alexanderdou

vor 5 Jahrendiscuss

I work in the space (specifically, on the Payer/Health Insurance Co side) and this is my current bugaboo

From best I can gather, there are a handful of High-Level issues. But for the sake of brevity, I'll highlight what I think is the biggest:

The data requisite to make a confident estimate lives in many different parties' databases. To make an estimate, you would need: (1) Full List of Procedures and Services to be done (keywords here: CPT and ICD codes); (2) Contracted Rates between Payer and Provider; (3) Patient's Deductible, OOP Max, and Plan Benefits; (4) List of which services require Pre-auth

(1) lives with the Provider

(3) and (4) live with the Payer

(2) lives in between, but is also a huge problem because it's a many-to-many sort of relationship (many Payers have many contracts (e.g. annually re-negotiated contracts) with many Providers)

alexanderdou

vor 6 Jahrendiscuss

In a similar fashion: I purchased a helmet + bikeshare membership

I live in an urban environment, so I don't want to store a bike (or worry about getting it stolen). It's 1) vastly increased my footprint and appetite for checking out new areas and 2) helped me get some more exercise into my days.

alexanderdou

vor 6 Jahrendiscuss

> Not keeping your interviewer engaged

Ugh. I'm going through the interview process right now and this peeves me so much

The presumption that I, the supplicant, need to be interesting and keep the interviewer, who has deigned to give me 30 minutes of their time (often 23 minutes because, "sorry I'm late but I also have a hard stop at the top of the hour") "engaged" makes the interview so lopsided, awkward, and just nonproductive

That being said: > Not preparing for the interview

Is completely legit. I have walked out of a couple of interviews wishing I had prepped a little bit more so that I could make the conversation a productive one

alexanderdou

vor 6 Jahrendiscuss

I think there's a balance here, as with everything.

If you're too far on the <---"unstructured" end of the spectrum, you hop from one thing to the next and take things as they come. You sleep at constantly fluctuating times, you eat meals of convenience, etc

But if you're too far on the "structured/run-by-routine"--> end of things then you get what is described in the parent comment

So it's like "how do I introduce the minimum routine that will set me up for good days without being stultifying". (just to be clear, hopefully I'm not coming off as lecture-y, I'm just kind of writing/thinking out loud what your comment kicked off in my head)

alexanderdou

vor 6 Jahrendiscuss

I'm very early in my career, but I've noticed that being able to sense, reflect on, and grapple with one's emotions to be so lacking at work.

It's also been one of the biggest invisible skills in my own career:

    it helps me navigate disagreements with colleagues by "getting us on the same side of the problem, rather than on opposite sides";
    it helps me avoid self-sabotage by creating narratives in my head and falling into the cognitive distortions of mind reading and fortune telling that I know I'm particularly prone to;
    it helps me interface with customers and graciously accept feedback, even if it's not delivered in the kindest way

But nobody teaches it. It was never in a training. I never learned it in school. It's almost like nobody knows it exists!

Anyway, btw, thanks for your work. I recently signed up for your newsletter and it's been really wonderful. I really enjoy the kindness you bring to your writing.

alexanderdou

vor 6 Jahrendiscuss

One of the big issues I always find with "Closed Lost Reasons"[1] like this is that it rarely captures the truth accurately. It misses the truth in a couple of ways:

   1. Deliberate obfuscation by main actors who want to protect their jobs ("It is difficult to get a person to understand something, when their salary depends on their not understanding it.")

   2. Continental drift- the farther you get from the action (or, more likely, the set of actions) that precipitated the event, the more you rely on memory and hearsay

   3. "The Rage to Conclude"- humans LOVE denouement, to “know”, to have things wrapped up and make sense. But rarely is the world so simple. We try to boil a set of reasons down into one über-reason

So on the factory floor, the people doing the labeling are incentivized to shift the blame and obfuscate their role in the loss. And then the manager is trying to sort through all the noise to identify which set of reasons is the most likely for this loss. There's a lot lost in translation from the "truth" of how the deal was actually lost.

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With this particular article, I categorize it in "content marketing babble": advice that is generalized to the point that it is not useful to me. The Common Lessons section leaves me with general advice but no tractable ways to understand what that looks like in the real world with real constraints and stresses.

IMO, the Lean: validation section could be extremely valuable IFF they supplied hard examples from the failed startup dataset that fueled this article. Like "Here are links to the case studies where the team behind [Closed Company A] felt that they could have spent more time validating before building. This is the featureset that they built prematurely, and here they ponder on ways they might have tested it cheaply"

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All that aside:

I've actually been quite an avid reader of Failory for a couple of months now. I check in every so often to go over new interviews. I think the interviews (https://www.failory.com/interview-failure) are a lot more useful: the format allows for more nuance, more context over the conditions of the business, and more reflection.

I often find myself wanting to ask more questions in-line to the interviewee, kind of like a hyperspecific, morbid Quora question.

[1] I'm co-opting this term from Sales/Marketing lingo. I originally wrote Root Cause Analysis, but I know that RCA has a very specific software definition and set of rituals, so I wanted to

alexanderdou

vor 6 Jahrendiscuss

From the article, it appears that the suit hinges on a claim that “The CU Foundation has underperformed the S&P 500 fund by approximately 5.49 percent per year from 2010 to 2019.”

Does anybody have experience here? Is this an actual case? It seems kind of easy to cherry-pick historical dates that some investing body could have allocated resources some other way.

It's worth noting that he does have skin in the game: he's donated $5M to the foundation over the years, but isn't that kind of the risk you take by giving your money over to someone to manage? That they might make choices that you might not?

alexanderdou

vor 6 Jahrendiscuss

Yeah, I think I'm noticing more brands offering direct purchasing on their own ecommerce portals.

They're almost always worse experiences* but I figure it's worth it to support companies as they try to prop up retail channels other than Amazon.

* Long aside: For example, I'm dipping my toe into learning how to write Python scripts and I wanted to write one to check if Cookies and Cream flavor was In Stock on Optimum Nutrition once a day or so, but I'm pretty sure the website doesn't work (or maybe just every flavor is out of stock)

alexanderdou

vor 6 Jahrendiscuss

I hadn't considered that!

How are you thinking about danger from those types of items? Now that you've got me thinking, maybe like faulty wiring and my apartment burns down?

alexanderdou

vor 6 Jahrendiscuss

My own personal rule is now:

> I don't buy anything I'll put in/on/around my body on Amazon (e.g. Vitamin supplements, Lotion/face sunscreen, Protein powder)

Even if the brand is legit, I'm still not 100% confident that Amazon's co-mingling stock and switcheroos that can happen in the long supply chain will result in a "real" thing arriving at my door

alexanderdou

vor 6 Jahrendiscuss

I would recommend recording yourself speaking.

I'm currently between roles (COVID layoffs), and I got feedback on my webcam interview demeanor and speaking style.

My approach for this was to practice my answers to common interview questions out loud while recording myself with Photobooth and then watching the recordings.

There are a couple of dimensions in which I've found this helpful:

   * Sheer number of reps. These help me get more comfortable with telling my career story up until this point, and I've found that my comfort has a direct impact on my interviewer's comfort
   * I spot tics and habits that I wouldn't have otherwise. I noticed that I had a tendency to start my answers with "so, uhhh...". In some cases simply realizing the presence of a tic/habit was enough to get rid of it
   * The recordings reduce the channels from 2 (output + input) to just 1: this helps me analyze what I'm saying and how I'm saying it without having to also think about what I'm going to say
   * Recordings also provide a historic record that I can look back on and see improvement, which helps keep me motivated when the job hunt gets me sad

As a note, if you're anything like me you'll probably hate the sound of your voice. The thing that clicked for me was realizing that this is just the voice that everybody else hears and my friends & family love, and so there's nothing to be ashamed of

alexanderdou

vor 6 Jahrendiscuss

> Only directed attention, effort and completing discrete projects will bring me to where I want to be.

I agree with you here.

But I also want to point out that you have to ends to the spectrum of "using information": * At one end: Pure Consuming * At the other end: Pure Doing

What I'm getting from what you wrote is that if you're not "Pure Doing" (e.g. doing discrete projects), then you might as well not do anything. Is that accurate?

alexanderdou

vor 7 Jahrendiscuss

Perhaps I've just always been extraordinarily lucky, but I've never heard the developers I work with complain about our Pointing and Development cycle (and I'd like to think I do try my best to 1) proactively ask them for feedback and 2) recognize and squelch any of my own reactionary defensiveness that comes from feedback).

One thing I see a lot in the comments is about time estimates and the amount of pressure that that brings and the rarity in which it works.

In my teams we NEVER talk about time of delivery with Engineering. I've always been trained to think of pointing as an estimate of "complexity" (e.g. 1 point is roughly the complexity associated with a copy change).

Then, by getting a track record of historical points completed in a week, we can transform our way from feature => complexity => time.

alexanderdou

vor 8 Jahrendiscuss

Created an account to comment on this, so I'm new, but I read the Welcome and Guidelines.

This is something deeply interesting to me and I'd love to see more comments around it. Here are some questions I have, as someone who has been in the health insurance brokerage space for 3 years early on in my career.

In the case of the Jordans, they had a $2K deductible that the article fingers as the main source of their obligation. However, it further says that they ended the year owing ~$8K (on top of their monthly payments of $501). That just seems like a bad plan: high deductible, low lifetime max or bad coinsurance split. So on top of a high deductible, it offers bad coverage in the case of catastrophe. To me, that brings up two things: 1) lack of savings (I think there's a statistic that like 50% of americans couldn't get $500 together in case of an emergency) and 2) high deductible plans that can bury families. This strikes me as similar to the problem of treating addiction; it takes so many people to treat addiction: psychiatrists, therapists, internal medicine, financial support, job searching, housing support. Healthcare, specifically how an employee navigates it, seems to be a similar problem, requiring budgeting, finding time to find a doctor, etc etc. Are there any companies or people working on this kind of stuff right now?

It also appears that short-termism is another factor in play here. Because of changes to the tax code, companies began offering cheaper plans, thinking that it would cause employees to be more frugal but instead it just caused them to cut back on all preventative care. Does anybody know of example companies that didn't do that? That recognized the risk up front and resisted the short term gains on quarterly guidance?

Lastly, I think it's admirable what the new Gawande-led venture stands for, but I just had a vision of a future where only giant mega-corps will have the leverage—both financially and politically—to properly insure their select few Chosen employees. Is that at all likely? Or have I been watching too much 3%?