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Moon Shots in Healthcare

I think many of are familiar with Google’s use of the term “Moon Shots” and to a lesser degree their Google X projects.  I was inspired to see who in healthcare is using the term and think about a few moon shot ideas myself. 

I didn’t find much else out there (although I’m sure there is).

So, here’s some of my thoughts:

  1. Curing cancer.  But I think this is one many people think about.
  2. Creating a healthcare system that people actually understand.  That would be great!
  3. Making healthcare a positive experience.  Not easy, but it should be achievable in many settings.
  4. Preventing disease progression.  Maybe too simple, but there has to be some stretch about using data to predict risk and trigger proactive, personalized engagements that successfully change behavior.
  5. Integrated data.  The idea of interoperability of data across the care continuum with the ability to make it actionable would be great.
  6. Remote monitoring of people without them having to do anything.  The Internet of Things will make this much easier (some day), but the idea of simply integrating technology into our lives to monitor us and look for ways to improve our life is a great goal. 
  7. Integrated devices such that our decisions are improved would be great.  A device that knows I’m getting hungry and that I’m about to pass a McDonalds could suggest a healthy alternative. 
  8. Reducing global obesity by teaching kids about health.  This is a great one with complexity like addressing food deserts, sleep patterns, food selection, and general attitudes about health. 
  9. Eliminating negative stress in order to improve health.  This is another tricky one as our lives become more and more stressful.

I’ll leave the list open…what would you add?  I know there are some big stretch thinkers out there. 

  • Digital pills you can print in a 3D printer
  • “Doc in a box” solutions that could be in every home where the physician can get your vitals and interact with you all virtually.
  • Self-healing band-aids that turn into skin.
  • A pill that you take once a year, and it doses you ever day.
  • A machine that can actually diagnose you (like that mirror in the one cholesterol advertisement).
  • A pill to cure addition to cigarettes and other addictive substances.
  • Food that turns bad cholesterol into good cholesterol.

Lessons Learned And MVPs

 I’m a big believer in trying to capture and learn from everything you do.  When you work in the start-up and turnaround space, not everything will be a clear success

After looking back on my time at my last turnaround, there are several clear takeaways:

  1. Demonstrate Incremental Benefits…All The Time.
    1. Taking on long-term projects is dangerous.  Sponsors change.  Markets change.  New technology comes out.  If you’re working on a multi-year transformation, you need to demonstrate incremental wins and have clear milestones.  You should assume you don’t have the next round of funding and build for success at each point.   I could say this is using an Agile approach, but it’s more than that. 
    1. This one probably seems so obvious from the outside looking in, but it’s easy to get carried away with trying to take on too much.  In this particular case, we thought we had a 3-year timeframe to build and deliver on the vision.  We created a vision of care coordination that was really innovative, but we knew that no one had pulled it off before.  We then tried to coordinate care coordination and cost management which also hadn’t been done.  It would have been better to deliver one thing at a time and make ourselves incredibly sticky in that area.
  3. Know Your Customer…Really Well.
    1. When coming into a business, it’s so important to know the customer base and what they feel about the business.  Do they love it?  Do they engage regularly?  Is it just a commodity?  And why.  In this case, clients seemed to love the business, but it was because it was a massively customized business doing all the wrong things.  As we brought the business into compliance and created re-usable processes, it changed the relationship with the customers.  The relationships weren’t sticky, and we didn’t have clear alignment of goals.
  4. Partner Well.
    1. When you’re in the early stages of growth, it’s tempting to try to partner with people bigger and leverage their brand.  While that can help, it’s often a big distraction.  Some times, you commit to something that you can’t achieve putting pressure on a key relationship.  And, other times, you put so much at risk tied to the big company that when you realize that you’re not important to them then you have real challenges.  This gets back to the traditional understanding of buy, build, or partner and understanding your core competencies.
  5. Have A Clear Value Proposition.
    1. You’ll always find early adopters especially when you have a compelling vision, good sales people, and good management.  But, they won’t make your business for you if you can’t clearly demonstrate value.  You have to have access to data.  You have to be able to report on what you do and demonstrate how you’re creating a ROI.  In today’s competitive market, companies without a clear value proposition don’t last long.
  6. Be Different.
    1. This is a tough one.  We all watch the competition and see a path towards success, but as a younger company, trying to compete on price is a sure path to disaster.  Like the Blue Ocean Strategy, you want to compete in a different area.  Find your niche and do it better than anyone else in a way that is really different.  Trying to build something to just catch up always puts you behind. 
  7. Hire Slow and Fire Fast.
    1. This is something many people say, but they don’t always do.  It’s important to get the right team.  It’s important to hire in a logical sequence.  For example, getting a great sales team before your solution is built is great for the pipeline but frustrating to everyone in between.  On the flipside, in a smaller company, a toxic personality or someone that doesn’t fit can kill you.  You need to realize that quickly and let them go.  No one likes to do it, but you do a disservice to everyone else if you keep them. 

The past few years have been really interesting as I learned more about case management, disease management, utilization management, oncology, kidney care, and many other parts of our healthcare system.  The key is leveraging all of this as I move forward in my new role

I think another related topic to think about here is some of the lessons around MVPs (minimum viable products)

I always use the Apple 1 as my case study for an MVP.  

Apple Minimum Viable Product

Leaving The Start-Up World To Join Deloitte Consulting

Several of you have read between my not so subtle hints on the blog.  Several of you have helped me in my search.  But, after 8 years of chasing that elusive start-up and turnaround bug, I’ve decided that going back into the corporate world is going to allow me to better contribute to transformation in healthcare.

I began my career in healthcare in 1999 when I was a manager at Ernst & Young and my mentor was running the managed care practice.  I got to play an exciting initial role which was convincing health plans why the Internet was going to change their business model and why they should have a website focused on members.

That member focused role changed my career path in an exciting way.  I went to a CRM start-up focused on helping health plans with product configuration.  I then ended up going to Express Scripts which at the time acted more like an $8B start-up driving changes in the marketplace. There I worked on lots of consumer facing solutions.  But, as the business grew and I enjoyed the thrill of new challenges, I left to work on my own idea – pharmacy kiosks.  That was 2006.

Since then, I’ve worked on kiosks.  I’ve worked on Business Process Management technology.  I’ve worked on healthcare communications, and I’ve worked on a care management platform.  They’ve all been great learning experiences.  But, as the private equity guys decided to exit my last business, I decided it was time to do something different and stop having to worry about raising money every year.  I actually want to focus on driving change in this very exciting time in the marketplace.  While I went back and forth between line management and consulting, I’ve decided that consulting offers me more of what I want right now.  I get to work across the industry.  I get to work on really complex problems.  I get opportunities to publish thought leadership.  I get to be part of a constant learning environment.  I get to work with great teams both internally and externally.  In short, it feeds my need for constant, new challenges.  And, it allows me to move the family back to St. Louis.

So, starting in August, I’m joining Deloitte Consulting where I’ll be part of their Strategy & Operations practice focused on payers and PBMs.  I’m really excited about it.  I’ve been excited by the people that I’ve met, the references I called about their work, and their approaches towards work-life balance and being part of the community.

I’ve always loved consulting and working with clients.  I think this time rather than being the fresh-faced MBA graduate (that I was at E&Y) that I’m looking forward to bringing a broad set of experiences to the table to help think through the challenges.  I’ll have to capture some of my lessons learned from this past role and share them in another post.  They can build on the prior lessons learned that I’ve shared.

Should Providers Have Private Conversations With Your 12-Year Old?

There was an interesting story which came out of Michigan this past week from Christy Duffy about how her physician’s office was requiring all minors between the age of 12-17 to have a 5 minute private conversation with them (according to the law).  Of course, it appears that they made a mistake per her later post, but I think it serves to make several interesting points.

1. Don’t always assume that someone’s interpretation of the law is right if it doesn’t make sense.  Sometimes, you have to apply common sense and push back or ask questions.

2. There is a gray area between protecting the rights of our kids and protecting our rights.  While the intent of allowing our kids to have honest and open conversations is appropriate, there needs to be some involvement of the parents.

It’s an interesting topic for discussion.  Should our teenagers have access to providers on their own?  Yes.  If a teenager has a health issue, I think we’d all prefer that they talk to a professional rather than Dr. Google or their friends to find the answer.

Should a provider be able to force a private conversation with a minor?  Yes…if they have a legitimate concern about abuse, but I don’t see any other reason.

Should a teenager who’s covered by my insurance and lives in my house be able to block me from having access to their medical records?  Yes.  This is the law, but should providers be having private conversations to offer them this option?  I don’t think so.  I would like them to have those discussions with me and my child to say that here are their options.

Should a teenager have a private conversation with their provider about STDs, HIV, and birth control?  Yes, BUT I’d like to have the conversation at the right age with me in the room initially and then offer the private option.  I don’t think forcing that conversation on a 12-year old would make sense in a private setting.

Ultimately, this comes down to the issue of access to the medical records online.  What I heard was that this would also require the provider to get a cell phone and e-mail address for my kids.  Obviously, if they’re doing something confidentially with the doctor, that’s one thing, but as a matter of record, I disagree.  (I don’t even give out my kid’s Social Security numbers.)  I don’t want my kids to start getting e-mails, phone calls, and letters sent directly to them as early as 12-years old.  And, yes…I do try to shelter them a little.  We talk about all the issues, but in a way that my wife and I want them to learn, not according to some formula driven approach that’s mandated.  But, ultimately, I don’t think a 12-year old is mature enough to make all their own health decisions or to feel like they should.

Obviously, some part of this falls on the parent regardless to create an environment of open dialogue with their kids.  The kids have to feel comfortable talking with their parents which is important for health and many other challenges that our kids have to deal with.  And, unfortunately there’s always bad people in any profession so while sexual abuse by a physician or nurse is rare it’s not unheard of.  Ideally, I think you should have the choice of when to encourage a private conversation and never have it mandated (unless of course the provider suspects abuse).  Unfortunately, with a report of abuse being made every 10 seconds, we have a huge problem in our country.

Reconciling Legal Marijuana With Drug Prevention

As the parent of kids, I’m obviously concerned about what they do as they grow up.  On the one hand you want them to learn to make decisions.  On the other hand, you don’t want to endanger them.  That requires helping them to understand right from wrong.  That requires helping them to make smart decisions and understand the long-term implications of them.

This is where I struggle with the modern attitude towards the legalization of marijuana.  While it may not be a “gateway drug” according to science, it is certainly highly correlated with future drug use, and it has a negative impact on health.  Additionally, it’s addictive for about 10% of people and more addictive when you’re younger.

As someone who has watched people throw away their life on drugs and the son of someone who worked in drug and gang rehabilitation centers, I personally see it as a slippery path.  I agree that alcohol may be the gateway “drug” when not used appropriately and can be very dangerous for kids and for many adults who can’t control themselves.  You can find lots of research on alcohol related deaths due to increased disease burden or simply drunk driving.

So, like many health related topics, the information out there is very confusing for our kids.  On the one hand, we point out what your brain looks like on drugs (if you remember the PSA from the 80s and 90s).


On the other hand, we talk about medical marijuana, and we have states where it’s now legal to buy marijuana like Colorado.  But, the idea of walking down the street and seeing cannabis stores is crazy to me.


Perhaps a sad sign of this issue is the spike in travel to Colorado especially around Spring Break.  They’ve also seen an enormous jump in applications to go to college in Colorado.  (I think I’ll bet on causality not just correlation here.)

At the end of the day, I think we want to keep our kids safe and help them avoid anything addictive – tobacco, drugs, and alcohol.  (And, yes…you could take this further to look at caffeine or sugars or other things that impact their health.)  At a minimum, we want to help them understand the facts and make sure they know the risks and determine if they fit the addictive profile or not.  They already have a hard time navigating childhood and adolescence…let’s be careful not to make it too easy for them to fall off track.   Unfortunately, decisions like this  have broader implications on our next generation even if they don’t actually use marijuana.

Of course years ago, we used opium, cocaine, and herion as medicine also…but we outgrew that phase of “modern healthcare” so maybe this too will pass.

Internet Turns 25 – Looking Back And Forward

happy birthday

Wow!  The Internet turned 25.  Do you remember when you started using computers and technology?  I can.

I think my first computer was the Commodore 64 which we plugged into our home TV for a monitor and used a tape recorder to store files and access programs.

commodore 64

I can remember when we got 3 Macintosh computers to use at school.

first Mac

I can remember when we got our IBM PC Jr.


After that, computers started being a little more common where we had them in high school for typing, but at the same time, people were using electric typewriters more than computers.  (I can’t believe that they still sell electric typewriters – see Wal-Mart ad.)

I can then remember being at the University of Michigan with massive computer labs of Apple computers.  At that time, I still remember using the Gopher technology that had been developed out of the University of Minnesota and pre-dated today’s Internet and HTML.


This eventually led to all the excitement about physical companies having websites and being able to do amazing things like order pizza online…the rise of e-commerce and eventually the dotcom bubble.

I still smile when I think that one of my first assignments in healthcare was to convince managed care companies to build a website.  I flew all around the country as a consultant with Ernst & Young LLP meeting with teams to convince them of what the Internet could do, why they should build a website, what functionality to put on it, and how to drive members to the website.

And, now, our kids grow up with this as normal.  Everything can be “googled”.  There is no card catalog to look things up or waiting to figure out why someone is late.  Things are instantly available.  (If you’ve never seen the list of what graduates will never remember, here’s a link to their 2017 graduate list.  Always interesting.)

So, I’ll wrap this up with a look at the future from a new report by PEW.  Here’s 15 predictions from their report:

1) Information sharing over the Internet will be so effortlessly interwoven into daily life that it will become invisible, flowing like electricity, often through machine intermediaries.

2) The spread of the Internet will enhance global connectivity that fosters more planetary relationships and less ignorance.

3) The Internet of Things, artificial intelligence, and big data will make people more aware of their world and their own behavior.

4) Augmented reality and wearable devices will be implemented to monitor and give quick feedback on daily life, especially tied to personal health.

5) Political awareness and action will be facilitated and more peaceful change and public uprisings like the Arab Spring will emerge.

6) The spread of the ‘Ubernet’ will diminish the meaning of borders, and new ‘nations’ of those with shared interests may emerge and exist beyond the capacity of current nation-states to control.

7) The Internet will become ‘the Internets’ as access, systems, and principles are renegotiated

8) An Internet-enabled revolution in education will spread more opportunities, with less money spent on real estate and teachers.

9) Dangerous divides between haves and have-nots may expand, resulting in resentment and possible violence.

10) Abuses and abusers will ‘evolve and scale.’ Human nature isn’t changing; there’s laziness, bullying, stalking, stupidity, pornography, dirty tricks, crime, and those who practice them have new capacity to make life miserable for others.

11) Pressured by these changes, governments and corporations will try to assert power — and at times succeed — as they invoke security and cultural norms.

12) People will continue — sometimes grudgingly — to make tradeoffs favoring convenience and perceived immediate gains over privacy; and privacy will be something only the upscale will enjoy.

13) Humans and their current organizations may not respond quickly enough to challenges presented by complex networks.

14) Most people are not yet noticing the profound changes today’s communications networks are already bringing about; these networks will be even more disruptive in the future.

15) Foresight and accurate predictions can make a difference; ‘The best way to predict the future is to invent it.’


Fail Fast To Succeed Sooner – The Big Company Challenge

I was reading an article this morning about asking the question “are you afraid to fail?”  It’s an article about innovation which reminded me of one of my favorite quotes from David Kelley at IDEO.

Fail Faster

It also reminded me of another article from 2006 in Business Week about How Failure Breeds Success which was when I left Express Scripts to pursue several entrepreneurial opportunities.

Stefan H. Thomke, a professor at Harvard Business School and author of Experimentation Matters, says that when he talks to business groups, “I try to be provocative and say: ‘Failure is not a bad thing.’ I always have lots of people staring at me, [thinking] ‘Have you lost your mind?’ That’s O.K. It gets their attention. [Failure] is so important to the experimental process.”

BW Failure Cover

It also got me thinking about success rates in companies.  We all hear so much about the success of entrepreneurs and these 20 year old billionaires.  Is that reality?  Here’s a few stats from an article in the WSJ and a study by the Census Bureau.

  • 80% of companies make it to year one
  • 60% of companies make it to year three
  • 50% of companies make it to year five
  • 35% of companies make it to year ten

Sounds pretty depressing.  What about the fact that according to the WSJ article, only 5% of them achieve the projected ROI and 30-40% of them liquidate all their assets returning nothing.

“People are embarrassed to talk about their failures, but the truth is that if you don’t have a lot of failures, then you’re just not doing it right, because that means that you’re not investing in risky ventures.  I believe failure is an option for entrepreneurs and if you don’t believe that, then you can bang your head against the wall trying to make it work.” (David Cowan – Bessemer Venture Partners in WSJ article)

Just watch the show Shark Tank sometime.  There are amazing entrepreneurs with interesting ideas who have sacrificed so much to try to make it work.  I always try to tell people that it’s not just about passion and hard work otherwise people would succeed all the time.  Some things you do learn from Shark Tank along with the book The Art of the Start is how to frame and present your ideas.

So, why is this so important?  We’re on the the verge of huge transformation in the healthcare industry.  I think Oliver Wyman did a good job of discussing this in a whitepaper last year.  You can read article after article about mHealth, telemedicine, and remote monitoring.  (I’ll point you to Rock Health or The Center For Connected Health as two starting points.)

Of course innovation has been the buzz for several years now.  I think Jim Collins does a good job of teeing up this issue in discussing churn in the Fortune 500 list.  With the technology and VC crowd, the more recent term for business model innovation is “pivot“.  I think you’ve seen a lot more Chief Innovation Officers and innovation labs in healthcare companies these days.

I came across an interesting blend of technology consulting, investing, and innovation last night in the BCG Digital Ventures group.  In watching part of a YouTube video by their CEO, I think he does a great job summarizing how consulting maps to the investment paradigm.

  • Innovation is like seed capital
  • Product development is like venture capital
  • Commercialization is like growth capital

Interestingly, I probably get 1-2 calls a week from people in big companies that really want to get out of the big company and come work in the exciting start-up space.  I always tell them that the grass always looks greener on the other side of the fence so be careful.  It can be great, but it can be really tough.  It’s just a different type of risk and not everyone can take the emotional and potentially financial risk.  On the flipside, I also get people that look at the different entrepreneurial things I’ve done and say “why?”  They want to know why I didn’t just stay in a F500 company.  Sometimes, I think of this 8 years as a boomerang where I’ll end up back in a F500 company, but I’ll be a much more valuable product development, strategy, and innovation executive.  [This idea of boomeranging was one that Gensler introduced me to years ago in architecture where they encouraged people to work at different companies and come back if relevant.]

Depending on the day, I also think about what I’ve learned since I’ve never had one of those huge exits that everyone talks about.  I’m not cashing in on all my options to make money.  I’ve summarized many of those learnings on the blog, but here’s a few that I’ll call out.

  1. Firepond was my first venture into this space.  It was a 20-year company that General Atlantic had invested in to turn around as a product configurator in the CRM space.
    • Learned about CRM (customer relationship management) technology.
    • Learned about how to develop, structure, and manage alliances.
    • Learned the importance and how to structure offshore deals.
    • Learned about global sales and embedding technology into different solutions.
    • Learned about evaluating and buying companies.
  2. CentralScript was my second venture I started it from an idea I tried to sell at Express Scripts (and later was suggested to them by Clayton Christensen).
    • Learned about writing a business plan and financial modeling and projections.
    • Learned about the legal structure of businesses.
    • Learned about raising money and how to work with and evaluate angels and VCs.
    • Learned about building a team and structuring contracts with them.
    • Learned about selling and evaluating partners.
  3. Talisen Technologies was my third venture which was another turnaround where I worked with a friend of mine who had raise some private equity to do a technology services consulting roll-up.
    • Learned about Business Process Management technology.
    • Learned about how to build support companies around a technology platform.  (The opposite of Firepond where I was the technology company.)
    • Learned about the difficulties of transforming an existing company and evaluating new companies.
    • Learned about how to use blogging and create exposure using social media.
  4. Silverlink was my fourth venture (and most successful experience) and first real start-up where it wasn’t trying to turnaround an existing asset but building off what the founders had built.
    • Learned about how to present to and work with the Board of Directors.
    • Learned about managing a sales force.
    • Learned about product development, training, documentation, and product lifecycle.
    • Learned about sales and marketing and being responsible for growth and a team.
    • Learned about account management.
    • Learned the value of using thought leadership, social media, and the press to drive awareness and pipeline.
    • Learned how to develop competitive analysis and differentiation.
    • Leraned about pricing and analytics.
  5. inVentiv Medical Management is my current venture which is part of a broader entity, but it’s still the same concept which is a 20-year old company that we’re transforming into a new platform and new business model.
    • Still in-progress so more to come…

So, I wrote all this to make the point that innovation is difficult.  You have to take some risks.  Like the article said upfront, you have to believe you can fail.  You have to have a plan for what to do if you do fail.  Big companies should provide a safety net to people to fail fast.  I think I’ve learned a ton that I wouldn’t have learned staying in the big company.  At the right time, that will be a huge asset as I look to help drive the transformation and pivoting of a larger entity!

Are Sports Good For Kids?

This was an interesting question that I was thinking about this morning.

I could take this several directions:

  • I could look at the benefits of exercise from sports (assuming the kids actually got enough exercise in practice – see older blog post).
  • I could look at the benefits of working in a team which I see from team sports.
  • I could look at the recovery benefits of losing and coming back which is very important in business and life. (how do you handle adversity)
  • I could look at the dangers of sports.
  • I could look at concussions in football and the discussion of helmets for soccer.
  • I could look at the negative impacts of parents on their kids relative to sports.
    • Fighting at sport events.
    • Pushing their kids too far.  (below are some things I’ve heard and seen)
      • Just keep running even if you throw up.  You’ll be fine.
      • If you have to pee, just pee in your swim suit.  You can’t be distracted during the meet.
      • If you do that again, we’re going to get up at 5 in the morning and go to the gym and practice it 100x before school.
      • You need to work harder so you can be in the Olympics at 16.
      • This is our college plan.  They have to be the best at this sport.
      • I pulled them out of school so they could practice more.  (The kid was 7.)

But, I saw an article about the time that kids start school, and it got me thinking about sleep and sports and the impact on kids.

Let’s start with some established facts:

sleep guidelines

Now, let’s assume most grade schools start around 8:00.  (My kid’s school starts at 7:30.)  That means that they likely have to get up by 7:00 at the latest.  So, they should be in bed by 9:00 PM on average probably earlier for most kids and families where people are catching the bus or driving to school.

If their sports are starting practice or games after 6:00 PM, how likely is it that they’re home, calmed down, with their homework finished, and in bed by 9:00 PM?  Even if they are, how many parents are getting their kids to bed by 9:00?

“Sleep may be the most important, though overlooked, contributor to your children’s development and health. The reality is that children can survive without exercise and on little food (though I don’t recommend either), but all children need sleep. It’s often unnoticed because you don’t usually see your children sleeping and its benefits are not readily apparent (though its costs usually are).

The influence of sleep on children is profound. Quality sleep has been found to be associated with improved attention, reduced stress, greater emotional control, better mood, improved memory, greater ability to learn and return information, better grades, improved mental health, lower risk of obesity and other health problems, and longer life.” (From a good article on kid’s sleep in the Huffington Post)

So, just to be clear…I think kids should be in sports.  I just think we (as parents) need to be more concerned about making sure we don’t sacrifice our kid’s sleep on a regular basis for them to play sports and lead them into health issues and school issues.  The tradeoff isn’t worth it.  (IMHO)

The Healthcare Mark-up Game – Driving Up Healthcare Costs

The idea of healthcare costs and the need for healthcare transparency has become a front page issue. With the shift to consumer driven healthcare and high deductible plans, the average consumer is increasingly aware of what things cost. And companies like Change Healthcare provide tools to help consumers navigate this maze.

But, what I don’t hear many people discuss is the issue of middlemen and how this adds cost to the system. I’ve worked for several middlemen so I think I understand the model well. Of course, these companies make good (and true) arguments which is that they lower costs due to scale based efficiencies. But, healthcare is big business so everyone has to get paid somehow. Some of the “non-profits” make the most money.

Let’s look at prescription drugs:
– This begins with the manufacturer who adds the marketing and sales costs to the actual ingredient and packaging and shipping costs.
– The drug is then shipped to a wholesaler who stocks the drugs and ships them to pharmacies.
– The drugs are then sold by the pharmacy to the consumer and the pharmacy bills the payer.
– Assuming the payer isn’t the actual employer, the payer will then bill the employer.

So who all gets paid in this process:
– The manufacturer of the drug
– The advertising companies (they name the drug, they create the packaging, they create the ads)
– The marketing companies (they set up the websites, they create the mobile apps)
– The law firms (trademarks, patents)
– The sales companies (they hire and manage the pharma reps)
– The data company (the manage the Rx data to help target the reps)
– The shipping companies (transportation)
– The wholesaler
– The pharmacy
– The marketing and communication companies (refill programs, on the bag messaging)
– The technology companies (switch company, adjudication company)
– The recruiters (hiring, staffing)
– The PBM (contracting, rebating, customer service)
– The payer (adjudication, customer service, risk management)
– The broker (commission)

Still wonder why healthcare is expensive?

I wish I had an easy answer. A lot of these services are needed and it would cost more if the employers all had to do this themselves. There would be no scale. There would be no efficiencies.

This is certainly one argument for the efficiencies of a single payer system but I don’t think that’s very efficient IMHO.

How Bank Of America Messed Up My Account At Citibank


To say I’m frustrated would be an understatement. This scenario seems like something from a movie in which the evil bank blatantly abuses their power over the financial system to push people into economic hardship.


I write about this here for two reasons:

  1. Maybe this will bring it to someone’s attention that will help and
  2. All we generally hear about is the bad customer service in healthcare which pales in comparison to this.

Here’s the scenario:

  • On 6/3/13, we paid off our Bank of America mortgage when we sold our house in St. Louis.
  • On 6/17/13, BofA sent us a payoff check for our overpayment of our escrow.
  • On 7/5/13, that money was deposited into our Citibank account.
  • On 7/18/13, BofA confirmed that the check cleared.
  • On 7/23/13, Citibank removed the funds from our account and stated that BofA had rejected the check.
  • After several calls, Citibank could not explain the reason for the funds being removed other than to say the check wasn’t paid by the institution. Here’s some of the reasons that they’ve made up to try to tell me why:
    • First they told me that we both didn’t sign the check. That was wrong.
    • Then they told me that it was made out to a business. Which it wasn’t.
    • Then they told me that BofA rejected it. Which they didn’t.
    • Then they told me that it was because I used an ATM. Which I didn’t.
    • Then they told me to go into the branch office where I made the deposit. I used the same lock-box that I’ve used for years. There are no branches in St. Louis or Charlotte.
  • On 7/30/13, we had a 3-way call with Citibank and BofA to confirm the check was paid.
  • On 8/1/13, BofA faxed proof of payment to Citibank.
  • As of 8/5/13 after more calls with the 3rd supervisor at Citibank, they still couldn’t prove that the check was paid or find the BofA proof even after they had selected the location for the proof to be faxed.
  • I then got all fired up:
    • Followed the @AskCiti Twitter account and asked them to direct message me contact information for someone who could help me…with no response.
    • E-mailed the CEO of Citibank with no response.
    • E-mailed 3 members of the Committee on Financial Services with no response.
    • E-mailed the Ombudsman at the CFPB with no response.
    • E-mailed 3 members of the Citibank Board of Directors with no response.
    • E-mailed the WSJ reporter who wrote the article about Citibank’s use of Twitter for customer service.
    • E-mailed 6 other members of the Citibank executive team with no response yet.
    • Wrote my original blog post here throwing Citibank under the bus
    • Tweeted again to @AskCiti for help linking to the blog post

FINALLY, there was some action on 8/6:

  • The 3rd supervisor at Citibank called me back several times to see if he could help.
  • The @AskCiti people direct messaged me and called me several times.
  • The Executive response team at Citibank stepped in to help.  They even called the Bank of America CEO’s office to get them involved.
  • I’ve now had a direct person in both offices to call several times a day to try to get resolution.

In a surprise turn of events, it was Bank of America that screwed this up.  While they swore on 5 different calls that they paid the check, in the end, they showed it as cleared, but they never actually sent the money to Citibank causing the issues.  There’s some customer service issues to blame on both sides, but fortunately, the Citibank team could listen to the recorded three way call where B of A swore that they paid Citibank getting me all riled up.  I’m not sure how this happens or why me, but this has been a frustrating experience.  After 11 years with Citibank and different accounts with B of A for years, you want more.

In the end, they’ve been helpful, but I shouldn’t have to go so far to get resolution.  (Of course, B of A still hasn’t paid Citibank although they have provisionally credited my account the money…not that I’m willing to spend it yet.)


Do you ever feel like no one can help you with your issue in a company? It’s not like I have hours of free time to play games with the bank. Why can’t big companies ever actually resolve something themselves?

The Role Of Healthcare Technology Curator

When I worked as an IT consultant, you had two clear choices – an enterprise system (e.g., SAP) or a best-of-breed (BOB) strategy.  People liked the simplicity of an enterprise system, but you may have sub-optimized reporting or some flexibility in your solution.  On the other hand, the BOB strategy required more maintenance, effort, and coordination to pull it off in a coordinated fashion.

In today’s healthcare world, I look at and meet with a ton of technology companies.  The struggle is how to keep up with all the change in the industry and be nimble enough to engage the new start-up, but flexible enough to evolve with the market without impacting the consumer experience.

Maybe it draws on my training as an architect, but I was describing my technology vision as one of a general contractor.  The buyer (client) wants a BOB solution.  They want everything optimized – data, reporting, workflow, content, mobile, clinical algorithms, etc.  At the same time, they often underestimate what it takes to manage all of these vendors, integrate the data on the backend, and create an integrated consumer experience across multiple vendors and technology platforms.

That’s where I see some real value add as a “technology curator”.  I see one of my roles in helping manage an evolving ecosystem of healthcare companies and working with a flexible technology platform that can quickly plug and play with different solutions.  This also allows me to have pre-built integrations with certain solutions, but I can also offer consumers the ability to choose their device (for example) and with the right API set up just be device agnostic in my solution.

Over time, this offers clients a lot of flexibility.  The get the BOB approach within an enterprise system environment.  They don’t have to keep issuing RFPs and evaluating vendors (since we’re doing that).  They don’t have to stitch together multiple data sets to create the integrated, longitudinal view of the consumer (since we’re doing that).  They don’t have to pretend that they’re offering a cohesive consumer experience (since we’re doing that).  And, most importantly, they are flexible over time to jump from solution to solution within the architecture without disrupting everyone since it’s behind the “presentation layer” that the consumer experiences.

Relocation vs. Travel – Presenteeism and Health Implications

Surprisingly, I’ve been happily living in the St. Louis area for almost 20 years. I moved here after going to the University of Michigan for graduate school at Washington University, and I never thought I’d stay. My girlfriend (now wife) moved a year later, and we’ve loved it ever since. We’ve built two houses, had two kids, and made a lot of friends.

I’ve had chances to move many times to Kansas City, San Francisco, Boston, Columbia (SC), Florida, Minneapolis, New York, New Jersey, and several other cities. All of them I have turned down. So, one of the big questions I get asked now days is why are you moving out of St. Louis since you’ve commuted for so long and “enjoyed” it. That’s a tough one, but as someone who cares about my health, let me position this from a health perspective for all of you.

Ultimately, we’re moving for one reason which is to spend more time with my family. Of those 20 years, I estimate that I’ve spent at least 9 of them where I traveled 50-90% of the business days. You can do the math, but if I assume 15 days per month on the road over 9 years, that’s about 1,620 days that I’ve been gone or 4.4 years. That’s a lot of time to miss with your wife and kids.

But, I also see several health reasons for this:

  • Most people I know (including myself) sleep better at home and have a more regular routine. No early morning flights. No late night flights. No uncomfortable beds. No loud neighbors. No temptation to work until all hours of the night. And, as I’ve talked about many times, lack of sleep is a major contributor to productivity, decision making, and health.
  • You eat better at home and don’t have to eat out every meal which can affect your calorie intake and therefore your weight.
  • Long commutes have both mental and physical health implications (none of them good) as you can see in this article and infographic on LifeHacker along with this other article on ABC.
  • Being at home and spending time with your family can also affect them (as we know health is social). Here’s one example about eating with your kids that I often quote.

Of course, commuting has some productivity gains (if done right) from a work perspective:

  • You can work long days without worrying about other things that you should do when you’re home. (Why do you think consultants are so productive?)
  • You can find some nice quiet time on planes to work. (Although this has gone down over time with more crowded flights, more connecting flights, and smaller seats.)

You have to trade this off with productivity lost on travel days (e.g., I wake up every Monday at 4:30, leave for the airport at 5:30, land in Charlotte at 10:15, and get to my office around 11:30 with best case 90 minutes of work done).

But, moving definitely impacts your presenteeism as I’m learning (at least for a few months). After 20 years in one city, there’s a lot to do to move. You have to find new service providers (doctors, dentists, handyman, vet, hair), new schools, new sports teams, new stores, etc.

But, for those of you that aren’t convinced since you think travel is glamorous, let me share just a few stories with you.

  • On one of my toughest travel days, I had breakfast with a CIO in Boston at 6:30 am; caught a flight to Minneapolis to give a presentation over lunch; then caught a flight to have a dinner meeting in San Francisco. Long day.
  • In some weeks, I used to spend over 20 hours a week in a plane (not including airport time). Talk about sitting disease.
  • Just yesterday, when I tried to squeeze in one last trip before I moved, I got up at 3:30 to catch a 6:00 flight. I flew to Florida took a few calls, had a meeting, and then came back to the airport to catch an 8:oo PM flight home. That flight was delayed until 2:05 AM meaning that if I hadn’t just gone to get a hotel room (without any clothes or toiletries) that I would have gotten home 24 hours after I left the house.

Of course, the frequent flyer miles and hotel points are great. We’ve taken many a trip with it. I’ve given my parents free flights. Heck, we’ve even given our dog walkers free flights.

The key is to evaluate several factors which are what I’ve looked at:

  • Will you be traveling from which ever city you live in? Don’t move your family just to be traveling out of a new city.
  • Do you like the new city and would you consider living there long-term? For example, I know I probably would never like true city living in NY.
  • What is important to your family and is it present in the new city? This is a complicated one to find the right mix of services and education.
  • Can you afford to live in the new location without a major impact on your quality of life (or will your job account for this)?

Anyways, this has been one reason why I haven’t been blogging as much lately. The move is all consuming especially with lots of things going on at work. I have 4 more days in St. Louis before moving so we’re excited and nervous.

No Fat Customers Please – #BoycottAbercrombie

My kids have worn Abercrombie and Fitch clothes for the past few years even thought I find the advertising suggestive and the store environment not particularly inviting for the average adult (loud music, small aisles, very young staff). Even with that, I was shocked to see some of the recent news about their attitude towards their customers in response to why they don’t stock XL and XXL clothing sizes. With today’s focus on customer experience and competitive retail environment, this seems like not only a bad business model, but one that is shallow and unhealthy.

“In every school there are the cool and popular kids, and then there are the not-so-cool kids. Candidly, we go after the cool kids. We go after the attractive all-American kid with a great attitude and a lot of friends. A lot of people don’t belong [in our clothes], and they can’t belong. Are we exclusionary? Absolutely. Those companies that are in trouble are trying to target everybody: young, old, fat, skinny. But then you become totally vanilla. You don’t alienate anybody, but you don’t excite anybody, either.” (source article)

But, a bad business model and a shallow minded CEO isn’t a reason to boycott a company. And, after growing up in a family where we boycotted many companies due to business practices, I never saw myself as someone who would support this “hippie” approach. That being said, I think that Abercrombie’s attitude is a real issue for the health of our kids for 3 reasons.

  1. We have a major obesity issue in the US. (from CDC)
    1. Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years.
    2. The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period.
    3. In 2010, more than one third of children and adolescents were overweight or obese.
    4. Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors.3 Obesity is defined as having excess body fat.
    5. Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors.
  2. We have a bullying issue in the US. (source)
    1. Over 3.2 million students are victims of bullying each year.
    2. 1 in 4 teachers see nothing wrong with bullying and will only intervene 4 percent of the time.
    3. Approximately 160,000 teens skip school every day because of bullying.
    4. 1 in 7 students in grades K-12 is either a bully or a victim of bullying.
    5. 56 percent of students have personally witnessed some type of bullying at school.
    6. Over two-thirds of students believe that schools respond poorly to bullying, with a high percentage of students believing that adult help is infrequent and ineffective.
    7. 71 percent of students report incidents of bullying as a problem at their school.
    8. 90 percent of 4th through 8th graders report being victims of bullying.
    9. 1 out 10 students drop out of school because of repeated bullying.
    10. Harassment and bullying have been linked to 75 percent of school-shooting incidents.
    11. Physical bullying increases in elementary school, peaks in middle school and declines in high school.  Verbal abuse, on the other hand, remains constant.
  3. We have a suicide issue in the US. (CDC fact sheet)
    1. Among young adults ages 15 to 24 years old, there are approximately 100-200 attempts for every completed suicide.
    2. In a 2011 nationally-representative sample of youth in grades 9-12:
      1. 15.8% of students reported that they had seriously considered attempting suicide during the 12 months preceding the survey;12.8% of students reported that they made a plan about how they would attempt suicide during the 12 months preceding the survey;
      2. 7.8% of students reported that they had attempted suicide one or more times during the 12 months preceding the survey; and
      3. 2.4% of students reported that they had made a suicide attempt that resulted in an injury, poisoning, or an overdose that required medical attention.


As adults, I believe we have a responsibility to break the cycle of bullying and set an example. This isn’t time to create a fraternity culture in adulthood. We have systemic issues to address in serious ways. I know we won’t be shopping at Abercrombie again, and I think my kids have lost their interest in wearing the clothes.

Presidential Physical Fitness Award – Reasonable? Role Models?

I must admit that I don’t remember taking the presidential fitness test as a kid. With that being said, I was surprised to learn from my daughter that in her class of club soccer, volleyball, and baseball players she was the only kid to meet the highest level (greater than the 85th percentile across several measures). She made it today by running her mile in 7:37.

So, what does this require? It made me curious. Here’s what you have to do:


Could you do that?  These seem pretty difficult to me.  I could probably do the mile in 6:06, but I doubt I could do 53 pull-ups.  And, I doubt I could sit and reach 7 inches beyond my toes.  (Looking at the 17 year old male standards.)

On the other hand, we certainly need our kids to be more fit.  We have a big childhood obesity issue.

Childhood Obesity

But, it also made me think about Michelle Obama’s efforts in this space.

Lets Move

I think these programs are good starts, but lets not forget that obesity is a social issue and kids learn from those around them.  Let me ask the uncomfortable questions about those who our kids look up to.

  • How many overweight coaches do you know?
  • How about overweight teachers?
  • How about policemen and firefighters?
  • How about clergy?

These are all key role models…not to mention us parents who are often overweight.

I guess my suggestion here to the President would be to think about how to use our massive government payrolls as a foundation for change. Let’s think about the Presidential Fitness Challenge and create a broader wellness solution to change the visual role models for our kids and figure out how to help companies invest in this.

For example, we know that sleeping is correlated to weight and health.  I was talking to my brother-in-law who is a police officer when he told me that they are expected to get 8 hours of sleep a night.  Imagine if companies set this expectation for their employees (sleep impact on work).  

“Sitting Disease” may make a great late night comedy story line, but it’s a reality of our information economy that has to be addressed.


Is Healthcare An Investment Or A Cost?

As I’ve been looking at the employer view of healthcare, it strikes me that there are two different fundamental approaches.

  1. Healthcare expenses are a cost.  We want to drive down the costs as much as possible.
  2. Healthcare is an investment in our human capital.  We want to optimize our spend with the best outcomes.

Unfortunately, this likely means that the most vulnerable population is disadvantaged in this model (i.e., the hourly worker who is in a job where they are easily interchanged with another employee).

But, for companies where their biggest asset is their people (e.g., Microsoft), it seems clear that they would want to focus on healthcare as an investment.

This might drive you to make different decisions.

  • What if you looked at your formulary (for medications) based on side effects not necessarily costs?
  • What if you were willing to pay more for drugs with a clear impact on productivity (e.g., no drowsiness)?
  • Would you pay more for facilities that were better able to get people back to work?
  • Would you really push people into high deductible plans when this forces them to spend more time figuring out the system and navigating it?
  • Would you provide them all with devices to help them manage their healthcare?
  • Would you hire health advocates to help them navigate the system?
  • Would you provide them all with second opinions for major diseases (e.g., cancer) at no additional out-of-pocket costs?
  • Would you make sure to implement a telehealth solution so they weren’t away from the office as much?
  • Would you provide them with an onsite gym?
  • Would you provide them with healthy food onsite?

It seems like you would look at these types of decisions differently.  It wouldn’t be about the lowest healthcare premium.  It wouldn’t be about pushing them to a limited network.  It wouldn’t be about limiting their choice.  It wouldn’t be about shifting costs.  It would be about guiding them to make choices that kept them happy, productive, and engaged so that they could do the best work for you.

This would involve addressing stress.  It would involve addressing sleep patterns.  It would involve helping them create a work-life balance.

New Year Blog Survey

Happy New Year!

For those of you that are regular readers, I’d love to get your thoughts on the following:

  1. Do you like me including infographics in the blog?
  2. Do you like the mix of content from mHealth to PBM to population health management?
  3. Do you like the mix of short posts sharing articles and other information or would you prefer less posts that were more detailed analysis of a subject?
  4. What would generate more discussion / comments on the blog?

Thanks for your time.  You can comment here, e-mail me at gvanantwerp at mac dot com, or respond anonymously to the survey embedded here.

Sandy Hook Tragedy – Gun Laws? Mental Health Impact?

The tragedy at Sandy Hook Elementary School was a shock for everyone.  In a connected world, it doesn’t take six degrees of separation to know someone who lost a child.  I’m only one degree away from several people.  And, for those of us with kids, it really makes you look at your school and their processes.

I wanted to take a moment to say that my thoughts and prayers go out to those families and the community and to capture a few thoughts.

moment of silence

General Thought #1:  While we have a clear gun violence issue in this country (see infographic below), we’ve been slow to make any meaningful changes.  Will this finally push us over the edge?  I’m not sure.  Certainly, those that like to own guns believe it might as you can see the sales of guns have spiked in the past few days.  This seems like an opportunity for Obama to create a legacy for himself by changing this paradigm.

General Thought #2:  The other big question or potential impact here is whether this will change the way schools or society in general deal with mental health issues.  Even at the simplest level, I think about the stigma placed on people on anti-depressants.  People who have depression don’t often openly discuss it, but the reality is that 16% of Americans are taking an anti-depressant (almost 1 in 5).  If you assume there are many others that aren’t diagnosed or aren’t medicated, it becomes a significant population.

Interesting Video: The one thing I saw last night from a 9-year old was the video below which wasn’t made about Sandy Hook but was released and dedicated to them.  It covers the broader topic of bullying and violence including school violence.

Gun Violence in America

Browse more data visualization.

What I Learned Day One at the mHealth Summit #mhs12

I only had time to attend one day of the mHealth Summit in DC. Overall, it seemed like a well attended event with a good vendor area.

But, what I saw left me with concerns about the maturity of the space.

1. Every vendor has their own portal. There was no idea of convergence or sensitivity to the care manager or provider or patient having to access multiple sites to collect data. Of course, there were a few exceptions.

2. There’s still some heavy lifting for the consumer, but it’s getting better. For example, one food application lets you scan in your food but that calorie counter isn’t integrated into any activity monitor. Another application was trying to monitor social activity for part of their depression algorithm but they weren’t leveraging the data sitting on the phone itself – numbers of calls, movement, etc.

3. There are some really creative solutions being tried but the scale of the studies is small. I was excited to see what was being done with obesity, but the case studies were less than 150 participants.

4. There are a lot of non-healthcare people jumping in which is great from an innovation perspective, but healthcare is tricky and making sure to apply consumer literacy filters to the clinical guidance you get is important. For example, I asked one vendor why he had several chronic diseases covered but ignored high cholesterol. He pointed out that he had a heart disease component, but IMHO I don’t know many people with high cholesterol that would self select into heart disease.

On the other hand, there were some really positive things.

1. The user interface on a lot of these is very elegant.

2. The devices are getting smaller and smaller with a few disposables on the way.

3. The data captured and reporting is really interesting and insightful although I’m not sure how it will all be used by patients, physicians, or companies.

4. Technology is much more scalable than people centric strategies which is critical in the US and globally.

5. Several companies really get it and are focused on device neutral approaches for capturing and disseminating data.

Overall, it reminded me of some of my concerns about the Health 2.0 movement a few years ago in terms of business models and distribution models. But, keep the innovation coming. It’s fascinating and thought provoking. But, there will definitely be a shakeout in the years to come.

Can Sushi Be Delivered As A Custom Food Chain? – How Do You Roll


Until a few months ago, I would eat sushi once a month (at the most).  Now, I’ve been lucky that our Charlotte office is right across the street from How Do You Roll which allows you to come in a build your own sushi roll (ala Subway).  This is a franchise model which has been around for a few years. 

My quick summary is:

  • Good choices of fresh meat
  • Good fresh vegetables
  • Lots of options for creating unique sushi rolls
  • Quick
  • Good service
  • Reasonably priced (e.g., combo of roll with edamame and drink for <$10)

What Would You Pay For A Week Of Life?

I was at an Oncology meeting earlier today, and there was a brief discussion about pharmaceutical costs which is certainly one factor in overall healthcare costs.  (See article on the 11 most expensive drugs ranging from $200-$410K / year)  Ultimately, this always brings you back (at some point) to the topic of Quality Adjusted Life Year (QALY) or (a new term to me) “futile care” meaning care done essentially with a very low probability of working. 

Of course, like the lottery, we all like to believe that we’ll be the 1% for which this effort pays off.  (see Prospect Theory or a broader article on use of incentives in healthcare).  This can often be a very cost effective way to get people excited.  This is especially true for poorer people who spend as much as 3% of their income on lotteries which have a very low return

But, the question at the center of this is what you would pay for a week of life?

  • $100
  • $1,000
  • $10,000
  • $50,000

And, would that answer change based on timing?  I believe so.  If asked today, when you were healthy, would you agree to spend $50,000 to gain one week of life?  Perhaps not.  When you’re on your death bed and realize that you still want to see a few more people, your answer may change.  And, your family’s answer might change.  If you had to make that decision for your parent, it might be tough to make at the hospital, but if you sat down with them when they were healthy and asked them whether they would like you to spend your kid’s college savings account on gaining them a week of life, the answer might change.

But, what about when the money’s not yours.  We all know the infamous diner’s dilemna where we’re likely to spend more money when your splitting the bill with everyone.  When you’re covered by insurance or by the government, it’s not always your money being spent.  So, what if it was positioned differently?  If you knew that spending $50,000 for that one week of life meant that there wouldn’t be money to fund a shelter for 3-months that provided 20 homeless families with a place to sleep.  Would that change your answer?

It’s a tough question.  No one like to put a financial value on life.  I don’t have an easy answer other than having the discussions earlier with the patient and framing them the right way. 

Never mind the question about quality of life…Would you rather die in 2 days at home or would you rather live 8 days in the hospital where your throwing up all the time?

I don’t know the economic tradeoff of these treatments or drugs so this isn’t specific to any scenario, but is a situation which come up and everyone runs away from.  I understand why.

Are You Turning Data Into Knowlege?

I’ve used this framework for years, but I wanted to post it here as I think about outcomes reporting. (image source)

This is key as you move to add value around data and use the knowledge and wisdom to create informed actions.


Sports As Training For Real Life

A former sales executive once pointed out to me the fact that he liked to hire people that had competed at the highest level in sports.  I didn’t understand why, but his explanation made a lot of sense to me. 

  1. They learned how to set goals and train and prepare for those goals.
  2. They knew how to win.
  3. They knew how to lose, reflect on the loss, move on, and prepare to win again. 

I think number three is what gets lost in the “trophy generation” that we see out there today.  Kids that only know how to win and throw their rackets or get upset if they lose.  They don’t understand the value of competition, of being pushed, and of learning how to lose with grace.

Do You Push Your 10 Year Old To Be An Olympian?

When I was watching the movie The Tooth Fairy last week, it really got me thinking about how some people push their kids so hard into sports at such an early age.  I heard one 10 year old parents talk about their kid being in the next Olympics (when their not even the best at their sport that I know). 

Here’s some examples of what I’ve seen which seem wrong:

  • A 6-year old that is home schooled so he has more time for private lessons in his sport
  • A kid who is only rewarded if she sets 3 records this summer
  • A kid who is paid to beat certain people at her sport
  • A kid who is punished by extra practice if she doesn’t perform perfectly
  • Multiple kids playing on 2 or 3 different teams simulateously in the same sport
  • Kids training 4-5 hours per day / 6 days a week at age 9

I see more and more parents (of kids under 11) video tapping their performances and then breaking down their play after they perform with them.  The focus is always on the negative.  As I heard one kid say, “be my parent not my coach”.  I think that’s important.  Parents can’t project their expectations of paying for college and fame on their kids at such an early age. 

This leads to self-esteem issues.  It leads to burnout.  It leads to over training.  And, it can lead to false expectations that manifest themselves in poor sportsmanship. 

For example, I know one kid that my kid has to compete with came up to her and said “why are competing on this team…I can’t win if you compete”.  Never mind the team spirit.  This kid wants the personal recognition even in a category that she doesn’t compete in year-round, but she thinks she should be a star in whatever she does.  This is what leads kids to cheat and be bullies. 

Here’s a few other articles on this topic:

Here’s a quote from an interview with David Ellis a sports nutritionist about specializing too early:

Early bloomers typically have an advantage on these AAA teams, and while they dominate the domestic stage with their early maturity and specialization, they are not as competitive on the international stage once other competitors have matured. In fact there is evidence that the athlete who didn’t specialize early and was a little later in maturation might end up being the better athlete! Why you ask?

That multi-sport athlete kept on developing motor skills and competitive vision that might have been more challenging in totality than the narrowed focus of the specialized athlete. These multi-sport athletes are hungry to compete as they approach their prime, and because many were late bloomers, they had to be smarter players to make up for their lack of size and strength. So when their bodies do catch up maturation-wise, they often times have a sharper set of skills, and the net result is an athlete who has the tools and the motivation to compete at an elite level versus the burn out early specialized athlete who often seems to have peaked too early and below their net potential.

Bad Pitch

I was just reading an email pitch that I received from a healthcare social networking vendor talking about their system for engaging patients and physicians.

Maybe, it’s just me but that seems to imply some understanding of how to engage people and use social media. First, they didn’t use my name in the email. It just said “Hi ,”. Then, at no point in the pitch did they say anything about why they reached out to me. And finally, they then asked me to tweet specific pre-formatted tweets that they had created. If I wanted that, I would follow them and do a RT.

And to top it off, they don’t offer a way to follow-up to learn more. It was just shameless self-promotion. #Fail

The Value of the Family Dinner

Studies have shown that kids who eat dinner with their families do better in school, feel more socially connected to their parents, have better peer relationships, and are less likely to try drugs and alcohol.

Wow! That quote from Grace Freedman at certainly makes a compelling case. The article in Spirit magazine (Jan 2012) goes on to say that according to a 2010 Pew Research poll only about half of families make dinner a daily ritual and roughly 20% eat together only occasionally or never.

It certainly is a challenge with long workdays, commutes, travel, and kid activities.

Does Duration Of Team Matter In Business As In Sports?

One thing that I often think about is the amount of change in the teams within rapidly growing companies (e.g., many PBMs). Does this have an effect on internal knowledge, productivity, and therefore success? It’s a great question. With that in mind, I found the infographic below very interesting.

At the same time, I looked back a few years to see how much change there has been in the management teams at each of the largest PBMs (Medco, Express Scripts, and CVS Caremark).  [Honestly, it was less change than I had expected, and I didn’t look at average age since I’m not sure that’s a great proxy in business while it may be in sports.]

  • At Express Scripts, 7 of the 10 people listed on the website have been there that entire time.  Most of them in their current roles. 
  • At CVS Caremark, 6 of the 10 people listed on the website have been there that entire time althought there has been more movement across roles. 
  • At Medco, 14 of the 16 people listed on the website have been with Medco that entire time and the two others might have also but their start date wasn’t listed in their bio. 

So maybe more change is needed?  Certainly with the changes in the market dynamics, there is always a need for bringing in a fresh perspective…at the same time, the PBM industry is complex and continuity given long-term contracts is important. 


by visually via


Tiny Tower Retail Pharmacy Missed Branding Opportunity

Tiny Tower is a simple yet addictive game you can play on your iPhone or iPad.  My kids figured out the other day that you could re-name the floors.  For example, one of the floors is a pharmacy.

So, instead of saying “pharmacy” this could say Walgreens or CVS or Express Scripts.  What a missed opportunity.  I’ve talked about this before, but I think the pharmacy industry in general has missed integrating themselves into Hollywood and gaming.  When’s the last movie or TV show you saw where the primary actor was a pharmacist or worked at a PBM or even worked at a health insurance company (and was shown in a positive light)?

Here’s an easy branding opportunity.  It also seems like an easy revenue source for the Tiny Tower founders.  Why not have companies pay them to brand these?  Why not have people playing the game earn points to buy up from McDonalds to Red Robin?

Candy For Cash (or Toys)

Is this what Halloween looks like at your house?  A big pile of candy!

Similar to the guns for cash program that many police departments have done, we’ve developed a candy for cash program at my house.  The kids can get as much candy as they want and eat a few pieces tonight.  But, they then have to pick their favorite pieces and can keep about a gallon ziplock full of candy.  For the past few years, we’ve actually taken the candy to ToysRUs and basically given it to the cashier as we buy something.  The kids think it’s actually being used to buy the toys while we both get rid of the candy and gives them some incentive not to rot their teeth and eat unhealthy amounts of sugar for months to come.

Why Not Make “Low Fat” Normal And Label Others “Full Fat”

One of the foods my kid loves comes in both normal and a low-fat version.  But, we’ve always bought the low-fat version.  One day, they were out so I bought the normal version.  I was surprised when he was upset.  Why did you buy me the full fat version he asked?

It got me thinking.  Like “loss aversion” would reversing the positioning of products work?  There’s always talk about the “fat tax“.  Why not try making low-fat the standard and requiring labeling that points out what products are full of fat?


Should Health Companies Be Brutally Honest With Consumers?

I saw a statistic today that said that the Domino Pizza’s stock price has gone up by 233% since they began acknowledging that they had a reputation of a low-quality product.  Fascinating!

Would that work for health plans or PBMs or pharmaceutical manufacturers?  If they acknowledged the perception that consumers have for them, would that engage consumers?  Would consumers respond well to that?

Imagine messaging around prior authorization that sounded more like this…

“We’re calling to let you know that you need a prior authorization to get your [drug, service, device].  I know you think we’re just doing this to cut costs and override your physician’s decisions, but that’s not true.  We care deeply about you, but our physician team determined that there’s a chance for overuse of this [drug, service, device].  All we’re asking is for your physician to answer a few questions to validate the proper use.  We’ve even launched a web service so this can be done with minimal disruption.” 

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