tansforming us healthcare plan

Ó Neeraj Mahajan 20091

Strategic Win-Win America Project (SWAP) for Smart Health & Prosperous Economy (SHAPE)

An innovative solution for

Affordable & Quality Health & Wellness

Transforming Healthcare: Because Change is Necessary...and Inevitable

“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)

Ó Neeraj Mahajan 2009 2

Philosophy

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…


Dr Narender K Gupta, MD, FRCP

SWAP: Founder CEO

Dr Narendra 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.


Healthcare Goals

“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.”


Our Vision

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


Objective: Smart, Healthy & Prosperous America and a vibrant World Economy

Our Goal:

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


More Smiles Per Mile– Across the World

Our Objective:

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


Smart America = (Healthy + Prosperous America ) x Wellness worldwide

Healthcare Management:

New Trends & Beliefs 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…


The need : A new model Healthcare

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


On-demand, need-specific Healthcare at the Doorstep of the Consumers

Before We Go Further : Top 5 Future–Ready Healthcare Trends

New health management trends that we cannot afford to ignore:

Empathy-

Availability 24 x 7 x 365

Innovative delivery

Continuous & chain-linked

Non-exclusive


Understand the specific needs of the Consumer and give him exactly what he wants not something you expect him to buy

Trend # 1 Top 5 Future–Ready Healthcare Trends:

Empathy = Connect


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




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




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…


Innovative delivery


Innovation is the key to success…


Innovative delivery


Innovation is inevitable…


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


Innovative delivery


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.


Innovative delivery


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

Fusion

Healthcare Communications


Innovative delivery


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…


Innovative delivery


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

New Mediums of Healthcare Delivery:

Print – Posters, brochures, patient information handouts & newspapers

Television, live and on demand webcasting, streaming media

Radio, podcasting

Internet, websites, portals, blogs, forums, patient support groups

Social media & Word of mouth

Mobile

DVD & other electronic formats


Continuous & chain-linked


Health & Wellness does not begin and end with the patient

Patient CareFamilySupport GroupsSocialCommunity

Hospital

Physician

Pre/ Post Op Care

Physiotherapy

Counselling

Meditation

Step by Step Process


Non-exclusive


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.

So then…

Are we prepared to face the future?


US Healthcare Industry

Where Do We Stand Today..?



Importance 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.


750,000 physicians, 580,000 establishments, 5,200 hospitals- 3.8 million inpatient and 20 million outpatients daily across 50 states


Importance of Hospitals

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.


Healthcare is a…

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.



Concerns

Access to care

Quality of care

Cost of care

Technology adoption

Burden on providers

Shortage of providers

Margins for providers declining

Policy Concerns



Stakeholders

Healthcare consumers

Employers

Hospitals


Physicians

PharmaCompanies

Insurance Companies

Government

Diagnostic Labs

MT &

Billing companies

All The Participants Must Transform


Segments

Healthcare Services Industry

Microbiological Testing

Outsourcing

Transcription

Quality Assurance

Validation

Compliance

Chemical Analysis,

Other Services


US Healthcare

Spending Trends


1960 1970 1980 1990 2000 2005 2006 2007P 2008P

$28 $75

In billion $

US Healthcare

Spending %age of GDP


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


Diagnosis


But … First Let’s

IDENTIFYThe Problem Areas


Frontline of the Battlefield

Bottlenecks at the Point of Entry

Emergency Department

Wait times exceeding six hours

Uninsured &

Under-Insured

Capacity Constraint

s


Hospital

Physician

Pharmacy

Healer

Physioth

erapist

Health Insurance


Main Problem


Consumer Health

Services : THE

PATIENT

Consumers are forced to interact with facilities focused around the needs of the Employer, Healthcare Provider, Payer or Supplier

Provider Centric Healthcare

US Healthcare

Unequal Distribution


What the top 50% and bottom 50 % consume ?

US Healthcare

The Uninsured


Source: KPMG Healthcare Industry Report 2006

US Healthcare

The Gap


Source: KPMG Healthcare Industry Report 2006


Problems 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



Problems 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.



Problems 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?


Does ‘I Love You- America’ mean Live Here Die Elsewhere ?

US Healthcare Burning Issue

Are Americans getting their penny’s worth?

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. Ó Neeraj Mahajan 2009 43

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



Are Americans getting their penny’s worth?

US Healthcare

Additional burden- The Baby Boomers

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



Uninsured & the Underinsured

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.


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.



American Paradox


American Paradox

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.



Core Issues to be discussed

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?



Issues to be considered

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


US Healthcare

Concerns for the Real America

“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


Far too many Americans are simply one pay-check, one natural disaster, one illness, away from discovering how vulnerable they actually are…

US Healthcare

Symptoms of a medical malice

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


US Healthcare

Symptoms of a medical malice

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.


Issue: Healthcare in times of recession

“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


US Healthcare

Shape of things to come

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.


US Healthcare

Shape of things to come

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.


US Healthcare

How this will affect

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 hitÓ Neeraj Mahajan 2009 57

US Healthcare

How this will affectThe 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.Ó Neeraj Mahajan 2009 58

US Healthcare

How this will affectThe 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.Ó Neeraj Mahajan 2009 59

US Healthcare

How this will affect

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


Medical Tourism

Beneficial, but for whom?

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.


How does all this help America ? ?


The Way Out


80:20 FormulaSolution: Inside-Out

The 80:20 Formula

Objective : 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


The 80:20 Formula

Why : Inside - Out

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


The 80:20 Formula

Benefits : Inside - Out

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



Finally, The Solution



Solution: Inside-Out

Our Win-Win Strategy- Who Gains:


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

Advantage America

How USA Benefits:

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


Advantage India – How India Benefits:

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 feeÓ Neeraj Mahajan 2009 69

Advantage Humanity –Benefits:

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.


Indian Doctors: why Americans feel confident…

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.


Benefits of Universal access to patient information and medical record

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


Case Study # 1: Doctor on Phone- first time in India

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.


Case Study # 1: Doctor on Phone- first time in India

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…



Priorities & Concerns


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.






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


Case Study # 2 : Patient care without boundaries

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.


US Healthcare

How the Consumer decides

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


Customer Response Management and Intelligent Marketing

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.


Team Strategic Win-Win America Project (SWAP) for Smart Health &

Prosperous Economy (SHAPE)

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


Neeraj Mahajan’s additional role & responsibilities

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



Thank You !!