New Frontiers of Health: A Partners in Care Interview Series with Elaine Batchlor, MD, MPH, Founding CEO at Martin Luther King Jr., Community Hospital
PART ONE OF THREE: “I grew up in the L.A. medical community and it felt like that was where I belonged. They were the people that I knew, they were the people that I had something in common with, and I just really love L. A.”
Partners in Care Foundation will present the Vision & Excellence in Healthcare Leadership Award to Elaine Batchlor, MD, MPH at its upcoming 20th Annual Tribute Dinner at the Beverly Hilton Hotel in Beverly Hills on Monday, June 3, 2019.
Dr. Batchlor serves as Chief Executive Officer of Martin Luther King, Jr. Community Hospital (MLKCH) a state-of-the-art safety net hospital that provides compassionate, quality care to the South Los Angeles community.
It is her pioneering work as founding CEO of MLKCH that brought Dr. Batchlor to the Award Selection Committee’s attention. With excellence embedded as a core value, Dr. Batchlor insisted that MLKCH provide not just good care, but quality care equal to that found in hospitals in more affluent areas. Her diverse background in medicine, public health, health policy and healthcare administration are all evident in the innovative and collaborative approaches used by the hospital to meet their historically-underserved community’s needs.
Partners in Care Foundation sat down with Dr. Batchlor for a conversation about her background, interests, and career path. We’re pleased to share her observations in anticipation of the upcoming Tribute Dinner, where she will be recognized with this prestigious award in recognition of her work.
My interest in medicine started when I was a young girl. I read a book about St. Luke, who was a physician. That whet my interest in medicine, and in school – the combination of science, healing, and social advocacy really excited me. So did the history of medicine and healthcare, how the healthcare system evolved, how it worked, and how it didn’t work. I studied those topics in college, and they have stayed with me through the years.
In medical school I was attracted to the science of internal medicine and the specialty of rheumatology. You really had to think about what was going on with those patients and what you were going to do to help them. It meant collecting information and then synthesizing an approach to treatment. I liked the idea that you develop an ongoing relationship with your patients.
Rheumatology is based on the science of immunology, which is very interesting. Patients with rheumatologic diseases are generally people with chronic illnesses that don’t go away. Much of what you do is help those patients manage their illnesses over time. I find them to be stoic and inspiring in the way they cope with their circumstances.
I spent five years in post-graduate training, first, in internal medicine, and then rheumatology. Upon finishing the rheumatology program, I took a job teaching at UCLA in the rheumatology department which allowed me to do research, some teaching and practice rheumatology. During that time, I also earned a degree in public health.
Following UCLA, I landed my first health care administrator job with the Ross-Loos Medical Group, which was a staff model HMO and part of the Cigna Health Plan. I oversaw the outpatient healthcare centers and medical group. From there, I went to work for a network model HMO. Then, with Prudential, I worked for a few years as a medical director. And then, I spent about eight months as medical director for LA’s county office of managed care.
After those administrative jobs, I had the opportunity to do something different. I was recruited to Oakland by the California Healthcare Foundation. The Foundation was focused on improving the delivery of healthcare in California, especially financing and organization. The people working there were bright and talented, with resources and connections. During that time, I was able to develop relationships with a variety of healthcare leaders from across the state, while studying and speaking about healthcare issues.
The time at the California HealthCare Foundation took me back to my long-standing interest in the organization of healthcare as a system and gave me a platform to observe how it worked from more of a 300-foot level.
A lot of what I was doing there was shedding light on how various aspects of the healthcare system functioned and identifying opportunities for improvement. One area was work force development. Nursing was, and is, a concern, and we were looking at supply versus demand, effectiveness of the education system, areas for improving nurse training, and alignment of supply with demand. We did some work related to the pharmaceutical industry, and around both hospital and provider financial performance and sustainability.
Much of this work was informed by insights gained during my training at Harbor-UCLA, where I was able to experience first-hand how the care was organized and how the delivery system operated. And, how safety net care worked and didn’t work for multiple populations. Those experiences led to strong opinions, but they kept me interested in health services, and continued my interest in how the healthcare system is operated and organized.
After a few years working in Oakland, I was introduced to the CEO of Los Angeles Care Health Plan, Howard Kahn. We hit it off immediately, and he offered me a job as Chief Medical Officer for the Plan. It turned out to be a very good move.
I grew up in the Los Angeles medical community and it felt like that was where I belonged. They were the people that I knew, they were the people that I had something in common with, and I just really love Los Angeles. I love the scale of Los Angeles. I love the diversity of Los Angeles. I love the culture of Los Angeles.
Working for a foundation is fun. You get to meet a lot of smart people. You get to work on interesting issues. But going to work for L. A. Care was an opportunity to direct programs that would improve healthcare. It put me closer to where the hands-on work is done. And that was a big part of the job’s attraction. Everything I had done prior to joining L.A. Care had an impact on my thinking and approach. Working in the trenches of the county health system for five years; having gone to school and earned a degree in public health; having spent five years looking at healthcare from a system perspective. All that influenced how I thought about things, and what I decided to do when I landed at L.A. Care.
Some of the first things that I did after joining were purely practical and focused on improving healthcare for the Plan’s members. Everything from pursuing accreditation for the health plan, quality accreditation for the plan, and raising the bar for provider performance. Measuring their performance, incentivizing their performance. Operating a regional extension center to help providers adopt information technology. Those were the things that I did while there.
I’m proud to say we were able to improve quality and performance for the Plan’s members. Once we have the metrics in place, we were able to follow the metrics. We were able to move a significant number of providers onto electronic health record systems to get them to start doing quality management and improvement in their practices. So, I had a very definite sense of progress and achievement while there.
PART TWO OF THREE: “I’m Always Thinking of Ways to Keep A Population Healthy.”
In Part Two of our interview series, Dr. Batchlor talks about the challenges at Martin Luther King Jr. Community Hospital.
Being recruited as CEO at Martin Luther King, Jr. Community Hospital was a new challenge. It felt meaningful and worthwhile – an opportunity to get closer to where care is delivered, and where I would have greater impact on both quality and access to care for patients. I was comfortable that my abilities and experience would translate well to this setting. Just as importantly, I liked the people I would be working with on the hospital board.
Right from the start, the project was a “green field” opportunity where I could be part of designing a system from the ground up. We were starting from scratch. Free to design it the way we thought a system should be put together.
That meant building a modern, state-of-the-art, healthcare delivery organization that would improve the health of the community it was serving. One that would leverage technology and modern approaches to healthcare delivery. And, use best practices and evidence-based medicine.
The only constraint – or legacy – we had was in building out an existing structure that had never been completed. That’s how the hospital ended up sized at 133 beds. But, the thinking about hospitals and healthcare in general these days, is to not admit as many people in the hospital as you can. The goal is to keep people healthy and out of the hospital.
Anyhow, I had never run a hospital before, and finding ways to grow bed count wasn’t important to me. Instead, I came at the design from the perspectives of population health management, population health improvement, and community health improvement. This was my opportunity to really do population and community health, using the hospital as an anchor in an integrated system of healthcare. Provide more outpatient care and less inpatient care.
I don’t think of myself as a hospital administrator. My focus isn’t on developing “profitable” service lines. I never thought that way. My background is population health management, so I’m always thinking about ways to keep a population healthy. How do you manage a specific group or community’s health? How do you allocate resources across the continuum of care to maintain the health of that population? That’s more my perspective. But I also think that the healthcare environment itself is changing. And we are in a place now where healthcare providers are being held accountable for population health and providing value for the money that we’re consuming. So, hospitals are having to change their business model. They just haven’t gotten there yet. An advantage of being new is that we didn’t have much invested in the old business model.
An example of our new model is the weekly farmers’ market held in front of the hospital. The local community is what could be described as a “food desert,” where it is difficult to buy fresh or good quality, affordable food. If nutrition impacts population health, then having the hospital sponsor these markets allows community residents and patients access to fresh and healthy foods. That’s just one activity “moving” the organization beyond the hospital’s four walls and out into the community.
Another example is a program we started before the hospital opened. Even before we had a building, the first program we offered is something we call, “Know Your Basics.” And it is a community program in the truest sense of the phrase. We went out into the community and met residents where they were. Still today, we go to hair salons, barber shops, shopping malls, churches, boys’ and girls’ clubs, the schools.
We go where people already are and educate them about health risks. We do health screenings. We help connect residents with medical care. And we help connect them with health coverage. And when I say we do health screenings, I mean things like checking blood sugar, blood pressure, BMI. We teach people about obesity, diabetes, hypertension, signs of a heart attack, and signs of a stroke. Those are conditions that are epidemic in our community, and so far, we’ve reached thousands of people through that program.
We also instituted a program called, “You Can,” which is a partnership with community schools – elementary, middle, and high school. It has two objectives: expose students to healthcare career and job opportunities; and to mentor them about health, staying healthy, eating healthy, personal hygiene, exercise, and related topics.
On the immediate horizon is a mobile health program, where we’ll be taking a broader array of health services into the community using telemedicine and mobile vans. We’re co-developing our mobile health program with an organization called Greenfield Labs, which itself is a partnership between IDEO and Ford Mobility Solutions. We’re looking ahead to offering both virtual and community-based care. We’ll be doing more home-based care as well.
After we opened the hospital in 2016, we established a medical group and set up an outpatient medical practice with both primary and specialty care. The goal was to provide a place where patients could receive follow-up care once they left the hospital, and as necessary, ongoing management of their health and chronic diseases. That way they wouldn’t unnecessarily end up back in the hospital, either in the emergency department or as an inpatient.
We saw this as recognition that our job is not to fill up the hospital. Our job is to prevent people from needing to be in the hospital, and one of the ways to do that is to go upstream and provide the kind of care that is in very short supply in this community. It also recognizes that when people are discharged from the hospital, they’re vulnerable, and they need to be medically managed, and without that management at home, they’ll bounce right back into the hospital.
Setting up this medical practice was really the first step toward filling out a continuum of care that’s needed to manage the health of this community and its population. On the inpatient side, there were lots of people coming into the emergency department, both for minor things that could be treated in an outpatient setting if they had access. And, very serious conditions that had advanced because they hadn’t been appropriately treated prior to coming to the hospital.
The next step is measuring the impact we’re having on the health status of our patients. Is our work preventing complications? Is it reducing readmissions to the hospital? Is it reducing unnecessary emergency department visits? Is it improving their health over time? We’re using metrics that have been developed specifically to monitor performance in outpatient settings. To those, we’ve added public health community-based health metrics – such as the number of people who die from complications of diabetes. Or, the number of people who die from congestive heart failure.
We recognized before the hospital even opened that doing community health means partnering with community-based organizations, such as the American Diabetes Association, and the American Heart Association. Local community colleges provide healthcare professionals to help with screenings. We have a community health liaison who works with community organizations, like the Watts Gang Task Force, the homeless service agencies, and various community organizations focused on social determinants of health. Community health requires partnering with the community.
PART THREE OF THREE: "I'm proud of the incredible team of people who work here. They are talented, caring, and wholly committed to the mission of serving this community."
In Part Three of the interview series, Dr. Batchlor discusses the role of individuals and social advocacy in her approach to population health.
I’ve been asked where I see excellence in the MLK System. Without hesitation, I would say it is in our people, and in the standards we have set and strive to achieve.
Many of the people on my team have been with me from the beginning. They came to MLK for the same reason I did, which was the opportunity to create something new. And, because it’s a mission-driven organization, the opportunity to do something for a community that really needs access to healthcare and improved health.
We talk about this mission a lot. Along with our mission, we have a strategic plan and organizational goals guiding our work. We communicate a lot. I talk to each of our new employees every two weeks. During new employee orientations, I talk about how the hospital came about, what we are trying to accomplish, and how we are achieving our goals. There’s a lot of communication happening, as well as assessing the work we’re doing, and making changes as needed over time.
I’m proud of the incredible team of people who work here. They are talented, caring, and wholly committed to the mission of serving this community. The people we’ve recruited could work anywhere, yet they’ve chosen to come here. And I think that is due to our work culture. It is adaptive, innovative, and oriented towards achievement. We set high standards. We’re performance-oriented.
When people visit MLK, they always say that our staff are friendly and enjoy their work. And I’m proud of the fact that we have a culture that is supportive, that’s caring, that’s problem-solving. So, just to give you an example, our emergency department was designed to care for approximately 45,000 patients a year. We are at 100,000 a year and still going up. Despite that high volume of patients in a space designed for far fewer, we are providing top quartile, top decile patient experience. We have great outcomes. And we’re able to do it because we’re scrappy, we’re adaptive, we’re always doing and trying new things. And we care about our patients.
Our future is focused on continuing to develop the infrastructure necessary to provide the services this community needs, with a huge emphasis on outpatient and community-based services. Our future is recruiting providers. We can’t provide healthcare without providers, and our community currently has a 1,200-physician deficit. So, filling that deficit is a priority. Our future is population and community health. And transitioning from Martin Luther King Jr. Community Hospital, to the Martin Luther King Jr. Community Health System.
Training programs will be another key to a successful future. We started nursing training programs last year, and we’re going to be starting physician training programs in 2020. We must grow our own workforce.
We’re also proud that our hospital is an anchor institution in South L. A., fostering economic development, both public and private, in a way that we haven’t seen in the past. This is changing the community for the better.
For example, there’s currently a housing project nearby – Jordan Downs’ – and it’s going to be completely torn down and redeveloped over the next five years. In its place will be mixed-income housing and retail space. And the residents of the housing project will be rehoused in the new development. We’re seeing more of that kind of community transformation and development, which is supported by elected officials in this area with investments of public money. But there’s also private money here too. For example, we’ve raised almost $20 million from private philanthropies to bring physicians into the community. And physicians that we’re hiring are choosing to live in the community.
Interestingly, my experience with fundraising has been to go completely against conventional wisdom. Going against the grain is one of the things that has helped me achieve success throughout my career. You could ask, “did your experience working for a foundation help you raise money?” I’d have to say, when I worked in that world, the conventional wisdom was, philanthropic organizations will never give money to support physicians’ compensation. Yet if I had believed that and been willing to go along with that, I would never have raised $20 million for physicians. Because the conventional wisdom in philanthropy is that donors aren’t going to give for physicians.
What made us successful at MLK is thinking about everything in a different way. And being able to think outside conventional wisdom, which has been a part of my career all along. Like when I went to work for L. A. Care, people asked, “why are you doing that?” The view was if you go to work in a Medicaid health plan, you’ll never be able to do anything else. But that wasn’t the case at all. When I left L. A. Care to start working on opening MLK, people thought I was crazy. It will never work. But I saw how it could work. And I was willing to take the chance. And that’s brought success.
I’ll give you another example of thinking outside the box. We’ve used a new market tax credit program here to raise over $10 million, and it’s a very complicated program. And, it wasn’t initially used by people in healthcare. It was used more for housing and other types of infrastructure. But we learned how to do it, and all the while that we were learning how to do it, people were telling me, it’s too complicated, it’s too competitive. You’ll never figure it out, and it’s not worth it. I did it anyway, and it took a while to learn it, and to figure it out, but once we did, it paid off. We used it for capital, for equipment and projects. Infrastructure projects. It helped us buy an MRI scanner, do some renovation projects, and expansion in the hospital. We’re using it to develop a medical office building on campus.
Again, it goes back to people. Our success has been because of good people who are determined, talented, committed, and driven. And good problem-solvers. With vision. Our people have been willing to put up with a lot of stuff. Opening this hospital wasn’t easy, and it wasn’t inevitable. Back then no one thought it would work. It took a lot of effort and grit and whatnot. Our people were willing to take something on that didn’t necessarily look like it was going to be a success.
Let me tell you something. I was raised by parents who were social activists. They took me to the Poor People’s March on Washington when I was a kid, and I had the opportunity to hear Rev. Martin Luther King give his famous “I Have A Dream” speech. When I was young, my parents moved into an all-white suburb of Washington, D. C., so we could go to good schools – good public schools. We were kind of outcasts in that community. And I got used to being my own person. I spent a lot of time in the library, reading. But I got comfortable going my own way.
What impact do those experiences have on me today? Other than we’re going to build a just healthcare system? We’re going to improve the health of people who live in Southern California. I want to influence policy. I want to see healthcare coverage expanded. I want poor people to have access to high-quality care. And I am very interested in environmental justice and climate justice, too. That’s going to be a huge public health issue. So, I think at this point, for me, My next challenges involve influencing policy.
It fits my passion for acquiring new knowledge and learning new things. And that is something that has served me well throughout my career and taken me into different and new directions. Just the fact that I love learning new things, and I love new challenges. A huge part of it is just being willing to do things that are different. I’m constantly looking for new things. And then I try them.
Dr. Batchlor is married, has twin sons in high school and says about herself, “I have quite the sense of humor. People recognize me by my laugh!”
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