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 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/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”