Healthcare Transformation

New Resolution

Why a new resolution to stimulate growth is likely.

Some professional economists are calling the recent drop in unemployment a dead cat bounce.

By definition, a dead cat bounce is a temporary recovery in share prices after a substantial fall, caused by speculators buying in order to cover their positions.

The uptick in employment may not be the sign of recovery that some are hoping. Time will tell.

However, President Trump tweeted a negative statement about the Green New Deal this week which leads me to believe the political winds of change are blowing. 

Green New Deal

The Green New Deal is a resolution to address climate change and equality. A resolution simply means that a strategy takes national priority.

The Green New Deal is commonly associated with Alexandria Ocasio-Cortz [AOC] who has been labeled a socialist and part of the far left. Don’t be put off. The labels are meant to create fear by those who are resisting change.

An example of this labeling from the stimulus package following the Great Recession is the Accountable Care Act [ACA]. As you know, the ACA attempted to close the coverage gaps and establish the technology framework needed to modernize the healthcare system. Even though the need was clear and the funding was provided, many resisted the change and some even referred to it and still refer to it as a “government take over of healthcare”.

The outcome of the ACA was not perfect but it reduced the number of Americans uninsured and provided the framework needed to enhance the data capture that will enable research and better resource management. It also created new jobs and spurred innovation within the industry. None of which amounts to a government take over of healthcare.

Healthcare is a component of the Green New Deal. Whether or not we see a national system as part of a new resolution is questionable but insurance reform is expected.

Other Expectations

I’ve been participating in some calls this week that are shedding some light into what we can expect in a new resolution.

  • Interoperability + Data Repository: There seems to be wide spread acknowledgement that the system is too fragmented to meet the needs of researchers and consumers.
  • Public Health: There needs to be more focus on public health as opposed to facilities so that the industry can get ahead of disease.
  • Regulations: Talk about the need for speed in drug development surfaced which always leads me to believe that we’ll see a reduction in regulations.


One discussion was about establishing the right culture that will give the public more confidence in public-private partnerships. 

The key values that surfaced are:

1/ Honesty

2/ Trust

3/ Transparency

For organizations adopting these values, define the behaviors that support the value and those that don’t so that there is no misinterpretation. 

Other conditions that need to be present for a successful partnerships are:

1/ Common Purpose

2/ Digital Maturity

3/ Clinical Leadership

Healthcare Finance 3.0

Reimagining healthcare finance post Covid19.

I have been participating in some Zoom meetings to hear how others are reimagining healthcare post Covid19. There is broad consensus that use of Telehealth will not diminish because consumers are using it now. In fact, 80% of physician visits are now Telehealth visits.

Most are still questioning the longevity of current Telehealth reimbursement. When first conceived, Telehealth use was supposed to help reduce the cost of healthcare and with current reimbursement levels, it’s not achieving that objective. Convenience and limitations of the technology may be driving up cost.

When costs go up, everyone starts talking about the need for more value based care arrangements even though structural issues makes it hard for many healthcare organizations to make those arrangements work.

So the question that remains to be answered is how do we develop a more sustainable model?

Healthcare Consumerism vs. Accountable Care Organizations [ACO]

We have competing ideas at play in the healthcare industry.

On one hand, we want everyone to behave as healthcare consumers. That means we want every American to carefully select the healthcare services they need based on quality metrics and cost so that they get the best outcome possible.

On the other hand, we want to narrow their choices and limit their options so that we can control their spending and achieve defined outcomes of quality.

There are elements in both strategies that could work if we combined them in different manner.


Ideation is not about having the perfect idea but rather generating fresh ideas to solve a problem. Asking questions helps to get the process started:

1/ Who should control the purse strings?

2/ Is the Healthcare Consumer capable of making informed decisions?

3/ Can we better empower the healthcare consumer?

4/ Is it possible to offer choice and control costs?

5/ Who should define a quality outcome?

Developing a Sustainable Model

If we answer the questions from different perspectives, new ideas and needs emerge. 

For instance, if we start from the healthcare consumer perspective:

1/ The consumer could control the purse strings even if they are not paying for the service out of pocket.

2/ The consumer could make informed choices if we laid out a healthcare roadmap for them.

3/ The consumer could be informed of all the options for events on their healthcare roadmap.

4/ The consumer could be better empowered to choose their physicians and control costs.

5/ The consumer knows how they want to feel and move post service and is in the best position to assess whether or not they got their expected outcome. 

The expected outcomes needs to be established with their physician. Atul Gwande MD talks about physicians understanding all the options but also understanding the limits of medical interventions so that healthcare consumers develop reasonable expectations.

Healthcare Roadmap

Based on the answers, we’re missing the healthcare roadmap that gives consumers actionable information based on their genetic profile and lifestyle. 

Various companies are collecting information on their current health status, pre-determinants of health, genetic and risk profile but so far there is no repository for the information.

Professional economists believe the government should maintain a single repository of this type of information so that it is safeguarded and continuously used to better understand the needs and cost of healthcare.


As an industry, we usually talk about “medical necessity” as a way to define coverage even though there are always issues in defining necessity and limiting care. 

Most consumers don’t read all the fine print in their policy and likely don’t understand the concept of medical necessity. To empower the healthcare consumer, policies need to be easier for them to understand what’s covered and what’s not.

Different nomenclature such as uncontrollable event versus controllable event could help.

1/ Uncontrollable events are those predicted in their healthcare roadmap. 

Everyone has some sort of flaw whether genetic or lifestyle that leads to an increased cost. So financially shielding healthcare consumers from all uncontrollable events seems fair to all. Incentivizing healthcare consumers for sustained behavior change may help lower the cost of their roadmap and the total cost of care.

2/ Controllable events are the services healthcare consumers want and can plan for in advance of the event.

Thinking about events enables us to think more holistically about everything that might be needed and that could enhance the healthcare consumer experience. Controllable events could be either paid out of pocket or financed through a supplemental plan. 

Direct to Consumer

Other industries are reconfiguring to enable more direct to consumer sales. There is a role for it in healthcare as well to fulfill the miscellaneous needs of healthcare consumers. 

Direct to healthcare consumer platforms are providing the same level of service and transparency as direct to consumer services. Prices are coming down for over-the-counter drugs and medical supplies. 

The expenses could be paid either out-of-pocket or a pre-tax account [aka: HSA account].

Achieve Peace

We need to win the Covid19 war and achieve peace.

I’ve been listening to leaders in the financial industry about what they hope to see post Covid19.

There is unanimous consensus that Covid19 will have a much bigger economic impact than the 2008 financial crisis that gave way to the Great Recession. We recovered from that crisis, but it left a massive gap in wealth that has contributed to the political divide. In their words, we won the war but failed to achieve peace.

Achieving peace means addressing the wealth gap. Some think a new American Dream is needed to grow the pie and to divide it more equally, while others are simply calling for more focus on Main Street and individual Americans and less on Wall Street and corporations. Their main concern is whether or not there is enough political will to narrow the gap. 

There is also a gap in healthcare that needs to be addressed. The Accountable Care Act [ACA] helped but it didn’t get the job done.

What’s the future then?

Learning from the past is important but the healthcare industry has recycled a lot of ideas that don’t work. If we use the lens economists and financial professionals use when assessing broader market dynamics and opportunities, we can start getting out of our box.

1/ Store of Wealth: What companies performed the best in recent months and are in the best financial position to survive the recession? Understanding why will give us new insights into the technologies and services most valuable to providers and patients respectively.

2/ Asset Type: Are industry segments still relevant given the level of cross pollination? Traditionally we’ve thought about the industry in terms of biotech, med tech, health tech, healthcare technology, insurance and services but segments imply a silo. Silos are not relevant when thinking about value in a service economy.

3/ Geography: Is geography still a constraint on delivering value? We often think about healthcare as being a local service but we’ve learned through medical tourism that people are willing to travel for a better price, higher quality of care and better service. Covid19 creates the opportunity to re-evaluate the types of service that should be delivered locally and virtually versus those that are better delivered in Centers of Excellence [COEs] and teaching facilities.

4/ Global: What systems failed under pressure? Covid19 has made it clear that we are all affected by others around the globe and dependent on others around the globe. We need to design redundancy into those systems to prevent future failures and to restore the confidence of provider organizations and the public.

This is the beginning of a big shift that will change how we operate, who we work with and who we serve.

Beyond Healthcare

Covid19 presents an opportunity for changes to industries that affect the health and wellbeing of all Americans and to incentivize meaningful innovation that will help lower the cost of healthcare and achieve peace.

Medicare for All

Don’t assume Medicare for All is off the table for the 2020.

A health tech colleague and I touched on Medicare for All when thinking about topics that should be addressed with his board. I’ve been thinking about it more lately because a 2018 poll recently circulated through my Twitter feed. The poll showed 70% of Americans supported for Medicare for All.

With unemployment estimated at roughly 14% now and climbing, many Americans are going to be without healthcare coverage. Some will qualify for Medicaid but others will slip through the cracks. Some coverage is better than none but no one is going to be really happy.

Healthcare is going to be an even bigger 2020 election topic than most likely anticipated. As an industry, we need to be thinking about financing versus care.

Healthcare Finance

The healthcare system is needlessly complex. What many don’t realize is that there are over 3,000+ commercial payers nationwide and it’s a bit of a moving target year to year as to which plans are operational. Plans consolidate or cease operations for other reasons. It’s time consuming to decipher all the changes. Add all the other payer classes and it becomes even more complex.

Legacy systems aren’t designed to keep up with payer and EDI changes in real time and few people in the industry understand the updates needed to the systems to ensure the data flows seamlessly. It’s no fault of their own. Most involved in revenue cycle management are not trained in healthcare finance or systems. They’re skilled at processing and managing large volumes of transactions.

Payer and EDI changes come before all the permeations of networks, authorization requirements, clean claim guidelines and payment details which add even more complexity to the process.

Managing all those permeations typically requires sophisticated contracting technology that is expensive whether it’s managed in-house or outsourced. The cost runs  6-12% of net revenue which is an estimate of collections and even more when the cost of uncollected claims is factored in.

The complexity in the payment process is why claims go unpaid, providers get financially stung out and eventually look for a partner. Consolidation increases the cost of healthcare not the quality of care.

Medicare for All

There are two main levers for healthcare providers to manage their revenue stream: payer mix and case mix. Medicare for All reduces the number of payers which means payer mix would no longer be a lever.

Eliminating a lever might make some financial professionals uncomfortable. Concerns such as coverage for treatments, drugs and services not appropriate for traditional Medicare beneficiaries but appropriate for younger beneficiaries would need to be addressed as well as scope of coverage or what we think of as plan design.

The risk of federal debarment which is the exclusion from participation keeps the fraud and abuse in check even more so than in the commercial market. It should not be a non-issue.

Meaningful Innovation

Another Medicare Advantage plan recently received venture funding. When I read the description of the company, it seemed more like a strategic initiative for existing health plans not a disruptive idea typically funded by Venture Capitalists.

Insurance companies are lucrative businesses if the management can achieve the needed scale and minimize benefit payouts, or in other words claims payments. There are a few ways to do it: skim the market for healthy members that will incur fewer claims, add complexity to the claims process to reduce payments or pay providers lower rates than Medicare.

Without getting into problems with those sorts of practices, none move the healthcare industry closer to achieving the triple aim and ultimately, delivering more value to the healthcare consumer.

Financing vs. Care

We might not agree about the cost of Medicare for All, but we can all agree with the basic premise that less complexity generally means lower cost. 

Our fear gets the worse of us when we start thinking about winners and losers. Winners and losers assume the status quo. No one in the industry has been operating in a status quo mode for years.

Streamlining the financial complexity doesn’t diminish the quality of care delivered. If anything it focuses all the players on what they do best.

National Dialogue

Healthcare leaders can help shape the national dialogue.

I needed some repairs done over the weekend and got an ear full from the handyman. He couldn’t contain his emotions about the economic impact Covid19 is having on everyone. Who can blame him?

Mixed into some interesting theories about China and the US, were some new perspectives about the environment, the level of inequality and the prioritization of government spending.

Given the level of interested in Stakeholder Capitalism, I’ve been thinking about how to incorporate workers from every level at “the board table”. There is value in hearing the unvarnished perspectives from people of all walks of life. 

However, this experience left me wondering whether there is a way to filter out the disinformation without affecting the value of the input.

Critical Thinking

I’m not the only one thinking about this right now. Jonathan Haber, author of Critical Thinking has been too. He recently hosted a webinar called Essential Knowledge in the Times of Crisis.

As a society, our critical thinking skills have reportedly become a bit lax. Consequently, we’re leaning too far into our biases especially when it comes to political and other issues that help define us.

The good news is that critical thinking can be taught, assessed and mastered if implemented correctly. General and immersion techniques are commonly used in educational settings now but are less effective than infusion which involves explicit instruction.

Explicit instruction requires the teacher or leader to pause and explain the example when critical thinking is infused into a lesson or problem.

Elements of Critical Thinking

According to Jonathan Haber, there are six [6] elements of critical thinking. Specifically: 

1/ Structured Thinking: Developing a form of logical thinking.

2/ Language Skills: Developing the ability to structure statements from your thinking.

3/ Argumentation: Using your structured statements to form an argument.

4/ Background Knowledge: Having a good foundation of knowledge on the topic.

5/ Persuasive Communication: Amplifying your argument with more convincing and compelling language.

6/ Understanding and Controlling for Bias: Being aware of your own biases and being open to new information, facts and ideas rather than dismissing it as “poppycock”.

National Dialogue

There is a role for healthcare leaders to play in shaping the national dialogue.

A few physicians in my social networks are sharing research, explaining the findings and answering questions so that people interpret the information correctly. It’s been really helpful for me and others in the network. Even if they don’t ask questions, they get the benefit from the group dynamic.

Non-physician leaders could build on that momentum to help develop the background knowledge on the environment, inequality, government spending and other related topics. 

A few ideas of things that all leaders could do now: 

1/ Book Clubs: Leaders could host virtual book clubs and facilitate the discussions. Buy the books for participants.

2/ Lecture Series: The Common Wealth Club is hosting virtual events on relevant topics. Tickets are very affordable especially if you’re already a member. Again, leaders could facilitate discussion following the lecture.

3/ Social Networks: Use social networks to engage with people in “positive economics” which is the explanation of the current situation rather than being prescriptive or opinionated. 

In addition to being heard, people need to know you care. Investing your time in their development shows that you care.

Covid19 Stimulus

How long can stimulus be used to sustain the economy?

I’ve been reading Paul Krugman’s latest book, Arguing with Zombies to better understand the stimulus funding and debt. The numbers are eye popping.

Economic stimulus is a proven way to restore confidence and to reduce the severity of market cycles. There is a depression era framework that supports the generous use of stimulus funding to return the economy to full function. The resulting debt gets repaid in following boom years.

However, we might be in some uncharted territory with Covid19 because it’s harder to quantify the need and the impact when the virus hasn’t been contained.

The question then is how long can stimulus be used to sustain the economy? Economists are coming up with different answers and some of the answers are probably making Republicans uncomfortable. Hence, the desire to get everyone back to school and work as quickly as possible.

How + When

No one has the answer to that question yet either but in Arguing with Zombies, Paul lays out a framework for public intellectuals. It is good for everyone to understand and for leaders to use especially during times of disruption and transformation.

Framework for Public Intellectuals [and Leaders]:

1/ Stay with the easy stuff. 

Keep with proven data and things that have a right answers rather than sharing theories of things that may or may not pan out.

2/ Write and speak in plain language.

Maintain the integrity of the content while conveying the information in a way that is accessible to everyone regardless of education and background.

3/ Be honest about dishonesty.

Call out disinformation and policies made in bad faith. Policy decisions that affect human life should be based on verifiable facts.

4/ Talk about motives.

Everyone and every company has a motive. If we can’t be open about our motive and discuss it, than there is probably something fundamentally wrong with it.

Everything doesn’t have to be political.

I was delighted when Gavin Newsom acknowledged President Trump for fulfilling all direct requests that he could. His action follows the old adage of give credit when credit is due.

With that said, we need to look at the whole experience and outcome of the Trump Administration as we head into the 2020 election and consider how much of a role government should play in reducing market risk and inequality.

Covid19 has highlighted the level of existing inequality in deaths and infection rates. Lower socioeconomic classes have paid a higher price.

Companies are writing into the Wall Street Journal [WSJ] about their contributions to the Covid19 relief efforts. Many are backfilling gaps that should have been filled by the Federal Government.

A recent WSJ email questioned whether we’ll see a heightened level of corporate responsibility for all stakeholders following the Covid19 pandemic or a return to business as usual. What are your thoughts?

Arguing with Zombies

As you might guess, Arguing with Zombies explains why we keep having the same debates on key issues such as healthcare, climate change, inequality and debt.

Paul distills the facts and explains the motivations behind the related policies using his framework. It’s a good book to add to your reading list now.

Think Global

Why you should start thinking globally now.

Covid19 is making the US healthcare industry cross the chasm to consumer driven healthcare. 

Previously imposed ideas of what we thought were possible in healthcare and other aspects of life are being challenged every day. No one is accepting a lower standard of care or service but rather realizing that there are pros and cons to delivering service online.

Based on my own experience and insights from others, we should all start thinking about the global potential.

Global Markets

Everyone has the potential to prosper in a global economy. The cost of doing business is decreasing in developed countries and increasing in developing countries.

Retired healthcare providers have rejoined the workforce and are supplementing care via telehealth services. We’ve created a new way for them to participate on their terms while increasing the supply of medical expertise to the market. 

It’s an important proof point to acknowledge because many countries have been fretting about how to meet the demands of aging populations. Designing services that continue to empower physicians and other healthcare providers will enable us to meet the growing global demand.

The cost of providing telehealth and virtual services is substantially lower than a bricks and mortar service. Providers don’t need receptionists, schedulers, coders and billing staff. We’ve had the ability to automate all of these functions for years but many providers were scared to let go of the past and venture into the future. 

Reimbursement and Wages

Reimbursement for telehealth services is reportedly about 30% lower than an in office visit now. That may change post Covid19 pandemic. There is a lot of concern about the potential of over utilization. 

One prominent Oncologist who is using telehealth services to have end of life discussions with his patients shared that it’s harder for him to gage the patient’s reaction and to offer comfort. Consequently, he’s scheduling a follow on discussion a few days after the initial discussion to answer questions. 

Telehealth is enabling him to enhance his service by doing more timely follow up with the patient. Some might think that is an example of over utilization whereas others will think that is an example of good service and patient care. 

Establishing a standard of care and appropriate reimbursement is going to be tricky because there are a lot of variables to be considered. As a benchmark, payment for online services outside the healthcare industry have decreased by more than 30% and are constrained by the consumer’s ability to pay in light of the economic impact.

Health tech companies shouldn’t expect to receive a premium now given the amount of consumer technology being researched and used in the delivery of care. It will be hard to justify. Plus consumer technology is raising the bar for health tech companies. Dated, poorly designed and restrictive interfaces are not going to be accepted by healthcare consumers in the near future.


There is an increasing need to establish global standards for healthcare professionals to facilitate a global healthcare marketplace. 

While some US physicians have been tossing around the idea of unionization to address their working conditions and pay, they might be better off fighting for a new organization that establishes global credentials. Technology is going to empower them in new and better ways to work on their terms if they embrace it.


There is political discussions happening now around infrastructure as a way to stimulate the economy after the Covid19 shutdown. Governments should be investing in infrastructure because roads and bridges effect everyone’s ability to live productively.

The definition of infrastructure needs to evolve. Good roads and bridges represent how we functioned in the old economy but less important to how we will function in the near future. Internet access and reliable connectivity is quickly becoming more important for our ability to work and live.

Coverage is still spotty or limited in older parts of major cities, rural areas and other countries. Hopefully, political leaders are considering that as they plan the next round of stimulus funding so that everyone has equal and affordable access to opportunity and healthcare.

Covid19 + Beyond

Preparing for the impact of Covid19 and beyond

Years ago, Bill Gates tried to warn us all about the risk of a deadly virus. Unfortunately, we didn’t heed his warning.

The good news is that he has left the boards of Microsoft and other companies to focus his efforts on the Gates Foundation.

His efforts will likely change the way healthcare organizations prepare, governments track outbreaks and how vaccines are developed.


The thought of making a meaningful change might be inspiring you to get more involved in the transformation underway.

If you’re thinking about healthcare venture capital or startup, here are a few takeaways from my studies last week:

1/ Venture is big business: Returns have normalized as more money runs into the sector. That may change if stock markets continue to contract.

2/ Small funds preform better than big funds: Funds less than $500 Million are more likely to return 2x the capital invested after fees. Big funds are reportedly more dependent on the management fees and might be impacted more than smaller funds.

3/ Entrepreneurs are important: If there is no entrepreneur, there is no need for venture capitalists, investors, lawyers, accountants or other professionals. Entrepreneurs deserve your respect.

4/ Terms: Many of the deal terms seem to be driven by scarcity which makes for a really toxic working relationship. If you have to control the company, it’s probably not a deal worth doing.

5/ Fees: The healthcare industry is not the only industry resistant to change. Personal interests often get in the way of much needed progress in venture too.


The Hulu documentary about Hillary Clinton is worth watching if you have some down time. It’s available on Netflix and likely other streaming services.

What many Americans didn’t realize, Hillary had the respect of several staunch Republicans including: John McCain, Lindsay Graham and Bill First MD from her work on various bills including the Children’s Health Insurance Plan [CHIP]. Many didn’t get past the name “crocked Hillary” and “lock her up” chant to learn the truth.

Regardless of what you think about the Clintons now or more broadly Democrats, there are some important takeaways for us all.

1/ Media: Headlines are meant to get our attention not provide the substance for a meaningful debate on the issues. Unfortunately, many Americans now seem to have an attention span limited to about 140 characters. That makes it really hard to share the information needed for everyone to make good decisions – even in times of Covid19.

Just remember, the devil is in the details. Before you loose your head, use the three [3] D’s from Radical Candor for good decision making: Discuss, Debate and Decide.

2/ Timing – Some risks can be mitigated. Others come out of the blue and totally change the game. Game changers take out everything that’s weak.

Scale appropriately and sure up your resources to weather the storm ahead. We’re likely not going to see a return to business as usual in the near future. Let’s hope for a U [2001 recession] and not a L [2008 crisis] but consider both in your strategic plans.

3/ Progress: There is often a gap in what we want to do and what we can do within a given political landscape. 

Ultimate success requires a lot of small steps and zigzags to achieve a goal. Progress is good. Celebrate each small win.

Whatever happens, it’s going to be one heck of a ride!


Could co-housing help solve the homeless issues?

Did you catch the Fortune article asking “Can San Francisco be saved?” The article raises the point that for people without housing, there is no health. Unfortunately, the story gets worse.

Many medieval diseases [typhus, tuberculosis and likely Covid19 soon] are now showing up in the homeless populations and consequently, threatening the health of everyone else too. 

We have to deal with this problem because things are only going to get worse for everyone if we don’t.


I’ve been indulging my interest in design lately and attending lectures on architecture and home design. 

People are always curious about why I’m there. The answer is simply curiosity and interest. However, in conversation I mentioned was that I was interested in the intersection of housing and health as well as design and health.

As soon as you state a clear reason, people start sharing ideas and offering resources for potential solutions. Co-housing is one of the solutions that a really successful architect mentioned to me.

Co-housing incorporates all of the elements of a multi-generational community under one big roof. It includes both private and common spaces. Similar to corporate culture, shared values makes the co-housing community work.

It works for some and possibly in some cases, like addressing the homeless population. 


I spoke with a consultant who works with organizations on issues related to bias. She also volunteers with non-profit organizations that assist underprivileged women.

A short conversation with her is all you need to understand the flaws in our current approaches to addressing the homeless issue. Housing is important but it’s the first step in a relatively long process of helping people to re-enter society.

The homeless population needs to be reoriented to living in a home so that they learn the proper use and care for appliances and learn the social norms of living in a residence.

Once the initial orientation period is complete, the hard work of addressing their underlying problems begins. Depending on the individual issues, people may or may not have the bandwidth to hold down a job.

We often think of dollars spent rather than dollars saved. However, professionals working with the homeless industry benchmark savings against inpatient hospital costs. The cost per day of properly serving the homeless is about five times [5X] less than a hospital day.

Plus think about the duration of the expense. No long term solution, no limit on the cost.


What many of us don’t appreciate is that the homeless have a community and people who watch out for them.

When they are placed in housing outside of their community, it creates additional problems and doing so may never help solve their original issues. 

We need to think about how to preserve those communities during their transition back into society. That’s why co-housing might be a good option.

The question that remains is given the limited supply of land and affordable housing in most major cities, how do we create these structures without building on golf courses, parks and other plots valued by others in the community.


Have you seen that HGTV design show about people living in repurposed firehouses, lighthouses and ships? 

That’s why I can’t help but think repurposing old cruise ships as transitional co-housing homes might be an answer. Many of the homeless are in cities along the coasts with real land constraints. 

Cruise ships have private rooms, commercial kitchens, large dining areas, outdoor space, medical facilities, gym and recreational areas. Plus it would be an easier way to scale up and if all goes well, scale down as demand falls. They seem to fit the bill.

With that said, there are a lot of experts who have ideas and insights to address the issues. We need to engage with them to generate ideas and develop a now-near and far strategy to address the homeless and shortage of affordable housing.

Employers need to be part of the long term solution because most people migrate to cities for work. With the quality and affordability of technology, there’s really no reason for people to move. We just need to open our minds to new possibilities.

Conscious Capital

Can entrepreneurs and conscious capitalists solve all the world’s problems?

I’ve been researching impact investing and some of the ideas around it including stakeholder capitalism, conscious capital and frugal innovation.

While I don’t have my arms fully around the topic yet, I see somewhat of a ground swell happening that is important to acknowledge. More and more people of all ages are looking for broader meaning in their work.

I’ll share a few ideas and discoveries now and will circle back with more.


It seems like everyone wants to point their finger to one reason or another for why healthcare costs have skyrocketed. However, the one reason that doesn’t get much attention is the “number of sophisticated options” that are available now. It’s likely because progress is viewed as something positive.

The problem is that many people don’t have access to the sophisticated options because they’re too expensive. Did you know that over 5 Billion people don’t have access to safe surgical services? It’s a bigger problem than HIV/AIDS, TB and Malaria combined. 

Equipment costs are part of the problem. I recently discovered an emerging medical device company that is making the needed equipment more affordable through frugal innovation. 

They have been working in some of the most resource constrained countries and challenging situations with high demand and now are making inroads into the US healthcare market. It will be interesting to learn how their value proposition translates and how physicians respond to the idea of frugal innovation. 

Frugal innovation is more than a strategy. It denotes a new frame of mind: one that sees resource constraints not as a liability but as an opportunity — and one that favors agility over efficiency. Frugal organizations don’t seek to wow customers with technically sophisticated products, but instead strive to create good-quality solutions that deliver the greatest value to customers at the lowest cost.


According to Be the Solution, 75% of the $1.4 Trillion annual US healthcare spend is on chronic diseases that are preventable with better lifestyle choices. 

It seems like a big number. However, it’s inline with my 2018 estimate of $874 Billion which includes the spend for spine and joint issues [35%], heart disease [35%], diabetes [12%] and obesity [18%].

Changing bad habits is not easy. Habit formation experts believe that changing a habit that requires one decision [i.e. flossing or exercising daily] is easier than changing a habit [i.e. diet] that requires moment-to-moment mindfulness, virtuous behavior or an entire set of new habits. Even then, bad habits can be easily rekindled if you’re not mindful. 

What’s not clear to me yet is whether or not there is a viable business model to support habit change or if sales tax is the better solution for curbing unhealthy behavior.


Be the Solution is somewhat refreshing. The book acknowledges the magnitude of the problems ahead but reframes them as opportunities for entrepreneurs and conscious capitalists.

You can’t take on the world’s challenges if you’re not in the right state of mind. So I’ll leave you with a reframe exercise to do.

According to positive psychologist Martin Seligman doing these seven [7] things will improve your health, happiness and well-being:

1/ Cultivate positive emotions about the past by increasing gratitude, forgiveness and letting go.

2/ Cultivate positive emotions about the future by learning to recognize and dispute pessimistic thoughts.

3/ Cultivate positive emotions about the present.

4/ Cultivate a state of flow.

5/ Develop virtues that lead toward a sense of gratification.

6/ Develop your signature strengths in work, love and parenting.

7/ Use your signature strength in service of something bigger than you.