Defining a Health Information ExchangeThe United States is facing the largest shortage of healthcare practitioners in our country’s history which is compounded by an ever increasing geriatric population. In 2005 there existed one geriatrician for every 5,000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the industry is estimated to be short 200,000 physicians and over a million nurses. Never, in the history of US healthcare, has so much been demanded with so few personnel. Because of this shortage combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who need it in a uniform fashion. Imagine if flight controllers spoke the native language of their country instead of the current international flight language, English. This example captures the urgency and critical nature of our need for standardized communication in healthcare. A healthy information exchange can help improve safety, reduce length of hospital stays, cut down on medication errors, reduce redundancies in lab testing or procedures and make the health system faster, leaner and more productive. The aging US population along with those impacted by chronic disease like diabetes, cardiovascular disease and asthma will need to see more specialists who will have to find a way to communicate with primary care providers effectively and efficiently.This efficiency can only be attained by standardizing the manner in which the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, was able to reduce their potential disease outbreaks from 5 to 8 days down to 48 hours with a regional health information exchange. Regarding standardization, one author noted, “Interoperability without standards is like language without grammar. In both cases communication can be achieved but the process is cumbersome and often ineffective.”United States retailers transitioned over twenty years ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of patients as inventory, perhaps this has been part of the reason for the lack of transition in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any square in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Visualize any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the “art of medicine” is a barrier to more productive, efficient and smarter medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more rapidly thanks to increases in standardization of regional and state health information exchanges.History of Health Information ExchangesMajor urban centers in Canada and Australia were the first to successfully implement HIE’s. The success of these early networks was linked to an integration with primary care EHR systems already in place. Health Level 7 (HL7) represents the first health language standardization system in the United States, beginning with a meeting at the University of Pennsylvania in 1987. HL7 has been successful in replacing antiquated interactions like faxing, mail and direct provider communication, which often represent duplication and inefficiency. Process interoperability increases human understanding across networks health systems to integrate and communicate. Standardization will ultimately impact how effective that communication functions in the same way that grammar standards foster better communication. The United States National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is now on it’s third version which was published in 2004. The goals of HL7 are to increase interoperability, develop coherent standards, educate the industry on standardization and collaborate with other sanctioning bodies like ANSI and ISO who are also concerned with process improvement.In the United States one of the earliest HIE’s started in Portland Maine. HealthInfoNet is a public-private partnership and is believed to be the largest statewide HIE. The goals of the network are to improve patient safety, enhance the quality of clinical care, increase efficiency, reduce service duplication, identify public threats more quickly and expand patient record access. The four founding groups the Maine Health Access Foundation, Maine CDC, The Maine Quality Forum and Maine Health Information Center (Onpoint Health Data) began their efforts in 2004.In Tennessee Regional Health Information Organizations (RHIO’s) initiated in Memphis and the Tri Cities region. Carespark, a 501(3)c, in the Tri Cities region was considered a direct project where clinicians interact directly with each other using Carespark’s HL7 compliant system as an intermediary to translate the data bi-directionally. Veterans Affairs (VA) clinics also played a crucial role in the early stages of building this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis hospitals like Baptist Memorial (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children’s Clinic, St. Francis Health System, St Jude, The Regional Medical Center and UT Medical. These regional networks allow practitioners to share medical records, lab values medicines and other reports in a more efficient manner.Seventeen US communities have been designated as Beacon Communities across the United States based on their development of HIE’s. These communities’ health focus varies based on the patient population and prevalence of chronic disease states i.e. cvd, diabetes, asthma. The communities focus on specific and measurable improvements in quality, safety and efficiency due to health information exchange improvements. The closest geographical Beacon community to Tennessee, in Byhalia, Mississippi, just south of Memphis, was granted a $100,000 grant by the department of Health and Human Services in September 2011.A healthcare model for Nashville to emulate is located in Indianapolis, IN based on geographic proximity, city size and population demographics. Four Beacon awards have been granted to communities in and around Indianapolis, Health and Hospital Corporation of Marion County, Indiana Health Centers Inc, Raphael Health Center and Shalom Health Care Center Inc. In addition, Indiana Health Information Technology Inc has received over 23 million dollars in grants through the State HIE Cooperative Agreement and 2011 HIE Challenge Grant Supplement programs through the federal government. These awards were based on the following criteria:1) Achieving health goals through health information exchange 2) Improving long term and post acute care transitions 3) Consumer mediated information exchange 4) Enabling enhanced query for patient care 5) Fostering distributed population-level analytics.Regulatory Aspects of Health Information Exchanges and Healthcare ReformThe department of Health and Human Services (HHS) is the regulatory agency that oversees health concerns for all Americans. The HHS is divided into ten regions and Tennessee is part of Region IV headquartered out of Atlanta. The Regional Director, Anton J. Gunn is the first African American elected to serve as regional director and brings a wealth of experience to his role based on his public service specifically regarding underserved healthcare patients and health information exchanges. This experience will serve him well as he encounters societal and demographic challenges for underserved and chronically ill patients throughout the southeast area.The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and governs regulatory aspects of health reform. The NHIN collaboration includes departments like the Center for Disease Control (CDC), social security administration, Beacon communities and state HIE’s (ONC).11 The Office of National Coordinator for Health Information Exchange (ONC) has awarded $16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to better patient care through reductions in replicated tests, bridges to care programs for chronic patients leading to continuity and finally timely public health alerts through agencies like the CDC based on this information.12 The Health Information Technology for Economic and Clinical Health (HITECH) Act is funded by dollars from the American Reinvestment and Recovery Act of 2009. HITECH’s goals are to invest dollars in community, regional and state health information exchanges to build effective networks which are connected nationally. Beacon communities and the Statewide Health Information Exchange Cooperative Agreement were initiated through HITECH and ARRA. To date 56 states have received grant awards through these programs totaling 548 million dollars.History of Health Information Partnership TN (HIPTN)In Tennessee the Health Information Exchange has been slower to progress than places like Maine and Indiana based in part on the diversity of our state. The delta has a vastly different patient population and health network than that of middle Tennessee, which differs from eastern Tennessee’s Appalachian region. In August of 2009 the first steps were taken to build a statewide HIE consisting of a non-profit named HIP TN. A board was established at this time with an operations council formed in December. HIP TN’s first initiatives involved connecting the work through Carespark in northeast Tennessee’s s tri-cities region to the Midsouth ehealth Alliance in Memphis. State officials estimated a cost of over 200 million dollars from 2010-2015. The venture involves stakeholders from medical, technical, legal and business backgrounds. The governor in 2010, Phil Bredesen, provided 15 million to match federal funds in addition to issuing an Executive Order establishing the office of eHealth initiatives with oversight by the Office of Administration and Finance and sixteen board members. By March 2010 four workgroups were established to focus on areas like technology, clinical, privacy and security and sustainability.By May of 2010 data sharing agreements were in place and a production pilot for the statewide HIE was initiated in June 2011 along with a Request for Proposal (RFP) which was sent out to over forty vendors. In July 2010 a fifth workgroup,the consumer advisory group, was added and in September 2010 Tennessee was notified that they were one of the first states to have their plans approved after a release of Program Information Notice (PIN). Over fifty stakeholders came together to evaluate the vendor demonstrations and a contract was signed with the chosen vendor Axolotl on September 30th, 2010. At that time a production goal of July 15th, 2011 was agreed upon and in January 2011 Keith Cox was hired as HIP TN’s CEO. Keith brings twenty six years of tenure in healthcare IT to the collaborative. His previous endeavors include Microsoft, Bellsouth and several entrepreneurial efforts. HIP TN’s mission is to improve access to health information through a statewide collaborative process and provide the infrastructure for security in that exchange. The vision for HIP TN is to be recognized as a state and national leader who support measurable improvements in clinical quality and efficiency to patients, providers and payors with secure HIE. Robert S. Gordon, the board chair for HIPTN states the vision well, “We share the view that while technology is a critical tool, the primary focus is not technology itself, but improving health”. HIP TN is a non profit, 501(c)3, that is solely reliant on state government funding. It is a combination of centralized and decentralized architecture. The key vendors are Axolotl, which acts as the umbrella network, ICA for Memphis and Nashville, with CGI as the vendor in northeast Tennessee.15 Future HIP TN goals include a gateway to the National Health Institute planned for late 2011 and a clinician index in early 2012. Carespark, one of the original regional health exchange networks voted to cease operations on July 11, 2011 based on lack of financial support for it’s new infrastructure. The data sharing agreements included 38 health organizations, nine communities and 250 volunteers.16 Carespark’s closure clarifies the need to build a network that is not solely reliant on public grants to fund it’s efforts, which we will discuss in the final section of this paper.Current Status of Healthcare Information Exchange and HIPTNTen grants were awarded in 2011 by the HIE challenge grant supplement. These included initiatives in eight states and serve as communities we can look to for guidance as HIP TN evolves. As previously mentioned one of the most awarded communities lies less than five hours away in Indianapolis, IN. Based on the similarities in our health communities, patient populations and demographics, Indianapolis would provide an excellent mentor for Nashville and the hospital systems who serve patients in TN. The Indiana Health Information Exchange has been recognized nationally for it’s Docs for Docs program and the manner in which collaboration has taken place since it’s conception in 2004. Kathleen Sebelius, Secretary of HHS commented, “The Central Indiana Beacon Community has a level of collaboration and the ability to organize quality efforts in an effective manner from its history of building long standing relationships. We are thrilled to be working with a community that is far ahead in the use of health information to bring positive change to patient care.” Beacon communities that could act as guides for our community include the Health and Hospital Corporation of Marion County and the Indiana Health Centers based on their recent awards of $100,000 each by HHS.A local model of excellence in practice EMR conversion is Old Harding Pediatric Associates (OHPA) which has two clinics and fourteen physicians who handle a patient population of 23,000 and over 72,000 patient encounters per year. OHPA’s conversion to electronic records in early 2000 occurred as a result of the pursuit of excellence in patient care and the desire to use technology in a way that benefitted their patient population. OHPA established a cross functional work team to improve their practices in the areas of facilities, personnel, communication, technology and external influences. Noteworthy was chosen as the EMR vendor based on user friendliness and the similarity to a standard patient chart with tabs for files. The software was customized to the pediatric environment complete with patient growth charts. Windows was used as the operating system based on provider familiarity. Within four days OHPA had 100% compliance and use of their EMR system.The Future of HIP TN and HIE in TennesseeTennessee has received close to twelve million dollars in grant money from The State Health Information Exchange Cooperative Agreement Program.20 Regional Health Information Organizations (RHIO) need to be full scalable to allow hospitals to grow their systems without compromising integrity as they grow.21and the systems located in Nashville will play an integral role in this nationwide scaling with companies like HCA, CHS, Iasis, Lifepoint and Vanguard. The HIE will act as a data repository for all patients information that can be accessed from anywhere and contains a full history of the patients medical record, lab tests, physician network and medicine list. To entice providers to enroll in the statewide HIE tangible value to their practice has to be shown with better safer care. In a 2011 HIMSS editor’s report Richard Lang states that instead of a top down approach “A more practical idea may be for states to support local community HIE development first. Once established, these local networks can feed regional HIE’s and then connect to a central HIE/data repository backbone. States should use a portion of the stimulus funds to support local HIE development.”22 Mr. Lang also believes the primary care physician has to be the foundation for the entire system since they are the main point of contact for the patient.One piece of the puzzle often overlooked is the patient investment in a functional EHR. In order to bring together all the pieces of the HIE puzzle patients will need to play a more active role in their healthcare. Many patients do not know what medicines they take every day or whether they have a living will. Several versions of patient EHR’s like Memitech’s 911medical id card exist, but very few patients know or carry them.23 One way to combat this lack of awareness is to use the hospital as a catch-all and discharge each patient with a fully loaded USB card via case managers. This strategy also might lead to better compliance with post in patient therapies to reduce readmissions.The implementation of connecting qualified organizations began earlier this year. To fully support organizations to move toward qualification the Office of National Coordinator for HIE (ONC) has designated regional education centers (TN rec) who assist providers with educational initiatives in areas like HIT, ICD9 to ICD10 training and EMR transition. Qsource, a non-profit health consulting firm, has been chosen to oversee TNrec. To ensure sustainability it is critical that Tennessee build a network of private funding so that what happened with Carespark won’t happen to HIP TN. The eHealth Initiatives 2011Survey Report states that of the 196 HIE initiatives, 115 act independently of federal funding and of those independent HIE’s, break even through operational revenue. Some of these exchanges were in existence well before the American Recovery and Reinvestment Act in 2009. Startup funding from grants is only meant to get the car going so to speak, the sustainable fuel, as observed in the case of Carespark, has to come from value that can be monetized. KLAS research reports that 54% of public HIE’s were concerned about future sustainability while only 35% of private HIE’s shared this concern.Hospital Implications of HIP TN (A Call to Action)From a Financial perspective, taking our hospital into the future with EMR and an integrated statewide network has profound implications. In the short term the cost to find a vendor, establish EMR in and outpatient will be an expensive proposition. The transition will not be easy or finite and will involve constant evolution as HIP TN integrates with other state HIE’s. To get a realistic idea of the benefits and costs associated with health information integration. we can look to HealthInfoNet in Portland, ME, a statewide HIE that expects to save 37 million dollars in avoided services and 15 million in productivity reduction. Specific areas of savings include paper or fax costs $5 versus $0.25 electronically, virtual health record savings of $50 per referral, $26 saved per ED visit and $17.41 per patient/year due to redundant lab tests which amounts to $52 million for a population of 3 million patients. In Grand Junction Colorado Quality Health Network lowered their per capita Medicare spending to 24% below the national average, gaining recognition by President Obama in 2009. The Santa Cruz Health Information Exchange (SCHIE) with 600 doctors and two hospitals achieved sustainability in the first year of operation and uses a subscription fee for all the organizations who interact with them. In terms of government dollars available, meaningful use incentives exist to encourage hospitals to meet twenty of twenty five objectives in the first phase (2011-2012) and adopting and implement an approved EHR vendor. ARRA specified three ways for EHR to be utilized to obtain Medicare reimbursement. These include e-prescribing, health information exchange and submission of clinical quality measures. The objectives for phase two in 2013 will expand on this baseline. Implementation of EHR and Hospital HIE costs are usually charged by bed or by the number of physicians. Fees can range from $1500 for a smaller hospital up to $12,000 per month for a larger hospital.Perhaps the most compelling argument to building a functional Health Information Exchange is patient and community safety. The Healthbridge reduction in disease outbreak detection of 3-5 days is a perfect example of this safety benefit. Imagine the implications in the case of a rampant virus like avian or swine flu. The goal is to avoid a repeat of the 1918 influenza outbreak and ultimately save the lives of our most at risk. Rick Krohn of Healthsense makes the case for a socially responsible HIE that serves those who are chronically ill, uninsured and homeless. As the taxpayers ultimately bear the societal burden for our country’s healthcare coverage, the need to reduce redundancies, increase efficiency and provide healthcare worthy of the United States is imperative. Right now our healthcare is in the Critical Care Unit it’s time to stabilize it through operational excellence starting with our hospital. Let’s rebuild the Tower of Babel and enhance communication to provide our patients the healthcare they deserve!

Need some inspiration for marketing your business? The recent age of technology has continuously exploded over the past few years, and different marketing methods have come and gone. A business needs to stay on top of the latest statistics regarding strategy if it wants to compete in its respective market. This research has been compiled here for precisely that purpose. In this paper, some of the top marketing methods of 2021 are highlighted for B2B (Business to Business) and B2C (Business to Consumer) marketing. In addition, the pros and cons of each are laid out to help give more depth to the general idea of B2B and B2C. Hopefully, you will find inspiration to adopt these methods into your marketing strategies.B2B (Business to Business) vs. B2C (Business to Consumer) MarketingThe concept of B2B vs. B2C marketing is self-explanatory; it is simply a difference in the target audience. However, the differences in their marketing methods are not self-explanatory, so an easy way to visualize these statements is through an example. Let’s say you are a grape farmer, and harvest is approaching. You could go the B2B route of selling to a grocery store or vintner(winemaker), or you could go the B2C route of setting up an online store or stand at a local farmers market. It’s no easy choice. Do you sell to a lower price per grape to the store/vintner while buying in bulk? Or do you sell at a higher price directly to consumers, but you must go through the effort of reaching the consumer, and you risk not selling all your product? It is also not as simple as just selling your product. You must market it. This brings up the central question inspiring the following two sections:Two B2B Marketing MethodsSEO:Search engine optimization, or SEO for short, is an essential strategy to implement into your marketing if you are working B2B. Out of other marketing methods, SEO is the best strategy to generate income for your business, but what does implementing SEO entail? The goal of SEO is to optimize the content on your website (Onsite SEO) and promote it (Offsite SEO) to more frequently place your website at or near the top of user searches within search engines such as Google Bing, Yahoo, and you name it. The key is to understand your target audience and what keywords will go into their search bar. Search Engines like Google are automated. You cannot tell Google that your website is selling grapes to businesses. Your content must reflect that. Try searching “buy grapes in bulk.” Keywords from each website are displayed in the search. This part of Onsite SEO is relatively intuitive. Still, you must go beyond including all kinds of keywords in your content because your audience isn’t as predictable as you might think, and they may not necessarily be looking for your business. For your grape business, maybe the audience will search more generally, perhaps “fruit in bulk” or something along those lines. Consideration is a must to ensure your website content matches as many possible searches as possible.Social Media Marketing:Social media is the home to many, and that is precisely why it is an excellent platform for you to promote your business. Social media marketing is a great strategy to implement into your marketing and works great in tandem with other marketing efforts such as Offsite SEO. This strategy has incredible influence over B2B conversion rates resulting in increased traffic to your website and profit for your business. It is challenging to master and potentially dangerous if you outsource and entrust the work of Social Media Marketing to someone reckless since one bad tweet could get your business in trouble. However, the humanization your brand gets trust and the free feedback you receive from those online is worth the effort. Whether it’s a short video, an image, a tweet, a comment on another post, this kind of content, while seemingly worthless, is excellent for your business. These little bits are easy to digest for other users, and they are tricked into digesting it in some cases as although they may not be actively looking to spend their money, seeing these social media posts gets them to think about your business even if its subconscious.Two B2C Marketing MethodsPPC (Pay Per Click):”Pay Per Click” refers to the monetization method where each click comes at a price. For example, should Pay-Per-Click advertisements be used on sports articles, readers may be drawn to click on ads regarding the teams mentioned in the report, such as apparel, other articles, or activity-related products. This uses the reader’s interests to help target advertisements and can also spread awareness. Search ads can boost brand awareness by up to 80 percent instilling memories into consumers, thus showing the importance of targeted marketing having a profoundly positive effect on the advertised product through exposure. Similarly, the widespread use of the internet with Google’s 160 billion searches per month showcases the potential monetary profit of Pay-Per-Click advertisements. Thus, not only do the advertisers receive payment for clicks on their advertisements, but the likelihood of users buying the advertised product increased due to the increased website traffic and appropriate placing of the ad.Cobranding Marketing:Co-branding is an essential strategy used by several top brands to keep their product or service new and different. It is a partnership where two companies create a unique third product using their brand name to draw in consumers, resulting in monetary or publicity gains for both parties. There are several benefits to co-branding: a broader audience as this method brings two brands together, which includes their respective following. An example of this occurred recently when the South Korean pop group known as “BTS” partnered with McDonald’s to make their signature meal. Fans of both McDonald’s and BTS came together, resulting in this co-branding deal boosting McDonald’s worldwide sales by 41% during the agreement and the pop group making a reported 8.89 million USD from the partnership.Any competent business owner knows to seize every opportunity to promote and expand where reasonably possible, and what’s the harm in reaching out to another company with an idea if you truly believe it will work?The following contains some short summaries detailing the basic pros and cons of each marketing method.B2B Pros• Profit Margin – The nature of B2B sales is generally far more prominent than most B2C sales. B2B sales often are in bulk with small items with perhaps scheduled re-orders or other cases like contractors the sale is always going to be significant. In addition, the market potential for B2B feeds into this profit margin well. Something such as grapes going B2C at a farmers’ market is limited in that it targets consumers who want to eat the grapes or perhaps use them for a recipe. However, grapes going B2B have various options like selling in bulk to vintners, grocery stores, companies that make grape jelly, you name it.• Location of Sales – A large majority of B2B commerce is done on the web. This is a good thing as it is far easier to manage an online presence than to maintain something like a storefront. The location for your selling also benefits the audience you sell to. It is more convenient for them to shop online rather than require physical effort to purchase a product. The ease of a good online website and the smoothness of the transaction go a long way for getting sales.• Security – No part of B2B is easy, but once you secure some contracts or ongoing deals, there’s good stability to be had from that. B2C is scary in that you could have your products go from flying off the shelves to forgotten quicker than you may realize. Any stability in the business world is something to be desired.B2B Cons• Competition – This con applies to both B2B and B2C, but in a scarier way. If you aren’t already a big name in your respective market, it is going to be extremely difficult to secure any contracts, deals, or even just one-time purchases. Even if you manage to secure one deal, you run the risk of your business flopping if you rely on just that to stay afloat. It is also harder to compete in marketing against more prominent names as they are already out there, so it is relatively easy to stay out there. Still, you must work on both getting out there and maintaining whatever position you hold. Other problems with the competition are the monopoly many places have. Big names can survive simply undercutting your price to whatever consumer while you might not be able to. You must be very careful when entering markets and avoid being shut out.• Difficult Entry – Given the vast majority of B2B commerce taking place online and the quick judgment by consumers, you need to have a robust online presence and a good website which can be expensive and difficult to set up initially. Extensive research must be done to understand the customer’s desire and streamline that experience for them.• Negotiations – You, a business trying to min-max profits, are selling to another company trying to accomplish the same. A big part of B2B commerce is negotiating with customers to reach a deal that both parties are happy with, especially since prices you may list on your website are likely not as low as you are willing to go.B2C Pros• Sales Cycle – Sales cycle is essentially the stage at which a purchase is made. There is a significant benefit to B2C commerce in that the sales cycles are much faster and easily influenced by provoking certain emotions. B2B sales take an immense amount of time as they are often big purchases for big projects, and so the buyer will take their time to ensure they find the best deal with a high-quality partner. B2C commerce can happen in seconds with someone thinking, “Oh, these grapes look good, let me buy them!”. If you can cater your product towards the quick decision-making of buyers, you can generate good sales.• Discounts – One great thing about B2C is the ability to offer discounts. This partly feeds into the sales cycle, but having values makes customers feel like they are getting a good deal and may buy a product they don’t even need. Or in some cases, loyalty programs offering discounts or free items after certain purchases can be geared towards your profit margin when set up correctly. Loyalty programs are great as it gives the incentive to create a relationship with customers like that in B2B markets. Still, here you can get repeat customers to provide you with business continuity.• Customer Base – While B2B markets directly to a business, B2C calls to a consumer. Everyone in the world is a consumer and is thus a potential customer, while B2B does not have that liberty. This, of course, does not mean your product appeals to everyone and will mean you have an infinite customer base, but the percentage of people potentially looking for a product like yours is massive. This can be of big help to any B2C business, especially those that sell “occasional” purchase products like furniture in that a large customer base means you do not need to rely on repeat customers.B2C Cons• Slow return on investment – The high upfront costs of starting your business with storefronts, websites, marketing campaigns add up quickly. With the generally low price of B2C products and usually prolonged initial start to new business, one should expect profits to be in the red for a while.• Quantity of sales – With large sales comes to the downside of an increased number of issues customers may have. If one wants to get good ratings and maintain an excellent reputation, one must deal with problems that arise well. It is easier said than done since many issues can be hard to resolve in ways that don’t overeat out of profit.• Marketing – This applies to any business, but it is especially hard for B2C commerce. Like how big-name B2B companies can undercut you and shut you out, B2C companies do that on a more complex scale. The profit margin on a majority of B2C products is already low given the generally low price anyway. So it is hard to compete for customers looking for a reasonable price. When you cannot afford to lower your cost further, how do you market your product as “worth the price” in the face of competitors? It is hard enough to get your product on the shelves or in the market, but you also must market that to large numbers of customers.Which is better? B2B or B2C?The simple truth one, as an aspiring business owner likely knows, is it depends. It truly does not matter which one is better, and depending on your business, both might even be an option. This paper is not meant to sway a business owner to go down a specific route but rather inform one about the way they plan to take already. There is no easy method in the business world, and as someone without any business experience, I am not in a position to dictate where one’s business should go.

HEALTH AND DISEASEThe concept of Health is somewhat difficult to understand. When we say a person is healthy, it means to the lay man that the person is normally doing his activities and does not outwardly show any signs of any disease in him. However, for the medical man it denotes the conformity to certain standards like physical measurements, biochemical norms and rates, physiological standards, etc. Even these standards vary with race, rest, exercise, food, habits, starvation, climate, altitude, latitude, etc. It has been extremely difficult for scientists concerned with human biology to lay definite criteria for health and define the term Health in a specific manner.From the history of medicine we know that there have been various systems of medicine or healing arts evolved in different parts of the world during different civilizations. But in no system has there been a clear-cut definition of health.In the oxford dictionary health means the state of being free from sickness, injury or disease, bodily conditions; something indicating good bodily condition. A few decades ago this meaning was conveyed in the definition of health but recently the World Health Organization have considered it necessary to give a direction towards the achievement of a robust and happy and active bodily and mental condition capable of continuous productive ability and, therefore, have defined health as follows:”Health is a state of complete physical, mental and social well being and not merely an absence of disease or infirmity.” (WHO—1948) it will be seen that even after having this definition it will be difficult to conceptualise and standardise positive health with specific clear-cut attributes and criteria for measurement. A person may be enjoying mental equanimity and enthusiasm for doing anything. He may also be physically able to do any amount of work, but he may be having some minor dysfunction or deficiency or even a mild infection causing a very minor disturbance which however does not upset his normal activities.For example, Hyper pigmentation on the skin or lack of pigmentation on the skin; angular stomatitis due to B complex deficiency; a ring-worm patch on the skin, etc. In these conditions strictly speaking the person cannot be called ‘health’ but for outward purpose he will appear healthy and he will also be fully active. Similarly, under the mental component there are ever so many stresses and strains that an individual is exposed to and depending on his own mental make-up he is either able to overcome the strain or suffers from worry and depression. If in spite of his worry he is able to function normally others may take him to be healthy, whereas the worry may normally be making him mentally unsound.Social well-being is very much related to the mental adjustment of the individual to others around him in the family or in the community. Sometimes it may so happen that a person may find it had to adjust with his group and may, therefore, be under a mental strain. But he may be doing his work normally from which others would judge him to be healthy. It is only if he reaches a break-point and behaves either in a withdrawn manner or becomes aggressive that his mental condition will become manifest to be seen and experienced by others.We have, therefore, to understand that the term health is not an abstract thing but a relative concept. In it we see a continuum of freedom from sickness to better health and positive health. When we say positive health we refer to a condition in which the body has sufficient reserve nutrition and resistant factors to prevent the invasion of the body by any micro-organism or by the deprivation of any nutritional factors causing a deficiency pathology and, therefore, completely free from disease.Disease is a little less difficult to define than Health. It denotes the condition of the human body in which something has gone wrong and has upset the Norman functions of the body including the mind. As in health there is also a continuum from a predisposition or premonition of illness which may or may not be experienced or noticed even by the individual concerned, to a definite condition of illness manifested by signs or symptoms and impairment of body functions.This continuum may further extend from mild sickness to severe sickness and death or recovery from sickness back to a debilitated condition and later to a normal condition.As has been pointed out in the previous paragraphs the normally of health of person may shift towards positive health depending on the improvement of health by wholesome food, wholesome water proper living conditions, proper work atmosphere, good personal hygiene, etc., or the deterioration of health due to faulty or inadequate food, infection through food, water or air, skin or due to external injuries, accident etc.For maintenance of good health the following things are essential:1. Adequate quantities of proper nutrition
2. Adequate quantities of safe drinking water
3. Proper shelter with adequate ventilation and lighting
4. Proper clothing
5. Proper work, exercise and rest and recreation
6. Proper social conditions for a harmonious existence and work
7. Proper security from fear of any kind
8. Proper sexual behavior
9. Personal hygiene
10. Provision and utilization of health services.Disease can be due to say one or more of the following causes:1. Genetic traits
2. Congenital deformity or malformation
3. Cancer
4. Malnutrition
5. PoisonsThe above are the direct causes.The science of epidemiology employs various methods and approaches to explore, investigate, identify and establish the cause of disease as against maintenance of health in the individual, in the community and in a geographical area. Modern epidemiology has revealed a multiple causation theory for most of the diseases. The direct or immediate causes may be congenital, traumatic, infection or cancerous growth, etc. But besides these direct causes, many indirect and predisposing causes have been described,For example, tuberculosis is caused by the tubercule bacilli, called myco bacterium tuberculosis, this is the direct cause. The other causes which predispose a person to the infection by tubercule bacillus may be overcrowding, poor nutrition, bad ventilation, heavy work, fatigue, etc. It may be appreciated that these causes are socio-economic causes. The economic factors arising out of poor means of livelihood, inadequate food, etc., are also inter-related with human and social factors like bad ways of living, customs, habits, beliefs, superstitions, etc. Taking another example, malnutrition may be due to either lack of availability of nutritious food in adequate quantities or the wrong practices of preparation of food in which nutrients may be wasted. The economic factors may be the cause for non-accessibility and the social factors may be the cause of wastage of nutrition even after the food stuffs are available or on the contrary over eating and addiction to alcohol, etc., causing metabolic disorder. In the rural countryside we have a lot of locally available food resources but the habits may be such that the people do not know what can be eaten and how, for deriving nutrition.The human and social factors are very predominant determinants in any society or community. In affluent countries many of the metabolic diseases like obesity, heart diseases, diseases due to air pollution, etc., are on the increase due to social customs. In the poor countries the large number of communicable diseases and nutritional deficiencies are due to poor sanitation, poor hygiene and low and faulty intake of food. These are again in turn due to economic and social factors.Study of human behavior is extremely important in public health and in any community oriented programme. The mere opening and establishment of hospitals or clinics or treatment centers by any government or voluntary agencies does not immediately ensure that all the people will use the facilities whenever they fall sick. For a person to seek treatment for a particular illness from a doctor or an institution the following stages of human behavior are expected to take place.Social psychology has a very prominent place as a diagnostic tool in the beginning of the programme and also as a tool of evaluation where the programme is under progress or at its termination. For example, in the control of Cholera or any gastro enteric infection, it will be futile to introduce any sanitation programme unless the people know the causative factor and the mode of transmission of infection. There may be need to improve the water supply, provide proper excreta disposal, food hygiene and personal hygiene. All these things involve a scientific awareness of the reasoning behind each measure or practice and a change of behavior accordingly.

No matter what the occasion, choosing the right entertainment can turn a good evening into a truly memorable event. Despite a glamorous location or delicious food it is usually the entertainment that guests remember. You may choose to organise everything yourself with the help of a party hire company or you can hire an event organiser to handle the details for you. There are many different types of entertainment to choose from, so it is important to pick the right entertainment to suit the type of event.WeddingsThe type of entertainment that is appropriate for a wedding depends on the wedding itself. With couples choosing between formal and more traditional weddings, to holding their ceremony and reception at the beach or in a garden, the atmosphere of their wedding is largely determined by the location. Once a couple has decided where the wedding is to be held all other decisions are generally influenced by this choice. A couple might also have more than one set of entertainment, as they may have musicians at the ceremony as well as at the reception. A more formal day could involve having a string quartet at the church and then a jazz band at the reception. Depending on a couple’s budget they may have a soloist at the ceremony and a DJ later on. For a couple to choose entertainment that their guests will remember they should match the type of musicians to suit the style of wedding.Corporate EventsA corporate event can range from a lunchtime picnic to a formal black tie evening. Not only will the style of event influence the choice of entertainment but also the guests themselves. A formal evening with important clients might not be the place for dancers in skimpy outfits, nor would you choose an evening of classical music for the Christmas party of the teenage staff of a fast food outlet. Entertainers at corporate events don’t have to just include musicians. A whole range of entertainment can be hired to impress your guests, from magicians, dancers, ice sculptors, comedians and even acrobats. Find something that will stand out and make the event stand out in your guest’s memories. If they don’t forget your event they won’t forget your company either, and that makes for a successful evening.Parties and moreChoosing entertainment that is original can be a challenge but the key is to pick something to suit your audience as well as something that will stand out. Fund raisers could have anything, depending on the venue, whether you hired a band, an animal farm or a celebrity MC. After a run of attending friend’s twenty-first birthday parties the DJ’s may be wearing a little thin, so why not try something like a bush dance or hire a karaoke machine. A clown at a children’s party is fairly standard, as is hiring a fairy entertainer for a little girl’s birthday, so how about getting the snake handler? The children certainly won’t forget that one.

An off-the-shelf mainstream accounting program works well for micro and small businesses. Large companies are much better off with customized enterprise resource planning (ERP) systems that integrate supply chain, customer relationship management, human resources and all other data systems. Whereas a dedicated accounting software is all you need to run your medium-sized business.Assessing Your Business NeedsRequirements vary by industry so make sure whatever you look at works for your industry! Regaradless, your accounting software must provide income and expense tracking and report generation.Before you start sending RFPs, take some time to figure out exactly what you want from your accounting system. Products vary from simple checkbooks and cash-accounting systems to more complex financial management, payroll, inventory management, tax accounting and job costing. Many software offerings are modular so you buy what you need now and then add additional functions when needed.Accounting software should provide the following tools:
Generate balance sheets and profit and loss statements
Track accounts receivable/payable
AR/AP aging
Job costing
Quarterly tax payment estimates
Income tax preparation
Sales tax preparation
Payroll
Quarterly and year-end reports
Available inventory
Inventory aging
Purchase order creation
Compute cost of goods sold
Some of these features are standard on all accounting programs. Others are exclusive to ERP systems. Remember, that software created specifically for your industry may be the best solution, especially if you are dealing with complex processes or regulation.Other ConcernsYou may also want to consider other features, such as customizable reports, check printing and electronic invoices, to name a few. A service business will likely require an hourly billing function too. You may wish to consider a Web-based or “hosted” solution, which offers faster implementation, easier upgrading, lower costs and avoids technology infrastructure expenses.Ease of UseYou should include input from the primary users of your accounting software. This will ensure that you get the right product based on their needs. It will also minimize complaints and buy-in when you make a final decision.When you give any software a trial run, test the software publisher’s technical support and sales team. The ideal accounting software publisher should be a business partner. If they aren’t willing to go the extra mile for you, then look somewhere else.Choosing accounting software for your business might just be the most important decision you make. Choose wisely. If you need help, feel free to contact me for help. That’s why I’m here.

Starting a business online can be an arduous and unrewarding task. For starters, there are so many options out there – how do I spot the right one for me? How can I develop a laser beam approach to help me recognise the business of my dreams? One way to answer to that question is to build a framework to work in. If you want to know what that looks like, read on!Starting a business online begins with choosing the right model, so you need to figure out how to unscramble the desires lurking beneath the surface. The best way is to take time out at the beginning to ask yourself a series of focused questions that will become the framework for your business online.It also helps you spot a blind alley when you see one. Expert marketing means it is so easy to be led along by every promise, it can be difficult to figure out if the business you are considering is truly what you want.Skipping this step can also set you up for a lot of disappointment as well as wasted time and money. It might be harder to spot the online ‘opportunities’ that are not totally genuine, or not really workable to a newbie. So, make yourself a coffee, find a quiet area and ask yourself the following questions:1) Do I want to deal with a physical product? Am I happy to be involved with handling and receiving goods? Do I want a product I can promote online, but also physically sell, or do I want to make products and sell them on the internet marketplace?Answering these questions will help you identify whether the online business platform you require is for an established product or one you are making yourself. An example of this would be running a party plan business. You would be out and about in the community, meeting new people, selling a well known brand, but you would also be using Facebook and ebrochures to build a thriving business online. Or you could design and make your own products and set up shop using somewhere like Etsy to promote and sell your own goods.2) Do I just want an electronic product or service? Do I want a business promoting somebody else’s internet product or do I prefer to use the skills I already possess?Answering these questions will help you identify which specific type of electronic business you want. An example of this would be an affiliate using the Clickbank and Amazon marketplace to promote other people’s products to earn commission. Or it would be starting your own Virtual Assistant business to offer online typing or secretarial services for customers around the world.3) Do I want to physically store and ship goods to other people, or have someone else do it for me?Answering these questions will help you identify the businesses that will do all the work for you. An example of this would be starting a business with an online auction site like eBay, where you would find, log the details, sell and post the product yourself. Or you could start a business where someone else stores and ships the goods to the customer whilst you market and promote the product with a pre-designed website in a dropship business.These are just a few questions to start your framework, but there are many others you could ask, such as do I have all the training I need, or will I require more? If the answer is yes, where is a good place to get the help I need?Successful businesses online know how to utilize the internet for profit and increase their online skill base. So, for your next step you might like to check out how one internet centre trains both total newbies and seasoned pros to make money online. I hope you have found ‘starting a business online – how do I spot the right one for me?’ helpful.

The first important point that would qualify you as a borrower to low rate interest personal loans is that you should enjoy good credibility, have a good source of income to repay loans and also have good financial stability. Financial institutions and lenders are very eager to give low interest loans to those borrowers because of the low risk attached in lending.Do you need a low rate interest personal loan now? Do not go fix up the agreement with the first lender you meet and negotiate with; shop around by investigating about various lenders who lend money. This could be financial institutions, moneylenders and also your own friends and relatives. Your friend or relatives may ready to give you loan without security. However consider all aspects including long term relations, fees and low interest loans.Conduct a wide market survey of the different banks and lenders and get a comprehensive data of all of them. Lending institutions with whom you have had good credit dealings in the past may be ready to give you low rate interest personal loans. Besides your financial stability and profitable reason for the loan could also influence them.Then contact the bank that offer low rate interest personal loans and meet the bank’s financial assistant to determine the real value of the personal loan. These loan officers are able to guide the customers through the process and assist them in assessing the real interest value of the loan. Micro-finance companies and N.R.I banks besides government organizations do offer low interest loans with just a proof of address and credit history.The creation of web portals by banks has made it very easy to shop for personal loans at low interest rates. However a personal visit to the bank thereafter can give you a real idea of how far such low rate interest personal loans are for you. Certain banks require a lot of documentation, verifications and other hidden costs.Some who do not have a strong financial stability or credit standing may consider borrowing from their friends and relatives or may prefer their near and dear to act as a guarantor for their loan. So you may have access to low rate personal loans and flexible repayment terms, however written agreements eliminates communication flaws and are legally binding on both parties.You could find a good bet in low rate interest personal loans given by certain loans and financial companies. However most of these companies believe in lending money at high interest rates to high risk companies only, but they have recently started giving loans at low rate with a variety of incentives and rewards instead of penalties to encourage easy and speedy repayments.Cash credits and unsecured personal loans are available for the not-so-financially-strong borrowers. These may be good in the short run when you repay back soon, but these prove to be costly in the long run due to increased rates as time elapses. However it is best to find out and compare their plans and schemes regarding interest loans.To conclude if you have decided that you want to take a loan, first visit the bank or any other lender or inquire online to get full details of such personal loans at low rates. However it is suggested that one always remains within ones means and avoids taking loans, but contingencies that play an important role in most people’s life makes them go for loans and look out for interest personal loans.

Usually people with a bad credit record find it difficult to get an auto loan. Most loan providers are reluctant to release a huge amount to people with poor credit rating. In addition, automobile loans for applicants with bad credit will have much higher interest rates compared to normal auto loan interest rates. This is due to the risk of repayment by people with bad credit is much higher.Nowadays, demand for the credit card and loan is on the rise. The money lenders start to opt for the credit scoring which is based on the mathematical algorithm. This algorithm is designed to assess the credit worthiness of applicant. This credit rating is much effective tool to measure the level of the risk to approve the loan application compared to previous criteria.If you have higher the credit rating, the more chances you will get the loan application successful. There are some factors like delay in payment, unpaid, etc will certainly deteriorate your credit ratings. There are major three agencies like Experian, Equifax and TransUnion which provide the credit ratings services for you. People with poor credit are still possible to repair their bad credit records. First of all he should take time to review his credit reports which he can get it from reporting agencies as mentioned above. He should examine whether there is any mistake in the credit report. He must check properly to find out any pending payment which is not reported earlier.If you want to apply for the automobile refinancing, you should select the suitable auto car loan at lower interest. The bad credit auto loan is beneficial to those who have poor credit ratings. Before applying for the loan, applicants should investigate whether the company offers the good interest rates or not. Online bad credit loan service is the best option to apply for your loan refinancing.Before signing the loan contract, people should go through the whole agreement to avoid any misunderstanding. Furthermore, to apply for the new auto car loan, he must estimate the value of the car also. There is minimum car value required by each loan lenders. The car value should be at least worth that specified value.Poor credit auto car loan is now reachable easily online. Many loan companies nowadays understand that more and more people do not have perfect credit ratings. Many people actually do not know this bad credit auto loan is actually very popular among car lenders nowadays.With little understanding of bad credit auto loan, it is possible for you to own a car now. Nowadays, you can find out much lower interest rate auto car loans online compared to you get the bad credit loan from the market. Most of the car loan online lenders will provide application details to let the people with poor credit record also can get the loan successfully.With automobile refinancing, you can also take opportunity to improve your credit ratings. The secret is choosing the cheapest loan repayment that you can afford and carefully making repayment to the auto loan timely.In conclusion, auto loan refinancing not only provides you a chance to own your dream car but also giving you a chance to repair your credit records and save more money from higher interest rate you are having. Auto loan refinancing is also much easier to apply for compared to other types of loan. If you are familiar with debt consolidation strategy, this is another good option for your to improve your overall financial status.

Key Insights
The strong pullback in the U.S. dollar provided significant support to stocks.
Treasury yields have pulled back after touching new highs, which served as an additional positive catalyst for S&P 500.
A move above 3730 will push S&P 500 towards the resistance level at 3760.
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Pfizer Rallies After Announcing A Huge Price Hike For Its COVID-19 Vaccines
S&P 500 is currently trying to settle above 3730 as traders’ appetite for risk is growing. The U.S. dollar has recently gained strong downside momentum as the BoJ intervened to stop the rally in USD/JPY. Weaker U.S. dollar is bullish for stocks as it increases profits of multinational companies and makes U.S. equities cheaper for foreign investors.

The leading oil services company Schlumberger is up by 9% after beating analyst estimates on both earnings and revenue. Schlumberger’s peers Baker Hughes and Halliburton have also enjoyed strong support today.

Vaccine makers Pfizer and Moderna gained strong upside momentum after Pfizer announced that it will raise the price of its coronavirus vaccine to $110 – $130 per shot.

Biggest losers today include Verizon and Twitter. Verizon is down by 5% despite beating analyst estimates on both earnings and revenue. Subscriber numbers missed estimates, and traders pushed the stock to multi-year lows.

Twitter stock moved towards the $50 level as the U.S. may conduct a security review of Musk’s purchase of the company.

From a big picture point of view, today’s rebound is broad, and most market segments are moving higher. Treasury yields have started to move lower after testing new highs, providing additional support to S&P 500. It looks that some traders are ready to bet that Fed will be less hawkish than previously expected.

S&P 500 Tests Resistance At 3730

S&P 500 has recently managed to get above the 20 EMA and is trying to settle above the resistance at 3730. RSI is in the moderate territory, and there is plenty of room to gain additional upside momentum in case the right catalysts emerge.

If S&P 500 manages to settle above 3730, it will head towards the next resistance level at 3760. A successful test of this level will push S&P 500 towards the next resistance at October highs at 3805. The 50 EMA is located in the nearby, so S&P 500 will likely face strong resistance above the 3800 level.

On the support side, the previous resistance at 3700 will likely serve as the first support level for S&P 500. In case S&P 500 declines below this level, it will move towards the next support level at 3675. A move below 3675 will push S&P 500 towards the support at 3640.

Summary
SPDN is not the largest or oldest way to short the S&P 500, but it’s a solid choice.
This ETF uses a variety of financial instruments to target a return opposite that of the S&P 500 Index.
SPDN’s 0.49% Expense Ratio is nearly half that of the larger, longer-tenured -1x Inverse S&P 500 ETF.
Details aside, the potential continuation of the equity bear market makes single-inverse ETFs an investment segment investor should be familiar with.
We rate SPDN a Strong Buy because we believe the risks of a continued bear market greatly outweigh the possibility of a quick return to a bull market.
Put a gear stick into R position, (Reverse).
Birdlkportfolio

By Rob Isbitts

Summary
The S&P 500 is in a bear market, and we don’t see a quick-fix. Many investors assume the only way to navigate a potentially long-term bear market is to hide in cash, day-trade or “just hang in there” while the bear takes their retirement nest egg.

The Direxion Daily S&P 500® Bear 1X ETF (NYSEARCA:SPDN) is one of a class of single-inverse ETFs that allow investors to profit from down moves in the stock market.

SPDN is an unleveraged, liquid, low-cost way to either try to hedge an equity portfolio, profit from a decline in the S&P 500, or both. We rate it a Strong Buy, given our concern about the intermediate-term outlook for the global equity market.

Strategy
SPDN keeps it simple. If the S&P 500 goes up by X%, it should go down by X%. The opposite is also expected.

Proprietary ETF Grades
Offense/Defense: Defense

Segment: Inverse Equity

Sub-Segment: Inverse S&P 500

Correlation (vs. S&P 500): Very High (inverse)

Expected Volatility (vs. S&P 500): Similar (but opposite)

Holding Analysis
SPDN does not rely on shorting individual stocks in the S&P 500. Instead, the managers typically use a combination of futures, swaps and other derivative instruments to create a portfolio that consistently aims to deliver the opposite of what the S&P 500 does.

Strengths
SPDN is a fairly “no-frills” way to do what many investors probably wished they could do during the first 9 months of 2022 and in past bear markets: find something that goes up when the “market” goes down. After all, bonds are not the answer they used to be, commodities like gold have, shall we say, lost their luster. And moving to cash creates the issue of making two correct timing decisions, when to get in and when to get out. SPDN and its single-inverse ETF brethren offer a liquid tool to use in a variety of ways, depending on what a particular investor wants to achieve.

Weaknesses
The weakness of any inverse ETF is that it does the opposite of what the market does, when the market goes up. So, even in bear markets when the broader market trend is down, sharp bear market rallies (or any rallies for that matter) in the S&P 500 will cause SPDN to drop as much as the market goes up.

Opportunities
While inverse ETFs have a reputation in some circles as nothing more than day-trading vehicles, our own experience with them is, pardon the pun, exactly the opposite! We encourage investors to try to better-understand single inverse ETFs like SPDN. While traders tend to gravitate to leveraged inverse ETFs (which actually are day-trading tools), we believe that in an extended bear market, SPDN and its ilk could be a game-saver for many portfolios.

Threats
SPDN and most other single inverse ETFs are vulnerable to a sustained rise in the price of the index it aims to deliver the inverse of. But that threat of loss in a rising market means that when an investor considers SPDN, they should also have a game plan for how and when they will deploy this unique portfolio weapon.

Proprietary Technical Ratings
Short-Term Rating (next 3 months): Strong Buy

Long-Term Rating (next 12 months): Buy

Conclusions
ETF Quality Opinion
SPDN does what it aims to do, and has done so for over 6 years now. For a while, it was largely-ignored, given the existence of a similar ETF that has been around much longer. But the more tenured SPDN has become, the more attractive it looks as an alternative.

ETF Investment Opinion

SPDN is rated Strong Buy because the S&P 500 continues to look as vulnerable to further decline. And, while the market bottomed in mid-June, rallied, then waffled since that time, our proprietary macro market indicators all point to much greater risk of a major decline from this level than a fast return to bull market glory. Thus, SPDN is at best a way to exploit and attack the bear, and at worst a hedge on an otherwise equity-laden portfolio.