Let’s have a conversation
We had the pleasure of speaking with Melissa Newton Smith, a renowned expert in Medicare Advantage and Star Ratings, who recently announced a strategic alliance with ProspHire. Melissa brings three decades of experience in healthcare strategy, operations and quality improvement, with a particular focus on Medicare Advantage. Her expertise has been instrumental in driving innovation and excellence across the industry. In this interview, we'll explore Melissa's insights on the evolving landscape of healthcare, the impact of this new partnership and her vision for the future of Medicare Advantage.
Background and Expertise
Can you tell us about your background and how you became an expert in Medicare Advantage and Stars?
As a lifelong learner, it's very humbling and a little awkward to be called an “expert.” It’s not a title I readily embrace because my goal has never been to become or be an expert, but rather to do meaningful work for my clients by staying curious, knowledgeable and focused on their goals and needs. Every day I dedicate time to exploring the latest regulatory updates, industry news, research publications and insights from others to keep pace with this constantly evolving field.
My journey into Medicare Advantage (MA) and Star Ratings was unplanned and unexpected. As a CPA, my background initially focused on managing federally funded grants and contracts. In 2008, when my children were young, I chose to scale back to a part-time role and a former KPMG colleague graciously created a position for me in a Part D plan. At the time, I knew nothing about Medicare Advantage, but I quickly leveraged my business acumen and innate curiosity to learn and eventually excel in the growing MA and Part D landscape. As CMS transitioned the Star Ratings program from the Demonstration stage, I saw an exciting opportunity to make an impact in a nascent field. I joined an MA-PD plan's Star Ratings team, where I embraced the challenge of building impactful programs and delving into the complexities of health plan quality from the ground up. My passion for learning fuels me. I am an avid reader and genuinely enjoy dedicating the time required to quickly absorb, comprehend and, more importantly, apply the vast body of knowledge needed to succeed in this industry. I knew nothing about the terms, industry norms and technicalities when I began my Star Ratings journey in 2011. My learning journey was, and still is, vast and my expertise is the product of consistent and persistent learning alongside the relentless pursuit of success for my clients.
The Strategic Alliance
Congratulations on the alliance with ProspHire! What inspired the alliance and what excites you about working with ProspHire?
This alliance is a natural fit of my long-standing belief in the power of partnerships and the reality that organizations need more expertise and support than ever before. This is an exciting time in our industry, filled with rapid, sweeping and frankly existential changes for health plans, providers and vendors.
Our team has increasingly been asked to provide expanded, sustained personnel and support to manage implementations, augment staff capacity and drive routine operations for our clients. By combining our team’s insights and advice alongside ProspHire’s strong project delivery capabilities, we will be able to offer even greater value to our clients as they navigate significant changes in MA, Medicaid and the broader healthcare sector.
Our clients thrive on teamwork and collaboration and this alliance reflects the same spirit of working together for shared success.
ProspHire has a strong reputation for delivering transformative project outcomes in healthcare. How does your expertise complement their approach and what unique value do you believe this collaboration will bring to the industry?
My expertise lies in optimizing performance using curiosity, creativity and personal experiences to design and implement innovative strategies for success. ProspHire's reputation for delivering transformative project outcomes perfectly complements my work and approach. Together, we bring a powerful combination of strategic consulting and operational excellence, focused on driving measurable, sustainable improvements in healthcare quality. This collaboration will allow us to design and implement solutions to the industry's most pressing challenges, from improving member experiences to transitioning to digital quality measurement which will ultimately raise the bar for healthcare outcomes across the board.
Healthcare Innovation and Operational Excellence
The healthcare industry is rapidly evolving, especially with the growing focus on quality and efficiency. How do you envision this partnership helping healthcare organizations navigate these changes and achieve their goals?
Healthcare organizations today are under immense pressure to balance quality with efficiency while navigating regulatory changes. Almost every organization needs some combination of strategic foresight and operational agility to help understand the changes and adapt quickly enough to achieve corporate objectives. Our focus on data-driven strategies, innovative care models and member-centric solutions will enable healthcare organizations to not only meet but exceed their quality and operational goals, ensuring long-term success.
In your opinion, what are the biggest challenges you’re seeing in the Medicare Advantage space and how do you plan to address these through your collaboration with ProspHire?
The nature and number of changes in Medicare Advantage has introduced a complicated web of interrelated changes required for organizations to both survive and thrive. We are seeing plans, providers and vendors struggle to fully understand these changes and design operational adaptations to cope with them as fast as will be necessary for success. We plan to help plans address these challenges by bringing technical expertise and skilled staff to customers to accelerate and enhance operational activities and adaptation.
The alliance between ProspHire and the Newton Smith Group is described as a significant step toward advancing healthcare innovation. What does healthcare innovation mean to you and what areas are you most focused on?
For me, healthcare innovation is about creating solutions that not only address immediate challenges but also anticipate future needs. It's about making care more accessible, efficient and person-centered. In this alliance, I’m particularly focused on innovations that improve access to care and member experiences, such as integrating technology to achieve personalized engagement at scale in alignment with CMS and NCQA regulatory and quality requirements. We’re also increasingly helping plans, providers and vendors redesign and leverage new payment models to better align incentives across the care continuum, ensuring that both quality and value are rewarded.
Goals and Vision
Looking ahead, what are your long-term goals for this partnership and how do you see it evolving to meet the future needs of the healthcare industry?
Our long-term goal is to build a framework that allows health plans, providers and vendors to continuously adapt to the evolving healthcare landscape, particularly as Star Ratings, regulations and the healthcare environment in general become more complex. We want to ensure that organizations are not just reactive but proactive in their approach to care delivery and quality improvement. As the healthcare industry continues to evolve, I see this partnership expanding into new areas, such as personalized care models, digital quality measurement, advanced analytics to improve health outcomes and deeper integrations of member experience tools to drive outcomes at scale.
Are there any upcoming projects or initiatives with ProspHire that you are particularly excited about?
YES! Just as we support clients in designing and deploying innovations, we are designing some innovations of our own within our practices. We have exciting plans for 2025 and can’t wait to share them soon!
Industry Trends
What trends do you see emerging in the healthcare industry that will impact Star ratings?
We expect continued technological modernization, which is occurring alongside tighter margins and an unprecedented pace of regulatory changes to continue in the coming years. These interrelated, sometimes competing forces, will require significant examination by leaders and experts to ensure effective decisions are made with reasonable risks.
As Medicare plans prepare to navigate the regulatory changes ahead, what are the 3 areas Health Plans need to consider?
Health plans will need to strengthen the degree to which they focus on access to care, sustained health improvements and well-managed costs. Plans will need to prioritize access to care as the most critical aspect of member experience and health outcomes to drive continued Star Ratings success.
Second, they must invest in real-time data infrastructure to ensure that care gaps (not just HEDIS gaps) are closed quickly and efficiently.
Finally, plans need to focus on sustainable, mass-personalized care interventions that address both clinical and social needs, especially as CMS continues to emphasize health equity and outcomes.
As we wrap up our conversation with Melissa Newton Smith, it’s clear that her insights and experience will be invaluable in guiding healthcare organizations through an era of transformative change. Her commitment to innovation, operational excellence and patient-centered care aligns seamlessly with ProspHire’s mission to drive impactful improvements in healthcare quality. This alliance brings together Melissa’s strategic vision and ProspHire’s project delivery strengths, forming a powerful partnership poised to address the most pressing challenges in Medicare Advantage and beyond. With this combined expertise, we are well-positioned to create a lasting positive impact on healthcare outcomes, ushering in a future where quality and efficiency go hand in hand for the benefit of members and the industry.
Ready to take your Medicare Advantage strategy to the next level? Partner with ProspHire and leverage Melissa Newton Smith’s unparalleled expertise in healthcare innovation and quality improvement. Connect with us today to discuss how we can help you drive operational excellence, optimize your Star Ratings and meet the challenges of a rapidly evolving healthcare landscape. Together, let’s build a tailored roadmap for success. Reach out now and let’s get started on your journey to measurable, sustainable outcomes.
