New age models in elective surgery care – Times of India

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Healthcare has become one of the largest sectors of the Indian economy. According to NITI Aayog’s report, the overall Indian healthcare market is forecast to grow up to $370 billion by FY 22 and the surgery market is approximately around $100 billion. Most common elective surgeries performed in India include Laparoscopy (hernia and gallstone), Proctology (Piles, fissures) Gynaecology (Hysterectomy, Vaginal cyst removal), Urology (Kidney stones & Prostate), Vascular (Varicose Veins) and Ophthalmology (Cataract & LASIK). There are promising emerging healthcare delivery models
NITI Aayog’s report also says that up to 60% of health facilities are concentrated in a handful of large cities across the country which means access to quality healthcare services is limited to only tier-1 cities. Presently, only 30%-35% patients in India undergo surgery compared to 60%-65% globally and comparatively elective surgery numbers are much lower.
India has its own unique challenges. On one hand, there is a gap in supply of beds, diagnostic infrastructure, doctors and on the other hand, a large part of existing health care infrastructure is under-utilized. There’s a huge opportunity to standard and optimally utilize healthcare delivery in India and through that provide access to those living in smaller cities-towns.
Tectonic shift in patient expectations
In today’s day and age, patients have become more aware, want to have greater access to information and want to play an active role in the decisions related to their care. Patients are no more passive recipients but are the ones now driving their own healthcare experience and becoming engaged during the entire journey. Young, digital-savvy patients are expecting end-to-end care including:
Convenience: Hyper personalised pre-hospital and in-hospital services, including pick up and drop, paper-less admission and discharge process and hassle-free insurance clearance.
Cost assurance: Price transparency and interactive details on each cost item.
Real-time information on OT schedule, procedure, doctor visit, result of procedures.
Dedicated care plans from dieticians/physiotherapist and for other support for rehabilitation
This shift in behaviour and expectations has created the need for new models of healthcare delivery and engagement.
Ambulatory surgery centres (ASCs)
These are specialized medical facilities that provide surgical care for the procedures that don’t require an overnight stay in a hospital. A patient isn’t admitted to a hospital and can go home the same day of their procedure. While hospitals can be trusted to provide quality care, they have their fair share of frustrations for patients seeking elective surgery, like scheduling delays. In the US, over the last decade, Ambulatory care centres have become a popular alternative to inpatient hospital settings thanks to their flexible scheduling options, calmer and more comfortable environments, and lower costs. In India, hospital groups like have Apollo and Care have started working on such separate facilities with all the benefits of a large hospital but in a friendlier, more accessible facility.
Hub-and-spoke configuration of assets
Many health care providers started urban hubs which have sophisticated equipment and high-quality talent. Spoke facilities are in the far- flung area closer to the community. They are gateways but are not miniature hubs. In the western countries, most hospitals invest in equipment and offer a full range of services in the facilities, which leads to underutilization.
In India, the spoke facilities focus mainly on diagnosis, routine treatment, and follow-up care; they channel patients to the hubs for sophisticated procedures and surgery. HCG, for instance, has multiple spoke hospitals located in tier 2 & 3 towns arrayed around  their centre of excellence in Bangalore which serves as the urban hub. In this way they can provide integrated approach to cancer care. There are many other hospitals working on the same distributed model of care and configuration of Assets.
Asset light – Healthcare service delivery model
Then there are health care providers which have de-linked fixed asset costs of the hospital from the patient value chain. For Instance, Pristyn Care provides end to end patient care. They have fulltime surgerons and have multiple OPD clinics in a city. These surgeons see patients in the OPD and if a surgery is required, they operate in a partner hospital for an agreed fee.
Unlike full-fledged hospitals, Pristyn Care is not saddled with fixed asset costs, which can be a major drag on finances, especially when unutilized. Instead, it rents such idle infrastructure i.e., beds, operating rooms, ICUs at its partner hospitals. Further, it assigns a care coordinator to the patient to support the patient in surgical care journey both pre and post surgery. Point to note: Asset light model should not be confused with the agrregator model as in this model the companies employe their own doctors and backend staff.
Care coordination in the surgical journey as a service
These are the organizations which provide process and technology services to relieve the administrative burden from the provider and the patient. Kaizen health is a good example of such a model in the US which uses process and technology to provide access to the patients and saves staff hours of the health care provider. The concept is relatively nascent in India, however, there are early movers experimenting with solutions in this space as well.
Transition care centers
Post surgery, many patients look for additional care and support since they are not yet ready to assume their normal life again. Many short-term facilities (less than 21-days) are cropping up in the country and are addressing the gap in the patient care journey. Physiotherapy and speech therapy form a crucial part of the patient care plan at Transition Care centers.
What’s in the future?
Many healthcare systems are adopting more innovative care models but all of them need to have the following common characteristics:
Patient first approach: Rigorous process management, which includes standardization of clinical and operational processes, extensive use of new technologies and analytics.
Clinical leadership:  Quality control measures to ensure that the clinicians and para medical staff work to their best abilities
Technology first: Accept and adopt to the possibilities of the newer ways in which health care can be sought and delivered. Use of newer technologies and solutions are paramount in delivering care in a convenient and empowering manner.
Technology is no longer a separate function or business, but an integral way of providing a service. Thus, digital healthcare needs to be recognized as a full-fledged healthcare service, with the same enabling incentives that are provided to physical healthcare establishments.
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Views expressed above are the author’s own.
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