prior to co-founding Farragut Partners, Jeff served as a Professional Staff Member on the House Energy & Commerce Committee under Chairman Fred Upton (R-MI). In that role, he helped organize the committee’s policy agenda and promoted the Chairman’s legislative priorities including work on online privacy and data security issues. He also served as a liaison to Republican Member offices on the committee and worked directly with Members and senior staff to help them further their policy goals.
Before serving on the Energy & Commerce Committee, Jeff spent five years working with senior Member of Congress Rep. Ed Whitfield (R-KY) where he handled the Congressman’s most important legislative priorities, including health care policy, and served as Rep. Whitfield’s top policy advisor. During his time with Rep. Whitfield, Jeff worked on a number of significant bills including the Patient Protection and Affordable Care Act, the Food and Drug Administration Amendments Act of 2007 and the Food Safety and Modernization Act.
Working with his founding partners, Jeff MacKinnon and Joe Vasapoli, Jeff has built Farragut Partners into a premier DC lobbying firm. A Louisiana native, Jeff resides in Washington, DC with his wife Nicole.
Erich Mounce
Oncology Care Partners (OCP)
Erich Mounce
SESSION
Monday, October 23, 2023; 2:40 – 3:35 PM
Employer-Medicare Overlap: Benefits Landscape for Medicare Age Employees
About the Speaker
Mr. Mounce is the Chief Executive Officer of Oncology Care Partners (OCP), a transformative provider organization in cancer care designed to provide care exclusively to patients within value-based contracts, Medicare Advantage Plans for example. OCP is focused on disrupting the fee for service status quo in oncology care.
Erich has over 40 years healthcare experience with a unique mix of operational leadership for physician-led care models, ambulatory care delivery settings, and acute care hospital systems. Erich served as the Chief Operating officer of OneOncology, a national network of 15 high-value oncology medical group practices. Prior to OneOncology, he served as the Chief Executive Officer of The West Clinic / West Cancer Center, one of the nation’s top community oncology practices. During his tenure with OneOncology and West Cancer Center, he gained a national recognition for private practice innovation and development of collaborative multidisciplinary operating models with partnerships, such as hospital systems, payers, and participation in early value-based oncology care models.
Prior to his experience in the oncology sector, Mr. Mounce served in a variety of C-suite roles for an acute care hospital company and a physician owned Medicare Advantage plan. Mr. Mounce began his healthcare career with the Los Angeles City Fire Department where he proudly served in the field for a decade as a Senior Fire Paramedic.
Yen Nguyen, PharmD
Oncology Consultants
Yen Nguyen, PharmD
SESSION
Tuesday, October 24, 2023; 10:10 – 11:00 AM
State-Level Successes: Local Policy Changes to Reduce Costs & Improve Care
About the Speaker
Yen obtained a PharmD from the University of Texas in Austin and BS from Texas A&M University in College Station. Being a pharmacist for 20+ years, her pharmacy background consists of PBMs, hospital, mail-order, retail chain, and community oncology. She was awarded three years straight as the fastest growing pharmacy in sales for the Southwest Region of over 140+ stores at Kroger. She then followed her passion of oncology by joining Oncology Consultants in 2006 as their in-office dispensing pharmacist. Fast forward, Oncology Consultants is now the largest independent physician private practice in Houston with 22 oncologists and 15 clinical sites. Since then, she has started 2 additional specialty pharmacies with dual specialty accreditation with URAC and ACHC designation in the same year. Yen was one of the original Advisory Members for Specialty Oncology Network for ION and currently serves on the Executive Board of National Community Oncology Dispensing Association (NCODA) and Community Oncology Pharmacy Alliance (COPA). She is the brainchild behind the NCODA’s Cost Avoidance Waste Tracker, NCODA Financial Assistance Tool, and the NCODA logo. She previously served as the Digital Strategist for NCODA. She is currently appointed to serve on the Public Policy Council for the Texas Pharmacy Association. Yen has extensive knowledge on GPOs, payer contracts, credentialing, pharmacy process and buildouts. In her spare time, she hobbies are golfing, fishing, and fooding.
Ted Okon, MBA
Community Oncology Alliance (COA)
Ted Okon, MBA
SESSIONS
Monday, October 23, 2023; 1:50 – 2:35 PM
Is the EOM a Successor Model?
Monday, October 23, 2023; 4:40 – 5:35 PM
PBM Policy & Regulation Update: Latest From D.C. & Beyond
About the Speaker
Ted Okon is a nationally recognized expert on the policy and politics of cancer care. He is quoted extensively in the press, including guest appearances on TV and radio news shows. Ted has testified before Congress on cancer issues and is frequently on Capitol Hill discussing the nation’s cancer care delivery system. Ted’s target areas of expertise include the cost of cancer treatment, health care reform, Medicare reimbursement, pharmacy benefit managers (PBMs), drug shortages, and the changing landscape of cancer care delivery in the United States.
Ted has dedicated his career to healthcare business and policy. He has worked for several pharmaceutical companies including Merck and Warner-Lambert, now part of Pfizer, and IMS Health. He co-founded and took public the health care information business Medical Marketing Group. He also founded two oncology companies (an oncology clinical research network and an information network) and has traveled extensively to China, India, Singapore, the U.K., and the Middle East, analyzing and discussing cancer care delivery.
As executive director of the Community Oncology Alliance (COA), Ted oversees the strategic direction of this non-profit organization dedicated to patients and providers in the community cancer care setting, under the direction of a dedicated board of oncologists and practice administrators. Ted also travels the country speaking to state oncology societies, professional organizations, and companies about the challenges facing the nation’s cancer care delivery system. He has authored numerous articles and studies relating to cancer care policy and politics, reimbursement, and clinical issues.
Ted holds a BS degree from Fairfield University and an MBA from the Carnegie-Mellon University Tepper School of Business. His wife, Susan, practiced as a certified oncology nurse.
Kathy Oubre, MS
Pontchartrain Cancer Center
Kathy Oubre, MS
SESSIONS
Monday, October 23, 2023; 3:40 – 4:35 PM
The Right Treatment for the Right Patient: Understanding Biomarkers & the Role They Play in Oncology
About the Speaker
Kathy Oubre is the CEO of Pontchartrain Cancer Center in Louisiana. Kathy is a board member of the Community Oncology Alliance and co-chairs the Drug Policy and Regulatory Affairs committee and serves on their Government Affairs committee. Kathy chairs the NCODA Oncology Institute. She also serves on the Strategic Advisory committee and Leadership Council for Flatiron Health. Kathy is a member of ACCC and serves on their Government Affairs and Oral Oncolytics Advisory committees. Kathy also serves on the editorial boards for The Center for Biosimilars and the Journal of Evidence-Based Managed Care.
Brittany Parker
Central Coast Oncology & Hematology
Brittany Parker
SESSIONS
Tuesday, October 24, 2023; 10:10 – 11:00 AM
State-Level Successes: Local Policy Changes to Reduce Costs & Improve Care
About the Speaker
Brittany Parker is a graduate of the University of Nevada Las Vegas, holding a degree in Healthcare Administration. Her professional journey commenced in the hospital and multispecialty outpatient settings before she began working in private practice at Central Coast Oncology & Hematology (CCOH) located in Santa Cruz, California. Since 2014, Mrs. Parker has played a pivotal role at CCOH as the Practice Manager, skillfully overseeing a dedicated team of 40 employees. Her unwavering passion lies in making meaningful changes in our healthcare system, particularly in supporting independent clinics. Her role as Practice Manager at CCOH has given her a clear understanding of the challenges that come with running an independent oncology practice in today’s healthcare landscape.
One of Mrs. Parker’s notable achievements is her demonstration that engaging with representatives at both the federal and state levels can indeed be straightforward and accessible. With the guidance and support of experienced COA team members, as well as the encouragement from Dr. Michael Yen, she has effectively demystified the intricacies of this process, making it more approachable and manageable. Mrs. Parker firmly believes that healthcare professionals should actively reach out to their representatives at all levels of government to voice their concerns. She emphasizes that no one is better suited to explain pressing healthcare issues than those directly involved in patient care.
Mrs. Parker’s journey, characterized by her steadfast commitment to supporting independent oncology practices, stands as an authentic source of inspiration. Her experiences and advocacy encourage all to actively participate in shaping the future of healthcare.
Debra Patt, MD, PhD, MBA
Texas Oncology
Debra Patt, MD, PhD, MBA
SESSIONS
Monday, October 23, 2023; 4:40 – 5:35 PM
PBM Policy & Regulation Update: Latest From D.C. & Beyond
About the Speaker
Dr. Debra Patt is a practicing oncologist and breast cancer specialist in Austin, Texas, and an executive vice president of Texas Oncology with responsibilities in healthcare policy and strategic initiatives and the managing partner for the Central and Gulf regions. She is an active leader in breast cancer and research in healthcare informatics. Dr. Patt has responsibility for breast cancer research in Austin and leads our multidisciplinary tumor boards for breast cancer. As an expert in healthcare policy, she has testified before Congress to protect access to care for Medicare beneficiaries. She chairs the Council on Legislation for the Texas Medical Association and works to formulate responsible healthcare policy that improves the health of Texans. She serves as the Editor in Chief of the Journal of Clinical Oncology Clinical Cancer Informatics and drives engagement in clinical informatics solutions to enhance healthcare. Her research is in clinical decision support, predictive analytics, telemedicine, HEOR, tools for patient symptom management and quality improvement. Within Texas Oncology, she serves on the payer relations, marketing, telemedicine, strategy, policy, management executive, marketing, and revenue cycle committees. She serves on the Board of Directors for the American Society of Clinical Oncology and serves as the Vice President for the Community Oncology Alliance. She is the past-chair of ASCO’s clinical practice committee and served on ASCO’s nominating committee for the ASCO Board and the Conquer Cancer Foundation as well as the health IT work group, EHR, technology, and data requirements workgroup, and guidelines committees. She previously served as the chair of the Texas Medical Association’s Council on Legislation. Dr. Patt is the past President of the Texas Society of Clinical Oncology. She is a clinical Professor at Dell Medical School at The University of Texas at Austin.
Giancarlo Pillot, MD
St. Louis Cancer Care
Giancarlo Pillot, MD
SESSIONS
Tuesday, October 24, 2023; 10:10 – 11:00 AM
State-Level Successes: Local Policy Changes to Reduce Costs & Improve Care
About the Speaker
Giancarlo Pillot, MD is a medical oncologist practicing in metropolitan St. Louis, MO with St Louis Cancer Care, LLP. He completed his training in internal medicine, followed by medical oncology and hematology at Washington University St Louis/ Siteman Cancer Center in 2006.
St Louis Cancer Care LLP is an independent practice, providing personalized exceptional care to patients in the region for greater than 30 years. It is the largest independent practice in the metro St. Louis area, with all of the physicians in the practice being named Castle Connolly “Top Doctors” every year since 2006.
Shiela Plasencia
Community Oncology Alliance (COA)
Shiela Plasencia
SESSIONS
Tuesday, October 24, 2023; 1:30 – 2:25 PM
How Are We Moving the Needle on Health Equity?
About the Speaker
As Director of Practice Support, Shiela Plasencia brings a wealth of knowledge to COA membership. Ms. Plasencia acts as a critical link between practice administrators, distributing insights and tools to improve practice operations and pursue the highest quality care for patients. She also oversees the COA Administrators’ Network, a peer-to-peer network for administrators for practice leaders to share best practices for addressing the unique issues they face.
Prior to joining COA, Plasencia served as director of quality improvement, compliance, and value-based care at Oklahoma Cancer Specialists and Research Institute (OCSRI), a community oncology practice she joined in 2004. Through her leadership, OCSRI earned the American Society of Clinical Oncology’s QOPI Certification and is one of only two practices in the state of Oklahoma to hold this certification. In 2016, Plasencia joined the Coalition of Hematology Oncology Practices (CHOP) and served as its President from 2019-2021.
Alti Rahman, MHA/MBA, CSSBB
American Oncology Network, LLC.
Alti Rahman, MHA/MBA, CSSBB
SESSION
Monday, October 23, 2023; 1:50 – 2:35 PM
Is the EOM a Successor Model?
Tuesday, October 24, 2023; 1:30 – 2:25 PM
How Are We Moving the Needle on Health Equity?
About the Speaker
Alti Rahman is the Chief Strategy and Innovation Officer at American Oncology Network. He holds a dual Masters Degree in Business and Healthcare Administration and is a Certified Six Sigma Black Belt .
Alti is proud of his South Asian heritage and has fond memories of his childhood when he lived in the middle east in a small country of Kuwait. His career in healthcare started as a mental health case worker. Those powerful experiences shaped his pursuit of a career in healthcare administration where he felt there was a tremendous gap in medical interventions and pursuit of public health goals.
Prior to joining AON, Alti spent 15 years at a community oncology practice, pursuing value-based care and continuous innovations around operational, cost and quality improvements.
Alti holds additional supplementary roles including: Board Member of COA (Community Oncology Alliance), Chair of the Health Equity Committee for COA, Board Member of the Oncology Circle Advisory, Past Treasurer for the National Cancer Care Alliance and Past President and Treasurer of the Coalition of Hematology and Oncology Practices (CHOP).
Alti believes that the future of healthcare involves a multidisciplinary and unapologetically collaborative approach keeping the patient at the center of all decisions.
Barry Russo, MBA
The Center for Cancer & Blood Disorders
Barry Russo, MBA
SESSION
Monday, October 23, 2023; 2:40 – 3:35 PM
Employer-Medicare Overlap: Benefits Landscape for Medicare Age Employees
About the Speaker
Barry Russo, CEO, has been with The Center for Cancer and Blood Disorders, a private community practice based in Fort Worth, Texas, since 2002. Barry has over 30 years of healthcare experience – he has worked in academic and community practices as well as academic and community hospitals. The Center has over 50 providers & 400+ employees at 18 facilities in the DFW area. The Center offers medical oncology, radiation oncology, hematology, gynecologic oncology, breast oncology surgery, stereotactic radiosurgery, integrative medicine, imaging, laboratory services and retail pharmacy.
Barry is a current board member of COA and Advisory Board for the Cancer Center Business Summit (CCBS) and current member of ACCC, ASCO and TXMGMA.
Barry has an MBA from the University of Dallas and resides in Colleyville, Texas.
Susan Sabo-Wagner, MSN, RN, OCN, NEA-BC
American Oncology Network, LLC.
Susan Sabo-Wagner, MSN, RN, OCN, NEA-BC
SESSION
Tuesday, October 24, 2023; 1:30 – 2:25 PM
How Are We Moving the Needle on Health Equity?
About the Speaker
Susan is the vice president of clinical innovation at AON and oversees the clinical programming function that includes care plan design, care program implementation and monitoring, and clinical integration with payers and providers.
She has over 25 years of experience in healthcare. Previously, she was the executive director of clinical strategy at Oncology Consultants in Houston, Texas, where she developed and implemented innovative clinical strategies and policies that led to the growth of the company. Susan has created clinical and operations protocols for all levels of practice to promote value-based care initiatives in both commercial and non-commercial payer populations. She has established an appropriate framework and oversight, including input into growth, strategy, resourcing, and decision-making to innovate around consumer-focused oncology programs. Developing a community-based oncology navigation program and collaborating to implement a fully integrated initiative to address social determinants of health within the practice has been significant in her role.
Susan currently sits on the COA Administrators Network Board (CAN), the COA Patient Advocacy Network (CPAN) Advisory Panel and the Houston Cancer Health Equity Collaborative. She is an advisor to the Health Equity & Access Committee for the Texas Society of Clinical Oncology (TxSCO) and sits on the COA Health Equity Committee.
Susan holds a Bachelor of Science in Nursing from the University of Pittsburgh and a Master of Science in Nursing Administration from the University of Texas at Arlington. Additionally, she has the Nurse Executive Advanced Certification and has held the Oncology Nurse Certification for 16 years.
Carl Schuessler, Jr., DHP, DIA, GBDS
Mitigate Partners, LLC
Carl Schuessler, Jr., DHP, DIA, GBDS
SESSIONS
Tuesday, October 24, 2023; 8:15 – 9:00 AM
Participating in a CIN to Collaborate for Better Cancer Care
About the Speaker
As Co-Founder and Managing Principal of Mitigate Partners, a risk management, cost containment and employee benefits consulting firm, Carl Schuessler leads a consortium of 25+ employee benefit consulting and brokerage firms. Carl brings more than 30 years of experience in benefits consulting and financial services to the field and pioneered the fiduciary approach to benefits advisory services. His passion for fixing the problem of runaway health-care costs in this country and his desire to treat the employer’s money as his own led him through years of research culminating in the development of his proprietary FairCo$t Health Plan. This innovative plan design seamlessly integrates 20+ cost containment solutions with a high-performance health-care solutions platform. This combination provides first-class benefits at substantially lower costs to employers all while realizing better clinical outcomes for plan members. A founding Health Rosetta Charter Certified Advisor and The 2022 Executive Leader Healthcare Leader of the Year,Carl and Mitigate Partners have been nationally recognized for their work in creating localized, employer-built, health-care plans in Forbes, Entrepreneur, Innovation & Tech Today, Physician Outlook Magazine, Free Market Medical Association, and Bold TV. By removing misaligned incentives, directing care based on quality and cost, and, ultimately, helping courageous employers fix their plans, employers are saving 15-to-30 percent in their healthcare spend. An accomplished speaker, Carl often rallies audiences with stories of how Mitigate Partners are challenging Wall Street (insurer-built) health plans by creating Main Street (employer-built) health plans and bending the healthcare cost curve.
Level of Education: B.B.A. – Risk Management, Insurance and Estate Management – University of Georgia
Family/Interests: Native of Macon, Georgia, moved to Atlanta in 1989, and resides there with his wife, Missy and their three children, Mary May (24), Carl III (22) and Hattie (19). He enjoys children’s activities (coached 43 of his children’s teams), fly fishing, golfing, hiking, and hunting.
Patrick Shields
Utah Cancer Specialists
Patrick Shields
SESSION
Tuesday, October 24, 2023; 10:10 – 11:00 AM
State-Level Successes: Local Policy Changes to Reduce Costs & Improve Care
About the Speaker
Patrick Shields is Director of Business Services at Utah Cancer Specialists where his current roles include oversight of the revenue cycle management (RCM), business development and legislative initiatives. Patrick has over 22 years of leadership and practice management experience in optimizing business operational structures to maximize efficiency and support revenue growth. Before his time at Utah Cancer Specialists, Patrick served as Director of Operations for a third party revenue cycle management company providing outsourced RCM and practice management services for a multitude of physician specialties, as well as other healthcare systems. Patrick is currently serving on the Practice Management Committee for the National Cancer Care Alliance (NCCA) and the Legislative Task Force for the Society of Utah Medical Oncologists (SUMO), where they’re focused on PBM reform, white bagging legislation and alternative funding programs. Patrick was born and raised in Salt Lake City, Utah where he currently resides with his fiancée and fur baby Britta. When he isn’t advocating for physician and patient rights, he prefers to spend his time camping, traveling, and motorcycle road trips.
Michael Stancil, MPS
Pittsburgh Business Group on Health
Michael Stancil, MPS
SESSION
Tuesday, October 24, 2023; 9:05 – 9:55 AM
Show Me the Money! Alternative & Transparent PBMs
About the Speaker
Mike Stancil is CEO & President of the Pittsburgh Business Group on Health, Vice President of Bridges 4 Health Equity, and cofounder and CMO of Leaficient. He earned his bachelor’s degree from Slippery Rock University and his master’s degree from George Washington University. He currently serves on the Executive Service Corp through the Bayer Center for Nonprofit Management, is a member of the Pittsburgh Business Times Leadership Trust and was selected as one of City & State’s Power 100 for 2023.
Ann Sweeney, MA, CCMP
Blue Ridge Cancer Care
Ann Sweeney, MA, CCMP
SESSION
Tuesday, October 24, 2023; 12:30 – 1:25 PM
The OMH & Patient-Centered Cancer Care Certification: Lessons Learned & a Path Forward
Tuesday, October 24, 2023; 1:30 – 2:25 PM
How Are We Moving the Needle on Health Equity?
About the Speaker
Ann Sweeney, MA, CCMP, SSGB is the Sr. Director Quality Programs & Process Improvement at Blue Ridge Cancer Care. She has 15 years of change management and process improvement experience in healthcare and has worked in value-based care roles for the last 7 years. Ann oversees all quality and value-based programs at BRCC including EOM, MIPS, Virginia Premier/Medicaid VBC contract, Anthem OMH+, PCM, ASCO/COA Patient-Centered Cancer Care Certification, and assists the clinical team with QOPI. In between managing these programs, Ann supports patient experience and employee wellness & culture initiatives, she is launching BRCC’s first Diversity & Inclusion Affinity Group, and directs multiples process improvement projects within the clinic. Ann is a former career firefighter, originally from Pittsburgh, PA and a Penn State graduate. She currently living in Roanoke, VA with her husband and 4-year-old son.
Michael Thompson
National Alliance of Healthcare
Purchaser Coalitions
Michael Thompson
SESSION
Monday, October 23, 2023; 12:50 – 1:45 PM
Multi-Stakeholder Collaboration to Optimize the Whole Person Cancer Journey
About the Speaker
Michael Thompson is the President and CEO of the National Alliance of Healthcare Purchaser Coalitions (National Alliance). The National Alliance represents over 40 healthcare coalitions collectively supporting private and public purchasers providing health coverage to over 45 million Americans and over 400 billion dollars of healthcare spend. The National Alliance helps to lead improvements in health, equity and value for our companies and communities across the country. Current areas of focus include delivery and payment reform, whole person health and health reform policies with a particularly with a special focus on hospital fair pricing, high cost claims, mental access and quality and drug costs.
Prior to joining the National Alliance in 2016, Mike was a Principal in the health practice at PricewaterhouseCoopers (PwC) for 20 years. Thompson is a nationally recognized thought leader for business health strategies and health system reform and is known for developing and promoting collaborative cross-sector health industry initiatives. Prior to joining PwC, Mike served as an executive with diverse roles with Prudential Healthcare for over 17 years.
Mike is a Fellow of the Society of Actuaries, serving on the Health Practice Council, and chairs the Medicare Sub-Committee of the American Academy of Actuaries (AAA). He is also widely recognized as a leading national advocate for mental health and well-being and was Past President of the New York City chapter of the National Alliance for Mental Illness (NAMI). Mike previously was also an active member of the board of the Northeast Business Group on Health for 11 years.
Karen van Caulil, PhD
Florida Alliance for Healthcare Value
Karen van Caulil, PhD
SESSION
Monday, October 23, 2023; 12:50 – 1:45 PM
Multi-Stakeholder Collaboration to Optimize the Whole Person Cancer Journey
About the Speaker
Karen van Caulil, PhD is the President and CEO of the Florida Alliance for Healthcare Value. She leads this nationally recognized business coalition on health, overseeing all activities and operations including research projects, educational programs, conferences, and member engagement. Dr. van Caulil previously served in leadership positions for the University of Central Florida College of Medicine and the Health Council of East Central Florida.
Dr. van Caulil represents the Florida Alliance’s mission and work locally, regionally, and nationally, actively serving on numerous boards and advisory committees for organizations such as the National Alliance of Healthcare Purchaser Coalitions, The Leapfrog Group, Florida’s Agency for Health Care Administration, and many others.
Dr. van Caulil graduated from Duke University with a Bachelor of Sciences degree in Biology with completion of the “Science, Technology, and Human Values” degree program. She received a Master of Science in Public Health in Health Policy and Administration from the University of North Carolina at Chapel Hill and a Doctorate in Public Affairs from the University of Central Florida.
Lalan Wilfong, MD
The US Oncology Network
Lalan Wilfong, MD
SESSION
Monday, October 23, 2023; 12:30 – 12:45 PM
Day One – Welcome to PES
Monday, October 23, 2023; 12:50 – 1:45 PM
Multi-Stakeholder Collaboration to Optimize the Whole Person Cancer Journey
Monday, October 23, 2023; 1:50 – 2:35 PM
Is the EOM a Successor Model?
Tuesday, October 24, 2023; 8:00 – 8:10 AM
Day Two – Opening Remarks
Tuesday, October 24, 2023; 2:30 – 2:45 PM
Summit Wrap-Up & Observations
About the Speaker
Dr. Wilfong is Senior Vice President of Payer and Care Transformation at McKesson and a practicing medical oncologist/hematologist, seeing patients at Texas Oncology locations in Dallas. Prior to this role, he served as Vice President of Value Based Care and Quality programs at Texas Oncology and led the launch and implementation of the Oncology Care Model. He also served as medical director of Texas Oncology’s COVID-19 Task Force and was the physician lead for their electronic medical record conversion.
A committed advocate for community oncology, Dr. Wilfong’s focus is transforming cancer care to deliver better outcomes to patients by aligning patient goals and values with treatment options. In his role at McKesson, his priorities are helping define the future of value-based care payment reform, improving patient/physician communication, optimizing actionable analytics, and improving the quality of patient care.
He previously led the Value Based Physician Champion task force for The US Oncology Network and served as chair of the US Oncology Pathways Task Force. He volunteers on the ASCO quality measures task force and the ASCO guidelines committee. He has been honored to receive various teaching and community service awards.
In 2003, Dr. Wilfong completed a fellowship at the University of Texas Southwestern Medical School in hematology and medical oncology. He completed his internship and residency in internal medicine at the University of Texas Southwestern Medical School, Dallas, Texas in 2000. He earned his M.D. from the University of Texas Southwestern Medical School, Dallas, Texas in 1997. He earned a B.S. degree in mathematics at Texas Tech University in Lubbock, Texas in 1993.