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«Advisory Committee Nominees and Bios Health insurance carriers Molly Firth, Community Health Plan of Washington Jim Pinkerton, Regence Indira ...»

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Advisory Committee Nominees and Bios

Health insurance carriers

Molly Firth, Community Health Plan of Washington

Jim Pinkerton, Regence

Indira Paharia, Molina Healthcare

Glen Bogner, Molina Healthcare

Meredith Mathews, California Blue Shield

Kitti Cramer, Premera

Karen Merrikin, Group Health Cooperative

Consumer advocates

Laura Treadway, LifeLong AIDS Alliance

Robin Shapiro, Health Perspectives Group

Larry Thompson, Whatcom Alliance for Healthcare Access

Erin Dziedzic, Cancer Society Julie Finholm, PAVE Pam Oliver, community member James Williams, Washington Poison Center Sharon Beaudoin, WithinReach Janet Chung, Legal Voice Catriona Colerick, EOS Moms & Pops Organizing Washington EGID Resources Foxy Davidson, Sickle Cell Task Force Janet Varon, Northwest Health Law Advocates Brenda Montgomery, The American Diabetes Association Misha Werschkul, SEIU Healthcare 775NW Health insurance brokers Sean Corry, Sprague Israel Giles Vernon Bonfield, Washington Health Insurance Agency Chris Free, Rapport Benefits Group Dave Maddock, Washington Association of Health Underwriters Peter Carpenter, ClearPoint Crystal Selby, Propel Insurance Ted Blotsky, Employee Benefit Services-Associated Employers Trust Health providers Debbie Wilkinson, HealthPoint Rhonda Hauff, Yakima Neighborhood Health Services Dian Cooper, Cowlitz Family Health Center Lloyd David, Polyclinic Leo Greenawalt, Washington State Hospital Association Michael Vanderline, UW Medicine Hiroshi Nakano, South Sound Neurosurgery Rudy Vasquez, SeaMar Gerald Lorch, Washington State Chapter of the American College of Cardiology Lucy Homans, Washington State Psychological Association Glenn Lux, Washington State Medical Association Dyhan Lal. Washington State Hospital Association Suzanne Petersen Tanneberg, Children’s Hospital Thomas Easterling, Washington State Obstetrical Association Jennifer Allen, Planned Parenthood Joy Zaragoza, Washington Dental Service Patty Hayes, Public Health – Seattle & King County Jon Almquist, American Academy of Pediatrics Terri Fox, Washington State Academy of Nutrition and Dietetics Lydia Bartholomew, Aetna, Washington Academy of Family Physicians Small business representatives Donna Steward, Association of Washington Business Mike Fournier, Washington Farm Bureau Joshua Welter, Mainstreet Alliance Tribal representative Sheryl Lowe, American Indian Health Commission Leslie Wosnig, Northwest Portland Area Indian Health Board Ralph Forquera, Seattle Indian Health Board Larry Cronin, Kalispel Tribe Employer Coalition Mary McWilliams, Puget Sound Health Alliance Carol Wilmes, Association of Washington Cities – Employee Benefit Trust AC Nominee: Health insurance carriers Molly Firth, Community Health Plan of Washington Director of Public Policy Molly Belozer Firth is the Director of Public Policy at Community Health Plan of Washington, the state’s only safety net health plan, and Community Health Network of Washington, a network of communitybased health centers across the state. She has strategically advocated for Washington State's community health centers and public programs for over six years.

Molly’s strategic public policy development expertise, coalition building skills and understanding of the needs of low-income populations have been recognized through several statewide leadership positions, including currently serving as the Chair of the Friends of Basic Health Coalition, on the WithinReach Board of Directors, and on the Title XIX Medicaid Advisory Committee.

For the last several years, Molly has led Community Health Plan’s efforts around health care reform policy development, education and implementation on both Exchange development and Medicaid expansion. She has also worked extensively with stakeholders to influence the development of the Exchange in both the legislative and administrative arenas. Community Health Plan has consistently supported the development of the Exchange and is preparing to enter this new market to provide continuity of care for public program enrollees as they increase income. As a result, Molly would bring a unique and important perspective to the Exchange Board’s Technical Advisory Committee.

Molly remains committed to improving access to health care for uninsured and underserved individuals and families throughout all her efforts.

Molly received her Master of Public Health degree from Tufts University School of Medicine, and a BA in Biology from the University of San Diego.

AC Nominee: Health insurance carriers James D. Pinkerton, Regence CLU, ChFC, CPCU, HIA Assistant Director, Actuarial Jim began his health insurance career 32 years ago. Prior to his current position as Assistant Director, Actuarial with Regence, he held several other positions in Actuarial as well as positions in Underwriting, Group Sales and Claims Administration. In Jim’s current position, he works closely with Regence’s Public Policy personnel to analyze and develop legislation at both the state and federal levels. He is currently the Chairman of the Risk Adjuster Board for the Utah Health Exchange and participates on the Washington Health Care Authority’s Health Exchange Technical Advisory Committee and the Oregon Health Insurance Exchange Actuarial Workgroup, as well as several industry advisory groups. Jim holds a BA in Business Administration from Washington State University. He also holds designations as a Chartered Life Underwriter, Chartered Financial Consultant, Chartered Property Casualty Underwriter and Health Insurance Associate.





AC Nominee: Health insurance carriers Indira Paharia, Molina Healthcare Psy.D., M.B.A., M.S.

Vice President of Clinical Programs, Policy, Research & Development Dr. Indira Paharia currently leads health policy and clinical program development for Molina Corporate and is responsible for disseminating best practices across all Molina State Plans. This encompasses disease and case management, care transitions, long-term care, behavioral health, and medical home models for 1.6 million Medicare, Medicaid, and CHIP members, including disabled and dual-eligible populations. In this role she has established the national strategy and process by which state health plans carve-in long-term care and behavioral health benefits, and she has developed the company’s Dual-Eligible integrated model of care. She is also a subject matter expert for developing accountable care organizations and value-based benefit design.

Before joining Molina Healthcare in 2009, Dr. Paharia was responsible for behavioral healthcare management and worksite wellness at Regence BlueCross BlueShield for 3 million commercial, Medicare, and Medicaid members. During her time with Regence, she obtained URAC Comprehensive Wellness Accreditation for Regence health coaching, worksite wellness, and online wellness programs.

She also led clinical and administrative policy development for compliance with the Federal Mental Health Parity and Addiction Equity Act of 2008.

Dr. Paharia has served on national committees for URAC, DMAA/CCA, and the Center for Medicare and Medicaid Innovation (CMMI). She is a Clinical Assistant Professor at the University of Washington Department of Psychiatry and she has published articles and texts on the biopsychosocial integration of medical and behavioral services. Dr. Paharia is a licensed clinical psychologist specialized in behavioral medicine, and she began her career as a treating provider and university professor. She received her doctorate in clinical psychology from the University of Denver, as well as an MBA in healthcare management and an MS in healthcare finance from Temple University.

AC Nominee: Health insurance carriers Glen H. Bogner, Molina Healthcare MBA President Glen is responsible for Washington health plan operations, as well as the implementation and execution of various strategic initiatives. Molina Healthcare of Washington has approximately 350,000 members enrolled in its health plan and is the largest Medicaid Managed Care company in the state. Bogner has over 20 years of healthcare industry experience and has held numerous leadership positions in the healthcare industry. He has served as the senior vice president of business development for CuraScript (Express Scripts), Inc. in Orlando, Florida, the chief operating officer of Schaller Anderson, Inc. (Mercy Care Plan) in Phoenix, Arizona and the vice president of Mercy Health Plans, Inc. in St. Louis, Missouri.

Bogner received his Masters of Business Administration degree from the Washington University in St.

Louis, Missouri.

AC Nominee: Health insurance carriers Meredith Mathews, Blue Shield of California Chief Medical Officer AC Nominee: Health insurance carriers Kitti Cramer, Premera Vice President of Regulatory Affairs and Deputy General Counsel AC Nominee: Health insurance carriers Karen Merrikin, Group Health Cooperative Senior Policy Advisor AC Nominee: Consumer advocates Laura Treadway, Lifelong AIDS Alliance Director of Insurance Policy & Services AC Nominee: Consumer advocates Robin Shapiro, Health Perspectives Group Small Businesses Founder and Owner I founded and am currently CEO of Health Perspectives Group, Patient Health Perspectives and Health Advocacy Strategies. Together these business employ 45 people in Seattle. We have been recognized as a ‘Best Place to Work,’ and a ‘Fastest Growing Business,’ in our area. The focus of our work is to work with biotech and pharmaceutical companies to integrate actual patient experiences into their communications and marketing. We also connect patients one-to-one to help them face health care challenges. Web sites are: www.hpgroupllc.com; www.hastrategies.com; www.phperspectives.com.

I am also co-founder and President of Allied Health Advocates, a professional health advocacy company helping patients and their families navigate the health care system by providing a nurse advocate and/or insurance advocate. More information is at: www.ahadvocates.com.

Represent Non-Profit Alliance for AutoImmune Diseases I currently serve on the Executive Board of the AutoImmunity Advocacy Alliance, a coalition organization representing multiple autoimmune diseases (i.e., Rheumatoid Arthritis, MS, Diabetes, and related diseases) Previous Committee Experience I have previously served on other Boards and Advisory Committees, (many as Chair) including: Arthritis Foundation, Temple Beth Am Board of Directors, Temple Beth Am School Board, Seniors Making Art, Washington Biotechnology Foundation, Junior Chamber of Commerce (in Washington, DC).

I feel very passionately about providing access to health care. My entire career has been dedicated to helping people understand, advocate for themselves and participate actively in their health care experience. I see the Exchange as a challenge and opportunity to communicate and engage people in our state. I believe my experience would be an asset to the Committee and would like to put it to work for the Board. Please let me know if there is a more formal application process or if you would like any additional information to consider my background and experience in what I might contribute to the Exchange Advisory Committee.

AC Nominee: Consumer advocates Larry Thompson, Whatcom Alliance for Healthcare Access Executive Director

SUMMARY OF QUALIFICATIONS

Proven success in achieving operational, financial and strategic results in demanding situations.

Strengths in managing and leading start-up, turn-around, and high grown environments.

WORK EXPERIENCE

Executive Director (9/10 - present) Whatcom Alliance for Healthcare Access, Bellingham, WA Executive Director of nonprofit organization providing direct client services and systems level advocacy to improve access to health care in Whatcom County, Washington. Initiated transformative project, “Designing the Future of Health Care in Whatcom County,” a community wide effort to implement new health care delivery system. Developed and implemented strategic plan to adapt organization and programs to changing economic climate and in response to federal health care reform. In one year increased organizational budget by 56%.

Chief Executive Officer (1/05 – 6/10)

SKAGIT VALLEY MEDICAL CENTER, MT. VERNON, WA

Chief Executive of a physician-owned medical group, with 450 employees in seven locations, in three counties. Developed and implemented a strategic plan for anticipated growth of the medical center which, as implemented, resulted in increasing net revenues from $26 million to $56 million annually and building provider group size from 48 to 105. Established multiple new locations and services lines.

Instrumental in negotiating merger with a regional hospital.

Managing Partner (7/99-12/2004)

EAST WEST CONSULTING, BELLNGHAM, WA

Built a health care management consulting practice focusing on assisting provider groups, public policy in health care, and association management. Also developed successful import/export health care products business.

Administrator, Network Region (9/95-7/99)

GROUP HEALTH COOPERATIVE OF PUGET SOUND, BELLINGHAM, WA

Directed operations for the network division of this HMO of 70,000 network enrollees in nine counties.

Led management team in functional areas of contracting, network development and management, provider services, customer services, care management/UM finance and decision support.

Held pmpm claims cost growth to zero over a three year period; completely re-engineered network operations, reducing administrative costs pmpm by 40% over three year period while improving staff morale and satisfactions.

Business Manager, South Region (4/93-9/95)

GROUP HEALTH COOPERATIVE OF PUGET SOUND, TACOMA, WA

Organized and managed finance, decision support, care management and IS functions for a staff model group practice of over 100 physicians serving 160,000 enrollees. Successfully led major initiative to shift from straight salary to mixed salary and performance pay.

Manager, Provider Relations (4/89-4/93)

GROUP HEALTH COOPERATIVE OF PUGET SOUND, SEATTLE, WA

Accountable for contracting and provider relations activities in region with more than $80 million in purchased services. Developed organization –wide provider payment policy which greatly decreased rate of growth in purchased services.

Consultant (6/88—4/89)

THOMPSON & ASSOCIATES, SEATTLE, W A



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