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Total Value; Total Return

I came across a new website today for the Center for Value Based Health Management.  Their definition of Value-Based Health Management is below.

“The planning, design, implementation, administration, and evaluation of health management practices that are grounded in evidence-based guidelines across the healthcare continuum.”

It is a great concept.  The question always is how to do this without confusing the patient.  There are lots of plan designs out there that could be used, but become so confusing that patients don’t know how to meet the payor’s goals while minimizing their out-of-pocket spend.

The site also talks about a publication called Total Value Total Return which has seven rules for developing a value-based solution for your employees.  They seem like good fundamentals:

  1. The Health of Your Organization Begins with Your People.
  2. To Realize Total Value, You Must Understand Total Costs.
  3. Higher Costs Don’t Always Mean Higher Value.
  4. Health Begins and Ends with the Individual.
  5. Avoid Barriers to Effective Treatment.
  6. Carrots Are Valued Over Sticks.
  7. Total Value Demands Total Teamwork.

The Carrots Over Sticks comment made me think of all the press about forcing wellness down the throats of employees.  I have a recent article on that that I will post on later.

Myers-Briggs in Healthcare: Part 2 of X

I was looking for a book the other day to read on some of my flights and came across Health Care Communication Using Personality Type by Judy Allen and Susan A. Brock. I have just started reading it, but I related very well to their key assumptions:

  1. People prefer to communicate in different ways.
  2. Most people have a preferred style of communication.
  3. It is easier to communicate with some people than it is with others.
  4. A system exists which provides a simple framework for understanding these differences.

As I have mentioned before, I think that Myers-Briggs is a good framework for understanding people. I often pull up my notes about my personality type and can see that I respond as predicted to certain situations.

Applying some of their initial thoughts with my perspective, it would seem like there are some basic hypotheses that you could make in talking with patients.

  • Extraversion: People that like to talk things out. Probably more likely to respond to verbal outreach.
  • Intraversion: People that like to think things through. Probably more likely to respond to print (e.g., letter or web).
  • Sensing: People that like the specifics and the details. Probably more responsive to a detailed message (e.g., you can save exactly $X by doing this). Probably want to see the path of exactly who needs to do what.
  • Intuition: People that see the big picture. Probably more responsive to a communication that helps them understand the impact of their decision on overall healthcare trend. Probably want to understand their options versus being guided down a path.
  • Thinking: People who are very logical. They should respond well to automation and would want an if/then type of message.
  • Feeling: People that are more emotional. They would likely respond best to live agents where they could empathize with them and potentially even respond to a “peer pressure” type of message (e.g., most people are now using generic prescription drugs).
  • Judging: People that are organized, punctual, and focused on getting things done. They would likely respond to messages about how to save time and money delivered in the quickest format possible.
  • Perceiving: People that are flexible, don’t plan ahead, and are often more disorganized. They would likely respond to a just-in-time message, a compliance reminder, and a communication process that did everything for them (e.g., you should go in for a colonoscopy…would you like us to schedule that for you).

Obviously, one framework doesn’t solve everything, but I expect that there is a lot more to gain from this book as I read through it. I was just so excited after the first section given my interests that I wanted to post this quick entry.

Information Latency: Why Don’t We Change?

I have had this note to self for a while so I am finally going to put a quick entry out here on the topic.

The issue is data latency or more appropriately information latency.  The data often exists right away, but the challenge is how to you get the data into a usable form, with context, and with enough data to make decisions.

In communications, this manifests itself in healthcare in two ways that immediately jump to mind:

  1. In a traditional letter program:
    • You send a letter to a patient (7-10 days from data targeting to mailbox)
    • Patient opens the letter and has to contact their physician (if they choose to do anything)
    • Patient trades messages with physician and/or has to schedule an appointment
    • Patient meets with physician who (for example) writes them a new prescription
    • Patient waits for medication to run out then refills with new drug (e.g., generic, on-formulary drug)
    • Claims get aggregated and reports run
    • Best case – 30+ days to see if program had any effect (most likely 6 months)
  2. In a traditional survey:
    • Company prints a survey and mails it to 10,000 people hoping for a 10% response rate to get a statistically valid sample size of 1,000
    • Patients fill out the survey over the next month and mail them to a data entry company
    • Data entry company manually enters them, aggregates the data, and creates a report
    • 45-60 days later the company has information from the survey

Of course, the issue with both of these is that you have lost a huge window of time especially if you need to make changes to your program or the survey tells you that you need to gather more information.

Why don’t more companies talk about on-the-fly program changes and how to use modern technology to get real-time feedback for programs where they can pause the program, make change (e.g., change the message, add a new question), and then continue the program?

Making Good Decisions

This is a classic article that I have reused several times.  The article “Great Escapes” by Michael Useem and Jerry Useem appeared in Fortune (6/27/05) on pg. 97.  It is about thing to use to avoid typical decision making problems.

These are all relevant for anyone in business or healthcare, but with the massive amount of change required in healthcare, it seems like these will be relevant at the macro level.

  1. Problem: Analysis paralysis
    Solution: 70% solution
    “A less than ideal action, swiftly executed, stands a chance of success, whereas no action stands no chance.”
  2. Problem: Sunk-cost syndrome
    Solution: Burn the boat
    “There is no such thing as timeless perfection, only obsolescence.”
  3. Problem: Yes-man echoes
    Solution: Voice question not opinions
    This one is pretty obvious, but if you have a strong personality or executive in the room, once they state their opinion you will get a much different level of interaction.
  4. Problem: Anxiety overload
    Solution: Look at the clock
    “A panicked mind stops processing new information, reverts to tried-and-true responses, and is prone to snap decisions that make things worse.”
    It talks about fighter pilots looking at the calm clock while things are spinning on their gauges.  The idea of finding a calming point to focus on.
  5. Problem: Warring camps
    Solution: Let the battle rage
    “Political infighting can be destructive, but battles over substance, managed well, can be constructive.”
    This reminds me of a boss who taught me that it was critical to have a close team where people could share opinions openly to drive value.
  6. Problem: A wily adversary
    Solution: Clone your opponent
    “Assigning a person (or a group) to think like your competitor can expose flaws that, identified early, are less likely to be fatal.”
  7. Problem: To be?  Or not to be?
    Solution: Go with the omen
    I am not so sure about this, but the point is that sometimes your mind is made up and allowing an event to trigger a decision may make sense.
  8. Problem: Inexperience
    Solution: Educate your instincts
    “Blind instincts cannot be trusted, but they can be educated.”  (Think flight simulator as preparing you for different situations.)
  9. Problem: Self-interested thinking
    Solution: What would Sara Lee do?
    Harder to use advice, but they suggest imagining that the company is a person with rational desires – security, growth, good relationships, respect, and a sense of purpose.  Then thinking about how they would react.  (Or our test at Express Scripts was what would Barbara Martinez say.  She is a journalist on the topic for the WSJ.)

Henry Ford said, “My advice to young men is to be ready to revise any system, scrap any methods, abandon any theory if the success of the job demands it.”

Communications

I can never stress the value of communication skills to anyone I met regardless of the path they want to go down in life.  I have had the luxury from an early age of public speaking beginning with something called Model United Nations (MUN) where you represent a country in mock-simulations of the UN process.  [We even won a national championship at my high school...and it really isn't as geeky as it sounds.]

In graduate school, I participated in Toastmasters for a while which I think is great for someone who needs a casual setting to practice and get feedback.  I can even remember using one of the techniques from there (counting “ums”) when my sister told me she was going to be a lay minister in the Catholic church and be giving sermons.  [Note: Feedback on presentation skills isn't always well received by people not seeking it out.]

I found a couple of presentations on the topic that I thought might be interesting to some of you.  Additionally, you might research the Minto Pyramid Principle which is a structured approach to communicating by an ex-McKinsey consultant.  (It was required reading/training at Ernst & Young years ago.)

This one is a little basic, but I have seen so many bad powerpoint presentations that obviously many people could use the primer.

One last one before getting back to work…Here is one on marketing which obviously has communications at its core.

Working With Clients: Some General Thoughts

One of the best discussions I have heard for account management was by Andrew Sobel. I was digging through some files today and came across some of my notes. I thought I would share a few of my takeaways which I think are good general advice.

  • It is essentially to be trusted.The four attributes of trust that he discussed were Empathy, Generalist, Synthesis, and Integrity.
  • Be an Advisor not an Expert.Experts are afraid to learn anything new.
  • An Expert’s mind believes that there are few options that make sense. A beginner’s mind is open to many options.
  • At 5-years old, we ask about 200 questions per day. By age 20, we only ask about 20 questions a day. Ask more questions. [Reminds me of another piece of advice that said that to “ass-u-me” is to make an “ass out of you and me”.]
  • Perceived competence leads to trust.
  • Empathy means listening, know your own biases, and having humility.
  • Reflection leads to creativity.

He also suggested acting as if you were independently wealthy. [Not always easy, but not worrying about the politics and other issues frees you up to speak your mind.]

He (or his company) laid out the following comparison on their key point which was “Be an Advisor not an Expert”.

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It is easy to play the expert. It is much harder to play the role of advisor.

    Types of Business Blogs

    I was looking at something that someone sent me from Paul Gillin’s Social Media Report about different types of blogs. I found it pretty interesting especially some of the examples.

    First, he talks about company blogs including the CEO blog and the group blog. They definitely can be interesting, but it really is a question of momentum and interest. I also think blogging has to be from top of mind not from some carefully scripted public relations process. (I.e., there will be times that the blogger gets someone upset and stirs some discussion…which ultimately is a positive)

    For example, I was really disappointed to see that Unica was unable to continue their blog. Now, on the other hand, I do think there is a definite role for topical blogs that have numerous participants from several companies. I used to syndicate my old process management blog through one of these sites and found it worked great. (Not to mention that I got 7,000 readers overnight.)

    Paul talks about three other types of blogs – Executive Blog; Advice Blog; and Advocacy Blog. Here are a couple of examples that he gives:

    For more on corporate blogs, you can go to his website or BlogWrite.

    I have talked about why I blog before, but I often think about it as a modern journal and an alternative to e-mailing people with articles that I read. If it helps business…great. The reality is that I am passionate about what I do and talk about it all the time. I choose the job to emulate my passion. I would think that is the only way a corporate blog will work and be genuine.

    A Few Other Facts From CSC’s Survey

    While I was flipping through CSC’s 2004 Customer Intelligence Diagnostic Survey, I found a few other interesting facts:

    • Only 20.7% of the 58 Fortune 1000 companies have a 360 degree view of the customer (i.e., consolidated data across the enterprise)
    • Only 41% of them had used external data to augment their internal customer data
    • Only 10% of the companies had a high degree of confidence that their customer data was clean, accurate, and timely
    • 20% of the companies never capture responses to marketing campaigns for evaluation and another 40% only collect the data occasionally
    • Only 25% were capturing and using customer preferences
    • Only 28% were using an external source (e.g., National Change of Address) to update and verify addresses
    • 62% of them were segmenting customers based on demographic or behavioral criteria
    • 59% of them segment customers based on preferences and needs
    • Almost 80% believe they are missing revenue opportunities due to poor data quality or lack of integrated information
    • Only 22% make customer insights readily available to all their personnel in sales, marketing, and service
    • Only 19% have business rules and triggers to launch targets treatments across customer touch points

    There were no healthcare companies included in the survey, but I am sure they would have lagged even more.  Now, some of this has likely changed over the past few years, but there is a lot to be done to address the opportunities.

    Sticky Messaging

    We used to talk a lot about stickiness of websites and eyeballs back in the late 1990s. The word still has some attraction and is a key point in the recent McKinsey interview with Chip Heath. Chip is a professor of Organizational Behavior at Stanford University’s Graduate School of Business.

    “The key to effective communication: make it simple, make it concrete, and make it surprising.”

    Although the article is primarily around what executives need to do to make their messaging and ideas stick with diverse audiences, it has a lot of relevance for healthcare.

    “A sticky idea is one that people understand when they hear it, that they remember later on, and that changes something about the way they think or act.”

    Think about all the things you want to tell your patients or members or employees (or vice-versa all the things you patients want your healthcare companies to tell you):

    • There has been a change to your X (copay, formulary, network).
    • You have an opportunity to save money by doing X.
    • We are missing X data that will delay your coverage.
    • We see that X happened and wanted to gather data on your experience or proactively address your question.
    • Welcome to our plan. Have you registered on the website? Have you received your ID card?
    • Please take this Health Risk Assessment.
    • Your credit card has expired. Would you like to update it?
    • Your order is delayed. If this is an emergency, please do X?
    • We see you were on the website. Did you find what you needed?
    • Do you need a copy of your X (formulary, provider directory)?
    • You have not yet picked a Primary Care Physician. Would you like to do that now?
    • Did you receive the information that we sent you?
    • Are you following your physicians orders? Did you do X? Why or why not?
    • Our records show us that you are due for a X. (Flu shot, screening)
    • Are you using any over-the-counter products that we should have in our database to identify drug-drug interactions?
    • Please remember to refill your medication?
    • Are you having any side effects or complications associated with your recent medication or procedure?
    • Have you enrolled yet in our disease management (or incentive) program? Would you like more information?
    • Welcome to the plan.
    • We know it is time for open enrollment. We hope you will renew with us. We are offering a local meeting to help you learn more about your benefits. Would you like to attend?
    • X has changed with your drug, condition, etc. There is new information available at Y.
       

      Getting back to the article…He offers several good examples of sticky messages which are primarily what I would call rallying calls for organizations. In healthcare, the key is to find these simple messages that compel people to act. So, bottom lining it, he gives six basic traits:

    1. Simplicity – short and deep
    2. Unexpectedness – uncommon sense messages generate interest and curiosity
    3. Concreteness – his example is don’t say “seize leadership in the space race” but say “get an American on the moon in this decade”
    4. Credibility – this should be so easy in healthcare if you leverage all the people and stories out there
    5. Emotions
    6. Stories

    He has a few great stories such as:

    • A Nordstrom’s person wrapping something bought at Macy’s just to make the customer happy. [And probably without point it out.]
    • A FedEx driver who forgot the key to a box simply unbolting the box from the ground and throwing it in the truck so they weren’t late.

    These things reinforce the message while becoming a type of urban legend that stay with people. They evoke emotion in a simple way.

    One good example I have from Express Scripts was around trying to motivate people to change from one drug to another. When Zocor was going generic, we decided to launch a huge multi-modal campaign to drive down Lipitor marketshare and move people to Zocor so that when it went generic everyone would win. [Clients would save; patients would save; and we would make more money.] It worked. But, prior to the program, we worked with linguists and others to design and test a set of messages. The one that resided best was “we have a secret that can save you money”. People were intrigued and listened. They felt like they were being let in on something that was important. We ended up positioning it similar to a Consumer Reports Best Buy. It worked.

    Applying Technology Trends to Healthcare

    McKinsey recently put out their 8 technology trends article (access available with free registration). I thought I would translate those to the topic of healthcare communications. Hopefully, we don’t have to be hit by a bolt of lightning to change, but we realize and can document the ROI of acting now and improving our system by involving and reacting out to patients.

    1. Distributing Cocreation – This is the trend which is happening in many industries where consumers (patients) and suppliers (providers) are taking more involvement in product design and even advertising. New media and technology have enabled this to happen. This is a big opportunity for healthcare. In general, I see companies doing focus groups, but not letting product design be driven by the consumer. I don’t see competitions to design the next advertisement for a managed care company happening today.

    “By distributing innovation through the value chain, companies may reduce their costs and usher new products to market faster by eliminating the bottlenecks that come with total control.”

    1. Using Consumers as Innovators – This conceptually seems similar to the first trend although there are likely more differences than semantics, but the value remains in letting consumers push healthcare. How do we capture what they want and the value associated with it? How do we create business models that allow companies to exist to provide that offering? It’s not easy for individuals to drive innovation since we are often tied to what we know.
    2. Tapping Into A World Of Talent – For the past few decades, many other industries have focused on getting their executives to gain multi-cultural experiences by working globally. There have also been studies that link innovation to diversity. With the exception of pharma, most healthcare companies aren’t global. Sure, all the big companies look outside the US for models and occasionally to sell to the government entities, but not much has taken off. The primary expansion in leadership that I have seen over the past five years is a lot more healthcare companies recruiting in executives from non-healthcare companies which will create some diversity and bring a new perspective to the table. Interestingly, I think this also is an issue in the patient outreach process. Are your communications taking into account the diversity of your patient population – e.g., language, messaging, channel, speed of voice?
    3. Extracting More Value From Interactions – This is very true for healthcare. I would bet that the majority of communications in healthcare are either reactive (you call them) or required by regulatory issues (e.g., explanation of benefits or annual notification of change). These programs were originally designed to cost as little as possible so that someone could check the box. Well, guess what. Over the past few years, companies are realizing that these communications are their best ability to influence patients. So, what are the “golden moments” that exist where an interaction can drive loyalty, satisfaction, wellness, etc. Companies need to figure out what the potential value is and how to capture it.
    4. Expanding The Frontiers Of Automation – Automation has been a focus for years. Healthcare is not an exception expect people struggle with how to provide care and a personalized experience while leveraging automation and technology. And, now with technologies such as web services, companies can be interlinked and automated which (when done right) can improve the consumer’s experience. Of course, the second challenge is that automation is best when it enables a process and people don’t often think, manage, or operate from a process perspective.
    5. Unbundling Production From Delivery – I think the whole concept of unbundling could be very interesting given consumerism. Unbundling has already happened for the corporate buyer…they can buy health insurance separate from pharmacy. So, could I (the consumer) one day buy long term insurance separate from prescription coverage separate from my provider network separate from customer support. Could I choose my disease management company? What would that mean for group discounts, bulk purchasing, underwriting models, etc.?
    6. Putting More Science Into Management – We are a lucky generation in that we have access to reams of data and information. Of course, the challenge is how to turn this into intelligence and use it. It is easy to get overwhelmed and frozen. But as managers, using information applying algorithms, linguistics, and neurosciences to it to create personalized communications that apply to each micro-segment of your population is a great opportunity. It translates success from luck to predictable outcomes.

    “From “ideagoras” (eBay-like marketplaces for ideas) to predictive markets to performance-management approaches, ubiquitous standards-based technologies promote aggregation, processing, and decision making based on the use of growing pools of rich data.”

    1. Making Businesses From Information – Healthcare has long embraced this trend. There are numerous companies (e.g., IMS) which are built around information. There are clinical companies that produce drug monographs for use by clinicians. There are aggregators of information (e.g., ePocrates). The point is that companies not only create data exhaust, but as they apply decision sciences, they become consumers of more and more data.

    “Creative leaders can use a broad spectrum of new, technology-enabled options to craft their strategies. These trends are best seen as emerging patterns that can be applied in a wide variety of businesses. Executives should reflect on which patterns may start to reshape their markets and industries next—and on whether they have opportunities to catalyze change and shape the outcome rather than merely react to it.”

    These seem like reasonable trend predictions that are applicable generally and make a lot of sense form a healthcare perspective.

    Prioritization Framework

    I was cleaning out some files over the weekend and came across an old prioritization matrix that we used at Ernst & Young when I was a consultant there. I found it to be relatively easy to use and understand so I thought I would share it. Ever person I know always struggles with how to select which project to do using a consistent framework that takes into account more than simply financial ROI.

    We ranked each of the following on a scale of 1-5 and weighted each category to total 100%:

    • Potential Value
      • Strategic alignment (5 = enterprise sustaining and helps build learning organization vs. 1 = tactical)
      • Financial impact (5 = high ROI, lowers costs, and is growth oriented vs. 1 = lowers costs)
      • Customer satisfaction impact (5 = affects all constituents, builds loyalty, and creates differentiation vs. 1 = affects only one constituent)
      • Competitive status (5 = used by all traditional and evolving competitors vs. 1 = used by no competitors)
    • Ability to Execute
      • Organizational readiness (5 = requires minimal cultural, process, or technical change vs. 1 = requires new systems, business model, and staff)
      • Proven technology ( 5 = implemented at multiple sites with proven value proposition vs. 1 = concept only, no proven value proposition)
      • Time and resources required to implement ( 5 = resources easily accessible and can be broken into 3-6 month deliverables vs. 1 = scarce resources and no deliverables until after 12 months)

    Staying Current – Blog Options

    Obviously none of us have time to stay current with everything. Remembering all the blogs you like, visiting them regularly, and reading all the e-mails, mail, and publications can be overwhelming. I can’t simplify it all, but I thought I would suggest two ways of staying informed if you find this or other blogs interesting.

    First, you can subscribe to the e-mail list. What this means is that any day there is a new post you will get an e-mail sent to you. Here are a few screen shots so you see what that means. It is an easy to read format sent by Feedburner. It has links to forward the article and unsubscribe at anytime. (But, you should know that you will get a confirmation e-mail from Feedburner after you register. Make sure it doesn’t get caught in your spam filter. I have about 10 people that have signed up to receive updates, but they have never confirmed.)

    I find this easy since I read a lot offline, and I visit when I need to not trying to time new posts.

    e-mail-start.pnge-mail-end.png

    The second option is to use a blog reader tool like iGoogle where you can have all your blogs. I use this as my start-up page in my browser so I can see what the world is talking about from traditional media to different bloggers.

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    HBR Health Consumer Segmentation

    Harvard Business Review has an article “What Health Consumers Want” by Caroline Calkins and John Sviokla (both from Diamond Consultants) in the December 2007 issue.  I think they sum up one of the problems that I talk about with a couple of quick comments in the beginning:

    “Yet the idea that companies might profit by segmenting customers to address their varied needs seems almost foreign to the health industry.”

    “Companies can uncover areas of untapped value by analyzing patterns in demand for health products and services.”

    They point out that looking at people from a health and wealth perspective at the same time is very revealing.  Which certainly makes sense as many people are predicting that these two markets will come together at some future stage.  Their research pulled out four consumer groups [with my summary of their text]:

    1. Healthy Worriers – receptive to new things, willing to change, look at dynamic between wage inflation and healthcare costs, look to employers for information, overwhelmed by choices
    2. Healthy, Wealthy, and Wise – fit, health conscious, financially confident, want choices, not scared of complexity, self-service tools important, service focused
    3. Unfit and Happy – manage own money but overconfident on health issues, don’t trust MDs, need tools and incentives to drive action
    4. Hapless Heavyweights – not particularly health or financially oriented, typically overweight, need support groups and penalties

    Personally, I find it nice that they point out the fact that some groups want incentives and some need penalties.  I have blogged about this a couple times as one of the simplest examples of why segmentation and message flexibility is so key.  I think the first two have a nice opposite with simplicity versus choice.

    Do We Know What We Want?

    In the November 2007 issue of Harvard Business Review, there is an article called Mapping Your Competitive Position by Richard A. D’Aveni.  From a general business perspective, it’s a good article which presents an interesting case about how you could have predicted that Apple would have dropped the price on the iPhone.  (Hint: Look at their behavior around the iPod and where the competition was and was predicted to go with the Razr.)

    It made me wonder what the competitive map for healthcare would look like.  What are the market groupings for pharmacies, providers, PBMs, MCOs?  What is the price line and what would people pay for or not pay for?

    “Most customers are unable to identify the features that determine the prices they are willing to pay for products or services, according to a 2004 survey by Strativity, a global research and consulting firm.  Worse, 50% of salespeople don’t know what attributes justify the prices of the products and services they sell.”

    The article points out that most people involved in the process don’t know or fully understand the value proposition.  So…if we are going to try and redesign and improve healthcare, how can we do that?  Do consumers understand what matters?  Do the politicians?  Will we citizens understand who to vote for?

    WSJ on Texting in Healthcare

    Obviously my entries about texting in healthcare are timely. Today’s WSJ includes an article (pg D1) by Rachel Zimmerman called “don’t 4get ur pills: Text messaging for Health”.

    She points out several compliance type programs where this is being used (outside the US)…birth control pills (England), AIDS (Australia), psychological support for bulimics (Germany), and smoking cessation (New Zealand).

    Apparently, the American Telemedicine Association is developing guidelines for the appropriate use of text messaging in healthcare (along with other new media). The executive director, Jonathan Linkous, was quoted as saying “There are obviously times when telemedicine is inappropriate. Texting someone to tell them they have cancer is one of them.” [I think we can all agree.]

    Of course, with health costs being concentrated in a small percentage of the population which is typically older, can texting make a difference? It isn’t easy to type on those small mobile phones with arthritis. Lots of seniors don’t even carry mobile phones. Plus texting is a whole different message as the article points out. My kids will probably get it much better than me.

    Plus, using condense information can be risky. We had this problem in sending messages to pharmacies where we had a finite amount of characters to say “Drug A is not covered but the following drugs are covered but if medically required then the physician has to call 800-xxx-xxxx to request a prior authorization”. Other than reminders or pushing them to a very specific action it may be a challenge.

    I think sending links or phone numbers via text message could be helpful. For example, using co-browsing, a company could trigger a message a message suggesting the patient call-in for more information or also go to another site. [What is co-browsing…this is when a company (typically a call center agent) can see where an individual is on the web and what they are looking at to help them.]

    She mentions a few companies:

    There certainly is a need for something that is quick and ubiquitous around healthcare. For someone under 40, I think texting could work great. For people over 40 (an arbitrary line), I think automated voice is better. It is just as quick. It is ubiquitous. And, it can be personalized and change during the call versus going back and forth via text messages.

    Reverse Auction for MDs / Hospitals

    auction.jpgIn healthcare, you sometimes hear people talk about waiting (at the pharmacy, for an appointment) while other people seem to get right in.  A lot of this has to do with geography (remember ‘healthcare is local’) but it also has to do with cycles.  For example, Mondays are always busier after the weekends.  [I have heard ERs are often busier during a full moon, but I don't have research on that (and didn't look).]

    Certainly, another driver of healthcare costs are some of the large capital purchases at hospitals for imaging or other diagnostics.  If every hospital has to have the latest and greatest but they are only use 20% of the time, that isn’t an efficient use of capital across the healthcare system.  If you have to spread that cost for the equipment across 1/5th of the potential patients, it means you are overcharging by 5x.

    Reverse auctions wouldn’t be easy, but BidRx pulled it off in pharmacy.  [I am not sure how successfully.]  The reverse auction model would be consumerism at its best.  The consumer would post their needs – a CAT scan, a PCP, a neurosurgeon, open heart surgery.  Physicians or hospitals would bid on their business based on the parameters – timing, price, etc.

    In a theoretical sense, it would be interesting to test and see if it would work.  But, my objective was not to sit in the ivory tower, but to look at a model that would improve healthcare capital efficiency by better utilizing fixed costs.  If hospitals and MDs could bid for patients to fill their slow times, wouldn’t the following be possible:

    • Less need for capital redundancy (i.e., every hospital would not need to have the same equipment)
    • Less wait times for patients since they would be slotted in to open times
    • Less peaks and valleys at doctor’s office and hospitals since they would be offering a “discount” for you to come on Wednesday versus everyone wanting to come on Monday

    Participation wouldn’t be easy, but ultimately, changing our healthcare model won’t be easy.  Just an idea.  There is something here to make the system more efficient.

    Mashing Two of My Posts

    I was thinking about Google’s SMS service earlier today (see post on this).  Separately, I was thinking about my post on remembering health information (e.g., drugs, strength, previous lab values).

    So I went to one of the Google Health Blogs to suggest the idea.  Unfortunately, the e-mail they list bounces back and you can’t leave comments…strange.  Why not combine the two comments from my earlier blogs was my suggestion?  Obviously, it only appeals to a piece of the population, but I would love to be able to text message my PHR (Personal Health Record) with “Rx name, strength” or “PCP name, phone” or “HCL scores and dates”.  [Look at myPHR, iHealthRecord, ActiveHealth, Microsoft, or Google for PHR solutions.]

    It is always so difficult to remember that information, but if I could get it texted to me in a few seconds, it would be great.  I have to believe there is some unique code in my Blackberry that could serve as a unique identifier for security purposes.  Just a thought…

    BTW – If you try to find Google blogs on health, you find out there are dozens of Google blogs:

    “There’s all this hubub about what Google and Microsoft are doing,” Aetna CEO Ron Williams (pictured) said this afternoon on a visit to Health Blog HQ. “We’re perplexed by the fact that their vaporware gets all this attention and we get very little.” (comment on the WSJ Health Blog)

    Don’t forget to add this blog to your reader or sign up for e-mail updates whenever a new entry is posted. 

    Emotional Intelligence (EQ)

    I will admit that I have a lot to learn around EQ which is firmly grounded in neuroscience, but I wonder why I don’t hear a lot about this from a communication perspective. Obviously, our reaction to information varies based on where we are emotionally. At the simplest level, I think EQ is why guerilla marketing or grass roots marketing can sometimes be so effective. For many people, group interaction and group perceptions drive their behavior.

       

    Daniel Goleman is the author who popularized the EQ term with his book “Emotional Intelligence” published in 1995.

    He has identified Five Dimensions of Emotional Intelligence. The first three are personal and the final two are social.

    1. Self-Awareness – Knowing one’s internal states, preferences, and intuitions
    2. Self-Regulation – Managing one’s internal states, impulses and resources
    3. Motivation – Emotional tendencies that guide or facilitate reaching goals
    4. Empathy – Awareness of other’s feelings, needs and concerns
    5. Social Skills – Adeptness at inducing desirable responses in others

    After typing these out, I wonder if we could get an EQ score for companies. That would be an interesting ranking to see how aware and empathetic companies really are.

    I liked this image I found that represents Executive EQ or EQ for Business.

    eq-for-business.jpg

    So, I think the key question here is how could we capture an individual’s EQ (or a proxy for it) and use that in our targeting and messaging to them about healthcare.

    P4P – Pharmacists vs. MDs

    p4p.jpgI only heard a piece of the presentation yesterday at AHIP (America’s Health Insurance Plans), but I was a little surprised. They were talking about the topic of P4P (pay for performance). The survey population clearly supported P4P for MDs with the primary objective being preventative care and compliance. This focus did surprise me since I imagined it would have been more focused on cost management.

    The survey population wasn’t interested in all at P4P for pharmacists. This surprised me a little bit especially given the access differences. Certainly, physicians can impact bigger dollar decisions (e.g., drugs vs wellness or surgery vs other options), but if the focus is on preventative care and compliance, they pharmacists have easy access to the patients.

    Pharmacists are a walk-up option. No appointment is needed. Some pharmacists really know their patients. Both parties are really busy so rewarding them for the additional responsibility is appropriate.

    I think it was about 20% that thought about rewarding pharmacists and clearly the focus (not surprisingly) was on driving formulary compliance and generics. In many cases, they have rewards to do this today.

    If you’re interested in seeing one of the studies out there, here is one on Medicaid. The conclusion was:

    “Medicaid directors and their staffs generally report positive feedback on their pay-for-performance programs and believe that the overall quality of care being provided is improving, although they have mixed opinions about cost savings resulting from the programs. Directors are considering changing some of the measures, incentives, and even the data collection strategies to improve their existing programs and to shape planned programs. Overall, they believe that pay-for-performance is adding to their repertoire of tools to improve the care provided to their Medicaid populations.” [K. Kuhmerker and T. Hartman, Pay-for-Performance in State Medicaid Programs: A Survey of State Medicaid Directors and Programs, The Commonwealth Fund, April 2007]

    Analyzing Your Writing

    Lois Kelly has an interesting post on her blog about the Linguistic Inquiry and Word Count program. You run text through the program and it categorizes the writing style. She compares 3 CEO bloggers. I grabbed text from my site and ran it through.

    If I understand the results below correctly, it says I am fairly honest, somewhat outgoing, not very optimistic, have no anxiety, am actively thinking about the topic, and use lots of big words. I am sure my writing about all the problems in healthcare explains the low score on positive emotions, and I intentionally try not to make things too personal.

    LIWC dimension

    Your data

    Personal texts

    Formal texts

    Social words – outgoing

    7.08

    9.5

    8.0

    Negative emotions – anxiety

    1.13

    2.6

    1.6

    Big words (> 6 letters) – higher grades which tend to be less emotional

    22.35

    13.1

    19.6

    Text Google for the 411

    Google seems to be everywhere. It is probably the one site that I have to teach my kids to know to get anywhere. Perhaps they need a “Google Kids” which offers games, safe content, etc.

    Anyways, this is more of a tip than anything about healthcare, but I was fascinated to find out about Google’s SMS service (aka text message) yesterday. I tried it a few times this morning right before I got on the flight. If you go to Google’s page at sms.google.com, you can find out more.

    All you really need to know is that if you send a text message to Google (466453) you get information back almost instantly.

    For example, I sent a text message saying “weather Boston” and before I could even type my next message, I had the weather report. Then I sent in another text for “AA 1577″ (American Airlines flight 1577) and instantly had information on flight status and what gate it was leaving from. You can do it for scores (e.g., “Red Sox”) and many other things. If you are like me and on the go a lot and hate to pay fees for 411, this is great.

    Geekipedia

    Sure…a little off topic, but understanding technology is one of the critical components (in my humble opinion) to driving innovation and change in healthcare. Healthcare is not an early adopter of solutions. There is too much fear about change (and litigation).

    So, when Wired but out this magazine supplement called Geekipedia, I knew it was a must read. As it says on the cover “149 people, places, ideas and trends you need to know now”.

    Here are a few that jumped out at me:

    • AJAX – a suite of web-development technologies which produce squeaky clean surfaces. This allows web designers to build web sites that act like applications and accept user input and computing results without fetching entirely new pages from a server. I have worked with developers to use this before. Very cool. You see it on a lot more sites now, but anytime you enter data and the site changes without refreshing it…they built the site using AJAX.
    • APIs – application programming interfaces are sets of rules that govern how apps exchange information. These have been around for years and typically only mattered to the programmers and your engineering staff…but today APIs allow you to create custom applications using desktop widgets and mashups to have personalized sites that do all types of cool things.
    • Collaborative Filtering – this is the recommendation algorithm you see on Amazon or Netflix or many other sites. I can see healthcare one day embracing this in patient centric forums – patients with your similar benefits and genes were most likely to respond to this form of treatment.
    • Distributed Computing – most of you should know about this as the use of our computers to solve problems has been part of the news (good and bad) for years, but the point is to leverage the memory of individual computers in a network design to create a virtual supercomputer to solve complex problems that look at lots of data over years – e.g., SETI@Home that looks for extraterrestrial intelligence or FightAids@Home which looks for new AIDS treatments.
    • Mashup – these are sites / applications that are combinations of existing offerings that are cut and pasted together. For example:
    • Meganiche – with the Internet’s utilization now, it is possible to have a niche within a niche. For rare diseases, this could have some value.
    • Neurologism – all of the new areas of research driven by the breakthroughs in understanding the brain.
      • Neurofitness
      • Neuroceuticals
      • Neuroinformatics
      • Neuromarketing
      • Neuroergonomics
      • Neurosemantics
    • RNAi or Ribonucleic Acid Interference – “the silent assassin of cell biology”. It protects against viruses by tearing up the viral RNA and preventing it from making copies of itself.
    • RSS or Really Simple Syndication – you see this everywhere – on my blog, on websites, even in the new Outlook. This allows you to stream information to your reader (e.g., Google Reader) to see new information without having to go to all the individual sites. I wonder how many managed care companies and PBMs offer this on their websites today. It would be nice to get this pushed right to my personal Google page.
    • SEO or Search Engine Optimization – this is the use of tags and other links to maximize how your website shows up in a search.
    • Ultrahigh-throughput gene sequencing – this is all about the speed at which genes are sequenced which is obviously a big driver of personalized medicine and genomics. I am not sure I buy the prediction of “it won’t be long before a stall at the local shopping center will work up your genome ‘while u wait’”.
    • Widgets – these are small applications which can typically be embedded in a website using reusable code (e.g., a BMI calculator or mortgage calculator)
    • Wikipedia – this is a site that provides the modern encyclopedia full of links and information that is created by the net community – are you out there? Is your company or product?

    It makes you wonder. As healthcare moves to more consumer centric and sales to commercial patients mimics Medicare Part D, will you see a United Healthcare avatar in Second Life or a Medco Facebook page. And, when will be see YouTube and Flickr being used to paint positive pictures of our healthcare system for the many people that it does work for. If politicians can begin to use these sites and big corporations encourage personal advertising of their brands, healthcare should give it some consideration.

    Understanding Healthcare (Wurman)

    Richard Saul Wurman has been publishing for years and done many interesting things.  I just stumbled upon his Understanding Healthcare site today.  It is worth a visit.  You could get lost in it, but it has lots of great examples about how to frame healthcare issues visually.  I took a few screenshots below to get you interested.

    One shows the top 10 causes of death in the US (note all this is a few years old) by age.  Very easy to understand the data this way.  One shows the tests that you need by age.  (I could use this now.)  The other is just representation of some data around caregivers.

    wurman-causes-of-death-by-age.png

    wurman-timeline.png

    wurman-caregiver.png

    Silverlink – My New Employer

    After trying a few entrepreneurial things, I am excited to have accepted a job working with a consulting client of mine – Silverlink Communications. [I am also a former client of theirs from my time at Express Scripts.] The role is a good mix of entreprenerial and stability since they are a high growth, VC backed company. And, one of the most impressive things is their track record of delivery and impressive clients including lots of the big MCOs and PBMs (examples).

    As I was getting ready to do an e-mail blast out to a 1,000+ people in my Outlook database, I figured that linking them to the blog and answering their predicted questions here might be a good solution. I could go with the micro-segmentation of my audience (i.e., my healthcare friends want to know something different than my consulting friends) that I started to do, but it’s turning out to be more time consuming than I would like.

    So here goes. Here is more information about what I am doing and why. If you are in the healthcare space, I would encourage you to look at Silverlink and give me a call. We can leverage our technology and services to help you cut costs, grow revenue, and inprove patient satisfaction and outcomes.

    Q&A:

    • Who is Silverlink and what do they do? Silverlink is a healthcare technology company that provides HIPAA compliant, targeted communications to patients [consumers] primarily using a automated voice-centric technology. This allows them [us] to push information (e.g., reminder call), collect data (e.g., surveys, COB, HRA), and qualify leads for transfer to a live agent (e.g., retail-to-mail, brand-to-generic, 30-day to 90-day). They provide consulting support, data mining, and great reporting. [and now outsourcing]

    [Official PR Text] Silverlink is the leader in automated voice solutions for healthcare enterprises. Silverlink’s services enable customers to design, deploy and manage HIPAA compliant automated call programs to educate, collect information from and drive behavior of thousands of patients and members at a time. Serving six of the top ten health plans and with a customer base that collectively represents over 150 million covered lives, Silverlink drastically reduces the cost of communicating with customers while improving financial results and customer care.

    • Why did you join Silverlink? (A) Proven Value Proposition and Technology. (B) Great Team. (C) Very Impressed by Client Feedback. (D) Good Investors. (E) Great Market Demand.

    We saw great results at Express Scripts. In one controlled study we ran through research, we saw our success rates improve by 30% by blending letters and calls. Additionally, access to data and flexibility were critical. We launched one new call program in under a day (either for Katrina or for a new drug warning).

    Everybody is talking about consumerism and Health 2.0. Silverlink plays right into that strategy. Delivering timely information to patients. Blend their core technology with multi-modal, data mining, and experience based branding, and you have a unique opportunity to change the paradigm.

    • What are you going to do for them? I am going to be responsible for building out a business process outsourcing (BPO) and professional services group. As with any process oriented change, technology often enables step improvements. Their core technology has allowed companies to radically reduce key metrics (cycle time, response rates, collection ratios). By helping drive more of the process, introducing some new services, and leveraging our industry experts, we will help clients drive market differentiation.
    • Should I look at them as a solution provider for my business? If you are a PBM, mail order pharmacy, specialty pharmacy, medical device fulfillment company, or managed care company, they have many proven solutions to help you with. If you are a retailer, disease management company, or provider, there are numerous ways to use the technology. And, if you are a technology or services company, there are ways of embedding their technology into your solution.
    • Do consumers really like automated calls? You would be surprised. Using good voice talent with the right caller ID with the right sonic branding will get people to answer the phone. People throw away mail. We get too many e-mails. We still answer the phone and listen to voicemails. The response rates are great. On some programs, a reach rate in the 80-90% rate is not unusual.
    • (For my VC friends) Who backed them? There are several angels along with HLM (big healthcare VC firm), Kaiser Ventures, and Sigma Partners ($1.5B technology VC firm).
    • What happened to the other things you tried over the past year? Neither took off. Learned a lot about being an entrepreneur. I put a lot of my lessons learned here. No regrets since I believe everything happens for a reason.
    • Are you relocating? Not for now. We are going to try commuting. Since I will be spending time with clients and in other meetings, we are going to see how this works. Plus, the housing market is no good (at least for selling).

    I am sure I could go on. But, while you are here, I would encourage you to look at the Silverlink website (PBM, MCO, Medicare, Medicaid, DM, Specialty/DME) and also at rest of my blog. If interested, register to get updates to the blog via e-mail by clicking here.

    Information Therapy Blog

    I was looking at the Healthwise website and The Center for Information Therapy and came across a blog by the team there with some good discussion topics. It is definitely worth your read. Here were a few things that caught my eye:

    • Can we more effectively engage consumers in better managing their own health by learning from Hollywood or video games about how to draw people in through entertainment? By doing so, can we make health care “fun” or at least truly engaging? (entry)
    • Since research shows that 40%-80% of everything a doctor tells a patient in the office is forgotten, taking along a patient advocate is a great strategy. Unfortunately, it is not always an option or sufficient. In order to ensure effective communication, every patient should leave the doctor’s office with an information prescription (Ix). (entry)

    Customer Event

    What a great week. I have been so busy that I haven’t had time to blog, but I will try to catch up over the next few days.

    I always love to mingle with customers and talk to them about their experiences with a company. As a former client, a current consultant, and a future employee of Silverlink, I got to join their customer event this week where 40 customers talked about how they use the technology and services to lower costs, increase efficiency, and grow revenue. Talk about empowering.

    Some of the key content / discussions revolved around the following:

    • JD Powers study on healthcare company satisfaction including a great non-healthcare example.
      • It showed how satisfaction with auto insurance actually went up and was higher when the company raised rates but pro-actively told the consumer versus when they lowered rates. Talk about the power of communications.
    • Lots of talk about how marketing and data analytics are going to drive healthcare and how non-healthcare companies are setting the expectations for patients very high compared to the current state.
    • How disjointed healthcare communications are – provider, pharmacy, PBM, MCO, DM companies. No consistency.
    • A great presentation by Liz Boehm from Forrester research which made a few key points:
      • She reinforced the loss avoidance point I blogged about the other day stating that savings is equal to one unit of happiness while loss is equal to two units of unhappiness. So, for many, losing money is a bigger factor than saving money.
      • She pointed out the fact that any healthcare site that quotes a price always has some disclaimer about the accuracy. Why can’t we simply guarantee a price (like any other industry)?
      • She showed that member services (IVR, web) are the 3 most important factor in chosing a carrier after price and network.
      • She showed research that consumers are generally dissatisfied with contacts across all channels from their health plan.
      • She talked about using a persona to design programs and prioritize efforts.
      • She compared channels across cost, reach, engagement, and immediacy.
      • It was obvious that we have a long way to go.
    • Heard from a few customers that talked about how they allow Customer Service Representatives (CSRs) to go “off the clock” to help patients so that they can still track average call time but allow for flexibility.
    • I talked about process innovation and how to apply that to your communication process. I also talked about business process outsourcing.
    • We heard about best practices in driving response rates. Everyone always seems so amazed when they hear about response rates of 50, 60, or 70%. Very difficult to get and/or measure that in other channels.
    • Talked about how MCOs are using the automated call technology – ANOC (Annual Notification of Change) for Medicare, Collections, Lead Management, COB, Missing Information, Wellness Program Recruitment, Reminders, Surveys, and many others.
    • We heard about calculating the ROI with a detailed methodology.
    • We talked a lot about models from other industries that could apply.
    • We talked about data mining and analytics.
    • We talked about member satisfaction, loyalty, and how to survey and capture that information.
    • An outside consultant talked about experience based branding and how sounds can be your brand – Harley‘s engine, Sprint‘s pin drop, Ford‘s door chime, AOL‘s “You’ve Got Mail”.
    • Had several clients talk about how they use Silverlink‘s technology to enhance their product suite

    All of the conversations and presentations reinforced how critical successful communications are to healthcare and how big of a hill we have to climb. It was great to see how effective, timely, and personalized the Silverlink technology could make the process. It is worth looking into if you are a managed care company, a device supplier, a PBM, a pharmacy, or even a provider.

    Prescribing Information (Ix)

    I think the Information Therapy concept is a great way to think about consumerism and information in the healthcare space.  I was recently reviewing a presentation by Healthwise which pointed out 3 Simple Rules:

    1. Self Care Rule – helping people do as much for themselves as possible
    2. Guideline Rule – helping people ask for the care they need…giving them the guidelines
    3. Veto Rule – helping people say “no” to care they don’t need

    Another place where you can learn more about this concept is at the Center for Information Therapy.  From a health plan perspective, here is one of their white papers which will help you begin to conceptualize this.

    The key here is that we should be able to use data to trigger information events that are personalized to people.  This obviously needs to be actionable information that is in a format and uses terminology that patients can understand.  There is a huge difference between data and information.  Lots of data is sent to patients along with a typical “barfing” of information with no context or prioritization.

    It is a great opportunity.  Lots of healthplans and consumer sites are embracing this.  As this gets refined and becomes mainstream, it can help drive wellness and a change in ownership for healthcare where consumers really feel responsible and can act responsibly for their care.

    You can also look at Josh’s blog for more ongoing dialogue.

    Healthcare Blogs

    What a list!  I just came across the list of top Healthcare Blogs.  I am not on there yet, but I just submitted myself to be tracked.  This is a great resource for those of you that get lots of feeds or use Google Reader to track blogs.

    Picture is worth a thousand words (at least)

    As a former architect, I am a big believer that pictures have significant value in the business world.  I have been asked dozens of times to take complex ideas and simplify them down to a single-frame image that people can post in their cube or use in a meeting.  These images can be powerful.

    At Express Scripts, we choose to take on the battle of moving market share from Lipitor to Zocor a few years ago.  This was set up to save clients and patients billions of dollars as the Zocor patent expired.  We had a list of 50 ideas which we paired down to 30.  The challenge was how to get people to think about and rally around the 30.  I came up with what was initially called the “bubble chart” which showed the 30 ideas in swim lanes and then time-mapped horizontally against key milestones.  This became used everywhere and even presented to the street.

    This is important to BPM in several ways:

    1. If BPM is to be transformational, you need a future state vision that can be captured and disseminated across the company.
    2. If process mapping is part of your communication strategy, a simple to understand process map is critical.

    I started thinking about this when I received an e-mail newsletter from BentonsEdge which is a company that helps you frame out your value proposition.  I have met with Dan Davison, the CEO, several times.  He seems to have a great process and good understanding of helping clients get to a simple story about their value proposition.

    One example is below.  It is a little busy, but it captures all the complexities of raising capital in a one-page slide which is amazing.

    http://www.tellingyourstory.com/content_library/files/whitepapers/RaisingCapital.pdf

    Bentonsedge_startup

    Read more…

    The McKinsey Way

    You can certainly never go wrong looking at McKinsey. Their consultants are usually very top notch and their process of thinking and root cause analysis is great. Although this post is more about how you analyze a problem (i.e., business process innovation), it also makes a point about how important process and methodology is. The only way of delivering consistent, high-quality advice worldwide is to have a process of training and consulting that leverages smart people and delivers them to clients.

    (Never mind the fact that McKinsey once told me that they only interview people with a 4.0 or people with a 3.8 and above from a top 5 business school. I didn’t fit the bill, but I have several good friends who were there. I have lots of respect for them.)

    The McKinsey Way is actually a book so you can see some insight into the company. I have read the book and recommend it. Rather than re-type all my notes, I found comments about the book at MeansBusiness and on blog called Brian Groth’s Life at Microsoft and looked at notes on MECE (mutually exclusive, collectively exhaustive) from a book review on The McKinsey Mind.

    My old boss who worked for McKinsey was a genius at asking the probing questions. She knew how to get to root cause better than anyone I worked for. This is essential in diagnosing any problem not least of which are process problems. (Since I assume you only look at BPM to drive value where you have some type of problem.)

    So MECE, as Brian states in his blog, it suggests you should do the following:

    1. Identify the problem using a mutually exclusive, collectively exhaustive framework and then map the problem out using some type of logic tree (see example).
    2. Create a hypothesis (or hypotheses) about the solution…this drives your analysis.
    3. Analyze the data…remember that the only thing that is right is data (assuming some data integrity).
    4. Repeat steps 3 & 4 until you find a fact-based solution that makes sense.

    From the book, some of the other key points are:

    1. “The most brilliant solution, backed up by libraries of data and promising billions in extra profits, is useless if your client or business can’t implement it.”
    2. “Most business problems resemble each other more than they differ.”
    3. “If you get your facts together and do you analyses, the solution will come to you.”
    4. “If you keep your eyes peeled for examples of 80/20 in your business, you will come up with ways to improve it.”
    5. “Know your solution so thoroughly that you can explain it clearly and precisely to your client in 30 seconds.”
    6. “It’s much better to get to first base consistently than to try to hit a home run and strike out 9 times out of 10.”
    7. “Just as you shouldn’t accept I have no idea from others, so you shouldn’t accept it from yourself, or expect others to accept it from you. This is the flip side of I don’t know.”
    8. “When you’re picking people’s brains, ask questions and then let them do the talking. Keep the interview on track by breaking in when necessary.”
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