In the “Six Levels Down” episode of the Against the Rules podcast, host Michael Lewis followed healthcare provider Athenahealth’s journey to fixing one of their biggest problems – getting insurance companies to pay their bills – and in the process, discovered the power of the L6.
What does a healthcare provider learning how to get insurance companies to pay their bills have to do with dairy farming? On the surface, nothing. That’s why we need to go “six levels down” to find “the L6” in a medical billing office to see the transferable lessons.
“The L6, [or] Level 6, is the person six levels down from the top … who knows what you badly need to know,” Lewis says in the podcast. “[This] expert is buried under a big organization or system, [and] has no status. [They] might have a voice, but no one hears it.”
Todd Park, a tech entrepreneur who has started and sold billion-dollar companies, including Athenahealth, built his career on a single insight: finding the L6.
In the late 1990s, Park and a business partner bought a childbirth clinic because they recognized women and their babies were having many expensive medical treatments that could have been avoided with better prenatal care. They thought they could manage clinics more efficiently and, overnight, found themselves with a great opportunity and a great crisis.
Regardless of the treatment provided by the clinics, which was the problem they thought they were solving, they found they couldn’t get insurance companies to pay them. This was the problem they didn’t know they needed to solve.
Insurance billing was extremely complex, and they found that even the insurance companies didn’t understand their own rules. Park and his business partners needed an expert, someone who had mastered all the rules created by the health insurance companies.
Bob Gatewood was hired to run the clinic and lead the effort to improve the billing system. In looking for ways to improve their billing system, he visited billing offices to try to learn how to improve. Gatewood said that when they visited billing offices, “Every single monitor was covered in sticky notes.” Actual Post-it notes taped to computer screens captured the expertise of individual billing specialists and allowed the clinics to properly bill insurance companies (and receive payment for services rendered).
Over time, by learning and collecting the information captured on the sticky notes, the billing specialists were able to increase the revenue for the clinics. However, the information on the sticky notes had no way to be transferred to anyone else. The sticky notes were only effective for one person. Gatewood and his team set out to find the billing specialist who could bring all the information on the sticky notes together into a system that could be taught and shared with others.
Where is this type of information captured on your farm? The answer may be different for milkers, herd managers, office staff and other roles, depending on what they have available where they are. Notes might also be captured on their phones. Think about the details these notes might capture about your business. Were you aware of all of them already? Why or why not? Who should and shouldn’t have access to this information? Consider how transferring the knowledge captured on "sticky notes" around the farm could help empower employees, improve profitability, and enhance the health and safety of animals.
Gatewood also found that successful medical billers had a type that he named "Gladys": This person is “super Type A, attention to detail and likes to hold people accountable for their mistakes.”
Gatewood’s real-life Gladys was Sue Henderson. Henderson made herself invaluable and nearly irreplaceable from her years developing her expertise and strong moral indignation for the rules of insurance billing.
Henderson was paired with a software developer to input her knowledge systematically into coded software to replicate at scale. It took years to develop, but they eventually sold the business for $5 billion.
Who is Gladys – the L6 – on your farm?
Who has a strong sense of what is right and wrong on the farm? Who has an instinct for what is going on and what is happening on the farm that often turns out to be accurate? How are you supporting "Gladys" on your farm? What problem can "Gladys" show you?
It is not quick or easy, and may not be worth $5 billion to your business, but what if finding the L6 on your farm added value that money can’t quantify, like quality of life, improved family relationships, increased employee satisfaction, renewed sense of purpose and increased satisfaction? Some things you can’t put a dollar value on.
What are you doing today to find the L6 on your farm?
