Mind the Gap(s)

Ask Questions, Learn, Close the Loop

It was disturbing (but maybe not surprising) to read the findings of a Medco-sponsored survey this week. They found that over 60 percent of enrollees in Medicare Part D still did not understand the coverage gap – the so-called "doughnut hole" – where they must pay the full cost of their prescription medications. I said “still” because this plan went into effect in 2006. Most respondents didn’t understand the concept, didn’t know what counted toward the gap or at what point coverage resumed.

Woody Eisenberg, chief medical officer at Medco, said the Center for Medicare and Medicaid Services did “a fair job” in communicating what everyone expected to be a complex set of rules with multiple moving parts. There are, indeed, cases where fair or good is good enough but not here. Two years out, it’s painful to think that millions of people are not deriving the full benefit of such an important health program. This is one communications gap that must be closed.

There are plenty of other gaps like this one where great intentions fall short in the execution. And, there are other gaps that we leave open because we fail to close the loop. I’m sure we’ve all been there. We did all of the research and all of the planning. Then, we deployed the program and watched for outcomes. But how often have you really been involved in a post-mortem review and analysis of a program or a pitch? I’m not talking about a hallway conversation or a chat in a taxi cab. What was learned? What were the unintended consequences of our actions? What should be added or deleted to the next stage of the program? What else do we need to learn and from whom? Did we inform the internal and external teams that were part of the program success (or failure)? Did we provide adequate feedback to those involved? Whose performance should be celebrated and what steps should be taken to improve others? How did we manage our resources? Did we ask the people paying for all of this if they were happy?

There’s one more loop that we frequently fail to close. In business, where success is often founded on forming positive relationships, we are terrible at saying thank you. Win or lose, a thank you to staff, to vendors, to consultants, to anyone who had a stake in the effort is both the cheapest and richest expression one can offer.