Sell The Concept Before You Show The Data

The other day I wrote about how I believe that salespeople should go easy on the data in their initial sales presentation. I feel this way because 1.) I think the right approach is to sell people on your product's concept first and then back it up with data and 2.) in that initial meeting most people aren't going to take your data seriously -- they don't trust you yet and they know that data can be manipulated to tell any story you want. Seth Godin recently wrote a two sentence post titled, Belief is more powerful than proof. This is really what I'm trying to say. That is, get your prospects to believe what you're saying -- to "buy" your concept -- and then back it up with proof.

For example, if you try to tell people that fewer and fewer people are using the internet, no matter how much proof you show, nobody is going to believe you. It doesn't make sense. They won't believe it.

But, if you tell people that mobile is the fastest growing internet access channel, due to increased Wi-fi access, the growing prominence of the "mobile-only" user, increased processing speeds, etc., people will believe you. They'll buy the concept. It makes sense.

Only after you've confirmed that your story and your concept make sense to the prospect should you show them the data (data that validates and drives home the point). Something like the chart below. Concept first, data second.

Mobile is eating the world

15 Reasons Why Healthcare Has A Business Model Problem

I’ve worked in start-ups my entire career. Part of the fun of working in a start-up is creating, testing and iterating your business model. In order to succeed you need a business model that both makes sense intuitively and works financially. If it doesn't make sense, it doesn't work. When I entered healthcare not too long ago (an industry that has existed in one form or another for thousands of years) and started to dive into the detail and understand the motivations of the different players in the market (providers, patients, payers, government, etc.), I quickly realized that something wasn't right.

The business model of healthcare didn't seem intuitive and clear to me like it did in other industries. So I sat down with a pen and paper and tried to scribble out the model. I was sure I could figure it out. I drew a box for each of the stakeholders and labeled them with their different motivations and then drew lines between them indicating the different money flows.

Trying to make the model make sense for all of the stakeholders literally made my head hurt.

I felt a little bit better last week when I heard Jonathan Bush, the CEO of AthenaHealth, state clearly in an interview at Duke University's business school that the problem with healthcare has never been a clinical problem or a scientific problem, the problem with healthcare has always been a business model problem.

This is so true. There are so many inherent challenges with healthcare that make the business model extremely difficult to figure out and get right. I came up with a list of 15 reasons why healthcare has a business model problem.  I'm sure there are many, many more, so feel free to add them in the comments.

  1. The vast majority of care is paid for directly by a third-party, so patients have little incentive to shop around, effectively averting supply and demand and a reliable market equilibrium
  2. If patients did have an incentive to shop around, on a practical level, it would be nearly impossible to do (without a clinical background, it’s extremely difficult to measure quality or evaluate what care is or isn’t necessary)
  3. Because of the way care is paid for, patients plan procedures months in advance (pregnancies, knee surgeries, etc.) but finance them like they're unexpected emergencies
  4. An enormous amount of patients have their care subsidized or paid for by the government (~21% of federal tax dollars go healthcare)
  5. Many patients are irrationally loyal/unloyal to their doctors because they're not impacted by costs or able to measure quality
  6. Sick patients jack up the price for healthier patients (payers pass on costs)
  7. There are for-profit, non-profit and government-funded providers competing to provide the exact same services to the exact same patients
  8. An endless number of moral issues surrounding care make consensus on a business model extremely difficult
  9. It's an extremely local industry and difficult to scale across geographies
  10. Financially speaking, providers and patients are at odds with one another (providers do well when patients are sick, at least in a fee-for-service market)
  11. It’s an extremely fragmented  industry (patients see different providers for different services – a patient could have more than 10 different doctors that don’t have to talk to one another); consolidation is desperately needed to bring down cost
  12. Death is an outcome of poor or insufficient care, so it’s impossible to cap prices -- healthcare prices are extremely elastic
  13. People don't want care unless it's urgent but when they want it they want the best
  14. By law, providers cannot turn some patients away and in many cases must provide care for free
  15. Unlike most insurance providers, health insurance providers generally pay for everything, not just catastrophes (this would be like your car insurance company paying for your oil changes and your gas)

Cannibalize Your Own Job

If you have a job, especially if you have a good job, that pays a decent wage, the odds are that it's only a matter of time before your employer outsources, automates, or finds a way to do the work that you do more cheaply. And when they do, you're either going to take a pay cut or you're going to be out of work. The days of working in the same job for 30 years, getting a nice watch every decade, and a retirement party at the end are long over.

In a global economy, mediocrity is unsustainable. Companies must constantly be getting better -- faster, smarter, more profitable. Successful companies are perpetually searching for ways to cut costs and add efficiency, and that includes getting rid of expensive humans.

Given this, to survive in this world, most of us have two options:

The first option is to fight it. Stay below the radar and try to fit in. Make friends with your boss and delay the inevitable. Don't make a raucous, don't try to scale things. Stay quiet and stay out of the way. This is not a bad short term strategy. It will likely work for some amount of time. But in the long-term, the forces of profitability and efficiency are going to catch up with you and your average performance will be out the door.

The other option -- the much, much better option -- is to embrace this reality. Instead of fighting it, actually help your company outsource, automate or cheapen the things that you do. You should help make your job more scalable. There's nobody in a better position to identify which tasks can be done more cheaply and which tasks can't. Help your company identify those things that can be done more cost effectively and come up with ideas on how they can be done more efficiently and advocate for it. You don't want to be doing that kind of work anyway.  You want to be doing the hard stuff that adds value. And this will allow you to spend more time on the stuff that your company needs.

And after you’ve scaled your current work, do it again. Keep cannibalizing your own job.

Of course, depending on the complexity of your job, it could take a long time to cannibalize yourself. In some cases it could take years.

Also, note that once you cannibalize yourself, you don't have to leave your company. Just the opposite. You should be thriving at your company and getting promoted, or at least spending more time on more valuable work (which you should be compensated for).

So in your job today, keep producing -- writing great code, building great products, closing big deals, etc., but while you’re at it make sure you’re aggressively looking for ways to scale -- before somebody else does.

Facebook, Twitter & Middle Class Jobs

Thomas Friedman had a great piece a couple of weeks ago in the New York Times, titled Why I Still Support Obamacare. I recommend checking it out. He talks about the ACA but points out a much larger economic trend -- the disappearance of the middle class. It used to be that big companies needed lots of workers to run their businesses. Those businesses created lots of good paying, long-term, reliable jobs. Those jobs are what made up the middle class.

But more and more companies are finding that they don't need as many employees as they used to need in order to thrive. As an example, Facebook is a $110 billion company but only has 8,000 employees. GE, a more traditional company, has about 3 times the market cap of Facebook but has 40 times the number of employees. Fast growing tech companies are creating lots and lots of value but they're not creating lots and lots of jobs.

Friedman quotes James Manyika from McKinsey:

To be in the middle class, you may need to consider not only high-skilled jobs, “but also more nontraditional forms of work,” explained Manyika. Work itself may have to be thought of as “a form of entrepreneurship” where you draw on all kinds of assets and skills to generate income.

This could mean leveraging your skills through Task Rabbit, or your car through Uber, or your spare bedroom through AirBnB to add up to a middle-class income.

Friedman's point in the column is that affordable, mandated healthcare is going to be critical as more people begin working independently.

In many ways this is an exciting trend, but this shift in how people work, who they work for and the emergence of the "free agent" job market is going to have an extremely wide-ranging political and economic impact. It's something our policymakers need to be thinking about.

5 Reasons You Should Read Blogs Written By VCs (even if you're not a VC or a founder)

The other day I was looking through my blog feed (I use the Reeder iOS app) and it occurred to me that I follow just under a dozen blogs written by venture capitalists. My three favorites are Fred Wilson, Chris Dixon and Bijan Sabet.

I started thinking about why I read so many of these blogs. I'm not a VC, and I don't really want to be. Are they really worth the time?

Here's why I think they are absolutely worth the time. Any why you should read them too.

1. Because of the risk profile of VCs they are always ahead of the game. VCs focus on ideas and technologies that, for the most part, are ahead of their time. They make investments in ideas that are highly risky that haven't yet gone mainstream but eventually will. Whether you're just investing for yourself, thinking about staying ahead in your career or just a curious person, it's important to be aware of what's coming next. In addition, most of them are investing in consumer products. An extra perk is that VC blogs will help you stay aware of consumer software and services that you might want to use yourself.

2. They attract communities of smart, motivated people. Every day I read blogs on sports, career, fitness, healthcare, technology and marketing and it seems that the VC blogs get way, way more comments from readers than the others. In addition, the quality of conversation happening in the comments sections of VC blogs is extremely high. Often when I read a VC blog I'll only scan the post but I'll scroll down and read the most popular comments in detail (there's great stuff in there). The people hanging out on these blogs are people you want to hang out with (at least virtually). In addition, I'm sure there are some out there, but I haven't yet seen a VC blogger that doesn't interact with their readers.

3. They'll make you a better blogger (and thinker). One of the neat things about VC bloggers is that they don't have all the answers -- and they know they don't have all the answers. In their posts, you'll find that they're really just putting out ideas, and thinking out loud (if they had all the answers, their investments wouldn't be so risky). As a result, they'll help you generate some great ideas on things to write about and think about. See an example here.

4. They write about things that you should know about. I remember back in college the career counselors would tell us, "before you go into an interview, make sure you know what's being written about on the front page of the Wall Street Journal." Those days are over. These days, if you're interviewing in tech, you better know what VC bloggers are writing about.

5. They'll give you better context. One of the challenges in working at a startup (or any company, really) is that you don't always get to see the context of leadership. I always try to remind people to keep in mind that everyone has a boss (the exec team reports to the CEO and the CEO reports to the board). CEOs don't make decisions to make your life miserable, they make decisions to help make the company better -- or, more practically, to make their boss (the board) happy. I've found that by reading what's going on in the mind of VCs (who very often hold board seats) I get to see a bit of what a founder or CEO is facing. And that gives me a better understanding of what their context might be when making decisions that impact my team. In any company or any situation, context is crucial.

I highly recommend the three blogs I mentioned above. In addition, Forbes did a pretty good article a while back on the Top 10 Best Venture Capital Blogs. I recommend checking out some of those as well.

EMR Unbundling (Continued)

The post I wrote about the unbundling of the EMR a few weeks ago received quite a bit of attention. KevinMD republished it and Deanna Pogoreic from the Med City News featured it in her own article on the topic titled, What Craigslist can tell us about the future of health IT startups and the EMR market. Combined, the post was Tweeted well over 100 times. Given some of the commentary around the post, I wanted to provide two quick clarifications:

1.  I actually believe that unbundling is good for the bundler. In my post, I talked about how much value Craigslist brought to consumers when they bundled everything into one place on the web (apartment listings, job listings, personals, etc.). Now they’re finding that niche players are coming in and providing superior value and biting off pieces of their business. On the surface this seems bad for Craigslist. But I don't think it is. Allowing competitors to bite off areas of weakness will make Craigslist better. Back when online classified listings were valuable, simply aggregating them into one place was valuable. But now that's a commodity and Craigslist has spread themselves too thin. Competition will force them to pick an area where they can add real consumer value (as they did back when they started). The same will be true for EMRs. Unbundling (competition) is good for everyone.

2.  I probably wasn't clear enough about how long the process of EMR unbundling is going to take. As I mentioned in the post, there are large switching costs in B2B products that don't exist in B2C products. In addition, because of long-term enterprise contracts, strong vendor relationships, risk mitigation and other factors, it will likely take a lot more time for the EMRs to become unbundled than it will for a consumer website like Craigslist to become unbundled. Also, successful unbundling requires the EMRs to open up their platforms for integration -- which will take time. But my overall point still stands. Demand for the best product, over time, will always overcome switching costs and vendor resistance. Doctors and healthcare execs are consumers just like the rest of us. They want the best value -- it just takes them a bit longer to make the purchase.

5 Sales Presentation Tips

Here are 5 somewhat random things to consider when giving a sales presentation to a group of people that you're meeting for the first time. 1.  Take their guard down. I don't believe in "always be closing." I believe in "always be leaving." Be clear and open about the fact that it's very likely that the solution you have is not right for your audience (depending on your close rate, it's probably not). This is not emotional, you're simply there to determine whether or not there's a fit. If at any moment you determine that this prospect is not a good fit for your solution you should be ready to politely pack up and leave. You want your prospect leaning forward to learn more, not leaning back trying to avoid a pushy salesperson.

2.  Give credit to the competition. Never, ever bad mouth your competitors. Whatever you say they won't believe you. Compliment your competitors but differentiate yourself by explaining what they do better than you and what you do better than them. In fact, I don't believe that you have competitors. You may be trying to solve the same problem, but I guarantee you're going about it differently. Carve out that niche. Don't say you're better, say you're different. And help craft a framework for the audience on how they should think about the different solutions.

3. Go easy on the data. They don't know you and they don't trust you and most people are smart enough to know that data can be manipulated to tell any story you want. Sell them on the concept. Appeal to their logic or their compassion. Get into the data in follow-up meetings once you've built up some credibility.

4. At least once tell them something your product doesn't do well. Be humble. There's nothing wrong with product flaws. There is something wrong with salespeople that don't recognize that their product has them. You're not selling features anyway, you're selling a concept and a potential business impact. You'll gain credibility and generate a more honest discussion by admitting your weaknesses.

5. Be interesting. Most of the stuff that the people in the room are going to do for the rest of their day is likely to be somewhat boring. Raise the bar and be compelling. Challenge the audience's thinking. This actually isn't that hard and it's much more fun. I don't say this out loud, but when I'm about to start presenting, here's what I'm thinking: "I know you're busy and you're expecting a boring presentation, so I'm going to keep this short, efficient, interesting and provocative. I'm going to make you think about something that you don't think about that much but I think about all the time. And at the end you very likely may not buy this product but I guarantee you'll be glad you spent this hour with me."

As I'm writing this I'm thinking of more and more tips. I'll post more of these soon.

B2B Pricing & Malcolm Gladwell's New Book

Last Sunday night on a late plane ride back to New York I finished reading Malcolm Gladwell’s new book, David and Goliath. It’s not his best work, but it's still thought provoking and worth the time. David And Goliath

The cliff notes version of the book is that it turns out that David wasn't such an underdog after all. He was actually at a huge advantage in his battle with Goliath because he was able to change the rules of the game. Lots of underdogs win by changing the rules of the game so that they become the favorite. To prove his point, Gladwell discusses the civil rights movement, World War II, middle school basketball and many other examples. It's an interesting concept and a pretty good read.

Anyway, as part of his argument, he spends a lot of time talking about the difference between linear curves and U-curves. He argues that there are some things that correlate and may seem like they should sit on a linear curve, but in reality they sit on a U-curve.

Perhaps the most interesting and classic example that Gladwell uses is the correlation between class size and test scores. You might think that the class size/test score graph would be linear -- as class size increases (the X-axis), test scores go down (the Y-axis). That's the conventional thinking.

But it turns out that's not true. The reality is that when class size gets really small, studies have shown that test scores actually begin to decrease again. When there isn’t a range of opinions and when the teacher is too focused on one student, the quality of education goes down. Students benefit from the energy and discussion that comes with having lots of other students in the class. So the correlation between test scores and class size really looks more like a U-curve. Test scores are optimal when the class is around 25 students. Too big is bad and too small is bad.

U Curve

This is also true of crime and punishment. Many believe that as the severity of punishment increases, the amount of crime goes down. But studies have found that there’s a U-curve effect here as well. As punishment becomes more and more severe for smaller crimes, citizens begin to believe that the system isn't fair. That it’s us against them. And they commit more crimes as a result. So you obviously don't want punishment to be too lenient, but you also don't want it to be too strict. Like a lot of things, eliminating crime isn't simple. It isn't linear.

The corollary back to the story of David and Goliath is that you can't improve education simply by adding more teachers and reducing class size and you can't reduce crime by simply making punishment more severe. With complex problems, brute force doesn't always win.

With the U-curve in mind, I've been thinking a bit about price increases and how they impact client relationships. Traditionally, companies like to have modest annual price increases of, say, 2% to 5% per year. Companies like these small increases because they reduce the risk of putting a large strain on their client relationships or losing clients all together. And generally, due to inflation and other factors, clients usually find these increases acceptable.

But as you begin to raise the annual price increase more and more you'll generally see clients resist more and more; 2% is acceptable,15% is not. Like the examples above, on the surface, it seems that the correlation between price increases and client resistance should be graphed on a linear curve. As the price goes up (the Y-axis), so does resistance from clients (the X-axis). Keep your price increases low and your clients will be happy.

But I don't think this is true either. As price increases, client resistance certainly increases, but only to a certain degree. At some point, say 10% and up, in order for the increase to make sense there has to be a substantial and fundamental product change. A 20% increase isn't caused by inflation, increased labor costs, or a greedy salesperson. The increase is happening because there's a substantial change in the product and the product's value. As a result, clients should be much more accepting of this change and client resistance will start to go back down -- creating a U-curve. If the increase is sold and communicated properly, clients will begin to recognize that they're buying a much different product, or at least a much more valuable one. They'll understand that the rules have changed. In fact, I'd argue that at some point most clients would welcome these large but less frequent increases more than they would the small, annoying increases that don't show a corresponding increase in product value.

Increasing price is a requirement of any sustainable long term B2B relationship. And like most things, it's not simple. It's not linear. So when considering a strategic approach to pricing, companies should consider the U-curve and not rely on small, inflation-based annual increases that barely impact revenue. They should cancel those increases. That energy is better spent finding ways to change the rules -- to completely rethink product function, value and positioning. To make a splash. To delight rather than satisfy.

In short, the lesson of the U-curve is actually pretty simple. Don't avoid client resistance by keeping price increases small, modest and frequent; get clients behind them by making them big, bold and rare.

Internet Marketplaces Should Be Seller Agnostic

When you're running an internet marketplace (Etsy, OpenTable, eBay, Uber, KickStarter, Yelp, etc.), it's very tempting to give sellers the opportunity to buy premium placement. This could be things like homepage placement, better placement in search results or enhanced profile pages. Selling this stuff is certainly a very logical way to monetize your user base.

But the problem with this approach is that every time you give priority to a seller that pays you more money, you've muddied your value proposition and taken an equal amount of value away from your user base.

A good marketplace is one that creates an easy, beautiful, seamless and open buying experience that enables rating and recommendation systems so that users can decide the best sellers and the worst sellers. Selling premium placement effectively circumvents your users' preferences putting you in a race to the bottom.

Sure, by charging for premium placement, in the short term, you'll generate some cash. And you can use that cash to do some marketing so that you can generate more users. But over time, if you want to continue to grow, you'll need more and more money and more and more marketing. That will force you to create more and more premium placement options (subsequently devaluing your marketplace).

The better approach is to prioritize the user and compete in the race to the top. Give your users the best possible marketplace experience and let them decide which sellers should win and which sellers should lose. Those great experiences will result in buyers telling their friends to use your service and that will result in more people going through the experience and more people telling their friends to use your service and on and on.

That's the way to scale. And you can't do it favoring one seller over another. Give sellers a great experience too, but don't prioritize them. Prioritize the user.

Fighting For Mobile Real Estate

The other day I wrote about the unbundling of web services. That's where an aggregator comes along and adds value by pulling lots of different services into one place -- Craigslist and Facebook are good examples. As these companies become successful, competitors come in and bite off little pieces of their service and build slick apps that do one thing really, really well. StubHub and AirBnB are good examples of apps that are 'unbundling' Craigslist.

With this in mind, I came across this chart noting that later this year mobile internet usage is going to exceed desktop usage.

Mobile Usage

As mobile usage overtakes desktop usage, specialized apps that do one thing really well are going to be more and more important.

As we know, the challenge with a mobile app is that they're very limited in what they can do. You can't do as much on an app as you can do on the desktop. So as mobile becomes a bigger part of our lives I think we'll see more and more of this unbundling.

But I think we'll also see more and more bundling of retailers and merchants. That is, we're not going to download multiple grocery store apps or multiple clothing store apps or multiple travel apps.

Using myself as an example, I travel a lot. I book with 5 different airlines and probably 6 different hotel chains. As we move towards more and more mobile usage, am I going to download 11 apps? Of course not – I’m going to download one -- Expedia.

The interesting paradox with mobile is that while it will certainly continue to force innovation and specialized, "unbundled" web services, it will also drive lots of "bundled" retailer and merchant applications. Consumers will increasingly demand (and need) less and less clutter on their screens.

In short, the apps that will win the fight for real estate on our home screens will be those that serve a very narrow function very effectively (buying a plane ticket) while at the same time offering the broadest variety of options (tickets from every carrier).

Massachusetts Healthcare

Each year the state of Massachusetts holds a costs trends hearing where they discuss the drivers of healthcare costs and examine what various healthcare constituencies are doing to rein it in. I came across this response from Partners Healthcare System responding to a series of questions from the state. It’s kind of heavy but definitely worth reading if you’re into this type of thing.

In it, Partners lays out its strategy to reduce costs. The primary driver of cost reduction is population health management.

There are two key components to their population health management plan:

  1. Patient Centered Medical Homes. Partners is requiring all of their primary care providers to become patient centered medical homes which is a team-based approach to care that is led by a PCP working with nurses, mental health experts, case managers and supported by an integrated technology system. This gives the PCP all of the resources and infrastructure to truly manage the health of a patient and keep them healthy and out of the hospital. Rather than seeing the patient and sending them to a specialist or off to the hospital without any care coordination, the PCP has a team that is dedicated to making that patient healthy and following the patient through the entire continuum of care. It’s easy to see how this approach is better than the old model.
  2. Integrated Care Management Program. This is a program that focuses only on the 5% of the population that drives 50% of healthcare costs – i.e. patients that have the multiple, complex conditions. Each patient is continuously monitored by a nurse manager and a PCP that proactively identify and address issues and ensure medication and appointment compliance. Again, the goal being to ensure that these patients are requiring and consuming less and less complex care.

In addition, in partnership with Medicare and other commercial payers, Partners has aligned its population health management approach with its business model as it has begun to take on more and more risk-based contracts so that they’re on the line financially for keeping patients healthy.

Partners is not alone. Most, if not all of the other large providers in the state have similar plans.

Regardless of your opinions on the ACA or your opinions on Partners, it's pretty amazing to see how far Massachusetts has come in being a system that cares for the sick to a system that keeps people healthy.

Imagine for a moment if you were a widget manufacturer and the government came to you and said you have to do something about your revenues, they’re simply too high. You’d say, “Ok, no problem, I’ll just stop making as many widgets, lay-off some employees and close a couple factories.”

You’d make less revenue but you’d keep your profit margin.

The analogy to healthcare is that imagine if instead of cutting its production, that manufacturer actually made a deal with the government and said “Ok, I'll sell fewer widgets. But, you have to agree to pay me a monthly fee for me to proactively go out and invest in programs that will make the community not want or need my widgets. And for every widget that I sell, you can take that out of my monthly fee.”

That’s literally what’s happening in Massachusetts healthcare. The hospitals are taking on a completely new approach to business and caring for patients. Their model is rapidly becoming one where they will not make money when people get sick, they’ll make money when they’re not treating the sick.

This stuff is great to see.

BlackBerry's Rise And Fall

The Globe & Mail had a great profile of the rise and fall of BlackBerry last week that’s worth reading when you have some time – it’s a fairly long piece. It got me thinking, BlackBerry is going to make a great business school case study some day. Anyway, I’ve always been of the opinion that BlackBerry didn’t fail because of hardware. As a very loyal user for eight years, I've always believed that they failed because they were way, way too late to the app game. I remember buying a new BlackBerry long after they launched the app store and finding that the app store didn’t come installed. I had to go download the App Store app so I could start downloading apps. And when I downloaded it I found that it was super hard to use. It’s clear that apps weren't a priority for BlackBerry.

When Apple released its App Store it was the core part of the phone. It was easy to use and the app options were nearly unlimited. The advent of apps literally made the iPhone 100x better. That's not an exaggeration. And for some reason BlackBerry missed this opportunity and got into the app game way too late. As a result they literally had no chance of competing against the iPhone or the Android.

I’ve always wondered why they missed this and the Globe & Mail article offers some insight. Check out this excerpt:

Trying to satisfy its two sets of customers – consumers and corporate users – could leave the company satisfying neither. When RIM executives showed off plans to add camera, game and music applications to its products to several hundred Fortune 500 chief information officers at a company event in Orlando in 2010, they weren’t prepared for the backlash that followed. Large corporate customers didn’t want personal applications on corporate phones, said a former RIM executive who attended the session.

Surely BlackBerry had lots of problems but imagine operating in a super competitive business and having one group of customers holding you back from creating the best product you can for another group of customers?

Blackberry could’ve tried to serve both sets of customers but intrinsically and culturally their corporate customers put them at a massive disadvantage when it came to innovation and serving the consumer.

What a paradox: it seems that what once made BlackBerry so successful – large corporate contracts – may be the thing that eventually caused their demise.