Strategic Planning That Leads to Actionby Jamie Daugherty, Executive Director Strategic planning often sounds like something reserved for large health systems with dedicated planning departments, outside consultants, and lengthy board retreats. In reality, smaller home health, hospice, and in-home care organizations may need strategic planning even more. When resources are limited, we cannot afford to invest time, money, or leadership attention in the wrong priorities. The pressures facing home-based care providers make this especially important. Agencies are balancing workforce shortages, rising operating costs, increased regulatory scrutiny, changing referral patterns, and reimbursement that does not always keep pace with the cost of delivering care. CMS’s proposed home health policies for 2027 demonstrate how quickly assumptions can change. The proposed rule includes another temporary payment adjustment, recalibrated case-mix weights and LUPA thresholds, additional enrollment enforcement provisions, and possible changes involving palliative care and the home health wage index. Even when the projected national payment total appears positive, the effect on an individual agency can be very different based on its patients, geography, workforce, and operations. Read the CMS proposed-rule fact sheet. We also continue to see examples of smaller and rural providers struggling to remain viable. Just this month, a county-operated home health program in Illinois announced that it would close after serving its community since 1969. Its administrator cited ongoing financial losses and difficulty recruiting staff. Although that closure is not in Oregon, the underlying pressures will sound familiar to many rural providers here. Read the report on the closure. Strategic planning will not eliminate those pressures. It can, however, help an organization decide how it will respond before circumstances make the decision for it. A Strategic Plan Is Not a Wish List One of the most common planning mistakes is creating a long list of worthwhile ideas without making meaningful choices among them. An agency may want to expand into a neighboring county, introduce a new service line, upgrade its technology, recruit more clinicians, strengthen referral relationships, improve quality scores, and increase employee retention. Each goal may have merit, but few organizations can pursue all of them simultaneously. A useful strategic plan establishes priorities. It should make clear:
If everything is a priority, nothing is. Start With an Honest Assessment Good planning requires leaders to look at the organization as it currently exists—not only as they would like it to be. That assessment should include more than annual revenue or average daily census. Leadership should understand:
This is not an exercise in pessimism. Honest planning protects the mission by ensuring that decisions are based on operational reality. Separate Strategic Work From Daily Operations Home-based care leaders spend much of their time reacting to immediate needs: a staffing callout, a difficult referral, a survey concern, an authorization problem, or a delayed payment. Those matters are important, but they can consume every available hour. Strategic planning creates space to ask a different set of questions:
The answers should shape budgeting, recruitment, technology investments, service development, and advocacy. A strategic plan that is disconnected from those decisions is unlikely to influence the organization’s future. Build a Plan That Can Change A strategic plan should provide direction without pretending that leaders can predict every regulatory or economic development. Home-based care changes too quickly for a document to remain untouched for three or five years. Agencies should establish a longer-term direction but review progress at least quarterly. That review should consider whether assumptions have changed and whether resources still match the stated priorities. Adjusting a plan when the environment changes is not failure. Continuing to pursue an outdated plan simply because it was approved is far more dangerous. At the same time, leaders should be careful not to abandon priorities every time a new challenge appears. The purpose of regular review is to make thoughtful adjustments—not to replace strategy with constant reaction. Connect the Plan to Accountability The planning retreat is not the end of strategic planning. It is the beginning. Each priority should have an accountable leader, measurable milestones, an expected timeline, and an identified resource need. Boards should receive concise progress reports that show what has been completed, what is delayed, and where a decision or investment is needed. This also allows the board to fulfill its role without becoming involved in daily operations. The board sets direction, approves major investments, monitors performance, and holds leadership accountable. Management determines how the work will be accomplished. Planning Is Ultimately About Stewardship For mission-driven home-based care organizations, strategic planning is not merely a business exercise. It is an act of stewardship. Our organizations exist to serve patients, families, employees, and communities. Protecting that mission requires us to make difficult choices, understand financial realities, invest carefully, and prepare for what may be ahead. The strongest strategic plans are not necessarily the longest or most polished. They are the ones leaders actually use. As agencies begin preparing for 2027, now is the time to move beyond asking, “What do we want to accomplish?” We should also ask, “What are we prepared to prioritize, resource, measure, and complete?” That is where strategy becomes action. |