Health Insurance and Health Care Reform in 2014

The most significant changes implemented by health care reform legislation will come into force on January 1st of 2014. These changes will have at least some impact on all individual and family policy holders and will also effect grandfathered policies that were effective on or before March 23, 2010. The positive changes will be for those who have been rated up or declined for health insurance in the past, for those who are currently or plan to become pregnant, and those whose income is less than 400% of the federal poverty level (I will be developing a worksheet to help you determine whether you are eligible for a subsidy). The negative changes will be for those who have an average or better than average health rating and for those on the younger end of the health insurance spectrum (20s-30s).

If You’ve Been Declined or Rated Up

If you have pre-existing conditions, you are now in the sweet spot of health care reform. Starting in October of 2013, health insurance companies will be able to begin accepting applications for policies with a January 1st, 2014 effective date. These policies will not use health status or pre-existing conditions to determine benefits, to decline or charge higher rates. Moving forward, the only factors that will contribute to your health insurance premium is the plan you choose, your age, and tobacco usage. I am not yet aware of how currently effective policies will transition, whether your rating will simply be removed from your existing policy or whether you will need to apply for a new policy to get rid of your rating. I will know more as we get closer to the open enrollment period starting in October 2013.

Maternity Coverage

If you are pregnant or are planning a pregnancy, starting on January 1st, 2014, all new health insurance policies will cover maternity automatically. It has not been made explicitly clear whether women who are currently pregnant will be covered. However, given the language of new policies regarding pre-existing conditions, I am comfortable in speculating that there will not be a waiting period for women who are currently pregnant and whose due date falls in 2014 and beyond. I will give updates as I become aware of definite regulations.

Health Insurance Subsidies

Health insurance policies sold through the NC exchange on or after October 2013, with January 1st effective dates, will be eligible for the subsidy. The subsidy amount will be based on your income and you will be eligible if your income is less than 400% of the federal poverty level. Based on income brackets, the premium you owe for your health insurance policy will be calculated as a percentage of your annual income. As previously stated, I will be creating a calculator to help you predict what percentage of your monthly income a health insurance policy will cost you. Health insurance agents will have the ability to assist you in purchasing a policy through the exchange.

Young and/or Favorable Health Rating

If you are young and/or have a favorable health insurance rating, in almost all cases, you can expect rate increases in 2014. This rate increase is due to required pre-existing coverage and to rate variance shrinking from young to old subscribers. The purpose of coverage penalties for currently uninsured individuals is an attempt to bring in healthy policy holders and temper this increase. There will be high deductible plans available to those who want to satisfy the health insurance mandate while minimizing monthly premium expenses.

There is a danger however, that individuals with low health care expenses will be driven to companies that have high complaint ratios, but offer coverage that fulfills the mandate, because those with poor health are likely to gravitate towards the health insurance companies that most reliably pay claims. If a scenario like this occurs, the reliable health insurance company’s premiums will be driven very high, which may even cause them to go bankrupt if they are unable to attract healthy subscribers. The tragedy of this type of scenario would be that the bargain basement health insurance company would come out on top for the very fact that they don’t do a good job of paying claims.

Grandfathered Versus Non-Grandfathered

If your health insurance policy was effective on or before March 23, 2010, and you have not made changes to your benefit level since then, you have a grandfathered plan. Grandfathered plans are not subject to many of the health care reform requirements, so if you are one of those who expects to see rate increases due to coming changes, it makes sense for you to stick with your current plan for now. If you are in your 20s or 30s, and/or have a very good health rating with your current plan then you probably fall in this category. However, in several years, up to 40% taxes will be applied to grandfathered plans that will cause them to lose their appeal. When these taxes are applied, then in almost all cases it will make sense to roll into a non-grandfathered plan.

When to Enroll (Open Enrollment)

Starting in October of 2013, you will be eligible to begin applying for a policy that falls under the new health care regulations. The initial open enrollment period will last for 6 months. After this time, there will be an annual open enrollment period at the end of each year (October 15th-December 7th) in which you may switch your benefit level or apply for a policy with a new company. Outside of open enrollment periods, you may change your policy during special enrollment periods created by certain life events such as moving your residence, losing group coverage, getting married, or having a baby.

How to Enroll

The enrollment process for policies sold outside the exchange likely remain much the same as they are today with two major exceptions. Medical underwriting will no longer be a part of applications and enrollment periods will be restricted as described above. Policies sold inside the exchange will have the same type of applications as outside except there will be required proof of income if you are eligible for a subsidized policy. It is not yet clear what specific documentation or tax form will be required to substantiate claims of income.

Current Policies

If you currently have a health insurance policy that you are happy with and plan to keep your policy beyond the open enrollment period, your policy will likely transition on January 1st of 2014 and be automatically modified to accommodate the new regulations coming into force. As previously stated, I am not aware of how ratings on current policies will be handled. They might stay on, in which case you would need to apply for a new policy without a rating to shed your old health rating. The more likely scenario is that non-grandfathered policies will automatically shed their health rating and transition into the new rating pool for that specific policy.

What Should You Do?!

There’s nothing to do immediately. As October moves closer and the NC health insurance exchange is up and running, I will be able to provide more specific details and directions in navigating the coming changes. I wish you well and invite you to contact me with questions or concerns.

Fat Sick and Poor – Overcoming Barriers to Becoming Healthy and Well-Thy

Social Determinants of Health: Causative Agents that Determine Health Outcomes
In Australia, a social model of health has been developed by health professionals and policy makers, in order to study the effects of the social determinants of health upon given populations. Social policy drives a lot of health funding, in particular statistics indicate that the most socially disadvantaged group within a given population also have the highest rate of chronic health problems, and highest number of risk factors leading to the development of chronic health problems (including cardiovascular disease, obesity, cancer, diabetes). The social determinants of health are the causative agents that are studied within social models of health, and examined by epidemiologists (health professionals who study the effects of various factors that cause disease within a particular population). This paper discusses how people’s bad health is not a result of their accumulated poor choices; people’s bad health is a result of socially determined agents, including a lack of health education, opportunities and lack of access to health facilities, particularly in rural and remote areas. A person can potentially overcome socially caused disease and illness, through the assistance of a health professional such as a nurse.

The Role of the Nurse As a Helper Towards Health
A nurse can work in partnership with a person in building their levels of health literacy, education, referral and help in building confidence towards making healthy choices, regardless of circumstances. Nurses are in particular well positioned to understand a person’s social context, and help a patient to overcome the negative factors within the realm of causative agents. The most critical underlying factor in assisting a person to overcome the social determinants of their health is their level general perceived self- efficacy (their belief in their own ability to make and continue making healthy choices, and engage in health protective behaviours.)

How a Person Interacts Within the Social Health Model
An individual, within the social models of health, has the power of free agency, and can and does interact with the social determinants of health. Generally, the social determinants of health flow from upstream factors to the midstream, and finally to the downstream factors. Upstream factors are the furthest from the individual, and include the broad aspects of a society that a person belongs to. These include the culture of a society and social cohesion, the stability of the government, health policies and language and media. Midstream factors are more direct in their impact on an individual, and these include factors such access to education, where in the social gradient the person is, their access to health care, where the person is employed, their social network (or lack thereof), the neighbourhood they live in and the built environment in which he or she lives.

Health Professionals Seeing an Individual in Social Context
A health professional cannot look at a patient’s condition in isolation – a health professional should take into account socially determined factors – that contribute to a state of ill health within the person. When determining appropriate treatment and supports for a patient, examining the person in their social context will assist in determining valid treatments, and providing education and referral to services that will assist in mitigating the socially determined circumstances that contributed to the development or onset of the disease or illness state.

Chronic Stress As a Risk Factor
One of the highest contributing factors to ill health is the effects of chronic stress. In a study by Pyter et al. (2014) the effects of abstract stress and social isolation were studied on mice. Social stressors negatively affected healing, increased bacterial load in the body, and also caused high levels of inflammation in the body of the subjects. Inflammation and impaired healing caused from elevated levels of stress, particularly in chronic situations, leads to increased susceptibility to disease.

Examining Socio-Economic Disadvantage
The most disadvantaged parts of society – in Australia – rural and remote areas in particular, have high levels of unemployment and general disadvantage economically. Statistically in demonstrated in the Australian Institute of Health and Welfare (2012) paper, the most economically disadvantaged groups coincided with both rural and remote communities, and they had the highest incidence of both risk factors for chronic disease, and incidence of chronic disease.

Contributors to Chronic Diseases
With a combination of high stress levels due to social stressors and economic disadvantage and high risk factors, rural and remote areas of Australia are a melting pot for high rates of chronic disease. High levels of stress are particularly noted in rural and remote areas, for example, due to the high number of disparate suicides by men in rural and remote areas compared to men living in urban environments. A paper by Beaton (2012) outlines the statistics demonstrating that men are more likely to commit suicide who are living in rural and remote areas.

Self Medicating to Relieve Stress
When experiencing stress, patients are noted to desire to self-medicate using substances that produce mind-altering effects and moderate anxiety levels, such as alcohol and tobacco. Alcohol and tobacco use, in particular excessive alcohol and daily tobacco use, are two of the focus risk factors that are used in studying the risk of developing chronic diseases. Le, Funk, Lo, and Coen (2014) demonstrated that alcohol and nicotine are often taken together, and a cyclical relationship happens between excessive drinking and increased tobacco use. Further evidence indicates that stressed people in a study self-reported functional addiction to alcohol and tobacco use as mood regulation tools (Snel, 1998).

Poorer Leads to Higher Risk Factors
The effects of daily smoking and excessive tobacco use are known high risk factors for cardiovascular disease, and lung disease, and some cancers. Statistically, in the paper by the AIHW (Australian Institute of Health and Welfare, 2012), the most socially disadvantaged individuals, in rural and remote areas, had the highest number of reported risk factors: daily tobacco use, obesity, poor nutrition, excessive alcohol use, and lack of exercise; and the highest rates of chronic diseases. Comparatively, people in urban and regional areas with higher population density had less rates of disease, and also a lower incidence of risk factors for chronic disease.

Contributors to Stressful Environments
A number of determinants are thought to cause higher rates of stress within low socio-economic populations, including social isolation, high rates of stress caused by major life changes (such as family breakup, divorce, unemployment, lack of stability), and these leads to the use of tobacco and alcohol to self-medicate during times of stress (as per Snel, 1998). In rural and remote areas, Australia has traditionally had difficulty placing medical facilities due to isolation and cost of establishing large facilities in rural and remote locations. Generally due to lack of access to cheaper fresh fruit and vegetables, access to primary health care and prevention and health promotion services, inexpensive exercise facilities and incentives, the socially determined elements, amongst the rural and remote poor lead to high rates of chronic disease when compared to healthier and wealthier urban populations (Australian Institute of Health and Welfare, 2012).

Barriers to Experiencing Wellness
In addition to the social determinants of health acting upon an individual, a number of barriers are potentially experienced by people when attempting to improve their health status. A study in Sweden by Hammarstrom, Wiklund, Lindahl, Larsson, and Ahlgren (2014) studied a number of barriers to women who were attempting to lose weight. They discovered that a number of social stressors, and difficulty with the self (adjustment to diet and self-belief) impaired the ability to lose weight. They conversely discovered that receiving social support, and determining goals and improving self-determination facilitated in weight loss and subsequent improvement in health.

Hopping Over the Barriers to Health
In more studies of how improving self-efficacy and working in partnership with health professionals, it was demonstrated that an active improvement of general perceived levels of self-efficacy and motivation led to better health outcomes for the patient. These studies include Wood, Englander-Golden, Golden, and Pillai (2010), where self-empowerment and social support improved health outcomes for people experiencing substance abuse, and Mohebi, Azadbakht, Feizi, Sharifirad, and Hozori (2014) determined that patients’ levels of micronutrient intake improved as they had better levels of general perceived self-efficacy.

Compassionate Health Care
Nurses have a vital role in helping a patient: advocating for the patient, using motivational interviewing, developing therapeutic partnership, educating regarding appropriate health protecting behaviours, and encouraging the development of social support and increasing levels of self-motivation within the patient. Hybels et al. (2014). Benzo et al. (2013) discusses the importance and success outcomes of motivational interviewing to discuss behaviour changes in patients diagnosed with COPD.

Empowerment to Be Healthy Happy and Strong
A nurse has an empowering role, and can point the patient towards developing healthy social networks, and making health protecting choices. The role of social support, such as in the study by Harvey, where it was noted that social support can improve health outcomes cannot be understated. For people who are in faith communities, social support is evidenced by improved general biological health markers compared to other populations, this was studied by Hybels et al. (2014).
Nurses also have a unique position as health professionals to use motivational interviewing and therapeutic partnership with patients, in order to empower them and remove barriers to obtaining better health outcomes. Benzo et al. (2013) discusses the importance and success outcomes of motivational interviewing to discuss behaviour changes in patients diagnosed with COPD.

Nurses and Advocacy
As members of the community in which they live, nurses have the opportunity not only to act as treating health professionals, and part of medical and allied health teams, but also to act as advocates in the community for the most vulnerable members of the community. Nurses have a role to play in building the ability of individuals in the most disadvantaged areas to build social capital and develop healthy social networks of supportive individuals. Nurses can be community champions, social role models and professionals who educate individuals, groups and communities that they can make changes, both as individuals and groups to improve their capacity to make health decisions, thereby improving the health outcomes for everyone in the community.

REFERENCES
Australian Institute of Health and Welfare, AIHW. (2012). Health Determinants, the key to preventing chronic disease. Canberra: Australian Institute of Health and Welfare.
Beaton, Susan and Forster, Peter. (2012). Insight into Men’s Suicide. Retrieved 24th April 2014, from http://www.psychology.org.au/inpsych/2012/august/beaton/
Benzo, R., Vickers, K., Ernst, D., Tucker, S., McEvoy, C., & Lorig, K. (2013). Development and feasibility of a self-management intervention for chronic obstructive pulmonary disease delivered with motivational interviewing strategies. J
Cardiopulm Rehabil Prev, 33(2), 113-123. doi: 10.1097/HCR.0b013e318284ec67
Hammarstrom, A., Wiklund, A. F., Lindahl, B., Larsson, C., & Ahlgren, C. (2014). Experiences of barriers and facilitators to weight-loss in a diet intervention – a qualitative study of women in Northern Sweden. BMC Womens Health, 14(1), 59. doi: 10.1186/1472-6874-14-59
Hybels, C. F., George, L. K., Blazer, D. G., Pieper, C. F., Cohen, H. J., & Koenig, H. G. (2014). Inflammation and Coagulation as Mediators in the Relationships Between Religious Attendance and Functional Limitations in Older Adults. J Aging Health. doi: 10.1177/0898264314527479
Le, A. D., Funk, D., Lo, S., & Coen, K. (2014). Operant self-administration of alcohol and nicotine in a preclinical model of co-abuse. Psychopharmacology (Berl). doi: 10.1007/s00213-014-3541-2
Mohebi, S., Azadbakht, L., Feizi, A., Sharifirad, G., & Hozori, M. (2014). Predicting of perceived self efficacy in the amount of macronutrients intake in women with metabolic syndrome – 2012. J Educ Health Promot, 3, 21. doi: 10.4103/2277-9531.127608
Pyter, L. M., Yang, L., McKenzie, C., da Rocha, J. M., Carter, C. S., Cheng, B., & Engeland, C. G. (2014). Contrasting mechanisms by which social isolation and restraint impair healing in male mice. Stress, 17(3), 256-265. doi: 10.3109/10253890.2014.910761
Snel, J. & Lorist, M.. (1998). Nicotine, Caffeine and Social Drinking. Australia: Harwood Academic Publishers.
Wood, T. E., Englander-Golden, P., Golden, D. E., & Pillai, V. K. (2010). Improving addictions treatment outcomes by empowering self and others. Int J Ment Health Nurs, 19(5), 363-368. doi: 10.1111/j.1447-0349.2010.00678.x

Astrological Predictions for 2013-2014

Let’s take a look at my predictions for 2012-13 and see what actually happened:
Here’s what I predicted:
– More uprisings and riots.
There were riots in Egypt, Tunisia, Libya, Afghanistan, Pakistan, Syria, Israel, Greece and Spain.

– An escalation of natural disasters. There was an avalanche in Afghanistan, epic fires in Colorado, and a 7.7 earthquake off the east coast of British Columbia, Canada causing a tsunami in Hawaii.

– Water issues worldwide. We saw widespread flooding in Nepal, Pakistan, Russia, Romania, North Korea, Nigeria, the UK, Spain, a typhoon in the Philippines and Hurricane Sandy.

– Rising unemployment into double digits in many countries. Spain and Greece are over 25% and an average of 11% in the 27 EU member states. US is reported at 8% but probably closer to 12%.

– Governments taking more control over our privacy. On November 20th, the Senate rewrote a bill which now allows the feds to read private emails without a warrant. This law increases government access to emails and other digital files. This rewrite was done quietly and secretly. It now allows more than 22 agencies to access Americans’ email, Google Docs files, Facebook wall posts, and Twitter direct messages without a search warrant. It also gives the FBI and Homeland Security more authority to gain full access to Internet accounts without notifying either the owner or a judge. I am expecting sneaky controls over our freedoms and our privacy to encroach on us gradually and without our being aware of it until it’s too late.

– More QE. i.e. money printing. In September of 2012, the US embarked on QE3, another huge round of borrowing and money printing.
– Pension plans going bankrupt. E.g. The US Postal Service is broke and cannot pay into their pension fund, teachers retirement funds have gone broke, public pensions in many countries are underfunded and in danger of going under.
– More focus on banks and financial institutions, a tightening of their regulations, more bailouts, more greed and more fraudulent activities. And that’s exactly what’s happened.
– Growth of new technology, mobile phones and social networking. Apple launched its IPhone 5 in September, Smartphones, Twitter, LinkedIn, Tumblr and Pinterest have all seen accelerated growth. There were advances in Iphones, android phones and an upsurge in the use of mobile apps.
– A rise in anti- immigration laws and regulations. Since 2010, when Arizona introduced draconian immigration laws, 35 other states have tried to introduce similar rulings.
– Price of gold and silver continuing to rise. Whilst precious metals didn’t perform as well as I expected, they have still risen nearly 5% this year and it is only a matter of time before gold reaches over $3000 an ounce and silver is at $100 an ounce.

2013-2014 – Important Astrological Aspects
– There is a great deal of Water activity with Saturn in Scorpio, Neptune in Pisces and Jupiter going into Cancer on June 25th making a Grand Trine in Water.
– All three Mercury retrograde periods are in Water signs.
– Intense Cardinal activity happening building up to the Grand Cross in December, one of the most powerful astrological aspects with Uranus in Aries, Pluto in Capricorn, Jupiter in Cancer and Mars in Libra.

The ongoing square between Uranus in Aries and Pluto in Capricorn is very much in force during 2013. Remember that Uranus rules uranium and Pluto rules plutonium so there is a likelihood of increased nuclear instability and nuclear accidents.

This is going to be accentuated when Jupiter goes into Cancer at the end of June 2013 as Jupiter always increases and amplifies everything, so you can expect even stronger dissonance with respect to the economy, politics, weather changes especially earthquakes and volcanoes.

The USA has Jupiter and Sun conjunct in Cancer (July 4th, 1776), so the second half of 2013 and the first half of 2014 is its Jupiter return. Expect to see issues around Homeland security, the safety of US citizens, and a search for belonging and security in general. The positive and negative issues will be highly polarised.

It will be a year of opposites: war and peace, moving forwards and moving backwards, safety and vulnerability, balancing business and personal, home and work, emotional ups and downs, periods when a great deal is happening and periods that seem as though nothing is happening, holding onto the past and yet striving towards the future. The Cardinal signs signify that we need to be responsible for our own destiny and not rely on our governments to provide stability and security for our future.

Let’s not forget the powerful Grand Trine in Water with Jupiter in Cancer, Neptune in Pisces and Saturn in Scorpio. This is particularly strong during July 2013 but lasts energetically until mid-2014. This will bring increased confidence especially by lawmakers and governments in our economic and political systems. There could even be an upswing in the economy and the US dollar could go up in value. If it does happen, it will probably be short-lived and by the middle of 2014 if there has been an improvement in the economy, it is likely to be followed by a sharp drop a year or so later.

Neptune in Pisces for the next 14 years indicates more flooding, tsunamis and excess water especially in coastal areas. There could also be issues with water purity and contamination.

On February 9th, Mars is conjunct to Neptune which could be very favourable. It could be an opportunity to achieve something you have been dreaming of.
On 21st March, Mars goes into Aries and will be conjunct with Uranus. This is a combustible combination and could lead to explosions and sudden riots, upsets, surprises. It can also indicate war.

On 21st July 2013, Mars conjuncts with Jupiter in Cancer which adds more power to the T-square with Uranus and Pluto. I expect this to bring more sudden changes with respect to governments, control issue, power, the economy, social issues.

On December 7th, Mars goes into Libra which completes the Grand Cross with Uranus in Aries, Pluto in Capricorn and Jupiter in Cancer. This is extremely powerful and will be the beginning of even more vast changes. Mars usually stays in a sign for about 2 months, but this time it goes retrograde on March 1st 2014 and stays in Libra until July 26th 2014. So we can expect another 6 – 7 months of opposing energies where agreements are hard to find and where progress is restricted. This can be happening not only on the macro level, but also on the micro level in your own life. You may feel as though your life is not moving ahead, as if you are in a holding pattern and you don’t know what action to take. When you take action there may be little or no apparent results. Keep in mind that the earth is in the middle of all these opposing and squaring planets and you may find yourself trying to look forward and being pulled backwards, deciding to take a risk and then backing out of it, changing your mind frequently, your location, your job and your relationships. It will take a huge effort for you to break free of old, destructive habit patterns and to move into a new, more uncertain yet happier life.

Old structures that are no longer working for you will be pulled down. You may feel lonely, isolated and abandoned, but try to remain strong and realise that the reason that this is happening is because subconsciously you wanted more for yourself in your life. The old relationships that were draining and not fulfilling, the job that you hated, the lack of purpose and direction you felt in your life… all this had to change for you to be happy and feeling as though you were fulfilling your destiny on the planet. You will have the opportunity to move to a higher vibration, but to do that you will have to let go of the old and to be ready to move into the unknown and to have faith in the new. It will be a particularly powerful time for the Cardinal signs: Aries, Cancer, Libra and Capricorn (and this will apply if it is your Sun, Moon or ascendant sign), and also for all the water signs: Cancer, Scorpio and Pisces.

Summary of Predictions for 2013-2014:
– Worsening global economic crisis with more demonstrations and civil unrest
– Youth protesters will turn violent even though we have had mainly peaceful protests so far
– Higher unemployment
– Stock market earnings slide lower
– Multiple investigations of banking corruption and fraud
– Rising oil and food costs
– More failures of large insurance companies
– Extreme weather patterns from very hot to very cold
– Gold and silver to be very volatile with even more price manipulation, sometimes going lower and then much higher
– More power outages and for longer
– Survival kits will become a necessity
– Alternative power sources will become more mainstream – more use of green technologies: solar power plants, rooftop solar panels, wind farms, geothermal uses, hydrogen power plants
– Greater paranormal activity – more reporting of visitations from other beings
– Space exploration increasing and the uncovering of greater knowledge
– More people power using Twitter, Facebook and other social media concerning customer service. For the first time ever the consumer will have the power when rating a restaurant, hotel, airline, computer, products and services in general
– Increase in military threats especially in the Middle East and this could be very explosive towards the end of 2013 when Mars is square to Uranus
– Despite the crisis, some industries will grow. E.g. certain medical areas such as: regenerative medicine growing new bones, cartilage etc.
– Growth in certain food industries, catering, food technology
– New types of restaurants and food outlets
– Greater knowledge and research placed on nutrition and diet
– Healing and health products become more prominent
– Focus on locally grown food and its preservation
– Advances in water purification techniques
– Energy efficient housing construction market growing e.g. passive houses
– Security businesses could see massive growth – physical and/or virtual
– Breakthroughs in oceanography and our understanding of the sea
– 3D printing become more accessible and getting closer to becoming mainstream
– Traditional newspapers becoming obsolete – new forms of media where we the people are the reporters, not the controlling few who sift the news and keep us uninformed

I am anticipating that overall economically, times will get worse over the next few years. Some economists are forecasting an upswing in the economy from the middle of 2013. And indeed with the grand water trine and Jupiter in Cancer, this is possible for a brief time. However, we should not be misled into thinking that the crisis is behind us and that we can confidently invest with security. With Uranus strongly featuring for the next 6 years, we will have to learn to expect the unexpected. I didn’t expect gold and silver to drop as sharply as they have done over the last few weeks. However, markets never go up in a straight line. If they did, everyone would be able to make a fortune. I am anticipating greater volatility and uncertainty in the markets with wider swings from high to low than ever before. If you are a good trader during these times, you could make a fortune. However, you could also lose a fortune. But the opportunities will be there.

The key through all this hardship is going to be compassion and love with people coming together and helping one another through the changes. We can choose to make this a pleasurable and joyful time or we can make it even more difficult for ourselves. The choice is ours. I vote for helping one another, looking out for different ways of doing things, thinking outside the box, sharing our knowledge and expertise, working together and creating a new, exciting and better future for us all.

Top 10 Trends in Sales and Business Development for 2014

Will companies be hiring more salespeople in 2014? What will companies do to stand out from the competition? Will CRM systems expand or contract? How will the economy impact business growth? These are some common questions I hear as I address audiences around the world. Here are my predictions for the ideas and trends that will shape sales and business development in 2014.

1. Evolution of Subject Matter Experts

Buyers can now get just about all of the information about your company, products, and services from your website. However, what they do not have is the trends, best practices, or creative applications that determine whether or not there is a fit for the customer’s situation. Buyers will continue to value the subject matter experts.

If you want to know whether or not you rise to this standard already, ask yourself if your ideal clients would value the meeting from your team enough that they would pay for the session. If so, then you might already be there. If not, then you have a goal for 2014.

2. Content Becomes Emperor

Last year, people said, “content is king.” In 2014, content will continue to be the core to building value and getting heard above the noise. Buyers (and Google) value the best educators, as Marcus Sheridan of TheSalesLion.com says. It used to be that companies feared sharing their best stuff on their websites. As more initial investigations for solutions move to search engines, your ability to stand out from the crowd comes down to whether or not you are addressing the most important questions for your ideal customer. If you are stuck with your head in the sand, you might just get run over.

3. Continued Shift Toward Vertical vs. Geographic Focus

The shift from vertical to geographic focus tends to work in cycles. With the advancement in video-based communication and collaborative technologies, geography becomes slightly less of a big deal. However, the increased value placed on subject matter expertise will shift the table in a big way in 2014 toward vertical markets.

4. Collaborative Sourcing and Selling

Over the past five years, there was a trend of buyers beating up on weaker suppliers. While the short-term goal of the buyer was a reduction in costs, the unintended consequence was the destruction of many suppliers and companies who either lacked a competitive advantage, or failed to identify their lack of negotiation and sales prowess before it was too late. Ultimately, buyers lost a portion of their supply chain. The more sophisticated buyers will seek sellers with whom they can work collaboratively to obtain the greatest value. Buyers realize that the cheapest price has little meaning if the vendor cannot deliver as needed.

Collaborative selling will reward results and outcomes, but will continue to punish those selling commodities.

5. The Shift Toward Project-Based Services Engagements

Buyers have discovered that paying by the hour creates a disincentive for innovation and efficiency. The longer it takes the vendor, the more they earn. However, for the client, the faster they get a solution, the better. The hourly-vendor who delivers the most efficiently makes the least money. In 2014, the top performing professional services organizations will start shifting as much as 30% of their billing to project-based, or outcome-based pricing (with assumptions to protect themselves). Buyers want results, and they’ll pay for it. However, the savvy customer rarely wants to sign a blank check for hours of time without a defined outcome.

6. Sick of Waiting for the Economy – Build your own

Most economists say that the economy will continue to bump along in 2014. Innovative companies with a great story will start putting their capital reserves to work to build their own economy. The economy grows when businesses grow. And, those with creativity and value will get tired of waiting for the so-called “economy” and will build their own environment to thrive. This will drive accelerated growth in the latter half of 2014 to carry into a strong 2015.

7. Hiring Trend for 2014

Recognize that there is a need for subject matter experts. Be on the lookout for businesses cross-training their subject matter experts on how to manage a sales process. Those who do hire sales professionals or sales managers will rely more on specialized recruiters to ensure their next hire is the right one. Hiring people who were just looking for work has burned many companies. Often, the hiring companies discovered that those people were out of work for a reason. There are great ways to find a gem without using a recruiter, but recruiters are still the best way to attract superstars from other companies.

8. Simplified CRM Solutions

Years ago, companies realized they needed something beyond a spreadsheet (or napkin) to keep track of their business pursuits. Customer Relationship Management (CRM) solutions emerged to maintain knowledge, automate forecasting, and improve communication. However, over time, the CRM solutions have taken on a life of their own. The data entry requirements had become so overbearing that few organizations enforced compliance (mostly because the only people who filled out all of the fields were the worst performing reps). Look for a shift in 2014 for companies to identify the top eight (or three) pieces of information they need to understand if a deal is legitimate or not. They will ask reps to maintain fewer pieces of information, but will require compliance.

9. Better Qualification for Efficient Pipelines

It used to be that if a company was trying to reach $5 million in revenue, it would often look for a pipeline of $8 to $10 million. Today, companies often set a three to five-time multiplier. So, for $5 million, they pursue $15 million to $25 million in opportunities. Sharp organizations have started tracking the cost associated with pursuing unlikely deals. Instead of chasing everything, companies will define specific criteria for what makes a good pursuit, and which ones should be dead on arrival. The definition maintains focus, and preserves resources for the proper pursuit of the opportunities that deserve the company’s attention. Look for companies to qualify based on the relative impact and importance to the customer of solving the issue, rather than the desire of the company to sell something.

10. Honesty Prevails

With so much hype and old-school tactics, buyers will reward sellers who identify their own limitations. Claiming you are an expert at everything will be hard to believe when the buyer can search to discover the truth. Humility and candor will be sought after skills in 2014.

Health Insurance Likely To Be Dropped By Employers

McKinsey & Company, a management consulting firm, has released a new report stating that the new federal healthcare bill signed into law last year may dampen the number of employers willing to offer Americans health insurance on a significant level. The public option, it appears, plays the predominant role in health care insurance in the United States. A survey was conducted recently of 1,300 employers on the topic of health coverage. 30% of these said that by the year 2014, they will stop providing their employees with health insurance. 2014 is the year the health care law will go into effect. 50% of employers, who said they grasp the concept of reforms, suggested they would definitely not look for an alternative to employer coverage.

McKinsey acknowledges that the numbers derived from this study are higher than previous surveys. For instance, the Congressional Budget Office estimated that 7% of employees who are provided health insurance by their employers will have to transfer their coverage to a government run program. McKinsey also defends the results in the report, saying the new law and public options were explained to the people participating in the poll.

The current administration passed the federal Affordable Care Act last year, where employers with 50 workers or more are required from the beginning of 2014 to offer their employees reasonable health care coverage or pay each worker a penalty of $2,000 (minus the first 30 employees), and avoid offering higher paid employees better benefits than the employees on a lower scale. Americans who are unemployed or work for employers who don’t provide health insurance have the option of buying new insurance through the state program. Proponents of the law have argued that the new law will allow more individuals to become insured. According to statistics released by the Commonwealth Fund 46% of companies with less than 10 employees and 52% of companies with less than 50 employees provide health insurance, compared to 98% of firms with more than 200 employees.

Employers are just beginning to grasp the law. For families making $88,000 annually, they will be eligible for a federal subsidy in the state health insurance program. Employers are bound to push employees on this income scale to take advantage of the federal subsidy. For instance, if employers offer employees compensation instead of health insurance, the employees can buy the federal subsidy health care coverage. This is a win-win situation for the employee and employer. Such health coverage will protect the employer from having to pay high health insurance cost, which is rising every day.

McKinsey predicts that such statistics could make Americans lose their employer covered health insurance. If McKinsey’s prediction is right, the primary role the government wants to play in reforming health care for Americans could become its downfall. Instead of offering liberty and happiness, the health care law may become a bigger problem than before. 2011 is showing a crisis in health care. The reality is that most Americans are afraid of government provided health care; they feel that this very reason could lead employers to not expanding their companies, meaning loss of jobs!