TEAM
Caroline Wilson McDonald
Founder and Principal
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.
Caroline is also a SNP Model of Care Surveyor on behalf of the National Committee for Quality Assurance (NCQA).
Caroline began her career working in Market Intelligence for Healthways (now Tivity Health) and then joined the Business Development and Managed Care Department at Community Health Systems. Caroline has a BA in Economics from Vanderbilt University and a MBA from Harvard Business School. She lives in Portland, OR.
Roy Plummer, RN
Advisor
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.
Flo Ann Osterbauer, LPN
Advisor
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.
Kera Morelock, MHA, LSW, CCM
Advisor
Kera has been working in the healthcare industry for the past 20 years. She spent her first few years working as a Social Work Discharge Planner at a Transitional Care Unit, and the past 15 years working with Medicare Part C and Special Needs Plan (SNP) plans. During her time at three separate Managed Care Organizations, she has had the privilege of holding several roles including Care Coordinator/Case Manager, Care Coordinator Lead, SNP Program Manager, and SNP Program Director.
Kera believes the time she spent working as a Care Coordinator doing in-home assessments and care planning for Dual Eligible Special Needs Plan (D-SNP) members provided her the ability to gain insight into the unique needs of these vulnerable members and their caregivers. It also enabled her to see firsthand the approach needed to manage and coach vulnerable SNP members in their homes. It was this early experience that led her to become passionate about the work being done for society’s most vulnerable members, not only at an individual level, but how members’ needs are addressed and treated at a systemic and program level.
As a SNP Program Manager, she used her expertise to develop policies and procedures to improve compliance with Centers for Medicare and Medicaid Services (CMS) regulations as well as provided auditing, training, and remediation of any care coordination issues found within the health plan and for outside delegates. As the program manager, she was also responsible for maintaining and revising the Model of Care for two D-SNP plans and implementing two brand-new Institutional Special Needs Plan (I-SNP) plans into new geographical markets. This successful implementation/launch included training and delegation oversight of over 120 facility partners.
Prior to becoming a Consultant, Kera worked for a one of the nation’s fasting growing Medicare Advantage plans as their SNP Program Director tasked with the monitoring and creation of SNP program Key Performance Indicators (KPIs), the launch of new 4 new SNP Plans, and as a SNP Subject Matter Expert (SME) to assist and develop all new policies and procedures, tools, and Model of Care’s. She also has had the recent opportunity to lead the program through a recent successful CMS audit.
Education, Licenses & Certifications:
Master’s Degree in Health Administration, Healthcare Leadership
Bachelor’s Degree in Science, Social Worker
Licensed Social Worker by Minnesota Board of Social Work
Certified Case Manager
