Healthcare isn't immune to supply and demand

Original post:  Dec 16, 2015

For years, hospitals have claimed that the wide variation in costs could be attributed to factors such as quality or patient mix. A recent analysis of the underlying billing data revealed that is not the case.

Here is an excerpt from Becker's that explains what happened:

Researchers analyzed the real prices hospitals negotiate with private insurers and found places that spend less on Medicare do not necessarily spend less on healthcare overall.

The new "Big Data" project from researchers at Carnegie Mellon University, Yale University, University of Pennsylvania and the London School of Economics shows that the prices hospitals negotiate with private health insurers vary significantly within and across geographic regions in the U.S.

For the study, the researchers analyzed 92 billion health insurance claims from 88 million people covered by three of the nation's largest health insurance companies: Aetna, Humana and UnitedHealthcare. The data was provided by the Health Care Cost Institute and represents spending and utilization for about 30 percent of individuals in the U.S. with employer-sponsored health coverage.

The study shows spending patterns for the privately insured aren't the same as those for Medicare, which may cause policy makers to reexamine some of the markets that have been lauded for their healthcare models.

Time Magazine went on to add further analysis:

Shopping for health care services is incredibly difficult. Prices for the same service can vary widely, for little discernible reason. A MRI might cost you $511, or it might cost $2,815, depending on where you go.

A new study sheds some light on why some people see much higher prices than others. For the first time, researchers analyzed some 2.92 billion actual insurance claims for 88.7 million people across the country. They found that a person on one end of the country “routinely” might have to pay eight times more than they would somewhere else in the country — for the same procedure. Within the same city, hospitals would routinely charge three times more than other hospitals nearby.

Market power inevitably led to higher prices. This is exactly what economic theory says should happen in a rational market.

One of the most important factors influencing the crazy differences in price? The number of hospitals in any given region. The researchers found that even after controlling for other factors, areas with just one hospital had prices that were 15.3% higher than areas with four or more hospitals. Areas with two hospitals had prices that were 6.4% higher, and areas with three hospitals had prices that were 4.8% higher.

“We have this large body of evidence covering many, many years that consistently shows if you happen to live in an area with only one hospital you are going to pay a lot more,” study co-author Martin Gaynor told Marketplace.

Intuitively, this makes sense. When you have health insurance, you pay monthly premiums to get access to the health care providers in your insurer’s network. Your insurer negotiates with local hospitals to get lower prices for its pool of customers. In areas where there’s more than one hospital, the hospitals may be more inclined to compete for each insurers’ customers — and therefore more inclined to cut better deals with insurers. But in areas where there’s just one hospital, that hospital has little incentive to lower prices: If you get sick, you’re going there no matter what.

With the trend leaning towards increasing consolidation in the healthcare market, this trend bears watching.

One of the most important counterweights to this type of market power is exactly the analysis conducted. By sharing their actual billing data, major payers can compare rates and help to negotiate more competitive pricing for their members.

Here are the links to the articles:
Becker's:  New data shows experts were wrong about where healthcare costs less
Time:     Health Care Costs More in Cities with Fewer Hospitals 

10 secrets to influencing absolutely anyone

Original post:  June 11, 2015

We're often asked to work with other teams or individuals. Many of them will be outside our department or possibly even our organization. Without some way to influence them, it may be difficult or impossible to meet our deadlines and objectives.

This article from Time gives some hints that could help you get what you want--without blackmail.

I've personally used many of the tips discussed in the article. I think it's a solid start. My only comment would be to amend #10 to read "Chat face-to-face (if possible)".
For best results, you'll have to tailor your approach to meet your personality and skill set.

Here is a link to the full article:  10 Secrets to Influencing Absolutely Anyone - TIME

Here are the 10 tips. Please refer to the full article for the complete explanation.

1. Spend lots of time listening
2. Ask lots of questions
3. Make a human-to-human connection
4. Let your own guard down
5. Never miss a chance to say thank you
6. Never miss a chance to give praise
7. Never miss a chance to apologize
8. Strive to give people what they want
9. Let people save face
10. Pick up the phone 

Putting time into perspective

At a website called waitbutwhy.com, there is a fascinating infographic that discusses time from a very interesting perspective. It's far too large to replicate in its entirety, but I thought I would show you the part that goes back to Christopher Columbus landing in America. It's something of an arbitrary point, but it does give you some idea of how we perceive historical events. It's interesting to compare that to our perception of the current moment to try to get some mental idea of how long ago some of these events really were.

I was quite amazed to think about how different history might be for someone who is 30 than it is for me. I don't think of someone at that age as that much younger than me, but I think the reality is quite different!

There were a couple of fun facts sprinkled in there:

• A current 90 year-old was born closer to Lincoln's assassination than to our current day!
• The oldest living human today is 116. She was born closer to Washington becoming the first president than to today!

Here is the link to the full infographic:  http://waitbutwhy.com/2013/08/putting-time-in-perspective.html

Where do you find the time?

Original post:  Oct 1, 2014

We all know people who are incredibly busy. Ironically, it seems that many of those same people still find time to squeeze in another task. This article from the Advisory Board interviews a few superstars and asks them "How do you do it all?"

There were four recommendations these individuals made that the author picks out to highlight:

  

Austin: "I don’t drive on my commute. I walk and take the train. Walking (up to 6 miles per day) replaces what would otherwise be time spent at a gym or similar. During my commute, I catch up on news and, yes, some entertainment by podcast (at 2x speed—people speak too slowly). I read and take care of email on the train."

Tyler: "Do the most important things first in the day and don’t let anybody stop you. Estimate 'most important' using a zero discount rate. Don’t make exceptions. The hours from 7 to 12 are your time to build for the future before the world descends on you."

Austin: "I ignore most office and institutional politics, skip every possible meeting, and don’t pay close attention at all times in most of those I attend. (These habits can be potentially dangerous. I have some protective workarounds, which rely on the skills, interests, and good will of others. Gains from trade.)"

Tyler: "Don’t feel you have to finish a book or movie if you don’t want to."

One of the Advisory Board executive directors, Allison Shimooka, gives her top six productivity tips:

1. Know yourself and understand your role—what value do you bring to play? Focus your effort and attention there.

2. When you are asked to do something, before automatically saying yes, ask questions to scope the yes. Determine if the person asking really needs you to do it, and if so, do you need to do an A+ job or if giving 80% effort is sufficient.

3. Determine which of your own projects need to be A+, and which ones where a solid B will be fine.

4. Scope, scope, scope your role.

5. When working in partnership, or when people are asking you do things, establish a relationship of trust. That will allow you to push back, and rescope the project if necessary.

6. Never procrastinate. It never pays off.

What are your best tips?

Here is the link to the full article:  'How do you do it all?' Secrets from super-efficient people | The Advisory Board Daily Briefing

20 things 20-year-olds don't get

Original post:  Sep 19, 2013

I must be getting old. When you start identifying with this type of an article, the unmistakeable signs start staring back in the mirror.

That said, there is much of the advice that rings true no matter what your age. As I read through the list, I saw that there were some things I had always done. There were others I may have started on but still need to work on. There are still others that I have not yet put into play.

Here are the ones that resonate most for me:

• Time is not a limitless commodity

It sounds so simple but it rings true. Even when I was 20, I was very aware of the precious nature of time. Perhaps it is why I have this relentless desire to find the most economical way to do just about anything. As I've grown older, I've learned that things always take longer than you think they will. I've also learned that you can never quite accomplish as much as you hope you will, but that with enough effort you can be satisfied with the result.

• You're talented, but talent is overrated

No matter how insanely gifted anyone is, without hard work that talent is likely to be wasted. There is always someone who will be just a bit more talented. If it's not now, it will be soon.

• Pick up the phone

I always prefer a face-to-face discussion if it is possible. You can learn so much more than you can over the phone. While a videoconference is OK, I still prefer live human interaction.

Here is a link to the full article:  http://www.forbes.com/sites/jasonnazar/2013/07/23/20-things-20-year-olds-dont-get/

Which ones do you like? 

Chopped

Original post:  Aug 16, 2012

My wife and I enjoy watching a show on the Food Network called "Chopped." The show features four chefs who compete to cook an appetizer, entrée, and dessert featuring four mystery ingredients within a time limit of 20-30 minutes.

It is fascinating to watch the creative process in action. We both love to eat a wide variety of exotic foods and the show certainly doesn't fail to disappoint. It takes incredible skill to transform some really crazy ingredients like beef hearts or bubble gum into sumptuous dishes.

A recent episode featuring celebrity chefs was actually quite instructive. It featured 16 Food Network celebrity chefs competing for a $50,000 prize for their favorite charity. In addition to the enormous time pressure the judges face in taking these wild basket items and transforming them into a delicious plate, there was the added pressure of trying to win the competition for their charitable organization. You could literally see the chefs trying to focus their efforts in a desperate attempt to provide that extra added touch that could help elevate their dish above their competitors.

I was most fascinated by watching how the relentless ticking of the clock affected even the most talented chefs. They could have kept things quite simple and easily presented a passable dish in the time given. However, since they knew they were competing against other talented foes, they had to design complex and complicated dishes to bring depth to their flavors and to balance a number of competing tastes and textures to make their efforts stand out. One of the favorites who seemed destined to win the overall title made a simple error by forgetting one of the main mystery ingredients. He had cooked them and they were sitting inches away from the plate. In the rush to complete his dish, he forgot to garnish the plate with the required element. His dish was outstanding in every other aspect, but he was "chopped" because no one else made any error quite as bad (even if their dishes didn't taste quite as good).

It is also instructive to note that the judges grade on three key elements:  taste, appearance, and creativity. The runner-up lost primarily because he did not "dress" his plate as well as his opponent. His dishes, while delicious, did not look as great. Other chefs were cut because they simply cut up the ingredients and hid them on the plate instead of transforming them into something better.

If we can translate this competition to our own work life, I think we can see the impact that deadlines have on even the most talented personnel. It's amazing to think of what might have been had that favorite taken the time to remember to garnish his plate or that runner-up had cleaned up his presentations. There is a lesson there for all of us.

The fierce urgency of now

Original post:  Mar. 14, 2012

Patience has never been a strength for me. I certainly wouldn't classify myself as having no patience, but I have a hard time waiting for things. Idling in heavy traffic drives me bonkers. I feel as if I am constantly calculating all the other things I could do with the time that is slowly wasting away.

I try to check these impulses as much as I can with my boys. Last night, they had set up a battle scene with their Lego minifigures in our upstairs hallway. I asked them to clear a path since it was time for bedtime stories. After first arguing that they had not had enough time to play, we agreed that they could stage a strategic retreat of the figures to defend their home base near the wall. This had the double advantage of clearing a passageway for normal foot traffic. It might have been easier to insist that they immediately put everything away, but I thought that we could work out a compromise that still accomplished the mission.

It's interesting when the roles are reversed. One strategy we often use with the boys is to defer gratification. We don't say no. We simply say that they can't have it now. If they would like to read one more story but it's bedtime, we let them know that they have to wait until tomorrow. After the ritual of begging and pleading, we eventually hold firm. That wait can seem like an eternity to a young boy. I can also report that they almost never forget to collect the following day!

I often forget that for a child a day is a much greater share of their young life. Twenty-four hours seems so long to them. In our high activity world of business, it almost seems as if it is over before it has begun.

I am working to try to temper my impulses while still retaining a proper sense of urgency in my work life. There is a story associated with that, but it will have to wait for tomorrow.

Days are long, years are short

Original post:  September 7, 2011

My wife and I dropped off our five-year old for his first day at kindergarten this morning. Amidst all of the commotion, I found my mind drifting back to a memory that still seemed fresh of bringing him home from the hospital those many years prior.

Somewhere along the way, a fellow parent shared advice about raising children with me. That empty nester fondly told me "the days are long, but the years are short." It's taken some time, but I think that phrase now rings true to me.

There were many sleepless nights and messy diaper changes where I wondered if the pain of the moment would ever end. They always would. Looking back, the excruciating pain is nearly completely forgotten, but the truth is that they felt interminable at the time they were happening.

How does this relate to my work life?

One goal I try to set for myself is to get something positive accomplished daily. Sometimes it is a major achievement. Most often, they are fairly simple "wins." As long as I am making some type of forward progress, I am content. While it may not seem like a high bar, it can actually be quite a challenge to sustain that rate over time. Over the course of time, the pain of the many long days is forgotten and you can look back over the short years and smile contentedly (as you wonder where all the gray hairs came from)!