Employers can fix America's healthcare problems without new technology or federal policy changes.

I recently watched a video on the CEO of Safeway describing about how they revolutionized their healthcare policy. It's a little dated, but the premise is sound.

http://coe.berkeley.edu/static/streaming/gtl-conference/2009/recording-part-1.html
(It's somewhere past the hour mark)

In short, most employers have been seeing around an 8.5% annual growth in health care costs, but Safeway's has been flat despite providing quality service. They do this by actively encouraging their employees to adopt healthier habits. Their policy is founded on some great principles:

1. Insure everyone: Everyone is covered, regardless of pre-existing conditions. It's still cheaper to provide preventative care to higher risk individuals than to treat them after a serious health issue arises. 
2. Create personal responsibility: Safeway had weight-loss competitions within stores, with thousands of employees competing. Within one year, they managed to move 7% of their total employees out of the "obesity category."  
3. Reward healthy behavior with financial incentives: Employees who don't smoke get an extra $300 of credit, which goes to their retirement account. Not obese? +$300. Don't have high blood pressure, hypertension, high cholesterol? Same deal.
4. Pay for results, not service - Safeway does a survey of prices and picks a fair (usually close to the median) amount they'd cover. Employees can choose to go to any hospital they want and Safeway would subsidize the procedure by the predefined amount.

You don't need new technology to drastically improve healthcare. You don't even need policy change. The fundamental goal of healthcare spending is to make people healthier, and doing so would reduce the need to spend on healthcare. I bet that employers can collectively cut $500B/year in healthcare costs within 5 years simply by being proactive about making their employees healthier. That's a quick 3% of GDP that can be better spent elsewhere.

I got 25K views from HN, but now what?

So I made a quick hack mapping hospital chargemaster prices in the country:

http://www.bestmedicareprice.com/

It got #1 on Hacker News all day Friday, giving me ~25,000 views. Whoo!

I'm trying to semi-live blog my thoughts about this. I never planned on working very deeply in health care because of all the red tape, but this might be the momentum to get me started.

What I learned:
- There is interest. People don't know how much prices fluctuate throughout the country
- Some people want to see more data, such as growth rates of chronic diseases, commodity procedures (like dental), or price comparisons for treatments around the world
- Data in healthcare is highly fragmented based on state, often not very insightful, and usually non-existent.
- People are genuinely willing to help me in this issue because it strikes a chord with many

My questions, in order of severity:
1) How can I use this, or any other accessible data, to make a sustainable business in this space? Sell visualized data and reports to insurance companies? Sell simulation software to state Medicare organizations to help them plan policy? Make a kayak.com for elective procedures? I need help figuring this out. Healthcare is a vast space that I know little about right now, so any direction would help tremendously
2) Where can I get health-quality data about doctors and hospitals?
3) How can I reach patients who are looking for cheaper, out-of-pocket procedures and can't find it?

Writing Experiment - Blogs without scroll

A lot of people who strive to improve their writing muscle embark on a daily writing challenge, usually consisting of 1000 words every day for 100 or 365 days. I've tried several of these myself, but I'm going to reveal my sad truth--I can't do it.

Well, to elaborate, I can't write 1000 words of publishable content a day. Some days, I have more important things to do than share a fleeting thought--like spending time with family. Other's I'd rather opt for an extra hour of sleep. Maybe someday when writing comes naturally and I have fewer things on my plate, 1000 words/day would be doable, but that time is not now.

I have dozens of 50-90% written blog posts somewhere archived in my google docs. The topics are all over the place--startup lessons, education reform, travel experiences, psychology, and life values. Many of them are long and took days to write. Sure, I could finish them, but the last 10% takes half the time, and I have little to gain from publishing a post that will get only a few hundred views and no comments.

So here's an experiment I want to try out: write and publish a paragraph of juicy, rich meat 3-4 days a week. This would minimize boring revision time, force me to be concise, and train me in writing what is essentially an elevator pitch.

Would it make a great blog? Probably not. Would people read it? I don't really care. Would it make me holistically a better writer? No. But releasing short, roughly-edited snippets is better than never releasing masterpieces.

My time limit is 15min/post, starting with this one.

 

It Took 3 Days of Customer Development to Realize My Idea Sucked.

As an engineer in the Bay Area, I routinely receive cold emails from recruiters expressing excitement in my technical background. Messages often start out with the unfortunately familiar “I see you know Javascript! I'd love to chat more about your interests” And of course I don't respond--clearly they either didn’t look very deeply into my background to comment with more insight, or they lack the technical know-how to say anything more.

But what if they knew that I may not be as technical as my engineering degree from a top school indicated? Would they have still reached out? With that whiff of opportunity, I decided to test out a new startup idea.

Hypotheses:

• Many recruiters lack the necessary technical skills or industry experience to effectively evaluate a candidate’s skills. 
• Identifying quality talent would optimize time and energy spent on placing and promoting a candidate and thus help recruiters make more money. 

Business Idea: I’d use technical experts in the crowd to perform resume checks or introductory phone interviews on a recruiter’s candidate. This would function as a third-party certification to add credibility when recruiters promote qualified candidates to companies, and help them allocate time on the right candidates.

Armed with a gorgeous signup page, a list of questions, and half a dozen phone meetings lined up, it was time to see if all of Steve Blank's rants actually mean anything.

THE FEEDBACK

Turned out that all eight recruiters I spoke with said they’d never use it, and here’s why:

• Certifications weaken trust - One recruiter likened skill checks with white papers--they do nothing except “manage risk.” Recruiters want lasting relationships with companies, but a hiring manager asking for credentials is the same as saying “I don’t trust you. Give me proof.” 

• Most companies don’t want the best people -This probably sounds ridiculous in Silicon Valley, where talent is perpetually lacking. However, most larger companies are not highly innovative and use old technology. A qualified engineer would propose a better product that would involve revamping the system, which often means fixing what isn’t (obviously) broken. These companies tend to prefer sacrificing skill for stability. The engineer who is competent and willing to operate and maintain legacy systems and stick around for a few years is worth more than the genius who’d stir trouble by modernizing. Plus, they don’t pay enough to attract or retain the best.

• Some recruiters actually want to be good at their jobs - The best recruiters want to train themselves in whatever industry they focus on to adequately vet candidates. Whether or not they actually succeed is another story, but reliance on third-party certifications is like admitting that they don’t know the subject. 

• Darwinian filtering works - Because the bar to be a recruiter is exceptionally low, many are inexperienced and underqualified. These recruiters would benefit the most from a technical skill vetting service, but they also tend to underperform in other essential skills (networking, keeping candidates engaged, etc.) that they’d leave the industry anyway within a year or two.

• Matching is hit or miss - The best and the worst candidates are easy to recognize, so vetting services are only really useful for those inbetween. However, there is so much variability that a candidate may have botched an interview simply because he was tired that day or didn’t know that one question. One company might say the client too “arrogant” to be hireable, while another might say he is charming and meshes with the team perfectly. It’s often more insightful simply to throw the candidate at a few companies and test the responses.

THE REAL PROBLEM

Turns out I didn’t even bother sharing the website with a single recruiter I spoke with. I also wasted three days designing and coding a pretty landing page to collect signups: www.aidrecruit.com (if it's still up). I did not speak to in-house corporate recruiters or small businesses, so there may still be an opportunity there. I focused this as a value-add tool for agency recruiters and agency contractors.

The underlying goal of customer development is to figure out the real pain point and then build the right solution. From all my chats, the recurring problem was not evaluating candidates, but engaging them. This involves a few steps:

1. Identifying when/if they are in the job market
2. Somehow convince them to come to meetups, beer nights, coffee meetings, etc.
3. Once they are emotionally invested, get them to talk about their background or interests and answer a few preliminary technical questions.
4. Actually propose jobs they'd be excited about

As of right now, the best way to figure this out is also the slowest--long term, in-person relationship building.