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/
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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/
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From Data to Purpose: Unveiling Subbu’s Journey to Healthcare Leadership and Clarity
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 Transition04:15 Medicare Advantage Evolution & Skills08:28 "Journey from Veterans to Tech Healthcare"12:26 Balancing Local and Global Healthcare17:28 Pioneering Yoga's Western Influence19:14 "Mastering Time Management & Clarity"22:20 Star Ratings and Population Health Management26:09 Culture and Strategy in Health Systems31:32 Medicare Star Ratings Timeline32:49 CMS Risk Adjustment Audits Intensify37:31 Streamlining Healthcare for Better Outcomes41:34 Preparing for Audits and Budgeting44:30 "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/
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The Healthcare STARcast - Show Promo
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. Stay tuned!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/
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.
Canada - english