Mary Walter

Mary Walter

Mary Walter is an accomplished executive leader with more than 30 years of experience in healthcare including extensive work in managed care insurance the past 25 years, quality and oversight of every aspect of health plan operations. She is deeply entrenched in the commercial, Medicare, Medicaid and Marketplace quality space that includes strategy and execution in quality compliance, interventions, population health, HEDIS, Stars, risk adjustment, value-based care and pay for performance, risk management, accreditation, delegation oversight, vendor management, geographical expansion and more.

Mary has worked managing state Medicaid relationships, both commercial and government business, meeting employer group, CMS and state quality regulations, including various accreditation requirements. In addition, she has led health plan quality operations and developed key partnerships to create and execute high quality programs and projects. She has partnered with multi-faceted provider groups including integrated delivery, fee-for-service, and capitated network models as well as accountable care organizations, management services organizations and independent practice associations to carry out upside/downside risk value-based care and pay for performance programs to improve the quality of customer care outcomes.

Before joining HMA, Mary founded and served as president of Healthcare & Integration Solutions, LLC. (HCIS), where she provided her expertise on quality measures including state Medicaid audits, Stars and HEDIS performance, patient safety, and quality compliance. She also supplied insight on strengthening fiscal operations in areas including marketing and sales, budgeting, product and market expansion, and key performance indicators.

Mary has also served as vice president of clinical quality of U.S. Medical with Cigna Medicare and has held several quality leadership roles with the top payers including Coventry, Aetna (now CVS Health), UnitedHealthcare, Anthem, Kaiser Permanente, and Molina Healthcare.

In those positions and experience, she led strategy, execution, and growth of the clinical quality teams, where she elevated population health management strategy and quality compliance oversight. Her leadership resulted in a CMS All Star nomination by passing the CMS audits for organization determinations, appeals and grievances, special needs plan model of care, and supported first-tier, downstream and related clinical entities. In addition, she supported her leadership team to fully pass HEDIS, risk management and NCQA audits with top scores year over year. She also received top regional and national awards for the TeenScreen Depression and Suicide Prevention Program at Kaiser Permanente.

Mary earned a Bachelor of Science degree in exercise physiology, and a minor in health at Iowa State University. In addition, she is a registered nurse, earning a three-year diploma, practical nursing degree at Iowa Methodist School of Nursing in Des Moines. She also holds a certification in process improvement/LEAN six sigma as an Improvement Advisor from KP National Process Improvement Institute.

She volunteers her time serving as a key board member for a non-profit organization that has a national footprint and volunteers in the community Food Share Program assisting families with food insecurities. Mary’s other passions include specialty cooking, entertaining, biking, hiking, raising an organic garden, landscaping, reading, and serving in her local church.

David Wedemeyer

David Wedemeyer is an established data expert and a seasoned consultant with expertise developing Healthcare Effectiveness Data and Information Set (HEDIS) and risk programs, process improvements, and software tools.

In the medical management field, he has experience with quality improvement and has provided subject matter expertise in building software tools to auto-code service and diagnosis codes for electronic medical records (EMR) systems. This included working with certified vendors and health plans. In addition, he has developed processes for standardized data pulls from electronic medical records databases and supplemental sources.

David has significant accreditation expertise, specifically National Committee for Quality Assurance (NCQA) Accreditation and has been a featured speaker on this topic at numerous conferences including the Medicare Advantage Congress conference. At HMA, he will assist clients with a wide range of NCQA needs while helping them navigate process improvement, risk adjustment, Medicare Stars programs, and requests for procurement of new state and federal programs.

He has prepared, audited, and submitted all requirements for NCQA Accreditation. With a focus on improvement and return on investment, he also developed HEDIS, Consumer Assessment of Healthcare Providers and Systems, and Health Outcomes Survey and Starts proactive programs to save organizations efforts and resources.

David has extensive experience writing responses to request for proposal (RFP) questions pertaining to all medical management areas for state and federal business including Medicaid and Medicare programs in California and Arizona.

Before joining HMA, David served as senior director of quality improvement with LA Care Health Plan where he directed and developed workgroups and quality projects focused for improvement in Model of Care and Medicare Stars programs, and oversaw all annual credentialing, quality review, and evaluations including HEDIS, NCQA, Medicare and Medicaid programs.

A former vice president of quality improvement with Care1st Health Plan, he developed Special Needs Plan (SNP) programs and the SNP model of care as well as the plan’s Medicare Risk Assessment and Adjustment process, consistently leading the plan to improvements in HEDIS rates and reaching High Performance Levels. He also developed a web portal for data exchange and group dashboards aimed at improving ratings and outcomes to streamline efforts. Under his leadership, the plan secured a commendable NCQA rating.

With a background in direct patient care, David began his career in nursing, serving as a registered nurse, nurse coordinator, urgent care staff nurse and staff development coordinator. He received a Bachelor of Science in Nursing degree from the University of Phoenix. He also completed certifications as an emergency medical technician and licensed vocational nurse.

Margaret Williams

Margaret Williams headshot

Margaret Williams has over 20 years of experience as a health plan leader, with extensive expertise developing, implementing, and coordinating quality related activities and objectives in the managed care, medical group, and health plan arenas.

Overseeing day-to-day operations for various quality departments, she developed vast experience in a number of areas, including Credentialing, Clinical Quality, Risk Management, Appeals and Grievances, Delegation Oversight, and Utilization Management. She is skilled at facilitating evaluation and maintenance of systems and strategies to support NCQA accreditation, as well as compliance with state and federal regulations.

Prior to joining HMA, Margaret served as the associate vice president of Quality Improvement for Care1st Health Plan/Blue Shield California. She integrated knowledge of various regulatory requirements and directed leadership in order to deliver high audit scores and 100 percent compliance with state, federal, and national accreditation requirements.

Previously, Margaret was the Clinical Quality consultant for United Healthcare’s Las Vegas markets. In prior roles with United Healthcare, she served as clinical director of Quality Management and as manager of Quality Management.

Margaret is licensed as a Registered Nurse in the State of California and has Health Care Quality Management certification.

Margaret received her Associate of Science in Nursing from Shawnee State University in Portsmouth, OH, and her Bachelor of Science degree in health care management from the University of St. Francis in Joliet, IL.

She enjoys her free time exploring nature with her husband and reading.

Diana Criss

Diana Criss headshot

With nearly 30 years of experience as a health plan executive, Diana Criss brings an extensive depth and breadth of managed care expertise to HMA.

Prior to joining HMA, Diana was senior director of operations and clinical management for Consumer Mutual Insurance of Michigan. In this role, she was responsible for development of the Customer Service, Claims, Quality, and Clinical Operations Departments. She led the submission of the Qualified Health Plan process with CMS, including taking the lead with the State of Michigan’s Department of Insurance and Financial Services to secure approval as a Health Insurance Co-Op, the state’s first. Diana guided the organization’s NCQA accreditation and oversaw all processes for claims and customer service as well as the Federal Complaint System (HICS).

Before joining Consumers Mutual, Diana was director of governmental programs with Priority Health. She was responsible for the direction of the Medicaid and MI-Child program including compliance with all state and federal contract requirements, Michigan Department of Community Health re-bid process, compliance audits, and the financial stability of the program. While at Priority Health she also directed the Medicare Advantage process to identify areas for improvement in their position with CMS.

Diana has served in a variety of leadership roles with several health plans, including program director, director of clinical operations, and director of network development, director of operations and regulatory compliance, Medicaid project manager and product manager.

She developed and taught the “Physicians in Medicaid Managed Care” curriculum at Michigan State University and Wayne State University. The curriculum focused on teaching residents how to work within risk models with health plans to deliver high-quality, low-cost health care in the right place at the right time.

Diana received her Associate Degree in Business from Lansing Community College.