Trick or Treating for State Healthcare Innovation Treats

When I was a wee lad, I loved to go trick or treating each Halloween. Nothing was better then dressing up in a great costume and walking door-to-door to get my plastic orange pumpkin filled up with candy. My favorite was those little root beer barrel hard candies … YUMMY!

I think my best costume was the year I went out dressed as Elvis. Imagine a 12 year old dressed as Vegas Elvis, with the white jumpsuit, big lapels and the mutton chop sideburns. I got alot of root beer barrels that year. This year I went to the 27th Annual NASHP Conference in Atlanta dressed as a confused IBM Executive.

As part of my role in IBM Smarter Care, I have recently been focused on understanding the government healthcare transformation strategies of the US States in the wake of the Affordable Care Act.

What a better place to get the goodies then the NASHP Conference. The event attracts a “who’s who” of state healthcare policy people who also drive the content and focus of the conference. I may have gone confused but came back armed with answers (my treats).

My plastic pumpkin was filled with goodies by the end of the pre-conference on the first day. The best treat (for me) was the keynote delivered by Dr. Elizabeth H. Bradley from Yale University. Her keynote was based on her new book The American Health Care Paradox: Why Spending More is Getting Us Less. Her point of view asserts that when you combine social services spending with healthcare spending you can achieve more. Our archaic division of health and social services, and our allergy to government programs, is hurting us. The book offers a unique and fresh perspective on the problems the Affordable Care Act won’t solve.

There were other treats as well. The pre-conference on care coordination was led by NASHP Program Manager, Dr. Barbara Wirth. It featured an all-star line-up of state executives sharing how they were using CMS Innovation Funding to improve state healthcare outcomes on behavioral health, infant mortality, long-term care and supporting services using care models such as Patient Centered Medical Homes, Health Homes and more.

The one treat that I really wanted … I didn’t get (and it wasn’t root beer barrels).  It was an understanding of the technology being used to help achieve the outcomes being cited in the sessions. Software is essential to enabling care models where patients are crossing care settlings, caregivers, locations and even care programs. There is no way this can be done economically using the good old fashioned way of paper, folders, faxes and phone calls.

Realistically, it’s too early for many of these new programs to expect a lot of detail on this. On the other hand, the omission(s) makes me scared (get the pun) that this may not be on the radar screen of those making policy decisions … and those responsible for rolling out these innovative programs.

Healthcare reform is not just about innovative payment models, policy design and care delivery models. It must also include innovative technology to deliver on the promise of consistent quality, scalable delivery and affordable care. The use of big data (not just EMRs), analytics and care coordination software all help enable the benefits Dr. Bradley spoke about where social programs and healthcare come together to enable better outcomes at lower costs. Dynamically linking these technologies to health policy is where innovation can and will happen. Not linking them may cause your programs end-up like an old Haunted House where dust and cobwebs cover up ghoulish and ghastly looking programs (ok, really sorry for the pun).

Maybe next year I’ll pull out my Elvis costume when I go to NASHP in Dallas (October 19-21, 2015) even though I know it’s far too small for me.

In the mean time, I’ll urge NASHP to push this technology agenda, along with all of those implementing reform through government healthcare transformation. Start thinking and planning for the technology that will power your initiative now.

For me, Halloween comes twice this year. The IBM Health and Social Programs Summit is being held October 20-21st in Washington, DC. This event convenes a global network of thought leaders, industry experts and practitioners to discuss industry trends and directions, and compare best practices and leading technology innovations in the fields of Health and Social Programs. I will be speaking, as will Dr. Barbara Wirth from NASHP, along with The Honorable Patrick J. Kennedy, Dr. Paul Grundy, Dr. Stephen Morgan and many more. I hope to see you there … and bring some root beer barrels!  There will be plenty of treats for you too.

How To Quickly Tell If You Have An Innovation Problem

At a recent speaking engagement, I was asked if there was a quick way to tell if an organization has an innovation problem.  The organization in question has a long and proud innovation track record … and has been meeting its revenue and cost objectives. On the surface, all seemed to be in order … but that was not the case.

As I pondered the question my brain quickly rifled through various best practices for analyzing product lines and portfolios including the Boston Consulting Group Growth Share Matrix first published in 1970 by BCG founder Bruce Henderson.  The matrix is based on the clever use of question marks, cash cows, dogs and stars as way to stratify a given portfolio … and to help allocate resources based on two factors (company competitiveness and market attractiveness).  While over 40, the model and methodology remain viable and are still widely used.

There are other approaches such as the Deloitte Consulting Growth Framework … but my preference is the McKinsey 3 Horizons of Growth.

The McKinsey model has also stood the test of time and is more intuitive (at least to me). It addresses a fuller spectrum of portfolio analysis issues and breaks down as follows:

  • Horizon 1 – Extend and defend core businesses.
  • Horizon 2 – Build emerging businesses.
  • Horizon 3 – Create viable options.

It is based on the traditional “S” curve adoption and growth principle but asserts that at a key point on the adoption curve, new innovation (and investment) is needed to enable future horizons of growth as indicated above.  Each horizon ensures future waves of new revenue growth and continued innovation.  In all, 3 horizons are needed.  Each horizon requires a different approach, people, skills and management method.  As you might suspect, each horizon level is also increasingly intrapreneurial. Most importantly, you need to manage all three horizons concurrently … even though based on different principles:

  • Horizon 1 – This is typically a fully capable or mature offering / platform that is being managed by “business maintainers” using traditional performance, operational and profit metrics such as return on invested capital (ROIC).
  • Horizon 2 – This is typically new capabilities that are being built-out or acquired in emerging business scenarios by “business builders” based on growth aspirations using metrics such as net present value (NPV).  This stage is well past the experimentation phase, has early adopters and expected to show scalable grow in the near future … followed by profit soon thereafter.  The Crossing The Chasm model by Geoffrey Moore comes to mind for me.
  • Horizon 3 – This is the experimentation phase where requirements may be unclear.  It needs to be led by “evangelists or visionaries” and governed by validation or iteration metrics such as number of interviews, feedback sessions, number of iterations or other early stage progress metrics. It is typified by prototypes, market validation, agile development and directional pivots.  The Lean Startup concept by Eric Ries comes to mind.

Upon some investigation, the balance of investment (for the company in question) was far too heavy on near-term (or proven) revenue performance offerings (Horizon 1) and not enough on longer-term growth options (Horizons 2 and 3).  In light of conservative spending by most companies coming out of the recession, this was not an unexpected finding.  The tendency in business for the past few years has been to focus on short-term initiatives … sometimes at the expense of ensuring future growth options.

A simple mapping of your own portfolio of offerings to the three horizons may be just as revealing as it was in this case.

Most organizations should strive for roughly 70% investment on Horizon 1 offerings, 20% investment on Horizon 2 and potentially as much as 10% on Horizon 3 offerings.  These percentages may vary from company to company … and industry to industry … but represent a reasonable breakdown for any organization to evaluate itself.

When was the last time you evaluated your offerings using some method like this? If you don’t know the answer, or if it has been longer then 12 months, then invest the time do this.  Your future could literally depend on it.

I feel good that I was able to steer them in the right direction using such a proven method to manage innovation.  My innovation initiatives are progressing.  The Intrapreneurship: Tackling The Challenges of Bringing New Innovation to Market AIPMM webinar replay is available in case you missed the live event and The First Annual Intrapreneurship Benchmark Survey on Commercializing Innovation survey remains open through June 30, 2014.  I plan to compile, analyze and publish the survey findings in Q3.

As always, leave me your thoughts and opinions here.

Help Stop the Senseless Killing of Important Innovation

The great business management philosopher Yogi Berra once said, “If you don’t know where you are going, you’ll end up someplace else.”  This is how I feel about the current state of business innovation.  New innovation usually starts out on the right path but often ends up in the ditch.

Innovation is clearly a key driver of organic growth for all companies.  67% of the most innovative companies say innovation is a competitive necessity regardless of sector or geography.  Leading innovators have grown 16% higher then that of the least innovative companies(1).  It’s no wonder that 91% of companies believe innovation is a top strategic priority(2).

It turns out that many organizations actually struggle to bring organic innovation to market.  Even though 84% of executives say innovation is extremely or very important to their companies’ growth strategy, only 39% say their companies are good at commercializing new products or services (3).

Connecting innovation programs (and resulting new inventions) to what happens later with market adoption (and revenue growth) isn’t possible without what happens in between.  My theory is that there is a critical gap … one that is unnecessarily killing many promising innovations.

Not enough is known about the reasons why so many organizations struggle to bring their own organic innovation to market.

With that in mind, I have decided to create  The First Annual Intrapreneurship Benchmark Survey on Commercializing Innovation.  The survey is available immediately and can be accessed at https://www.surveymonkey.com/s/intrapreneurshipbenchmark.  It will collect data to establish new benchmarks.  Once collected, the data will be analyzed and included in a written report.  The full report will be made available to survey respondents.   Highlights will also published later in 2014 in selected business publications as well as on this website.

You can help stop the senseless killing of important innovation too.  After all, “When you come to a fork in the road take it” – also Yogi Berra.

 Take this fork with me.  Seriously, please help me by taking a few minutes of your time to share your experiences in this area by taking the survey.

As always, leave me you thoughts and comments below.

Footnotes:

(1) PWC Report “Breakthrough Innovation and Growth” – September 2013

(2) GE Report “Global Information Barometer” – January 2013

(3) McKinsey & Company Report “Innovation and Commercialization” – 2010

(4) Ernst & Young Report “Igniting Innovation: How Hot Companies Fuel Growth from Within” – 2010

 

What Is An Intrapreneur Anyway?

The word entrepreneur is more than 150 years old, having come into English from French in 1828. But it was not until comparatively recently that its intra-corporate counterpart, intrapreneur, was introduced to the business lexicon.

“a person within a large corporation who takes direct responsibility for turning an idea into a profitable finished product through assertive risk-taking and innovation.”

The term is usually credited to Gifford Pinchot (the grandson of the first Chief of The US Forest Service, also the 28th Governor of Pennsylvania, with the same name). According to Mr. Pinchot’s website, in a 1982 The Economist magazine article, Norman Macrae gave credit to Gifford Pinchot as the inventor of the word intrapreneur. Mr. Pinchot went on to publish his book “Intrapreneuring” in 1985. In 1992, The American Heritage Dictionary added Intrapreneur … giving new legitimacy to the term.

There are obvious derivations of the word … Intrapreneurship, Intrapreneurial, Intrapreneuring and even Intrapreneurist (the name of this blog – but I’ll save that explanation for another blog – it’s sort of a John Wayne thing).

In a September 30, 1985 Newsweek magazine interview, Steve Jobs used the term to describe his team, “The Macintosh team was what is commonly known as intrapreneurship, a group of people going in essence back to the garage, but in a large company”).

Wikipedia has embraced and references the original American Heritage Dictionary definition cited above. This definition is by far the best. I give this definition an “A”.  I will make a small tweak or two in my version below but it’s a solid “A” nonetheless. There are strong decision-making and collaboration components in support of the risk taking aspect … and navigating corporate politics make collaboration essential, which is something entrepreneurs don’t have to worry about. Also implied in the definition, is the fact that the role requires strategy, execution and delivery of results.

My tweaked version is: “a person within a large organization who takes direct responsibility for turning an idea (or innovation) into a profitable finished offering through assertive risk-taking and effective stakeholder collaboration.”

Here are some other popular definitions:

Dictionary.com (which is based on the 2014 Random House Dictionary)an employee of a large corporation who is given freedom and financial support to create new products, services, systems, etc., and does not have to follow the corporation’s usual routines or protocols.

My rating is a “C-“. This definition is a little loosy goosy … intrapreneurs may get some latitude but freedom is a stretch. Saying they do not have to follow protocols is also a stretch.

Dictionary.com II (which is based on the 2009 Collins English Dictionary)a person who while remaining within a larger organization uses entrepreneurial skills to develop a new product or line of business as a subsidiary of the organization.

My rating is a “B-“. This definition is tighter. Saying that an intrapreneur develops a new product as a subsidiary does not make sense organizationally though.

Merriam Webster Dictionary: a corporate executive who develops new enterprises within the corporation.

My rating is a “D-“. This definition is too short and limiting. You don’t have to be an executive, and intrapreneurs don’t develop just new enterprises or work in only corporations. Pretty poor for such a prestigious brand. I suppose being too narrow is not as bad as being wrong though.

Speaking of wrong … the usually reliable Investopedia has a rather bizarre definition: An inside entrepreneur, or an entrepreneur within a large firm, who uses entrepreneurial skills without incurring the risks associated with those activities. Intrapreneurs are usually employees within a company who are assigned a special idea or project, and are instructed to develop the project like an entrepreneur would. Intrapreneurs usually have the resources and capabilities of the firm at their disposal. The intrapreneur’s main job is to turn that special idea or project into a profitable venture for the company.

My rating is an “F” (can I rate it lower?). This definition is laughable. Being assigned an idea and instructed to be an entrepreneur is a hilarious notion. It sort of misses the point doesn’t it? … and takes all the initiative out of it. Having all the resources and capabilities at one’s disposal is also an amusing thought.

When I started writing this blog, I did not expect to find such a large disparity of definitions. I was disappointed to find so many uninformed (aka lame) “name brand” definitional sources.

What is your definition?

As always, leave me your thoughts and ideas here.

Amputations or Analytics … a Call to Action for Entrepreneurs and Intrapreneurs Alike!

Doctor George Shearer practiced medicine in central Pennsylvania from 1825 to 1878 (in the Dillsburg area). He was a pillar of the community and is believed to have been an active surgeon during the Civil War. He was 61 at the time of the Gettysburg battle.

According to the National Library of Medicine, the exact number is not known, but approximately 60,000 surgeries, about three quarters of all of the operations performed during the Civil War, were amputations. Although seemingly drastic, the operation was intended to prevent deadly complications such as gangrene. There were no anti-biotics during this era.

Back then, amputation was the recommended treatment for major injuries, such as damage from gunshots or cannonballs. These amputations were performed with a handsaw, like the one Doctor Shearer used (shown below). During the war, surgeons prided themselves in the speed at which they could operate, some claiming to be able to remove a leg in under one minute. Ouch! Literally!

Image

(Photo: Doctor George Shearer’s Actual Surgical Kit)

Keep in mind that local anesthetics were not invented until the 1880s and many procedures were performed without ether or chloroform … the only real anesthetics during the era.

In 1861, this was the best standard of care for those injuries. I think we can reasonably conclude that better treatment options (and outcomes) exist today.

Recently, The Mayo Clinic published an eye-opening report entitled, A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices. The report focuses on a published medical practices and how effective they are. Things must have improved since 1861 … right?

The report examines published articles in prominent medical journals of new and established medical practices (such as a treatment guidelines or therapies), over a recent 10 year period (2001-2010). 2044 medical practice articles were reviewed. The findings are fascinating but one section of the report jumped off the page at me. Of the 363 articles that tested an existing standard of care, 40.2% reversed the original standard of care … and only 38.0% reaffirmed the original standard of care. The rest were inconclusive.

In other words, (in this case study) the current published medical standards of care are wrong MORE then often then they are correct. Wow!

I do feel obligated to point out that this is a very limited slice of the overall published standards of care … but still. It is just me … or is this mind-blowing!

I am not talking about gulping down some Jack Daniels so I don’t feel my leg being sawed off. This is researched and tested medical standards of care within the last 13 years. And yet … over 40% of the time, it’s WRONG. In fairness I should point out that they were right 38% of the time. No wonder the US Healthcare system checks in as the 37th best worldwide despite outspending everyone else by a huge margin (per capita).

It’s 150 years later, has the standard of care improved enough? We may not be sawing legs off at the same rate these days, but maybe it’s time for a new approach. Why are other industries so much farther ahead in leveraging their data with analytics to improve quality, reduce costs and improve outcomes? What could be more important then saving life and limb?

Years of data have been piling up in electronic medical records systems. Genomics is not new anymore. Isn’t it about time we brought analytics to this set of opportunities?

Some leading organizations already are … innovative solutions and companies are popping up to meet this opportunity. Entrepreneurs like Scott Megill, co-founder and CEO of Coriell Life Sciences, is a great example. Coriell Life Sciences is an offshoot of the Coriell Institute for Medical Research, a 60-year-old non-profit research organization. In 2007, the Institute launched an effort to bring genomic information to bear on health management. Coriell Life Sciences was established to commercialize the results of that research. Vast amounts of genetic information about individual patients has been available for a number of years, but it has been difficult to get at and expensive. “This company bridges the gap,” said Dr. Michael Christman, the Institute’s CEO.

Coriell’s approach is so innovative, they recently walked away with the coveted “IBM Entrepreneur of the Year” award.

Intrapreneurs at IBM have been busy commercializing the breakthrough innovation, IBM Watson – that originally debuted on Jeopardy! in 2011. Watson is based on a cognitive computing model.

Grabbing a few less headlines is IBM Patient Similarity Analytics, which uses traditional data driven predictive analysis combined with new similarity algorithms and new visualization techniques to identify personalized patient intervention opportunities (that were not previously possible).

These are a couple of obvious examples for me, but in reality we are just at the beginning of leveraging big data. New analytics and visualization tools must become the “handsaw” of today. We need these tools to be at the root of today’s modern standards of care.   If Dr. Shearer were alive today, you can bet his old surgical kit would be on the shelf, having been replaced by analytics that he could bring to the point of care.

For many Entrepreneurs and Intrapreneurs, the journey is just beginning, but there is a long way to go. A 2011 McKinsey report estimated that the healthcare industry can realize as much as $300 billion in annual value through analytics. Yowza!

What are you waiting for?

As always, leave my your thoughts below.

Best Business Decision Making Tool Ever?

Those of you who know me, know that I have spent my career as both an Entrepreneur and more recently … an Intrapreneur.   I have also been on a slightly quirky quest to find useful tools and models that will enable me to make better, more objective decisions that increase the chance of success and minimize risks.

Whether you call yourself an Intrapreneur or not, you probably have a need to make decisions about your own projects. Which brings me to today’s posting. I have come to rely on a handful of basic but indispensible tools and am curious about whether these are same tools and methods that everyone else relies on.

My favorite tool by far is the SWOT Analysis. I have used it hundreds of times over the years for everything from personal career planning to many different business situational assessments. I even used it to start the project that eventually became IBM’s Patient Care and Insights solution. At the time, we were trying to decide how to approach bringing a major breakthrough in healthcare analytics innovation to market that has been invented by IBM Research named Patient Similarity Analytics … and it all started with a SWOT Analysis.

A SWOT Analysis is an easy to understand and versatile way to assess your position at any point in time. Think of it a tool to assess any situation from 4 different positions or perspectives (Strengths, Weaknesses, Opportunities, Threats).  It can be as simple as making a list for each of the SWOT categories. There are many different ways to apply and use SWOT Analysis. It’s power is in it’s versatility.  Once the items are listed, decision making becomes easier bordering on obvious. The listed items can also be scored or weighted with other relevant information such as likelihood, impact, etc.

Strengths

  • List strength 1
  • List strength 2
  • List strength 3

Weaknesses

  • List weakness 1
  • List weakness 2
  • List weakness 3 
Opportunities

  • List opportunity 1
  • List opportunity 2
  • List opportunity 3
Threats

  • List threat 1
  • List threat 2
  • List threat 3

Catherine Kaputa has a wonderful way to use SWOT as a career / personal brand assessment in her book on personal branding titled “You Are A Brand”

Eisenhower Analysis

Credited to Dwight D. Eisenhower, an Eisenhower Analysis (also known as the Eisenhower Box, or Decision Matrix) is a time management or prioritization tool. It is best used when trying prioritize, organize or otherwise get control of a situation or workload. The goal is to easily recognize the highest priority items from the noise. As an example, many people confuse “urgent” work with “important” work and this helps bring clarity to those kinds of issues. Once the items are listed, prioritizing is clear. Like SWOT, the listed items can also be scored or weighted with other relevant information such as likelihood, impact, etc.

Urgent and Important (1)

  • List urgent important item 1
  • List urgent important item 2
  • List urgent important item 3
Important (2)

  • List important item 1
  • List important item 2
  • List important item 3
Urgent (3)

  • List urgent item 1
  • List urgent item 2
  • List urgent item 3
Neither Urgent nor Important (4)

  • List non-urgent non-important item 1
  • List non-urgent non-important item 2
  • List non-urgent non-important item 3

Franklin Analysis (Pros / Cons)

Credited to Benjamin Franklin, the Franklin Analysis (also known as the pros and cons analysis) is a comparison tool for decision making … typically in a list format. It is used when comparing the pros (positives, pluses or benefits) to the cons (negatives, minuses or costs). This tool is most effective when there are many items to consider and the decision is not obvious. Many people bring emotion into decision making and this approach helps keep an objective perspective. Like the SWOT and Eisenhower approaches, the listed items can also be scored or weighted with other relevant information such as degree of importance, etc.   Totals can even be calculated from the weighted scores.

Pros

  • List positive item 1
  • List positive item 2
  • List positive item 3
  • List positive item 4
  • List positive item 5
Cons

  • List negative item 1
  • List negative item 2
  • List negative item 3
  • List negative item 4
  • List negative item 5

There are literally hundreds of decision making models and approaches but I kept this list to the most well known. What is your favorite tool? As always, leave me your thoughts and ideas here.

Entrepreneurship Alive and Well in Local DC Area

I had lunch recently with my good friend and local entrepreneurial legend Ching-Ho Fung.  Ching-Ho was the Chairman of Parature until the recent sale to Microsoft in January for $100 million.  We were both in a reflective mood and discussed the state of entrepreneurship in the DC region.  I was struck how much is happening in support of entrepreneurship.

Along those lines, I attended a DC I-Corps event on 3/28 on the recommendation of Jim Chung, the Executive Director of Entrepreneurship and Technology Transfer for George Washington University.  DC I-Corps is a regional program designed to foster, grow and nurture an innovation ecosystem in the nation’s capital, the nearby states of Maryland and Virginia, and the mid-Atlantic region.  It is sponsored by the National Science Foundation and jointly run by the University of Maryland College Park, George Washington University, and Virginia Tech.

The event featured presentations by four “teams” who are graduating to the next phase of the program and will/may become ventures one day soon.  Keep an eye out for ToxFix, ReadAhead, SmartPupilometer and RedShred.  All four look promising because they address real-world problems.  It’s part of the “Evidence Based Entrepreneurship” concept taught within the program.  I was particularly fascinated with RedShred as their RFP response solution is based on natural language processing techniques … something I have blogged about many times.  It’s a great example of a burgeoning Cognitive Computing solution.

Interestingly … the definition of a start-up by the I-Corps program is “A temporary organization designed to search for a scalable repeatable business model”.  I love this concept since it teaches entrepreneurs to find problems first that they can then address with a solution (and it’s value) before anything else.  It’s the right model.

I can’t tell you how many meetings I’ve been in where some product manager is trying to apply the “every problem looks like a nail if you are a hammer” mentality.  That’s the wrong model.  Additionally, many entrepreneurs think the first thing they need to do to find venture capital.  There is a place for that but it’s not first.

I-Corps has gotten it right.  From what I can tell, this looks like a good program for anyone with an idea, or invention, to get started on the right foot.  In recent years, all of the local universities seem to be been expanding their focus on entrepreneurship.

The Dingman Center for Entrepreneurship at the University of Maryland have certainly expanded their offerings.  Next for them is the 2014 Cupid’s Cup Business Competition.

I plan to attend that one as well … and hope to see you there.  I also plan to blog more on both entrepreneurship (as well as intrapreneurship) going forward … so stop back soon.

As always, leave me your thoughts and comments below.