Healthcare Radius November 2017 by Itp India

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Aligning business and healthcare in India

Total number of pages 48

November 2017 Vol 6 • Issue 2 • `50

SOUTHERN

TITAN DR ABHINAY BOLLINENI,

DIRECTOR, KIMS HOSPITALS, ON THE GROUP’S EXPANDING FOOTPRINTS

INFRASTRUCTURE

ONCOLOGY HOSPITAL, NAGPUR

STRATEGY

DIGITAL APPROACH TO HEALTH INSURANCE

Published by ITP Media (India)

Contents 32

36 BULLETIN 10 This month's important news updates.

STRATEGY 23 Digitalisation and standardisation of practices can bring about significant changes in the claims exchange process.

EVENT 30 A premier India healthcare portal in three foreign languages was launched during Advantage Healthcare India 2017 .

INFRASTRUCTURE 32 A 100-bed comprehensive oncology hospital is coming up in Nagpur

IT 36 Cognitive computing

18 COVER STORY Dr Abhinay Bollineni, Director, KIMS Hospitals, on the groupâ&#x20AC;&#x2122;s expanding footprints.

NOVEMBER 2017 | HEALTHCARE RADIUS

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MANAGEMENT 44 The upkeep of equipment deals beyond breakdown maintenance of equipment.

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EDITOR'S NOTE

NOVEMBER 2017 • VOL 6 • ISSUE 2

Stifling growth

ITP MEDIA (INDIA) PVT. LTD

Bandra (West), Mumbai – 400050. India

he Indian healthcare industry has been reeling under the impact of a slew Government regulations. First came the demonetisation drive that reduced the cash paying business of hospitals. Second came the GST that marginally increased the cost of healthcare delivery. Third came the capping on price of stents and implants that caused a dip in revenue by around 15 to 20% in cardiology and orthopaedic business of hospitals. It has also resulted in a number of MNCs withdrawing high-end stents and implants from the Indian market. Such regulations in quick succession have stifled the growth of the industry. Several groups have witnessed the stream of patients from rural areas becoming a trickle. It has also dampened the investment climate with PE investors now being doubtful about funding healthcare companies. While many multi specialty hospital groups are struggling to recover the plunge in business, some have strategised novel ways to ramp up their revenues. But will such short-term strategies work or would the Government come up with more regulations to choke growth? Thankfully, the cloud of doubt hovering over the industry has not deterred the expansion plans of some traditional groups. One such group is Hyderabad’s Krishna Institute of Medical Sciences, which has been on a growth trajectory, fortifying its presence in AP-Telangana and now venturing beyond south. Read our cover story to find out about the group’s acquisition spree. Also, read about cost control measures that are much needed to keep escalating healthcare costs under check and steps to digitise health insurance claims in this edition.

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A DV I S OR Y B O A R D OUR EDITORIAL BOARD HOLDS UP A MIRROR TO THE HEALTHCARE INDUSTRY, HELPING US UNDERSCORE THE KEY TRENDS AND DEVELOPMENTS OF THE INDUSTRY

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Chairman, KG Hospital & Post Graduate Medical Institute

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NOVEMBER 2017 | HEALTHCARE RADIUS

BULLETIN

StanPlus raises $1.1 million funding

StanPlus is currently spread across eight cities.

StanPlus, a Hyderabad based medical transportation startup, has announced securing an investment of $1.1 million as seed funding for a minority stake. StanPlus was founded in 2016 by three INSEAD MBA graduates - Prabhdeep Singh, Antoine Poirson and Jose Leon with an aim to build India's largest ambulance network dedicated to bringing quality and efficient ambulances services for emergency, non-emergency and afterlife support. The fund will help continue its aggressive scale-up in

Robotic surgery for heart recovery In a first of its kind in Karnataka, Aster CMI Hospital’s heart surgeons has performed robotically assisted surgery for mitral valve conditions. With the help of robotic arms, surgeons at Aster CMI Hospital have successfully performed four mitral valve surgeries, with invasions as minimal as 2.5 cm to 3.5 cm. “We doctors sit at a console, and, with inputs from the camera, which gives us a complete view of the mitral valve in the patient’s body, guide the three robotic arms which are more dexterous as a human wrist, and are able to rotate almost 360 degrees, making surgical manipulation easier and more precise,” says Dr Mahadev Dixit, Chief, cardiac sciences, Aster CMI Hospital. Dr Dixit, has, with the help of these robotic arms, successfully performed four mitral valve surgeries so far, three of which are on women. “All four patients are doing well,” said Dr Dixit.

NOVEMBER 2017 | HEALTHCARE RADIUS

the rapidly growing medical transportation industry in India. The latest round of investment is being led by Kstart (Kalaari Capital’s Seed Fund) and co-invested by CM Diamant, a chain of medical centres and hospital in Canada and Africa, and INSEAD Angels (Asia). Said Prabhdeep Singh, Co-founder & CEO, “The amount invested will be used to increase our advancelife support fleet and expand across geographies, innovate with cutting-edge technologies and to cover all medical transportation categories in the near future.” Antoine Poirson, Co-Founder & COO, added, “With this additional investment we would like to continue our remarkable growth of last one year and supplement our vision and mission.” “StanPlus’s approach to medical transportation is enterprising,” added Muthiah Venkateswaran, Partner at Kstart. StanPlus is currently spread across eight cities including Hyderabad, towns of Andhra Pradesh, Telangana. The StanPlus ambulances are equipped with advanced life support systems, BLS care systems, cardiac machines, other patient care systems and trained paramedics and staffs for better assistance. The in-built technology enables real-time tracking of the ambulance.

Cytecare launches ‘comprehensive oncology’ On the occasion of the ‘World Hospice and Palliative Care Day’, Cytecare added a new dimension to the multi-modal treatment approach for cancer by introducing ‘comprehensive oncology.’ Cytecare’s comprehensive oncology services have been crafted keeping patient’s quality of life during and after treatment in perspective. Suresh Ramu, CEO & Co-founder, Cytecare Cancer Hospitals, said, “The services include pain and palliative care, onco nutrition, psychooncology, physiotherapy, mind-body medicine (yoga), navigators, speciality clinics that support the various symptoms of patients and home healthcare through partners. There is sufficient evidence that such an approach in addition to the core treatments can enhance the quality of life and improve clinical outcomes for patients.”

Exceptional Technology, Extraordinary Care Godrej AV Solutions brings a range of audio visual solutions for healthcare segment.

Technology is enabling modern healthcare institutions to stay ahead of competition and maintain high levels of excellence. To deliver quality medical care consistently, healthcare institutions across India are enhancing their communication and learning environment. Godrej AV Solutions fully understand the need of adaptation of AV technologies in healthcare facility and how it will help institutions to improve operating efﬁciency and high level of patient care. With our tie-ups with leading AV product manufacturers across the world, we bring a portfolio of AV solutions which helps modern health care facilities in improving communication, information sharing and training. Our expert sales and design consultants help in developing innovative audio visual solutions for modern healthcare institutions. Reliability and prompt after sales support help us differentiate and be a preferred choice of our valued customers. We offer the following solutions for the healthcare sector: • AV Enabled Operation Room Solutions • Digital Training / Class Room Solutions • Conference / Meeting Room Solutions • Video Recording, Streaming and Archiving Solutions • Auditorium / Seminar Hall Solutions • Telemedicine Solutions • Digital Information Kiosks • Information Display( Digital Signage) Solutions • Patient Room Solutions • Paging and Background Music Solutions • Large Format (Video Wall) Display Solutions Godrej & Boyce Mfg. Co Ltd. Interio Division, Plant 14P, Pirojshanagar, Vikhroli (East), Mumbai - 400079. INDIA Tel.: +91 22 6796 2665 / 2666 / 2653 Fax: +91 22 6796 1526 Email : avsolns@godrej.com Website: www.godrejavsolutions.com

Mag.AD- Healthcare /Trim Size 20.5 x 27.5 cm

BULLETIN

ICMR guidelines on biomedical and health research The Indian Council of Nadda applauded the Medical Research (ICMR) efforts directed by ICMR has released two national to ensure that the biomedguidelines, which would ical and health research specifically help in underis carried out in an ethical standing the complexities manner to maintain and of ethical issues around improve the public trust research involving human towards medical research. These guidelines are aimed to protect and safeguard the participants (adults and ICMR undertook an interests of individuals and communities. children). These guidelines extensive exercise by are aimed to protect and engaging with experts and safeguard the interests of individuals, communities and diverse stakeholders such as patient groups, civil society, the society as a whole. lawyers, clinicians, scientists, members of ethics comThe ‘National Guidelines for Biomedical and Health mittees and others through regional, national as well as Research Involving Human Participants – 2017’ was public consultations to prepare these guidelines. released by Union Minister for Health & Family Welfare, Dr Soumya Swaminathan, Secretary-DHR and DGJagat Prakash Nadda, and the ‘National Ethical GuideICMR, said, “Medical research is the need of the hour lines for Biomedical Research Involving Children’ was and therefore it’s important to not only be responsive to launched by Anupriya Patel, Minister of State for Health emerging issues, but to also build greater trust towards & Family Welfare. research. It is important that every stakeholder, whether These guidelines will help strengthen the protection a researcher or a member of an ethics committee, or a of rights, well-being and safety of research participants sponsor, is aware of the provisions made in the revised involved in all types of biomedical and health research. ethical guidelines."

Ethics is key in bariatric surgery The Indian Association of Gastrointestinal Endosurgeons (IAGES) organised its second fellowship programme in bariatric and metabolic surgery (FALS) between 6th to 8th October in Mumbai. Dr Phil Schauer from Cleveland Clinic, during the programme shared the results derived from a five-year trial known as Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) that showed excellent outcomes of surgery in diabetics. The study found that bariatric surgery gives Type 2 diabetes sufferers a much better chance at remission than conventional treatments that combine lifestyle counseling with medications. "The really surprising thing, especially for gastric bypass patients, is that nearly a third sustained a complete remission of diabetes," said Dr Schauer. Dr Ramen Goel, Director, Bariatric and Metabolic surgery, Wockhardt Hospitals, highlighted the need for ethical practice in the field. “It is not a question of whom to operate but when not to operate. One should have the courage to refuse surgery if someone is psychiatrically unstable or doing it for image reasons only.”

NOVEMBER 2017 | HEALTHCARE RADIUS

Hinduja Hospital launches palliative care services With an aim to provide emotional and physical support to chronically ill patients, PD Hinduja Hospital & Medical Research Centre recently inaugurated its new palliative care service. Under this initiative, the hospital will provide palliative care services, pain relief treatment and counselling to in-patients and OPD patients, including cancer patients. Usha Raheja, Trustee, Hinduja Hospital, said, “PD Hinduja Hospital has always been supporting various initiatives to help and enable patients to fight their disease and share their experiences. We understand the importance of end of life care and with this new service, we hope to serve society with much-needed medical attention.”

BULLETIN

Apollo Hospitals collaborate with Samsung Samsung India, India’s biggest consumer electronics and mobile phones brand, and Apollo Hospitals, Asia’s largest and healthcare group, announced their collaboration to jointly run the Samsung-Apollo technology backed Mobile Medical Care to screen large sections of populaThe collaboration would jointly run the Samsung-Apollo technology backed Mobile tion for non-communicable diseases Medical Care. particularly for the under-privileged sections of the population. NCDs are responsible for over 50% of deaths and this is increasing located in urban areas and the people living in remote at a rapid rate. If this continues India will not have sufrural areas. The programme will be launched in Tamil ficient resources to treat the NCD affected population. Nadu and Uttar Pradesh. The Samsung-Apollo Mobile Medical Care Unit Dr Hariprasad K, President, Apollo Hospitals, said, “It is Programme will be executed with the operation of encouraging to see that corporates like Samsung are also mobile medical care units (buses) fully loaded with the taking a step ahead in bridging the healthcare gap, espescreening technology including ECG, stress test, echocially at the grassroot level. We hope to make it a major cardiogram, ultrasound, mammogram, pap smear and success and create a new model of healthcare delivery blood sample collection. These screening procedures for far flung rural areas.” Deepak Bhardwaj, Vice Presiperformed in remote locations will be processed and redent, Samsung India, said, “Through this collaboration, ported in Apollo Hospitals. This is enabled by leveraging we aspire to provide many more people in the two states technology and bridging the gap between large hospitals easy access to quality healthcare facilities.”

Healthcare IT companies raise $5.5 Bn in VC funding Mercom Capital Group, llc, a global communications and research firm, released its report on funding and mergers and acquisitions (M&A) activity for the Healthcare Information Technology (IT) / Digital Health sector for the third quarter and first nine months (9M) of 2017. Global VC funding in 9M 2017 was 31% higher than the same period in 2016 with $5.5 billion raised in 586 deals compared to the $4.2 billion raised in 463 deals in 9M 2016. Q3 2017 VC funding came to $1.5 billion in 227 deals, a 38% decrease compared to the record $2.4 billion raised in 194 deals in Q2 2017. The 227 deals in Q3 2017 were the most recorded in a single quarter since 2010. The digital health sector has now received $24 billion in 3,258 VC funding deals since Mercom began tracking in 2010. Total corporate funding in health IT companies - including VC, debt, and public market financing - came to $1.7 billion in Q3 2017 compared to $2.4 billion in Q2 2017.

NOVEMBER 2017 | HEALTHCARE RADIUS

Ayurveda witnesses global resurgence Shripad Yesso Naik, Minister of State (Independent Charge) Ministry of AYUSH, stated that a threefold increase in market size of Ayurvedic products from $2.5 billion to $8 billion is envisioned by 2022. He was speaking at the Ayurveda Conclave organised by the Ministry of AYUSH and CII on October 16, 2017 at New Delhi. “Ayurveda is witnessing a resurgence in India and around the globe. The government has already begun work on building AIIMS like facilities for Ayurveda. To converge the research approach of AYUSH systems with the modern medicine, the Ministry of AYUSH and ICMR have decided to have molecular based studies on specific leads from the Ministry.”

MEDICAL RECRUITER

BULLETIN

GenePeeks collaborates with CORE Diagnostics GenePeeks, Inc., a computational “GenePeeks is delighted to add genomics company focused on CORE Diagnostics to our list of outtransforming disease risk analysis, standing global partners,” said Anne announced an exclusive distribuMorriss, Co-founder and CEO, Genetion agreement with CORE DiagnosPeeks, adding, “We look forward to tics, a next-generation diagnostics working with the exceptional CORE provider committed to bringing team to address the European bias best-in-class clinical technology and embedded in traditional screeninnovation to India. ing and help Indian families better This new distribution agreement understand their risk of conceiving a furthers GenePeeks’ goal of exchild with a serious genetic disease.” panding access to its breakthrough Zoya Brar, Co-founder and Manpreconception screen and adaging Director of CORE Diagnostics, vanced analytics platform in new said, “We are excited to partner markets around the world. CORE with GenePeeks to expand our will exclusively offer GenePeeks’ portfolio of innovative testing Zoya Brar, Co-founder and Managing preconception screen in their services and support the growing Director of CORE Diagnostics extensive market of 29 states and interest from Indian families and seven union territories across India, their healthcare providers in pregreatly expanding GenePeeks conception screening. GenePeeks’ global footprint. Demand for preconception screening technology provides a unique opportunity to identify and care in India is increasing, particularly as awarerisk to Indian families that was often uncharacterised ness of heritable disease risk grows. historically and hidden from clinical view.”

Researchers demonstrate ‘mind-reading’ brain-decoding tech Researchers have demonstrated how to decode what the human brain is seeing by using artificial intelligence to interpret fMRI scans from people watching videos, representing a sort of mind-reading technology. The advance could aid efforts to improve artificial intelligence and lead to new insights into brain function. Critical to the research is a type of algorithm called a convolutional neural network, which has been instrumental in enabling computers and smartphones to recognize faces and objects. “That type of network has made an enormous impact in the field of computer vision in recent years,” said Zhongming Liu, Assistant Professor in Purdue University’s Weldon School of Biomedical Engineering and School of Electrical and Computer Engineering. The researchers acquired 11.5 hours of fMRI data from each of three women subjects watching 972 video clips, including those showing people or animals in action and nature scenes.

NOVEMBER 2017 | HEALTHCARE RADIUS

Midmark India launches new motorised bed Midmark (India), a leader in the area of patient positioning equipment, has announced the launch of their new motorised bed ‘Electra’, designed and positioned to capture a new market in India’s tertiary care sector. The new bed by Midmark India aims to revolutionise the traditional hospital bed and transform it into an accelerator in a patient’s recovery process. The new bed has been designed and built to enhance patient comfort and caregiver efficiency. Manufactured and designed entirely in India, the bed not only matches world class standards from a quality, efficiency and safety point of view, but also is priced competitively for the Indian healthcare industry.

BULLETIN

Vice Chairman & Managing Director, Philips

hilips India has announced the appointment of Daniel Mazon as Vice Chairman & Managing Director for India subcontinent. In his new role, Daniel will be responsible for driving the overall growth for Philips businesses in India, while focusing on customers and operational excellence. Daniel is a seasoned leader with close to two decades of work experience in the healthcare industry. Daniel has been with Royal Philips for the past six years and prior

to his appointment in India, he led the Philips Healthcare transformation in Latin America. Daniel started his career with GE Healthcare, in USA, and spent over 12 years in various roles across operations, quality, strategy, product development and sales and marketing. Daniel is a graduate in engineering from Texas A&M University and holds an executive degree in general management from Harvard University.

CEO, Asian Heart Institute

ormer CEO of Aurangabad’s Kamalnayan Bajaj Hospital, Dr Shamim Khan, has assumed charge as CEO of Mumbai’s Asian Heart Institute. The 230-bed hospital is one of the premier cardiac hospitals of the country. He also worked with Columbia Asia as GM for the group’s Pune unit. In his previous years, he has worked in various capacities in Wockhardt Hospitals, Fortis Hospitals and Nova Specialty hospitals.

His stint in Dubai in VPS healthcare gave him an exposure of the industry outside India. He has done his MBBS from Govt Medical College, Aurangabad, Maharashtra, along with MBA from IBMR, Pune, Green Belt Six Sigma certification from Benchmark Six Sigma and PGDHHM from Symbiosis Institute of Health Science, Pune.

Unit COO, Jupiter Hospitals

ol SKM Rao, Sr VP-South, Columbia Asia, has joined as COO of Pune unit of Jupiter Hospitals Group. His primary role is to manage the group’s 440-bed state-of-the-art hospital in Pune that comes with high-end centres for cancer and liver transplantation. Subsequently, he would also look after the group’s two upcoming projects- which are still in the planning stage. In Columbia Asia, Col Rao was handling

five units of Columbia Asia- four in Bengaluru and one in Mysuru. He joined CA as GM or centre head of Yeshwanthpur branch in Bengaluru in 2010 and later moved to Pune as the centre head. He has also worked as COO of Aster DM Healthcare, Qatar. Col Rao has over three decade of managerial experience in healthcare, including 25 years in the Indian army.

HEALTHCARE RADIUS | NOVEMBER 2017

COVER STORY

Accelerated growth Dr Abhinay Bollineni, Director, KIMS Hospitals, on the groupâ&#x20AC;&#x2122;s expanding footprints BY RITA DUTTA

Krishna Institute of Medical Sciences (KIMS) has a network of hospitals spread over Andhra Pradesh and Telangana. Now, it is slated to acquire hospitals outside the twin states

NOVEMBER 2017 | HEALTHCARE RADIUS

COVER STORY

KIMS is slated to acquire a slew of projects. One of them is a hospital in Indore. Please share details. Yes, we have been looking at a hospital project in Indore for some time. We get a high footfall of patients from Indore and thus wanted to tap that market. We are in the process of signing a JV deal to acquire stake in a 180-bed hospital on the AB Road. I can’t disclose the name of the hospital at this juncture. This hospital is spread over 1,40,000 square feet and has been founded by a group of doctors. It was started around two years back. How do you plan to re-launch the hospital? We plan to enhance management bandwidth, expand scope of services and also invest in new technology and infrastructural gaps. We also plan to introduce new facilities like endoscopic ultrasound and robotic surgery for gastro, gynaecology, urology and oncology. We will further scale up the number of beds All our projects in Madhya Pradesh would now be in association with this group. KIMS also had plans to start a Greenfield project in Indore. Any progress? Yes, around 5 km, from the hospital we are

set to acquire, we have taken a land measuring 75,000 square feet on a long-term lease. We have plans to build a Greenfield hospital focusing on oncology and organ transplantation. This would be a 200-bed hospital, but would have 100 beds to begin with. It would be spread over 1.5 lakh square feet. . You recently started another hospital at Ongole in AP? Yes, we have acquired 100% stake in Aarogya Hospital at Ongole in Andhra Pradesh. This hospital, started by a group of doctors, had been shutdown for six months before we took over. This is a 350-bed hospital with an in-built area of 2.5 lakh square feet. This is the first corporate hospital in Ongole. So how did you re-vamp the hospital? We did not have to invest in the technology, as it was way superior to the market demands. We only needed to invest in getting the clinical acumen and management bandwidth. Market buzz is that KIMS is also in talks with Icon Krishi Hospital. Is it true? Yes, we are entering a JV with Icon Krishi Hospital in Vizag. The 250-bed hospital would be re-branded as ‘KIMS Icon’, a unit of Krishi Ikon Healthcare. We plan to expand

1. The group has recently acquired 100% stake in Aarogya Hospital at Ongole in Andhra Pradesh.

HEALTHCARE RADIUS | NOVEMBER 2017

COVER STORY

2. KIMS is entering into a JV with Icon Krishi Hospital in Vizag.

the scope of services being offered today by adding more specialities such oncology and organ transplantation

is a huge demand for healthcare services in that area. With Vizag, we will add another facility to the costal belt.

Why this sudden impetus on oncology and organ transplantation? We want to position our hospitals as providing comprehensive multi speciality services. However, except Secunderabad facility of ours, none of the hospitals offer oncology and organ transplantation. So introducing oncology and organ transplantation in all projects would enhance our range of services.

What about your plans for eastern India? We have been scouting for a project in Guwahati for some time. But, most importantly, we have signed a PPP with the Government of Odisha to build a network of hospital and PHCs in Bhubaneswar. On the Government land measuring 5 acres, we are building a tertiary care hospital and four PHCs. The project would be operational after 18 months. As per the agreement, we have to reserve a certain percentage of beds for the BPL and Government scheme patients. The investment for the project as well as the management is by KIMS Hospitals

In terms of geographic spread, where would the focus be for KIMS? We are the largest organised private healthcare provider in the coastal belt. Besides AP and Telangana, our focus would also be on central and eastern India. That is an under-served area. We intend all our future projects to be multi specialty hospitals with a bed strength ranging from 200 to 250. In AP-Telangana, now we have our presence in Secunderabad, Kondapur, Nellore, Rajahmundry, Ongole and Srikakulam. There

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What about your plans for IPO? We continuously evaluate our fund raising options and will discuss at an appropriate time. You had plans to start a Greenfield in Vijayawada and another project in Dilkush Nagar. Any progress?

COVER STORY

3 Yes, we are still interested in both the projects as they strengthen our footprints in our present market. But nothing interesting has come up so far. What criteria you look at before zeroing in on an acquisition project? We look at the available medical talent,

whether the infrastructure is scalable, as well as the paying capacity and the patient catchment area. You had plans of foraying into diagnostics, pharmacy and medical supply... We would look into that as and when the opportunity comes. Right now, we are focused on hospitals.

3. The groupâ&#x20AC;&#x2122;s flagship hospital in Secunderabad.

HEALTHCARE RADIUS | NOVEMBER 2017

COVER STORY

4 THE GROUP’S PRESENCE • Secunderabad - 900 beds • Kondapur -150 beds • Nellore -225 beds • Rajahmundry - 150 beds • Srikakulam -175-beds • Ongole - 350 beds

What difference has your present investor, ICICI Venture, made, after investing in 2014? They help the company make strategic decision and bring in a lot of cross industry expertise in running organisation as the ICICI group is a very large organisation.

4. KIMS has recently added 80 beds in its Kondapur unit.

KIMS is a family-run entity. Do we see a professional CEO in the coming years? Many of our family members are a part of the management of KIMS Hospitals and they have been managing the hospitals for the last 15 years. One our biggest strength

NOVEMBER 2017 | HEALTHCARE RADIUS

and success has been our dedicated family members and professionals. After having tapped all members of the family interested in healthcare, we intend to build a management team by bringing in more professionals as an when needed. But we already have professional CXOs, like group CFO and group CIO. Now we are in the process of hiring a CHRO from the corporate world. If we hire more CXOs from the corporate word, what would be my role? I would be out of job! What about expansion of the existing projects? We have recently added 80 beds in Kondapur, 25 beds more in our mother and child hospital again at Kondapur. In Rajahmundry, we intend to add another 250 beds in a project that is 1 kilometre away from our existing hospital. In a few years, we aim to add another 2,000 beds.

STRATEGY

A digital approach Digitalisation and standardisation of practices can bring about significant changes in the claims exchange process BY MUNISH DAGA

s the state and central governments strive towards making healthcare affordable, the Indian healthcare industry is transitioning to innovate and introduce best practices using technology to provide basic healthcare access to all citizens. The sector is also having the potential to leverage technology to bring in standardisation, create efficient delivery systems thus ensuring reach, growth, and profitability. With this approach, technology can be used to address problem areas across various levels of the healthcare delivery process.

The Consumer Problem As health insurance serves a crucial healthcare need, meeting the policyholderâ&#x20AC;&#x2122;s expectations in terms of product and service is crucial. The current scenario, however, is far from ideal. To start with, the unavailability of unbiased information while purchasing a policy and lack of awareness about utilisation guidelines, cashless policies has crippled the adoption of policies in India. Secondly, once a patient is admitted, the lack of transparency of the health insurance approval and reimbursement process leads to an unsavoury hospital

1. Lack of transparency of the health insurance approval and reimbursement process leads to an unsavoury hospital experience.

HEALTHCARE RADIUS | NOVEMBER 2017

STRATEGY

2 experience. Thirdly, the current process of information exchange between hospitals and payers is also prone to errors, back and forth between insurance desks that result in longer turnaround times, where customer service too suffers.

2. The current process of information exchange between hospitals and payers is also prone to errors.

Link the Hospital The volume and scale at which insurance desks in hospitals process health insurance claims daily justifies the need for a streamlined and simplified approach to claims processing that ensures a hasslefree experience for the hospital as well as the patient. Common problems faced by hospitals include â&#x20AC;&#x201C; long waiting time after the discharge in case of cashless insurance, back and forth between the insurance desk and the payer and answering continuous queries about policy approval status from relatives due to the lack of transparency in the whole process. Additionally, while hospitals are dealing with multiple insurers to process patient claims, the information exchange process is still manual, time consuming and prone to error.

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Primary and Secondary Healthcare Several experts in the industry suggest that going forward, the industryâ&#x20AC;&#x2122;s agenda must expand its focus to include an outpatient health insurance cover to enable the utilisation of primary and secondary healthcare, synonymous to the tertiary services that are currently being provided. Fewer than 2.50% of patients in any given year need hospital-based care, which implies that 97.5% of all conditions would need to be dealt with at the primary-care level. (Mor & Kalita, 2014). Justifiably, there is a need to invest considerably in primary level healthcare within a framework that averts patients from hospital-based care unless required. Since the primary and secondary healthcare providers cater a customer base much larger than that of the hospitals, handling traffic on such a large scale would require a network of primary health facilities that are adequately staffed, skilled and supported along with a reliable logistical support system on a strong technology framework. Certainly, given the challenge and need, upon this day and age, a technological framework that can support such a large volume of transactions for real-time response is one that is completely automated. The Role of Technology The aim must be to develop an active interdependent relationship with technology as opposed to complete dependency. This relationship will serve the needs of all stakeholders, while also improving efficiency, transparency, and delivery of resources. Similarly, across the key challenges and issues elaborated on earlier, digitalisation and standardisation of practices can bring about significant changes in the claims exchange process: A. For the consumer and the hospital: For a better way of delivering health insurance, a technology framework should be

STRATEGY

implemented which brings the provider and the payer into a single platform to exchange claims electronically hence enabling quicker processing of claims data. Automation in terms of providing messages and emails about claim status to the policy holder would result in transparency. From a hospitalâ&#x20AC;&#x2122;s perspective, electronic data gathered from the claims exchange process will help them view monthly transactions, identify trends, and streamline financial data that can be analysed on a large scale. On a public level, health insurance data can be used to identify healthcare trends â&#x20AC;&#x201C; age groups when individuals are being diagnosed with diabetes, frequency of diseases by geography, etc. With relevant data, predictive analysis is a great way to work on solutions that can benefit coming generations. B. For outpatient health insurance: Delivering primary healthcare to consumers without a digitised technology framework is difficult. A patient visiting a physician for fever cannot wait for the payer to approve eligibility and adjudication on email. A comprehensive healthcare policy linked with a database such as AADHAR can be a way to deliver outpatient schemes. To elaborate on how it would work - the patient walks in to the clinic, produces the ADHAAR ID, the physician enters the ID for eligibility, selects the ailment from a dropdown menu, administers treatment, clicks the button, the amount is deducted from the sum insured. Similarly, the pharmacy and the diagnostic centre can also be linked on this platform where reports are shared digitally, medicines can be ordered through the platform and delivered home. Technology also opens possibilities such as appointment scheduling, effective grievance redressal, and case record maintenance from the primary care level. With

3 technology, we have a better chance at reaching out to a larger populace, especially those in need. With technology, we have a better chance at simplification. What Lies Ahead The health insurance sector should make much more progress towards becoming more electronic based. In an age where financial payments such as income tax returns filings, paying taxes, statutory documents such as Form 16, TDS deduction forms are all paperless, health insurance claim transactions still require a lot of paper. We must work towards enabling a technology platform and standard where this need is reduced significantly if not eliminated. We as an industry must collaborate to make that happen because without the aggressive adoption of technology, best practices and creation of standards rapid progress is difficult.

Munish Daga is CEO of Remedinet Technologies.

3. Health insurance claim transactions still require a lot of paper work.

HEALTHCARE RADIUS | NOVEMBER 2017

CONSUMER CONNECT

Redefining value in CT Your dream is diagnostic confidence. The cost-effective Access CT makes that dream attainable "Philips Access CT is providing us radiation reduction with the iDose4 with which the radiation is decreased but the image quality is not hampered. We have the 70 KVP protocols which offer the lower dose but without compromising the image quality for paediatric and infants. We have the 1024 metrics, which gives us the higher image resolution especially for smaller and minute organs." - Dr Vanita Gupta, Consultant, Radiology, Ivy Hospitals, Chandigarh

s healthcare needs grow across the globe, many healthcare organisations are increasingly challenged to efficiently diagnose and treat a greater number of patients. Health providers looking to enhance their CT capabilities may be faced with challenges such as patient populations with low ability to pay, or inefficiencies related to growth and expansion. For healthcare organisations, a valuefocused CT solution such as the Philips Access CT offers the low total cost of ownership and diagnostic confidence needed to drive clinical, financial and operational efficiencies. Built with smaller, rural and community hospitals in mind who are often times buying their first or second system, Access CT offers an attractive TCO while bringing the image quality needed to do routine head and body imaging. Coupled with Philips legendary remote service and tube reliability, Access CT takes the worry out of purchasing and operating a CT scanner. Finally, by using proven Philips technology, Access CT delivers excellent image quality at low dose through iDose4 and allows hospitals to stretch their clinical capabilities from routine imaging to more advanced applications such as brain perfusion, lung nodule analysis, vessel analysis and virtual CTC. Philips Access CT provides consistent image quality across a diverse patient population and a wide range of exam types, enabling healthcare organisations to expand care capabilities to treat more patients. Philips Access CT is equipped with a 3.5MHU tube and equivalent 56kW generator, 0.75s fast rota-

NOVEMBER 2017 | HEALTHCARE RADIUS

tion speed and industry leading iDose4 technology. Philips Access CT provides a number of benefits for physicians and organisations to realise true value from their CT investment, including: Increased referrals – The iFlow console workflow platform enables consistently high image quality through features that simplify and automate the technologist’s routine, helping providers to maintain and increase their referral base. Lowering operating costs – Philips’ iDose4 reduces the need for tube replacement—the most significant reoccurring cost associated with CT ownership—by offering a proven reconstruction algorithm that allows providers to reduce exposure time (mA) and extend tube life. Greater clinical breadth – Advanced applications on the console allow hospitals to stretch their clinical capabilities from routine imaging to more advanced applications such as brain perfusion, lung nodule analysis, vessel analysis and virtual colonoscopy (CTC), while keeping costs down. Dose management – 70 kV scan mode can reduce dose by up to 20%, which is especially valuable in paediatric patients. Maximum uptime - Philips’ 24/7 monitoring can predict issues before they arise, ensuring that providers can minimise downtime and maximise patient throughput. We’ve taken proven, advanced Philips technologies and put them into Access CT for enhanced diagnostic confidence and clinical outcomes.

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CONSUMER CONNECT

Easy, affordable upgrade to DR This system equips facilities to convert roombased or mobile imaging systems to DR through use of a wireless tablet PC This system uses a virtual access point in the DRX detector to manage image capture and display images on the tablet. The tablet PC is self-powered and rechargeable. It has a 12-inch touch screen and weighs just 3.6 pounds.

NOVEMBER 2017 | HEALTHCARE RADIUS

arestream Health makes converting to DR easy and affordable with the launch of its CARESTREAM DRX-Transportable System/Lite. This system equips facilities to convert room-based or mobile imaging systems to DR through use of a wireless tablet PC that gives users complete control of the X-ray system and displays diagnostic images as they are acquired. Control from the wireless tablet eliminates the need to interface with a generator and use a cable connection, which delivers exceptional flexibility and saves both time and money. An access point in the detector communicates with the access point in the tablet to create a flexible solution that enhances workflow. This new system is available in the United States, Canada, Europe and selected countries around the world. It will be displayed at the Radiological Society of North America meeting. “The ability to quickly and easily convert CR systems to DR with the use of Carestream’s wireless tablet offers dramatic advantages for healthcare providers,” said Sarah Verna, Carestream’s Global Marketing Manager for X-ray Solutions, adding, “The lightweight wireless tablet equips users to capture DR exams from any room-based or mobile imaging system while moving freely throughout the radiology department and the hospital.” This system uses a virtual access point in the DRX detector to manage image capture and display images on the tablet. The tablet PC is self-powered and rechargeable. It has a 12-inch touch screen and weighs just 3.6 pounds.

READ THE LATEST MEDICAL TOURISM INDIA HANDBOOK 2017 EDITION BY HEALTHCARE RADIUS MAGAZINE

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Published by ITP Media (India)

CARE CONTINOUS: STEPS TAKEN BY HOSPITALS FOR POST OPERATIVE MANAGEMENT OF MEDICAL TOURISM PATIENT

CARE CONTINUOUS

SPECIAL EVENT FEATURE

STEPS TAKEN BY HOSPITALS FOR POST OPERATIVE MANAGEMENT OF MEDICAL TOURISM PATIENTS

Top Reads of this Edition: • Oncology Medical Tourism • Medical Tourism beyond borders • India shining or fading • Choosing a medical assistance company • Emerging markets • Creating a strategic advantage • Strategies to tap new markets • Advantage stem cell therapy • Advantage Healthcare India 2017 – Show preview • Impact of price regulations • Shifting Sands

Reach us @ tushar.kanchan@itp.com | M-98214595952

Also featured in this edition:  Kovai Medical Center and Hospital: A medical pioneer  Regen Ortho Sport India: Advanced orthopaedic stem cell procedures  Wockhardt Hospitals: Life wins always  SIMS Hospital: A heaven for technology  Jaslok Hospital: A transplant hub  Sharp Sight: Eyeing Quality  Continental Hospital: A new lease of life  Digestive Health Clinic: Destination for Bariatric surgery in India  SPS Hospital: Achieving Medical milestones  Cytecare Cancer Hospital: Combating cancer

EVENT

Promoting India as a MVT hub A premier India healthcare portal in three foreign languages was launched during Advantage Healthcare India 2017 BY TEAM HR

A 1. Over 70 countries and 700 hosted buyers from across the world participated in the event.

dvantage Healthcare India 2017, the third global summit on medical value travel (medical tourism) jointly organised by FICCI; Dept. of Commerce, Ministry of Commerce & Industry, Government of India; and Service Export Promotion Council (SEPC), was conducted in the presence of thousands of delegates and the who’s who of the Indian healthcare industry. The three-day event was meant to promote India as a premier global healthcare destination and enable streamlined exports of healthcare services. Over 70 countries and 700 hosted buyers from across the world participated along with thousands of business visitors from India and abroad. A FICCI – Quintiles IMS knowledge paper on ‘Medical Tourism in India’ was released during the event, highlighting the progress made to ensure the ac-

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celerated growth of MVT in the country and the way forward. The Ministry of Commerce and Industry, Government of India, along with SEPC a launched a healthcare portal www.indiahealthcaretourism.com in three languages – Arabic, Russian and French, which provides comprehensive information to medical travelers. Welcoming the delegates, Gaurav Gupta, Principal Secretary, Department of IT, Biotechnology & Tourism, Government of Karnataka, said, “Karnataka holds immense potential in wellness and medical tourism. Bengaluru, Mysuru and Mangalore have some of the best hospitals in Asia, while Udipi, Gokarna, Mysore and Bijapur have developed as wellness destinations. The state boasts of direct connectivity with world capitals, Eastern healthcare wisdom and expertise in Western medicine. There

EVENT

are 19 NABH accredited hospitals in Bengaluru alone. Karnataka is home to 56 medical colleges and offers the highest number of MBBS seats in India. Considering this, we are shortly going to come out with a medical and wellness tourism policy for Karnataka. It proposes to set up a marketing fund for promoting the state as a MVT destination and give financial assistance to entrepreneurs for wellness tourism.” Dr Shalini Rajneesh, Principal Secretary, Health & Family Welfare, Government of Karnataka, added, “In Karnataka, we have the best of natural ambience for good health and it can cure worst of illnesses. The Government of Karnataka is the first in the country to bring out an integrated health policy, trying to integrate allopathy with AYUSH. Karnataka is well positioned to benefit from the MVT opportunity. It has 26,000 modern clinics and hospitals in the private sector, in addition to 40,000 AYUSH practitioners. We also have 30,000 traditional healers who, though not well known globally, have as many foreign clients as Indian ones! They have effectively provided healing to thousands of people worldwide which has been effective in cases where Allopathy has no answer.” In her inaugural address, Rita Teaotia, Secretary, Dept of Commerce, Ministry of Commerce and Industry, Government of India, said, “MVT is a win-win for patients and providers – it creates jobs and encourages interchange of cultures across borders while fulfilling healthcare needs of people. As the focus on medical tourism shifts to Asia, India has emerged as one of the fastest growing markets. The size of the Indian MVT industry is currently $3 billion, but the scale of the entire Indian healthcare industry is $ 110 billion.” Said Satyajeet Rajan, Director General, Ministry of Tourism, Government of India, “Some interventions by the Ministry of Tourism to facilitate MVT to India have been pathbreaking, such as the introduction of e-medical visas ranging from 60 days to 6 months and doing away with the require-

2 ment for foreign patients to report to FRROs. We are going to set up six facilitation centres in Bengaluru, Chennai, Hyderabad, Kolkata, Delhi, and Goa by January next year to cater to medical tourists. We are also focusing on promoting homestays for medical tourists to bring down their cost of stay in India. I congratulate the Karnataka Government for its medical and wellness tourism policy. We will also like to bring out a similar policy at the Central Government level next year.” MVT has emerged as one of the fastest growing segments of Indian tourism industry. According to a FICCI-IMS report,over 5,00,000 foreign patients seek treatment in India each year, making the country a key medical tourism destination in Asia. However, coordinated efforts are required by key stakeholders to turn India into 'the provider to the world' and accelerate MVT growth from the existing 15% to 25%. Foreign patients mostly come to India for heart surgery, knee transplant, cosmetic surgery and dental care, as the cost of treatment here is considered the lowest in Asia, much lower than Thailand, Indonesia, Singapore and Hong Kong. Several panel discussions took place at the summit, with more than 40 speakers sharing their views on themes like AYUSH: the Indian system of medicine for healing and rejuvenation; Clinical excellence in medical care: destination India; Leveraging technology for diagnosis, treatment and after care; Karnataka: an emerging destination for medical value travel; health insurance-a key enabler for tertiary care.

2. The release of QuintilesIMS knowledge paper on medical tourism in India.

HEALTHCARE RADIUS | NOVEMBER 2017

INFRASTRUCTURE

A patient-centric hospital A 100-bed comprehensive oncology hospital is coming up in Nagpur BY TEAM HR

1. The hospital would cater to the Vidharbha region of Maharashtra, eastern MP and southern Chhattisgarh.

agpur, the third largest city in the state of Maharashtra, is slated to witness the commissioning of a comprehensive oncology hospital in the month of December. The 100-bed hospital, located at MIDC, Hingna Road, is a joint venture between American Oncology Institute (AOI) and the Cure All Group, promoted by the Nangia Family- a prominent business family of Nagpur that owns a super specialty and radiation therapy centre in the same city. The Greenfield hospital, built ground up, is known as ‘American Oncology Institute at Nangia Specialty Hospital’. Says Dr Lloyd Nazareth, Group CEO, AOI, “The hospital

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will serve almost 25 million patients from the Vidharbha region of Maharashtra, eastern Madhya Pradesh and southern Chhattisgarh regions.” The hospital will provide a comprehensive range of cancer services with surgical oncology, medical oncology, haemato-oncology, BMT and full range of cancer diagnostics. The hospital would also offer oncology-related specialties like surgical and medical GI, urology and ENT. The investment for the project is Rs 90 crore project, of which the Nangias are investing on the infrastructure while AOI is investing on the equipment. "AOI would fully operate the facility," says Dr Lloyd. What was the brief given to the architect

INFRASTRUCTURE

and interior designer for the project? Says Rajesh Sivan, Head of projects, AOI, “We wanted to design a hospital which is patient centric, aesthetic and serves the need for the local community. We wanted the hospital to be technically advanced, take care of the future needs, as well as focus on academics and hence should have adequate space allocated for meetings, conferences and library.” The facility will focus on AOI’s USPswhich is protocol-driven care, centralised treatment planning for radiation and participation in international tumour board for complex case discussion and cloudbased EMR. Design of Various Areas Lobby - It has been designed as a double height air conditioned lobby to create a more spacious ambience and warmth to the patients. OPD waiting area - The OPDs are located on the first floor with adequate waiting space and overlooking the double height lobby space. A centralised OPD reception takes care of the patient billing and queue system. Diagnostic wing - The diagnostic wing is on the first floor in conjunction with the OPDs for an easier patient movement. The section houses the PET CT, MRI, ultrasound, Mam-

mogram room and the X-ray. The diagnostic wing has an adequate waiting space and a reception and a billing desk. Types of rooms - The in-patient rooms are on the upper floors and have a good mix of single rooms, twin sharing and triple bed rooms. All rooms are air conditioned with adequate space for attendants to stay in the room along with the patients. “The rooms are aptly designed for a clear demarcation between the care givers area and the patient areas. Dedicated toilets in each room are aesthetically designed with proper patient safety norms and a nurse call system,” says Sivan. OTs - The hospital has three state-of-theart OTs with the OT complex having support areas like the pre and post op area, CSSD, doctors and nurses lounges, sterile supply stores, etc. Cafeteria - A large kitchen supports the entire hospital for the needs of the patients, relatives and the staff. A dining area and a cafeteria with a cold pantry are on the ground floor which can accommodate around 80 people. Types of Flooring and Glass There are different types of flooring used in the hospital like the vinyls, ceramic tiles, marbles, Kotah stone, etc. These are used keeping in view of patient safety and

Dr Lloyd Nazareth, Group CEO, AOI

2. Locally available flooring materials and outage construction materials have been used.

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INFRASTRUCTURE

3 AT A GLANCE Name of the project: American Oncology Institute at Nangia Specialty Hospital

Rajesh Sivan, Head of projects, AOI

3. Warm and soothing colours have been used.

Promoted by: The property has been built by the Nangia Family. AOI will operate it Approx cost of the project: Around Rs 90 crore Total bed strength: 100 in-patient beds Operational bed strength: 100 beds Duration of the project: 18 months Date of commissioning of the project: By December 2017 In built area: Approximately 115k square feet Land area: 3,150 sq metres False Ceiling/Roofing: Mineral fibre and gypsum Use of drywalls: Yes, Gypsum Type of paints: VOC-free paints Architect: Chaney Architects Pune (all interiors, RCC and MEP are under M/s Chaney Architects)

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aesthetics of the place. A lot of thought has been given while designing and specifying the flooring material especially keeping the patient safety in mind. Glass had been used carefully in areas where patient movement is minimum but also gives more light into the areas and makes the internal spaces look brighter. Use of Green Building Methods The fenestrations are designed with a shading skin to reduce the heat load into the building, thus giving an efficient HVAC system. Locally available flooring materials and outage construction materials have been used. Soothing Colours Warm and soothing colours are used across all floors with splash of brighter tones on accent walls. â&#x20AC;&#x153;Only VOC-free paints are used in the entire hospital. Anti fungal paints are used in sterile clinical areas,â&#x20AC;? says Sivan.

OPINION

Regulation impact Hospitals, which generated higher percentage of their revenue through cardiology, have been severely impacted BY RATAN JALAN

egulation in pricing of stents and implants in the recent past has had a dramatic impact. It has resulted in average drop in price for procedures such as angioplasty and joint replacement, particularly for large hospitals, in the range of 15-30%. Other than issuing specific instructions about the pricing for certain consumables to be followed by hospitals, the authorities had issued further instructions cautioning hospitals not to charge any additional amount through ‘innovative’ heads as was done by a few immediately after the price control. TPAs, on the other hand, continue to put pressure on hospitals for further reduction. Since a high percentage of profit for a large hospital typically is on account of margins on materials, such a substantial drop in price and almost complete erosion of margins on the specified items has had significant adverse impact on a hospital’s margin. Margins available to hospitals on account of stents in the earlier scenario were a lot more generous than what was possible for implants. To that extent, hospitals, which generated higher percentage of their revenue through cardiology, have been severely impacted. Hospitals, which served relatively larger proportion of lower income groups or insured patients, may have got impacted a little less. However, the price drop hasn’t had any positive impact on volumes. To offset the

impact, hospitals have adopted a number of measures. Most of the hospitals have increased the price of different components including bed charges and most of the other services by about 5 – 15% to offset some of the losses. Such a price increase has been done across all the specialties, not just cardiology or orthopaedics. To a limited extent, the hospitals have also managed to offset some of the loss through higher billing on account of ‘out of package’ items. Pressure on margins led to hospitals aggressively exploring means to reduce materials wastage through rigorous monitoring of ‘bill of materials’ for different procedures. A few hospitals have also rationalised brands of a wide range of consumables across different room settings. For example, now what gets used in a ward is different than it is in the ICU or a private room setting. Unfortunately, such a harsh measure by the Government has made a number of MNCs withdraw high-end stents or implants from the market, in the process leaving the patient with a limited choice: relatively lower-quality products. As they say, two wrongs don’t make a right.

Ratan Jalan is the Founder and Principal Consultant of Medium Healthcare Consulting.

1. Many MNCs have withdrawn high-end stents or implants from the market.

HEALTHCARE RADIUS | NOVEMBER 2017

Benefits of cognitive computing

Enterprise automation platforms built on a cognitive computing foundation can help organisations reduce their rising costs BY VENKATESHWARAN ANANTH

s healthcare insurance and healthcare payer organisations witness major changes in their environment, artificial intelligence with cognitive computing abilities holds significant promise for the industry. There are three important challenges for change management initiatives: • Change across multi-variant dimensions (Examples: consumer trends, payment innovations; and disruptor-induced removal of intermediaries from traditional payer models). • Uncertain nature of change (Example: Future of ACA and scope of CMS bundled payment). • Pace of change manifestation (Example: Last-minute CMS guidelines to operationalising ACA members)

1. Cognitive computing, as an emerging paradigm for application development, provides a collaborative platform for the discovery of insights.

Facing Complexities Health insurance organisations are facing significant complexities in their core business entities - product (and benefits), network and medical policy. While the passing of the ACA has had an impact, the

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complexity is also due to consumer-directed health plans or high deductible health plans gaining momentum as a means of involving customers in the cost equation. Payment reconciliation and member engagement aspects were further complicated by health saving accounts. Initiatives to promote bundled payments (MLR mandates, ACO, PCMH and CMS drives) drove the payers to look for comprehensive payment innovations and led to significant carve-outs and special network arrangements to optimise the costs of specific demographics and high-cost procedures. As medical policies are used as guidelines by payer organisations for adjudging the necessity of specific procedures, any significant progress in medical science can put pressure on clinical staff in the UM area in evaluating cases vis-à-vis medical policies and new research. Change Management and Implications While some organisations have begun to transform their traditional IT systems and processes (static business process rules and

well-defined and scheduled release cycles) into the agile shop to meet the fluctuating business demands, the uncertainty around the change and its pace of manifestation constrain IT organisations’ ability to lock step with the business partner and provide adequate support. Cognitive computing, as an emerging paradigm for application development, provides a collaborative platform for the discovery of insights. AI has Evolved Cognitive computing simulates human thought processes by integrating components from various AI disciplines including: • Machine learning which automates analytical model building and uses statistical analysis to find insights from data. • Natural language processing which enables computers to analyse contextdependent human language. • Deep learning which recognises complex patters like images and sounds using artificial neural networks. Cognitive Computing Holds Promise Changes in population demography, pressures of cost inflation, consumer-directed defined contribution products and expansion of individual mandate have significantly affected the healthcare payer industry. Payer organisations continue to look for opportunities to reduce costs while improving the overall quality of clinical and administrative faculties as mandated by MLR and STAR. Cognitive computing can manifest benefits including: • Automating repetitive tasks. • Providing richer context through data assimilation for better decision making or consumer engagement. • Leveraging big data to improve customer service. The time is ripe for organisations to leverage the evolution of AI and cognitive computing for enterprise strategy. Payer organisations can automate routine maintenance costs of IT systems and get deeper

2 insights on ticket data, understand the root cause behind the L1 tickets and help either eliminate the need for L2 and L3 or automatically service the L2 and L3 tickets. For example, payer organisations with multiple enrollment and billing systems can automate tasks that currently require manual reconciliation, such as tickets raised by the help desk during open enrollment. Enterprise automation platforms built on a cognitive computing foundation can help organisations reduce their rising costs of enterprise security through a dynamic approach to identifying these patterns, analysing the root causes, a growing knowledge base of vulnerabilities, and performing automatic fixes. Managing Business Operations Business operations functions span across sales and quote to ID cards, pre-authorisation and claims payment in the healthcare payer ecosystem. Healthcare operations have significantly seasonal workload characteristics. Government business typically sees increased activity during open enrollment period (October – January) while commercial business sees spikes in activity during January and July when a larger number of clients renew their contracts. During the peak season, business operations teams of-

2. Cognitive platforms enable customer service operations by delivering integrated experiences and robotic automation.

HEALTHCARE RADIUS | NOVEMBER 2017

3 ten have to hire temporary augmented staff. Managing costs without affecting quality becomes the primary focus for the operational organisations during this period. Enterprise automation through cognitive computing platforms can help organisations in: • Deployment of robots to perform routing activities. • Leveraging natural language processing to steer call volumes to digital agent support. • Enable quicker decision making for business operators by improving the quality and presentation of data.

3. Cognitive computing platforms can enable organisations to deploy AI capabilities in the form of machine learning, deep learning and NLP.

Providing Integrated Experiences Cognitive platforms enable customer service operations by delivering integrated experiences and robotic automation. Key features of the platform include: • Unified dashboard that aggregates information from disparate systems. • Non-intrusive product that intelligently monitors user device activity and application usage. • Robotic automation of repetitive tasks, transactions and processes. • Intelligent context-based routing to the right experts. Digital Agents for Customer Service Cognitive computing platforms can enable

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organisations to deploy AI capabilities in the form of machine learning, deep learning and NLP to amplify the cognitive capabilities of the end business users. Many healthcare organisations are in the process of transforming their customer service centres to customer engagement centres. Cognitive platforms can act as virtual digital agents and create a uniform experience across IVR, chat or other mobile devices like iWatch by leveraging its NLP and machine learning capability to translate messages to and from a format that can be consumed by the machine learning analytics layer. Some relevant use cases of cognitive computing for healthcare: 1. Improving auto adjudication rate: Can improve AA rate, reduce operations costs based on the health plan’s current adjudication throughput and avoid manual involvement – can predict, prevent and automate resolution of complex pending claims through advanced analytics and machine learning techniques. 2. Contact centre optimisation: Easy-to-use interface for queries and benefits information – Can ingest thousands of member contacts and provide natural language search and support for contact centre representatives. 3. Conversational AI Chatbots – To receive, look up and respond to typical member and provider queries through conversational AI- enabled cloud and situated devices. From enabling the flexibility to deal with payer complexities and changing market demands, automating repetitive processes and providing strategic insights, cognitive computing and AI can significantly aid healthcare organisations meet challenges in the change management.

Venkateshwaran Ananth is Vice President – Healthcare with Infosys.

FINANCE

Impetus on cost control The cost of our healthcare is getting out of control BY D V SIVARAM

he Indian healthcare system comprises physicians, hospitals, pharmaceutical companies, medical devices, clinical trials, telemedicine, health insurance, medical equipment and medical tourism to name a few. The Indian healthcare sector is growing at a tremendous pace due to the ever increasing demand resulting from increase in standards of living and increased expenditure from both public and private sector. Deloitte Touche Tohmatsu India has predicted that the Indian healthcare market, which is worth around $ 100 billion, will likely grow at a CAGR of 23% to $ 280 billion

by 2020. The revenue of Indiaâ&#x20AC;&#x2122;s corporate healthcare sector is estimated to grow at 15% in FY 2017-18. Cost control 'Cost control' in the current healthcare system is very important for the growth and development of industry and the economy as a whole. At present, the cost of our healthcare is getting out of control and it is very important for the government to intervene and take quick remedial action. If the healthcare costs continue to spiral upward and drugs and devices become increasingly unaffordable, it will not only contribute to

1. Majority of Indian healthcare industry is not using any kind of analytics to identify and address the loopholes in the system.

HEALTHCARE RADIUS | NOVEMBER 2017

FINANCE

2 inflation but create unrest and imbalance in the society. There will be pressure on the Government to provide affordable access to drugs, devices and healthcare by bringing in various incentives which will promote a subsidised economy. As such, it is very essential to control the cost of healthcare.

2. All the stake holders within the healthcare space have a role to play in reducing costs.

Challenges to Cost Control Lack of ownership: The entire public sector and the private sector (especially the so called professionally managed companies where direct day-to-day supervision is missing from the promoters) and also the PPP (Private Public Participation) is suffering due to lack of ownership from top to bottom across all functions resulting in wastage of resources which is the real challenge faced not only by healthcare industry but by every industry in the country. Lack of synergy: Many healthcare establishments, small and medium, are not having synergy in the way they function as they are highly unorganised. The lack of proper supply chain management, lack of trained, skilled and experienced human resources and the ever increasing attrition are creating an imbalance in the system

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resulting in lack of synergy. Lack of scale: The major chunk of Indian healthcare industry consists of individually practicing physicians, small and medium healthcare establishments and these players are not able to achieve the economies of scale due to their size which leads to increase in costs. Lack of analytics: Majority of Indian healthcare industry is not using any kind of analytics to identify and address the loopholes in the system and to understand the customer expectations and to meet them. Lack of proper co-ordination from the Government: The Government due to the practical, economic, and political obstacles is not able to bring in a comprehensive legislation covering all the stake holders in the healthcare system which can make the industry highly organised and effective. Cost of funding: Currently a lot of private equity players are investing in the Indian healthcare industry looking at the great potential of the industry as a whole. But the cost of private equity funding is very high. As a result, very few organisations are actually able to deliver results to these investors. Corrective Steps A. Role of the Government The Government should play a pivotal role by consulting all the stake holders of healthcare industry such as doctors, insurers, pharmaceutical companies, medical equipment manufacturers, business heads of healthcare industry and the consumers, and thereby bring in a comprehensive legislation addressing all the issues of healthcare. The Government of India has already taken several initiatives in this direction. Some of them are: â&#x2122;Ś The Union Cabinet has approved the National Health Policy 2017, which will provide the policy framework for achieving universal health coverage and delivering quality healthcare services to all at an

FINANCE

affordable cost. ♦ AYUSH Ministry is working with various agencies, institutions and Ayurveda researchers and practitioners across the world to turn India into a global hub for knowledge, research, practice and developmental projects on traditional medicines at an affordable cost. ♦ The Government of India plans to set up a single window approval system for innovation in medical research, in order to grant permission/approvals within 30 days from the date of application to Indian innovation projects that have applied for global patent. ♦ The Government of India initiated selective price control on some of the critical components used in the healthcare system ♦ The Union Government encouraging import substitution for all the devises and medical equipment used in the healthcare system by encouraging ‘’make in India’’. ♦ The Government of India encouraging generic medicine in every part of the country which will bring down the healthcare costs substantially. B. Role of Private Sector ♦ Organisations involved in healthcare must accept greater accountability for resource management. Doctors and physicians who hold significant influence on healthcare spending should shoulder greater accountability and ownership and try to bring in reduction in the overall costs by improving the quality of healthcare system. ♦ Physicians should refuse to write prescriptions for a costlier drug when a lower-cost alternative is available. Private sector should play a major role in promoting generic medicines. ♦ Improvement in supply chain management and organising the affairs of the organisation by disseminating objective cost benefit information will help in con-

3 trolling the costs. ♦ Self-regulation within the organisation by inculcating sense of responsibility and ownership across the value chain will lead to containing the wastage of resources and thereby contributes to cost control. All the stakeholders with in the healthcare space have a role to play in reducing costs, but not everyone is equally inclined to do so. So, what is the way out? The complexity of healthcare system and the diverse interests of the various stake holders does not seek simple solutions and hence the solution should be mutually benefitting all the stakeholders of healthcare landscape by recognising the criticality of interdependence. Hence a balancing act with an aim to control the overall cost of the entire healthcare system is what is required from the Government as a co-ordinator.

D V Sivaram is General Manager & Company Secretary with Apollo Health and Lifestyle Limited.

3. Physicians should refuse to write prescriptions for a costlier drug when a lowercost alternative is available.

HEALTHCARE RADIUS | NOVEMBER 2017

ANALYSIS

Recovery in growth?

A 6.3% revenue growth and 17.7% PAT decline YoY with EBITDA margin drop of 370bps is expected BY SRIRAAM RATHI AND VINAY BAFNA

1. A decline in EBITDA margin due to continued pressure on US business and increased R&D spend is expected.

e expect healthcare companies to report recovery in revenue growth for the quarter ended Sep'17. This would be mainly on account of recovery in domestic formulations from negative growth in Q1FY18 which got impacted by GST implementation. However, we expect EBITDA margin decline of 370bps YoY due to continued pressure on US business and increased R&D spend. The margin and PAT decline would be primarily due to substan-

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tial drop in Sun Pharma earnings. Increased competition and pricing pressure would continue to impact growth in US -focussed companies. We expect weak results from: 1) Sun Pharma due to continued pricing pressure in Taro portfolio and FDA issues at Halol plant,. 2) Apollo Hospitals on lower occupancy and losses in Navi Mumbai Hospital. Overall, we expect the companies to report 6.3% revenue growth and 17.7% PAT

ANALYSIS

decline YoY with EBITDA margin drop of 370bps. Some key pointers ♦ India secondary sales: The Indian pharma market witnessed moderate growth, as the industry recovers from restocking post the implementation of GST in July’17, at average 6.2% in value terms during the quarter (source: AWACS). The inventory days have improved from the average of 17 days in Jun’17 to 30 days in Sep’17 indicating recovery. ♦ US generics: We expect Q2FY18 numbers to show moderate growth to decline in US sales. ♦ Factors to watch: The key factors to observe in Q2FY18 numbers and management commentary would be: i) Recovery in domestic business post impact of GST implementation, ii) Update on USFDA issues plaguing several companies, iii) Continued pricing erosion in US business with consolidation of the buyers and increased competition, and iv) Growth in emerging markets after stabilisation of currencies and any working capital issues in these markets.

Top-growing categories (MAT September, 2017): ♦ Anti-infectives and respiratory grew -3.5% and 0.6%, respectively. ♦ Chronic segment continued to drive sales in the markets growing at 10.3% due to cardio vascular (9.7%) and anti-diabetic (17.3%) segments. ♦ Gastro-intestinal and derma grew by 6.1% and 12.7%, respectively, while VMN and Neuro/CNS grew by 5.4% and 6.3% respectively. ♦ Pain/analgesics, anti-neoplastics and gynaec grew by 4.8%, 7.3% and 7.8% YoY. ♦ The urology and blood related segment registered 9.6% and 13.0% growth.

by higher occupancy and expected recovery post GST and impact from regulatory challenges and ii) addition of newer beds, commercialisation of Navi Mumbai Hospital in recent past and losses in AHLL to impact profitability. ♦ Dr Lal Pathlabs: i) Expect growth to return as demonetisation and GST impact wane out and seasonally strong quarter, however ii) high base of last year and higher expenditure towards new labs in Kolkata and Lucknow would impact margins. ♦ Fortis Healthcare: i) Revenue growth would largely be in line with industry growth and ii) PAT increase on is on account of improvement in EBITDA margin due to improving operating leverage and lower tax rate. ♦ Thyrocare Technologies: i) Strong performance led by seasonally good quarter especially in the low value and high volume category, ii) High imaging growth as more centres operationalised however, iii) EBITDA margin to remain largely flattish.

Company-specific Factors ♦ Apollo Hospitals: i) Growth to be driven

Sriraam Rathi and Vinay Bafna are research analysts with ICICI Securities.

2. For Fortis Healthcare, the revenue growth would largely be in line with industry growth.

HEALTHCARE RADIUS | NOVEMBER 2017

MANAGEMENT

Equipment upkeep

The upkeep of equipment deals beyond breakdown maintenance of equipment BY DEEPAK AGARKHED

1. The upkeep of medical equipment is necessary to ensure that patients are diagnosed or treated timely.

he repeated leakages of endoscopes and wrong reading from cell counter units are a few examples of delayed patient clinical service on account of medical equipment. Besides clinical, the impact is on financial revenues for high-end equipment like MRI. The medical technology in hospital has been playing a vital role in patient diagnosis and fast recovery, over the past two decades. The decision of procuring technology is mainly done based on its projected utilisation rate and its criticality to services offered in the hospital. Considering that planned estimated patient load in hospital have the necessary infrastructure and manpower, the maximum uptime of equipment will play an important factor. The upkeep of medical equipment is necessary to ensure that patients are diagnosed or treated timely and discharged in a timely manner. The upkeep of equipment deals beyond breakdown maintenance of equipment. A survey of user feedback and audit of clinical areas was conducted in one of the

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private hospitals to understand the major bottlenecks for keeping the high upkeep of equipment. The result of the study was an eye-opener to the maintenance team as well as to the user of equipment. • For any household appliance purchase, we get operator manual for user group to refer to and understand how to operate. This was missing in most areas and equipment users were not knowing several important features of the equipment. • Unclean equipment surrounding area particularly at the rear side. • Lack of awareness of adverse events related to medical technology when wrongly used both on the patient and the operator. • No proper inventory maintenance and planning by clinical engineering team. • Non maintenance of equipment history reports for critical decision making like spare part procurement and condemnation. Improving the upkeep of equipment is a structured approach which starts right from the equipment planning stage. Proper facility planning where equipment

MANAGEMENT

gets installed should consider environmental conditions needed for equipment like proper temperature and humidity. Other factors like clean electrical power, sound grounding point, space for maintenance and equipment orientation on proper foundation are required. All service providers claim that they have the best product to offer to a hospital. Most often, the hospitals decide on equipment based on quotation provided by the service provider. It may not mention all necessary hardware, software and accessory details including break-up costs and technical data sheet. The right choice of technology is a skillful method to evaluate best among many models available in the market. Unfortunately, as India does not have necessary quality conformance standard for equipment like the US FDA or European CE mark, it is sensible to consider FDA and CE while shortlisting desired medical technology. Proper execution of equipment commission has direct correlation with better upkeep of equipment. It is desirable to check the following details before commissioning of

equipment. Installation qualification (IQ) deals with environment checks, physical checks and system checks related to ordered equipment. Energy source like electrical power are connected and equipment is checked during IQ. Operational qualification (OQ) deals with verification of operation of various modes as per the agreed performance criteria and initial calibration of equipment. Performance qualification (PQ) deals with testing equipment before daily usage on subject, operability, user training and creating standard operating protocols for equipment. It is desirable to check following details after commissioning of equipment: Maintenance qualification (MQ) deals with routine service, maintenance contract including technical support, equipment cleaning and recalibration. The typical method employed in any hospital is segregation of work of operator like technician, nurse and maintenance by clinical engineer. Encouraging the operator to understand and fix minor problems through training by adopting TPM (total productive maintenance) will help improve the uptime

2. Proactive risk mitigation studies will help to improve the standard of equipment care.

HEALTHCARE RADIUS | NOVEMBER 2017

MANAGEMENT

3. Recalibration and quality assurance must not be skipped to avoid inaccurate results from equipment. 4. The hospital should have a methodology to do root cause analysis of all incidents related to medical equipment.

of equipment. The performance qualification checklist usage on a daily basis by the operator and its review by the clinical engineer during daily walk through inspection is a part of good practice of TPM. The planned maintenance frequency should be based on risk factors associated with the equipment. The action of breakdown of equipment should be rapid including procurement of spare parts. Unfortunately, most of the compliant of non-functional equipment are on an account of incomplete knowl-

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edge of equipment usage by the operator. The regular refresher training for old staff and fresh training to new staff will improve the upkeep. The regular upgrading of hardware and software of equipment will ensure that new clinical and safety features are incorporated. With information and communication technology closely interfaced with medical technology, the provision of remote diagnostic maintenance facility for equipment will help to start early problem identification and action before it is noticed by the operator. Care should be taken to address possible virus threats and compromise of patient database. Recalibration and quality assurance must not be skipped to avoid inaccurate results from the equipment. The hospital should develop history cards for equipment, preferably in an electronic way to capture complete details like date of commissioning, details of preventive and breakdown service call logs including replaced spares details. The regular proactive risk mitigation studies like FMEA and audits based on hospital accreditation standards will help to improve the standard of equipment care. The hospital should have a methodology to do root cause analysis of all incidents wherein the medical equipments are involved. The preventive and corrective action plan must be shared to all clinical areas, so that the same type of events are not repeated. Initiatives like 5 S for cleanliness, Kaizen for continuous improvement and Anzen for safety will help hospital to fortify the upkeep of equipment. The organised medical equipment management will not only improve the upkeep of equipment but also reduce the risk of adverse events.

Deepak Agarkhed is General Managerclinical engineering, quality and facility, Sakra World Hospital, Bengaluru.

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