Sunday, December 17, 2017

First Quarter Forecast; 2018…

Its has been quite a year…

Some things worth considering as we end 2017 and enter 2018;

First, in general; It only takes one highly loaded and disruptive issue in the geopolitical/military, social or economic arena to turn the market sectors (collectively) upside down.

Globally healthcare spending increases will be around 4 to 6% as efforts are advanced to improve quality and access in systems which may have lacked investment in infrastructure due to limited funding.
This may in some part be influenced by increasing “globalization” and will likely impact the cost of care to the individual consumer.

In the United States the country continues to not be in “lock step” as it relates to many factors.

External pressures at the national, regional and local level such as geography (rural vs. urban), population density, demographics, unemployment, insurance coverage and immigration are just some of the variables.

In addition (no specific order) some top of mind areas to consider;

  • The future of the 340B program as well as the ACA are areas to watch and in advance of any changes put measures in place that limit any unintended consequences.
  • The proposed Tax Bill will have an impact on federally funded research.
  • At the current “run rate” China will surpass the United States in biomedical research.
  • Technology will play an ever increasing role in connecting the consumer/patient with the healthcare system.
  • “Cost shifting” to consumers may be slowing down as what may be considered “reasonable” limits (think high deductibles etc.) are increasingly exceeded.
  • Narrow networks.
  • Wellness initiatives to guard against burnout (in and out of the health sector) increase.
  • Mergers, acquisitions and enhanced affiliations give rise to more health system “super regionals”.
  • The demand for Population Health initiatives which focus on leveraging new technologies to address social determinants will expand.
  • Novel financial models aimed at mitigating downward economic pressures will be tested.
  • Cost containment measures will continue.
  • New care delivery constructs which enhance effectiveness and efficiency will be pursued. 
Stay tuned

Sunday, July 30, 2017

A New Alchemy in Healthcare; A Periodic Table for Healthcare Delivery ©

Chemistry and action;
Second law of thermal dynamics, Law of Entropy
Order to chaos

Complexity builds with discovery
Discovery in this sense meaning a new and perhaps unrecognized requirement or variable that when understood and applied creates conditions necessary for a positive outcome be it clinically, experientially, regulatory or financially.
Healthcare delivery in the aggregate has historically dealt with ever increasing complexity in a variety of ways in the search for  “goldilocks” conditions, not hot not cold, just right.

One can posit that every healthcare “discovery” created essential elements or necessary conditions which described those factors, there interdependencies and relationships; a periodic table for Healthcare. Lets check out the elements;

1) Co
Positive clinical outcomes, starting with “first do no harm” is the key element in the healthcare periodic table. This is the element to which all others must “interrelate” and without it, no other sustainable structure can be created. It incorporates; safety, human factors and high reliability
2) Pe
Patient Experience
            Patient > and = Customer

3) Fp
Financial Performance
            Positive margins

4) Ee
Employee Engagement
            A staff that derives meaning from there work and translates that into the             patient experience

5) G
            Ease of access,
            a sub element; maturity as an organization

6) Msh
Market Share
            A strategic approach to serving more

7) Ca
Competitive Advantage
            Differentiated “destination” programs

8) Ca2
Clinical Alignment
            Medical Staff, & Clinical Enterprise, strategically and economically

9) Pm
Payor Mix
            An understanding of the delicate balance of this “catabolic” element in your             market is essential

10) L
            If you can choose it you can influence G, Msh & Pm

11) R
            Essential component of Ca not found in most cases without AcM

12) GL
Governance & Leadership
            The wrong group of alchemist can turn lead to gold or gold to ash

13) AcM
Academic Medical Center
            A critical component for many of the elemental structures noted if you are             fortunate enough to have it as part of your Periodic Table

If the elements come together in just the right order you may have those
Goldilocks Conditions previously noted:
Integrated healthcare delivery platform
Safe, positive clinical outcomes
Clinical staff; quality providers
Academics, medical school, research & pipeline of clinicians
Market relevancy
Differentiated services & indispensability
Aligned clinicians & clinical enterprise
No silos, synergy throughout
Low cost structure, low debt, low age of plant, net assets &reserves
Positive margins

Richard Gannotta NP, DHA, FACHE

Sunday, July 23, 2017

Healthcare 2018 early predictions & areas to watch

My thoughts on a few areas of keen interest for 2018 and beyond. 
Patient care, healthcare policy, delivery, technology and economics sure to be impacted by these examples with more to come…

1) Medication & Pharma
I am still a believer that genetic, genomic and nanotech will have a tremendous influence on health and disease in the future, right now watch;
           PCSK9 Inhibitors, a very promising class of cholesterol lowering drugs

2) Augmented Reality for Healthcare
The applications in healthcare delivery are endless, the tech companies that are exploring this arena  are absolutely worth looking into.
For a better idea of what I am referring to, click on the University of Maryland site below, a “glimpse of things literally right around the corner;

3) Artificial Intelligence
From Google to Watson the future of healthcare delivery is being changed by AI. Nothing more to say…

4) In home care (not to be confused with home healthcare)
Care in the home,  from what historically would be found in an inpatient general med surg 
unit to ICU care will increasingly be “pushed out” of hospitals. Coupled with a well developed clinical infrastructure and advanced by remote technology it can be a safe and economically favorable alternative to inpatient care (think disease specific and operative bundled payments)…

5) Social Media
One of the most, perhaps singularly influential and game changing areas that will impact consumer driven healthcare. 
From a market perspective, ignore this sector and its opportunities at you own “peril”.

Tuesday, July 4, 2017

Individual & Organizational Well Being & Inspired Leadership for Healthcare and Business

Individual & Organizational                                                July 4th 2017
Well Being & Inspired Leadership for
Healthcare and Business

Here are some potential benefits of several “key” practices that can;

Align individual aspirations and organizational mission.

The result: Increased performance, positive outcomes &
Inspired Leaders


Its benefits;
            Acceptance & Non Judgment

Mindfulness means paying attention in a particular way;

•On purpose
•In the present moment
•Non - judgmentally


Works as a renewing agent

Decreases stress levels and improves overall effectiveness; the experience of compassion will set in motion restorative mental, emotional, and physiological processes.

All of this leads to a more positive environment which research has shown affects how that organization actually performs.

This infers a powerful business case for compassion.

In addition, caring relationships are the key to arousal of the PSNS which
Can lower blood pressure, enhance immunity, and lead to overall better health.

Healing environments

Facility design
Minimize stress, remove barriers, equals an efficient healing environment

Personalized relationship between staff and customers.  In healthcare between caregivers & patients, consider care delivery proximity and space

Integrative /Complimentary & Alternative Medicine
Increasing the availability and use of complimentary therapies in the inpatient setting may be beneficial

Inspired Leadership

The inspired leader, any position and level in the organization, puts all three practices in motion; Mindfulness and Compassion creates a Healing Environment.

Final thoughts & practices to consider;

Listen & become “People whisperer’s”

Compassionate & Honor Spirit

Self-defined and aware


Takes Sabbath seriously

Is servant vs. manager

Attitude of courage, gratefulness

Sunday, June 25, 2017

NYU Research

Really happy to report that research with my friend and colleague Dr Tom D’Aunno
is progressing well with many interesting insights!!!

Tom and I are looking retrospectively at disruptive “game changers” in healthcare over the last 30 years, all sectors.
This will lay the ground work for more “precise” forecasting and futures…
Look for further reporting this summer.