How can we use digital technologies to combat the spread of COVID-19?

To use a recent industry analogy, the virus moves along its own supply chain, from source to recipient (person to person), often with many individual cases occurring in clusters. These patterns can provide us clues as to how the virus will further propagate. Digital technology, in the form of current industry network operating models coupled with transparency and predictive modeling, may offer a solution.

Data analytics and predictive modeling have evolved exponentially over the last few years from retailers predicting pregnancies before the pregnant individuals even knew themselves, the anticipation of client buying habits through industry models to the influencing of major international political elective and economic outcomes.

So where do we get the data?

The Facebook Nation has grown past the 1 billion soul mark as of January 2020 and organizations are using this information, some for constructive reasons, to predict consumer behavior and buying habits. Needless to say, organizations are collecting data including the Government, Healthcare organizations, Pharma and many more.

So now that we have the fuel, we need the rocket!

Present-day commercial operating models have provided a network of Buyers and Sellers who transact orders and share information. The more partners who connect over these networks, the more the networks grow and the more powerful and valuable they become. Combine that with the power of the digital age, and the network will grow exponentially. Healthcare organizations, as well as the Government, already use these models internally – it’s time to start sharing.

How can we use this information to combat contagious diseases besides COVID-19?

COVID-19 is thriving due to several key factors two of which are the following:

• It is a highly contagious disease with a long incubation period which spreads quickly and predictably through human contact
• Misinformation and lack of information accelerates the spread of the disease

The network model with supply chain capabilities described above offers a solution, the key being that the same partners in this network model, Providers, Payors, Pharma Companies, and even social media must band together and provide end to end supply chain visibility. Furthermore, the application of effective behavioral predictive modeling capabilities will provide insight into the human movement and behaviors which spread the disease and enable healthcare entities to take a proactive approach.

This same network also provides the structure for the proper dissemination of preventative and instructional information for patients tailored to their specific venue.
To provide this we need, agile digital and IT capabilities and the ability to plug into the network and communicate with partners consistently and effectively.

This is possible through the application of evolved supply chain models, the implementation of Agile methodologies allowing us to be nimble, and the use of predictive modeling techniques on the vast amount of data collected already for retail purposes.

Needless to say, the implementation of tele-models into these supply chains reduces the risk of contagion even more! – That is a whole new topic though.

Conclusion

The answer lies in communication and collaboration within the partner’s walls and across the network which connects us all. It’s time to increase transparency and take a unified approach. Understanding the behavior of the patient, the sharing of this information and the infusion of modern technology is tantamount to success.

Please feel free to reach out to discuss this further.

This blog is part of a series exploring Agile methodologies. Read the last post in the series here.

Conventional Earned Value Management (EVM) is a project management technique for measuring project performance and progress. It has the ability to combine measurements of scope, time, and costs (the Project Management Triangle) and is measured against a project baseline

• The quality of work is constrained by the project’s budget, deadlines and scope (features) and the project manager can trade between constraints.
• Changes in one constraint necessitate changes in others to compensate or quality will suffer.
• In a single integrated system, earned value management is able to provide accurate forecasts of project performance problems, which is an important contribution for project management.
• Planned Value, Earned Value and Actual Cost are the three main features of Earned Value Measurement

Earned Value Estimation in Agile has historically been challenging to measure.

Agile metrics neither provide estimates of cost at completion of the release, nor cost metrics to support the business when they consider making decisions like changing requirements in a release.

• Pure Agile methods do not define how to manage and track costs to evaluate expected Return on Investment information
• Iteration burn-down and burn-up charts (as used in Scrum) do not provide at-a-glance project cost information.
• Traditional EVM calculations require a baseline difficult to express in an Agile framework
• The concepts of Planned Value, Earned Value and Actual Cost are derived differently in the Agile framework

Agile Earned Value Management uses the Scrum framework artifacts as inputs, uses traditional EVM calculations, and is expressed in traditional EVM metrics.

• It requires a minimal set of input parameters:
  • the actual cost of a project,
  • an estimated product backlog,
  • a release plan that provides information on the number of iterations in the release and
  • the assumed velocity.
  • All estimates can be in hours, story-points, team days or any other consistent estimate of size. The critical factor is that it must be a numerical estimate of some kind.

Earned Value (EV) against the Planned Value (PV) lies at the core of any Earned Value Management technique so how does it work in the Agile world?

• Planned Value is the value of the work planned for a certain date within a project plan.
  • In the Agile world, this translates to the sum of the estimated feature sizes for all the features up until the planned date.
• Earned Value is the value of work completed at the same date as used for PV.
  • For Agile, it is the sum of the estimated story points for the features up until the calculation date
• Actual Cost is the cost in dollars to complete a set of features.

This approach provides a measure of Earned Value using Cost Variance and Schedule Variance in a manner almost identical to the Waterfall technique.

Please feel free to reach out for a detailed example of Earned Value calculation for Agile Scrum projects

‘Till next time

Many major providers did not properly plan for the previous presidential election results. Aetna CEO, Mark Bertolini, according to an article published in the Hartford Courant, sent his team back to the drawing board to develop another plan due to the potential repeal of the Affordable Care Act by the Trump administration.

Many Payers are reeling to adjust to this election result and the uncertainty and direction could cause the expenditure of a great deal of money and resources before the smoke clears.

One thing the two administrations (Obamacare and Trumpcare) should agree upon is the concept of value-based care as an alternative to Fee for Service.

Although fee-for-service reimbursement models promote quantity of services, value-based care models reward healthcare providers for the quality of care that they give to patients. Value-based care is focused on providing better care for individuals, improving population health management, and reducing costs by rewarding Providers for more effective and meaningful patient outcomes. Let’s dig a little deeper.

Fee-for-service models:

• Providers are paid for the specific services they performed.
• Services are billed separately (not bundled)
• Costs are calculated by what commercial payers and Medicare would pay

Under Fee-for-service models, costs increased and outcomes were not improving. Doctors were seeing more patients and claims were processed in a fragmented network.

Value based service models: (Four of the most popular)

• The Accountable Care Organization (ACO) – groups of healthcare providers, doctors and hospitals who provide patients with quality, synchronized care for better patient outcomes
• Bundled Payments – administered for services related to a specific care episode. This gives providers the flexibility to construct the bundles, develop the health care delivery structure, and control the allocation of payments among participating providers,
• The Patient Centered Medical Home (PCMH) – where providers treat patients by collaborating with a primary care physician who coordinates all required and logical care. Kind of like a cousin of the ACO.
• Pay for performance (Medicare) – awards bonuses and enacts penalties on providers to improve or see their patients migrate to higher-quality options

Value-based models seek to decrease the current fragmentation of systems, which drive up the costs of Fee-for-service based models, through the promotion of collaboration, bundling and a focus on the patient outcomes as opposed to the control of specific costs and activities.

So, which way are we headed?

Sylvia M. Burwell of the department of Health and Human Services, announced the HSS’s plan to move away from Fee-for service models and committed to guidelines and a timeline to do so. Within the next few years, the HSS plans to shift 50% of Fee-for-service payments to Value based. The ACO even has created several of new institutions and payment arrangements to drive in that direction. Anyone who wants to work with Medicare needs to follow suit.

According to a KPMG survey, 26% of Payers plan to enter Value based payment arrangements by 2020.

It only makes sense that Payers and Providers will be pursuing technologies and analytics capable of sharing and measuring healthcare cost, data and quality from many sources.

“The transition from fee-for-service to pay-for-value has been referred to as one of the greatest financial challenges the U.S. healthcare system currently faces,” stated a survey from Healthcare Information and Management Systems Society.

Historically, the pursuit of improving patient outcomes through value-based models has met with considerable success suggesting this is the direction both the government and the private sector should be headed, after all, a better patient outcome is the goal, right?

I would be very interested to share your opinions, thoughts and comments.

How Payers and Providers are using Population Health Management to improve patient outcomes and manage costs.

According to Markets & Markets, the largest market research firm worldwide:

“The population health management market is projected to reach USD 42.54 Billion by 2021 from USD 13.85 Billion in 2016, at a CAGR of 25.2% in the next five years (2016 to 2021). “

It only makes sense that Payers and Providers must collaborate as they are at the forefront of this movement.

How Care Management used to work….

Let’s have a look at how care management systems developed over the last couple of decades. Before the Affordable Care Act, which made a huge impact on the industry, payers were the ones who cared more about managing the health of populations because they had the greatest monetary risk. They needed to manage the patients on the top of their pyramid who were costing them in excess of 70% of their total expenditures and so, the Care Management Market was born.

With the Payers at the helm, Care Management worked as follows:

• Member Claims were analyzed reactively to assess risk
• The employers of these people would be notified if they had a disproportionate amount of high risk people
• Proactive and preventative programs would be put into place to manage and counter the risk
• Payers invested a great deal of money and resources towards infrastructure which would support individual patient engagement
• Employers shared the costs of the risk mitigation in support of the Payer’s efforts

The evolution of Care Management – next steps….

After payers and providers had squeezed as much blood from the old Care Management Model (stone) as possible, they started looking for disruptive ways by which to leap to the next level and better manage their revenue cycles, so then came:

• Value Based Management
• Population Based Management
• Accountable care

These approaches required the accumulation and assimilation of a great deal of data in order to be effective so, where do we get the data? Well, for one thing, it needs to be “real time” data from EMR and HIE vendors who have connected to providers and payers. Now, the challenge is to integrate the data effectively.

Next step?

Providers and Payers need to work together closely creating solutions and systems which will promote real time dissemination of data resulting in genuine value based patient outcome management.

In addition, payers and providers need to work harder than ever before to manage healthcare spending and make care more affordable for patients and our taxpayers. These new models of reimbursement coupled with more effective care management strategies will enable the stabilization of runaway healthcare costs.

I welcome your thoughts and opinions.

This blog is part of a series exploring Agile methodologies. Read the last post in the series here. This post will explore Agile estimation and the different estimation techniques.

Estimation is more the “art” than the “science” of program management so polish the crystal ball and let’s get started.

Agile estimation is fundamentally different from conventional waterfall estimation.  Waterfall tends to be “bottom up” while Agile is “top down”. The waterfall approach for estimating projects is to spend several weeks or months at the beginning of a project defining the detailed requirements. Tasks are defined and resources are assigned to tasks. The detail must be defined before cost and schedule can be estimated.

The drawbacks to this approach are that things change rapidly in today’s environments and the proposed solution can quickly become obsolete. The top down (Agile) approach uses Rolling Wave Estimation incorporating new information as it is discovered and adjusting to the rapid changes as the project progresses. This allows for the rapidly changing requirements in today’s software projects.

ESTIMATION:

There are three levels of estimation in Agile:

1. Proposal/Project Level – performed during the initial phases of a project
2. Release Level – plans the release of features bundled to provide frequent and rapid delivery
3. Sprint Level – planning of the tasks associated with the completion of individual stories in a sprint

ESTIMATION TECHNIQUES:

There are several different types of estimation techniques at each level.

On the project/ proposal level, one could use statistical models based on the past behavior of the teams. This is part science and part intuition and must be adjusted as the team evolves.

On the release level, there are several popular estimation techniques such as:

• Affinity Mapping
• T-Shirt Sizes
• Dot Voting
• The Bucket System
• Planning Poker

The important thing to note is that all of these estimation systems involve collaboration and comparison.

To make a real life analogy on comparison, say you go for lunch at a restaurant.  The waiter asks you what size soup you want, cup or bowl?  You know a bowl tends to be twice as big as a cup but you don’t know how many ounces are in the cup or bowl.  This is an example of relative estimation, are you really hungry? (Bowl) or just a little? (Cup)

Another fascinating aspect of Agile estimation is using the Fibonacci sequence of numbers to estimate relative sizes – entire white papers have been written on how this natural sequence of numbers follows so many natural patters in our universe and I will discuss this sequence in more detail in future blogs.

One of the most critical aspects of Agile estimation is the fact that one constantly adjusts as things change.  For this reason, it is not really possible to plan too far into the future as, if you do, you will inevitably, have to plan again.

Till next time.

According to Merriam-Webster, “Agile is marked by ready ability to move with quick easy grace.” Of course, this not only describes the adjective, but also the methodology.

I’m an Industrial Engineer with an affinity for data and numbers and a Jersey Boy who realizes the need to break free from conventional approaches in order to provide rapid and innovative results.

To say that things move a lot faster today is to state the obvious and, to deal with this, we need to move quickly and carefully.

This is the first of many posts that will explore Agile Street Smarts and how to approach and practice the Agile Methodologies in our Hybrid Waterfall/Agile world.

My take on Agile is that it is a versatile, maneuverable, intuitive and adaptive approach which involves process, a good measure of gut feeling and street smarts. As Agile practitioners, we are constantly reevaluating our performance, approach and velocity – receiving continuous feedback and sometimes moving at blazing speeds.

Unfortunately, the whole world does not operate this way and sometimes, we have a need to translate our progress, performance and results
to the Waterfall world. There are conventional metrics that executives and finance groups expect us to provide such as Earned Value and Forecasting and therein lies the challenge.

Agile, to me, is an approach I have been using for a good part of my professional career. Many years ago, I studied Operations Research and Industrial Engineering and the Agile approach was in the fabric of our methodologies – whether we knew it or not.

One of my favorite Agile characteristics is, ” By the time you plan and figure something out, it has changed and you need to start again,” so don’t overthink.

In my next blog entry, I will discuss an approach I have used to estimate and forecast Agile projects and subsequent blog posts will highlight topics such as  Earned Value Metrics, transitional strategies the military model and the different Agile “flavors”.

Stay tuned.

What does it take to create a lean, mean project machine? Many have wrestled with this in the past.

How do you get your teams to perform at optimal levels?

SEMPERFI

• Support don’t smother,
• Empower and trust,
• Motivate ,
• Put forth – communicate,
• Energize,
• Release – deliver,
• Fail fast,
• Iterate

Turns out, Marine Seal Teams are stellar examples of the optimal Agile teams but before you start yelling “Oorah!” let’s talk about why.

I’ll admit, I’m not the first to suggest this analogy, many team leaders understand this and have used this approach, however, most companies I have worked with consist of people with less intensity than your typical Navy Seal unit.

As a matter of fact, according to Military.com, only about 6 percent of SEAL applicants meet the requirements needed to qualify.

So how do we motivate the workforce to perform on this elite level without experiencing a 94% dropout rate? OK, probably a bit of an exaggeration when it comes to product owners, project managers, developers and BA’s.

The first step in the drama is to define and create a core, shared Culture for your teams to make them teams and not just groups of people. They must understand how to support and communicate with one another – the “rules of combat”.  When teams function consistently and in sync, less thought goes into the “overhead” associated with anticipating a colleague’s actions making the team more efficient.

Since high performing teams require high performing leaders, the commanders of the teams need to be able to Trust, Enable, Activate and Motivate their TEAM. (Just loving those acronyms today!)

Well, there are several core skills and practices we get from our elite protectors to our Agile framework which we can apply. They will enable us to:

• Make Quick, Effective Decisions
• Cooperate
• Adapt
• Predict
• Exploit Successes
• Gain Advantages
• Succeed

The leader’s responsibility on an Agile team is to be the mortar in the stone wall that holds all of the rocks together.  They must “fill the cracks” functioning wherever they are needed and support the weak points. They must enable all the cogs to work well and in unison.

The leader needs to be an effective communicator as well promoting communication throughout his team on the field, as well as central control and overall leadership.

Effective leaders should bubble up, and down, the relevant information from their areas (also known as the KPIs in the Agile world). They should provide tactical information (Agile project statistics) and functional information (how the overall delivery of system function is progressing), totally understand, and be in touch with all aspects of the program.

They should be in tune with their team’s and leaders behavior so they can pro-act and re-act with agility to every situation that arises. Doing this requires an understanding and sensitivity to human behaviors – the human side of agile. This enables us to more effectively forecast and predict how our fast moving Agile projects will progress and behave and keep them functioning and delivering at optimal levels.

We will explore this further in future blogs where we will discuss models used to do this.

Stay Tuned