Tansforming us healthcare plan

 Neeraj Mahajan 2009
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An innovative solution for
Affordable & Quality Health & Wellness

“Health of nations can no longer be viewed in isolation, separate from
countries an ocean apart, thriving or decaying based only on what occurs within
national borders. We know that disease and the bugs that cause them are
mobile, and do not recognize the borders they cross. Slave ships carried
mosquitoes and, with them, yellow fever to the New World. SARS made its trip
on a commercial airliner. HIV has transported itself in every way possible. But
today we see that there is another mobile aspect of global health: people and
the services they can offer, as well as people for the services they want.”
-- Dr. Margaret Chan, Director-General, World Health Organization (WHO)
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Though the ultimate dream for any business institution is to expand its
operations and make reasonable profit, in the process… but when the
motivation behind this drive is to improve a country’s healthcare delivery
machinery, ease the pain, save lives and improve the living conditions of the
people craving for standardized & quality Medicare… the whole endeavor
becomes a Noble Cause… That alone is our driving force and life’s mission…
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Dr Narender K Gupta,
MD, FRCP

Dr Gupta is board certified as a Fellow with the Royal College of Physicians & Surgeons
of Canada. He is also an Assistant professor with the Medical College of Ohio. He
actively participates in the latest research in Diabetes Hypertension, Hyperlipidemia and
Obesity. He has been recognized continuously since 1991 by the American Diabetes
Association and the National Committee on Quality Assurance (NCQA) as a provider with
distinction for outstanding Diabetes care.
Dr Gupta was recently elected as one of the 100 national physicians in USA to join the
Vascular Biology Group at the University of Florida to research the multiple effects of
hypertension, high cholesterol and renal dialysis on the blood vessels of the body.
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“Health care includes, but is not limited to preventive, diagnostic, therapeutic,
rehabilitative, maintenance, mental health or palliative care and sale or dispensing of a
drug, device, equipment or other item in accordance with a prescription.”
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 To establish the brand Eternal Health & Wellness Centre as a Globally
reputed medical institution striving for excellence and imparting the Highest
Quality Medicare at Affordable Cost
 To ease the sufferings and pain for the people who need this care in USA &
India
 To positively contribute to strengthen a healthy, prosperous and evergreen
America
 To be known for medical best practices and highest professional standards-
Worldwide
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Objective: Smart, Healthy & Prosperous America and a vibrant World Economy

 Transforming Healthcare
 Prevent and manage chronic diseases
 Help control the rise in health care costs
 Try and bridge the gap between the Have’s and the Have-not's
 Expand healthcare coverage for the long-term uninsured
 Restructure the way in which doctors and hospitals are paid
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More Smiles Per Mile– Across the World

 High-quality healthcare services
 Available and Affordable
 Choice of Premium, Optimum & Budget category facilities & specialists
 On demand Health, Wellness & Medicare at reasonable costs
 Virtual Hospital - 24x7 worldwide
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Smart America = (Healthy + Prosperous America ) x Wellness worldwide

 Health is wealth – literally for everyone from the patients to care givers and the
economy.
 No retakes – Health once lost can be repaired, but nothing is better than the original.
Even God can’t do better than He did first time…
 People worldwide are beginning to take their Health issues very seriously
 Healthcare Today has taken a shift from Facility centric healthcare model to consumer
centric one..
 Empowered consumers are seeking information on the Internet in record numbers
 Dissatisfied consumers are willing to spend their own money to get the care they want
 More & more consumers want to manage their own care and have greater access to
their physicians.
 Physician – Patient relationship is changing rapidly…
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A new health management tool that is:
 Custom made
 Efficient
 Personal
 Password-secure
 Innovative
 Priced transparently
 Flexible
 Improves Quality
 Reduces the cost of service.
 Improves patient access
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On-demand, need-specific Healthcare at the Doorstep of the Consumers

New health management trends that we cannot afford to ignore:
 Empathy-
 Availability 24 x 7 x 365
 Innovative delivery
 Continuous & chain-linked
 Non-exclusive
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Understand the specific needs of the Consumer and give him exactly what
he wants not something you expect him to buy

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No system anywhere in the world, healthcare or otherwise can afford to
ignore the needs of the people for whom it is designed.

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Patients can wait but disease…pain & suffering doesn’t… Also as they say
a stitch in time saves nine…

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Just like justice delayed is justice denied, healthcare delayed is as good
as opportunities lost as nothing damaged in the body can be made to
work better than the original. Even human body’s spare parts are not
easily available…

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Innovation is the key to success…

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Innovation is inevitable…

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The secret of success in business is to find out where
people are going, and to get there first – Mark Twain

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Television, Multi-media, internet and mobile mediums have extended the
reach of the healthcare system directly into the homes of the consumers
so why wait for them to come over.

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It’s the age of fusion and synergic synthesis. Healthcare is no longer
confined to the Doctor’s Clinic
Fusion
Healthcare Communications

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Why wait to inject medicines & drugs later when you can actually inject
disease prevention awareness in people’s lives, much before the infection
spreads?
Inject
Awareness…
if you must…

Bridging the gap between the Doctor’s clinic and the patient’s home…
extending the reach of healthcare

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Health & Wellness does not begin and end with the patient
Patient
Care
Family
Support
Groups
Social
Community
Hospital
Physician
Pre/ Post Op Care
Physiotherapy
Counselling
Meditation
Step by Step Process

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In today’s shrinking and mobile - global village - nothing – not even disease is a
country or persons personal problem.
A disease could originate in the slums of Calcutta but could affect people in New
Delhi or New York by the same evening and become a nightmare for Canada or
China by the weekend.

Are we prepared to face the future?
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 Healthcare in the U.S. is nearly a $1 trillion a year industry and the largest private
sector employer, providing employment to one in every 11 US residents
 Healthcare is 15% of the US economy, expected to reach 19.6 percent of GDP by
2016.
 More money is spent per person on health care in the United States than in any other
nation in the world
 Health care sector provides high-quality jobs that support families and stabilize the
economic foundations of hundreds of communities.
 The health care sector is a significant source of tax revenue for the local and state
economies.
 Due to advances in technology people are living longer and accessing health care
more frequently. As the size of this aging population grows the need for quality
healthcare will grow even more.
 A strong health care sector improves quality of life and helps America attract and
retain businesses and jobs.
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750,000 physicians, 580,000 establishments, 5,200 hospitals- 3.8 million
inpatient and 20 million outpatients daily across 50 states

 The hospital employment multiplier, as calculated by Bureau of
Labor Statistics is approximately 2.5. This means that for every one
hospital job, another 1.5 jobs are created in the surrounding area.
Hospitals represent an excellent alternative investment opportunity
and are likely to spur steady employment growth and help to
improve domestic economies and services. Local citizens will be
inclined to remain in the area, thanks to the improved economy and
available employment opportunities.
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 Personal issue for individuals confronting serious illness in terms of
taking the right decisions and treatment options.
 Clinical issue for healthcare professionals caring for the sick.
 Business issue for employers in terms of large increases in the cost
of healthcare coverage for employees.
 Political issue for the nation’s leaders seeking to address voter
concerns about the cost and quality of healthcare.
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 Access to care
 Quality of care
 Cost of care
 Technology adoption
 Burden on providers
 Shortage of providers
 Margins for providers declining
 Policy Concerns
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Healthcare
consumers
Employers
Hospitals
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Physicians
Pharma
Companies
Insurance
Companies
Government
Diagnostic
Labs
MT &
Billing
companies
All The Participants Must Transform

Healthcare Services
Industry
Microbiological
Testing
Outsourcing
Transcription
Quality
Assurance
Validation
Compliance
Chemical
Analysis,
Other
Services
Medical Equipment
and Supplies
Manufacturing
& selling of
Medical
Ophthalmic
Lab apparatus
Electro
medical
Dental &
Surgical
appliances
Alternative
Medication Industry
Alternate
Medications &
therapies :
Ayurveda
Yoga /
Pranayam
Homeopathy,
Aromatherapy,
Massage therapy
Dietary Supplements
Industry
Vitamins,
Minerals,
Herbs,
Botanicals,
Amino acids,
Whole foods,
Nutraceuticals
Biotechnology
Industry
Pharmaceutical
Industry
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32
1960 1970 1980 1990 2000 2005 2006 2007P 2008P
$28 $75
In billion $

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1960 1970 1980 1990 2000 2005 2006 2007P 2008P 2017P

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But … First Let’s
IDENTIFY
The Problem Areas

Bottlenecks at the Point of Entry
Emergency Department
Wait times
exceeding
six hours
Uninsured
&
Under-
Insured
Capacity
Constraints
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Consumers are forced to interact with facilities focused around the needs of
the Employer, Healthcare Provider, Payer or Supplier
Provider Centric Healthcare

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What the top 50% and bottom 50 % consume ?

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Source: KPMG Healthcare Industry Report 2006

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Source: KPMG Healthcare Industry Report 2006

 High Cost – Hurting the Economy- grown to $2.5 trillion annually. Americans spent
more than $ 2.26 trillion or $7,439 per person on healthcare in 2007 up from $2.1
trillion — i.e. 16.5 percent of gross domestic product (GDP) or $7,026 per person, the
previous year. These costs are expected to increase to $4 trillion and 20 percent of
GDP by 2015.
 Uneven quality - more than 80 percent Americans think the health system needs
complete overhaul— 2008 Harris Interactive poll
 Uneven benefits - 5% of the population accounted for more than half of all costs in
1996.
 Limited access to care – just about 15% of the country’s population
 Uninsured Population- 45-47 million. Approximately 16 % of the U.S. citizens below
age 65 have no health insurance coverage. Sixty-five percent of uninsured families
have incomes less than 200 percent of the federal poverty level (FPL), or about
$37,000 for a family of four. Such families generally cannot afford to buy insurance or
to pay the employee’s share of the cost of employer-sponsored health plans

 Welfare State?- According to the Institute of Medicine of the National Academy of
Sciences, United States is the "only wealthy, industrialized nation that does not ensure
that all citizens have coverage”. About 15.3% or 45.7 million Americans remained
without health insurance coverage during 2007.
 Inequality- The World Health Organization (WHO), in 2000, ranked the U.S. health
care system as the highest in cost, 37th in overall performance, and 72nd in terms of
overall level of health (out of 191 member nations included in the study)
 Lopsided Growth- Growth in spending is projected to average 6.7% annually over the
period 2007 through 2017. Health insurance costs are rising faster than wages or
inflation, and medical causes were cited by about half of bankruptcy filers in the
United States in 2001
 Where does the Dollar go?- Hospitals and physician spending take the largest share
of the health care dollar, while prescription drugs take about 10 percent.
 Administrative Disorder - 18–25% of health care spending is “administrative overhead”
— $500 BILLION in 2008 alone. A study by Harvard Medical School and Canadian
Institute for Health Information determined that some 31% of U.S. healthcare dollars--
more than $1,000 per person per year, went into healthcare administrative costs.
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 Fairly unfair towards the have-not’s- The sum paid to a doctor for a service rendered
to an insured patient is generally less than that paid "out of pocket" by an uninsured
patient. In return for this discount, the insurance company includes the doctor as part
of their "network“. This creates an unfavorable advantage in favor of those who pay
huge premium just to be lowest-cost treatment .
 Systems can but diseases don’t discriminate- Quite a few Americans do not qualify for
government-provided health insurance and there are some who are not provided
health insurance by an employer. There are others who are unable to afford, while
some like those with a pre-existing disease who cannot qualify for insurance cover
due to whatever reasons and in addition to these there are Americans who choose not
to purchase private health insurance. Most of the times such people simply go without
needed medical treatment. This problem is that diseases, virus or pain doesn’t check
a person’s health insurance policy document before making their lives miserable.
They are Americans…They too love America but what is the guarantee that a flu or
disease that attacks them, wouldn’t infect others?
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Does ‘I Love You- America’ mean Live Here Die Elsewhere ?

 High costs- low benefits: United States spends more money on healthcare than any
other country, both in absolute dollars and on a per capita basis – inspite of this life
expectancy and other health indicators are lower than other developed countries.
 Subsidy losses: U.S. spends the most on pharmaceuticals per capita in the world,
despite this drug prices are rising because U.S. consumers are in effect subsidizing
costs which drug companies cannot recover from consumers in other countries
 Harmful Treatment: A study published in The New England Journal of Medicine
indicates that only 55% of the time, Americans receive recommended clinical
treatments and 11 % of the time they receive treatments that may be harmful
 Hidden costs? Personal healthcare costs as a percentage of GDP have risen
steadily since 1960, while the percentage of the cost paid by consumers has
decreased. The truth is that there are so many hidden costs that most Americans do
not know the cost of their healthcare.
 Uneven distribution of healthcare resources: About 5 % consumers use more than
half of total healthcare services while 50% of consumers spend almost nothing at all
 Overhead costs – A study by American Association of Health Plans attributed 22 %
of healthcare costs due to non-clinical issues like government mandates, regulation,
and litigation costs.  Neeraj Mahajan 2009
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 Medical Errors: Even though “to err is to human”, every year 98,000 patients
die due to preventable medical errors in the business process of care,
equivalent to a 747 crashing every day, killing all on board.
 Self inflicted avoidable wounds: The US has 40 percent more MRI machines
and 54 percent more CT scanners per one million people than its OECD
counterparts. Physicians in US order two to eight more scans than the
average physicians elsewhere. 30 to 40 percent of the diagnostic tests being
done are unnecessary or inappropriate. The excess capacity of durable
medical equipment of this nature accounts for about $40 billion additional
expenditure to the US health care system.
 Medical Malpractice: Current estimates set the cost of malpractice at
between 5 and 8 percent of national health expenditures. This includes costs
of insurance, litigation, settlement costs and additional patient care costs.
 Fraud- Almost 10 percent of total healthcare costs
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 In the US about 13,000 individuals are expected to turn 60 each day over
the next 20 years.
 Sharp rise in demand for healthcare services as 78 million Americans enter
the retirement age.
 As people in the US and Europe age the inherent demand for healthcare
continues will continue to grow.
 In specialty areas of cardiology and oncology, hospitals will need to create
greater delivery capability to support these patients. At the same time, this
will be a major catalyst for healthcare costs reaching almost 18% of GDP by
the end of 2008
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 According to recent census data, 47 million – about 16% Americans have no health
insurance, and 120 million are under-insured.
 According to a Commonwealth Fund study underinsurance implies- annual out-of
pocket medical expenses totaling 10% or more of income, 5 percent or more
expenses among adults with incomes below 200% of the federal poverty level, health
plan deductibles equaling or exceeding 5% of income.
 Most uninsured are working-class Americans whose employers do not provide health
insurance, and who either earn too much money to qualify for a local or state
insurance programs for the poor or do not earn enough to cover the cost of a health
insurance plan designed for individuals.
 Nearly 37 million uninsured Americans are adults (age 18-64). More than 27 million
work part time and 38% of uninsured households have incomes of $50,000 or more.
 Such people are more likely to report financial stress because of medical bills, forgo
healthcare, and experience coverage gaps for prescription drugs.
 As the number of those with health savings account (HSA) increases and people have
to take more responsibility for their medical costs, medical tourism could grow even
more.
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 Medical Exodus: A Deloitte consultancy report predicts that the number of Americans
going abroad for treatment will soar from 750,000 last year to 6m by 2010 and reach
10m by 2012. This exodus will be worth $21 billion a year to in four years’ time.
 Saving or Myth: While some people may advocate sending US nationals to offshore
facilities for expensive elective surgical procedures from economic point of view,
offshore surgery could decrease overall U.S. healthcare spending by 1 % - 2 % only.
 Symptom of the Problem, not the Solution: In an article in New England Journal of
Medicine, Millstein and Smith point out that the flight of American patients to foreign
destinations for lifesaving operations is a symptom, not the solution of the problem.
 No immunity: an adverse outcome such as a severe stroke or death, in a foreign
country may will pose additional problems for the families of poor patients.
 More Losses than Gains- Losing even a small number of profitable insured patients
may erode the viability of some programs & institutions that provide such services.
 No Liability: in case of an adverse outcome it may be difficult for the patient to get the
claim adjudicated in a foreign court.
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 By 2017, fifteen million innovation-seeking consumers will transfer $400 US
billion (base case scenario) of healthcare spending from U.S. providers to
hospitals overseas.
 International travel extends a critical solution for the 46 million uninsured
Americans and out-of-pocket patients faced with attenuating costs for care.
 Treatment abroad in places like India is sometimes 10% of the cost of
domestic care (e.g. aortic valve replacement costs on average of $100,000
in the U.S. and $12,000 in India).
 Patients show vulnerability due to their inability to understand cost and
treatment comparisons, and discern the medical risks involved.
 According to a New York-based healthcare research organization-- The
Commonwealth Fund report nearly half the working-age population in U.S.
risks being financially devastated if confronted with the need to pay for major
surgery– simply because they have no insurance or inadequate insurance.
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 Who wins if America looses ?
 Who gains from the inherent inefficiencies of the US healthcare
system?
 Can there be more accessible and affordable healthcare options for
US citizens?
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 Good but not enough- Is what seems good-actually good always, anytime?
 Closing the eyes is no solution…
 Escapism-Can US Healthcare improve just by exporting the problem cases?
 Long term effects on the US economy & healthcare?
 Setting the priorities right– can or should country’s like India bypass the needs of its
under-privileged masses and allocate its scare resources to cater to the five star
comforts of the richer US citizens?
 Who benefits -- Can even a sizable percentage of domestic Indian citizens equally enjoy
the same facilities and pay the prices that the average US citizen can afford by virtue of
difference in dollar-rupee conversion?
 Impact of this shift in focus from masses oriented ‘Health for All’ philosophy to treat
diseases of the rich and those with the purchasing power?
 Universal debate: low cost facilities for poor v/s profits from the rich?
 Consequences- It isn’t a simple mathematical equation of adding & multiplying the
Haves and subtracting the Have not’s
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“There are two different Americas in our country today - one for those at the top
who get everything they want, and another for everybody else who struggles
just to get by.” -- Former Senator and Democratic Vice Presidential candidate,
John Edwards, on the widening gap between the rich and the poor in America
"Nothing as big and emotional and costly as health care (reform) is going to be
easy," -- Rep. Ron Kind
"Medicaid is under the gun. If we have more people on poverty, we have more
people straining the safety net.” -- Diane Rowland, executive director, Kaiser
Commission on Medicaid and the Uninsured.
“It's the exact opposite of what you would expect. The way Medicare is set up it
actually punishes you for being good.”-- Mary Brainerd, CEO, HealthPartners
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Far too many Americans are simply one pay-check, one natural disaster, one
illness, away from discovering how vulnerable they actually are…

 According to an article in New York Times, relationship between doctors and
patients is deteriorating. Possible factors behind this deteriorating
relationship include differences in how doctors and patients view the practice
of medicine. Doctors may focus on diagnosis and treatment, while patients
are more interested in wellness and being listened to by their doctors
 In an international comparison by the Commonwealth Fund (2007) 37% US
adults reported that they had foregone needed medical care in the previous
year because of cost; either skipping medications, avoiding seeing a doctor
when sick, or avoiding other recommended care. The rate was even
higher— 42%—among those with chronic conditions. 19% of U.S. adults
surveyed reported serious problems paying medical bills
 A significant number of Canadian doctors plan to cut back on their hours or
stop working completely over the next two years, according to a new survey
of nearly 20,000 Canadian physicians.
 Doctor shortage: more than 4,000 physicians plan to stop practicing within
the next two years, the survey suggest
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 Most doctors in Canada are happy, but admit to being frustrated by
paperwork and say they're feeling squeezed by expectations and sicker
patients.
 More than half -- 55% -- of the new MDs are women under 35.
 Women in their child-bearing years tend to work fewer hours
 Whereas most Doctors work an average 52 hours per week and provide an
extra 130 hours per month of on-call duty, younger doctors -- men and
women -- are working fewer hours.
 Stress: Nearly 40% of doctors surveyed said they have partially or
completely closed their practice to new patients.
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 “You can't separate the economy from healthcare. It's 17% of the gross domestic
product right now and it will be 20% of GDP in seven years. …The industry had a
pretty good run for 25 years, but now there are all these Scud missiles flying at it.” -
Paul Keckley, Executive Director, Deloitte Center for Health Solutions
 In September 2008 The Wall Street Journal reported that consumers were reducing
their health care spending in response to the current economic slow-down. Both the
number of prescriptions filled and the number of office visits dropped between 2007
and 2008. In one survey, 22% of consumers reported going to the doctor less often,
and 11% reported buying fewer prescription drugs
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 Within a decade $1 out of every $5 spent in US will be on healthcare
 More and more people are beginning to realize that the U.S. health system, despite
being the most expensive, is not perfect
 Lack of affordable health insurance will create a new, emergent breed of people whom
the New England Journal of Medicine classifies as "medical refugees"-- patients
traveling abroad for heart surgery and other procedures
 A recent Deloitte Report estimates that over 23 million Americans could be traveling
overseas by 2017-- spending over $79.5 billion dollars at international hospitals.
 Already 750,000 Americans are expected to have travelled abroad for treatment in
2007 and over six million will be doing by 2010.
 With increasing globalization and crumbling borders- it is only a matter of time before
we see the emergence of multinational corporations for clinical services. Even now
organizations like Patients With Passports, a U.S.-based Medicare arranger, provides
expert travel planning to eight foreign countries for medical and dental care.
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 More and more patients are now willing to “do their homework” in consultations with a
professional organizations like MedRetreat which have experience in overseas
medical travel. For instance after extensive on-ground assessment of foreign hospitals
wishing to participate in the medical tourism, MedRetreat turned down nearly half the
proposals because the hospitals fell short of the company’s quality standards.
 To address the concern for Quality among the potential medical tourists, many
‘offshore hospitals’ are now obtaining accreditation from bodies like Joint Commission
International (JCI), a subsidiary of the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO), which offers accreditation to hospitals in the US.
 Hospitals that participate in medical tourism will invariably reserve the highest quality
of care and best physicians for international patients.
 Accredited hospitals are potential winners in wooing medical tourists. Several
hospitals offering medical tourism in India meet or exceed the standards of care of the
finest hospitals located in US.
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Hospital & other service providers
 Hospitals are likely to regulate and shrink their operations, and spend less on hospital
equipment and supplies in the tight credit markets.
 Smaller companies unable to finance their growth will become takeover targets for
larger medical device companies with a better cash position.
 Medical devices and instruments such as cast instruments, dermal instruments,
scalpels or scissors associated with elective cosmetic procedures may shrink in
demand as people postpone such treatments.
 As more and more high quality and low cost procedures become available abroad,
Hospitals in US will start feeling the pinch .
 Companies that specialize in long term care and other nursing home type care-giving
will be insulated from these pressures. This is because older folk or people with
serious disabilities find it hard to move to another country.
 The overall demand for healthcare, employment and medical insurance will take a hit
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The Doctors :
 By 2020, U.S. could be short up to 200,000 doctors & 800,000 nurses. The shortage of
professionals will continue to get worse through 2014
 Thus far, there hasn’t been any “huge outcry” by doctors against medical tourism but it is
not too long before they too may start to feel the pinch due to the missing numbers.
 Many of the physicians are probably not worried about losing business because of a
shortage of physicians in the U.S. that is causing many patients to be turned away
 The doctor-patient relationship is changing. Many practicing doctors in US are finding that
increasing patient expectations are putting more demands on their time. At times patients
want things explained that they've read on the Internet, even though not entirely relevant to
their current problem.
 U.S. physicians, in general, haven’t objected to medical tourism as many of them are
familiar with foreign doctors, or are themselves originally from foreign countries and
understand the credibility of receiving care abroad
 However in the long, run high cost of medical training plus high cost of practicing will reduce
the supply of trained medical personnel in the US.
 As transactions costs in the US continue to increase, many of the Foreign doctors operating
in the US may start feeling homeward pull.
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The Patients:
 American patients with a medical condition may in fact get their diagnosis
performed in the U.S. After finding out what procedure needs to be done, they
may ask the approximate cost from their physician and then should be able to
compared it with the cost of having the same procedure performed overseas.
 Medical tourism is not a practical solution for all patients and procedures. Most
patients, especially the ones in need of high-risk medical procedures, may not
opt for it, even if offered the opportunity. For instance it is not advisable for
patients to travel overseas for quadruple-bypass surgery.
 Communication barriers are a cause of concern for most medical tourists. A
patient traveling to a foreign country may face the risk of miscommunication due
to lack of familiarity with a foreign culture and language barriers
 In view of the risks involved, clients might want to have the option of canceling
their procedure after they arrive in their destination country. MedRetreat for
instance promises to return 20 percent deposit for a procedure, should the
clients, change their mind after arriving. As a result, the financial risk to the client
is only the cost of travel and cost of stay.
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Overall Quality of Healthcare in US:
 All this will reduce the quality of health care available in the US and improve the quality of
health care available abroad.
 In the long run this will further increase health care costs in the US relation to health care
costs abroad. Already medical procedures performed in the US. are 30 to 80 percent more
expensive than those performed overseas
 Hospitals will continue to struggle. Some of the larger hospital setups may survive with
hundreds of millions of dollars in revenue and debt
 Most smaller practices will continue to merge in order to create value opportunities in the
midst of diminishing margins.
 A number of hospitals will close down in response to the credit crunch
 Quality of care will decline as many hospitals and health systems may struggle to manage
their debt portfolios.
 Tightening wallets in times of Global recession will force more and more people to look for
cheaper healthcare options- even overseas
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 It is a well known fact that Medical tourism has a positive impact directly by improving
the health care infrastructure within a country, and indirectly because of the new
economic activity and opportunities for growth that it generates all the way down the
economic ladder
 Destination countries are realizing the value of medical tourism and are trying to lure
tourists from the U.S., Western Europe or Canada both at the government and the
individual hospital level.
 As a result of the increasing supply of participating hospitals, an increasing number of
medical tourism companies are emerging onto the scene to get between care
providers and consumers to arrange medical tours.
 Influx of international patients will create career opportunities that encourage foreign
physicians to remain in their home countries as opposed to moving to the U.S.
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How does all this help America ? ?

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80:20 Formula
Solution: Inside-Out

 80% goal - Healthcare at the doorstep of the consumer –
Streamline operations at a wide network of state of the art medical
facilities so that patients does not have to travel overseas and finds it
prudent to receive superior treatments at comparable costs, that too
within walking distance from their homes.
 20% goal – Assurance of Streamlined, Safe and Supervised
treatment at pre-selected overseas facilities in cases where the
same procedure cannot either be done at a lesser cost or requires
immediate, unavoidable treatment, economically unviable
investment, staffing or maintainance
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 Centralized planning for 300 million Americans is unrealistic
 Doesn’t work anywhere else in the economy
 Goes against the American grain
 By developing a market driven and government endorsed strategy to
streamline health care costs, US citizens can significantly reduce their health
insurance expenditures and lower overall costs to the health care system.
 The savings can spur the growth and development of a healthy &
economically wealthy America
 The spin-offs can benefit many friendly nations and add to their economic
development -- leading to generation of employment and opportunities within
their own boundaries
 In the long run this can result in reduction of immigrants to t he US
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 Even if a small percentage of the amount spent on traveling abroad
for medical treatment could be saved and reinvested into the US
facilities the long term benefits could be much more than the
immediate gains
 Investment in hospitals, research and medical education, can spur
sustainable economic development and employment opportunities in
US with enough spin-off for the rest of the world.
 Only strong healthy and economically strong America can be the
true Super power that can not only transforms itself but the rest of
the world as well
65

66
Strategic Win-Win America Project (SWAP)
for Smart Health & Prosperous Economy (SHAPE)
Solution: Inside-Out

67
 Advantage America – Health & Wellness 3600 Plan
 Healthy Healthcare Industry, Satisfied Doctors & other professionals, Satisfied patients
 Advantage India – Health & Wellness 3600 Plan
 Healthy Healthcare Industry, Satisfied Doctors & other professionals, Satisfied patients
 Advantage Humanity
 Sharing of knowledge, expertise and infrastructure
 Recession proof growth of Health, Medicare & Wellness industry worldwide
 One Big Virtual Hospital- anyone, anywhere in the world can consult a doctor across
another continent without stepping out of their homes
 Better Patient Awareness though specially designed Audio-video, print material and web
content. Cost effective option to seek expert advise through live web chat and email
queries
 Better and More Informed Choices- Libraries, reading rooms and counseling by qualified
Doctors whose job is just to explain the how’s, whys and other complicated medical
terminology to the patients

1. Advantage America – Health & Wellness 3600 Plan Healthy Healthcare Industry,
Satisfied Doctors & other professionals, Satisfied patients
 Centres of Excellence impart quality Medicare
 Horizontal Integration- One Country, one rate for the same medical treatment or services
 Advantage Doctors:
 More & regular patient footfalls – also from other states, even those uninsured
 Lesser dependence on unfavorable terms of Insurance Companies
 Improved choices for patients
 Wider availability & choice A, B or C category Doctors -- almost at the patient’s doorsteps
 Pre approved Doctor– recommended Quality Medicare & Wellness Centres to chose from
 Each of the doctors have been graded by a Board of Health Industry professionals under Premium,
Moderate and budget panel based on the fee, professional experience and a certain minimum level of
infrastructure & services in each category
 Less waiting – as different centres and doctors with similar experience & facilities within the same country
charge the same fee
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2. Advantage India – Health & Wellness 3600 Plan Healthy Healthcare Industry,
Satisfied Doctors & other professionals, Satisfied patients
 Centres of Excellence impart quality Medicare
 Horizontal Integration- One Country, one rate for the same medical treatment or services
 Advantage Doctors:
 More & regular patient footfalls – also from other states, even those uninsured
 Lesser dependence on unfavorable terms of Insurance Companies
 Improved choices for patients
 Wider availability & choice A, B or C category Doctors -- almost at the patient’s doorsteps
 Pre approved Doctor– recommended Quality Medicare & Wellness Centres to chose from
 Each of the doctors have been graded by a Board of Health Industry professionals under Premium,
Moderate and budget panel based on the fee, professional experience and a certain minimum level of
infrastructure & services in each category
 Less waiting – as different centres and doctors with similar experience & facilities within the same country
charge the same fee
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3. Advantage Humanity – The world as one big Virtual Hospital where anyone can consult an
expert doctor anywhere in USA or India and get their advise, even without stepping out of their homes--
just by paying a fee online.
 Lesser need for travel to unfamiliar places away from ones own country for medical treatment
 Monitored & less risky emergency medical travel even outside ones country where it cannot be
avoided
 Structured pre-and long term, post emergency care – within the country of regular stay
 Pre approved, Doctor– recommended Quality Medicare & Wellness Centres to chose from
 Less waiting – as different centres with similar facilities and experienced doctors nearby the
patients home town charge the same fee
 Better patient advocacy through specially designed literature – printed brochures, audio-video and
web content
 Live counseling by qualified doctors and health motivation staff who explain the How’s, Why’s as
well as complicated medical terms in layman terms– which normally remained unexplained as
Doctors have to attend to other patients as well, and in the process help them take right decisions.
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 One quarter of physicians in the U.S. are foreign-born, so the concept of having a
Thai...or Indian physician is really nothing very new or very foreign to an American
patient
 Many Americans have confidence in Indian physicians because they have been
treated by them in the U.S.
 Many Indian physicians have moved to US and Britain after finishing medical school,
lured by better working conditions and salaries.
 Indian-trained doctors account for 5 percent of U.S. doctors, according to government
statistics.
 Many Doctors in Indian Hospitals hold at least one foreign degree/ affiliation or have
at least a few years of working experience in US health system
 Accreditation- Many top Indian hospitals and medical facilities like Wockhardt’s
hospitals are accredited by Joint Commission International and hence considered at
par with many US facilities.
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 The next healthcare provider will not have to search for or guess about a patient's
allergies, medications, or current and recent past diagnoses and other pertinent
information.
 The next healthcare provider will be informed about the patient's most recent healthcare
assessment and services.
 The next healthcare provider will be informed about recommendations of the caregiver
who last treated the patient.
 As patient demographics will be provided, time and effort will be saved by not having to
repeatedly ask a patient for demographic information in detail.
 Rather, this information can be more quickly and easily verified.
 Costs associated with the patient's care will be reduced, for example through avoiding
repetitive tests and basic information gathering. The effort required to update the
patient's most essential and relevant information will be minimized
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 BPL Mobile, Mumbai’s leading mobile service provider, recently launched ‘Doctor on
Call’, a 9-to-9 service for live interaction between doctors and patients over the phone.
 Powered by HealthcareMagic.com, the service will provide consultation over the
phone where the doctors will diagnose the patient’s problems under three categories -
‘Acute’, ‘Chronic’ and ‘Emergency’.
 While the service does not claim to replace a family Doctor, ‘Doctor on Call’ will be
useful on all occasions when one can’t reach the trusted doctor; in an emergency, for
second opinions and for recurrent ailments
 Priced Rs 15 per minute this service may be beneficial for people who worry about
loss of pay/ business during absence from work, dread long queues or those who
haven’t got a prior appointments. Such people often end up denying themselves
timely medical advice just to avoid upsetting their busy and tight schedules. Even the
aged, sick and those who cannot travel unaccompanied can now call this number
without any need to worry about the travel. This way one could even seek the doctor’s
advice when traveling on a far away business or holiday.
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 The Doctor who attends the call will probe to understand the patient’s
condition of the on the phone and then offer home remedy to the subscriber.
 Acute condition: the attending doctor will suggest a future course of action in
terms of Lifestyle change, preventive measures and specialist to be
consulted for further management of the disease
 Chronic condition- in case of an Emergency, the doctor will suggest if the
calling patient needs to be rushed to the nearest hospital, based on the
history and will immediately end the call.
 With medical assistance over the mobile phone the service will be able to
reach out further more to the typical Mumbai dwellers who are always on the
move.
 Using a mobile phone as a platform for healthcare delivery may ultimately
prove to be the next logical and innate step towards easing the suffering in
people’s lives that too at a affordable cost…
74

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 One country one price for the same or similar procedure and consultation
 Standardized care- pre-op screening in one country to be acceptable in the
receiving facility in another country as well.
 Owned Centres, channel partners & Virtual Hospital– experts for tele-
diagnosis, tele-consultation, second opinion, referral and tele-nursing care.
 Assurance of Post-op follow up, long-term rehab and disease management.
 No waiting -- the Patient can but disease, pain and suffering doesn’t wait…
 Minimum need for cross country travel--travel only if you must for
emergency treatment but get pre and post op care in the home country
 Real time Monitoring -- the doctor whom you trust is in the loop at every
stage and can see your blood sugar level, weight or BP and well as
prescription and treatment course of action at his own computer work station
in the home country, and thus give his own suggestions, if need be, even
during the duration of emergency translocation

 Mobile ICU- Specially equipped helicopters, air & ground ambulance services in USA
& India for emergency evacuation of critical patients. Imagine a person “Alpha” on the
way to attend a business meeting or holiday in a third world country when the medical
emergency strikes… This place does not seem to have appropriate medical facilities
and his family is insisting him to USA or nearby big hospital which has the latest
medical facilities with modern diagnostics to evaluate and stabilize the patient’s
condition. This is where ground & air ambulance or helicopters and specially fitted
jets can play a life saving role.
 Standardized Diagnostics & reporting– similar Diagnostic standards and bench-marks
with common minimum factors in every report within a city, country or across the
continent – for world wide acceptance and reliability.
 Economically viable and cost effective matrix of High-tech Diagnostics– Matrix of
High-tech Diagnostic Base Camps in major cities across USA & India, each with a
network of as many as possible collection centers and report pick-up points, ideally
within 2-5 km radius of patients homes.
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 Single window services for medically supervised and monitored travel for emergency
treatment- Same agency quotes and takes orders for booking premium, moderate
and budget category hospitals as well as fixes appointment with the best Doctors in
the affordability range (from a Medical Board recommended pre-approved panel of
hospitals and specialists– rated on the basis of qualifications, proficiency and
facilities), provides trained nursing escorts as well as does the bookings for airlines,
hotels, travel insurance, currency exchange and money transfer . And helps in
processing of insurance claims on behalf of the patient, if need be.
 One point – universal management & regular up gradation of patient history and
prescription data- standard, user friendly format incorporating all the required
information in a single source makes it easier for doctors and convenient for the
patients
 Centralized billing and payment of taxes- to avoid duplicate efforts and tax on taxes
already paid.
 Economic model to make treatment affordable for even the uninsured and
economically not so well off
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Motorola's world-class mobility products and healthcare software applications
extend mobility to the point of care and beyond. Such healthcare solutions
allow sharing of real-time information anywhere, inside or outside the facility, for
increased patient safety and more attentive care. These include:
 Medication Administration Solutions- Ensure that the right patient receives
the right medication, the right dose, by the right route, at the right time..
 Mobile Physician Rounding Solutions- Access information, order tests, scan
billable items and more – all from the patient’s bedside.
 Remote Patient Monitoring Solutions- Monitor patient vital signs and adjust
medical equipment while moving throughout the healthcare facility.
 Specimen Collection Solutions - Protect and streamline the collection
process to improve accuracy and speed test results.
 Wireless Broadband for Healthcare- High-speed, reliable and secure
connectivity and information access.
78

A research brief published in December 2008 by the Center for Studying Health
System Change found that most U.S. consumers rely on word of mouth and
physician referrals when choosing health care providers
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 Patients can keep all of their health and insurance information in one place,
make appointments and requests via e-mail with their physician's office,
receive information on subjects they choose, receive reminders about
medication schedules, classes or exercise timetables and other health
calendar entries, participate in support groups, and keep health journals.
 You build trust, strengthen relationships, and learn more about what your
patients want and need so you can constantly adjust and fine-tune your
programs.
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 Dr Narendra K Gupta
Founder CEO, Visionary & Mentor - Strategic Win-Win America Project (SWAP) for
Smart Health & Prosperous Economy (SHAPE)
Founder CEO Eternal Health & Wellness Foundation (USA)
President – Society for Medicare
 Neeraj Mahajan
Project Director & Coordinator - Strategic Win-Win America Project (SWAP) for
Smart Health & Prosperous Economy (SHAPE)
Country Head (India), Eternal Health & Wellness Foundation (USA) for import and
market penetration of SMARTubeTM in India
Secretary – Society for Medicare
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Project Director- responsible for :
 Concept, visualization and navigation
 Strategic Planning- Project Architecture
 Coordination – from drawing board to board room for grass root level implementation
 Market research, feedback & trend analysis- for MIS
 Healthcare marketing & new business development
 Corporate Communications- External & Internal
 Motivation and team building
 Strategic tie-ups with related institutions and service providers in USA, India and other countries
 Medical advocacy -- Doctor & patient outreach programs
 Content development for patients awareness building
 Crisis Management & strategic new initiatives
 Media Management
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