The Longevity of Solutions — Transcript
[00:00:00.02] Jim: we’re going to discuss is consulting solutions, and this really gets to the efficacy, ethics, and longevity of consulting solutions, and those are a lot of touch points to try to cover in one podcast, and as I told Ken. I’m kind of curious to see where this will go especially longevity. My experience is while I’m proud of the work that I and others did during my career, I also realized that most of it didn’t have a very long shelf life and I, and I say that because our area of expertise was in a area of government where the rules change constantly, the target audience changes constantly, and certainly the politics change much more quickly than they should. So when I think about this, it’s the longevity of things that we do. My take on it is, if you wanna see longevity in your career, especially to continue past the time you retire, then consulting’s probably. probably not for you, but that’s just my opinion. What do you think?
[00:01:34.22] Ken: - Yeah, I agree with you, and I think my opinion changed over time. When I first became a consultant, I really believed, I guess I didn’t understand the impetus for the products and projects we were working on. went in. I say that because I genuinely thought people wanted to understand their revenue flow or a system that would help them or something like that. I later came to realize a lot of this, I hate to say it, but is political in its nature, and I think it’s important to I’ll give you an example. I did some work in the transportation industry and when electronic vehicles first started popping up, it became quite a scare because most tax revenues associated with a vehicle aren’t from license tabs, but rather they’re from a gas tax imposed by states, and when you have a vehicle. that doesn’t use gas, it’s like suddenly the revenue drops, and they were basically asking the question, oh my goodness, what do we do if the revenue drops and what are our alternatives? And I don’t think the answer or the question wasn’t being asked that way. It was simply a political reality that we need to figure out how to keep our revenue up as a government agency or as a state with this whole new technology that’s coming about, you know, what can we do? And it was funded through political means. means now, in that time period. then and now. I don’t think there’s been a significant, you know, we came up with a number of scenarios, but I don’t think there’s been a significant impact of EVs on revenue for a number of reasons, and those don’t matter. But in this case, it was purely funded by PANIC, but it was presented in the government. eyes of how do we make the world a greener place and all those sorts of things. So I think I maybe I became more cynical as I got older, but they weren’t truly interested in bettering the world through electronic vehicles. They were simply concerned about how they made money, and there were so many of those that were political or, you know, a lot of our health services, in the case of our health and human service projects, there were federal grants or federal monies that were given, “Gee, if you replace your system, we’ll match 80% of the cost of it.” And so whether you needed a system or not, they needed to justify replacing the system or having help replacing the system in some manner or another. So I think that it really – wasn’t about improving the service to Medicaid recipients. It was about the fact there was federal funds available and politically we better spend them, right? I didn’t find it unethical to participate in those projects, but I knew they weren’t long-term solutions, and in the case of the EV, what every state has done, there were all kinds of alternatives. But basically, if you own an EV, they simply charge you more for your license tabs. You know, they charge you what they think the revenue would have been on the gas tax, and I don’t know a state that’s not true in. So it’s, you know, it’s kind of gone. So, you know, that’s kind of my first take on this, on consulting solutions. believe any of the solutions we ever came up with were long-term simply because the sands are shifting under, in health and human services, the sands are constantly shifting under them about funding sources and regulations and all those sorts of things, be it, you know, let’s restrict giving benefits, or let’s give more benefits, or let’s give less money or more money. So the sands are constantly shifting. The projects that are generated from that are generally political. Let’s figure out what to do in light of where the sands are right now. Let’s make ourselves look good. But there were very few solutions I did as a consultant that are that were. or very long-term things. Maybe a couple of things in the private sector. For years and years, I wrote one of the initial systems that would bill for what they called roaming when you went out of your area with your cell phone. You’d be charged more for going out of your defined geographic area, and I wrote a system to handle the billing on that that probably stayed in place for 10 years until the idea of roaming went away, at least in in the United States, you still if you go overseas, you end up paying extra fees and things like that, or getting another SIM card, basically getting a different phone number, but there were a few of the solutions I had. I have a couple others, maybe a couple of systems that stayed in place, not because they were the greatest solution in the world, but because there was no money to do anything to, you know, to replace them in time. Had the money been there to replace them, they would have done it. I was thinking of one juvenile justice system I helped. It had helped with the development of, and it stayed in place for a long time. As a matter of fact, I believe they still use the back end of it and just put a, replace the front end for various reasons. So.
[00:07:24.08] Jim: Yeah. Isn’t it amazing what changes and what doesn’t? over time because I just recently qualified for Medicare and I being a numbers guy couldn’t figure out the reimbursement amount that Medicare was putting on it but then I remembered back in the mid 80s when I was working in Medicare I helped a Blue Cross Blue Shield implement some reduction that they took after they reimbursed the provider because they didn’t want it to affect the provider different directly. It was an indirect tax. So the end result is everything is calculated and it shows one amount for what the providers to be reimbursed, but the check is actually for a different amount that is still that is still going on to this day and it cracks me up, but an example. would be in Medicaid, they used to find fraud by only looking at the behavior of, let’s say, licensed physicians, who they called providers, and people who qualified as beneficiaries, would run peer groupings and you weren’t expected to rise above your peers in the amount of money or services that were received. Well, that completely ignores the idea that there could be other people defrauding Medicaid or Medicare or whatever social program it is who are neither beneficiaries nor providers.
[00:09:22.78] Ken: And that actually has turned out to be the case, right? Yeah, there have been several high–
[00:09:27.24] Jim: - Well, apparently, yeah, I’ve been going at it for many years now, but these systems were created to catch the group that’s recognized rather than the outsider who’s just coming in, and it makes perfect sense, right? That’s where the flow money is.
[00:09:45.17] Ken: - On the surface of it, yeah, it makes sense, and it’s not, it’s, that’s a necessary control but not a sufficient control and it doesn’t come from that.
[00:09:54.30] Jim: - Exactly.
[00:09:55.07] Ken: - You know, yeah.
[00:09:55.89] Jim: - Yeah.
[00:09:56.85] Ken: - Did you have any, any long-term, not long-term successes, any solutions you provided that you think are still in place that were, you know, good solutions?
[00:10:13.03] Jim: - Yeah, in fact, I was just reflecting on this the other day because I do read in detail every one of those EOBs or EOBs or whatever you want to call it, the statement. of what the health insurance.
[00:10:32.35] Ken: - Yeah, explanation of benefits, yeah.
[00:10:34.23] Jim: - Paid out, yeah, explanation of benefits, thanks. I do read through those in detail and I was reflecting one of my very first, if not the first consulting project I worked on as a staff member was helping a small state to implement, and this is all at the same time, standardized procedure codes for medical procedures. It was CPT-9 at the time. I don’t know what the current.
[00:11:05.86] Ken: - Yeah, probably 52. That’s a long time ago.
[00:11:07.93] Jim: - Yeah, much higher.
[00:11:09.21] Ken: - Yeah.
[00:11:10.04] Jim: - And at the time it was ICD-10, which is the diagnosis coding scheme state had made up its own procedure codes and its own diagnosis codes and there’s some other coding that goes on a claim that they had also made up their schema for and the federal funding partner said no more we’ve got to standardize all this so even though the systems that I helped to implement and was like, it wouldn’t be an exaggeration to say it was my daily activity for a couple of years, researching and helping them to implement and then use these standardized codings, DRGs. I mean this this state went whole hog. diagnosis related groups or the coding that’s used or at least used to be used for inpatient hospital stays. So all of that, even though they’ve moved along in the coding versions, that stuff still remains. So, and it felt good to get them moved from something. that was not defensible. That was the main problem. It was not defensible and it was not comparable, so it was really hard to see how they were doing in comparison to say other states, to the private sector, best practices, because essentially all of their claim coding was made up.
[00:12:45.35] Ken: How about the opposite? Any solutions that died maybe before their time or that you don’t feel like were taken seriously? I’ve had a couple of those too.
[00:12:54.18] Jim: Oh yeah, I saw them die while the project was going.
[00:12:58.96] Ken: Right, yeah, that’s what I was just going to say. My biggest memory is halfway through a project, The funding went away, the need remained, the funding went away, so we did a quick wrap up with whatever funds were remaining for the week or so of the project, a quick wrap up to a quick basically DAC PowerPoint presentation and pass it off, but there was no way they had the money to implement it, and it was, I felt that’s probably the only one I felt I felt bad about, not in part because I didn’t have the time and budget to do the quality of work I would have liked, and in part I thought it was a reasonable project. I’ve had projects go away that I thought, “Good, it should go away,” and I don’t feel bad about those, or never materialize where we’d win an engagement and they kind of say,
[00:13:53.53] Jim: But yeah one that comes to mind for me is I didn’t have any say over whether it should continue or not again I was staffed to it and it was very much related to what I you know the first one I mentioned but it was completely different in that a state had decided that their Medicaid workman’s comp reimbursement system and a local Blue Cross Blue Shield that did work for the state benefit system. the state legislature said all three of those will use the exact same system, and since it was a political decision, the state staff couldn’t overturn it, and I worked for a partner who had a very large revenue stream coming from this project. but it everyone knew it was going to fail because systems are based on policy and rules and Those those three programs did not have any intersecting policies or rules to work with They were all as different as different could be and yet they wanted us to automate it into one system, and we said, “At best, you’re going to have three systems, and you could put it under an umbrella and call it one system,” and it, the whole thing just failed.
[00:15:33.87] Ken: That’s a topic for another time. We’ve all, we’ve seen that where political solutions are forced on it. But overall, you know, I think the bottom line here, if we were speaking to consultants is probably the majority of your solutions are not long-term. Generally, they’re there to address a political or funding, let’s call those the same thing, a political need, and if you get a win, feel good about it, you know, get something that’s long-term solution, feel good about it, because I think they’re fairly rare. any concluding remarks on your part?
[00:16:12.97] Jim: No, I completely agree. If you get even a few of those in your career, great, that’s wonderful, but I wouldn’t expect it.
[00:16:22.82] Ken: But don’t be discouraged. I mean, you’re there for a reason, and even if the reason is a temporary political, you know, dealing with tension, political issues, which most of them are, there’s some value in that, just not kind
[00:16:35.21] Jim: of a long-term solution. Yeah, yeah, that’s just not the nature of the consulting business, I don’t think.