Curious Times and Curious corporate bedfellows


Dear Jeff, Jamie and Warren

We haven’t met, but each of you express a candor that suggests you are open to informal input.

Image result for Dimon bezos buffett

Naturally, I was not alone in my surprise over  your companies- JPMorgan Chase, Berkshire Hathaway and Amazon announced plan to enter the healthcare marketplace.  The cover story I saw, explained your unified commitment to contain, if not reduce employee healthcare costs, without mentioning  any specifics.

My first thought was perhaps this was a prelude to a presidential bid.  The announcement’s bold leadership play has garnered great public enthusiasm.  My second thought recognized  the power vacuum that followed the failure of the national government to make change. Your united commitment, and unspoken appeal for other CEOs to join you could create further momentum for market driven change.

These thoughts still didn’t feel quite right. I remain optimistic and root loudly for other change agents to shift the tide.  As we all know, the challenge to deliver healthy outcomes and affordable healthcare for all are not one dimensional. The complicated systems presently in place fail to address the larger complex inter-relationships between community and individual health.

Have you read David Freedman’s recent assessment of US healthcare system conundrum?  It’s not that long, and should be a required read for every team  contemplating entering this space. He writes

“It’s easy to think of “health” as just another category of social-service spending. But a great deal of modern research suggests that it might be more accurate to think of it as the payoff of all the other services put together.

Are you Seizing advantage or opportunity?

I do hope this announcement, in spite of subsequent commentary suggesting otherwise, that your three musketeer esprit de corp adds up to more than a pure group purchase power play. Elizabeth Rosenthal commentary in the NYTimes explains

“Together, these three behemoth corporations will be able to wrest great deals and discounts in their negotiations from hospital systems, drug manufacturers, medical device makers and doctors’ groups.”

OK, it’s why I’m asking you to widen your goal. Don’t  settle for negotiating a better deal than what  present healthcare arrangements are able to wrangle.

To Jeff, I wondered why you sought out Jamie and Warren to play in an arena internally Amazon team’s have been working, and compromise your reputation and general industry slaying capacity? Amazon’s platform successfully  delivers efficiency and value to end users. Are you suddenly squeamish about squeezing healthcare providers and yes, your employees too?  Scott Galloway, the NYU Stern faculty describes in The Four  your outsized vision has long exceeded the pure e-commerce play that is Amazon today.  Galloway further empathizes your tireless advocacy for technology  touched by realism about automation’s impact and downstream effect on wages.

These last points makes Jamie a strange bedfellow, as the banking business depends on individuals’ with incomes.  But that’s a different letter and article.  Jamie, under your leadership JP Morgan Chase offers expertise in compliance, as well as payments and savings that can create some cost saving synergies in Healthcare.  More importantly, both industries service and needs are intensely local and subject to state regulations.  The consolidations in both banking and healthcare had to rethink bricks and mortar location and staffing. Increasingly, financial services delivery via un-staffed, self-standing kiosks/ATMs and/or rely on mobile enabled applications. Banks, relative to healthcare, historically leveraged technology savvy to fuel growth balance risk and reward effectively and efficiently.  Jamie your investments and innovation, though slow starting, and less evenly distributed across the investment, consumer and commercial bank–they do suggest you can leverage the to deliver greater opportunities and create value in  Healthcare.

Warren,  I’m also hoping these are a few of the elements of value you spotted too.  Again, several closer observers of your group planning reiterate that limiting your collective primary intention to lowering employee healthcare costs, reduces the life value of the proposal. That shortsighted objective is certainly not likely to deliver the return on investment necessary to make a dent.  I’m counting on you Warren, and your experiences creating larger and profitable opportunities from reorganization.

The flaws in a hasty solution

I’m equally certain you all noticed the dramatic rise of Net Income among healthcare insurers.  If you haven’t finished a deeper analysis, start with this one by the Leavitt group that reveals a more complex picture.  “[I]nsurers made money in the Medicare, Medicaid and group health insurance markets and lost money in the individual market, which is why some of them exited the individual market in many states.” 

As early as 2006, Michael Porter summarizes the strategic dynamics and cost challenges associated with creating quality healthcare outcomes in   Redefining Health Care: Creating Value-Based Competition on Results.  The environment he  describes of dysfunctional competition leads  players to “strive not to create value, but to capture more revenue, shift costs, and restrict services.” Porter felt that healthcare lacked discipline and a management and business focus.

Jeff, Jamie and Warren is that your take too?

I don’t know if it was conversations at Davos and chats with deeply knowledgeable wranglers of this problem that inspired you to act.

I’m inspired by data. As the Affordable Care Act continues to make available additional data, it’s possible to learn more about what works.

Since 2006, researchers in both social and medical science enable more models of service and extends understanding of human health at the individual and population level. Much of healthcare activities used population data to allocate resources. Efforts to reduce costs associated with an individual can now take into consideration individuals’ behaviors.  Continued use of aggregate process and success measures mask the affects of too many associated care conditions and reactive activities.

There’s a complex relationship among these issues, and how they are translated into interventions and dosage appear to prevent rather than deliver consistent beneficial outcomes. Hilary Hatch the CEO of Vital sign offered this explanation:

“Population health puts people into categories by conditions (diabetes, hypertension, depression), age, lab results and medical billing data. These categories presume their own importance. When in fact, psychosocial, behavioral and environmental factors determine individual health far more.  Patient goals, preferences and barriers to care tell us what stands between that patient and better health. Without this data, population health efforts are undermined.

The explosion of personal health monitoring devices correspond with more data that contribute to advancing understanding of the workings of the human body.  Another entrepreneur, Mario Schlosser recognized that “no entity in healthcare  has enough data visibility to help you[individuals] navigate the system.”

Is this your collective aspiration too?

Why not just partner with Success?

A few weeks ago, I attended a presentation at Chicago Booth’s Rustandy Center by the Chief Medical officer for Oak Street Health, Griffin Myers  This new medical group does not serve everyone, but the patient population they do serve have consistently better outcomes.  The business model that Oak Street Health adopted throws out the traditional fee for service model insurers favor. Instead they get paid when they deliver services that work, the successful outcomes embodied by Accountable Care Organizations as specified in the Affordable Care Act.   Oak Street established a value-based care delivery model exclusively serving  Medicare (and Medicaid dual-eligible) patients in low income areas. They presently operate 24 clinics across Illinois, Indiana, and Michigan.

This intereview with Griffin Myers on Tasty Trade gives a great overview

Another alternative model of care that should inspire the three of you is Oscar Health, whose estimated valuation of $2.7billion, and claims to be the first technology-based insurance company. Mario Schlosser, an immigrant from Germany realized before the birth of his first child an opportunity to put his own special skills as a data scientist to work.  His first hand experience navigating the complexity of  the healthcare system led him create Oscar Health in 2012. The company “uses data and product design to guide you through your health care and get you healthy.” As of Oct 2017, he has raised over $720 million and  delivers over 100,000 patients  concierge style team care in New York, New Jersey, San Francisco, Cleveland, Nashville, Austin, San Antonio, LA and Orange County.  Note, many of these cities feature innovative health care service providers but  boast a volume of technology talent too.

This interview with Mario on Techcrunch Disrupt in 2017 is a good overview.

 

Both these approaches recognize that healthcare requires high touch, and a constellation of services to produce the desired outcome.  Both of these innovative for profit companies are heavily invested in use of  data and  technology.

So Jeff, Jamie and Warren under your leadership, will you be equally committed to  facilitating connections between traditional care givers, services and systems or just cut out the human to human touch?

Whatever you do, it will be interesting and I’d be happy to help.

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Time is money, are you using real time data wisely?


busby-berkley-snowflakeTime is money, are you using real time data wisely?

Are you feeling up to date, in sync with the times? Both individuals and organizations find it challenging to fully leverage technology and integrate the sea of real time data that surrounds us.

This past week, I attended a local Internet of Things (IOT) conference, only to be reminded how we’ve been kidding ourselves with respect to the human machine dynamic.  When Factiva reported in 2013, that the previous two years had created 90% of the world’s data, it also reflected the impact of visibly faster technology and emergent opportunities for those capable of wrangling more data. Similarly, the exchange of information machine to machine and the responses that  IOT and the Industrial IOT (IIOT)  make possible  will soon surpass all human generated information.

Information has never proven more valuable to competitive advantage than now. The key istimely mastery and/or the ability to separate meaningful data from noise. Possessing  Real time capabilities merely up the ante. 

Suddenly,  all of the conversations about the real, meaningful  difference of  Big Data clicked. The challenges I knew and had experienced working with volumes of data is not something everyone experiences, and itswhy I missed the significance of the message. Language can do thar. Today’s – competitive advantage relies on learning synchronicity between people, and also between people and machine. 

Yep, syncing as in coincident timing. Timing reactions require coordination on the order of the elaborate dance numbers Busby Berkley made famous will separate winners and losers. 

People learning rates

People are interesting precisely because we begave inconsistently.  These same traits  make us effective competitors and efficient information processors.  We focus and only selectively pay attention, which means we consciously ignore most information in our midst. Unlike machines, we are slow few of us possess capabilities to process high volumes of complex data at high speeds. 

How people integrate data remains a bit mysterious. Part conscious and part unconscious, each of our senses connect to different parts of our brain and the information isn’t always processes with consistency. 

Humans create their own reality. For example, our eyes see things differently than what we describe and not because of language problems. Automatic transformations correct using depth perception and pre existing knowledge to flip the image, while sound tends to retain its integrity. 

Similarly, information new to us versus updates also  process differently; and yet, endless streaming information can overload and confuse us. Today’s powerful computers don’t experience anxiety or fatigue though they may overheat or fail.

The natural limits of time and energy challenge people to choose their focal point, the when and how we respond to data and perceive opportunities. For example, few of our waking moments and activities require conscious thought. Our body takes care of itself and manages to coordinate processing of external sensory information with internal demands. This syncing makes possible mindless activities like breathing, eating, walking and resting.

Consciously, our ability to track our time and energy is spotty.  Still, unstructured/unplanned  moments, especially those that demand little of us mentally remain ideal, while society frowns on the same characteristics when referred to as idleness. The contradiction reflects the value we attach to purpose or meaningful use of effort over time that results in tangible output.

Artists create, builders build, analysts compute and chefs cook for example by adding their effort over time. They make something or transform original materials/inputs.

The notion of efficiency also boosts the value of effort by measuring the effort relative to the output produced over time. Likewise effectiveness, measures the additional value produced relative to the starting inputs. Together, these measures translate into meaningful consistent tokens of value that permit ready exchange, or wealth accumulation.

In this context, the accumulated tokens of value allow us to buy ourselves time to take vacation or be idle as easily as buy us time to learn, create and do more.

Machine learning capabilities

This also explains precisely why technology advances prove so valuable, as they have progressively reduced the amount of time and effort necessary to perform a task. As a result, we DO spend less time on common, routine activities than was previously necessary.  Internal plumbing saves us time we spent fetching water, Wheeled transportation saves us time we spent walking, and similar telecommunications vastly removes the break in communications that once necessitated considerable effort  to cross the distance by one if not both parties, or the enlistment of a proxy to carry the message on their behalf. The human messengers were replaced first and written notes/letters, and then the telegraph dramatically reduced the time between message sending and receipt.  Now text messaging and email is displacing telephone and video conferences.

This evolution in communication methods affects the people’s interaction styles but also their information needs and expectations.

Real time communications savings and benefits are not equally distributed and so inefficiencies persist.  On one hand they present a new opportunity to replace planning and documentation of activities essential when communications were primarily indirect and time lagged. Built-in tracking, boosted transmission capabilities and data recording can both fill in and increase information gaps.  Problems associated with incomplete, unsupported or even delayed information that always created risk persists, but for new reasons.  The flood of data from more sources both people and machine generated pose new challenges to separate out meaning, predict and or respond in timely, relevant manner.

Another opportunity real time capabilities offer are all around us, assisted by the information collected and transmitted from multiple data sensors scattered across the environment.  In fact, it’s how airplanes fly automatically, rail road cars notify switches of their location to either open or close crossing gates, motion sensors in buildings adjust level of lighting and air temperatures, and Tsunami warning systems saves lives.

In general, people are wired to process information in real time. We use an array of body language cues to understand how to  manage the situation and engage with the people in our midst, and yet we do it unconsciously.  Planning on paper is a far more conscious activity, time consuming and energy draining.  Worse, planning often stops us from activating the unconscious real time processing.  We follow the plan, rather than notice the inconsistency or the more obvious information we may or may not have incorporated.  Best example, is the step by step navigation systems that we know are less than perfect.  Have you found yourself using the navigation only to discover it’s asking you to turn onto a one way street going the wrong way? Or your location is “ahead” of the GPS signal and so you miss a turn?

My point is this.  Too many built in business procedures and processes were designed in the absence of real time information.  In order to be more relevant, more valuable people will need to revisit their processes with respect to learning, creating and doing.  It will require a shift in attitude, refocus of needs and adjustment in expectations.  It’s a shift from a look back and partner with machines that look forward, use more data sources and get to analysis faster.

If you have any examples of success or any challenges I’d love to hear about them.

[i] Mike Hogan, “big Data of your Own,” August 2013, www.factiva.com

John Adams, “Be careful or Big Data could Bury your Bank,” January 25, 2013 http://www.factiva.com

Are you wired for growth?


https://i1.wp.com/cgamagazine.ca/wp-content/uploads/iStock_000020240421XLa_opt1-572x210.jpegI wanted to call this post, switched on  growth, but that didn’t fully capture the emerging idea in my head.

Upon waking I found myself wondering about two very different idea. What makes flowers in chicago bloom in November and why the internet never seem to run out of capacity? Since its not uncommon for my ideas to make sense to me but sound to others as if I’m hovering in the clouds at 30,000 feet, allow me to explain.

We distinguish two types of changes –transitional and transformational. I doubt caterpillars or tadpoles in their initial state can do anything that prepares them for their existence post their transformation into butterfilies and frogs? People in the course of their development do.  We have an uncanny ability to remember past experiences and in many cases it forms our thinking about the future. In other words, if we set our minds to it we can imagine our future in ways that I suspect is impossible for tadpoles and caterpillars.

Seeds don’t imagine flowering, instead they are merely wired for growth.  Something switches on when they find themselves in the right environment and as long as the conditions persist to sustain that signal they keep on growing.

Research into human development when combined with the neuroscientists understanding of our brain’s  growth reveals that humans bear a similarity to seeds.  From the conception moment, as long as the environmental conditions prove favorable, we manage to grow inside the womb, and then we do go through our own transformation as we emerge into the wider world at our birth.  Our sensititity and early instincts begin to form long before we experience our first breath of fresh air.

The different parts that we call the human brain just as the different body parts that comprise our stature do have limits. The internal instructions of DNA and RNA have some latitutde which is why environmental conditions do have an impact.  But it’s the same underlying code that turns some seeds eggs into tadpoles and some into humans.

The biggest advantage humans have over all other creatures and life forms seems to be their ability to alter their environment.  In other words, we can modify and then optimize the conditions in which we can thrive. Social tools like communicaions and today’s more advanced incarnations  realized through a combination of hardware and software offer amazing opportunities.

The motivation to transform our surroundings not unique to humans, as evident in nesting behaviors. Birds have been observed building rather elaborate nests, as do other creatures establishing protective and cozy environments that protect their young. Likewise learning or mimicry has been observed in the animal kingdom, and even to some degree plants who move with the sun.

The more distinctive qualities of humanity, such as fashioning materials with our hands has evolved to a much greater degree than in other animals. Unlike other animals, our internal wiring as refashioned and transformed our brain to be capable of a variety of higher functions one of which is manifest by this post.  The abilit to formulate ideas, conceive of connections without seeing them and then describing them in a manner thtat others can understand now or at some point in the future?  That’s pretty different from the tricks my favorite dog and plants can manage.

Ok, enough background.

Transitions the ability to adjust and assimilate new information depends on prior experience.  I’ve never met anyone who can remember their life in the womb, but again researchers studying human development know among all of our senses, vision is the last to develop.  In fact it takes babies months before their eyes  can hold focus while shifting their line of sight between objects near and far.  I mention sight becasue it’s an easy transition to understand.  Who hasn’t crossed a threshold and found themselves momentarily blind by the extreme difference in light levels.  It takes a few moments before your eyes acclimate, doesn’t it?

Transformations, as we described above are a wholly different experience.  Imagine walking only to find the next step plunges you into a deep hole filled with water?  your body responds in even less time than your eyes take to adjust.  If however you were on the edge of the water and had maken a conscious choice to go for a swim, your body knows exactly what to do. Again no transition or acclimation to the needed unless of course you want to open your eyes underwater.

Differentiating between conditions that require transitions and permit instant transformation is what I beleive separates an agile and flexible organization ever ready to grow.  Both benefit from planning but their response time to change varies dramatically.  If your organization desires to remain competitive learning and building the right capabilities and capacities matter.

I believe that like the human brain, an organization needs a flexible responsive platform to coordinate and integrate the exchange of signals. Why a platform? Simple answer is humans are only good at keeping in mind about two or three thoughts at once, the platform like the really capable personal assistant can track and pop up the right messages at the right time.

No, I don’t mean Siri.  Why?  becasue Siri may be able to talk to my calendar and figure out much of my personal peculiar turns of phrase and short hand names for things I need and use regularly.  Siri doesn’t yet fully take advantage of signals other than location, or the fixed notations.  Siri may help me, but  I haven’t seen the enterprise version, have you? When you do, let me know I’ve got several assignments for her.  I’m betting you do too.

Getting to the future


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Everyone thinks about the future. The dreams of the Pilgrims  arriving in Massachusetts are no different from our individual aspirations for new possibilities and changing situations and circumstance. What new freedoms will be there,what will people be permitted to  think, wear, eat, live or DO?

My interests and passions to do what I can now to make things betters isn’t unusual.  The company I keep all agree in increasing possibilities and making changes that benefit more people, not just me and my family.  In the season of thanks giving, I’ve noticed the launch of a series of web sites  matching wishful doers with need serving organizations, and in the process create social impact.  The process used by these sites mimics many of the matching sites, whether its capital rich hedge funds seeking people needing to preserve and grow their capital, entrepreneurs on Kickstarter seeking funds to build their business or start their social impact match service. The technology itself minimizes the value of my personal network by making it possible for me to cast a wider net and build relationships that are not based on naturally limiting, real world contexts that form my identity, e.g. where I grew up or where I went to school, or my cultural, ethnic or religious ties. The stumble upon place or the sophisticated search to match my interests still rely upon individuals’ ability to influence others of the information’s value.  The  technology may be new but these resource matching problems are part of an ongoing cycle that doesn’t change, and the match solutions operate within the same system that create the resource gaps.

 

Where’s the change?

Snow appearing on the ground signals another recurring, predictable change, as does the falling price of the iPhone.  Outwardly, we show signs of adapting to this news.  Where you stand in the continuum of variation in response changes your understanding of the  most predictable of change’s magnitude.  It also explains why not everyone seeks to incorporate or welcome the change in their life.

When the obvious answer satisfies us, we ignore or suppress the possibilities that the change may be worth investigation. Changing temperatures or icy, snowy conditions difficult to miss and though we adapt and incorporate the obvious, we all adapt a little differently.  Our experience colors our understanding and response to the change.  Seekers go one step further.  They consider the choices others make and wonder if that too may be worthwhile for themselves.  They are curious about paths that open further possibilities or improve their status, conditions etc.

Seekers both experience and confirm their responses to transition moments by first learning and listening to others before sharing their own perceptions. Going beyond their  response to the change , they are conscious of the potential ripple effects.  Some look harder to find the likely path, similarly they may try to get out front and position themselves to catch the inevitable fall of the lined up dominoes. They don’t merely watch the event unfold, they try to connect what they see to a range of possible experiences and look for possible variations that happen beyond their immediate vicinity, situation or context.

Reporters,  when covering breaking news for example, share or retell what others experience in moments of change.  Often they are  hip or shoulder deep in the same experience as it unfolds, yet, they leverage and try to take advantage of their experience.  They try to reposition themselves for what will come next.  There’s an art to reporting.  It requires  piecing many different perspectives together to fill in what the participants, experts or contributors immersed in the experience overlook, misunderstand and maybe fail to identify.  Reporters are a special breed.  Their descriptive reporting shortens the distance between their audience’s detached experience and the actions and activity of their present surroundings.  Using their own senses to connect the meaning of other’s experiences they help their audience acquire a more complete, multifaceted view.

Multidimensional matters

Strategists and good consultants do this too. They leverage their experience while keeping one eye on the future.  They also help those stuck in the present to connect, hope and inspire an alternative set of prospects. Their job encourages explorations, cuts the distance between present circumstances, progress and a rosy future  for their client’s clients.  The lookout on the Mayflower merely let others know what was in sight before those on board could see it. No one would call these lookouts strategists, or leaders.  Lookouts can’t inspire people to acclimate, though they do warn them of what’s coming. Inspiration comes from a vision that transcends our fears and our expectations, not an easy task.

Today technology changes and innovations come at all of us faster than our ability to fully digest the last ones. Some of the effects cross connect, meaning that adoption of one makes it impossible to ignore the next.  Speed at which the connections happen make it simpler to stand by  and avoid participating.
No one is every fully ready for the future, but strategists can help in those moments of relentless change. their skills and experience naturally connect the dots, explore possibilities and overcome natural resistance.

Knowing your desires or dreaming about an idyllic world won’t get you to the future, though it is an interesting way to start. Regardless of what comfort level and satisfaction you feel with the changes as they occur in your midst, you need to take a wider view.  Challenge your experiences, raise your sensory awareness levels to uncover more possibilities.  Changing your perspective, point of view or the dimension in which you’ve come at the problem  guarantees your advantage as the future unfolds, and should increase the power of your risk assessment by virtue of your  wider stance.