PRIZM HEALTH ADVISORY - Key Persons
Caroline Wilson McDonald is the Founder and Principal of Prizm Health Advisory. Prior to starting Prizm Health, Caroline built her SNP expertise over five years with Cigna-HealthSpring, the sixth largest SNP operator in the U.S. with SNP membership representing over $1 billion in revenues. Caroline joined the company in 2011 as the SNP Program Manager and the first dedicated employee to the full SNP product line (Dual, Chronic and Institutional SNPs). She continued on to oversee the company's SNP products as a Quality Improvement Director until 2016.
During her time at Cigna-HealthSpring, Caroline developed in-depth knowledge of the company's health services functions and established structures and detailed processes to monitor and comply with SNP regulatory requirements. She improved NCQA SNP Model of Care scores from an average of 87% in 2013 to 100% by 2015. She also led the department that provided oversight, CMS audit readiness, quality improvement and project management functions to the operational areas responsible for implementing the company's SNP Models of Care (MOC). In addition to her SNP oversight responsibilities, Caroline led case management quality and process improvement initiatives for the company's broader Medicare Advantage membership.
Flo has more than 25 years of experience in health care management, specializing in Medicare (CMS) Compliance, Star Ratings, and Special Needs Plan (SNP) Oversight. Flo is passionate about customer engagement and Medicare compliance.
Most recently, Flo served as Cigna-HealthSpring's SNP Oversight Director where she led efforts to increase the health plan's implementation rate for Health Risk Assessments, Care Planning, Interdisciplinary Care Team meetings and Care Transition coordination. Flo began her career in compliance and believes that adherence to CMS' SNP requirements is critical to increasing member health outcomes. Prior to her role as Cigna-HealthSpring's SNP Oversight Director, Flo worked for Cigna Healthcare of Arizona as the Medicare Stars Lead, where she was instrumental in the health plan's achievement of a 5-Star Rating in 2015 and no CMS audit findings. Flo is a Licensed Practical Nurse and lives in Phoenix, AZ.
For over 40 years, Roy Plummer has been committed to serving the healthcare needs of individuals and populations and improving the quality of their care and services. Roy has worked in Managed Care for the last 20 years and has had a variety of roles supporting and leading quality management and accreditation activities for several national health plans in both Commercial and Medicare lines of business including as the Vice President of Quality Improvement for Cigna-HealthSpring.
Roy's broad experience includes development, execution, and integration of quality management programs, HEDIS® project management, State and Federal audit support, market readiness reviews, Special Need Plan MOC development, leading NCQA health plan accreditation surveys, and performing cost and utilization analysis. Roy is a Registered Nurse and lives in Nashville, TN.