Approach

How Elaria Agentic works

The point of view behind every engagement, the three missions of academic medicine, and the four steps from the floor to the board.

Point of viewAcademic medicineHow an engagement runs
Point of view

The organization is the patient. The KPIs are the vitals.™

The median nonprofit hospital now clears about 1.2 to 1.5 percent on operations. Roughly 43 percent lose money on operations. Fee-for-service Medicare pays about 12 percent below cost.

Sources: Fitch, Moody's and S&P FY2025 medians; Kaufman Hall / Vizient, Aug 2026 data; MedPAC, March 2026.

THE DIAGNOSIS
Profit is what great people and a great product earn, minus what broken process leaks. In most hospitals the first two are excellent. The third is where the margin goes.

I evaluate every organization through three buckets — People, Product, Process. I borrowed the lens from The Profit, Marcus Lemonis's turnaround series, because it is the most practical way I have found to break a complex operation into parts an executive team can actually act on. Nearly twenty years across insurance, healthcare and education have only confirmed it: when one bucket is misaligned, the other two cannot save you.

Hospitals have world-class people and a product patients trust. What they are missing is process: legacy systems, manual handoffs, prior-authorization queues, denials, and skilled clinicians doing clerical work. That is where agentic AI belongs — not replacing Epic or the ERP, but sitting on top of them and closing the leaks.

So I treat the institution the way a clinician treats a patient: history, vitals, diagnosis, treatment plan, follow-up. The vitals are the margin, the payer mix, the denial rate, the days cash on hand. The treatment is a sequenced roadmap a chair, CEO, COO or CFO can take to the board, with the margin impact, the capital ask and the risk posture on one page.

People
Talent, culture, emotional intelligence first.
Product
Outcomes, brand, the service lines that earn.
Process
Where the leaks are — and where agents work.
See the Executive Intelligence page: the numbers behind declining margins →
Academic medicine

Three missions. One pool of dollars.

An academic medical center doesn't run one business. It runs three: patient care, education and research. Each depends on the others, and all three draw on the same dollars.

PATIENT CARE
The clinical enterprise earns most of the revenue, and in most academic centers it also helps fund the other two missions.
EDUCATION
Residency, fellowship and continuing medical education programs carry real costs in faculty time, space and support that rarely show up cleanly in a service line's P&L.
RESEARCH
Research is what sets academic medicine apart, and it shapes the care of tomorrow. Grants often don't cover its full cost, so the institution makes up the gap, often from clinical margin.
FUNDS FLOW
When an agent frees margin in a clinical department, the board's question is where that margin goes. A funds-flow model that ignores education and research will optimize the clinic and quietly starve the mission. Every roadmap I build shows the impact on all three.

I have worked inside all three missions in academic orthopedics: the clinical enterprise, residency, fellowship and continuing-education programs, and faculty research.

Elaria's mission: help health systems put agentic AI to work for patient care, education and research, without trading one for another.

Approach

How an engagement runs

1

Listen

Before I recommend anything to you, I go where the work happens (scheduling, coding, the supply dock, the unit) so the plan you take to the board matches how the work is actually done. The problem described in the boardroom is rarely the problem on the floor; I find that gap before it costs you.

2

Diagnose

People, Product, Process, mapped from what I heard on the floor rather than from an org chart: where each is strong, where it leaks margin, and where agents fit.

3

Decide

An executive brief with options, costs, and a recommendation — written for a board, not an IT ticket.

4

Deliver

Hands-on oversight of the roadmap or pilot until the results are in your board reporting and your organization runs it without me.

THE RULE WE DO NOT BREAK
Hear it from the floor before it reaches the board.
Most consulting starts at the top and never leaves the conference room. I verify at the desk, the dock and the clinic before I write a diagnosis, so the recommendation you sign is one your organization can carry out. Every agent I design is built around how the work is actually done.
Start here

Thirty minutes. Your systems, your questions, no slides.

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