I'm working on a "low code" web app that helps developers build web apps (not marketing or blogs or e-commerce sites). Create your data models in the app and get an API, a database (or connect your own), and a Next.js app with all of the scaffolding, models, forms, validation, API calls, policies, access and authorization, etc. ready for you to use and customize.
I did some research into this for my current employer and the challenges are pretty well laid out here: the penalties are minimal ($300 / day or $~110,000 per year), the data is kept in the invoice or billing systems, which are complex, and the hospitals do not want to share the truly groundbreaking data, which is the per-provider costs.
In addition, when you Google for competitors you don't find a lot of them, but once you start looking at hospital websites you find that quite a few of them (about 50% of the ones I looked at) have at least a partial solution, often provided by their analytics company as an add-on or footnote.
It does not appear there is a great market opportunity here unless the penalties increase (which the CMS has talked about vaguely, but hospitals are already asking for relief until after the pandemic).
I worked in health care IT (insurance / provider side) during ACA's implementation.
My takeaway is that Congress is technically ignorant of how ossified these backend systems are, but the enforcement agencies (e.g. CMS) are the grease between law and implementation.
F.ex. ACA language and guidance being tweaked right up until the supposed "must be compliant by" date.
Generally speaking, it works about as well as one might hope. All the stakeholders get together, hash out a reasonable schedule for actual implementation, and then everyone generally works towards that.
It helps that the relationships are generally interdependent, and there's enough money sloshing through the system to fund change. So all parties generally do a fair job at converging on the requested changes, quicker than they'd like, but slower than the government would prefer. And then the few trailing insincere implementers start getting beat with fine sticks once the majority of their peers have successfully implemented.
I agree with everything you said. We're in the ACA space, so this should been right up our alley (government puts new legislation in with penalties to force employers to do something they don't really want to), but the ACA had a much bigger stick and a much longer runway.
Starting January 2023, insurance companies and plan providers need to publish similar data, so to your point that might be the interdependency required for compliance.
Obligatory these views are my own, not my company's.
Based on what you know about the system and all parties, curious on any ideas you'd have to speed compliance (without bankrupting anyone).
Would increased fines do it? Compliance bonuses [0]? Something else?
[0] Showing a few of my cards, I was really impressed with the inner workings of the FEP program, from a management perspective. They seemed to have landed on an effective system of fine + incentive that strongly encouraged good behavior and positive results.
TBH I didn't dig all that deep. Once you look at the size of the market (~6000 US hospitals, most of them in groups [0]), annual subscription (would need to be some fraction of what they would pay in penalties), percentage of market share you could capture (say 25%), discounts for groups, level of support, investment and unknown source systems, etc., I didn't evaluate it as a viable / likely opportunity, especially outside of our existing market.
All of that said, if you knew the space and backend systems and could figure out a way to make it easy, one thing I did hear is that hospitals don't like to be non-compliant, so I think they want a solution (or this to just go away), it just needs to be a really minimal investment for them in cost and time to implement and maintain. The provider data coming into play in 2023 may be the main driver to "normalize" some of this being out in the open.
Usual disclaimers again: my views, not my company's.
$110k per year seems like a no-brainer for the hospital to just pay rather than comply, assuming they are just purely acting in their own self interest and not for the common good.
This is great. How do they deal with the on-going maintenance of the tools they build? Do they move to the main product team or does the internal systems team continue to maintain them?
I find it humourous that the latter is "normal". Netflix and online streaming really have changed our perspective; I'm not even that old (30!) and I wouldn't call "watch any show anytime" normal.
Just show up - I started this last year going to the gym - if I didn't feel like going to work out, I just went to the gym and messed around, did whatever I felt like, even for 15 or 20 minutes and then left. The discipline has translated into other projects - a camper reno, a game engine, etc. Just showing up is more than half the battle, even if you don't accomplish much on one given day.
I started this two months ago, too. My motto is "Showing up is the victory."
Once I'm in there, I give it my best. Some days my best sucks. I don't worry about that. I got my ass into the gym. It's the habit that matters.
It's about consistently showing up.
For context, I'm 34 and clinically considered morbidly obese. My relationship with exercise, like virtually all obese people, is one of yo-yo diets and countless failed attempts at getting fit. I never before lasted more than a few weeks.
A big part of the problem, I came to realize, was being too results-oriented. I'd be highly motivated those first couple weeks when the pounds seem to drop so quickly, then lose all motivation when the weight loss slowed down to a healthier rate. Then I'd get depressed, quit, and binge eat until I reached a new low of physical fitness and self-esteem, and start over.
This time around, I just get my ass to the gym. That's it. I don't care what the scale says. I do try to eat better, but I don't beat myself up about it when I fail -- because beating myself up just causes me to binge some more. I just pick myself back up and hit the gym the next morning.
Here are some results so far:
1) I've discovered I actually LIKE lifting weights. So I do mostly that. I look forward to the feeling of my limbs being like jelly. It feels like accomplishment. To be clear, I've never, ever liked any form of exercise before. By changing my focus to "just show up", I've freed myself to find something I like, rather than trying to keep up with anyone else.
2) I've been tracking my weight, and after an initial loss of 25 pounds I've put back on another 10. But, my waist line has gone down 3 belt notches, so I try not to take the number on the scale too seriously. Sometimes it's up, sometimes it's down.
3) My focus at work is through the roof. I just feel better. Less sluggish. Able to concentrate more, which is mega important as a programmer (preaching to the choir, I'm sure).
4) I sleep better and wake up on time without much of a hitch most of the time. I'm still not super chipper first thing in the morning, but I don't hit snooze either.
5) I have more energy to give to the people I love, i.e. my kids and my partner. I'm still not superman, but I'm not sitting on the couch begging to be left alone either. I play. I do stuff.
Sounds like you're on a great path, and I have a couple comments. First, results oriented is great, but health and fitness is a life long thing like breathing. The journey is what's important here.
Second, don't beat yourself up when you fail. We all fail at times. What you can't do is let a simple failure snowball. Recognized you failed and get back on track. A trick I use is not to wait until tomorrow to go to the gym, go right then even if you've already been today. And when I say right then, I literally mean right then if you can.
Finally, don't focus on the scale. Focus on doing the right things every minute of every day and the scale will follow. Again, it's the process and finding how you can live your entire life as healthy as you can.
Scott Adams does this too. He goes to the gym everyday and laces up his shoes. Once that's done, it's considered a "successful day at the gym". Of course 99% of the time he stays for a workout... but yeah, the odd time he just goes home after lacing up his shoes.
I love this. It sounds bad, but lowering the bar for expectations and just thinking that showing up and doing something is a win is fantastic for building habits and discipline. I have so many friends who haven't done much with their lives for fear of screwing up, but it turns out that inaction is screwing up.
I just went to the gym and messed around, did whatever I felt like, even for 15 or 20 minutes and then left.
A super key part of encouraging a good habit, IMO. Showing up is the hard part, and if you give yourself permission to just tool around or leave early if you're not feeling it, at least you're still cultivating the habit.
I did the same while at my old job, since it was literally across the street from a gym. I went to the gym during lunch every day, where "going to the gym" just meant turning up and getting changed.
Going during my lunch hour worked better than trying to go in the morning or evening, since I was already constrained to be nearby at the start and end of that hour (plus I don't drive), whereas outside work it was easier to sabotage myself by thinking that I could be doing something "more productive".
There are always plenty of excuses in the moment too, so I adopted a mindset where going to the gym was a given, and anything that encroached on that was an inconvenience; e.g. if I had some errand to run I would instinctively plan to do it before or after work rather than at lunch. As someone who tries to be helpful and humble, it really took effort to prioritise my own wellbeing sometimes!
Another trick I did was to mark every (week)day that I turned up at the gym with a big X on a physical calendar, which gamified it by trying to avoid breaking the current "streak".
Probably worth saying that it worked too! I focused on strengthening my arms (e.g. if I was only there 10 minutes then that's all I'd do) and they went from mostly fat to noticably muscular after about 3 months.
Unfortunately I moved a few years ago and never managed to get back into a good routine :(
Showing up is huge. I've added a couple more recently that are related.
1) Get up at 6am every morning even on the weekends and go right to the gym. It sucks for a little while, but it has really raised my life productivity to a new level. My sleep has gotten much better. My head hits the pillow and I'm out. I naturally stopped looking at my phone after 9-10pm because I was just ready to sleep.
2) Anytime I think about something I don't want to do, I stop whatever is I'm doing and do that thing instantly. It has really flipped around my mindset, and made me realize many of these things I put off only take a few minutes anyway. So much is done, that I end up with tons of free time at the end of the day to work on other things. Freeing my mind of nagging procrastination also does wonders.
When I started going to the gym, I had to deal with a lot of internal resistance. Feeling embarrassed about being old and fat and obviously totally ignorant about what I was doing.
A few months with a personal trainer got me past my fear of the gym. That was huge.
100% this. Just going by as frequently and consistently as you can is so important. Even if it’s just to walk 10 minutes on a treadmill, you’ll get more comfortable with doing it every day.
Two reasons in my experience: first, reproducability gets orders of magnitude more complicated as you grow. One person can do something over and over with no documentation, a few people can learn from them, but once you get to 10 - 20 staff in a role and you have some churn, you need good documentation, training, and QA since your risk for errors goes up no matter how good the documentation and training is.
Second, as others have mentioned is coordination. Now introducing a new process, feature, or whatever to clients or internally means creating the requirements, the documentation, working with sales or client services on timing and release, working with QA on test scenarios, working with training to get it into training programs, etc.
Plus kids clothes! My wife and I do about half of our clothes shopping for our 2.5 year old at Value Village and bring stuff there that we or she don't use anymore. She doesn't care about labels, the clothes are cheap, and she'll grow out of them in 6 months (and they may end up donated back again).
Technically, of course you can, but practically, if someone sued, you would probably have a hard time convincing others that you are complying with your own policy. It's probably easier to just to change your ToS/privacy policy.
This is spot on. I would add that as a manager, it is my job to foster good relationships with other managers and use those to remove bottlenecks for my team. I spend a good portion of my day on the phone and walking around the office connecting the dots and getting buy-in or compromises and making sure everyone is on the same page about what's being built. On top of that is having a clear "second" who people can go to when you're out to do the same thing.
Another piece is being able to make decisions and stand by them. That doesn't mean never backing down, or always being right, but you'll often make quick decisions with less than ideal information and need to be comfortable with that. You'll be wrong a non-negligible portion of the time, so you'll need to own that, work to fix any issues, etc. and not take it too personally.
As a manager of other managers, I like to tell my team that you're in a good place when work can continue on without you; your job is to push things forward, drive process changes and improvements, message successes up and down, etc.
