A Letter to my Readers

Dear Readers,

Many of you would have noticed that I have hardly been writing this year.

Almost a year has gone by, without a single new post on this blog. Some of you might have wondered, where have I been hiding. Well, to tell you the truth, for most of the year I have been incredibly busy, mostly chasing business for Fortis Healthcare. Till recently, I was heading Sales and Marketing there and this involved a lot of travel, a daily commute from my home to work and, which would easily top 80 kms a day and would gobble up at least 3 hours on the roads in Delhi. Now, anyone who lives in Delhi, knows what this means both on a good and God forbid on a bad day. All this added up to a 12 plus hours a day of work and travel, which left me no time to do anything else.

And than, there was travel in India and abroad. This in a given month would easily consume a minimum of 10 days. While, I love traveling and usually find it uplifting, it would still leave me with even lesser time home, where I mostly write. While on long plane journeys pretty much around the world, I learnt I could easily read, but unfortunately, I also learnt on these journeys that writing inside an aircraft  is not my cup of tea. For me it is a solitary vocation, to be pursued in the privacy of my home.

Thus, over the year, as I read and traveled and toiled at Fortis, I kept accumulating new experiences, great insights and thoughts, that I knew would one day be shared with many of you on this blog.

Last month, I left Fortis, and returned to work at Max Healthcare, which has been a happy hunting ground for me in the past too. Returning to Max Healthcare, also meant less hours commuting to work (the office is 15 minutes away from home), less travel (at least in India, all of our hospitals are in North India, most of them in the National Capital Region) and hence, I am now hopeful of putting together more posts and the output here should go up.

Well, from the point of view of the journey of this blog, this year has just run away too quickly. As I recommence this journey, I shall look forward to your usual comments, feedback and encouragement.

Sincerely,

Anas

 

Learnings from the World Medical Tourism Congress

Last month, I had the opportunity to represent Fortis Healthcare at the World Medical Tourism Congress, held at the Caesar’s Palace, in Las Vegas. The conference was organized by the World Medical Travel Association and had participants from across the world.

Here a few things that stuck me as relevant for a larger discussion.

Medical Travel is now such a huge global phenomenon that we had thousands of people assembling in the wonderful Vegas to discuss how to make sense out of all of this. The conference had the mammoth Caesar’s Palace full, with all rooms sold out. The conference was held simultaneously in multiple conference rooms across the hotel, with folks attending sessions that were of interest to them.

The Congress had various stakeholders in the Medical Travel arena coming on a single platform. These included hospitals, medical facilitators, insurance companies, third party administrators, health plan managers and benefit managers from large corporates interacting with each other. Since the conference was in the Us we had a large number of hospitals from the Latin American countries. These included hospitals from Mexico, Costa Rica, Colombia, Argentina and even the small Dominican Islands. Fortis and Apollo Hospitals were representing India, while we also had hospitals from Turkey, Thailand and even Poland setting up stalls in the display area of the conference.

The Medical Facilitators, whom I met were really from across the world. We had a fairly large number of these who are based in the US and are largely sending patients to Latin America. We also met facilitators from China, Kuwait, Ukraine, Uzbekistan, Colombia and Nigeria.

The US seems to be completely in the grip of Obamacare. The law has spawned a small industry of experts, each trying to interpret the complex law in their own way. many experts held forth on how the law was a great opportunity for reforming the healthcare environment in the US. Almost, everyone agreed that the present mess of huge costs and a very large population of the uninsured will certainly be addressed well by the law. There were a lot of doubts on the execution challenges confronting the law and with the health exchanges taking off, all kinds of plans were being bandied about. I believe the law will create new opportunities for medical travel and will open many doors for people to travel and save costs on their medical bills. The travel will probably be more domestic than international, but as time goes by the confusion will clear and this will turnout to be the game-changer in the US healthcare.

While representing an Indian hospital, I was very pleasantly surprised to see the immense goodwill Indian doctors enjoy in the US markets. Most people I met believed that the Indian doctors were the best. Many had seen them at work in their local hospitals and the doctors had apparently impressed with their knowledge, skills and compassion. The other things that stood out as a distinct advantage was the English language (of all things). many wondered at proficiency that we had in the Queen’s language. I sent silent prayers to Thomas McCaulay,who unknowingly and with a completely different intent had introduced the charms of the English language to the natives.

Strangely, while many whom I met were aware of the prowess of Indian doctors, they did not know too much about Indian hospitals. Several people had no idea as to who were the leading players in healthcare in India and what was the value proposition, apart from healthy outcomes. When, we shared our price list with the local facilitators, there were only gasps of complete surprise and disbelief. With a CABG in the US going for USD 105000, our price of USD 7500, was truly unbelievable.

I believe Indian Hospitals need to engage with the US market a lot more. They just don’t know much about us. The government of India and other industry chambers such as CII, FICCI etc. must help facilitate this dialogue. In the conference, many countries were actually represented by their trade bodies promoting Medical Travel and individual hospitals were represented under this broad umbrella.

Finally, my compliments to the organisers. They really put up a massive show, very well organized with clearly defined programs, relevant content and mostly expert speakers. I think we need to have more of these to happen, so that Medical Value Travel really takes off around the world.

The Story of a World Record on the World Heart Day

World Heart Day was on Sept 29th this year and I was on tenterhooks.

Fortis Healthcare was aiming to create a Guinness World Records (GWR) record of the maximum cholesterol tests done in a city on a single day and I was nervous. We had been preparing for this day for the last four weeks and the day of reckoning was here.

The previous night I had slept late, mentally going through a check-list of things that we had closed, wondering about all that which may go wrong and hoping for the best the next day. Once, I had ticked off most things on  my mental check-list, I slept well and was up bright and early. It was time to see how the last 4 weeks of intense effort would now fructify.

The idea to attempt a world record of cholesterol tests came from Dr. Ashok Seth, the Chairman of Cardiac Sciences, at Fortis in New Delhi. Dr. Seth knows how to throw a challenge to the team. My colleague Jasrita and I had met him to discuss about the World Heart Day and Dr. Seth immediately threw down the gauntlet. He got us excited and committed. He got us thinking and wondering. A simple cholesterol test can serve as a warning sign for heart disease, we can use the test as a marketing device to create awareness about the disease. We hoped to get a few thousand people to come (fasting) to our hospitals on a warm Saturday morning to get their cholesterol levels checked.

Jasrita, Arnab and I got down to serious work. We had to plan and organise the campaign, get the hospitals excited and aligned, find a media partner who can drive home the message and have a diagnostic lab join hands with us in doing the physical testing. Fortis has more than half a dozen hospitals in the National Capital Region, who had to come on-board to participate in the activity. Most importantly, we had to find the money for a big campaign like this.

The Partners

Crayons

We roped in our advertising agency in Delhi as the key partner in developing the communication and for media planning. Crayons, has been working for many years and the CEO of Crayons, Ranjan has been a personal friend for over a decade. The Fortis team and the Crayons team met in their office for a detailed briefing. We took them through the idea, they loved it and saw great possibilities. They were raring to go. Two weeks later, Jasrita and Arnab trooped into my office with the first set of creatives, neatly printed and mounted on boards. The agency was surely putting its best foot forward. Also, they had churned out a lot of work. We had 4 different communication routes and tonnes of creatives. Jasrita, Arnab and I went through all the material calmly, debated and discussed each route and decided to sleep on it. I also asked Arnab to leave it lying around in my office overnight. We also agreed that, while we were attempting a World Record, it would not be appropriate for us to talk about it in our advertising.

The next morning we again went over the entire pile. We discarded two routes and shortlisted two for further discussions with Dr. Seth and Ashish, who is the Chief Operating Officer (COO) of Fortis. We met them on a Wednesday afternoon in Ashish’s office and took them through the ideas and the creatives. We unanimously agreed on a creative route. The die was now cast. Jasrita, Arnab and I would later fine tune the communication, pour over commas and full stops and agonize over every word written in the copy of the communication. We needed to get it just right and we knew that even a single word left out-of-place can leave a bad taste in the mouth.

The Hindustan Times

The Hindustan Times group is the second largest media company in the country and they rule Delhi. We called in the HT team for a briefing early on. They loved the idea as well. Of course, they were keen on our business as these are lean times for folks in the media business, but I would like to believe that they liked the idea more than the commercials. I have always believed that a partner delivers the best, when they buy in an idea. This is exactly what we did with the HT team. Of course, it helped that I knew them well as HT is my former employer and these guys are friends. While we negotiated hard, they eventually gave us a great deal.

SRL Diagnostics

SRL Diagnostics is a subsidiary of Fortis and is the largest diagnostic chain in the country. Jasrita worked hard with them to agree to collecting more than 10000 samples from 20 odd locations spread across the NCR. They were really a difficult bunch and the logistics of the exercise had to be meticulous. The last thing we wanted was to have people having a bad experience while giving samples, or the samples getting mixed up or reporting going haywire. Jasrita nailed everything down. Our favorite term during these days was ”idiot-proof”. We planned to make the entire process idiot-proof, dumb it down so that even the last person in the line should have no difficulty in understanding the process and following it. We meticulously calculated the number of phlebotomists needed at all the sample collection facilities, provided each of them with clear directions and fervently hoped that all will turn-up at the appointed hour. Jasrita wrote mails after mails detailing out a simple process over and over again so that everyone understood.

Guinness World Records (GWR)

Guinness World Records has a process for every record. They sent us reams of information about what all they needed to certify our record. They made us go nuts with their demands about arranging assessors, video-recording of all the sessions, the strict time-keeping, physical inspections of the sites and finally collection and evaluation of all the data. Boy, they are really thorough. They made us go through hoops but we complied on every single count. Jasrita, handled them adroitly, understood their detailed instructions and passed them on faithfully to the operations team. We were always fearful that we may fall foul of their elaborate process and miss out on the record on a technicality. What a pity that would have been.

The BTL Folks

We had a couple of ”Below the Line’ marketing agencies supporting us. They promoted the concept of a free cholesterol test directly to consumers. They went around parks looking for morning walkers, spread awareness in the hospital neighborhoods by distributing pamphlets and getting people to sign on for the test. Thus, one afternoon my wife and I were accosted by a young man at a Barista Coffee Shop, who explained to me what a cholesterol test was and how I can get one done free on Sept 29th at a Fortis facility. Bravo!, we both gladly registered.

Salt Mango Tree

You may wonder, what they are. Salt Mango Tree is in fact our agency for digital advertising. They trawl the internet for us. They also run our digital campaigns. For World Heart Day they promoted us on the Google sites, Facebook and Twitter. They created excitement in the digital world and got us a huge fan following on the net.

While, we had the partners lined up, a big challenge was to get each hospital charged up. We called meetings of the sales people from all the hospitals and, explained to them what we were attempting and asked them to contribute. Each hospital came up with ideas on getting folks to come to the hospital to give their samples. We met many times as a group, discussed progress, new ideas and revised plans. Goals were set, targets were mutually agreed upon and shared. The teams came together. The Corporate Sales teams too joined in. The word spread. We loved it. Aditya Vij, who is the CEO of Fortis Healthcare spoke with me. His big concern understandably was not the record but the customer experience that we were geared to deliver the next day. I assured him that we were ready.

Sept 29th 2012

I reached Fortis Escorts Heart Institute at around 0630 in the morning. I ran into Ashish, who too was wandering in. We had asked him to be the first donor of the day. The program was to begin at 7 in the morning and end at 1230. Even at 0630, we had the waiting area full, with people waiting for the tests. We began with Ashish and there was no looking back. Soon, I started receiving reports of a large turnout at almost all our facilities. The campaign had created a huge amount of excitement. We had people trooping in everywhere. Yet, the processes held up. We did not encounter any chaos anywhere.Everything went according to plan and by 11 we knew we were ahead of the existing record.

By the time we stopped at 1230, we were confident of having set a new GWR record. The GWR assessor took the entire afternoon in ascertaining our claims. He went through reams of physical data, the forms that we had collected and footage from across all our 20 locations. It was a mammoth exercise.

In the evening we assembled for a small function. The GWR representative asked Ashish to hazard a guess about the number of people who came for the test. Ashish who is usually ahead of the curve answered with a broad smile ”14161”. The GWR assessor looked a little abashed, smiled and said ”a very well-educated guess indeed”.

Medical Travel Must Come of Age

Medical Travel to India has now reached a certain level of maturity and business size and it has started getting serious attention from all manner of people. Back of the envelope calculations indicate that the opportunity today is approx. USD 500 mn and growing at least 30% or more pa. And these numbers are only the revenue that Indian Hospitals generate from patients traveling to India for medical treatment. Add to this the possible revenue from their stay in hotels in India and the airfare, we are perhaps staring at a business opportunity worth close to USD 1 bn today.

Strangely, for a business opportunity of this size, we still do not have organised players in the market. Almost all the patients traveling to India are being facilitated by small time medical travel operators, who make a commission in the process. Sadly most of these facilitators are completely unorganized, bring in patients through their personal contacts in places like Iraq and Nigeria and have very little resources to support or provide a vow experience to the patients. Many of them started as translators, who were hired by the hospitals as they received the first wave of foreign patients. They interacted with these hapless patients and earned their trust, branched off on their own and started getting patients referred by those who had come earlier.

While, these folks have so far done a reasonable job of patient facilitation, the time is ripe for the advent of the new generation of medical travel operators. These would in all likelihood be young entrepreneurs, tech-savvy and more in tune with the needs of our ”experiences” driven service economy. They would probably be initially supported by some of the larger Indian Hospitals, who would of course benefit immensely from foreign patients reaching their doors much better looked after. They would also hope to benefit from more patients coming through.

At Fortis Healthcare, which is India’s largest healthcare company and where I work, we are encouraging this trend. We would like to work with and support medical travel operators, who are professionally driven and are much better organised in joining us in sourcing international patients. We are identifying potential partners in various parts of the world and beginning to work with them in an effort to create a new and a different kind of eco-system. Hopefully, this would allow for a far better and a completely seamless experience to the patients who are traveling to us from all parts of the world.

I also believe that very soon we will have large travel operators also entering the business. The business case is so compelling that they can not really afford to stay out. Recent reports have indicated that Thomas Cook has decided to enter the market and I have had several discussions with Abercrombie and Kent, who are already setting up the medical travel infrastructure that they need, to roll out the business across multiple continents. They are exploring markets as far as Eastern Africa and Middle East where they are setting up information and patient facilitation centres to help connect patients to hospitals.

At the global level with medical travel destinations like Jordan and Turkey in Asia, Costa Rica and Panama in Central and Latin America, China and South Korea in the far East emerging as the new medical travel destinations (Thailand and India being there for several years now) the sky is really the limit. A global operator can easily facilitate patients into hospitals in any of these countries. Moreover, this would also provide their existing travel businesses a significant bump up as patients traveling to hospitals are usually accompanied by family and friends. Thus more air tickets and more hotel nights will directly contribute to their existing travel businesses.

Honestly, I have been quite baffled that large travel companies have so far not stepped in. My best guess is that they haven’t really looked upon medical travel as a large enough a business for them to get into. Medical travel in India has grown quietly. Not many people outside the healthcare industry, fully know about the extent of the business today even less about its potential. Also, they are is still a serious lack of awareness about the profile of medical travelers. Today we have patients in our hospitals at Fortis who have traveled thousands of miles and have come for extremely high-end medical procedures such as transplants and challenging paediatric cardiac surgeries.

Something in my bones tells me all this is about to end. Patients, should now be able to choose their hospitals and doctors anywhere in the world a lot more transparently, have their travel arrangements done professionally and receive the world’s finest medical care without the worries of a rickety and unreliable system which exists today.

Patients should be able to travel to their doctors and their hospitals a lot more sure about what they truly are getting into free of worries from everything except their medical condition.

The Healthcare Opportunity in India

Everybody acknowledges that the healthcare industry in India has a lot going for it. Patients from across the world are looking at state of the art Indian hospitals for cheap and quality care. The doctors and the nurses are considered to be one of the best in the world, their is abundant supply of good quality medical talent, health insurance is penetrating deeper and the market is predicted to grow substantially.

A quick look at the numbers tell the story. Healthcare is presently a USD 35 bn industry and is expected to grow to USD 75 bn by 2012. A Confederation of Indian Industry report says that investments worth USD 50bn are required annually for the next 20 years to meet the growing demand. India will need 3.1 mn additional beds (presently 1.1 mn) by 2018