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16 Rules for Effective Decision-Making

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https://www.leadershipnow.com/leadingblog/2019/04/16_rules_for_effective_decisio.html

16 Rules for Effective Decision-Making

WHERE WE GO in life is determined by the choices we make. How we make those decisions becomes critical. The speed of change, the abundance of choices, the unknown unknowns, and the impact of a connected world, all conspire to make decision-making a labyrinth. We face traps everywhere.

In Labyrinth: The Art of Decision-Making, Pawel Motyl examines “The most prevalent weak spots in decision-making processes, not only in business but in life in general; during crisis and calmer times; in both individual and group decisions.” 

I agree with Motyl that “We really do live in a world where everything is out of whack and everything we thought we knew is being called into question.” It calls for a deeper look at not just what we think, but more importantly how we think and a clear understanding of how we got there.

Motyl digs into the series of decisions that led to some of the modern world’s most dramatic events: from the Cuban missile crisis to the 1996 Mount Everest climbing disaster; from the Apollo 13 rescue mission to the ill-fated Daimler–Chrysler merger.

Using many and varied examples Motyl reveals 16 rules for effective decision-making. The rules with the accompanying narrative are well-researched and intriguing. Here is the overview: 

Rule #1
Prepare for a black swan (an unpleasant surprise or event that we cannot predict from prior experience), because one thing is certain: sooner or later you will meet one. Because of easy access to information and globalization, black swan events are on the rise.

Rule #2
The better it’s going, and the more successful you are, the more you are at risk of turkey syndrome. The deeper you fall into turkey syndrome, the nastier your black swan will be.

Rule #3
The more you admire someone, the more critically you should examine their opinions. The more exciting somebody’s vision seems, the more closely you should test its foundations in reality. This fundamental misunderstanding comes into play here: “a harmonious group = a tight group = an effective group”

Rule #4
The more everyone around insists something is impossible, the more you should check it yourself. Several times.

Rule #5
The greater the investment of time, effort, money, and our own reputation, the harder it is to objectively assess a situation and make the right decision. 

Rule #6
If you find yourself in a black swan situation, go into inquiry mode. Whatever your intuition or experience is telling you may be wrong. 

Rule #7
Set up your own Executive Committee. Surround yourself with people who don’t think like you. Value those who disagree with you, and who aren’t afraid to say it.

Rule #8
When improving and organization, also pay attention to the best and most efficient processes. In a black swan situation, they can fail. Do you have a backup plan?

Rule #9
Shoot down Concordes and hunt for monkey habits. Eliminating loss-making projects and bad practices frees up time for other things, increasing a company’s agility and flexibility.

Rule #10
Recognize the value of your failures (and those of others). Thoroughly analyze your past failures and draw in depth, objective, and actionable conclusions for the failure.

Rule #11
Never stop shaping the organizational culture. It can be your greatest ally, or your worst enemy, in making the right decisions.

Rule #12
Great leaders are distinguished by their awareness that greatness is no guarantee of infallibility.

Rule #13
Don’t be a “decision drunk”—use data for illumination, not only for support. Data can be a great ally, when properly analyzed.

Rule #14
Never ignore the values and convictions of other generations, especially those only just entering the market. Even if their influence on decision-making today is minimal, the new normal means this may change sooner than you expect.

Rule #15
The world of data overload is also a word of new possibilities. Actively seek out opportunities to engage a cost-free force that can radically improve the quality of your decision-making.

Rule #16
Encourage and create leaders around you. Dispersed leadership involves many people, which means there is less risk of a single person making a poor strategic choice.

 

 

 

When the cycle turns: Healthcare Subsectors Ranked by Vulnerability to Economic Downturn

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https://www.capitaliq.com/CIQDotNet/CreditResearch/RenderArticle.aspx?articleId=2223124&SctArtId=470487&from=CM&nsl_code=LIME&sourceObjectId=10964199&sourceRevId=6&fee_ind=N&exp_date=20290429-17:15:44

 

https://www.spglobal.com/marketintelligence/en/news-insights/trending/klmhcli3tn4os6wkclht0a2

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S&P: Hospitals vulnerable to recession as healthcare sector stays defensive

The healthcare sector remains defensive but has become increasingly vulnerable to an economic downturn because of deteriorating ratings, comparatively higher leverage and greater industry disruption, analysts at S&P Global Ratings said in a new report.

Healthcare companies’ issuer credit ratings are becoming more vulnerable to a cyclical downturn in comparison to prior recessions, according to the rating agency, which also said that proposals from the U.S. government are threatening the sector’s creditworthiness.

Credit quality has fallen considerably since the last recession in the healthcare sector — where products and services continue to show a largely inelastic demand — with 66% of healthcare companies carrying B ratings, according to the April 29 analysis.

Ratings estimates that about 20% of for-profit healthcare companies have investment-grade issuer credit ratings, in comparison to 54% in 2005. The rating agency believes this transition shows an increase in smaller and mainly private equity-owned healthcare issuers.

Hospitals among subsectors most vulnerable to economic slowdown

The subsectors most vulnerable to an economic downturn are hospitals, healthcare service providers and hospital staffing services, based on leverage metrics and relatively higher disruption in comparison to other subsectors, the rating agency added.

Ratings analysts said companies like Tenet Healthcare Corp., Prospect Medical Holdings Inc. and HCA Healthcare Inc. would be affected by a potential rise in uncompensated care — with patients opting for lower cost options — since insurance coverage tends to decline as unemployment rates increase during a recession. In addition, healthcare companies such as Acadia Healthcare Co. Inc. and WP CityMD Bidco LLC would be highly exposed to reimbursement rates based on Medicaid and Medicare plans.

The healthcare segment at highest risk in an economic downturn is temporary nurse staffing, which is highly sensitive to cyclicality, more so than part-time physician staffing and full-time employment.

Pharmacy benefit managers, often called the drug middlemen or PBMs, such as CVS Health Corp. and Aetna Health Holdings LLC, which are responsible for negotiating drug prices between drug companies and insurers are also at risk of exposure to a downturn.

The Trump administration wants to end the safe harbor protections, which permit PBMs to collect rebates, by Jan. 1, 2020, and move the U.S. to a fixed-fee discount model.

Ratings analysts believe healthcare companies with a portfolio of research and development, medical devices, pharmaceuticals and biologics manufacturing will be more insulated and can expect steady demand during a recession, which will help achieve astrong revenue base.

Companies like Pfizer Inc., Amgen Inc. and Teva Pharmaceutical Industries Ltd. may be at the receiving end of a slight shift in the sector, which will see customers increasingly preferring lower-cost generic and biosimilar alternatives. In addition, increased usage of high-deductible insurance plans will bolster switches to lower-cost options.

Life sciences companies like Danaher Corp., Thermo Fisher Scientific Inc. and PerkinElmer Inc. mostly see repeat sales of their products, and since there is an increase in the use of diagnostic tests, the life sciences subsector would be more resilient in an economic downturn.

Medical devices companies Baxter International Inc., Abbott Laboratories, Becton Dickinson and Co. and Hologic Inc. should expect consistent demand though there is some exposure to patient and hospital admission volumes.

However, Ratings analysts believe the medical devices subsector “does not have a large target on its back, in terms of cost control, versus the pharmaceutical industry.”

Given the mostly inelastic demand in the healthcare sector, McKesson Corp., Cardinal Health Inc., Owens & Minor Inc. and other such companies in the drugs and medical products’ distribution segment will be largely insulated from the economic downturn, Ratings analysts added.

 

 

 

 

Health Insurance Enrollment Trends for Year-End 2018

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https://www.markfarrah.com/mfa-briefs/health-insurance-enrollment-trends-for-year-end-2018/

Mark Farrah Associates (MFA) assessed the latest year-over-year enrollment trends, comparing fourth quarter 2017 with fourth quarter 2018 segment membership based on data filed in statutory financial reports from the NAIC (National Association of Insurance Commissioners) and the CA DMHC (California Department of Managed Health Care).  As of December 31, 2018, almost 265.2 million people received medical coverage from U.S. health insurers.  This number is down from 265.6 million, or approximately 428,000 members, from a year ago. Year-end enrollment trends indicate membership gains for Medicare Advantage (MA) and Employer Group administrative services only (ASO) business while the managed Medicaid market, Individual, and Employer Group Risk segments experienced year-over-year declines.

Segment by Segment Enrollment Trends

As of December 31, 2018, the Individual segment lost over 1.0 million members year-over-year (YOY) and the Employer Group Risk segment, including Federal Employees Health Benefit Plans (FEHBP) business, experienced a decline of approximately 897,000 members. The Employer Group ASO segment persisted as the largest source of coverage in the industry, enrolling nearly 121.6 million people. Medicare Advantage experienced moderate growth in membership as over 736,000 more seniors chose an MA plan YOY.  Managed Medicaid saw a slight decrease YOY, by more than 36,000 members.  A more in-depth look at each segment follows.

  • The Individual segment experienced a significant decline of 6.7% from 15.5 million in December 2017 to 14.5 million in December 2018. Some factors that have led to a decrease in the individual market include increased costs for providers, increased premiums for members, and the repeal of the Affordable Care Act’s (ACAs) individual mandate.
  • Managed Medicaid membership marginally declined by 0.1%, or approximately 36,000 enrollees between December 31, 2017 and December 31, 2018.  Despite the decline in membership, Medicaid continues to be the largest government-sponsored health program in the United States, measured by enrollment.
  • Medicare Advantage (MA) enrollment increased from 20.7 million as of December 31, 2017 to 21.4 million at year-end 2018 according to plan-reported statutory reports. The MA segment remained the segment leader in terms of percentage increases – consistently growing YOY.

 

 

  • Employer Group Risk membership, including Federal Employees Health Benefit Plans (FEHBP) membership, experienced a 1.5% decline between 4Q17 and 4Q18. This equates to a segment decrease of over 897,000 as more employers continue to shift towards self-funded (ASO) insurance for their employees.
  • Employer group ASO (administrative services only for self-funded business) membership grew by over 814,000 members from December 2017 to December 2018.  YOY, the increase was 0.7%, nearly offsetting the decrease in the Employer Group Risk decline at a one-to-one ratio.  MFA identified 121.6 million ASO covered lives, which encompassed 46% of total health enrollment by segment for 4Q18.

Conclusion

As of December 31, 2018, almost 265.2 million people received medical coverage from U.S. health insurers, down approximately 428,000 members from a year ago. Year-end enrollment trends indicate membership declines for a majority of the health care segments. Health care will continue to be subjected to regulatory and political pressure as the upcoming presidential election approaches.

The Individual market continues to be the most volatile health care segment. Repealing the ACA remains a controversial topic that is gaining steam as 2020 swiftly approaches. While there has yet to be a popular front runner in terms of a conservative replacement plan, Medicare for All is a progressive replacement plan that aims for public sector health insurance.  In addition, managed Medicaid has expanded under the ACA but recently work requirements have gained popularity. Managed Medicaid work requirement waivers have already been approved or are currently pending in 15 states. Currently, 37 states including the District of Columbia have chosen to expand their Medicaid programs. Although Montana is counted in the 37 expanded states, a bill is currently being discussed that would extend the current expansion cutoff date past June 30, 2019.

 

About the Data

The data used in this analysis brief was obtained from Mark Farrah Associates’ Health Coverage Portal™ database. It is important to note that MFA estimated fourth quarter 2018 enrollment for a small number of health plans that are required to report quarterly enrollment but hadn’t yet filed.  Employer group ASO figures may be estimated by Mark Farrah Associates using credible company and industry resources.  Individual, Non-Group membership reported by some carriers may include CHIP (Children’s Health Insurance Program).

These adjustments may have resulted in moderate understatement or overstatement of enrollment changes by segment. Findings reflect enrollment reported by carriers with business in the U.S. and U.S. territories.  Data sources include NAIC (National Association of Insurance Commissioners) and the CA DMHC (California Department of Managed Health Care).  As always, MFA will continue to report on important plan performance and competitive shifts across all segments.

 

About Mark Farrah Associates (MFA)

Mark Farrah Associates (MFA) is a leading data aggregator and publisher providing health plan market data and analysis tools for the healthcare industry.  Our product portfolio includes Health Coverage Portal™, County Health Coverage™, Medicare Business Online™, Medicare Benefits Analyzer™, and Health Plans USA™.  For more information about these products, refer to the informational videos and brochures available under the Our Products section of the website or call 724-338-4100.

Healthcare Business Strategy is a FREE monthly brief that presents analysis of important issues and developments affecting healthcare business today.  If you would like to be added to our email distribution list, please submit your email to the “Subscribe to MFA Briefs” section at the bottom of this page. 

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Medicine is a Team Sport

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https://www.linkedin.com/pulse/four-ways-show-appreciation-your-employees-regardless-cynthia-ring/

Four Ways to Show Appreciation to your Employees Regardless of Company Size

Several years ago, I was touched to receive a Patriot’s football signed by all my staff. I was working in healthcare at the time, myself and the CEO had a saying, “Medicine is a Team Sport”. The football, with the signatures and that saying written across it, symbolized the work we had been doing within our culture. It represented everyone on the team having an equal voice in the quality and delivery of care to our patients. It even represented my love for football. Receiving that very personal gift, was one of the moments I felt most appreciated in the workplace.

To me, employee appreciation means to feel valued for the contributions I make and bring to the success of the company’s mission and business objectives. I want to feel like I matter, like what I do and bring in the way of intellect and ideas matter, I am heard, respected, seen and have a sense of belonging.

Employee appreciation doesn’t need to require a huge budget or even a ton of time. Here are my top ways to show appreciation to your employees regardless of company size.

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Say Thank You – Really, Just Say It

The national research as well as our own, with our workforce, reinforces that a simple thank you is still the most important way and what most employees are hoping for in the way of feeling appreciated. A thank you can be delivered in person, a written note sent home, a public thank you during a department meeting, a word art email thank you, or even a simple text or phone call. Don’t overlook this often underestimated form of appreciation in the office.

Make Fun Mandatory

At Harvard Pilgrim, we like to show our appreciation to our employees in a variety of fun ways. Some examples include scavenger hunts, on-site bowling, on-site golf tournaments, cornhole tournaments, ice cream socials, chair massages, and even manicures. In addition, we have employee resource groups that host a variety of business and social events throughout the year like Chinese New Year parties and service projects. The events celebrate who we are as a collective people and show appreciation for what each of us bring to the mission of our organization. Plus, it strengthens bonds within teams and encourages people to make new connections.

Give Experiences

If you are going to provide something in the way of cash or gift cards, try and make them experiential. Pay for part of someone’s landscaping project so that every time they are outside with their family in the yard, they are reminded of the company while they are enjoying their new space. Work with a farmer’s market to gift an employee with an experience of someone coming to their home and doing a farm to table meal, or a gift card to a farm-to-table experience for themselves and nine of their friends. If your appreciation is going to be cash-based only, it will not create a sustainable culture of appreciation.

Make Holidays Worth Celebrating

Outline a communications plan that spans the calendar year and notes Employee Appreciation Day, professional appreciation days, holidays as well as days special to your organization and the communities your organization serves.

Consider, giving each employee their birthday off with pay or a half day so that they can spend it doing something for themselves or institute a small budget by department so that a monthly celebration can take place for everyone who celebrated a work anniversary or birthday during that month. Encourage employees to make it personal by sharing a story of their 5 years with the company or what they most like to do to celebrate their birthday while not at work.

Too many people still think that appreciation involves money and that if you don’t have a spot bonus program you can’t appreciate your staff adequately. Appreciation is not about rewards. Appreciation evokes a feeling or response to being valued for who you are and your contribution.

People naturally want to do well, to do their best, to make a difference and to help others. If we create an environment where we are visibly celebrating what people do, how they do it and what it does for the company, the customer or the community, we will inspire them to continue to do what comes naturally; i.e., their best. Like Maya Angelo once said, “People will forget what you said, People will forget what you did, but they will never forget the way you made them feel”.