The Impact of American Healthcare on Global Industry and What Needs to Change
Welcome to Episode 6 of The Healthcare STARcast! This episode, hosted by Subbu Ramalingam, dives deep into the fundamentals of the US healthcare system - the world’s largest and most influential healthcare market, with an annual spend of nearly $4 trillion. Subbu Ramalingam explores why the American system, despite its staggering costs, still struggles to deliver the best health outcomes, and how its evolution through a series of policy decisions has led to an incredibly complex landscape.Whether you’re a healthcare professional, a policy enthusiast, or just curious about why US healthcare matters far beyond its borders, this episode offers a clear breakdown of managed care frameworks, the realities of healthcare inflation, and the trade-offs faced in balancing affordability, quality, and sustainability. With insights drawn from decades of hands-on experience across risk adjustment, quality programs, and value-based care, Subbu Ramalingam makes the intricate US healthcare ecosystem accessible for listeners around the globe.Tune in to get an insider’s perspective on why changes in US healthcare ripple worldwide, and learn what’s being done, and what still needs to happen - to improve outcomes for millions of people both in America and beyond.Timestamps:00:00 "US Healthcare's Global Impact"03:31 "Healthcare Challenges and Solutions"07:25 "Medicare Shift and Cost Crisis"10:59 Global Healthcare Payment Models15:01 "Understanding U.S. Healthcare Complexity"18:58 "Managed Care and My Journey"24:14 Healthcare Coordination and Quality Metrics26:49 "Shift to Value-Based Care"31:14 "Addressing America's Healthcare Challenges"33:41 "Healthcare Insights & Frameworks"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.”
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Medicare Advantage Star Ratings: Embracing Health Equity and Digital Quality for 2027 and Beyond
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 Challenges08:32 "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 Plans21:32 Performance Tracking and Intervention Plans24:22 "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 Collection44:13 Simplifying Healthcare Data Exchange45:10 "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.”
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Navigating Stars in Healthcare: Data, AI, and Success Strategies for Health Plans
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 Insights04:12 Building a Unified Health Data System08:28 Health Plans' Strategic Missteps11:09 Improving Patient Care with Timely Data15:37 "Assessing Progress and Future Uncertainty"16:29 Maximizing Performance in Final Quarter21:40 Comprehensive Analytics Platform Launch22:45 Rapid Insights & AI in Healthcare26:54 Drug Measures Impact Performance Score29:36 Addressing Drug Measure Performance34:01 Redefining Health Equity Strategy38:35 Optimizing Care with Voice Agents40:08 Cautious AI in Clinical Decisions45:00 Flexible AI Governance Principles46:37 "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.”
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Medicare Shake-Up: Surviving the Big Beautiful Bill and RADV Audits in 2026
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 Disabled08:28 Doge Effect Alters Social Security12:17 PPO Retreat Signals Industry Worries14:53 Reimagining Administrative Benefits for 202620:01 Improving Provider Network Accuracy22:48 Risk Adjustment Data Accuracy Focus27:20 Impact of Costs on Mid-Tier Plans28:58 "Challenges in Health Equity Measures"31:29 Audit of Supplemental Benefits Use35:18 Prioritizing Member Outreach Roles40:22 "Enhancing Member Experience Returns"42:42 Connect on LinkedIn: John GormanShow 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.”
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Connecting Quality, Compliance, and Population Health in Managed Care with Charles Baker
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 Health05:53 "Insurance's Role in Community Health"10:05 Breaking Silos in Compliance Strategies11:18 Proactive Data Management for Medicare Advantage16:17 Regulatory Compliance Cadence Analysis19:32 "Medicare Advantage and RADV Focus"21:24 HMO Cost Control Evolution27:50 Healthcare Consulting & RADV Support30:54 Ensuring Audit-Ready Clinical Documentation35:10 Policy Presentation: Key Opportunity36:49 Holistic Teamwork for Data-Driven DecisionsShow 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.”
The Healthcare STARcast is where healthcare’s true leaders shine. Hosted by Subbu Ramalingam, a seasoned healthcare executive, this podcast goes beyond STAR ratings and risk scores to reveal the strategies, innovations, and mindsets driving real-world healthcare excellence.Every episode delivers clear insights, bold frameworks, and practical ideas designed for healthcare executives, operators, clinicians, and innovators ready to lead at the next level. Whether you're improving quality, scaling value-based care, or reimagining patient outcomes, The Healthcare STARcast gives you the edge to lead with confidence.
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