I’ve been watching my clients — and myself — these past two years around the experience of charging fees, asking for payment, suggesting folks re-enroll in their programs, etc., and here’s what I’ve found …

Very few people like asking for money, and no one finds it easy — we universally hate it.

Why?

Because asking for money brings up thousands of insecurities and doubts. We’re scared to look money in the face, command it, control it, and to put ourselves out there. Asking for fair compensation means putting a formal stake in the ground about where we stand in a value equation. And most are simply too unclear about their own worthiness to do that.

Folks tell me that when they ask for money from clients or customers, questions swim inside their heads about their value, impact, and “appeal.” They fear that asking for money is the opposite of being “pleasing” to people, and will be a huge turn off. (For a fascinating discussion around if we should worry about what other people think of us, see Jonathan Fields’s recent post “What Other People Think IS Your Business.”)

In tough times like these, consultants, coaches, practitioners and entrepreneurs struggle hard to stand up for what they want/deserve in compensation or fees/prices, fearing no one will pay. And in the end, many aren’t sure themselves what their services are worth.

At the root of this money challenge are shame, doubt and insecurity: Am I good enough? How can I put a value on what I offer? Will there be enough people to pay this? Will they come back? Did they think my work was a good value? How do I fare against the competition? Did I give them great results?

In exploring the question of money with coaches and consultants who are highly financially successful and charging upwards of $400 an hour with ease, I’ve observed these five traits:

1) They have tapped into a large pool of potential clients who can easily pay their fees.

2) They’ve had prior high-level business experience and success that contributes to their sense of worth and value.

3) They’re very well-boundaried — they know where they end and others begin, and are clear about how they stack up against the competition.

4) They focus on business development continually — they understand the power of networking and building a supportive referral network.

5) Most are men.

I’ve observed in my research that men in general have greater access to a sense of “entitlement” — they believe they deserve the fees they’ve set and don’t tend to agonize or apologize about what they are worth.

Women on the other hand have been culturally trained to think less hierarchically and more about connection, equality, and empathy. Midlife women in particular simply have deeper challenges than men in standing up and speaking up about what value they bring and how they excel and stand apart from the competition. That said, for women to be successful entrepreneurs, consultants, practitioners and small business owners, they must find new ways to strengthen their ability to authoritatively command the fees they deserve.

While asking for fair compensation remains challenging for me, I’ve created greater success this year only after figuring out beyond a reasonable doubt what I feel my services are worth. I didn’t make the numbers up — I conducted diligent, open-hearted research — with clients, competition, experts, role models, the marketplace, etc. I asked my clients how they assessed the value of our work together, and the impact it made in their lives. And I left my ego at the door when these conversations occurred.

Further, I faced the powerful realization that certain professional endeavors — such as being well-known in the media — don’t necessarily bring you clients who can pay your fees. I’ve learned (and teach my clients) that you’ll be sorely disappointed in your practice or business if you don’t figure out: 1) who your ideal client is, 2) what your optimal method and model of generating income/revenue is, and 3) how you can continually find more clients you love to serve who can pay you what you deserve. In the end, you need to determine new, sure-fire methods to generate more success doing the work you love.

The reality is that for most, asking for money IS hard, but it gets easier when we become crystal clear about what we’re worth and how we’re exceptional at what we do. Once we know in our hearts and minds what to charge, then it’s time to speak up and ask for it without reservation.

Curious about your thoughts — do you find asking for money in your practice or business hard, and if so, what makes it easier for you?

Editor’s note: This guest post was written by Dave Chase, the CEO of Avado.com, a patient portal & relationship management company that was a TechCrunch Disrupt finalist. Previously he was a management consultant for Accenture’s healthcare practice and founder of Microsoft’s Health platform business. You can follow him on Twitter@chasedave.

Entrepreneurial epiphanies surface in random places. For Eric Page, it was watching Brad Pitt’s latest movie, Moneyball. The epiphany caused him to shift Amplify Health’s business model from a provider of technology to a heavy user of technology. While there is a wave of disruptive technology in healthtech, as interesting is the wave of disruptive innovation on the care delivery side of healthcare. These companies aren’t technology companies, however technology plays a pivotal role.

Previously, Page had been the Founder & President of REM Medical, a clinic for sufferers of sleep apnea. A key part of any sleep clinic’s service is prescribing CPAP machines. The problem is that the percentage of people who actually follow-through is quite low (40%) even though the results can dramatically improve one’s life. A series of behavioral insights, often applied through the use of technology allowed REM Medical to double the industry average adherence to 79%. As healthcare shifts from a “do more, bill more” model of reimbursement to a value and outcomes-based model, these kinds of results will separate the winners from the losers. Amplify Health’s original vision was to package the behavioral insights in software and sell them to providers.

With the success of his previous company, Page thought it would be easy to sell this vision to healthcare providers. Unfortunately, many healthcare providers are making the same mistakes that newspaper companies made in the late 90’s. That is, they aren’t moving as quickly as circumstances dictate. The problem is that urgency is sometimes only evident in hindsight. This is what led to the Moneyball epiphany.

For those who haven’t seen the movie or read the book, Moneyball tells the story of how Major League Baseball’s Oakland A’s Billy Beane (the team’s General Manager) was faced with a payroll that was one-third the size of their competition. Beane realized he needed to come up with a different way of picking players or he’d lose bidding wars against richer teams. For over 20 years, baseball statistician Bill James had proffered theories of baseball statistics that flew in the face of conventional wisdom on what statistics best represented a player’s value to a team. James was ignored until Billy Beane came along. He applied James’ theories with great success regularly fielding playoff teams that had one-third to one-half the payroll of the teams they competed against.

While watching Moneyball, Page had the realization that he had been acting like Bill James evangelizing his theories. Even with a successful track record, he wasn’t getting the traction he desired. Instead, he decided he should become Billy Beane and apply his knowledge to his own company. Rather than monetize via a software licensing model, Amplify Health will be in the onsite clinic segment delivering primary care and managing chronic conditions. [See DIY Health Reform: Employers Solving Healthcare Crisis One Onsite Clinic At A Time for more on onsite clinics.]

Amplify Health isn’t alone in this trend. Other examples include MedLion, One Medical Group, Qliance and White Glove Health [Disclosure: MedLion is a customer of Avado's]. These are healthcare providers who’ve applied technology to enhance their competitive advantage. Traditional healthcare providers should be on notice about these types of disruptive innovators. After all, in the late 90’s the newspaper companies were worried about other media competitors and big players such as Microsoft. What devastated their business models was an array of niche competitors who bit by bit hollowed out chunks of their business. Companies such as Monster.com, eBay, Cars.com, Zillow, Craigslist and many others. Like newspapers that were oligopolies or monopolies, many large health systems haven’t been faced with the level of competition that is emerging. As William Gibson has stated, “the future is here, it’s just unevenly distributed.”

By definition, the legacy HealthIT vendors have optimized their solutions around the legacy reimbursement and delivery models that have created the hyperinflation in healthcare crushing family, business and government budgets. The exciting aspect of this for the healthtech startup community is entire new categories of software are emerging to support disruptive innovation taking place on the care delivery side. Even more promising is that many providers, payers and pharmaceutical companies have set up innovation groups. I wrote about one earlier — Healthcare Field of Dreams In Idaho: Health System Opens Innovation Center. An array of new models are being tested at organizations such as Horizon Health Innovations, Catholic Health West, Trinity Health, Catholic Health Initiatives, Blue Cross Blue Shield of Florida, Catholic Health Partners, Blue Shield of California and many others.

Often what has passed for innovation in healthcare is a clever way to maximize the latest reimbursement code or government incentive. For example, a large swath of providers are chasing after Meaningful Use incentives. Meanwhile, there are others building a sustainable competitive advantage in rethinking delivery models from the ground up. Not long ago, CareMore was acquired for $800 Million by WellPoint because they’d developed a creative new delivery model. VCs are taking notice. For example, Dirk Lammerts, MD is a VC with the Burrill Venture Capital Group who has stated he will avoid investing in businesses dependent on Medicare reimbursement. Rather, he wants true disruptive innovation.

Taking place this week is the Health Innovation Summit being put on by RockHealth. I’m moderating a panel on business models for health-related startups – panel members include Linda Avey, Ron Gutman and Jennifer Wong. I will speak to some of the aforementioned business models and the accompanying business models for companies that support those entities. Collectively, we’ll discuss models ranging from monetizing mobile apps to how value can be derived as a byproduct of customer use (e.g., PracticeFusion) to media models and more. What creative business models in healthcare should we be aware of? Please add your comments below.

This duration also saw Japan alteration from being a feudal world to having a retail monety kolekcjonerskie Krakow economy and sinistral the Japanese with a slow Western influence.