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April 2014

HarvardX: PH210x United States Health Policy

Ph210x_banner608x211PH210x United States Health Policy, taught by Professor John McDonough from the Harvard School of Public Health, is quite simply the best MOOC I have taken to date (and I have enrolled in quite a few, out of both personal and professional interest). The course is entering its fourth week tomorrow - I have to admit I only completed Week 1 so far due to other obligations, but I'm slowly catching up - and runs for a total of 13 weeks, requiring about 3-4 hours of work (mostly watching informative videos) about the US healthcare system.

Since my research is in healthcare finance, I like to think I know quite a bit about the ACA and health policy in the US today and the Health Policy Orientation Workshop in October and the National Health Policy Conference in February, both held in DC and organized by AcademyHealth, were a great help in getting a better sense of the system, but when it comes to teaching the basics of the health policy system, PH210x is a home-run. (Of course, part of the value of the conferences is also to interact with healthcare policy-makers, and MOOCs have more content-based strengths.) I also like that the "homework" questions are multiple-choices "check all that apply", instead of "pick the one answer that is true" that I have seen in other MOOCs (where I usually could guess the correct answer before watching the videos) or the "peer grading" system that other courses have put in place - I don't think peer grading works very well when the audience is highly heterogeneous.

Week 1 was an introduction to the US health policy system and the reform, presented by John McDonough. The topics on following weeks, presented by outside speakers, were Medicare (Week 2) and Medicaid (Week 3). Week 4 - online tomorrow - will be the basics of healthcare finance and payment, as well as private health insurance. Week 5 will be on quality - a topic of particular interest to health systems engineers. The whole 13-week syllabus is available on the course webpage on edX.   

In summary, if you are interested in US health policy, I highly recommend that course.

Further readings:

In praise of the career premortem

I recently came across a short Harvard Business Review article on "Performing a project premortem" by Gary Klein (September 2007) - premortem as opposed to post-mortem, or in other words: thinking about what could go wrong at the beginning of a project rather than after it has failed. Since it's this time of year where advice books for soon-to-be graduates pop up in bookstores all over the country, I thought it'd be a good idea to advocate for the career premortem for all the college seniors about to step into the workforce. 

The idea is to imagine yourself five or ten years from now with your career at a low point. What could have happened to bring it there? While this is no fun to think about, the awareness of what could go wrong will hopefully motivate you to take action now, or better navigate potential pitfalls. Here are a few ideas (feel free to suggest others!). Five or ten years from now, your career may have hit the rocks because:

  • You're the only one who know what you would've been capable of if you'd been given the chance. (Think getting all those As in college is going to open extra doors for you after you got the job? It won't. Even if HR has your transcript, which is a big if, your boss has other things to do than remembering your GPA. You need to convince him that you're the right person for the job now.)
  • You didn't want to pay your dues and insisted on getting responsibilities the company only gave to people with more seniority. This gave you a bad reputation. You have such low levels of awareness that you don't even realize the reputation you have now. You also don't realize that the HR- and lawyer-approved platitudes the company is telling you to explain why you're not a good fit for this or that better job are sanitized excuses to hide the fact the company has a vastly different opinion of your aptitudes than you do. People dropped hints of how you could improve but you refused to listen.
  • You didn't care about your first job but never found a way to transition into something you liked more.
  • You failed to find a sponsor. (A mentor is someone who gives you advice but has no direct influence on your career. A sponsor is someone who advocates for you in the hierarchy and sends stretch assignments your way so that you can grow.) Obviously, your boss should give you stretch assignments, but you don't want your boss to be the only person aware of you in the company. A lot of career transitions are done through networks.
  • You failed to bring enough value in your first few years on the job for anyone to see you as a star performer. You've become a low-B performer: not someone whose performance would put his job at risk, but someone who plays the boring supporting roles and whose advancement is stalled.
  • You ran with the wrong crowd. (You became best pals with the worst slacker in the office who invited you to all the happy hours, or the gossipy busybody who, you later found out, was telling everyone else lies about you to get ahead. Or you became Facebook friends with all your 22-year-olds co-workers and treated them to all your pictures playing beer pong because you thought the pics were harmless, since your co-workers were your age. Turns out they wanted to get promoted more than you did. Or, you were left with no ally when your boss left.)
  • You failed to understand what you'd be judged on and to position yourself according to those criteria. You never asked your boss what he viewed as a successful first (or second or third) year for you and what skills you needed to develop to be promoted to the next level. You just thought it would all happen "naturally". You never made a personal development plan and counted on something else (your boss, the company, the established career path) to show you the way. Five years after college, your career is stalled and you struggle to think of any new skills you have acquired since you graduated.
  • You see some of your not-as-bright college classmates graduate from top MBA programs and move on to prestigious companies and wonder why you got left behind, although you've been rationalizing for the past four years why you didn't have time to take the GMAT or why you didn't need an MBA and why things were just fine, really.
  • You didn't handle well the "soft skills" part of the job. (Other people stepped on your toes or stole the credit. You didn't play nice with the people, especially less obviously powerful people, who had the power to make your life difficult. See bullet point on bad reputation too above.) 
  • You stayed too long in a toxic environment because it was never so terrible that you felt the pressing need to change jobs. 
  • You put out an image that was counter-productive to the attainment of your long-term goals (example: the jokester on the team).
  • You stayed way too long in that small town where your first job was and where there were no other opportunities. You stayed way too long in a dead-end job.
  • You thought you could pull off career success the way you pulled off an A in college by alternating periods of low and high efforts, and you realized too late you were headed straight for the rocks your career now finds itself on.
  • You never tried to see the situation from the eyes of the people around you, such as your colleagues, your boss, your HR manager. You never asked yourself, of all the people they could staff on this project or recruit for this position, why would they decide to pick me?
  • You rationalized that things weren't so bad until you woke up one day and had to admit things had moved straight to the job-from-hell zone while you weren't looking. (Read about the boiling frog syndrome. It might ring a bell.)

If you're interested in the people side of HR management (such as "why is she getting promoted and not me" and "why does this incompetent person remain employed?"), I love the Evil HR Lady blog and website. She has a way of telling it like it is in a frank but not hurtful manner. Recent posts include "The secret to gaining more career bargaining power" (here), "How to survive a vindictive boss" (here), "Why are you staying in that terrible job" (here) and "How to mess up a salary negotiation" (here - it is about a case in academia but has valuable information about other settings as well). 

For more information on project premortem (with simple translations to career premortems), please refer to "The Premortem Technique" by Olivier Serrat of the Asian Development Bank.

From HFM Magazine

Logo_mainBelow are a few articles from recent issues of HFM magazine (the monthly magazine of the Healthcare Financial Management Association) that caught my attention. All articles linked require login.

A framework for managing risk-based managed care contracts (article, December 2013) This article discusses the operational, competitive and financial risks associated to the patient population, the use of patient care management to manage operational risk, the competitive risk that may arise when boundaries between payers and providers are blurred and tactics to manage financial risk beyond malpractice and stop-loss insurance.

The new break-even analysis (article, December 2013) While the idea of questioning the assumptions that underlie break-even analysis will not strike analytics professionals as particularly groundbreaking, it is certainly a novel suggestion in healthcare finance, where quantitative tools are more recent. The article also has the added benefit of providing a detailed list of healthcare-specific factors that decision-makers should consider in their analysis, such as service on medical equipment and length of stay (especially when a new technology has the potential to decrease length of stay by an unknown amount). It is also important to consider patient demographics and competition to assess new capital investments. Finally, the article provides simple, illustrative examples for joint replacement technology investments and prostate surgery technology. 

Collaborating with payers to deliver value (article, October 2013) I liked this article for the sidebar on Mountain States Health Alliance or MSHA, which I have been researching as part of my research. MSHA is the majority owner of Integrated Solutions Health Network, a regional health solution company, through which it has created a self-funded insurance plan, its own Medicare Advantage plan and an ACO called AnewCare Collaborative.

The structure of value (article, January 2014) The author recommends the following: compelling vision, alignment of cultures between partners, early wins, measurement of patient and staff satisfaction both before and after initiatives are implemented.

Developing an exchange strategy (article, January 2014) I was very impressed by this article, which advises (1) "understanding how both the public and private exchanges work", (2) "conducting a thorough analysis to quantify how exchanges will affect the organization's current and future patient populations and revenue base" (what the author refers to later as "anticipating changes in the payer mix", on the grounds that "in many states, a greater proportion of exchange enrollment is projected to originate from commercial lives than from the uninsured"), and (3) "determining when to participate in the exchanges, keeping in mind current market position as well as competitors' exchanges."  

HFM magazine has many more fascinating articles in each issue that are must-reads for anyone interested in current practices and trends in healthcare finance.