Nikki Troiano Gainey

𝐓𝐰𝐨 𝐁𝐢𝐠 𝐂𝐨𝐦𝐦𝐞𝐫𝐜𝐢𝐚𝐥𝐢𝐳𝐚𝐭𝐢𝐨𝐧 𝐌𝐢𝐬𝐭𝐚𝐤𝐞𝐬 𝐘𝐨𝐮 𝐂𝐚𝐧 𝐀𝐯𝐨𝐢𝐝 When Geoffrey Moore's 𝑪𝒓𝒐𝒔𝒔𝒊𝒏𝒈 𝒕𝒉𝒆 𝑪𝒉𝒂𝒔𝒎 was first recommended to me, I remember thinking, “How does an IT-centric book apply to medical?” But it really does! The book highlights the gap between early adopters and the mainstream market. Many growth-stage MedTech companies I’ve worked with get stuck in that chasm—fantastic technology, devoted early adopters, but little expansion within or beyond those initial accounts. To cross that gap, you must find a mainstream niche with a serious pain point your solution addresses. Then, build out the services around your product so you’re solving the entire problem and focus on dominating that specific niche. It may seem counterintuitive, but the smaller the niche, the better because dominating the niche is key. Mainstream buyers will seek validation from peers like themselves, not the early adopters you have already convinced. Yes, KOLs can help, but they must be relatable to your mainstream target physicians. 𝐓𝐰𝐨 𝐦𝐢𝐬𝐭𝐚𝐤𝐞𝐬 𝐈 𝐬𝐞𝐞 𝐦𝐨𝐬𝐭 𝐨𝐟𝐭𝐞𝐧: 1. Overusing early adopters as references 2. Failing to identify and focus on a clear niche If your company or portfolio company is stuck in the chasm, reach out and let's discuss. #medtech #privateequity #venturecapital #healthcare

This 👂 podcast episode and insight’s from a16z Bio + Health's Julie Yoo spoke so clearly to the fundamental challenge facing both 🩺 clinicians and 🏥 healthcare systems.  There is a huge disconnect between supply, in the availability of clinicians, and demand, in the increasing volume and complexity of healthcare needs. -     36% of physicians plan to reduce their hours next year according to the AMA -     48% of physicians reported feeling burned out in a 2024 Medscape survey At the same time, the demographic baby boomer bubble and steady increase in the prevalence of major chronic disease, which consumes up to 90% of healthcare expenditures according to some estimates, is driving demand. With this context, Yoo points to a major opportunity for AI adoption in healthcare in 2025. Yeah, a VC hyping a wave of new AI companies that will replace the decades of training and experience of clinicians, the skeptic would say.  But Yoo is thoughtful in pointing to the role AI can play, and is already playing, through solutions such as ambient, autonomous scribe solutions (of which local star Abridge is leading the pack) in not replacing, but freeing up productivity for clinicians. There is so much unstructured context in both the complexity of disease and treatment options and the social/emotional considerations that we shouldn't be looking for AI to *replace* clinicians. But companies are getting better at finding the structured, repetitive and time-consuming places where AI tools can *help* clinicians. Nearly two-thirds of doctors cited bureaucratic tasks as the leading contributor to burnout. Rigorously trained-AI driven solutions can be a force multiplier for clinicians, and I’ve seen several interviews where nurses and doctors go as far as to say some of these solutions are ”restoring their joy in practicing medicine”. Our health is precious; and we rightly want any technology engaging with it to be developed thoughtfully and thoroughly tested. This requires top AI talent and diverse and realistic training data. Pittsburgh’s strengths in both areas is why we are an emerging hub for data-driven healthcare. #AIinhealthcare #clinicianburnout #healthinnovation #digitalhealth

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…and private equity wants in on the action. Well that makes sense 🙄 Turns out running a hospital is very, very hard. A 4.3% margin is not healthy, even for a non-profit. Payors and pharma continue to point the finger at these “rich” hospitals and complain about market consolidation, 340B, and any number of other phantom problems, but in reality most are just trying to survive. Many of these grievances are gaslighting in its purest form. Those making it work are focused on the basics. The strategic plan has highly pragmatic, common sense initiatives that return a tangible benefit with clear measurable targets as opposed to chasing trendy buzz words. They control labor and they control drug cost. On the pharmacy side, they deeply understand the economics and have an appropriately positioned business minded, strategic pharmacy leader. #pharmacist #pharmacy #hospitals #healthcare https://lnkd.in/g9d9VTcK

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Healthcare Economics 101: "PROFIT MARGIN and Short-Staffing" Less salaries = More profit -- this cartoon shows you how it works. Every time a boomer doctor retires or quits and their slot is not filled PRONTO,the remaining doctors work ethic kicks in and they burn themselves out to cover the patient care demands The institution bumps up their profit margin And the manager gets a pat on the back for running a "tight ship" Know this:  There is a massive finanacial DISINCENTIVE to hire and staff appropriately as long as you keep showing up and doing the work Managers everywhere prey on our ethics to pad profits - not ALL managers, but the majority for sure Forcing doctors to play chicken, pushed to the point of threatening to quit if you don't get reinforcements It is an obnoxious, evil management habit ...and so unnecessary This short staffing policy cripples the organization's long-term viability in search of short term profits (and executive bonuses) DOCTORS =>> GET OUT OF THERE Quit that Job - It's a fantastic job market with LOTS of virtual options. You do not have to put up with this manure. Here is our #1 Physician Job Search Training that guarantees your success in finding a MUCH better position. https://lnkd.in/g82SWNQ6 I know you feel guilty just thinking about leaving "What about my patients? What about my staff?" That is what this manager is counting on ... your ethics and dedication. It is predatory behavior. Here's a Mantra we teach "Don't be the last rat off a sinking ship" AND LEADERS: Knock this evil behavior off ... dammit! As we slide into the Boomer Doctor Retirement Cliff - recruitment, retention and locums coverage should be your TOP PRIORITY

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This leaves me perplexed. If the government, as a payer for all health care services, wants to reduce what it pays for drugs (let's just say, for the sake of argument, to a degree more aligned with their added health benefit) in order to fund ANOTHER health program, in this case home care for the elderly, what's wrong with that? Isn't that the best, most ethical reason for which to seek lower prices for drugs, doctors, hospitals, etc? Every cost is a potential "piggy bank" for other priorities that we, as a nation, might want to spend more on. I could even argue that a moral society should wish to spend less on drugs (or any other health service) in order to increase funding for services outside of health care, such as education, or industrial investments that would help safeguard the environment for future generations. Drugs are surely not the only area of health spending that we should be scrutinizing, but hospitals and physicians came under government cost control years ago to support other priorities, so why not drugs? And I really hope people will think deeply before criticizing efforts to find savings wherever possible to support home health care for our most vulnerable citizens. Am I missing something?

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Have y’all ever watched someone pour water in a cup so fast that it overflows? That’s where I think we are in US #healthcare right now, and according to an article by Yahoo Finance, I’m spot on: US Healthcare spending rose to $4.8 Trillion in 2023, an estimated 17.6% of US GDP. Now I’ve worked in roles across #publichealth, #healthcare and #pharma, but admittedy never quite understood the economic jargon of comparing US healthcare spending to gross domestic product (GDP). So here’s my attempt at explaining this in plain language. ✨ GDP is the total value of all goods produced in a country during a time period; it’s a measure of the size and health of an economy. ✨ Healthcare spending refers to all money spent on healthcare services and products in a country— i.e- hospitals, doctors, medications, insurance… ✨ Why do we compare the two? When we compare healthcare spending to GDP it helps us understand how much of our economic resources are being used for health related expenses. ✨What does this headline mean? U.S. healthcare spending grew faster than the economy *overall* last year—and is expected to do so through 2032. Think of it like this: if we pour water in a cup too quickly, it will overflow. This is like healthcare costs rising faster than the economy can sustain. ✨What’s driving the increase in cost? 1) Insurance coverage has hit historic highs, 2) Medicare is projected to have the highest spending growth, 3) Hospital spending is soaring… Here are a few additional thoughts I had… 💡 How will the rapid uptake of #AI in healthcare, impact these projections? 💡 I wonder how projected healthcare workforce shortages will impact this? 💡*This* is what we mean when we say everyone should care about #healthequity, because inequities are costing all of us. What do y’all think about future drivers of cost or solutions? Drop me a line in the comments! #healthcareonlinkedin

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What does calling my cable company have to do with Medicaid? I had to call a certain notorious cable/internet provider recently. The one with customer service so bad that it was skewered in a classic South Park episode. I blocked out an hour and braced for my inevitable PCOM aneurysm rupture. Shockingly, it was a breeze. The rep was friendly, and my issue vanished in minutes—a far cry from their usual 'dial-one-to-scream-into-the-void' reputation. So, what changed? Competition happened. A decade ago, our choices for cable and internet were as limited as the soda options in a health spa. Now, thanks to a buffet of streaming services—even including live local TV—the old cable giants had to step up their game or step aside. Turns out, competition is more effective than caffeine at improving service quality. Why can't Medicaid beneficiaries get the same treatment? Currently, most Medicaid coverage is through Managed Care Organizations (MCOs), where the state pays a fixed monthly rate per patient. This model should spur cost-efficiency, but it often just limits the scope of care. Low payments to doctors, restricted access to necessary services—who does that help? Could strict government regulations guarantee better service? Maybe, but FA Hayek (and a basic reading of history) prove that bureaucracy alone can't engineer excellence. And choice for Medicaid patients? Virtually non-existent. Many areas offer just one MCO. If you're dissatisfied, too bad—there's no alternative. It's like being stuck with dial-up in the era of fiber optics. Long wait times for basic procedures, no freedom to seek better coverage... It's eerily reminiscent of the old cable monopoly days. In the private sector, at least there's a semblance of choice: HMOs, PPOs, HSAs... But for Medicaid recipients? Sorry, the state chooses for you. Hope you like it. Our Medicaid system desperately needs a dose of competition. Isn't it time we offer Medicaid patients the luxury of choice that drives quality up and costs down? https://t.co/C7XE6CpIIP Joe Grogan Lisa Grabert Joanne Spetz Cheerag Upadhyaya, MD, MBA, MSc, FAANS, FACS Brian R. Gantwerker, MD, FAANS, FACS Sanjay Dhall Larry Bucshon, M.D.

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A whirlwind of activity last week at the America's Physician Groups conference. Lots of solid insights shared by health system leaders. Some notable thoughts: +++ Artificial intelligence is intelligent in different ways: By now, we all know ai has a diverse set of use cases, incorporated in different applications and tools. But there are fundamental differences in how the intelligence itself is brought to life. Examples include: - Predictive AI, used to forecast future outcomes by leveraging historical data. Shout out to UCLA’s CKD/ESRD early intervention protocol (Joycee Berin) and Diagnostic Robotics’ intelligence care post-dicharge journeys (Kira Radinsky) - Protocolized AI, used to automating a user’s administrative load by using a set of detailed, pre-defined rule sets. Thanks to ARC for sharing their experience using Elaborate 's automated outpatient lab summaries (Manish Naik) - Generative AI, used to create new content. Great overview of ambient documentation at MGB as well as Cedars’ Sinai talking through its medical ontology model powering acute triage (Caroline Goldzweig) Across system leaders and experts, there was clear agreement that the first step to implementing intelligence intelligently is defining the ‘jobs to be done’. That way, internal and external stakeholders are clear on what they're solving for when they architect the solution.  +++ Scaling AI takes time and rigorous observation: Market leaders describe a phased pilot approach that allows clinicians to build confidence and system leaders to measure ROI before deploying systemwide. Loved hearing Rebecca Mishuris outline MGB’s novel approach of piloting two solutions against one another, to pressure test implementation, workflow, and value creation. +++ Proving ROI continues to be challenging: Lots of vendors using lots of different metrics to prove value, but the majority of leaders agreed that estimating the ROI of these new tools today is part science, part art. Demonstrating the ROI of the “soft” metrics around provider burnout and retention seemed to be a big opportunity, especially for investment in more efficient primary care and PCP wellbeing. After all, PCPs drive referrals to specialty-level care (and higher reimbursements) for health systems. Appreciated Anurang Revri's overview of how working team setup can also impact ROI estimates. +++ Value-based care = tools + humanity: VBC will require not only implementing tools to support clinical documentation, risk capture, upcoding, etc, but also humanizing interactions to engage patients. Countless examples, but one that made me smile was a depression focused chat bot responding in the following interaction: - Context: post-discharge check in Bot: Hi Freida, how are you feeling today after your surgery?  Patient: I’m having a tough time, am in a lot of pain.  Bot: Well, it can’t be that bad, I’m sure it will get better with a positive mindset!    🤣 🤣 🤣 Can't wait for next go-around!

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Remote patient monitoring is at a tipping point: rising chronic diseases, strained systems, and mounting costs demand immediate action. Enter Remote Patient Care. At #AHA24, Cadence shared the largest U.S. analysis to date, delivering a clear message: scalable solutions exist. The results? Fewer hospitalizations, improved blood pressure control, and lower total costs, with a majority of patients in underserved areas.

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In our recent chat, Christina Farr defined today’s healthcare market in one word: weird. As “stay alive until 2025” shifts to “grow now,” boards and investors are seeking new CEOs to usher in long-term sustainability. But the weird market is complicating things. That’s why I was excited to join Chrissy, Ash Zenooz, MD, and Luba Greenwood, J.D. on the latest episode of the Second Opinion Media podcast. Listen here: https://lnkd.in/edyDpGny We discussed everything companies and candidates need to build the relationships that form successful CEO searches. Here are three key takeaways. 1) The traditional view of what makes the “right” CEO is changing. Boards need to look beyond what CEO candidates have done and where they’ve worked. A first-time CEO who understands your challenges and offers creative solutions might be a better bet than someone who’s been there and done that. 2) CEO success is a give and take. To deliver results, your next leader needs to bring adaptability, reliability, and quick decision making — an experienced executive chair, and patience to build the proper team will pay long term dividends. 3) Relationships beat transactions. Just as transactional relationships hurt healthcare, transactional CEO searches hurt companies. Finding the right leader is about understanding candidates as people: their backgrounds, thinking, and outcomes. Invest the time to build a relationship with your candidates, and do it in person. Thank you for sitting down and talking all things healthcare talent with me, Chrissy, Ash, and Luba! YouTube: https://lnkd.in/edyDpGny Spotify: https://lnkd.in/eWb6p_z2 Apple: https://lnkd.in/eEDTp4VQ

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I get Dr. Yang's concern about large, wealthier health systems adopting AI sooner than smaller, poorer organizations, but this is actually a good thing...unless your time horizon is myopically short. Big organizations, with much larger budgets and sophisticated IT teams, can afford to take risks, make mistakes, and test out exciting (but still unproven) emerging tech while smaller organizations certainly can't (for the most part). So let the behemoths take all the risk, do the heavy lifting first, and then smaller organizations get to adopt truly proven solutions at lower risks/prices...once these have run the Kaiser, Mayo, Intermountain, etc., gauntlet. It's all part of the plan... #healthcare #startups #startup #ai #generativeai #digitalhealth #emergingtech Kaiser Permanente Cleveland Clinic Mayo Clinic Risant Health Intermountain Health https://lnkd.in/gckgQB_q

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It is no secret I also believe in a hybrid model to use digital health at its highest. No one has demonstrated this better than Sylvana Q. Sinha, Esq. at Praava Health. Here she shares her insight on it with Forbes. Thanks for including my thoughts!

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Taking stock of primary care today and looking ahead.... Increasing presence, market share for non-traditional providers - payers, advanced primary care providers, primary care enablers. Question marks over retail's presence in primary care and what care models and patient populations they might need to focus on to be a force. #VBC #populationhealth #primarycare #caremodels

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⚠️⚠️⚠️As a generation of healthcare leadership is retiring, how are you adapting your marketing and sales strategy?⚠️⚠️⚠️ Younger and more internet-savvy leaders mean that word of mouth and old sales networks aren't going to take you as far as they did even just a few years back. Your content should be doing more heavy lifting. #HospitalContentMarketing

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⚠️⚠️⚠️As a generation of healthcare leadership is retiring, how are you adapting your marketing and sales strategy?⚠️⚠️⚠️ Younger and more internet-savvy leaders mean that word of mouth and old sales networks aren't going to take you as far as they did even just a few years back. Your content should be doing more heavy lifting. #HospitalContentMarketing #GenX #Millenials #GenZ

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⚠️⚠️⚠️As a generation of healthcare leadership is retiring, how are you adapting your marketing and sales strategy?⚠️⚠️⚠️ Younger and more internet-savvy leaders mean that word of mouth and old sales networks aren't going to take you as far as they did even just a few years back. Your content should be doing more heavy lifting. #HospitalContentMarketing

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