After a global pandemic and with unwinding coming to an end, Medicaid teams across the country are digging in to build agile programs that can navigate the unforeseen challenges of the future. One key to long-term success is developing the internal capacity of Medicaid agencies to effectively balance the mission of delivering equitable and high-quality care while managing a complex array of federal, state, and local priorities.

With this ongoing dynamic in mind, the Center for Health Care Strategies (CHCS), with support from the Robert Wood Johnson Foundation, partnered with New Jersey’s Medicaid program, NJ FamilyCare, to create an organizational development strategic plan. The plan aimed to support staff in leading change; aligning internal efforts with broad health transformation goals; and developing the next generation of Medicaid leaders. CHCS recently spoke with Jennifer Langer Jacobs, Assistant Commissioner (Medicaid Director), Division of Medical Assistance and Health Services, NJ Department of Human Services, to discuss the impetus for embarking on this organizational development journey, what “managing the volcano” means, and how the team prioritizes internal capacity to best address the needs of Medicaid members.

Q. Why did you want to invest in an organizational development plan for NJ FamilyCare?

A. Our work happens at a tremendously busy crossroad where the complex American health care system meets the real lives of our members. There is deep need in our communities, and we do this work in an unpredictable policy environment. With all that we are managing, we need to be as strategic and agile as we can be — and we need each member of our team to feel a sense of mission and belonging that motivates them day-to-day. Building our capacity, developing our team members, and supporting wellness are key ingredients to ensure that we are well equipped to engage with meaningful innovation and meet the needs of those who rely on us, which vary so greatly by community and by individual.

Q. What is one thing your team has improved upon related to organizational development that you’re excited about?

A. I think we have gotten much better at managing to what we call the true-true, a phrase I borrowed from David Mitchell’s novel, Cloud Atlas. As an example, while it may be true that we launched a certain program, the true-true could be that members and providers aren’t substantially engaging with it for some reason. Maybe we didn’t communicate well, or we don’t have buy-in, or our process is making it hard, or maybe it’s just not meeting the need that’s out there. Understanding the true-true gives us the ability to make better decisions about what we do next — but it usually also makes people a little uneasy. We have put some new structures in place to support the candor we are looking for, and we’ve gotten pretty good at pulling together collaborative groups from around our organization and our community to get a clearer picture of what is really going on and why. Then we can make a better call about what to do next for greatest impact.

Q. Your senior leadership team coined a phrase, “managing the volcano.” Can you tell us what this means and how it relates to the organizational challenges NJ FamilyCare faces?

A. During a meeting with CHCS, our team was talking about the exciting and unpredictable nature of our work. We never know what’s going to happen, but we always know that SOMETHING is going to happen! One member of the team described it as living next to a volcano. We think we have our priorities clear, but then boom! Suddenly we get new federal rules, state legislation, emerging member needs, advocates’ priorities, provider issues, health plan concerns, system disruptions, and broad-reaching health care system shifts.

While much of that work is beautiful and powerful, like the erupting volcano, the change also needs to be managed before, during, and after. I suppose you can move out of town if it’s not your speed; but if you love where you live — and we do! — you have to be prepared for unplanned events, ready to move in the moment, and excited to explore the new landscape that emerges. Over the past couple of years, we have invested in building structures and processes to manage incoming priorities, and our team continues to evolve and grow in this area. Also, we’re from New Jersey so we obviously have no idea what living next to a volcano is like — but the metaphor sure helped us think differently about an environment of constant change!

Q. What steps are you taking to build your organization’s ability to serve its members within this ever-changing environment?

A. We have defined four overarching goals that guide our work annually. We keep these goals front and center year-round, and everyone has a piece of the big picture. The first three goals relate to policy and program, and the fourth goal is related to culture — show people we care. People outside our agency focus on the first three goals, but I’m equally focused on the fourth because this goal reflects our organizational culture and the way we work together as a team to get the work done with compassion and camaraderie. We have to be really clear about exactly how we will show people we care so that we can hold ourselves accountable to that.

We also leverage the idea that energy follows focus. If we want to change an outcome, we need our experts to identify the needle that we can move, be clear with operational partners, like county agencies and health plans, and set up frequent reporting of lead and lag measures to direct energy and accountability to that outcome. We’ve found that when we do this well, we get better results.

Q. How do you center the diverse perspectives of your members while building NJ FamilyCare’s capacity to better serve them?

A. We meet frequently with our community advocates and those relationships are crucial. We use North Star principles to set our intentions for the work we do together. These are aligned to our organization’s overarching goals, but the idea here is to get really clear about the principles that will guide our discussions and decision-making around very specific policy work. Maybe we are implementing an eligibility expansion for people with disabilities — how do we want to show up for that? Or maybe we are working on a new federal mandate with our health plans and providers — what needs to be top of mind all the way through? We invite members and providers to the table to give us feedback on those North Star principles and when they’re feeling right, we lock in with our community and move forward — and we then keep the principles in front of us as a guide for the duration of the work.

We are also very deliberate about lifting up the voices of the individual people we serve.  As an example, we have always been very mindful about addressing member concerns — every member matters and every individual concern needs to be resolved. But recently, we amplified those voices by creating a team that focuses on what we can learn from and do next with those resolved concerns, which may be pointing us to a need for broad process improvement, clarification of language, or larger systemic change.

Q. How have you kept inclusion in the forefront of your strategy?

A. I think any large organization is going to experience the sense of being “siloed” and having some functional disconnects. I have never met one that managed to escape that! We have tried to acknowledge the inevitability and counter that with very deliberate efforts to come together in shared virtual and in-person space.  

As an example, we have an unscripted Zoom meeting every Monday that started in March 2020 and welcomes all team members who bring leadership energy, which I define as velocity and stability.  People are encouraged to forward the meeting invite to other staff, so the meeting has grown to average attendance north of 100 people a week! I value this so much for bringing us together as a team. We talk about what people did over the weekend, we share internal priorities and short-term needs, and we recently used this forum to go over our strategic plan for the year ahead. We’ve also got a Teams channel for this group so that we can broadly share documents and get feedback. It’s really helpful to connect informally and get a sense of what’s on people’s minds, while we are also sharing what’s new and managing prioritization together. I think there’s an add-on cultural effect of people feeling that there’s an expectation of transparency and coming together that should be replicated beyond our Monday meeting. 

Our Lunch & Learn series is another example of coming together. I didn’t expect this to matter so much to people, but it turns out it does. People show up to these sessions — and we regularly get requests for new topics! We also have wellness and charitable events organized by our team — we collected toy and coat donations for local organizations this past winter, and we’re in the middle of a diaper drive right now.

Q. What tips do you have for a Medicaid agency interested in embarking on organizational development work?

A. As a Medicaid agency thinks about organizational development, it’s important to broaden the definition of leaders. Leaders are those who bring velocity and stability to our work. The person receiving member complaints is as important as an individual on the senior leadership team. We need to be deliberate about lifting all voices, especially front-line and mid-level staff, and giving them an opportunity to lead.

Also, having shared vocabulary is critical because language is connective tissue. When we talk about the true-true, energy follows focus, and managing the volcano — we know what we are talking about, and this reinforces our bond and goals over time. Lastly, we benefit from having outside perspectives from leadership experts to guide us through the journey. They provide structure, support, and perspective to do this important work, even when the volcano is doing its thing, and it feels like there is no time.

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