Author: LBodnarchuk

Q&A with Dan Crogan, Principal and SVP of Consulting

Welcome to our Q&A session with Dan Crogan, a Principal and the Senior Vice President of Consulting at ProspHire. The Firm takes a distinctive approach to healthcare organization transformations, centered on expert delivery and execution. We view our teams as extensions of our clients, measuring success not just by project completion but by seamless integration of change into daily business activities. With a commitment to understanding the client’s vision and tailoring innovative ideas to accelerate plans, ProspHire collaborates closely with clients, recognizing the unique nuances within each organization. We’ll explore how ProspHire’s healthcare exclusive focus, collaborative approach and emphasis on how driving adoption sets us apart in the healthcare consulting industry. You’ll also learn about methodologies, success stories and the role technology plays in achieving impactful healthcare transformations.

ProspHire emphasizes expert delivery and execution in healthcare organization transformations. Can you share examples of how this commitment has led to successful outcomes for your clients and what strategies your team uses to ensure excellence in delivery and execution throughout the project lifecycle?

Our dedication to expert delivery and execution has consistently driven successful outcomes for our clients. We understand that the healthcare industry is complex and every health plan has unique member needs and unique challenges. Our team leverages our client’s expertise because no one knows their members and challenges better than them. We approach each engagement as if we are an extension of their team and utilizes our experiences to customized solutions, continuous improvement and transparent communication. Together they help us deliver exceptional results for our clients and drive positive transformation and sustainable growth in the industry.

ProspHire's approach and philosophy

Approach and Philosophy:  Can you elaborate on ProspHire’s approach to viewing the internal teams as an extension of clients that are healthcare organizations? How does this approach contribute to successful transformations?

We look at each healthcare organization as if we are an extension of their team. The way we measure success isn’t just when the project is completed or goes live, it’s when the change is adopted as a business-as-usual activity. By doing this, we’re able to work with the leader to understand their vision and why it’s important to the company. With their vision and our experience, we can bring innovative ideas to accelerate their plans and develop the roadmap with the client’s delivery teams on how the project can be completed. An important thing for us to remember is, even though we may have successfully completed the same project 100x elsewhere, how it gets done within each client’s walls can be drastically different and we need to adapt to those differences.

Differentiation in the Industry: ProspHire prides itself on being 100% healthcare focused. How does this exclusive focus differentiate you from other consulting firms in the industry?

ProspHire distinguishes itself in the consulting industry through an unwavering dedication to healthcare. It’s a commitment that sets us apart from many of our competitors. We approach our engagements as being an extension of the clients’ teams, building a deep understanding of their needs and objectives. We take pride in our unique capability to enhance our clients’ strategies, executing projects with precision and efficiency. Our measure of success goes beyond project completion; it is defined by the seamless adoption and transition of projects to the client, ensuring they can independently operate without external assistance. This approach emphasizes long-term effectiveness over short-term milestones, reinforcing ProspHire’s reputation for delivering value to our clients.

ProspHire success stories

Success Stories: Can you share a recent success story where ProspHire partnered with a healthcare client to achieve significant transformational outcomes? What were the key factors that contributed to that success?

We’ve been dedicated to delivering transformative outcomes in healthcare for nearly a decade and every project has its own unique significance. Whether it’s a small, two-person engagement lasting just a few weeks to swiftly address a client’s immediate needs or a complex project like launching a new ACA product or helping a client in achieving a coveted 4-star rating for Quality Bonus Payment (QBP) or helping a dental client integrate other DSOs as part of acquiring new practices, we approach each with the same level of commitment and pride. What sets us apart is our understanding that every client has choices when it comes to selecting consulting firms and we are honored when we earn their trust to partner together on any engagement. It’s the combination of dedication, adaptability and trustworthiness that consistently contributes to our clients’ success and sets us apart in the industry.

Methodologies and Frameworks: ProspHire adapts methodologies to the client’s environment. Can you provide examples of the diverse methodologies and frameworks your teams leverage to ensure effective delivery and execution?  

We pride ourselves on our ability to tailor methodologies to suit each client’s unique environment and references for project execution. One of the key approaches we take is to leverage the delivery model that best aligns with the specific needs of the client and the type of engagement. Our diverse team is equipped with a range of certifications including PMPs, CSM and can provide expertise in agile methodologies, waterfall, scrum, ITIL, among others. Additionally, we have certified nurses on staff, further enhancing our capacity to understand and address healthcare-specific challenges. Over the past five years, we have extended the certifications to our clients through our ProspHire University.

Keeping up with the trends in healthcare

Keeping Up with Trends: How does ProspHire stay up to date with the latest trends and regulations to provide clients with the most relevant and impactful solutions?

Staying on top of the latest trends and regulations in healthcare is fundamental to our mission of helping our clients provide better access to quality healthcare. First and foremost, we prioritize listening to our clients, striving to understand their pain points and how we can alleviate them, enabling to focus on future planning. Secondly, our exclusive focus on healthcare allows us to closely monitor changes from entities like CMS and government agencies, translating them into actionable insights for our clients. Additionally, we actively participate in conferences and maintain a robust network of partners, creating an environment to discuss public insights and their implications. Lastly, our commitment to innovation ensures that we continuously evolve to meet our clients’ changing needs. With a dedicated innovation team, we transform ideas into tangible solutions, addressing both current challenges and anticipating future requirements. This multi-faceted approach ensures that ProspHire remains at the forefront of industry trends, equipping our clients with the tools and strategies they need to succeed.

Technology and Transformation: Given ProspHire’s technology-agnostic approach, how does technology play a role in healthcare transformation projects and how do you ensure its seamless integration for project success?

Our world is enabled by technology one way or another. At ProspHire, our approach is to be technology agnostic and apply proven methods of delivery and implementation to any engagement we earn. We aim to be fluid with the market and products so we can provide a neutral opinion to our clients based on what they need vs. products we’re tied to. Not every client needs the exact same solution, even if the problem is similar. There are enterprise-wide factors that need to be accounted for before making these decisions and spending a lot of time and money implementing the change.

Collaboration Strategies: Collaboration is crucial in solving complex challenges. How does ProspHire develop strong collaboration between its consultants and the client’s internal teams to ensure seamless execution?

Building strong collaboration between our consultants and our clients’ internal teams is paramount to driving seamless execution in tackling complex challenges. We approach every client engagement as an extension of their team, rather than as an external group. We recognize that no one understands our clients, their team dynamics and their challenges better than they do themselves. Therefore, our focus remains on integrating seamlessly into their operations, rather than drawing attention to any perceived differences. The ultimate testament to our collaborative approach is when our clients tell us that they can’t distinguish our consultants from their own full-time employees. This feedback reaffirms our commitment to working hand-in-hand with our clients, leveraging our expertise to support their goals while maintaining a unified and cohesive team dynamic.  

Change Management: Large-scale healthcare transformation projects often require changes at various levels of an organization. How does ProspHire manage change management strategies to ensure smooth transitions and adoption of new processes?

Managing change in large-scale healthcare transformation projects begins with a strategic approach embedded withing our contracts. While contractual obligations provide a framework for change management, our motivation extends beyond mere legal requirements. We prioritize clarity in our contracts to underscore our ultimate objective: to alleviate our clients’ pain points, effect transformation and facilitate the smooth transition of responsibilities back to their teams. Our emphasis is not on prolonging our involvement but rather on empowering our clients to operate their programs independently. This approach reflects our commitment to responsible and efficient project execution, ensuring that that our clients can quickly adapt to new processes while positioning us as trusted partners for future initiatives.  

Leadership and Differentiation: As a principal and the Senior VP of Consulting, what key qualities and expertise you believe your team brings to the table that truly differentiates ProspHire in the healthcare consulting arena?

I firmly believe that our team’s key qualities and expertise set us apart in the healthcare consulting arena. One of our core strengths lies in our unwavering commitment to a shared end goal. This may seem straightforward, but as our firm expands, the importance of over communication becomes paramount in ensuring alignment among our leadership and staff.  Our overarching objective is clear: to serve our clients’ needs without exception. This means sometimes referring them to another resource or competitor if we can’t address their problem responsibly and promptly. We refuse to allow our clients to remain in pain or wait for solutions that may not materialize. This dedication to client-centric service underscores our leadership approach and distinguishes ProspHire as a trusted partner in healthcare consulting.

Community HealthChoices RFA

The RFA for Pennsylvania’s MLTSS services was released on January 30th, opening the door for Pennsylvania Managed Care Organizations to plans to apply to provide unique services to the 400,000+ eligible Pennsylvanians. Shifting away from statewide contracts, Community HealthChoices (CHC) awards will occur by zone, following a model similar to the physical HealthChoices program. 

Since the Last RFA

Following the initial launch of the Community HealthChoices program, DHS has included notable changes to the program objectives in alignment with greater department goals going into this RFA:

  • Expanding from the Triple to the Quintuple aim, reflecting improved population health and addressing health equity
  • Emphasizing equity, social determinants of health and cultural competency with a “zone” approach to address the needs of Pennsylvania’s communities
  • Encouragement of Participant directed model services, allowing individuals to have more control over where, when and how some of their services and supports are delivered by increasing Participant understanding of benefits
  • Highlighting whole person coordinated care and community services to promote the expansion of collaborative and integrated approaches to care
  • Strengthening collaboration with and coordination of behavioral health services

A Regional Approach

The governance of the CHC program is a significant change for applicants, particularly incumbents, as a criterion for this RFA is to clearly and specifically develop an approach to address the “particular and unique demographic, cultural, economic, geographic, or other relevant characteristics of the regions, counties, and municipalities comprising the zones(s)”. As a key element of the applicant’s Soundness of Approach there are several opportunities to complete an application for statewide coverage while following the technical submission opportunities to highlight the regional approach to care. This will be particularly of interest to DHS to address access to care in rural and underserved areas of the Commonwealth.

MLTSS Distinctions

While incumbents focus on program enhancements and changes, new applicants focus on adaptation of current lines of business to meet MLTSS requirements.

  • Unique Provider Network: Establish or enhance provider networks by contracting with LTSS providers to meet network adequacy with cultural competency in mind, leading to new partnerships and potential value-based contracts that do not currently exist
  • Person-Centered Service Plans: Develop or improve internal staffing to meet CHC requirements for care coordination, enabling tailored whole-person, or patient-centered, service plans that address participants’ needs, goals and preferences
  • Rebalancing of Services: Seek to implement and enhance options for least restrictive, community-based living support for members to experience uninterrupted, patient directed, high-quality care
  • Care Coordination & Integrated Services: Understand the integration of existing services (Medicare, Behavioral and MA) to enable appropriate utilization of clinical and other LTSS services, increasing member satisfaction and quality scores

How Dental Practices Can Achieve Workflow Optimization

Effective communication keeps dental practice workflows running smoothly, from the front desk to the operatories and waiting rooms. Communicating and sharing data across teams and devices allows practitioners to provide empathetic and optimized patient experiences.

Dental practices have various options for digitizing and optimizing equipment. Achieving dental practice workflow optimization through design thinking and emerging technology will boost productivity and enhance the overall quality of patient care. Let’s explore dental practice management and strategies for improving front and back-office workflows.

Understanding Dental Practice Workflow

A dental practice must consistently deliver excellent oral healthcare services to patients. An efficient workflow organizes and streamlines these processes, allowing for a smooth patient stream, shorter wait times and effective coordination among staff.

Dental practice workflows include tasks such as:

  • Scheduling appointments
  • Checking-in patients
  • Collecting medical history
  • Performing examinations and treatments
  • Facilitating proper follow-up care
  • Managing insurance and patient collections

A well-designed dental practice workflow addresses potential bottlenecks, reducing errors and improving communication. The three areas that often experience slowdowns are the reception areas, sterilization rooms and operatories. Paperwork, non-digital impressions and inaccessible online information throughout the dental practice are the primary culprits.

Here are other obstruction causes.

  • Schedule Utilization: Overbooking and downtime could mean your scheduling needs improving.
  • Time management: Dental practices need to account for the time it takes to discuss treatments and insurance with patients on top of the time required to diagnose, anesthetize or treat. . A lack of time management can increase patient wait times and general practice availability.
  • Practice resourcing: Dental practitioners and staff are in high demand. Many offices struggle to properly staff their practices on a regular basis, which creates challenges efficiently managing full schedules.

While bottlenecks can occur anywhere and anytime, regardless of planning, digital workflow optimization strategies can streamline and automate some processes, opening more opportunities for your practice.

The Importance of Design Thinking and Emerging Technology in Dental Practices

Workflow optimization involves improving effectiveness. The goal is to create a more efficient environment, allowing dental professionals to provide high-quality, timely care while ensuring a positive patient experience. Streamlining processes may include coordinating tasks better among dental staff, but it often involves implementing emerging technologies and digital systems with design thinking.

Create a more efficient dental practice environment

Design thinking is a creative problem-solving approach focused on understanding people’s needs and finding practical solutions, which are especially applicable to those providing patient-centered healthcare services. It involves compassion, experimentation and collaboration to develop innovative solutions to various workflow challenges. 

Technology use has increased among healthcare providers and dental practices worldwide. In 1984, only 11% of dental practices in the United States used computers. Today, teledentistry is equally as effective as in-person consultations for diagnoses and assessments.

Here are other time-saving technology examples that have improved dental practice workflow.

  • Digital radiography: Digital X-ray systems instantly produce high-quality images for diagnostic purposes, allowing dental professionals to save, send and view the images from nearly any device.
  • Electronic health records: Digital patient record management systems streamline documentation and give different healthcare providers easy access to patient information when needed.
  • Intraoral cameras: Small handheld cameras capture detailed images of patients’ oral cavities and dentition, aiding in diagnosis and treatment planning without sending dental impressions to a lab.
  • CAD/CAM technology: Computer-aided design and computer-aided manufacturing systems allow you to create same-day dental restorations like crowns and veneers, eliminating the need for multiple appointments and temporary fixes.
  • Communication tools: Secure messaging and teleconferencing platforms allow efficient communication among dental team members, specialists and patients.
  • Management software: Dental practice management software helps with appointment scheduling, billing, inventory management, patient communication and overall organization. The ideal solution is to have one platform that can handle everything in the same place without switching between different devices or programs.
  • Automated appointment reminders: Some tools can automatically send reminders to patients via text messages or email, reducing no-shows and optimizing appointment scheduling.

How to Use Design Thinking and Emerging Technology in Your Dental Practice

Using manual processes will limit your productivity, overwhelm your team and prevent you from having a competitive edge. To achieve workflow optimization with emerging technology, you can introduce new software and processes by following these steps.

  1. Identify workflow challenges: Start by analyzing your existing workflows and finding areas for improvement. This step may involve studying your patients’ experience, appointment booking system, treatment planning and revenue cycle management.
  2. Involve your dental team: Gather your team’s input and insights regarding their workflow challenges. Their firsthand experience and expertise can provide valuable insights into areas that require optimization and improvement.
  3. Map your current workflow: Create a visual representation of the existing workflow to understand the sequence of steps, handoffs between team members and the potential bottlenecks.
  4. Identify opportunities for improvement: Analyze your mapped workflow to identify where you can enhance your efficiency, eliminate redundancies and automate manual tasks. Look for opportunities to standardize processes, reduce paperwork and leverage technology solutions to streamline your operations.
  5. Find solutions to implement: Effect technology that can automate tasks, improve communication and centralize all your information.
  6. Redesign your workflow: Remodel the workflow based on the areas of improvement and technology solutions you found. Determine the best task sequence and handoffs between team members and incorporate tech that will enhance these tasks’ efficiency.
  7. Implement and test: Apply the redesigned workflow in phases, starting with specific processes or a pilot group. Train your team to ensure they are comfortable with the changes. 
  8. Continuous evaluation and improvement: Monitor and evaluate the effectiveness of the new workflow and gather feedback from the team. Identify any issues or areas that require further refinement and make necessary adjustments. 

Optimize Your Dental Practice with ProspHire

Workflow optimization is a continuous process. Thus, you should always seek ways to improve and adapt to meet changing needs. It requires a strategic approach that combines design thinking principles with emerging technology. When you partner with ProspHire, we work with you and your dental team to identify challenges and opportunities to create a more efficient, patient-centered and productive environment.

To learn more about our dental practice management services, contact us by filling out our online form or giving us a call.

Optimize Your Dental Practice with ProspHire

Unlocking Health Equity: A Strategic Framework for Success in the Health Equity Index Era of the Stars Program

In the ever-evolving landscape of the Medicare Stars program, the introduction of the Health Equity Index (HEI) in the CMS Final Rule of 2023 marks a pivotal moment in shaping the future of Medicare Advantage plans. Set to become a key determinant in Star Ratings from 2027 onward, the HEI presents a groundbreaking shift in focus—prioritizing health equity, recognizing social risk factors (SRFs) and urging plans to better serve underserved populations. 

HEI Objectives, Considerations, Timeline

As the industry prepares for this transformative change, ProspHire is at the forefront, introducing a comprehensive strategic framework for success. Comprising four essential pillars—Data and Analytics, Benefit Design, Member and Provider Engagement and Community Partnership—our approach is designed to empower health plans in navigating the nuances of the HEI landscape. We dive into the intricacies of the Health Equity Index, unraveling its objectives to enhance health equity, incentivize improved care for underserved communities and foster growth for plans aiming to extend their reach. Health plans must put focus on these four pillars to establish a strong foundation.

To access the key activities in ProspHire’s health equity strategic pillars please provide the information below and click on download now. 

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Digital devices, IoT, ICT

The Importance of System Integration in Healthcare

Have you ever felt like navigating the intricate web of healthcare systems is becoming more challenging by the day? You’re not alone. In the ever-evolving landscape of integrated health systems, system integration is a game-changer. It holds the key to streamlining operations, improving patient safety and unleashing the power of data-driven decision making.

What Is System Integration in Healthcare?

When we talk about system integration in healthcare, we’re referring to connecting and harmonizing the different software applications, platforms and systems you rely on.

Picture this — you have one system for patient records, another for lab results and another for billing. They all do their jobs independently, but what if they could work in harmony? That’s where system integration comes into play.

Why Is System Integration in Healthcare Important?

It’s impossible to overstate the importance of system integration in healthcare. In today’s complex, high-tech landscape, integrated health systems have become a necessity rather than a luxury. Why? It all boils down to efficiency and effectiveness. When different software applications and systems operate in isolation, healthcare organizations face multiple challenges. Fragmented systems mean segregated data, workflows and decision-making. It’s like trying to solve a puzzle with missing pieces.

System integration fills those gaps and creates a seamless information flow. By connecting various systems and enabling them to communicate and collaborate, healthcare organizations can achieve streamlined processes, improved operational efficiency and enhanced patient care.

Imagine a world where data flows effortlessly across departments, healthcare providers have access to complete and accurate patient information at their fingertips and team members make timely decisions based on comprehensive insights. That’s the power of system integration in action.

Additionally, system integration paves the way for innovation with the increasing emphasis on interoperability and data-driven healthcare. It sets the foundation for advanced analytics, personalized medicine and improved patient outcomes.

In a nutshell, healthcare system integration can break down barriers, create synergies and unlock the full potential of integrated health systems.

How System Integration Benefits Providers

Let’s dive into how system integration in healthcare can make your life easier and more efficient.

Enhances Convenience

First, system integration brings a world of convenience to the table. Instead of toggling among multiple systems and applications and struggling with different interfaces and logins, you have one cohesive platform consolidating all the necessary information.

It’s time to stop wasting time and mental energy trying to navigate a maze of disjointed systems. With system integration, you have a streamlined workflow that allows you to focus on what matters most — providing quality care to your patients.

Improves Accuracy and Accessibility

Access patient records to enable you to make more informed and astute decisions

Another critical benefit of system integration is the improved accuracy and accessibility of patient information. Integrated systems consolidate patient data into a single, comprehensive record. No more hunting down information scattered across various platforms.

You can easily access complete and up-to-date patient records, enabling you to make more informed and astute decisions. Whether it’s reviewing medical history, tracking test results or coordinating care, having all the necessary information at your fingertips is a game-changer.

Fosters Collaboration

Don’t forget about the power of collaboration. Integrated health systems enable seamless communication and information exchange among healthcare providers and Healthplans. With system integration, you can easily share data, consult with specialists and coordinate care plans. This collaboration improves the efficiency of healthcare delivery and enhances the quality of patient outcomes.

Creates Data-Driven Decision-Making

Moreover, system integration opens doors to data-driven decision-making. Integrated systems let users collect and analyze vast amounts of data, giving you valuable insights into trends, patterns and outcomes.

You can leverage this information to identify best practices, optimize treatment plans and predict potential health risks. Harnessing the power of data allows you to deliver more personalized and targeted care to your patients, ultimately improving their overall health and well-being.

In a nutshell, system integration empowers healthcare providers to deliver high-quality care more efficiently and effectively.

How System Integration Benefits Patients

System integration isn’t only about simplifying processes for providers or payers — it also benefits patients. Let’s explore how integrated health systems positively impact patient care and outcomes.

Enhances Patient Experience

Firstly, system integration enhances the overall patient experience. Imagine having to repeat your medical history, tests and medications every time you visit a different provider or facility. It can be frustrating, time-consuming and potentially risky if critical information falls through the cracks.

However, with system integration, patients can enjoy a seamless journey across the healthcare continuum. Integrated health systems consolidate patient records, ensuring all relevant information is readily available. They eliminate the need for repetitive paperwork and enable health professionals to provide personalized and efficient care.

Improves Safety

One significant advantage of system integration for patients is improved safety. Integrated health systems minimize the risk of errors, such as incorrect medication prescriptions or missed interactions. When all healthcare providers have access to a patient’s comprehensive medical history, including allergies, existing conditions and previous treatments, it enables them to make well-informed decisions and avoid potential pitfalls.

Integrated systems act as a safety net, providing patients with optimal treatments and interventions, reducing adverse events and enhancing overall safety while emphasizing on keeping patient information safe.

Promotes Continuity of Care

With system integration, healthcare providers can easily share information, coordinate treatment plans and follow up on patient progress. This seamless information prevents gaps in care and reduces the chances of missing crucial details.

Patients can enjoy a smooth transition among healthcare settings, knowing that their providers are well-informed and working together toward their well-being.

Facilitates Data-Driven Healthcare

Integrated health systems facilitate large-scale patient data analysis. By leveraging this wealth of information, healthcare providers can identify trends, predict potential health risks and personalize treatment plans.

This data-driven approach ensures patients receive tailored care that aligns with their specific needs and preferences, improving health outcomes and overall satisfaction. To sum it all up, system integration in healthcare places the patient at the center, fostering a seamless, safe and personalized care experience. It empowers healthcare providers to deliver coordinated, efficient and effective care that makes a difference in patients’ lives.

Embracing the Power of System Integration in Healthcare with ProspHire

Embracing the Power of System Integration in Healthcare With ProspHire

Unlocking the potential of system integration in healthcare is no longer a luxury but a necessity. It streamlines operations, improves patient safety and unleashes the power of data-driven decision making. As we navigate the ever-growing complexity of healthcare systems, integrated health systems are critical to success.

At ProspHire, we understand the challenges you face and the transformative impact of system integration. Our expertise in technology, infrastructure, enterprise architecture and vendor selection enable us to maximize your investment and achieve desired business outcomes. Let us partner with you in this exciting journey of creating cohesive and efficient healthcare systems. Are you ready to take the next step? Fill out our contact form to learn more about ProspHire’s system integration and selection services or read our clients’ results. Together, we can shape the future of healthcare delivery and drive positive change for patients and providers alike.

Luke Laurin

Q&A with ProspHire’s Luke Laurin on Dental Practice Management

ProspHire brings a wealth of expertise and insights into the dynamic field of Dental Practice Management. We’re talking with Practice Leader Luke Laurin and diving into the strategies, challenges and innovation that shape the modern dental landscape.

There are several trends we are seeing:

  • Increased focus on preventive care and oral health education with patients to reduce the need for more invasive treatments. There’s more emphasis on prevention rather than just treatment.
  • Greater use of digital technologies like integrative practice management systems (PMS), digital imaging, digital impressions and scans, digital treatment planning and AI. This includes technologies like CAD/CAM for restorations.
  • Rising popularity of cosmetic dentistry procedures like teeth whitening and veneers driven by greater consumer focus on dental aesthetics and appearance.
  • Use of minimally invasive techniques and materials to preserve more natural tooth structure whenever possible. Less drilling and removing of tooth material.
  • Growing use and integration of dental implants to replace missing teeth and provide anchor points for replacements like bridges and dentures.

We are also seeing a number of challenges:

  • Practices are aiming to control costs, reduce overhead expenses and manage lower insurance reimbursement rates. Not focusing on these challenges can impact profitability and the ability to reinvest into implementing new technology at the clinic.
  • It is challenging to keep up with rapidly evolving technologies and integrate them into the dental office and workflow. Additionally, there are significant learning curves with clinic employees and DSO support staff.
  • The increasing amount of student debt for new dentists makes it harder for them to purchase and finance a practice.
  • Increases in the cost of capital have led to a slowing in acquisition activity and lowering ROI, forcing some to consolidate practices.
  • There are ongoing shortages of non-dental healthcare workers like dental assistants and hygienists in many areas. This makes it harder to adequately staff practices.
Dental Practice Management Trends

How does ProspHire support dental practices?

ProspHire’s Dental Management Practice team addresses challenges for our dental clients with innovative solutions that help streamline practice/administrative processes, improve communication and collaboration between DSOs and practices, ensure compliance, enhance revenue cycle management and bolster your reporting capabilities. We partner with you and your vendors to implement standard solutions that are fine-tuned to your unique way of operating dental practices. 

Here are some of the ways we can support you through PMS implementation and optimization:

  • Lead Implementation, Training and Go-Live Support
    • Conduct training sessions (both online and in-person if possible) for staff on using the new software, focusing on workflows, key features and basics.
    • Provide user manuals and standard operating procedure guides for workflows that are changing.
    • Offer onsite go-live support when transitioning from old system to new PMS, having IT staff/PSM vendor on-site to help troubleshoot issues in real time.
    • Set up feedback channels to gather input on challenges or questions about the system post implementation and provide timely responses.
  • Optimization Assistance
    • Review initial workflows set up in the PMS and work with practice to optimize these based on how the staff actually uses the software. Look for unnecessary steps and correct user behavior
    • Examine reporting needs and ensure correct reports are being generated and used to support decision making around patient care, inventory, billing etc. Set up new reports as needed
    • Conduct usage reviews to identify additional PMS features that could streamline workflows. Offer recommendations and end-user training.
  • Ongoing Support
    • Field staff questions and respond to system issues. This includes troubleshooting error messages, fixing configuration bugs, resolving login issues etc.
    • Set up system for feature requests/enhancement suggestions from dental practice and prioritize these change requests based on impact to operations and effort required to complete.
    • Maintain PMS with regular software patches, updates and bug fixes to improve stability and performance and provide release notes of changes to end-user community.
  • Workflow Redesign and Improvement
    • Discovery, Analysis and Redesign
      • Conduct interviews and shadow staff to map out current workflows, identify bottlenecks and improvement opportunities.
      • Review relevant metrics and key performance indicators (production, patient cycle time etc.).
      • Document findings in process maps and improvement recommendations report.
      • Facilitate working sessions with dentists and staff to redesign workflows based on findings.
      • Consider opportunities to standardize processes, eliminate non-value steps and improve technology integration.
      • Develop updated process documentation and job aids once new workflows are finalized.
  • Workflow Implementation
    • Provide staff training on changes to workflows, systems and responsibilities.
    • Ensure forms, checklists and other documents align to support new workflows.
    • Project team members remain available onsite during rollout to answer questions and resolve transition issues.
  • Ongoing Workflow Refinement
    • Gather staff feedback regularly post-implementation to identify remaining pain points.
    • Continuously review metrics for target areas not yet hitting goals and make minor tweaks.
    • Conduct refresher training on updated workflows if major gaps are observed.
  • Clinical Operations Management
    • Staffing & Scheduling
      • Help dental practices create schedules that maximize provider time while ensuring adequate coverage for projected patient demand. Adjust as needed based on cancellations, no-shows, emergencies, etc.
      • Develop a staffing plan tied to a schedule that allows for proper patient handoffs, task distribution across dental assistants and hygienists and coordination with front office team.
    • Patient Flow & Experience
      • Review office layout and patient flow to identify opportunities to improve bottlenecks and lag times and provide recommendations.
      • Ensure schedule allows sufficient time for procedures while avoiding excessively long patient cycle times. Adjust slots if needed.
      • Offer front-office optimizations for phone interactions and in-office exchanges to deliver positive patient experiences and that correct information is collected during scheduling and registration.
    • Quality & Safety Protocols
      • Provide templates for clinical operation policies and protocols around infection control, medical emergencies, documentation etc.
      • Implement checklists and reminders to verify compliance with dental regulations and quality control procedures.
      • Coordinate OSHA and HIPAA training logistics with practice safety officer.
    • Performance Reporting
      • Help leadership define relevant KPIs to track patient access, cycle time, cancellation rate, procedure volume etc.
      • Set up dashboards and automated reporting to distribute for consistent monitoring of operational performance.
      • Identify areas not meeting targets and facilitate problem-solving initiatives to resolve.
PMS Implementation and Optimization

Can you share an example of a successful cost-saving measure or revenue enhancement strategy you’ve advised dental practices to adopt?

One effective strategy is the adoption of modern technologies to streamline operations, enhance patient experience and improve overall efficiency. While the initial investment in technology may seem significant, the long-term benefits often outweigh the costs. Improved efficiency and patient satisfaction can lead to increased revenue and reduced operational costs contribute to overall savings. It’s essential for dental practices to carefully evaluate their specific needs and select technologies that align with their goals and patient demographics.

Additional examples of cost-saving revenue enhancements include:

  • Offer cosmetic dentistry or whitening services. These are often paid directly out-of-pocket so increase profitability.
  • Provide membership plans tied to regular exams and preventive care. Steady recurring revenue stream.
  • Upsell elective procedures during checkups. Many patients don’t think of upgrades until prompted.
  • Expand social media marketing and online reputation management. Drives new patient growth and better word-of-mouth.
  • Offer patient financing plans through vendors. Increases ability for patients to purchase bigger ticket treatments.
  • Pay attention to legacy AR and devote a task force / team-based approach.
Cost-Saving Revenue Enhancements

How do you stay up to date with the latest industry trends and best practices in dental practice management?

Staying informed is an ongoing process and a combination of these is often the most effective approach: regularly reviewing materials and guidance from ADA and state/local dental associations; attending major dental conventions and conferences; meeting with technology vendors for software previews and demos of emerging tools and shadowing dental contacts in their cutting-edge practices. It’s crucial to assess the credibility of the information sources and tailor efforts to the specific needs and goals of the dental practice.

What is your approach to helping dental practices streamline their administrative and operational processes to improve efficiency?

Here is a comprehensive approach I would recommend to help dental practices streamline processes and enhance efficiency:

  • Conduct Thorough Practice Assessment
    • Review office layout and patient workflows
    • Shadow staff to understand current roles/duties
    • Identify any redundant efforts or bottlenecks
  • Evaluate Use of Technology
    • Assess what software/tools are currently utilized
    • Determine opportunities to better leverage technology (imaging, cloud storage, automation tools etc.)
  • Standardize Common Processes
    • Document consistent protocols for hygiene, sterilization, patient intake etc.
    • Create procedure manuals and templates for training
  • Implement Paperless Systems
    • Switch charts, forms, Rx etc. to structured digital formats
    • Install tablet sign-in, intra-office messaging, cloud-based document management
  • Examine Dental Coding/Billing Practices
    • Ensure accurate CDT coding for maximum insurance reimbursement
    • Provide ongoing coding education to billing staff
  • Strategize Staffing Plans and Roles
    • Cross-train where helpful to increase flexibility
    • Consider expanded roles for hygienists and assistants
  • Track KPIs for Continuous Improvement
    • Key metrics like chair utilization, case acceptance rates, accounts receivable
    • Make adjustments based on practice data

Implementing these strategies requires a collaborative effort and a commitment to ongoing improvement. Regularly reassess and adjust processes based on feedback, technological advancements and changes in industry standards to ensure long-term efficiency gains.

In what ways do you guide dental practices in ensuring compliance with industry regulations and maintaining high standards of patient care?

Maintaining rigorous compliance and high care standards is a top priority when supporting dental practices and ProspHire can play a crucial role in guiding the practices to ensure compliance with industry regulations and maintain high standards of patient care. Here are some of the ways we can support:

  • Stay constantly up to date on changing regulations from OSHA, CDC, ADA and state dental boards and relay important updates to the practice.
  • Conduct regular reviews with the practice to identify any areas of vulnerability or gaps related to infection control, radiography safety, data security, etc and develop action plans.
  • Research and vet vendors carefully from both compliance and quality standpoints before recommending partnerships.
  • Develop easy-to-follow protocol guidelines and visual aids for display in clinics regarding proper PPE use, disinfection techniques, etc.
  • Schedule annual or bi-annual practice infection control audits using established assessment frameworks to systematically identify opportunities.
  • Monitor patient review/rating platforms along with internal surveys to benchmark satisfaction and care experience.
  • Develop staff continuing education curriculums covering both hard and soft skills to reinforce stellar care delivery.
  • Guide the design and scheduling of clinical spaces to allow abundant time for complete sterilization/disinfection between patients.
  • Ensure clarity on latest regulations around digital patient record storage systems including frequent encrypted backups.
  • Update informed consent forms and advise on appropriate patient documentation procedures.
  • Promote high standards by comparing the practice against quantified benchmarks on key parameters.

ProspHire’s Dental Practice Management team can empower dental practices to navigate complex regulatory landscapes, uphold high standards of patient care and implement continuous improvement processes. This collaborative approach helps practices not only meet regulatory requirements but also excel in delivering quality dental services.

What key performance indicators do you use to measure the success and progress of dental practices you work with?

Measuring the success and progress of a dental practice involves tracking key performance indicators (KPIs) that reflect various aspects of the practice’s operations, financial health and patient satisfaction. Here are some key performance indicators that we recommend assessing the success and progress of dental practices, including clinical and operational metrics:

Clinical KPIs:

  • Treatment acceptance rates – % of recommended procedures ultimately performed
  • New patient conversion rates – % that schedule follow-up from inquiries
  • Recall compliance rates – % of patients following maintenance intervals
  • Cancelation and no-show rates
  • Patient retention rates year-over-year

Operational KPIs:

  • Production per provider/hygienist – tracks revenue contribution
  • Accounts receivable days outstanding – gauge collection efficiency
  • Patient wait times – ensures prompt service
  • Schedule effectiveness – measures how well appointment slots are filled
  • Insurance claim acceptance rates – monitors billing accuracy
  • Cost per patient visit – manages practice overhead
  • Rating platform reviews and survey feedback – indicates patient satisfaction

We collaborate with dentists to determine the optimum targets for each KPI based on practice goals and then build customized dashboards that compile the data points from electronic records, billing systems and patient platforms to allow for clear tracking over time. Reviewing the insights together enables data-driven decisions to continuously refine strategies and operations.

Clinical KPIs vs. Operational KPIs

How do you tailor consulting services to meet the unique needs and goals of each dental practice you serve?

Our approach always starts with developing a deep understanding of each dental practice’s unique set of circumstances, priorities and objectives. From there, tailoring the unique needs and goals of each practice is essential for providing effective guidance and support. Here are a few key steps and strategies:

  • Goal-setting collaborations – Facilitate sessions to define practice vision, targets for growth/profitability, areas for improvement.
  • Custom practice analyses – Conduct assessments aligned to established goals, focused specifically on SWOT variables, operations data, patient metrics.
  • Targeted execution planning – Develop strategies and detailed project plans based directly on the practice’s most pressing identified opportunities.
  • Personalized coaching services – Provide regular guidance aligned to practice strengths, culture and growth pace, adjusting as dynamics shift.
  • Differentiated reporting tools – Design KPI dashboards indexing indicators like production, collections, ratings etc. per the practice’s key areas of focus.
  • Hand-picked recommendations – Curate technologies, solutions and vendor partnerships appropriately suited to support the practice’s priorities.
  • Ongoing innovation – Continually suggest fresh, relevant ideas tailored to the practice’s evolving objectives.

The most impactful solutions emerge when every aspect stems from a complete understanding of the practice’s unique starting point challenges and aspirations for the future. Our personalized approach enhances the likelihood of successful outcomes and long-term collaboration.

How is ProspHire positioned to assist dental practices to stay ahead of the industry curve?

We aim to help dental practices stay ahead of the industry curve by providing tailored solutions from strategic planning to technology integration to performance optimization to staff training and development. The combination of broad industry perspective and personalized practice partnership enables us keep clients on the cutting edge.

Connect with me today for more details on our services, methodologies and industry-specific expertise.

Doctors looking at laptop

Understanding the Benefits of Staff Augmentation for Healthcare Organizations

Staff Augmentation is among the vital project delivery service solutions for healthcare companies and organizations as it offers a strategic, flexible and beneficial means of sourcing expert talent in the most effective way possible. When the need arises, in-house team members can benefit from the required expertise and assistance of experienced and appropriate industry professionals who specialize in this form of healthcare industry service.

There are several reasons to use staff augmentation in healthcare, including the swift onboarding process and the relief that the human resource department experiences due to circumventing conventional staffing solution requirements.

Learn more about staff augmentation, its potential benefits and how it can bolster your resources and transform your organization.

What Is Staff Augmentation?

If you require short-term talent acquisition solutions to either fill a skills gap, bolster current resource shortages or support increased workloads, then healthcare organization staff augmentation might be the right solution for you.

Although often used to fulfill specific skill and experience needs, staff augmentation can address several staffing and human resource challenges in the healthcare sector. Staff augmentation supplements an organization’s existing staff with prescreened external professionals temporarily to meet fluctuating demands or address critical projects or operating areas.

This allows a healthcare organization to scale its workforce quickly to precise needs without hiring additional full-time employees.

How Does Staff Augmentation Work?

The process typically begins with a healthcare organization identifying the specific staffing needs and skills requirements for a particular project or to improve current systems and operational efficiencies. The organization then collaborates with an external staffing agent or management consulting company to source the appropriate and qualified personnel.

The company will have screened professionals with the qualifications, licenses, experience and credentials of an appropriate team member. The healthcare organization and staffing company agree on clearly defined terms of engagement, including the contract duration, compensation, non-disclosure agreements (NDAs) and other relevant details that will also see that the augmented staff comply with all regulatory and compliance standards, such as HIPAA privacy and security rules, governing healthcare organization employees.

Once they’ve selected the appropriate staff, the healthcare organization does a brief orientation and integration to help the augmented staff understand the work and relevant company policies and procedures.

Who Makes up Augmented Staff?

The professionals, sourced by the management consulting company or other type of firm, are often referred to as augmented staff or might be called contractors. These individuals seamlessly integrate into the existing healthcare organization teams, working side by side and bringing the sought-after expertise to fulfill a specific role and required tasks.

A critical point is that these individuals are highly skilled, qualified and experienced professionals with vast knowledge in their specific field of expertise and have extensive knowledge of the healthcare industry. The sole difference between them and permanent employees is that they have made their careers in augmentation rather than finding fixed employment with a single organization.

4 Key Benefits of Staff Augmentation

In addition to the apparent benefits of staff augmentation, such as enlisting short-term talent to fill skills gaps and supplement existing teams, there are several other notable advantages. The benefits of staff augmentation for healthcare organizations include flexibility, scalability, acquiring specialized skills and improved efficiency.

This list of benefits is not exhaustive, and speaking with your provider about your specific needs will reveal how you can fully benefit from this service.

1. Enhanced Flexibility and Scalability

Staff augmentation empowers your healthcare organization with unparalleled flexibility and scalability, both in the ability to change how you hire specialized professionals and adapt to changing workloads and company demands. This means you can meet optimal staffing levels during peak business periods and make cost-effective adjustments once the company and client needs have been met. Overall, you can access many scalable workforce solutions and tailor them to current and foreseeable needs. Moreover, staff augmentation often offers a seamless process that fills the needs without impacting your core business. This means your operations continue uninterrupted while benefiting from the additional human resources and invaluable expertise.

Staff augmentation offers you access to a diverse talent pool

2. Access to Specialized Knowledge and Skills

One key aspect of staff augmentation is that it offers you access to a diverse talent pool of highly qualified healthcare-related professionals. As a healthcare organization, you gain specialized expertise that helps to address skills gaps and enhances the overall quality of your operations and performance. For instance, short-term needs for specialists in billing, case management or coding are perfect examples for tapping into and leveraging the knowledge of external professionals.

Moreover, as these professionals work closely with your in-house teams, you can tap into their skills and knowledge and learn from them. The transfer of knowledge is a long-term benefit where your team can discover new techniques and industry practices.

As augmented staff work with various companies, they constantly experience ongoing learning and have significant industry insights. They work to stay abreast of technological advancements, best practices and regulatory requirements and can help further learning among your staff.

3. Improved Operational Efficiency

Adding the right additional skilled staff through staff augmentation can improve organizational and operational efficiency, which assists in reaching peak performance. The external professionals are responsible for specific tasks within a project or your organization and use their expertise to help streamline operations, optimize workflow and enhance general performance.

If you require assistance to speed up single projects to meet tight deadlines or need to focus on executing larger tasks with the help of specialized skills and creative solution implementation, augmented staff can certainly help you. This service aims to provide a flexible and responsive element to your workforce that integrates seamlessly.

You can onboard augmented staff far more quickly than traditional staff employment procedures. This means you can easily add professionals to offer focused and result-driven work to meet your organization’s needs as soon as possible. With additional resources and expertise, your existing team benefits from workload distribution. They are less likely to suffer from overwhelm and burnout, which could slow operations even more.

4. Cost and Time Saving on Quality Expertise

Although healthcare organizations should avoid using staff augmentation purely as a cost avoidance strategy, it is a cost-effective means to acquire quality expertise in the short term and for precise needs.

Instead of protracted hiring processes, including announcing job vacancies and sifting through resumes, you have the convenience of selecting from external healthcare professionals who are fully equipped to help with your precise requirements. This means you can avoid recruitment overheads and eliminate the need for long-term employment commitments and associated benefits costs afforded to permanent staff. Staff augmentation provides a cost-effective solution with tailored resources for immediate and short-term needs. The time saved on onboarding these professionals also means accelerated project timelines, which adds to your operational agility.

Benefits of Staff Augmentation With ProspHire

Benefit From Staff Augmentation with ProspHire

ProspHire specializes in providing healthcare consulting services and solutions, including project delivery. We offer a comprehensive array of valuable and focused packages to assist you and your organization in maintaining progression and realizing ongoing improvements.

For further insight into how ProspHire can assist you in your healthcare staff augmentation, process improvement, project completion, compliance needs and other related healthcare field requirements, please contact us.

Soaring to New Health: Season 1 Recap

View our Season 1 Infographic above

If you’re a healthcare leader seeking insights to enhance cost efficiency, quality and patient experience, look no further than “Soaring to New Health,” ProspHire’s podcast that informs, entertains and inspires.  

Co-hosted by Chris Miladinovich and Dan Crogan, this podcast delves into the ever-evolving healthcare landscape, exploring topics with industry experts and thought leaders. As Season 1 wraps up, let’s take a moment to revisit some highlights and anticipate what’s in store for Season 2.

Click on the infographic to view some more in-depth information about the first season of Soaring to New Health.

Creating Competitive ACA Plans: How To Balance Affordability and Coverage Quality

The Affordable Care Act (ACA) — also known as “Obamacare” — is an inclusive healthcare law that aims to make healthcare insurance available to more people. It does this by lowering healthcare costs and mandating several requirements to ensure the plans are inclusive and accessible.

More Americans have enrolled for healthcare through the ACA than ever before — even the White House addressed the record ACA enrollment numbers. An ACA plan is a roadmap for your company to create and offer an affordable insurance plan with adequate coverage. ACA plans are crucial for the individuals who enroll, the healthcare insurance providers and the industry. Creating ACA plans diversifies your organization and lets you enjoy business growth and expansion.

Most importantly, understanding the complex and evolving regulations under the ACA is critical to ensure your plan is compliant.  The ACA requires all health plans in the marketplace to offer ACA-compliant programs that meet specific requirements. Of course, creating comprehensive plans that suit your business model is a top priority and balancing affordability and coverage is imperative. This guide outlines the requirements for an ACA-compliant program and how to launch your plan to cover costs and coverage.

What Impact Does ACA Have on Healthcare?

The ACA has had a positive impact on the health sector. The two main benefits of ACA are that it is inclusive and accessible. More Americans have healthcare today than ever before due to the affordability of these Plans for many individuals.

Additional benefits include:

  • Comprehensive Provider Networks that must meet federal and state adequacy standards.
  • Under the ACA, health insurance providers can’t deny coverage due to a preexisting health problem.
  • The ACA prohibits health insurance providers from charging higher premiums based on gender, pre-existing conditions and other factors.
  • All ACA plans must cover preventative services.
  • Affordable access to prescription drugs.

As the ACA marketplace continues to evolve, there are still opportunity areas:

  • Not everyone qualifies for ACA subsidies, so many Americans still find healthcare unaffordable.
  • In areas with several issuers and product offerings, individuals can struggle to compare plans and navigate enrollment windows.

While these pros and cons affect individuals more than they do your business, it’s essential to be aware of them, as you can consider these points when creating a competitive ACA plan that meets consumer needs.

What You Require to Set Up an ACA-Compliant Health Plan

Creating a compliant health plan that follows the rules established by the ACA is essential:

  • Cover essential health benefits: Cover the essential health benefits for your state to be ACA-compliant. These benefits include hospital stays, outpatient care, emergency care, maternity and newborn care, pediatric care, mental health coverage, prescription drugs, rehab services, lab resources and accessible options for preventive care.
  • Rate review requirements: Comply with all state and federal regulations when developing and adjusting rates during annual review.
  • Cap out-of-pocket expenses: To have an ACA-compliant plan, you must limit out-of-pocket costs for covered services. The out-of-pocket limit doesn’t include monthly premiums, out-of-network care and services, spending on services not covered in the plan and costs that exceed the amount for a service that you, as the provider, charge. This limit is set by the state in which you operate.
  • Reporting requirements: Comply with reporting requirements by always submitting the required data of your plans, including enrollment numbers, coverage costs and the number of denied claims.
  • Network adequacy requirements: The provider networks you contract with must be able to meet your customers’ needs adequately. Look into your state requirements for adequacy, including qualitative and quantitative standards.
How to Launch ACA Plans that Balance Affordability and Coverage

How to Launch ACA Plans That Balance Affordability and Coverage

The ACA plan you design will meet certain benchmark standards but will also have elements unique to your organization and the portfolio you are building for target and expected populations. These general steps serve as an excellent springboard for launching your plans to make ACA more affordable:

Create an Outline and Goals

Develop a plan that outlines your goals and the strategies you can implement to achieve your objectives. ACA plans can be standardized, so finding various ways to stand out in the market while remaining compliant is vital. You can accomplish this by considering your current and intended market, branding, pricing, provider networks and the plan’s overall design. You want to use your strengths to position yourself in the competitive health insurance market.

The planning stage may take several months of researching the market but it does pay off when you offer a plan customers will gravitate toward.

Get Your Licensure

You must get licensure for the state(s) you operate in. Dive straight into obtaining your licensure as soon as you start the planning phase, as obtaining licensure is a lengthy application process that can take months to finalize and can vary greatly depending on your state. Consider the fees involved so you may add that to your budget. Plan so that you have all the required documents to get your credentials and licensure without a hitch, including but not limited to:

  • Your National Provider Identifier (NPI)
  • Certificate of Authority
  • Financial Documentation
  • Organizational Structure
  • Attestations

Establish Provider Networks

Establish contracts with reliable provider networks that meet state requirements and who you trust to meet your customers’ needs. Develop an established provider network over a few months as you recruit and negotiate the terms of each affiliation.

Design Products and Strategize Pricing

The most crucial step is creating products, services and pricing options that comply with ACA’s regulations. Collaboration is the key to ensuring you make the best outline for products and pricing. Bring your financial team on board, your customer services team, your design team and marketing as you brainstorm on implementing new products, tweaking existing services, determining enrollment strategies and developing premiums.

Explore strategies regarding health costs to develop a realistic plan for balancing affordability and coverage that benefits you and your customers.

Submit a Qualified Health Plan Application

This is a yearly process that all health plans must complete to offer plans in any state or federal ACA marketplace. The application process opens in April and is concluded in September each year. Applications include templates and documents that outline your plan’s product offerings, rates, benefits, network and other vital information.

Development Systems

Strategize your options as you design and implement the practical components of your ACA plans. Practical elements include promotions or hiring new staff, choosing the best technology systems to fit your plans, how you will execute claims processing and implementing compliance procedures.

Develop and Grow Your ACA Plans with ProspHire

Develop and Grow Your ACA Plans with ProspHire

Having an ACA-compliant plan in your portfolio is crucial and developing the best plan for your business is undoubtedly a top priority. At ProspHire, you have a professional and reliable consulting firm supporting healthcare organizations as you develop and expand your portfolio. Our professional team works alongside you to tailor your ACA plans to your organization while offering expert advice and meaningful strategies to execute successful plans. We also assist you with marketplace accreditation, vendor implementation and business growth. Contact us today to achieve your ACA plan goals and learn more about our ACA plan development and expansion services.

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Soaring to New Health Blog – Episode Six, The Stars are Aligned

Welcome to Season 1, Episode 6 of the Soaring to New Health Podcast.

This episode is The Stars are Aligned. We’re diving deep into the world of healthcare and performance improvement. Medicare Stars and its far-reaching implications – what it is, why it’s important for health plans and members, common challenges and successful strategies. Dan Weaver, Senior VP of Stars and Quality at Zing Health and Andrew Bell, Stars Performance Leader at ProspHire.

Medicare Star Ratings are a way to measure and compare the quality and performance of Medicare Advantage and Prescription Drug Plans. The ratings are based on a scale of one to five stars, with five being the best, and they reflect various aspects of the plans such as customer service, patient outcomes, preventive care and benefits. Medicare beneficiaries can use the ratings as a guide when choosing a plan that suits their needs.

In Medicare Stars Plans, there are three categories based on the quality ratings on the plans: plans that have lost their rating, plans that have maintained their rating and well-positioned plans. For those that have lost their rating, recommended strategies include both foundational elements if identifying and addressing the deficiencies and implementing robust processes for advanced analytical components.

Dan Weaver says preparedness is the key. Gather your resources to collaborate and review and compare interpretations, seek outside expertise to help you align on steps that focus on sustainable improvements in quality and continuously monitoring and improving performance. The challenges to successful Star ratings are going to be different for every plan – from resource constraints to provider network challenges to data accuracy and documentation. Addressing these requires a comprehensive and targeted approach, including strategic planning, investment in resources, collaboration with stakeholders and a commitment to continuous quality improvement.

It’s crucial to understand that, at any given moment, your plan is influenced by activities spanning three distinct Star years. Approximately a year before the service dates, HOS surveys are conducted. These service dates take place within a calendar year. The subsequent year involves operational impacts, encompassing CAHPS survey, TTY foreign language testing and other pertinent assessments.

The Medicare Stars Program is highly regulated by CMS and it is common to see modifications to the program, be it measures added or removed, calculation adjustments or weighting changes. Looking ahead, CMS proposed to reduce the weight of patient experience/complaints and access measures from 4x to 2x for the 2026 Star Ratings.

For the more in-depth discussion on Stars Performance Improvement download the Soaring to New Health podcast, The Stars are Aligned, where you find your podcasts.

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