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/

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/

Welcome to the inaugural episode of The HEALTHCARE STARcast, where your host Subbu Ramalingam invites you to go beyond the usual healthcare metrics to uncover the heart - and the purpose - behind the people leading change in the industry. In this episode, we get to know Subbu, a seasoned leader in star ratings and risk adjustment, whose journey spans continents and roles, from fintech innovations in India to driving population health initiatives and nonprofit work in the US and abroad.

Subbu shares his personal stories of how diverse backgrounds, challenges, and values have shaped his passion for healthcare. You’ll hear about the profound impact of combining data, technology, and mission-driven leadership to improve both the business and human side of medicine. Subbu opens up about the principles that guide his work, the importance of clarity and prioritization, and why true transformation in healthcare requires collaboration across silos.

Whether you’re a healthcare operator, an executive, or just fascinated by the stories of those making a real difference, this episode sets the stage for thoughtful conversations on leadership, clarity, and the ongoing evolution of healthcare.

Timestamps:

00:00 From Finance to Healthcare Transition

04:15 Medicare Advantage Evolution & Skills

08:28 "Journey from Veterans to Tech Healthcare"

12:26 Balancing Local and Global Healthcare

17:28 Pioneering Yoga's Western Influence

19:14 "Mastering Time Management & Clarity"

22:20 Star Ratings and Population Health Management

26:09 Culture and Strategy in Health Systems

31:32 Medicare Star Ratings Timeline

32:49 CMS Risk Adjustment Audits Intensify

37:31 Streamlining Healthcare for Better Outcomes

41:34 Preparing for Audits and Budgeting

44:30 "Medicare Audits and AI Insights"

48:25 "Healthcare Star Cast Launch"

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/