Transformation

Post: Fixing Problems

Are you having trouble fixing a problem?

I was talking to a colleague yesterday about the fact that people most often call me when they have a problem and they are having trouble fixing it. Why?

Common Issues:

1/ Flawed assumptions: Assumptions are made about what’s causing a problem without checking all the facts.

2/ Timeline: Deadlines to get the project done and the need to get it done overshadows whether it’s the best solution or not.

3/ Perception: People outside the department or discipline don’t understand or don’t care enough to prioritize your needs.

Best Advice: Taking a step back to reassess things is hard but it’s worth taking the time to get it right.

What I know to be true:

1/ People might not understand your needs but that doesn’t mean they don’t care. Help them understand.

2/ Often systems and processes just need to be fine tuned. Fine tuning requires less work than starting a new for your limited resources such as engineers.

3/ Deadlines are sometimes arbitrary. Know whether the deadline is someone’s ideal deadline or a real one and why.

Fair Price for Healthcare

Getting a fair price for healthcare is tricky because it’s not an apples to apples comparison.

Benefit season is starting soon. I’ve compiled some of my recent posts to help you get your arms around the latest strategies being offered to establish a fair price for healthcare services and to help you manage your total cost of healthcare.

Charges [aka List Price]:

Healthcare charges still seem to be a bit of a mystery to everyone. So let me start by explaining how most providers develop their list price and why.

The charge for most services in healthcare is based on a multiple of the Medicare fee schedule — at least initially. There are so many billing codes that it would be really hard for providers to keep up with the cost of each one which is why most base their charges on Medicare.

The tricky part is the multiple because every payer has their own methodology for payment. To capture the full amount due, the provider has to establish a charge that is sufficient to capture any outlier payer. Unfortunately, the multiple [aka: the markup] can make the charges seem unreasonable.

The charge for new services usually captures part of the cost savings so that providers are incentivized to adopt new technology. It helps them cover the cost of doing so. The charge and the price [contracted rates] consumers pay usually go down over time assuming the provider updates their chargemaster.

Then there are what I will refer to as the “fraudsters” who will keep increasing their charges to capture more and more from insurers as benefit loopholes close, such as out-of-network coverage. Their charges defy all logic and unfortunately, create an aura of mistrust.

Tip: The best way to protect yourself from fraudsters is to ask for an detailed estimate prior to service. Have them explain it to you.

Ambulatory Surgery Centers (ASCs):

ASCs offer a lower cost alternative to hospital based services and are a good option for surgeries and other service for the low acuity population. For those with increased medical risks [obesity, heart disease etc.] hospitals are a safer option.

The Ambulatory Surgery Center (ASC) industry grew rapidly from 2000–2008 largely because it provided surgeons a way to make more money from something they already do. It also gave them more say in and in some cases, more control over their work environment in terms of support staff, supplies and business practices.

Unfortunately, many were more focused on making a fast buck from the out-of-network strategy [aka: fraudsters] rather than providing an efficient service to lower the cost of healthcare. That’s changing.

Economical Credentialing and Narrow Networks:

Some health plans have been developing narrow networks that are economically credentialing some providers [aka: the fraudsters] out of their networks for past behaviors. It’s one way to lower cost but many not be a win for those that value choice.

Unfortunately, penalizing providers usually forces more consolidation which drives up price. Many ASCs are being sold to hospitals and healthcare systems that have more leverage with the payers to negotiate higher prices for their services. Pricing transparency tools that use historical claims data may not reflect the new higher prices.

Bundled Payments:

Bundled payments are catching on as a new reimbursement model in healthcare but not all bundles are the same.

Bundles are a flat fee paid to a healthcare provider for a full episode of care. By limiting the payment, it forces the provider to reduce the cost of care for the defined service and guarantee a certain outcome.

If you’re considering using bundles as a way to control your healthcare costs, there are several questions that you should be asking, such as:

1. Who are the providers included in the network? Not all providers are included in every network or selected the the same way.

2. What is the scope of service included? The services and amount of service included in the flat rate will vary bundle-to-bundle.

3. How is a quality outcome defined? Is the patient returned to pre-injury condition or returned to a basic ambulatory state or returned to work?

4. How much control do employees/patients get? Can they select all their providers or just some, the location, the time, the supplies and implants used or is that the tradeoff for a lower cost?

5. What is the expected cost savings over standard contracted rates? What level of savings makes it worth it to you?

Understand what you’re getting and trading off for a lower cost of healthcare. Bundles can pose problems is they are not Administered well because there are always some who will game the system. You have to think through these deals carefully.

Change is Hard Won

Changing the healthcare system takes time. Everyone needs to do their part to lower the cost of healthcare.

1. Healthcare Consumers: Many Americans don’t change their unhealthy habits until they have a major life event like a heart attack, cancer scare or some other health related crisis. The cost of all those unhealthy habits plus the life events drive up healthcare costs for everyone and no one wants to foot the bill.

2. Healthcare Providers: Healthcare providers don’t change until there is a financial benefit for doing so. Many providers didn’t adopt technology that costs maybe 1–2% of their revenue until the government incentivized them to do it. Why? Because they were focused on their top line rather than their bottom line.

3. Health Plans: Health Insurers don’t change their coverage and payment practices until they understand how something impacts their medical loss ratio. Untimely payment decisions make it hard for providers to change how they serve and delight patients. As you know, not many people are willing to work for free.

There are no silver bullets to fix healthcare. Americans need to take a good look in the mirror and own their part, providers need to focus more on the bottom line and insurers need to do more timely financial modeling to fix the incentives for providers.

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About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, telehealth appointments with Sports Medicine experts and other tips to help you achieve more success in work and life.

Lean In for Healthcare

We need to “Lean In together” to solve the biggest challenge facing healthcare now.

One of my sisters asked me when Lean In was first published if I had read the book. Even though it was getting great reviews, I had no desire to read about another women’s struggles in business and life — no matter who wrote it. However, I checked the book out of the library last week when none of the other books on my list were immediately available.

Lean In made me laugh out loud and cry because it validated so much of what I had felt and experienced over the course of my professional career and life. Some of Sheryl’s personal stories are funny but the book is also filled with some good information and stats for those struggling with the idea or the reality of balancing their careers with family life. It is a book that both men and women should read to inform their perspective and behavior towards one another.

Ironically, I was at home reading Lean In while millions of others all over the world were marching for equal rights. I didn’t join the Women’s March in San Francisco mainly because large crowds make me anxious. To some degree, I regret it now. Opportunities to make our voices heard matter even if they are deflected by those who need to hear them. They will eventually have to listen.

It will come as no surprise to those who know me well that I was also a little mentally preoccupied. I was thinking about the expected changes in healthcare, my HBA mentoring group and recent conversation with others in the industry.

Healthcare:

When I was working for one of the California based payers years ago, I said to the then VP of Strategy that everyone involved in healthcare needed a voice at the table to solve the problems. It wasn’t anything that I had read or heard, but rather what I really felt after working on both sides of the industry for about five years. When the ACA was drafted, everyone involved in healthcare had a voice at the table.

Like any other strategy, the plan for the ACA was hatched with the best information available at the time. Parts of it worked as expected and as with any other strategy, other parts need to be adjusted now that we have more information. It should come as no surprise to any of us especially those involved in healthcare. Repeal and replace sounds more dramatic but “the replacement” is likely to have many of the same elements as the ACA.

The biggest issue that remains is the rising cost of healthcare. There may be some fat left to be squeezed from insurers and prescription drugs. However, healthcare providers seem to be tapped out. For me it’s evident by the level of tension between physicians and administrations.

I don’t believe that we can financially engineer our way out of the rising cost of healthcare because the medical risk for the country is too high. Like the banking industry leading up to the financial crisis, the medical risk is spread across the industry with some verticals better capitalized than others to absorb it. As the screws get tightened, parts of the system will be squeezed to the breaking point. Unfortunately, it’s likely to be the parts serving the most vulnerable Americans.

Mentoring Group:

I participated in the inaugural HBA mentoring group around the time of the financial crisis. It was a great opportunity to meet other women in the industry and gain the perspective of those working in different fields. What’s more interesting to me now having read Lean In are the limiting beliefs that are holding some of the women back.

We did an exercise to help one another prepare for their next job. As part of the exercise, we reviewed the description for a desired job and resume for each person in the group. One of the women in the group is a highly trained scientist working in quality assurance for a biotech company. When she reviewed my resume and the job that I had selected, she told me that she didn’t see the exact qualifications for the job on my resume. She was looking for an exact match. When I selected the job, I was looking at it with a skills and competency lens. I didn’t need to have the exact experience to know that I could do the job as described. I chalked up her feedback as that of a scientist. However, now I understand that her perspective is how most women think which can be limiting to not only her but others including me. Reportedly, men don’t look for an exact match when they select and apply for jobs. My guess is that they may not hire that way either.

Communication was another problem raised by the group. The quality scientist was upset that her manager was always late to meetings. The group concocted this very elaborate plan for her to address the issue. I suggested to her that she just tell her manager “your tardiness isn’t working for me”. No one in the group believed that it could be that simple and dismissed my suggestion. However, Sheryl relays a story about Mark Zuckerberg joining a group at the office to learn Mandarin. When one of the women in the group was talking in Mandarin about one of their managers, Mark kept asking her to simplify so that he could understand what she was saying. Finally, she blurted out “my manager sucks.” Now that is something simple enough that everyone can understand and work to fix.

Mentors and mentoring groups are good because they open us up to different perspectives and challenge the beliefs that are holding us back. We need to get out of our comfort zones and if we are going to rise to the challenges ahead.

Recent Conversations:

Last week, I was able to meet with other executives working in different verticals of the industry. We discovered some shared experiences and mutual interests but what I appreciated most was being able to say “what do you think?” No one person has all the answers and it serves us all to do a reality check on your own perspective and role. Some of us are carpenters fixing problems within the existing system as we go and others are disrupters looking to turn healthcare upside down. We need both to solve the biggest challenges facing healthcare.

With that said, I initiated a new circle for healthcare professionals on the Lean In web-site so that we can meet, share, learn and challenge one another. I don’t have specific goals for the circle other than to give everyone a seat at the “table” who wants one.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, advice from professionals and other tips to help you achieve more success in work and life.

Understand your Brand

Whether you know it or not, you have a personal brand.

A new year is right around the corner. You or someone you know may be thinking that they need or want to do something different and need help refining their personal brand.

One of my friends found a mentor earlier this year because she is contemplating the next step in her career and felt that she could benefit from having some guidance. We went for a walk this weekend and when I asked what was new, she told me about her recent meeting with her mentor.

There may have been more said during the meeting but what was relayed to me was that her mentor suggested that she develop her brand attributes and establish a schedule for regular blog posts. It was clear that she didn’t know how to start.

I’ve outlined the plan we talked through during our walk this weekend. It’s designed to be done over the course of a year. You may be able to do it faster.

Establishing a personal brand

If you’ve been hired to do a job, a project, a gig of some sort then you already have a brand. It’s the reason people chose you over all the other people applying, pitching or trying out for the gig. Do you know why they chose you and not someone else?

The first step to developing your brand is to understand why someone chooses you. If you’re not sure — ask your your boss or your client — why they chose you.

The plan

I started living my life in quarters when I started my own consulting business back in 2000. Not many people other than those sales likely think of life in quarters, but for me it helps set my focus for a specific effort and gives me a specific timeframe to evaluate that effort.

Thinking in quarters, we talked through a plan to understand and refine my friend’s personal brand so that she’s ready to start a new consulting business in 2018.

Q1: Discovery:

Collect the information needed to define what and who. During the first quarter of 2017, my friend is tasked with talking to at least three (3) people that she has worked for in the past to learn why they chose her and what she did that they valued most. I know some of her colleagues so we talked through some specific people and what to ask. In general, you want to consider the person that you’re speaking with whether they are or were your manager, client, colleague or co-worker to frame your questions in a way that draws out the answers you need.

Remember, you’re not looking for flattery but rather honest input about the value you bring to the organization, department, project, team or whatever is relevant to your relationship with that person. Your job is to uncover the attributes that they find valuable so that in the future you can identify others like them that will realize similar value.

Q2: Review the feedback

Define what and who. During the second quarter, my friend will be reviewing all of the responses carefully to distill the themes. She needs to identify the cross section of what people value and what she likes to do and wants to do next to uncover the “what”.

Some of the answers may be revealed quickly and others may be harder to distill. People at different stages of their career, different levels and with different backgrounds will likely respond differently which is why you have to look for the common threads or themes. If the answers you need aren’t clear, ask more questions, speak with additional people or do some research about the field to get the needed clarity.

Q3: Test your work

Publish a few blog posts. During the third quarter, my friend will be writing and publishing a few blog posts to test her hypothesis of “what” and “who”. The tone of her posts will also help develop the “personality” of her brand and flush out a manageable publishing schedule.

Blogging is no easy task which is why many companies outsource the work to professional writers. It’s something that I’ve always enjoyed but it requires creativity and discipline. If you haven’t done much writing in a while, start slow and don’t be too critical of your work. It’s a skill that gets better with time. Publishing has never been easier with so many different social networking sites.

Q4: Commit to your Brand

If everything has gone well in Q1 — Q3, my friend will be ready to formalize her “brand attributes” next year at this time. Brand attributes are the foundation of the brand and include the name [if different than her own], logo, personality and pricing.

Knowing your brand attributes is just as important if you’re looking for your next job.

Photo: Your logo may be a professional photo that you can use on a blog and all social sites you choose to share your ideas, case studies and examples of your work.

Posts: Your personality should come through in your posts so that people hiring you or who will be working with you, get a sense of you before you ever step foot through the door.

Pricing: Your pricing should be reflected in the compensation package you negotiate. Understanding the fair market value of your work is the first step in negotiating a fair package.

I was introduced to the idea of a personal brand years ago at a HBA event when Ellen Looyen presented. I hope the process outlined above makes it easier for you or at least gives you some ideas of how to start. Let me know how it goes.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, advice from professionals and other tips to help you achieve more success in work and life.

Structure to Win

Organizational structure is the foundation for how people communicate, collaborate and perform on the job and affects overall performance of the company.

Most people talk about organizational cultural as being one of the key principles of creating a great company but structure is equally important. Culture is a function and reflection of the structure.

Leading companies use the customer’s voice to align the organization, foster teamwork and create products that meet the customer needs.  Most have adopted a matrix structure and assigned people from functional departments to cross functional teams responsible for managing products and/or services.  Moving more expertise to the front lines gives the product managers and/or general managers respectively the timely support needed to solve problems, develop solutions, create new products or processes and enhance service that meets the needs of their customers.

Many companies operate with a weak matrix structure meaning the company is structured according to function [aka: functional silos] rather blending resources from the different functions into cross functional teams.  A functional structure helps develop expertise, systems and processes needed to enable staff do a specific job well, but are weak structures for promoting collaboration and enhancing customer focus. In fact, functional structures are thought to tilt the organization away from the customer which is never a good thing.

Granted there are challenges with every organizational structure and matrix structures are no different.  Studies of cross functional teams have reported that 75% are dysfunctional.  Getting people to work together is no easy task.  However, there are a few learnings from leading companies that can help make cross functional teams more successful in any organization.

People: Functional managers need to assign people who have the knowledge and experience to contribute to the cross functional team and the people assigned need to be open to working with others that think differently than them.

Support: Functional managers need to support the cross functional teams and evolve their method of monitoring, developing and supporting their people working outside the department.

Rewards: Functional managers need to be rewarded for supporting the cross functional team and the success of the team.  Broader metrics that reflect the company goals should be more heavily weighted in their compensation structure.

Developing an organizational structure is not a one and done type of exercise. Structures need to evolve to help the organization outperform in good times and be resilient to changes in the economy, industry and technology.

The changes underway in healthcare are a good example. With healthcare becoming more consumer focused, healthcare provider organizations should be adopting a matrix structure of cross functional teams to support and develop their service lines. The main role of a service line manager is to help build the business – similar to a Product Manager or General Manager in other industries. Speaking from my own experience working as an interim Service Line Manager for a prominent teaching hospital, few have the direct support needed.  Most have to manage from the middle with influence as their main method to get the information and resources needed to do their jobs well.  Granted influencing others is an essential skill for any manager but influence alone can limit management effectiveness especially in a weak matrix structure.

Structural changes should also be made to help employees be more efficient and productive with their time so that they have time off from work to live healthy, happy lives. If people are routinely working more than 8 hour days, is it a function of the culture, structure or their job? It would pay to find out.

“Quality in a service or product is not what you put into it. It is what the client or customer gets out of it.”

– Peter Drucker

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success.  She is also the founder and CEO of Hello Workout.