Healthcare: Big Government Vs. Small Government

James Suroweicki has a great column in the New Yorker this week laying out why he believes Romney’s healthcare plan won’t work. Regardless of your opinion on the matter, he calls out some important and unique qualities of the healthcare industry that should be considered when weighing both candidates’ plans; that is, weighing how much we should rely on the free market versus the government to solve the healthcare cost crisis.

I recommend reading the entire article but here are a few of the most notable things to consider:

1. Unlike most consumer goods, healthcare consumers don’t have the expertise to properly value one treatment, hospital, or doctor versus another.
2. Most major healthcare purchases are made by insurers, not consumers, so they lack a direct say on the price of a treatment.
3. One way for a buyer to get a seller to reduce their price is to walk away and not buy the product at all.  In healthcare, consumers can’t just walk away from treatments like they can a new car or a new cell phone -- they have to buy the treatment to survive.

These fundamental realities of the healthcare industry make this issue far more complex than the simple big government/small government ideologies that many of us use to guide our political and economic beliefs.

The Healthcare Mandate's Impact On Healthcare Costs

I read Goldman Sachs’ recent report on Election Outcomes and Potential Impact to Healthcare Stocks earlier this week.  Basically the report outlines what’s likely to happen to the different healthcare verticals in the event of a Romney win or an Obama reelection.  The vertical that will be most impacted by the election seems to be hospitals and health systems.  The reason is that the universal healthcare component of Obama’s Affordable Care Act will dramatically change the payer mix for most hospitals.  Suddenly 30 million people will have insurance on one day that didn't have insurance the day before.  That means that people who weren't inclined to get care are more likely to get care (more hospital revenue) and, perhaps more significantly, hospitals will get paid for the care that they give to patients that don’t have insurance (more hospital revenue). In addition to helping hospital stocks, the conventional thinking seems to the be that the healthcare mandate will also lower overall healthcare costs.  To illustrate that point, here’s a vicious cycle that’s currently driving up the cost of care that may be disrupted significantly with the roll-out of the mandate. Let’s use an imaginary uninsured patient named John:

1. John doesn't have insurance.
2. John gets sick.
3. John doesn't want to pay for care out-of-pocket so he delays seeing a doctor.
4. His condition gets worse.
5. His condition eventually gets so bad that he shows up at the emergency room and gets lots of acute (and expensive) care.
6. He doesn't have the money to pay the hospital so the hospital loses lots of money.
7. To make up for this lost money, the hospital charges its insured patients more for their care.
8. To make up for these price increases, the insurers raise their premiums.
9. Because of the high premiums, people drop their insurance.
10. Repeat.

By requiring John to get insurance, he’s more likely to seek care earlier, thus reducing the costs and losses to treat him, thus allowing hospitals to lower costs, thus allowing  insurance companies to reduce their premiums, thus allowing more people to afford insurance.

Of course what sounds good in theory may not work in practice. But it’ll be interesting to see how the mandate will impact healthcare costs should Obama win in November.

How I Interview Job Candidates

I think a lot about the best way to interview job candidates.  I’m always trying to determine how effective they’ll be at my company but also how much they’ll actually want to be at my company.   I want to be sure that we’re going to like them long after they’re hired and, just as importantly, that they’re going to like us long after they’re hired. Here’s the framework I’m currently using when I interview a job prospect:

1. Resume Walkthrough.  First, I walk through their resume to get to know them.  I try to understand why they chose their schools, companies and industries and I always ask why they left each job.  Walking through their resume gives me a really good sense of who they are.  It can be somewhat of an intense conversation so it helps me get to know them right away.  On the surface, I don’t care about gaps in resumes or sabbaticals but I like to understand the choices that the candidate made and why they made them.   At the end I always ask them my favorite interview question.  I ask them to tell me what they want to do without naming a company or an industry.  Specifically I want to know how they want to add value to an organization.
2. Analysis of Strengths.  Next I dig in on their strengths.  I assume that they’re really good at what they do but I like to understand exactly why they believe they are so good.  Often I’ll ask something like, “if you’re the top performer on your team and I asked the average performer on your team what makes you so good, what would they say?”  This gives some insight into how analytical they are about their success.  I don’t really care that much about hearing about their success, I want to hear about why they’re successful so I can assess whether or not that’ll be transferrable to my company.  Candidates that can’t intelligently tell you why they’re successful are risky.
3. Hesitations.  At this point I’m in a good position to assess my hesitations.  In a nice way I tell them exactly what I think of them so far and what I’m hesitant about.  And I give them a chance to respond.
4. Tension Breaker.  Then I lighten things up and ask what they do for fun.
5. Questions.  Lastly I ask if they have questions for me.   I can usually get a good sense of how much they’ll like working at my company by the questions they ask.

This approach has been working well for me lately so feel free to borrow it.  I’ll try to document how this changes over time.

The Elevator Pitch is Dead

A while back there was a post on the Harvard Business Review blog titled, Win the Business with the Elevator Pitch.  The post started with this scenario:

Pretend that you are in an elevator at one of your industry's trade shows. You're heading down to the lobby when the doors open on the thirtieth floor. You instantly recognize the executive who walks in and quickly glance at his name badge to confirm he is the CEO of the most important account you would like to start working with. You have never met him before nor have you been able to generate any interest from his organization. You have forty-five seconds to introduce yourself, explain what your company does in a way the CEO would find interesting and applicable, and motivate him to take the action you suggest. Ready? Go!

The post went on to give advice on the best way to structure your elevator pitch and even gave a script.  I wrote the following comment on the post:

Great post, Steve. Though I have to tell you that if I ever found myself in the position you describe in the first paragraph, the last thing I would do would be to try to pitch.  Business people, particularly CEOs, hate being sold to -- especially in person, in an enclosed area, by someone they don't know.  A better approach might be to introduce yourself casually, talk about the event or the weather or sports -- basically show that you're a nice guy.  Then if you happen to bump into the CEO later on, you can start to talk more about what you do and -- if appropriate -- have a conversation about how you might work together.

Of course it may be unlikely that you'll get this CEO alone again -- but I'd argue that it's just as likely as converting a 45 second elevator ride with someone you've never met into a material sale.

That said, if you do decide to make the pitch on the elevator the framework you've described above is a great one.

The elevator pitch is dead. Yes, you need to be able to quickly and concisely explain your product's value. And having an elevator pitch in your mind is a great way to do that. But in today's complex sales environment, battering CEO's with your sales pitch is not going to work.

It's not about top-down pushy sales or bottoms-up deference to your prospect where you simply "learn about their business", it's about doing the work to build synergistic partnerships that scale way beyond the sum of the two parts.

So if you find yourself in the elevator with your dream prospect, don't pitch them -- get to know them. And if you're able to keep the conversation going outside of the elevator learn about what they do and tell them about what you do.  And get their implicit permission to keep in contact with them. And when it's appropriate to talk to them about how a partnership could help both of your businesses, send them your ideas and setup a time to talk (preferably, not in an elevator).

B2B E-Commerce

Erin Griffith had a good post on PandoDaily titled, Whatever Happened To The Promise of B2B E-commerce. I find this to be a super interesting topic. In short, Erin argued that "the trillion-dollar promise of B2B commerce may finally be on its way."

Personally, I'm not so sure. I posted the following comment -- though for some reason it never got posted to the post, so I thought I'd post it here.

Great post, Erin.

Though I’m not sure I agree that b2b e-commerce is finally on its way.  There are multiple, inherent transactional differences between b2b and b2c that, I believe, make a transition to b2b e-commerce nearly impossible in the short to medium term. There are so many steps in a large enterprise’s buying process that cannot be replicated in a scalable manner online (customized legal agreements, reference checks, price negotiation, unique purchase approval structures, payment terms and the individual emotions that drive big purchases). Just look at the legal side for a moment. Most e-commerce sites have their own “terms of use” section that dictates the legal terms associated with the use of their site. Large enterprises will want to review and customize these terms of use based on their own policies, procedures and appetite for risk.  It’s very difficult for e-commerce sites to allow for this in a scalable way across hundreds or thousands of clients.

Now you may argue that e-commerce has come such a long way that technology should be able to replace much of this bureaucracy. But in a large enterprise each of these steps represent a task that is completed by someone with a job. So you can either eliminate those jobs or assign those individuals to work on something else. But just like purchasing, reorganizing non-strategic job roles for an unclear upside will take a long, long time. And in my view, real growth in b2b e-commerce is simply going to have to wait.

MVP in B2B

Minimum Viable Product (MVP) has become an enormously popular way of releasing web applications. The idea is to get a product that works in front of users quickly and cheaply, watch them interact with it and constantly iterate and improve.  In some cases developers will release changes to the product every day, if not multiple times a day. This is also often referred to as an "agile" development environment. This approach is distinct from the old fashioned, "waterfall" approach where changes to the product are planned and implemented less frequently in well planned batches.

In a b2c environment, MVP works extremely well because a developer can release features and iterate based on data/learnings that they capture by watching thousands of users interacting with their code.

In a b2b environment, though, often this isn't so easy.  At the outset, there may only be one or two individuals using the product so good data and learnings may not be as easy to capture.  As a result, it's critical that when b2b organizations use an MVP approach they be super disciplined about setting up formal feedback loops where feedback is filtered quickly and regularly back to their product team. Most clients should support this as they’ll get to see much of what they recommend being built into products rapidly.  But it’s important to get buy-in on participation in the feedback loop from the early adopters.  This may be a new concept for them as most of their current software vendors are more than likely using the ‘waterfall’ approach.

Also, given the pace of change in an agile development process, it's important that the client-facing team is aware of the more significant product changes that are being made.  Often, an agile, MVP driven environment can lead to such fast paced change that b2b salespeople aren’t aware of the significant features or changes being released.  And an awareness of the substance and timing of product changes can be an excellent way to speed up deal movement and client adoption.

Social Selling: 3 Questions & Answers

There’s been quite a bit written recently about social selling – that is, using social media to help companies and salespeople drive revenue. Much of the advice is targeted at companies -- with tips on how to have conversations with prospects/clients through social media. I’m much more interested in how individual reps can use social media to their advantage.

A few thoughts:

1.  Which social networks should I be posting on?

I've written in the past about social graphs. You need to decide on the audience that you'll interact with in each social network. For me, at a high level, I interact with people I know professionally on LinkedIn, pretty much anyone on Twitter, friends and acquaintances on Facebook and only very close friends on Foursquare. You can view a list of my social networks on my About page.

It seems to me that the best social network to talk to your prospects and clients is LinkedIn and possibly Twitter. Your prospects/clients, for the most part, don't need to see your Facebook photos.

2.  What is the point of social selling?

So often I hear salespeople talking about how their clients/prospects just “don’t get it”. They have an awesome solution to their problem but their contact just doesn’t see it. It’s not that the contact is stupid, it’s that they’re looking at the problem through a much different lens. As a result, they don’t see your solution as the clear answer. Using social media intelligently is a great way to slowly and steadily begin to get your clients/prospects to see their problems through your lens. That isn’t to say you should be posting things to try to sell or to teach people something they don’t know.  Instead, the approach is to show your audience how you see things and let them come on board with your way of thinking at their own pace. Social sales is a very passive form of "drip marketing". I've written a few posts on drip marketing -- check them out to get some more context on this -- you can find them here, here and here.

3.  What kinds of things should I be posting?

Knowing that the goal is to attempt to get your clients/prospects to see the problem the way you see the problem, you should post links to intelligent articles, blog posts, white papers, etc. related to the problem that your product addresses. Don't be afraid to widen your problem into other areas -- you don't want to appear to focused on your own small world. The critical thing here though is to never just post a link. Post a short note about the topic with your take on it or a quick introduction as to why people should find it interesting. The point is that it's interesting to you and something you're passionate about so you want to share it with your network. Finally, if your company gets some good press, I'd advocate posting links to those articles and videos on your social networks. Don't overdo it and post it in a humble way, but allowing your clients/prospects to see what others are saying about you and your company is another effective and passive way to help clients/prospect see you in a better light.

In short, social sales is not going to close deals. But if done well it's a great way to get your clients/prospects to change the perception of their problem, your solutions, your company and you in a favorable way.

Is There A Shortage Of Sales Talent?

An article on the Harvard Business Review blog today talked about the shortage of good sales talent and the need for more formal sales training programs. My theory is that there's actually a lot of sales talent out there but those people simply don't want sales jobs. Here's the comment I posted.

Great post and an important topic.  I believe that in today's business environment you need a variety of skills to be a good salesperson -- it's not about back slapping on the golf course anymore.  Sales is much more complex now.  You need to have a strong understanding of finance, economics, accounting, marketing, strategy, technology, product and management to understand what makes a good prospect, what problems your prospects have, where markets are going and how your company's products can fit in.  These skills are not easy to acquire.  In my experience, they come from getting an MBA or working in a client-facing role in a very early stage company where you're forced to wear a lot of hats and figure out how to make your product work or, in a rare case, you've gained these skills on your own by educating yourself.  And I've found that people that have that kind of experience under their belt are, for the most part, uninterested in filling a typical "sales" job.  They're interested in getting into finance or consulting or strategy.  This is because sales has a stigma to it.  People with that kind of ambition and experience often don't want to tell their friends and family that they're a "salesperson".  Not because sales isn't an admirable job -- it is -- but because there's a stigma attached to it.  People that don't understand the complexity of today's sales environment think of the used car salesperson trying to sell them a lemon.

As a result, I believe we need to begin to stop using the word "salesperson" to describe the roles we're trying to fill.  And not just for recruiting reasons.  Because the word no longer describes what these people are being asked to do.  These people aren't selling knives door to door to every house in town.  They're not pitching and responding to objections.  They're seeking out and understanding business opportunities, carefully selecting the appropriate individuals to connect with, having open, informal business conversations, validating assumptions, iterating those assumptions, refining products and services, participating in internal and external strategic planning, creating mutually beneficial partnerships, negotiating legal & business terms, setting goals for the partnerships and seeing that those goals are met.

I believe that the sooner that companies create roles and job titles around this new skill-set, the sooner we'll see more professionals signing up to fill these jobs.

Hard Work Isn't Enough Anymore

There was a good op-ed from Thomas Friedman in yesterday's New York Times titled, Average Is Over, Part II.  The key line for me is:

Thanks to the merger of, and advances in, globalization and the information technology revolution, every boss now has cheaper, easier access to more above-average software, automation, robotics, cheap labor and cheap genius than ever before. So just doing a job in an average way will not return an average lifestyle any longer.

I've written in the past that hard work isn't enough anymore and as Friedman points out this is becoming more and more true. If a person or a machine anywhere in the world can do your job as effectively as you can at a cheaper cost it is simply a matter of time before you're unemployed. You have to find a way to add irreplaceable value.

In some ways, I think the key to thriving in this new environment is just to simply be aware that doing a "good enough" job isn't enough anymore.

I'm glad Friedman is giving people that awareness.

An Expensive Knee Surgery

I counted sixty-three different people involved in her care. Nineteen were doctors, including the surgeon and chief resident who assisted him, the anesthesiologists, the radiologists who reviewed her imaging scans, and the junior residents who examined her twice a day and adjusted her fluids and medications. Twenty-three were nurses, including her operating-room nurses, her recovery-room nurse, and the many ward nurses on their eight-to-twelve-hour shifts. There were also at least five physical therapists; sixteen patient-care assistants, helping check her vital signs, bathe her, and get her to the bathroom; plus X-ray and EKG technologists, transport workers, nurse practitioners, and physician assistants. I didn’t even count the bioengineers who serviced the equipment used, the pharmacists who dispensed her medications, or the kitchen staff preparing her food while taking into account her dietary limitations.

Atul Gawande, writing about the resources required to complete his mother's knee surgery in this week's New Yorker article Big Med.

User Driven Valuations

I wrote about Facebook's IPO back in May pointing out how unbelievable it was to me that a company that started back in 2003 and really doesn't make anything of substance or have a very compelling revenue model could go public at a $100 billion dollar valuation. I ended the post by saying, "the world has changed".

Well, maybe not. A lot has changed for Facebook since then (see stock price chart above).

Their market cap is now below $40 billion and the consensus seems to be that their stock price is going to continue to fall. That said, their shares are still trading at around 32 times earnings -- so there's still a decent amount of hype around this IPO.

One of the primary reasons for all of the hype is that Facebook is so widely known and widely used. They have hundreds of millions of users; many of them use the product several times a day, every day. And the vast majority of these users know absolutely nothing about investing.  But because they use the product and know the product, they were compelled to buy some shares. As a result, the company was hugely overvalued following its IPO.

Contrast this with Globus Medical, a medical device company that went public on Friday with virtually no hype. It’s unlikely we’ll see this stock nosedive like Facebook. They have a fraction of the customers that Facebook has – they make medical devices used in spinal surgery – so there are far fewer people interested in owning a piece of the company. There’s far less hype.

There have been literally thousands of consumer web services started and funded over the last couple of years. Many of these companies have millions of users and no revenue or compelling revenue model. As a result, I’d expect to see more and more companies go public in the near future with inflated valuations that are propped up by their user base.

The Facebook IPO underscores a good lesson for amateur investors: just because you use a product every day doesn’t mean it should be a part of your portfolio.

Don't Be A Salesperson

One of the biggest challenges in sales that I hear about all the time is when a salesperson has had a good meeting with a prospect but now that prospect has stopped returning emails and phone calls. The salesperson keeps emailing and keeps calling but never hears back. Eventually the salesperson concludes that the prospect is either rude or just isn't interested in the product or service. I think that conclusion is completely missing the point.

As a professional, when another professional that I have met with calls or emails me I will always call or email them back. And I've found this to be true of nearly everyone I've interacted with in my career. It's a general courtesy to respond to another professional when they contact you about something. And I'm even more responsive when I believe that the professional has something that can benefit my business. And when I've determined that a partnership between our businesses doesn't make sense, I'll always communicate that to the professional with a call or an email.

But here's the catch: the professional relationships I'm talking about are what I call "mutually beneficial relationships". They are interactions where the professional can help me and I can help the professional. There's a level playing field of professionalism and shared value. However, when I begin to believe that the person I’m speaking with is trying to sell me something that I’m not interested in or is only trying to help themselves, they go from being a professional to being a salesperson. And I’m much less responsive with salespeople than I am with professionals.

To me, the worst thing that can happen to a salesperson is to be viewed as a salesperson. Because in the prospect’s mind you have gone from being a professional looking to provide value in return for value to someone that is beneath them. You've gone from being the cool and interesting guy at the end of the bar to the loser that walks around hitting on anything that moves. And as you try harder and harder to push your agenda, the less interested the prospect becomes.

My advice: don't be a salesperson, be a professional. Be laser focused on mutually beneficial relationships. Have a healthy paranoia that the person you're talking to doesn't care about what you're saying. If you don't know, ask them. Walk away from prospects and people that aren't interested. You're bringing value and your prospects are bringing value -- if there isn't a match, walk away.

To say it simply, you should strive to create relationships with prospects where every email you send and every call you make is promptly responded to and returned. And that’s not a function of your pitch or the quality of your product. That’s a function of your ability to be perceived as a professional interested in providing mutual value.

NOTE: I’m not talking about job titles here. You may have the word “sales” in your title and that is fine. This post isn’t about titles, it’s about how you’re perceived as a businessperson.