Clinical Episode Payment Models
CLINICAL EPISODE PAYMENT MODELS
Accelerating and Aligning Population-Based Payment Models
Emily DuHamel Brower, M.B.A., is senior vice president of clinical integration and physician services for Trinity Health. Emphasizing clinical integration and payment model transformation, Ms. Brower provides strategic direction related to the evolving accountable healthcare environment with strong results. Her team is currently accountable for $10.4B of medical expense for 1.6M lives in Medicare Accountable Care Organizations (ACOs), Medicare Advantage, and Medicaid and Commercial Alternative Payment Models.
Ms. Brower joined Trinity Health from Atrius Health in Massachusetts, where she last served as vice president of Population Health. There, she built and executed the essential capabilities required to achieve strong financial and clinical outcomes within integrated care models under value-based reimbursement, particularly for publicly insured populations.
Prior to her career at Atrius Health, Ms. Brower spent 15 years in leadership roles at Urban Medical Group, a Massachusetts nonprofit healthcare organization specializing in the care of medically complex, chronically ill populations across a community-based, long-term care continuum. During that time, Ms. Brower launched a Program of All-inclusive Care for the Elderly (PACE) program and other innovative, capitated contracts for medically complex populations and served as Principal Investigator for a multi-year research project analyzing cost and quality outcomes to support payment reform.
Ms. Brower received her B.A. from Smith College and her M.B.A. from the New York University Stern School of Business.
Mr. James Sinkoff is the Deputy Executive Officer and Chief Financial Officer for Sun River Health (formerly known as Hudson River HealthCare), and the Chief Executive Officer of Solutions 4 Community Health (S4CH); an MSO serving FQHCs and private physician practices.
Sun River Health cares for over 240,000 general medicine, dental, behavioral health, mental health, agricultural, public housing, homeless, developmentally disabled, HIV and substance abuse patients and families generating nearly 780,000 patient encounters in over 43 clinical sites in both rural and urban settings in 10 counties of the Hudson Valley, 2 counties on Long Island and all of NYC. Sun River Health provides a full range of primary care, behavioral and mental healthcare services including but not limited to pediatrics, internal medicine, family medicine, OB/GYN, dentistry, urgent care, MAT and specific specialty care such as cardiology, endocrinology, and ophthalmology. Over 95,000 patients are managed under a variety of risk-based contacts as well as 11,000 MSSP ACO patients.
Mr. Sinkoff has worked in all sectors of the healthcare industry starting his career with Ernst & Young as an auditor and then as a senior management consultant to hospitals, physician practices, long term care facilities, and home health agencies. In the late ‘90s, he became the director of managed care financing for Berkshire Health Systems. Subsequently, he became the Chief Financial Officer for Fidelis Care New York (now Centene). Mr. Sinkoff was the Chief Executive Officer of Whitney M. Young Jr. Health Center in Albany, New York, before joining Sun River Health and Solutions 4 Community Health in late 2009.
As the DEO, Mr. Sinkoff oversees all aspects of Sun River Health’s service delivery system; clinical, financial and operational. He has been invited to share his thoughts on many topics including value-based systems of care, health equity, IT, interoperability, LEAN and Emotionally Intelligent management. Mr. Sinkoff is a coach to a number of clients seeking to grow and achieve their professional aspirations.
Mr. Sinkoff was an appointed member of the NYSDOH Transparency, Evaluation and HIT Workgroup. He is a member of the board and an executive committee member of the Health Care Transformation Task Force, formerly a part of the Levitt Group. He is a member serving the Robert Wood Johnson Foundation to Improve Health Equity led by the University of Chicago, the Institute for Medicaid Innovation, and the Center for Health Care Strategies. He is a member of the legislative, public policy and sub-committee on health center financing of the National Association of Community Health Centers. He is a member of the board of Amida Care, an HIV and Special needs plan. Mr. Sinkoff is the former chair of the board of the Community Healthcare Association of New York.
Victor is the Chief Medical Officer for TennCare, Tennessee’s Medicaid Agency. At TennCare, Victor leads the medical office to ensure quality and effective delivery of medical, pharmacy, and dental services to its members. He also leads TennCare’s opioid epidemic strategy, social determinants of health, and practice transformation initiatives across the agency. Prior to joining TennCare, Victor worked at Evolent Health supporting value-based population health care delivery. In 2013, Victor served as a White House Fellow to the Secretary of Health and Human Services. Victor completed his Internal Medicine Residency at Emory University still practices clinically as an internist in the Veteran’s Affairs Health System.
Dr. Brandon G. Wilson, DrPH, MHA (he, him, his) joined Community Catalyst as the Director of the Center for Consumer Engagement in Health Innovation, where he leads the Center in bringing the community’s experience to the forefront of health systems transformation and health reform efforts, in order to deliver better care, better value and better health for every community, particularly vulnerable and historically underserved populations. The Center works directly with community advocates around the country to increase the skills and power they have to establish an effective voice at all levels of the health care system. The Center collaborates with innovative health plans, hospitals and providers to incorporate communities and their lived experience into the design of systems of care. The Center also works with state and federal policymakers to spur change that makes the health system more responsive to communities. And it provides consulting services to health plans, provider groups and other health care organizations to help them create meaningful structures for engagement with their communities.
Dr. Wilson joined the Center, following his tenure in federal service as a Senior Public Health Advisor with the Centers for Medicare and Medicaid Services (CMS) Office of Minority Health, where he led strategic initiatives to implement the Biden/Harris Administration’s priorities on health equity for underserved communities, and developed a health equity business case portfolio. He most recently received the CMS Impact Award from CMS Administrator Chiquita Brooks-LaSure for advancing health equity and accessibility in COVID-19 for persons living with disabilities. Prior to joining CMS OMH, Dr. Wilson led a $250 million portfolio in the CMS Innovation Center’s Accountable Health Communities Model and the Health Care Innovation Awards. At CMMI, he spearheaded the Health Equity Working Group, which laid the foundation for CMMI’s health equity focus in its 10-year strategy refresh. He later directed culture of patient safety quality improvement projects for the NIH Clinical Center Office of the Director, by reducing medication errors in the inpatient oncology pharmacy department. He also headed recruitment and retention approaches for increasing minority screening, enrollment, and retention in preventative and therapeutic vaccine clinical trials and participation in the Community Advisory Board at NIH. For his exceptional commitment and dedication in identifying a solution for a global infectious disease threat by advancing a malaria vaccine through a clinical trial, Dr. Wilson received awards from NIH’s Director, Dr. Francis Collins and NIAID’s Director, Dr. Anthony Fauci.
Dr. Wilson brings a wealth of knowledge, skills, and abilities in advocacy, health policy, and research from national policy organizations as the National Association of People with AIDS. Dr. Wilson completed his Master’s in Health Systems Management at George Mason University and his Doctor of Public Health at Morgan State University. He also holds Public Health faculty appointments at Purdue University and the UNC Gillings School of Global Public Health, where he teaches courses in health economics and policy, cultural competence and communications for health professionals, community health assessments, and healthcare marketing. His research interests include using patient centered and indigenous models of care, health economics outcomes research, policy analysis, and community-based participatory and action research to eliminate health disparities and advance health equity in underserved and disinvested communities.
Tamara Ward is the SVP of Insurance Business Operations at Oscar Health, where she leads the National Network Contracting Strategy and Market Expansion & Readiness. Prior to Oscar she served as VP of Managed Care & Network Operations at TriHealth in Southwest Ohio. With over 15 years of progressive health care experience, she has been instrumental driving collaborative payer provider strategies, improving insurance operations, and building high value networks through her various roles with UHC and other large provider health systems. Her breadth and depth of experience and interest-based approach has allowed her to have success solving some of the most complex issues our industry faces today. Tam is passionate about driving change for marginalized communities, developing Oscar’s Culturally Competent Care Program- reducing healthcare disparities and improving access for the underserved population. Tamara holds a B.A. from the University of Cincinnati’s and M.B.A from Miami University.
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Dr. Peter Walsh joined the Colorado Department of Health Care Policy and Financing as the Chief Medical Officer on December 1, 2020. Prior to joining HCPF, Dr. Walsh served as a Hospital Field Representative/Surveyor at the Joint Commission, headquartered in Oakbrook Terrace, Illinois.
Dr. Walsh is an Aerospace Medicine Specialist, who provided primary care to aircrew and special operational personnel and their families during much of his 21-year active-duty career in the U.S. Air Force. Upon retirement in 2006 he served as an Urgent Care Physician at the previous Memorial Health System in Colorado Springs between 2006 and 2008 and practiced at the Centura Center for Occupational Medicine in Colorado Springs, CO and Pueblo, CO between 2006 and 2009.
His prior positions include serving as the Chief Medical Officer, South State Operating Group of Centura Health, Corporate Chief Medical Executive for Centura Health in Denver, Colorado, and the VP of Medical Affairs at St. Francis Medical Center in Colorado Springs, Colorado.
Dr. Walsh received his B.A. at the University of Southern California, his M.D. from the Medical College of Ohio in Toledo, Ohio, and a M.P.H. from Harvard School of Public Health. He completed his residency in Aerospace Medicine at the USAF School of Aerospace Medicine at Brooks AFB, Texas.
Dr. William Shrank is Humana’s Chief Medical Officer (CMO). He leads the Integrated Health Solutions team that consists of several key clinical areas of the business. Dr. Shrank oversees Humana’s senior-focused, purpose driven, primary care organization, and guides the implementation of Humana’s integrated care delivery strategy, with an emphasis on advancing the company’s clinical capabilities. He launched Humana’s health equity department, Humana’s population health strategy (the Bold Goal), and the Humana Healthcare Research team. Across all divisions, Dr. Shrank promotes the idea of Humana as a learning organization and has dedicated his team to rapid learning – where meaningful insights are generated accurately and quickly, and enhance Humana’s ability to continually evolve to improve the health and health outcomes of those we serve.
Dr. Shrank is a member of the Management Team, which sets the firm’s strategic direction, and reports and to President and Chief Executive Officer, Bruce Broussard. Additionally, Dr. Shrank serves on the Board of National Committee for Quality Assurance and is co-chair of the Clinical Transformation Taskforce for the Health Care Payment Learning and Action Network.
Dr. Shrank joined Humana in April 2019 having previously been employed by the University of Pittsburgh Medical Center (UPMC) as CMO, Insurance Services Division from 2016 to 2019. At UPMC, Dr. Shrank was responsible for clinical operations, policy and quality for approximately 3.5 million members in government and commercial lines of business.
Prior, Dr. Shrank served as SVP, Chief Scientific Officer, and CMO of Provider Innovation at CVS Health from 2013 to 2016. From 2011 to 2013, Dr. Shrank served as Director, Research and Rapid[1]Cycle Evaluation Group, for the Center for Medicare and Medicaid Innovation, part of the Centers for Medicaid and Medicare Services.
Dr. Shrank began his career as a practicing physician with Brigham and Women’s Hospital and as an Assistant Professor at Harvard Medical School.
Dr. Shrank completed his medical degree from Cornell University Medical College, his residency in internal medicine at Georgetown University and his fellowship in Health Policy Research at the University of California, Los Angeles. He also earned a Master of Science degree in Health Services from the University of California, Los Angeles and a Bachelor of Arts degree from Brown University.
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Mat Spaan, MPA, has worked with the state of Minnesota since 2008 in implementing and developing health policy and payment reform initiatives, with his most recent work managing care delivery and payment activities within the state’s Medicaid program. Since 2013, one of his primary roles is as lead on Minnesota’s Medicaid ACO demonstration, known as the Integrated Health Partnerships (IHP) program, and the development of value-based purchasing in Medicaid.
Mat’s previous state projects have included the development of the state’s All-Payer Claims Database and planning director overseeing the creation of a hospital and physician clinic cost and quality comparison tool. Prior to joining the state, he’s held several interesting positions in the private and nonprofit sectors, including as a manager with a national health advocacy organization, organizer for a neighborhood arts and economic development nonprofit in New Orleans, and as a boat captain on Lake Michigan. Mat earned his Master of Public Administration degree from the University of New Orleans.
Dr. Mark Friedberg is Senior Vice President of Performance Measurement and Improvement for our company, the largest private health plan in Massachusetts and one of the largest independent, not-for-profit Blue Cross Blue Shield plans in the country. We serve more than 3 million members and more than 20,000 employers and are consistently rated among the nation’s best health plans for overall member satisfaction and quality.
Mark is responsible for all activities related to measuring and improving the performance of our provider network, including quality and equity metrics used in our value-based contracts such as our Alternative Quality Contract. He also oversees data analytics related to our own performance, ensuring we meet or exceed state and federal standards as well as HEDIS, NCQA and CMS quality measures.
Before joining our company in 2019, Mark was a researcher at the RAND Corporation, a leading policy research organization, where he led multiple projects to measure, evaluate and improve health system performance.
He is a general internist who provides primary care at Brigham and Women’s Hospital, where he completed his residency and fellowship. Mark works at the Brigham a half day each week.
Mark has an M.D. from Harvard Medical School, a Master of Public Policy from the Harvard Kennedy School of Government, and a Bachelor of Arts from Swarthmore College. He is also a part-time assistant professor of medicine at Harvard Medical School. Mark enjoys music, food, and beach trips with his family.
Brian W. Powers, MD, MBA is Deputy Chief Medical Officer at Humana. In this role, he works across the organization to support rapid learning and evaluation of Humana’s integrated care delivery strategy; to lead research in payment and delivery innovation; and to drive physician engagement, alignment, advocacy, and education across the company. Prior to Humana, he led population health strategy and analytics for CareMore and Aspire Health, both care delivery subsidiaries of Anthem. In prior roles, he was responsible for initiatives to improve health care quality and value at Mass General Brigham, the National Academy of Medicine, and the Massachusetts Health Policy Commission. An accomplished researcher, Dr. Powers is an Assistant Professor of Medicine at the Tufts University School of Medicine, has published peer-reviewed studies in venues such as JAMA, Science, and the New England Journal of Medicine, and serves as Deputy Editor of Healthcare: The Journal of Delivery Science and Innovation. He holds an MD from Harvard Medical School, an MBA from Harvard Business School, and an AB from Bowdoin College. He completed his clinical training in internal medicine and primary care at Brigham and Women’s Hospital and is a practicing internist.
Elizabeth Fowler, Ph.D., J.D., is the deputy administrator and director of the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Fowler previously served as executive vice president of programs at The Commonwealth Fund and vice president for Global Health Policy at Johnson & Johnson. Liz was special assistant to President Obama on healthcare and economic policy at the National Economic Council. In 2008-2010, she was chief health counsel to Senate Finance Committee Chair, Senator Max Baucus (D-MT), where she played a critical role developing the Senate version of the Affordable Care Act. She also played a key role drafting the 2003 Medicare Prescription Drug, Improvement and Modernization Act (MMA). Liz has over 25 years of experience in health policy and health services research. She earned her bachelor’s degree from the University of Pennsylvania, a Ph.D. from the Johns Hopkins Bloomberg School of Public Health, where her research focused on risk adjustment, and a law degree (J.D.) from the University of Minnesota. She is admitted to the bar in Maryland, the District of Columbia, and the U.S. Supreme Court. Liz is a Fellow of the inaugural class of the Aspen Health Innovators Fellowship and a member of the Aspen Global Leadership Network.
Mark McClellan, M.D., Ph.D., is Director and Robert J. Margolis, M.D., Professor of Business, Medicine, and Health Policy at the Margolis Center for Health Policy at Duke University. He is a physician-economist who focuses on quality and value in healthcare, including payment reform, real-world evidence, and more effective drug and device innovation.
He is former administrator of the Centers for Medicare & Medicaid Services and former commissioner of the U.S. Food and Drug Administration, where he developed and implemented major reforms in health policy.
He is an independent director on the boards of Johnson & Johnson, Cigna, and Alignment Healthcare and is co-chair of the Accountable Care Learning Collaborative and the Guiding Committee for the Health Care Payment Learning and Action Network.
Marc Harrison, M.D., President and CEO of Intermountain Healthcare, is a pediatric critical care physician with a proven track record as a top operation executive on a global scale. He is a national and international thought leader on transformation and innovation—ranking in Fortune’s Top 50 World’s Greatest Leaders in 2019. He also ranked third on Modern Healthcare’s 100 Most Influential People in Healthcare in 2020.
Dr. Harrison is leading Intermountain’s 41,000 employees—who are all called caregivers—to embrace bold new approaches to improve health, re-define value-based care, and serve people in new ways. For example, Intermountain launched Civica Rx, a not-for-profit generic drug manufacturer and distributor, to make generic medications more available and affordable in hospitals across the nation. Intermountain is also a founding member of the Utah Alliance for the Determinants of Health, which is a collaboration of community partners designed to proactively address forces that affect people’s health well before they come to a clinic or a hospital.
Dr. Harrison also served as CEO of Cleveland Clinic Abu Dhabi, Chief of International Business Development at Cleveland Clinic, and Chief Medical Operations Officer at Cleveland Clinic.
He received his undergraduate degree from Haverford College and his medical degree from Dartmouth Medical School, completed a pediatric residency and pediatric care fellowship at Intermountain’s Primary Children’s Hospital, and completed a Master of Medical Management at Carnegie Mellon University.
Dr. Harrison is an all-American triathlete and represented the U.S. at the 2014 World Championships. He is also a two-time cancer survivor with his sights currently on completing an Ironman.
Marshall H. Chin, M.D., M.P.H., the Richard Parrillo Family Professor of Healthcare Ethics in the Department of Medicine at the University of Chicago, is a practicing general internist and health services researcher who has dedicated his career to reducing health disparities through interventions at individual, organizational, community, and policy levels.
Dr. Chin co-chairs the CMS HCP-LAN Health Equity Advisory Team. He also co-directs the Robert Wood Johnson Foundation Advancing Health Equity: Leading Care, Payment, and Systems Transformation program and collaborates with teams of state Medicaid agencies, Medicaid managed care organizations, and frontline healthcare organizations to implement payment reforms to support and incentivize care transformations that advance health equity. He also partners with eight urban and rural communities to integrate medical and social care to reduce diabetes disparities through the Merck Foundation Bridging the Gap program.
Dr. Chin is a graduate of Harvard College and the University of California at San Francisco School of Medicine, and he completed residency and fellowship training in general internal medicine at Brigham and Women’s Hospital, Harvard Medical School. He is a former President of the Society of General Internal Medicine, and he was elected to the National Academy of Medicine in 2017.
Christina Severin is a leading health care executive with more than 20 years of experience and numerous accomplishments in managed care, delivery systems, health insurance, Accountable Care Organizations, quality, public policy, and public health. She has led Community Care Cooperative (C3) since the organization’s launch in 2016, leveraging the proven best practices of ACOs throughout the country, building the organization on the collective strengths of its health centers, and growing the organization to better serve MassHealth members throughout the commonwealth. Christina’s prior leadership experience includes serving as President and Chief Executive Officer of Beth Israel Deaconess Care Organization and as President of Network Health, a nonprofit Massachusetts health plan.
Dr. Judy Zerzan-Thul is the Chief Medical Officer at Washington State Health Care Authority, Co-Chair of the LAN Care Transformation Executive Forum, and a general internal medicine physician. She leads the state of Washington’s Medicaid Transformation Project, where she collaborates with stakeholders to advance health equity and the innovative use of data. As Chief Medical Officer of the Washington State Health Care Authority, she administers the state’s Medicaid program. She also works to advance the LAN’s strategic objectives to drive equitable health outcomes and lower the total cost of care.
Dr. Zerzan-Thul specializes in value-based payment models and healthcare financing. Prior to her role as the Chief Medical Officer for Washington State, Dr. Zerzan-Thul was the Chief Medical Officer at the Colorado Department of Health Care Policy and Financing. She led the implementation of the Affordable Care Act (ACA) in Colorado. She has extensive experience designing and implementing health plans and benefits for Medicaid programs. Dr. Zerzan-Thul’s background also includes leadership positions in the Medicaid Medical Director’s Network. She has also served as a committee member and advisor for national organizations, including the Agency for Healthcare Research and Quality, the National Quality Forum, the National Committee for Quality Assurance, the National Academy for State Health Policy, the Patient-Centered Outcomes Research Institute, and the Centers for Medicare & Medicaid Services.
Dr. Zerzan-Thul holds a Doctor of Medicine from Oregon Health and Science University and received a Master of Public Health in Health Policy and Administration from the University of North Carolina. She completed the Robert Wood Johnson Clinical Scholars Program at the University of Washington/VA Puget Sound Health Care System in 2007. From 2008 to 2010, she was a non-residential Health and Aging Policy Fellow for the office of Senator John D. Rockefeller IV of West Virginia, where she supported public policy for the Affordable Care Act.
Elizabeth Kasper is the Special Policy Advisor for Alternative Payment Models at North Carolina Medicaid. In this role, she works with external and internal stakeholders to support the design and implementation of value-based payment models and policies that advance NC Medicaid’s priorities. Liz’s 20-year career in health policy and health services research has also included work on health quality and public health measures, federally qualified health centers, Medicaid clinical policy, and pharmaceutical regulation and reimbursement. Liz holds a Master of Science in Public Health from the University of North Carolina at Chapel Hill and a BA from Oberlin College.
Alicia Berkemeyer is responsible for all programs related to provider networks, value-based programs, primary care, and commercial pharmacy for Arkansas Blue Cross and Blue Shield and its affiliates. She has led and managed the development of patient-centered medical homes, employer clinics, and pharmacy programs. Berkemeyer played an instrumental role in Arkansas being chosen as one of only seven regions in the United States to participate in the federal Comprehensive Primary Care initiative and assisted the state in receiving significant funding from the Center for Medicare & Medicaid Innovation in the form of a State Innovation Model grant.
Dr. Palav Babaria was appointed Chief Quality Officer and Deputy Director of Quality and Population Health Management of the California Department of Health Care Services beginning in March 2021. Prior to joining DHCS, she served as Chief Administrative Officer for Ambulatory Services at the Alameda Health System (AHS) where she was responsible for all outpatient clinical operations, quality of care, and strategy for primary care, specialty care, dental services, and integrated and specialty behavioral health, as well as executive sponsor for value-based programs including the Medi-Cal 1115 Waiver. She also previously served as Medical Director of K6 Adult Medicine Clinic, where she managed a large urban hospital-based clinic, overseeing all practitioners, improving quality of care, and patient safety programs. In addition, she served on the Clinical Advisory Committee with the California Association of Public Hospitals/Safety Net Institute. She also has over a decade of global health experience and her work has been published in the New England Journal of Medicine, Academic Medicine, Social Science & Medicine, L.A. Times, and New York Times. Dr. Babaria received her bachelor’s degree from Harvard College, as well as her MD and Master’s in health science from Yale University. She completed her residency training in internal medicine and global health fellowship at the University of California, San Francisco.
Chiquita Brooks-LaSure is the Administrator for the Centers for Medicare and Medicaid Services (CMS), where she oversees programs including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the HealthCare.gov health insurance marketplace.
A former policy official who played a key role in guiding the Affordable Care Act (ACA) through passage and implementation, Brooks-LaSure has decades of experience in the federal government, on Capitol Hill, and in the private sector.
As deputy director for policy at the Center for Consumer Information and Insurance Oversight within the Centers for Medicare & Medicaid Services, and earlier at the Department of Health & Human Services as director of coverage policy, Brooks-LaSure led the agency’s implementation of ACA coverage and insurance reform policy provisions.
Earlier in her career, Brooks-LaSure assisted House leaders in passing several healthcare laws, including the Medicare Improvements for Patients and Providers Act of 2008 and the ACA, as part of the Democratic staff for the U.S. House of Representatives’ Ways and Means Committee.
Brooks-LaSure began her career as a program examiner and lead Medicaid analyst for the Office of Management and Budget, coordinating Medicaid policy development for the health financing branch. Her role included evaluating policy options and briefing White House and federal agency officials on policy recommendations regarding the uninsured, Medicaid, and the Children’s Health Insurance Program.
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Dr. Chris Chen is Chief Executive Officer of ChenMed, a premier physician-led, technology-enabled healthcare organization. A champion for equitable health outcomes, ChenMed is transforming the care of underserved, overlooked seniors.
Dr. Chen is a bold innovator leading a revolution in healthcare through a global full-risk model; custom-designed physician training programs; and a proprietary technology platform, purpose-built for value-based care. He has led ChenMed to remarkable outcomes – equalized health inequities, 30-50% fewer hospitalizations, and high net promoter scores.
Since becoming ChenMed’s CEO in 2009, Dr. Chen has built the decades-old, highly successful ChenMed model into a scalable organization now spanning dozens of cities across many states.
ChenMed’s unique approach, proprietary technological capabilities, and results have led it to be named to Newsweek’s “Most Loved Workplaces” list, Fortune Magazine’s “Change the World” list, as well as earning recognition by the White House, the Department of Health and Human Services, and the U.K. National Health System. ChenMed has also been featured in publications such as Modern Healthcare, Health Affairs, Forbes, The Economist, Wall Street Journal, New England Journal of Medicine, The Guardian, and Medical Economics – which named ChenMed, “Best Primary Care System in the U.S.”
Under Dr. Chen’s leadership, ChenMed has also won multiple best places to work awards, including being certified a “Great Place to Work®” by the Great Place to Work Institute in 2021 and honored as the only primary care medical practice on the IDG Insider Pro and Computerworld “Best Place to Work in IT” list.
Brought up in South Florida, Dr. Chen graduated from the University of Miami’s Honors Program in Medicine. He went on to complete his medical training at Beth Israel Deaconess, a Harvard University teaching hospital, after which he completed a fellowship in cardiology at Cornell University Medical College in Manhattan, New York. A board-certified cardiologist, Dr. Chen sees patients at the company’s Miami Gardens, Florida medical center.
Marc Harrison, M.D., president and CEO of Intermountain Healthcare, is a pediatric critical care physician and recognized national and international leader in healthcare transformation. His leadership has placed him on Fortune’s Top 50 World’s Greatest Leaders in 2019 and regularly on Modern Healthcare’s Most Influential People in Healthcare.
Dr. Harrison leads Intermountain’s 59,000 employees—called caregivers—to reimagine operations and ways to keep people and communities healthier. Together, their mission-driven approach fuels their vision to build a model health system that delivers the best and most equitable outcomes by providing high-quality, more affordable care that is accessible to everyone.
To support this, Dr. Harrison has embraced unconventional, public-private partnerships to confront some of the most pressing systemic challenges facing the communities and industry. Under his leadership, Intermountain partnered with 1,400 hospitals nationwide to launch Civica Rx, a nonprofit generic drug manufacturer and distributor, to make generic medications—to include insulin in 2024—more accessible and far more affordable. Intermountain is also a founding member of the Utah Alliance for the Determinants of Health, which is a collaboration of community partners proactively addressing forces that affect people’s health often before they get sick. Also, Intermountain is partnering with an international genomics leader and more than 100,000 volunteers to advance medical breakthroughs that will help prevent and treat genetic diseases for people around the globe.
In Dr. Harrison’s first five years leading Intermountain, the company’s primary service area grew from focusing mainly on Utah communities to serving people throughout the Mountain West through a disciplined growth strategy and significant investments in telehealth and rural health. His leadership style has helped make Intermountain a magnet for healthcare innovation. This includes spurring new partnerships leading the national movement toward value-based care, advancing clinical education, and establishing a new Digital Hippocratic Oath to improve hospital data interoperability and secure patient privacy rights.
On his popular podcast, A Healthier Future, Dr. Harrison interviews leaders from an array of industries and backgrounds to explore how we can work together to improve health. He is among the most influential healthcare leaders on LinkedIn (320,000 followers)—regularly engaging in conversations about his team, health innovation, family, and leadership.
Before leading Intermountain, Dr. Harrison served as CEO of Cleveland Clinic Abu Dhabi, chief of international business development at Cleveland Clinic, and chief medical operations officer at Cleveland Clinic. He received his undergraduate degree from Haverford College, his medical degree from Dartmouth Medical School, completed a pediatric residency and pediatric critical care fellowship at Intermountain’s Primary Children’s Hospital, and a Master of Medical Management at Carnegie Mellon University.
Dr. Harrison is an all-American triathlete and represented the U.S. at the 2014 World Championships. He is also a two-time cancer survivor, with his sights currently on completing an Ironman. He is also a loving husband and proud father of three adult children.
Dr. William Shrank is Humana’s Chief Medical Officer (CMO). He leads the Integrated Health Solutions team that consists of several key clinical areas of the business. Dr. Shrank oversees Humana’s senior-focused, purpose driven, primary care organization, and guides the implementation of Humana’s integrated care delivery strategy, with an emphasis on advancing the company’s clinical capabilities. He launched Humana’s health equity department, Humana’s population health strategy (the Bold Goal), and the Humana Healthcare Research team. Across all divisions, Dr. Shrank promotes the idea of Humana as a learning organization and has dedicated his team to rapid learning – where meaningful insights are generated accurately and quickly, and enhance Humana’s ability to continually evolve to improve the health and health outcomes of those we serve.
Dr. Shrank is a member of the Management Team, which sets the firm’s strategic direction, and reports and to President and Chief Executive Officer, Bruce Broussard. Additionally, Dr. Shrank serves on the Board of National Committee for Quality Assurance and is co-chair of the Clinical Transformation Taskforce for the Health Care Payment Learning and Action Network.
Dr. Shrank joined Humana in April 2019 having previously been employed by the University of Pittsburgh Medical Center (UPMC) as CMO, Insurance Services Division from 2016 to 2019. At UPMC, Dr. Shrank was responsible for clinical operations, policy and quality for approximately 3.5 million members in government and commercial lines of business.
Prior, Dr. Shrank served as SVP, Chief Scientific Officer, and CMO of Provider Innovation at CVS Health from 2013 to 2016. From 2011 to 2013, Dr. Shrank served as Director, Research and Rapid[1]Cycle Evaluation Group, for the Center for Medicare and Medicaid Innovation, part of the Centers for Medicaid and Medicare Services.
Dr. Shrank began his career as a practicing physician with Brigham and Women’s Hospital and as an Assistant Professor at Harvard Medical School.
Dr. Shrank completed his medical degree from Cornell University Medical College, his residency in internal medicine at Georgetown University and his fellowship in Health Policy Research at the University of California, Los Angeles. He also earned a Master of Science degree in Health Services from the University of California, Los Angeles and a Bachelor of Arts degree from Brown University.
Mark McClellan, MD, PhD, is Director and Robert J. Margolis, M.D., Professor of Business, Medicine and Policy at the Margolis Center for Health Policy at Duke University. He is a physician-economist who focuses on quality and value in health care, including payment reform, real-world evidence and more effective drug and device innovation. Dr. McClellan is at the center of the nation’s efforts to combat the pandemic, the author of COVID-19 response roadmap, and co-author of a comprehensive set of papers and commentaries that address health policy strategies for COVID vaccines, testing, and treatments, nationally and globally. He is former administrator of the Centers for Medicare & Medicaid Services and former commissioner of the U.S. Food and Drug Administration, where he developed and implemented major reforms in health policy. Dr. McClellan is an independent board member on the boards of Johnson & Johnson, Cigna, Alignment Healthcare, and PrognomIQ; co-chairs the Guiding Committee for the Health Care Payment Learning and Action Network; and serves as an advisor for Arsenal Capital Group, Blackstone Life Sciences, and MITRE.
Dr. Judy Zerzan-Thul is the Chief Medical Officer at Washington State Health Care Authority, Co-Chair of the LAN Care Transformation Executive Forum, and a general internal medicine physician. She leads the state of Washington’s Medicaid Transformation Project, where she collaborates with stakeholders to advance health equity and the innovative use of data. As Chief Medical Officer of the Washington State Health Care Authority, she administers the state’s Medicaid program. She also works to advance the LAN’s strategic objectives to drive equitable health outcomes and lower the total cost of care.
Dr. Zerzan-Thul specializes in value-based payment models and healthcare financing. Prior to her role as the Chief Medical Officer for Washington State, Dr. Zerzan-Thul was the Chief Medical Officer at the Colorado Department of Health Care Policy and Financing. She led the implementation of the Affordable Care Act (ACA) in Colorado. She has extensive experience designing and implementing health plans and benefits for Medicaid programs. Dr. Zerzan-Thul’s background also includes leadership positions in the Medicaid Medical Director’s Network. She has also served as a committee member and advisor for national organizations, including the Agency for Healthcare Research and Quality, the National Quality Forum, the National Committee for Quality Assurance, the National Academy for State Health Policy, the Patient-Centered Outcomes Research Institute, and the Centers for Medicare & Medicaid Services.
Dr. Zerzan-Thul holds a Doctor of Medicine from Oregon Health and Science University and received a Master of Public Health in Health Policy and Administration from the University of North Carolina. She completed the Robert Wood Johnson Clinical Scholars Program at the University of Washington/VA Puget Sound Health Care System in 2007. From 2008 to 2010, she was a non-residential Health and Aging Policy Fellow for the office of Senator John D. Rockefeller IV of West Virginia, where she supported public policy for the Affordable Care Act.
Marshall H. Chin, M.D., M.P.H., is the Richard Parrillo Family Professor of Healthcare Ethics in the Department of Medicine at the University of Chicago, Co-Chair of the Centers for Medicare and Medicaid Services Health Care Payment Learning and Action Network Health Equity Advisory Team, and Co-Director of the Robert Wood Johnson Foundation Advancing Health Equity: Leading Care, Payment, and Systems Transformation National Program Office. Dr. Chin is a practicing general internist and health services researcher who has dedicated his career to reducing health disparities through interventions at individual, organizational, community, and policy levels. Through Advancing Health Equity he collaborates with teams of state Medicaid agencies, Medicaid managed care organizations, frontline healthcare organizations, and communities to discover best practices for advancing health equity by fostering payment reform and sustainable care models to eliminate health and healthcare disparities. He also applies ethical principles to reforms to reduce health disparities, discussions about a culture of equity, and what it means for health professionals to care and advocate for their patients. Dr. Chin is a former President of the Society of General Internal Medicine and was elected to the National Academy of Medicine in 2017.
Marc Harrison, M.D., president and CEO of Intermountain Healthcare, is a pediatric critical care physician with a proven track record as a top operations executive on a global scale. He is a national and international thought leader on transformation and innovation—ranking in Fortune’s Top 50 World’s Greatest Leaders in 2019. He also ranked third on Modern Healthcare’s 100 Most Influential People in Healthcare in 2020.
Dr. Harrison is leading Intermountain’s 41,000 employees —who are all called caregivers—to embrace bold new approaches to improve health, re-define value-based care, and serve people in new ways. For example, Intermountain launched Civica Rx, a not-for-profit generic drug manufacturer and distributor, to make generic medications more available and affordable in hospitals across the nation. Intermountain is also a founding member of the Utah Alliance for the Determinants of Health, which is a collaboration of community partners designed to proactively address forces that affect people’s health well before they come to a clinic or a hospital.
Dr. Harrison also served as CEO of Cleveland Clinic Abu Dhabi, chief of international business development at Cleveland Clinic, and chief medical operations officer at Cleveland Clinic.
He received his undergraduate degree from Haverford College, his medical degree from Dartmouth Medical School, completed a pediatric residency and pediatric care fellowship at Intermountain’s Primary Children’s Hospital, and a Master of Medical Management at Carnegie Mellon University.
Dr. Harrison is an all-American triathlete and represented the U.S. at the 2014 World Championships. He is also a two-time cancer survivor, with his sights currently on completing an Ironman.
Emily DuHamel Brower, M.B.A., is senior vice president of clinical integration and physician services for Trinity Health. Emphasizing clinical integration and payment model transformation, Ms. Brower provides strategic direction related to the evolving accountable healthcare environment with strong results. Her team is currently accountable for $10.4B of medical expense for 1.6M lives in Medicare Accountable Care Organizations (ACOs), Medicare Advantage, and Medicaid and Commercial Alternative Payment Models.
Ms. Brower joined Trinity Health from Atrius Health in Massachusetts, where she last served as vice president of Population Health. There, she built and executed the essential capabilities required to achieve strong financial and clinical outcomes within integrated care models under value-based reimbursement, particularly for publicly insured populations.
Prior to her career at Atrius Health, Ms. Brower spent 15 years in leadership roles at Urban Medical Group, a Massachusetts nonprofit healthcare organization specializing in the care of medically complex, chronically ill populations across a community-based, long-term care continuum. During that time, Ms. Brower launched a Program of All-inclusive Care for the Elderly (PACE) program and other innovative, capitated contracts for medically complex populations and served as Principal Investigator for a multi-year research project analyzing cost and quality outcomes to support payment reform.
Ms. Brower received her B.A. from Smith College and her M.B.A. from the New York University Stern School of Business.
Dr. William Shrank is Humana’s Chief Medical Officer. His responsibilities include implementing Humana’s integrated care delivery strategy, with an emphasis on advancing the company’s clinical capabilities and core objective of improving the health outcomes of our members. He leads Humana’s Care Delivery Organization, clinical operations, and the Bold Goal population health strategy. Dr. Shrank most recently held the position of Chief Medical and Corporate Affairs Officer (July 2019-July 2021) during which time he reorganized and advanced our government affairs division. He is a member of the Management Team, which sets the firm’s strategic direction, and reports and to President and Chief Executive Officer, Bruce Broussard. Additionally, Dr. Shrank serves on the Board of National Committee for Quality Assurance and is co-chair of the Clinical Transformation Taskforce for the Health Care Payment Learning and Action Network. Dr. Shrank joined Humana in April 2019, having previously been employed by the University of Pittsburgh Medical Center (UPMC) where he served as Chief Medical Officer, Insurance Services Division from 2016 to 2019. At UPMC, Dr. Shrank was responsible for clinical operations, policy and quality for approximately 3.5 million members in Medicare, Medicaid, behavioral health, Managed Long Term Services & Supports and commercial lines of business. He also developed and evaluated population health programs to further advance the medical center’s mission as an integrated delivery and financing system. Previously, Dr. Shrank served as Senior Vice President, Chief Scientific Officer, and Chief Medical Officer of Provider Innovation at CVS Health from 2013 to 2016. Prior to joining CVS Health, Dr. Shrank served as Director, Research and Rapid-Cycle Evaluation Group, for the Center for Medicare and Medicaid Innovation, part of the Centers for Medicaid and Medicare Services from 2011 to 2013, where he led the evaluation of all payment and health system delivery reform programs and developed the rapid-cycle strategy to promote continuous quality improvement. Dr. Shrank began his career as a practicing physician with Brigham and Women’s Hospital in Boston and as an Assistant Professor at Harvard Medical School. His research at Harvard focused on improving the quality of prescribing and the use of chronic medications. He has published more than 250 papers on these topics. Dr. Shrank received his medical degree from Cornell University Medical College, and completed his residency in internal medicine at Georgetown University and his fellowship in Health Policy Research at the University of California, Los Angeles. He also earned a Master of Science degree in Health Services from the University of California, Los Angeles and a Bachelor of Arts degree from Brown University.
Karen Dale is the Market President for AmeriHealth Caritas’ Medicaid managed care organization in Washington, D.C. In addition to her role as Market President, Dale was appointed to AmeriHealth Caritas’ newly created position of Chief Diversity, Equity, and Inclusion Officer. Having held multiple positions of leadership during the past two decades, Dale has worked with a broad group of stakeholders to address policies and other key factors impacting the delivery of health care services. In addressing the range of needs experienced by the nation’s vulnerable populations, Dale has cultivated a focus that has helped AmeriHealth Caritas concurrently innovate, while meeting the highest levels of quality and service. These efforts include the use of digital tools to aid in the management of chronic diseases, peer-to-peer outreach using community health workers and peer specialists, and the use of a human-centered design member engagement approach. Dale’s vision is notably reflected in key programs addressing Black maternal health, racism, housing, transportation, violence interruption, and food insecurity. In addition, her philosophy that healthcare must evolve into a health ecosystem that promotes, wellness, without barriers, starting where people are, has led to several collaborative relationships with providers, community partners, philanthropists, and businesses to implement sustainable, scalable solutions with high impact.
Ms. Dale was a member of the Leadership Greater Washington Class of 2003. She serves as a board member for both Volunteers of America National Services and the Volunteers of America National Board, as well as the Access to Justice Commission.
Ms. Dale holds a Master of Science degree in psychiatric mental health nursing from The Catholic University, Washington, D.C., and a Bachelor of Science degree in nursing from George Mason University, Fairfax, Virginia.
Andrea Gelzer, MD, MS, FACP has had the roles of senior vice president medical affairs and corporate chief medical officer at AmeriHealth Caritas for more than a decade. At AmeriHealth Caritas, she has been responsible for the development of the company’s integrated care management model, deployed new approaches to alternative/value-based provider payment, developed many innovative population health management strategies for vulnerable populations and built corporate infrastructure to sustain significant growth. She serves as the key clinical spokesperson and policy advocate for the company.
Dr. Gelzer currently serves on several influential industry committees Health and Human Service (HHS) Health Care Payment Learning and Action Network (LAN) Care Transformation Forum (CTF), the Core Quality Measures Collaborative (CQMC) Steering Committee, and the executive committee for the Gravity Project. She is a member of the Board of Directors for the American Telemedicine Association (ATA) and is the immediate past Chairman of the Board of Directors of HealthShare Exchange (HSX), Philadelphia’s regional health information exchange. Dr. Gelzer earned her undergraduate degree from Tufts University, her doctor of medicine from St. George’s University, and a master’s degree in preventive medicine/administrative medicine at the University of Wisconsin, Madison. She is certified by the American Board of Internal Medicine and by the American Board of Preventive Medicine in clinical informatics.
Karen Dale is the Market President for AmeriHealth Caritas’ Medicaid managed care organization in Washington, D.C. In addition to her role as Market President, Dale was appointed to AmeriHealth Caritas’ newly created position of Chief Diversity, Equity, and Inclusion Officer. Having held multiple positions of leadership during the past two decades, Dale has worked with a broad group of stakeholders to address policies and other key factors impacting the delivery of health care services. In addressing the range of needs experienced by the nation’s vulnerable populations, Dale has cultivated a focus that has helped AmeriHealth Caritas concurrently innovate, while meeting the highest levels of quality and service. These efforts include the use of digital tools to aid in the management of chronic diseases, peer-to-peer outreach using community health workers and peer specialists, and the use of a human-centered design member engagement approach. Dale’s vision is notably reflected in key programs addressing Black maternal health, racism, housing, transportation, violence interruption, and food insecurity. In addition, her philosophy that healthcare must evolve into a health ecosystem that promotes, wellness, without barriers, starting where people are, has led to several collaborative relationships with providers, community partners, philanthropists, and businesses to implement sustainable, scalable solutions with high impact.
Ms. Dale was a member of the Leadership Greater Washington Class of 2003. She serves as a board member for both Volunteers of America National Services and the Volunteers of America National Board, as well as the Access to Justice Commission.
Ms. Dale holds a Master of Science degree in psychiatric mental health nursing from The Catholic University, Washington, D.C., and a Bachelor of Science degree in nursing from George Mason University, Fairfax, Virginia.
Frederick Isasi, J.D., M.P.H., is executive director of Families USA (FUSA), one of the nation’s leading nonpartisan, nonprofit health care advocacy organizations established to ensure that all people receive high-quality, affordable, consumer-centered care.
A national thought-leader and subject matter expert on the social issues and solutions related to driving value and equity into health care and providing high-quality coverage, Isasi draws on decades of experience in the health care industry, public policy, and law. In doing so, he advances a pragmatic and intersectional policy agenda for achieving better health at lower costs and reducing systemic inequities in the American health system.
Under Isasi’s leadership, FUSA advocates for issues such as fair drug pricing, racial equity, maternal and child health, and ending surprise medical bills. He also works to strengthen and protect policies such as the Affordable Care Act (ACA), Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), and Oral Health for All.
Isasi founded FUSA’s National Center for Coverage Innovation to help state and federal policymakers and consumer leaders develop and implement pragmatic, nonpartisan approaches to expand and improve health care coverage. He also founded and directs FUSA’s Center on Health Equity Action for System Transformation, the only national entity exclusively dedicated to developing and advancing patient-centered health system transformation policies designed to reduce racial, ethnic, and geographic inequities.
Isasi’s work and experience flow from his life-long commitment to achieving high-quality, affordable health care for all. That passion stems from growing up in North Carolina as the son of Cuban immigrants. He saw first-hand the health care barriers families in poverty, people of color, people with language barriers, and rural communities generally experienced.
Isasi’s passion for change drove his extensive academic accomplishments. He was a Powers-Knapp Scholar at the University of Wisconsin, where he earned a B.S. in Cellular Biology. He earned a Master of Public Health from the University of North Carolina and was inducted into both the Delta Omega and the Frank Porter Graham honor societies. He obtained a J.D. from the Duke University School of Law, where he was a Pamela B. Gann Scholar and a staff editor of the Duke Journal of Gender Law and Policy.
After receiving his Masters in Public Health, Isasi worked as a senior policy advisor at the District of Columbia Primary Care Association, working on issues such as the Master Tobacco Settlements and Medicaid reimbursement. After law school, Frederick joined the international law firm Powell Goldstein (now called Bryan Cave LLP) as a health care attorney with a practice that focused on representing public hospitals and health systems, immigrant health care issues and state Medicaid programs.
Isasi then joined New Mexico Democratic Sen. Jeff Bingaman’s staff, serving as senior legislative counsel for health care to the Senate Finance Committee and the Committee on Health, Education, Labor, and Pensions. Isasi was Senator Binagaman’s principal negotiator throughout closed-door, bipartisan negotiations. He was also the Senator’s advisor and chief negotiator for the CHIP Reauthorization Act of 2009. And he directed Bingaman’s efforts to address Medicare and health care challenges systematically caused by low-income, cultural and racial disparities.
Upon leaving his Senate position, Isasi became vice president for health policy at the Advisory Board Company, a leading international organization that advises 3,100 hospitals, health systems, provider groups, and payers. He founded its health Policy Department. Under Isasi’s leadership, the company leveraged the power of health system data and developed evidence-based policy solutions for modern health care challenges. He also bolstered the company’s work with policymakers in Congress, the Obama Administration, and the states to improve health care transformation efforts across the nation.
After leaving the Advisory Board, Isasi led the health division at the bipartisan National Governors Association’s (NGA) Center for Best Practices. He worked directly with governors of both parties and served as the organization’s national voice on health care delivery and payment reform, improving Medicaid and health exchange planning and oversight. He also directed technical assistance for states as they navigated changes to their health care systems due to national policy shifts.
Isasi frequently testifies on health policy issues in both the Senate and House of Representatives. His public, private, and advocacy work gives Isasi deep expertise in Medicaid, Medicare, private health insurance, health equity, payment, and delivery reform, and the social determinants of health as they intersect with health care quality and payment and equity issues. A skilled communicator able to explain complex issues clearly, he is a sought-after national speaker on health care affordability issues, Medicaid, state health care innovation, health system transformation, and behavioral health.
Isasi has served on a myriad of panels and boards at institutions such as the National Academy of Medicine, the Brookings Institution, the National Committee for Quality Assurance, Duke University’s Margolis Center for Health Policy, Catalyst for Payment Reform, the Health Care Payment Learning & Action Network and Bipartisan Policy Center. He is regularly featured in national outlets, including The New York Times, NBC, Bloomberg, The Wall Street Journal, and The Washington Post.
A Cuban-American, Isasi is a proud member of the LGBTQ+ community and resides in Washington, D.C.
Marshall Chin, the Richard Parrillo Family Professor of Healthcare Ethics at the University of Chicago and a practicing general internist and health services researcher, has dedicated his career to reducing health disparities through interventions at individual, organizational, community, and policy levels. He has elucidated practical approaches to improving care of diverse individual patients and addressing systemic, structural drivers of disparities in the health care system. Through the Robert Wood Johnson Foundation Advancing Health Equity: Leading Care, Payment and Systems Transformation program, Dr. Chin collaborates with teams of state Medicaid agencies, Medicaid managed care organizations, and frontline healthcare delivery organizations to implement payment reforms to support and incentivize care transformations that advance health equity. He also partners with eight urban and rural communities to integrate medical and social care to reduce diabetes disparities through the Merck Foundation Bridging the Gap program.
Dr. Chin is a former President of the Society of General Internal Medicine (SGIM) and has won mentoring awards from SGIM and the University of Chicago. He was elected to the National Academy of Medicine in 2017.
Dr. Chin is a graduate of Harvard College and the University of California at San Francisco School of Medicine, and he completed residency and fellowship training in general internal medicine at Brigham and Women’s Hospital, Harvard Medical School.
Focusing on appropriateness, care variation, and person-centered care for all patients through dissemination of best practices.
Reducing disparities and improving health equity through reallocation of resources to address SDOH (e.g., housing, food insecurity, transportation).
Improving predictability for providers through improved risk adjustment for complex patients, offering stronger incentive structures for Medicaid beneficiaries, and flexibility on waivers.
Providers who are successful in FFS may lack a compelling reason to transition to APMs, but may be unable to compete with the person-centered care delivered by providers in APMs. Introducing APMs through multi-payer pilots in these markets (particularly for independent and smaller providers) may increase competition and reduce FFS entrenchment.
Ensuring providers adopt timely data and analytics capabilities, combining multiple data sources (e.g., electronic health record and claims data), to enable successful participation in value-based payment models.
Providing patients and caregivers with cost, quality, and appropriateness of care data in an actionable, easily understood, and accessible manner. Ensuring that electronic data can be easily shared meeting advanced technology standards (e.g., HL7 FHIR) to improve care delivery.
