Welcome back to The Healthcare STARcast! In today’s episode, host Subbu Ramalingam is joined by Dwight Pattison, founder and principal advisor of QP Advantage, for a deep dive into the evolving world of Medicare Advantage star ratings and healthcare quality. With the recent release of Star Ratings and a rapidly shifting landscape - including the sunsetting of bonus points, membership shifts, and the rise of “Excellent Health Outcomes for All” - there’s never been a more important time to understand what’s changing and how health plans can adapt.

Subbu Ramalingam and Dwight Pattison break down the new focus on social risk factors, demystifying the intricacies of the Health Equity Index and what it means for plans serving dual-eligible and low-income populations. They also tackle the move toward digital quality - what it really means, why it matters, and how both health plans and providers can prepare for a future where data flows seamlessly across the healthcare ecosystem.

Whether you’re an executive scrambling after star rating surprises, a frontline team adapting to new measurement strategies, or just curious about the data-driven future of healthcare, this episode is packed with practical insights, best practices, and strategies for thriving in 2027 and beyond.

Tune in as we move “beyond ratings toward excellence,” and discover what’s next for healthcare quality, equity, and digital transformation.

Timestamps:

00:00 "Healthcare Shifts: What's Next?"

06:03 Health Plans Face Ongoing Challenges

08:32 "Healthcare Plan Rating Adjustments"

11:49 "Health Equity Metrics Overview"

16:05 "Unequal Rewards in Member Plans"

18:49 Performance-Based Rewards for D SNP Plans

21:32 Performance Tracking and Intervention Plans

24:22 "LIS Factor Importance in Measures"

29:53 "Streamlined Digital Health Data Sharing"

31:05 "Uneven Data Flow Challenges"

36:45 "Data Roadmap for Better Outcomes"

37:49 Prioritize Clinical Data Collection

44:13 Simplifying Healthcare Data Exchange

45:10 "New Playbook for Future Success"

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 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.”