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. 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
Quotes, Hooks, & Timestamps:
I think you talked about social determinants of health even before it was a."
— Subbu Ramalingam [00:01:43 → 00:01:48]
"I can tell you, Subbu, in 35 years of doing this here in DC, I have never seen a bigger shit sandwich delivered upon the American public than the Big beautiful bill. This thing is a full blown assault on health care in this country."
— John Gorman [00:02:46 → 00:03:02]
"And starting In January of 2026, unless Congress intervenes, we are looking at 4% across the board Medicare cuts to help finance this tax cut for billionaires. And I don't have to tell you of all people that a 4% across the board cut, if that's allowed to go through in January, is absolutely catastrophic for our industry."
— John Gorman [00:04:27 → 00:04:54]
"So we're going to have a hunger crisis again among our seniors where these folks are going to be eating dog food and cat food at the end of the month when their Social Security checks run out."
— John Gorman [00:05:50 → 00:06:01]
"This is a war on the poor, man. And the poor are really the lion's share of the membership in Medicare Advantage. So this is the scariest time I think I've seen in this program."
— John Gorman [00:06:46 → 00:07:44]
"RADV audit has been the talk in the last few months, but in the clients that we engage with, I engage with and you engage with and I directly support the RADV work."
— Subbu Ramalingam [00:09:50 → 00:10:02]
"We need food, we need shelter, we need transportation, security. All those things need to become priorities and benefit design."
— John Gorman [00:14:28 → 00:14:37]
"The last thing you want splashed all over your local headlines is that, you know, we got nailed for a clawback payment in, you know, the eight or nine figures that indicates that there was, you know, upcoding at best and gaming of the system at worst going on at your plan."
— John Gorman [00:23:50 → 00:24:09]
"It's not just making food or transportation or housing available to certain members of the plan that are desperately in need of them now. It's going to be, did you make them available? Did you assist them in accessing those benefits? And what was the throughput on the folks that actually use them?"
— John Gorman [00:32:09 → 00:32:29]
"There's courage needed to kind of like stand behind the membership and say, I'm going to put this benefit no matter what the ROI is. I'm going to test this out and then see what comes out. I'm going to learn more."
— Subbu Ramalingam [00:36:46 → 00:37:01]
Learn more
Show Website - https://healthcarestarcast.com/
Subbu Ramalingam - Show Host - Linkedin - / 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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