Written by Jay Turo on Monday, April 8, 2013
You’re invited to attend a webinar on Tuesday, April 16th at 1pm Eastern / 10am Pacific about opportunities in the Healthcare Information Technology sector.
To register, click here.
Over $200 billion MORE was spent on healthcare in 2012 than in 2011.
Let's put that number in perspective - the increase in healthcare spending last year was greater than the revenues of Microsoft, Cisco, Google, and Apple.
And with the Affordable Care Act slowly but surely becoming the law of the land and the Baby Boomer generation retiring and hitting their “peak” healthcare spending years, there is no end in sight to the growth.
You Can Cry About It or You Can Seek Opportunities In It
While out-of-control healthcare costs and bureaucratic systems remain one of our most vexing societal challenges, private sector entrepreneurs are moving fast and smart to address various aspects of the problem.
And are building dynamic growth companies while so doing.
Healthcare Information Technology – A $30 Billion Business
Healthcare Information Technology (HIT) is one of the great and growing bright spots in the U.S. economy – it’s a $30 billion+ a year industry growing at over 14%/year.
It is comprised of big sectors:
• Practice Management Systems (PMS) - a $4 billion/year business growing at 11%/year
• Electronic Health Records (EHR) - a $1.5 billion/year business growing at 22%/year
• Revenue Cycle Management (RCM) - a $1 billion /year business growing at 15%/year
• And last but certainly not least - Transcription, Billing, and IT services, clocking in at $24 billion/year and growing at 12%/year
Within each of these sectors are dozens of under-the-radar companies experiencing strong revenue and profitability growth, developing dynamic and cost-saving technological innovations, and are being courted by financial and strategic acquirers.
Companies like Castlight Health, Practice Fusion, Kissner Software, and Strategic Solutions Management.
Meet An Industry Leader
I would like to invite you to an exclusive opportunity to meet, via web conference, the principals of one of the most innovative medical billing companies in the country.
Combined, they have over 40 years of experience in successfully overcoming and profiting from some of the most vexing challenges in medical billing and information technology, and are well-versed on the regulatory and technological changes sweeping the industry.
On the web conference, they will share:
• Who the winners and losers will be when the brave new world of the Affordable Care Act meets the cloud computing and Big Data revolutions
• Why practice areas like obstetrics, surgery, and podiatry are in a unique period of change and consolidation
• How the “dream” of combining billing, practice management, and electronic health records systems into turnkey platform is in fact becoming a reality
• How the emerging world of mHealth – the use of iPads and tablets and mobile devices to deliver care - is and is not transforming modern medicine
• And much, much more
To preserve the intimacy of the presentation, we are limiting the web conference to the first 35 registrants.
So sign up right away to attend via the link below:
Best regards, and look forward to connecting.
Written by Jay Turo on Monday, April 1, 2013
Why - once we have met our basic needs for food, warmth, and safety - do we work?
And work hard.
There are the usual, default answers.
For Status. Power.
In response to a "fight or flight" instinct, hardwired deep in us.
Because when we were young, we saw our parents do it and when we grew up, we wanted to be like them.
What a bunch of hamster on a wheel mumbo-jumbo that makes folks at the end of their life look back and say why did I waste so much of my precious life on that?
Instead, how about this?
Let’s be heroes.
Wikipedia defines a hero as one “who, in the face of danger and adversity or from a position of weakness, displays courage and the will for self-sacrifice…for some greater good of all humanity.”
Now, that’s good.
It touches the various dimensions of our being.
Heroism in action is a strong, hard effort - a pushing to the limits of one’s physical endurance.
Heroes are intellectually wise. They are fair, sober, and big, and rarely let anger and fear get the best of them.
And when we are in the presence of a hero, we are spiritually risen up, are we not?
And you know what goes hand-in-hand with heroism?
Hard, honest work - taking great, exquisite care to do things right – is what heroism is all about.
As is teamwork.
And creative work, toward an idealistic end.
Work on the behalf of the powerless, for and with the young and the old, heroic.
Winning the right way - with grace and authentically recognizing those that aided in your journey - so very heroic.
And trying your absolute hardest and most honest best, and coming up just a bit short, even more so.
Heroic work, in all its forms, is work worth doing.
You know it when you see it. And unfortunately, also when you don’t.
Let’s look for the heroes in our lives - those right around us and those in their so blessed multitude in this wide, wide, and inter-connected world of ours.
Let’s celebrate and strive to be like them.
Everything else is just noise.
Written by Jay Turo on Monday, March 25, 2013
Depending on how you slice it, this is either a golden or a leaden business age.
It is a golden age, as never before in human history has there been so much access to great opportunities as there are right now.
Crowdfunding, private equity and debt secondary markets like Second Market and SharesPost, peer-to-peer lending sites like Prosper.com and Lending Club, and the Big Three social networking giants - Facebook, LinkedIn, and Twitter - have made information and intelligence on, and access to opportunities better and greater than ever before.
Yet, the overall spirit and mindset of business is anything but golden.
Huge and historically unprecedented public sector debt and social safety net obligations in the United States and Europe - layered on an overlapping and inter-connected global banking system cast a pale “macro” of systemic risk over the markets.
Compounding matters, never before has the drumbeat of news and information been louder, mostly shrilling that the financial sky could fall at a moment’s notice.
The overall effect of this both real and perceived angst is a “crowding out” of all of the good stuff that is happening out there.
So what should the growth-seeking, yet sober executive and / or investor do?
Well, first and foremost, get one’s mind and spirit right.
And the best way to accomplish that is to focus on what author Matt Ridley so eloquently describes as what has been since the dawn of Man the guidepost to our better future.
Entrepreneurship lives and grows in the “micro” - in sectors and niches within the overall economy either protected from or aided by the larger current.
And entrepreneurship is the antithesis of sclerotic, bureaucratic, and beyond human scale organizations (see Big Media, Big Government, Big Business) of such complexity and inertia that the application of individual motive force them to far more often than not is ineffective, no matter how good the intention.
Rather, entrepreneurship is undertaken via that finest form of collaboration known to history - small, impassioned teams driving toward an idealistic vision and mission.
To sell some thing or some service of a type, or in a way, or at a price that has never been done before.
And to make money doing it.
And the really good news is that there are more entrepreneurs - far, far more - hundreds of millions worldwide striving to have their brilliance and creations expressed and realized, and to make their futures their own.
And in their multitude, in their collective uniqueness, they are the hope and the light of the world.
Even better, be one of them.
In mindset, in spirit, and in appetite for change and risk and daring.
You’ll feel a lot better.
Written by Jay Turo on Monday, March 18, 2013
Every business needs a vision - a clear definition of what its leadership seeks the business to become.
And every business needs a strategy - a roadmap of how the business will reach its vision.
Once the vision and the strategy are clear, the next step is action planning – the day-by-day mapping of how all of this good but sometimes theoretical “stuff” will actually get done.
This involves determining which projects will be completed (and as importantly, which ones will NOT), by whom and when, and how many resources - work hours, money, and assets - will be required.
Now, this is lovely for the whiteboard but what business more often than not looks like is…
Unclear, Unshared Vision. With all the time most management teams spend talking to each other, it's surprising how often they have different pictures of what everyone is supposed to be doing and in what direction they are supposed to be heading.
It's the hard and repetitive job of leadership to repeatedly communicate the plan (i.e. the vision, the strategy, and the day-to-day roadmap) until all are on the same page.
And then rinse and repeat.
Planning Once Per Year, Out Of Routine. So many of us, in January, think about our personal goals for the year ahead.
Similarly, many businesses work on their yearly plan during the same month of every year.
And then they forget about it.
The best businesses, in contrast, create, refine, and live their business plans in real time, every day.
Yes, this is far, far easier said than done, now more than ever because of…
The Tyranny of the Urgent. In my humble view, the greatest challenge to businesses attaining greatness is how difficult it is, because of technology, to not let those “urgent, but NOT important" activities dominate our days.
More than ever, we must fight for the time and attention to do the important work, and block out those insidious distractions everywhere and always around us.
No Process or Methodology For Strategic Planning. A best practice is to focus on vision and strategy in one set of sessions, and then on the day-to-day action planning in another.
In discussing vision and strategy, we are in creative mode, exploring any and all options and ideas.
In contrast, figuring out the best day-to-day action plans is best suited for separate, more analytical-type meetings.
With appropriate time set aside for vision, for strategy, and for action planning, a business can experience the collective joy that comes from knowing exactly what it is striving toward and how it will get there.
Everyone at the business will feel more grounded, balanced, and centered.
Being so, all will come to work with greater purpose and passion.
And, at the end of the year, will have far more to show for their efforts.
Written by Jay Turo on Monday, March 11, 2013
When it comes to education, this 21st century of ours is truly both the best and the worst of times.
It is the best of times as never before in human history has more information, more ways of learning, more access to best practices, been available to more people -- regardless of socio-economic condition and geography -- than it is today.
And, with 3 billion more people in the next 10 years coming online and joining the global information exchange, this remarkable and so very inspirational trend will only accelerate and grow.
Now, as anyone that has ever despaired over a never emptying e-mail inbox, over ever distracting and focus eroding text messages, over the always-growing mountain of things to read, listen, and watch, it can quite often feel like the worst of times too.
Yes, it is fair to say that the net sum of human information has grown far faster than that of human wisdom, satisfaction, and even happiness.
Now, the first and obvious point here is that this very well could be simply a distortion of relative versus absolute perception.
For these days, NOTHING grows like information - with every three weeks the aggregate total added to it being greater than that accumulated from the beginning of recorded time through the year 2000
So, of course, the growth of everything/anything else will pale in comparison.
Now, once we recognize this, we should also see that as this mountain of information has grown, so has grown access to and consumption of the world's greatest art, literature, and music.
Which does make us, collectively, far wiser than ever.
And with the percentage of the world's population living in poverty at its lowest level in human history, our collective satisfaction, as measured by freedom from hunger, from premature death, and by access to choice as to one's work, one's mate, one's place to live, is both very good and increasing as well.
And with being wiser and more satisfied, yes we are collectively much happier, too.
This is all well and good, but far more exciting is that we have only begun to scratch the surface of how this “always-on” Internet world of ours might transform for the better our inner lives as it has our external ones.
How this might come to be came into focus for me through a conversation with the President of one of California's most admired colleges of graduate education.
In the process of helping to develop a five year strategic plan for the school, the President and I were discussing the relative merit of enrollment growth of online versus traditional on-campus enrollment.
As we were getting pretty granular into the various modeling approaches and ways to assign value to a “virtual” versus an in-person student, I stopped and noticed a certain pause and quiet in the room.
I looked up, and in the President’s eyes was a faraway look.
He paused, and then quietly said, “values-based education cannot be measured, it just is.”
He then took a sip of water, and more loudly added, “and it is only from this place do we measure our outcomes, not the other way around.”
This inside out approach is where technology can and will lead us.
It will be a slow and bumpy, but very much an upwardly sloping road, towards all of us being truly well educated - online.
Written by Jay Turo on Thursday, March 7, 2013
Last week I flagged the shocking and even depressing statistics that most entrepreneurs - holding constant for socioeconomic factors - make less money, work more hours and suffer more work-related stress - than their employed counterparts.
And when we combine these statistics with those that show a very incredibly low percentage of startups and small businesses ever attaining meaningful profitability, it is remarkable that people ever dream to be entrepreneurs and start businesses at all.
But start them they do!
Quite possibly the most amazing and inspiring number in all of American business is 550,000.
That is the approximate number of new businesses that are started in American each and every month, or more than 6 million per year, or close to 3% of the U.S. adult population.
Now these opposing statistics beg the question, “Why?”
Why would 550,000 people - who statistically are far better educated and wealthier than the population as a whole - engage in behavior that on the surface clearly seems contrary to their self-interest, irrational, and dare I say, delusional?
Well, on the cynical side, many of these brave folks probably think the odds of economic success are greater than they really are. And even if they know the odds, they think that they don’t apply to them.
On the slightly less cynical but still not totally inspiring side, one could argue that businesses are started out of boredom – out of the need for that “action rush” that in the realm of business only an entrepreneurial endeavor can truly provide.
Inspirationally, many believe like I do that entrepreneurship is the greatest force for positive change in the world today, and they start and grow businesses to be positive change agents, on levels big and small.
They start restaurants to create and share beautiful food, service, and atmosphere.
They open day care facilities to provide quality, spirited child care for working families.
They start creative agencies – graphic design, public relation, web development firms, and the like to leverage their business and creative talent to its most effective end.
And they start drug development and medical device companies to help people live longer, healthier lives.
And thousands of types and forms and sizes of business in between, led by entrepreneurs with aspirations big and small, driven by motivations both pedestrian and soaring.
But at the heart of all of their reasons for starting businesses, at least of the ones that survive, is that often begrudged but really most inspiring motivation of them all.
They start businesses to make a lot of money.
Now the key word in that sentence is make – as in bringing into existence through creativity, effort, and as often as not more than a little serendipity and luck, something that did not exist beforehand.
Making money is the difference between Mo Ibrahim becoming a billionaire through bringing inexpensive mobile telecommunications to millions in Africa and Mo Gaddafi stealing billions of his people’s money at the point of a gun.
It is the difference between Steve Jobs and Apple creating $325 billion in market capitalization (and untold additional hundreds of billions in economic and multiplier effect), and governmental “who you know” redistribution and inefficient waste of this created wealth.
Now often, for the entrepreneur and those that back them, the touching of this money often takes many years, even decades, of under-paid, hard, and often thankless work, before a cash windfall in the form of a business sale or a public offering.
But that is a story for another day.
For now, find those that can truly make money, encourage and back them, and you and the world will get to a better place.
Written by Jay Turo on Monday, March 4, 2013
This past weekend, I had the privilege of moderating a planning session for the leaders of some of the world's best known and most successful collections agencies, collectively responsible for billions of dollars of receivable's debt.
They traveled from around the world to progress toward a common end - making doing business globally as credit safe as doing so close to home.
This is of course extremely challenging, and in a world of exploding international trade, also an enormous opportunity.
So for 40 hours over three days together we grappled long and hard with the various aspects of the business problem - from the right SaaS technology to use to fee-sharing to compliance to channel and end-user marketing.
It was hard. It was draining. It was often contentious.
It was time away from the pressing and equally vexing concerns of everyday work.
AND it was glorious.
Now, if you thought that in a hard bitten business like collections - and at a meeting attended by 25 year+ industry veterans - that there wouldn’t be many moments of idealism, well you would be mistaken.
No, there were a LOT of those “aha” moments - always the best and most inspirational evidence that whole new worlds of strategic and tactical possibility had been discovered.
For sure, post-meeting the participants have now traveled back to their home markets and are faced with the hard challenges of tactical implementation and the inexorable pull of business as usual.
And while meeting for 40+ hours, and traveling to them from around the world IS hard and painful…
…and while we all love our e-mail, our text messaging, our web conferencing, our video hangouts…
…There is just no substitute for personal contact.
And there is NO faster, better, and yes cheaper way to arrive at great and actionable business ideas.
So for a moment, let’s all put down the phone, turn off the e-mail, stop the texting.
And fly, drive, run, walk, crawl to that conference, that party, that face-to-face get together.
When done right, it is always time well spent, and in its aggregate creates both businesses well run and lives well lived.
Written by Jay Turo on Monday, February 25, 2013
So much of the challenge that both entrepreneurs and investors face in earning return on time and capital is driven by the low growth rate of the economy as a whole.
U.S. GNP growth, after averaging 3.6% annually for the period 1982-1999, has since 2000 slowed to a mere 1.8%.
Not coincidentally, in that same period stock market returns have declined dramatically.
From averaging over a 17% annual return rate in the '80s and '90s, most of the major indices have painfully dwelled in negative return territory since.
And to pile on the misery, with budget deficits exploding from 58% of GNP in 2002 to over 100% today, all of the "free" money poured into the system over the past decade has not had any kind of meaningful stimulative effect.
But it is going to be okay.
Why? Well, because as business people and as investors we do not work in the "macro", but rather in the far more confined - and controllable - dimensions of our particular “micro.”
And here, we can escape from the “tyranny of the average.”
How? Well by simply exhibiting that most blessed of American freedoms – individual action.
Here are actions that smart entrepreneurs and investors can take today to “break out” and attain well above average results and returns:
Think and Act Globally. The developing world continues to maintain rates of growth and virgin and nascent market opportunities probably never again to be seen again nearer to home.
How about China, even with its recent slow-down, still averaging well over 8% growth?
Or India, at 6%?
Not your cup of tea? Well how about Mexico, Brazil and South Korea all growing faster than 4%?
And don’t tell me that you can’t compete there - via technology these markets are more accessible to small and medium-sized US businesses and investors than ever.
Think Sector. The overall economy may be flat, but there are sectors within it that are booming.
Like software, growing close to 6% annually.
Or how about the entertainment industry, growing at 5.5%?
Even seemingly mature industries, like transportation & food services, are growing at close to 5%.
Think Inefficiency. Remember that to make a small fortune - and a big difference - we do not need to solve the challenges and difficulties of the overall economy.
No, we just need to find those little market and competitive inefficiencies, those niche needs and wants, those investment strategies born and won far from Wall Street.
Now, when tens of thousands us follow our particular rainbows toward our particular pots of gold the byproduct of all of this thoughtful, opportunistic, and individual action…
…is that yes collectively we all do win.
Written by Jay Turo on Monday, February 18, 2013
The greatness of Napoleon, Caesar or Washington is only moonlight by the sun of Lincoln. His example is universal and will last thousands of years…He was bigger than his country - bigger than all the Presidents together…and as a great character he will live as long as the world lives.”
- Leo Tolstoy, The World, New York, 1909
In honor of President’s Day, I went and saw Steven Spielberg's great movie “Lincoln” this past weekend.
As it has for many, the movie exceeded my very high expectations for it.
The film's core narrative - President Lincoln's efforts to get the 13th amendment abolishing slavery through Congress before the end of the Civil war - offered a treasure trove of leadership wisdoms applicable to our modern day.
The movie paints a basic leadership dilemma in stark relief, namely what is the proper balance between morality and expediency?
Between "being right" and being effective, and to what degree do moral ends justify messy means?
Lincoln, through the leadership role into which he was uniquely thrust, probably grappled and suffered more publicly with this dilemma than any person in history.
Beset on all sides by the bitterest of adversaries - the incorrigible racists and States’ Rights advocates of the Southern and Border States on the one hand and the moral absolutists (combined with desire for revenge) of the Radical Republican North on the other - no matter what decision Lincoln made or action he took there would be a large, powerful, and vocal group vociferously opposed to it.
Adding monumentally and tragically to Lincoln's challenge was that so much of his power and decision making revolved around those most awful of choices - to send tens of thousands of young men into battle from which the almost certain outcome for very many of them would be death.
For anyone, the awesome responsibility of this kind of leadership is beyond overwhelming.
For a great soul like that of Lincoln's, it was tragic beyond our ability to possibly relate.
But it was also triumphant, and for any of us that strive to do great and moral things with our lives, there is no better role model.
First, Lincoln did not make his enemies "wrong."
Rather, he found that delicate and transcendental space whereby he was strong in decisions to prosecute that bloodiest of American wars harshly and vigorously, but while so doing found space in his heart and in his leadership directives to not deny the humanity nor the deserving of forgiveness of his enemies.
Secondly, he did not lead from "up on high," but rather with great vigor and charm appealed to the “better angels” of his adversaries to see things a bit different - more nobly and more charitably.
And finally, Lincoln recognized that even in the midst of a horrible war, that laughter is as much a part of living as are tears.
And thus, so often when a stern reprimand or harsh words would be the reaction of a lesser leader, Lincoln chose humor to make his point.
This is maybe Lincoln’s greatest lesson for modern leaders.
To stand and to work for great things, yes…
To forgive your adversaries, yes…
But, to do so not with a heaviness of heart or obligation of purpose but with a gentle and even mischievous lightness of being that makes the journey its own reward.
And when done with the dexterity and openhearted wisdom of an Abraham Lincoln, things not thought possible even to dream about come to pass.
Happy President’s Day.
Written by Jay Turo on Monday, February 11, 2013
Last week, my column received quite a reaction as I pointed out how much of a disaster the public equity markets have been these past 14 years.
I shared some key statistics, especially that while from August 1982 to September 1999, the Dow Jones industrial average rose from 777 to 11,078, in comparison since 1999 it has moved only from 11,078 to 13,986 (approximately 25%).
Given that inflation since then has reduced purchasing power by over 37%, the net return for the period has been significantly negative.
To this, a lot of folks came back with basically two questions / comments:
1. Why has this happened?
2. What should we do about it?
Well, first of all with overall GNP growth rate being cut in half, from averaging 3.6% annually from 1982 to 2000 to 1.8% from 2000 - 2013, there is simply less money to go around.
Then, the returns that are to be had…well they have been mostly eaten up by the huge big bank infrastructures built up as trading volumes have increased over twenty-fold since the 1980s.
Sadly, slow overall GNP growth remains our most likely macroeconomic reality, and does anyone really see Wall Street slimming down any time soon?
So what to do about it?
Well, I suggest three prescriptions:
1. Give up on the public markets.
2. Find market inefficiencies.
3. Do it Right.
“Doing it right” should of course be all of our favorite, so on a webinar I will be hosting later this week I will share what I have discovered as to why today’s smart investors avoid the public markets and where, why, and how they invest now, including:
• How many of them no longer invest in “companies,” but rather only in projects
• How they are and how they are NOT planning to utilize the new laws regarding crowdfunding
• How they are utilizing “cross-border” and “in-kind” transactions to shelter returns from Obama era tax increases
• How they limit risk through "Black Swan" portfolio theory and modeling
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