Healthcare India- Innovation – Access – Growth

Healthcare  in India - innovation - Access - Growth

Healthcare in India – Innovation – Access – Growth

Healthcare  in India seems to finally be coming of age , came  across a  few  very interesting business models , new ventures  , which should ideally solve  for  existing gaps in the market. Thought would share them with you:

The Glocal Story : In a country such as ours  with  a population of 1.23 Billion, where 22% of the  population is below the  poverty line  (Earning less than Rs. 33.3 (urban) and  Rs.27.2 (rural)), the need for  subsidized / low  cost quality healthcare is  quite clearly evident.  To top that about 70% of our population is rural . Two ex  civil servants did see this gaping hole and  decided to fill it. Glocal healthcare established its first 100 bedded secondary care hospital in Sonamukhi , WestBengal in the year 2010, since then 4  more hospitals have been comisioned in 3 and 4 tier  cities. Whats  even more interesting is that  a plan for commissioning  50 more such hospitals over the next 2  years  is in the pipeline. The total bed capacity would be a whooping 5500 once the plan is executed.

That  is insane but why does it work for them because they use  a Basic model which they have tested over the last five years and perfected to some degree and this includes

1) Well defined catchment area a tier 3 or 4 tier city with a  population of 1 lac urban and 5  lac rural

2) Well defined service mix only  secondary care  well defined specialities ( as per the CEO only 42 diseases account for almost 95% of the disease burden in rural areas)

3) Low project cost – An investment  of only Rs. 8 Crores for the comissioning of the entire hospital  including  civil work, equipment and housing for doctors. (Low land cost, no frills, less area, modular approach and  inhouse construction). And a total of 6- 8  months only for completion.

3) Low fixed cost – A Staff of only 100 for the 100 bedded hospital  which includes 12 onroll doctors thus low fixed costs

4) Utilization of resources which a  bigger corporate hospital would shy away from for example local medicos are welcomed into the hospital and  made part of the care giving team .

5)Partnerships for resource development. Training provided by  a partner agency  to nursing aids and technicians thus filling a  gap in terms of manpower scarcity.

I think this would be the gist of the model  and  of-course the main central  proposition of  quality healthcare at 20 – 40% less than the market rate.

Will the model be a success when scalled up is yet to be seen. Though there is a  definite need for such healthcare, however currently the model works because  it is supported by a state government insurance / Cashless healthcare provision scheme . This accounts for 55% of their business.  But atleast its a  refreshing new approach to healthcare.

The DaVita Nephrolife partnership –  According to recent studies around 17% of the  indian urban population suffers from Chronic Kidney Disease.  Dialysis is a  harsh reality for these patients a  regular affair and no matter how  dark it may sound Nephrolife has  been able to see this demand. With a  potential  market size  of $350 million growing at 20 odd  % annually somebody had to get organised. With what started out as a stand alone dialysis centre in Bangalore  in 2009 after their partnership with DaVita and NEA in 2011 has grown to a network of 14 centres in  a short span of 2  years.  Whats special about this partnership is that the partners not only infused funds  in the tune of $25 million but also brought along with them experience  in previous healthcare  projects and for DaVita healthcare specifically experience in their chosen speciality of Nephrology and Dialysis.

The Key to success be flexible ,  partner, see the bigger picture and  focus on the game.

1) Be Flexible – Various formats of basic business model  – Stand alone  Dialysis centres,  Satellite Dialysis centres , Stand alone integrated Kidney care  centres, Box in Box model for tertiary and secondary care hospitals (either  on rental model or as  a JV)

2) Partner  – The flow of funds  helps when establishing such  a capital intensive setup. Per bed cost is estimated at around the $25 – 40000 mark, however returns are  expected at an EBITA of around 20%. And along with that comes the administrative expertise and  knowhow. Local partners further  reduce capital burdens as well as provide stronger local networks.

3) See the Bigger  Picture: The concept with DaVita  Nephrolife is to provide integrated Kidney care services to build a  care network  , not just  Dialysis  but rather  an entire spectrum of care ranging from prevention ,  diagnosis, Dialysis and end stage kidney disease management (Transplant) , be it through their centre or a  partner centre.

4) Focus on  the game  –  whats interesting is that they realise the chronic nature of most kidney disease and the  importance of establishing long lasting relationships. The single  speciality focus also gives them a certain degree of advantage over multispeciality centres which  can at times  be distracted.

Again its  for time to tell whether  these Healthcare ventures  would succeed  in the future. However its nice to see a new approach to Healthcare in India  an approach based around flexibility,  partnerships and real patient needs.

Disclaimer: The views expressed in this  post are my own and  are  not meant to be derogatory  to any institution or organisation. These are just my thoughts and  these are open for further  discussion and  development. Please do comment and  share and  let’s get some universal cognition into this. Thank you for your patience and  tolerance.

Defining your KPI’s – What is your Hospital Measuring ?

KPIs what are you measuring

Ill start with a  Cliche  – “What is not measured is not done”, but  i truly believe  in the power of measurement  and that’s why measuring all that you have envisioned for your hospital becomes critical.  But then how good are our hospitals at measuring?

Before we can really answer that question we need to identify what it is exactly that we our measuring.  I have come across a few discussions which were based entirely around what hospitals should measure and honestly every individual seems to have his / her own response.  Yes there are some basic KPIs such  as  ALOS , Occupancy, Revenue etc that keep cropping up from time to time however  I haven’t really come across a  really well defined KPI directory that you can choose from .  And sadly enough some  rare  managers and administrators that I have come across  are not  even aware of  the  entire  implication that a  particular KPI has  on the  functioning  of the  hospital.

My attempt here is not to define a directory for you but rather to set a direction to our way of thinking about KPIs

So what do hospitals measure?

Our entire KPI classification is based around

 Clinical Quality  – e.g. Medication errors, outcomes, mortality, hospital acquired infection , repeated surgeries, readmissions etc

Operational Quality – e.g. waiting times,  Going  above  estimates, Consultation quality, Discharge times, Admission times etc

Operational efficiency – e.g. ALOS, Volume growth, Cost per bed, Material cost  %, utilization rates, Your basic time motion studies regarding process efficiency etc

Financial health – eg. EBITA, Debtors outstanding, Case mix, Revenue source mix, Cash to debtor’s ratio, Cash flow etc.

This is definitely not all inclusive in terms of KPIs or categories but basically top of the head stuff. I have  also seen people merge Operational quality and efficiency but id rather keep them separated.

Wow that’s quite a lot of things to measure  if you think about it and  we haven’t even quite scratched the surface yet.  How will I keep an eye on the ball when I’m being bombarded with balls? The answer my friend is simple identify what’s important for you

So what is important for you? Prioritise

The KPI dashboard that you are most concerned about is directly related to the level / nature of involvement that you have with the organization.

If you are a C level executive your KPI dashboard might be entirely different from let’s say someone related solely to Operations which might be different from the individual heading Quality. When i say different it doesn’t mean there is no overlap there will be overlaps but functionalities are different.

So a CEO would have some of these things on his / her  mind  –  EBITA , Material Expenditure, Volumes for critical procedures , Case Mix , ALOS, Debtors , Utilization etc.

And then this further would percolate down to departmental levels.  Eg OPD would have different Performance indicators such as waiting times, doctor punctuality, material consumption, Staff attendance, Overtimes, Complains, average consultation times, volumes,  etc .Marketing would have measures  like – call volunmes, sector wise revenue, cost per  customer  acquisition ,  doctor wise  performance, activity vs conversion etc

I would say define your parameters well at the departmental levels to drive true quality and efficiency.

Ideally a C level manager should look at about 30 – 50 selected indicators on a daily basis and then selectively look at indicators from departmental levels which show huge discrepancy from the expected values or unusual results. Focus can also be shifted while working on specific projects. Please note it’s difficult to keep an eye  on 170 parameters so prioritise and reorganize your dashboard  on regular intervals

At the departmental level each department should be encouraged to develop their own KPI bout 20 – 30 against which they measure themselves. Please remember while defining your KPI it’s important to understand why you are measuring it and whether you need to include it, be specific and be selective.  Also VOC (voice of customer) must  be imbibed into your Dashboard structure. Lastly  identify the correct method to measure the KPI you are defining a lot of times time is wasted on goose  chases with either  the  wrong  data or  erroneous  data  collection.

Implementation 

This is the tough part here is where you record, review and correct and this is not only for a particular phenomenon that you  are  measuring  but also your dashboard structure add omit and refine the  dashboard as  you go along. But before  that  i can not stress on the  importance of getting the  message across to your entire hospital team. The  grass root level must understand the  importance of  an entry they make or the data they capture to ensure the quality of data and the  success of the system.

What would be the benefit?

The answer is simple consistent quality service provided with efficiency and accuracy.

HIS / BI Tools

I am certain there are quite a few HIS systems as well as Business Intelligence tools which integrate with your HIS systems to raise alarm and to bring things to your notice. However treat them as tools but don’t be over dependent on them. Because solutions which come in a tin are not necessarily the solutions we need.

Authors note:

My overall experience with KPI mapping in hospitals in India is that we are inept at measurement.  Most hospitals basically follow a basic set of indicators that are commonly predefined and taught in Hospital Management courses, however creative development of newer indicators seems rare.  A problem that is causing this is that management professionals are not necessarily keen at sharing their knowledge,  and the knowledge share which happens is mostly of data which is already out there in the  public domain.  Also as an industry there is a lot to learn from the Manufacturing sector and we must keep our minds open to newer possibilities through cross industrial / sector learning. In the end Collective Cognition is the need of the hour.

Disclaimer: The views expressed in this  post are my own and  are  not meant to be derogatory  to any institution or organisation. These are just my thoughts and  these are open for further  discussion and  development. Please do comment and  share and  let’s get some universal cognition into this. Thank you for your patience and  tolerance.

Value Based Healthcare Delivery

I recently came across this talk by Michael Porter about healthcare that he had delivered at Harvard  Business  School though the  talk was  generally about the healthcare system in the US  however  i felt that  it was quite  relevant  to healthcare  systems in general across the globe.

One  of the  most  important things that he talked about was  Value Creation and  improving the  Value delivery system. But then the question which arises is what is the  true value.  How do we  define Value becomes  critical , is it just patient outcomes , is it cost of delivery , could it be a  generalised figure and  he defines  it quite comprehensively  he says that it the patient health outcomes achieved  relative to the money spent to achieve those outcomes.  Which becomes a  simplified outcomes as numerator and cost as denominator.

This is  quite  a shift  in our existing way of  measuring success  which are either  based around profit maximisation, or Volume  delivered, or  access to healthcare in general. Quality as  it stands currently is  based entirely around the  process definition and  improvement. Be it any guideline we  follow NABH or JCI its  mostly process based. Process improvement  is very important  however outcomes  are  even more important.  And  are we really measuring the  clinical outcomes. If the  system is to improve  then the competition has to move from being profit or  process based to becoming outcome based and then to value creation and thats the  only way we can get a  handle on the spiralling costs of healthcare delivery.

So how do we really shift the  focus to value.

Lets Look at Outcomes outcomes need to defined per  patient and  his / her medical condition. We need to look at survival,  functional status, independence, residual defect / illness. Yes it is an intensive  exercise  but the  results would truly be  enlightening and  a true move towards the  goal  of quality. Define the  Outcome parameters for any surgery / medical treatment that is meted out including survival rates, extension of survival period, dependence of medication etc etc.

Secondly identify your costs. For some strange reason healthcare seems to shy away from a  practice which is so commonly followed in the manufacturing  sector and this is ABC (Activity based Costing ) .For Healthcare i would suggest a  time related Activity based  costing. Whats even more  specific is that it will  be a  patient based time related activity based costing.  We tend to see ourselves as distinct departments and subunits and we tend to do our costings similarly too(that  is if we do our costings). However a  true costing exercise must capture the entire cost related to the  patients  journey through  care  pathways. And through this way we should be able to define  the true value of a  patient outcome. The focus needs to be on the  Outcome , and  existing technology in terms of HIS  systems must integrate these costing parameters  but  the  end result could truly be transformational .

I personally look  forward to a  day where  we will focus on the right performance indicators though that  is a  different post in itself. But  i think this could very well be a move  in the right direction be it for a private hospital, a charitable trust or a  public trust.  Efficiency , effectiveness  both would be  effectively measured and  documented and  true value would lead to better profits / access/ volumes so this is a  win win no matter  which way you take  it.

Here is the  Video if you are  interested , apologies for the poor sound quality.

Disclaimer: The views expressed in this  post are my own and  are  not meant to be derogatory  to any institution or organisation. These are just my thoughts and  these are open for further  discussion and  development. Please do comment and  share and  let’s get some universal cognition into this. Thank you for your patience and  tolerance.

Going Cellular on healthcare – an exploration

According to mobile analytics firm Flurry India’s connected device installed (smart phones and tablets for the uninitiated) base grew by a whooping 160% from April 2012 to April 2013. According to the latest report of IAMAI and IMRB, till Oct. 2012there  are a total of  76 million mobile internet users  ie accessing internet from their  mobile devices  in India and this doesnt include  dongles and data cards.  This number is expected to reach 130.6 million by march 2014 and 164.8 million by march 2015.

Now those  are  crazy  stats but the  question here  is  are  you on the  smart phone  yet. Applicability for   smart devices in hospitals is just  at its infancy but the  possibillities are just enormous.

A Hospital Based  App  –  this is for marketers as well as for  operational convenience. Though i have thought of other  applicability ill leave that for another post.

Developing one  basic downloadable hospital application with various utility parameters set into it. So lets get my thoughts straight here these  are just some random ideas that  i have  worked  upon or come across which work or should work you can always add  more in the  comment section.

a) Pill Reminders  – once a  prescriptions been filled  out and dispatched from the pharmacy this application can be downloaded and it will remind you when you need to take your  medicines  could be used for both in and  outpatient. I think this application is already being used  by Wallgreen  (part of the wall mart enterprise)

b) Health check reminders once you have booked  a  health checkup this does a basic count down to the  health check reminding you from three days  prior to the HC . and  one day before it sends you details as to what is expected from you . Also allows  you to give an online feedback

c) Virtual consultant  feed your query get an answer and  tie in for fixing up an appointment

d) Appointment  scheduler no calls required like an online consultation allows you to choose a speciality a consultant and an available time slot maybe about a  month in advance again a  reminder system can be put in for when your consultation is due

e) Diet check – basic calorie / special need diets  includes interesting recipes as well as  a basic calorie calculator such apps already exist on  the  ios and  android markets and can be integrated they are  for free  usually.

f) im not to sure if this can be done but basically an emergency helpline number that  the  app can directly feed into your mobile and  which will be  accessible at the  touch one button

g) Promotions any new  promotion pass it on  to your existing customer , though this is a  bit of an issue but can be

h) Disease research  – if you need to know anything about a  particular disease  get the data here

i) Patient connect  – connecting with patients suffering from similar disorders successfully treated by the  hospital with contacts if required like mobile testimonials and brand ambassadors. also mention best times to contact.

Thats  just the  tip of the iceberg i am certain as we go ahead we can find more utility.

Whats important for a particular app to be successful is that its  patient centric and understands  what purpose in patient care or patient  information provision it serves.  The  App has to be utility focussed and  not just there because  everyone is moving onto the  mobile platform or because  you want  to push messages to your community  from your hospital. If thats the  approach you have  then even if people do  download your app  they will get  rid of it faster than you can say flu. So remember friends utility is king and thats the only way you can create a  successful app.

Disclaimer: The views expressed in this  post are my own and  are  not meant to be derogatory  to any institution or organisation. These are just my thoughts and  these are open for further  discussion and  development. Please do comment and  share and  let’s get some universal cognition into this. Thank you for your patience and  tolerance.

Health Care Communication – Keeping it simple

I really do love this video, it just appeals to me in so many ways.  Recently i was  following this conversation on Linked in it’s on the group it’s called the  Healthcare marketing community  join it if you  are  interested. The  conversation that I was being a  part of was the complexity of communication in healthcare and it indeed is very important to understand as  Marketers the intricacies of the  message that we are sending out.

In recent times i have come across a  lot of  institution centric  advertising,  or speciality centric  approaches  specially in india. But that’s not it sometimes we do use a  patient centric approach but somehow the brand behind the  patient treatment seems to become to loud.

Heres another video by Pfizer around which the  discussion was based

But then how are these advertisements different .   I think they are different  because  they work on the following two levels .

They are clear  about their understanding of  who they are  looking at  reaching out to , or  what phase  of the see- think – do stage there at.

More importantly they understand the whole emotional tumult that s associated with a disease not just  for the  patient but also his care givers, friends and family.

That,s what really ties in both the advertisements for me . While the first is fact based  and the other  more emotion based  i still feel that somehow they follow the  same line  of thought.

It’s so simple at times but we seem to get  lost in the complexities  of our brand,  So here’s to keeping it simple

Disclaimer: The views expressed in this  post are my own and  are  not meant to be derogatory  to any institution or organisation. These are just my thoughts and  these are open for further  discussion and  development. Please do comment and  share and  let’s get some universal cognition into this. Thank you for your patience and  tolerance.

The SEE – THINK – DO Marketing framework for Hospitals

Let  me  be  honest the  ideas  here in terms  of application might be  mine  , but this  models  been developed by Mr. Avinash Kaushik , author  of Web Analytics an Hour a  Day and  Web Analytics 2.0 . i haven’t had the  privilege of reading these  books as of yet however  i do frequent  his blog Occam’s Razor and  i would suggest that  having read  this do visit his  site. Its  a  highly intelligent and informative blog  and a  must for all marketers. You could visit  his  site  before  hand  and  develop your own thoughts  about the  model too.

So  lets  get started whats the  SEE-THINK-DO framework all about.

We all know  how as marketers we  view  the  purchase  decision  / Funnel , be  it the  AIDA concept (Awareness, Interest, Desire, Action) or the  CAB (Cognition, Affect, Behaviour) or any other but that’s  basically it. I would say See – think- Do is the  same thing but  its thinking from the consumer’s point of view. The other  two are  very marketer oriented terminology, and  believe you me terminology  at times can change  our thought and behaviour.  Also when it comes to Healthcare other than maybe some cosmetic procedures and  maybe birthing , the  desire is usually amiss. However  the  decision funnel still retains the same  shape. We as individuals  do consider which hospitals  we would like to go to, be  it consciously or subconsciously.

So in the  SEE phase are people  who will require healthcare,  specifically the specialities you  cater too. this  is a  very broad category, and a very large part  of the  population will belong to this category  . The purpose of this categorization is not inclusion but rather  exclusion people who will not use your  services must be excluded. So maybe a generalist target population could be considered here

The Think phase has  people who use healthcare  services and are thinking about it,  this is evident by even a  slight intent . They necessarily are  not  planning to use healthcare services immediately but think they might do so sometime  in the  future.  this is a part  of the see population. So might be  people who are health aware  , who seek out  information regarding health.

The  Do segment  are  people who are actively  seeking healthcare providers. Who are shopping for care and are  in need for it.  this  is a  subset of the  think people eg If  it’s an elective  procedure we actively assimilated information, listen talk and  shop.

So we have these  stages what next. The  whole point to this framework is that it allows for us to consider each of these segments in our marketing plan, it helps us in creating content which is  specific and  yet broad  enough for these categories. It allows us to select channels which would be most effective. Now remember  this is not a  prescriptive frame  of reference  like all frames of references its  basically  a concept  an idea to increase your understanding of your customer and for optimising your  marketing  plans and strategies to  maximise benefit. The  key word  here  is yours.

Basing  our Content  Strategy around  The  Framework

Before  we  go to market and  decide  on what channels we  will engage in its  important  to have a  definitive  content strategy based around the  Framework. If  your  call to  action at all times is  buy buy  buy , then you are catering to a  very specific do segment. This is a  small segment and you  would lose out on the  opportunity to engage the  Think and to attract the  SEE people. Thus  your content the  way it’s housed or structured needs to be as broad and as  specific as  possible . This  is  much easily achieved on  a website  , however offline media is a slightly different ball game  however  , i  do believe depending on whom you are reaching out to there are  components that can be added to your print advertisement  or bill board which do more  than just cater to one single segment.

Eg Heart Care, lets say we are  targeting a very specific cardiac care population, while you run a  general solid copy introducing care “1000,000 hearts beat  under our care”,  for the  see public you could also integrate a  Facebook / blog address for the  think population to connect with our stories visit and  integrate  a  website  and  telephone for the  do population simple facts but are we doing them. Digital media provides us  with a  much better  opportunity to create these touch points and must be considered while creating our content  structure and design. And then there  could be specific campaigns which cater individually to each of these  segments individually for the see stage the campaigns will be brand oriented, for the  think stage they could be  narrower speciality or  disease  oriented and for the do stage they could be  action oriented and  need to be further  narrowed down .

Basing our Channel strategy around the  framework.

We need to consider what channels are we looking at to help us in reaching out to our target population and  more importantly which segment are we looking at reaching out  to through what channels. these  will dictate the creatives we  go ahead with.

Also probably an important  thought here  would be can we  actually increase the utility for a  particular channel to go across multiple  segments  through maybe changing our content.

The end result should be more effective  campaigns and better utility of channels.

Eg again ill take  it offline bill boards  when we  enter  a  market at times you might have  basic billboards  which initially are  for the  see  population but with time these can be effectively used to engage.

Similarly your keyword clusters would be  perfect for the same  , broader  keywords for the see population and narrower keywords for the think and do population.

Basing our measurements around the  framework

The third  stage would be to measure  for what we are trying to achieve. Somehow we  tend to focus on one core  measure and that  is conversion. Thats all we  talk about that’s  all we  know that’s  all we  measure  against. But  as was  stated before if the  core purpose of the campaign is to target the see population then how can we expect them to convert , conversions might happen and  probably  will happen but  in exceptional cases  in this case conversions is not the right measure. As Avinash states we cant really judge fish on their ability  to climb trees, lets measure them on their ability to swim. The  major concern here  is that perceived failure  leads to squashed campaigns and then there’s nothing left to do we  and  we miss  out on  an opportunity to engage a  potential customer because  we were measuring for conversion.  So its important to develop metrics for each of these stages

eg See – brand awareness, increased community, site  visits, conversations

Think  – interactions, query resolution, blog hits, call ins , page  depth , conversations,

Do – the part we love conversions, revenue, cost  per  conversion an   likes.

Well now you have the tool to measure the performance  of any particular campaign  and if id doesn’t work kill it  and if  it does hit it. Also i think some of these considerations can then further be applied to other  sales channels such as  doctor referrals, what stage is the  doctor at and what particular strategy we will have for him. Is that not brilliant  would it not naturally work much more efficiently.

So do try it and  see  of t works, whats there to lose if we engage with our customers as we  do currently im certain a time will come where nothing will work and people would just be put off because we are not sending out a  message that they are  ready for. Anyway with  social media and other reciprocal channels coming in people  are  selecting what they choose to listen to , so lets base our campaigns around our clients needs rather than ours and lets  cater to their selective attentions.

Disclaimer:

The views expressed in this  post are my own and  are  not meant to be derogatory  to any institution or organisation. These are just my thoughts and  these are open for further  discussion and  development. Please do comment and  share and  let’s get some universal cognition into this. Thank you for your patience and  tolerance.

Analysing the common Primary Healthcare Model

Have  you ever wondered why there  is such little  investment in primary healthcare setups by established  healthcare  players. Though there have  been models like the  Apollo Clinics, or the  Manipal Cure and care. But why the  limited expansion and why only such few players.

A population of over 1.2  billion surely deserves a  better  primary healthcare setup and  honestly though individual private clinics are sprouting up  day in and day out why is it then that corporate healthcare chains are finding it so difficult in  establishing their presence .

The very evident answer to that probably would be the  bottom line the  EBITDA margins.Let us  consider what  exactly are the  revenue streams in  a Primary healthcare setup and what are the approximate gross margins associated with them.

OPD consultation – The  base of the stream  is the  Opd consultation and other than a basic one time registration charge the Consultation fee can be split with the consultant  according to various models. Though from my limited  knowledge the most common model is the  70 – 30 split, though in other cases a base rental model can also be selected specially if the  clinic  is located  in a  prime location. But consider this, this is a prime revenue  stream , the stakes can’t be changed much unless we are looking at growing consultants. The reason for this is our direct competition with hospitals, tertiary care providers , and established consultants if they do choose to visit a  primary care setup would ideally do it atleast on similar terms as with most established  corporate  hospitals. And there are a few hospitals out there who are  not looking at gaining anything from the  opd consultation component. It’s a  tough market ,  thus unless  we devise a  new model maybe even profit  sharing model could be considered, which promises larger returns once the  clinic is established  its difficult to see how this particular component can change, honestly for me  the  profit sharing model would eliminate two major problems of  community clinics ,  the  consultant  attrition and the Cash flow drying up . Another  way around it could be to review the  entire  community clinic model in terms of clinical manpower selection (growing  consultants) and have a  strategy in place there  to increase share in revenue , but of course this would come with longer break-even times, and maybe higher  marketing expenditures.

The LAB  –  i think this probably is the  king maker in the  community healthcare centre. To make the clinic setup profitable in-house investigation facilities are important.  And probably the critical factor here is reaching a  certain critical mass to make on site  batches optimal.  The  Health checkup vertical  as well as the opd will feed this. In addition it’s also important to establish the centre as a  really good competitive  path lab, and  competition just increases manifold from there. Another  problem here  is  insecurity if you are  looking  at establishing you lab as a  critical revenue earner there  will always be the  insecurity with GPs about patient poaching and this needs to be dealt  with effectively.  The  gross margins here are  around the  60 to 80% mark i think  from what  i have heard. But  then it all depends  on volumes.  I think an important  strategic decision here is  how we enter the market. We ideally  should look at reaching a  critical  number  of  clinics in a  geography / city so that a  central lab can be established and we can get some economies of scale.

The Pharmacy  – this is another very important  factor for the  primary healthcare  setup , the  in-house pharmacy the margin  here would be around the  25-32% gross. When compared to hospitals and surgical consumables  this is less. Again the  strategy ideally would be to establish the brand independent of the  clinic, as a  stand alone pharmacy. Again the  model would gain from a  centralized purchase department, to gain from economies of scale. However external factors such  as the DPCO if they are to be implemented stringently would affect our margins further  here, both in terms of negotiation abilities as well as  margins .

The referral revenue – This is specially applicable to primary setups linked  with corporate hospitals where a  certain revenue inflow  occurs from patient  referral and conversion

It makes  me wonder why other  corporate giants don’t entre this arena. It seems to be profitable, and  im certain the capital expenditure associated is comparatively negligible. I mean it’s just the  Land / property cost associated and most diagnostic machineries now are  available on the consumables model thus decreasing the  basic cap ex required.  The associated operation expenditure  is similar to hospital opds in   terms  of proportioning costs on scales. But then consider this most marketing departments  from corporate hospitals are ready to support primary care setups, for star referral doctors.  They are  willing to provide  free consultations in lieu for conversions, then must primary care setups for hospitals be considered as separate cost units. Could they be an extension of marketing activities  outreach community setups . Just a  thought need to look at  the financials of this.

Another  solution to the  primary care setup would be the  PPP model and I think this has been discussed before. However  most  corporates would be a  little  apprehensive about the pricing with PPP models and the  SE stratum they would be targeting might differ. Though the  volumes would definitely increase and the associated costs will decrease as associated  land / rent costs will be removed. But then again wont the mid ranged primary care setup models like the  Aushadhi  / med plus mode in AP gain from such an association.

Well lets see what the future holds  for us here, but primary care definitely needs some good effective players the gap between demand and supply is enormous and  not just that  ,  I personally feel that honest ,  transparent primary care  setups  could gain loads from a highly knowledgeable  and aware  middle class population who  would love to be associated with quality primary care brand , where  there  is continuity of care and honest  and transparent referral pathways  for when  secondary and tertiary care is required.

Disclaimer:

The views expressed in this  post are my own and  are  not meant to be derogatory  to any institution or organisation. These are just my thoughts and  these are open for further  discussion and  development. Please do comment and  share and  lets get some universal cognition into this. Thank you for your patience and  tolerance.