Health plans are suing CMS, cut points keep moving, and the 2027 landscape is shrinking. Here's what Stars leaders should actually do in Q4.

Rex Wallace is joined by RWC's Angelo Rexach and Jenn Kerfoot, President and COO of Duos, for a state-of-Stars conversation heading into the fourth quarter. They break down what Plan Preview 2 revealed about HEDIS and Part D cut points, why the reward factor threshold matters, and what the 2027 landscape files signal about PPOs, standalone Part D, and the shift toward D-SNP and C-SNP specialization.

Then they get into the litigation. Jenn walks through how Loper Bright and the end of the Chevron doctrine changed the fight, and why Clover's argument that CMS lacked the authority to make the rules is different from everything that came before. Angelo raises a scenario few people are talking about: what happens to Medicare Advantage Star Ratings if Part D measures end up in play.

The advice for Q4 is consistent: stay the course, work the measures, prepare for CAHPS, and stop waiting for the courts to save your rating.


GUESTS
Angelo Rexach, Policy and Analytics, RWC
Jenn Kerfoot, President and COO, Duos


#MedicareAdvantage #StarRatings #HealthcareQuality

A health plan CFO on why your quality budget keeps getting cut, and how to actually win it back.

Anna Mateja, Chief Financial Officer of Community Health Choice, joins Rex Wallace and co-host Paige Caprara to break down the financial backdrop facing health plans in 2026: margin compression, membership contraction after the marketplace subsidies lapsed, risk-adjustment surprises, and a GLP-1 line that in some disease states has climbed past half of drug spend.

This one goes past the headwinds. Anna makes the case for how quality leaders can still win investment when margins are tight, why the vendor cost is never the real cost, and what most people get wrong about market exits. Her answer isn't money. It's ownership. She closes with the shift she wants to see by 2030: quality metrics that measure what members actually care about instead of the process box we check today.

If you work in Medicare Advantage, Stars, HEDIS, quality improvement, or health plan finance, this is the finance conversation the show has been missing.

Every health plan and provider is investing in a better experience — so why does healthcare still feel so disconnected to the person living it?

In this episode of Beyond Quality, Rex Wallace is joined by three leaders who spend their days inside that gap: Heidi Salerno of Rex Wallace Consulting, Jason Wolf of The Beryl Institute, and Amber Maraccini of Medallia. Together they unpack where the healthcare experience breaks down, why trust erodes at the handoffs between plan and provider, and what coordinated care actually looks like when an organization designs for it on purpose.

The conversation keeps circling one idea: there's no "member experience" and no "patient experience." There's a human experience — and right now, we've made that human responsible for holding a fragmented system together. The panel digs into the data behind fragmentation, why handoffs are a patient safety issue and not just a satisfaction one, and whether plans and providers should finally share accountability for the whole journey instead of just their slice of it.

Essential listening for quality leaders, member and patient experience teams, and executives across Medicare Advantage, Medicaid, and provider organizations who want healthcare to work end to end, not door to door.

Guests:
Heidi Salerno — Member Experience Consultant, Rex Wallace Consulting
Jason Wolf, Ph.D. — President & CEO, The Beryl Institute (theberylinstitute.org)
Amber Maraccini — Healthcare Executive Advisor, Medallia

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