Leadership from the top down needs a significant revamp. Fortunately, the departure of the infamous SVP will likely help the organization in the long run. However, many of the policies and structural decisions implemented during that time continue to negatively impact the program today.
One of the most misleading initiatives was the implementation of tiering two years ago, which came with promises of reduced caseloads—20–40 for CCMs and 60 for CNs. In practice, those expectations were not met. As a TV show host would say, “that is a lie.”
The company’s mission is meaningful, and I continue to believe in its purpose. Many members genuinely need kidney disease education and support. Unfortunately, the current operational model often prevents staff from delivering meaningful, high-quality care.
Several roles within the program feel redundant or ineffective. Member Engagement Specialists, for example, provide limited measurable value in their current structure. Wellness Coaches often function no more than glorified engagement specialists than as clinical educators, and they rarely deliver the level of education members truly need. While these roles may have been introduced to offset nursing shortages as the client base expanded, they do not adequately replace clinical expertise.
The CCM role—particularly on the mainland—has unrealistic expectations. Nurses are effectively asked to perform the responsibilities of multiple roles while managing full caseloads and provider-related tasks. In practice, it often feels like the workload of three positions combined into one, which is not sustainable.
Data quality is another major challenge. Information is frequently outdated—sometimes by several months—by the time it reaches clinical staff. This leads to inaccurate tiering and member assignments. It is common to encounter incorrect provider information or misclassified members, making effective outreach and case management unnecessarily difficult.
Micromanagement of calendars ultimately became a breaking point. While accountability is important, the level of control over scheduling leaves little room for natural workflow or even brief time away from the desk. At the same time, staffing shortages persist following reductions in force, even as new clients are added. Teams are often left scrambling to cover calls due to insufficient staffing.
Education and training are also lacking. Important updates—such as new forms or workflow changes—are often communicated only through brief emails rather than structured training. Clinical town halls sometimes focus heavily on non-operational topics instead of providing practical guidance thus includes spending over 30 minutes with a Q&A of an ELT member. Trying to make someone human to us does not help. We are adults and know people are real and have lives outside of HMS and don’t need a whole run down. The education team has limited visibility beyond onboarding, and even new hires often leave training without a clear understanding of essential systems and processes—such as scheduling, voicemail setup, documentation expectations, or required assessments. These gaps place unnecessary strain on preceptors and team members.
Technology is another significant frustration. The EMR and scheduling systems require numerous workarounds to complete basic tasks. When issues are raised, responses often feel dismissive or shift blame to the user rather than addressing underlying workflow problems. Many systems appear to have been developed without sufficient input from professionals experienced in case management. Additionally, there is a continued push for app utilization among a largely elderly population that often does not use or engage with such technology, making the effort largely ineffective.
Finally, communication across departments—including clinical, quality, management, education, and IT—is inconsistent. Guidance is often interpreted differently across regions and leaders, resulting in varying expectations and workflows. This lack of alignment creates confusion and inefficiency and has been an ongoing issue for years.