Being tactical is seductive, but very risky. The technical intricacies of Star Ratings make it enticing to focus on things that are concrete, detailed and immediate. But getting too tactical too quickly lets staff lose themselves in the day-to-day calendar clutter of too many meetings and too much time spent on details – at the expense of what matters most, and most urgently.
Medicare Changes Are Overwhelming
Success during transformational change requires transformational leadership. This year, we’ve helped many Medicare Advantage (MA) plans cope with the uncertainty and feelings of being overwhelmed by evolving from thinking small and focusing on measure-level bricklaying within Stars to organizational improvement. Plans should evolve from tactical interventions and workplans to agenda setting, priority assessment and leadership and from Stars teams being tactical warriors to corporate diplomats.
The looming changes in Star Ratings and other non-MA quality improvement programs will not be solved by Stars or Quality leaders alone. They will require new types of teamwork and more intense, faster collaboration than plan leaders have had to use during the last five to six years. We must spend our experts’ time growing and developing newer functional department leaders and teaching them how to think beyond just leading their own functional unit so they can be Stars-aligned transformational leaders.
We are at a unique moment in Medicare Advantage. CMS is changing Medicare, MA and Medicaid policies, and Star Ratings faster than ever with no time to spare solving for health equity, digital transformation, voice of the patient, and interoperability at the same time. CMS’ clear alignment with the National Committee of Quality Assurance (NCQA) and Pharmacy Quality Alliance (PQA) signals they've done their diplomatic collaboration too.
Stars is a revenue-generating program since quality bonus payments (QBP) depend on health plan success. It’s time to accelerate the chase to preserve this revenue. The most urgent priority varies by contract, plan benefits package (PBP) and organization. In some, the highest priority may be in product/benefit design. For others, it will be in sales and marketing, data and analytics, or risk adjustment. For many plans, it will be in the white spaces—areas of need where no strategies or tactics exist.
In every case, the problems need to be rapidly identified so solutions can be deployed just as quickly.
Start by Identifying Challenges
We can’t invest time and budget in the right solutions without clearly identifying the right problems. Solving for the new needs of Stars requires us to spend more time making sure we are solving the right problems.
We know how hard it is to succeed in Stars during an era of change when decisions must be made with no safety net and high-stakes consequences. Our Stars Innovation programs are tailormade to drive rapid organizational alignment to identify and solve the most urgent problems our clients face. Every member of our team has deep expertise in a functional area needed for success, with a proven track record of success during eras of change like this one. We love helping plans achieve and sustain success. Email me at melissa.smith@healthmine.com for more information.