January 22, 2026 in healthcare transformation, Member Experience, Provider Engagement, Quality Scores, Risk Adjustment, STAR

You are Mediocre!

2025 Was Mediocre for Healthcare. And We Need to Admit It.

Let’s stop pretending.

Despite the conferences, the white papers, the dashboards, the pilots, and the buzzwords, 2025 was not a breakthrough year for healthcare performance. It was a year of mediocrity.

Costs continued to rise.
Access continued to deteriorate.
Member trust continued to erode.
Provider burnout worsened.
And too many organizations hid behind “complexity” instead of owning execution.

The Hard Truths We Need to Say Out Loud

Cost of care is still escalating.
Not slowing. Not stabilizing. Escalating. And most organizations are still attacking symptoms instead of root causes.

Risk Adjustment V28 did not deliver the financial stability many plans expected.
For many, it created margin compression and premium challenges without a compensatory operational strategy. We relied too heavily on coding mechanics instead of clinical transformation.

Stars performance remains elusive.
Not because the measures are impossible — but because the system underneath them is fragmented. You cannot out-measure a broken operating model.

Member experience is still treated like a survey outcome instead of an operational discipline.

Provider abrasion remains high because we have not simplified workflows or respected clinical realities.

This isn’t a technology problem.
This isn’t a regulatory problem.
This is a leadership and operating model problem.

But Here’s What We Finally Did Right

2025 did give us one critical breakthrough:
We finally started admitting that the status quo is not working. That matters.

Across health plans, health systems, ACOs, MSOs, and vendors, more leaders are acknowledging uncomfortable truths:

  • That silos between quality, risk, network, operations, and finance are destroying outcomes
  • That over-engineered programs with under-executed operations do not scale
  • That innovation theater has replaced operational discipline
  • That we cannot measure our way out of structural dysfunction

Recognition is not transformation — but it’s the first prerequisite.

The Path Forward Is Not More Strategy. It’s Structural Realignment.

If we are serious about moving from mediocre to good (and eventually to great), we must fundamentally realign around five operational truths:

1. Member Experience Is Not a Department — It Is the Operating System
You cannot delegate member experience to marketing, CAHPS teams, or call centers.
It is created (or destroyed) in:

  • Access to care
  • Continuity of care
  • Care navigation
  • Clinical trust
  • Frictionless coordination

Until organizations design care models around the lived member experience, scores will remain mediocre.

2. Provider Engagement Must Replace Provider Management
Most “provider engagement” strategies are still transactional:

  • More portals
  • More forms
  • More checklists
  • More burdens

True engagement means:

  • Simplified workflows
  • Shared data transparency
  • Respect for clinical time
  • Real partnership in outcomes

Burned-out clinicians cannot deliver top-quartile quality, no matter how sophisticated your analytics are.

3. We Must Simplify Medical and Dental Care Pathways
Complexity is not a virtue.

It is the enemy of scale, consistency, and affordability.

We have built:

  • Overly fragmented specialty pathways
  • Redundant authorizations
  • Disconnected dental-medical integration
  • Disjointed transitions of care

If we want to drive down cost while improving outcomes, we must:

  • Standardize evidence-based pathways
  • Integrate dental and medical models
  • Remove administrative friction
  • Design care around longitudinal outcomes, not episodic billing

4. Access to Specialists Is Quietly Undermining Care Protocols
This is one of the most under-discussed failures of 2025.

Care models assume:

  • Timely specialty access
  • Coordinated referrals
  • Closed-loop consults

Reality looks like:

  • 3–6 month waits
  • Lost referrals
  • Fragmented communication
  • Members abandoning the process altogether

You cannot claim population health success when your most vulnerable patients cannot access the care your protocols require.

5. We Must Align Around a True Hospitalist Model
The acutely and chronically ill patient is paying the price for systemic misalignment.

Too often:

  • Health plans operate in isolation
  • Health systems optimize locally
  • Post-acute coordination is fractured
  • Accountability disappears at transitions

A true hospitalist model — aligned across payer, provider, and post-acute ecosystems — is not optional.


It is essential for:

  • Reducing readmissions
  • Improving transitions of care
  • Managing complex populations
  • Stabilizing total cost of care
  • Restoring dignity to the sickest patients

A Message to Healthcare Leaders: Wake Up

We cannot afford another year of mediocre

The system cannot absorb more:

  • Strategy decks without execution
  • Pilots without scale
  • Innovation without accountability
  • Collaboration theater without ownership

What healthcare needs now is not more ideation.

  • We need disciplined execution.

  • We need structural courage.

  • We need operational leadership.

  • We need aligned incentives.

  • We need simplification.

Most importantly, we need leaders willing to say:
“We didn’t perform well enough. And we are changing how we operate.”

2026 Must Be the Year We Move From Talking to Doing

  • Not better messaging.
  • Not better branding.
  • Not better dashboards.
  • Better operating models.
  • Better alignment.
  • Better execution.

The industry doesn’t need more thought leadership.
It needs operational leadership.

Because mediocre is no longer sustainable — financially, clinically, or ethically.

Related Posts

By browsing this website, you agree to our privacy policy.
I Agree