Every CIO, whether in healthcare or not, is confronted with the dilemma of how to balance the now with the new. Whether it is EMR deployment, improving cash flow or plugging holes in the HIT system, the problem is the same: finding the right balance betweenoperational improvement and innovation.

Having a close link between strategy and execution is critically important. Your strategy is your promise to deliver value: the things you do for customers, now and in the future, that no other company can do as well. Your execution occurs in the thousands of decisions made each day by people at every level of your company.

The problem is immediate since we are seeing attempts to rapidly change the healthcare business model from fee for service to bundled payment., with the announced goal of Medicare making 50% of its payments to doctors and hospitals on the basis of the quality of care they provide, rather than the quantity, by the end of 2018. Hitting that goal would mark a big change in a program that paid providers $362 billion for their services in 2014.

Most large companies have a hard time innovating for four basic reasons. BIG MEDCINE has the same problems.

So how does Sickcare USA Inc. bridge that gap? Most docs in private practice are having a hard enough time keeping their heads above water complying with payment and IT regs. Biomedical and digital health entrepreneurs have one eye on fee for service to keep the profits flowing while at the same time have another eye on bundled payments as the model of the future with the need to drive down costs.

Most Chief Medical Information Officers and CIOs spend 99% of their time working on operational efficiency. At the same time, the CEOs are charged with seeing around corners and creating a strategy to bridge the gaps. Unless they are on the same page with clear marching orders, budgets and sponsorship, things move slowly into the future.

Healthcare sorely needs new business models. To survive companies need to run three-horizons of innovation

• Horizon 1 – execute their existing business model(s)
• Horizon 2 – extend their existing business model(s)
• And for long-term survival – Horizon 3 – search for and create new/disruptive business model(s)

While traditional analysis suggests that Horizon 3 disruptive innovations take years to develop, in today’s world this is no longer the case. The three horizons are no longer bounded by time. Today, disruptive Horizon 3 ideas can be delivered as fast as ideas for Horizon 1 in the existing product line.

Unfortunately, very few industry leaders, including sick care, spend much time on the next and the new. For example, the average CIO spends most his or her time getting the EMR deployed, not worrying about a new EMR.

One way to “see” the future is to view it through a parabolic mirror, i.e. look at what you see now and call it the future. No matter how successful you are as a company or a leader, you have to be on alert to anticipate market shifts and adapt your business accordingly.

Here are some ways you can positively anticipate a market shift before the turning point occurs.

Perhaps we have it backwards. Instead of dedicating 95% on operational efficiency and operations management, particularly in medical practice management, an alternative would be to outsource it and focus on taking care of patients and worrying about practicing medical practice entrepreneurship, with a focus on innovation and strategy instead. Here’s how to take advantage of trends, predict them or create them yourself.

However, implementing them will be a painful process for all the stakeholders. After all, the now is a whole lot more comfortable than the fear of the new.