- Strengthening payer-provider relationships through improved communication around claims adjudication, providing transparency into denials, accelerating payments, automating data exchange, and reassessing denial
reversals
Join us for an engaging panel discussion featuring a lineup of industry experts as they tackle pressing questions at the intersection of health plan payment integrity and hospital revenue integrity. Discover the challenges and solutions in achieving payment accuracy and delve into the potential of collaboration and data sharing between health plans and hospitals. Explore critical topics, including the impact of payment inaccuracies on financial health, the role of technology and automation, navigating regulatory complexities. Gain insights into measuring success and envision the future of payment integrity in healthcare. Don't miss this opportunity to be part of a dynamic conversation that could reshape the healthcare landscape. Join us as we challenge conventional wisdom and seek innovative solutions to drive payment accuracy forward.
My name is Conor McCauley. I am the Director of Payment Integrity Clinical Capabilities at Highmark. Being a Critical Care nurse, it is easy to see there are issues surrounding healthcare funding. Inserting clinical insights into reimbursement methodologies can lead to affordability and improved patient outcomes. Clinicians are well positioned to make a difference here. My passion is developing an engaged team, effective processes, and surrounding clinicians with the right technology, data, and market insights so they can work at the top of their licensure.
Dave Cardelle, R.Ph., is on the executive team at AMS and serves as the Chief Strategy Officer. He leads a dedicated team of professionals focused on transforming the payment integrity (PI) industry. With a BS in Pharmacy from the Massachusetts College of Pharmacy in Boston, MA, Dave brings a unique blend of healthcare expertise and domain knowledge to his role.
As the CSO, Dave leverages years of experience in the PI industry, including working for both Payer and Provider organizations to help AMS grow through innovative product, sales, marketing, and client relationship strategies.
Throughout his career, Dave has consistently demonstrated a keen understanding of healthcare-related matters, a skill that proves invaluable in the context of payment integrity. His passion for advancing the industry and commitment to maintaining the highest standards of integrity have earned him a reputation as a true industry expert.
Advanced Medical Strategies (AMS) is a leading enterprise healthcare affordability platform that unifies the industry's most comprehensive payment, pricing, clinical, financial, and operational intelligence into a single AI-powered platform. By integrating payment integrity, price transparency, decision intelligence, risk management, clinical standards of care, reimbursement policy intelligence, financial benchmarking, statistically valid analytics, proprietary implant and medical device cost intelligence, and advanced healthcare data, AMS helps healthcare organizations improve payment accuracy, reduce unnecessary spending, and strengthen financial performance.
AMS empowers organizations to prevent, identify, and recover overpayments across pre-payment and post-payment workflows while delivering transparent insights that address the root causes of payment errors, improve reimbursement strategies, strengthen policy governance, support more competitive provider contracting, enhance fiduciary oversight, and advance enterprise healthcare affordability. By transforming complex healthcare data into actionable intelligence, AMS enables clinical, financial, payment integrity, contracting, compliance, and executive leaders to make more informed decisions that improve operational performance, financial outcomes, and healthcare affordability across the healthcare ecosystem.
Brooke Switzer is the Director, Global Public Policy at iHerb where she delivers the strategic direction for government relations, industry affairs, and public policy. She currently leads the public policy team on a variety of U.S. and international regulatory matters across a range of topics including accessible health and nutrition, e-commerce, digital services, ESG, and cross-border trade. Brooke is an international relations and public affairs specialist with over 20 years of experience developing strategic communications and advocacy campaigns for the private sector, nonprofit foundations, and trade associations. Brooke is pursuing a doctorate of law and policy from Northeastern University in Boston, Massachusetts, and holds an MBA from Lynn University in Boca Raton, Florida, and Bachelors of Business Administration from John Carroll University in Cleveland, Ohio.
Tim Gerke is a noteworthy leader of positive disruption who specializes in strategies harmonizing people, process, and technology to take organizations to the next level in growth and profitability. With a passion to drive success for all stakeholders in human and animal health, Tim loves innovating business strategies that focus on an overall proactive approach in making sustainable health a centerpiece to a better world.
Tim has over 25 years of successful execution on this mission in executive and leadership roles with Fortune 500 companies like Bayer and Deloitte, preparing him to be a dynamic change agent for small to mid-size companies hungry to strengthen their position in the marketplace. In the last decade Tim has led the repositioning, rebuilding, and turnaround of several companies who were then sold in premium transactions to private equity including FoodScience with the DaVinci, VetriScience, and Pet Naturals brands sold to Wind Point Partners, Clinics Choice as part of the VetsPlus , Inc sold to DW Healthcare Partners, and most recently rejuvenating the Allergy Research Group, Nutricology, NutriLink and Clinical Education, UK to be sold as an attractive portfolio to WM Partners. Tim has partnered with numerous companies to reorganize sales and marketing strategy and leadership development, while also consulting to update and clear regulatory hurdles for several contract manufacturers for both pharmaceutical and nutraceutical products.
Tim is a sought-after speaker for organizations, groups, associations, and non-profits because of his innovative strategies for building effective leadership and culture. Tim has facilitated hundreds of forums on critical human skills such as trust, emotional intelligence, change management, conflict resolution, and effective communication.
Tim is committed to finding the next innovations that will advance the cause of optimal health for a world in need.
Bob is the Founder and CEO of Cor Health in San Diego, CA. Cor Health is developing technologies to track inflammation and the impact of lifestyle choices. We call this Self Health. Bob is formerly Director of Platform Architecture, and Watch architect. He is an Inventor & Entrepreneur with 3 exits in tech and health tech. Bob's career spans more than 25 years in the field of instrumentation for spectroscopy. He was awarded the Williams-Wright Award in 1996 for outstanding contributions to infrared spectroscopy. He is the author or co-author of 12 articles and book chapters and co-editor of one book on infrared micro-spectroscopy, holds 62 issued and pending US patents. He is past president of the Coblentz Society, past president of the Rio Grande section of the SAS, a past-president of the Southwestern Connecticut section of the Optical Society of America, and a member of the Society for Applied Spectroscopy. In his spare time he makes wine, pizza and sourdough. He and his family live in San Diego California.
