How Hospital Bottlenecks Cause A Healthcare Gridlock
The healthcare industry is complex and interdependent. Much like a highway interchange, it relies on multiple players and processes to flow smoothly.
But just like in an interchange, a single roadblock can bring the system to a grinding halt—leading to serious consequences for all involved.
The Healthcare Silos
In healthcare, there are three primary players, each with their own priorities. However, they stay in their own lane and rely on independent software systems to achieve their goals.
|Healthcare player||Main priority||System used|
|Patients||Seek an engaged and personalized experience||Digital technologies
- Example: mobile health, wearables
- Provide constant monitoring and instantaneous updates
|Providers (Doctors, nurses, and more)||Provide the highest quality of care||Electronic health records
- A comprehensive record of a patient’s medical history
|Payers (Insurance companies)||Balance the cost and quality of care||Claims database
- Information on medical appointments, bills, and more (some claims can take 60 days to process)
This leads to frustrations for all parties, including poor communication and uncoordinated care.
A Not-So-Patient Journey
What factors lead to a less-than-desirable experience? Challenges arise from the moment a patient walks into a hospital
- Entering the Emergency Department (ED)
Overcrowded EDs are often the first point of contact for a patient. On average, 43.3 per 100 people visit the emergency department annually in the United States for everything from fevers to injuries. Of these, 6 out of 10 must wait longer than 15 minutes before they can be seen by a provider.
- Playing the Waiting Game
Patients are willing to endure up to 2 hours in the emergency department, but wait times often surpass that. The average wait time in 2017 was upwards of 352 minutes, or almost six hours. As a result, up to 9% of patients leave without being seen (LWBS).
There’s simple psychology behind why some people aren’t able to wait it out. According to former Harvard professor David Maister, unoccupied time that is compounded with anxiety makes a wait feel longer.
These long waits also affect a patient’s perception and satisfaction of the care they eventually do receive.
The True Cost
After they’re admitted, inconsistent processes and flows continue to plague patient experiences.
A typical hospital stay can rack up a single patient close to $12,000 across 4.6 days. With these costs climbing every year, uncoordinated care adds to these receipts by extending the stay.
Uncoordinated care also creates a dire strain on resources, including the humans behind all the work. The resulting physician burnout costs the U.S. health system $32 billion annually. While lost productivity causes over half ($18 billion) of this amount, another $8.5 billion is due to poor experiences, which impacts patient satisfaction which leads to falling margins for hospitals.
Severe bottlenecks compound these issues, forcing the healthcare system into a gridlock.
What’s Causing the Jam?
Disjointed communication and a lack of visibility across systems are the major reasons for these costly standstills. This is analogous to using a paper map to navigate:
- No updates based on the current situation
- Time-consuming to figure out specific route to a destination
- Show multiple routes, but not the fastest way to get there
What if there was a smart GPS to help the healthcare industry overcome roadblocks?
- Real-time, dynamic updates on the current situation
- Knows where you are, and where you need to go
- Filters only the appropriate and relevant information
The Leidos careC2 Command Center solves healthcare traffic jams.
The coordinated technology suite rapidly identifies and reduces bottlenecks and delays in the care process. This improves the operational flow of hospitals—so that patients, providers, and payers all reach their destinations safely and efficiently.
How Precious Metals Royalty and Streaming Companies Create Value
Discover how royalty and streaming companies offer a unique way to invest in precious metals and the mining industry.
Gold and Silver Royalty and Streaming Companies
Investing in precious metals often seems like it boils down to either buying the physical gold or silver or investing in shares of specific mining companies, both with their own very distinct advantages and risks.
Rather than having to settle for the simplicity of bullion or extensive research in individual mining companies, precious metals royalty and streaming companies provide investors with exposure to a diversified portfolio of miners’ revenues and produced metals.
These companies are not operators of mines. Instead, they seek to find undiscovered value by financing and working directly with miners to forge agreements that provide their shareholders with steady exposure to precious metals production.
This infographic from Empress Royalty outlines exactly how gold and silver royalty and streaming companies operate, and how they mitigate risk and create value for their shareholders.
What Do Precious Metals Royalty and Streaming Companies Do?
Royalty and streaming companies are an important part of the mining industry’s financial ecosystem, as they provide capital to mine operators and explorers in exchange for a percentage of revenue or metals produced from the mine.
Mining companies receiving this investment are able to further develop or expand projects, providing greater returns for both their shareholders and the companies with royalties and stream agreements on the projects.
These agreements typically last for the life of a mine, providing steady cash flow to royalty and stream holders while cutting out various risks associated with mining companies and operations.
“What it takes in the royalty business is patience and cash.”
– Pierre Lassonde, co-founder of the first royalty and streaming company, Franco-Nevada
The Difference Between Royalty Agreements and Streams
Royalty agreements and streams have similarities in their structure, but ultimately have some key differences.
- Royalty agreements, also called net smelter return (NSRs), provide the royalty holder a percentage of the mine’s revenue from production, typically around 1-3%. There are also other kinds of royalty agreements like net profits interests (NPIs), where the royalty holder receives a percentage of the profits rather than the revenue.
- Streams provide the right to purchase a certain percent (typically 5-20%) of metal production directly from the mine. Typically, streams will have an already decided purchasing price for the metal, which is usually either a fixed dollar amount or a fixed percentage of the spot price.
Royalties are more common than streams as they provide cash directly to the royalty company rather than the option to buy the physical metal which then needs to be sold.
While royalty and streams differ in what is delivered, both kinds of agreements avoid operational costs as they receive cuts from the top line.
The Growing and Diverse Landscape of Royalty and Streaming
The niche sector of gold and silver royalties has changed greatly since the founding of the original royalty business, Franco-Nevada in 1980.
While still fairly small today, the subsector has grown to have more than 10 companies with a market cap of $100M USD each, with five surpassing the $1B mark.
Here are the top 10 royalty and streaming companies by market cap:
|Company||Market Capitalization (USD)||Forward Dividend Yield|
|Wheaton Precious Metals||$17.8B||1.20%|
|Osisko Gold Royalties||$1.9B||1.39%|
|Metalla Royalty and Streaming||$368.3M||0.37%|
|EMX Royalty Corporation||$308.0B||0.00%|
Source: Yahoo Finance
While the three big names of Franco-Nevada, Wheaton Precious Metals, and Royal Gold tend to focus on larger and more secure ounce-producing agreements, the newer precious metals royalty companies start out by establishing a few cash-flowing agreements in their portfolio.
After this, they can begin targeting more speculative agreements with developing or exploration projects which are typically worth smaller dollar amounts and are slightly riskier or further from production, but have the potential of undiscovered upside.
Some royalty companies don’t even deal with mining companies at all, and focus exclusively on buying royalty and stream agreements held by third party companies or prospectors.
How These Companies Reduce Risk and Capture Upside
By avoiding many of the operational costs, royalty and streaming companies cut out a large amount of risk that is typically associated with mining investments.
In precious metal bull markets, it’s typical to see mining company revenues rise alongside the prices of gold and silver.
While mining companies’ operational costs will also rise, royalty and stream holders simply reap the benefits of high margins as they sell their physical metals at higher prices, despite having acquired them at lower fixed prices according to their agreement.
Another key advantage royalty and streaming companies have is their ability to diversify their portfolios and be selective with their agreements. This allows them to escape concentrated jurisdictional or asset risk and make agreements with mines which are already producing or close to production.
Since royalties and streams tend to last as long as the associated mine is operational, the holders of these agreements also benefit from any increased production or lifespan.
Royalty and Streaming Companies: Stable Exposure to Metals
As precious metals royalty and streaming companies are able to carefully choose their agreements and are overall less exposed to price downturns, they provide investors with a more stable investment in gold and silver.
Royalty and streaming companies typically have dividend policies which ensure shareholders are consistently rewarded with rising dividends, while many gold and silver mining companies cut dividends aggressively during precious metal market downturns.
As they help finance new projects and expansions, royalty and streaming companies take advantage of high margins in a unique form of financial arbitrage while providing their shareholders with stable exposure to precious metals and mining operations.
History of the Silver State: Nevada and its Silver Districts
Silver made Nevada the state it is today with its famous silver districts. Today’s infographic sponsored by Blackrock takes a look at the history of the state’s silver districts and where the future lies for silver.
History of the Silver State: Nevada and its Silver Districts
Nevada and its silver districts built the western territory into a modern American state.
Today, the world best knows Nevada for its modern gold production—however, a new generation is rediscovering Nevada’s famous silver districts and their potential.
This infographic comes to us from Blackrock Gold and outlines the history of Nevada and its legendary silver districts.
A Timeline of Nevada’s Famous Silver Districts
The Paiute, Shoshone, Quoeech, Washoe, and Walapai tribes populated the territory that is now the American state of Nevada before the Europeans arrived in the 18th century.
Nevada became part of the Spanish Empire as part of the greater province of New Spain, and then later Mexico after independence. As a result of the Mexican–American War and the Treaty of Guadalupe Hidalgo, Mexico permanently lost Alta California in 1848.
The United States continued to administer the area as a territory. As part of the Mexican Cession in 1848 and then the California Gold Rush, the state’s area was first part of the Utah Territory, then the Nevada Territory in 1861.
However, the great Comstock mining boom of 1859 in Virginia City consolidated the area as part of the United States. Silver discoveries and mining spurred development and statehood, all by uncovering the famous silver districts of Nevada.
An eccentric Canadian from Trenton, Ontario, Henry Comstock gave his last name to a discovery that launched mining in Nevada. In 1859, Comstock revealed his discovery and sparked a silver rush, sending thousands of prospectors into Nevada and becoming the genesis of Nevada’s mining industry.
Accidental Treasure: The Tonopah Silver District
Over time, miners exhausted the initial discoveries of silver until the Tonopah District in 1900 revived silver mining in the state.
As the legend goes, Jim Butler discovered the Tonopah district and its silver-rich ore. He went looking for a pack mule that wandered off in the night and sought shelter near a rock outcropping.
When Butler discovered the animal the next morning, he picked up a rock to throw at it in frustration and noticed the rock was heavy. He had stumbled upon the second-richest silver strike in all of Nevada’s history.
Silver production exploded in Tonopah and peaked at 450,000 ounces a year in 1915. However, between World War 1, the Great Depression, and World War 2, the country was exhausted of workers, and silver production tumbled by 1950.
The early suspension of mining in the region left it ripe for new exploration and discovery.
Unrealized Potential in Nevada for Silver Discovery
Today the bulk of the current mining in Nevada occurs along the Cortez and Carlin gold trends in the northeast. However the state’s earliest discoveries lie in what is known as the Walker Lane Trend that extends the entire western border of the state.
Several companies have taken note and are applying modern exploration to a neglected area for a new generation of silver discovery, and the Tonopah lies at the center of the Walker Lane Trend.
It is in the Tonopah Silver district where the past of Nevada lies—and the future will, too.
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