With a nationwide network of healthcare facilities, Lillian Care aims to deliver primary healthcare to underserved areas. Ärztenachrichtendienst spoke with founder Linus Drop about the concept.
So Mr. Drop, can you tell me briefly what it is exactly that you are planning with Lillian Care?
The concept is based on two components: We are opening general healthcare practices in medically underserved regions. To the patient, they look like normal medical practices. Inside, however, they are organized differently. First of all, our physicians are not in the practice five days a week, but instead are offering telemedical services from home on a specific days.
In many cases, physicians are no longer willing to relocate to these underserved regions. We want to make it possible to practice general medicine in rural areas without having to move the center of your family’s life there.
The second thing is the distribution of work. We have too few doctors in general, so we need a different distribution of work within such a practice. This is where we rely on a medical team, in which significant parts of the treatment are provided by non-physician staff. In our case, this will mainly be physician assistants, but community health nurses may also become involved in the future. This is what has long been practiced in many other countries – Scandinavia, the UK, and the US. The complex cases are handled by the physician, the simpler ones by the nurses – and the outcomes are equivalent or better than they are here.
However, we ensure that the physicians retain overall responsibility by means of supervision. We deliberately wanted to move away from concepts such as substitution and delegation, because such terminology reflexively triggers certain opinions. And what we are doing is something in between. A physician is involved in any treatment we provide. The goal is to find a balance: As much as possible should be handled by others, but the physician remains involved — simply for a much shorter period of time. Nevertheless, he or she can intervene at any time.
You are organizing the entire operation as a medical care center. How large will the individual facilities be?
Yes, it’s a medical care center, we can’t organize it any other way. But the physicians can also become shareholders. We don’t want the physicians to be „just“ employees, but also partners in the big picture. That’s an option, the physicians don’t have to do it, but we offer it to all of them.
Nor is it a matter of the physicians having to bring a lot of capital to the table. For the launch, we’re classically investor-funded. To get things rolling, we’ve organized the capital. For us, it’s more about getting the physicians more involved in the decision-making process and about commitment.
Size-wise, the practice is oriented toward two physicians in terms of patient volume. But the breakdown will be different: one physician or one doctor and 1.2 full-time positions for physician assistants or something similar. The units will be rather small, because the localities we want to go to are usually quite small.
All administrative things will be completely centralized, we want to keep that out of the practices. Because on site, the focus should really be on treatment.
Do you want to focus exclusively on underserved regions?
Yes. We really want to solve problems and not be another player going in and cherry-picking in cities where the situation is fine.
Are you only looking at primary care physicians or specialists as well?
For the time being, we’re thinking exclusively in terms of primary care physicians. Of course, once such a structure has been created, one could imagine bringing in specialists as needed on certain days. However, we would then do so with partners – we really want to focus on primary healthcare.
What role does family doctor-centered healthcare play in your planned practices?
Family doctor-centered care is definitely an important point for us. We assume that our practices will benefit from this.
Where exactly will you be launching your practices?
Overall, we are looking nationwide. We are starting with the first practices in the German state of Rhineland-Palatinate — quite deliberately there and not in the Uckermark or Brandenburg, in order to demonstrate: This is not just a problem in the east, and it is not a problem that only affects a few federal states.
Then we will take action in the region around Osnabrück. The Osnabrück region is also one of our shareholders through a holding company, so we have a lot of support from all sides.
It is highly likely that we will then also become active in the state of Westphalia-Lippe. We are currently in talks with two districts there. Of course, the project of the Association of Statutory Health Insurance Physicians of Westphalia-Lippe (KVWL) regarding physician assistants is of great interest to us. We are a perfect fit for that.
How far have the plans progressed?
The first four units should be active by the end of this year or the beginning of next year – this now depends primarily on lease agreements.
Wasn’t it difficult to find staff?
As far as Medical Assistants and Physician Assistants are concerned, we have a real luxury situation. We have received so many applications that we can choose the best from the many good ones. And they really do have to be on site in the practice five days a week. We just have something for them that interests them: To be more accountable and to be more visible. Of course, we also pay them reasonably.
We are also very satisfied with the physicians. We have three or four interested parties for all locations.
It’s great that there has been so much interest, even though this market is so competitive. That gives us a tailwind. Because without physicians and non-physician staff, you can think up a lot of things, but you can’t do anything.
How many practices are you planning for the long term?
Very long-term, if you are looking at the 2030s, we are anticipating several 100 practices that we are targeting. But when you see that there will be a shortfall of 11,500 practices, even 100 practices from Lillian Care is just a drop in the bucket. We can’t solve the problem alone — that’s why we don’t see ourselves at all as competing with other companies or other physicians. In fact, it will take everyone who can come up with something to solve the problem of healthcare shortages.
Other medical centers have failed because they are not economically viable. Why should this be different for you?
One hears very different reports in this regard. Of course, the working hours and schedules of freelancers are different from those of salaried employees. This is regardless of profession. Our approach: We want to combine both the advantages of being an employee with the opportunities of an entrepreneur. After all, that’s what many physicians want: Not to bear the overall financial responsibility and risk alone, but still to help shape a company.
Of course, we need motivated team players in our practices. I am optimistic that we will create a well-functioning and, of course, ultimately economically viable enterprise.
Everyone is aware of the problems, health insurers, chambers — especially the municipalities, which in some cases are really in a state of alarm. I sense a great willingness on all sides to deal flexibly with the regulatory rules so that we can actually establish something. The new German digitization laws also provide for easier access to telemedicine.
How did the idea for Lillian Care come about in the first place?
I’ve been in the field of telemedicine for the last 20 years and I’m really excited about the possibilities. But I also know the limitations. Today, mere remote treatment can — unfortunately — only solve relatively few cases conclusively. It solves the problem that we have too few physicians, only to some extent, but not completely.
I then went on several study trips to other countries with the German Managed Care Association — and everywhere the distribution of roles between physicians and nurses is completely different from ours. That was the second part of the idea.
I have known my two comrades-in-arms for a long time. Florian Fuhrmann was at kv.digital for a long time and has a perfect understanding of the technology side. Markus Liesmann is responsible for operations at our company. He has established wound centers throughout Germany — this also involves a branch concept and cooperation between physicians and non-physician staff.
So the three of us all bring experience to the table. Usually, you think of start-up entrepreneurs as being in their mid-twenties. We are a kind of silver founder. In this highly regulated field, experience is incredibly important. You don’t get very far with pure motivation; you have to know where the pitfalls are.
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Source: https://www.aend.de/article/225035
