Driven by Data.
Inspired by Outcomes.

Driven by Data.
Inspired by Outcomes.

About

By partnering with Tessellate, you will benefit from industry-leading solutions that deliver proven results. Our risk adjustment and quality programs bring together every piece of the puzzle to improve revenue integrity and improve quality of care. We offer end-to-end solutions that are provider-centric, low abrasion and can be quickly implemented. Tessellate's experience working with Medicare Advantage and Commercial plans, driving effective provider engagement, and supporting strategic initiatives in risk adjustment and quality will provide solutions that achieve your goals and deliver value beyond the numbers.

The average health plan likely documents and reports less than 60 percent of the chronic conditions of its members. Tessellate improves risk score accuracy and simultaneously reduces RADV audit risk while boosting Star Ratings.

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Solutions

Tessellate brings you the most innovative and versatile solutions in the industry. You can increase the compliance and completeness of clinical condition documentation, improve risk score accuracy and drive quality improvement for Stars with help from Tessellate.

  • Serves over 1 million Medicare Advantage and Commercial members
  • Operates in over 20 states and Puerto Rico
  • Manages over $5 billion in risk adjustment-related revenue
  • Delivers over $300 million in quality-related bonus revenue
  • Has achieved a 4-Star Rating for a national PPO plan the past four years

Provider Engagement Coordination

A differentiated prospective program. Between our on-site Provider Engagement Coordinators (PECs) and our proprietary process, this program focuses on assisting providers with complete and accurate documentation with minimal abrasion.

  • Provider-centric prospective program
  • Improves risk score accuracy
  • Improves clinical Star measures
  • 1- to 3-month implementation timeline
  • In-market resources
  • Technology enablement

Risk Adjustment

A true end-to-end risk adjustment solution. Our program has unique comprehensive capabilities and a fully integrated approach. While most efficient as a combined package, all risk adjustment solutions are available as point solutions. We dive deep into member profiles, provider performance and condition-specific analysis to deliver superior outcomes. The solution includes:

  • CMS bid process and benefit design
  • Projections, modeling and reporting
  • Retrospective services
  • RAPS/EDPS data submissions
  • RADV audit support

Quality Improvement

A partner with years of demonstrated success in Stars and HEDIS. We offer an end-to-end integrated and tailored solution that delivers improved Star Ratings and HEDIS scores through proven strategic initiatives. We leverage our unique health plan knowledge and clinical expertise to create an innovative offering that delivers 4-Star program performance.

Meet Our Leadership Team

As president of Tessellate, Mary A. Smith is an industry-shaper and is widely recognized for her expertise in the leadership and strategic execution of risk adjustment, quality programs and provider engagement solutions.

Diverse experiences

Prior to creating Tessellate, Mary started her career as a medical technologist at a 300-bed community hospital, and thereafter as an onsite utilization coordinator for an HMO. Mary then joined the Blue Cross family, first with Independence Blue Cross and then with Blue Cross Blue Shield of Michigan where she served in a number of executive roles related to health care delivery strategy, utilization management, and enterprise execution, and leadership roles encompassing product development, care management, data analytics, information technology and organizational design.

She is also active in the community, serving as a volunteer non-trustee on the Mission & Quality Assurance committee for Leader Dogs for the Blind.

Integration for success

Mary always looks to drive higher performance, anticipate change and quickly adapt. She was responsible for the implementation and formation of BCBSM's business partnership with Data Driven Delivery Systems. This outstanding move vertically integrated best-in-class risk coding operations and provider engagement solutions with risk adjustment and quality program operations to create Tessellate.

Passionate people

Mary is passionate about her team and is always looking to diversify people's skill sets and experiences. She is a practiced student of the StrengthsFinder discipline and is invested in developing her team members.

"We're always on the hunt for talented people," Mary said. "Talent starts with intelligence, but that's just the beginning. We're also looking for individuals who are persistent, demonstrate integrity and effectively communicate."

Mary's passion is infectious, instilling confidence and inspiration in all those who interact with her; she excels at creating teams that win.

Education

She earned a bachelor's degree in public health administration from Stockton State College in New Jersey, and was a board certified medical technologist.

Gerri Cash serves as Tessellate's vice president of quality programs, overseeing quality strategy, operations, and performance management; operational communications; and process engineering. She's a founding member of the Tessellate team and an integral part of the executive core team.

Proven success

Before the creation of Tessellate, Gerri showcased effective leadership in multiple roles during her 18-year tenure at Blue Cross Blue Shield of Michigan, including director roles for the Stars program, project and portfolio management, project implementation, and various leadership roles in IT and customer service. Gerri's leadership in the Stars program resulted in continued 4-star performance for BCBSM. In 2015, Gerri received the peer-nominated Leader of the Year award through the National Management Association.

Laying the groundwork

Gerri's many accomplishments through her various roles at BCBSM contributed to the founding of Tessellate, including the implementation and execution of key programs with partner plans throughout the nation. These flagship partnerships, and the significant improvement in risk adjustment and quality performance, were instrumental in developing Tessellate and positioning it for growth.

Driven

One of the biggest contributors to Gerri's success is the passion she has for her team members. Not only does she bring out the best in her colleagues, but she also invests in their development.

"Tessellate's most valuable asset is its people," she said. "We've faced change and found success. That wouldn't be possible without such hard working and dedicated employees."

The only thing that equals Gerri's love for her team is her passion and support for the safe treatment and rescue of dogs. She's a longtime supporter of Midwest Boston Terrier Rescue and has two adopted Boston Terriers, Thor and Nola. Whether it's the protection of animals or the development of her employees, Gerri's passion breeds success in everything she touches.

Education

Gerri earned a bachelor's degree in public communications and marketing, as well as a master's degree in business administration from Central Michigan University.

Eric Cormier's role as chief operating officer risk adjustment operations goes beyond ensuring the company's operational excellence and seamlessly delivering risk adjustment products and services. He fulfills promises.

Years of practice

Medicare programs are Eric's prime focus. Before joining Tessellate, he managed risk adjustment operations as the chief operating officer for Data Driven Delivery Systems. While there, Eric was instrumental in developing the Provider Engagement Coordination Program, and leading all client implementations as the company grew from 25,000 members to more than 300,000 in less than three years.

Eric previously served as a regional general manager for Aetna's Medicare and individual businesses, in addition to holding various finance positions. He was responsible for all aspects of Medicare Risk Adjustment Revenue.

Community activities

Eric is extremely dedicated to his community. In addition to volunteering for a number of organizations, he served as the PGA Tour Tournament co-chair for the Canon Greater Hartford Open; treasurer of the Homeward Bound Foundation, which supports people living with complex disabilities; treasurer of the U.S. Junior Chamber of Commerce and president of the Greater Hartford chapter.

"I've taken great pride in helping my community ever since I was a Boy Scout," Eric said. "That ties into why I love my job so much. We're reducing premiums and increasing benefits through products Medicare beneficiaries can't get anywhere else. I'm very excited for the opportunity to continue our growth and effectiveness on their behalf."

Education

A certified public accountant, Eric holds a bachelor's degree in accounting from the University of Connecticut.

Susan Crowley, Tessellate's managing director, business operations and supplemental data, oversees a diverse set of functions including finance, client implementation, business readiness and regulatory analysis.

Effective leadership

Prior to joining Tessellate, Susan held various leadership roles at Blue Cross Blue Shield of Michigan. She most recently managed the data and innovative solutions team for the company's Center of Excellence. In that role, Susan and her team led multiple efforts to solidify the acquisition and management of more than 300 data sources, in addition to acquiring new data to strengthen the delivery of risk adjustment and quality support functions.

In 2016, a year of significant change for the business, Susan also led a number of Center of Excellence teams, such as risk adjustment analytics, regulatory and HEDIS.

Solid foundation

Susan began her tenure with BCBSM after finishing high school and held numerous positions in a variety of business areas – from membership and billing to claims – before pursuing a bachelor's degree in business. She has a long history of reducing risk and cost by leveraging her deep knowledge of the business, as well as drawing on her extensive experience in operations and customer service.

Cheaper by the dozen

Growing up with 12 brothers and sisters, there was little focus on individuals in Susan's home.

"My dad always told us, 'don't tell me what you've done, show me what you can do,'" she said. "My family was a big team. Watching each of my siblings find success helped me stay focused and build a solid work ethic. It also taught me to value the people around me, which is why I have such a deep appreciation for my talented coworkers today."

Education

Susan earned a bachelor's degree in business from Michigan State University.

As managing director of product management, Sue Kuypers oversees Tessellate's product portfolio. She brings a fresh perspective to product development, focusing on designing and deploying products that address customers' needs and achieve their goals.

Lead by example

Sue held various leadership roles throughout her more than 16 years with Blue Cross Blue Shield of Michigan. Most recently, as director of enterprise risk adjustment, she was accountable for strategy development, initiative execution and submissions for about 350,000 Commercial ACA members and 380,000 Medicare Advantage members.

In addition, Sue was responsible for HEDIS submissions, Medicare Part D operations, finance, data management and other senior market segment functions. She also helped the company realize $260M in revenue annually from prospective and retrospective risk adjustment programs.

Sue previously worked for ANR Pipeline Company and Dialogue Marketing.

Education

Sue holds a master's degree in finance from Walsh College in Troy, Michigan, and a bachelor's degree in accounting from the University of Michigan-Flint.

Marc Lucas serves as Tessellate's vice president, risk adjustment strategy, analytics and performance management. He's responsible for managing tailored risk adjustment strategies for more than a million members and beneficiaries nationwide.

Drawing on his health care experience and actuarial background, Marc creates algorithms that pinpoint risk adjustment inefficiencies. From there, he's able to design and deploy creative solutions, integrating with quality and care management.

Risky Business

As vice president of risk adjustment for Blue Cross Blue Shield of Michigan, Marc was responsible for managing all aspects of the risk adjustment program, including the development of products and services that supported the corporate growth strategy and reduced audit risk.

He previously worked for Evolent Health as senior director of health plan performance, working with health plans on risk adjustment, quality and care management.

Not for self

A qualified naval nuclear engineer, Marc served as a lieutenant commander in the U.S. Navy working on submarines in the Adriatic Sea, Arabian Gulf, and Atlantic and Pacific Oceans.

"My naval experience taught me that ‘you get what you inspect, not what you expect,' and that anyone can make a difference," Marc said. "After 20 years in the Navy, I still feel like I'm serving my country. Using data, my team works to find efficiencies within the health care system and make changes that contribute to the productivity of our country."

Education

Marc earned a master's degree in applied mathematics from George Washington University and a bachelor's degree in mathematics from the United States Naval Academy. He is also an Associate of the Society of Actuaries.

Chief Information Officer Larry Moncol is responsible for fitting together the product development and information technology services pieces of Tessellate's puzzle, with each piece supporting the company's operations and growth strategy.

Technologically advanced

Larry has spent the majority of his IT career in the health care industry. He knows how to build talented teams, manage successful acquisitions and lead technical integrations.

Before joining the Tessellate team, Larry served as the chief information officer for Data Driven Delivery Systems where he led the development and integration of technology products and platforms to support company growth.

Larry also held the role of chief information officer at Verisk Health in the revenue and quality integrity division. In addition to managing product and platform integration programs, he oversaw more than 100 internal and external team members. Similar to his current role, Larry was responsible for quickly scaling an IT organization to support revenue growth from $25M to $162M in three years.

"I have been fortunate to work with incredible teams that get the job done, and my Tessellate family is no exception," Larry said. "Everything we accomplish is a team effort."

Family ties

In addition to caring for two dogs of their own, Larry and his family are involved with FETCH a Cure, a nonprofit that aims to improve the quality of life for pets. He's also a proponent of trying new things. He and his eldest daughter are currently learning to play the guitar together.

Education

Larry holds a bachelor's degree in political science from James Madison University.

The purpose behind our passion.



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