All posts by blackfriar

health market quality, healthcare, policy, politics

Margaret Faux: Unitended consequences of streamlining Medicare billing

 

http://blogs.crikey.com.au/croakey/2014/12/16/tony-abbott%E2%80%99s-medicare-%E2%80%9Cdeforms%E2%80%9D-or-how-to-trick-senators-101/

Tony Abbott’s Medicare “deforms” or How to Trick Senators 1.01

MARIE MCINERNEY | DEC 16, 2014 3:51PM | | PRINT

The Federal Government’s co-payments Plan B will add another layer of co-payment complexity to the Medicare system that neither doctors nor patients fully understand now. That raises a whole range of issues around unintended consequences, particularly for patients but also for our system, which has prompted this appeal to the Senate to learn from what’s happened in the past and look to different solutions in the future.

***

Margaret Faux writes:

Senators, section 20A needs your help, urgently!

Section 20A of the Health Insurance Act 1973 (the Act) is Medicare’s heartbeat. One of the key machinery provisions of the Act, it describes Medicare’sbulk billing arrangements, and it is fibrillating on the verge of collapse.

Section 20A has been amended, repealed, re-introduced and tinkered with on 16 occasions since it was first introduced. Some of the changes have been incidental but one was not, and it has had long term consequences which have contributed to the continuing upward spiralling of inpatient medical fees. The intention was that it would have the reverse effect.

Tony Abbott’s latest stunt will see the same upward spiralling of GP fees, because when you look beyond the smoke and mirrors of the most recent co-payment iteration, it is nothing more than a cunning manoeuvre to divert attention from the main game. The new proposal cannot be introduced by regulation alone, and it’s the sneaky little legislative change that is required, that will break Medicare’s back. It happened in 2000 and it is happening again.

Bulk billing 1.01

Unlike much of Medicare’s legislative scheme which is mind bogglingly complex, section 20A describes a simple two step bulk billing process (the legal term being an assignment of benefit). My changes in brackets and bolded:

S20A Assignment of Medicare benefit

(1)  Where a medicare benefit is payable to (a patient) …. (the doctor and the patient) may enter into an agreement, in accordance with the approved form, under which:

(a)  (the patient) assigns his or her right to the payment of the medicare benefit to (the doctor); and

(b)  (the doctor) accepts the assignment in full payment of the medical expenses incurred in respect of the professional service by the (patient).

Bulk billing has always been optional by virtue of the inclusion of the word ‘may’ in section 20A, however in choosing to bulk bill, the doctor forgoes his or her right to collect any additional fees from the patient, because he or she must accept the bulk bill amount ‘in full payment’ for the service provided.

Doctors have been found guilty of criminal fraud for breaches of this section in circumstances where they have charged their patients additional fees or ‘co-payments’ when bulk billing, including when the co-payments have been called something else such as booking fees or counselling fees. The current legal position therefore is that irrespective of the name allocated to any ‘co-payment’, it is illegal to charge it when bulk billing for a single professional service. The only exception involves the administration of certain vaccinations, which provision is neatly tucked away in the regulations.

The High Court has upheld this interpretation on numerous occasions and, with the exception of two brief periods in the history of s20A,bulk billing has always operated in this way. Seems pretty straight forward.

Last week in his joint press release with Health Minister Peter Dutton, Prime Minister Tony Abbott announced that under the new proposal an optional co-payment of $5 will be permitted when bulk billing. To enable this, an amendment to s20A of the Act will be required. So what’s the big deal about that?

Well we’ve been down a very similar path before when s20A was amended by the introduction of subsection (2A), which was necessary to facilitate the introduction of no-gap schemes, and unfortunately, it didn’t quite go as planned.

No-gap billing 1.01

No-gap schemes are a sort of hybrid bulk billing system for inpatient services. The fee paid to the doctor has two components; the first is a 75% Medicare rebate, the second is a top up by the private health fund, after which one total amount is paid to the doctor.

When introduced, the stated purpose of these schemes was to limit the out of pocket expenses faced by patients when they go to hospital. The idea was that there would be…well…no-gap, except when there was a gap, called a known-gap, which would be permitted under a sort of sub-branch of the new no-gap schemes.

When these schemes were debated in the House of Representatives on 10 April 2000, MPs variously espoused the complete protection and safeguarding of consumers, expressed concern that there appeared to be insufficient detail as to how patients would be informed about fees, celebrated the fact that medical fees had finally been conquered and patients would thereafter be empoweredto shop around for doctors, and one particularly excited and optimistic MP even suggested that these schemes would somehow help us all to better understand how health insurance operates.

It was only the Member for Lowe John Murphy who was alive to the fact that changing s20A might have unforeseen consequences. He said:

I believe that the amendments made to the Health Insurance Act 1973 to allow automatic assignment of a contributor’s Medicare benefit to a registered organisation to facilitate simplified billing and payment arrangements to be built into the gap cover scheme will mean yet one more way in which bulk-billing will be undermined—something that the Liberal Party has always wished to accomplish. Bulk-billing is something that those who sit on this side of the House will defend to the death.

Bulk billing was indeed undermined but the seemingly innocuous change to s20A was largely over-shadowed by the greater objectives of streamlining and simplifying inpatient billing processes. The necessary change to s20A appeared to be nothing more than a simple mechanical tweaking of the Act to facilitate the operation of the new schemes. And it was true that the schemes could not operate without this tweak. When the go live date came around, the schemes were sold to consumers and health professionals as ‘simplified billing’ arrangements. It’s perhaps the greatest misnomer in the entire Medicare mire.

There are just under 6000 Medicare services, most of which are claimable to each of the 36 registered health funds in Australia, all of whom have no-gap schemes but not known gap schemes, all with unique rules and requirements, some capping their known gap amounts, others not, all with different fee schedules and payment arrangements and some even pay different rates in different states. Only those at the claiming coal face (where the tax payer dollars are spent) really understand just how complex medical claiming is, how easy it is to make unintentional errors and how difficult it is to correct them. No-one knows that in practice, the known gap is usually known to no-one except the patient. And this is not because of any deliberate misuse of the system by anyone, it occurs because the system itself is flawed. And that innocuous little tweak to s20A took the patient right out of the transaction, which in effect created an open book of cheques pre-signed by the patient (though the patient is oblivious to this) just waiting to be cashed.

While doctors do their level best to stay off Medicare’s radar, out of court and comply with the rules, if the rules are labyrinthine and the machinery of billing is left to secretaries, administrators and third parties, then there are bound to be unintentional slip-ups.

In attempts to apply quality control measures to the huge volumes of claims hitting their systems, some health funds are now using data matching processes to try to capture inconsistencies between the hospital claim (this is for the accommodation and theatre fees) and the medical claim. The two claims are supposed to match. But this is also fraught because there is no way of knowing which of the two claims is incorrect when a mismatch is identified. Hospital account departments make errors too. In fact this week a client asked me what she should do because she had become aware that the hospital had claimed incorrectly in her name. She said:

The hospital has sent a hospital accommodation bill to the patient stating that the mirena was inserted for contraceptive reasons but it was actually for another reason for which the relevant MBS item number is different than the one they submitted which was incorrect. When I submit my claim which item number should I use?

Confused and worried doctors are as common as confused patients in the world of medical billing. Patients have often been told one thing by their health fund, another by Medicare, another by the hospital, yet another by the doctor and often we tell them something different again.But spare a thought for doctors, they struggle too. Yesterday, on a fairly typical day in the office, a phone call came through from a brand new surgeon just starting in private practice enquiring about medical billing. I asked him if he had given consideration to the claiming method/s he wanted to use – bulk billing, no-gap, known-gap, full gaps? He replied:

‘Sorry, I don’t know what any of those are; I’m just new to all of this.’

It’s a standard response, no surprises there.

Patients are mostly in the dark when it comes to medical fees and would not know if Medibank Private’s known-gap scheme has a cap or not (it does) and will have no hope of understanding when the proposed $5 co-payments can or can’t be charged, and it will be impossible to protect them from incorrect charges being raised (even if they are raised unintentionally). Consider these real examples of a trip to the GP which were put to me by GPs during a webinar presentation just a few weeks back.

‘What if a patient has a consultation, a mirena inserted, and a wound dressed? Do I have to bulk bill them all or can I split them and charge fees for some and not others? What are the rules?’

‘What about a complex skin cancer removal, a consultation and a vasectomy?’

‘What if the patient comes in and has a consult, is sent off for an x-ray and then comes back later that day with the x-ray results and we find a fracture, but it was caused by a metastasis (cancer invading the bone)?’ – This means that what started off as a suspected simple broken bone has now become a cancer diagnosis and the doctor will likely spend a very long time planning the treatment and management of the patient –‘Is it two item 23s or one item 23 and one item 36 or just bundle it all up into one item 44 or how do we bill for that?’

The rules that apply to each of these scenarios are neither simple nor consistent nor even readily accessible by perusing the Medicare Benefits Schedule. Given doctors are already unsure about how to correctly bill for these services, what hope will patients have? Rumour has it that the Government will try to explain the new scheme by way of an advertising campaign. But so unique is each patient encounter that no national advertising campaign is ever going to make this clear – not for patients, or doctors. It would be a bit like trying to explain the tax system in a 30 second grab on prime time television.

There are two end user groups of the Medicare system, doctors and patients, neither of whom fully understands how it works, and adding another layer of co-payment complexity, facilitated by a seemingly minor change to the legislation, will only serve to compound the difficulties they already grapple with. And just as there were insufficient safeguards to protect consumers when s20A (2A) was inserted to facilitate no-gap schemes, there are not only insufficient safeguards under the Government’s co-payment proposal, there are none.

Instead of shifting responsibility for the health of Medicare to the end users, a responsible government will first look within Medicare for answers. There is known waste, inefficiency and incorrect claiming amounting to over $1 billionper year, that neither increasing the Medicare levy nor introducing co-payments will fix. And if addressing internal inefficiencies to save costs is good enough for the ABC why is it not also good enough for Medicare?

So Senators, your predecessors made what they thought was an innocuous change to s20A for the purposes of simplified billing. Don’t fall for today’s ruse of establishing a ‘price signal’. Do what every responsible householder would do – see if you can make what you have work better for you first, before deciding you will have to pay more for the same service.

Margaret Faux is a lawyer, the founder and managing director of one of the largest medical billing companies in Australia and a registered nurse. She has been involved in Medicare claiming for 30 years and is a research scholar at the University of Technology Sydney examining the interface between Medicare and medical practitioners. 

The illustration is by Bradfield Dumpleton, a freelance illustrator and independent arts educator with a passion for creative communication and who specialises in cartoon art for community health and educational organisations.  For more info: bradfielddumpleton.com

complex adaptive systems, data saving lives, EF, facts & data points, health market quality, healthcare, policy, politics, quantified self, rapid learning health systems

Yach: Changing the Landscape for Prevention and Health Promotion

 

http://www.huffingtonpost.com/dr-derek-yach/changing-the-landscape-fo_1_b_6439328.html

Become a fanExecutive Director of the Vitality Institute

Changing the Landscape for Prevention and Health Promotion

Posted: Updated:

By Bridget B. Kelly and Derek Yach*

Chronic diseases like heart disease, diabetes, and cancer are major contributors to poor health and rising health care costs in the U.S. The cost of treating these conditions is estimated to account for 80 percent of annual health care expenditures. More and more, experts agree on the great potential for preventing or delaying many cases of costly chronic diseases by focusing on environmental, social, and behavioral root influences on health. Yet the U.S. has been slow to complement its considerable spending on biomedical treatments with investments in population-based and non-clinical prevention interventions.

What is getting in the way of strengthening our investments in prevention and health promotion? A few consistent themes emerged across multiple expert consensus studies conducted by the Institute of Medicine (IOM), which were summarized in the report Improving Support for Heath Promotion and Chronic Disease Prevention — developed in support of the recent Vitality Institute Commission on Health Promotion and Prevention of Chronic Disease in Working-Age Americans.

First, prevention is challenging — chronic health problems are complex, and so are the solutions. Second, decision-makers who allocate resources have tough choices to make among many competing pressures and priorities; prevention and promotion can be at a disadvantage because their benefits are delayed. Third, there is a need for better, more usable evidence related to the effectiveness, the implementation at scale, and the economics of prevention interventions. Decision-makers need information that makes it easier to understand, identify, and successfully implement prevention strategies and policies. As noted in a recent opinion piece in the Journal of the American Medical Association (JAMA), limited investment in prevention research has resulted in an inaccurate perception that investing in preventive measures is of limited value. This has profound implications for federal funding allocations.

The mismatch in funding allocations is seen right at the source of our nation’s major investment in new health-related knowledge: the National Institutes of Health (NIH). A new paper in the American Journal of Preventive Medicine found that less than 10 percent of the NIH annual budget for chronic diseases is allocated to improving our knowledge base for effective behavioral interventions to prevent chronic diseases. This means that despite the immense potential for prevention science to reduce the burden of chronic diseases in the U.S., it is woefully underfunded compared to what we invest in researching biomedical treatment interventions for these conditions. NIH investments affect what evidence is ultimately available to those who decide how to allocate resources to improve the health of our nation, and they also affect the kinds of health experts we train as a country. By not investing in prevention science and in a future generation of scientists capable of doing high quality research in prevention, we are perpetually caught in the same vicious cycle where prevention continues to lag behind in our knowledge and therefore our actions.

There is hope that the landscape is slowly changing. Initiatives such as the NIH Office of Disease Prevention‘s Strategic Plan for 2014-2018 and the Affordable Care Act’s mandated Patient-Centered Outcomes Research Institute (PCORI) have the potential to strengthen prevention science and build the evidence-base for effective prevention interventions. Innovations in personalized health technologies and advances in behavioral economics also show great promise in improving health behaviors for chronic disease prevention.

The Vitality Institute Commission’s report emphasized the need for faster and more powerful research and development cycles for prevention interventions through increased federal funding for prevention science as well as the fostering of stronger public-private partnerships. It is essential to generate and communicate evidence in a way that enables decision-makers to understand the value of investing in prevention while taking into account their priorities, interests and constituencies. This will lead us to more balanced investments, make prevention a national priority, and boost the health of the nation.

*The authors are responsible for the content of this article, which does not necessarily represent the views of the Institute of Medicine.

cool, storytelling

What Makes Gladwell Fascinating

 

https://www.linkedin.com/pulse/20131007120010-69244073-what-makes-malcolm-gladwell-fascinating

  Influencer

Wharton professor and author of GIVE AND TAKE

What Makes Malcolm Gladwell Fascinating

Oct 7, 2013

I used to dread going to parties. I stood around struggling with small talk, waiting for an opening to debate about big ideas. That changed 13 years ago, the day I readThe Tipping Point.

Suddenly, everyone wanted to talk about Malcolm Gladwell’s ideas, and I felt right at home. He made social science cool in watercooler chatter, spawning an entire genre of books that blend stories and studies to explain how the world works. He carried me through a decade of dinner parties with Blink and Outliers. With last week’s release of David and Goliath, I’ll be set for a while.

Gladwell refers to his books as “conversation starters,” and when people pick up that conversation, they often start criticizing his work. As a social scientist, I think this is a missed opportunity. I’m not saying that Gladwell’s writing is perfect or that his arguments are always true. I just want to make sure that we don’t throw out the baby with the bathwater, since we can learn as much from analyzing what he does right as from poking holes in his work. At a recent event, the discussion shifted away from the substance of Gladwell’s arguments, and toward the style: why is he arguably the most spellbinding nonfiction writer of our time?

The most popular explanation was storytelling skills: he’s a master of suspense, to the point that his books read like mystery novels. Some people waxed poetic about how he brings characters to life—who could forget the Six Degrees of Lois Weisberg or the tragic genius of Chris Langan? Others highlighted his ability to present sticky concepts that quickly make their way into the lexicon, like thin slicing, the 10,000 hour rule of expertise, and the magic number of 150 for social groups. And of course, his ability to illustrate social science with examples from popular culture loomed large in the discussion. Who wouldn’t want to read about how Hush Puppies took off, why Phantom of the Opera and Sesame Street hit it big, and what led Bill Gates and the Beatles to greatness? (There’s even a Malcolm Gladwell Book Generator website that plays on this notion by proposing new titles like Clarissa: How One Woman Explained It All; The Cheers Effect: How and Why Everybody Knows Your Name; and Lando: Intergalactic Lessons in Smoothness.)

If you believe that Gladwell’s success is primarily driven by his writing, I think you’ve overlooked the most important factor. What makes him most interesting is not the narratives themselves, but rather the ideas behind them.

In 1971, a sociologist named Murray Davis published a groundbreaking paper that opened with these two lines:

It has long been thought that a theorist is considered great because his theories are true, but this is false. A theorist is considered great, not because his theories are true, but because they are interesting.”

Davis argued that the difference between the dull and the interesting lies in the element of surprise. When an idea affirms what we already believe, we’re bored—we call it obvious. But when an idea is counterintuitive, we’re intrigued. Our curiosity is piqued, and we’re motivated to ask questions: how could this be? Is it really true? What else might this explain?

Challenging our assumptions is what Malcolm Gladwell does best. To see how he does it, let’s take a look at what Davis called The Index of the Interesting. Davis classified 12 different ways of challenging conventional wisdom, and Gladwell’s key ideas map beautifully onto at least five of them.

1. Bad is Good and Good is Bad

The idea here is to take a negative and unveil its positive side, or vice-versa. This is the theme of David and Goliath, where Gladwell argues that disadvantages can give us advantages. Who would have thought that a disability like dyslexia could actually make people more successful? With reasoning reminiscent of the Daredevil comic books, he illustrates how the absence of one ability—reading—can lead people to develop other abilities in areas like creative problem solving, acting, listening, and rule-bending. He presents data suggesting that losing a parent as a child, one of the worst things that can happen in life, may actually increase your odds of becoming president or prime minister. He also explores the other side of the coin, arguing that power led the British Army and Southern segregationists to underestimate uprisings in Northern Ireland and Alabama.

2. What Looks Like an Individual Phenomenon is Really a Collective Phenomenon

Another way to challenge assumptions is to show that what we think is caused by individuals is in fact caused by broader societal forces. This is the heart of Outliers. Gladwell argues that we think professional hockey and soccer players make it because of talent and hard work, but it’s really about being born a few months earlier than their peers. We assume that planes crash due to mistakes made by individual pilots, but it’s actually about the cultures in which they were raised. We believe Bill Gates and the Beatles achieved greatness because of their talents, but they had to be in the right place at the right time.

Gladwell does the opposite in The Tipping Point, arguing that major collective changes are actually fueled by small numbers of people. Styles and social movements catch on when connectors build bridges between people and ideas, mavens share expertise, and salesmen convince people to come aboard.

3. What Seems to Succeed Fails, and What Seems to Fail Succeeds

It’s interesting when something that appears to work doesn’t, or when something that looks ineffective proves to be effective. In David and Goliath, Gladwell covers evidence that contrary to popular belief, small classes in schools don’t lead children to learn more. In Blink, he adopts the reverse strategy, showing that although we expect reason to outdo intuition, we underestimate the power of intuition. We believe that the best way to spot fake art is through systematic analysis, but an expert can tell in the blink of an eye. Even when critical information is stripped away, and we only have tiny clues, our intuition can be strikingly accurate. A 10-second silent video clip is enough to spot an engaging teacher; an audiotape with the words garbled so that we can only hear the tone still allows us to identify the surgeon who was sued for malpractice; and a 15-minute conversation about taking out the garbage allows us to predict which marriages will fail.

4. What Appears To Be Local is Global

It’s also surprising when seemingly isolated events are in fact driven by common forces. This is another hallmark of The Tipping Point, which shows how the same kinds of dynamics can explain the spread of sexually transmitted diseases, pop culture trends, and crime sprees. We also see it in David and Goliath, where the willingness of underdogs to play by a different set of rules serves as a lens for illuminating events as diverse as the success of the American civil rights movement and an inferior basketball team with an inexperienced coach making the national championship. (The Gladwell Book Generator picks up on this theme too, with the faux title Nothing: What Sandcastles Can Teach Us About North Korean Economic Policy.)

5. What Looks Like Disorder is Actually Order

The ability to find structure in chaos is another quality of interesting theories, and this is a signature strength of The Tipping Point. We think fads come out of nowhere, but if we appreciate Gladwell’s three rules of epidemics—the law of the few, the stickiness factor, and the power of context—we can better understand the systematic factors that cause them to spread. Confusion also turns into clarity inOutliers, where the puzzle of why a man with genius IQ works as a bouncer is traced to his difficult upbringing, and in David and Goliath, where the mystery of the greatest medical breakthroughs in modern history is also informed by a difficult upbringing.

On Becoming Interesting

Of course, execution is important. Before presenting an idea, Davis observed that the author “articulates the taken-for-granted assumptions” of the audience, and only then reveals how the idea challenges these assumptions. This rhetorical strategy is visible in each Gladwell book: articulate what we currently think, and then present examples and evidence to show how our beliefs are incomplete, inadequate, inconsistent, or just plain wrong.

Interesting ideas are counterintuitive, but not all counterintuitive ideas are interesting. Davis warned that if we believe too strongly in an idea, we don’t want to see it questioned:

one must be careful not to go too far. There is a fine but definite line between asserting the surprising and asserting the shocking, between the interesting and the absurd… those who attempt to deny the strongly held assumptions of their audience will have their very sanity called into question. They will be accused of being lunatics; if scientists, they will be called ’crackpots’. If the difference between the inspired and the insane is only in the degree of tenacity of the particular audience assumptions they choose to attack, it is perhaps for this reason that genius has always been considered close to madness.”

Gladwell is very careful on this front. In David and Goliath, he intentionally avoided analyzing the Israel-Palestine conflict, knowing that it was a hot-button issue, and instead chose other conflicts that were more likely to intrigue than offend. At the same time, recognizing that his ideas need to have meaningful consequences, he addresses topics that matter to society. Gladwell writes about improving education and fighting crime, making planes safer and curing cancer, electing the right president and championing human rights. He also writes about ideas that matter to us as individuals. As Davis put it:

an audience will find a theory to be interesting only when it denies the significance of some part of their present ’on-going practical activity’… and insists that they should be engaged in some new on-going practical activity instead. If this practical consequence of a theory is not immediately apparent to its audience, they will respond to it by rejecting its value until someone can concretely demonstrate its utility: ’So what?’ ’Who cares?’ ‘Why bother?’ ’What good is it?’”

Gladwell’s books make us care. He challenges us to rethink how we raise our children, how we build our workplaces, and how we live our lives. He gives us hope that if we practice enough, we can become great musicians or athletes. That if an idea is worthwhile, we can make it take off. That if we change the way we evaluate people, we can overcome stereotypes and give disadvantaged people an equal chance. That if we face disadvantages of our own, we can draw strength from them.

The Dangers of Interestingness

Although it’s tempting to use the Index of the Interesting as a guide for developing an idea, Davis advised us not to do that. It works better as a mirror than a map. When we try to generate ideas in this formulaic fashion, it comes at the expense of creativity. Rather, the Index comes in handy once we have an idea: we can use it to explore different assumptions that we might be challenging. But this too proves difficult, Davis observed, because “assumptions about a topic” are often “too diverse or too amorphous” for any idea to be “universally interesting.” Perhaps Gladwell’s true genius lies here, in identifying common assumptions that lie just beneath the surface—beliefs that are so widely accepted, so taken for granted, that we don’t even know we believe in them.

The punch line from Davis is that interestingness is in the eye of the beholder. What’s fascinating to one audience is obvious to another. Over time, assumptions evolve, and reactions depend on the current assumptions of your audience. This means that if you successfully champion an interesting idea, it will eventually cease to be interesting, because everyone will believe it. And that’s why we need Malcolm Gladwell to keep writing new books.

Adam is a Wharton professor, an organizational psychologist, and the author of Give and Take: A Revolutionary Approach to Success, a New York Times and Wall Street Journal bestseller. Follow him here by clicking the yellow FOLLOW above and on Twitter @AdamMGrant

Photo: Pop!Tech/Flickr

business, cool, management and leadership

7 Emails You Need to Know How to Write

http://unreasonable.is/skills/the-7-emails-you-need-to-know-how-to-write/

The 7 Emails You Need to Know How to Write

8 months ago
by Teju Ravilochan
0 Comments

Why Give a Damn:

Emails are how we communicate with each other in this day and age. Writing them well can be the difference between successfully building a relationship and not. This post includes example emails for how to get meetings, ask for introductions to investors, say no gracefully, and more!

The author of this post, Teju Ravilochan, is co-founder and CEO of the Unreasonable Institute.

When emailing, we do things that we’d never do in real life.  Tweet This Quote

Emails are strangely awkward. They give us the ability to start a conversation with anyone in the world, without the social cues of an in-person interaction. So we do things that we’d never do in real life via email. Can you imagine walking up to someone at a dinner party, handing them a large document and saying, “Hey Steve, it’s great to meet you! I’ve heard a lot about you and was wondering if you’d give me feedback on my business plan?” And yet, I get emails like this. A lot of people get emails like this.

So this post is dedicated to effectively writing what I believe are seven of the most important relationship-building emails. I’ve assembled articles and examples for each of the emails below and hope this helps you to start the critical relationships you need to produce extraordinary results!

1. How to get busy people to respond to your emails.

Want to get in touch with Eric Schmidt, former CEO of Google? Adam Grant, New York Times best-selling author of Give and Take (which is one of my favorite business books of all time, by the way), lays out six key steps for getting important people to respond to your emails in this post. He includes a story of how a Princeton undergrad sent an email that got a response from then-Google CEO Eric Schmidt! This is a great post!

2. How to ask for an introduction.

This post from Scott Britton, whose company SinglePlatform, exited for $100 million, includes analysis of an email requesting an introduction. Critical elements include:

  • An explicit ask
  • A compelling context as to why you’re asking for the intro
  • An example of traction or partnerships that boost credibility
  • Appreciation, and
  • A template email the recipient can forward onto the person you want an introduction to

Another Great Example: Tim Ferriss offers this exceptional example of how someone reached out to him asking for connections to angel investors.

3. How to make an introduction between two people.

LinkedIn Founder Reid Hoffman and two-time author and entrepreneur Ben Casnocha explain that there are three ways to introduce people over email. The very best of the three involves:

  • Checking with both parties to make sure they want the introduction,
  • Making the intro with a short explanation of who each person in the introduction is and why they should connect
  • Clarifying who will take the next step (e.g. who will follow up first)

This might be more work than putting two people’s email addresses in the CC field and saying, “Jason and Brad, consider yourselves connected!” But it is far more effective in ensuring your true outcome: that the two people you are introducing meaningfully connect and build a mutually productive relationship.

4. How to ask for feedback.

Techstars Founder David Cohen receives 50 cold email requests for feedback each day. In the post above, he explains why the featured email brilliantly won his attention and earned thoughtful feedback from him. The core elements include:

  • Knowing the person you’re emailing and showing them that (echoing Adam Grant’s post)
  • Making the request specific and easy to answer for him

Read the post to see how it’s done concretely!

5. How to ask for a meeting.

Scott Britton’s elements of a good meeting request include:

  • Offering value to the recipient,
  • Explaining the context of meeting clearly (ideally including a brief agenda),
  • Asking for a small, discrete amount of time (like 25 minutes),
  • Making it convenient for them (by offering to meet where it might be convenient for them), and
  • Recognizing that they are giving you their time.

Are you noticing some patterns here? A little thoughtfulness goes a long way in getting people to say yes to your requests. Read the post to see an example!

6. How to be politely persistent in getting someone to write you back.

I assume that people I reach out to cold (and even people I get introduced to) won’t respond to my first email. It often takes 2-3 emails to hear back from them. Impact Hub Boulder Co-Founder Greg Berry taught me the best technique I’ve come across for getting responses for folks who haven’t emailed me back. It involves sending them an email about a week later saying,

“[Name], I hope your day is going great! Forgive me for emailing you again, but I just wanted to follow up on the email below and see if you might have any thoughts. Consider this no more than a friendly nudge!”
This “nudge” email has been surprisingly effective, because it acknowledges the recipient is likely busy (and that my email isn’t her first priority), uses the word “friendly” (which is warm and understanding), and is short.
If this follow up email doesn’t work, I write them again maybe two weeks later and say,
“I hope you’ll forgive me for writing you yet another email, but here at the Unreasonable Institute, we believe in persistence to an unreasonable degree. If [opportunity / ask], isn’t up your alley, I completely understand. I simply did not want to miss this chance to [opportunity – like ‘invite you to be a mentor at the Unreasonable Institute’ or ‘connect you to an investment opportunity I think would be perfect for you’].Whether it’s a fit or not, I sincerely appreciate you considering the request.”

The difference between successful people and very successful people is that very successful people say ‘no’ to almost everything.  Tweet This Quote

I’ve written hundreds of these kinds of emails and received only one clearly negative response (which said, “Stop it. You’re annoying me”). Interestingly, that was the one email where I left out the phrase “friendly nudge” and didn’t ask them to “forgive me for emailing again.” But in other cases, I secured a funder for $1 million (which took several emails over the course of 6 months), and the New York Times best-selling author Chip Heath to serve as a mentor at Unreasonable Institute (which took over a fifteen emails over the course of four years).

7. How to say no gracefully.

In the words of Warren Buffet, “The difference between successful people and very successful people is that very successful people say ‘no’ to almost everything.” Odds are that tons of opportunities are flying your way: invitations to speak at conferences, requests for advice, suggestions to open operations in new locations. You might be excited by many of these, but when some come along that you’re not interested in, here are two examples of how to say no.

The first is a humorous example from author E.B. White, which I found in this blog post by Greg McKeown. It reads:

“Dear Mr. Adams,Thanks for your letter inviting me to join the committee of the Arts and Sciences for Eisenhower.

I must decline, for secret reasons.

Sincerely,
E.B. White”

The second example comes from an email I recently sent:

Thanks so much for reaching out, [name]. I appreciate what you’re trying to do.One of our core values is militant transparency, so I’ll be fully honest. At the moment, I want to whole heartedly give myself to our core priorities, involving getting our new Institutes up and running, growing our team, and raising capital. That means I’m choosing to decline a lot of conversations I’d otherwise like to have; so I won’t be able to prioritize hopping on the phone with you.

If there’s something quick I can help you with or if you have a specific question, do send me an email about it and I’ll be happy to get back to you!

My best,
Teju

Master these seven emailing skills and I submit that you will produce remarkable results for your work!  Tweet This Quote

In Conclusion: Conclusion: Knowing how to make asks via email, particularly in being considerate to the people you are reaching out to, will go a long way in helping you build the relationships you’re looking to build. And the good news is that you can start practicing right away with everyone you email! If you would like, feel free to send me a practice email anytime at teju@unreasonableinstitute.org.
Happy emailing!

data saving lives, healthcare, healthy habits, rapid learning health systems

The Temporary Tattoo That Tests Blood Sugar

 

http://www.theatlantic.com/health/archive/2015/01/the-temporary-tattoo-that-tests-blood-sugar/384581/

The Temporary Tattoo That Tests Blood Sugar

An electronic sensor may mean the end of finger pricking.

UC San Diego

A painful prick of the fingertip reveals a mountain of medical information for many diabetes patients. But health professionals have long struggled to find a reliable and painless way to gather blood sugar measurements. Just last year, Google announced that it was developing contact lenses that measure glucose levels in its user’s tears. But now, nanoengineers may have found an even easier way for diabetes patients to monitor their vital levels: temporary tattoos.

Amay Bandodkar, a researcher at the University of California, San Diego, has created a flexible sensor that uses a mild electrical current to measure glucose levels in a person’s body. Measuring blood sugar levels multiple times a day is vital for diabetes patients because it shows how well their body is managing their disease as well as the dose of insulin they require, if they need any at all. But because many people find needles unpleasant, they tend to avoid measuring their levels, which puts them at risk of developing serious medical complications. The new device is painless—It contains electrodes printed on a thin tattoo paper that patients can even dispose after use. “Presently the tattoo sensor can easily survive for a day,” Bandodkar said in a statement. “These are extremely inexpensive—a few cents—and hence can be replaced without much financial burden on the patient.”

The tattoo has already provided accurate glucose measures for seven healthy patients, the team reported in a recent issue of the journal Analytical Chemistry.The patients, all non-diabetics between the ages of 20 and 40, wore the tattoos before eating a sandwich and drinking a soda. Following the carb-rich meal, the tattoo recorded the spike in each patient’s glucose levels as accurately as a traditional finger-stick device. The tattoo is a few steps away from providing the numeric value of glucose levels, so scientists have to remove and analyze it in order to retrieve its measurements. Eventually, Bandodkar said the tattoo will have “Bluetooth capabilities to send this information directly to the patient’s doctor in real-time or store data in the cloud.”

The researchers hope the tattoo will eventually be used to monitor levels of other compounds in the blood, like metabolites, medications, or alcohol and illegal drugs. Whatever the application, the fewer needles the better.

business, entrepreneurship, management and leadership, storytelling

Don’t give reasons for prices – it triggers a psychological reflex to regain control and bargain down the price

 

http://www.forbes.com/sites/stevemeyer/2015/01/09/the-1-reason-why-salespeople-leave-money-on-the-table/

The No. 1 Reason Why Salespeople Leave Money On The Table

Comment Now

Salespeople talk too much.

In an earlier article, I discussed a study suggesting salespeople would be more persuasive if they relied more on visuals than words. Here we’ll talk about what’s perhaps the most likely point in the selling process where salespeople say too much – and trigger the price bully that lurks in every buyer’s heart.

Courting is a little like sales, right? Imagine you’re a guy who’s been dating a woman for some time and you decide to propose. You want to close the deal. So you buy her a ring and take her to a nice restaurant. As you hand her the ring, you lay out, like bullet points, the five reasons you’re the guy for her.

What she wants is for you to let the ring, and the sincerity expressed in your misty eyes, do the talking. Laying out your value proposition at this point seems like desperation, or doubt. She’s thinking, “After all that courting, why does he think he needs to convince me? Or is he not convinced himself?”

How many times have you seen salespeople, just before a close, try to justify their price by revisiting the key benefits of their product or service? How many times have you succumbed to that urge yourself?

It’s a bad selling tactic. The research suggests you will trigger the same reaction in your prospect that our hapless Romeo triggered in his Juliet.

Justifying your price seems like common sense. If you’re going to ask someone to do something, how could it be a bad idea to remind them of the reasons? There’s actually a landmark study out there that seems to give credence to the idea. Unfortunately, most people completely misread its conclusions.

The study, called “The Mindlessness of Ostensibly Thoughtful Action,” was conducted in 1978. It observed how people waiting in line to use a copier responded when somebody at the back of the line tried to cut ahead. When the person simply asked to go first, 60% agreed. When the person said, “May I use the Xerox machine because I have to make a copy?” 93% said yes – even though the “reason” itself made no sense.

Based on this study, salespeople are often advised that there’s some mechanism in the human psyche that responds to reasons, and that enumerating them will improve close rates.

Problem is, there was a second part to that study. In Part 2 the researchers raised the stakes. They had the line-cutter say, for example, “I need to make 20 copies; can I go first?” Predictably, fewer people said yes, only 24%. When the line-cutter tried again, adding a bogus reason why he had to make 20 copies, the reason had no effect.

So that study showed that reasons work when the stakes are low but provide no benefit when they’re high, which they usually are in selling situations.

A more recent study showed that giving reasons not only doesn’t help, it actually hurts salespeople. Researchers analyzed two negotiations over the price of an apartment. With buyer Group 1, the sellers presented a price, then added justifications, pointing out that the building had an elevator and was in a desirable neighborhood. With buyer Group 2, they simply named the price and remained silent.

Buyer Group 2 didn’t bargain as hard and agreed to a higher price. Why? The researchers said the justifications made buyers in Group 1 feel they were being pushed into a corner, and that the seller was trying to do their thinking for them. And here’s what’s really interesting: The Group 1 buyers responded to justifications by coming up with reasons why the apartment wasn’t so great. “Yeah, that’s all true, but parking is a pain and there aren’t enough washing machines.”

The researchers described this pushback as a psychological reflex to regain control, which is the most powerful insight in this study. Justifications are perceived by the buyer as an attempt to take control. Just stating your price and remaining silent leaves the buyer in control. For whatever reason, buyers who feel they’re in control are less likely to undermine your value proposition and demand a lower price.

All that said, there is of course an appropriate time to lay out your value proposition – early in your discussions as you’re conducting discovery and mapping your product or service to customer needs. Just don’t do it late in the sales cycle when you’re negotiating price.

As hard as it may seem, you’ll get a higher price if you just say, “Here’s what it costs,” and then shut up.

You might want to go easy on the misty eyes though.

cool

Gritty Star Wars Imagery

Zip: I tried to find gritty Star Wars art

From: http://imgur.com/a/rNPff

I tried to find gritty Star Wars art

By iwantaspaceship · 8 months ago · 38 images · 750,396 views · stats

I wish we could have a gritty Star Wars series

…where the struggle between the Rebels and the Empire was more about people…

…and less about explosions, and zany aliens…

It would be great to see stormtroopers represented as elite infantry, not clumsy cannon fodder…

…and be reminded that they are human beings as well as soldiers…

…and that they have suffered mightily as the Empire consolidated power.

What would it be like to follow the story of a conscript? Would a poor kid, conscripted into the imperial army, have ever been to orbit?

…let alone set foot on exotic worlds?

Maybe some of them really believe in what the Empire is doing? Maybe some of them just want to go home?

Some of the Rebel soldiers are still true blue heroes….

..but there could be charismatic leaders who are basically terrorists….

…using propaganda just like the Galactic Empire….

…in an attempt to depose the emperor and write themselves into galactic history. (like Tom Zarek from Battelstar Galactica)

…they prey on the ideals of soldiers…

…who believe that the Galactic Empire is a monocultural oppressive regime which must be overthrown…

…and maybe the ends too often justify the means…

The Galactic Empire has worlds that are highly industrialized and densely populated, like Coruscant…

…but there are also worlds that are barren and lawless, like Tatooine…

…suggesting a huge disproportion of wealth and resources between developed and undeveloped worlds throughout the empire.

The Rebel soldiers would basically be defectors from the imperial underclass…

…but many Rebel soldiers wouldn’t fully appreciate the legacy of the Old Republic they are trying to restore…

…and that by eliminating the emperor, galactic power will only transfer from a dictator to hundreds of wealthy senators…

One character of the series could be a kid from the Imperial homeworld, Coruscant, who had received a formal education. S/he joins up with the Rebels because they’re sympathetic to the Rebel Alliance’s mission to build a multicultural senate that represents the galactic community…

…but their dissolutionment upon discovering the unspoken motivations of corrupt and self-aggrandizing Rebel leaders would be a way to examine the hypocrisy of the Rebel Alliance…

Another character could be a poor kid who witnessed the invasion of their homeworld and the indiscriminate slaughter of its inhabitants…

…we see the brutality of the Empire’s campaign through the pain of a character who has lost their home, culture, and identity…

…and we can understand why some of the rebel soldiers are merciless and pragmatic, and think that actions akin to terrorism are completely justified.

How about instead of giant space battles the Rebels realize early on that they’re vastly outnumbered…

…and the only way they can succeed, is to lure the Empire into a brutal war of attrition?

The massive resource-intensive mission to destroy the Death Star could be an against-all-odds assault at the end of the 1st season. where the Empire has forced the Alliance’s hand by locating the secret base on Yavin 4.

…imagine if the Rebel assault on the Death Star was a last ditch effort, and it failed, the Yavin base gets destroyed, and a bunch of characters die Game of Thrones style? Wouldn’t that be awesome?

We could also see the graft, violence, and vice in Mos Eisley…

…and how far the Empire’s reach extends into government of remote worlds like Tatooine….

A less hapless C-3PO could make droid espionage pretty cool.

Maybe we could see how the politics of Mos Eisley as an administrative center, affects the moisture farmers in terms of political representation, taxes, civil rights…

…this would set the table for us to really appreciate a new character in the following season: the badass nephew of a moisture farmer from a backwater planet whose uncanny pilot skills turn him into a war hero and a symbol of hope for the Rebels. Maybe kind of like a Star Wars version of Shepard from Mass Effect. His affair with the Alderaanian Princess leading the Rebel Alliance could provide some political intrigue.

Oh yeah, the Jedi. Taking down a Star Destroyer like a boss.

Thank you for reading! Instead of a cat, here’s Jar Jar getting punched by a stormtrooper. Sorry if this artwork has been posted before, I hadn’t seen it so I thought I’d make an album.
complex adaptive systems, data saving lives

Torch: Facebook Offers Artificial Intelligence Tech to Open Source Group

 

Facebook Offers Artificial Intelligence Tech to Open Source Group

By

Mark Zuckerberg, chief executive of Facebook. By releasing tools for computers to researchers, Facebook will also be able to accelerate its own Artificial Intelligence projects.
Mark Zuckerberg, chief executive of Facebook. By releasing tools for computers to researchers, Facebook will also be able to accelerate its own Artificial Intelligence projects.Jose Miguel Gomez/Reuters

Facebook wants the world to see a lot more patterns and predictions.

The company said Friday that it was donating for public use several powerful tools for computers, including the means to go through huge amounts of data, looking for common elements of information. The products, used in a so-called neural network of machines, can speed pattern recognition by up to 23.5 times, Facebook said.

The tools will be donated to Torch, an open source software project that is focused on a kind of data analysis known as deep learning. Deep learning is a type of machine learning that mimics how scientists think the brain works, over time making associations that separate meaningless information from meaningful signals.

Companies like Facebook, Google, Microsoft and Twitter use Torch to figure out things like the probable contents of an image, or what ad to put in front of you next.

“It’s very useful for neural nets and artificial intelligence in general,” said Soumith Chintala, a research engineer at Facebook AI Research, Facebook’s lab for advanced computing. He is also one of the creators of the Torch project. Aside from big companies, he said, Torch can be useful for “start-ups, university labs.”

Certainly, Facebook’s move shows a bit of enlightened self-interest. By releasing the tools to a large community of researchers and developers, Facebook will also be able to accelerate its own AI projects. Mark Zuckerberg has previously cited such open source tactics as his reason for starting the Open Compute Initiative, an open source effort to catch up with Google, Amazon and Yahoo on building big data centers.

Torch is also useful in computer vision, or the recognition of objects in the physical world, as well as question answering systems. Mr. Chintala said his group had fed a machine a simplified version of “The Lord of the Rings” novels and the computer can understand and answer basic questions about the book.

“It’s very early, but it shows incredible promise,” he said. Facebook can already look at some sentences, he said, and figure out what kind of hashtag should be associated with the words, which could be useful in better understanding people’s intentions. Such techniques could also be used in determining the intention behind an Internet search, something Google does not do on its regular search.

Besides the tools for training neural nets faster, Facebook’s donations include a new means of training multiple computer processors at the same time, a means of cataloging words when analyzing language and tools for better speech recognition software.

EF, health market quality, healthcare, healthy habits, policy, politics, rapid learning health systems

A pinch of prevention will prevent a pound of turnstile medicine

 

http://www.afr.com/p/opinion/pinch_of_prevention_will_prevent_cTMfa5vns8VzT46UA8cigJ

JOHN DWYER

A pinch of prevention will prevent a pound of turnstile medicine

PUBLISHED: 12 HOURS 58 MINUTES AGO | UPDATE: 12 HOURS 38 MINUTES AGO

 

A pinch of prevention will prevent a pound of turnstile medicineA lack of infrastructure in Australia to care for more people in a community, rather than a hospital, costs us dearly. Photo: Louie Douvis

JOHN DWYER

Poorly considered and obviously unacceptable policies have forced the government to go back to the drawing board to consider ways to improve the cost effectiveness and sustainability of our health care system. This time let’s move beyond the government’s focus on having us pay more for a visit to our GP to concentrate on the evidence-based structural reforms we should be discussing. This time broad consultations are promised. Hopefully, the following facts and suggestions will influence decisions.

A good start would see the government stop talking about the fiscal sustainability of Medicare. Were it not for the destructive division of health care responsibilities shouldered by State and Federal governments, Canberra would not be looking at Medicare as if were isolated from the rest of the health care system. Hospital expenditure, at nearly $60 billion a year, dwarfs Medicare spending ($19 billion a year) and is increasing more rapidly. The immediate catalyst for changes to Medicare is not a fiscal crisis – our 9.3 per cent of GDP spent on health is about average for the OECD –but rather the unsatisfactory health outcomes delivered that are fuelling the growth in hospital care. A lack of any real infrastructure to provide our community with an improved capacity to prevent illness and care for more people in a community rather than hospital setting is costing us dearly.

More than 600,000 admissions to hospital each year (average cost more than $5000 per episode) could be avoided by a timely community intervention in the three weeks prior to admission. There is no doubt that the future of cost-effective, readily available hospital care is dependent on a reduction in the demand for hospital services. That must be the goal of a restructured Primary Care system. Last year Australians forked out $29 billion to supplement their health care (second only to the US in terms of out of pocket expenses). Much of this was spent on paying for surgery in the private sector. Public hospitals are swamped with complex medical patients seriously reducing their capacity to offer timely surgical services. Reducing medical admissions and restoring timely surgical services is a key to reigning in surgical costs and better educating the next generation of surgeons.

This time could our new health minister and her department open their eyes to international trends in cost effective health care that are producing better health outcomes. There is now an abundance of evidence that a focus on prevention in a personalised health system improves outcomes while slashing costs. Some systems have reduced hospital admissions by 42 per cent over the last decade. The British government has just been presented with a review that concluded that an extra 72 million ($132 million) spent on improving primary care in the community would save the system 1.9 billion ($3.5 billion) by 2020. The data available provides the government with a clear message that it does not want to hear. Only by spending more money on arestructuredMedicare will significant system wide savings be achievable.

A competent government would be looking at a timetable for introducing the highly successful Medical Home model of Primary Care, where teams of health professionals populate a practice and are available to enrolled patients. The infrastructure is available to help people avoid illness, have potential problems recognised earlier, offer co-ordinated in house care for people with chronic problems and care for many in the community currently sent to hospital. International experience tells us that a decade is required for the completion of necessary changes. We need to start on that journey and, fortunately, can do so without any panic about current health expenditure.

There is another related imperative that needs urgent action. Only 13 per cent of young doctors express any interest in becoming a GP. Only 1 per cent are contemplating a career as a rural GP. Primary Care training is rigorous and GPs are true specialists. How does all the rhetoric from Canberra about the pivotal role they play sit with the proposed $31 fee for a standard consultation. The discrepancy in the income potential for GPs when compared to that of other specialists is now huge.

Young doctors looking at the professional life of our GPs are uncomfortable with the current “fee for service” model that encourages turnstile medicine that is so professionally unfulfilling. Many GPs join corporate Primary Care providers preferring a salary. In New Zealand the government has facilitated 85 per cent of the nation’s GPs moving away from fee for service payments. The same is true for 65 per cent of US Primary Care physicians. Throughout the OECD health systems recognising the perverse incentives associated with fee for service remuneration are exploring changes that increase a GP’s remuneration for keeping people well.

There are numerous cost impositions in our health system that should be addressed before we are asked to pay more. Nine departments of health for 23 million people. A $5 billion dollar cost for the private health insurance rebate that could be better spent on achieving the above goals. $20 billion dollars spent on poor value or unnecessary procedures. The government asks: “if you don’t like our ideas then what would you do?” Well, here come the suggestions, please listen.

John Dwyer isEmeritus Professor of Medicine at the University of NSW.

The Australian Financial Review