Welcome to another episode of Care Decoded, the show where we break down the complexities of risk adjustment, documentation, and AI to power better healthcare. In today’s episode, host Dr. Sunil Nihalani is joined by Subbu Ramalingam — a seasoned former health plan executive and expert at the intersection of star ratings, risk adjustment, and healthcare quality.

Together, Sunil and Subbu dig into why star ratings aren’t just about checking boxes, but about truly improving patient care and experience. They discuss how health plans and providers can bridge the often-siloed worlds of risk adjustment and quality improvement and why accurate data and collaboration are key to better — and more meaningful — outcomes.

You’ll hear real-world examples illustrating how documentation and coding impact patient care, the latest updates on CMS risk adjustment data validation (RADV) audits, and why aligning risk and quality programs matters more than ever. Plus, Subbu shares actionable advice for healthcare leaders looking to turn mountains of data into engines for quality while keeping the patient at the center of it all.

If you’re a healthcare leader, clinician, or just passionate about making sense of the care ecosystem, this episode is packed with the insights you need to help decode the path toward better care. Let’s dive in!

Timestamps:

00:00 Data's Role in Meaningful Care

04:01 Optimizing Patient Care Experience

09:37 Risk Adjustment and Eligibility Alignment

14:00 Coordinating Care for Diabetic Members

17:48 CMS Launches Overdue RAD Audits

20:29 Enhancing Health Plan Audit Processes

22:35 Healthcare Industry Shift Forecast

27:16 Health Plan Overdocumentation Issues

31:02 Healthcare System Risk Score Management

33:38 Aligning Health KPIs and Outcomes

35:56 Chronic Care Spending Concerns

40:19 Healthcare Data Interoperability Challenges

43:18 Integrating Home Data in Care

Subbu Ramalingham - https://www.linkedin.com/in/subburamalingam/

ATTAC Consulting Group (ACG) - https://www.attacconsulting.com/

Podcast's Website - https://caredecoded.com/

Dr. Sunil Nihalani - CEO and Founder at Inferscience - https://www.linkedin.com/in/sunil-nihalani-a6983a5/

Inferscience - https://www.inferscience.com/

Podcast Powered by TopHealth - https://tophealth.care/

Welcome to the very first episode of Care Decoded, where we peel back the layers of healthcare innovation with people who are reshaping the industry from the inside. In this episode, Dr. Sunil Nihalani, Founder and CEO at Inferscience, dives into his unconventional journey from his childhood in India where his family was far from medicine to the creation of Inferscience, a company dedicated to making risk adjustment and clinical documentation more efficient for physicians and payers.

Sunil tackles some of the most pressing challenges in healthcare today, like navigating clunky electronic medical records (EMRs), the true pain points behind documentation, and how artificial intelligence is poised to actually help rather than just add to the hype. Sunil shares personal stories from his career, what inspired him to move from bedside care to tech entrepreneurship, and why he believes thoughtful technology can actually give doctors back the time and passion for patient care.

If you’re a physician bogged down by endless paperwork, a healthcare leader or a payer looking for real examples of AI making a difference, or just curious about how risk adjustment is impacting patient care and funding, this episode will inspire and maybe even challenge your views. Let’s get decoding!

Timestamps:

00:00 Improving Patient Care with EMRs

06:09 Unexpected Breakthrough in Risk Adjustment

09:37 Importance of Accurate Medical Documentation

11:21 AI Scribes Improve Clinical Efficiency

16:21 Physician Data Review Challenges

18:27 Physician-Led Healthcare AI Innovation

22:18 Medical Imaging & Prior Authorization Rules

25:10 Global Tool for Physician Data Summarization

26:58 Balancing Gratification and Business Challenges

Podcast's Website - https://caredecoded.com/

Dr. Sunil Nihalani - CEO and Founder at Inferscience - https://www.linkedin.com/in/sunil-nihalani-a6983a5/

Inferscience - https://www.inferscience.com/

Podcast Powered by TopHealth - https://tophealth.care/

Care Decoded is the go-to podcast for clinicians, health plan leaders, and quality champions navigating the evolving world of risk adjustment, value-based care, and smarter documentation. Hosted by Inferscience, this show takes you inside the workflows, decisions, and technologies that turn clinical complexity into clarity. From demystifying HCCs and RAF scores to decoding CMS changes and exploring the impact of AI, we help you understand the data behind every diagnosis.

This show isn't about theory. It's about impact. Not about compliance. But confidence. Not about more clicks. But clarity at the point of care.

If you're building the future of care – one chart, one visit, one code at a time – Care Decoded is your ultimate guide.

Podcast's Website - https://caredecoded.com/

Dr. Sunil Nihalani - CEO and Founder at Inferscience - https://www.linkedin.com/in/sunil-nihalani-a6983a5/

Inferscience - https://www.inferscience.com/

Podcast Powered by TopHealth - https://tophealth.care/