Sunday, February 28, 2021

Do you know your Medicare number offhand? Try memorizing this!

 

 


Being asked for a new piece of information by Reception when you are waiting in line for a colonoscopy screening is no fun – especially when this information is not listed anywhere as required for check-in, and you’ve never been asked for it before.  In my case, it put me in the role of problem-solver, not my job as patient.  Yet another example of assumptions made by medical centers but not communicated to the patient—especially in time to do anything about them. 

The latest Medicare number is an 11-digit alphanumeric randomly generated “Medicare Beneficiary Identifier” (MBI), introduced to prevent fraud and identity theft and protect patient information.  It went into effect in January 2020.  It replaces the familiar Social Security number.  Normally it is part of any insurance company record, whose own member number substitutes for the Medicare card.

Like Canada’s postal code (as well as the British, Irish, and Dutch), but even longer than the longest such postal code in the world, Iran’s 10-digit format, it is difficult to read, type, or memorize.  This is, of course, the better to thwart thieves intent on ID theft by making it impossible to guess, and by removing any links to Social Security.  But the same goes for the legitimate code owner: in this case, me.  Here’s the format:  1AA1A11AA11, where A is a letter and 1 is a digit. 

This might be expressed as 5DH7D32RS87, for instance (not my personal MBI, BTW).  This format risks mistaking certain letters for numbers (like O and l for zero and one), and the Q looks a lot like zero while G looks like a 6 and B can appear as 8.  When you type out these mixed codes, your brain is forced to toggle between two systems, numeric and alphabetic, which results in mental stress.  It also requires the added motion of hitting and releasing the Caps key again and again.

Recently I had a close encounter with this piece of information I didn’t know I needed, and unlike my SS number, have never tried to memorize.  I arrived at Reception at 8:30am for my screening, for which I had spent the past week prepping with diet and clearing-out medication—not a process anyone ever looks forward to repeating.  The screening itself is easy; the prep is where all the work is.  Just the thought of wasting and then repeating this effort is highly stressful.

Everything went fine until I was asked for my Medicare number.  I never carry my Medicare card, and I knew the clinic had all my insurance numbers from six months ago.  The patient instructions specify not bringing any valuables, so I left them home.  Here I was now thinking that all my diet and prep steps were about to be derailed – an upsetting potential.  According to the reception staff, Medicare is insisting more and more often on the number, and the practice must enter it in order to admit the patient.  Of course, had I known I needed it, I would have made a point to bring it with me.  Apparently there is no advance notice – just a demand by the check-in system that works by random chance.  And at a point when there is really nothing the patient can do about it. 

This missing code instantly created a gap that had to be bridged, one that threatened to block my care.   As the staff began running around trying to figure out this sudden new demand—as if this were the first time they had ever seen it--I began thinking hard: how could I as patient solve this for Jefferson GI?  And a tandem thought: Why was this suddenly the patient’s job?  This is analogous to standing in line to board your plane, only to be told you need a second form of ID—and all you have to show is your driver’s license.

I suggested calling Cigna, my Medicare Advantage insurance, which must link to Medicare.  There was also Medicare itself; had they tried here?  How about my primary care doctor, also in Jefferson’s system?  Maybe Billing would have this information.  It turns out, after 15 or more minutes and a steady line of patients building out behind me, that’s where the department found it.  I was at last admitted, but only after a hair-raising episode of fear, uncertainty, and doubt.  Patient Assistance even suggested that if these ideas failed, I could always call my husband at home and have him locate it for me in my home office.  However, he had just escorted me to the building and wouldn’t yet be there to wade through my medical files.  Now my household was getting involved, not a direction I wanted to go. (Those living alone are on their own here.)

I did point out to Patient Assistance that this Medicare card requirement was a bottleneck that needed to be handled.  Will they be able to solve this?  Isn’t the reception staff tired by now of trying out fixes?  Don’t they need a solution that works?  Or is the patient going to be the go-to party to solve problems that belong to the health system?  I’ll find out in another year, when my return visit will schedule. 

Update:  On emailing Billing, I received the following reply from the staff: 

The front desk is required to ask all patients that have Medicare Advantage plans for their original Medicare ID# [the MBI].  The system prompts them to ask.  I’ve sent an inquiry to the registration team at Jefferson to ask them why this is such an issue. It seems to have become an “ask” after we had a recent upgrade.  I will let you know what they tell me when they respond to me next week.

Is this new prompt built into the software upgrade?  Reception tells me they see it randomly, not routinely.  In any case, upgrades need to be examined for any new demands on the users on both sides of the counter.  And then coordinated with instructions to patients before, not after, the admission process.  This clearly was not carried out, meaning the patient could end up without service.  At the least, it produces some hard emotions and memories, and delayed service that cascades back down the waiting line.    

 

Tuesday, February 2, 2021

Mission + Vision: Just Do It

 


Mission and Vision started as two separate exercises by senior managers to identify what their business is doing and what it ultimately wants to achieve.  These two statements (along with the Value Proposition for the customer outcome) are often now combined to express both being and becoming.  The main idea is to create a clear focus for decisions and opportunities in the service of a clearly stated direction and purpose. 

Steve Jobs said this about his company’s motivational value: “If you are working on something exciting that you really care about, you don’t have to be pushed.  The vision pulls you.”   General Eisenhower said much the same thing decades before about the easiest way to get a string to move. "Pull the string and it will follow wherever you wish. Push it and it will go nowhere at all."

A consultant to the US Army asked what their mission statement was.  "We don’t have mission statements,” the officer in charge replied. “We have missions.”  Organizations like the military are social enterprises, with public-good goals that citizens generally understand from the outset.  Productivity consultant David Allen’s company name tells what he does and what he wants for his clients: “Getting Things Done.”  The Moonshot Factory, the skunk works of Alphabet, puts their mission this way:  The goal is to “create radical new technologies to solve some of the world’s hardest problems.”  The desired achievement?  “10x impact on the world’s most intractable problems, not just 10% improvement.” 

Mission / Vision has a double role.  It works both to clarify purpose within the company for making decisions and to know how those decisions align with the company’s direction. It informs the self-image of the brand idea or company core ideal.  For external purposes, a capsule statement like Nike’s 1988 “Just Do It” slogan inspires confidence in the brand and serves as a legend that carries the brand’s dedication to sportsmanship and health.  Inspiring achievement of greatness, it still doesn’t reveal exactly how Nike expects this to happen.  (The story goes that the phrase echoed convicted serial killer Gary Gilmore’s last words to his firing squad, “Let’s do it.”)

For another example, how about Microsoft’s revised mission of 2014 “To empower every person and organization on the planet to achieve more.”  The original 1992 Gates and Allen purpose as a corporation was to “put a computer on every desk and in every home.” Because as soon as there was a computer on every desk (and Starbucks table), the mission had to be expanded and updated.  The Fortune counterpart is “Making business better.”  These are sweeping mandates, like IBM’s signature “Think.”  Are they too broad?  “Making the world better” and “Making a difference” are laudable aims.  But how, why, and with what results, and for whom?

I have always been fond of the elevator pitch, a telegraphically cogent mission statement made famous by the TV Western series “Have Gun, Will Travel.”  That’s the message.  The business card adds some needed information:  the principal’s name and contact information: “Wire Paladin, San Francisco.”  However, this explains HOW Paladin operates, but not what he does, which is far more important.  He settles disputes, often complicated ones, as a talented negotiator with the gift of understanding the real issues behind his clients’ conflicts.  He is often, however, mistaken for a simple gunfighter or assassin.   

Further problems emerge when we dig deeper, for example, with Ed Catmull, co-founder of Pixar and President of Disney animation studios.  Here is what he said about Disney animation: “The real goal of what we’re doing is to have a positive impact on the world.”  Or the mission of the East-West Center (where I did my graduate work at the University of Hawaii): “The East-West Center promotes better relations and understanding among the people and nations of the US, Asia, and the Pacific through cooperative study, research, and dialogue [at plenty of conferences].”  What question does this beg?  It’s a lofty goal, but how will the results be measured, and will they tell you if you are succeeding in the long view or just operating year to year?  What is “positive impact,” and “better relations and understanding”?  These cases should be red-marked by any business school. 

The Starbucks mission gets closer to the “How” question in their mandate “To inspire and nurture the human spirit—one person, one cup, and one neighborhood at a time.”

Corporate consultants Bain & Co.’s website presents a view of mission and vision that very few businesses seem to have enacted (April 2, 2018, home site).  “Ensure objectives are measurable, approach is actionable, and the vision achievable.”  That directive seems to live far from the common practice of even the biggest and most successful companies in drawing up their missions and visions. What is missing is accountability. 

How about revising a couple of missions: TED Talks “To spread ideas.”  Adding “One expert talk at a time” tells how this happens.  American Express: “We work hard every day to make AmEx the world’s most respected service brand.”  This can be made more effective by just claiming the outcome as “World’s most respected service brand.”  It’s good that AmEx works hard—but we assumed that.  And now back to Nike: “Bring inspiration and innovation to every athlete in the world.  If you have a body, you are an athlete.”  Is this believable?  Or just a form of flattery?  How about “Inspiring innovation for the athlete in everyone.”  (You’re welcome.) 

Like the Army, perhaps business needs more missions and fewer statements.

Here is a mission statement I made up for Cultural Studies & Analysis, my think tank that studies culture: “Explore the universe of culture to discover how and why people around the world think, believe, and act, in order to benefit both business and education.”  How will I do this?  By making my Vision into an achievable objective: “Work on interesting projects, with interesting people, and go interesting places [both mental and geographical].”  Both statements can be measured by project numbers, industries studied, and problems framed in ways our clients had not seen before, with outcomes to clarify human motivation for problem solving, creativity, and innovation. 

Sunday, January 10, 2021

Black Swans: What you don’t know CAN hurt you


There may be a piece of information consumers need that they don’t know exists - or even suspect is out there.  Black Swans suddenly change the way you see and assess situations, the “leverage multiplier” needed to redefine problems, revealing new sources for solutions.

“The unspoken breakthrough dynamics of a negotiation….  Factors you didn’t know about and were not accounting for.…the leverage multiplier.”

-- Chris Voss, Never Split the Difference (2016)

Black Swan events have become infamous factors in the global culture now emerging, the wider culture we all inhabit.  The pandemic of the past year 2020 is a leading example.  But the term is not a new one.* Once people thought that all swans were white, as those were the only ones they had ever seen. Their worldview changed when the first black swan in nature was actually sighted in Western Australia by the Dutch explorer Willem de Vlamingh in 1697.  From that moment of discovery, the swan of a different color at once became a metaphor for newfound potential.   In 17th-century London the term was used to denote an unforeseeable event, one with wide and usually unintended consequences. 

While the cues and markers might be around and even visible, until there is a verified sighting – real proof of existence that people can agree on—there is no mental file folder that can allow the mind to consider and build on an idea.  An example is the current Covid world crisis that, while predicted in theory, was nevertheless not seen or prepared for. Impossible ideas are relegated to fantasy, making it impossible to operate within the realm of creativity and innovation as possibilities with real potential.  Other examples of “impossible” inventions?  1) the theme park and 2) Assisted Living, both thriving institutions of consumer entertainment and senior living.

Founder of the Black Swan Group Chris Voss navigates corporations through the complex problem-solving process of negotiation, the key skill in multi-party actions. Voss has assembled a manual of problem-solving approaches based on his background as an FBI hostage negotiator.  His experience models the tactical uses of emotional intelligence to avoid compromise, ending with a resolution in the client’s favor.  

It is easy to imagine developing training along the lines suggested in the Voss book outside the more left-brained Getting to Yes approach, aimed at discovering the Black Swans in the equation to fill in vital information either missing or disregarded.  The simple recognition of these factors can result in summary resolution of problems that so far have been stubbornly resistant to a mutually satisfying solution.   

Part of the success outcome, of course, depends on the wits and experience of the negotiator to spot that piece of information, or its space in a familiar pattern, that will signal how the original problem got its start and kept on rolling.  As well as how to untangle and reorganize which facts and events are vital in order to redefine the problem and multiply the leverage to win.  

On the consumer front, these could be: A glitch in computer programming no one has identified or fixed: the Y2K crisis, the widespread EPIC (“disaster”) software failures in healthcare, or the JPMorgan Chase bank overdraft charges of $34 up to three times per day. These each took many months to recognize and uncover.  Or a company acquisition that blocks customer repairs and refunds; an offer to reduce a loan rate has been retired, but thousands of customers are still eligible under its terms—and the new service reps don’t know it even existed.  Most typically, the company’s own needs, rules, and liabilities are driving the negotiation, but the service reps are talking as if they have a “customer-first” ethic, confusing every interaction.  The credit card company, the health insurance company, the hospital, the doctor, the physician practice group, and Medicare each have different policies and practices, and they are not in alignment, creating chaos for the patient and family.  No one has an aerial view of the overall gridlock—the EPIC program failures are still on a roll as of this month. 

Finding solutions requires relocating the problem connection between the customer’s problem and the company’s problem.  It takes a wider vista to find the missing piece or pattern. 

Taken to a panoramic scale, in a recent Fortune issue ((Aug/Sept 2020), editor Clifton Leaf writes about the value of cross-cultural commerce in itself. Cross-border trade now is nearly two-thirds of world economic output; long before this, it made America the first world superpower. This emerging world is opening new markets for ideas as the key attribute of the Global 500, the planet’s top firms.  “You get to dip into an entire new world of knowledge and innovation activity that has been closed to you before,” says Fabian Trottner, economist at UC San Diego who explores the export / innovation connection.  This wider horizon can yield unsuspected swans in the form of new information leading to new frames of reference.  Just what is called for to solve intractable problems ranging from consumer issues to international crises. 

___

*The Black Swan: The Impact of the Highly Improbable (NY: Random House, 2007) by Nassim Nicholas Taleb is the popular source for this concept.