What Bloggers Really Hear

When bloggers hit submit on their first post, we all hope for comments about how thoughtful and introspective we are, how clever our animal husbandry and colonoscopy imagery is, and that the Huffington Post begs us to be their new featured writer. Actually, we really hope that we just meet some like minded folks who also think that colonoscopy jokes are hilarious and perhaps find a community. Instead what we usually get are messages like this:

Hello, This is Shiela from bestdogfoods dot org dot uk. We stumbled on your blog while searching for Best Dog Foods related information. We operate the largest Best Dog Foods website featuring more than 30,000+ blogs. Our site averages 200,000+ unique visitors per month. Based on your blog's popularity and other factors, we have featured your blog at bestdogfoods dot org dot uk dot bogus link. We would be grateful if you could add the following details to your blogs main page. Looking forward for your confirmation. Thanks Shiela bestdogfoods dot org dot uk P.S. If You Have More Quality Blog We Can Feature Those.

Contrary to Shiela's claim, my blog was not featured on that page. I also am completely convinced that Shiela repeatedly spelled her own first name wrong. However, Shiela did inspire me to provide insight into the blogging world by sharing the utter garbage that people email me. Since I have no other ideas for a post and really want to have 4 posts this month, I'll subject readers to a true blogger navel gazing post. There is nothing that bloggers like more than to write about the thoughts behind their thoughts. Like Lebron James, once you start uncensoring yourself, it's really hard to stop (I mean, Lebron, you really thought that your league contraction idea as a solution to oppressed super stars who have to play in Minnesota wouldn't make you look like even a bigger dick?).

Here are some of the really bad short-sighted ways that people interact with other bloggers (like me):

The disingenuous link offer: One of the easiest things to do is ask someone to link to each other's blogs. You express some genuine interest, demonstrate that you read their blog, and offer to exchange links. Having a first name that seems real and spelled correctly is an added bonus. The part that turns a simple exchange into a really low stake scam is when the soliciting blogger never links the other blog. Hospital dot com is the biggest offender as they repeatedly offered me the link exchange but have no obvious place on their site for links.

The comment disguised as an excuse to link: Masters Dissertation dot co dot uk has left flattering comments under the name "Marketing dissertation" and "MBA dissertation" with links back to their website in the comment. My post was "informative" and they had "not found any proper resource for their research" until they read my post about how MBA guys should try to score at the Veterinarian Graduate Programs due to the favorable female:male ratio. I published the first comments as I was properly flattered but after the 4th or 5th time, I just felt like the girl at the bar who was hearing a bad pick up line.

Teeth Whitening is also guilty of this approach but even more guilty because they don't even try to use a name that remotely disguises their intent.

The urgency to link or write about comment: There's nothing like getting a request to link or provide some publicity that accuses you of ignoring their previous multiple attempts to get your attention. I supposed some might feel guilted into acting but I figured that if I ignored them and couldn't even remember ignoring them, it couldn't have been that important. The oddest part was that Team USA was using this approach during the last Winter Olympics to raise awareness for athletes. I guess that's what people mean about organizations that don't understand social media.

The crappy guest post offer: I've received a few emails from the writer of accredited college online dot com for guest post services. However, the sample articles that the writer sent included "100 tips on how to raise a brilliant bilingual baby" with a first tip of "Speak another language at home." I had visions of a guest post on "100 tips on raising a goat" with a first tip of "Find a male goat and a female goat and get them horny". Get it, the goats are horny? Horns and horny? Get it? Hmm, I think that I might have an idea for a guest post for that writer.

All of these short sighted techniques that bloggers use to get a little bit more traffic obscure actual legitimate interactions and community building. As a result, I was completely skeptical about the one email that I got where the person was truly interested in paying me to advertise. I was even more stunned when they proved to be legitimate and actually did pay me. Thus, I can claim that I actually have monetized my blog.

However, most of these attempts show that there are not a lot of smart people working on web advertising and the competition is never so intense when the stakes are so low. Now, I am going to try and complete my 100 tips for raising goats. What do goats eat anyway?

My Predictions for the Health Care Industry in 2011

It's the holiday season which means it's time for holiday parties, left over money in the company budget is blown on work parties, lots of food, plenty of excuses to drink alcohol, and lots of nostalgia. For bloggers, this means guaranteed blog topics either in a form of 1) a review of the year that was or 2) predictions for the next year. I have a tradition of making conservative predictions. Last year there was a trend for bloggers to dismiss predictions as so last year and boldly proclaim that no one can predict the future. Really? Is that the best that you can do? Are you going to tell me that bears poop in the woods (and wipe their butts on the the rabbits) and "refudiate" isn't really a word?

With that introductions, my non-refudiable 2011 health industry predictions are:

1. Hospital Executives will be the next set of CEO's to be hauled in front of Congress: and struggle to take their inquisitors seriously. I mean it's probably tough not to laugh at the histrionics of some of the members of Congress, let alone not stare at Henry Waxman since he's so funny-looking. Or want to ask Dennis Kucinich if he wants to sit on your lap and tell you what he wants for Christmas.

However, hospital executives will have to practice refraining their giggles as recent articles have pointed out how some hospitals are so dominant that they can paid above market rates by insurance companies. Another article pointed out that California inpatients hospital costs have increased 150% (or 11% annually) since 2000. The best defense that hospital executives could muster in response to these articles was "the data must be flawed." That's not much better than a response of "So's your face." Hospital costs (and accompanying specialists) make up at least half the health care dollar and are growing too fast not to be identified as key driver of runaway health care costs. While the insurance companies have received the most public scrutiny this year, next year it will be on like Donkey Kong for hospitals.

2. Despite state budget woes, Medicaid will continue to grows: I wanted to pick a word that rhymed with woes and couldn't figure out how to use toes. Since 2007, the number of Medicaid recipients has grown 16% nation-wide to 50 million. In Oregon, it's grown 25% in the last year. This growth doesn't even include the projected 16 million new Medicaid enrollees in 2014. This isn't going to change in 2011 since the states are getting larger matching funds from the federal government. Every $1 the state spends brings $1.60 from the federal government. Medicaid is still one of the best ways to arouse, er no, stimulate a state economy.

3. Everyone gets more comfortable with Medicare Advantage: Despite becoming the ginger-headed step child of government programs, a lot of reform provisions are borrowed from Medicare Advantage. Risk adjustment based on health conditions in the Exchanges is from Medicare Advantage. Open Enrollment periods are being used for individual insurance for those under 19 years of age. Currently, seniors are in the middle of the November 15th-December 31st Annual Election Period for Medicare Advantage. One of the crankier bloggers who doesn't like health reform (or much of anything) sees open enrollments as good replacement for an individual mandate that will likely be challenged in the Supreme Court. The senior citizen model for health insurance is quickly becoming the market norm under health reform only with slightly better shoes and a mobile phone app.

4. Health Care Costs will actually decline: Earlier in the year, there was discussion of reduction in the Pentagon budget. What they really mean was not an actual budget cut but the budget just wouldn't increase as much as it typically did. Rather than an increase of 3% in the budget, the increase would only be 1%. Until Robert Gates took a dump in the punch bowl and announced that there would be an actual budget cut complete with negative numbers.

This situation was pretty similar to health care costs where the holy grail was an increase that merely matched inflation. This may be the year that we see an actual cut. The money that insurance companies are inhaling from businesses like a frat guy sucks on a bong is about to get bogarted. The canary in the West Virginia coal mine was the Connecticut's Insurance division rejection of Anthem's 20% rate increase for individual plans and a counter offer of 0%. The rejection of rate increases is likely to become more common. Providers are likely to get similar treatment if the "budget" or health insurance revenues are frozen like a Siberian winter.

For the record, Senator Lieberman expressed disappointment at the Connecticut Insurance Division's decision because he saw a great opportunity to be a dick wad.

5. There will be more consolidation in the health care industry. This prediction is to absolutely guarantee that I get one of these right. Predicting consolidation is as safe as predicting that your human resource department will do something aggravating. There has been annual consolidation in every industry from health insurance to Thai food carts since the 12 tribes of ancient Israel were consolidated in 10. Even ancient Hebrews understood economies of scale and market power.

Figuring out how to Write Objective Statements on Resumes

One of my annual blog posts is a review of the resume objective statements written by graduating class of Wharton Health Care Majors. Analyzing objective statements has been a hobby of mine for a while as I made fun of my classmates objective statements during our end of the year banquet. Some feel that I may need new hobbies and probably some new friends given one of my hobbies is to alienate my classmates/friends. However, a self-deprecating sense of humor goes a long way and it's my blog so I get to pretend that I'm funny.

First the disclaimer. The people for whom I am about to make fun of (Wharton Class of 2011) are orders of magnitude smarter than me. From looking at their pictures they are also really really really ridiculously good-looking. No one in my organization lets me even pick a lunch place, let alone make a hiring decision, so what I wrote should not be considered to be actual career advice.

Allow me to elaborate on the Wharton MBA Resume Objective statements:

So you're telling me that I have a chance: In previous years, students had grand visions of requesting "strategic opportunities" or "leadership opportunities". This year, everyone was more humble with requests for a simple "opportunity". One student trumped all as he was looking for a "strategic leadership opportunity." No one has raised the stakes like consumer goods companies raise the number of razor blades with a 3rd adjective prior to opportunity. Nor went for complete honesty by requesting an opportunity "that doesn't suck monkey balls."

Ask not what your company can do for you: Actually, this year's students are telling their companies what they expect of them. Many students use their objective statements to tell companies that they are looking for "entrepreneurial" or "innovative" places to work. Luckily all the established highly bureaucratic Fortune 100 companies that mostly hire at Wharton don't seem to be too worried. Some want their teams to "high quality". One person wants their company to be both "entrepreneurial" and "pioneering". Upon checking this person's resume, I was disappointed that they did not work for the pioneering company that develop the educational game Oregon Trail. One person was just looking for a company that was "promising".

Does anyone remember how we originally used the word leverage? The word that appeared most often in everyone's objective statement was "leverage." Everyone was looking to leverage something whether it be their scientific and business background, their leadership experience, or just leverage their levers. I can't argue with the whole idea of leverage. Whenever I go to the bathroom, I try to leverage my trip and do both number one and number two. I try to leverage my hand washing, too but my wife doesn't seem to appreciate it.

Some in this class actually figured out how to write an objective statement: My biggest surprise was not how good-looking all the students were (seriously, did they air brush the picture or are people in their 20's really that much better looking than the general population?). The surprise was that a number of students wrote really good objective statements. They didn't fill the objective statements with unnecessary adjectives that really just say "doesn't suck monkey balls," or hedge every career opportunity. Some figured out how to write an objective statement that provided succinct and relevant information to a future employer. Most used the word "leverage" but there's definitely worse words to use (like "create value").

The best objective statements simply said "An opportunity to leverage my X background and Y background." It's elegant, simple, and relevant. It tells the employer their industry background that they're looking to build off. It shares who they are. After seeing this solution to an objective statement, I realized that they might just create strategic value in an impactful resume. Argh, must stop reading resumes. I am going to strategically go to the bathroom and try to leverage the 2 remaining squares of toilet paper.

Judging WikiLeaks: Amazon and PayPal's Glass Houses

It's safe to say that the story of WikiLeak's posting of diplomatic cables or what happens when diplomats stop being nice and start getting real is as ubiquitous as Leslie Nielsen quotes. WikiLeak's actions have triggered government investigations and lively debate about the role of news organizations and democracies. WikiLeaks creates extreme discomfort and operates in shades of gray as it forces us to deeply question the definition of freedom and role of government. Personally, I like my government like I like my negligees which is transparent. However, this debate is far from clear.

What I think is clear is Amazon and PayPal's role in the WikiLeaks story. PayPal dropped WikiLeaks as a customer which cut off their primary way of receiving revenue. Amazon kicked WikiLeak off their servers because Senator Joe Lieberman complained. Both companies judged WikiLeaks before any judicial body had made a decision and put their political and possibly ethical opinion above shareholders or the traditional role of a business.

The role of business in society is the subject of a few lectures in the required business school ethics class. One side will claim that shareholder value trumps all as business' prime purpose is profits not societal change. The other will claim the business needs to support its communities and there is a return in investing in society. Businesses have also become intertwined in politics in positive ways such as the boycotts of oppressive regimes and as corrupting forces by pumping money through PACS and lobbyists.

However, PayPal and Amazon's role is beyond a business decision to invest or even endorse a particular position. Their actions were similar to blockading a harbor or funding rebel troops. PayPal's blog claimed that cutting off WikiLeaks' account was prompted by a violation of the service provider's policy, "which states that our payment service cannot be used for any activities that encourage, promote, facilitate or instruct others to engage in illegal activity." Comments on this PayPal blog post are closed. However, one can freely comment on the Pay Pal blog post "Tips for Safe Selling this Holiday Season".

I find it perplexing that PayPal seems to have decided that WikiLeak's engaged in illegal activity when no court has convicted WikiLeaks. Considering the scrutiny of financial institutions and new regulations, PayPal may find themselves convicted of committing illegal activity before WikiLeaks. I had a recent phone conversation with their outsourced India-based call center about fees that I was charged on a transaction that were not disclosed clearly. When I asked them who their regulatory agency was, they had no idea.

With regards to Amazon responding so quickly to Joe Lieberman's complaints, I have to say, seriously? Lieberman is an old east coast orthodox Jewish guy which means he complains 30 times a day by definition. Amazon's customer service is probably on a first name basis with him over complaints about how his last order, Big Dick Cheney, turned out not to be about the former vice-president.

In reality, both companies probably caved into political pressure faster than the Kardashian's update their twitter posts. I just hope that they at least got a good deal for selling their souls and advancing well beyond the normal role of business in politics. Because people in glass houses should change their clothes in the basement.

Wharton Admissions to use Behavior-based Interviewing aka Late 90's Human Resource Innovation

During my latest perusal of my Wharton alumni news, I noticed the following excited announcement:

"This year Wharton MBA Admissions will be taking an innovative new approach to our admissions interview by implementing a behavior-based interview."

It also included offers to train interested alumni on this technique. Behavior-based interview was a late 90's interview technique based on the theory that past behavior is a good predictor of future behavior. However, the whole premise that the past is an indicator of the future is what destroys a financial firm every 10 years.

Additionally, this provides another example of how social psychology studies tend to provide statistically significant proof of blindingly obvious human behavior. This behavior prediction model is on par with the study that stereotypes truly do impact our perception of others. Thus, the stereotype of the Fed Ex MBA is still appropriate. The reason that we have stereotypes is because they are usually true.

However, I digress. One applicant described their experience with Wharton's behavior-based interview and included specific questions. Generally, a behavior-based question asks about what you did in the past in response to difficult situations and what the results were. For example:

"Tell me about a time where a coworker told you that monkeys would fly out of their butt before they agreed with your idea. How did you respond, what did you do to get them to support your idea, what were the results, and did a monkey actually fly out of an orifice?"

I think that a behavior-based interview mainly measures how well someone answers interview questions. I have seen many an interviewee somewhat rightfully respond that they truly can't think of a time when coworkers told them that that their idea was on par with animals flying out of people's orifices. However, they would be happy to answer questions that were more directly related to the job that they were applying for, such as what is their experience developing a marketing plan.

Therefore, why did Wharton switch their admissions interviewing? This could create more conspiracy theories than Chemtrails. My ideas are:

1. They wanted to do it before Harvard or Stanford in order to not look like they just follow whatever those schools do. While intended to be a joke, this is actually probably a likely factor in the decision.

2. Their current interview technique was not yielding enough relevant new information. This is probably the main answer. Wharton, and most school's current interviews, are conversational with the idea of gleaning personality behind the paper application and selling the school to the applicant. There's only so much you can learn from an interview that is more of a victory lap for the applicant and the 30 minutes interview has limited effectiveness with convincing an applicant to turn down Stanford for Wharton.

This is the same reason that schools tend to change essay questions. The "describe an ethical dilemma" essay did not root out future rogue traders or peddlers of now toxic assets but just produced standard responses. Thus, schools dropped that essay.

Harvard actually has a rigorous interview technique where they review the application and ask follow-up questions on the essays. For example, one of my friends described in an essay how they wanted to invest in businesses with a similar business model as our local organic grocery store chain that promotes living wages and sustainability. When the Harvard interviewer grilled him on the grocery stores' wage and benefit structure and ROI on sustainability, he almost caved and responded with, "I just like the grocery store and wanted to make it seem like I think about business models while trying to figure out if I should buy local carrots or organic ones that were shipped from developing nations." As a result, Harvard gets a lot of differentiating information from applicants during the interview.

3. Wharton is trying to figure out which applicants interview well which will help Wharton's job placement statistics and ranking in magazines. Since behavior-based interviews mainly measure how well someone interviews, Wharton can screen out candidates that are not as good at corporate interviews. Thus, they will create a class that is better at getting jobs.

This is more of a conspiracy theory since MBA programs spend a significant amount of time training its students on how to interview well. Students tend to be smart enough to figure out how to answer these behavior questions and prepare enough stories in advance. I am pretty sure there's a social psychology study somewhere that proves this.

My Society of Insurance Research Presentation: The Business Opportunity that Health Reform Created

Some eager followers of Roll Away the Dew may remember that 2 weeks ago, I presented at the 40th Annual Society of Insurance Research (SIR) Conference in Jacksonville, FL. Other eager followers may still be recovering from Thanksgiving and that pumpkin cheese cake so everyone's mileage varies. Linked below for everyone's powerpoint pleasure is my presentation on the business opportunity that health reform created for Medicaid. I'm trying to figure out a catchier slogan that have the acronym of "SIR GALAHAD" or "TRON" but am having trouble.

SIR Medicaid Opportunity Presentation

View more presentations from dongrunt.

For those who may not plan to peruse all 13 dense slides, the cliff notes are as follows:

• Medicaid is going to become a larger insurance market. By 2016, almost 1 in 5 Americans will have Medicaid compared to 1 in 10 with individual commercial insurance or 1 in 8 with insurance through a small business.
• Market impact varies by state much like the Thanksgiving stuffing.
  
• States that are complaining about budget impact are not talking about how the federal government will pay for 100% of the new Medicaid eligibles from 2014-2016 and 90% of the cost for 10 more years.
• These post 2014 Medicaid eligibles will be very different than the current Medicaid eligibles. New eligibles from reform will be mostly adults, be working poor, and have successful experience managing their own health. The main difference between this new pool of Medicaid eligibles and a blue collar service union group is the union membership.
• Provider partnerships and financial arrangements will have to be different and no longer rely on the number of physician visits as the vehicle for payment. Reimbursement needs to focus on care teams, long-term partnerships, and reward medical management. Federally Qualified Health Centers (FQHC) provide an excellent opportunity.

At the end of my presentation, I had convinced a very Liberatarian crowd who had this view of government to give Medicaid a different look. My next step is convincing my employer to invest in these ideas.

As far as the rest of the Society of Insurance Research conference, it was a very interesting event with compelling speakers that had some great analysis of the segments of people who buy property and casualty insurance. Plus, at what other conference do you find yourself exclaiming how those property and casualty folks really know how to party?

The MBA Admissions Consulting Season in Review

About 7 posts or 2 months ago, I had threatened to hibernate due to the upcoming MBA admission consulting season. Round 1 deadlines have long ended and most applicants have some idea of their fate or at least the fate of their MBA applications.

Here is what I can share about the 2010 admissions seasons in review:

• Clients are asking a lot more questions: I could no longer pass myself off as all knowing and all wise merely because I had successfully applied to business school during an era when AOL email addresses still had significant market share. Clients questioned my lack of focus on the importance of grammar or why one of their stories showed personality while another was just pontificating like a Harper's essay. While I would prefer that clients think I was wise and all knowing, I gave them a lot of credit for some of their questions. Since I was always very deliberate with my feedback, I usually satisfied them. For anyone considering working with an admissions consultant, I would invite questioning and scrutiny of the consultant's analysis up until a few days before the deadline. However, once you are that close to the deadline, the scrutiny looks like resistance to submit. There is also greater risk of rewriting your drafts in a late night flash of apparent brilliance that does not look as good in the morning light.
• Admissions really has a holistic approach: Clients who work in more technical areas have projects where every line of code or test scenario matters . The admissions process is much more of a big picture with broad brush strokes. That's why grammar doesn't really matter since the admissions review won't get at that level of detail. Admissions truly uses an 80/20 review process where they glean 80% of the necessary information from 20% of the application. However, what that 20% of the application includes will always vary based on the applicant so there is no formula to capture it. Main takeaway is to focus on larger themes in essays and not ponder punctuation.
• I now know how recommendations do not matter: In my previous posts, I have classified the recommendations as the most useless part of the application. Writers and applicants spend a disproportionate amount of time based on the value that they contribute. I would climb up on my bully pulpit (aka this blog) to urge schools to reduce the amount of effort it takes to complete them. However, from reviewing some recommendations, I now understand their role. They are supplementary to themes in the essay. Recommendations can really bring some of your characteristics to life and help admissions really see what an applicant is truly like. However, they will not add anything that's not already in the essay or they won't be be believed. They're basically like the movie version of the book. The book is always better and if the movie doesn't follow the book, we just assume excessive artistic license.
  

Relationship between Hospitals and Health Plans: Strange Bed Fellows are Getting Stranger

The relationships between hospitals and health plans has been fairly simple. It's all about exclusivity and the payment. Health plans would ideally like a discount for an exclusive relationship but may pay more for an exclusive relationship with the right hospital. That relationship can directly bring more business to the health plan because potential members may really want to be able to access care at that hospital. Additionally, a benefit design that provides limited or no out of network benefit can really accelerate membership growth for a health plan.

Hospitals tend to focus on payment first since they have higher fixed costs and don't have vehicles like a benefit design to drive business. Exclusivity or limited exclusivity is also a goal in hopes that their beds will be filled primarily with the members of well paying health plans. However, as I found with recent discussions with hospitals, it's secondary to payment. Their negotiating levers are limited. As a result, hospitals are mainly looking for the attractive partner first and if it turns into a beautiful relationship where they cook and remember each others birthday, that's a bonus.

Some hospitals and health plans work out a favored nation status with each other like the Michigan Blue Cross plan and area hospitals. Under this arrangement, the hospitals gave Blue Cross the guaranteed best price for any health plan. In relationship terms, that's like getting her agreeing to get together in the back seat of a Volkswagen. The Justice Department is calling that anti competitive behavior in its law suit against Blue Cross.

The result could shift the traditional health plan and hospital relationships. Both businesses have been growing so large in certain geographies that it's becoming hard to avoid anti competitive behavior. In 24 states, 2 or fewer insurance companies control 70% of the market. In some local markets, hospital systems like Sutter in Northern California or St Charles in Bend, OR can demand the best rates and don't have to worry about exclusive relationships (or using protection). AHIP, the health plan lobbying group, is continuing its bid to be the least effective lobbying organization by releasing statements over concerns of the anti-trust implications of Accountable Care Organizations (ACO's). Despite the logical and appropriate payment model of ACO's, AHIP is too concerned that it will give providers more market power.

As a result, the times are right for new thinking about the hospital and health plan relationship that doesn't mirror primal urges. With both industries teetering on the edge of an anti-trust law suit, the problem may be solved by others if hospitals and health plans don't come up with a solution. Personally, I think that focusing more on the exclusivity in the relationship could be the answer. ACO's create an opportunity for a long-term partnership and could (but not likely) be structured where there can be only one hospital or one health plan in this three way with primary care providers. Health plans and hospitals with similar market segments, philosophies or levels of quality might pair up and find more synergies pursuing common customers.

This is basically a model similar to Kaiser Permanente and closed systems only have historically had limited appeal. However, history is changing and it may be time to stop basing the relationship on how many dollar bills are required to be thrown on stage.

Roll Away the Dew is Speaking at the Society of Insurance Research Conference

It's road trip time at Roll Away the Dew. Well, actually it's just a plane trip with a connection in Altlanta, on the way to Jacksonville, Florida where I will be speaking at the 40th Annual Society of Insurance Research Annual Conference (SIR A.C.). Did you know that Jacksonville is the largest city in terms of square milage in the lower 48 states? That actually sounds horrifying me to as an example of uncontrolled urban sprawl that we don't see here in Oregon with our Urban Growth Bounderies. However, I did hear very positive things about Amelia Island and Florida in November is not something to look down at.

Readers may be wondering what Roll Away the Dew could pontificate upon for 45 minutes. How many colonoscopy or animal husbandry jokes will the speech include? Will the inmate and asylum analogy continue? Will familiar topics of MBA's behaving badly be broached or will this be a pure health care focus on the strengths of the Medicare Advantage program, the dysfunctions of the Individual insurance market, or the future of Accountable Care Organizations? Will the words, MediCAID for all be uttered and for those guessed this topic, you know Roll Away the Dew way too well!

Actually, I think that I need to make a "MediCAID for All" T-shirt for the conference. I will be speaking at the newly created Health Insurance track for the Society of Insurance Research. My topic will on the business opportunity that health reform created for Medicaid managed care companies. If there is a health care organization that can afford to ignore a market that is going to almost double then I want to see your business model. That's because that health care organization must be performing at a very high level in commercial, Medicare, individual, self-funded or other aspects of health care to be able to ignore 25% of the market.

If you want to hear more about my presentation, come to Jacksonville, Florida from November 14th-17th. I hear that the Property and Casualty insurance guys really know how to party. Another option is to just wait until after the conference when I'll do a full postmortem on my site.
Before I do that, I think that I really need to make myself a MediCAID for all T-shirt.

Seeking True North or How to Talk like an MBA

I graduated from my MBA program at the tail end of the dot-com/corporate scandal/Not so Great Recession of the early 'oo. As a result, I interviewed a lot and got to hear a lot of corporate jargon. Most jargon was a harmless way to avoid being specific about any answer. MBA's, including graduates of online MBA programs, pick this up to show they understand corporate code. The only insidious example was during my interview with The Advisory Board Company (ABC).


The ABC is very serious about their corporate jargon to the point it's used to brainwash employees. Every employees' answer to a question ends in an inflection? That is because ending in an inflection makes you sound curious? And interested in what everyone is trying to say?

The most egregious example was my interviewer's answer to my question of "What would you say the ABC company does best or how would you distinguish yourself from other consulting companies?" I admit that my question was a little obnoxious but I had already written off ABC as a likely employer and wanted to have some fun.

"We are best at finding true north?" my interviewer inflected back. I dug my nails into my thigh to keep from laughing. True North was a popular corporate cliche at that time that means finding the right strategic direction. Or finding any strategic direction. Or any direction and if it's actually strategic, that's a bonus. It merges on saying that ABC can predict the future on a high end or like saying they were really best at peeling the onion or kicking the tires on the low end. As Damon, from the HBO TV series Hung said, "All that you get when you peel the onion is more onion."

With that back story, I would like to share a recent column that has some of the best corporate jargon that I have seen in a long time. Here are my favorites from the link above:

End of the Day
Formerly 5 to 5:30 p.m., now defined as an uncertain point in the future when everything magically turns out okay. Example. "At the end of the day, the pollution in the groundwater may just drain into the earth's core and become unnoticeable."

Space
Industry or field. Example: "I'm in the manufacturing space," "I'm in the waste disposal space," "She's in the adult film space," or "He's in the space exploration space."

Can't Wrap One's Head Around
Unwilling to get into the details or deal with the facts; intellectually lazy. Example: "I can't wrap my head around all this recycling business; Let's throw everything in the dumpster behind Home Depot and let them deal with it."

You will also talk like an MBA, especially if you remember the inflection in your voice?

The Guards take over the North Gate: The battle for the Asylum of Health Reform Rages On

In the battle for the implementation for the first provisions of health reform, I will continue to beat my inmates battling for control of the asylum analogy like an actual inmate probably used to be beaten in an asylum. In the latest battle, the guards or the government agencies like the Oregon Insurance Division have beaten back one of the craziest inmates.

This inmate in question is Lifewise of Oregon, a subsidiary of Premera, the Washington Blue Cross/Blue Shield company. Lifewise typically acts like Oz's Ryan O'Reily. They don't look very strong, kind of wiry, but are devious and will not hesitate to do whatever they need to win. Lifewise's interpretation of guaranteed issue for children 19 and under or no longer denying coverage due to pre-existing conditions was that they could wait until September 2011. However, the law states that this provision must go into effect September 23, 2010. The Oregon Insurance Division informed Lifewise that all new sales of individual insurance plans would be suspended until they complied with the law. Lifewise also needed to comply by the end of October so they could participate in the first open enrollment period for children 19 and under.

Lifewise's defense was "that it is in alignment with the “good faith” provision of the U.S. Department of Labor FAQ (dated 10/8/2010),which provides issuers a reasonable period of time to come into compliance with the requirements of the Act". In other words, they would be happy to comply but would do it later. This is the same defense that young children use to avoid cleaning their room, high schoolers use to avoid doing their homework, and college graduates use to avoid moving out of their parents' house. I think that only college graduates are moderately successful with this defense.

Technically, Lifewise files their individual plans in September which is why they though that they could wait until September 2011. They planned to continue to deny coverage to children under 19 with pre-existing conditions until that date. However, there is nothing in the law or general field of logic that supports this conclusion.

Forcing an insurance carrier to not flagrantly disregard a health reform provision should not seem like a victory. However, if Lifewise's behavior was allowed to continue much longer, it would have been much worse. It would have provided every other insurance carrier with a complete disincentive to comply with health reform or made the future riots even worse.

Riots in the Asylum: Part 3 of the End of Pre-Existing Conditions for Children

When we last left this series of health reform implementation gone wildly badly, it looked like the inmates had built a roof top hot tub and organized a spa day. The state insurance divisions appeared to be overwhelmed trying to set up a system to ensure that insurance carriers would provide insurance for those under 19 without denying coverage to anyone with pre-existing conditions. This is also call guaranteed issue for children.

Insurance carriers had been defining their own rules or not participating. It had gotten even worse as insurance carriers started introducing perfectly legal ways to charge people even more money for insuring children in response to this legislation. This new method was to change the "underwriting tier" or how they classified the price based on the type of family unit that was applying. Most insurance carriers have a family tier that is the same whether a family has 1 child or 12. Only 5%-10% of families have even more than 2 children so it's not like John and Kate + Eight are getting a free ride. However, insurance carriers announced that they would no longer offer a family tier but would now charge families per child. When one thinks of Jon and Kate + Eight or OctoMom, this doesn't sound like a bad idea. However, for a family with 5 children this could triple the amount of money they pay for health insurance.

Regence Washington announced this change and attributed it to health reform. While nothing in health reform was related to underwriting classifications, it did cause insuring children to become more expensive. As a result, insurance carriers are moving away from any pricing strategy that makes it attractive to provide insurance to children. This probably represents the peak of the inmates' control over the asylum and showed just how many perfectly legal strategies they could deploy to not support guaranteed issue for children.

However, the insurance divisions sent in the riot squads, cut the electricity, drained the hot tubs, and poured out the exfoliating cremes and cucumber wraps from spa day. In response to Regence's Washington decision to stop selling child only policies, the Washington Insurance Division charged them with age discrimination. The California and Maryland state legislatures have introduced legislation to require insurance companies to offer child only plans. It's gearing up to be a siege on the asylum.

However, given how easily insurance carriers have short-circuited this legislation, I am not optimistic that the guards will regain control. The hole in the logic of any of the state insurance divisions or legislators, especially Washington's, is that the child only plan was an invention of the insurance industry. When insuring children was an attractive prospect, insurance companies developed new ways to insure them. A child only policy is not an inherent right of citizenship (except in Ohio, New York, and Virginia where this was mandated into state law a while ago) but a private sector innovation.

When the courts would probably rule in favor of the inmates, the Obama administration might need to rethink it's health reform implementation approach.

Oregon Health Insurance CEO Forum: Lame and Lamer

Last year I attended, the Oregon Health Insurance CEO Forum and noticed some excitement in the air around some new developments such as cost transparency, value-based benefit design, and the importance of caring for children. This year, despite their very industry being turned upside down, they talked about popular health care topics from the 80's and 90's. That was the lame part. The lamer part was four CEO's including the CEO from local Blue Cross, Regence, which used to have the largest market share, didn't attend. Considering the unpopular decisions their plans were making around not providing access to insurance for children, it was not very likely that their absence was because they were receiving humanitarian awards elsewhere.

First, the Lame:

• The popular topics from the 80's were around capitated arrangements with providers where the primary care physician manages medical costs and how 10% of the population uses 70% of health care costs. The Cigna Northwest Region CEO, Chris Blanton, still wanted to talk about how employer groups should play an active role in driving health insurance change. The only thing that was missing from his 90's flashback was flannel as employer groups are either currently pushing the innovation to the limits of what their employees will accept or scrambling to understand the post-health reform environment.
• To further underscore the stock shorting performance of Cigna's Blanton, he did a poor job of hiding the smirks on his face when questions were asked such as what did everyone think about Health and Human Service's (HHS) assessment that health reform would only increase insurance prices by 1%-2%.
  
• Robert Pallari, the former CEO of the Portland-based Legacy Health System and architect of the Oregon Health Plan was the moderator. He was also formerly colorful and bombastic as he lobbed soft ball questions like "Look into your crystal ball and tell me what you see in the future?", "How will health reform influence your organization", and "What type of partnerships are you pursuing with providers?"
• Actually Pallari did blatantly insult the Kaiser Permanente CEO, Andy McCulloch, by pointing out that the Kaiser system has been as much about setting up barriers to health care as it is about providing care. Perhaps, McCulloch was too distracted by Banton's smirking or thinking about who play 3rd base for the Cleveland Indians in the 80's since his expression didn't change at all. Nor did he respond.
• During this forum, the battle for the future of the individual insurance market was raging, the payment process for Medicare and Medicare Advantage is being completely revamped, and the new health reform provisions had been effective for 5 days. Three of the CEO's were trying to decide if their individual plans should remain open to children while Cigna and their Chief Smirking Officer had already decided to close their plan to children. Yet not one question was asked about insurance for children. Last year, CEO's couldn't talk enough about how important it was. I badly wanted to ask the question but I recognized that it would a CLM (Career Limiting Move). Next year, I'll find a plant in the audience to ask questions like this one.
  

There were some bright spots:

• ODS CEO Robert Gootee did have the great line of pointing out that we "can't drink our bath water and call it champagne" about some of the more egregious performances.
• Gootee also called the Secretary of HHS and Middle Finger Extending Kathleen Sebelius by the name, "Kathleen Celibate". That would explain a lot. Actually, I talked with someone who worked at HHS who did vouch for Celibate's er I mean Sebelius's administrative skill. That person also pointed out that just because she has been launching the political attacks doesn't mean that she wrote them or necessarily believes in them. It's just politics.
• My main conclusion from last year's forum was that we should let our children grow up to be actuaries. This conclusion was proven again by the presence of the PacificSource Chief Operating Officer, Sujata Sanghvi, who is a Harvard educated actuary!
  

And the Lamest Aware goes to:

• While the CEO's that did show up gave lame performances, at least they came. Well, Cigna's Blanton could have just sent a 12 year old boy to smirk for him so I don't give him credit for attending.
  
• On the other hand, Lifewise, Health Net, United, and Regence sent no representatives. They all have announced that they are no longer offering child only coverage in the individual market in the last few days so their lack of attendance is probably not a coincidence.
  
• Lifewise's membership has been dropping like acid at Woodstock, Regence has lost their 2 largest group accounts in the last 2 years and 40% of their group enrollment, Health Net is trying to sell itself, and United is well, still United. Given how badly these plans are currently doing, I can't imagine that they would have many great ideas to share. Perhaps it's best that they did not attend.
  

The Inmates have taken over the Asylum: the 2nd step of health reform

When we last left health reform, one of its most significant early changes was dangling over the cliff. Guaranteed issue or the practice of no longer denying health insurance for children under the age of 19 was scheduled to start on Sept 23rd. Health insurance plans or the inmates in this analogy were expected to change their practices but there was a trouble brewin' on the horizon. The insurance companies pointed out that with this provision, children could drop their insurance whenever they didn't need it and then enroll whenever they needed it. This would be expensive and individual insurance could become even less affordable. The Obama administration was so concerned that they gave the state insurance divisions flexibility to negotiate and offer concessions like a limited period of time when children could enroll or open enrollment period.

How did the state insurance divisions and Obama respond in this crisis when it emerged in early August? Late and ineffectively. If they were super heros, school bus would have toppled over the cliff. If they were Austin Powers, they would have been eaten by sharks with frickin laser beams.

Children were supposed to stop being denied insurance on September 23rd. As that date approached, the two state insurance divisions in my area (Oregon and Washington) had yet to issue any guidance or rules to respond to the insurance companies' concerns. In response, the insurance companies steadily began to announce that they would stop offering insurance to children. First, national carrier Health Net, stopped offering individual insurance to anyone. Other national carriers like Cigna, Assurant, and Aetna pulled out of the child or dependent only market. This means that a parent must both pass the health screening and enroll in the individual insurance plan in order to purchase coverage for their child with these plans. In Oregon, the nail in the coffin was when when Regence, the local Blue Cross plan who sells almost half of the individual insurance plans in the state, announced they were leaving the child only market. When there is market uncertainty, the market seeks certainty. The main result of this health reform provision has been the disappearance of the option for children to purchase insurance without a parent.

There was great hope that reform would stop insurance companies from sinking to the lowest common denominator. It was thought that there would be vigorous and clear enforcement by the regulatory bodies that would convince all insurance companies to participate in guaranteed issue for children under fear of fines, exclusion from future opportunities, or even sharks with frickin laser beams. The biggest fear that insurance companies had is that they would be the only ones participating, receive a disproportionate share of unhealthy children, and be at a competitive disadvantage that they couldn't recover from. This fear was not allayed.

Instead, the Obama administration and Health and Human Services (HHS) did not provide sufficient support and guidance to the state insurance divisions. The state insurance divisions to not have the resources nor bandwidth and were overwhelmed by the issues with this implementation. Insurance companies filled this leadership vaccuum by announcing their own interpretations and intentions for how they would implement guaranteed issue.

The Washington and Oregon insurance divisions finally issued draft guidelines on open enrollment periods and other provisions that would apply on Sept 23rd which was the day that they were supposed to be implemented. Insurance brokers have reported that some insurance carriers like Lifewise, don't intend to comply until Sept 2011 when they have to refile their plans. However, that's actually fairly irrelevant since the insurance division haven't been able to provide guidance and ensure compliance for the insurance companies that have expressed an interest in following the rules.

I had higher expectations for reform then this.

Hibernating for the MBA application season

All my faithful readers (Hi Mom, Dad, Halley, and Uncle Danny!), have noticed that my blog posts have slowed from their raging torrent to more of a trickle. That's because MBA applicants have started to work on their applications and it's been a busy start for admissions consultants. Therefore, I've decided to declare some form of hibernation for this blog while I spend the next month or two shredding essays on leadership, teamwork, and other lofty MBA goals, words counts, and the occasional self-esteem of the future MBA class of 2013.

The application environment has shifted as more candidates are using some sort of skilled or professional reviewer. This does not mean that everyone is using admissions consultants or an applicant is at a disadvantage if they do not. I don't use anxiety to sell. What it does mean is the days of sending your essays to your parents to review for a comma adjustment here and there are done. There is enough information on the web and people can access skilled reviewers. As a result, essays are consistently more coherent, tightly written, and better answer the questions.

In order to not leave applicants or readers lost and without any guidance in my blogging hiatus, here are some tips that I can share about the early MBA application season:

1. Current MBA students typically give bad advice: MBA students are focused on being accepted by employers and have forgotten what they did to be accepted by business schools. Business schools look for different criteria than employers. Employers like to hear business jargon, a detailed explanation of your investment philosophy, or your strategic planning capabilities. MBA programs want to hear about how you will be a contributing member to the class in your essays. Every MBA question is some variation of "Who the f#ck are you and why do we care?" not "Here's a case study. What framework would you use?"
   
2. MBA admissions look at work history and academic performance to guess how smart or successful you will be. Therefore, the essays are for describing you as a person. If your hopes, dreams, rises, and falls in your essays all center around leveraging your life mission towards creating organization value that maximizes risk and return, you either have been very focused on an MBA since you were 12 years old or will come across as a complete tool. Or more likely, both.
3. Achievements move the essay along but are not the primary focus. MBA applicants have generally been very successful compared to their peers. As a result, most of their interviews are more like victory laps where they expect questions like, "Really, tell me what you did next! How did you escalate the project plan to achieve the next milestone?" MBA admissions want to know what that achievement actually meant to your personal development and the emotional connection should be slightly more developed than "Everyone appreciated my contribution." The focus is how the achievement shaped you in to who you are today and not about admiring it like a wedding centerpiece.
4. No cliches. If your essay ends with something like, "This experience taught me that it was about the journey not the destination," there are a few outcomes all of which are bad. 1) That sentence is true for 99% of the applicant pool and you did nothing to distinguish yourself from the masses. 2) If the reader thinks that's actually a plot twist, then you lost them a long time ago.
   
5. You will not get denied due to your recommendations. Actually, that's not completely true. If your recommender answers 50% of the questions with, "So's your face," then you might get denied. Or if you use a generic To Whom it May Concern form or some of those universal recommendation forms that's floating around, you might get denied. Nothing tells a school that based on your careful research, they are clearly your top choice like using a generic form that says, "I'm applying to so many schools, I can't even keep track."

Happy MBA application season everyone.

Moving Away from a Middle Finger Relationship in Health Reform

During one of the many webinar's on health reform where I was multi-tasking (or looking at youtube videos of water skiing squirrels), there was a presentation on the evolution of the relationship between insurance companies and regulators. The speaker described it as an arm's length relationship that needed to move towards a hand shake or hug for the industry to be more successful. I disagree with this. The relationship is not currently arm's length but rather a middle finger relationship that may involve orifices shortly. The worst part is that the Obama administration has a model in place that could move the insurance industry and regulators to a friendlier position.

Health and Human Services Secretary and prominent middle finger extender, Kathleen Sebelius, fired off a statement last week accusing the insurance industry of blaming health reform for a 1%-9% increase in prices. Sebelius felt the price increase attributed to health reform should only be 2% at the most. The insurance industry pointed out that removing maximums on lifetime benefits, making preventive services like colonoscopies free for everyone, requiring that children under 19 never be denied insurance, and other provisions are not going to make insurance any cheaper and defended their numbers.

Implied was that insurance companies should reduce their profit margins which average 3%. While that is reasonable (and expected given the current viewpoint that the only difference between insurance companies and a horde of pillaging Vikings is that the insurance companies have moderately better personal hygiene), the insurance companies have been losing profit margin with other reform provisions. There are billions in new fees and a requirement that medical expenses be at least 80%-85% of revenues which has taken a few percent off profit margins already. Additionally, the reduction in Medicare Advantage payments will increase the cost that employers and individuals pay for insurance. Medicare Advantage was most of the profit margins for insurance companies the last few years.

Insurance companies are prepare to give the middle finger right back by refusing to participate in the coverage of all children under 19 by not offering individual insurance to any children at all. There has been some movements in that direction and it's increasing in my home state. Individual insurance covers 9% of all Americans and children make up around 1/3 of that group. Therefore, it's a very small line of business and insurance companies are signaling that they may leave it entirely rather than follow the new rules. Individual insurance may stop being sold to any child no matter how sick or how healthy as a result. I was initially surprised at the speed in which insurance companies deployed a nuclear option. However, given the Obama approach towards the industry, it's not like insurance executives were going to be invited to play pick up basketball anytime soon.

The state regulators are in no position to enforce rules as Sebelius has promised they would. In my state, the email around a proposed open enrollment period as a solution to this issue had the subject line, "Please disregard previous email, this is the correct version." If state regulators can't even send the right attachment with a very important email, they are not in a position for this volatile and tricky negotiation.

What makes this situation even more unfortunate is that the Obama administration has a way to avoid all these dueling middle fingers. That way is the much maligned Medicare Advantage program. This is the program that Obama has said doesn't work since it overpays insurance carriers since it pays 15% more than the federal government pays for traditional Medicare.

The private Medicare Advantage program used to be called Medicare + Choice and it paid 5% less than traditional Medicare. Not many insurance companies and only 7% of the seniors participated in it. I listened to a webinar with Tom Scully, former administrator of Medicare, where he explained that they needed to pay insurance plans more for participation. This increased payment did result in 25% of seniors participating and a lot more insurance companies. However, he agreed that 15% more was too much which is why Obama should have cut the payments (despite the impact on employer and individual insurance which I describe above). With the payment cuts, there are quality bonuses that plans can earn for demonstrating good customer service, medical management, and ensuring high quality care. To earn these bonuses, plans have to cover preventive services for free, pay 85% of revenue on medical expenses, and similar requirements as health reform. However, insurance plans are not fighting these provisions because of the Golden Rule. Medicare has all the gold so they make the rules. Insurance plans will be paid more for following these provisions and less if they do not.

This supports a future health insurance model of the government contracting with private insurance plans which is the current Medicare Advantage model. It's the simplest incentive plan in the planet. If the government controlled all payments for health insurance, insurance companies would have to follow the rules. There are no middle fingers given in Medicare Advantage. In fact, Tom Scully's advice for how insurance companies could form a successful relationship with Medicare regulators was:

"Suck up, suck up, and suck up some more. Take a nap, then suck up, suck up, and suck up again. Medicare likes working with good plans and doesn't like working with plans that don't follow the rules."

Table Manners at the Executive Table or Keeping your Interview Skills Good Enough to Eat

In a thrilling sequel to my previous post, I offer more complaints about Human Resource recruitment and the thrilling conclusion to my theory around applying for jobs as a networking technique. The sequels are rarely as good as the original but I think the bar for my first post was pretty low. Complaining about Human Resources falls in the same category as complaining about your hold experience with an appliance call center or the customer experience of airport security. No one's story is unique, we only want to share our complaint, have no real interest in listening to others, and these type of blog posts can be completed while someone is sitting on the toilet.

Having set the bar low enough to trip over, I can assure the reader that my post will be slightly more interesting and I will not need toilet paper after I am done typing.

Recruiter complaint: After filling out the recruiter's questionnaire, she wrote back and told me to complete the section for current employees as soon as possible. When I responded that I was no longer a current employee, she wrote that she had realized that mistake after she had sent the email. Her recovery technique was apparently waiting until I pointed out her mistake. I'm glad doctors don't use that same technique of waiting for patients to have an adverse reaction to their medication before correcting their mistake.

However, after my painful experience (that was probably equally painful to read) was done, I was allowed to interview with the division vice president. I did some preparation but there is nothing like a live interview to make you realize the difference between practice and game time. It's almost like the difference between masterbation and actually having a partner. None of the interview questions were unexpected but it made me realize how I needed to adjust future preparation. This insight enforced my belief that applying for jobs as a networking technique is a good idea because of the additional opportunities for live interview practice.

Interview Questions:
Why do you want to leave your current position and come back to work for us? The real reason was because the new job would allow me to work from home and pay based on a state with a higher cost of living. The job itself was in an area that interested me, too and I liked the company which were my actual answers. It was a surprisingly difficult question to answer since I couldn't respond with my true #1 reason. As a result, I probably will not apply to jobs in the future if I can't articulate the real top reason in my interview.

Tell me about a time where you had an ambiguous assignment.
The interviewer was fairly vague with the questions and made them very open ended. She didn't ask me to explain the results, what I did, how I responded but left that up to me. I knew to include these aspects but I did have to take a few moments to gather all my thoughts without the framework in her question. Ultimately, I used my story that I also use to answer the questions about a time that things did not go well or I had failed. As a result, I'll have to remember to develop a separate story for ambiguous assignments because. . .

Tell me about a time when things didn't go well.
Doh! I had to think for a few minutes since I had used my typical failure story. The interviewer also specified that this be a more current story since my ambiguous assignment tale was about my first job after college.

Describer your work style:
I had to wing this one a little bit and as a result, I didn't factor in that she had just told me that her department's culture is about action and getting things done. That should have been my work style too but instead I was a little too honest about the fact that I still act like a former social worker who likes to check in with everyone.

Do you have any questions for me?
Of course I do. Even though I talked with some of my former coworkers about this job, had worked at this company, and looked up your profile on Linked In, I will always have questions. Like, tell me about your background and how you arrived in this position so I know who I am going to work for. Or what will a successful candidate do in this position or what advice would you give to someone who accepted this job. Even ask what are the key challenges in the industry or with this position. It's better to ask a dumb question than no question. I've seen interviewees not ask questions and they look disinterested in the position.

The fact that I had been reviewing MBA admissions essays and offering a lot of critique of the importance of building up the stakes in the story, focusing on what you did, and what you learned helped me structure my answers. However, it did reinforce the fact that we can probably all anticipate the typical questions that we will be asked in an interview and should have a few separate stories prepared. Preparing these stories can give you something to do the next time you're sitting on the toilet without a blog post to write. While we're at it, could someone get me some toilet paper?

Getting a Seat at the Executive Table

We all have stories about bad experiences with employment recruiters, traffic, and eating too much at In-N-Out burger after midnight. We love to tell the stories but have no interest in listening to others. That's why blogs are great tools for providing those needs that are only at the very tip of Maslow's Pyramid.

I have learned that I am an attractive candidate for jobs because I am currently employed. Online dating doesn't even produce as bizarre relationship dynamics as employment recruiters. They seems to covet most what they can't have (the currently employed) and doesn't want those who want them the most (the unemployed).

I habitually apply to jobs at other companies as a networking technique. It's part of the Generation X shark mentality where we need to keep swimming in order to stay alive. It keeps my resume fresh and my interview skills sharp, I meet people at other companies, and learn about opportunities. Some would argue that this is a terrible approach because the transaction always involves the word no. Either I say no to an opportunity or the company says no to me. However, I no longer become just another application to the recruiters and hiring manager for any future opportunity.

Therefore, I applied to a job at a company where I used to work to gauge my market worth and network with a new department. On Tuesday morning, I had an interview scheduled with a lead manager and vice president. On Tuesday afternoon, I talked with the recruiter. By Tuesday evening, I had no interviews, a fairly difficult questionnaire to complete, and the job requirements were changed. Not surprisingly, I considered this to be a fairly negative interaction with the recruiter. Here are the details:

• The recruiter was waiting for the results of a questionnaire that she thought that she had sent me. But she had actually forgotten to send it which created a problem. If I did not complete the questionnaire before interviewing, then one could question the value of it. Therefore, she had to preserve the process and cancel the interviews.
• One should question the value of her questionnaire. It combined the obvious details (Are you eligible to work in the United States) with the vague (Describe your experience in consulting, health care, project management, data analytics, and reporting. In other words, Tell me about yourself).
• The recruiter's biggest concern was that I had not been fired from this employer previously. She was very good at zeroing in the obvious. To be fair, I've learned that people do like re-applying to companies where they exhibited the impulse control of a meth addict and the ethic of an Illinois governor. However, she had access to my file and could have easily answered the question.
• Poor grasp of geography. The recruiter's concern was that I work in a region where they do business which could have been addressed with a compass and a road map. Actually, you don't even need the compass.
• She closed by telling me that they had numerous qualified candidates already implying that she was doing me a favor by talking with me.

From reading Human Resource and employment blogs, I can even guess the defense from other recruiters. They could point that if they didn't need the information, they wouldn't have asked for it. All candidates have to follow directions and they won't go on a scavenger hunt looking for where we live or our employment files. It's their job posting so we follow their rules.

However, it was fairly clear to me that the recruiter was late to the game in the hiring process and had to stall or she would have lost control of the process. The recruiter's value-add would have been questioned. My blog is the one place in this world where I get to be judge, juror, and executioner (even when I babysit my 2 year old, I don't have that power). Which leads me to my main point that recruiting or human capital management has to have their basic operations in place before they can ask for the seat at the executive table. That step is still being skipped for those looking to transform Human Resources.

At my organization, I have watched responsibilities and budget steadily being stripped from Human Resources when they could not meet their objectives. When they lost applications, they were forced to focus on application management for basic positions and executive recruiting was removed. When they showed improvements, they were steadily given back responsibility. While basic blocking and tackling doesn't provide great fodder for recruitment and Human Resource transformation, it can prevent future business leaders from giving those assignments to the Human Resource department.

The Inmates are Running the Asylum: The 1st steps of Health Reform

The first parts of health insurance reform will start in a little over a month (Sept 23rd to be exact). One of the more significant pieces is that children under the age of 19 will no longer be denied coverage for an individual insurance plan due to pre-existing conditions. Overall, this is good and makes us a more compassionate and humane nation. This change also shows how tightly connected every piece of the health care system is as the details behind this change are getting really complicated. Just like the directions for assembling Ikea furniture, what seems simple is getting really difficult.

The Obama administration is turning the details over to the states who are in turn asking the insurance companies for guidance. This is how much of health reform will be implemented as the state insurance divisions, Medicaid offices, or other agencies will be making hard decisions based on a federal framework. To fully appreciate it, picture what would happen if the federal reserve turned interest rate setting and trade over to the states. Actually, that sounds too hard to visualize. Picture what would happen if parents turned the house hold management over to their 4 year old.

No longer denying children under 19 insurance seems simple to do. When someone who was born after 1991 applies for insurance, they get insurance. The only option is to say Yes, here's your insurance.

This is also called guaranteed issue. The difficult part is that in order for an insurance scheme to be viable in a world of guaranteed issue, individuals must be required to purchase insurance to eliminate what economists call the Free Ride. This is also called the individual mandate. If you want to sound like an insurance executive at your next cocktail party, you can say, "Without an individual mandate, you can't have guaranteed issue." Combine that statement with urinating in the ice bucket and you'll be the hit of the party.

As a result, children under 19 can just get insurance when they go to the doctor, then drop their insurance, and pick it up again when they need to go to the doctor again. Sounds great except that makes insurance more expensive and pretty soon unaffordable. This loophole is big enough to undermine the whole program. As a result, states are offering insurance companies concessions to avoid the collapse of the insurance market for children. Some include only allowing children guaranteed issue one month out of the year (called open enrollment) or requiring children under 19 to stay on an insurance plan for a certain period of time with penalties for leaving early.

Insurance companies are threatening to no longer allow only children to purchase insurance but requiring parents to be on the plan, too. Ultimately carriers could stop offering individual insurance to children under 19 at all so the states do have to offer possible concessions.

The Obama administration has allowed the states to offer concessions, mainly the open enrollment option, to address the situation. However, this puts the states in the awkward position of negotiating and trying to determine which concessions to offer. It gives insurance companies an opportunity to develop their own concessions. The final result of guaranteed issue for children could be very different than what everyone envisioned.

When I worked in previously worked in psychiatric facilities, I noticed that the only difference between the inmates and staff is who had the badge and keys. This may be the case with the future implementation of health reforms as the state divisions and insurance companies are being handed the keys and badges.

Olympic Penninsula: Marmot Pass and Buckhorn

Our most recent climb was near the Quilcene Ranger Station in the northeast part of the Olympic Penninsula. A friend recommended Buckhorn Mountain near the Marmot Pass as a good peak to scramble up to enjoy the views of Mt Constance, Deception, and Mystery and some potential wildlife. To the left is a picture of the Marmot Pass, a 6000 foot trail intersection.

When we arrived at the Big Quilcene trailhead (#833), there were quite a few day hikers that I would characterize as a good representation of the Medicare Advantage demographic that I have blogged about. When they talked about their day hike to the Marmot Pass, I started to wonder about my selection of an overnight backpacking trip or fear that these seniors were getting steroid prescriptions instead of Viagra.

The Big Quilcene trail is well-marked and follows the Quilcene River. After 4 miles and 5500 feet of elevation, I reached Camp Mystery which was my intended campsite. Camp Mystery is not marked but there are several obvious campsites with flattened areas, sitting logs and nearby water sources. According to the climbing guides, I could either scramble up the scree slope pictured below and to the left or hike towards Marmot Pass for a southwest ascent. Summit Post recommended the scree scramble so I followed that web site's advice.

The scree slopes were steep. I looked for an opening among the trees at around 5300 feet of elevation. I followed what I thought were other climbers' tracks through the scree but was probably goats. It was steep, like quick sand, and pretty painful. I moved towards the southwest corner since the slope looked more forgiving and I was hoping to find that trail to Buckhorn Mountain (pictured below to the right).
















I happily took the trail the rest of the way up and was glad that I did not have to go down the scree slopes on a return trip. I told myself that the scree slopes were a good way to avoid the fierce marmots who surely must inhabit Marmot Pass. Luckily, there were no wildlife sightings in camp as I had heard that bears visit Camp Mystery. Only wildlife incident somehow involved the nuts that I left in the car being eaten and the bag being torn up. Next time, I'll take the path most traveled and leave the scree slopes to the goats.

Parallels between Peace Corps Training and Harvard Business School

The Peace Corps and Harvard Business School (HBS). One program is experiencing rapid growth and becoming increasingly relevant while the other program has been pronounced an outdated relic. Surprisingly (or not surprisingly), (HBS), the program with the $3+ billion endowment and its own gym is the one facing an inflection point (for some reason it's really hard to refrain from using HBS jargon when writing about HBS). The Economist's Schumpter's recent piece about HBS's programme was not coloured (hard to refrain from using British english when quoting the Economist) by recent times as much by the approach of the new dean, Nitin Nohria.

I generally agree with the Economist's analysis of the state of MBA affairs because they avoid taking a 2 year view of MBA's behaving badly and pronouncing them irrelevant. As long a masters degree is a requirement for certain levels of jobs, an MBA will continue to be a good masters degree to get. On a simple level, it really helps you get a job by teaching resume writing and interview skills, providing access to companies and internships, focusing on the job search, and providing all kinds of statistics to track this progress. A Masters in History also teaches students new material but nudges graduates towards PhD programs as opposed to business schools' approach of flinging its graduates into whatever employment target they can hit.

Back to the topic on hand, Nohria's new approach at HBS focuses on "competence and character" as well as getting its students' boots dirty. Competence and character is a general prerequisite when your graduates have been accused of behaving like a Viking hoard who pillaged and plundered the global economy. The only hint of an apology that followed the burning of the global village was preceded by a loud belch. Getting boots dirty refers to more hands on internships with companies as part of the classwork. Less theory, more application, and more real work. It's not about looking good in boots with stiletto heels but getting functional with Gore-tex boots.

The Peace Corps got its volunteers already dirty boots even dirtier with a change in its training programme (oops still using British) er program 10 years ago. The 3 month training prior to starting the 2 years of service was labeled as too theoretical with not enough application. Volunteers generally lived in close proximity to each other in comfortable suburbs near capital cities with classroom based training. At night, everyone got together and partied- I mean networked. There was a shock and adjustment period when volunteers started their 2 years of service in more isolated rural environments and their work was no longer in a controlled environment. Therefore, Peace Corps training got more hands on. Volunteers were more spread out in starker environments and their training involved working on existing projects. Their development worked started during the training period not after completion.

I don't have any data on the impact but as you can imagine from the logic and general movement of all Peace Corps country training programs, it was a successful model. It's fairly logical and makes sense that HBS would move in this direction.

The drawback to this approach is by spreading volunteers or business students in small groups with immediate work and deadline, there isn't enough time to bond as a group. My Peace Corps training involved all 25 of us in close proximity. The classroom schedule allowed for ample social time and adjustment which I frankly needed to prepare for my 2 years of Peace Corps service. I was not ready to get my boots as dirty as some of my fellow volunteers. The bonding as a group in business school forms the basis for the vaunted future HBS network and from learning from talented classmates.

My Peace Corps Volunteer group was incredibly close and we still stay in touch over 10 years later. I don't know if I would have that connection with the more applied hands on training model and time will tell if HBS and other business students have sufficient time to forge their bonds and future network. Since business school curriculum changes with every fluctuation in the MBA application cycle, I am confident that this will be evaluated and changed if necessary. Like a good pair of boots, the MBA philosophy and curriculum gets resoled at least every 10 years.