Scaling the Healthcare Service Delivery Model
By Arunima Rajan
Learn about the different factors to consider when scaling up a healthcare service delivery model, so that you can ensure quality care for your patients.
Historically, India has had significant challenges with its healthcare system. With a population of over 1.3 billion, the country has just 0.5 public hospital beds per 1000 people-far, below the World Health Organisation’s (WHO) recommended level of 5 beds per 1000 people. This shortage leads to long waiting times and hospital overcrowding, which can result in poor patient care. To meet the needs of its population, India must scale up its healthcare delivery models. Thankfully, there are several initiatives underway to make this happen.
One such initiative introduced in 2003 by the government is the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY). It aims to reduce regional disparities in availability, access, and reliability in tertiary healthcare services and enhance the country's medical education facilities.
The PMSSY has two components:
i. Establishment of new national institutes of medical science
ii. Upgrading government medical colleges.
The private sector is also working to expand and improve hospital resources.
While pointing out that scaling improves the healthcare system, Dr. Vikram Shah, Founder & CMD of Shalby Hospital, explains there is a caveat “...it is essential to check if the necessary supplies and equipment are available to support the intervention at scale.”
He also mentions that the hospital wants to add 321 additional beds.
“Moreover, we can make the most of the expansion of technology-enabled at-home healthcare. Regular emails and SMSes to patients' relatives and physicians keep them abreast of their treatments and operations, eliminating spillovers and minimising unnecessary tests and procedures. We are working on asset-light models and franchise options with Shalby Orthopedics Centre of Excellence (SOCE) to utilise Shalby's primary specialty, orthopaedics, and provide technical expertise to our franchises. Another way to grow is to think about a perfect in-house IT architecture that allows for error-free patient recording for clinical analysis. Scaling up requires knowledge of how to restructure during a crisis. During the Covid-19 outbreak, we needed to prioritise existing patients while increasing the capacity to manage new ones. Expanding a company's footprint can also help it grow. Over the next 3-4 years, Shalby intends to establish more than 50 franchises in India,” adds Dr. Shah.
What Next?
Standard patient-to-doctor telemedicine models are no longer unique. The solution to “What Next” is being considered by all major health providers. “Providers are exploring options for administering healthcare where individuals are most at peace—in their homes,” says Pramod Kutty, CEO&Co-Founder, Connect2MyDoctor. “The subsequent phase of telehealth delivery in developing nations will focus on value-add solutions like Remote Patient Monitoring, Home Care, and Tele-Rehabilitation, among others. In a platform drive approach, video consultation acts as a cross-functional offering across multiple services rather than being a standalone feature. Healthcare providers will be more proactive in reaching out to patients to provide better wellbeing. Our partnerships with Shalby Hospitals (across all ten multi-speciality hospitals), Jaslok Hospitals in Mumbai, KIMS in Trivandrum, Royal Bahrain Hospital, and the University of Sharjah are evidence of our vision,” he explains.
With the advent of 5G, technology will be the only driver to build last-mile healthcare delivery network. Devices have become more accurate and portable in the med-tech ecosystem.
“We have integrated medical devices into the platform to enable healthcare workers to monitor over eight vitals in less than 20 seconds. In case of any anomaly, the doctor on a remote video call can monitor the patient using a portable stethoscope with a whole set of rich features like noise cancellation, in-app sound wave visualisation and other powerful features to give a clear picture of the patient’s health. Technology will also enable care for the needs of pregnant women and patients undergoing chemotherapy during recovery phase,” adds Kutty.
Scaling up a Healthcare Startup
Dhruv Suyamprakasham, the founder of iCliniq, an online medical consultation platform, points out that most telehealth companies in India are not profitable. “The goal of a telehealth platform is not just enabling interaction with doctors and patients; they have to focus on medical outcomes. The second most important factor before scaling up is intact unit economics. If the business is not profitable, it’s just a hobby,” adds the entrepreneur. Memorial Sloan Kettering Cancer Center had partnered with iCliniq to provide remote opinions to Indian patients. “These hospitals are far ahead of us in terms of the research that they conduct. Such collaborations will improve our access to care,” adds Suyamprakasham. Catering to a billion people in India is not an easy task.
Yudhyavir Singh, who is an Assistant Professor at AIIMS, New Delhi, notes that major challenges for scaling up a public hospital are lack of autonomy, lack of financial support for infrastructure upgrade, paramedical workforce shortage, shortage of doctors, unplanned opening of hospital (not opening in a suitable area according to patient load or type of speciality required, lack of outreach); lack of use of technology is also another hurdle. The lack of political will or resolve is another barrier to expanding public health infrastructure.
Good, Replicable and Innovative Practices
Kaustav Ganguli is the Managing Director at Alvarez & Marsal. According to him, the key factors that must be considered for scaling a healthcare service model are:
Clarity on target segments and geographies
Delineation of the value proposition for different segments
Definition of various formats or boxes that support the proposition-segment combinations
Proof of evidence of unit economics viability for each format-segment combination
Governance model for performance review and control
Ongoing review and refinement of network and portfolio and finetuning of formats and propositions.
Ganguli notes that clarity on target segments relates to a clear understanding of segments, town tiers, geographies one is going after and the problem statements one aims to solve. For example, a mass-affordable offering in IVF will define its segments very differently as against something that is very premium and only focused on the topmost socio-economic segments.
Organisations have to clearly articulate how its offerings are solving key issues for its consumers. The highest success rate at the lowest prices could be a compelling value proposition in IVF but it will not work if the delivery model does not support that proposition.
He adds that the definition of various formats will define the different types of units one requires to succeed at each intersection of a proposition with a target segment. “Taking the example of Eyecare, one could say that I will work with large hub formats (10K+ sqft) with full services in locations with high-demand density and smaller spoke formats (4-5K sqft) with only select services in locations with thinner demand density,” he notes.
Proof of evidence of unit economics is the all-important question on unit economics viability. “Does the unit ramp up adequately to offer me targeted breakeven and payback within previously estimated time periods? If not, what factors affecting the format economics should we re-invent to make the unit work? Scaling up expansively without proof of concept can be suicidal - the early experiments in dental chain network creations taught us that,” he elaborates.
The governance model for performance review and control is about running pilots and learning from them. “Learning cannot come about in an unstructured fashion. One must define the scope, objectives and KPI framework for such pilots and run a governance model to monitor what is working and what is not. Ongoing review and refinement of network and portfolio is about incorporating learnings to finetune, overhaul or completely rethink your models. It is also about knowing when to step back from a failed model and try changes. One of the most important things to do is to scale only after pilot implementations deliver evidence of unit economic viability. It is important to get the unit models right before large-scale rollout and expansion,” he concludes.
Scaling up a healthcare service delivery model is not an easy task. To ensure high quality of care and best treatment outcomes in an scale-up project, the human resource shortage and the lack of affordable made-in-India products are two key elements to account for. With careful consideration and thoughtful planning, however, it is possible to create a successful scaling strategy for any healthcare project.