You may not have signed up for this, but it’s the reality. Don’t accept this reality? Fine. Know this: denial of this reality means xxxxxxxxx will die.

And, if you ask me, it’s a pretty incredible reality.

Because it means you have the opportunity to fix arguably the largest problem in our country: overpriced, opaque, excessive and uncompetitive healthcare. (I will buy you the book. Tell me your address. Seriously. Don’t like reading? Fine. Watch this interview. )

That is what you get to work toward every day.

Good news: unlike those punk kids one-year out of college, you can leverage the insights of an actual money-making business to inform your startup.

Bad news: this leverage can turn into a crutch and halt innovation – xxxxxxxxx becomes merely another version of xxxxxxxxx.

Other bad news: almost nobody in this organization views xxxxxxxxx as a startup, so you are going to constantly run into risk-averse naysayers who want to do things the way they have always been done.

Note: “the way things have always been done” is not a compelling argument for doing just about anything.

What does a startup mean? Few things (in no particular order):

1. There are no rules. So long as ethics remain intact, do whatever is needed to get stuff done.
   • If you wait for others to do things, Create will die
   • This requires a level of scrappiness
   • This requires that you do things that don’t scale. (some parts of this article are far less relevant, but I would argue a complete read is worthwhile)
2. Stuff is going to be broken
   • Always
   • Prioritize what matters and move forward.
   • Ask for forgiveness, not permission
   • Be honest about your mistakes and you’ll find the world is a forgiving place
3. Listen to users
   • You don’t have all the answers
   • You must suck as much knowledge as possible from the few users that you have
   • READ LESSON #1 (actually, read all the lessons)
   • Also, talk to the people who declined becoming users
   • Talk to users of competitive products
     • What do they love
     • What do they hate
   • Listen to providers
     • I don’t care how little money you are bringing them, find a way to listen, and find a way to know, at the very least, the problems you would solve for them when Create is HUGE
     • EVERYONE has problems: “The next suitable person you’re in light conversation with, you stop suddenly in the middle of the conversation and look at the person closely and say, “What’s wrong?” You say it in a concerned way. He’ll say, “What do you mean?” You say, “Something’s wrong. I can tell. What is it?” And he’ll look stunned and say, “How did you know?” He doesn’t realize something’s always wrong, with everybody. Often more than one thing. He doesn’t know everybody’s always going around all the time with something wrong and believing they’re exerting great willpower and control to keep other people, for whom they think nothing’s ever wrong, from seeing it. This is the way of people. Suddenly ask what’s wrong and whether they open up and spill their guts or deny it and pretend you’re off, they’ll think you’re perceptive and understanding. They’ll either be grateful, or they’ll be frightened and avoid you from then on. Both reactions have their uses, as we’ll get to. You can play it either way. This works over 90 percent of the time.” From “The Pale King”
   • You must believe in the mission
     • Do you think a health system should sign up for Create?
     • Do you think a member should sign up for Create?
     • If you answered anything other than OF COURSE YES, you must get there (I can help because I do indeed answer OF COURSE YES)
     • Answering OF COURSE YES doesn’t mean the product is perfect today. It does mean the vision is incredibly valuable (hint: it is) and you will do all you can to arrive at that perfect state
   • Tell a good story
     • Your data is going to suck at this point, but your story can’t. People buy stories, not data.
     • That’s true even if they say they want data.
   • Remember incentives (2-hr read. I’ll give you $13 if you read it and find it valueless)

I’ll stop for now.

I thought of this stuff in light of the xxxxxxxxx meetings and an innocuous Skype message from xxxxxxxxx .

I know all this stuff is HARD. REALLY, REALLY HARD.

You may be asking, why the hell should I do this? It’s a fair question. There are people with bigger titles and bigger salaries ostensibly in charge of this stuff and you can get along just fine thank you very much doing what you do.

Summary of my very long answer: you should do this because it is more fun.