Reverse Innovation in Health Care: How to Make Value-Based Delivery Work Kindle Edition

While the authors’ attempt to introduce “best practices” in India is commendable, the ideas are impractical if not impossible in the US health care system. Some of the ideas are downright scary – “reuse of single purpose surgical supplies.” It’s difficult to pinpoint all the differences between India and US in a complex topic as health care, but two immediate factors come to mind. First, there are entrenched reasons for the cost differences between the US and the rest of the world. For one, the US has an extremely litigious penchant towards health care providers, and a daunting level of checks and balances such as FDA clearance (and inspections) over pharmaceuticals and medical devices. One reason why the $1 voice prosthesis in India costs $700 in the US. Related to this, the US is one of the few markets where medical procedures and medication charges are not capped by the government; most nations even the most democratic and developed ones run health care as a utility. As a result, the US being a high-margin market subsidizes the high cost to develop “innovations” for the rest of the world. Second, the US medical networks have the “hub-and-spoke” model the authors recommend – it’s just isolated within a network. To gain the scale efficiencies in the book, individual networks would need to build a consortium to pool resources. Even if the networks are willing to work together, the efficiencies will still be difficult to gain based on the demographic and geographic profile of the US. Yes, the authors present us with 4 working cases in the Americas, but these institutions serve outliers of the general US population (e.g., Cayman Islands), and cannot be a foundation for the current health care needs of Americans. “Reverse innovation” may be a great concept in commodity industries, but for US health care, this book should be stored at the unreachable, top of the bookshelf [of ambulance chasing attorneys].

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.

The authors highlight lessons from healthcare innovators in India and how the lessons from India can be applied to US health care challenges. They highlight key issues of cost, access, quality and how these innovators have tackled these challenges. Other challenges in American health care such as healthcare disparities between social and ethnic groups are largely unaddressed , perhaps because these challenges also persist in India. I visited one of these hospitals during my executive MBA at Oxford university and found there care models quite impressive. The book is well researched and I commend the authors for a job well done. I recommend the book to CFOs, physician executives and administrators.

This book is very inspiring and made me rethink my role in the community. Social innovators, keep on innovating :) !

Must read for anyone who is involved in healthcare

In Reverse Innovation (2012), Vijay Govindarajan and Chris Trimble explain a process by which business leaders can identify the significant differences between rich-country and poor-country needs. "Reverse innovation does not begin with inventing, but with forgetting. You must let go of what you've learned, what you've seen, and what has brought you your greatest successes. You must let go of the dominant logic that has served you well in rich countries. If you want to use today's science and technology to address unmet needs in the developing world, then you must start with humility and curiosity." That is to say, reverse innovation can help to reverse the negative trends and tendencies that can weaken an organization.What are the core principles of value-based health care as practiced in India? According to Vijay Govindarajan and Ravi Ramamurti, there are five:1. A driving purpose: care for all2. A hub-and-spoke configuration3. An enthusiastic use of technology4. Task-shifting and continuous process improvement5. A culture of ultra-cost-consciousnessGovindarajan and Ramamurti note several correlations between these core principles and principles of value-based competition offered by Michael Porter and Elizabeth Olmstead Teisberg in Redefining Health Care: Creating Value-Based Competition on Results (2006):o Players should focus on creating value fort patients, not just lowering costs.o Competition should center on medical conditions over the full cycle of care.o High quality care should be less costlyo Value should be driven by provider experience, scale, and learning at the medical-condition level.o Innovation that increases value should be strongly rewarded.Most of those who are thinking about purchasing this book are probablky curious to know what happens when a health care organization attempts to replace its status quo with value-based health care as practiced in India. Govindarajan and Ramamurti include several lessons to be learned from each of these four organizations:Health City Caman Islands (HCCI) Pages 119-121Sample Lesson: Be frugal in capital expenditures and in variable costs.University of Mississippi Medical Center (UMMC) (144-146)Sample Lesson: Create a demand-driven network shaped by grassroots speed.Ascension Health (166-168)Sample Lesson: Use scale not just for market power but also to dramatically lower costs.Iora Health (188-190)Sample Lesson: Have a "social heart" but couple it with a "business brain."It is worthy of note that years ago, after days of negotiation facilitated by then President Jimmy Carter at Camp David, President Anwar Sadat of Egypt and Prime Minister Menachem Begin reached several agreements. At a press conference later, they were asked how, after centuries of savage bloodshed, they could reach these peace accords. Begin replied, "We did what all wise men do. We began at the end." That in essence is what reverse engineering is all about.Govindarajan and Ramamurti are well aware that no two health care service areas are exactly the same in terms of need, capacity, demographics, and resources. And the same is true of health care organizations within those areas. They fully recognize and understand cultural values and sensitivities that must be taken into full account. They also realize that the competitive marketplace is more volatile, more uncertain, more complex, and more ambiguous than ever before. All that said, the fact remains that world class health really care can be delivered affordably.I highly recommend this book to directors and administrators of all health care organizations as well as to all federal, state, county, and municipal officials who are involved in oversight and/or funding of those organizations. The process is reverse innovation and in this book Vijay Govindarajan and Ravi Ramamurti explain HOW. I'm certain that the material they provide in this book will help to save thousands of lives as well as billions of dollars all over the world.Bravo!

‘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.

Wonderful book.Loved the insights

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

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

Covers key issues