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‘Mid-Majors’ and the Power of Local
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“Bourbon, Horses and Start Ups, Oh My”
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Why ‘Place’ Matters in Health Care
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Close enough
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SXSW is booming and the who’s who is there, cool tech is on display, and sponsored parties are humming away.
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Keep grasping, the next Facebook is in there somewhere
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Now SXSW is great and we’ve had a blast attending and speaking there. But meanwhile, in a quiet corner of the fly over states, the real action is happening. CodeapaLOUsa is Louisville’s technology conference, now in its second year.
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Pastel colors are big in the ‘Ville
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Few hundred folks from throughout the region, mostly from similar places like Cincy, Indy, and smaller spots you haven’t thought of as tech hubs (outside the advertising sections of airline magazines); various technology sponsors (HP, Amazon’s R&D center a2z, Microsoft, Café Press and a host of smaller folks); and tech, specifically code-heavy sessions and demonstration projects. Different than interactive design and social media a la SXSW, or even cool tech looking to start a company a la H@cking Medicine at MIT, this was general pure-play software development, in a regional venue.
We did a little session, “Bourbon, Horses and Successful Start Ups, Oh My: How to Found, Build & Exit Your Tech-Based Start Up… in Louisville… or Someplace Like It.”
On one hand, basically the same thing as what we’ve done at MIT and Harvard (taking cool tech and turning it into a start up that creates real business value) just changing the slides to revolve around Bourbon.
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On the other hand, it was all about the pros and cons of doing this in smaller venues like Louisville – playing in a ‘mid-major’ league like Gonzaga, George Mason, VCU – or better yet Butler.
Now we’ve had a pretty good run in the tournament, getting a win and then rolling it into another.
And we’ve done it outside Silicon Valley, New York and the like and are doing it from Louisville again with RowdMap.
The pros of the traditional hubs are well-known (3Cs usually: Culture, Capital and Clients), but the mid-major’s have real advantages and, although not as glamorous or sexy, there’s something very helpful about going through the mid-major tournament before hitting the big dance – and as the technology advances and access to it is distributed and democratized, the financial models for start-ups change and the movement to the mid-major hubs accelerates.
Now Louisville has a nice culture and some resources, a disproportionately active tech community with recent history of several successful start-ups both dedicated to public good through education or education and business partnerships, as well as others more traditional ranging in sizes in various spaces from tech/media to consumer interaction data & analysis to health care as well as:
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Make up is big in the ‘Ville, too
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… and the active growth is evidenced by the general hot vibe of things like CodepaLOUsa. Vertical-wise, it’s a logistics powerhouse and a health care hub ranging from plans, to hospitals, to ACO activity and notably a Long Term Care (nursing home) Mecca.
It also has some other intangible assets:
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Melanie’s alma mater hard at work
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… not to mention this:
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We’ll buy any magazine with fried chicken on the cover
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Now it’s worth noting that when Bon Appetite is featuring Southern Cooking as a real cuisine and Yale School of Architecture is building a distillery on Whiskey Row as an example of manufacturing in the 21st century, it’s not just ‘gentrification’ but an embrace of indigenous American culture.
But the real secret of places like the ‘Ville, is in a particular piece of that culture: access to solid people – fundamentally sound folks – not necessarily those making SportsCenter highlight clips but those playing team ball and executing like mad. Sounds corny and cliché? Maybe. But it’s true. During our last final four run, the nature and character of the folks we worked with made the difference – wouldn’t have gotten out of the play-in games without them.
Now there’s more of the same up and down the I-65 corridor, more than you would expect if you’re used to boogey-boarding in the SoCal surf.
When speaking in the big leagues about entrepreneurship stuff, one of the key points we make is that you want to look at the pockets of failure, or areas where things haven’t worked historically or simply don’t have the glitz and sex appeal…
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Well, there is this
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… then figure out why it hasn’t worked yet - put together a new scheme, then shoot the ball.
So kudos to CodepaLOUsa, and things like it in these spaces, so often overlooked, both on the geographic map as well as the market map. These will be the places of asymmetrical innovation in the future. Part of that is because of the characteristics of the mid-major players – and how that’s amplified in a league whose size creates access to, and meaningful exchanges with, them. Now this doesn’t only extend up and down the I-65 corridor; there’s good folks everywhere. The point is to put yourself in a place to find these folks and work with them, ensuring that when you win, those you admire and respect win too.
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On a more health care specific note, geography, or more precisely the way you understand it and manage it, determines success. No, I don’t just mean that the supply-driven nature of care can be captured, modeled and used for social good and to create a financial win-win for patient and health care entity a la the Dartmouth Atlas for Unwarranted Variation.
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Oddly, not included in the Department of Commerce’s official tourism brochure
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Actually, all health care takes place at the local level, one way or another. Certainly there’s the providers people access, but all the folks you want to reach live in a specific place, within a specific culture, that has defining characteristics. A culture of wealth or poverty, education or lack thereof. Behaviors, habits and sentiments likewise. And your competitors face these cultures as well, either the same or markedly different. You have raw forces of population size, age and disease prevalence but also dynamic ones like interaction with behaviors that determine wellness, as well as the specific local views that define a ‘good’ experience and determine ‘satisfaction’.
The point for start-ups is this. If you’re looking to make it to the final four, knowing your local culture, its pros and cons, and basing a strategy around those, are fundamental to any sound game plan, especially now that the game has changed (evolved) and mid-majors are coming on strong. Gonzaga’s a little Jesuit school in the sticks, now a perennial powerhouse; Butler in the national championship was a fluke, until they did it back to back.
The point for health care is this. If you’re trying to maximize profit and reimbursement by managing populations, these are really collections of folks living in, shaped by, and responding within specific locales. And often your success will be determined by the folks living precisely in those places the glitzy and glamorous would rather fly over.
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Your strategic advantage, seriously
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Your advantage is maximizing your understanding about these place, especially the particular ways individuals living in them respond to interventions and how these impact your metrics from clinical to satisfaction and ultimately financial. And no, not through hiring an anthropologist to do some post-Foucault-ian ethnography waxing on about pockets of Gramscian hegemony.
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Actually, Gramsci is crucial for behavioral models outside health care, seriously
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You need a data-driven approach, with a platform that quantifies this qualitative data, turning these characteristics of culture that define locales into tangible data elements in your analysis and giving you an advantage in your profit generation by turning these flown-over particularities into a decided quantitative advantage.
This is particularly true in the new game of reimbursement with zero-sum competitive dynamics and market consolidation penalties – you need a game plan (or road-map) to turn Intervention Expenditures, always executed at the local level, into Centers of Profit.
You need to put in your time in a mid-major gym, mastering the fundamentals and executing like mad.
Then you need to take the shot.
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Special thanks to the CodepaLOUsa organizers, particularly Chad Green and Joe Wheeler.
Special note: Joe’s better-half Amy is the force behind the cosmetic start-up, Talullah, pictured above.
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