Harvard Business Review Press Reverse Innovation in Health Care: How to Make Value-Based Delivery Work

Having devoured more books on value in healthcare than hot dinners I thought I had encountered most ideas ….. this however was refreshing and offers those interested in practical organisational delivery of value new ways to value creation that sits outside the conventional 1st world approach. A fine read

Sensacional.Faz pensar nas enormes oportunidades na saúde para o Brasil.Disrupçao e vontade de executar

Many have tried to address the skyrocketing costs of American healthcare. Many have written about the astonishing results by hospitals in India such as Narayana Hrudalaya in Bangalore and Aravind EyeCare in Chennai. But Govindarajann and Ramamurti draw a straight line from one to the other and suggest some radical solutions for American healthcare from unexpected places. They back their hypothesis with real world American examples such as Ascension, the largest Catholic hospital system in the world, Iora Health serving Boston, Nevada and New York and the U Miss hospital center deep in the American south. The book should be required reading for any healthcare executive in government, in the corporate world and in the non profit arena.

Troisième livre de cet auteur pour moi, et là c'est vraiment mauvais, deux ou trois exemples étalés sur tout l'ouvrage, bref du vide

‘Vallavanukku Pullum Aayudham’ (English: For a wise man, even a blade of grass is a weapon) is a famous proverb in Tamil, an Indian language. This proverb in fact aptly describes the concept of frugal ground up innovation, in a poor country like India, where every asset is put to maximum use. In an environment of poverty and scarcity, the very constraints and limitations create enormous human capabilities for creative innovations. What if these innovations are transported to rich countries of abundance and wealth and applied in unique ways to solve problems at fractional cost? Prof Govindarajan (or VG as he is fondly called) pioneered this path breaking concept of Reverse Innovation using GE’s china made low cost ultrasound machine as a case study in 2012.This book is devoted to applying Reverse Innovation to deliver affordable and high-quality health care in the United States using ultra-low cost high quality medical care processes that are being successfully practiced in India on a large scale.America spends about 18 percent of its per capita income on health care. This accounts for about $10000 for every man, woman and child in the country. Yet, the quality is not the best and a large part of the population is underserved. On the other hand, the per capita total income in India is only $ 1670, and yet there are several players who provide best in class, high quality health care at about 5 percent of the cost in America. Those who can’t afford, don’t pay! Yet these world class health providers are profitable and growing. They are not simple out patient primary health care centers, but those who perform high end surgeries and treatments in the areas of ophthalmology, cardiology and cancer. Arvind Eye hospital in India for example is the largest eye care facility in the world where a cataract surgery for those who can afford costs a meagre $100 and free for the poor. A typical heart surgery at Narayana costs only about $2100, tens of thousands of dollars less than in the United States.The book provides a powerful case for the American health care industry to learn from the Indian Exemplars (seven top institutions like Aravind Eye, Narayana Health, HCG oncology, Deccan Hospitals, Care Hospitals, Life spring, LV Prasad are discussed) and adopt them at home to achieve the goal of affordable quality health care at home.The best part of the book is that i has developed a Breakthrough Business Model to conceptualise and understand the five core processes of the exemplars namely, Purpose (quality health care for all), Configuration (Hub and spoke), Leveraging Technology, Task shifting processes and Ultra-cost-consciousness. (This is at the core of what the authors call value-based health care, a significant departure from the American fee-based system.)While the Indian exemplars excel at all the five aspects of the breakthrough business model, it is possible to identify one or two of these selectively and yet, achieve significant results, argue the authors citing examples from four innovators like UMMC, HCCI, IORA and Ascension.Process improvement and innovation is a constant endeavour in the exemplars. Yet, the biggest force that drives these organizations twenty fours hours a day, are the people who have a strong alignment and identity with their founders’ vision. ‘Eliminating needless blindness’ is the mission at Aravind, where the founder Dr V, was a follower of Sri Aurobindo and believed in the ‘perfectibility of the human soul’ and “by helping a patient, you are helping yourself.” Dr Devi Shetty of Narayana Health was inspired by Mother Theresa who said that God was preoccupied while creating children with heart problems and hence sent Dr Shetty to treat them. We do not need better examples of angels on earth.We need more such angels, and reverse innovation to provide health care for all humans on this planet. “Health care is a human right,” says Dr Shetty.Processes can be replicated. Higher Purpose, Passion and Compassion are hard to copy. Daniel Pink would probably prescribe “A Whole New Mind’’ to heal America. Else, we have the danger of American health care system intruding into India, and not the other way.If America succeeds in transforming its health care in the coming decade, this book would go down in history as the most influential book that made it happen.