Welcome to another insightful episode of The Healthcare STARcast! In today’s discussion, our host Subbu Ramalingam sits down with industry veterans Mark S. Ryan and Neetu Rajpal to dive deep into the current state and future of Medicare Advantage STARS, data-driven success, and the evolving external forces shaping the healthcare landscape.

Coming fresh off recent developments, including the Plan Preview 2 cut point release, our guests examine the mounting pressures facing health plans, from inflation and utilization spikes to regulatory changes and technological innovation. Mark shares his extensive experience in both government and private health plans, while Neetu offers a tech-forward perspective on breaking down data silos and leveraging real-time analytics for improved member care.

Whether you’re a health plan leader, a provider, or simply intrigued by the changing dynamics of healthcare quality ratings, this episode is packed with practical strategies, thoughtful perspectives on AI adoption, and a candid look at how plans can use technology to close care gaps and stay ahead in the STARS game.

Tune in for a conversation that’s as optimistic as it is realistic, delivering actionable takeaways for the months ahead!

Timrstamps:

00:00 Healthcare STARcast: Stars & Medicaid Insights

04:12 Building a Unified Health Data System

08:28 Health Plans' Strategic Missteps

11:09 Improving Patient Care with Timely Data

15:37 "Assessing Progress and Future Uncertainty"

16:29 Maximizing Performance in Final Quarter

21:40 Comprehensive Analytics Platform Launch

22:45 Rapid Insights & AI in Healthcare

26:54 Drug Measures Impact Performance Score

29:36 Addressing Drug Measure Performance

34:01 Redefining Health Equity Strategy

38:35 Optimizing Care with Voice Agents

40:08 Cautious AI in Clinical Decisions

45:00 Flexible AI Governance Principles

46:37 "Heartfelt Gratitude"

Show Website - https://healthcarestarcast.com/

Subbu Ramalingam - Show Host - Linkedin - https://www.linkedin.com/in/subburamalingam/

FloWise Leadership - https://flowiseleadership.com/

ViVega Business Services - https://www.vivega.co/

ATTAC Consulting Group - https://www.attacconsulting.com/

Media Partner - TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Welcome back to another episode of The Healthcare STARcast! In this powerful conversation, Subbu Ramalingam is joined by industry thought leader and serial entrepreneur John Gorman for an unfiltered deep dive into the seismic policy changes shaking up Medicare Advantage and the healthcare landscape at large. Recorded on August 19th, this episode tackles head-on the fallout from recent legislation, what John refers to as the “biggest change in 35 years”, and explores its sweeping impact on health plans, providers, and, most importantly, vulnerable seniors and dual eligibles.

From discussions about the devastating effects of Medicaid cuts and looming Medicare sequestration to urgent warnings about the future of social services, John offers a frank, expert perspective on the “war on the poor” and why health plan leaders need to rethink benefit design, focusing on the real needs of members, like food, housing, and transportation. Subbu and John also dig into the operational pressures facing plans, the inefficiencies of prior authorization, the coming storm of risk adjustment audits, and what leaders at every level should be doing now to prepare.

If you’re a health plan executive or boots-on-the-ground operator, this is essential listening for navigating one of the most challenging periods in American healthcare. Get ready for actionable insights, candid advice, and a rallying call for courageous leadership and member-centric innovation as we step into uncharted territory together.

Timestamps:

00:00 "Health Bill's Impact on Medicare"

05:30 Severe Cuts Impact Seniors and Disabled

08:28 Doge Effect Alters Social Security

12:17 PPO Retreat Signals Industry Worries

14:53 Reimagining Administrative Benefits for 2026

20:01 Improving Provider Network Accuracy

22:48 Risk Adjustment Data Accuracy Focus

27:20 Impact of Costs on Mid-Tier Plans

28:58 "Challenges in Health Equity Measures"

31:29 Audit of Supplemental Benefits Use

35:18 Prioritizing Member Outreach Roles

40:22 "Enhancing Member Experience Returns"

42:42 Connect on LinkedIn: John Gorman

Show Website - https://healthcarestarcast.com/

Subbu Ramalingam - Show Host - Linkedin - https://www.linkedin.com/in/subburamalingam/

FloWise Leadership - https://flowiseleadership.com/

ViVega Business Services - https://www.vivega.co/

ATTAC Consulting Group - https://www.attacconsulting.com/

Media Partner - TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Welcome to The HEALTHCARE STARcast, the show that breaks down the complex world of healthcare to reveal the real strategies and mindsets driving excellence. In this episode, host Subbu Ramalingam sits down with Charles Baker, Vice President at ATTAC Consulting Group and an expert who has worn many hats in the industry, from clinical social work to executive compliance roles. Charles shares his unique journey from the hospital floor to the executive suite, offering fresh perspectives on population health, risk management, and how healthcare organizations can break out of silos to tackle today's biggest challenges.

Together, Subbu and Charles dig into the realities of compliance, quality improvement, Medicare Advantage pressures, and the evolving landscape of risk adjustment and RADV audits. You'll hear actionable insights for health plan leaders and providers, a no-nonsense approach to regulatory changes, and practical ideas for bridging the gaps between compliance, operations, and patient care.

Whether you’re leading a health plan, driving quality initiatives, or reimagining care delivery, this conversation is packed with timely advice and big-picture thinking to help you navigate change and deliver real value for patients and communities.

Timestamps:

00:00 Rethinking Community-Focused Mental Health

05:53 "Insurance's Role in Community Health"

10:05 Breaking Silos in Compliance Strategies

11:18 Proactive Data Management for Medicare Advantage

16:17 Regulatory Compliance Cadence Analysis

19:32 "Medicare Advantage and RADV Focus"

21:24 HMO Cost Control Evolution

27:50 Healthcare Consulting & RADV Support

30:54 Ensuring Audit-Ready Clinical Documentation

35:10 Policy Presentation: Key Opportunity

36:49 Holistic Teamwork for Data-Driven Decisions

Show Website - https://healthcarestarcast.com/

Subbu Ramalingam - Show Host - Linkedin - https://www.linkedin.com/in/subburamalingam/

FloWise Leadership - https://flowiseleadership.com/

ViVega Business Services - https://www.vivega.co/

ATTAC Consulting Group - https://www.attacconsulting.com/

Media Partner - TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”