Beyond Quality

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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Health literacy is not a soft skill. It's a quality infrastructure issue.

You've invested in an outreach vendor. You've built the workflows. You've rewritten the scripts twice. None of it matters if the member on the other end of the phone doesn't understand what they're being asked to do — or why.

Helen Osborne has spent 30 years asking one question: what can all of us do to help improve health understanding? She's the founder of Health Literacy Consulting, author of Health Literacy from A to Z, and host of the Health Literacy Out Loud podcast. My co-host Jennifer Nguyen and I dig in with her.

We get into why the original definition of health literacy missed the mark, the six factors that affect understanding, where health literacy fits inside CAHPS and Star Ratings strategy, and a story about a Spanish-speaking member who read "once a day" as the number 11 — and ended up in the ER three times before anyone figured it out.

If you lead a quality program, build outreach materials, or own member experience at a Medicare Advantage or Medicaid plan — this one's for you.

Find Helen at healthliteracy.com.

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Beyond Quality is hosted by Rex Wallace of Rex Wallace Consulting. Learn more at https://www.rexwallaceconsulting.com/

In this episode of Beyond Quality, host Rex Wallace and this episode's co-host Laurie Call welcome Dr. Matt Poepsel, PhD, Vice President & Godfather of Talent Optimization at The Predictive Index, to explore why every business problem is, at its core, a people problem. The conversation unpacks how healthcare quality leaders can drive results through influence rather than authority, and why that skill has never mattered more. Dr. Poepsel introduces the Predictive Index, a six-minute behavioral assessment used by 94% of best-in-class companies to build self-aware, high-performing teams. The trio also takes on the AI question head-on: rather than replacing human connection, automation is making it the last real differentiator. If you lead quality improvement programs, manage cross-functional teams, or just want to understand what separates good organizations from great ones, this episode is for you.

What if quality wasn't just a department but the entire operating strategy of your organization? In this episode, host Rex Wallace sits down with improvement scientist and author Dr. Dave Williams and co-host Ryan Bernstein to explore how healthcare organizations can move beyond project-level process improvement and start thinking in systems.

Dave breaks down the tools and mindset shifts that help leaders understand their organization as a system, why testing before scaling is non-negotiable, and what it really means for leaders to own outcomes rather than delegate them.

Quality as an Organizational Strategy and the QOS Field Guide are available on Amazon. Connect with Dave at davidmwilliamsphd.com or on LinkedIn.

In the first episode of Beyond Quality, host Rex Wallace and co-host Nate Lucena welcome actuary Eve Anderson, Director of Actuarial Services at Zing Health, for a candid conversation about quality as a financial strategy in Medicare Advantage. Eve unpacks the difficult cycle smaller MA plans face, offering rich benefits they can't afford while struggling to achieve the Star Ratings that would fund them, and explains why there's no shortcut to four or five stars. The trio digs into why measuring ROI for quality initiatives is so challenging, how organizations can build stronger financial cases for quality investments, and what it looks like to align long-term financial goals with quality performance targets. Eve also offers practical guidance for quality leaders who need to communicate more effectively with finance and executive teams, and shares a candid take on the limitations of CAHPS as a measurement tool.