Rational Conservative Meanderings ...

A Medicaid Cost Reduction Idea ...

A tiny Oregon experiment may be showing the way to a more effective way than just covering the costs ... getting people "better" so they don't need the system as often.  At a health system in tiny Bend, Oregon, which has 144 people utilizing the Emergency Room more than 14 times a year under Medicaid, they've provided "behavioral improvement specialists"  (social workers) to work with the 60 % of the 144 willing to be worked with ... and have cut the ER visits in half and saved more than $3,000 per person per year.  It's providing personal attention to help the high users develop better lifestyle/habits that keep them out of the sick care system.

On the Street
•  ALL TEC members I talk with will NOT take advantage of the ObamaCare penalty (paying it and moving employees to the individual exchange).  They feel they have a moral responsibility to continue coverage since they can afford it competitively ... reserving a final judgment until they see the impact of actual exchange costs.
•  I talked recently with a tuned-in local observer who knows of a 65-person employer, with low margins who employees low-wage workforce, will cut employees hours to 29 so that he doesn't have to provide health insurance.  This may be the bigger "unintended consequence"; there have been stories in the media about companies with low margin products and services planning to do this.

Harry Dent Redux (and Mark Parrot)

     Remember Harry Dent's Age/Demographics way of looking at economic growth ... that we are driven by our age/time in our lives to be consuming certain things given our lot in life?  In our 30s and 40s we're major consumers of housing, education and cars.  But beginning about age 50, we switch to saving to pay down debt and save for retirement, spending less on major stuff.  

     The last of the Baby Boomers are now passing age 50 ... so that massive purchasing power isn't any more.  Do you think that is part of our sluggish recovery?  Duh!
 
On Health Insurance/Medicare paperwork:
•  A friend of mine who runs a small independent provider is retiring.  "If the objective of Medicare was to run me out of business with excess paperwork and aggravation, they have succeeded.  I want no more of it.  For every five minutes I spend with a patient, I have to hire someone to spend an hour dealing with the back-and-forth of insurors and Medicare."
•  Another friend, talking with his primary doctor:  "Cost Savings?  I'll tell you about cost savings.  At this location, we have 12 physicians ... and 50 people who deal with the paperwork."

Advance head Fred Monique on our local economic development competitiveness:

No, we're not as good as we think.  Here's the truth:
     1.  Not a Right To Work state, which would attract business expansion.
     2.  Incentives to relocate here are weak, comparatively.  "We lost Bass Pro Shops because we wouldn't provide a tax break."  (It's businesses that create jobs, using last year's profits to fund development of new jobs.  Why are they taxed on their income at all?)_
     3.  Our sites and permitting requirements are less than favorable.
     4.  Our state efforts are "inward-focused," not externally-focused.
     5.  We're not great for Young Professionals ... fast-growing, exciting businesses.
     6.  At home, we need to provide more support for Second Stage companies ... those with $2-to-$50 million, and growing ... strategic alliances, leadership education, etc.
But ...
     We're very good for families ... low cost of living, low housing costs, low crime, good schools.
     Very good for entrepreneurs.
Nationally, we're in the bottom quartile of areas:  Our missing components are Right To Work, investment companies, and a research Institution.

Meanderings ...

•  Legislators, almost by definition, are not leaders.  It's the role of LEADERS to provide the Vision ... and the Guidelines!  Then, legislators can create the programs within those guidelines.

•  High taxes and many, complex regulations are THE major indicators of "Crony Capitalism", a bastardization of the economic system that results in today's distrust.  Regulations always have winners and losers, and taxes take from losers and reward winners (sometimes the general public, oftimes special interests).  These always demoralize and de-energize ... the feeling that the game is stacked against me if I become entrepreneurial and take risks.  Which brings us to this great quote ...

•  "The argument for limited government is really an argument for not overburdening politicians.  Leave as much as possible to the market, to the law of contracts, to the courts.  Don't pile up on politicians more and more impossible choices they have to make on our behalf."  By WSJ columnist Holman Jenkins on March 23.

2016 Election: Susan and Ole ...

The year is 2016 and the U.S. has just elected the first woman president, who happens to be from Wisconsin. A few days after the election, the president-elect, whose name is Susan, calls her Father, Ole, and says, 'So, Dad, I assume you will be coming to my inauguration?' 'I don't tink so. It's an 18 hour drive."   'Don't worry about it Dad, I'll send Air Force One, and a limousine will pick you up at your door.'   'I don't know. Everybody will be so fancy. Vhat vould your mother vear?'   'Oh Dad,' replies Susan, 'I'll make sure she has a wonderful gown custom-made by the best designer in Washington.' 'Honey,' Ole complains, 'you know I can't eat dose rich foods you eat. Do day serve tap beer?'   The President-to-be responds, 'Don't worry Dad. The entire affair will be handled by the best caterer in Washington; I'll ensure your meals are salt free. You and Mom just have to be there.'    So Ole reluctantly agrees and on January 20, 2017, Susan is being sworn in as President of the United States. In the front row sits the new president's Dad and Mom. Dad recognizing the senator sitting next to him leans over and whispers, 'You see dat woman over dare wit her hand on da Bible, becoming President of da United States?'   The Senator whispers back, 'You bet I do.'   Ole says proudly, "Her brother played football for da Green Bay Packers."

Highest Effiency: 90 Minutes at a Time

Working in 90-minute intervals turns out to be a prescription for maximizing productivity. Professor K. Anders Ericsson and his colleagues at Florida State University have studied elite performers, including musicians, athletes, actors and chess players. In each of these fields, Dr. Ericsson found that the best performers typically practice in uninterrupted sessions that last no more than 90 minutes. They begin in the morning, take a break between sessions, and rarely work for more than four and a half hours in any given day. ...

Along the way, I learned that it’s not how long, but how well, you renew that matters most in terms of performance. Even renewal requires practice. The more rapidly and deeply I learned to quiet my mind and relax my body, the more restored I felt afterward. For one of the breaks, I ran. This generated mental and emotional renewal, but also turned out to be a time in which some of my best ideas came to me, unbidden. Writing just four and half hours a day, I completed both books in less than six months and spent my afternoons on less demanding work. ...

By managing energy more skillfully, it’s possible to get more done, in less time, more sustainably. In a decade, no one has ever chosen to leave the company. Our secret is simple — and generally applicable. When we’re renewing, we’re truly renewing, so when we’re working, we can really work.

                                   -- Tony Schwartz, CEO of The Energy Project, in a New York Times column (2/10/13)

On Change Management/Culture

My long-time TEC III member, Mitch Weckop, CEO of Skyline Technologies, made a great  presentation to a meeting of the local Servant Leadership group recently, regarding his learnings on how to make change happen.  They are not only about process, but also about the cultural items that ingrain a low performing culture and inhibit the movement to the needed one.  You have to recognize and change them ... to make change happen!  The essence of his remarks:

Most people have frustrations and want to change things. CEOs certainly do. And so do VPs,

managers, directors, salespeople, accounts payable processors, machine operators and ... And not just

at work ... in personal lives, and in the community.

And we can. But you have to make sure it's something you're passionate about (because

changing other people's habits is very, very hard), and that it's something you can directly impact.

(Forget about world hunger, the national debt, etc.). And, that directly impacts you (because that's

what will sustain your passion).

First of all, he says, you have to map out your process. Here it is:

1. Identify the Current Reality, especially the negative or sub-optimal result it is achieving.

2. Document the Reality you would Like To Have. What would it "look like" in broad

descriptors, especially the positive results it is providing.

3. Identify the "Rubber Bands" that are keeping the current culture intact. This will be a long

list of specifics ... things that need to be changed.

4. Identify the Work required to Break those Rubber Bands. Not only do you list here the

details of the New Reality (usually opposites of what"s listed in #3), but the specific

Challenges you will have in making them happen. Identifying the "barriers" is important,

because then you think about how to overcome them; you are less surprised when you

encounter them, and more confident because you have a plan. What's very important is

knowing that when you try to change someone else's habits, there is much pullback.

Eventually, most will come around, but some won't and they will be very publicly vocal.

You have to be firm and resistant.

5. Finally, Prioritize what you will do By Quarter. You can't start everything at once. Start

with a few, very few, and fight to get them to work. As people get comfortable with them,

they will be more accepting of your next changes at a faster pace. You'll also be learning

about how to make these things happen. Having the time schedule in place gives you

confidence that there is a foreseeable completion ... even though it will go slower than you

think, and the schedule will be lengthened.

Developing this Process Map doesn't take long ... just a few thoughtful hours or days by your

core group of people who will be masterminding it. At a transportation company, Weckop's 5-person

senior team developed the process in little more than an hour.

What takes long is implementing it. At the transportation company, it took three years to

achieve the New Reality described on the Process Map.

Here are things you have to look for, because they are CULTURAL ... meaning they are

ingrained, even invisible habits and processes that fight AGAINST change. Your current culture

wants to perpetuate itself, and is designed to do so.

So, you must identify and change the cultural elements that are retarding change. Here is

what to look for:

1. Stories. Your organization has stories that are perpetuating the current reality. They talk

about the world that was, lifting it up, celebrating it. You don't want to kill those stories,

because they are part of the legacy, but you need to initiate NEW STORIES ... ones that

describe the new reality, the new vision, the new rewards that you want the organization

to embrace. Look at your desired reality, and tell the story of how you developed it ... and

tell it OFTEN! There will soon be sub-stories, new ones that get created on your journey.

Craft them carefully, and tell them, too. Weckop says, "Be very intentional about the

stories you need to tell. They must be compelling, and justify your new vision."

2. Language: BE intentional about your descriptors. Make them more compelling than the

current ones. Example: Employee titles. Receptionist has become Ambassador and Mgr,

First Impressions. More and more have become Technicians or Technical Consultants.

3. Artifacts: There are all sorts of things around the office and plant that support or are

memories of the old culture. Remove them, and replace them with something new,

ideally emblematic of the new culture. Start with vending machines with high fat content

foods.

4. Status: Who gets special parking places? Certainly not executives. Customers for

certain. Then, nobody ... egalitarian? Or an employee who got a special award or

recognition?

5. Symbols of Success: "My office has more ceiling or floor tiles than yours, so ..." Better:

Who gets selected to go to special training, to visit customers, etc.!

6. Taboos: Look for Taboos that are counter-productive. We should be doing them. Then,

begin the fight to change that cultural element.

7. Rituals: What happens all the time that reinforces the old way, the old guard, the old

culture? Locate it. Change or replace it .. to what you need now. Create new rituals that

reflect the new regime. Could be simple things ... like a new approach to the employee

cookout.

8. Rewards: Whom and when do you reward? For seniority? No. People who are taking

you in the new direction, at a faster speed than others! Make sure there is a

Principles/Values check ... but that's a 'cost of entry,' not a gainer.

Says Weckop: "Find where your passion is about something that needs to change, and go for

it!"