The Leadership and Feedback Loops: A Tale of Communication

The Leadership and Feedback Loops:  A Tale of Communication

Marcy O’Neill

September 19, 2015

        One of the analogies used most about United Health Group is “it is hard to turn the ship.” Engrained processes allow new products to move product, to licensing, to network, to sales, to implementation, to claims. Each of these systems has existing feedback loops and they hum along with mandated turnaround reporting and metrics turned in. We represent our own layers of subsystems within the health care system. We can tell you to the .01% of a person what we need in a call center if we are going to add a product. If the product is a medical product…

The Affordable Care Act (ACA) mandated pediatric dental and vision coverage be included with medical coverage for particular plans, creating new requirements for these lines of business. Within the matrix that is the United Health Group, these changes were reviewed by multiple project teams with hundreds of people in complex balancing feedback loops. The interactions between the lobbyists, provider interest groups, and state regulators worked to interpret the regulations and flip the switch. Many teams had to overcome many challenges but as Meadows points out, one of the traps of systems is improper goal setting. “Even people within the systems don’t often recognize what the whole-system goal they are serving.” (Meadows, 2008) pg. 161. Within our teams, it wasn’t necessarily clear if the whole-system goal was a regional market, a national market, or even a claims unit. As time has passed, the focus has shifted from solely revenue to compliance and from single segments to whole group successes as the organization has had more time to work through the first years of the ACA but this realization has taken time to understand along with leadership changes to come to fruition.

The organizational focus on revenue placed emphasis on the medical products. Further decisions to ingrate the dental and vision support teams into the larger medical support teams eliminated the balancing loop for the dental and vision products, but did not immediately replace it with a feedback loop into the medical processes. The challenge for leadership within the dental and vision organizations during this time was to keep people focused, while it seemed that there wasn’t organizational focus on the products they spent their time on. It required tenacity and an ability to be Machiavellian. There were those who both loved and feared particular leaders who stayed in the ever smaller specialty space.

Knowing that a system will deliver what it’s been designed to deliver, the model set out for the medical with embedded dental and vision coverage was built to deliver medical products with a dental and vision add-on. These systems did not and were not designed to include dental or vision processes. The key personnel from the dental and vision teams have never been part of the balancing feedback loop for the larger medical process were either unaware of how to influence the balancing feedback loop or lacked the leadership to add another feedback loop to the process. The medical process when examined works quite well but the goal was focused on revenue and did not include the dental and vision products. Since these products will never compete with the medical in revenue, they are not top priority.

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