As I was exploring healthcare on the web today, I saw a service I thought was interesting - a web based expert (Cleveland Clinic, aka CC) second opinion healthcare service.  I applaud CC for heading down this path, as I feel this is where healthcare needs to go, but the $565 price tag is proof that the consumer/buyers need to demand better pricing.  If I had cancer I may pay that, and perhaps that is what CC expects.  But there are somethings which I just need a quick opinion on and would like to get an expert opinion.  Perhaps CC has looked at this part of the market and chooses to leave it to the nurses and doctors at other vendors - e.g. maybe I can get the virtual second opinion at Walgreens online for $40?

Regardless, as the healthcare data and transparency waves continue to rise, we as consumers will be better positioned to educate ourselves about healthcare and make better quality and cost decisions - playing a significant role in the reform of healthcare as we know (or in some cases don’t know) it today.

Here’s the article: MyConsult: Second Medical Opinions From Doctors at The Cleveland Clinic

FYI, this topic related to a book I just finished reading by G. Halvorson (CEO Kaiser Permanente) - Health Care Reform NOW! (recommended reading).  

Today I decided to take a quick look at Google’s answer (Google Health) to M$’s HealthVault.  Upon registering for the service I was first greeted with Google’s legal conditions for using the service.  As I read them over many issues, thoughts, improvements, and questions came to mind.  I post them here for discussion purposes - that is, what do you find unique, beneficial, disturbing, confusing, etc. about what’s below?  I plan to follow up to this post with my $.02 once I schedule time to do so, but for now, consider these questions and points:

1. Google will share some of your information with its partners - see below
2. What if Google is subpoenaed for your health information?  How much control do you have over that process?
3. Since Google isn’t accountable under HIPAA law what are the implications to you?
4. How does what is below tie in with the Google Health Privacy Policy?
   1. e.g. Google will not sell, rent, or share your information (identified or de-identified) without your explicit consent, except in the limited situations described in the Google Privacy Policy, such as when Google believes it is required to do so by law.

Google Health Terms of Service

GOOGLE HEALTH TERMS OF SERVICE

Welcome to Google Health.

1. Your Agreement with Google

Your use of Google Health is governed by this agreement. “Google” means Google Inc., located at 1600 Amphitheatre Parkway, Mountain View, CA 94043, United States, and its subsidiaries or affiliates involved in providing Google Health.

2. Not Medical Advice; U.S. Use Only

Google Health does not offer medical advice. Any content accessed through Google Health is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through Google Health. Call 911 or your doctor for all medical emergencies.

You may only use Google Health if you reside in the United States.

3. Your Account and Use of Google Health

You must provide accurate and complete registration information any time you register to use Google Health. You are responsible for the security of your passwords and for any use of your account. You must immediately notify Google of any unauthorized use of your password or account by following the instructions at this link: http://www.google.com/support/accounts/bin/answer.py?answer=48601.

Your use of Google Health and any content accessed through Google Health must comply with all applicable laws, regulations and ordinances, including any laws regarding the export of data or software. You must be at least 18 years old to use Google Health.

You may not access Google Health other than by the interfaces provided by Google or interfere with or disrupt the proper operation of Google Health.

4. Use of Your Information

If you create, transmit, or display health or other information while using Google Health, you may provide only information that you own or have the right to use. When you provide your information through Google Health, you give Google a license to use and distribute it in connection with Google Health and other Google services. However, Google may only use health information you provide as permitted by the Google Health Privacy Policy, your Sharing Authorization, and applicable law. Google is not a “covered entity” under the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder (”HIPAA”). As a result, HIPAA does not apply to the transmission of health information by Google to any third party.

5. Additional Terms

Your use of Google Health and any content accessed through Google Health is subject to each of the additional terms provided in connection with Google Health, including the Google Health Privacy Policy, the Sharing Authorization, and the Google Health Legal Notices.

6. Content and Services Accessed through Google Health

Google Health may include content that you find offensive, including health-related content that is sexually explicit.

Google may make third-party services available through Google Health. In order to use a specific service, you may choose to allow the third-party service provider to retrieve, provide, and/or modify health and other information in your account or otherwise share your information with the service provider. Once you enable a specific third-party service provider to access your account, the service provider may continue to access your account until you affirmatively disable access. Third-party service providers include both health care providers and other entities. It is your sole responsibility to review and approve each such third-party service before sharing your information through or otherwise accessing it.

Google may screen, modify, refuse, or remove certain content or third-party services, but is not responsible for and does not endorse any third-party content or services. Google further does not endorse any third-party service providers, other health care providers, products, services, opinions, or web sites accessed through Google Health.

USE OF THESE SERVICES AND RELIANCE ON THIS CONTENT IS SOLELY AT YOUR OWN RISK. GOOGLE MAY NOT BE HELD LIABLE FOR ANY DAMAGES ARISING OUT OF OR RELATED TO YOUR USE OF ANY THIRD-PARTY SERVICE OR CONTENT. Providers of these third-party services and/or content are Google’s “Licensors”.

7. Google Proprietary Rights

Google and its Licensors own all proprietary rights to Google Health. Google gives you a personal, revocable, non-assignable, and non-exclusive license to use Google Health.

8. Modification and Termination of Google Health

Google may place limits on, modify, suspend or terminate Google Health generally, and may suspend or terminate your use of Google Health if you fail to comply with this agreement. This suspension or termination may delete your information, files, and other previously available content. If Google terminates Google Health or your use of Google Health, this agreement will also terminate, but Sections 3, 5, 7, 8, and 10-13 shall continue to be effective after this agreement is terminated.

9. Changes to this Agreement

Google may change this agreement and will post the modified agreement at https://www.google.com/health/html/terms.html. If you do not agree to the modified agreement, you should stop using Google Health. Your continued use of Google Health after the date the modified agreement is posted will constitute your acceptance of the modified agreement.

10. Indemnification

You will defend or settle any third-party claim against Google, any third party Google Health feature providers, or any of Google’s other licensors arising out of or related to your use of Google Health.

11. Exclusion of Warranties

NEITHER GOOGLE NOR ANY OF GOOGLE’S LICENSORS MAKE ANY EXPRESS WARRANTIES, AND EACH OF THEM DISCLAIMS ALL IMPLIED WARRANTIES, INCLUDING IMPLIED WARRANTIES OF ACCURACY, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT. NEITHER GOOGLE NOR ANY OF GOOGLE’S LICENSORS MAKE ANY WARRANTY THAT THE CONTENT IN GOOGLE HEALTH SATISFIES GOVERNMENT REGULATIONS REQUIRING DISCLOSURE IF INFORMATION ON PRESCRIPTION DRUG PRODUCTS. CONTENT IN GOOGLE HEALTH IS DEVELOPED FOR USE IN THE UNITED STATES, AND NEITHER GOOGLE NOR ANY OF GOOGLE’S LICENSORS MAKE ANY REPRESENTATION CONCERNING THE CONTENT WHEN USED IN ANY OTHER COUNTRY.

12. Limitation of Liability

NEITHER YOU NOR GOOGLE OR ANY OF ITS LICENSORS MAY BE HELD LIABLE UNDER THIS AGREEMENT FOR ANY DAMAGES OTHER THAN DIRECT DAMAGES, EVEN IF THE PARTY KNOWS OR SHOULD KNOW THAT OTHER DAMAGES ARE POSSIBLE OR THAT DIRECT DAMAGES ARE NOT A SATISFACTORY REMEDY. THE LIMITATIONS IN THIS SECTION APPLY TO YOU ONLY TO THE EXTENT THEY ARE LAWFUL IN YOUR JURISDICTION.

NEITHER YOU NOR GOOGLE OR ANY OF ITS LICENSORS MAY BE HELD LIABLE UNDER THIS AGREEMENT FOR MORE THAN $1,000.

The limitations of liability in this Section do not apply to breaches of intellectual property provisions or indemnification obligations.

13. General Legal Terms

If you have not signed a separate written agreement with Google related to Google Health, this agreement is the entire agreement between you and Google related to Google Health, replacing any prior agreements. If there is any conflict between this agreement and a signed written agreement between you and Google related to Google Health, the signed written agreement will control.

Google’s Licensors may be third party beneficiaries to this agreement. There are no other third party beneficiaries to this agreement. The parties are independent contractors, and nothing in this agreement creates an agency, partnership, or joint venture.

If Google provides you with a translation of the English language version of this agreement, the English language version of this agreement will control if there is any conflict.

Failure to enforce any provision will not constitute a waiver of that provision. If any provision is found unenforceable, it and any related provisions will be interpreted to best accomplish the unenforceable provision’s essential purpose.

This agreement is governed by California law, excluding California’s choice-of-law rules. THE EXCLUSIVE VENUE FOR ANY DISPUTE RELATING TO THIS AGREEMENT IS SANTA CLARA COUNTY, CALIFORNIA. YOU AND GOOGLE CONSENT TO THE PERSONAL JURISDICTION OF THESE COURTS. Nothing in this agreement limits either party’s ability to seek equitable relief.

April 28, 2008

Sharing authorization agreement

AUTHORIZATION

I hereby authorize Google to share the health information contained in my Google Health profile(s) in its entirety, to only those entities and individuals I designate, for the purpose of providing me with medical care and for the purpose of sharing my information with others that I choose.

I understand and agree that this authorization permits the disclosure of health or treatment information about me, to the entities and individuals I designate, that may also contain sensitive information relating to the following:

* HIV or AIDS

* Mental illness or any mental health condition

* Alcohol or substance abuse

* Sexually transmitted diseases

* Pregnancy

* Abortion or other family planning

* Genetic tests or genetic diseases

I understand and agree that this authorization also covers any record that was created by a doctor or other health care provider other than the doctor or health care provider who supplied the record to Google Health.

This authorization will remain in effect and permit the ongoing disclosure by Google of information in the Google Health Service until I delete my profile(s) in the Google Health Service entirely or revoke the authorization. I may revoke this authorization at any time by using the features or options described in the Google Health FAQ. I understand that my revocation will not apply to actions Google has already taken in reliance on my prior authorization.

I understand and agree that in addition to the information I choose to share, Google may only share information in the limited circumstances described in the Google Health Privacy Policy.

I understand that I may request a copy of this authorization at any time.

A gentleman I recently worked with today fwd’ed me this article which completely resonated with me:

Why Zappos Pays New Employees to Quit—And You Should Too - Harvard Business Online’s Bill Taylor

I think the onboarding process at Zappos is great - it gives those who have an interest a very healthy does of the company, and then weeds out those not passionate about the job.  Companies reputations are built on its leaders, but also by the troops on the ground.  Zappos recognizes this it seems and has instituted a process to ensure it has people that really want to work for it.  I’d guess that it’s a snowball effect as well - that is, the onboarding process is also a team building exercise to some extent, and I’d bet that many of the people not only like what they do, but who they work with while they do their job.  Many probably are not only colleagues, but friends.

This is a start to my detailed book review of Good to Great by Jim Collins.

Good to Great – In Review

Introduction

Below you will find my raw (caveat: not completely polished) notes about the book. The notes consists of thoughts about the book contents itself, the thoughts book spurred from within me, and questions for which most of I do not have answers to, only associated philosophies. I organized my notes by chapter with a closing note related to my overall thoughts about the book.

Overall Thoughts

Discipline is a key theme throughout the book. I agree that to be great, one must be disciplined. It is a differentiator between those who lead and those who follow. The interesting thing to me is that discipline tends to imply a high amount of work. When I think discipline two things jump into my thoughts: the military and professional athletes. Both have discipline, but I’d argue the two are quite different. One requires a driver to instill discipline in the others, while (some) the professional athletes discipline themselves – almost involuntarily. Some athletes simply have their passion become their discipline, and therefore, to be disciplined doesn’t take “work”, it becomes play, it becomes fun. These points speak to the fact that by following one’s passion, their true passion, they will be successful. It’s almost a universal law by definition: If passionate, you are disciplined, and you will succeed. If you fail, you have falsely identified your passion.

Chapter 2 – Level 5 Leadership

Page 17: I loved the quote by Harry S. Truman at the beginning of the chapter – “You can accomplish anything in life, provided that you do not mind who gets the credit.” It made me think of the type of leadership by which I like to try to live by. I stress “try” in that sometimes ego gets the best of me. It is truly a great leader who can be self-confident and humble enough to not “need the (ego) feed”. Perhaps that type of leader has an ego fed from within. Besides, the people around you, those who you work with, know you, your capabilities, and passions – there isn’t a need to advertise who has done what, it is known, or in some cases, comes to be known.

Chapter 3 – First Who… Then What

Page 42: The quote at the end of the first paragraph states: “Great vision without great people is irrelevant.” This very much aligns with my philosophy that success starts with having the right people. This became part of my philosophy after a friend, who upon graduating from business school asked for my advice on whether she should be more focused on making sure the company she joined had the right idea (i.e. one she believed would work) or that it had the right people. We debated the question for a bit, but no matter the perspective taken, it still comes down to the having the right people. Fact is, the “right” people will not only generate the right ideas, but they’ll be able to ensure they don’t stay just ideas, but are instead realized.

Page 44: What caught my attention on this page was the concept of getting “… the wrong people off the bus.” Collins states that getting the right people on the bus is “… nothing new.”- neither is getting the wrong people off the bus. The thing is that good leaders know who their best people are and who their worst people are. For example, having worked at my fair share of large healthcare insurers and their senior leadership, I have seen leadership blatantly call out their worst people, yet leave them in critical roles on which the success of the company depends. A couple points related to the “off the bus” topic: 1) at a minimum one Level 5 leader must be present for this action to possibly take place 2) even if 1) is satisfied, if a company has a very large amount of people which need to get off the bus, this process can take many months, likely even years. I’d like to hear Collins general thoughts on how, for example, a large healthcare insurer with say 50% of it’s workforce clearly not producing, would get these people off the bus without minimal shareholder and customer impact. For example, one could argue that the company’s Level 5 leaders would only need to remove the weak leaders and new strong (Level 5) leaders could then turn the other employees around. Additionally, page 53 strengthens the point that those who aren’t achieving need to be removed from the bus, in that they not only aren’t achieving success, but they impede those who are achieving. Removing the wrong people from the bus also ties into the discipline and rigor pieces Collins writes about. Something that takes a long time, will take a significant amount of discipline. To quote page 52: “ To be rigorous, not ruthless, means that the best people need not worry about their positions and can concentrate fully on their work.”

Chapter X – not done yet…

Page X: xxxx

About the Author:

Zachary has been a technology fanatic since he first laid his hands on an Apple IIe when in high school. Upon graduation from the University of Michigan Zachary went to work for Intel where he found his passion of being a liaison between business and technology people, helping both better understand one another. As the waves of the Internet swelled Zach decided to take part, leaving Intel and joining Akamai Technologies. After helping businesses better leverage the Internet at Akamai, Zachary decided to join Diamond Consultants where he helps clients better use technology to improve operations and support growth strategies. It should be noted that Zachary’s first focus is on people, as he believes that to do great things it first requires great people, as they are the creators of business and technology. To put together a great meal, one must first ensure the ingredients are of the highest quality.

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Pages Referenced:
17, 42, 44, 52-56, 58, 61, 73, 121, 128, 129, 134, 138, 141, 142, 144, 147, 148, 152, 168, 172, 176, 184, 182-184, 192, 205

I should be watching a movie.  No, I should be doing business development and writing reviews.  No, I should procrastinate and write a blog entry on the boomers and their impact on the US healthcare system in the next 20-30 years.  Will the Boomers be the main reason the US healthcare systems goes kaboom around 2020?

Recently George Churchill and I were discussing the “big three” so many in the payer space seem to be focused on - healthcare affordability, access, and quality.  He asked me what was the “next thing” after the big three.  Volume came to mind.  While the boomer generation won’t necessarily be the driver of spending increases (see Uwe Reinhardt’s WHCCE data/presentation), one can’t ignore the fact that they will still drastically increase the need in care from 2010 onward.  The US needs to figure out the expense side of the equation, but also needs to figure out the volume side of the equation - how will it care for so many in need?  My hypothesis is - similar to that how manufacturing has moved out of the US - the boomers will get their care outside the US.  This is already happening (see recent FastCompany article), and if there is a lack throughput in the US (and/or a sacrifice in quality) the savvy boomers won’t put up with it.  Many are well financed and will likely take their money and perhaps premiums elsewhere.  Sure, it’ll scare them at first.  All unknown and new things scare most people, who wants to be the guinea pig?  But like the cell phone, it’ll become the status quo eventually.