“What do you guys actually do?”
This is a question that we hear often. And admittedly it is quite fair. A public benefit corporation with the name “Integral Leaders in Health” does seem a bit enigmatic. “Are you consultants?” “Are you a think-tank?” “What do you actually lead?” “How do you financially support yourself?”
Again, all fair questions.
The simple answer is ILH are medical care brokers. Often brokers in other fields resent the term “broker” to describe their line of work. We, however, are quite comfortable with both the title and the role. While the ILH role has become more defined over the past two years, our vision has remained unchanged. We are leading the direction of medicine to where patient well-being is the priority by improving medical care. Medical care -- defined as the patient’s perception of the health care system’s ability to meet their sense of well-being --feels broken to many Americans. At ILH, we have collected numerous cases where patients are unable to navigate the healthcare system; multiple examples of suboptimal and depersonalized communication; of overzealous corporatization and of non-clinicians interfering with the doctor-patient relationship. Our findings are not anecdotal. In the two most recent Harris Polls (2022 & 2023), only 27%-32% of respondents rated American medical care as “favorable.” The troubles with medical care are real. Patients are frustrated. They feel that their well-being is not the primary objective of a system that seems expensive, self-absorbed and massively disjointed.
As brokers, our tactics at ILH are relational. We broker relationships (relationships that we have accumulated over the past 35 years) to improve medical care. The best relationship brokers utilize integral leadership -- skills that align disparate stakeholder groups to accomplish win for all solutions. While at ILH , our motivational purpose (the why) and tactics (the how) have remained steadfast, our operational focus (the ’what’) has, indeed, evolved.
So, what is our what? What do we do at ILH?
We do three things.
We broker relationships that educate stakeholders about good medical care.
These include doctors, patients, payors, hospitals and community members. We believe the Harris Poll numbers previously cited are symptoms of a looming crisis a “medical care crisis.” In fact, we wrote a book about the topic (Unbalanced—The Evolving Medical Care Crisis/ Taylor & Youkey). Crisis or not, awareness about the situation is critical for driving improvement. That means developing focused education directed at the various stakeholder groups. To that end, we have just completed a semester-long course at Furman University’s Osher Life-Long Learning Institute (OLLI) devoted to the American medical system. We are rededicating our efforts to publish articles on our website and on social media. And we are educating payors and hospitals, on physician alignment models that optimize doctor autonomy and reduce burnout.
Our most ambitious educational project involves a partnership with the South Carolina Medical Association (SCMA) aimed at boosting health care in rural South Carolina. After receiving a SC Department of Health and Human Services grant, we completed a self-study which led to the development of an application to the Accreditation Council for Graduate Medical Education (ACGME) to make the SCMA a Sponsoring Institution for Graduate Medical Education (GME). When accredited, the SCMA will sponsor medical residencies for new doctors at rural hospitals where the tenets of good medical care (Availability, Affability & Ability) will be stressed. Our hope is to retain more doctors in rural South Carolina -- a critical need for our state.
We broker relationships that bolster physician autonomy.
A significant symptom associated with the “medical care crisis” is clinical burnout among doctors. Physician burnout rates as high as 65% are frequently reported. It is unrealistic to think that medical care will ever improve as long as doctors are burned out and professionally disengaged. Interestingly, the percentage of doctors that are employed by a corporate entity (e.g., a hospital where, in most cases, they have surrendered control and autonomy) is similar to the percentage of doctors experiencing burnout (70%-80% nationally).
Is this coincidental? We do not know.
What we do know is that autonomous doctors tend to be purpose-driven practitioners who value independence and who usually adhere to moral values that place the patient’s interests above their own. Purpose driven people, including doctors, rarely experience clinical burnout. Autonomous doctors are almost always highly engaged and take ownership of their affairs (and usually their profession). Alarmingly, the latest SCMA statistics for South Carolina show only 16.3% of the 12,000 active South Carolina physicians (approximately 2,000 doctors) are in independent practice. Most doctors are employed by a hospital where they ultimately answer to hospital administrators. Too often, employee contracts at hospitals shield doctors from up-side/down-side performance risk (usually a base salary with performance incentives and no performance disincentives). The result is a well-paid doctor relieved from the administrative and financial success of the practice. And while such arrangements would seem to make life easier for the doctor, the opposite has paradoxically resulted. Administrators, as it turns out, make lousy clinical bosses. Driven by corporate priorities from their employer, doctors lose their sense of purpose. The result is physician burnout.
At ILH, we are actively engaging providers—both doctors and hospitals—to create partnerships that promote doctor autonomy. In addition, ILH is working closely with the two most prominent independent physician associations in SC (as well as the SCMA) to create a network of independent doctors who work with hospitals (not for hospitals). Such a network can capture the economic and operational advantages of being hospital employed without sacrificing autonomy or their sense of purpose.
We broker relationships that foster organizational sustainability.
ILH is a mission-based public benefit corporation formed to accomplish community benefit (i.e., better medical care). That said, without financial sustainability, ILH has no chance of accomplishing its mission. To that end, ILH has brokered a relationship with veteran upstate businessman Jeff Powell to become its president. Jeff brings enormous resources from his 35 years of experience running business start-ups in the healthcare space. By monetizing our brokered relationships, Jeff l gives ILH the business know-how for success and long-term sustainability.
So, what does ILH do?
It brokers relationships that improve medical care through education, promotion of physician autonomy and long-term financial sustainability. It is this focus that will allow us to lead the direction of medicine to where the patient's well-being becomes the gold standard.
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