Healthcare organizations don’t usually struggle with strategy. More often, they struggle with getting people to actually adopt the change.
In Episode 2 of Soaring to New Health, Dan Crogan and Chris Miladinovich talk with Michael Meadows from Limetree about why good ideas in healthcare so often stall once implementation begins and what leaders can do differently to make change stick.
The conversation centers around behavioral science and the reality that people don’t make decisions based on logic alone. Employees, members and patients all bring habits, assumptions and personal experiences into the way they respond to change. That’s why even initiatives backed by strong data and clear business cases can still struggle with adoption.
Throughout the episode, Meadows shares examples of the behavioral barriers organizations run into every day, from confirmation bias to change fatigue to “sunk cost” thinking — continuing to push an initiative forward simply because too much time or money has already been invested.
The discussion also looks at the difference between mandates and nudges when trying to influence behavior. Mandates may create compliance, but nudges help move people toward action in a way that feels more natural and sustainable. In healthcare, that can affect everything from preventive care outreach to operational workflows and customer service interactions.
One of the biggest themes from the episode is that organizations often underestimate the human side of execution. Technology, systems and process changes matter, but there is still a person on the other side making decisions every day. Leaders who understand that are far more likely to build initiatives that people actually embrace.
Season 4 of Soaring to New Health opens with a reality many organizations are still catching up to: Compliance isn’t a checkbox. It determines whether your business can grow.
Where It Breaks
The biggest mistake? Treating compliance as something you add on later. As Jessica Zeff explains, when compliance is brought in after decisions are made, organizations are forced to go back, fix and rebuild, often at a high cost.
That’s when you see:
Missed risks
Rework and delays
Inability to prove what was done
And in today’s environment, that last one matters most.
The Shift Happening Now
Compliance has moved from enforcement to enablement. It’s no longer about pointing out what’s wrong; it’s about helping organizations:
Understand risk
Build stronger operations
Move forward with confidence
As Andrew Bell highlights, the downside of getting it wrong has never been higher: audits, penalties and funding risk are all increasing. You don’t just need to be compliant. You need to prove it, continuously.
“Compliance isn’t a constraint on growth; it’s the condition for sustainable growth.”
What High-Performing Organizations Do Differently
They don’t treat compliance as a function. They build it into how the business runs.
That means:
Bringing compliance in early, not after the fact
Embedding accountability across teams
Using data to monitor risk in real time
Aligning governance with execution
The result? Fewer surprises, faster decisions and stronger performance.
The Bottom Line
When compliance is reactive, it slows you down. When it’s built in, it gives you the confidence to move faster and scale without creating risk.
Let’s Talk
If you’re navigating growth, transformation or increased regulatory pressure, compliance can’t sit on the sidelines. At ProspHire, we help organizations move from reactive compliance to embedded, operational infrastructure, so you can execute with confidence. Connect with our team to start the conversation.
CMS’s CY2027 Final Rule simplifies the Stars program but raises the stakes for performance. With fewer measures and greater concentration of weight, small performance gaps will have outsized financial impact, especially for plans near 4 Stars. CMS estimates $18B+ in payment reductions over the next decade, reinforcing that even incremental changes in performance now carry meaningful financial consequences.
CMS is accelerating a shift away from administrative measures toward those that directly reflect member experience and clinical outcomes. As process-focused measures are phased out, performance will be driven by how members experience care and whether that care leads to meaningful health improvement, not how well processes are documented. While the Reward Factor remains in place and the Health Equity Index reward will not be implemented, the overall direction signals increased weighting on performance in areas that matter most to beneficiaries, including access, experience and outcomes. The table below outlines the 11 measure removals and additions that bring this shift to life across the Stars program.
The removal of these measures will shift domain weighting. Starting in SY2029, HEDIS will carry the greatest influence on overall Star ratings, reinforcing that clinical outcomes, not process, will drive performance.
Domain Weights
Quality Improvement (QI) not shown in domain weight total
The result is a more streamlined program with less margin for error. With fewer measures acting as buffers, performance will be driven by a concentrated set of core metrics with fewer opportunities to offset underperformance.
What This Means Now and What to Do About It
Success in this environment will require more than closing gaps at the measure level. As CMS continues to concentrate weight on outcomes, performance will be driven by a smaller, more sensitive set of metrics with far less room for error.
Plans need to quickly shift from managing measures to managing populations:
Which populations are actually driving performance?
Where are outcomes breaking down across the member journey?
Are interventions targeted or broadly deployed with limited impact?
At the same time, execution becomes more complex, not less.
Stars performance is no longer owned by a single team; it’s produced across the organization. Performance depends on how well clinical operations, network strategy, pharmacy and member experience work together to drive outcomes. Gaps in alignment across these areas will show up quickly and financially.
CMS is also moving toward greater direct accountability. While certain measures (e.g., Appeals) are rolling out of Stars, they remain subject to audit and monitoring. The buffer that Stars once provided is shrinking. Performance, compliance and financial outcomes are becoming more tightly linked.
The result is a near-term reality many plans are already feeling:
You still need to deliver on current-year performance
While simultaneously redesigning your strategy for what’s next
With limited resources, increasing financial pressure and no clear “extra capacity” to do both
Where ProspHire Can Help
Leading plans are already shifting their Stars strategy: moving from measure-level optimization to enterprise execution.
We partner with plans to move beyond strategy and into action:
Prioritizing what Matters Most – aligning investments and interventions to the populations and measures that drive performance
Turning Data into Action – understanding not just where gaps exist but why and what to do about them
Driving Cross-Functional Alignment – connecting clinical, pharmacy, experience and operations to deliver results
Integrating Stars Efforts End to End – bringing CAHPS, HEDIS and Part D into a cohesive, member-focused approach
Executing and Sustaining Change – supporting implementation and long-term adoption so strategies deliver lasting results
This is not a moment for theoretical strategies or incremental adjustments. It requires focused prioritization, strong partnership and disciplined execution. In a program with fewer measures and higher stakes, performance won’t be determined by strategy. It will be determined by execution.
As dental organizations modernize their technology environments, the conversation often focuses on selecting the right systems. But across the industry, leaders are discovering that technology alone does not drive transformation. Execution does.
The report brings together perspectives from technology providers, advisors and industry leaders to examine the trends shaping dental organizations in the years ahead.
In the Planet DDS Dental Industry Outlook 2026, ProspHire’s Jack Warwick explores the operational realities dental organizations face when implementing new platforms across multi-location practices. From data migration and system configuration to workflow redesign and staff training, successful implementations depend on disciplined execution and change management.
For dental support organizations and multi-location practices, the takeaway is clear: technology investments deliver value only when strategy, operations and frontline adoption move together.
Click HEREto Download the Planet DDS Dental Industry Outlook 2026
The first $10 billion installment of the Rural Health Transformation (RHT) Program has been distributed, with allocations ranging from $147 million in New Jersey to $281 million in Texas. Over the next five years, the full $50 billion federal investment will flow through state-led transformation strategies.
But this is more than a funding announcement. It is a high-stakes experiment in state-driven healthcare redesign.
Created alongside nearly $1 trillion in projected Medicaid spending reductions over the next decade, the RHT fund was designed to soften anticipated rural fallout while giving states flexibility to innovate. Federal leaders have emphasized that states have “space to be creative” in designing their transformation approaches. As CMS Administrator Mehmet Oz noted following the announcement, “Some states will fail and we will learn from that.”
That framing matters. It signals three things:
There will not be a uniform national model.
Outcomes will vary significantly.
Execution capability will determine durability.
Without integration across these domains, funding risks fragmentation across well-intentioned but disconnected initiatives. RHT does not fund isolated projects. It implicitly demands operating model redesign.
Flexibility Increases Variance
States have latitude in how they deploy funds across approved categories, including prevention, workforce investments, technology modernization and care model innovation.
Flexibility encourages innovation. It also increases variance.
Some states will build coordinated, multi-year transformation roadmaps aligned to performance metrics and CMS reporting expectations. Others may distribute funds broadly without sequencing structural change.
The difference will not be intent. It will be implementation discipline.
The Medicaid Backdrop Changes the Stakes
RHT is unfolding amid broader fiscal pressure within Medicaid. For rural communities already operating with thin margins, transformation cannot be additive spending layered onto unstable foundations.
Sustainability will require:
Aligning payment reform with provider capacity
Ensuring workforce investments include retention strategy
Embedding analytics infrastructure into value-based initiatives
Sequencing modernization efforts to avoid operational overload
Rural transformation is not theoretical. It is operational. Over the next five years, the states that treat RHT as a coordinated system redesign, rather than a funding cycle, will be positioned to create durable improvements in access, quality and financial sustainability.
How geographic data and social determinants insights can help organizations identify and address maternal health disparities.
Disparities in maternal outcomes are real and persistent. Despite improvements in clinical care, preventable gaps in outcomes continue to exist, making maternal and perinatal health one of the clearest indicators of health inequity within the U.S. healthcare system. These patterns have existed for years, yet meaningful progress has been limited. The question is no longer whether inequities exist but how organizations take responsibility to address them.
Data Driven Insights
Health plans and providers see inequities through quality performance, member experience and long-term cost trends. Addressing these disparities requires more than broad programs. It requires focused strategies grounded in data and a clear understanding of the communities where members live.
To support this work, ProspHire has enhanced a sample of our Addressing Health Disparities Dashboardto highlight Maternal and Perinatal Health Equity. The dashboard brings together maternal health outcome metrics and key social determinants of health indicators at the state and county level.
This allows organizations to examine maternal outcomes alongside the social conditions that influence them.
By viewing health outcomes and SDOH indicators together, the dashboard helps organizations identify where disparities may exist and where targeted interventions or community partnerships may have the greatest impact.
From Awareness to Accountability
Organizations must move beyond identifying disparities to implementing focused programs, aligning resources and building partnerships that address the underlying drivers of equity. The dashboard is designed to start that conversation. The opportunity lies in turning geographic insight into a focused maternal health strategy that improves outcomes and advances equity across communities.
ProspHire partners with healthcare organizations to move from insight to execution, helping teams design and implement practical, scalable solutions tailored to the communities they serve.
Ready to make a difference? Partner with ProspHire to drive meaningful data-informed change in maternal and perinatal health equity. Reach out to our team today to start transforming insights into action and create lasting impact for your community.
We’re proud to congratulate six ProspHire employees:Luke Laurin,Hootan Shahidi, Jack Warwick, Ben Tarter, Lauren Lougney and Jeremy Spelios on earning the Denticon Master Trainer Certification. This accomplishment reflects more than product expertise, it demonstrates a continued commitment to growth, learning and delivering greater value to our clients.
As the dental landscape evolves, so does the technology that powers it. By deepening their mastery of Denticon and advancing their training capabilities, our certified team members are better equipped to support DSOs and partners with informed guidance, thoughtful change enablement and scalable education strategies. Their enhanced expertise ensures our clients benefit from up-to-date insights, refined best practices and a stronger foundation for long-term success.
We celebrate their dedication to continuous improvement and their ongoing commitment to elevating the client experience. This milestone reflects our unwavering focus on strengthening our capabilities so we can better serve the organizations that trust us as their partner. Congratulations!
Click hereto learn more about Dental Practice Management at ProspHire.
Member experience has become one of the most powerful drivers of Medicare Advantage Stars Performance. CMS continues to raise expectations for how members experience their health plan, placing greater emphasis on trust, access, communication and consistency across the entire journey.
CAHPS performance is no longer shaped by isolated touchpoints or seasonal outreach. It reflects how members feel about every interaction, across every channel, over time. There are no silver bullets. Sustainable CAHPS success is built through consistency, stability and brand credibility… doing the right thing, at the right time, for all members.
When experience efforts are disconnected from journey insights or only activated during survey season, plans risk missing the true drivers of member perception, loyalty and trust.
What Successful Plans Are Doing Differently
High-performing plans treat CAHPS as an always-on, insight-driven experience strategy rather than a one-time campaign. These organizations are:
Using member journey insights to understand the triggers, transitions and barriers, such as network and benefit changes or service disruptions, where proactive outreach has the greatest impact.
Delivering timely, personalized outreach through moment-based interventions thatfeel relevant and supportive. Real-time signals and operational data are used to trigger the right message, through the right channel, at the right time.
Aligning the entire ecosystem around consistency, ensuring internal teams and vendor partners operate cohesively. These plans recognize that trust is cumulative. Every touchpoint, regardless of who delivers it, contributes to the survey response.
Three Priorities for Data-Driven CAHPS Improvement
Our Perspective
At ProspHire, we believe CAHPS improvement starts with trust and is sustained through disciplined, insight-driven execution. By connecting member journey data with operations and member experience strategy, plans can move beyond short-term survey tactics and build relationships that drive long-term loyalty and Stars performance.
Design Experiences That Members Remember
CAHPS results are shaped long before the survey arrives. Now is the time to rethink how journey insights, moment-based outreach and consistent experience delivery work together to build trust, elevate satisfaction and drive meaningful results.
HHS released the 2027 Payment Notice Proposed Rule on February 9, signaling meaningful shifts for Health Insurance Exchanges, Issuers, brokers and agents. This annual notice sets the stage for potential changes and additions to the standards governing marketplace operations, plan design and compliance oversight.
As anticipated, the Proposed Rule seeks to reintroduce several requirements previously included in the 2025 Marketplace Integrity and Affordability Final Rule that were subsequently stayed by the courts prior to PY2026. These provisions include the elimination of certain Special Enrollment Periods (SEP), enhanced verification requirements for SEPs, restrictions on APTC eligibility for undocumented individuals and stringent income verification prior to receiving APTCs.
The Proposed Rule also takes several steps to increase state authority and autonomy by removing barriers to the creation of State-Based Exchanges and shifting network adequacy requirements and reviews to the states.
Lastly, the Rule looks to ease the administrative burden on Issuers by removing duplicative certification reviews, eliminating the Standard Plan Design Requirement, relaxing Essential Community Provider (ECP) contracting thresholds and discouraging additional state-mandated Essential Health Benefits (EHBs).
Why this Matters
While states and plans may experience autonomy and procedural relief, CMS has made it clear that compliance with federal regulations remains mandatory and that non-compliance will carry consequences.
What Should Plans Do Now?
Submit comments on the Proposed Rule by March 11
Complete a rapid compliance assessment of all impacted operational activities, assuming the rule is codified as proposed
Collaborate with state insurance departments to understand implications for the upcoming certification cycle
Re-design processes and procedures to align with codified requirements
Develop a compliance roadmap, including scheduled mock audits to proactively identify and mitigate risks
