Build an Effective Business Case for Additional Stars Resources

With the significant changes coming to the Star Ratings program, additional resources are becoming more necessary due to the identification of new processes to ensure continued success in current measures and to build success in new measures. We also know that funding is becoming tighter than ever. Requesting additional funds is not as simple as asking for money and it be easily granted to pursue the initiatives you need to drive Star success.

Many health plans require written business cases identifying the departmental needs and identifying the return on investment (ROI), even when it is just a pilot. Download the business case template I have used and recommend to speed up the process and focus on the substance of your team’s request, not the format. For many, writing a business case is a new process and for others it requires you to dust off those skills from the past to ensure you build out a strong business case to acquire the resources or funding needed for your program.

What is a Written Business Case?

A business case is a document that explains the potential ROI of a project and how it will impact performance in a specific area. Clearly written business cases will document how a project will be developed, implemented, and measured. The business case will allow the organization to get aligned on whether a project makes sense from a business standpoint and whether the request for resources and funding should be a priority investment for the business. 

There are several things to keep in mind when writing a business case for your Star Ratings program:

• Be brief and convey only what is needed, keeping in mind that the audience needs to fully understand your request.
• Ensure the request captures the interest of the audience and is clear and concise.
• Avoid using jargon, unless it is absolutely needed to address the gap you are trying to fill. If jargon is used, be sure to explain it within the business case.
• Always describe how the approval of the resource or funding will benefit the company and the performance needed to impact Star outcomes.
• Always show how the added resources/funding will impact future Star performance.
• Provide details on how performance for the project will be measured.

Build Your Star Ratings Business Case

When you are developing a new project to drive Star performance, we often see these projects fail because there is not a solid business case to stand upon. You should always start with the why, what, how and who to create a strong business case. These must be clearly communicated and through effective business case development, the why will always be addressed in greater detail. As you develop your business case in the initial project phase, know that it will be used as reference throughout the project cycle.

For Stars, there are always innovative ideas that bubble up that could potentially drive success. However, each idea cannot and will not get the funding needed to drive it forward without a strong business reason for pursuing the idea. Great Star leaders should have moved beyond the “throwing spaghetti at the wall and seeing what sticks” to a more solid approach of evaluating each idea. Every initiative should come to the team with a basic business case to be evaluated before funds are approved.

Throughout my career in Stars, I have used a basic business case template that is completed by teams bringing requests for funding to improve Star performance. This can be asking for funds for a particular initiative or to support bringing on a vendor to assist in closing gaps or making outreach to members, or it could involve a request for additional full-time employees to support the Star Ratings program.

While the approach may seem simple, having a documented business case will allow the Stars team to build approved business cases into their workplan and have a catalog of approaches taken historically to improve performance. When a new case is brought to the team, Stars leadership should review the plan to ensure all the required documentation is included prior to taking to Stars governance for final approval and issuance of needed funding or resources.

After Your Business Case is Approved

Monitoring outcomes of the project should always be required of all approved business cases. A cadence should be set, depending on the project's timing, for reporting to be provided frequently to the Stars team. Upon completion of the project, a formal presentation of outcomes should be brought to Stars governance, along with showing the ROI of the completed initiative.

Being organized with your approach to the approval and request for funds and resources, you are increasing accountability across the organization, versus approving requests with unknown or unwritten expectations for performance improvement. Over time, you will begin to see that only proven requests will come across your desk and an organizational shift to ensure ideas being generated truly impact the overall Star Rating for your plan. If you need help knowing where to focus your resources and building a business case for Stars improvement, contact me at John.Willis@healthmine.com.