Closing Care Gaps in Medicare & Medicaid: Insights from CaryHealth’s Adam Kustin

Healthcare leaders know that closing care gaps is one of the most urgent and challenging priorities in managed care. On a recent episode of Smarter Systems, Better Care, CaryHealth’s VP of Health Plan Partnerships, Adam Kustin, sat down with host John Faulkner to unpack how technology, pharmacy expertise, and patient engagement come together to transform outcomes for Medicare and Medicaid members. In this recap, we'll dive into Adam's insights on how CaryHealth's pharmacy-driven platform uses real-time data, AI-powered engagement, and cross-ecosystem collaboration to help health plans achieve better STAR ratings and member outcomes.
Here are some of the big takeaways from their conversation:
Healthcare leaders know that closing care gaps is one of the most urgent and challenging priorities in managed care. On a recent episode of Smarter Systems, Better Care, CaryHealth’s VP of Health Plan Partnerships, Adam Kustin, sat down with host John Faulkner to unpack how technology, pharmacy expertise, and patient engagement come together to transform outcomes for Medicare and Medicaid members. In this recap, we'll dive into Adam's insights on how CaryHealth's pharmacy-driven platform uses real-time data, AI-powered engagement, and cross-ecosystem collaboration to help health plans achieve better STAR ratings and member outcomes.
Here are some of the big takeaways from their conversation:
Identifying care gaps is just the starting line. What sets CaryHealth apart is its ability to transform raw data into real-world impact. By automating outreach to providers, pharmacies, and members, health plans can close gaps faster and track results in near real-time. As Adam noted, “Identifying open care gaps for members is table stakes—it’s what you do with that data that matters.”
While most people think of hospital quality scores, pharmacy measures are often the hidden drivers of Medicare STAR ratings. For example, medication adherence (like staying on a prescribed statin) carries “triple weight” in STAR scoring. CaryHealth’s foundation as a pharmacy makes it uniquely positioned to help health plans tackle these measures head-on. In a landscape where bonuses and penalties hinge on hitting quality targets, that expertise is invaluable.
Closing care gaps requires more than technology. It demands collaboration across the healthcare ecosystem. Members must be engaged and empowered, providers need streamlined tools, and health plans must align incentives. Adam highlighted the reality that success depends on all parties working together: “I can tell you to refill your prescription, but you still have to go to the pharmacy. Without tackling barriers like transportation or access, gaps remain.”
The path to achieving five-star ratings is tougher today than it was just a few years ago. Adam sees this as both a challenge and an opportunity: “There’s more energy around addressing care gaps, and health plans are leaning into the conversation. The next wave of success will come from integrating adjacent services into one seamless system, and CaryHealth is positioning itself as the quarterback of that effort.”
For Adam, the next 6–12 months will be all about evangelizing, sharing CaryHealth’s story, building partnerships, and helping health plans see what’s possible when technology and human touch come together. “This business is as much a passion as it is a job,” he reflected. “I love the company, I love what we do, and I believe in the difference we’re making.”
The bottom line? The future of managed care will belong to organizations that combine real-time data, pharmacy-driven insights, and AI-powered engagement, all while keeping people at the center.
Watch the full interview here → Adam Kustin: How technology is transforming Medicare & Medicaid.