Welcome to another episode of Care Decoded, the show where we break down the complexities of risk adjustment, documentation, and AI to power better healthcare. In today’s episode, host Dr. Sunil Nihalani is joined by Subbu Ramalingam — a seasoned former health plan executive and expert at the intersection of star ratings, risk adjustment, and healthcare quality.
Together, Sunil and Subbu dig into why star ratings aren’t just about checking boxes, but about truly improving patient care and experience. They discuss how health plans and providers can bridge the often-siloed worlds of risk adjustment and quality improvement and why accurate data and collaboration are key to better — and more meaningful — outcomes.
You’ll hear real-world examples illustrating how documentation and coding impact patient care, the latest updates on CMS risk adjustment data validation (RADV) audits, and why aligning risk and quality programs matters more than ever. Plus, Subbu shares actionable advice for healthcare leaders looking to turn mountains of data into engines for quality while keeping the patient at the center of it all.
If you’re a healthcare leader, clinician, or just passionate about making sense of the care ecosystem, this episode is packed with the insights you need to help decode the path toward better care. Let’s dive in!
Timestamps:
00:00 Data's Role in Meaningful Care
04:01 Optimizing Patient Care Experience
09:37 Risk Adjustment and Eligibility Alignment
14:00 Coordinating Care for Diabetic Members
17:48 CMS Launches Overdue RAD Audits
20:29 Enhancing Health Plan Audit Processes
22:35 Healthcare Industry Shift Forecast
27:16 Health Plan Overdocumentation Issues
31:02 Healthcare System Risk Score Management
33:38 Aligning Health KPIs and Outcomes
35:56 Chronic Care Spending Concerns
40:19 Healthcare Data Interoperability Challenges
43:18 Integrating Home Data in Care
Subbu Ramalingham - https://www.linkedin.com/in/subburamalingam/
ATTAC Consulting Group (ACG) - https://www.attacconsulting.com/
Podcast's Website - https://caredecoded.com/
Dr. Sunil Nihalani - CEO and Founder at Inferscience - https://www.linkedin.com/in/sunil-nihalani-a6983a5/
Inferscience - https://www.inferscience.com/
Podcast Powered by TopHealth - https://tophealth.care/
“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
CrimeLess: Hillbilly Heist
It’s 1996 in rural North Carolina, and an oddball crew makes history when they pull off America’s third largest cash heist. But it’s all downhill from there. Join host Johnny Knoxville as he unspools a wild and woolly tale about a group of regular ‘ol folks who risked it all for a chance at a better life. CrimeLess: Hillbilly Heist answers the question: what would you do with 17.3 million dollars? The answer includes diamond rings, mansions, velvet Elvis paintings, plus a run for the border, murder-for-hire-plots, and FBI busts.