Paying a Medical Bill Should Not Be This Hard

When it comes to paying a medical bill, I’ve had a backwards experience.  As the founder of Omedix, I built software that’s collected tens of millions of dollars in healthcare bill payments, but I hardly ever paid any healthcare bills of my own.  I was under 30 and hardly went to the doctor!

Next month I turn 34 and I am fortunate that neither my wife nor I has any chronic medical issues, but now we go to the doctor for the usual annual checkups.  In 2013, our health visits amounted to:

  • Annual well-checks with our primary care physician (PCP)
  • The lab tests our PCP’s requested
  • In her case, annual visit with an OB/GYN
  • In my case, annual check up at the dermatologist (skin doctor)
  • In my case, annual check up at the ophthalmologist (eye doctor)

Today, I’m about 4 hours in and almost done paying all the healthcare bills.  The experience has been…traumatizing.  First, multiple bills are sent for the same service, but with slight differences.  Second, our doctor tried to bill insurance, had the wrong info, sent us a bill for the full amount, was later informed the insurance was wrong, adjusted the bill, and sent an updated one.

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Give, Give, Give, Then Get

I’ve decided to try an experiment lately.  At every opportunity where I see I can possibly add value to someone in some way, I try to do so.

This can mean connecting someone with someone else I know, sharing insights from experiences I’ve had that may be applicable, or even mini-projects that leverage my technical skills.

Like any other behavior change, this is a habit that takes some work to build, so I’m not 100% ramped up yet, but at least the habit is building, so hopefully after a few weeks it will just be my default behavior.

Anyway, I’ve had a few interesting observations about it:

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Your New Normal and the Futility of Stress

I had a very powerful business experience about 4 years ago that taught me a lesson that I didn’t fully understand until recently.

I was the sole owner of a company that received a Letter of Intent from a publicly traded company to be acquired for around $1 million, all before I was even 30 years old.  Sure sounds sexy, right?  Well, the catch was that we were not profitable at that time and of course the time between receiving a Letter of Intent and actually signing all the contracts, getting a check in the bank, and considering the acquisition a done deal can be anywhere from a few weeks to over a year.

So we waited.  Doing our best to not be too unprofitable and not incur too many legal expenses, but thrilled at the prospect of an acquisition that would instantly remove all the stress.  I remember every day trying to act to the outside world like things were fine, but inside I felt incredibly stressed.  Each day was a new opportunity to obsess just a little bit more about when the acquisition would finally close.

And then finally it did.  Except that it didn’t go through, it fell through.

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Cutting Out the Noise

I keep noticing a recurring theme in my hobbies and in business: cut out the noise and focus only on the essential.

It seems so simple, but the fascinating thing about life is that the things and people we encounter so rarely do cut through the noise.  Instead it seems like most endeavors of consequence are messy, complicated and hard, and it’s not always clear why.

When you approach almost everything with the mentality of “how do I cut out the noise?” life becomes a very magical experience where a little effort in the right place can yield big results.

I think can think of at least 3 areas of my own life where cutting out the noise yielded big results.

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The Fundamental Entrepreneurship Challenge

Thrashing n. To expend a disproportionately high amount of energy relative to the quality of output you receive

When I was younger and looked at successful companies, I simply could not for the life of me understand how they ever went from NOTHING to what they were today. The modern equivalent would be like asking “How did Jamba Juice launch hundreds of stores across the country? How did that start?” It made sense to me that if you raised a massive amount of money and then immediately bought all the capital equipment and hired all the people you needed then you’d at least be capable of serving all the customers, and that the massive revenue from the customers would balance out your massive expenses…but how did it all come to be from NOTHING? It seemed like magic to me.

And from this line of thought I embarked on what I believe is the fundamental fallacy of entrepreneurial thinking: asking the question “what does a company need to do to succeed?”

What’s wrong with that rather innocent question? Well, it’s missing a critical component that ultimately matters more than anything else.


If I were speaking to my self from 10 years ago today I would make a very important point of clarifying that the real question is not how can you grow a company to be successful. The real question is, how can you learn to be successful in the shortest possible time?

A college professor once told me: “Given enough time, every single one of you could completely master the subject I’m about to teach.  But the problem is you don’t have enough time and neither do I.  So you’re going to have to figure it out in one semester while you take all your other classes, too.”  What a perfect example of the same phenomenon.  When you go to school, the question isn’t “what can I do, no matter the cost, to get the highest possible grade in this one class”, the question is “how can I get the best grades in all my classes this semester while still having lots of time for fun?”.

I would say for myself that I have experienced more personal and business growth in the last 12 months than in the prior 3 years combined.  One of the fundamental differences?  I’ve started imposing more constraints on myself than just “learning how to be successful.”  I think about how I spend my time on each of my days.  If I feel like I’m thrashing a little bit (see definition at the beginning of the article), then I know something’s wrong and I invest some time to assess what’s going on.

I think one of the main differences for myself is that in the past year I’ve been fortunate enough to find some amazing mentors.  These are people whose accomplishments I am blown away by, who I have a great personal relationship with, and who are willing to give me input on ambiguous issues that come up.  After enough conversations, you basically start to pick up the same patterns of learning and the lessons that they accumulated over a lifetime.  Mentorship, I’ve come to realize, is literally the primary mechanism through which society evolves itself.

I mean, think about it.  If you didn’t know how to write but you knew how to speak, how ridiculously hard would it be to invent this concept of an alphabet, which combines different “letters” together to form “words” which are expressed in “sentences” which are organized in “paragraphs” and annotated by “punctuation.”  Writing is such a basic thing and yet figuring out writing from scratch would take probably a millennium.  But learning writing?  Well, a few years in school.

That’s how it feels since I’ve been fortunate enough to find mentors.  The “learning on my own” process is shortcut by about 99%.

When I think about how much thrashing I’ve done at different periods in my business career, it just makes me sad.  As Mark Cuban says, you can make as many mistakes as you want in business as long as you don’t make a really big one.  So, yeah, I avoided a really big mistake, but I think about how much time I spent on some things that one great conversation with the right person could have saved me from.  I mean, really, think about it.  The idea that a single 1-hour conversation could save you months of work?

And that’s really what it comes down to in the end.  The enemy of entrepreneurial success is not failure.  The real enemy of entrepreneurial success is thrashing.  What would you rather be?  Moderately successful at age 30 where you have another 70 years to apply the lessons you have learned, spend money, earn money, love, live life, grow, etc.  Or ultra-successful at age 80 where you’ve spent the bulk of your life learning how to actually figure out how to be ultra-successful.

Life, of course, rarely presents such black & white choices and the greater point here is really about how given enough time, sure, just about anyone could learn to be as successful as they wanted, but that time is precious, and scarce, and should be spent thoughtfully and purposefully.  A day spent making awesome progress on something you care about is infinitely more satisfying than a day spent thrashing.


The Technical Founder: Strengths and Weaknesses

“We are hugely in favor of the technical founder. We will generally focus on companies started by strong technologists who know exactly what they want to build and how they are going to build it.”
Marc Andreessen

I’ve always prided myself on being a “technical founder.” Basically, it means that if I were hired as a dedicated software engineer I could make a pretty meaningful contribution to a software product, but that my primary role is to guide the growth of the company as CEO. I used to think that being a technical founder was an absolute advantage over non-technical founders since not only could I do the business thing, but I could really understand at a deep technical level how viable something is, and I also know what’s possible, which enables me to come up with product ideas and visions that non-technical founders might not be able to.

But life has this funny thing where our biggest strength can also be our biggest weakness. The trick is being honest with yourself about what they are.

On the positive side, being technical is wonderfully empowering. When I talk with our development team, we review details down to the database diagrams and how that will ultimately affect the product vision. I know with confidence at a deep technical level how powerful our software is and how that power can be leveraged in the future. I can formulate ideas for products based on knowledge of our database schemas, recognize problems that have high value to a client and are technically less challenging, or have an appreciation for those problems — like online registration, for example — that are actually quite complex and require considerable thinking.

I realize I love technology so much that these conversations are pure joy for me.

On the negative side, though, loving technology so much means you think in terms of technology. During engineering or product development meetings that works great. But when it comes time to put on the CEO hat, a mindshift is required. Because in CEO mode, those technical details are not empowering. In fact, they’re the opposite, they just get in the way.

Earlier today I had the opportunity to speak with an accomplished healthcare IT entrepreneur who could probably reasonably consider himself technical as well (MIT graduate). As I reflected on our conversation, I realized that there were moments in our conversation where he asked me questions that had a business — not technical — spirit behind them, yet I answered as if I were an engineering consultant, not a CEO.

The problem? My technical mind interprets his question first and foremost on a literal level and launches into a literal response! And sure enough that’s exactly my comfort zone! Comprehensive, technical responses.

But the funny thing is when I’m surrounded by businesspeople who only want to speak in high-level terms and I absorb their high-level mindsets for a small amount of time, I find I quickly adapt to the high-level thinking. Questions asked with a business spirit are answered in a business spirit, even if they have a technical element to them.

And this is the domain of the CEO. You step outside of the trees and speak only in terms of forests. You use the background technical information as minimally as possible, calling on it only when the situation makes a special request for it. You transfrom from being precise and comprehensive — a critical trait when designing software — to being loose and general.

Sometime this year it finally dawned on me why the CEO has to speak and think in these terms: because no one else cares about your details. They only listen to what your “proposition” is and then make a decision about whether you appear legit or not. The details simply aren’t important.

And sure enough we see this phenomenon in other spheres of life, too. I was SHOCKED to discover that one of the worst ways to sell software is to show it. Instead, the more you talk about it and the less you show it, the more inclined people are to buy it. Why? Because most people don’t care about details.

To summarize the conclusions in this post:

  • Being a technical founder is awesome
  • But watch out for situations where it gets in the way

Lead Like the Great Conductors

This is a beautiful exposition (and metaphor) on the role of a leader. I’ve often wondered if it’s better to set forth clear guidelines so that everyone knows exactly what to do, or better to provide people a framework within which to “tell their own story” (to use the words of Mr. Talgam in the video below).

Ultimately, I’ve found that different people respond to different styles. But if there is a “default style,” I believe the conductor who empowers the musicians to perform the music in their own style while providing subtle yet meaningful guidance on context, feeling, and intent produces the most beautiful music.

The Starbucks Paradox

I would say in the past month I had been going to Starbucks an average of 4 times per week.  One visit of $4.25 is easy enough to swallow, but when I started running the numbers, I was surprised to learn that $4.25 x 4 days per week x 52 weeks per year = are you telling me I spend almost $900/year sipping a latte?

I long ago realized that the value proposition of Starbucks is much more than just coffee.  Howard Schultz’s original vision was not to “make premium coffee and earn a profit,” but to transport the community-ness of espresso cafes he saw in Italy to the USA, where he felt our society had only grown more isolated over time.

Abstract as it may be, I think the stores do ultimately deliver on that concept.  I don’t go to Starbucks solely because I like the taste of my drink.  I go with a colleague, we know the baristas, we see people we know, it’s close by, it takes about 15 minutes…and so on.  Basically, it’s just kind of a nice way to take a break!

Nevertheless, I needed to cut down the frequency.  So here’s the strange part.

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A Series of Stresses or A Series of Adventures

Although I love what I do, one of the more frustrating aspects of running a business is that YOU are always the bottleneck for everything. The reason we don’t produce sites faster is because I, personally, have to review them. The reason sales are at X but not Y is because I personally have not yet hired the right salesperson and because I personally am too busy to proactively follow up with every single lead. The reason we haven’t developed our new products faster is because I personally have to do some user interface designs but have been busy with other things.

It sounds awful even just writing all that! Actually, the obsession with “I personally” is ultimately I think the completely wrong attitude when it comes to growing a company, but that’s the topic of another post I’ve been germinating lately.

Anyway, one unfortunate side effect of being the bottleneck is that it creates a feeling that I’m never finishing everything I want to, which is stressful. In school, we were always taught that finishing 100% of our homework was a good thing. You worked and worked until you finished what you had to do, and then you go have fun.

But what if you’re in a situation where you will literally NEVER finish all your work?

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Whew, it’s been a long time since I’ve written on this blog.  Nearly 4 months!

I feel like I have so many things I’d like to write about, but one thing in particular seems to keep popping up these days: the idea of being honest with people.

Maybe it’s my nature, maybe it’s my upbringing, but I just really feel uncomfortable when I’m not being forthright with someone.  If I feel like I’m withholding something or not disclosing something it makes me feel manipulative and uneasy.  I feel like I have to just come out with the truth, all of it.

So, basically any time I’m in any situation that presents an opportunity to tell a portion of the truth or the whole truth, I tend to tell the entire truth.  It just makes me feel good, i guess.  Frankly, I don’t really know.

But what I have noticed about being honest with everyone all the time is that it has all these wonderful, amazing benefits that are actually pretty hard to get with people:

  • People trust.
    Once people realize that I’m honest about just about everything all the time, they come to realize that if there’s anything going on I’ll say something about it so they learn to trust me.
  • People respect.
    Because people know I don’t BS, they respect what I say.
  • People want to do business.
    Yesterday I spoke with a client who asked me if he should get a content management application for this website.  From a financial perspective, this would have represented really easy money.  But the truth is this client would never really use it, and it’d be easy money for Omedix and wasted money for the client.

    “Honestly,” I told this client, “Just save your money.  If it becomes apparent over time that you would really benefit from this, we can always set it up for you then.”

    “Okay,” he said.  “Whatever you recommend sounds good to me.”

    I have to admit, I felt pretty good about that conversation.

    Tomorrow, I’m meeting with a client who wants to build a 12-week website in less than 4 weeks.  While theoretically that’s possible, it would require some serious wizardry on our end to make it happen.  I know it would be easier to win the business if I just said “Ok, I think we can do 4 weeks,” but I’ll be honest then, too.  It won’t guarantee a sale, but at least I’ll have shown that I won’t promise something I can’t deliver.

That last example actually brings up my last point:

Honesty means trading short-term gain today for long-term gain tomorrow.

People don’t usually lie or withhold details just arbitrarily.  They do it to gain something.  But lying is ALWAYS a short-term strategy.  Reputation is something that takes forever to build and minutes to ruin.  If someone finds out that you lied, or that you withheld important information to achieve short-term gain, their trust is evaporated and they’ll likely never want to deal with you again.

How do I know that?  Because I was on the “being lied to” end a few months ago.  A while ago I purchased a tire insurance policy for my car.  The idea is simple: if I have to replace a tire the insurance policy covers the full cost. The catch is that I have to go to a specific dealer to avoid being charged.  If I go to a different dealership, I have to submit a claim to be reimbursed.

So sure enough one day I got a flat tire.  I took my car over to a dealership near my home, and the service advisor I normally deal with told me that he could handle the tire replacement and I’d just have to submit a claim to get reimbursed.

“Is that a big deal?” I asked.

“No, not at all.  It takes 1-2 weeks to get your money back.  I’ll even help you fill out the claims.”

“Well, why don’t I just go up to the other dealer?”

“Well, we can just take care of it for you.”

I’ve worked with this guy in the past so I trusted him.

Well, it’s now been 8 weeks since I had that tire replaced and I submitted my claim (which was a complete pain, by the way) and I still haven’t received my reimbursement.  In retrospect, based on some other things he said, I’m led to believe that he knew how cumbersome this whole process is.

Short-term gain? His commission on the tire replacement.

Long-term loss? I’ll never go to him again, so he loses all future commissions.

To sum up, honesty — and not just honesty, but complete honesty — is an awesome way to go for the long-term.  It might be more challenging in the short-term, but the long-term benefits of trust, respect, and people who want to do business with you are awesome.