EP247: From Quality Measures to Medicare Advantage (Maybe for All) and Price Gouging, With John Gorman, CEO and Chairman of Nightingale Partners
Episode Description
In this episode, Stacey Richter talks with John Gorman, CEO and chairman of Nightingale Partners, about quality measures, Medicare Advantage (maybe for all), and price gouging.
WHAT YOU'LL LEARN
✅ How Medicare Advantage and fee-for-service Medicare value-based care measures compare, and whether the weighting is legitimate
✅ Why half of the Medicare Advantage star rating is attributable to member experience
✅ How Medicare Advantage could plausibly expand into a "Medicare Advantage for all" model
✅ Why a more rigorous antitrust approach to hospital mergers could help curb price gouging
✅ John Gorman's advice for independent physicians and rural hospitals navigating this landscape
WHY THIS MATTERS
John Gorman doesn't claim Medicare Advantage is problem-free—coding gamesmanship, wasteful quotas, and restrictive networks are all real issues. But he makes the case that MA's trajectory, combined with insurance carrier profitability and consolidation pressure, is reshaping how rural hospitals and independent physicians need to think about scale and negotiating leverage. His blunt advice to smaller providers: get bigger and more sophisticated in the value you bring, because there's strength in numbers when you're not adapting fast enough to survive.
MENTIONED IN THIS EPISODE
=== LINKS ===
🔗 Show Notes with all mentioned links: Episode Page
🔗 Healthcare Industry Acronyms and Terms
✉️ Enjoy this podcast? Subscribe to the free weekly newsletter
🫙 Support the podcast with a small donation to the Tip Jar
📺 Subscribe to our YouTube channel
🎤 Listen on Apple Podcasts
🎤 Listen on Spotify
=== CONNECT WITH THE RHV TEAM ===
✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X
00:00 Introduction.
01:37 The quality measures being used to assess value.
04:00 "Half of the rating is attributable to the member experience."
04:29 Are the ways that FFS and Medicare Advantage value-based care measures are weighted legitimate?
07:59 Insurance carrier profitability.
08:33 Medicare for all to Medicare Advantage for all—how John sees this morphing into the future.
11:07 Is insurance profitability at the expense of the rest of the country?
13:47 "A more rigorous antitrust approach to hospital mergers would certainly help."
15:10 "Get bigger and get more sophisticated in … the value you bring to the table."
16:49 "There's always strength in numbers."
20:35 EP202 with Frazer Buntin.
23:28 "If you're not adapting, you're dying in this environment if you're a hospital."
24:37 John's advice to rural hospitals.
27:44 EP219 with Arshad Rahim.
28:27 What Nightingale is and what they do.
Proudly Supported by
