The Culture Lab · Scored in public
The Ledger
Every field note that makes a prediction puts a line here, with a confidence level and a resolve date, so it can be scored in public. No line is ever deleted. When a date arrives, the line gets graded, right or wrong.
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Wrong so far
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Days until the first call resolvesNº 21 · The Invoice · Nov 30, 2027
Every call on the record
Home care aide turnover in the Home Care Salary and Benefits Report that HCS publishes in late 2027 is still above 30 percent. The industry keeps paying the invoice.
The published median caregiver turnover in the Activated Insights annual benchmarking report is still above 60 percent in the 2029 edition, despite broad adoption of AI documentation tools across the industry.
Within three years, the permission machine either enters traditional Medicare home health, through WISeR’s expansion or a successor model, or Congress and the courts kill the experiment entirely. No middle.
HealthView appears on at least one of the two national audited lists again, the Inc 5000 or Fortune’s Best Workplaces rankings, while the playbook keeps publishing.
That my ending will match my working backwards. That the man in the last room and the man who wrote this field note turn out to be the same man.
Within five years, healthy years become an explicit, headline currency of American healthcare: by September 2031, at least one major federal program or a top-five national payer publicly reports or pays against a healthspan-style yield metric (healthy days at home, functional years, or an equivalent) as a primary measure.
September 1, 2026 is healthcare AI’s Eternal September. Within three years AI use inside Epic hospitals goes from a pilot to the default for most clinicians, and it does not go back.
The hospital chart is spoken for. Claude wins healthcare from outside the hospital walls, in the home and the post-acute settings where the payer’s rules, not the EHR, decide what happens.
Anthropic’s Claude becomes the enterprise and developer default the way Facebook became the social default, while ChatGPT keeps the consumer share.
Every line stands until its date. Scoring is public.
About the author
Steven F. Gonzalez
President & CEO, HealthView · Founder, CultureAI.com
Steven Gonzalez has spent two decades testing one conviction: culture is not a values poster. It is the operating system of care. He leads from both sides of that idea, as President and CEO of HealthView and as founder of CultureAI, the operating system for culture, built on the belief that great culture and great systems are the same discipline. HealthView is a home health, hospice and palliative care company founded in 1967, a Fortune Best Workplace in Health Care and an Inc. 5000 company. Before HealthView he co-founded SpartX and helped build PokitDok from the founding team, both later acquired. He speaks nationally and advocates in Washington on the future of post-acute care. He writes for Inc. Magazine and Forbes through The Culture Lab.