The Affordable Care Act (ACA) mandates that health insurance companies pay for preventive health visits. However, that term is somewhat deceptive, as consumers may feel they can visit the doctor for just a general checkup, talk about anything, and the visit will be paid 100% with no copay. In fact, some, and perhaps most, health insurance companies only cover the A and B recommendations of the U.S. Preventive Services Task Force. These recommendations cover such topics as providing counseling on smoking cessation, alcohol abuse, obesity, and tests for blood pressure, cholesterol, and diabetes (for at risk patients), and some cancer screening physical exams. BUT if a patient mentions casually that he or she is feeling generally fatigued, the doctor could write down a diagnosis related to that fatigue and effectively transform the “wellness visit” into a “sick visit.” The same is true if the patient mentions occasional sleeplessness, upset stomach, stress, headaches, or any other medical condition. In order to get the “free preventive health” visit paid for 100%, the visit needs to be confined to a very narrow group of topics that most people will find vert constrained.
Similarly, the ACA calls for insurance companies to pay for preventive colonoscopy screenings for colon cancer. However, once again there is a catch. If the doctor finds any kind of problem during the colonoscopy and writes down a diagnosis code other than “routine preventive health screening,” the insurance company may not, and probably will not, pay for the colonoscopy directly. Instead, the costs would be applied to the annual deductible, which means most patients would get stuck paying for the cost of the screening.
This latter possibility frustrates the intention of the ACA. The law was written to encourage everyone – those at risk as well as those facing no known risk – to get checked. But if people go into the procedure expecting insurance to pay the cost, and then a week later receive a surprise letter indicating they are responsible for the $2,000 – $2,500 cost, it will give people a strong financial disincentive to getting tested.
As an attorney, I wonder how the law could get twisted around to this extent. The purpose of a colonoscopy is determined at the moment an appointment is made, not ex post facto during or after the colonoscopy. If the patient has no symptoms and is simply getting a colonoscopy to screen for colon cancer because the patient has reached age 45 or 50 or 55, then that purpose or intent cannot be negated by subsequent findings of any condition. What if the doctor finds a minor noncancerous infection and notes that on the claim form? Will that diagnosis void the 100% payment for preventive service? If so, it gives patients a strong incentive to tell their GI doctors that they are only to note on the claim form “yes or no” in response to colon cancer and nothing else. Normally, we would want to encourage doctors to share all information with patients, and the patients would want that as well. But securing payment for preventive services requires the doctor code up the entire procedure as routine preventive screening.The question is how do consumers inform the government of the need for a special coding or otherwise provide guidance on preventive screening based on intent at time of service, not on subsequent findings? I could write my local congressman, but he is a newly elected conservative Republican who opposes health care and everything else proposed by Obama. If I wrote him on the need for clarification of preventive health visits, he would interpret that as a letter advising him to vote against health care reform at every opportunity. I doubt my two conservative Republican senators would be any different. They have stand pat reply letters on health care reform that they send to all constituents who write in regarding health care matters.
To my knowledge, there is no way to make effective suggestions to the Obama administration. Perhaps the only solution is to publicize the problem in articles and raise these issues in discussion forums
There is a clear and absolute need for government to get involved in the health care sector. You seem to forget how upset people were with the non-government, pure private sector-based health care system that left 49 million Americans uninsured. When those facts are mentioned to people abroad, they think of America as having a Third World type health care system. Few Japanese, Canadians, or Europeans would trade their existing health care coverage for what they perceive as the gross inequities in the US Health Care System.
The Affordable Care Act, I agree, completely fails to address the fundamental cost driver of health care. For example, it perpetuates and even exacerbates the tendency of consumers to purchase health services without any regard to price. Efficiency in private markets requires cost-conscious consumers; we don’t have that in health care.
I am glad the ACA was passed. It is a step in the right direction. As noted, there are problems with the ACA including the “preventive health visits” to the doctor, which are supposed to be covered 100% by insurance but may not be if any diagnostic code is entered on the claim form.
Congress is so polarized on health care that the only way to get changes is with a groundswell of popular support. I don’t think a letter writing campaign is the correct way to reform payment for the “preventive health visits.” If enough consumers advise their doctors that this particular visit is to be treated solely as a preventive health visit, and they will not pay for any service in the event the doctor’s office miscodes the visit with anything else, then the medical establishment will take notice and use its lobbying arm to make Congress aware of the problem.
COMMENT: Should there not be an agreement up front between both parties on what actions that will be taken if said item is found or said event should be seen or occur? Should their be a box on the pre-surgical form giving the patient the right to denying the doctor to take proper action (deemed by whom?) if they see a need to? Checking this box would save the patient the cost of the procedure, and give them time for a consult. If there is not a box to check, why isn’t there one?
There are two separate questions posed by the checkbox election for procedures. First, does a patient have a legal right to check such a box or instruct a physician/surgeon orally or in writing that he does not give consent for that procedure to be performed? The answer to that question is yes.
The second question is does it serve the economic interest of the patient to check that box? For the colonoscopy, in theory the patient would get his or her free preventive screening, but then be told the patient needs to schedule a second colonoscopy for removal of a suspicious polyp. In that case, the patient would eventually have to pay for a colonoscopy out of pocket (unless he had already met his yearly deductible), so there is no clear economic rationale for denying the physician the right to remove the polyp during the screening colonoscopy.
But we are using the much less common colonoscopy example. Instead, let’s return to preventive care with a primary care doctor. Should a patient have the right to check a box and say “I want this visit to cover routine preventive care and nothing more”? Certainly. There is way too much discretion afforded physicians to code up whatever they want on claim forms such that two physicians seeing the exact same patient might code up different procedures and diagnostics for the exact same preventive health screening visit.
When I expect to receive a “zero cost to me” preventive screening, I do not imply that I am willing to accept a “bait and switch” change of procedure and payment due to the doctor from me. The “zero cost to me” induces consumers to go to the office visit; it is actually paid for out of the profits earned by the health insurance firms to whom consumers pay monthly premiums. Consumers need to hold doctors financially accountable for their claim billing practices. If you are quoted a “zero price” for a visit, the doctor’s office better honor that price, or it amounts to fraud.
It is all too easy to find any little old thing to justify billing a patient for a sick visit instead of a wellness visit. However, it is up to the patient to prevent that kind of profiteering at his or her expense.
It would be wonderful if HHS would give carriers the proper code or specify that other diagnostic codes cannot negate the preventive screening code used for a wellness visit. That is not happening now. DHS has been bombarded with so many questions and suggestions for health care reform that the department has a fortress like mentality. So realistically, consumers cannot expect DHS to address the coding issue for preventive health screenings any time soon. That leaves the full burden to fall on each consumer to ensure the doctor’s billing practices match the patient’s expectations for a free preventive health office visit. I investigated the web site and discovered some inconsistencies. For example, the site purports to list the services covered under the “preventive health” coverage benefit, yet it omits the annual physical exam. Also, the site states that colorectal cancer screening are provided for people age 50 or older. However, I have been advised in writing that United Healthcare will cover preventive screening colonoscopies for people under age 50. In essence, that government web page is a good start to learn about preventive health care benefits, but a better source would be each consumer’s own health insurance carrier. For those with temporary insurance or who are without any insurance coverage, unfortunately, the preventive health benefit of the ACA will not have any practical consequence.
Where will the money come from for the preventive health screening visit to a primary care doctor as well as the screening colonoscopy? We have to look at different scenarios. If the patient indeed has preventive health screenings with no other medical diagnoses, then the patient will be charged $0 for these services, and they will be paid for by the insurance carrier. The insurance carrier will pay these costs out of its operating income or profits. There is simply no other source for payment. The government has not offered to pay the insurance companies for these services.
If the patient is hit with various medical diagnostic codes during these preventive health screenings, then he or she will pay his customary charge for the primary care doctor’s office visit and the contract-negotiated price for the diagnostic colonoscopy. In that scenario, the consumer will be paying most of these costs, although the visit to the primary doc may be limited up to any applicable copay amount.
It is not a big shock or surprise to say preventive health care is going to be borne by health insurance carriers. The extent to which these carriers can pass along costs to consumers through higher rates depends on the degree of competition in their markets. Ehealthinsurance.com advises me that for the vast majority of states, the insurance carriers have NOT been able to shift these costs onto consumers through higher rates. That may change in 2013 or 2014. However, the trend is clearly moving in the direction of more power for consumers, more options and carriers available to supply health insurance in their states, which means greater competition and lower prices.
Deciding to start a business can be one of the most exhilarating decisions you make in your life. We are living in a world wherever everyone wants to make extra money and add to his income. Most people have achieved this by acquiring great business ideas. When one starts up a company, he must be ready to meet competition. It is important to note that you would not need to become rich or popular to succeed in business but have to think smartly. But there are a lot of moving parts and many different elements to consider.
10 basic tips essential to start a business successfully.
Tip 1: Get inspired and Love your idea
Every business begins with an idea you may have imagined of opening your own business for years, or motivation may have hit you suddenly. Nevertheless of the source, the first step of starting your own business is coming up with a business idea. And as important as your idea, you must in love with the idea.
Tip 2: Do Your Research / learn everything about the business
You’ve recognized your big idea, now it’s time to balance it with the reality. Are you truly ready to start a business? Answer the questions below and see what you need to prepare yourself for business. For a small business succeed it must fulfill a need, solve a problem or offer something the market wants.
You can identify this need in many ways by doing research, focus groups, and even trial and error.
As you search the market, some of the questions can be:
• Is there a need for your anticipated services or products?
• Who needs it? (Target Costumers)
• Are there other companies offering similar services or products right now?
• How is the competition?
• Can or how will your business fit into the market?
Tip 3: Make a Business Plan
You need a business plan in order to make your business idea a reality. If you expect to seek monetary support from an investor or financial organization, a formal written business plan is a must.
Even if you don’t need monetary support, a simple business plan can give you precision about what you hope to accomplish and how you plan to do it.
In overall, your business plan should summary your business goals and the inspiration behind them, as well as your plan for realization of your goals in terms of marketing and funding.
Tip 4: Planning Finances
Opening a small business doesn’t have to involve a lot of money, but it will involve some investment.
There are a number of methods you can fund your small business:
• With Small business grants
• By Financing
• With Small business loans
• Or Angel investors
You can also attempt to get your business off the ground by bootstrapping, using as little capital as necessary to start your business.
Tip 5: Business Structure
Your small business can be an individual ownership, a partnership, a limited liability company (LLC) or a corporation. The business structure you might choose will impact in many factors from your business name, to liability, and how you file your taxes.
You can choose an initial business structure, and with time re-evaluate and change your structure as your business grows and needs to be changed.Tip 6: The Business Name
The name you choose plays a role in almost every aspect of your business, so you want it to be a good one. Make sure you think through all of the possible consequences as you explore your options and select your business name.
Once you have selected a name, there is the need to check if it’s trademarked, currently in use and if stills free you will need to register it. A individual proprietor must register their business name with either their state or county clerk. Corporations, LLC, or limited corporations usually register their business name when the creation paperwork is filed.
These days you need to have a website, so please don’t forget to register your domain name once you have selected your business name. The best domains and more valuable online are the ones ending with .com.
Tip 7: Licenses and Permits
There are a range of small business licenses and permits that may apply to your situation, depending on the type of business you are starting and where you are placed. You will need to inquiry what licenses and permits apply to your business during the initial process.
Tip 8: The Business Location
Setting up your place to work is essential for the operation of your business, whether you will have a home office, a shared or private office space, or a retail location. You will need to reflect about your place, equipment, and overall setup, and make sure your business place works for the kind of business you will be doing.
Tip 9: Accounting System
One of the most essential systems for a small business is an accounting system. Your accounting system is essential in order to build and manage your budget, set your charges, conduct business with others, and file your taxes. You can set up your accounting system by your own, or hire an accountant to take away some of the work.
Tip 10: Promote Your Small Business
As soon your business is up and running, you need to start attracting customers. You’ll want to initiate with the essentials by writing a single selling offer and building a marketing plan. Explore as many small business marketing ideas as you can so you to choose how to promote your business most successfully. Completed these business start-up actions, you will have all of the most important small business bases protected, and be prepared for small business success.
15 Business Ideas to Generate Extra Income
If you want or need to start a side job because you still need to wait a little bit longer to start your own business, here are 15 suggestions for you.
1. Make money Blogging
If you enjoy writing, find a theme you’re passionate about and start a blog dedicated to covering that theme and anything else interesting you enjoy to talk about. All you need is a laptop, some time, and inspiration to consistently write. It can start as a hobby and turn into a business over time. Creating a blog is free, but if you want to look professional it can cost less than $ 12 per month.
2. Buying or selling on eBay
Thanks to internet there are more opportunities to make money than ever to buy and resell products for extra money. There are lots of people buy at a discount and resell them on eBay for profit.
3. Freelance writing
If you’re great with words, you might be capable to find some work as an online freelancer. A variety of publications need online content in the form of product, stories, service descriptions, and reports, and if you have the talent and ability, you could easily be the one to create them. Luckily, all you need is a computer and Internet connection to get started. You can start here freelancer.com
4. Social media expert
Now a day almost everyone uses Facebook, Twitter, and Pinterest, but did you know that many companies are willing to compensate people to support them managing their social media accounts and sometimes you can do it part-time from home. If this appeals you, to find social media jobs you can start by writing companies with a social media presence and visiting sites like Elance.com for opportunities.
5. Proofreading and editing
Do you have strong English skills and outstanding grammar? You may have chances to work as a proof-reader from home. Marketing for this can be hard; seek out those who might actually be able to use your services and advertise directly to them.
6. Virtual assistant
Many companies and individual professionals like having someone who can check and answer their email, organize task lists for them, someone who can update their calendars, and perform other administrative tasks, with minimal communication. The best of being a virtual assistant is that you can offer this service from home with a good Internet connection.
7. Website design
If you know a little bit about web design you can approach small businesses in your community, as they could use a very basic web presence to tell others about their business. These businesses usually don’t have a large budget for websites and create a great yet simple website is for you, get a bunch of clients from your local community, create sites for them, and maintains them for a small fee. You can easily get enough businesses to have a nice side business of your own with a low investment.
8. Affiliate marketing
Certain types of online businesses will pay you to promote their products and encourage sales. If you’re interested in learning more, check out affiliate marketing programs such as Click-bank, Commission Junction, and these websites are trustworthy and you can earn money by posting their products in your blog, website or Facebook. The secret of online business is all knowing targeting the right public and marketing efficiently. It can be overwhelming with all the information available online as more than 50% of the information is just a waste of time.
9. Become a business or life coach
If you are a good speaker and passionate about the business world and able to inspire and encourage others in a unique way, you could marketing your services as a business or even a life coach. Take your passion and expertise to the next level giving advice and suggest actionable steps people can take to progress their professional and private lives. 10. Start a resume writing service
If you’re excellent at writing remarkable resumes that in the end result in people getting the job, contemplate advertising those services. Most of your work will spin around writing, editing, designing, and proofreading, so you will only need few supplies outside of your computer and basic software to get started.
11. App Developer
Web app development is the creation of application programs that reside on remote servers and are delivered to the user’s device over the Internet. Now a day you can do apps with software’s you don’t really need to be a weirdo to do it, you can be an app developer for Facebook for instance and of course you can do it part-time and home based.
12. Business Consultant
If you are high organized and skilled being a good problem solver this job is for you. Companies bring Business Consultant to identify their problems, provide solutions and optimize companies. The only investments are your skills.
13. Data Entry Service
Many companies and online businesses require some type of manual information tracking, creating a vast amount of data entry work. Although there are many work-at-home scams related with data entry work, there are a lot of genuine chances available for genuine data entry businesses. If you are an excellent typist with an eye for detail, a data entry business is a great idea for you.
14. Freelance Writer
If you have the skill to write and inform people in a certain area, you can write small books or guides and sell them online, the biggest books platform is Amazon.com, where you can display your books for free and when they are sold, you will receive a percentage from the selling. Payments are made every month depending on your sales. Investment is only your time to write and imagination.
15. Internet Researcher
The Internet provides a vast amount of information. If you can quickly and efficiently navigate through that wealth of information, and essentially find a needle in a haystack, you can create a very successful business as an Internet researcher. Search for this kind of job online or about a company which is looking for this of service.
I give you only a glimpse what you could do, and these are just a few ideas, but many ideas were left behind.
First of all I advise you to think what you like to do as a hobby or in your free time, why don’t you make profit from what you are doing already?
You have the world as your disposal, but for a business to work out the first thing from all things is, it doesn’t matter what you intent to do, but you have to love it. If you love what you do it doesn’t feel like a job, you will be doing it with joy and this way you will be successful.
There are some side business opportunities that have grown more common in the past few years. And thanks to internet you have much more opportunities, ideas and help to develop your business.
The trail is an easy hike with fairly manageable switchbacks and is located at the Eastern Blue Ridge to Cooper Creek Recreation Area. Expect to see forests and a stream along the way. The whole stretch takes about 2.5 miles and the trail is easy to moderate. The trail starts at the parking lot about 0.3 miles from FS 236 and is marked by orange blazes. Some spaces at the FS 236 area are also allocated for campers. Regular army training exercises are done here so it is recommended to call Camp Frank D. Merrill in Dahlonega for the schedule of activities.
Cooper Creek Trail is about half a mile from the start of the trail which connects the trails for Mill Shoals and Yellow Mountain Trail. The footpath continues to an old roadbed and moves along the north side of the Yellow Mountain. At that point, the path follows the Mill Shoals Creek which is about 1.4 mile on the hike where you will pass by two rivulets. The Mill Shoals Trail has been rerouted where the trail ends at Duncan Ridge Road (FS 39) at the Shope Gap and forms a loop at the section of the Yellow Mountain Trail. From the start of the trail, the footpath ascends through a white pine and oak forest and emerges easily to the Cooper Creek Scenic Area on its northwestern edge. Then it turns into gradual and steady switchbacks as you continue around 0.7 miles before reaching Mill Shoals Trail at the top of a spur ridge. On this junction which is 0.7 mile on the hike, a blue-blazed trail sign informs that you are already at the Cooper Creek Trail. The path continues on an old roadbed on the right as it makes an easy ascent to the junction of Yellow Mountain where the Yellow Mountain trailhead is located.
Pace straight ahead to the path to Mill Shoals as it makes a descent onto a hardwood cove. There are American chestnut stumps in the area while other trees have already taken its place. You will then emerge out from this forest about 0.9 miles on the hike and continue to make a descent to an old logging road. The footpath makes a right turn and followed by a quick downhill switch to the left off the road towards Mill Shoals Creek. Cross two streams as the path follows through lines of tall white pine trees. The path then continues to pass along an old roadbed and sets onto Duncan Ridge Road (FS 39).At this point, the view offers a magnificent scene of Cliff Ridge and the Beebait Knob from a distance. The trail then turns right and continues to FS 39 for another mile onto Shope Gap at the FS 39 and old woods road junction. Then loop back by turning right towards the woods road by following Shope Gap Trail’s green blazes.
Curtains for 2008 are coming down in few days from now and if you see the developments the years witnessed, for instance the latest technology gadgets of 2008, it had been all complex devices that could perform intensive and incredible tasks. These latest gadgets 2008 are indeed with simple designs and several of them even user friendly, iPhone is one for sure. Most of the so-called latest technology gadgets are uni device multiple task performers. In fact the advent of nanotechnology enabled to device smaller gadgets that perform several functions while being nano in size. So said, it should be admitted that most of the latest electronic gadgets are designed for comfort, safety and weekend entertainment area. Iphone has revolutionized the communication and in fact changed its face and the latest technology gadgets of 2008 has given us the Apple 3G which is the world’s first multi-touch screen gizmondo. Other high-end gadgets include the tablet PCs, electronic medical equipment, Bluetooth calls, mobile entertainment devices, voice commands and visual/audible traffic rerouting as well as complex car systems with GPRSs.
And did I mention about the accelerometer sensor used in the iPhone technology and other high-end handsets? The technology enables a phone to rotate its image automatically when it is turned sideways. Another technological advancement is the ambient light sensor that detects changes in the light conditions and adjusts the display brightness automatically and the proximity sensor senses things that are larger than fingers when they come close and turns off the display in order to save power and accidental key presses.
In the healthcare industry, one of the major developers of latest gadgets in technology in 2008 had been Philips. Cliniscape is used to keep updates of each patient’s health condition by providing uses information of blood containers, medication and others. It is from the Philips and is used as a mobile point of care device in order to access medical applications such as iSite PACS medical image, clinical information Portfolio and information management system. And the latest computer gadgets in the field of education is the XO laptop which can be used at anytime and any place. Another innovation is the TI graphing calculators that can be used to solve complex math-related calculations. These calculators have large 3.5-inch display and more familiar mouse-like controls and spreadsheet capabilities, etc. The MacBook Air is the world’s thinnest laptop is another innovative product and a run away hit during 2008. The laptop is again by the iPhone manufacturers, Apple. The latest auto gadgets include car GPS, Bluetooth car starter, ozone air purifier, Driv-e-mocion and LED rims, etc.
Ever wondered what a well-planned and deployed business intelligence project can do for your business without all the challenges? By now if you’re not aggressively mining your data you’re not only leaving money on the table, you’re falling behind your competitors. Looking for basic aberrations and trends in data for sales, marketing, operations and customers is second nature to most companies. This will help you tread water for a time but did you know you unlock exponential value to your data once you reach cross functional, role based, and collaborative analysis which enables iterative business process improvement?
The challenges to operative data visibility are pretty easy to identify in a company. Do any of these ring a bell? You have a thousand spreadsheets stored on your network and different departments may have different values for the same measure? The executives have clear objectives and have a strategy but if you ask an individual contributor there is only a vague notion of what they are, or are pursuing their own department objectives? You have data, a vision for analyzing your marketing or industry metrics but your IT department takes so long to assist with setting up the reporting tools and infrastructure that it becomes irrelevant before you can act?
But let’s back up a little and first understand what business intelligence is in the first place. There are a lot of terms thrown around like analytics, ad hoc reporting, data warehouse, key performance indicators and forecasting to name a few. If you ask ten people you’re likely to get 20 answers to the same question. The fact is, business intelligence applied in a business environment is an ecosystem of both technical and business factors that drive performance in an organization aligned to strategic objectives. The business components like strategy mapping, business process improvement and collaboration are just as important to the technical reporting, warehouse and ETL tools.
The actual process for running or starting a business intelligence project is a prescriptive methodology that is very different from other types of projects and as such there are best practices based on the size of the organization, vertical, maturity, objectives and processes being measured. In some ways it’s both an art and a science.
In short form, you’ll thoroughly understand your company’s objectives and how your department fits into that story. Then analyze the different processes in your company that affect those performances. Determine the measures within those processes that can be affected by managing their performance. These should be as far back in the process as possible which we call leading indicators, those which can be changed before the results are locked into your balance sheet. Then on the business side you’ll start your internal marketing campaign, yes internal. And at the same time start to round up the data for your analysis. And this is when the real work begins!Though the following tips are not exhaustive or definitive, they are certainly some traps that a lot of organizations fall into while stepping up the BI Maturity Ladder from basic operational and transactional reporting to immersive and responsibility based performance management.
Executive sponsorship is critical but so is employee buy-in
Ever heard the term, “you can’t push a rope”? Leadership can have the greatest plans for moving the business forward but unless each and every contributor to the processes that affect the outcome have bought into the mission and actively participate, the movement won’t get very far. Yes you can use the hammer and tie incentives to performance immediately instead of over time for which you will receive immediate backlash as a result. Or better yet positive reinforcement by making progress and goals at a high level visible and celebrated for all to see and introduce some cross department competition on conformed measures. A good leader inspires the best in people, not the worst.
Pro tip: Leadership should make every effort to communicate not just on the metrics but also adoption and accuracy.
Drive vertical then go horizontal
Lofty enterprise goals are very hard to implement across an organization, it requires massive amounts of cooperation amongst departments to define measures, setup architecture and extract from complicated source systems which can be expensive. Instead start with one process that, for example, drives one channel of your sales funnel and then drive that vertical to the individual contributor level in the form or actionable reporting, “Here are the clients that need to be called today for satisfaction feedback”. In this way you can start to see immediate results and use it as a template to implement in your organization for other processes and departments.
Pro tip: Setup a regular BI governance and education roundtable meeting to foster communication and iterative improvement among the BI stewards at all levels.
Stay focused on the business drivers, not the technical hurdles
There is an odd dichotomy to business intelligence depending on your business or technical background. If you are a business person maybe you’ve heard of the Kimball methodology for data warehouse design. If you haven’t that’s okay but that’s what your IT professionals are using to build out your backend data repository and this may not always provide the data in the form that you need from a business perspective. It is an object oriented approach to data that, depending on the complexity of the data sources, can take months or years to develop and deploy. If your organization needs to be nimble shouldn’t you be able to make decisions faster than that? To overcome this as a business user, start with a coherent set of sample data and then prototype what you want in your role-based reports and dashboards, including objectives and goals. You should define the calculations, granularity, security, availability and as much agreement from business leadership as you can before approaching IT. Your month long sprints should include visible deliverables back to the business even if they are very small iterative improvements.
Pro tip: Your business intelligence architect is the best translator between business and IT, they will make this communication much easier.
Organizational change and data visibility is unsettling
When you first begin your BI initiative you will probably begin with interviews to better understand your processes from the different subject matter experts and data stewards. Through these interviews it will be pretty easy to spot who is not on board with your project. Everyone is busy and it’s not easy to squeeze out more time for yet another “pet” project of the higher-ups. Not to mention it may require change to already overburdened workers who are trying to do the best they can with less budget and time. But there can be other reasons as well, data visibility can expose weaknesses or mitigate control over a certain functional area. On the positive side, data visibility can also expose strengths and opportunities which may be leveraged in other areas. Once again, focusing on the ultimate objectives, clear an honest communication and support from the executive team is essential to moving through road blocks. The challenge is to make the change process as positive as possible for all involved. Rapid and successful improvements in processes leading to better metrics will help show value and increase confidence in the initiative.Pro tip: During requirements be sure to measure the current state process in terms of hours or cost or opportunity and then the improved state so later you can show your BI on BI in the form of ROI.
Don’t exclusively focus on financial metrics
At the end of the quarter or year it’s not uncommon to get a report on sales revenue, cost of goods sold, other expenses and profit. But by the time these are realized whatever variables led to these metrics are impossible to change for the current timeframe. You could only look in your rear view mirror for potential fixes to be applied to the next quarter or year. The goal should be to develop an early warning system amongst your operational, customer and employee metrics where if changes are made early enough you would still have time to moderate the effects. Think of your processes as a linear timeline that may intersect other processes. For example, if the goal is to reduce customer acquisition cost by increasing customer retention you might measure employee support training or development speed on customer requested functionality. Both of these processes affect financial performance but the leading indicators allow for much earlier identification and improvement prior to their impact on the bottom line.
Pro Tip: Use what-if scenarios to determine the highest impact leading indicators and set your goals. Indicators can be rated on impact, probability and complexity. Also be sure that you are using key performance indicators and not metrics, KPIs are mostly measured using percentages, indexes and ratios.
So the takeaway from starting and progressing a business intelligence initiative in your organization can have challenges but they can be overcome. Get strong executive sponsorship and involvement, start with a vertical challenge that can provide the best ROI, deliver a role-based solution that can be quickly deployed, understand that change and data visibility can be unsettling so make it a positive experience and finally, start with the financial metrics you want to improve but then identify as far back in the processes as possible those metrics and roles that affect them.
Eight Tips for Getting Started in Real Estate Investing
This article is just the basics for getting started in real estate investing. This is not a how to article but an article that gives you some information about things to do to get started. Everything in this article is tools that can be applied to helping anyone get started in real estate investing. I am going to give you my eight keys to getting started. Nothing is right or wrong but reflects the point of view of the author. Laws and legal practices vary from state to state, and laws can change over time. The author does not vouch for the legality of his opinions, nor is there any intent to supply legal advice. The author strongly encourages the reader to consult with professionals and an attorney prior to entering in any real estate transaction or contract. The author is not a writer but he is a real estate investor. There will be grammar mistakes and errors, so don’t be too critical of the grammar but focus your energy on what is being said. With that said prepare yourself to think a little differently and expand your mind. Let’s get started on an amazing adventure.
The Eight Tips are as follows
2. Goal Setting
3. Learning What To Do
4. Attending a Real Estate Investing Seminar
5. The Billings Montana Market
6. Finding a Mentor
7. Your Real Estate Team
8. Just Do IT
Before we get in to the bolts and nails of real estate investing in I want to talk to you about desire. If you are going to be successful at anything in life including real estate investing you have to have the desire to do it. Desire is defined as longing or craving, as for something that brings satisfaction or enjoyment. Desire stresses the strength of feeling and often implies strong intention or aim. In real estate investing if you don’t have a desire to learn and grow as a human being and really get satisfaction out of it, then real estate investing is going to be hard to do. When I go out and look at a property it brings me a lot of enjoyment. Every aspect brings me joy from talking to home owners, figuring out how I can make a deal work, to buying the house and to finding a good homeowner or tenant for the house. Real estate investing may not be for everyone but real estate investing can offer anyone the financial freedom we all crave for. If you do not have the desire for real estate investing that is ok, it can still help you to live your dreams and help you to get where you want to go in the future.
Why is real estate investing an amazing avenue for anyone to live out all of their dreams? Let me ask you a few questions. Do you have enough money to do anything you want? Do you have everything you want? No debt? A nice house? Great Marriage? The freedom to do anything regardless of how much it costs and the time it takes? If you have all of these things then you are one of the few people in America who does. Most people may be working fifty hours a week and making just enough to pay their bills. In today’s day and age most people are living pay check to pay check never really knowing if they will make enough to pay the bills that just keep piling up. If you cannot keep up with your monthly bills how are you going to plan for retirement or send your kids to college or have time to enjoy life. The answer to all of these questions is becoming financially free. Now it’s not going to be easy everyone will have to get off the couch and out of their comfort zone. Real estate is proven to be one of the fastest ways to get your out of the rat race of the nine to five and begin living the life you deserve to live. Everyone wants something different out of their life. Some dream of traveling the world, spending more time with family, volunteering, golfing, laying on a beach, giving back to the community, or anything that will make them happy. There are thousands of things that make people happy.
Making it in real estate takes a person who has a strong desire to change their lives for the better and think big. Anyone can become a great real estate investor. It is going to take a lot of work and can be a struggle at times but in the end it will be the most amazing feeling ever. The people that make it in real estate investing all have a few things in common. First they run their real estate investing business like any other business out there. Second they get out there and network with anyone and everyone. Some people might be like me and have a hard time talking to other people. If you are that is ok, anyone can learn how to become a people person, it just takes hard daily work. You have to push yourself past your comfort zone. The third thing is that you cannot be afraid to fail. Everyone has failed at something but the most successful people out their learn from their failures. The fourth thing is that you have to put a good team together. I will go into putting a team together in a later chapter. The concept of putting a team together is so that when you don’t know something you have team members that know what to do and can help you with questions. The can also make sure that you are not working yourself to death. You do not want to be the person doing everything in your business. Doing everything is a receipt for failure. You have to put together good people who you can trust and rely on. The fifth thing is that you need a mentor. Sixth and final is the desire to do it. No one can become successful at something if they don’t want to do it and don’t get satisfaction out of what they are doing.
2. Setting Goals
Having goals is one of the most important aspects of achieving what you want in life. You don’t want to just have your goals up in your head you want to write them down and past what you have wrote on the wall somewhere or in the bathroom mirror. You want to review your goals daily and read them out loud to yourself. This way you remind yourself everyday why you are building your business.
How should you start to write down you goals? First off you should think big, and by big I mean HUGE. If your goals are too small you will easily achieve them and have nothing else to look forward too. You should start off by asking yourself the question if I had all the money and time in the world what would I do, what would I buy, how would I spend my time, and how would I spend my energy. Are you starting to write these down? Well you should be. Think about what you want, spending time with family, traveling the world, the best cars, a castle, owning a small country, running for president, having the biggest real estate investing business in your area or in the country. Whatever your dreams and what you want out of your life, write it down. Some of my goals are becoming free, traveling the world, having a Ferrari, having 10 vacation homes all over the world. Right now I am just trying to get you out of your comfort zone of thinking and let your imagination run. There are several ways to set goals. I have learned a lot of ways you can set you goals and there is no right or wrong way. The best ways that I have found to set your goals is to break them up into two categories. First your short term goals. This should be goals from a month out to around a year. The second is your long term goals these goals are you think big goals and what you see for your future.
For year one I like to first make a list of what I want to achieve this year and I will give you an example of how to do that. For year one you want to be very specific first you want to list what you want your income to be at the end of the year, next how much cash in the bank you want (this is money in your checking account, not assets). Next you want to list how much you are going to give. Giving is a very important, this can be giving to charity, giving of gifts to friends and family, giving to your school or anything you can dream of. As long as what you give brings joy to others who need it more than you. Next list what bad habits you have that you want to eliminate. Weather is be quitting smoking, spending too much on junk, drinking too much, working too much, not spending enough time with family, too much TV, not exercising and many more. We all have bad habits that need to be changed in order for use to grow as human beings. Under each of these bad habits list out some steps that you can take in order to quit them. If you bad habit is being lazy and not exercising enough what can you do to change that. Well you can get a gym membership or a home work out program. Commit yourself you following through with a plan to work out 3-5 days a week. For you to change these bad habits you have to be totally committed and follow through with a detailed plan you set for yourself. After you have your plans in place you should start listing several things you want to achieve or do in the next year. This can be start a successful business, spend time with family, travel to 2-5 places and so on. Now under each of these you should also write a detailed plan on what you need and what you need to do in order to achieve these goals. Finally you should take all of this information you have a write on page on what you see your life being over the next year. Doing this is a great exercise to really see what you want out of life.
Goals Year One
This is what I am going To Do This Year
Bad Habits that will be changes:
Over Sleeping 1. Go to bed at 11 p.m. 2. Use a timer and set it for 8 hours 3. Set the timer on the other side of the room
Buying things that you don’t need: 1. Going out shopping less 2. If you have the urge to buy something think to yourself is thing item going to help me to achieve my goals of becoming financially free? 3. Tell friends what you are doing, so they can help to stop you.
What I want to Achieve:
Start a successful Real Estate Investing Business: (you should write a detailed step by step plan of everything you need in order to achieve your goal)
Travel: Where do I want to visit? 1. Gators football game (what I need to do it, money, etc)
And last your own page about what you want to achieve using words like I will and only positive words.
For long term goals you don’t need to be as specific right now, but you should list them and under them list a few steps or smaller goals that need to be achieved before you are able to achieve them. With the long term goals always think big. Another good exercise for long term goals is to make a collage of you goals. Put pictures of the house you want on it, places you want to travel, a picture of your family, a number of what income you want in or anything you can think of.
Knowledge builds confidence and destroys fear. If you are starting any kind of business you need to learn the ins and outs of that business. The best way I have found to learn about real estate investing is to read all about it. But once you know it you have to apply what you have learned. Learning and reading is just one step to take. There are thousands of books on the market about real estate investing and everyone has something you can learn from. You don’t just want to read real estate investing books though. You also want to fill yourself with motivational and leadership books. Every successful person that I know if a reader and they all spend at least thirty minutes a day reading something that will teach them about improving their business or helping themselves to become a better person. Some of the best books that I would recommend reading are listed below.
1. Rich Dad Poor Dad by Robert Kiyosaki (read this first and also ready everything in the rick dad poor dad series, great books to start with and will expand you mind)
2. Be a Real Estate Millionaire by Dean Graziosi
3. Flip your way to financial freedom by Preston Ely (this is an E-Book)
4. Four hour work week by Timothy Ferriss
5. The Attractor Factor
6. Short Sale Pre-foreclosure Investing by Dwan Bent-twyford and Sharon Sestrepo
7. Keys to success, by Napoleon Hill
8. Think and Grow Rich by Napoleon Hill
9. How to win friends and influence people
10. Any Book by John C. Maxwell (he has tons of amazing leadership books)
11. Getting Started in Real Estate Day Trading by Larry Goins
12. The E Myth by Michael Gerber
13. How to be a quick turn real estate millionaire by Ron Legrand
14. The Power of Full Engagement
15. The It Factor
16. Anything by Anthony Robins
There are tons more you can read but these will give you a great start. You should also read books on negotiating, sales, motivation, and biographies on American business people.
I hope this list gives you the knowledge it has given me. If you learn and apply what you have learned from these books there is no reason that you should not become very successful.
4. Attend a Real Estate Investing Seminar
Attending a Real Estate Investing Seminar can be one of the best places to learn about real estate investing from some very well known experts. There are several seminars going on all over the country every weekend. If you live in a big city it will be very easy to find one. If you live in a town like Billings Montana you might need to travel a little ways to find one. Now most of the best meeting cost money to attend them. Some range from five hundred dollars for three days and some can be up to $20,000. There are a few that I would recommend. Than Merrill is a great speaker to go hear. I have learned a ton from him. You can find his company online by Google searching him. Also rich dad poor dad has seminars all over the country. I attended one of their seminars in Billings Montana for only $500 dollars and learned a ton from it. There is also Preston Ely, Larry Goins, and hundreds of speakers out there. If you find a great book that you really enjoyed, then just simple search for that person online and see if they are speaking somewhere or offer a seminar close to you.
Another reason I recommend going to a seminar is because they get you pumped up and motivated. I have not yet found anything else that just gets you feeling like you can do anything. When you get back from one of these seminars you will have tons of energy and knowledge. Every time I get back from one all I want to do is going out and do a deal or ten.
These seminars will also provide you with several opportunities to purchase amazing real estate investing tools, software or learning material at a fraction of the cost. Believe me when I tell you all of the low priced seminars try to sell you something. But a lot of times what they are trying to sell is some really good stuff.
Another reason to attend a seminar is to network with other investors and build relationships with them. You can meet other investors who you can partner with on a deal, sell a deal too, people who will provide you with deals and so on. You should have hundreds of business cards made up and try to give them all out. You never know how much one business card you hand out can make you.
5. Learn About the real estate market in your area
Most real estate investors start their career off my investing around where they live. This is why I do my real estate investing in Billings Montana. You can venture out when you have more experience. The reason behind this is because we feel more comfortable with the areas and know the areas better. It is also easier to get local real estate information that we need. Investing in your local market is also cheaper to start out, there is less travel costs, you can see what you are buying and it may give you a feeling a comfort.
First you have to decide which part of town is the best place to invest in. This can be determined by what kind of real estate investing you choose to do. I have not gone over the types of real estate investing but some include rehabbing (fixing up and selling), wholesaling (finding deals and selling them to other investors), buying to rent, and there are a few others. These are the real estate strategies that I use for the most part. When looking at the market you need to see where other investors are buying their houses. Most of the best deals will be found in low to middle class neighbors hoods. By low I don’t mean drug infested war zones, what I mean is blue collar safe neighbor hoods that might have somewhat older houses and houses that are not on the higher end price side. Now you can find deals in the higher priced neighbor hoods but most will be in the low to middle income neighborhoods. When looking where others are buying ask local realtors, other investors or appraisers.
When talking with investors ask them several questions such as what neighborhoods they prefer, what type of houses they buy (3 bed 2 bath), and what they do (rehab, rent, wholesale). You should not look at other investors as competition but try and work with them.
There are different types of markets such as appreciating markets, flat markets, and deprecating markets. Appreciating markets are markets that there is no enough houses or a very high demand for houses which causes the price of houses to go up. The reason there is a high demand for housing can be because of job growth, a very appealing area, or several reason. Flat markets are markets that have no or very little growth. This means that there is not a lot of demand; buy just enough to fill every ones needs. Depreciating markets are where there is a lot more houses than people to fill those house. This causes house prices to start going down. This can be because of a large employer leaving the area, a natural disaster or just over building. There is an old saying buy in a bust and sell in a boom. In depreciating markets you can pick up several deals, while in appreciating the house prices are going to be much higher and harder to find great deals. The deal will still be out there you just have to know where to find them.
Learning your market is another key to becoming successful. Real estate Brokers and experts in your area can be the best source of information for you. Learn to use them to find out what kind of market you are in. If you are in Billings Montana we are in a pretty stable market. Billings Montana has not seen the ups and downs that other markets have experienced. I will have to say that I have been noticing a little bit of a downward trend but not much. Once the first time home buyer credit is over with we might see a little more decline. Every market can vary by neighborhood, so make sure you know you market well. I have seen the same houses just one mile apart selling for totally different prices. 6. Find a Mentor
Having a mentor to help you can be your biggest learning experience. Mentors can help you with any questions you may have, walk you step by step through the investing process, give you moral support, you learn from their proven system, and also network you with others in the business. Every successful real estate investor that I know says they owe a lot of their success to the mentors they have and had in their lives. I have had one of the best mentors around, my father. He is teaching me something new every day and pushing me to become successful.
When trying to find a mentor I would suggest network with the investors at your local real estate investors club meeting. There is a real estate investing club in Billings Montana that meets once a month. You can find information about real estate investing clubs in your area by searching for REA or real estate investors club then your area in Google. When you go to the meetings ask around who the biggest investors are. Then ask if you could get together with them sometime and discuss real estate investing. Ask them if they would consider working with you to get their career going. Offer your services as a bird dog. Bird dogs are people who go out find deals or leads about deals and give them to other investors. A bird dog gets from $500 to $3000 dollars depending on the deal. Make sure that you have a bird dog contract signed with the investors saying that if you find them and deal and they buy it that you get paid a certain amount of money. Being a bird dog helps you to build credibility with the investor and they are more likely to mentor you if you have something to offer them. If you would like to contact me with a question go to my web site Big Sky Property Solutions LLC.
7. Your Real Estate Team
Building an effective team can make your life as a real estate investor a lot easier. You are only one person and cannot do everything or be an expert in every aspect of real estate investing. Going at a project alone can become one of the most frustrating experiences you will ever encounter. Many people have become frustrated and quite real estate investing because they try and juggle too many things. Make sure that when putting a team together you provide everyone with win-win opportunities. When someone knows that working with you is going to make them money they will put you as a higher priority on their list. But you have to prove it to them that you are the real deal.
People to have on your real estate investing team include
o Real Estate Agents ( find the top agent for volume of sales in your area and other agents who work with real estate investors)
o Real Estate appraisers (find an appraiser that has done a few hundred jobs or more and make sure they carry errors and omissions insurance)
o Real estate contractors (good rehab crews that can get the job done in a timely manner, have 3-5 crews and on every deal get 3 estimates done. Ask for referrals from them and make sure they are licensed)
o Real estate attorneys (every investor needs an attorney, they can help to protect your assets, make sure you find one that works with investors)
o A property management company (can manage your properties and will give you leads on property they are managing that might come up for sale)
o Title companies (take care of the legal process and make sure there are no liens against the property you are buying, choose one that does hundreds of closings a year)
o Home inspectors(charge about $400 but will give you a great inspection and could save you thousands in the long run)
o And your Mentor
All of these people can help you in various aspects of real estate investing. You might find that there are a couple others that are keys to your business but this is just a list of a few.
8. Just Do it
There is no better phrase out there then JUST DO IT! Once you have learned all you can networked with investors in Billings and learned real estate investing strategies there is nothing left to do but get your feet wet. There is no better learning tool out there then doing a deal. Once you have completed that first deal you will know what to expect and find out that it is not as hard as you thought it would be. You will have learned what you did right and what was frustrating. Take that experience and ask yourself what would have made it run smoother. Apply that to your next deal. Then the next deal will be easier and it keeps getting easier as you go. I will say that every deal is different from the last but that what makes this business fun. You have to be creative and always keep on learning and growing with your business.
The average person never uses what they learn. Don’t be average apply your knowledge. When going out and doing your first deal act like you have done 1000’s of deals. The fastest way to change a habit is to act like it is true.
Five keys for success
1. Specialized Knowledge
2. Tools of a professional
3. Have the mindset of a winner
5. Money and the knowledge of leveraging it (you don’t have to have millions to invest in real estate, there are many strategies out there to use other people’s money, or no money at all)
This is going to conclude this article about getting started in real estate investing. I hope this gave you some ideas about how you can get started. I didn’t give you any strategies at this point but look for some in upcoming articles. These are simple steps you can use to get started. If you read this article thank you for listening.
Introduction: We’re Not #1
I believe Americans need a new way of thinking about health. Look where our current perspectives on the subject have gotten us – we are last among the world’s 17 most industrialized nations in all the key indicators of health. It’s hard to believe but true: we’re last in life expectancy; we have the highest rates of obesity, infant mortality, low birth weights, heart disease, diabetes, chronic lung disease, homicide rates, teen pregnancy and sexually transmitted diseases.
The lead author of the Institute of Medicine, NIH sponsored study that revealed this situation remarked that “Americans get sicker, die sooner and sustain more injuries than people in all other high-income countries.” (That’s a quote from the report.) Then he added this coup de grace: “We were stunned by the propensity of findings all on the negative side – the scope of the disadvantage covers all ages, from babies to seniors, both sexes, all classes of society. If we fail to act, life spans will continue to shorten and children will face greater rates of illness than those in other nations.”
Two Ways to Think of Health
I believe Americans are overly passive about their health. Good health can only be attained and maintained by conscious deeds. These deeds require planning and disciple. Examples include exercising regularly and vigorously, dining in ways that nourish the body without causing problems and otherwise behaving in positive, active ways.
The level of health you will enjoy is clearly affected by your lifestyle choices. Your health status depends to a great extent on whether you invest in your well being or not. If you make little or no such investments, your health will depend on chance, genetics, the aging process and the timeliness of the quality of medical care you receive.
If, on the other hand, you do invest, if you seek, protect and defend an advanced state of well being, the nature of the health status you will have will be dramatically different – and better.
Therefore, we need to distinguish these two kinds of health situations – one passive, one active.
The Institute of Health report that places America last reflects that segment of America that is passive. If the quite small segment of the American population that practices active health were separated, if their health data were compiled and compared, I’m sure we would be #1. For these and related reasons, I propose we view health in two different ways – by making a distinction between static health – which is how most view and approach their health, and earned health. The latter is what you get when you invest wisely in your own well being.
It’s a way of life I call REAL wellness.
Health As Currently Perceived
The WHO definition of health is unrealistic (nobody, not even the most devout wellite, enjoys “complete physical, mental and social well-being,” at least not every day). Most think of health in far less exalted ways. Most think they are well if they are not sick. This is pathetic. It equates with not needing immediate medical attention. For the vast majority, this is a “good enough” view of health. Thinking that way is a self-fulfilling prophesy. It means that not healthy is the best you can hope for. This is the static definition of health and it must be reformed and at least accompanied by another, comparison perspective for those Americans willing to do their part. That would be earned health.
I think we need ideas about health that remind people of a key fact, namely, that a passive situation is not as effective, desirable, protective or rewarding as a dynamic earned state of health. We should all be aware that static health, the default setting you get for just existing and doing nothing special to enhance health, can and must be reinforced and boosted.
Employing a term like earned health might remind people that health can be much more than non-illness. The term earned health can signal the availability of a richer level of well being. It can remind everyone that health at its best is more than a static condition. Health is a dynamic state; it gets better with effort, worse if ignored.
Earned health represents a higher health standard. Earned health is more ambitious and more consistent with a REAL wellness mindset and lifestyle than the current norm of health as non-sickness.
The Static/Earned Health Continuum
This continuum is another way of expressing Dr. John Travis’ original, simple line drawing model of health along a continuum, with “premature death” on the far left side of his continuum) and an ever-changing dynamic of “high level wellness” at the other, right side extreme. The “0” in the middle represents a neutral point, which could be simple non-sickness.
The Static/Earned Health Continuum
-10 ______________ 0 ______________ +10
Earned health is what happens from the neutral point to the +10 indicator. Everyone moves along an imaginary continuum of this kind every day, because health is dynamic, under constant change. By living wisely with the right behaviors, we fuel a state of health that is better than if we allow health status to be determined by the passage of time (i.e., the aging process, chance, medical interventions, circumstances and events.
This continuum is a simple way of depicting the basic fact that earned health evolves largely due to our own efforts to improve and protect our well being; static health, on the other side is affected by what happens to you.
By the way, Dr. Travis made regular expansions to his original model. You can view the latest edition and read more the continuum here. A related construct that will interest wellness enthusiasts is Dr. Travis Wellness Energy System.
Earned health is not determined or advanced by medical interventions. Static health, that is, health along the continuum from the center to the left of the of the continuum, is so influenced.
The Path to REAL Wellness
To become healthier in an earned sense, it’s up to us to act so as to move along the right side of the continuum.
The failure to appreciate the different nature of health, earned from static, partly accounts for why America can have so much medical care and yet not enjoy the best quality of health status. After all, modern medicine is a wonderful thing but there are two problems: people expect too much of it and too little of themselves. Understanding the difference between static and earned health might encourage people to be less passive – to realize the need for and value of REAL wellness lifestyles.
Here is a fable to express the limits of medicine to boost health status versus the power of our own behaviors.
Imagine a country where everyone owns high powered luxury cars – they cost next to nothing and are easily replaced. In this mythical country, everyone gets unlimited free medical care of the highest quality, plus all the medications they need plus there are highly skilled trauma teams set up at every intersection. The thing is, the people in this mythical country can do whatever they like – there are no laws governing auto safety. Everyone drives way over the speed limits, nobody wears seat belts, there are no air bags and no stop signs, traffic signals or rules of the road. One more thing – brakes haven’t been invented yet.
Interpretation of the Fable
The greatest advances in the mythical society would not follow from introducing more doctors, hospitals, drugs or trauma teams. Changes in customs and driver behaviors would, on the other hand, go a long way to promote a healthier society.
Changes in lifestyles are also the key to better health outcomes in the real world, our country in particular. We have a great health care system – now we need sensible people making wise lifestyle choices that make life not just healthier but more rewarding, more fulfilling and more attractive. We need to help people understand that health is not only a static phenomenon: Earned health offers so much more.
The philosopher Epicurus (c. 341-270 BCE) offered this bit of wisdom long ago: “It is impossible to live pleasurably without living prudently, honorably, and justly; or to live prudently, honorably, and justly, without living pleasurably.”
We all want to live pleasurably. Let’s recognize and act on the other qualities that enable us to earn active positive health. Let’s embrace REAL wellness lifestyles.
While consumers search for affordable health insurance, they have price in their mind as the top priority. A general conception among the consumers is that cheap health plans should not be costly-the cheapest health plan available in the market is their target. However, this approach is not good. Sometimes, paying for a cheap health insurance plan but still not getting the required level of coverage results only in wastage of money.
With the implementation of the affordable care act, the reach of affordable health plans is set to increase. Or at least, this is what is believed to be the objective of healthcare reforms. However, lots of consumers are still in confusion about how things would work. In this article, we will discuss some detailed options that consumers can try while looking to buy affordable health plans.
To get a hand on affordable health insurance plans, consumers need to take of certain things. First among them is about knowing the options in the particular state of the residence. There are lots of state and federal government-run programs that could be suitable for consumers. Knowing the options is pretty important. Next would be to understand the terms and conditions of all the programs and check the eligibility criteria for each one of them. Further, consumers should know their rights after the implementation of healthcare reforms, and something within a few days, they may qualify for a particular program or could be allowed to avail a particular health insurance plan. If consumers take care of these steps, there is no reason why consumers can’t land on an affordable health plan that could cater to the medical care needs.
Let’s discuss some options related to affordable health insurance plans state-wise:
State-run affordable health insurance programs in California
While considering California, there are three affordable health insurance plans that are run by the state government. Consumers can surely get benefitted by these if they are eligible for the benefits. • Major Risk Medical Insurance Program (MRMIP)
This program is a very handy one offering limited health benefits to California residents. If consumers are unable to purchase health plans due to a preexisting medical condition, they can see if they qualify for this program and get benefits.
• Healthy Families Program
Healthy Families Program offers Californians with low cost health, dental, and vision coverage. This is mainly geared to children whose parents earn too much to qualify for public assistance. This program is administered by MRMIP.
• Access for Infants and Mothers Program (AIM)
Access for Infants and Mothers Program provides prenatal and preventive care for pregnant women having low income in California. It is administered by a five-person board that has established a comprehensive benefits package that includes both inpatient and outpatient care for program enrollees.
Some facts about affordable health insurance in Florida
While talking about affordable health insurance options in Florida, consumers can think about below mentioned options:
• Floridians who lost employer’s group health insurance may qualify for COBRA continuation coverage in Florida. At the same time, Floridians, who lost group health insurance due to involuntary termination of employment occurring between September 1, 2008 and December 31, 2009 may qualify for a federal tax credit. This credit helps in paying COBRA or state continuation coverage premiums for up to nine months.
• Floridians who had been uninsured for 6 months may be eligible to buy a limited health benefit plan through Cover Florida.
• Florida Medicaid program can be tried by Floridians having low or modest household income. Through this program, pregnant women, families with children, medically needy, elderly, and disabled individuals may get help.
• Florida KidCare program can help the Floridian children under the age of 19 years and not eligible for Medicaid and currently uninsured or underinsured.
• A federal tax credit to help pay for new health coverage to Floridians who lost their health coverage but are receiving benefits from the Trade Adjustment Assistance (TAA) Program. This credit is called the Health Coverage Tax Credit (HCTC). At the same time, Floridians who are retirees and are aged 55-65 and are receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), may qualify for the HCTC.
Some facts about affordable health insurance in Virginia
While talking about affordable health insurance options in Virginia, consumers need to consider their rights:
• Virginians who lost their employer’s group health insurance may apply for COBRA or state continuation coverage in Virginia.
• Virginians must note that they have the right to buy individual health plans from either Anthem Blue Cross Blue Shield or CareFirst Blue Cross Blue Shield.
• Virginia Medicaid program helps Virginians having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, and elderly and disabled individuals are helped.
• Family Access to Medical Insurance Security (FAMIS) helps Virginian children under the age of 18 years having no health insurance.
• In Virginia, the Every Woman’s Life Program offers free breast and cervical cancer screening. Through this program, if women are diagnosed with cancer, they may be eligible for treatment through the Virginia Medicaid Program.
Some facts about affordable health insurance in Texas While talking about affordable health insurance options in Texas, consumers need to consider their rights:
• Texans who have group insurance in Texas cannot be denied or limited in terms of coverage, nor can be required to pay more, because of the health status. Further, Texans having group health insurance can’t have exclusion of pre-existing conditions.
• In Texas, insurers cannot drop Texans off coverage when they get sick. At the same time, Texans who lost their group health insurance but are HIPAA eligible may apply for COBRA or state continuation coverage in Texas.
• Texas Medicaid program helps Texans having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, elderly and disabled individuals are helped. At the same time, if a woman is diagnosed with breast or cervical cancer, she may be eligible for medical care through Medicaid.
• The Texas Children’s Health Insurance Program (CHIP) offers subsidized health coverage for certain uninsured children. Further children in Texas can stay in their parent’s health insurance policy as dependents till the age of 26 years. This clause has been implemented by the healthcare reforms.
• The Texas Breast and Cervical Cancer Control program offers free cancer screening for qualified residents. If a woman is diagnosed with breast or cervical cancer through this program, she may qualify for medical care through Medicaid.
Like this, consumers need to consider state-wise options when they search for affordable health coverage. It goes without saying that shopping around and getting oneself well-equipped with necessary information is pretty much important to make sure consumers have the right kind of health plans.
Australians already know that health coverage can provide security for individuals and families when a medical need arises. Many, however, do not know how to find the best value when comparing health insurance policies.
Below are 10 tips everyone should read before shopping for private health coverage.
1. Choose coverage that concentrates on your specific health needs, or potential health needs.
The first thing you should do before comparing your health plan options is determine which policy features best fit your needs. A 30-year-old accountant, for instance, is going to need very different coverage than a 55year-old pro golfer, or a 75-year-old retired veterinarian. By understanding the health needs that most often correspond to people in your age and activity level group – your life stage – you can save money by purchasing only the coverage you need and avoid unnecessary services that aren’t relevant. For instance, a young family with two small children isn’t going to need coverage for joint replacement or cataract surgery. A 60-year-old school teacher isn’t going to need pregnancy and birth control-related services.
Whether it’s high level comprehensive care you’re after, or the least expensive option to exempt you from the Medical Levy Surcharge while providing basic care coverage, always make sure you’re comparing health insurance policies with only those services that make sense for you and your family.
2. Consider options such as Excess or Co-payment to reduce your premium costs.
When you agree to pay for a specified out-of-pocket amount in the event you are hospitalized, you sign an Excess or Co-payment option that will reduce your health insurance premium.
If you choose the Excess option, you agree to pay a predetermined, specific amount when you go to hospital, no matter how long your stay lasts. With a Co-payment option, you agree to pay a daily sum up to a pre-agreed amount. For example, if Joanne has an Excess of $250 on her medical coverage policy and is admitted to hospital, regardless of how long her stay turns out to be, she will pay $250 of the final bill. If Andrew has signed a $75×4 Co-payment with his provider, he will pay $75 per day for just the first the first four days of his hospitalization.
For younger individuals who are healthy and fit with no reason to expect to land in hospital any time soon, either of these options are great ways to reduce the monthly cost of your medical insurance premiums.
Keep in mind that different private insurers have their own rules when it comes to Excess and Co-payments, including how many payments you will need to make annually on either option. It is important to read the policy thoroughly and ask questions in advance in order to have a clear understanding of what you are paying for, and what you can expect coverage-wise in the event that you are hospitalized. Also, make sure you choose an Excess option greater than $500 if you’re purchasing an individual policy, or $1,000 for family coverage, in order to be exempted from the Medicare Levy Surcharge. 3. Pay your health insurance premium in advance before the cost increases.
Each year insurance providers increase their premiums by approximately five percent sometime around the first of April, a practice approved by the Minister of Health. By instituting these annual increases, your health insurance provider retains the ability to fulfill their obligations to policyholders despite increasing medical costs.
Most private medical policy providers allow policy holders to pay for one year’s premium in advance, which locks them into the previous year’s rate for an additional 12 months – a great way to save money. In order to take advantage of the savings offered, most insurers require payment in full be made within the first quarter of the year, between January and March.
4. Lock in to low cost health insurance at an early age.
The most obvious advantage any Australian can take when it comes to saving money on your insurance premiums is to buy in early to the least expensive rate available. And by early, we mean before age 31. Everyone who is eligible for Medicare will receive at least a 30 percent rebate from the government on the price of their health care premium, no matter what age you are. However, by purchasing hospital coverage before the July first following your 31st birthday, you can be ensured the lowest premium rate available.
After age 31, your health insurance rate is subjected to a two percent penalty rate increase for every year after age 30 that you did not have health insurance. Therefore, if you wait to purchase private health coverage until you’re age 35, you will pay 10 percent more annually than you would have if you had purchased it at age 30.
There are exemptions for some people who were overseas when they turned 30, or for new immigrants, and certain others under special exception status. However, if you purchased private insurance after age 30 and are paying an age loading penalty on your health coverage, you will be relieved of the excess penalty after 10 years of continual coverage.
The earlier in life that you lock in to a private health plan, the more money you will save both immediately and over your lifetime.
5. Choose a health care provider who already works with your health fund.
Determine which hospital you prefer if and when the need for treatment does arise, and seek out those health insurance providers that have an agreement with your hospital of choice before making a decision on your health insurance purchase.
It’s a good idea to also find out if your insurer has a list of “preferred providers,” which would include those physicians and practitioners who also have made arrangements with the health funds regarding their charges for services. Request this information from every provider when comparing health insurance policies. This way you can be sure you’ll receive the full gamut of benefits available at the lowest possible cost. These preferred providers often have “no gap” cover – special rates that reduce or eliminate out-of-pocket expenses to policyholders.
6. Double check your health insurance policy before you schedule any treatment or procedures to make sure you have coverage.
Any time you are headed to a private hospital for treatment, first check to see if the hospital and your health insurance provider have an agreement to be absolutely sure you have adequate coverage. At the same time, check with your insurance provider, physician and the hospital to see if there is a Gap between their fees and the government’s Medicare Benefits. This is extremely important because if your physician charges more than Medicare covers and you do not have a “no Gap” plan set up, you could find yourself responsible for a considerable bill. Simply contact your doctor and your insurance company to double check on these items, and avoid being saddled with an out-of-pocket expense your weren’t expecting.
7. File your expense claims promptly.
When you have a health insurance membership card, you can file a claim against your benefits at the time of treatment with no additional paperwork or filing to worry about, at least in most cases. Sometimes, you may still need to file a claim with your insurance provider. When that happens, make sure to file your claim promptly. The typical cut off for insurers to pay health care claims is two years. You can file your health insurance claim directly with your provider or at your area Medicare office, which has a reciprocal agreement in place with most insurance providers. 8. Whenever you travel overseas, suspend your health coverage.
Anytime you travel overseas for more than a few weeks but less than 24 months, certain medical insurance providers allow policyholders to suspend their memberships for the time they’re out of the country, freeing the policyholders from paying premiums during that time period. While your insurance policy is suspended, your Lifetime Health Cover status remains intact, so you do not have to worry about age loading added when you return home. Contact your health insurance provider to make sure of their policy and rules regarding waiting periods and re-activation.
Remember too that Australia has reciprocal arrangements in certain countries, including New Zealand, Finland, Ireland, Italy, Malta, the Netherlands, Sweden and the U.K. For more information, visit http://www.smartraveller.gov.au.
9. Review your policy benefits annually.
Lifestyles change, individuals get married, have children, age – children grow up and move out on their own, couples separate. A lot can happen in the span of 12 months, which is why the Private Health Insurance Ombudsman recommends that everyone review their policy benefits once every year to make sure your coverage still fits your needs.
Regardless of your life changes, your Lifetime Health Cover status remains protected, and waiting periods for benefits that equal your current coverage are waived in compliance with the Private Health Insurance Act of 2007. This means you will be able to file claims related to features you had before you made any changes without interruption in benefits.
10. Compare policies to get the best price and the coverage you need.
To make sure that you are getting the best possible price on your health insurance premium, you must compare policies from different insurers, Make sure you are comparing policies that reflect the treatment plan and coverage you need, without filler services that you won’t need. The more you know about private health coverage and government sponsored Medicare, the more likely you will find the best value for your money when it comes time to purchasing or renewing your health coverage.
Elements of the Cause of Action for Abandonment
Each of the following five elements must be present for a patient to have a proper civil cause of action for the tort of abandonment:
1. Health care treatment was unreasonably discontinued.
2. The termination of health care was contrary to the patient’s will or without the patient’s knowledge.
3. The health care provider failed to arrange for care by another appropriate skilled health care provider.
4. The health care provider should have reasonably foreseen that harm to the patient would arise from the termination of the care (proximate cause).
5. The patient actually suffered harm or loss as a result of the discontinuance of care.
Physicians, nurses, and other health care professionals have an ethical, as well as a legal, duty to avoid abandonment of patients. The health care professional has a duty to give his or her patient all necessary attention as long as the case required it and should not leave the patient in a critical stage without giving reasonable notice or making suitable arrangements for the attendance of another. 
Abandonment by the Physician
When a physician undertakes treatment of a patient, treatment must continue until the patient’s circumstances no longer warrant the treatment, the physician and the patient mutually consent to end the treatment by that physician, or the patient discharges the physician. Moreover, the physician may unilaterally terminate the relationship and withdraw from treating that patient only if he or she provides the patient proper notice of his or her intent to withdraw and an opportunity to obtain proper substitute care.
In the home health setting, the physician-patient relationship does not terminate merely because a patient’s care shifts in its location from the hospital to the home. If the patient continues to need medical services, supervised health care, therapy, or other home health services, the attending physician should ensure that he or she was properly discharged his or her-duties to the patient. Virtually every situation ‘in which home care is approved by Medicare, Medicaid, or an insurer will be one in which the patient’s ‘needs for care have continued. The physician-patient relationship that existed in the hospital will continue unless it has been formally terminated by notice to the patient and a reasonable attempt to refer the patient to another appropriate physician. Otherwise, the physician will retain his or her duty toward the patient when the patient is discharged from the hospital to the home. Failure to follow through on the part of the physician will constitute the tort of abandonment if the patient is injured as a result. This abandonment may expose the physician, the hospital, and the home health agency to liability for the tort of abandonment.
The attending physician in the hospital should ensure that a proper referral is made to a physician who will be responsible for the home health patient’s care while it is being delivered by the home health provider, unless the physician intends to continue to supervise that home care personally. Even more important, if the hospital-based physician arranges to have the patient’s care assumed by another physician, the patient must fully understand this change, and it should be carefully documented.
As supported by case law, the types of actions that will lead to liability for abandonment of a patient will include: • premature discharge of the patient by the physician
• failure of the physician to provide proper instructions before discharging the patient
• the statement by the physician to the patient that the physician will no longer treat the patient
• refusal of the physician to respond to calls or to further attend the patient
• the physician’s leaving the patient after surgery or failing to follow up on postsurgical care. 
Generally, abandonment does not occur if the physician responsible for the patient arranges for a substitute physician to take his or her place. This change may occur because of vacations, relocation of the physician, illness, distance from the patient’s home, or retirement of the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable of the patient’s special conditions, if any, has been arranged, the courts will usually not find that abandonment has occurred.  Even where a patient refuses to pay for the care or is unable to pay for the care, the physician is not at liberty to terminate the relationship unilaterally. The physician must still take steps to have the patient’s care assumed by another  or to give a sufficiently reasonable period of time to locate another prior to ceasing to provide care.
Although most of the cases discussed concern the physician-patient relationship, as pointed out previously, the same principles apply to all health care providers. Furthermore, because the care rendered by the home health agency is provided pursuant to a physician’s plan of care, even if the patient sued the physician for abandonment because of the actions (or inactions of the home health agency’s staff), the physician may seek indemnification from the home health provider. 
ABANDONMENT BY THE NURSE OR HOME HEALTH AGENCY
Similar principles to those that apply to physicians apply to the home health professional and the home health provider. A home health agency, as the direct provider of care to the homebound patient, may be held to the same legal obligation and duty to deliver care that addresses the patient’s needs as is the physician. Furthermore, there may be both a legal and an ethical obligation to continue delivering care, if the patient has no alternatives. An ethical obligation may still exist to the patient even though the home health provider has fulfilled all legal obligations. 
When a home health provider furnishes treatment to a patient, the duty to continue providing care to the patient is a duty owed by the agency itself and not by the individual professional who may be the employee or the contractor of the agency. The home health provider does not have a duty to continue providing the same nurse, therapist, or aide to the patient throughout the course of treatment, so long as the provider continues to use appropriate, competent personnel to administer the course of treatment consistently with the plan of care. From the perspective of patient satisfaction and continuity of care, it may be in the best interests of the home health provider to attempt to provide the same individual practitioner to the patient. The development of a personal relationship with the provider’s personnel may improve communications and a greater degree of trust and compliance on the part of the patient. It should help to alleviate many of the problems that arise in the health care’ setting.
If the patient requests replacement of a particular nurse, therapist, technician, or home health aide, the home health provider still has a duty to provide care to the patient, unless the patient also specifically states he or she no longer desires the provider’s service. Home health agency supervisors should always follow up on such patient requests to determine the reasons regarding the dismissal, to detect “problem” employees, and to ensure no incident has taken place that might give rise to liability. The home health agency should continue providing care to the patient until definitively told not to do so by the patient.
COPING WITH THE ABUSIVE PATIENT
Home health provider personnel may occasionally encounter an abusive patient. This abuse mayor may not be a result of the medical condition for which the care is being provided. Personal safety of the individual health care provider should be paramount. Should the patient pose a physical danger to the individual, he or she should leave the premises immediately. The provider should document in the medical record the facts surrounding the inability to complete the treatment for that visit as objectively as possible. Management personnel should inform supervisory personnel at the home health provider and should complete an internal incident report. If it appears that a criminal act has taken place, such as a physical assault, attempted rape, or other such act, this act should be reported immediately to local law enforcement agencies. The home care provider should also immediately notify both the patient and the physician that the provider will terminate its relationship with the patient and that an alternative provider for these services should be obtained.
Other less serious circumstances may, nevertheless, lead the home health provider to determine that it should terminate its relationship with a particular patient. Examples may include particularly abusive patients, patients who solicit -the home health provider professional to break the law (for example, by providing illegal drugs or providing non-covered services and equipment and billing them as something else), or consistently noncompliant patients. Once treatment is undertaken, however, the home health provider is usually obliged to continue providing services until the patient has had a reasonable opportunity to obtain a substitute provider. The same principles apply to failure of a patient to pay for the services or equipment provided.
As health care professionals, HHA personnel should have training on how to handle the difficult patient responsibly. Arguments or emotional comments should be avoided. If it becomes clear that a certain provider and patient are not likely to be compatible, a substitute provider should be tried. Should it appear that the problem lies with the patient and that it is necessary for the HHA to terminate its relationship with the patient, the following seven steps should be taken:
1. The circumstances should be documented in the patient’s record.
2. The home health provider should give or send a letter to the patient explaining the circumstances surrounding the termination of care.
3. The letter should be sent by certified mail, return receipt requested, or other measures to document patient receipt of the letter. A copy of the letter should be placed in the patient’s record.
4. If possible, the patient should be given a certain period of time to obtain replacement care. Usually 30 days is sufficient.
5. If the patient has a life-threatening condition or a medical condition that might deteriorate in the absence of continuing care, this condition should be clearly stated in the letter. The necessity of the patient’s obtaining replacement home health care should be emphasized. 6. The patient should be informed of the location of the nearest hospital emergency department. The patient should be told to either go to the nearest hospital emergency department in case of a medical emergency or to call the local emergency number for ambulance transportation.
7. A copy of the letter should be sent to the patient’s attending physician via certified mail, return receipt requested.
These steps should not be undertaken lightly. Before such steps are taken, the patient’s case should be thoroughly discussed with the home health provider’s risk manager, legal counsel, medical director, and the patient’s attending physician.
The inappropriate discharge of a patient from health care coverage by the home health provider, whether because of termination of entitlement, inability to pay, or other reasons, may also lead to liability for the tort of abandonment. 
Nurses who passively stand by and observe negligence by a physician or anyone else will personally become accountable to the patient who is injured as a result of that negligence… [H]ealthcare facilities and their nursing staff owe an independent duty to patients beyond the duty owed by physicians. When a physician’s order to discharge is inappropriate, the nurses will be help liable for following an order that they knew or should know is below the standard of care. 
Similar principles may apply to make the home health provider vicariously liable, as well.
Liability to the patient for the tort of abandonment may also result from the home health care professional’s failure to observe, examine, assess, or monitor a patient’s condition.  Liability for abandonment may arise from failing to take timely action, as well as failing to summon a physician when a physician is needed.  Failing to provide adequate staff to meet the patient’s needs may also constitute abandonment on the part of the HHA.  Ignoring a patient’s complaints and failing to follow a physician’s orders may likewise constitute a tort of abandonment for a nurse or other professional staff member.
1. Lee v. Dewbre, 362 S.W.2d 900 (Tex. Civ. App. 7th Dist. 1962).
2. Kattsetos v. Nolan, 368 A.2d 172 (Conn. 1976).
3. 61 AM. Jur. 2d, Physicians and Surgeons § 237 (1981).
4. See, e.g., Tripp v. Pate, 271 S.E.2d 407 (N.C. App. 1980).
5. Ricks v. Budge, 64 P.2d 208 (Utah 1937).
6. M.D. Nathanson, Home Healthcare Answer Book: Legal Issues for Providers 212 (1995).
7. See, generally, E.P. Burnzeig, The Nurse’s Liability for Malpractice (1981).
8. Sheryl Feutz-Harter, Nursing Caselaw Update: In appropriate Discharging of Patients, 2 J. Nursing L. 49 (1995).
9. Id., 53.
10. See, e.g., Pisel v. Stamford Hosp., 430 A.2d1 (Conn. 1980) (nurses were held liable for failing to monitor the condition of a patient).
11. See, e.g., Sanchez v. Bay General Hosp., 172 Cal. Rptr. 342 (Cal. App. 1981); Valdez v. Lyman-Roberts Hosp., Inc. 638 S.W. 2d 111 (Tex. 1982).
12. Czubinsky v. Doctors Hosp., 188 CAl. Rptr. 685 (1983).