From the Desk of Dr. Sangani

As I reflect on the past year, I’m struck by how even the smallest decisions can profoundly shape our future. The forces driving change today—AI, elections, geopolitics, medical advancements, inflation, and even wildfires—affect how we work, lead, and live our daily lives. For a CEO, every big decision is built on countless micro-decisions, each one laying the foundation for what comes next. In my roles as a business owner, physician, real estate developer, and mentor, I’ve seen how these choices come together—often in surprising ways.

What I want to share isn’t a polished success story. It’s a candid look at the realities of staying adaptable and seizing opportunities in a world where the goalposts are always shifting. Whether you’re an investor, entrepreneur, or simply curious about how big decisions take shape, this is a glimpse into the mindset it takes to keep moving forward.

Let me tell you—it’s a mix of opportunity, risk, and a constant flow of decisions, from tactical to transformational. Here are the weightiest topics that have been on my mind these past few months, in no particular order:

How Rising Rates are Shaping Commercial Real Estate
The commercial real estate sector has been pressed on multiple fronts. Interest rates remain elevated, limiting both the availability and affordability of credit. As a result, transaction volume has slowed across the board, with buyers and sellers often struggling to see eye-to-eye on asset valuations. Despite the reduced deal flow, underlying property values have held relatively steady—which speaks to the continued long-term appeal of quality assets. Still, these values are undermined by an increasingly illiquid market. Simply put, fewer transactions are taking place, and the ones that do make it over the finish line are often characterized by lengthy negotiations and conservative financing terms.

As a commercial real estate developer, navigating these conditions requires deliberate choices—choices about which assets to hold, how to structure financing, and where to direct resources. This year has served as a powerful reminder that when the waters get rough, your balance sheet becomes your lifeboat, and cash flow is your guiding compass. We may not be able to control whether interest rates rise or fall, but we can control our internal financial posture and the way we direct resources.

Cash Flow: Our Financial North Star
In an environment where credit is constrained and operating costs are on the rise, having healthy cash flow is more than just a financial metric—it’s the bedrock of adaptability and choice. One of the lessons I’ve learned through the last 25 years of navigating market cycles is that it’s not enough to simply track what comes in and goes out. I need to think strategically about vendor relationships, negotiate when possible, and maintain the right mix of debt so as not to hamper long-term growth.

I’m reminded of Warren Buffett’s insight: “Only when the tide goes out do you discover who’s been swimming naked.” In other words, when credit becomes expensive, those without a careful grip on their cash flow can find themselves exposed. I have no intention of being caught off-guard.

Building a Defensive Balance Sheet
If cash flow is the compass, then a defensive balance sheet is the sturdy hull of the ship. At my firm, Encore, we’ve spent years cultivating a stable foundation—one built on prudent leverage ratios, diversified revenue streams, and a careful eye on maturities. While we pride ourselves on making bold moves when opportunities arise, we do so with an eye toward defending what we’ve already built.

In practical terms in 2024 and through 2025, this means reevaluating debt maturities and ensuring we’re not caught by surprise if financing options tighten further. It’s no secret that rising rates translate into higher interest expenses for those with floating-rate debt, so we’ve been exploring opportunities to lock in fixed rates or refinance on favorable terms. The objective is simple: to stay several steps ahead of any potential storm, and to preserve the flexibility to act quickly if (and when) those strategic opportunities present themselves.

A Word on Healthcare Costs
Resilience doesn’t just apply to balance sheet; it applies to the well-being of employees, too. As a leader, one of my most pressing concerns is the rise in healthcare costs—a challenge that extends well beyond our own industry. Providing quality healthcare to my companies isn’t just an ethical imperative; it’s integral to sustaining a motivated, productive workforce, and deeply personal to me as a physician.

The question, then, is how to keep premiums and out-of-pocket expenses in check during a period of inflation. This challenge required a series of deliberate decisions. First, we focused on negotiating better terms with insurance providers wherever possible. Next, we accepted that, in some cases, the company would need to absorb a portion of the costs to shield employees from the full impact. Finally, we encouraged the use of generic medications, which offer the same efficacy as brand-name drugs but at a fraction of the price. Each of these choices played a role in managing rising expenses while maintaining a commitment to robust, accessible healthcare for our team.

Emerging Healthcare Solutions: GLP-1
The healthcare landscape is also on the cusp of significant transformation. One particularly exciting development is the rise of GLP-1 medications—drugs that have shown remarkable promise in treating diabetes, assisting with weight loss, and potentially reducing various metabolic risk factors. I believe we’re just beginning to grasp the broader implications these treatments may have across the healthcare ecosystem. From lowering long-term costs associated with chronic conditions to improving overall employee wellness, the opportunities are vast. It’s too early to predict all the downstream benefits, but I see a future where GLP-1s could revolutionize how we treat (and even prevent) some of the most common health challenges we face. The individual and business decisions that stem for this potential overhaul remain to be seen. But I am open, curious, and closely watching this space.

Looking Ahead
As I look toward 2025, I see a world that still holds a fair share of unpredictability—capital can suddenly become scarce and market sentiment can flip on a dime. No one can promise a smooth ride in this business, but I’ve also been at this for more than 25 years, so I know the key is carefully considered incremental decisions. For my business that means focusing on maintaining a strong cash position, a defensive balance sheet, and healthy happy employees.

The thoughts I’ve shared here aren’t about perfection or a guaranteed path to success. It’s about embracing adaptability, remaining open to innovation, and recognizing that progress often comes one decision at a time. Thank you for joining me in this reflection—and for being part of a shared pursuit of progress, resilience, and success.

Wishing you and your families a prosperous new year.
With gratitude,
Dr. Bharat Sangani