Thursday, August 31, 2017

Rock Health’s Survey on Streamlining Enterprise Sales in Digital Health - Part 1

Anyone who’s been involved with ideating, defining, creating, selling or implementing software products and services for any length of time knows that selling to health plans, health systems and other healthcare enterprises is a ‘tough game across the board.” The sales cycle is long, you have to deal with the oft times quasi-governmental structure of a large, corporate enterprise and you have to be able to think on your feet and pivot quickly.

Digital Health Entrepreneurs and Healthcare Enterprise Executives

Early last week, Rock Health – an organization that exists to fund and support entrepreneurs working at the intersection of healthcare and technology – released a summary of results from a survey they conducted titled Streamlining Enterprise Sales in Digital Health. 80+ digital health founders and enterprise healthcare leaders responded to the survey, providing their perspective on three key questions aimed at better understanding successful B2B business practices in digital health:
  1. What type of relationship do enterprise customers want with startups—and how should startups approach potential customers?
  2. What are pilots for—and are they being used correctly?
  3. Healthcare sales cycles are long. How can startups get their pitches to the right enterprise buyers quickly?
This blog post is the first part of a two-part curated summary of responses to the three questions posed by the survey. 

Much of the content in this post is taken from this post on the Rock Health website. I'm merely presenting it in a format and order in which I believe may help many readers absorb the material.

Relationship Between Enterprise Customers and Entrepreneurs

Enterprise buyers noted that startups who pitch them often fail to realize that digital health startups exist in a potentially crowded space.

Enterprise buyers want—and expect—startups to demonstrate differentiated offerings from the customer’s perspective; to craft their pitch and “tune out the noise of what’s not relevant [to their unique value proposition] and align [the enterprise customer to] what your priorities are.”

Experience with Pilots

The survey reports that almost 70% of enterprise pilots converted to paying customers. Key considerations noted include:

69% of pilots had an active user within six months of the “handshake.” i.e. the time period from closing the deal to their first active user in the pilot.

Another 20% of pilots took between seven months and one year to engage their first user after the deal was made.

After a first, essential pilot that’s often needed to get an offering off the ground, startups must be sure to strategically time-box the pilot pitch process for subsequent pilots; or risk wasting a lot of time and lost opportunity.

Pilots Can Be Distracting

The pursuit of pilots can dilute a startups efforts. If you’re going to do pilots, don’t do more than one or two and make sure they convert into cash. Otherwise, pitching a pilot versus a sale is just diluting your efforts.

Startups should consider pricing pilots higher than the cost of a standard customer license. This can help to create aligned incentives.

Better to focus on deeper engagements with potential partners than spreading yourself thin.

It Won’t Go as Fast as You Think

It takes at least 18 months to contract with a health plan:
  • 6 months generating interest or a pilot
  • couple months to find an executive sponsor/business owner to push it through
  • 6 to 8 months for a technical security assessment
  • 4 to 6 months for contracting.
Even when a startup launches and has a contract with an enterprise customer, it doesn’t mean their enterprise pilot customer will be ready to implement—it could just mean the startup is a queue.

Build it Before They Come?

Avoid being tempted to oversell your product before it’s fully ready to go. Or maybe not?

39% of CEOs in the Rock Health survey approached customers for a pilot before their minimum viable product (MVP) was ready.

Enterprise customers want something that solves their pain points and scales fast. A lot of startups aren’t ready for rapid growth even if the pilot goes well.

How Startups Can Pitch to the Right Enterprise Buyers Quickly

Know that sales cycles are long, requiring patience and a knack for relationship building. Finding the right buyer in a big organization can be disorienting.

Crafting the pitch is tricky when talking to a complex, multi-faceted enterprise customer.

Knowing your competition is important but knowing “who your competitors are targeting” is not generally a factor in closing deals. Startups should assume enterprise customers know the competitive landscape (even if they don’t let on!).

Know your customer is more important: Several enterprise buyers felt that startups approach them with insufficient knowledge about their priorities, challenges, or knowledge of their organization’s role.

Make It Personal and All About the Enterprise

Every customer wants to feel unique; no one wants a “one size fits all” pitch. Differentiating your offering among competitors will strengthen the credibility of your product and sales pitch.

Entrepreneurs need to make their customer feel special by personalizing their pitch. The key to personalizing an approach is learning about the customer. An easy way to understand the basics of your customer include:
  1. Prioritize well-researched quality interactions over quantity.
  2. Read the most recent SEC filings – annual reports - and familiarize themselves with the customer’s product portfolio.
  3. Carefully review the LinkedIn profile for every customer on the sales call.
  4. Consider involving the enterprise customer as a co-developer so long as they have the right approach—and are the right partner.

More Coming Soon

The 2nd blog post will summarize the remaining information resulted from the Rock Health survey. Again, you can read the entire survey here. I'm merely presenting the results of the Rock Health survey in an alternate format that may or may not help you appreciate its value.

For more information on developing a relationship with healthcare enterprises, see this post I wrote “Developing Relationships with Corporate Enterprises: Questions, Considerations & Approaches for Entrepreneurs”

For more on digital healthcare, check out my blog at and consider following me on Twitter where I share as @ShimCode.

Thursday, July 20, 2017

More on the Value of a Worthwhile #HIT100 Nominee

Today’s HIStalk newsletter included a short piece from one of their often anonymous contributors -‘Expanding Paunch’ - who called into question the ‘worthiness’ of those who’ll be ranked among the #HIT100

[For those not familiar with what #HIT100 is all about, here's some info on this year's event.]

Scoring a #HIT100 Nominee - The Expanding Paunch Scale

From Expanding Paunch: 

“Re: HIT100. I’d like to see the winners scored on real-life experience and accomplishments instead of chronic Twitterhea.” I spent way too much time thinking about this idea, coming up with a scoring methodology that reflects what I look for in assessing someone’s accomplishments in deciding whether they are therefore qualified to render healthcare-related opinions. Here’s my first pass – score yourself and your peers and tell me which criteria you would change. I’ll grade the HIT100 once they are named, using the self-reported information (often inflated) from their LinkedIn profiles since everything should be right there. The scores I tested tracked pretty closely to my assessments of some of our industry’s more prolific pundits, ranging from 0.5 points to over 70. I was kind in deleting an additional metric that deducted points for using self-styled, questionably accurate labels such as thought leader, visionary, thinker, innovator, and entrepreneur.

Education & Work Experience - Analytical Approach
Expanding Paunch shared an interesting commentary about being worthy of the #HIT100 ranking and his/her accompanying ‘spreadsheet rating’ chart offered some good metrics for supporting for her/his position. Education and work experience are key requirements for being a good source of "HIT" information, ideas and opinions.

What does #HIT100 stand for?
To be clear, “HIT” means “Health Information Technology.” I think most people who’ve been active in health IT and social media for any length of time understand that the #HIT100 event was borne based on the idea of acknowledging one’s healthcare IT knowledge, skills, experience AND social abilities relative to the creation, curation AND dissemination of insight, ideas, opinions and occasional facts regarding healthcare information technology products, services, challenges, opportunities and issues - via social channels.

What Makes a ‘Good’ #HIT100 Nominee?
For some reason, ‘Expanding Paunch’ doesn’t appreciate the value that a solid background in information technology, a 'non-clinical' background, experience with content creation and curation, and the ability to share content across a range of social channels can have. 

I've shared my take on What Makes a Good #HIT100 Nominee and 11 Qualities of a Good #HIT100 Nominee.

Non-IT, Clinical Management Expertise Only?
‘Expanding Paunch’ apparently believes that a worthwhile health information technology social media “persona” can only be attributed to someone possessing an advanced clinical background in “management.”

Two major omissions in this ranking methodology are:

1. Penalizes those who aren't a "provider of clinical care" and/or not having a direct patient clinical care focus. 

I get the fact that ultimately it's all about the patient and providing clinical services. But the reality is that administrative, financial, communication and other 'non-clinical services' provided by people other than physicians are important parts of healthcare.

2. Doesn't include any acknowledgement of a person's social footprint.

What's an Ideal #HIT100 Nominee?
I guess a practicing physician who’s a CMIO at a vendor with some sort of 'informatics only' role is considered the ideal #HIT100 prospect? Regardless as to whether they actively share their knowledge via social channels, conferences, podcasts, etc.

How Do You Rank on the Expanding Paunch Scale?

I did a one minute calculation of my ‘#HIT100 worthiness’ based on the ‘Expanding Paunch' algorithm and I garnered about 20 points - apparently I’m not worthy. 

I'm looking forward to ‘Expanding Paunch’s’ rating of the HIT100 ‘winners.’  And I’d like to know more about how ‘Expanding Paunch’ ranks himself too.

Steve S - ShimCode

P.S. In the past, I spent a lot of time tabulating and sharing #HIT100 info and commentary when others wouldn’t or weren’t able to tabulate and/or share. This post is my contribution to this year's #HIT100 event.

Previous Blog Posts on the #HIT100

Thursday, July 6, 2017

What Makes a Good #HIT100 Nominee?

The popular 2017 #HIT100 backslapping contest started the other day on July 4th - Independence Day. 

How apropos!

All those who've lived in healthcare, information technology and social media space for any length of time in the short world of social media, must surely be chuckling about how many of those being nominated for the #HIT100 are largely devoid of any reasonable reason for their nomination.

Why Should You Be Nominated to the #HIT100?

Role & Presence

What is your role in the healthcare space and specifically healthcare IT?
What social channels do you have a presence on?
How has your social media presence grown over the past 1, 2, 4, 6, 8 years?
How many people connected to healthcare and IT ‘follow’ you on your various social channels?

What Value Do You Regularly Provide to Others?

How often do you include URLs and other 3rd party information in your tweets?
How often do people engage & reach out to you on your social channels?
How often do you respond to those who comment on/reach out to you on your social channels? Always? Often? Never? No one reaches out to you?
How often do you post?


How many times have you been interviewed? On podcasts? Print media? Otherwise?
How often do people comment on your blog posts?
How often do you comment on other’s blog posts?
How often are you quoted in trade magazines and periodicals?
How often have you presented at healthcare IT-related conferences?

Personal Investment
How often do you attend healthcare IT-related conferences? And what is your role at those conferences?
How do you directly support healthcare IT-related associations and non-profit organizations?
Have you ever been a Social Media Ambassador at a major healthcare IT conference? Which ones?

Who Wants to Hear from You?
How many associations, non-profits, and others not selling a for-profit product have you supported? How?
How many times have you hosted tweetchat?

Is It All About You?

How much of your ‘Social Presence’ is self-promotion versus sharing information, ideas and opinions with others? 

This is What it Is!

I hope these somewhat pointed questions don't get you too mad at me. If so, please call me out and share your perspective. 

Friday, June 2, 2017

ZDoggMD at the 14th Annual World Healthcare Congress - That's Two G's!

14th annual world healthcare congress whcc health care change
The 14th Annual World Healthcare Congress took place on April 30th through May 3rd in Washington, D.C. Mabel Jong (aka @MabelJong on Twitter) authored a number of interviews during the event – a total of 69 interviews based on my count of videos in the World Healthcare Congress YouTube channel! Wow!

One interview in particular caught my attention. 

This post is a transcript of that attention grabbing interview with Dr. Zubin Damania – aka @ZDoggMD on Twitter. Just so you know, that’s two “G’s” in ZDoggMD since everyone knows one "G" is necessary but not sufficient to be a gangster!

The Transcript!

Mabel: We're back! You're watching continuing coverage of the World Healthcare Congress here in Washington DC. Thanks so much for joining us and a special welcome to those of you who are joining us virtually. Now we're going to have some fun here. We have a very special guest in our studio: Dr. Zubin Damania who has the title of Rapping Doctor. I'm really curious, so strap in. So, Zubin, you're a doctor?

ZDoggMD: Yeah and I've never been given the title of Rapping Doctor except by you so this is first and I'm gonna take it.

Mabel: Okay.

ZDoggMD: I'm gonna roll with it. You know, the basic story is, I'm a physician. I'm an internist. A hospitalist. I worked at Stanford for ten years in a pseudo academic practice; hated everything about our system and the way that the system works: 
It crushes creativity innovation. It is a Greek, hierarchical kiss the ring, suck up to authority for your entire career and then one day you'll be the ring that's kissed. 
And that is the mentality of medicine. So, we get the system that comes out of that; which is a big steaming piece of crap. 

So, as a result I got very burned out. I had a midlife crisis early at 35 and started as a cry for help putting out videos on YouTube under a pseudonym ZDoggMD with two G’s because one is necessary but not sufficient to be a gangster; just so you know. 

Mabel Jong Interviews Dr. Zubin 'ZDoggMD' Damania

And (pointing at Mabel) it's funny to see how uncomfortable she is! I love it! I love it! Fight the power!

Mabel: I'm on my own show, I'm really chill.

ZDoggMD: So… in the setting of that, I started putting these videos out on YouTube and everything from Manhood in The Mirror, which was a parity of Michael Jackson's Man in The Mirror where I grabbed my testicles repeatedly [and] encouraged testicular self-examine in boys. 

And what I started finding is people from [unintelligible] were playing this video on repeat in the waiting room. Kids were getting it stuck in their head and we're going home and doing the self-exam. And one of them caught an early testicular cancer.

by reaching out to patients where they are, by being human, by not playing all the usual stodgy games that medical people play, we were able to actually make a difference 
and so, as the video started to grow, I was given an opportunity with Tony Hsieh - the Zappos online shoe store. He said: 

Quit your job at Stanford. Move your wife and your two kids to the heart of downtown Las Vegas where I'll give you a little startup money. And you have to try to see what you can do in your own way to make healthcare better because you're really good at complaining about it in your videos but you haven't done anything. You're still working the job that you think is broken where it's a hamster wheel and patients were coming in and out.”

So, after agonizing over that - because I had a nice job – okay? And the shirt with the alligator on it and all of that. We decided to go for it and we built a clinic called Turntable Health which is a new model primary care clinic that is a one fee, sort of, All You Can Treat Buffet of Care with a team. So, health coaches, nurses, licensed clinical social workers, doctors - all working together in service of the patient. But also in service of each other because that's the piece that's missing.

Not that: We don't support each other. We're incredibly hierarchical. When something goes wrong we all point the finger.” 

So, we said: “What if we changed all of that and we support each other with compassion so that we could support the patients?” 

And the idea is to keep them out of trouble. See them when they're well. As well as when they're sick. Get rid of the transaction component of health care so they don't pay co-pays. It's one flat fee that either they pay $80 a month or their insurer pays. And our biggest clients were insurers like Nevada Health Co-op, Culinary Workers Union

They said: “Look. We believe in a model of prevention. We're going to fund it and in return you're going to show us actual outcomes.

Mabel: Okay, yeah. How would this be scalable to other places that have those broken systems? What does it take? The component?

ZDoggMD: What we figured out is that you have to do it in a local way because all healthcare is local. So, if you try to do a direct primary care concierge light model in a downtown Las Vegas setting it's going to fail. It has to be integrated with say Medicaid. You have to do a pilot program with CMS. You can work with Medicare Advantage. But the principles are what we call health 3.0. 

So, it's basically this idea that you take the relationship of the old days of health care, which is Health 1.0 out, but it was very paternalistic, equalize it. Make it apart with your patient because the patients are empowered too. And you hold them accountable. 

You say: “You know what? You have to release this victimhood of illness and let me be the shepherd; but you're in charge.” Right? So that's one step. The second step is Health 2.0 where we're living now: ‘Click, click, click, click, click boxes in an EHR; wearables that nobody wears; quality measures that don't measure quality; carrots and sticks that incentivize the wrong behavior; all those things you have to transcend. 

You say yes, the technology is important but it has to enable the human relationship and what emerges is this [Health] 3.0 vision.

And it's very simple. It's just a vision that you can fulfill locally by saying: 
Ok. We're going to work in teams. We're going to focus on prevention. And we're going to get paid based on actual outcomes that matter to our patients; which means it needs to be physician and clinician lead but empowered by administrators and business people and government officials working together for the common cause: which is improve outcomes on a population and an individual level.”
Mabel: Okay. Yeah.

ZDoggMD: So, you can be evidence empowered. You can have all this evidence-based medicine but you can't be evidence enslaved. I can't go: “Well Mabel, I have to do a mammogram because the government says that if I don't click the mammogram box I won't get my 99213 code.” 

I have to go: “Let's talk about your concerns around breast cancer. What's your family history? Are you worried about a false positive where we might have to do a biopsy? If that worries you then see us more often and we'll stay connected. Rather than just reflexively ordering a test.

Mabel: Are you still in Las Vegas now?

ZDoggMD: Yeah, we're still in Las Vegas. We closed our downtown clinic but our partners IORA Health took [unintelligible – sounds like “took the commander fillet”] Yes, a fantastic human being, he took that model and now he's expanding in multiple states. So, what happened in Vegas doesn't stay in Vegas. 

So, what I've shifted to doing is a Facebook Live show that we do every single day. It's called Incident Report and it reaches anywhere from fifty to a hundred thousand viewers in episode. And we talk about how to build health 3.0. Taking the news of the day and parsing it through the engine of how do we make health care better.

Mabel: How are your viewers being impacted by what's going on in Washington?

ZDoggMD: You know, I would say that there's a lot of discussion about what is Trump going to do? What are the Democrats going to do? The Affordable Care Act. And we've had show’s about exactly this. The punchline is: It really doesn't matter because health care is a trans partisan issue.

If we all say: “You know, what we want - it's like what Jimmy Kimmel Live said yesterday in such an emotional way about his childhood [unintelligible – sounds like ‘had attention all gleeful oh yeah]"

And he said: “You know what, it was about everybody coming together in a team to take care of my son. And if I were uninsured, he might have died in the old days.

And with pre-existing, it's really about the tribe that we built on Facebook that says: No, it's bigger than politics. It's about human beings. And if we can figure out a way to [unintelligible] local versions to build that and they're suffering. Like these health care providers around the country are suffering, they feel commoditized. They feel like they're working in every line unappreciated. So, we're trying to give them focus.

Mabel: Okay. Yeah. Are you going to do any rapping?

ZDoggMD: Today? Yeah. Oh, it wouldn't be a wouldn't be a ZDogg show if we didn't. We're gonna do a piece on end of life. An outpatient medicine piece. A piece on the calling that is healthcare.

Mabel: Can you give me a little sample? Just a preview?

ZDoggMD: Sure. So Ain't The Way to Die was an Eminem Rihanna song [unintelligible] about how we don't have a conversation about end of life. 

Ain't The Way to Die was an Eminem Rihanna song zdoggmd healthcare shimcode

And it's told in two stages: one is the stage of the patient's perspective stuck in a bed on a ventilator unable to speak. So, it's just a spirit figure that's rapping and then the second phase is told from the point of view of the physician who feels like he's violating his oath to do no harm by torturing this patient because they never had the discussion before the patient was unable to talk. So, the patient comes out he's like:
<rapping>I can't tell you what I really want. You can only guess what it feels like. And right now, it's a steel knife in my windpipe. I can't breathe but you still fight because you can't fight long as the wrongs done right protocols tight. How the drugs. Try to sedate you like a pin cushion. I hate it. The more I suffer I suffocate. Right before I’m about to die you resuscitate me. You think you saved me and I hate it. Wait!</rapping>
So, it's something like that. There's a chorus and all that. Yeah. It'll be fun.

Mabel: You're going to be a hard act to follow Zubin.

ZDoggMD: I don't know. I mean you guys are actually, you know, dropping mad science. I'm a professional clown as my dad says.

Mabel: All right. Well look forward to more when we see you up on stage. Thank you so much.

 Thank you.

Mabel: And thank you for watching. That's why you need to stay tuned. I'm Mabel Jong 

And That's That!

Dr. Zubin Damania, uh, I mean ZDoggMD, will be sharing his unique insight into healthcare at next weeks 2017 AHIP Institute in Austin, TX. If you're attending, be sure to check him out on June 8th at 5:00pm.  And perhaps consider following him on Twitter where he shares as @ZDoggMD.  And perhaps me too where I share as @ShimCode.

Thursday, May 18, 2017

Vendors & Organizations I'm Looking Forward to Meeting at the 2017 AHIP Institute

The 2017 AHIP Institute takes place at the Austin Convention Center June 7th through the 9th. This is the 3rd AHIP Institute in a row I've been privileged to attend.

What Exhibitors Look Interesting to Me?

With all major conferences I attend, I like to share a bit of information about who and what I'm looking forward to 'seeing' and learning about - exhibitors, sessions and people.

The purpose of this blog post is to share my short list of 'must see' organizations at the AHIP Institute along with a short description as to why each organization is of interest to me.

In a future blog I'll share a list of sessions I'm looking forward to attending and why.

2017 AHIP Institute Exhibitors

Long-time Health IT Firm

Availity (1027) - @Availity -
A long-time, nuts and bolts healthcare administrative & financial transactions firm evolving into a clinical data integration outfit. Availity has established connections with many providers, patients and payers. Their ability to reach into payer and provider platforms is quite valuable.

Leveraging Social Determinants of Health

Healthify (522) - @healthifyus -
Company focusing on the importance of addressing social determinants of health. Healthify has a platform to capture and manage social determinants of health for vulnerable populations.

WellTok (807) - @WellTok -
Generates and maintains consumer & patient-specific information and connects same with available and relevant benefits, resources and rewards via personalized action plans. This outfit was founded by Jeff Margolis, a person I consider a true healthcare visionary.

Value-Based Care & Reimbursement

Let's face it. Value-based care is here to stay regardless as to what happens with the ACA. I'll venture to say that EVERY exhibitor at the AHIP Institute will have some angle on value-based care and reimbursement. These are the ones I want to learn more about.

Aver Informatics (1236) - @avercloud -
New firm helping healthcare payers and providers design, implement, and administer value-based programs.

CIOX Health (418) - @cioxhealth -
A seemingly boring, non-sexy ‘document retrieval’ firm well-positioned to benefit from value-based care and quality measurement movements. CIOX is a recent mashup of a few companies. I'm interested to learn more about the synergies they've achieved.

A company focused on leveraging quality measures and analytics for value-based care and reimbursement

Long time actuarial, risk management, clinical documentation and coding company providing the healthcare data aggregation and analysis needed for value-based programs. 

Zipari (1309) - @Ziparico
One of only a few firms providing health insurance-specific customer relationship management (CRM) platform. Zipari recently received a large investment. I think they'll be fighting or acquired by Salesforce. My opinion.

Connectors & Collaborators

CAQH (1318) - @CAQH -
Unique non-profit organization that supports healthcare transformation via collaborative and innovative programs and services. This outfit seem very open and 'giving.'

Healthcare Executive Group (321) - @HCExecgroup -
A group of mid-market healthcare executives organized to share information and advance healthcare innovation . I'll be in attendance at this booth and welcome the opportunity to share more about the Healthcare Executive Group.

Of Special Interest to Me

MarkLogic (1118) - @MarkLogic -
A developer of an enterprise NoSQL database platform I believe is positioned for a prominent role in the digital transformation of healthcare. I want to learn more about handling semi-structured and un-structured social determinants of health data.

Nitor Infotech (1039) - @nitorinfotech -

A software product engineering firm focused on assisting payers, providers and others with ‘productizing’ existing capabilities into marketable and supported COTS products. There is a lot of latent value in the legacy software and process many healthcare firms possess.

Citra (421) - @citrahealth - 
This is a company that sells the EZ-NET product that I sold to Quadramed in 1999 and that’s apparently still in use today. I'm interested in learning about their current product portfolio.

Attendee Gathering & Respite Areas

Photo Lounge (610)
Sponsored by NTT Data. Not sure what this is so of course I want to check it out. Seems like I should bring a comb?

Attendee Lounge (525)
Sponsored by Athena Health. Apparently some area to rest and refresh?

But Wait! There's More!

For a complete list of exhibitors at the 2017 AHIP Institute, their booth number and exhibit floor location, check out this interactive map.

You can also consider following me on Twitter where I share as @ShimCode. I'll be sharing more about healthcare data, technology and services leading up to, during and after the 2017 AHIP Institute in Austin.

== == == 
Note: To be sure, there are many great exhibitors and sessions at the AHIP Institute, I'm merely sharing those exhibitors and sessions that appeal to me. If you're reading this far you may think: 'Who cares Steve?' And that's okay. I ask myself the same question sometimes. :)

My AHIP Institute History
At my initial AHIP Institute in Nashville in 2015, I was honored to be among the first group of Social Media Ambassadors (SMA's) engaged by the folks at AHIP. There weren't any SMA's at last years event in Las Vegas but they are back this year. Check out the 2017 AHIP SMA's here.

While last year's event in Las Vegas didn't include social media ambassadors, I'm pleased to see that SMA's are back at this year's AHIP Institute. I was also fortunate to meet an organization in Las Vegas with whom I'll be helping out at this year's event in Austin. I look forward to sharing information and ideas about lowering healthcare costs and improving outcomes.