Given all going on in healthcare, it is time to contemplate real reform.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the fact that it is time to contemplate real reform given all going on in healthcare.

Key Takeaways:

Zeke Emmanuel, one of the key authors of the Affordable Care Act (ACA), had an interesting opinion piece in The Washington Post on December 2. It suggests many of the reforms I spelled out in my book, The Healthcare Labyrinth.

He calls out price as a huge concern for healthcare affordability and suggests site neutral payments and price caps.

There have been some promising developments this year, including a small step toward site neutrality and drug price reforms.

Price, costs, and premiums have been increasing dramatically (6% to 9%, if not more) annually, putting coverage out of reach.

That may mean we have to rethink comprehensive coverage. Some coverage may be better than no coverage at all or the inability to use your coverage.

There are some innovative ideas evolving that might encourage upfront primary care, including direct primary care tied to health savings accounts.

A new traditional Medicare pilot would also target controlling chronic conditions. It is a good idea.

Trump is now joining the crowds attacking health plans, arguing insurers make too much in profit. The last five years proves the declaration to be false.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

CMS issued some major regulatory proposals in its draft 2026 Medicare Advantage and Part D rule.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the recently released draft 2026 Medicare Advantage (MA) and Part D rule. Some major regulatory changes are in store for plans.

Key Takeaways:

The proposed CMS MA and Part D rule for 2027 was issued timely despite the government shutdown. It includes some significant changes.

The Star changes were the biggest, including repeal of the Excellent Health Outcomes for All equity reward and the sunset of operational measures.

CMS' focus in the balance of the rule is reducing regulatory burden and streamlining regulations.

Various utilization management health equity requirements codified by the Biden administration are proposed for repeal.

Four RFIs were issued, including seeking input on reforming the risk adjustment and Stars programs due to perceived overpayments as well as poor quality outcomes.

As with the rule, new program audit guidance from CMS streamlines the audit process and follow-up.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

CMS wants a much tougher MA Star ratings program and that could challenge plans and mean billions in lost revenue.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the fact that CMS wants a much tougher Star ratings program in Medicare Advantage and that could challenge plans and mean billions in lost revenue.

Key Takeaways:

Medicare Advantage Star ratings are in the doldrums. Little progress was seen in Star Year 2026 results.

Now, CMS says it wants to make the program even tougher. CMS is getting rid of "layup" measures -- mostly operational metrics – in favor of concentrating on more complex clinical measures to drive quality outcomes.

This is not a total surprise as the Biden administration telegraphed this before leaving. The change would shift emphasis to drug, health outcome, and improvement measures.

CMS also wants to eliminate the Excellent Health Outcomes for All reward slated to go into effect for SY 2027 because it dislikes anything health equity.

The proposal to eliminate the long-planned reward could be legally dubious.

Getting tougher and refocusing is not unreasonable, but it could mean billions in revenue is lost by MA plans. At least 25% of contracts could lose at least half a Star rating.

Complicating the Stars picture is MA plans' focus on dual eligibles and Special Needs Plans. These individuals tend to perform much worse on clinical measures.

To succeed, plans will need to invest more in Stars. The pivot to true healthcare outcome measures will require quicker and better data collection and analysis, better tracking and forecasting, ongoing strategy refinement, and novel tech-based interventions to close gaps on everyone.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance