Americans need to understand what’s behind the business of healthcare. Right now, most do not. For many, it remains a mystery. Even some physicians struggle to fully grasp it, as their focus is rightly on caring for patients—not navigating the business side of medicine.

But what patients know can give them power.

Your healthcare provider delivers care in return for a fee. That fee is ultimately paid by you—typically through your insurance carrier, whether public or private. However, one of the biggest factors influencing that cost is where you seek care. Location impacts pricing, transparency, and whether the cost actually reflects the level of care you receive.

Insurance companies are not in the business of providing care. They are in the business of managing claims—and often denying them—to generate profit.

Consider where you go: a community hospital versus a VA medical center. There are meaningful differences.

Even community hospitals, often marketed as “non-profit,” are actually private non-profit entities in the eyes of the IRS, operating under 501(c)(3) status. This allows them to avoid paying taxes, provided they meet certain requirements:

• Conducting Community Needs Assessments
• Reinvesting in their organization
• Maintaining Charity Care or Financial Assistance Policies
• Providing care to indigent populations under EMTALA

But let’s be clear: non-profit does not mean “no profit.”

These organizations absolutely pursue profit—referred to as margin. This is the revenue remaining after expenses are paid. While that margin is often described as “laser thin” (typically 1% to 4%), the scale matters. When organizations are generating billions in charges and billions in net revenue, even small percentages become very large numbers.

Americans should understand not only what they are being charged—but also how that money is distributed.

That includes executive compensation.

Medical care is undeniably expensive. But if even a single dollar is put back into the system more effectively, we all benefit.

If you want to start learning, it’s simple:

• Google your local non-profit healthcare organization along with the term “990 Form”
• Review their publicly available financials
• Study their highest compensated employees
• Look at their spending on travel nurses
• Then ask yourself: Is this fair?

Some executives take modest salaries. Others extract millions from their organizations and communities.

And don’t assume those roles couldn’t be filled by someone equally capable at a fraction of the cost.

Americans need to ask harder questions.

They need to examine the value of executives—the “suits”—who are extracting millions from the very fees generated by doctors, nurses, and allied health professionals delivering care every day.

As we approach the new fiscal year (FY27) on July 1st, budgets are actively being closed, tweaked to match expectations, and carefully inspected to the various departments within organizations large and small. No service line in modern healthcare ought to be left alone. However, is the use of benchmarking software and critical financial milestones only a useful activity when applied from the top down?

Benchmarking can be one of the most powerful tools in modern organizations—until you look at how it’s applied.

At the department level, benchmarking can work extremely well, or it can be a complete sham due to unique P&L, revenue/cost-driver variables and idiosyncrasies.

Nursing units, care delivery teams, and operations groups are constantly measured against clear metrics:

• Productivity
• Cost per unit or cost per unit of statistic
• Turnover rates (this is your organization red flag)
• Overtime and Hours worked per unit of statistic
• Outcomes and performance targets compared YOY

These benchmarks create accountability, drive efficiency, and make performance visible.

But the further up you go in an organization, the less clean benchmarking becomes.

Why?

Because executives don’t just participate in the system—they design it.

They choose:

• What gets measured
• How success is defined
• Which comparisons matter
• And which ones quietly disappear

That creates an imbalance.

Departments are benchmarked against external standards and internal expectations.
Executives are often benchmarked against metrics they helped construct.

It’s not that executive roles shouldn’t be measured—it’s that their performance is harder to isolate:

• Outcomes are long-term and influenced by many variables
• Decisions are strategic, not operational
• Success can be framed in multiple ways

But here’s the real issue:

When you control the metrics, you influence the narrative.

A department can’t redefine its benchmarks when performance drops.
An executive team can reframe priorities, shift targets, or highlight different wins.

This is why benchmarking feels objective at lower levels—and more subjective at the top.

The takeaway isn’t that benchmarking is flawed.
It’s that it works best where the rules are fixed—not where they’re being written in real time.

Strong organizations recognize this gap and try to address it by:

• Using external, independent benchmarks for leadership
• Tying executive outcomes to long-term results, not short-term optics
• Increasing transparency around how success is defined

Because accountability only works when the people being measured don’t also control the measuring system.

And it is past time to hold executives accountable. Patient satisfaction and turnover rates are some of the best metrics to manage up. Profit margins can mask the real perspectives of employees tasked with arduous everyday work and at a fraction of a fee compared to executive salaries.

It is time to bring integrity back to health systems and create cultures of resilience, transparency, and accountability.

Let’s stop pretending we don’t see it.

Healthcare executives didn’t quietly drift into astronomical pay—they engineered a system where the scoreboard measures everything except care. Somewhere along the way, the mission statement got mugged in a back alley and replaced with a balance sheet wearing a lab coat.

We are told healthcare is “too complex” for the public to understand—as if complexity itself is a moral shield. As if opacity is a virtue. As if the average patient staring at a five-figure bill for a two-hour visit just needs a better appreciation for “operational nuance.”

No. What they need is a flashlight.

Because here’s the absurdity: the people closest to patient care—nurses, physicians, technicians—are asked to do more with less, while those furthest from the bedside are rewarded as if they personally resuscitated the entire system.

Executives speak of “margin pressures” while approving compensation packages that look like private equity exit strategies. They talk about “efficiency” while building administrative empires with titles that require a glossary. Meanwhile, a patient is googling whether they can afford to follow up on a diagnosis.

And we’re just supposed to accept that?

We’re told high executive pay is necessary to attract “top talent.” Talent for what, exactly? Negotiating drug prices that somehow still vary wildly by zip code? Expanding square footage while shrinking trust? Perfecting the art of saying “patient-centered care” in a quarterly earnings call?

Let’s be honest: if this were truly a functioning market, the outcomes would reflect the incentives. But when the incentives reward financial growth over human outcomes, you don’t get innovation—you get distortion. You get a system where success is defined by revenue cycles, not recovery rates.

And here’s the kicker—much of this is happening under the banner of “non-profit.” Non-profit. Let that bounce around for a second. Organizations that enjoy tax advantages meant to serve communities are compensating leadership at levels indistinguishable from corporate giants. At what point does “competitive compensation” become “community extraction”?

This is not about villainizing individuals. It’s about interrogating a structure that has quietly normalized the gap between those who deliver care and those who monetize it.

Because transparency shouldn’t be controversial. If executive pay is justified, then show the math. Tie it to outcomes people actually care about: reduced medical debt, improved patient access, measurable community health gains. Not just EBITDA dressed up as altruism.

The public doesn’t need an MBA to understand fairness. They understand when the system feels tilted. They understand when trust erodes. And right now, trust is hemorrhaging faster than any financial metric being reported.

So yes—reexamine executive pay. Drag it into the daylight. Ask uncomfortable questions. Demand alignment between compensation and care.

Because if healthcare is truly about healing, then the system itself might be overdue for a diagnosis.

Projects Should End. Operations Should Improve.

By definition, a project has a clear endpoint. If the work never truly ends, it isn’t a project—it’s an operation.

Too often, leaders fall into the trap of applying project management to ongoing operational inefficiencies. They chase symptoms instead of addressing root causes. But the goal of any meaningful project should be simple: identify and correct the underlying reasons operations are broken in the first place.

---

Stop Managing Around the Problem—Fix It

At Integral Health, we believe project management should not exist to sustain inefficiency—it should eliminate it.

Our focus is helping healthcare organizations:

• Build strong internal capabilities
• Execute projects that create lasting operational clarity
• Transition from reactive problem-solving to proactive system design

The result? Operations that are clean, concise, and aligned with strategic goals.

---

The Hidden Cost of Outsourcing Operations

One of the most critical issues facing health systems today is the over-reliance on outsourced operations.

Whether it’s subcontracting, offloading, or “turfing” functions externally, the reality is this:

You are paying for someone else’s margin—often at the expense of your own operational control.

This issue accelerated during the COVID-era funding surge, when many health systems outsourced key functions to external vendors. What began as a temporary solution has now become deeply embedded.

Even more concerning:

• Many of these “small businesses” are backed by large investment portfolios or private equity
• Their primary obligation is profit, not long-term system sustainability
• They maintain persistent financial and operational control points within your organization

---

A New Healthcare Reality

As federal funding pressures increase in the coming years, health systems can no longer afford inefficient or externally dependent operations.

This is not just a financial issue—it’s a strategic imperative.

Health systems must:

• Reclaim operational ownership
• Remove unnecessary third-party dependencies
• Build resilient, internally optimized systems

---

Remove the Barnacles. Restore Control.

Integral Health helps organizations identify and remove these embedded inefficiencies—what we call “barnacles”—that weigh down performance and margins.

We work alongside leadership to:

• Analyze operational and financial structures
• Identify unnecessary vendor dependencies
• Rebuild streamlined, internally owned processes
• Deliver sustainable, measurable improvement

---

When You Save, We Earn

Our model is simple: we succeed when you do.

If your organization is ready to move from fragmented operations to disciplined, high-performance systems, we’re ready to help.

Reach out for a proposal.

Request for a Proposal

---

Attempting to pick up a guitar and look at the fret board for the first time and trying to make sense of the notes is no small endeavor for a new student of music. The same applies to understanding the intricate fibers of the healthcare fabric. Where do threads cross, knots form, and patterns emerge?

A young physician reciting the symbolic ethical pledge known as the Hippocratic Oath is an Ancient Greek nod to exceptionalism and care. If only that was the Greek I am referring to.

In music, to unlock a fret board, you must first vision the fret board as the piano keys, black and white. White keys are “natural” notes, and the black keys are the “sharps” and “flats,” the augmented and the diminished, the intricate parts of the key for which a song is played. In any given key, we will take our 7 chosen notes and throw out the 5 others (maybe to use later as an accidental).

The key to unlocking the keys is to think in intervals of tones: full tones, half tones, or, in American English, full steps and half steps. Understanding the space between notes really accelerates and annotates melody, but I am getting ahead of myself.

To understand the keys, it is important to start on the easiest scale, C major (or the relative A minor). In the Sound of Music, this note “C” is the onset of our favorite rhapsody, “Do-Re-Mi-Fa-So-La-Ti-Do.” In other words, this is the Ionian Scale (the classic major heptatonic scale) where the natural note “C” is the first note.. Now, I’ll transpose because the rest of these Greek heptatonic scales align respectively with the notes of C Major: (C) Ionian, (D), Dorian, (E) Phrygian, (F) Lydian, (G) Mixolydian, (A) Aeolian, (B) Locrian, and Ionian. To add a little more, think of these Roman Numerals indicating the tone of the scales as MAJOR or minor (I, ii, iii, IV, V, vi, vii*, I). That is one through seven with the seventh scale, Locrian, as getting an asterisk for being a little weird on how to identify it. However, do you see the translation?

Well, how about healthcare? How do you approach our modern healthcare system with the similar logic as we approach music? For starters, there are no boilerplates, templates, or one-size-fits-all. We are discussing purchasing groups who can buy the same medication on the same day and pay three different prices for the drug based on nothing other than location. Location, location, location. It’s the secret sauce to real estate, but also an interesting part of pharmacy purchasing.

Finance: the tail that wags the dog. The unfortunate reality of the power and the sheer size of the economic impact in the medical industry is that greed and profit have become entrenched deep inside the walls and stalls of hospital groups, administrators, and insurance providers alike. Money has ruled all but a physician’s decision on how to treat their patients from the time of Hippocrates. The physician will do what ever she or he will do to help an ailing patient indifferent of the cost. That is the true power and freedom of care delivery. However, when insurance companies and administrators prioritize profit over care the results are predetermined.

Physician leadership must be fully aware and transparent of their earnings, production, and overall financial contributions. Administrators of non-profit health systems, long left scratching their heads on what to logically do with EBIDA profits other than build more square feet and line their own pocks, have now paid themselves into a corner. Look no farther than Candid’s (f/k/a Guidestar) non-profit report for the IRS form 990. How long can physicians, allied health providers, nurses, and the diversified care specialists view leadership who pay themselves exponentially more than the “Clogs on the ground?” The executive pay scale is why a Congressional Ways and Means Committee Chaiman, Jason Smith, just referred to hospital systems as “hedge funds with hospital beds.“

Integral Health is here to stay because the problems plaguing our health systems are not going to go away anytime soon or by being left alone. We the people, and as a united people, need to stop allowing the lack of transparency to continue unfettered while the majority of us statistically hold some amount of medical debt on some hospital system’s general ledger.

We can learn Greek. We must learn Greek. And then we can continue the symbolic values of “doing no harm” and return health systems to a being truly a servant of the community, and not a lord. And we will accomplish this by doing a better job for less.

There is no shortage of attempts to explain our dysfunctional American healthcare system, or, as some have accurately described it, disease care system. Integral Health is working on educating consumers providers, and system leaders in order to route out inefficiencies that have ballooned the cost of care and stripped both physicians, providers, nurses, and patients of transparency and their rights to understand the costs they pay for their required healthcare.

Let’s get after it.

The CEO does not run the health system. Nope. The health system is ran by physician leadership. There is no more important role than empowering physicians to operate within the strict guidance assigned to various regulatory boards by the Center for Medicaid and Medicare Services (CMS). The authority is deemed to an entity, whether the Joint Commission or the state department of health depending on the bed size and hospital designation.

It is critical that all members are in alignment with this part. The required-by-law rules established within the health systems bylaws are sacrosanct. Physician leaders must be aware of the governance structures so that the right questions can be asked and total transparency is allotted to each committee: Medical Executive Committee, Privileging Review Committee, Credentialing Committee, etc.

This tangled web of Medical Staff Services is a common problem for health systems. However, outsourcing this vital need to vendors is not the solution. Instead, the governance structures need to be in total alignment and if there are issues, Integral Health will uncover what is going on and provide a thorough assessment and projected plan.