ibm healthcare in india

8/7/2019 IBM Healthcare in India

1/12

Healthcare

in IndiaCaring for morethan a billion

Executive summary

Healthcare

IBM Institute for Business Value

IBM Global Business Services

Toreceiv

eacopy

ofthe

fullreport,please

visit

ibm.co

m/health

care/hc2015


2/12

IBM Institute for Business ValueIBM Global Business Services, through the IBM Institute for Business Value,

develops fact-based strategic insights for senior business executives around critical

industry-specific and cross-industry issues. This executive brief is based on an

in-depth study by the Institutes research team. It is part of an ongoing commitment

by IBM Global Business Services to provide analysis and viewpoints that help

companies realize business value. You may contact the authors or send an e-mail to

[email protected] for more information.


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India has had notable health achievements

since independence in 1947. Lie expectancyhas doubled and inant mortality and crude

death rates have been greatly reduced.1 Some

diseases, such as small pox and guinea worm,

have been eradicated. Others, such as leprosy

and polio, have been nearly eliminated.2 And

Indias doctors and hospitals are increasingly

receiving recognition or the quality o care

they provide.

Nevertheless, India aces considerable

challenges. For example, the country accounts

or a relatively large share o the worlds

disease burden.3 And while Indias burgeoning

middle class has greater access to excellent

healthcare, the vast majority o citizens still

have limited access to basic care. The quality

o care varies signicantly, as well.

An examination o healthcare systems in

other countries underscores the importance

o achieving a value-based, aordable,

sustainable healthcare system in India. In a

recent study by the IBM Institute or Business

Value, we demonstrated that unrelenting

pressures are pushing many healthcare

systems along an unsustainable path.4 I

let unaddressed, many countries will reach

a breakpoint in their current paths, orcing

immediate and major orced restructuring.

What does this mean or India?

Without signicant changes, an unsustainable

path or India could have public health,

economic, social and political ramications.

For example, despite signicant investments,the healthcare inrastructure will likely remain

ragmented, ocused on acute, reactive,

episodic care and will be inaccessible or

many, particularly in rural areas. And the

insucient healthcare delivery capacity wouldbe exacerbated, as providers are burdened

by such issues as workorce shortages and

overcrowding.

Fortunately, a more positive scenario is

possible. However, it will require new levels

o accountability, tough decisions and

collaborative hard work on the part o all

stakeholders.

To help India avoid a healthcare crisis, we

recommend:

Healthcare providersexpand their current

ocus on episodic, acute care to encompass

the enhanced management o chronic

diseases and the lie-long prediction and

prevention o illness.

Citizensmake wiser health choices and

increase the value they receive rom a

transormed healthcare system.

Payershelp consumers remain healthy and

get more value rom the healthcare system, as

well as assist care delivery organizations and

clinicians in delivering higher value healthcare.

Supplierswork collaboratively with care

delivery organizations, clinicians, and patients

to produce products that improve outcomes

or provide equivalent outcomes at lower costs,

particularly or diseases endemic to India.

Societymakes realistic, rational decisions

regarding liestyle expectations, acceptable

behaviors and privacy policies as well as

the degree healthcare will be a societal right

versus a market service to provide all Indians

at least environmental and basic healthcare.

Healthcare in India: Caring for more than a billionExecutive summary

To download a complete copy

of Healthcare in India: Caringfor more than a billion,

please visit www.ibm.com/

healthcare/hc2015. The full

report includes a detailed

description of the drivers that

are changing the status quo

and that must be addressed,

as well as a hierarchy of

healthcare needs, principles

to guide transformation, a

vision for Indias healthcare

system, implications and

recommendations for keystakeholders (e.g., care delivery

organizations, doctors and other

care givers, consumers and

government) and more.

1 Healthcare in India


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2 IBM Global Business Services

Governmentaddresses the unsustainability o

the current system by providing the leadership

and political willpower to remove obstacles,

encourage innovation and guide the country to

sustainable solutions.

I stakeholders can act with accountability

and demonstrate the willingness and ability to

change, they can better harness the drivers o

change and achieve a win-win transormation.

Indias healthcare system can help its citizens

lead healthier, more productive lives, as well

as contribute to Indias ability to compete

globally. It can also help India win a competitive

advantage in the emerging global healthcare

industry.

Ingredients of a win-wintransformationAction and accountability are the basic

ingredients o change. To create a win-win

transormation in its healthcare system, we

believe India should undertake the ollowing

actions (see Figure 1):

Focus on value Consumers, providers

and payers should agree upon the deini-

tion and measures o healthcare value and

then direct healthcare purchasing, health-

care services delivery and reimbursementaccordingly.

Develop better consumers Consumers

need to make healthier liestyle choices and

become more astute purchasers o health-

care services.

Create better options for promoting health

and providing care Consumers, payers

and providers should seek out more conve-

nient, eective and eicient means, channels

and settings or health promotion and care

delivery.

A clear accountability ramework enables

these actions. Accountability must span the

system, including the provision o adequate

healthcare nancing and rational policy,

the adherence o healthcare proessionals

to clinical standards and quality care, theencouragement by payers o preventive and

proactive chronic care and the responsibility

by citizens or their own health.

The value transformation

Value is in the eye o the purchaser, but,

today, value in healthcare is dicult to see.

For example, data regarding quality is scarce

and mostly anecdotal or incomprehensible.Compounding this is the prevalence o

multiple orms o medicine, rom allopathic

medicine to more traditional, less regulated

orms such as Ayurveda, Yoga and

Naturopathy, Unani, Siddha and Homoeopathy

To complicate matters, the purchasers and

beneactors o healthcare consumers,

payers and society all have dierent opinions

as to what constitutes good value. Balancing

and resolving these conficting perspectives is

one o the major challenges in the successul

transormation o a healthcare system.

Win-Win

Transformation

Tran

sformin

g

Tra

nsform

ing

Transf

ormin

g

Value

Consum

erRes

ponsibility

CareD

elive

ry

Source: IBM Institute for Business Value.

FIGURE 1.

Keys to a win-win transformation of Indiashealthcare system.


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Today, consumers are largely responsible

or bearing the costs o healthcare, and their

ability to predict healthcare quality is equivalent

to a roll o the dice. Payers consumers,

public or private health plans, employers

and governments shoulder the burdeno healthcare costs, but have largely been

disintermediated rom or disinterested in the

quality o care discussion.

In the win-win scenario we envision,

consumers will assume much greater

responsibility or their healthcare, which, in

turn, will drive the demand or value data that

is readily accessible, measurable, reliable

and understandable. In response, payers will

help empower consumers by enabling greater

transparency into care costs and quality.

In the absence o pressure rom consumers

or payers or greater scrutiny, most providers

have not been orthcoming in providing

data around value. Recently, however, some

voluntary disclosures have emerged as some

corporate hospitals have begun to pursue

accreditation rom organizations such as the

National Accreditation Board or Hospitals and

Healthcare Providers (NABH) and the Joint

Commission International (JCI) in order to

promote their adoption o quality standards.

Payers also will take a more holistic view o

value looking not simply at the episodic costs

o procedures, but at how investments in high-

quality preventive care and proactive health

status management can improve quality and

help minimize the long-term cost structure o

care.

Finally, society will demand that payment or

and quality o healthcare services be aligned

to the value those services return, both to the

individual and to the country as a whole.

The consumer transformation

The second key element in the win-win

transormation o Indias healthcare system

is increased responsibility by consumers or

managing their healthcare services, as well

as their personal health management. AsIndia is pressed ever closer to the edge o

a healthcare crisis, the pressure is building

or consumers to change counterproductive

health behaviors and actively participate in

their healthcare decisions.

Today, consumers are not usually able to

dene value in healthcare. Some do not care

what healthcare costs because they see it

as ree or prepaid. Some do care, but nd

it prohibitively dicult to access meaningul

inormation they need to make sound choices.And many others do not have the health

literacy skills required to navigate these

choices.5

Compounding the problem is the disregard

by a segment o the population or healthy

liestyle choices. For example, tobacco use

is high in India, despite government eorts

to curtail this. Indians should be actively

engaged to combat illnesses and conditions,

especially since liestyle behaviors are a major

contributor to health status.

In the win-win scenario, we believe consumers

should increasingly comparison shop or

healthcare in the same manner they shop

or other goods and services. Liestyle

choices will also be more explicit, with poor

choices being accompanied by short-term

consequences.

Health infomediaries, or coaches, who help

patients identiy the inormation required to

make sound choices, interpret medical and

nancial inormation, choose between care

alternatives and channels and interact with the


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Among the poor, the ocus must be on

prevention and the achievement o improved

health status in terms o water supply,

sanitation, nutrition, access to vaccines,

vitamins and other low cost, but vital, services.

Preventive care may also be delivered by

midlevel providers including physiotherapists

nutritionists, exercise experts and midwives

in close coordination with doctors to address

Indias health workorce shortages o qualied

clinicians. While this will require a change

in the mindset among many consumers to

accept new orms or caregivers, it will open

up a strong demand or new and dierent

categories o healthcare proessionals.

Chronic careToday, as the incidence o chronic illness

increases, chronic care management remains

expensive, labor intensive and plagued by

wide variations in the eectiveness o care.

In the win-win scenario, particularly among

the upper and middle classes, we believe

chronic patients, increasingly assisted by

health inomediaries, will be empowered

to take control o their diseases through

IT-enabled disease management programs

that improve outcomes and lower costs. Their

treatment will center on their location, thanks

to connected home monitoring devices,

which will automatically evaluate data and,

when needed, generate alerts and action

recommendations to patients and providers.

The poor will likely continue to struggle to

meet basic environmental needs and, thus, will

lack the inrastructure to substantially limit the

progression o chronic disease. Eorts to stem

chronic disease will necessarily be aimedat the inectious and liestyle contributors to

chronic conditions.

providers they choose, are likely to become

xtures in the healthcare landscape or both

the well and the chronically ill, as well as or a

much broader socioeconomic segment o the

population.

A current example o health inomediaries is

the National Rural Health Missions Accredited

Social Health Activists (ASHAs). There

are thousands o emale ASHA volunteers

positioned at the village level and trained in

preventive health. They promote sanitation

and hygiene, disseminate inormation on basic

preventive healthcare and acilitate access to

public health acilities, particularly or women

and children.

The care delivery transformationThe third key element in the win-win

transormation o healthcare is a undamental

shit in the nature, mode and means o care

delivery. Healthcare delivery is overly ocused

on episodic acute care; it should shit and

expand to include and embrace prevention

and chronic condition management in order

to respond to the emerging environment.

Preventive care

Today, preventive care, which ocuses

on keeping people well through disease

prevention, early detection and health

promotion, is a concept without a champion in

India. Generally speaking, consumers ignore

it, payers do not incent it and providers do not

prot rom it.

In the win-win scenario, we expect the

notion o preventive healthcare will expand,

combining allopathic and indigenous

approaches and the best o the old and the

new. Consumers are likely to seek this carein new settings, such as their workplaces

and homes, which should oer lower prices,

enhanced convenience and more eective

delivery channels than traditional healthcare

venues.


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Acute care

Today, acute care is the oundation o the

healthcare economy, and its eectiveness

depends heavily upon the expertise o the

individual doctor. In the win-win scenario, we

anticipate that standardized approaches toacute care, developed through the careul

analysis o clinical data and the unrelenting

documentation o patient variation, will be a

widespread starting point in care delivery.

The availability o high quality care inormation

should enable the treatment o non-urgent

acute conditions, such as strep throat and

sinusitis, at the patients home via the use o

telemedicine or at-work settings that provide

low cost, good quality and convenience.

This will ree doctor time and encouragethe transormation o todays massive,

general purpose hospitals into centers o

excellence devoted to specic conditions,

combination triage centers, which determine

the specialized acility patients should go to,

and post treatment recovery centers, in which

patients are monitored beore returning home.

And in poorer areas, care standards should

enhance the education o local providers. In

most situations, however, with the exception

o scarce mobile healthcare services, people

living in remote locations without basic

services will likely still rely on traditional means

o treating acute illness.

Toward a value-based and sustainable

healthcare system

The transormational challenge acing

Indias healthcare system is considerable

but addressable. It should expand its

primary ocus on oten poorly coordinated

episodic care to encompass the lie-long

and coordinated management o preventive,

acute and proactive chronic care across

Indias burgeoning middle class, as well as

or those who will not benet rom economic

development.

This expansion should be achieved with

limited incremental unding in an increasingly

competitive global economy and healthcare

environment. Successul transormation will

require all stakeholders to actively participate,

collaborate and change. But, correspondingly,we believe the rewards o successul

transormation are high or all stakeholders.

Successul healthcare transormation also

requires a shared vision and a comprehensive

long-term plan created through an open,

inclusive process. This seems obvious, but is

rarely done. Too oten, change is addressed

in a piecemeal ashion, and solutions are

generated by a ew experts working behind

closed doors. The result is systemic chaos and

minimal buy-in.

As a starting point or this discussion, we oer

a multiaceted vision or Indias healthcare

one that addresses the nancial, inrastructure

and proessional resource gaps that Indias

healthcare system may ace (see Figure 2). It

also requires key stakeholders to collaborate

in the renement o the vision and to dene

an explicit set o values or a desired uture

healthcare system.

FIGURE 2.

Proposed vision for Indias healthcare system.

Source: IBM Global Business Services and IBM Institute for

Business Value.

Sustainablecoststruct

ure

Alignedincentives

Tr

ansparency,

choice

Rationa

lcoverag

ede

ci

sions

Mu

tual

accountab

ility

Expe

rimentali

nnovationwithin

Robust

informa

ti

oninfras

tructu

re

anation

alframework

Consistent,evidence-based,high-value care

Wellness andprevention

Innovation,safety and

quality


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Healthcare in India paints a portrait o what the

Indias healthcare system can look like in the

next decade. Parts o the portrait already exist

in the country with notable advances in the

public and private sectors. Even so, bringing

the entire portrait to lie is an extraordinarily

diicult, but vitally important task, which must

be inormed and achieved through a process

o debate and consensus, and action and

accountability.

We invite you to read the ull report which is

available at

ibm.com/healthcare/hc2015

And we hope that our ideas will serve as a

starting point or the transormation eort.

AuthorsSrivathsan Aparajithan is the Head o

Healthcare Business Solutions or IBM India.

He can be reached at [email protected].

Shanthi Mathur is responsible or Healthcare

solutions delivery in IBM India/SA. She can bereached at [email protected].

Edgar L. Mounib is the Healthcare Lead or

the IBM Institute or Business Value. He can be

reached at [email protected].

Farhana Nakhooda is the Healthcare Solutions

Manager or the IBM Asia Paciic Public Sector

team. She can be reached at farhanan@

sg.ibm.com.

Aditya Pai is a Managing Consultant with the

IBM Healthcare and Lie Sciences practice

in Toronto, Canada. He can be contacted at

[email protected].

Libi Baskaran is a Senior Consultant with IBM

Strategy and Change and is member o the

IBM Institute or Business Value in India. He

can be contacted at [email protected]


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Related publicationAdams, Jim, Edgar L. Mounib, Aditya Pai,

Neil Stuart, Randy Thomas and Paige

Tomaszewicz. Healthcare 2015: Win-win or

lose-lose? IBM Institute or Business Value.

October 2006. Available at

ibm.com/healthcare/hc2015

About IBM Global Business ServicesWith business experts in more than 160

countries, IBM Global Business Services

provides clients with deep business process

and industry expertise across 17 industries,

using innovation to identiy, create and deliver

value aster. We draw on the ull breadth o IBM

capabilities, standing behind our advice to

help clients implement solutions designed to

deliver business outcomes with ar-reaching

impact and sustainable results.

References1

Ministry o Finance, Government o India.

Union budget 2007-2008. 2007; Central

Intelligence Agency. The World Factbook.

https://www.cia.gov/library/publications/

the-world-actbook/geos/in.html; NationalCommission on Macroeconomics and

Health. Burden o disease in India.

September 2005.

2National Commission on Macroeconomics

and Health. Burden o disease in India.

September 2005.

3Ibid.

4Adams, Jim, Edgar L. Mounib, Aditya Pai,

Neil Stuart, Randy Thomas and Paige

Tomaszewicz. Healthcare 2015: Win-win or

lose-lose? IBM Institute or Business Value.

October 2006. http://www.ibm.com/health-

care/hc2015

5Health literacy is a term used to describe

the capacity o consumers to obtain,

process, and understand basic inormation

and services needed to make appropriate

decisions regarding their health. (source:

IOM Committee on Health Literacy. 2004.

Health literacy: a prescription to end

conusion. National Academies o Science.

Washington, DC).


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