8.08.2013

Emotional Intelligence in Leadership Careers

Ever notice how when kids misbehave, the first thing people wonder is how or what the parents are teaching them? The same thing applies in career life which is why it is crucial to follow the right leader.

As adults, our traits are molded by those whose lead we follow and overtime we shift closer to becoming a portrait of their habits. I was lucky enough to have bosses who taught me the value of emotional intelligence throughout my career. Kevin Pete, a senior Vice President, was one of the influential ones I reported to. His analogy was that hiring the best intellects and the best book smarts is easy; it's the intellects with strong emotional intelligence that are hard to come by.

There were certain things Kevin did which really impressed me and I started to insinuate his style. When he was giving me initiatives and feedbacks on my skills, he knew he was creating a new leader yet it never worried him that someday I may outgrow him. Suffice to say that he treated me like a child whose parents wants him to do better than them. This is actually a very important point because this is the difference between a manager and a leader. A manager is afraid of creating competition whereas a leader deliberately creates new leaders. He trained me to the point where I was promoted to report directly to the president and CEO of the company.

One thing I noticed common among Kevin and my new boss, Rick Haines (CEO of AultCare), was the fact that they both lead through inspiration instead of fear. Not once did I hear anything from either of them which implied directly or indirectly that if I didn't deliver xyz I would get fired. The end result was that I found myself trying to deliver results not to protect my job but to avoid disappointing them and breaking their trust.

The reason I brought my experience up is because these folks knew the power of emotional intelligence and through that they communicated the "why" instead of "what" to me. My understanding and agreement of why they want to do certain things made me felt connected to their cause and part of the family.

Never forget that as a leader you don't manage just people but also emotions. Our employees take cues from us more than we think and through slight adjustments in our style we can make it easier for them to approach us, enable them to report accurate statuses of where things stand without the fear of retribution and allow them to speak their mind on different strategic ideas.



7.23.2013

Big Data Implementation

So you have a fairly decent idea about what Big Data is but that's pretty much where the story stops. The technological shift is so curved that the most common challenge is figuring out how to go about with the implementation. This post is meant to give you food for thought and get you out of that twilight zone.

The Implementation Steps

There are many paths one can take to achieve Big Data goals. In my case I have divided the implementation into four main steps.

  1. Select Business Objectives and Hypothesis
  2. Explore Data
  3. Conduct Scientific Analysis and Big Insights
  4. Take Meaningful Actions 

Business Objectives

High level business objectives are often very similar across the board; it's taken for granted that they exist in the business plans which is why they don't normally come up during pre-implementation phases. Nevertheless, lest we think objectives are not important, I will talk about them as being the first step.

The real value from growing data comes from knowing what can I do with this data and how can I get value from it. You are not going to know what you need unless you have identified high level objectives.

High Level Objective Examples:
  • 360 view of a customer
  • Increase sales
  • Decrease fraud, waste and abuse
  • Cut unnecessary workforce costs
When selecting objectives think of items that are not specific questions but a gateway to them. From the examples mentioned above the "360 view of a customer" is a better choice than single questions like "how many users are satisfied with your service". The reason is that your research on "360 view of a customer" will also answer the satisfied customer question (among other things).

Data Exploration

If you recall the three Vs of Big Data, you will have to assemble data that conforms to the volume, velocity and variety. Your data warehouse, social media channels, customer interaction system and enterprise system are great sources for actionable insight.

The important thing to keep in mind is that data silos and Big Data cannot co-exist. In order to function as intended, Big Data needs to connect and communicate with all data types. This is one challenge that some companies may face with their database administrators or IT staff, primarily because most DBAs think about data in fixed relational and schema terms. However, when we talk about Big Data, we mean data that can be variable, of different types and structures or be needed in real-time.

Points on starting with the data sources
Do not try to identify and connect with each and every data repository in your organization from day one. Assembling too much too quickly will create a chaotic environment and will bring lots of garbage with it. Work in continuous phases instead.

The reason I suggest working in phases is the veracity of the data. I am sure with undertaking an important initiative like Big Data you would want to ensure the veracity of your results are intact. Here are some suggested steps (by the way, this is also where the Hadoop or MapReduce comes into play - I will write a separate post about that.):

Step 1: Connectivity - Discover data repository and establish connection.

Step 2: Data Analytics, Indexing and Extraction - Identify what objectives that repository fits under and recognize its users. Format your data by creating views and relationships so that it is useable. This will also give you an idea of its value and utilization.

Step 3: Develop Framework - Leverage the data by building a funnel-like framework where the different types of data meet. This will allow you to see patterns, themes and profiles. You will connect streams of data that are already formatted or are real-time directly into this framework.

For example: Your data warehouse should connect directly at this level and does not need to travel through the second step.

Step 4: Applications – Develop applications by using the framework as a source and offer these to your departments and data scientists.

Developing the framework and the application is the most crucial and difficult task. You will either have to develop applications in-house or use tools from third parties like IBM and Oracle.



Important note about the Framework – Your framework should allow you to explore data across multiple platforms like enterprise systems, CRMs, SharePoint, Emails, Files and Documents, Databases and Data Warehouses without replicating any information. Many businesses feel compelled to bring everything to a single location because logically it feels like our analysis will be way easier that way. However, I want to warn you that the main purpose of the framework is to avoid this single location practice. The ideal scenario is to leave the data where it is and consult it at that location whenever you need it.

Here is why the single location implementation is not a good idea for Big Data:

  • By the time your data flows through the regular formatting and other channels, it may be too late. Re-routing real-time data defeats the purpose of actionable intelligence. 
  • Centralizing everything means you are probably replicating your data which is not good since it will waste space and you will overwhelm your team with an overwhelming amount of information.
Example: If I want to gather real-time customer sentiment from social channels (say Twitter), it would be wise for me to have my framework go out and analyze Twitter and bring back the relevant data rather than copy all the data I can find from Twitter in my primary data warehouse.

Scientific Analysis and Big Insights

The applications you develop using the framework will allow you to conduct scientific analysis, create profiles, recognize themes and establish patterns. You can use this information to fulfill your objectives that were defined in the first step.

Scientific analysis and big insights can help the most with things like profiling, patterns, and 360 degree customer view and customer satisfaction.

Profiles and Patterns
Using the patterns and themes found in your data you can create profiles. These profiles can be matched against your new or potential customers to calculate their risk score, purchase potentials and needs. This is also known as predictive analysis.

Healthcare can benefits from predictive analysis by identifying the probability of an illness and kick-start preventative treatments. Fraud, waste and abuse can also be controlled by flagging the abusers of the service and taking appropriate actions.

Health Insurance Exchanges will benefit the most from predictive analysis by utilizing real-time risk scoring. This is huge because Obamacare does not allow insurance plans to ask for any pre-existing conditions anymore and Big Data can provide help to fill that information gap.

360 customer view dashboard
The velocity of the information available matters the most in customer interaction scenarios. Whether it be through email, website, in-person or by phone, the speed of data will enable you to market at the right time, solve issues effectively and recognize any concerns immediately.

If you observe the average amount of time logged by the customer service per call, you will notice that most of it is spent in either finding the information, having to look at multiple applications or rerouting to someone who has the missing piece. This can be avoided using the 360 degree customer view dashboard.

The customer service representatives are not data scientists which is why the dashboard should be a self-service pre-computed system and should display all the relevant information to them. They should be able to see the most current information without having to open multiple applications including recent email communication with the user, call logs, member status and subscription information.

The customer service can also bring sales and marketing to a whole new level. During the call the dashboard can empower them to see if there is a service that fits really well with something that customer already owns and whether there is high probability of the caller being receptive to the offer. Hence suggesting the right products at the right time.

Customer satisfaction trending
Google's CEO Eric Schmidt once confessed that if Google wanted to, it could have gotten into predicting the stock market just for fun. Google decided not to; nevertheless Eric's statement shows the power of mining trends in data.

Your Big Data application should mine Twitter, Facebook, call logs and email communications for real-time decision making patterns. Think about it! The real-time movements in these areas can easily tell us:

  • If a certain type of complaint is picking up momentum (lots of people calling about the same thing or talking about the same thing)
  • If there is a danger of an outbreak (healthcare can do this by monitoring their claims, calls and emails)
  • Whether a certain product is doing good in the market or not (it can tell us what buyers are thinking - it's expensive, good, bad or just right)
The trending and real-time analytics works similarly as text analytics where you take apart a string, remove noise data and look for words that appear again and again. If analyzed properly you should be able to tell where you need to divert your attention (e.g. high percentage of phone calls coming in due to a broken fan in your product).

Actions

The last and most crucial piece is to have meaningful actions to improve the outcome of an event. The kind of actions a business will take should be planned early on otherwise all you have is this Big Data staring at you with big results and nothing to act on.

Here are some actions with respect to the ideas presented throughout this post.

  • Customer service training should be modified to include a customer dashboard which will reduce the training time and the costs associated with it. 
  • Eliminate silos in the company by using Big Data as a means to have them collaborate and work as a team.
  • Increase revenue by improving marketing efforts through up-selling, cross-selling and suggesting services at the right time.
  • Reduce fraud, waste and abuse by flagging suspicious behaviors and by matching profiles of potential customers with the known abusers.
  • Increase customer satisfaction by taking appropriate steps depending on the trends found in the real-time data streams.
  • Brace for any outbreaks if a pattern is observed that is growing and contains a common disease variable.

Bottom Line

At the end of the day we will eventually arrive at a point where the source of data will not matter anymore. What will hold importance is the knowledge and ability to analyze the data effectively. For this reason you will have to pick and choose your battles on whether to use third party infrastructures, repository cloud or manage it all in-house. Same goes for data processing capabilities, if the size of your data is too large you can use platforms like Map Reduce and Hadoop.

Another challenge to Big Data is the notion believed by some that it is something evil. While there are pros and cons of everything, it is vital for us to understand Big Data is not evil. Many who bad mouth this technology don't realize how they may already be benefiting from it. Ask anyone who has ever been unfairly denied for a credit card or loan application should understand that had Big Data been in use, the outcome would have been different.

Thank you for reading and I hope I was able to give you some level of idea on Big Data implementation.


7.12.2013

What Big Data Is and What It Isn't

Want to know what is Big Data? Consider this: since the beginning of time until 1993 the amount of digitized data humans created was about 5 Exabytes (5 billion Gigabytes), in 2010 we created 5 Exabytes in just two days, and in 2013 we are creating that same size in 10 minutes. Just thinking about what we can do with this information gives me goose bumps.

7.07.2013

Threat of Hackers in Healthcare

When Captain Zap hacked AT&T, millions of Americans saved money on their long distance phone call bills. Captain Zap successfully penetrated the AT&T network and went on to be part of the hacking hall of fame. His case is famous because AT&T didn't even know about the hack until after the next set of bills went out. By then the damage was done and Cap Zap was nowhere to be found. He was eventually caught but it took 18 grueling months of FBI hard work.

6.01.2013

Extensionless URL Rewrite in ASP.NET

URL rewriting is on the most powerful and important feature one can implement when developing websites. Among many benefits the most obvious ones are security and easy to follow paths. Rewriting rules hide the querystring variables being passed and make it easier for search engines and visitors to understand and follow the pages.

A typical rewrite scenario is where you have a URL like http://www.site.com/Default.aspx?bookID=12. You can turn this URL into http://www.site.com/Books/12.aspx. You can even go one step further and remove the aspx extension, turning the URL into http://www.site.com/Books/12.

How to implement it

In this post I will use URLRewritingNet as an example. You can use other providers if you like, but the process is almost the same.

Step 1: The DLL
Download the rewrite dll from http://www.urlrewriting.net/159/en/downloads.html. It is a zip file which contains the actual dll (UrlRewritingNet.UrlRewriter.dll).

Step 2: DLL Installation
Add the UrlRewritingNet.UrlRewriter.dll file into the Bin folder of your website.


Step 3: Web Config Setup
Enter the following section into the configuration's <configsection> so that it can be advertised.

<section name="urlrewritingnet" restartOnExternalChanges="true" requirePermission ="false"
type="UrlRewritingNet.Configuration.UrlRewriteSection,
UrlRewritingNet.UrlRewriter" />


Step 4: Register rewrite as an HTTP Module
Since we will handle all incoming requests with UrlRewritingNet, we will have to register the component as Http Module in the <system.web /> section.

<add name="UrlRewriteModule" type="UrlRewritingNet.Web.UrlRewriteModule, UrlRewritingNet.UrlRewriter"/>


Step 5: Enter the URL Rewrite rules
After the end of <configsection> and inside the <configuration/> we will add the rewrite rules. It is these rules which are responsible for handling your URLs.

In the following example our rule will take the book id URL and translate it to the inner querystring url.

 <urlrewritingnet rewriteOnlyVirtualUrls="true" contextItemsPrefix="QueryString"
defaultProvider="RegEx" defaultPage = "default.aspx"
xmlns="http://www.urlrewriting.net/schemas/config/2006/07" >
<rewrites >
<add name="Rule1" provider="RegEx"
virtualUrl="^~/Book/(.+)$"
rewriteUrlParameter="ExcludeFromClientQueryString"
destinationUrl="~/Default.aspx?bookID=$1"
ignoreCase="true" />
</rewrites>
</urlrewritingnet>


Test run

If you visit /Book/12 it should translate to /Default.aspx?BookID=12

Troubleshooting

Rewrite rules with aspx extension work but the extension-less URLs give 404.
You may receive 404 (File or directory not found) error because under the Visual Studio webserver, every single request is passes through ASP.NET while in traditional IIS this is not the case. This can be solved by adding a UrlRewriteModule as a module in the <system.webServer> block.

<add name="UrlRewriteModule" type="UrlRewritingNet.Web.UrlRewriteModule, UrlRewritingNet.UrlRewriter"/>




Project files are available here: https://extensionlessurls.codeplex.com/SourceControl/latest

5.30.2013

Image displays in Firefox but not in IE

You have created a jpg image which looks really pretty in Firefox but the Internet Explorer shows a big fat "x". This boggled my mind for some time until I decided to look into it in detail. Lest you from keep guessing, the issue was CMYK format instead of RGB.

See the highlighted area in the image on the right indicating the CMYK mode. The CMYK mode (Cyan-Magenta-Yellow-Black) is good for media printing but is nothing something for the web display. Even though the RGB is intended for web graphics, the CMYK is still supported by majority of the browsers.

The reason some versions of IE may not display the image is because of the CMYK format. All you have to do is change the encoding mode (see image below) and all will be fine.


5.19.2013

Career as a .NET Consultant for Non-Degree Hopefuls

Neil deGrasse once famously said that science is not about simply memorizing facts only to spit them back during exams or to turn into a science parrot. I share the same view on IT and couldn't agree more with Neil.

We would be making a huge mistake if we evaluated candidates solely on their performance with their degrees. Memorizing a bunch of programming or technological facts and theories will turn one into an IT theory memorizer, while hands-on experience will create a true IT literate.

I bet when food connoisseurs judge a chicken entrée, for example, they go after the presentation, taste and visuals rather than the chicken's ability to dance or sing opera. Similarly the goal of any job is to get it done within deadlines and using the most efficient algorithms possible.

When I look for IT consultants, I specifically look for IT literates who carry a passion for what they do and can get the job done. I have hired high school grads with at-home experience who did a better job for me than most associate or bachelor degree holders. It could also be that non-degree holders felt like they had to work harder to prove themselves.

I am in no way trying to undermine the importance of a proper education, degree and credentials (I, myself, am planning to go for my PhD). The primary purpose of this post is to encourage all those without a computer degree to learn, experiment and see if IT is their cup of tea. I tried programming when I was 9 and I have been hooked since.

Programming Packages

IT consulting as an application developer always requires a mix of technical knowledge and not just one single language. Hence, if you are thinking about consultancy, you'll have to learn your primary language and then everything else that comes as part of that programming language package.

For example, during my high school year I started my career as a simple web developer with the knowledge of HTML, Java script, CSS and CGI. I then moved towards consulting as a PHP developer on a part-time basis. Being a PHP developer, my expertise was in LAMP (Linux, Apache, MySQL and PHP). You can think of LAMP as a programming package for PHP programming. My job as a PHP developer did not require me to work on the Apache server or configure Linux on a regular basis, but I needed the knowledge to be able to look in all the right places should a problem arise.

The point is to learn multiple things in order to be successful at a particular job. In this post I will discuss the ASP.NET programming package path.


ASP.NET (Web forms) Consultancy

As the name suggests, an ASP.NET consultant is one who specializes in developing programs, projects or websites using ASP.NET. The .NET language has two main types - Web and Win forms respectively. Win forms is all about "windows based" development (e.g. like developing a calculator), while Web forms is all about developing websites.

Here are some of the most important skills for any ASP.NET programmer:

Skill
Notes
HTML & CSSHTML is the markup language used for developing webpages. The CSS is the code used to style and format the webpage.
Software development lifecycleA typical application project goes through phases like planning, outlining the specifications, design & analysis, development and testing. This whole process is known as SDLC or software development lifecycle.
Web site hostingThis is the understanding of how the websites and domain names work and what kind of tools one need to launch a site.
IISInternet Information Services (IIS) – formerly called Internet Information Server – is a web server software application by Microsoft that helps manage and serve the websites from a local computer to the outside public.
Knowledge of OOP (Object Oriented Programming)OOP or Object Oriented Programming is a type of programming language which makes use of "objects" in its algorithms. Famous OOP languages are C++, C#.NET, Java, PHP, Visual Basic.NET
ASP.NET (C# or VB.NET)ASP.NET is a Web application framework designed for Web development. It was developed by Microsoft to allow programmers to build dynamic web sites, web applications and web services. Within ASP.NET there are two frequent paths taken: C# or VB.
Knowledge of a relational database - MS SQLA database is a structure where you store information. Famous relational databases are Microsoft SQL Server (MS SQL), MySQL (Usually used with PHP) and Oracle.

Regular universities teach these skills by taking students through a variety of courses like Java, C, C++ and concepts like Object Oriented Programming.

Below is a list of sources that non-university students can consult and learn on their own for free.

Skill
Notes
Source
HTML & CSSW3School provides excellent tutorial on HTML and CSS. Follow the link to W3School to check their chapters on HTML. You can write HTML code in notepad and save it as an HTML file and open it in a browser.w3schools
Software development lifecycleYou will learn more about SDLC as you advance in your programming skills. However, for sake of learning and having an idea, the link is provided to a tutorial blog. What is SDLC
Web site hostingThe best way I learned about hosting was through purchasing my own hosting account through hosting providers like Godaddy, M6 and 1&1.
ASP.NETYou will need to download Visual Studio to learn and practice ASP.NET. The best websites to learn ASP are YouTube, W3School and ASPNet.
Knowledge of a relational database - MS SQLUnderstanding databases is very important because you will need them to save your data. I like the ASPnet site for MS SQL tutorials.ASP NET

Here are some suggestions on honing your skills:

  • Don't wait for landing a job to gain experience. Instead, start your own website or some kind of a complex project which can be showcased on your resume.
  • Offer volunteer work to local businesses, churches or any company you know so that you can use it as experience on your resume.
  • Continue practicing and learning new concepts. If your financial situation allows, take small certificates.
  • Keep an eye on eventually completing an associate degree if not bachelor.  Build connections during any project you do so that you can use them as a reference.
  • Keep a documented list of projects you have completed. I have seen many experienced applicants fumble the question "tell me about some of the projects you have worked on."
  • Get in the habit of finding a solution on your own. Employers love the go-getters and solution finders. You can be asked "Tell me about a situation when you had to complete a project using tools or skills you never worked on before."

Reality Check

You should build a portfolio of your work to prove your expertise during interviews. You will also have to work harder than those who bring degrees to the tables. Nevertheless, if you are really good at what you do, you will definitely be able to land consulting jobs. You can also benefit from consulting companies like Tek Systems, Robert Half, Comsys (Experis) etc.

While temporary consulting is not an issue, getting hired permanently will still be a problem. In today's world, an associate, bachelor's or master's is a requirement for the majority of the IT positions.

My advice is that you get started in the field at an appropriate rate and save some money. Once you have a little bit of a wiggle room financially, go for some kind of a degree. You also have the option of attending online universities.

Bottom Line

Designing, programming and developing is like math. You can learn all the concepts and formulas you want but what would make you valuable is your ability to apply those formulas to fix problems that you may have never seen before.

IT is also similar to math in sense that you either use it or lose it. So go ahead and play with the tools, find out if you like it and never stop practicing. The biggest downer in the interviews I conduct is if I see a particular skill listed on the resume under the expertise but come to find out that the last time the applicant used it was 3-4 years ago.

Don't worry about the money. The money and wealth is only the after effect of you loving what you are doing and being good at it.

Good luck and happy programming!

 

5.10.2013

Implement Direct Enrollment or Lead Generation at the Health Exchange?


Henry Chao, the deputy CIO at CMS was probably not kidding when he said "Let's just make sure the Federal Health Exchange don't turn into a third world experience". We saw a slight glimpse of Chao's fears during the QHP submission period when the issuers kept experiencing the timeout issues.

During the planning phase the Govt. underestimated the website traffic by a major margin which is why when they went live, they suffered from a phenomenon similar to that of a traditional hacking attack known as DOS attack (Denial of Service). DOS attack happens when too many people visit one's website at the same time clogging its resources and rendering it unusable for everybody.

HHS recently announced that they will be adding some more servers to their HIOS fleet to facilitate seamless experience. Eventually their changes will allow issuers to get their QHP applications in, but this mess begs attention to a bigger event being the open enrollment!

The Federal Facilitated Marketplace

Starting October 1st the population interested in tax subsidies and Qualified Health Plans will visit Federal Facilitated Marketplace. This number of visitors will be way bigger than what HHS saw during its QHP submission time. I can only hope that the Feds have kept this larger traffic in mind when designing their hardware needs.

Direct Enrollment or Lead Generation

Direct Enrollment and the Lead Generation are one of the options through which the issuers can sell their products on the exchange. They are very important because they allow issuers to let consumers shop their plans without competing with anyone else.

The only single and the most important difference between these two options is that under Direct Enrollment, it is the issuer who carries most of the Burdon while under the Lead Generation, the exchange does all the processing. This brings us to the crux of this post which is the question that if one of these two algorithms is better than the other?

While I understand that due to IT staff size or budget shortages, having HHS do all the work would be the way to go for many plans; I lean towards the Direct Enrollment method. It is the safer bet of the two because it does not fully rely on the Federal servers.

Delivering on time is not enough

There was an article published this AM in USAToday that mentioned Whitehouse touting the success of ACA on the fact that it was hitting milestones on time. The problem is not delivering the milestones on time but delivering the products that will work. The USAToday failed to mention anything about the mess that happened at the Government severs which resulted in deadline extension. Only time will tell how the whole thing turns out but let's just hope it is not a nightmarish whack job scenario.

4.26.2013

Affordable Care Act is Anything but Affordable

Healthcare reform and the ACA mandate have been preached as a savior from the rising healthcare costs but the reality cannot be any farther from the truth. Simply put, the ACA is a program which focuses on paying the premiums rather than looking at how to bring down the healthcare costs.

4.07.2013

Reduce Time at Airports via Global Entry

Ensuring that our borders are protected from terrorists and making traveling experiences pleasant for peaceful citizens and for those who do not pose a threat is one of the main initiatives of the Department of Homeland Security. They do this through individual clearance programs like Nexus card, Global Entry and TSA Pre Check.

1.27.2013

Putting your pay raise to work

Now that you finally got that nice little raise, what you will do with it? Treat yourself to a nice dinner? How would you spend it? I am sure the question "how do rich folks spend their money" may have crossed your mind at some point or whenever you had a little bit of money to spare. It is no wonder that the rich are getting richer; the poor are getting poorer while the middle class is getting nowhere. The crux of this wealth accumulation balance lies not in our class but in our perception of how to best allocate our money.

1.26.2013

Making A Case for Surface Pro


The marketing push that Microsoft has garnered clearly suggests that the tech giant is fully geared up for mobile computing. Some say that Microsoft's strategic plans came too little too late, but I think it's perfect timing to see Office 365, Surface RT, Surface Pro, SkyDrive and Windows 8 all coming together at once.

1.15.2013

Health Insurance industry in post reform B2C world


The federally facilitated exchanges and the defined contribution models will shift the business-to-business (b2b) focus towards business-to-consumer (b2c). In the consumer market the brands and the perception they create are the primary influencers in purchase decisions.

1.09.2013

Become a great leader

During the year 1919 a man was fired by his boss from Kansas City Star newspaper. Lack of imagination was cited as the reason for letting go. That man, whose name we now famously know, was Walt Disney. Ironically Disney eventually bought ABC, the parent company that owned the newspaper.

1.04.2013

Rise of the Healthcare Pricing Tools

The notion "you get what you pay for" almost always holds true for general merchandise like clothing and related accessories. The high-end brands are usually expensive because their quality is directly proportional to the price of the product. Comparatively in case of healthcare, the price variances can be a little tricky and are tied to more than just the quality of the procedures.


Healthcare cost differentials

The cost of different kinds of treatments in a given area, city or state can vary substantially because they are dependent on fee schedules, demographics, and physician overhead.

A procedure like Lasik surgery can cost up to $4500 in New York while the exact same procedure runs for about $2800 in Ohio. Both of these treatments are about the same if judged on the scale of quality, procedure implementation, physician experience and time and yet there is a huge difference in cost.

Why the rise of the pricing tools?

Come 2014 the Affordable Care Act (ACA) will require everyone to get insured or face a penalty. This combined with the elimination of the pre-existing condition clause and the defined contribution model will put financial pressure on the whole industry and will create a consumer driven healthcare.

To stay afloat, the insurance companies will underwrite all subscribers as being under the same umbrella which will tie all participants together with an invisible financial thread. This thread will cause all participants to suffer equally for someone else not being able to pay their bills.

To ensure no one defaults on their payments and can afford the care, both the insurance companies and the consumers will demand to know the estimated cost of the treatments before they begin. This demand will give rise to the pricing tools.

Aspects that will matter

Pricing tools will be more than just a mere quoting system. Other facets like hospital versus private facilities, satisfaction ratings, availability and physician experience will equally count.

The consumer driven healthcare model will depend on:
  • How is the reputation of the hospital or a physician's office?
  • What kinds of deals are available inside or outside the plan network?
  • Is the physician willing to offer discount rates to individual customers?
  • What kind of satisfaction ratings did the physician receive?
  • What percentages of outcomes were successful?
  • Is there a price difference between a doctor's facility and a hospital?
  • Are there any payment plans available?

Different types of pricing tools

There are three primary ways of implementing the quoting system: the bluebook approach, the insurance average and the true cost quoting. All of these systems will have an Expedia-like feel with some even offering online shopping through a cart system.

Bluebook approach

Bluebook models already exist in the market but they tend to have a higher chance of deviation from the true estimates. They gather the pricing information from data bank companies like Vitals and then calculate the estimate by taking the averages.

The reason the bluebook approach is not realistic is because it does not take different, more-detailed possibilities into account, remove outliers or have access to different fee schedules. For example: A dental implant surgery can have the possibility of including a bone graft if the jawbone is too small. This is something that bluebook pricing would have trouble representing properly.

Insurance average

In this approach the pricing statistics are created by mining the claims data from different insurance companies. During the calculations the resultant information is further refined for accuracy by removing the outliers from the source costs.

Systems that offer cost information by mining claims data are usually more accurate than their counterparts. The weakness of this system comes from the absence of individual data like copays and deductibles.

True cost quoting

True cost systems are designed to offer more realistic estimates and are geared towards churning out individual estimates. The costs for different treatments are calculated using the same methodology as the insurance average models and then individual deductibles, copays and out-of-pockets are applied. The end result varies from user to user depending on their standing in their plan.

Opportunities and Challenges

The employer contribution model, ACA and consumer driven healthcare will force employers, hospitals, insurance companies and physicians to change their business models. Information and data availability will be at the center of this change.

Hospitals will have to rethink the patient exit surveys, feedback management and the way they charge their patients. Hospitals and doctor offices will be in a state of covert competition which will bring down prices for certain types of treatments.

Price comparison tools are already available in the market but they are not effective enough if they cannot utilize one's copay or deductible in the equation. Insurance companies will have to connect and offer data to their pricing tool vendors so that real-time quote calculations can be made.

Web presence for doctors will not just be "good to have" anymore - consumers will expect doctors to maintain a website. There is a vast opportunity present for software development houses to offer some kind of IT services to doctors because due to the ever increasing costs and overheads as it will be hard for physicians to hire IT staff directly.

Other reasons to maintain a solid web base are so that the physician can contact his/her patients electronically and get their feedback personally. We should not forget that the majority of the consumers leaving feedback on the public pricing tools will be the unhappy campers. Physician websites will allow physicians to showcase their good cases tilting the negative bias towards a positive one from the public areas.

1.03.2013

Landing Promotions and Raises

Money is one of the key rewards for excellence and is a catalyst to increased motivation. However, pay raises are often mistaken to be intertwined with promotions. A promotion is not and should not be the only way to get a healthy raise. 

This is a second post in the work success series. To read the first one, please visit Become Indispensable & Recognized at work.

The case that I tried to make in my first post was that you need to get recognized for being better than average. When you succeed in getting recognized for being better than average, you proceed towards further improving yourself and being extraordinary. When you are extraordinary, you see many options open unto you.

A pay raise is what you employer rewards you with in return for your hard work because your performance level has surpassed your current pay level. Promotions are additional responsibilities that are given to you because you have successfully demonstrated that you have the knowledge and the capacity to lead in a higher role.

Raises and promotions both require hard work and over delivery as pre-requisites. Both are forms of opportunities made possible by the presence of all the slackers. All you have to do is get ahead and avail these opportunities. It is easier than what most people think it is.

Here are some tips and traits that you can develop to score your dreams.

Create an appetite for success

Are you truly ready for your success? How bad do you want it?

I believe that success, wealth and happiness can be achieved by anyone. The probability of our success is directly relational to how bad we want to reach our goal. When it comes to pursuing our dreams, we will need to want them as bad as we want to breathe.

It is certainly true that luck plays a huge role in one’s success. But how do you define luck? In my view, luck is nothing more than one’s preparation meeting the opportunity. It is better to be prepared when opportunity knocks than seeing all kinds of lucky strikes pass you by.

You will need to learn to use your luck! I can give you opportunities all day long, but if you are not ready for them, you cannot avail any of them.

Develop the right attitude

Your attitude is what regulates your energy and the energy that you emit toward others. Four types of attitudes are common among successful people: attitude towards change, correction and advice, teamwork and gratitude.

Attitude towards change

The ability to look for opportunities at the time of change and capitalize on them will open new doors of luck for you. Being resilient towards change will do nothing positive because you cannot stop or avoid change.

Attitude towards correction and advice

One way to show your boss your determination towards being successful is by asking for feedback. However, you can completely destroy the usefulness of that feedback if you cannot listen to your boss without blocking the information or being defensive.

Some of the best advice that helped me with my career came from my bosses. I paid attention to what was being said and how could I improve my shortcomings. If I didn’t understand, I would ask for clarification. The more you understand and act on the feedback, the higher the respect your boss will have for you.

In my career, my mentor Tracy Hall helped me polish my project coordination skills. My manager Jacqui Schmotzer gave me tips on improving my communications skills. Bob Schleichert who was an Associate VP, showed me how to hire, negotiate, plan and budget for large scale undertakings. Kevin Pete, a Senior VP, taught me how to put it all together and be an effective leader.

So, you see, there is one thing common among all of the bosses I had, they all gave me feedback and opportunities, and left it to me whether I avail them or not. This also means that a true leader will play a key role in your success; hence make sure the one you are working for has those qualities!

Attitude towards teamwork

Your willingness towards helping your coworkers is a reflection of your leadership. Being able to jump in when needed and help others with their problems will earn you extra points.

Attitude towards gratitude

Your chances of success are slim if you cannot think of anything to be grateful for from your employer. Not to say that there are bad employers out there, but the majority of the time it is us who needs to change our perception.

You can improve your perception by a simple exercise. Take a piece of paper and write down everything you can think of that you like at your place of work. Do this over and over again until your sheet is full. This will affect your behavior and your employer will clearly be able to see your gratitude through your behavior.

Don’t be afraid to lose

Don’t let the fear of losing keep you away from accomplishing your dreams. The real loss we suffer in our life is when we cease to try something out of the fear that we will end up making fools out of ourselves.

I used to have a great deal of fear of public speaking. Having known this weakness, I still volunteered to speak about our experience at the graduation ceremony of Aultman Exploring Leaders. Mind you that this graduation event was attended by many high level executives at my company.

My speaking endeavor ended up anything but a Cinderella story; I panicked so bad that I forgot what I was going to say next. After subjecting my audience to a painful 30 seconds of silence, I managed to say some last words and ended my speech. Needless to say, I was furious, embarrassed and angry at myself.

I used those emotions of embarrassment and anger to improve myself by practicing hard. My next chance came three months later in form of an IT presentation. I practiced my speech in front of a mirror, friends, family and my pet cat. Finally the big day arrived and I sailed through my speech like a seasoned presenter. I tell you that the joy and the euphoria I felt after the speech was inexplicable and tastefully addictive.

Earn the flexibility

We all know that family and personal life is very important; however, in order to have a fair balance between work and personal life, you will have to work harder. Your boss will show flexibility around your family needs if your work is on time, is of high quality and you are there when your boss needs you. The secret to earning flexibility is to over deliver!

Bottom line

You should see an equitable increase in your pay if you truly are extraordinary and an over-achiever. However, if being a leader is your cup of tea and you want to go further down the rabbit hole, please stay tune for my next post in this series: Become an effective leader.

1.01.2013

No real Medicare solution in 2013 Fiscal Cliff deal

I was hoping, or to put it more accurately, dreaming, that the senate and the house will give sequestration and SGR a reasonable thought during the fiscal cliff discussions. Looking at the outcome I fear a gradual drop in the number of physicians dealing with the Medicare.

The fiscal cliff bill (HR 8) passed by the Senate delayed the Medicare payment cuts by one year. Current rates will continue until December 31, 2013, and at that time this patch will require more action.

Hospitals will pay for the delay

Besides not enacting a permanent fix, the other disturbing part is the cost of delaying is offset by requiring hospitals to fill the bill. Republicans did propose to pay for the bill through cuts to ACA and its beneficiaries, which the Obama administration overwhelmingly rejected.

Medicare cuts has no positive outcome

Hospitals will suffer because they will see reduced payments due to Medicare payment cuts and Disproportionate Share Hospitals plan. Physicians will suffer because they will either have to eat their losses or mitigate them by limiting their involvement in the Medicare program. Insurance companies will suffer because a reduction in Medicare physicians will affect their Advantage Plan’s provider network.

Doctors will leave Medicare

Many patients are questioning the old belief that doctors were supposed to join medical field to help people. Money should not be the primary factor. Some have gone so far as to say that professional honor is replaced by the goal of running a profitable venture, and I could not disagree more with this theory.

Doctors still join the medical field to help people, because many of these talented men and women could have gone onto other professions with more money, less hours and less hassle. But considering the large sum of medical school debt they accrue and the overhead of running their facility, the actual salary they are paid is like a rain drop in a desert.

Bottom line

Sequestration is a very serious problem which is not created by doctors in general. Instead of enforcing the existing laws, rules and regulations, the Government is further punishing care givers by adding more rules while leaving them hanging and guessing for the final outcome for another year. This will bring no positive change but force doctors to opt out of these programs.