Mary Walter

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.

Rachel Bembas

Rachel Bembas

Rachel Bembas is a results-driven leader in behavioral health quality and population health analytics who has worked extensively to advance population health outcomes through the development of targeted quality improvement strategies and meaningful performance metrics.

She has led cross-functional teams to improve health outcomes by using publicly reported measures including Healthcare Effectiveness Data and Information Set (HEDIS), Star, Health Outcomes Survey (HOS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS), to drive change.

Rachel has expertise in developing, implementing, and bringing to scale innovative and strategic behavioral health quality improvement business initiatives including quality improvement framework, value-based care, population health programs, and regulatory and accreditation preparedness.

Before joining HMA, Rachel served as vice president of performance measurement and improvement for Beacon Health Options where she led organizational quality improvement efforts, managed key performance indicators, and set benchmarks and targets related to performance metrics. She developed and led the organization’s social determinates of health (SDOH) measurement strategy and leveraged internal and external data to demonstrate organizational value to stakeholders.

With experience in clinical, academic, corporate, and governmental settings, she has created research strategy, designed and managed population health projects and programs, and designed complex analytics of Medicaid, Medicare, and commercial populations.

Rachel has statistical expertise in performance improvement strategy, leading organizations in building standardized data environments, outcome metric development, and standing up dynamic and meaningful visualizations and dashboards using Tableau, Power BI, Looker, and other data sharing platforms to effectively communicate information with stakeholders.

She earned a Doctor of Philosophy in human development and health promotion from Marywood University, a Master of Arts in experimental psychology from Townson University and a bachelor’s degree in psychology from Wilkes University.

Michele Bosworth

Michele Bosworth

A physician leader dedicated to collaboration and strategic approaches to healthcare solutions, Michele Bosworth, MD, is an academic innovator and clinical expert. She joins HMA after serving in various leadership positions with the University of Texas Health Science Center at Tyler (UTHSCT).

She previously served as executive director of the UTHSCT Center for Population Health, Analytics, and Quality Advancement. While there, she achieved maximum financial performance of 1115 Waivers, oversaw externally funded programs, and aligned academic, clinical and community initiatives.

Additionally, Dr. Bosworth is also the former chief quality and patient safety officer with UTHSCT where she led strategic councils and committees as well as developed and deployed safety and effectiveness programs. As chief medical information officer with UTHSCT, she championed electronic health records and information technology implementations as well as cultivated a safety-focused culture of optimization within the organization.

As a practicing physician, she worked in the UTHSCT Family Medicine Residency Program as core faculty and became the program’s clinic director. She completed her family medicine residency training at Mountain Area Health Education Center (MAHEC) in Asheville, N.C., where she was asked to develop and operate MAHEC’s first satellite clinic upon graduation. As such, Dr. Bosworth served as the founding medical director for MAHEC’s Cane Creek Family Health Center in Fairview, N.C., where she practiced full-spectrum family medicine while maintaining a teaching faculty presence in the MAHEC Family Medicine Residency Program.

She earned a Medical Doctorate at West Virginia School of Medicine in Morgantown, W.V., as well as a bachelor’s degree in biology from West Virginia University. She is a Fellow of the American Academy of Family Physicians, a diplomat of the American Board of Preventive Medicine in clinical informatics, and a Lean Six Sigma Green Belt.

David Polakoff

David Polakoff

An innovative leader and recognized expert in public policy, healthcare for seniors, and population health, David Polakoff, MD, is a seasoned consultant, executive, and healthcare leader.

Before joining HMA, Dr. Polakoff held various executive and leadership roles at the University of Massachusetts Medical School and Commonwealth Medicine, the University’s public sector consulting division, serving as chief medical officer, director of health policy and research, associate dean, professor, and executive director of the Center for Health Innovation and Quality.

As executive director, he led the Center for Health Quality and Research which represents a large operating group of Commonwealth Medicine, including medical management services, health services and survey research, training and education, health and human services consulting and technical assistance, and laboratory services. He provided executive leadership and oversight to large scale programs including the rebuild of the Massachusetts health insurance exchange to align with the Affordable Care Act, a state-wide multi-payer patient centered medical home initiative, and a $29 million award from the Center for Medicare & Medicaid Innovation to assist thousands of practices in the adoption of value-based reimbursement.

In addition, Dr. Polakoff served as chief medical officer of the Office of Clinical Affairs for Massachusetts’ nation-leading Medicaid program, MassHealth, the program upon which the 2010 national healthcare reform was modeled.

During his time at MassHealth, he served on the plan’s executive leadership team with responsibility for coverage policy, quality measurement and management, and the pharmacy program, including a self-contained public pharmacy benefit manager. He also oversaw utilization management, provider review and credentialing, clinical analytics, and clinical information technology.

As an internist specializing in geriatric medicine, he often speaks on policy and clinical care issues such as housing for an aging population, management of chronic illness, Medicare and Medicaid policy, and quality improvement across healthcare settings. He has also held academic and hospital appointments at the University of Massachusetts Medical School, Harvard Medical School and Boston University.

Dr. Polakoff earned his medical degree from the State University of New York (SUNY) at Stony Brook. He completed a residency in internal medicine at University Hospital in Boston and a fellowship in geriatric medicine through a combined program at Harvard Medical School and Boston University School of Medicine. He also earned a Master of Science in epidemiology from the University of Massachusetts Amherst and a Bachelor of Arts from SUNY, Buffalo.

Isis Montalvo

Isis Montalvo is an outcomes driven healthcare executive with expertise in nursing quality, business management, program development, healthcare policy, and education.

Before joining HMA, she served as vice president of medical management for Aetna Better Health® of California where she focused on managed care in Medicaid. With 33 years of experience as a nurse, as well as executive leadership and consulting experiences, she is a well-rounded, passionate, and patient-centered professional.

While serving as director of the National Center for Nursing Quality at the American Nurses Association, she was responsible for strategic planning and business development, which included advocacy, education and conference planning, publications, and product growth.

Focused on policy and quality at the forefront of nursing and healthcare, Isis has provided testimony to the Senate Finance Committee on value-based purchasing and has planned for and co-edited four books on nursing quality improvement and outcomes.

In addition, she has served in various roles leading teams, advancing strategic agendas, and improving services and patient safety. Isis is a collaborative leader with a focus on education, clinical and business optimization, and cross-functional teams and projects.

She earned a Bachelor of Science in Nursing from Columbia Union College, a Master of Science in Administration of Nursing Services from The University of Maryland, and a Master of Business Administration in General Business Administration from The University of Baltimore. She is a registered nurse licensed in both California and Maryland.

Isis loves to make cards and scrapbook. She and her wife, Natalie, live in San Diego with Athena, their 9-month-old hound/shepherd rescue.

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

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

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.