In today’s age of healthcare, one thing is certain: change will occur. For health plans, change is constant. It could come from rapid growth due to adding a new line of business or winning a state contract to expand. It could be due to new government regulations or accreditation requirements. Certainly the shift to value-based models has been a driver, as has consolidation of the industry. For these and many other reasons, health plans can find themselves short-handed in not just clinical leadership positions but also in operational, business and other executive level roles.
Today’s health plans cannot look at interim staffing as a fix simply at the front line and administrative level. Last year, we wrote about interim staffing for clinical leadership roles as an effective solution in times of need. While this remains true, in these times of great change, health plans may find role gaps across the organization, including in the C-suite. Rather than have people work double duty in hopes that the role will soon be filled, when faced with a talent gap, health plans should consider immediately engaging with a reliable partner who can fill the role on an interim basis. Health plans, and other employers, often grossly underestimate how long it takes to fill a full-time position, particularly in management and leadership roles. And operational continuity is key.
Roles and circumstances where interim support is effective include:
Corporate leadership: Turnover in leadership at the executive levels warrants immediate action. A search for full-time replacements can be daunting and lengthy. While boards of directors typically quickly establish an interim CEO, other roles, like Chief Financial Officer, may go unfilled. Working with a trusted source that has a network of executives with health plan experience who can step in immediately helps maintain continuity and key strategic initiatives.
Clinical leadership: As we’ve said before, there are many areas where interim clinical leadership is warranted. In times of significant membership growth or new product implementation where clinical oversight and management cannot keep up, interim solutions provide immediate oversight and can enable the plan to thoughtfully and deliberately fill the full-time position. This may include a CMO, medical directors or nurse executives to “keep the trains running”. Likewise, a backlog of utilization reviews or care plans due to rapid expansion can be alleviated, keeping the plan in compliance and the provider network satisfied.
Objective review of utilization, case or care management programs is also an area where interim support is effective. Often, someone outside the organization can more impartially evaluate program efforts and provide leadership and recommendations for improvement far better than internal staff.
Trial clinical roles can also be useful when plans are seeking to determine whether a specific position would be useful long-term. An example is hiring an interim team to provide care management for members with co-occurring physical and behavioral health issues or someone with deep pediatric or OB/GYN experience. If that expertise has a positive ROI or benefit to members, then a permanent position can be created.
Quality and accreditation are increasingly important areas in health plans. When a plan needs to maintain or improve Star or HEDIS scores, assess clinical policies and procedures, develop and perform against a QI plan or prepare for an NCQA or URAC review/audit, interim leadership can be dedicated to focusing and steering an organization to optimal results.
Regulatory compliance – As regulations change, a plan may find itself understaffed in being able to make changes or, as noted earlier, fall behind due to accelerated growth. Interim compliance leadership can stem the tide, driving updates within the organization and shepherding the plan through backlogs or other compliance shortfalls.
Specific clinical expertise – A plan may have products or services that require explicit experience, in areas such as Medicare Advantage, dual-eligibles, clinical policy development or clinical committee involvement. In these situations, bringing someone in with deep knowledge and experience can be invaluable.
When considering interim leadership and management, the following recommendations can optimize their value to you and your organization:
Prioritize needs – identify specific deliverables or initiatives to maximize expertise and effectiveness.
Allow focus – don’t let interim staff get bogged down in bureaucracy that has nothing to do or is distracting from what they need to accomplish.
Encourage outside perspective – encourage recommendations and sharing of insights.
Partner well – work with an organization that can bring the best expertise for the role you need to fill, with flexibility to fill the role for as long or as short as needed.
DeltaSigma has a history of working with our clients to determine strategies to improve outcomes for members. Including interim leadership and management solutions within those strategies can be an effective way to achieve critical initiatives and make the plan more successful.