Six Levels Down | Against the Rules with Michael Lewis

Summary

In this intriguing episode of "Against the Rules," Michael Lewis delves into the concept of hidden expertise and the often overlooked individuals who possess it. The episode primarily follows the journey of Sue Henderson, a medical biller whose profound knowledge of intricate billing rules saves a company and transforms a massive industry. Through the story of Sue and other similar individuals, the episode highlights the importance of recognizing and utilizing hidden experts, especially in times of crisis. Lewis explores how societal structures often mask true expertise, leading to inefficiencies and missed opportunities for problem-solving.

Highlights

• Michael Lewis shares his early realization that being labeled an expert often comes without actual expertise. 🧠
• The crucial role of Sue Henderson, whose knowledge in medical billing transformed Athena Health into a billion-dollar enterprise. 💼
• Todd Park’s revelation about finding hidden experts becomes a central theme as he navigates crisis management. 🤯
• The humorous yet eye-opening anecdotes of insurance companies wanting to buy back their own rules from Athena Health. 😂
• The significant societal takeaway: expertise is often buried under layers of hierarchy and requires deliberate discovery. 🛠️

Key Takeaways

• Discover the true impact of hidden experts like Sue Henderson, who, despite being overlooked, wield unparalleled expertise that can save industries. 🕵️‍♀️
• Michael Lewis reveals the flawed perception of expertise, emphasizing that real knowledge often resides in unexpected places. 🤔
• Unveil the journey of finding the level six experts, those who might not be in the spotlight but are crucial problem-solvers. 🌟
• Understand how companies can thrive by recognizing and applying the skills of hidden talents, leading to systemic changes. 🚀
• Learn about the unpredictability of expertise and how true experts might be tucked away beyond obvious reaches. 🔍

Overview

Michael Lewis kicks off season three of 'Against the Rules' by exploring a world where expertise isn't always as it seems. This episode delves into the life and value of those in our world who possess deep, rare knowledge but often go unnoticed. Through the captivating story of Sue Henderson, a medical biller whose insights redefined the healthcare industry, Lewis offers a lens into the unrecognized minds shaping massive change.

Henderson, our unexpected hero, showcases how profound understanding in a niche area can innovate and streamline big systems. Her ability to navigate complex insurance billing rules did not just save Athena Health but revolutionized how healthcare providers manage finances, proving that expertise can be a game-changer when correctly harnessed.

The episode invites listeners to question societal norms about who is considered an expert. It highlights the crucial task of seeking out the 'level six' - those buried in obscurity who hold the keys to resolving complex challenges. Michael Lewis’s narrative isn't just a story about finding hidden talents but a call to action in appreciating and leveraging these unsung heroes in our organizations and society at large.

Chapters

• 00:00 - 03:00: Introduction and Wall Street Experience The chapter titled 'Introduction and Wall Street Experience' begins with the author reflecting on a significant problem encountered during their time on Wall Street. This problem revolves around the issue of relying on experts. Decision-makers, even when dealing with substantial financial stakes, often struggled to discern which expert opinions were credible. This highlights a critical flaw in decision-making processes within high-stakes environments. The author, who had a background in art history and no formal training in finance, illustrates this predicament by sharing their personal experience of working in the financial sector as a young, inexperienced professional.
• 03:00 - 07:00: Writing Liars Poker and Perception as an Expert Michael Lewis discusses his experience of being hired on Wall Street and receiving substantial compensation to influence professional money managers. Despite his lack of expertise, he was perceived as an expert. In a radio interview on WMNI Radio's 'This is Wall Street', Michael Lewis, author of 'The Money Culture' and former Bond Trader for Solomon Brothers, speaks about his past experiences and his uncertain future prospects as a young man.
• 07:00 - 09:00: Introducing Season 3 of Against the Rules The chapter introduces Season 3 of 'Against the Rules' and reflects on the author's experiences in the financial industry. He recounts writing 'Liar's Poker' in 1989, a book revealing how he, among others, received substantial pay on Wall Street for dispensing advice that was often incorrect or meaningless. Despite explicitly proving he wasn't a financial expert in the book, he notes that people still sought his advice during his book tours.
• 09:00 - 16:00: Todd Park and the Formation of Athena Health The chapter titled 'Todd Park and the Formation of Athena Health' appears to revolve around individuals seeking advice or validation, as inferred from the mention of people treating written materials as manuals or self-help guides. The narrator discusses receiving a high volume of correspondence, particularly from the Midwest, like Ohio, from young people seeking guidance. The narrator suggests a pattern across their books, where they begin with limited knowledge on a subject, then engage with experts who have substantial understanding, emphasizing a process of learning and acquiring expert insight. This approach highlights the pursuit of knowledge and the transition from novice to informed through direct engagement with experts.
• 16:00 - 28:00: The Role of Medical Billers in Healthcare The chapter explores the role of medical billers in healthcare, using storytelling techniques to illustrate their impact and importance. The author describes characters in various challenging situations, such as financial crises and pandemics, to highlight the expertise and knowledge of medical billers. The chapter suggests that while the author gains insights into these situations through writing, the real experts are those actively working within these fields, like medical billers, during significant events. The narrative emphasizes the critical, yet often understated, role that medical billers play in the efficient and smooth operation of healthcare systems.
• 28:00 - 45:00: The Search for Experts and Expertise Blindness The chapter titled 'The Search for Experts and Expertise Blindness' discusses the notion of being perceived as an expert and the pressures that come with it. The individual reflects on the seductive nature of being treated as the person with all the answers, especially in the context of impending legislation. Despite the allure, there is an introspective moment where the individual questions the validity and impact of these perceptions after publishing a book.
• 45:00 - 42:00: Conclusion and Acknowledgements The chapter focuses on reflecting on the insights gained from interviews with various experts. The narrator encourages listeners to seek answers and further understanding from these experts, who have significantly influenced the narrator's knowledge. The discussion touches on the challenges these experts face in persuading those in power to take timely action on certain threats. The chapter acknowledges the complexity and uncertainty of dealing with emerging threats, and suggests that sometimes, the best response may simply be to admit not knowing everything.

Six Levels Down | Against the Rules with Michael Lewis Transcription

• 00:00 - 00:30 the first time I sensed we all had a serious problem that might One Day lead to our Doom was when I was working on Wall Street [Music] the problem had to do with experts people making important decisions had no idea who they should listen to or who they shouldn't even when millions of dollars were at stake I was a 25 year old art history major with zero training in finance then I got
• 00:30 - 01:00 hired to work on Wall Street where I got paid hundreds of thousands of dollars to persuade professional money managers to do things with millions of dollars obviously I had no real idea what to do with money yet I was taken as the expert hello and welcome once again to this is Wall Street here on wmin radio today's special guest is Michael Lewis he's the author of the money culture and former Bond Trader for Solomon Brothers what's in the future for yourself I know you're a pretty young man aren't you
• 01:00 - 01:30 it's turned 31. that young well I don't all would say so feels old in 1989 I wrote a book called liars poker in which I explained how I and a lot of other people on Wall Street got paid a bunch of money to give advice that was either wrong or pointless in this book I proved beyond a shadow of a doubt that I was not a financial expert And yet when I hit the road to sell liars poker people still ask me
• 01:30 - 02:00 what should I do with my money from the Midwest especially for some reason from Ohio I am inundated with letters from young people who have treated everything I've written as sort of a how-to manual and and and it's almost as if they can't conceive as a book as anything but advice and self-help all my books are the same in one crude way I start out knowing very little about the subject I go find actual experts people who know
• 02:00 - 02:30 stuff and write stories about them to my mind all I'm doing is describing great characters in some interesting situation a financial crisis a professional sport and turmoil a pandemic yeah I learned some things about those situations but pretty much everything I know about say the origins of the 2008 financial crisis I know from the people I've written about they are the experts I'm just a guy who writes books about them
• 02:30 - 03:00 still the pressure from me to Swan around as the true expert is incredible do you think that's what they believe well that's not true right now but do I I do I think they believe that after they pass this legislation that will be true yes I do think that I I do believe that I think that it's flattering to be treated as the guy with the answers more than flattering seductive but still after a book comes out I usually find myself thinking why on
• 03:00 - 03:30 Earth are you asking me ask the people who told me everything I know I picked them because I thought we should all be listening to them they're the ones you should ask were they unable to convince those in power to do something sooner I I think and I think the answer is um that the this particular threat when you're on TV you can never just say I don't know but but but beyond that I mean with a threat like this he almost
• 03:30 - 04:00 requires you can't say I don't know because you're the expert and you're the expert because you're on TV that you're dealing with you're dealing with a a an invisible enemy that replicates exponentially and by the time yeah I'm Michael Lewis welcome back to season three of against the rules where we explore unfairness in American
• 04:00 - 04:30 Life by looking at what's happened to various characters in American Life our first season was about referees our second was about coaches this season's about experts we're going to tell seven stories about them each contains a clue to a mystery at the heart of American Life how come a society is so great at creating knowledge is so bad at using it how come we know more and more yet behave as if we know less and less
• 04:30 - 05:00 how can one people be so incredibly smart and so breathtakingly moronic the experts are terrible the pandemics taught us a bunch of things that bosses miss the office more than their employees that are Centers for Disease Control aren't very good at controlling disease that these United States aren't all that interested in being united even in a crisis Mr President please listen to your public health experts
• 05:00 - 05:30 instead of denigrating them but the pandemics also taught us something about experts how fraught our relationship with him has become how hard it is for us to decide who they are and how to use them even when it's a matter of life and death but who cares what I think I'm not an expert I just find the people who are hi I'm Todd Park Healthcare and Tech entrepreneur and former public servant case in point I been in the succession
• 05:30 - 06:00 of situations of great opportunity or great crisis and had to help figure out what to do very quickly Todd Parks created three different billion dollar companies he solved some very big problems on behalf of the American government but he built his career on a single insight that the experts you most need are often not who you think they are
• 06:00 - 06:30 just finding the expert can be incredibly difficult especially when all hell is breaking loose Code Blue Room 305 back in 1997 Todd was a consultant fresh out of the Harvard Business School like a lot of people who go by the name of consultant he didn't really want to be a consultant so he went looking for a business idea a problem to solve he and another consultant who was married to a midwife nurse in training settled on a really big idea
• 06:30 - 07:00 the beginning of Life specifically pregnancy to the eyes of a male Management Consultant in 1997 pregnancy is conducted in the United States seemed wildly inefficient women and their babies were having all kinds of expensive medical problems that could have been avoided with better prenatal care by keeping women healthier during their pregnancies you could also make childbirth less risky and cheaper
• 07:00 - 07:30 and so these two 24 year old guys set out on this new Mission it was a bit weird they weren't doctors they didn't even have children and essentially the whole idea is that you deploy a whole team of folks not just the doctor but surfinder's Midwife social worker educator case manager nutritionist to love on a mom to be and get her the right care including very importantly non-clinical support Todd and his partner named their company
• 07:30 - 08:00 Athena Health they hired a few more people much like themselves smart young guys they raised millions of dollars and used some of the money to buy a childbirth Clinic in San Diego it mainly served women especially prone to bad outcomes during pregnancy undocumented immigrants for instance the clinic was the test case for Athena Health if it worked the company would create a lot more of them so um you know now all of a sudden
• 08:00 - 08:30 literally overnight we are now on the hook for payroll rent all of this stuff and the revenue that's Bob Gatewood Todd had hired him to help so almost immediately we started hemorrhaging money you know claims were going out but no money was coming in the first pregnancy Clinic was supposed to be like the first McDonald's or Starbucks proof of concept the concept never had a chance because they couldn't get insurance companies to pay them to make pregnancy cheaper and
• 08:30 - 09:00 better in fact they couldn't really get anyone to pay them for anything did you have any sense that was going to be a problem when you started no we thought oh billing is a solved problem everybody knows how to do that the interesting thing is that electronic health records the young entrepreneurs had thought they'd bought a business with it really bought was a crisis and a cause we then said okay this is a very special practice it's the public health safety net for so many women in San Diego County we must save this practice
• 09:00 - 09:30 we cannot allow this practice to sink beneath the surface of the sea and so we so we got plot all the stops and fight and figure out how to keep this thing afloat so you go from like whiz-bang entrepreneur who's going to build a a huge company on the basis of an idea to being philanthropist trying to save the safety net for San Diego County that's exactly right but in order to save the safety net Todd Park realized he and his Partners had to solve the problem that hadn't even occurred to them
• 09:30 - 10:00 the problem of not getting paid by the health insurance system those systems may be too kind of word for it essentially what's happened in the United States is that you've got a lot of different health insurance companies and they've invented a lot of different kinds of health insurance products uh your HMO PPO POS HMO based POS ppo-based POS all right and then like employers like to customize those just for them so there's like the GE version of the HMO based POS product for Wisconsin
• 10:00 - 10:30 there's not even an alternate universe where the design of the U.S health insurance system makes sense you could not build it to be more confusing but now that system was Todd's problem there are countless call them Insurance packages like different flavors of insurance that have propagate across the country Each of which has different rules associated with it with respect to how to Bill them and these rules are
• 10:30 - 11:00 really poorly documented they're very opaque they're changing all the time and medical doctors and medical offices have no idea what they are right so they'll basically put together a claim to bill for their medical office visit they'll send in the claim and it will get rejected No One Insurance Company set out to create the confusion but no one had any incentive to clear it up I mean the harder it was for doctors to figure out
• 11:00 - 11:30 how to get insurance companies to pay them the less the insurance companies ultimately paid out to the doctors Todd park now knows this because his last resort Clinic full of pregnant women is getting buried under unpaid bills the payers send back this thing called explanation of benefits which is really kind of misnormal doesn't really explain anything it says here's your claim it was denied for denial code zero five b and you look at the code at the in The Legend at the bottom of the EOB and you know it says something like you know insufficient documentation or something like something incredibly vague and not
• 11:30 - 12:00 helpful so then you pick up the phone and you call the health insurance company and get some poor analyst who also has no idea what that right and right but the problem is there is a knowledge base of rules that the payer that's totally opaque to the doctor and frankly pretty opaque to the payer so they don't even know their own rules exactly exactly Todd and his fellow company Founders needed an expert someone who had mastered all the rules created by America's health insurance
• 12:00 - 12:30 companies someone who knew how to get those companies to pay a bill Bob Gatewood kept seeing artifacts of this expertise everyone in these billing offices we walked into every single screen monitor was covered in sticky notes like the whole margin of the Monitor and so we would always point at the sticky notes and ask the person what's that and she would say most often is she she would say oh that's you know that reminds me that if a midwife does the
• 12:30 - 13:00 delivery I have to put a CZ modifier on the code or you know here this one reminds me that Aetna only reimburses for a GYN visit every 18 months not 12 months so I got to remember not to schedule an Aetna patient too soon and there were thousands and thousands and thousands of these things medical billing had become so complicated that hospitals were now employing a medical biller for each and every doctor
• 13:00 - 13:30 Todd and Bob noticed the successful medical billers were all of a type Gladys they called her super type A you know won't let anything past her likes to hold people accountable for their mistakes right and it's just kind of pissed all the time like angry that they're not getting paid what they should so at that moment given what you're you've just learned about just how critical Gladys is and how important like the business succeeds or fails on
• 13:30 - 14:00 whether Gladys is on vacation or Gladys is good does it strike you how odd it is that Gladys isn't valued [Laughter] well that's part of why she's pissed probably unless you know sometimes Gladys was the wife of the surgeon right right they were all women I'm not I'm not I'm not being sexist no no every single one we met was a woman um but yeah there were a lot of pissed
• 14:00 - 14:30 off Gladys who felt undervalued by the late 1990s the financial fate of entire hospitals turned on Gladys it occurred to Bob and Todd Park that they'd stumbled onto a better business idea find the best Gladys in the world if she actually existed if I had found you when you were I don't know 12 years old and I asked you what you were going to be when you grew up what might you have said I was going to
• 14:30 - 15:00 be an accountant this is Sue Henderson medical biller seriously it's a very very very very exciting and and the reason was math was just so simple for me everything about it was so incredibly logical and it just seemed a great path for me you you killed your dreams early I was very practical and I'm in very very organized individual I probably leaning a little bit on the OCD side and
• 15:00 - 15:30 so in accounting there isn't any gray so if you're doing the books and it's a penny off it's wrong someplace you have to figure out where that penny is and you can't just take it and tape it into the books and then close them [Music] Sue Henderson discovered medical billing almost by accident back in the 1980s accounting had captured Her Imagination medical billing she found even more
• 15:30 - 16:00 thrilling which was in and of itself kind of amazing you know medical billers generally are housed in basements I'm not exaggerating of uh hospitals or practices without a window and they're not appreciated and it's kind of fascinating because if you didn't have medical billers you can render all the services you want if you're never going to get paid you're going to go out of business they're
• 16:00 - 16:30 definitely unappreciated across the board how do you explain that given what you just said that you're going to go out of business if your medical bill is no good because I don't I I don't think that I shouldn't say I don't think I know doctors are not Financial people they care about patients that's what they care about the Dr Sue works for it don't really get what she does or how she does it they just leave her alone to play what is about to become a very high stakes
• 16:30 - 17:00 game so when you first get into medical billing medical billing isn't anything like as complicated as is going to become correct a lot of medical billers were overwhelmed by the complexity but Sue kind of liked it she sat in the basement of a hospital in Northern Massachusetts but she was ready to fly when would have been the first time where you walked into a job and you increased the receipts because you were
• 17:00 - 17:30 billing better well that definitely definitely would have been Holy Family Hospital in Methuen and that when would that have been that would be in the middle of my career 1980s 1990s yeah in the 80s yep in the 80s yeah and so you so that's a moment where you walk in and just by virtue of your command of the complexity you're able to generate more payment to the hospital it was a combination of complexity and it was a combination of looking at
• 17:30 - 18:00 a department that was just so unbelievably mismanaged they had a quarter of a million dollars in unapplied payments from the Medicaid system sitting what does that mean what does that mean the moment I asked the question I knew I didn't actually want to know the answer oh okay so what happens is
• 18:00 - 18:30 Cade is sending you all of these payments and you don't have a claim to which they cannot be applied so either you didn't send that claim out and they the details of what Sue Henderson does well even she has trouble making it sound interesting and she's more interested in the details and perhaps anyone in the world what's the secret to getting the revenue getting the money out of the insurance it unfortunately is playing by their rules that's the unfortunate part there's
• 18:30 - 19:00 simply now no way around that and so if they're saying you need a modifier 55 you need a modifier 55 period end of sentence there's no way around it and it's just playing by their rules what's a modifier 55 I don't actually care about a modifier 55. um the modifier 55 would be um a second I won't describe it exactly but it would be a a second procedure
• 19:00 - 19:30 code that is appropriate with the initial procedure code so it's there there are hundreds of versions of this problem with medical billing where there's some nitty detail that if you leave it off you just don't get paid there are thousands of them and over time they were basically in your head there were a lot of them in my head did you have you run across anybody any medical billers who who felt like you're equal oh that's a
• 19:30 - 20:00 very I can't answer that question because because I'm I'm quite sure there are I'm quite sure there are other people as equally knowledgeable absolutely um yeah I I don't know you just haven't met them I haven't met them over two decades in windowless rooms in clinics and hospitals in the Greater Boston area Sue Henderson makes herself
• 20:00 - 20:30 not just valuable but close to Irreplaceable then in the summer of 1999 she sees a want ad on monster.com for a medical biller from a startup called Athena Health based in San Diego but with an office in Boston it's Todd Park's struggling startup Sue applies she gets an interview they reject her but a few weeks later they call her back with a bizarre request he wasn't
• 20:30 - 21:00 offering me a job he was asking me could I come for lunch to meet with some potential investors that were coming so that they could kind of convince these investors that they had somebody who knew what he or she was doing and convinced them that this was a good idea to invest in the company so they were bringing you on as an expert in medical billing to demonstrate
• 21:00 - 21:30 to investors they knew about medical billing yep so I said okay you don't burn your Bridges so I went over and we had lunch in the little restaurant and I sat there for an hour and a half having lunch and being grilled by these investors about what I knew about medical billing as though I had already been hired and I did this three times
• 21:30 - 22:00 I didn't get paid for anything except I had a lovely free lunch and finally at the end of the three lunch process Bob Gatewood called and said we'd really like to hire you I had convinced everybody I knew what the heck I was doing of course she knew and of course Todd and Bob could see that they needed her and if they could just bottle her expertise she might make everyone rich [Music]
• 22:00 - 22:30 welcome back to against the rules [Music] unless the engines blob there's a strange British Play Written in the early 1900s called the admirable Creighton it was written by J.M Barry
• 22:30 - 23:00 who's more famous for Peter Pan I only saw it once but I've never been able to get it out of my head in the admirable Crichton an upper class British family is Shipwrecked they all wash up on a deserted island along with their butler named Crichton Titan oh my God locate the nearest Town Hall village find some transport and bring it back with him very good my Lord after the Shipwreck the butler Crichton behaves at first as he always has he bows and scrapes and speaks only when spoken to
• 23:00 - 23:30 but on the island the only one who has any idea how to survive the nobility are forced to admit it and defer to him lest they starve and by the end he's King of the island the British Lord is Creighton's slave and his daughters of the butler's Harem in waiting and the Lord is freaking out I should give the orders and you will obey them with the deepest respect my Lord no
• 23:30 - 24:00 [Laughter] the reason I can't get the admirable Crichton out of my head is because it's about the arbitrariness of social status and the way that status can disguise people's value Athena Health is his own little island Todd Parks washed up on it with Sue Henderson but he's at first a bit unclear about how to maximize her value so he called his brother Ty called me up and said Kenya we need
• 24:00 - 24:30 some help uh can you help me and so I said of course uh because when your older brother calls you uh you basically say yes this is Ed Park he was just then a 22 year old graduate of Harvard where he'd run the computer science club uh and so I packed up all my things and uh you know drove in my uh you know 10 year old Taylor Camry yeah in a three-day Sprint out west to join him in San Diego it wouldn't have been a startup if there wasn't a story about an old Toyota Camry
• 24:30 - 25:00 once Ed stopped driving he took a long hard look at the health insurance industry we went through and we tried to figure out what are all these rules and then we pretty quickly figured out that the rules weren't written down anywhere uh the only people who knew the rules were people who had actually worked in the industry and had been incredibly observant for the last five years people like Sue Henderson
• 25:00 - 25:30 or perhaps no one but Sue Henderson anyway Todd Ned figured out that what Ed needed to do was go into a room with Sue to see if he could replicate her brain in computer code and so Ed drove his Camry back to the Boston suburbs I I still remember the offices that we were working in there were these tiny little offices uh I think with you know the requisite three or four people to an office she's sort of the next office over and I was heads down coding and that was like what do I need to code to
• 25:30 - 26:00 make this thing work and so um her job was to basically help us get paid and my job was to try and figure out how to write a bunch of code to make it so that we could start doing it in a way that was semi-replicable [Music] for her Parts who was struck by just how much was in her head that was not in theirs yeah I think and and probably Eddie would um and he's going to kill me because I call him Eddie all the time I think that Eddie probably understood
• 26:00 - 26:30 the fact that they it had all his complexities but I think that he thought with all of these brilliant programmers that they could figure it out all by themselves that they could just figure it out it was a few days into it when Sue realized that Ed and I really had no idea what we were doing and so she sets us down she's like boys shut up I'm gonna give you a little lesson if she taught us about like how the accounting Works Bob Gatewood is remembering the day on
• 26:30 - 27:00 the island when it became clear who was the admirable Crichton well after she gave us that lesson we're like oh yes we will follow you we are your Grasshoppers and so you know she was basically the product manager at that point so she you know she would tell us what the system needed to do and we would go do it and we we bought her Hazel did she tell you about hazel the big printer we got her a big claims printer and she named it after her mother so we have a Gladys a Hazel and a suit
• 27:00 - 27:30 that's right so I was sitting in one room Sue was sitting out over in the next room and every day uh I would code something and put it out there and then you know that evening she would yell at me and so about something or other I did and sort of say like you can't like I don't understand what you're doing you can't do that I'm like what do you mean then she would basically explain to me that like you need to make sure that the procedure code with the highest charge amount is put first on the claim because
• 27:30 - 28:00 the insurance companies will like sometimes pay the first line in the claim and not the second third and fourth clients in the claim so I'm like I didn't know that great I'll do that and so I then I would change it and then it would be that way from then on this went on and on and on not for weeks or months for years [Music] the first three years Ed Park worked 18 hours a day he had a sleeping bag and slept under his desk
• 28:00 - 28:30 by day he had listened to sue by night it turned what was in Sue's head into software in the morning I would kind of wake up at six or so go to the bathroom you know that do you remember that pink soap that the clear pink soap that you sometimes get like from like from those dispensers from a long time ago I basically take that stuff run through my hair like you know shampoo in the sink and go back to my desk and keep programming so that was that's the kind of life I learned this weird new version of Athena Health
• 28:30 - 29:00 now totally depends on the value of one woman's expertise even though no one else had ever seen Special Value in Sue Henderson or consider the stuff in her head and expertise in a funny way that's why there's money to be made here up until now no one not even really Sue herself has figured out how valuable Sue is if I basically had asked her to go into the middle of a room and basically you know give her a stack of paper and said please write out
• 29:00 - 29:30 everything you know about billing she would not have produced the things that were necessary for us to be successful instead she'd had a set of experiences such that when she got placed into a sort of situation which I often did I put her into a situation where something didn't make sense right then she would basically say she would immediately recognize that something was wrong and she basically searched her database her head and said and ask herself why is this wrong the smart young Harvard
• 29:30 - 30:00 graduates are trying to fix a big problem in the Health Care System but what they're really doing is exploiting the world's inability to see the expert it's expert blindness Sue had a sense of moral indignation when something was wrong right and so there are some people who are essentially The Unsung experts but you get them into a room and you present them with something wrong and they won't tell you right like they're trying to read the room they're trying to figure out what you think the answer should be and they don't tell you that
• 30:00 - 30:30 like you're full of crap right Sue did not have that problem she if she thought it was wrong she would say Eddie I think you're wrong and uh uh she would tell me in no uncertain terms you get this sense that there are certain things in the world in particular Pursuit is medical billing for which they have a sense of moral indignation that they can't hide she cared a lot yes she cared a lot did you at any point think or wonder if there was someone who was even better
• 30:30 - 31:00 than Sue at this or did you think all along wow we probably have the best I couldn't conceive of anyone who who knew more than her like I would say it was three or four years until we got to the point where it was clear that we had something that did Justice to the knowledge in our head the contents of Sue Henderson's mind became a five billion dollar software company it has been one month since Athena Health announced the deal to be acquired by Veritas capital and Sue got a bit rich
• 31:00 - 31:30 but in the bargain she saved the U.S economy a small fortune by selling medical billing software to doctors offices Athena Health changed the U.S health care System doctors would never again need their own medical biller a single biller can now handle 10 doctors that biller is now in effect Sue Henderson many of our doctors basically said to us um look you saved my career I would have gone out of business if it hadn't been
• 31:30 - 32:00 for you guys but maybe the most telling response to the power of Sue Henderson came from a big health insurance company or anyway that's what Todd Park thought so I get a call um one day from a very powerful very sophisticated national health insurance company right way above average in terms of its Technical and operational prowess the insurance company had a bizarre request they said we'd like to license your rules engine from you I said I I
• 32:00 - 32:30 can't do that I can't tell you what your competitors Insurance rules are they said no no we want to license our own rules from you the insurance company itself didn't understand why it paid some medical claims and not others it was relieved that someone had figured it out I said well let me get this straight you want to license your own billing rules from us they said yes I said okay it's a little crazy can you just explain to me why
• 32:30 - 33:00 they said well look you know I mean we have a bunch of different systems we bought a bunch of different insurers uh you know there's a ton of spaghetti code in these disparate systems and we don't really know what the hell is in there I said fabulous that's incredible and and after that one insurance company did that did you find others also wanting to do it we said we said it was too weird we couldn't do it [Music]
• 33:00 - 33:30 thank you okay to recap this Invisible Woman becomes an expert in a subject no one really thinks of as especially important or even really a subject and her expertise changes a massive industry in retrospect are at any moment were you surprised by your value like your value to this new business I don't think most of the time that I
• 33:30 - 34:00 realized my value I think I was enjoying what I was doing and I don't think that I was thinking wow I'm I'm pretty valuable here and if I left they'd be in big trouble Sue Henderson saved Todd Park's first business but if you asked Todd Park that was only the second most important thing she did for him the most important thing she did for him
• 34:00 - 34:30 was to lead him to a bigger idea about where to find experts especially in a crisis Sue doesn't run the Healthcare System she doesn't run a hospital system but she doesn't run a Physician Group she doesn't run an insurance company right but she has an incredibly Good Sense on the ground of what is going on in an instinct for what to do to make things better right so uh so like in the Healthcare System she is absolutely an L6
• 34:30 - 35:00 the L6 the level six the person six levels down from the top the admirable crichtons that Insight became Todd's new obsession that you might never find the expert who knows what you badly need to know because she's buried under some big organization or system she has no status she might have a voice but no one hears it after his experience with Sue Henderson Todd Park basically became known as the
• 35:00 - 35:30 guy who could find experts where no one else thought to look [Music] during his first term in office President Obama addressed the American people hello everybody I want to talk with you about a new consumer website healthcare.gov it's a good resource for understanding the new law and it offers
• 35:30 - 36:00 a few simple tools to help you take your health care into your own hands Obamacare Americans were now suddenly eligible to sign up for a new health insurance Marketplace online on October 1st 2013. millions of uninsured Americans are going online this is healthcare.gov hoping to enroll in the Obamacare exchanges but the websites have been experiencing technical glitches senior medical that's the sound of a crisis healthcare.gov has crashed it's not just
• 36:00 - 36:30 embarrassing it's a political disaster after weeks of ignoring it the White House finally admitting what everyone already knew healthcare.gov is a mess the White House is scrambling to find someone anyone who can fix this nightmare Obama has by now brought Todd Park in as Chief technology officer for the Department of Health and Human Services we basically went to CMS the agency in charge of healthcare.gov that have been
• 36:30 - 37:00 working its heart out since the site went live on October 1st 2013. Todd found that the people in charge didn't actually know why the site had crashed or how to fix it neither did the people right under the people in charge or the people right under them we went down another layer and then another layer five layers down basically and then we finally got to layer six which is where all the contractors were who
• 37:00 - 37:30 were working on the site and uh you know found a really really difficult and tough situation but long story short at that layer and the layer beneath that layer right you have folks working for the people in charge of the contractors and folks actually one layer beneath that right um found people who really understood at least part of the picture right and had deep domain expertise had an instinct about what to do
• 37:30 - 38:00 why the Obama Administration hadn't found the people who knew how to fix their website on their own is a question for another day but this kind of thing seems to happen over and over again after the healthcare.gov debacle Todd always sent his Tech teams into any crisis with a specific instruction find the L6 I remember actually a report out from one of the teams they had been deployed to the state department because I believe it was the Visa processing
• 38:00 - 38:30 system of America that had broken yep and that was a huge problem obviously and so he said what what did you do he said well I went seven layers down and found two contractors who actually knew what the problem was and he said all I did was basically say okay I'm going to take your solution and deliver it seven layers up basically telling people in charge this
• 38:30 - 39:00 technical fix needs to be executed and it was and then America was able to process visas again ever asked yourself why you stumbled upon this pattern as opposed to someone else oh I I don't think I am unique in identifying the pattern I guarantee you there are l6s in your space in your organization right and the
• 39:00 - 39:30 key to your success in addressing a problem or tapping into an opportunity is not you it's not you it is actually someone else an L6 and you have to have the wisdom your job is to find the L6 and let them rock and roll find the L6 not the officially important person not the public person the person on TV not the person that seems like he knows what he's talking about
• 39:30 - 40:00 no you need to find the person who spent the last 20 years stuffed inside some basement without Windows quietly learning things and Who as a result might not be very good at advertising themselves or what they know there are some experts who for whatever reason um are really terrible at explaining what is going on and what to do either because they're just really terrible at explaining or because they're not clear thinkers or because they want to keep the secret sauce for themselves
• 40:00 - 40:30 in any given situation you think it will be obvious who the expert is it won't we'll go right along believing that the people who happen to be on top are the most important people until we sense we cannot afford to believe that anymore until say some crisis arises and just to survive you need to find someone who actually knows the answer to your question
• 40:30 - 41:00 thank you against the rules is written and hosted by me Michael Lewis and produced by Catherine Gerardo and Lydia Jean Cott Julia Barton is our editor with additional editing by Audrey dilling Beth Johnson is our fact Checker and Mia Lobel executive producers our music is created by John Evans and Matthias bossy a stellwagon symphonet we record our show at Berkeley Advanced media Studios expertly helmed by Topher Ruth thanks
• 41:00 - 41:30 also to Jacob Weisberg Heather Fame John snarz Carly migliori Christina Sullivan Eric Sandler Maggie Taylor Nicole Morano Royston preserve Daniela Lacon Mary Beth Smith and Jason Gambrell against the rules is a production of Pushkin Industries keep in touch sign up for pushkin's newsletter at pushkin.fm or follow at Pushkin pods to find more Pushkin podcasts listen on the I Heart
• 41:30 - 42:00 Radio app Apple podcast or wherever you listen to podcasts in case you missed it I recently recorded a new unabridged audiobook edition of my first book liars poker it's about Wall Street and how it became the place it is you can buy the new liars poker audiobook at pushkin.fm liars poker you could also buy it at audible or wherever audio books are sold foreign