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		<title>Endorse Me for These, Please</title>
		<link>http://aneconomyofmeaning.wordpress.com/2013/05/22/endorse-me-for-these-please/</link>
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		<pubDate>Wed, 22 May 2013 13:36:25 +0000</pubDate>
		<dc:creator>Joseph Carrabis</dc:creator>
				<category><![CDATA[Humor]]></category>
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		<description><![CDATA[What LinkedIn needs are Endorsements like these<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1332&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></description>
				<content:encoded><![CDATA[<p><a href="http://www.nextstagevolution.com" target="other"><img vspace="4" hspace="8" border="0" align="right" src="http://www.nextstagevolution.com/images/nse_blogging_logo.cfm?blog=EcoOfMean&amp;post=EndorsementMania" alt="NextStage: Predictive Intelligence, Persuasion Engineering, Interactive Analytics and Behavioral Metrics" title="NextStage: Predictive Intelligence, Persuasion Engineering, Interactive Analytics and Behavioral Metrics" /></a></p>
<p>Have you used LinkedIn lately? Say the past few months? It seems you can&#8217;t logon or look someone up without being asked to give them and a handful of others an endorsement. I recently shared an odd LinkedIn moment:</p>
<blockquote><p>Ever see what Linkedin thinks someone should be endorsed for and burst out laughing?</p></blockquote>
<p>A friend responded:</p>
<blockquote><p>Endorsement spam is growing. Some keep endorsing the same people over and over again &#8211; so their names keep showing up in the feeds of their Connections.</p></blockquote>
<p>I remember when I received my first endorsement. It was from someone I didn&#8217;t know at all well and for a skill I didn&#8217;t think I had. I emailed them thanking them for the endorsement but admitting some confusion; I wasn&#8217;t sure what I&#8217;d done that demonstrated the endorsed skill. When had they seen me demonstrate that skill? Or did they know someone who had?</p>
<p>
They never responded. I&#8217;m connected to over 2,000 people on LinkedIn. I think I&#8217;ve endorsed maybe ten and always for things I have personally experienced via them or with them or because of them.</p>
<p>
I also understand that endorsements are a little like political marriages in the heyday of the European royal courts; The endorsement creates an alliance. Kind of. Maybe. Sort of.</p>
<p>
But few people endorse me for things I believe I&#8217;m good at. <a href="http://itknowledgeexchange.techtarget.com/statingtheobvious/i-can-crack-my-knuckles-therefore-i-must-be-a-chiropractor-musings-on-expertise/" title="I Can Crack My Knuckles Therefore I Must Be a Chiropractor! (Musings on Expertise)" target="other">Maybe I don&#8217;t crack my knuckles enough?</a> Someone recently sent me a LinkedIn email and, in their personal banner, they listed themselves as a &#8220;thought leader&#8221; and &#8220;influencer&#8221;. </p>
<p>
Really? I guess we have different standards. </p>
<p>
No, I know we have different standards. A promoter once asked me to present at their conference but didn&#8217;t want to pay my appearance fee. He explained there were too many people willing to pay to appear &#8220;because they want to be seen as thought leaders&#8230;&#8221;. So, as I wrote in <a href="http://aneconomyofmeaning.wordpress.com/2012/07/03/10-things-you-need-to-know-before-you-go-consulting/" title="10 Things You Need to Know Before You Go Consulting">10 Things You Need to Know Before You Go Consulting</a>, it doesn&#8217;t matter if you can do it, it only matters if you can talk about doing it. And preferably to people who don&#8217;t know anything about it because the minute you start talking to people who do know something about it, <em>oops!</em></p>
<p>
Personally, I understand that many people are unfamiliar with what I know I&#8217;m good at. My personal email signature contains</p>
<blockquote><p>Joseph Carrabis<br />
Explorer, Investigator, Extrapolator and Instigator-Extraordinaire!</p></blockquote>
<p>One of our researchers said that defined me exactly. Especially the &#8220;Instigator-Extraordinaire!&#8221; part.</p>
<p>
But for those searching for endorsable qualities, I offer these:</p>
<ol>
<li>Can Run with Scissors
<li>Knows Which End Is Up
<li>Knows Which Side to Butter His Toast On But Tends to Ignore Toast Altogether and Uses Butter Sparingly
<li>Can Make it Through the Day Without Twittering About It
<li>(and the big one) Only Endorses When He Knows The Person Can Do It
</ol>
<p>Now if you&#8217;ll excuse me I have to go blunt my scissors, burn my toast, and tweet this.</p>
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Please contact NextStage for information regarding <a href="http://knowledgeshop.nextstagevolution.com/trainings.cfm" target="other">presentations and trainings</a> on this and other topics.</p>
<p>
<font size="1"><a title="Reading Virtual Minds Volume I: Science and History" name="Reading Virtual Minds Volume I: Science and History" href="http://knowledgeshop.nextstagevolution.com/rvmv1sah.cfm" target="other"><img src="http://www.bizmediascience.com/uploads/RVMsmallfrontcover-thumb.jpg" alt="RVMsmallfrontcover.jpg" width="100" height="151" align="right" /></a>Sign up for <a href="http://www.nextstagevolution.com/email1.cfm"><em>The NextStage Irregular</em></a>, our very irregular, definitely frequency-wise and probably topic-wise newsletter.</font><br />
<font size="1">You can follow me and my research on <a href="http://twitter.com/JosephCarrabis" target="other">Twitter</a>. I don&#8217;t twit often but when I do, it&#8217;s with gusto!</font><br />
<font size="1">Have you read my latest book, <a title="Reading Virtual Minds Volume I: Science and History" name="Reading Virtual Minds Volume I: Science and History" href="http://knowledgeshop.nextstagevolution.com/rvmv1sah.cfm" target="other">Reading Virtual Minds Volume I: Science and History</a>? It&#8217;s a whoppin&#8217; good read.</p>
<p>
Learn the latest regarding NextStage blog posts, conference sightings,<br />whitepapers, tools, presentations and more via <a href="http://knowledgeshop.nextstagevolution.com/knowledgeshop.xml">The NextStage RSS feed <img src="http://knowledgeshop.nextstagevolution.com/images/nextstage-rss.png" border="0" align="absmiddle" alt="Subscribe to NextStage's KnowledgeShop's RSS feed"></a>.<br />
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<br />Filed under: <a href='http://aneconomyofmeaning.wordpress.com/category/humor/'>Humor</a>, <a href='http://aneconomyofmeaning.wordpress.com/category/marketing/'>Marketing</a> Tagged: <a href='http://aneconomyofmeaning.wordpress.com/tag/social-networks/'>social networks</a> <img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1332&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></content:encoded>
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		<title>The Great Red Spot, Lonesome George and Happy Memories of My Youth</title>
		<link>http://aneconomyofmeaning.wordpress.com/2013/04/05/the-great-red-spot-lonesome-george-and-happy-memories-of-my-youth/</link>
		<comments>http://aneconomyofmeaning.wordpress.com/2013/04/05/the-great-red-spot-lonesome-george-and-happy-memories-of-my-youth/#comments</comments>
		<pubDate>Fri, 05 Apr 2013 20:11:53 +0000</pubDate>
		<dc:creator>Joseph Carrabis</dc:creator>
				<category><![CDATA[Meaning]]></category>
		<category><![CDATA[The Wild]]></category>

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		<description><![CDATA[Holding hands with Lonesome George as we walk across Jupiter's Great Red Spot<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1326&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></description>
				<content:encoded><![CDATA[<p><a href="http://www.nextstagevolution.com" target="other"><img vspace="4" hspace="8" border="0" align="right" src="http://www.nextstagevolution.com/images/nse_blogging_logo.cfm?blog=EcoOfMean&amp;post=LonesomeGeorge" alt="NextStage: Predictive Intelligence, Persuasion Engineering, Interactive Analytics and Behavioral Metrics " title="NextStage: Predictive Intelligence, Persuasion Engineering, Interactive Analytics and Behavioral Metrics " /></a><font face="Verdana,geneva" size="2">For those out of the loop, Lonesome George died about this time last year (June 2012).</p>
<p>
What&#8217;s that? Name&#8217;s familiar but you can&#8217;t place the face?</p>
<p>
You think that&#8217;s a Canadian comic? Maybe a character in some straight to DVD movie?</p>
<p>
<img src="http://upload.wikimedia.org/wikipedia/commons/thumb/a/a5/Lonesome_George_in_profile.png/220px-Lonesome_George_in_profile.png" border="0" align="right" title="Lonesome George" alt="Lonesome George">No, Lonesome George was the last of his species, a Galapagos tortoise. He died unexpectedly after an estimated 100 year run.</p>
<p>
Aye, Georgie, we hardly knew ye.</p>
<p>
No others of his species were ever found. Nor was George willing to mate with females of close species. Okay, he did once. Nothing came of it.</p>
<p>
I remember first hearing of Lonesome George late in high school. I was amazed, dumbfounded, awestruck. A living fossil much like the coelacanth, except we only ever found one, him. I read about him in National Geographic. I argued about his meaning with kids in the chess club and Mr. Edmunds, my science teacher.</p>
<p>
He became the symbol of the environment, the Green movement, ecological activism, et cetera.</p>
<p>
And more than anything else, I wondered about him. Did he know he was the last of his kind? A tortoise version of <a href="http://en.wikipedia.org/wiki/Yana_people#Ishi" target="other" title="Ishi, the last of the Yahi people">Ishi, the last of the Yahi people</a>? Did he wish his humans would let him back into the wild so that he could teach all of his tortoise wisdom to tortoises who weren&#8217;t of his tribe?</p>
<p>
And now he&#8217;s gone. I do mourn.</p>
<p>
<strong>Jupiter&#8217;s Great Red Spot</strong></p>
<p>
<img src="http://upload.wikimedia.org/wikipedia/commons/thumb/f/f9/GRS_in_far_infrared.jpg/220px-GRS_in_far_infrared.jpg" border="0" align="right" title="Jupiter's Great Red Spot" alt="Jupiter's Great Red Spot">Back in the early 2000s I was sitting in a parking lot listening to NPR (you did notice my &#8220;chess club&#8221; reference above, right?). Talk of the Nation was doing an episode on <a href="http://en.wikipedia.org/wiki/Schumacher-levy" target="otehr" title="Comet Schumacher-Levy's plunging through Jupiter's atmosphere and taking out the Red Spot">Comet Schumacher-Levy&#8217;s plunging through Jupiter&#8217;s atmosphere and taking out the Red Spot</a>.</p>
<p>
I knew about Jupiter&#8217;s Great Red Spot longer than I knew about Lonesome George. I was interested in astronomy since 3rd grade and got my first telescope (still have it, along with some others) when I was in 8th grade. I used it every night that first summer. I did the whole Galileo thing &#8212; craters of the moon, rings of Saturn, the girl&#8217;s dorm across the street.</p>
<p>
And Jupiter&#8217;s Great Red Spot.</p>
<p>
I remember calling into Talk of the Nation and saying that to me, seeing the Great Red Spot fade away after impact was mythic, an icon of my childhood imagination lost.</p>
<p>
Because, of course, I was going to explore that Great Red Spot. I was going to be on one of those rockets that did that kind of exploring.</p>
<p>
Kids think things like that.</p>
<p>
I still do.</p>
<p>
<strong>Happy Memories of Youth</strong></p>
<p>
Lonesome George is now on one of my bookshelves, right beside Jupiter&#8217;s Great Red Spot. Okay, just pictures of them.</p>
<p>
I sometimes wonder about the people I knew in school and college. I&#8217;ve pretty much done everything I ever wanted to do. Maybe my goals were small, I don&#8217;t know. But I wonder about the people I knew. What do they have on their bookcases? Do they even have bookcases?</p>
<p>
Do they ever remember their youth?</p>
<p>
Susan and I hold hands when we walk. Doesn&#8217;t matter if it&#8217;s in a mall, down the street, grocery shopping or in the woods. </p>
<p>
She is a transport mechanism for me. Not a time machine, but a transport. I hold her hand and I don&#8217;t have to remember any youths because I&#8217;m young again. A soft kiss and I&#8217;m exploring Jupiter&#8217;s Great Red Spot. I hear her laugh and I&#8217;m walking with Lonesome George but neither of us are lonesome and the world is not yet ancient around us.</p>
<p>
<strong>Happy Memories, Period</strong></p>
<p>
Don&#8217;t ever give up your memories of youth. Just find someone who&#8217;ll help you find them.</p>
<p>
<font size="1"><a title="Reading Virtual Minds Volume I: Science and History" name="Reading Virtual Minds Volume I: Science and History" href="http://knowledgeshop.nextstagevolution.com/rvmv1sah.cfm" target="other"><img src="http://www.bizmediascience.com/uploads/RVMsmallfrontcover-thumb.jpg" alt="RVMsmallfrontcover.jpg" width="100" height="151" align="right" /></a>Sign up for <a href="http://www.nextstagevolution.com/email1.cfm"><em>The NextStage Irregular</em></a>, our very irregular, definitely frequency-wise and probably topic-wise newsletter.</font><br />
<font size="1">You can follow me and my research on <a href="http://twitter.com/JosephCarrabis" target="other">Twitter</a>. I don&#8217;t twit often but when I do, it&#8217;s with gusto!</font><br />
<font size="1">Have you read my latest book, <a title="Reading Virtual Minds Volume I: Science and History" name="Reading Virtual Minds Volume I: Science and History" href="http://knowledgeshop.nextstagevolution.com/rvmv1sah.cfm" target="other">Reading Virtual Minds Volume I: Science and History</a>? It&#8217;s a whoppin&#8217; good read.</p>
<p>
Learn the latest regarding NextStage blog posts, conference sightings,<br />whitepapers, tools, presentations and more via <a href="http://knowledgeshop.nextstagevolution.com/knowledgeshop.xml">The NextStage RSS feed <img src="http://knowledgeshop.nextstagevolution.com/images/nextstage-rss.png" border="0" align="absmiddle" alt="Subscribe to NextStage's KnowledgeShop's RSS feed"></a>.<br />
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<br />Filed under: <a href='http://aneconomyofmeaning.wordpress.com/category/meaning-2/'>Meaning</a>, <a href='http://aneconomyofmeaning.wordpress.com/category/the-wild/'>The Wild</a>  <img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1326&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></content:encoded>
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		<title>What&#8217;s in Your Wallet? &#8211; What Your Business Cards Say About You</title>
		<link>http://aneconomyofmeaning.wordpress.com/2013/04/01/whats-in-your-wallet-what-your-business-cards-say-about-you/</link>
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		<pubDate>Mon, 01 Apr 2013 21:21:21 +0000</pubDate>
		<dc:creator>Joseph Carrabis</dc:creator>
				<category><![CDATA[Podcast]]></category>
		<category><![CDATA[Self-Marketing]]></category>

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		<description><![CDATA[Does your business card let prospects know you can be trusted?<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1319&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></description>
				<content:encoded><![CDATA[<p><a href="http://www.nextstagevolution.com" target="other"><img vspace="4" hspace="8" border="0" align="right" src="http://www.nextstagevolution.com/images/nse_blogging_logo.cfm?blog=EcoOfMean&amp;post=WalletPodcast" alt="NextStage: Predictive Intelligence, Persuasion Engineering, Interactive Analytics and Behavioral Metrics " title="NextStage: Predictive Intelligence, Persuasion Engineering, Interactive Analytics and Behavioral Metrics " /></a><font face="Verdana,geneva" size="2"><br />
Do you have 97 seconds and 99&cent; to learn how to market yourself better?</p>
<p>
NextStage&#8217;s <font class="producttitle">1 Minute MarketLift</font> podcast, &#8220;What&#8217;s in Your Wallet? &#8211; What Your Business Cards Say About You&#8221; can do just that in just that amount of time. Here&#8217;s how &#8220;What&#8217;s in Your Wallet? &#8211; What Your Business Cards Say About You&#8221; came about:</p>
<p>
A friend&#8217;s company (three offices, international client base, F100s to solopreneurs) was rebranding and part of the rebranding effort involved redesigning their business cards. They&#8217;d gotten it down to six styles and asked NextStage to take it from there.<br />
<br />
Before looking at their final six we asked, &#8220;What&#8217;s the one thing you want people to think when they see your card? What&#8217;s the one impression you want them to have?&#8221;</p>
<p>
Their answer was <em>&#8220;You can trust us&#8221;</em>. The podcast explains how to take any business card and have <em>trust</em> be the take-away.</p>
<p>
<a href="http://knowledgeshop.nextstagevolution.com/podcasts.cfm" name="NextStage Evolution's 1 Minute MarketLift Podcasts"><img src="http://knowledgeshop.nextstagevolution.com/images/NSE_podcast75.png" border="0" align="right" title="NextStage 1 Minute MarketLift Podcasts" alt="NextStage 1 Minute MarketLift Podcasts"></a>Have a listen to NextStage&#8217;s <font class="producttitle">1 Minute MarketLift</font> podcast, &#8220;What&#8217;s in Your Wallet? &#8211; What Your Business Cards Say About You&#8221;and let us know what you think.&nbsp;<a href="https://www.e-junkie.com/ecom/gb.php?i=NS1M&amp;c=single&amp;cl=111167&amp;custom=NS1M-DJdrbdAGdbyxhzbGA" target="ejejcsingle"><img src="http://www.e-junkie.com/ej/x-click-butcc.gif" border="0" alt="Buy Now" align="absmiddle"></a></p>
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<font size="1"><a title="Reading Virtual Minds Volume I: Science and History" name="Reading Virtual Minds Volume I: Science and History" href="http://knowledgeshop.nextstagevolution.com/rvmv1sah.cfm" target="other"><img src="http://www.bizmediascience.com/uploads/RVMsmallfrontcover-thumb.jpg" alt="RVMsmallfrontcover.jpg" width="100" height="151" align="right" /></a>Sign up for <a href="http://www.nextstagevolution.com/email1.cfm"><em>The NextStage Irregular</em></a>, our very irregular, definitely frequency-wise and probably topic-wise newsletter.</font><br />
<font size="1">You can follow me and my research on <a href="http://twitter.com/JosephCarrabis" target="other">Twitter</a>. I don&#8217;t twit often but when I do, it&#8217;s with gusto!</font><br />
<font size="1">Have you read my latest book, <a title="Reading Virtual Minds Volume I: Science and History" name="Reading Virtual Minds Volume I: Science and History" href="http://knowledgeshop.nextstagevolution.com/rvmv1sah.cfm" target="other">Reading Virtual Minds Volume I: Science and History</a>? It&#8217;s a whoppin&#8217; good read.</p>
<p>
Learn the latest regarding NextStage blog posts, conference sightings,<br />whitepapers, tools, presentations and more via <a href="http://knowledgeshop.nextstagevolution.com/knowledgeshop.xml">The NextStage RSS feed <img src="http://knowledgeshop.nextstagevolution.com/images/nextstage-rss.png" border="0" align="absmiddle" alt="Subscribe to NextStage's KnowledgeShop's RSS feed"></a>.<br />
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<br />Filed under: <a href='http://aneconomyofmeaning.wordpress.com/category/podcast/'>Podcast</a>, <a href='http://aneconomyofmeaning.wordpress.com/category/podcast/self-marketing/'>Self-Marketing</a>  <img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1319&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></content:encoded>
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		<title>Regional Hospital Innovation Unbundled: A Real Change Declaration</title>
		<link>http://aneconomyofmeaning.wordpress.com/2013/02/28/regional-hospital-innovation-unbundled-a-real-change-declaration/</link>
		<comments>http://aneconomyofmeaning.wordpress.com/2013/02/28/regional-hospital-innovation-unbundled-a-real-change-declaration/#comments</comments>
		<pubDate>Thu, 28 Feb 2013 09:47:12 +0000</pubDate>
		<dc:creator>David Morf</dc:creator>
				<category><![CDATA[Business Management]]></category>
		<category><![CDATA[Best Practices]]></category>
		<category><![CDATA[Change]]></category>
		<category><![CDATA[Decision Making]]></category>
		<category><![CDATA[healthcare]]></category>
		<category><![CDATA[policy]]></category>
		<category><![CDATA[sustainable]]></category>
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		<description><![CDATA[Regional health systems as population-wide resources can provide a "health supply chain" boosting regional health, labor productivity, and economic betterment.<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1228&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></description>
				<content:encoded><![CDATA[<p>This post first appeared <b><a href="http://www.linkedin.com/groupAnswers?viewQuestionAndAnswers=&amp;discussionID=216827908&amp;gid=93115&amp;commentID=121334196&amp;goback=.amf_93115_16303215&amp;trk=NUS_DISC_Q-subject#commentID_121334196">here</a></b> in a LinkedIn <b><a href="http://en.wikipedia.org/wiki/Healthcare_Information_and_Management_Systems_Society">HIMSS</a></b> group on the topic, &#8220;What will drive the next wave of healthcare innovations?&#8221; In that LinkedIn topic, the willingness to “envision possibility” is excellent as a theme for systemic change (Note: on 2013/03/13, a paragraph was added below on &#8220;How about region-wide protocols&#8230;&#8221;). However, much energy along the &#8220;envision&#8221; line looks to me to be very narrowly incremental within the boundaries of current regional operational and payment frameworks. How about workshops to “envision possibility” along new lines of inquiry as below to provide a &#8220;health supply chain&#8221; boosting regional health, labor productivity, and economic betterment?</p>
<p>For example&#8230;</p>
<p>How about serious energy for regional and population-wide health systems that address linking walk-in sites, primary care, and hospital care, where regional hospitals act as the head or heads of a regional health supply chain infrastructure, by applying a regional health resource based on the nation-wide patient- and practitioner-oriented <b><a href="http://en.wikipedia.org/wiki/VistA">VistA</a></b> resource (largest VistA enabling firm is <b><a href="http://www.medsphere.com/company/about">Medsphere</a></b>), possibly even partnering with people like a reoriented <b><a href="https://www.vha.com/AboutVHA/Pages/CompanyInformation.aspx">VHA</a></b> team to build a regional &#8220;supply chain&#8221; of regional health services?</p>
<p>How about funding the regional system with the aggregated health budgets of all regional private and public employers and also the disbursements by regional <b><a href="http://www.cms.gov/About-CMS/About-CMS.html">CMS</a></b> and state <b><a href="http://en.wikipedia.org/wiki/Medicaid">Medicaid</a></b>?</p>
<p>How about a region-wide <b><a href="http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/aco/">ACO</a></b> structure that included a funds aggregation and episode or capitation disbursement function (possibly with FFS for diagnostics) to handle the above funds flows, using the administrative processing resources currently offered under contract by health insurance firms?</p>
<p>How about chartering the regional ACO body to move toward cross-silo, distance-enabled health teams that reach from hospitals to the walk-in centers so that people can check &#8220;yes&#8221; on a walk-in <b><a href="http://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Act">HIPAA</a></b> screen to snap down a health recap from the Electronic Health Record (<b><a href="http://en.wikipedia.org/wiki/Electronic_health_record">EHR</a></b>) in the regional hospital infrastructure so the walk-in staff of MD-DDS supervised NP-PA-RN-PharmD-therapist pods can see in the health recap the morbidity profile and trended vitals-labs-meds, coupled with the ability to upload the results of the walk-in visit based on local event closing, networked upriver cross-silo tele-support, or upriver primary or hospital triage?</p>
<p>How about leveraging the walk-in infrastructure already forming mostly outside traditional hospitals by pharmacy-based retail health clinics (<b><a href="http://en.wikipedia.org/wiki/Convenient_care_clinic">RHCs</a></b>), and even more substantially by partnership franchises for urgent care centers (<b><a href="http://en.wikipedia.org/wiki/Urgent_care">UCCs</a></b>), community clinics (<b><a href="http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Introduction/qualified.html">FQHCs</a></b>), and employer-located front-line care facilities?</p>
<p>How about region-wide protocols coordinated through the regional ACO and regional health system for regional care coordination, patient navigation, meds management, and structured scalable care transitions for unit and organization transfers-discharges-followups involving any service areas within or between any regional health and wellness facilities?</p>
<p>The above notions are not to ignore the serious work fostered at the recent <b><a href="http://www.himssconference.org/">HIMSS13</a></b> conference.  However, exploring putting into motion regional health frameworks as sketched above seems the real meat and potatoes of a genuinely transformative and systemic patient-centered regional healthcare innovation process. In the most respectful way possible, I&#8217;d suggest asking if the current wave of activity is not mostly focused on optimizing islands of traditional physician-centered hospital and primary practice within the traditional health and intermediated funding infrastructure that costs too much and delivers too little.</p>
<br />Filed under: <a href='http://aneconomyofmeaning.wordpress.com/category/business-management/'>Business Management</a> Tagged: <a href='http://aneconomyofmeaning.wordpress.com/tag/best-practices/'>Best Practices</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/change/'>Change</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/decision-making/'>Decision Making</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/healthcare/'>healthcare</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/policy/'>policy</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/sustainable/'>sustainable</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/systemic/'>systemic</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/team-action-learning/'>team action learning</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/whole-system/'>whole system</a> <img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1228&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></content:encoded>
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		<title>Regarding the first Romney-Obama Presidential Debate: October 3, 2012</title>
		<link>http://aneconomyofmeaning.wordpress.com/2012/10/05/regarding-the-first-romney-obama-presidential-debate-october-3-2012/</link>
		<comments>http://aneconomyofmeaning.wordpress.com/2012/10/05/regarding-the-first-romney-obama-presidential-debate-october-3-2012/#comments</comments>
		<pubDate>Fri, 05 Oct 2012 23:55:18 +0000</pubDate>
		<dc:creator>David Morf</dc:creator>
				<category><![CDATA[Business Management]]></category>
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		<description><![CDATA[This was a debate designed to destroy, not inform.  It exposed one participant as fundamentally decent, and the other as low, cunning, and amoral.<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1212&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></description>
				<content:encoded><![CDATA[<p><img alt="" src="http://www.nextstagevolution.com/images/nse_blogging_logo.cfm?blog=Pol&amp;post=EM-FirstR-ODebate" />This post first appeared on Thursday October 4, 2012, in The Washington Post as an untitled <strong><a href="http://www.washingtonpost.com/lifestyle/style/in-debate-obamas-and-romneys-scripted-remarks-make-for-brain-bruising-television/2012/10/03/67f26e5a-0ca6-11e2-a310-2363842b7057_allComments.html?wp_login_redirect=0">top comment</a></strong>, and then in The Hungry Peasant on Friday October 5 titled <strong><a href="http://politics.hungrypeasant.com/index.php/2012/10/06/regarding-the-first-romney-obama-presidential-debate-october-3-2012/">Regarding the First Romney-Obama Presidential Debate: October 3, 2012</a></strong>.</p>
<p>In the Wednesday debate, both Romney and Obama did details, but Romney had a better game plan – if he wins the toss, start second so he can see Obama&#8217;s approach and delivery as the first speaker, and also so he can have the evening&#8217;s last word by which to leave the final impression on viewers.</p>
<p>But aside from debate game plans, the Romney team clearly pushed in the two-party debate planning process for the debates to focus on detail topics – the strategic goal being to cause Obama to focus on details and not have time to bring up his <span style="text-decoration:underline;">leadership in pulling the country out of a deep hole</span>.  The resulting dog that didn&#8217;t bark is that Obama never got into gear on his real value as a leader, versus his day-to-day work as a manager.</p>
<p>Then Romney played the next game plan card by claiming that Obama didn&#8217;t include Republican input to Obamacare.  At that point, Obama fell into the trap and failed to point out that the Senate leadership had openly stated their top job was to make Obama a one-term president, and that the House leadership was internally whipsawed by the take-no-prisoners stance from the Tea Party movement.</p>
<p>In the debate, Obama did not point out that the lack of bi-partisanship was due to the Republican decision to offer no willingness to make any negotiable and workable contribution to either the process or the substance.  In effect, the Republicans went on a sit-down strike, and then blamed Obama for not working with them.  And Obama did not use Romney&#8217;s artificial complaint about cooperation to make the point that the Republicans were the ones who chose to sit it out while throwing darts at the work in progress.</p>
<p>Obama&#8217;s missed opportunity to set the major legislative story straight set the tone for the evening.  From then on, it was detail after detail, where Romney’s business sense excels at building stories from highly artful and colorful numbers.  Obama&#8217;s lifetime as a lawyer in ward politics did not give him the instinct to elevate the exchange to the place where he really excels, which is connecting leadership with operational action across the huge mix of players in DC to get things actually to happen.  Wow.</p>
<br />Filed under: <a href='http://aneconomyofmeaning.wordpress.com/category/business-management/'>Business Management</a> Tagged: <a href='http://aneconomyofmeaning.wordpress.com/tag/change/'>Change</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/communication/'>communication</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/meetings/'>meetings</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/policy/'>policy</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/story-telling/'>story telling</a> <img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1212&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></content:encoded>
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			<media:title type="html">davidtoday</media:title>
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		<title>Message to Mr Obama Before the First 2012 Presidential Debate</title>
		<link>http://aneconomyofmeaning.wordpress.com/2012/10/03/message-to-mr-obama-before-the-first-2012-presidential-debate/</link>
		<comments>http://aneconomyofmeaning.wordpress.com/2012/10/03/message-to-mr-obama-before-the-first-2012-presidential-debate/#comments</comments>
		<pubDate>Wed, 03 Oct 2012 17:25:19 +0000</pubDate>
		<dc:creator>David Morf</dc:creator>
				<category><![CDATA[Business Management]]></category>
		<category><![CDATA[Media Influence]]></category>
		<category><![CDATA[communication]]></category>
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		<description><![CDATA[Unsolicited advice to Mr Obama on the day of the first presidential debate of 2012, touching on policy, polity, comity, history, and place in the emerging public mind.<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1200&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></description>
				<content:encoded><![CDATA[<p><img src="http://www.nextstagevolution.com/images/nse_blogging_logo.cfm?blog=Pol&amp;post=EoM-MessageToObama" alt="" align="right" border="0" />This post first appeared under the same title, <a href="http://politics.hungrypeasant.com/index.php/2012/10/03/message-to-mr-obama-before-the-first-2012-presidential-debate/">Message to Mr Obama Before the First 2012 Presidential Debate</a>, in The Hungry Peasant.  Remember that this was nominally intended to be given in the cadence of projected natural speech before a large group.  Such delivery would result in the easy pauses that occur as speech and breathing take their turns, thus converting the long written sentences into the ancient rhythms of oratory.  Thank you, and now, the post&#8230;</p>
<p>Focus on accomplishments to restart our country – leave off saying the bank crisis is the fault of others, as both parties did their part since 1980 and before to unwind and reject responsive regulatory safety nets for the nation&#8217;s banking system and securities markets.  Observe that if steps now taken, though vital as far as they went, were less strong than called for, it had to be that way to help the other side not frustrate the needs of millions across the country – that&#8217;s what it takes to join across the aisle, and that work of joining for the common good is a hope worth nurturing.</p>
<p>As to the future, now is the time to ensure our steps together toward life and safety in a big planet do not wreak havoc on our ability to share comity, to seek to know and think and speak unafraid about actions by your own government, to be ourselves in our own lives and bodies, to be unafraid to see justice at work for domestic and foreign matters in our country&#8217;s state and federal courts, to end the self-destructive War on Drugs, to face the future with confidence that we do know how to fund the necessary work of staying healthy, teaching our youth, exploring our world and the planets and all that science and poetry can reveal, and also caring for the ill and the wounded and the unemployed and the older population, and that we are wise enough to be clear in our vision so we can pay our debts not only by governing and taxing ourselves with prudence and progressive fairness, but also by spending wisely to help our economy grow at home as well as sell our works and foods to people around the world, not only including our friends in Europe and the British Isles, Russia, China, Japan, India, Asia, Africa, the Middle East, Southeast Asia, but also here in North America from Canada to Mexico, in the Caribbean Sea, in Central America from Belize and Guatemala to Panama, and in South America from Brazil, Peru, Bolivia, Chile, and Argentina to Venezuela, Columbia, Ecuador, and all their neighbors.</p>
<p>At home in this country, at peace in this hemisphere, North, Central, and South together, and at peace with all the nations and faiths who work toward mercy as well as justice in a shared quest for a larger and better life in this life and a deep belief in our ability as individuals and nations to achieve a better place for our children and their children as far as we can see—we ask and seek all this with our faith in a just and merciful God and our belief in our ability with His help to be wise enough to nurture our rapidly warming world and to achieve an enduring good and useful life for us all on this Earth.  Thank you, God bless you, and may His grace be upon us all.</p>
<br />Filed under: <a href='http://aneconomyofmeaning.wordpress.com/category/business-management/'>Business Management</a>, <a href='http://aneconomyofmeaning.wordpress.com/category/media-influence/'>Media Influence</a> Tagged: <a href='http://aneconomyofmeaning.wordpress.com/tag/communication/'>communication</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/dialog/'>dialog</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/policy/'>policy</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/story-telling/'>story telling</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/systemic/'>systemic</a>, <a href='http://aneconomyofmeaning.wordpress.com/tag/village/'>village</a> <img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1200&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></content:encoded>
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		<title>10 Things You Need to Know Before You Go Consulting</title>
		<link>http://aneconomyofmeaning.wordpress.com/2012/07/03/10-things-you-need-to-know-before-you-go-consulting/</link>
		<comments>http://aneconomyofmeaning.wordpress.com/2012/07/03/10-things-you-need-to-know-before-you-go-consulting/#comments</comments>
		<pubDate>Tue, 03 Jul 2012 17:26:30 +0000</pubDate>
		<dc:creator>Joseph Carrabis</dc:creator>
				<category><![CDATA[Business Management]]></category>

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		<description><![CDATA[Are you planning on becoming a consultant? Read this first, please.<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1182&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></description>
				<content:encoded><![CDATA[<p><a href="http://www.nextstagevolution.com" target="other"><img vspace="4" hspace="8" border="0" align="right" src="http://www.nextstagevolution.com/images/nse_blogging_logo.cfm?blog=EcoOfMean&amp;post=10Consultings" alt="NextStage: Predictive Intelligence, Persuasion Engineering, Interactive Analytics and Behavioral Metrics" title="NextStage: Predictive Intelligence, Persuasion Engineering, Interactive Analytics and Behavioral Metrics" /></a><font face="Verdana,geneva" size="2">So you&#8217;ve decided you&#8217;re going to be a consultant.</p>
<p>
Good for you!</p>
<p>
We use to define consultants as &#8220;unemployed with a briefcase&#8221;. That &#8220;unemployed&#8221; part is increasingly true in this economy. NextStage has been consulting since before it was officially &#8220;NextStage&#8221; (I started consulting in 1999. We became NextStage in 2001) and we&#8217;ve managed to keep going while others larger and smaller faded away, some quietly, some in blazes of unglory.</p>
<p>
But good for you, seriously. Here&#8217;s some things that may help you before you get too far down a road you can&#8217;t follow.</p>
<h3>1) Have an Active Client List Before You Start</h3>
<p><img src="http://www.heromachine.com/blog/wp-content/uploads/2011/09/legend.jpg" width="300" height="393" border="0" align="right" title="The Devil they know" alt="The Devil they know">There is a standard rule that customer acquisition is far more expensive than customer retention. Acquisition is more expensive than retention because, from the client&#8217;s side, the devil you know is better than the devil you don&#8217;t. In other words, clients may be getting rubbed raw by their existing consultants but they know they&#8217;re going to get rubbed raw, have a pretty good idea how raw they&#8217;ll get, how much it&#8217;ll hurt, how long the pain will last and what they&#8217;ll need to do to alleviate it.</p>
<p>
You, however, are completely unknown to them. They have no idea how much pain you&#8217;re going to give them, how raw you&#8217;ll rub them,  how long the particular type of pain you provide will last or if they&#8217;ll be able to alleviate it.</p>
<p>
Realistically, who would you go with?</p>
<p>
Everybody&#8217;s making promises to them and your promises are no different. You can even say &#8220;Give me a chance, no charge, and if things work, hire me for more&#8221; and they&#8217;ll balk because seasoned businesses know what you&#8217;re really saying is &#8220;Let me get a foot in the door and I&#8217;ll dig in deeper than an Alabama tick. You&#8217;ll never be able to get rid of me&#8221;.</p>
<p>
So, before you hang out your shingle announcing yourself to the world, make sure you already have some portion of the world willing to come under your shingle. And get written commitments. Potential clients can still back away and if it&#8217;s in writing it&#8217;s a little more embarrassing for them should they need to hire other consultants.</p>
<h3>2) Make Sure Those Clients Speak Well of You</h3>
<p>Ever heard<br />
<blockquote>It takes 47 <em>attaboys</em> to make up for one <em>ohsh?t</em></p></blockquote>
<p>The above is extremely true in the world of consulting because word-of-mouth can make or break you. Spend what you want on search engine listings, fancy websites, brochures, conference booths and the like, one bad referral and your business is ruined.</p>
<p>
That noted, don&#8217;t cave in to idiots. Stand your ground, hold your own, and always present yourself in the best terms possible. The business world may work with idiots at the helms of certain companies because it has to and that doesn&#8217;t mean it wants to. Another of my favorite sayings is<br />
<blockquote>If the butchers, the bakers and the candlestick makers think you&#8217;re an idiot, then you&#8217;re probably an idiot. However, if the butchers and the bakers think you&#8217;re great and the candlestick makers think you&#8217;re an idiot, the problem&#8217;s with the candlestick makers and you&#8217;re probably okay.</p></blockquote>
<p>
Like all rules, the Butcher-Baker-CandleStick Maker rule needs to be applied carefully and apply it you must, especially when you&#8217;re consulting. </p>
<h3>3) Get Advisors</h3>
<p>Part of the ability to identify prospects, partners, friends and yes, idiots, is in our social wiring. We learned a lot of it on the playground growing up. Another part of it comes from experience and as Steven Wright says<br />
<blockquote>Experience is something you don&#8217;t get until just after you need it.</p></blockquote>
<p> You can get experience before you need it by asking people to advise you on business matters. </p>
<p>
I recommend you seek out the counsel of others on all matters, actually, not just business because (and as we&#8217;ll note further down in this list) any one part of your life will affect all parts of your life. A painful personal relationship will affect business et cetera et cetera. The only way to avoid this kind of cross pollination is to have some one part of your life dominate all parts of your life. The person who is always &#8220;working&#8221; is an example of this and all things come with a price. If you&#8217;re always working then you&#8217;re not living and of the two, I&#8217;ll chose the latter. I&#8217;ve never heard &#8220;If only I spent more time in the office&#8230;&#8221; as anybody&#8217;s deathbed lament.</p>
<h3>4) Be Prepared to Spend the Bulk of Your Time Finding New Business</h3>
<p>You may be lucky enough to bring a full rolodex of clients to your consultancy. Good for you. Are they going to be clients forever? Are their businesses set up as legacies so that when new management comes in, your position with that business remains intact or will new management bring new consultants with them?</p>
<p>
People move on, retire and die. You need to keep your sales funnel full. Keeping it full means, as noted above, getting out where prospects can both find you and interview you. Often this &#8220;interviewing&#8221; takes place at conferences and conventions after the presentations and panel sessions are over. The technical term is <em>schmoozing</em>.</p>
<p>
<img src="http://upload.wikimedia.org/wikipedia/commons/1/19/Willie_Sutton.jpg" width="300" height="400" border="0" align="right" title="Willie Sutton, a wise man" alt="Willie Sutton, a wise man">Schmoozing is an art and part of that art is, paraphrasing Willie Sutton, going where the money is.</p>
<p>
For consultants, going where the money is means finding the conventions, conferences, networking groups, et al, where your prospects will be. It&#8217;s perfectly useless to spend money on a booth, brochures, presentations, panels, keynotes, et cetera, for a conference/convention/networking event that isn&#8217;t the best possible audience for your product/service/offering.</p>
<p>
Most consultants work with limited budgets and wise spending is paramount. Find the correct audience first, learn where they go and go after them. One minor thing I&#8217;ve learned that&#8217;s proven invaluable is to preface any schmoozing with &#8220;Mind talking a little business?&#8221; or &#8220;Mind <em>not</em> talking about business?&#8221; These phrases immediately convey my goals, let others know my boundaries, so on and so forth. </p>
<p>
If nothing else, if guarantees you and they won&#8217;t waste each others&#8217; time.</p>
<h3>5) Choose Your Networks Carefully</h3>
<p>You can go nuts preparing for, traveling to and attending conferences. As noted above, I recommend finding those that will return the most benefit to you.</p>
<p>
Right along with that and usually much more accessible are local networking events. Networking events are where bunches of unemployed people with briefcases (consultants, remember?) gather to exchange business cards, leads, ideas, partners and the like.</p>
<p>
And there are both online and offline networks. Online networks have blossomed in the past year, it seems. I get at least one invitation a week from a &#8220;close friend&#8221; &#8212; usually someone I don&#8217;t actually know &#8212; to join some new kind of business network. Some offer to pay me for making referrals for others, some offer free services for making referrals, there&#8217;s always some kind of offer that makes them better than the invitation I received last week.</p>
<p>
Same rules apply. Before you join an online network, check out the membership. Are the members prospects for what you do or offer? Can they bring you new business? Will they bring you new business? Are you just another notch in their belt or another dollar in their pocket (for their referral) or can you really benefit them and be benefitted in return?</p>
<p>
Decide accordingly.</p>
<h3>6) There Are Peers and There Are Peers</h3>
<p>You&#8217;ve got advisors, you know which conferences/conventions/networks to go to and you know who&#8217;s opinion matters.</p>
<p>
Put them all together and you can figure out who&#8217;s your peer. Sometimes peers are nemeses &#8212; they show up when you don&#8217;t want them to and most often keep you in line when you&#8217;d like to step over that line a bit &#8212; sometimes peers are allies, sometimes peers are adversaries and sometimes they are enemies. I prefer the nemeses because they help keep you honest. Exaggerate or misstate and they&#8217;ll let everybody know. They keep you on your toes and that, I think, is a good thing.</p>
<p>
But when you&#8217;re going to see a client and need some backup? Pick an ally, pick them well and carefully.</p>
<p>
Adversaries are not enemies. Sometimes adversaries can be allies and most often a good adversary ends up as a friend. Adversaries are merely those who are going after the same jobs you are. Spend time with them, learn about and from them. It&#8217;s the only way to be better than them.</p>
<p>
Enemies just want to hurt you. Leave them be. If you must respond to them, respond honestly. And document everything.</p>
<h3>7) Be Prepared to Spend the Bulk of Your Time Investigating the Tried&amp;True and New&amp;Blue in Your Field</h3>
<p>Prospecting and staying on top of your field are going to vie for time once you&#8217;re a consultant. Prospecting is covered in item 4.</p>
<p>
How does one stay on top of their field? Fortunately, some of that comes from networking. There&#8217;s also reading, writing, going to conferences and conventions, taking webinars, &#8230;</p>
<p>
So the first thing you&#8217;ll notice is that a lot of staying on top of your field can be done via what we&#8217;ve listed already. Good.</p>
<p>
Now comes the more interesting part, a variation of &#8220;There are peers and there are peers.&#8221; This time it takes the form &#8220;Learn how to discriminate between news and marketing fluff.&#8221;</p>
<p>
And there&#8217;s a lot of marketing fluff out there. One promoter pleaded with me to do a presentation and balked when I stated my fee. &#8220;There are many people interested in speaking at this event because they want the exposure and because they want to be seen as thought leaders in this emerging social analytics industry. Due to this fact, the market dictates that I cannot pay speakers when so many are lining up and eager to speak anyway (even though I am quite eager to get you on board).&#8221;</p>
<p>
So if conferences are really marketing events, do you want to subsidize some presenter&#8217;s sales pitch?</p>
<p>
Most people I know have been going to conventions and conferences on <em>social passes</em>. A social pass allows you access to the exhibitors&#8217; floor and not much else. No sessions, no keynotes, no workshops or trainings. It probably gives you access to the schmoozing sessions and that&#8217;s reason enough to go&#8230;sometimes.</p>
<p>
The reason social passes are so popular is because exhibitors pay big dollars for floor space on the exhibitors&#8217; floor and speakers often have to pay for access to the audience. I&#8217;m told that all but the top keynoters have to pay for the right to keynote.</p>
<p>
What entices exhibitors, speakers and keynoters to pay up? The promise of high attendance.</p>
<p>
But attendance was dropping a few years back because the sessions were repetitive, there was rarely anything new presented, the workshops et cetera were glorified sales presentations, &#8230;</p>
<p>
So how do promoters promise high attendance when the conventions themselves are no longer the draw?</p>
<p>
Social passes. They cost much less and they keep attendance numbers up.</p>
<p>
So unless there&#8217;s a real good reason for you to attend the actual sessions, workshops, keynotes and the like, you can stay on top of your field for a much lower price by going social. That and reading something other than marketing hype in your field, talking with your peers to learn what they know and are doing, so on and so forth.</p>
<h3>8) Take a Class in Negotiating</h3>
<p>The best definition of negotiating I&#8217;ve heard is<br />
<blockquote>The art of getting as much as you can of what you want while giving away as little as you can of what they want.</p></blockquote>
<p>Consultants need to know how to negotiate. Most large clients have rules in place regarding services/products rendered and payments made, most small clients don&#8217;t and my experience is that the smaller the client the more they&#8217;ll want for as little as possible.</p>
<p>
Negotiating is necessary for lots of reasons. Perhaps the most important is that the majority of people new to consulting don&#8217;t know what they&#8217;re worth, hence price themselves out of their market either positively or negatively, give too much away in the name of business development, give nothing away and always there&#8217;s some mix of the above.</p>
<p>
Another important reason to develop negotiation skills is to learn what jobs you shouldn&#8217;t take on, what clients you don&#8217;t want to sign.</p>
<p>
And if you&#8217;re beginning to see that new consultants need to know what to stay away from, you&#8217;re on the right track.</p>
<h3>9) Make Sure You Get Paid</h3>
<p>There are two types of clients: those who pay you in coin of the realm and those who pay you in promises to pay you in coin of the realm. Have you ever heard &#8220;Promises make a thin soup&#8221;? Learn it. It&#8217;s true.</p>
<p>
Clients that pay you are the ones you want. You can take that payment and pay your bills, buy nice things for those you care about, generally keep yourself and your business going.</p>
<p>
Clients that don&#8217;t pay you won&#8217;t pay you for lots of reasons. Surprisingly, many of those non-payment reasons have little to do with you, your product, service or offering in general. Most times non-payment occurs as part of a power play from client to vendor and closely resembles <em>victimizing behavior</em>. Sadly, this denial of payment most often occurs after you&#8217;ve demonstrated good value. The most insidious form involves having you in for an &#8220;interview&#8221; wherein the client asks how you&#8217;d solve some problem, you provide a working solution, they thank you but never call you back to implement. The giveaway to the latter is that they or their second in command takes lots of notes, but not when you talk about past engagements or references.</p>
<p>
My suggestion, should this or something similar occur to you, is to quietly walk away. But do share your experience when you go networking. That one outing may have cost you but the benefit you bring others will come back to reward you.</p>
<p>
Good and worthy clients will pay you and promptly because, should you go out of business for lack of funds, they&#8217;ve lost a trusted and worthy vendor. Letting a vendor go under does not help anybody&#8217;s business so good and worthy clients will make sure you&#8217;re paid or let you know well in advance there may be a hitch in payment, some of which may involve renegotiating your fee. Remember that in this case these people are having troubles of their own and want to negotiate in good faith. Forget any pound of flesh getting, they&#8217;ll remember that you helped them and come back over time.</p>
<p>
Again, good business, that.</p>
<h3>10) Make Sure You Have Family Support</h3>
<p>Most important for consultants is to have family support. Family support and a partner making sufficient income to support the family while your consulting business grows. It&#8217;s great to have family members believe in you, its better to have family members that don&#8217;t suffer because they believe in you.</p>
<p>
Not suffering can take lots of forms. Is everybody willing to pull together? Is everybody prepared to deal with a major change in financial lifestyle? Can your family take the strain of you having no work for three months then too much work on the fourth?</p>
<p>
So before you go the consulting route, make sure your family is with you. More than being with you, make sure they&#8217;re staying with you.</p>
<p>
Links for this post:</p>
<ul>
<li><a href="http://aneconomyofmeaning.wordpress.com/2009/12/17/firing-the-client/" target="other" title="Firing the Client">Firing the Client</a>
<li><a href="http://technologymarketers.com/StatingTheObvious/firing-the-client-redux/" target="other" title="Firing the Client, Redux">Firing the Client, Redux</a>
</ul>
<p>
<font size="1"><a title="Reading Virtual Minds Volume I: Science and History" name="Reading Virtual Minds Volume I: Science and History" href="http://knowledgeshop.nextstagevolution.com/rvmv1sah.cfm" target="other"><img src="http://www.bizmediascience.com/uploads/RVMsmallfrontcover-thumb.jpg" alt="RVMsmallfrontcover.jpg" width="100" height="151" align="right" /></a>Sign up for <a href="http://www.nextstagevolution.com/email1.cfm"><em>The NextStage Irregular</em></a>, our very irregular, definitely frequency-wise and probably topic-wise newsletter.</font><br />
<font size="1">You can follow me and my research on <a href="http://twitter.com/JosephCarrabis" target="other">Twitter</a>. I don&#8217;t twit often but when I do, it&#8217;s with gusto!</font><br />
<font size="1">Have you read my latest book, <a title="Reading Virtual Minds Volume I: Science and History" name="Reading Virtual Minds Volume I: Science and History" href="http://knowledgeshop.nextstagevolution.com/rvmv1sah.cfm" target="other">Reading Virtual Minds Volume I: Science and History</a>? It&#8217;s a whoppin&#8217; good read.</p>
<p>
Learn the latest regarding NextStage blog posts, conference sightings,<br />whitepapers, tools, presentations and more via <a href="http://knowledgeshop.nextstagevolution.com/knowledgeshop.xml">The NextStage RSS feed <img src="http://knowledgeshop.nextstagevolution.com/images/nextstage-rss.png" border="0" align="absmiddle" alt="Subscribe to NextStage's KnowledgeShop's RSS feed"></a>.<br />
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		<title>Nothing Ever Dies of Old Age in The Wild</title>
		<link>http://aneconomyofmeaning.wordpress.com/2012/05/11/nothing-ever-dies-of-old-age-in-the-wild/</link>
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		<pubDate>Fri, 11 May 2012 20:37:45 +0000</pubDate>
		<dc:creator>Joseph Carrabis</dc:creator>
				<category><![CDATA[The Wild]]></category>

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		<description><![CDATA[The Wild<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1136&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></description>
				<content:encoded><![CDATA[<p><a href="http://www.nextstagevolution.com" target="other"><img vspace="4" hspace="8" border="0" align="right" src="http://www.nextstagevolution.com/images/nse_blogging_logo.cfm?blog=EcoOfMean&amp;post=Wild" alt="NextStage: Predictive Intelligence, Persuasion Engineering, Interactive Analytics and Behavioral Metrics " title="NextStage: Predictive Intelligence, Persuasion Engineering, Interactive Analytics and Behavioral Metrics " /></a><font face="Verdana,geneva" size="2">I&#8217;m sitting on my backporch working. When the warmer weather hits, this is where I spend most of my time. I can see the woods behind our house, feel the sun on my bones, watch the bluejays, robins, orioles, cardinals, hummingbirds, nuthatches, morning doves, pigeons, squirrels, chipmunks and other assorted backyard denizens at the birdbaths, feeders and water buckets we leave out for those I call The Old Ones.</p>
<p>
I call animals The Old Ones because of my time studying anthropology. All the aboriginal peoples I&#8217;ve studied have views of wildlife that differ from those of most modern people and aboriginal views have rubbed off on me. Case in point, I&#8217;ve made friends with several generations of raccoons, turkeys, deer, skunks, opossum, woodchucks, beavers, fox and owl over the years. You can see many of them in our Facebook <a href="http://www.facebook.com/media/set/?set=a.165119400183564.40350.131316423563862&amp;type=3">Mascotology folder</a>.</p>
<p>
Even with the animals I&#8217;m friendly with, I still know they are wild. Many take food from my hand but none of them are tame, none are domesticated. They are wild.</p>
<p>
One of the rules of The Wild is that nothing dies of old age in The Wild. It just doesn&#8217;t happen. Animals grow old, grow tired, can&#8217;t move as quickly, can&#8217;t move as well, get injured, can&#8217;t get at whatever seed or bread or foodstuffs they can find and, in the end, even predators become prey in The Wild. </p>
<p>
<img src="https://aneconomyofmeaning.files.wordpress.com/2012/05/110826-sam-the-hawk-visits-our-backyard.jpg?w=600" border="0" align="right" title="Sam the Hawk" alt="Sam the Hawk">Even in my little backyard, backing up to many woodland acres, I&#8217;ve occasionally seen scatterings of feathers where Sam and Aris, our mated hawks, have caught something too slow at the feeders, and seen the remains of chipmunks, voles and mice in Bart the Owl&#8217;s pellets.</p>
<p>
<img src="https://aneconomyofmeaning.files.wordpress.com/2012/05/bart-the-owl.jpg?w=600" border="0" align="left" title="Bart the Owl" alt="Bart the Owl" hspace="5">Because I work quietly and prefer to listen to the sounds of The Wild (and sometimes Bach) the animals tend to ignore me. Sometimes all those around the feeders and water buckets will jump and flee and I&#8217;ll catch site of Reynard&#8217;s (a male fox) bushy red tail as he hurries back into deeper cover. I know he and his mate have kits to feed and don&#8217;t begrudge him his time hunting in my yard.</p>
<p>
But today I noticed a pigeon hopping among the flock that visits our feeders. Definitely hopping, not just oddly walking. I stared and noticed this pigeon had one leg, hence the hop. But there was something else odd.</p>
<p>
There was something strange in its tail feathers. It could still fly. It was a little awkward getting airborne, true, but it could still take flight when the others scattered. It was one of the last to leave the ground, though.</p>
<p>
I stared then picked up some binoculars I keep beside me on the table. The strange thing in its tail feathers was its other leg. Broken, twisted, how it got pegged in that position I don&#8217;t know.</p>
<p>
I know animals can feel pain. I&#8217;ve read the studies. I know. I also noticed that the male pigeons, the ones perpetually strutting and harassing the females at their seeds, were leaving this one alone. If anything, they knocked it over in their quest to show their plumage to some other female.</p>
<p>
This wounded pigeon would flap its wings and get back up. Sometimes that broken leg would get in the way of the wings and the pigeon would open its beak to make a sound I could not hear.</p>
<p>
But my ears are not those of Reynard who has kits to feed.</p>
<p>
And suddenly the other pigeons scattered, the chipmunks dashed into their holes, the squirrels scurried up their trees, the bluejays and robins and orioles and cardinals and others went to each and every compass point.</p>
<p>
And Reynard stopped to look at me, the pigeon in his jaws, its one good leg still kicking, its head still bobbing, its beak still open making sounds I could not hear.</p>
<p>
Reynard bowed his head, turned and trotted into the wood. I, transfixed, had stopped breathing but for how long I didn&#8217;t know. My chest was tight. I was sickened and relieved and had not moved. </p>
<p>
A moment later and the wildlife returned. My breathe relaxed. I turned back to my computer and started to write.</p>
<p>
<font size="1"><br />
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<p></font></p>
<p>
<font size="1"><a title="Reading Virtual Minds Volume I: Science and History" name="Reading Virtual Minds Volume I: Science and History" href="http://knowledgeshop.nextstagevolution.com/rvmv1sah.cfm" target="other"><img src="http://www.bizmediascience.com/uploads/RVMsmallfrontcover-thumb.jpg" alt="RVMsmallfrontcover.jpg" width="100" height="151" align="right" /></a>Sign up for <a href="http://www.nextstagevolution.com/email1.cfm"><em>The NextStage Irregular</em></a>, our very irregular, definitely frequency-wise and probably topic-wise newsletter.</font><br />
<font size="1">You can follow me and my research on <a href="http://twitter.com/JosephCarrabis" target="other">Twitter</a>. I don&#8217;t twit often but when I do, it&#8217;s with gusto!</font><br />
<font size="1">Have you read my latest book, <a title="Reading Virtual Minds Volume I: Science and History" name="Reading Virtual Minds Volume I: Science and History" href="http://knowledgeshop.nextstagevolution.com/rvmv1sah.cfm" target="other">Reading Virtual Minds Volume I: Science and History</a>? It&#8217;s a whoppin&#8217; good read.</p>
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<br />Filed under: <a href='http://aneconomyofmeaning.wordpress.com/category/the-wild/'>The Wild</a>  <img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1136&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></content:encoded>
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			<media:title type="html">Joseph Carrabis</media:title>
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		<title>The Brawl that No One Would Stop</title>
		<link>http://aneconomyofmeaning.wordpress.com/2012/02/28/the-brawl-that-no-one-would-stop/</link>
		<comments>http://aneconomyofmeaning.wordpress.com/2012/02/28/the-brawl-that-no-one-would-stop/#comments</comments>
		<pubDate>Tue, 28 Feb 2012 13:24:58 +0000</pubDate>
		<dc:creator>Joseph Carrabis</dc:creator>
				<category><![CDATA[Meaning]]></category>
		<category><![CDATA[Media Influence]]></category>

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		<description><![CDATA[What if someone started a fight and nobody YouTubed it?<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1127&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></description>
				<content:encoded><![CDATA[<p><a href="http://www.nextstagevolution.com" target="other"><img vspace="4" hspace="8" border="0" align="right" src="http://www.nextstagevolution.com/images/nse_blogging_logo.cfm?blog=EcoOfMean&amp;post=Brawl" alt="NextStage: Predictive Intelligence, Persuasion Engineering, Interactive Analytics and Behavioral Metrics " title="NextStage: Predictive Intelligence, Persuasion Engineering, Interactive Analytics and Behavioral Metrics " /></a><font face="Verdana,geneva" size="2">A recent news item out of Lynn, MA, is going viral. Twenty students stood around while two other students had a <a href="http://itemlive.com/articles/2012/02/27/breaking_news/breakingnews09.txt" target="other" title="English principal hands out suspensions in connection with videotaped fight">physically violent encounter</a>.</p>
<p>
How&#8217;s that for politically correct language?</p>
<p>
I&#8217;m not surprised by the brawl. There will always be brawls. Sorry. We&#8217;re in an era of gladiator sports. I watched the <a href="http://www.youtube.com/watch?v=dlkmsvXKHac&amp;feature=related" target="other" title="Lynn High School Fight || February 28th 2012 ">video</a> and was more impressed that they were able to go at it for eight minutes. Either they were in good shape or didn&#8217;t know what they were doing. But the violence? Nothing I haven&#8217;t seen in mixed-martial arts competitions, movies, video games, news items, life.</p>
<p>
People are concerned that no one stopped the fight. People are concerned that there were spectators &#8212; genuine spectators &#8212; with no interest other than who was going to post the video first.</p>
<p>
Well, that is inciting, don&#8217;t you think?</p>
<p>
I mean, if only we had cellphones with video and internet capabilities back in 1964!</p>
<p>
I&#8217;m sure <a href="http://en.wikipedia.org/wiki/Murder_of_Kitty_Genovese" target="other" title="Murder of Kitty Genovese">Kitty Genovese</a> would understand.</p>
<p>
I truly feel there&#8217;s no need to explain this post further, even though I know many readers will shrug with confusion and a lack of understanding.</p>
<p>
But should you make the connection, another example of Nothing New Under the Sun, please do comment.</p>
<p>
I dare you.</p>
<p>
<font size="1"><br />
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<p></font><br />
<font size="1">Upcoming Conferences:</p>
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<li>NextStage Evolution, Critical Mass and Adobe&#8217;s SXSW Core Conversation &#8216;F**k Privacy: Neuromarketing is the Web&#8217;s Future&#8217; at <a href="http://panelpicker.sxsw.com/ideas/view/13234" target="other" title="NextStage Evolution, Critical Mass and Adobe's SXSW Core Conversation 'F**k Privacy: Neuromarketing is the Web's Future'">SXSW 2012</a>
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<p>Come on by and say hello.<br />
</font></p>
<p>
<font size="1"><a title="Reading Virtual Minds Volume I: Science and History" name="Reading Virtual Minds Volume I: Science and History" href="http://knowledgeshop.nextstagevolution.com/rvmv1sah.cfm" target="other"><img src="http://www.bizmediascience.com/uploads/RVMsmallfrontcover-thumb.jpg" alt="RVMsmallfrontcover.jpg" width="100" height="151" align="right" /></a>Sign up for <a href="http://www.nextstagevolution.com/email1.cfm"><em>The NextStage Irregular</em></a>, our very irregular, definitely frequency-wise and probably topic-wise newsletter.</font><br />
<font size="1">You can follow me and my research on <a href="http://twitter.com/JosephCarrabis" target="other">Twitter</a>. I don&#8217;t twit often but when I do, it&#8217;s with gusto!</font><br />
<font size="1">Have you read my latest book, <a title="Reading Virtual Minds Volume I: Science and History" name="Reading Virtual Minds Volume I: Science and History" href="http://knowledgeshop.nextstagevolution.com/rvmv1sah.cfm" target="other">Reading Virtual Minds Volume I: Science and History</a>? It&#8217;s a whoppin&#8217; good read.</p>
<p>
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<br />Filed under: <a href='http://aneconomyofmeaning.wordpress.com/category/meaning-2/'>Meaning</a>, <a href='http://aneconomyofmeaning.wordpress.com/category/media-influence/'>Media Influence</a>  <img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1127&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></content:encoded>
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		<title>It’s Fall – Time for Talking Turkey about Healthcare…</title>
		<link>http://aneconomyofmeaning.wordpress.com/2011/10/13/it%e2%80%99s-fall-%e2%80%93-time-for-talking-turkey-about-healthcare%e2%80%a6/</link>
		<comments>http://aneconomyofmeaning.wordpress.com/2011/10/13/it%e2%80%99s-fall-%e2%80%93-time-for-talking-turkey-about-healthcare%e2%80%a6/#comments</comments>
		<pubDate>Thu, 13 Oct 2011 11:15:16 +0000</pubDate>
		<dc:creator>David Morf</dc:creator>
				<category><![CDATA[Business Management]]></category>
		<category><![CDATA[banking]]></category>
		<category><![CDATA[Best Practices]]></category>
		<category><![CDATA[Change]]></category>
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		<description><![CDATA[Regional healthcare teams and smart technology are core accountabilities for population health, labor productivity, and shared regional success.<img alt="" border="0" src="http://stats.wordpress.com/b.gif?host=aneconomyofmeaning.wordpress.com&#038;blog=8559255&#038;post=1101&#038;subd=aneconomyofmeaning&#038;ref=&#038;feed=1" width="1" height="1" />]]></description>
				<content:encoded><![CDATA[<p>We need to talk about healthcare, the role of funding, the need for healthcare teams, and core infrastructure from workplace culture to technology.  Parts of this post began as a <strong><strong><strong></strong></strong></strong><strong><a href="http://www.linkedin.com/groupAnswers?viewQuestionAndAnswers=&amp;discussionID=73840791&amp;gid=1749077&amp;commentID=54575986&amp;goback=%2Egmp_1749077%2Egde_1749077_member_73840791%2Egmp_1749077%2Eamf_1749077_16303215&amp;trk=NUS_DISC_Q-subject#commentID_54575986">comment</a></strong> in Employee Benefit News, a LinkedIn group.  Let’s start with the money.</p>
<p>There&#8217;s a pattern here—banks collect a 5% margin on health insurance cash flow.  This is not small potatoes.  Healthcare insurance, mostly self-insured employer costs, was about 33.5 percent of the $2.3 trillion spent on healthcare in 2008, i.e., almost 70 percent of the half of health cost not paid by Medicare and Medicaid (see <a href="http://www2.cms.gov/NationalHealthExpendData/downloads/dsm-08.pdf"><strong>National Health Expend Data</strong></a>). This annual $770 billion allows the 5% margin to feed some $38 billion into the banking sector’s <strong><a href="http://en.wikipedia.org/wiki/Income_statement">P&amp;L statement</a></strong>.  And, the annual $770 billion flow is money banks can invest in securities markets, or can lend.</p>
<p>Due to <a href="http://en.wikipedia.org/wiki/Fractional_reserve_banking"><strong>fractional reserves</strong></a> (banks can invest or lend all but a fraction of underlying deposits, or borrow against them), the health insurance cash flow running through the banking system supports the <strong><a href="http://en.wikipedia.org/wiki/Investment_banking">investment banking</a></strong> business with leveragable deposit volume that can be further leveraged by securitizing assets; or in making loans.  Banks make more money on a transaction basis by taking investment banking risks—very profitably, as long as the music plays.  As a result, banks tilt the huge insurance deposits toward leveraged securities investments; less so toward lending so long as lost jobs, constrained wages, underwater mortgages, and debt repayment limit non-luxury consumer demand and overall business hiring.</p>
<p>As for healthcare itself, the banks have no direct dog in the healthcare cost problem stemming from craft-based operations in the healthcare provider world.  If anything, insurance volume for costly health care feeds the deposit volume for banks.</p>
<p>And like banks, the health &#8220;insurance&#8221; (subscription) firms also don&#8217;t really have a dog in the healthcare cost problem as long as they pay out 80% of their revenues to hospitals and other providers.  The 80% is the minimum subscriber firm payout under the Affordable Care Act (<a href="http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act"><strong>ACA</strong></a>), and thus of course is the target maximum payout.</p>
<p>As provider health bills rise, subscription firms just need to hike their rates to hit the 80% payout target.  However, recently subscription firms were near a 75-78% payout ratio.  Therefore, current subscription firm rate hikes indicate they anticipate continued billing hikes by providers struggling to use craft-based work units to handle previously uninsured low and middle income patients.  By the time the ACA payout target takes effect, the subscription firms will be close enough to paying out 80%, such that provider billing increases will soon render subscription firms compliant with the ACA’s 80% payout.  And then the tit-for-tat provider billing pass-through to subscription firm customers will continue.</p>
<p>Upshot—the healthcare billing and payment cycle is a process with no brakes, even under the ACA’s 80% payout basis.  The only way to apply brakes on health costs is to deal with the craft culture at the healthcare operations level.  Even <strong><a href="http://en.wikipedia.org/wiki/United_States_National_Health_Care_Act">Medicare for All</a></strong>, while ameliorating healthcare access problems, could not alone address the operational cost bias built into underlying craft medical practices.</p>
<p>Toward this operational craft practice issue, it’s important to note that hospitals have worked hard to modernize their work.  However, what has taken place is an abundance of excellent tools wielded by individual craft practitioners in very small-team environments (the term &#8220;<a href="http://en.wikipedia.org/wiki/Information_silo"><strong>silo</strong></a>&#8221; often applies here).</p>
<p>The work tool ramp-up in an expanding work place that continues to apply processes rooted in standalone craft skills is a perfect recipe for aggressive unit cost growth.  Patient care accountability needs a preventive care population culture, healthcare teams, team hand-offs, and transparent <a href="http://en.wikipedia.org/wiki/Health_information_technology"><strong>HIT</strong></a> resources including analytics, remote monitoring, voice and image telemedicine, and public key performance <a href="http://en.wikipedia.org/wiki/Performance_indicator"><strong>indicators</strong></a>.  Especially for specialty and hospital care, teams need process <a href="http://en.wikipedia.org/wiki/Coaching"><strong>coaches</strong></a> (Atul <a href="http://www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande"><strong>Gawande</strong></a> in <em>Personal Best</em>, The New Yorker, October 3, 2011) and <a href="http://en.wikipedia.org/wiki/Bundled_payment"><strong>bundled payments</strong></a> adjusted for severity (Jeff <a href="http://healthblawg.typepad.com/healthblawg/2011/01/accountable-care-organizations-the-emperor-has-no-clothes-or-jeff-goldsmiths-plan-b.html"><strong>Goldsmith</strong></a>).</p>
<p>Let’s look a bit more closely at the connected ideas of healthcare teams, team hand-offs, transparent HIT resources, and process coaches.  This array encompasses patient-centered and geographically transparent operational team support and hand-off capability from public health teamed with primary care docs, through potentially dispersed specialist support teams and hospital and clinic team operations.</p>
<p>Here’s the message – what is needed are location independent healthcare teams and team hand-offs as the core entities of accountability for patient care.  This refines and extends an operational viewpoint from <strong><a href="http://www.nybooks.com/articles/archives/2011/oct/27/how-doctors-could-rescue-health-care/">ideas</a></strong> also discussed by <strong><a href="http://www.nybooks.com/contributors/arnold-relman/">Arnold Relman</a> </strong>in the New York Times Book Review for October 27, 2011.</p>
<p>The team accountability process builds on a sequence of team-based activities.  Appropriate teams need to be engaged from early in the public&#8217;s entry in prevention and wellness action, before matters become chronic or involve hospitals.  This means applying teams that connect prevention, public health, and general practitioners to stop a population’s emerging chronic conditions, one patient or population group at a time.  For patients whose diseases progress into mature conditions requiring specialty care and perhaps acute hospital care, the specialty and hospital stages need a patient navigator team, a care coordinator team, and a meds management and treatment discharge-followup team (30-day <strong><a href="http://works.bepress.com/cgi/viewcontent.cgi?article=1002&amp;context=annmarie_marciarille&amp;sei-redir=1&amp;referer=http%3A%2F%2Fwww.google.com%2Fsearch%3Fq%3Drecidivism%2520patients%2520returning%2520to%2520hospital%252030%2520days%2520after%2520discharge%2520wiki">recidivism</a></strong>, anyone?), enabled by end-to-end global <strong><a href="http://en.wikipedia.org/wiki/Electronic_medical_record">EMR</a></strong> resources and whole-treatment episode analytics.  The specialty care and hospital stages may enter a penultimate team care zone in <strong><a href="http://en.wikipedia.org/wiki/Operating_room_management">OR</a></strong> and <strong><a href="http://en.wikipedia.org/wiki/Intensive_care_unit">ICU</a></strong> activity.</p>
<p>Across the whole sequence, especially for specialty and hospital care, the stages will need process interpretation and continuous learning.  This means a funded coaching resource.</p>
<p>More about coaches and payment, then we’re done for the moment.  Coaches enable the healthcare team members to continue growing in situational skill and refinement across the whole team care process, from prevention-wellness to public health to surgery.  If coaching seems both pointless and admitting to a lack of skill that will induce lawsuits, it’s useful to see the reference above to Atul Gawande and his New Yorker <strong><a href="http://www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande">article</a></strong>, <em>Personal Best</em>.</p>
<p>The other matter—payment.  In a team environment, each whole specialty and hospital care episode needs to be funded as a bundled payment adjusted for severity (as above, <a href="http://healthblawg.typepad.com/healthblawg/2011/01/accountable-care-organizations-the-emperor-has-no-clothes-or-jeff-goldsmiths-plan-b.html"><strong>see</strong></a> Jeff Goldsmith).  Why?  Because the overall care process needs to be paid for as an efficiently integrated built process that generates production function value as a <strong><a href="http://en.wikipedia.org/wiki/Joint_product_pricing">joint product</a></strong>, not for each disaggregated nut and bolt in the process.  For example, key care components include transparent EMR resources and multiple whole-episode analytics that enable seeing each team episode in context with others.  And to address costly outlier episodes, team-based care organizations will need stop-loss insurance (a form of <strong><a href="http://en.wikipedia.org/wiki/Reinsurance">reinsurance</a></strong>) at the individual and group level, incentivized by premium discounts for groups with better actuarial performance records.</p>
<p>Real payoffs stem from smarter systemic prevention-wellness action and healthcare for regions, residents, workers, and employers—better health, reduced benefit expense, reduced absenteeism and presenteeism, increased work team productivity and more focused learning capability, a more resilient and competitive global presence, leading to more jobs and better pay.</p>
<p>So, this has been quite a trip.  The point being that prevention-wellness care and healthcare are a major <strong><a href="http://en.wikipedia.org/wiki/Wicked_problem">Wicked Problem</a></strong>, i.e., with many moving parts and participants.  Absent a serious effort to approach the task with humility, curiosity, determination, fortitude, and respect, from the inside as much as from the outside, we could end up poking the shared bear until it eats us up.</p>
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