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December 1, 2021

Meet Advent’s HEDIS Team- Elaina Breen

Elaina Breen is Advent Advisory Group’s Strategic Planning & Business Development Liaison and has been a Certified HEDIS Compliance Auditor since 1998. Elaina is also a registered nurse and women’s healthcare nurse practitioner with over 40 years’ experience in the healthcare field. She serves as Advent’s sounding board for business development strategies and has been deeply involved in a variety of leadership roles since the beginning of HEDIS.

Elaina’s interest in healthcare was jump-started during the Civil Rights Movement in America’s south, where she observed first-hand the impacts of poor housing, lack of adequate nutrition and limited healthcare options on minority populations. With a degree in Sociology and most of a master’s in elementary education, she shifted gears and completed a registered nursing degree. She then moved with her family to Alaska and spent 14 years caring for underserved populations, ultimately becoming a women’s healthcare nurse practitioner and one of two nurse practitioners in the state to hold first assistant privileges in surgery, a surgeon’s role. Elaina’s medical career spans academic research and establishing programs to prevent premature births, managing the care of infants with birth defects and conducting clinical trials of new medications. Pushing into the business side of healthcare, as Senior Manager at a Big Eight accounting firm, she had the opportunity to set up a HEDIS audit practice and run that practice as a “business within a business”. It was an opportunity that required all of her skills – business insight, forming and managing multidisciplinary teams and leadership within the national HEDIS community.

Elaina describes HEDIS data as a bowl of spaghetti; when you start to pull on one strand, you never know how many other strands are tangled with it and how they are all inter-connected. The fascination is with following a strand of logic, an errant rate or data set and figuring out how it all came together. She’s excited about how stream-lined and standardized data exchanges are improving ability to make meaningful changes in healthcare delivery.
 
Elaina has been a life-long athlete and is grateful for opportunities to race sailboats on San Francisco Bay, cross-country ski in the Sierras, hike mountains and deserts and kayak or raft as many American rivers as possible!

November 17, 2021

Meet Advent’s HEDIS Team- Alison Mangane

Healthcare has always been part of my life, my dad was a pharmacist, and my mom was a nurse, so starting a career in healthcare seemed logical. Chatter and literature about prevention, conditions, medications, etc. were part of my day-to-day experience. I started out my career in the financial world, it circled back into healthcare when I accepted a position in the finance department working at New York City’s first HMO. My first introduction to HEDIS was with a large national health plan, where in 1998 I was assigned a “small project”, collecting immunization records. I arrived at the first doctor’s office armed with donuts and reams of paper, as there were no electronic records or protected health information (PHI) regulations! Years later, after sitting in offices copying charts and many regulations later, here I am, a Certified HEDIS Compliance Auditor!

I am always marveling how the HEDIS world changes as time goes on. Medical Record Review (MRR) is evolving and transitioning to more real time electronic data. Here we are in HEDIS Measurement Year 2021 and supplemental data is the name of the game AND claims data is at the bottom of the hierarchy within the Electronic Clinical Data Systems reporting- we never would have seen that coming in 1998! Though my head is sometimes spinning, it excites me to see these changes moving in the direction of RESULTS, rather than just checking for more and more tests. My hope is that we will finally see the needle moving in the direction of improvements in the actual health of our population.

My free time is spent mostly walking and hiking. I love the arts and I am excited to get back to live performances—music, dance, plays and the like. You’ll also sometimes find me meandering around museums, or on a flight to somewhere.

November 10, 2021

Meet Advent’s HEDIS Team – Peggy Ketterer

Peggy Ketterer is a Senior Program Director and serves as a lead auditor for national clients with Advent Advisory Group. Peggy has been a Certified HEDIS Compliance Auditor (CHCA) since 1999. Peggy is also a registered nurse with over 30 years’ experience in the healthcare field. She served as a Practice Leader for over 10 years, across two different organizations. Her HEDIS work started with auditing mostly Medicaid plans, later expanding to Medicare and Commercial. She has expertise in supplemental data, particularly EHR feeds.

Peggy started her nursing career serving active duty in the U.S. Army, working on a surgical floor and later in a surgical intensive care unit. She also worked as a circulating nurse in an operating room following her active-duty service. When her first child was born, she moved to an External Quality Review Organization (EQRO), performing clinical reviews and quality evaluations of Medicaid health care. The EQRO sought out NCQA licensure and in early 1999, Peggy was certified as a HEDIS Compliance Auditor for the EQRO. 

Peggy enjoys working with clients with complex reporting processes. Peggy enjoys working with her clients to resolve challenges, explore solutions, and prevent risk. She particularly finds that reviewing EHR feeds, including the ingestion process, mapping, integration, and validation is also very rewarding. Peggy likes sharing the knowledge she has with Advent clients and learning about how HEDIS will evolve in the future sparks her interest.

Peggy loves hiking, weight-training, Zumba, tennis, belly dancing, card games, and volunteering. Peggy has two adult children and one four-legged child. A big highlight of recent years was traveling solo to Spain in 2019 to volunteer with other folks from various countries to assist Spaniards in learning conversational English.

November 3, 2021

Meet Advent’s HEDIS Team - Charmaine Geronimo

Charmaine serves as the lead analyst for three of Advent’s national health plan clients and leads development work for mapping review documents, value set analyses, medication list analyses and other tools used for reviewing source code. She transitioned to the auditing after working on the HEDIS project at a health plan level for over ten years. Although so much of what she does is the same, she enjoys working with different HEDIS teams towards solving every-day challenges that are perfunctory to any HEDIS project dynamic. More importantly, she enjoys collaborating with clients and business partners alike. 

Charmaine’s initial involvement in HEDIS was unplanned to say the least. Charmaine began her involvement with HEDIS Projects in the early aughts, while working in a regional managed care organization in Southern California. Her foray into HEDIS was in audit support where she worked with leaders and key stakeholders in the organization to complete the Baseline Assessment Tool (BAT); what we now know as the Roadmap. She also provided consultation to the technology team by converting technical specifications into business requirements as a subject matter expert and key business contact. She became more involved with administrative data management as reporting transitioned to a vendor; and that’s the area where she has worked for the past twelve years. 

Charmaine thrives off the consistent work and annual deadlines of HEDIS reporting. Of course, she’d prefer our partners and clients not go through the worry; but she couldn’t pick a better group of people with whom to work, to overcome challenges, remediate issues, find solutions and meet those deadlines!
 
Outside of HEDIS, she enjoys being a wife and mom; and doing all the odd jobs that come with that. She and her husband have two very active teenage girls; and they enjoy spending their free time with them. From tutoring homework, to cheering in volleyball and golf tournaments, to taking them to Mass where they serve as lectors and Altar servers, to going to the newest cool café for an Instagram photo and check-in, she’s there with her husband and their girls! Lastly, when the girls don’t have any activities, she likes to stream and binge on Korean dramas.

October 26, 2021

Check out the white paper Advent Advisory Group co-authored discussing Clinical Data Acquisition Best Practices for Quality Improvement. The white paper outlines the shift towards value-based payments and the use of clinical data in quality reporting. The article provides insight into the design of data for ingestion, storage, and use in reporting, as well as Advent’s experience conducting primary source verification. For additional information on Advent’s Electronic Data Validation programs, please contact Peggy Ketterer or Matt Flores at info@adventadvisorygroup.com.

October 20, 2021

Meet Advent’s HEDIS Team - Kalpna Shah

Kalpna Shah is a Client Manager for Advent Advisory Group and has been a Certified HEDIS Compliance Auditor since January 2015. In addition to HEDIS, Kalpna works with Physician Organizations to audit Integrated Health Association's (IHA) Align. Measure. Perform (AMP) reporting. Kalpna has also worked on URAC, DMHC and BH audits.
 
Kalpna started in healthcare as a lab technician in the Army Reserve immediately after high school. She trained at Fort Sam Houston in San Antonio, Texas and continued serving working as a lab technician in a field hospital unit in Los Angeles. While serving in the reserves, she obtained her Bachelor's in Biology and Master's in Epidemiology. She started working for San Bernardino County in AIDS surveillance but ended up moving to the Arizona state health department for a CDC project that was also focused on AIDS surveillance. Once the AIDS surveillance program was nearing automation in the late 90's, Kalpna got married and moved back to California. With her return to California, Kalpna joined the Southern California Kaiser Permanente Medical Group's quality improvement department, which had just started reporting HEDIS data. After ten years of working on HEDIS, Kalpna decided to take a sabbatical when her daughter was born and start a different chapter in her life. However, she couldn't stay away from HEDIS as she returned as an HEDIS auditor in 2013 before joining the Advent team in 2015.
 
Kalpna loved working with providers in improving processes and accurately capturing data to reflect the care provided which was not common in late 90's. Kalpna continues to love working towards improving healthcare and finds the digital data realm within HEDIS exciting for the potential benefits of closer to real-time improvement in healthcare delivery.
 
Kalpna is an active member of Rotary International, Duarte Education Foundation, and volunteers at her daughter's high school. Kalpna and her family love traveling, especially cruising. She has been on more than 18 cruises and has visited more than 50 countries. When Kalpna is not traveling, she likes to read, paint, watch movies, bike, and hike. Kalpna takes three months off in summer to do more of what she and her family love to do, travel and spend time together.

October 13, 2021

Meet Advent’s HEDIS Team - Diedra Chopp

Diedra Chopp is a Client Manager for Advent Advisory Group and has been a Certified HEDIS Compliance Auditor since 2009. She is a key team member in the development of Advent’s audit tools and processes. Diedra’s experience prior to joining Advent was with a managed care health plan. Diedra dedicated 18 years in working at a health plan and was responsible for managing a variety of business projects, including HEDIS report production.

While working at the health plan, in 1993, the CEO asked Diedra to respond to a request for information called HEDIS 2.0 “Health Plan Employer Data and Information Set” and to start filling out what was called the “Baseline Assessment Tool”(BAT). A small team began the journey for the health plan and Diedra has continued her HEDIS journey, now serving as a HEDIS auditor. 

Since working in the “HEDIS” world, from almost its inception of HEDIS creation, Diedra is continually reminded of where it all began and how it has evolved over the years. Diedra is fascinated with the breadth of expertise and data that is included to produce the annual HEDIS report. The saying “It Takes a Village” comes to mind. Multiple people from NCQA, employees of the Health plans and the various health plan departments, as well as the auditors from the licensed organizations all working together. There is never a dull moment, continually challenging and giving everyone involved opportunities to learn new things and expand. 

Diedra is artistic and enjoys creating home décor from multiple mediums, stained glass, wine bottles, and much more. Diedra loves spending time outdoors and particularly loves cycling, hiking, kayaking, and mushroom hunting. She’s proud of her two children and six grandchildren. Diedra’s daily companion is her new puppy, Pebbles.

September 28, 2021

Meet Advent’s HEDIS Team- Matt Flores

Matt Flores is a Client Manager for Advent and a Certified HEDIS Compliance Auditor since 2015. He has been a member of NCQA’s Data Collection Advisory Panel, the Audit Methodology Panel (as a former practice leader), Digital Measurement Collaborative and its Audit Advisory Panel, and is now a member of the Technical Measure Advisory Panel. He serves as Advent’s subject matter expert for digital quality with a focus on interoperability and data management evangelism.
 
Matt was introduced to the world of healthcare quality while
working as a respiratory therapist and family practice clinic manager at Keller Army Community Hospital at the US Military Academy at West Point in 2006, where he was in charge of implementing and tracking clinical practice guidelines and helping to design new electronic health record (EHR) flowsheets to accommodate best practices. While attending the Master of Healthcare Administration program at Penn State, he was hand-picked by a professor to apply for a HEDIS training program. Three months after first hearing the word HEDIS, Matt went to Washington D.C. to sit for the CHCA exam, where he successfully passed the rigorous test to become a Certified HEDIS Compliance Auditor (CHCA). Once in practice, he realized his most critical knowledge gap was in data management rather than healthcare management, so he transferred to Boston University to complete graduate studies in database management and business intelligence.
 
Matt is invigorated by the opportunity to work in an industry in a
period of transformation. Interoperability begins to impact the cost, quality, and accessibility of healthcare data; digitization of quality measures improves the efficiency and portability of measurement; a focus on Social Determinants of Health conspires to promote access and equity. It is an exciting time to identify and encourage best practices and to harness these trends for population health and efficient operations. 

When not standing in front of his seven screens, Matt is a consummate
Renaissance man, indulging the fierce curiosity of his 4 daughters, cooking, baking, gardening, swimming, playing tennis, camping, fishing, painting, singing, and dancing like no one is watching. If you attend Advent’s conferences, you may catch a few of his many impressions too.

March 22, 2021

Advent is a URAC-approved data validation vendor and a recognized industry leader in providing audit and measure certification services to pharmaceutical management organizations nationwide. We have extensive experience in partnering with Specialty, Mail Service and PBM-accredited organizations on successful rate submissions. With the URAC Data Validation scheduled to begin on July 1st of this year, Advent is uniquely positioned to ensure that your reported rates reflect the hard work and dedication your organization puts into serving your members.

For more information about Advent or to request a price quote, please visit us at https://lnkd.in/eixC-YJ or email Brian White, URAC Program Manager, at: info@adventadvisorygroup.com.