Providing Care in a MediCAID for Everyone World

For all who dream about a single payer US health care system, I continue to tell them the calories in that punch bowl by declaring that a US single payer system will look like Medicaid. I don't turn their dreams into a nightmares or urinate in that punch bowl. It's more like finding out that the girl of your dream has man hands.

In all likelihood, a national health care system will resemble Medicaid, the health plan that stretches dollars to the previously uninsured with tightly managed care and low provider reimbursement. According to Ingenix, in 2016, the number of Medicaid beneficiaries will grow by 30% while the numbers who have better paying commercial insurance will remain flat. Medicaid will be the fastest growing insurance market so providing care will become increasingly important. Here's how I think that it will play out:

1. Who are these new Medicaid beneficiaries? Some feel that the health care utilization of Medicaid beneficiaries is unique while some see the only difference between a Medicaid beneficiary and someone with a blue collar health insurance plan is union dues and 5% of the Federal Poverty Line. What we do know is that they will mostly be adults but what we don't know is how much pent up demand they have for health care services and what kind of services they want. What will probably happen is that their health care utilization will decrease over time as they can regularly access care as opposed to gorge on the newly opened health care buffet.

The significance is that for those who participate in the Medicaid world especially with dollars at risk in a capitated environment will have some rough early years. However, the health utilization will stabilize over time and there will be opportunities to be profitable in the future.

2. Nurse case management will be key: The type of care that current Medicaid beneficiaries receives is often related to their chronic disease state or difficult socioeconomic environment. Those types of problems don't require a doctor to tell a diabetic to eat more vegetables and not leave their guns on the kitchen table. Nurses or social workers are the best option. However, currently only doctors get paid for the visit while these types of providers do not. A change in the payment system can address the revenue side of the equation while greater use of mid-level providers (I think that's the right term for nurses or social workers. I wouldn't want to call them lower mid-level providers) instead of doctors will help the expense side.

3. The Medical Home will save the day! The Medical Home model is the idea that someone should get all of their medical services in one place and it should be coordinated. It is also a friendly place where a patient likes to go. Definitions vary wildly but it is the latest trend in health care delivery. The flip side of a medical home involving throwing random bits of health care in settings where no one knows your name isn't appealing so the Medical Home model should stick. Especially since there is more money for available in the form of Centers for Medicare and Medicaid demonstration projects or large employer groups who are so desperate to reduce health care costs that their alternative plan involves sacrificing a goat. Since there are so many organizations willing to pay for the research and development, the medical home model will be tested and ready for that influx of Medicaid beneficiaries.

4. Go Federal, Federally Qualified Health Center (FQHC), that is: There will be $11 billion available nationally to double the patients served by FQHC's or Community Health Centers. FQHC's receive federal grant funding are are reimbursed at their costs for Medicaid visits. They are well equipped and knowledgeable about providing care for the uninsured and Medicaid. They also get paid more than private providers due to the fact that they get reimbursed at cost for Medicaid patients. The application process for becoming an FQHC is not a simple one. However, with limited provider access and low Medicaid reimbursements for non-FQHC clinics, the benefits are well worth investigating the application process.

The Second Greatest Hat that I have ever Knit

For those who forgot, this is a blog about knitting as well as health care, MBA's, and whatever completely random topic that I have come up with in order to keep blogging (I may have to revisit my topic about whether or not 7-11 can be a flag ship store in a commercial district). Therefore, I proudly present the second greatest hat that I have ever knit on the left. The greatness is a combination of having abandoned knitting patterns for hats in favor of my own designs and the subtle patterns.

For those knitters out there, this hat uses Berrocco Cool worsted weight because I still had a lot left over from the toddler sweater. It's a blend so it's not too itchy nor warm which I like. I used size 4 needles and cast on only 100 stitches for a gauge of about 6 stitches/inch. That comes out to about a 16 inch circumference hat. No, my head isn't really small but actually kind of big at a weather system impacting 24 inches (Head!). Using normal knitting calculations, one would subtract 1 inch from head circumference and with a 6 stitch/inch gauge, cast on 138 stitches. If I followed normal knitting calculations, would this be the 2nd greatest hat? I think not. I like a snug fitting hat for warmth, comfort and fashion and have learned over time and practice that 100 stitches is right for me. For those less adventurous with gauges, I would offer the following advice:
1. If you think a project looks really small when you're just starting, that means you're on the right track. If the projects looks like the right size when you're starting, that means it will grow to such immense proportions that people will wonder if you are knitting for an elephant.
2. Knitting patterns seem to be written for the sizing of Shaquille O'Neal's family. Always check the size since it will generally be too big.

As far as the rest of the details, the beginning black band of the hat is knit with a knit 2, purl 2 rib pattern and the rest of the hat is straight knitting. I reduced by knitting 10 then knit 2 together (repeat), knit a row, knit 9 then 2 together, knit, knit 8 then 2 together, etc. I think that you get the idea. I stopped knitting after the knit 2, knit 2 together row and ran a kitchener needle through the remaining stitches and tied it all together. I decided when to start reducing based on trying the hat on and seeing if it covered my ears and almost covered the top of my head.

I definitely made some errors during the reduction since I knit while watching 30 rock. However, that is not the reason that it is the 2nd greatest hat! The greatest hat title was given to the hat below which was the original greatest hat that I ever knit.

Note the similarities. Greatness doesn't need to be changed to significantly. The original greatest hat had a very good run but had gotten stretch out and was no longer fitting my head as snugly as I would have liked. It disappeared on an Amtrak train in Montana around the same time that I was pondering its succession plan. This allowed for a very peaceful transition.

Don't let me write like Dan Brown!

I write like
David Foster Wallace

I Write Like by Mémoires, Mac journal software. Analyze your writing!

I heard of the website I Write Like (IWL) on NPR and read about it on Yahoo. After reading it on Yahoo, I figured that it was old news. Similar to how when I first heard about the Spice Girls through Newsweek while living in rural South America, I knew they were probably not the world's hottest band anymore.

IWL was developed by a programmer in Montenegro and uses key word analysis on text that you enter that is similar to the logic used on spam filters. Its creator has only entered 50 authors so your options for who you write like are limited. As you can tell by the badge above, I write like David Foster Wallace based on its analysis of my posts Bring Me a Bucket of Bankers, Love in the Time of MBA's, Free Markets Response to Gaps in the Individual Insurance Market, MBA's seeking health care jobs, Early Results of Medicare Advantage Cuts, and COBRA: Strategies and the Stimulus. At first, I thought that David Foster Wallace had written Breaks of the Game, one of my favorite books about the Portland Trailblazers 1977 NBA championship season and I was really excited. Turns out that David Halberstam wrote that book and that I have never heard of David Foster Wallace. However, since the majority of my most popular posts are written in his style, I checked out his book, Infinite Jest, from the library.

Of my other popular posts, The Legacy of the Leveraged Sell-Out was written like H.P. Lovecraft, the Summer Reading List for non-traditional MBA's was written like science fiction writer Iasacc Asimov, and Lake of the Angels: Olympic Peninsula was written like Stephenie Meyer, the writer of the Twilight series. Given that post is basically a trail guide, I really have to wonder about the Twilight Series.

One of my posts was written like popular writer Dan Brown which horrifies everyone who finds out that they write books with tortured logic and albino monks. Some people are told that they write like horror writer Stephen King and no one seems to know what to make of that. That wouldn't make me happy but it's nowhere near as bad as Dan Brown. Stephenie Meyer is pretty bad, too but I like vampires and werewolves more than Dan Brown's characters.

Personally, I think the programmer should load some really badly written books and attribute them so that someone could be told, "I write like someone who writes DVD programming guides," or "I write like the Unabomber." I admire IWL's creator for exercising this restraint.

Then We Were Done or when We have Blogged All there is to Blog

Bloggers do not blog forever. A lot of blogs don't get beyond 1 post. Conscious of the high failure rate and motivated to produce a quality blog, I made sure that my blog reached at least 100 posts during its first year and 8 posts per month. During my second year, I haven't had the same motivation and have settled on a respectable 6 posts per month.

The two main reasons that I got into blogging were to practice my writing and participate in the online blogosphere community. My interest in the blogosphere community did not burn out as much as it faded away. Some of my favorite bloggers that are linked under my "Men Are Smart, Women Are Smarter" section stopped writing. Others no longer seemed as compelling. My fantasy baseball team filled up my internet surfing time as I was no longer interested in what the blogosphere had to say. It had started to feel like everything there was to say on a blog had already been said and the arguments became circular.

1. Who owns social media at company? Marketing was nominated to own social media. No, Human Resources wanted to own it in their quest to get a seat at the table at a place that doesn't involve a buffet. No, everyone owns social media. No, no one owns social media. So, who owns social media again?

2. Be careful about what you post on Facebook. But if you don't want to be careful, understand your privacy settings. Wait, privacy setting changed. Okay, go back to being careful about what you posted on Facebook.

3. Generation Y is unique, special, and going to take over the world with Twitter. Generation X is still bitter and snarky and writes nasty comments back to Generation Y about how they should move out of their parent's house before they take over the world. Generation Y says the the home ownership dream is dead and they'd rather live at home and save money to start their own business. The Boomers are too busy actually running the world to care about either generation. Boomers win. Again.

4. The most important indicator of a blog's success is traffic. No, it's content. No, it's comments. No, none of those things help make money so I'll just become an affiliate marketer like people who sign up for Amway. But it's not call affiliate marketing anymore but multi-level marketing instead.

5. You should blog to show you are an expert about your niche! Get traffic to your blog to show off your expertise! But it's not about traffic, it's about connection and no one cares about your niche expertise in vintage cookie jars. Oh well, there's always multi-level marketing.

6. Resumes will never get you a job. Well, since every job asks for a resume, that's not really true. It's all about networking. And to be a really awesome networker, you should start a blog. Oh wait, forgot about #4 and #5.

7. It's important not to settle and find a career that makes you happy. I don't know what career will make me happy. But I know that I don't want to settle. So I've defined myself by what I don't want to do. Blogging makes me happy so maybe that will be my career. Crap, forgot about the last 4-6

8. I am going to blog about how something sucks. Well, it doesn't really suck since I am going to write a fairly nuanced post. Using words like suck in blog titles is good because it draws traffic. Traffic is important, oh wait, we've done this before.

9. I am a personal finance blogger. However, you shouldn't take advice from me but use a professional financial adviser. So should I ignore the advice about using a professional financial adviser since I shouldn't take financial advice from a random personal finance blogger? This is the ultimate circular argument kind of like those circular Excel formulas that trigger a big warning when I create them.

10. Making lists are great blog posts. Lists that end in a round number like 10 are even better since ending on a random number like 7 or 8 makes it look like you just ran out of ideas. Yes, I reached 10! Victory is mine!

My lack of interest in the blogosphere and lack of motivation to engage with this community is a disappointment. The internet provides many opportunities to join community and I really do like a good community. However, I haven't found it. I do like blogs from more experienced professionals and bloggers like Fred Wilson and Laurie Ruettimann but I'm realizing how unique their blogs are.

This leaves me with a blog that is an opportunity to develop my writing and motivates me to more fully research ideas. I use some of my ideas at work. Sometimes, I just try to impress the marketing department by talking about my blog.

Getting Really Horrified about the Personal Information that's on the Internet

The personal branding industry became prominent in 1997 with a Tom Peters article and now yields 7.9 million hits on a Monday night search by the Google. The main contribution of the personal branding industry seems to be fairly obvious guidelines on what you should share online. For example, putting up photos where you are scantily clad in a compromising position with a goat while drinking alcohol is apparently not good for your personal brand.

What would really actually be helpful and impressive from the personal branding industry would be specific guidelines for those of who just can't resist showering the internet with nudity, alcohol and barnyard animals. For example, is a picture with a knowing smirk, cocktail dress, martini, and a sheep personal brand neutral? What if the martini is replaced with a Pabst Blue Ribbon and there is a little bit of tongue emerging from the smirk? Is that bad for a personal brand or just a little racy? For those with these low levels of impulse control, knowing line and when have we passed it would be very useful.

These are the types of assignments that those who work in personal branding should have to wrestle with. No naked pictures online is the low hanging fruit. Give me the exact square inches of skin that can be shown to not hurt someone's personal brand and that is someone who has earned their fee.

The information that we can voluntarily share on the internet pales in comparison to the latest business models for online aggregators of personal information. The previous paragraphs were on my to do list as part of making fun of the personal branding industry. The meat of this post is about sites that that make you wish that untagging that awkward middle school picture was all that you had to worry about.

Spokeo is the New York Yankees of Privacy Violating free sites. It is frightening in both the information that it portrays (address and birthday) and its inaccuracies (attempts income, profession, and home value with no success whatsoever). A street level google map of your address just adds to the creepiness. It has all the information that someone would need to target you for marketing or a home invasion. The only good thing about the site is that it is easy to get your information removed.

Zabasearch is similar to Spokeo but more of a white pages and doesn't attempt to peddle financial information. When I attempted to find myself and a few others, it seemed to have this default setting of LAST NAME Hole or in my case it would be Hedge Hole. I don't know if the site was really calling me an A-hole, it was a glitch, or Hole is a really common last name. Overall, it seemed too inaccurate with basic information to be really harmful. To opt out of zabasearch, you have to fax them a request along with a proof of identity.

Pipl is an aggregating site that pulls in information from Spokeo, Zabbasearch, and Google in attempts to create an unauthorized profile. They are kind of the open market with some quality goods and some snake oil. I give them credit for having a real person respond to emails about removing your information. They will remove your results from google searches if you contact them at mail At Pipl Dot Com but will not take down your profile.

For $40, you can also pay many sites to get even more complete records of anyone that you want. I understand that business model and market need for this information for those who are willing to pay. I don't appreciate the business model of the sites above that use my available personal information as their product. At least include me on a pay for click model for people who search for me. All their sites claim that they search available public data bases and are merely aggregators who just happened to put together profiles that would only appeal to people who you generally wouldn't want to find you.