Episodes
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Season 3 Ep1 | The New Stars Reality: What the 2027 Star Ratings Mean for Health Plans in 2028
The 2027 Medicare Advantage Star Ratings are out, but the real value is not in simply looking at who moved up or down. The bigger question is what these results are telling health plans about the next era of Stars. In this episode of The Execution Gap, I step back from the rating itself and look…
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Season 2 Ep9 | From Compliance to Partnership: How Health Plans Create Lasting Provider Behavior Change
Getting a provider to act once is not the same as changing provider behavior. Health plans can create action through reminders, follow-up, incentives, audits, and escalation. But if the behavior fades when the pressure goes away, that is compliance — not adoption. In this episode of The Execution...
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Season 2 Ep8 | Provider Capacity Is a Quality Variable, Provider Engagement Strategy
A provider can have a lot of quality opportunity and still have limited capacity to execute it. In this episode of The Execution Gap, I share a lesson from my experience being responsible for Medicare Advantage contract performance: identified opportunity and executable opportunity are not the…
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Season 2 Ep7 | Plan Preview 2 Is Out. Now What?
Plan Preview 2 is out. In this special episode, Peter Saah steps away from the Provider Performance Playbook to talk through what Stars leaders should be thinking about now — before final ratings are public and before MY2026 closes. The episode focuses on the difference between a disappointing...
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Season 2 Ep6 | The Hidden Risk of Building Provider Strategy Around Key People
What happens when a health plan’s strongest provider relationship depends on one person? In this episode, Peter Saah explores the hidden risk of key-person dependency in provider engagement. A provider relationship may look strong because one representative knows the history, the real...
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Season 2 Ep5 | Why Health Plans Make Providers Performance Harder than it needs to be
Why Health Plans Make Provider Performance Harder Than It Needs to Be Provider performance problems are often treated as engagement problems. But what if the bigger issue is friction? In this episode of The Execution Gap, I break down how unnecessary complexity inside health plan quality programs...
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Season 2 Ep4 | | Why Provider Incentives Don’t Always Change Performance
When provider performance isn’t moving, the answer is not always a bigger incentive. In this episode, Peter Saah examines the contract economics behind provider quality and asks a more fundamental question: What does the contract actually make economically rational for the provider to do? The...
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Season 2 Ep3 | Why Providers Stop Responding
When a provider stops responding, we often call them “disengaged.” But what if disengagement isn't the problem? What if it's the symptom? In this episode, Peter Saah explores what may actually be happening underneath provider non-response—from data credibility and damaged payer-provider...
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Season 2 Ep2 | Stop Treating Every Provider the Same: Why Precision Provider Engagement Beats Mass Outreach
Most health plans already segment providers. But here's the bigger question: Does that segmentation actually change what happens next? In this episode of The Execution Gap, I explore why provider segmentation alone isn't enough—and why different performance problems require different…
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Season 2 Ep1 |Provider Performance - The Law of Diminishing Returns in Provider Outreach
Does more provider outreach always produce better quality outcomes? In the Season 2 premiere of The Execution Gap, Peter Saah launches The Provider Performance Playbook, a new executive series exploring how high-performing Medicare Advantage organizations influence provider performance at scale....
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Season 1 Ep15 | The Bottleneck: Why Your Slowest Process Determines Your Star Ratings
Every quality organization has a constraint. The challenge is that many leaders don't know where it is. In this episode, Dr. Peter Saah explains why improving every department doesn't necessarily improve overall performance and how one operational bottleneck can determine the speed of your entire...
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Season 1 Ep14 | The Second-Half Playbook: What Medicare Advantage Leaders Should Focus on Before MY2026 Ends
We're halfway through the MY2026 measurement year. At this point, the question isn't "What's our strategy?" That should have been answered months ago. The real question is: Where should we focus the time and resources we have left? In this episode of The Execution Gap, Dr. Peter Saah explores why...
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Season 1 Ep13 | Three Questions Every Medicare Advantage Executive Should Be Asking Right Now?
The Medicare Advantage Stars program may be entering a new era—one where methodology decisions are increasingly challenged not only through policy channels, but in court. The Clover Health and Elevance Health cases raise important questions for Medicare Advantage executives and quality leaders.…
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Season 1 Ep 12 | The AI Abstraction Myth: Why Reading Charts Was Never the Hard Part
Artificial intelligence has changed medical record abstraction. But it hasn't changed the most important question. Can your organization trust the evidence it's submitting? In this episode of The Execution Gap, Dr. Peter Saah explores why the future of healthcare quality isn't about reading…
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Season 1 Ep11 | The Retrieval Yield Gap: Why More Charts Don't Mean Better Results
Most health plans measure chart retrieval volume. Very few measure retrieval value. In this episode of The Execution Gap, Dr. Peter Saah introduces the concept of the Retrieval Yield Gap and explains why retrieving more charts does not automatically create more value. A health plan can retrieve...
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Season 1 Ep10 | Why the Chart You Retrieved May Be More Valuable Than You Think
Episode 11: The Evidence Utilization Gap — Why the Chart You Retrieved May Be More Valuable Than You Think Most Medicare Advantage plans have become very good at retrieving clinical evidence. Very few have become equally good at utilizing it. In this episode of The Execution Gap Podcast, Peter…
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Season 1 Ep9 | The Audit Readiness Gap: Why a Closed Gap Is Not the Same Thing as an Audit-Ready Gap
Episode 9: The Audit Readiness Gap Most healthcare quality teams focus on collecting evidence. Far fewer focus on whether that evidence can be defended. In this episode, Peter Saah explores a growing challenge facing health plans as ECDS reporting expands: the difference between a closed gap and…
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Season 1 Ep8 | Your ECDS Data Is Only as Good as Your Provider’s EHR Workflow
Episode 8: Your ECDS Data Is Only as Good as Your Provider's EHR WorkflowMost discussions about ECDS focus on interoperability, CCD ingestion, FHIR, data exchanges, and measure engines.But what if the biggest ECDS performance problem starts before any of that?What if the determining factor is the...
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Season 1 Ep7: ECDS Was Supposed to Solve the Data Quality Problem. It Didn't. It Moved It.
The promise of ECDS was real: real-time digital data replacing expensive, retrospective chart retrieval. The operational reality of MY2026 is more complicated. In this episode, Peter Saah breaks down exactly where the data quality problem went when hybrid reporting gave way to ECDS — why COL-E...
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Season 1 Ep6 | You Don't Have a Retrieval Problem. You Have an Abstraction Problem
The care happened. The physician documented it. The chart was retrieved. The evidence existed. And the measure still stayed open. That is not a retrieval failure. That is an abstraction failure. And it is one of the least measured — but most financially consequential — problems in payer quality...
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Season 1 Ep5 | When Manual and Digital Collide: The Reconciliation Problem Nobody Budgets For
Most health plans are running two data programs simultaneously right now — chart retrieval for hybrid measures still in traditional reporting, and ECDS digital feeds for measures like COL-E, CCS-E, CIS-E, and IMA-E that have already transitioned. Two vendor relationships. Two sets of timelines.…
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Season 1 Ep4 | The Data Feed Delusion: Why Digital Collection Fails Silently Where Chart Retrieval Fails Loudly
Following on Episode 3's look at late-year chart retrieval, this episode challenges the assumption that digital data collection solves the underlying problem. [Name] breaks down the three failure modes that make digital feeds dangerous precisely because they're invisible: the completeness…
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Season 1 Ep3 | Your Retrieval Report Is Lying to You
A retrieved chart isn't a closed gap. It's raw material. And raw material that arrives too late doesn't become finished product — it becomes write-off. Peter walks through exactly how late-year retrieval silently degrades abstraction quality, burns outreach budget on already-closed gaps, and...
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Season 1. Ep2 | Why Provider Outreach Fails to Close Gaps - Even when You Do It Right
Provider outreach isn’t failing—it’s being used at the wrong point in the process. In this episode, we break down why outreach volume stays high while gap closure remains low. The issue isn’t effort. It’s premature outreach execution—requests triggered before gaps are validated and without…
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Season 1. Ep 1 | Why Healthcare Quality Gap Closure Fails on Execution — Not Insight
Healthcare quality gap closure doesn’t fail because plans lack data—it fails because execution breaks down after gaps are identified. In this episode, we unpack where things actually go wrong across retrieval, abstraction, and outreach, and why fragmented workflows prevent real closure at scale....
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Season 0: Medicare Stars Foundations - CAHPS & STARS Strategy: Driving Excellence in Health Plans
Season 0: Medicare Stars Foundations This episode is part of the original Medicare Stars Podcast archive. The show has since evolved into The Execution Gap, focused on healthcare quality execution and gap closure at scale. _________________________________________________________ In this episode,...
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Season 0: Medicare Stars Foundations - Healthcare Without Walls: Harnessing the Power of Data to Address Health Equity
Season 0: Medicare Stars Foundations This episode is part of the original Medicare Stars Podcast archive. The show has since evolved into The Execution Gap, focused on healthcare quality execution and gap closure at scale. _________________________________________________________ In this episode,...
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Season 0: Medicare Stars Foundations - Risk Adjustment Data Validation
Season 0: Medicare Stars Foundations This episode is part of the original Medicare Stars Podcast archive. The show has since evolved into The Execution Gap, focused on healthcare quality execution and gap closure at scale. ________________________________________________________ RADV has become...
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Season 0: Medicare Stars Foundations - Elevating Healthcare Quality: Unleashing Effective Improvement Strategies in Health Plans
Season 0: Medicare Stars Foundations This episode is part of the original Medicare Stars Podcast archive. The show has since evolved into The Execution Gap, focused on healthcare quality execution and gap closure at scale. ________________________________________________________ In this episode…
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Season 0: Medicare Stars Foundations: Mastering HEDIS Audit: Strategies for Success
This episode is part of the original Medicare Stars Podcast archive. The show has since evolved into The Execution Gap, focused on healthcare quality execution and gap closure at scale. ________________________________________________________ Welcome to another information-packed episode of...
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Season 0: Medicare Stars Foundations - Burnout & Wellbeing of Healthcare Quality Professionals
This episode is part of the original Medicare Stars Podcast archive. The show has since evolved into The Execution Gap, focused on healthcare quality execution and gap closure at scale. ________________________________________________________ In the episode, we delve into a topic that has gained...
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Season 0: Medicare Stars Foundations - How to Build a Continuous Improvement Culture
Season 0: Medicare Stars Foundations This episode is part of the original Medicare Stars Podcast archive.The show has since evolved into The Execution Gap, focused on healthcare quality execution and gap closure at scale. ________________________________________________________ Globally…
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Season 0: Medicare Stars Foundations - Addressing Provider Barriers with CPTII Codes Utilization
Season 0: Medicare Stars Foundations This episode is part of the original Medicare Stars Podcast archive. The show has since evolved into The Execution Gap, focused on healthcare quality execution and gap closure at scale. ________________________________________________________ What will be the...
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Season 0: Medicare Stars Foundations - Implications of CMS AN & Proposed Rules
Season 0: Medicare Stars Foundations This episode is part of the original Medicare Stars Podcast archive. The show has since evolved into The Execution Gap, focused on healthcare quality execution and gap closure at scale. ________________________________________________________ In this episode…
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Season 0: Medicare Stars Foundations - 2024 CMS AN Proposed Rules Details and Winning Strategies
Season 0: Medicare Stars Foundations Katharine is a HEDIS auditor, the president of Healthy People; with 25 years of experience. She is also a member of NCQA's Data Collection Advisory panel. Health People is a HEDIS audit firm. This episode is a deep dive into 2024 CMS AN, Proposed Rules, and...
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Season 0: Medicare Stars Foundations - Boosting Member Experience (CAHPS)
Season 0: Medicare Stars FoundationsIn this session, we discussed the importance of CAHPS to Medicare Stars, and Valerie provided ways to improve CAHPS results through a partnership between healthplans and providers/healthcare organizations. She explained why setting the right expectations with...
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Season 0: Medicare Stars Foundations - Tips for a Successful HEDIS Season
Season 0: Medicare Stars Foundations This episode is part of the original Medicare Stars Podcast archive. The show has since evolved into The Execution Gap, focused on healthcare quality execution and gap closure at scale. _______________________________________________________ Phil shares some...
About this show
The Medicare Stars Best Practice Podcast will feature conversations with managed care leaders and staff on a variety of issues that influences performance and attainment of overall 5 Star Ratings.
Hosted by
Dr. Peter Saah
Categories