Re-engineering Indian healthcare 2.0 Tailoring for inclusion, true care and trust August 2019 1 | Reengineering Healthcare 2.0: Tailoring for inclusion, true care and trust 2 | Reengineering Healthcare 2.0: Tailoring for inclusion, true care and trust The government has built a comprehensive vision for healthcare in line with SDG 3 to ‘Ensure healthy lives and promote wellbeing for all at all ages’. Emphasis is on addressing key systemic, financial and human resource related challenges to facilitate access to healthcare for the last mile, through close collaborations with stakeholders from other ministries, healthcare industry, academia and civil society. Trust in the system will be crucial for building an efficient health system for a new India, which is inclusive, integrative and indigenous. Dr V K Paul, Member (Health), NITI Aayog, Government of India Ayushman Bharat Program will change the equation of healthcare in the country. It will promote equitable distribution of resources including specialists beyond the metros and Tier 1 cities with the unleashing of demand for healthcare and paying capacity. It will be an evolutionary process for private providers with new business models that focus on high volume and low margin business, sharing of resources, leveraging technology to be efficient & reduce length of stay and promote home based care. Dr Indu Bhushan, CEO, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB - PMJAY) and National Health Authority (NHA), Government of India A definitive is that healthcare must be equitable and inclusive to be true to its intent. It is wonderful that a very timely and pertinent report has been put together to help all in rethinking and redesigning processes and steer the course towards requisite decision making. Healthcare is at the cusp of tremendous change and the need of the hour is for radical thinking and disruptive solutions to address the dynamic economic and social milieu. Above all, the extent of the impact is the best barometer and the journey towards it would need to accommodate current expectations for greater involvement, clarity, and convenience in the healthcare delivery process. Furthermore, a healthier nation is the bedrock of a healthier economy. Ms Sangita Reddy, Senior Vice President, FICCI and Joint MD, Apollo Hospitals Enterprise Ltd Reengineering Healthcare 2.0: Tailoring for inclusion, true care and trust | 3 Foreword Rapidly transforming medical technology, availability of advanced diagnostic and therapeutic equipment, together with changing practice pattern of clinicians has revolutionized the way healthcare is being delivered globally. The healthcare sector is reinventing itself faster than ever, working on evolving, innovating and modifying care delivery models for integrated and value-based care, which will shape the future of healthcare. Emerging economies like India however, need to tackle the challenges of rising costs, inconsistent quality, inaccessibility to timely care, as well as confront the dynamics of globalization, consumerism, changing demographics and shifting disease patterns with increase in lifestyles and chronic disease, along with the proliferation of new treatments and technologies. With the launch of ‘Ayushman Bharat’ – the Indian government has demonstrated its strong commitment to providing healthcare for all, aligned to the SDG 3 goal. Healthcare has also been included as a key parameter in the country’s development plan through various comprehensive initiatives including Swachh Bharat, Digital India, Skill India, Start-up India, Make in India etc. over recent years. However, we have a long way to go before we can call ourselves a healthy nation in entirety. The Ayushman Bharat scheme, through its Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and 150,000 Health and Wellness Centers, will help the poor access quality healthcare and focus on preventive and primary care to reduce the disease burden in the country. The scheme envisions augmenting the healthcare infrastructure (hospital beds and workforce) through increased demand; promote standardization for quality health outcomes and structural reforms like effective use of health IT infrastructure. These shall also help improve claims management processes as well as provide the opportunity to leverage innovation and technology for better care outcomes. However, this vision can be achieved only with collaborative and outcome-based healthcare delivery both in public and private healthcare facilities. The government needs to implement the standardization of treatment protocols and billing process, along with Patient Health Records (PHR), Digital Claim Disbursement platform, Electronic Health Records (EHR) and SNOWMED CT as a part of the National Digital Health Ecosystem. Indeed, this is a tall order, but must be aimed to be achieved in next 5 years. The private healthcare providers with 70% of bed capacity and 60% of in-patient care are key stakeholders. While the government can mandate the adoption of these standards in public sector, market forces will ensure their adoption in private sector. Although, the concerns of financial sustainability of the private providers need to be addressed, along with affordability for the patient, through transparent and scientific costing practices. Hence, it is time that we re-engineer the healthcare ecosystem with systemic and structural changes, keeping the ground realities in mind, through innovative and sustainable models of care delivery as well as business processes. But above all, there is an urgent need to bridge the ‘trust deficit’ between the patient and the doctor; patient and the hospital; as well as government and the private healthcare provider for the Health of the Indian Healthcare. Owing to this, the Health Services Committee of Federation of Indian Chambers of Commerce and Industry (FICCI) felt the need to analyse the current scenario and come up with viable solutions for benefiting all stakeholders. FICCI has been working extensively in the healthcare sector as a change agent and has constituted multi-stakeholder forums to provide thought leadership and developed various recommendations and knowledge papers to suggest policy and regulatory reforms for betterment of the sector. Over the years, FICCI and EY have partnered for bringing out various reports covering critical issues and making robust recommendations for the healthcare sector. In 2016, FICCI-EY report on “Re-engineering Indian Healthcare- Empowered patient (consumer), enhanced outcome and efficient business” that evaluated several aspects of re-engineering our healthcare ecosystem and the role that government as well as private sector can play in bringing transformation to the sector. This FICCI-EY paper, on “Re-engineering Indian Healthcare 2.0”, is a step forward and an endeavour to outline the current challenges in the system and showcase emerging models of care delivery that can help improve outcomes of the healthcare system and make the healthcare business viable and sustainable. The paper focuses on realising India’s healthcare agenda through 3Ts - Tailoring for inclusion, Aiming True Care and Building Trust. The FICCI-EY Report, being released with the 13th edition of FICCI’s annual healthcare conference - FICCI HEAL 2019, scheduled on Aug 20-21, 2019; will also complement the theme of the conference- “Health of Healthcare in India”. Dr Narottam Dr Alok (Hony) Brig Dr Mr Gautam Ms Shobha Puri Roy Arvind Lal Khanna Mishra Ghosh Board Member & Former Co-Chair, FICCI Health Chair, FICCI Health Co-Chair, FICCI Health Assistant Secretary Chairman- NABH; Services Committee Services Committee Services Committee & General, FICCI Advisor-FICCI Health & Chairman, Medica & Chairman & MD, Dr CEO, Hinduja Hospital Services; Advisor-Medical Group of Hospitals Lal PathLabs Operations & Chairman- Fortis Medical Council, Fortis Healthcare Ltd 4 | Reengineering Healthcare 2.0: Tailoring for inclusion, true care and trust Preface The contours, context and contents of the healthcare ecosystem are rapidly evolving across the world. While the state of healthcare varies significantly across developing and developed countries and even within them, the underlying theme of change has a common thread, i.e., minimize disease burden, maximize reach of quality care and optimize the cost of delivered care. This has essentially brought a fundamental shift in the imperatives for the policy makers, providers and the public, leading to the emergence of cost of care, health outcome and health consumerism as the key performance indicators of the health system, underpinned by a quest for “healthcare” and not just “sick care”. India is in sharp contrast when compared to the developed world in terms of healthcare cost and expenditure, having one of the lowest per capita healthcare spend, total and public healthcare expenditure as a percentage of GDP and cost of health services. Consequently, issues of high disease prevalence, limited access to provider and low propensity to avail health services has been a challenge for the large populace with meagre means, which are barely enough to ensure subsistence. However, the healthcare industry in India is at the cusp of a transformation which will be characterized by unprecedented opportunities for growth in the affordable quality healthcare service offerings. In response, the healthcare system needs to tailor its current model for inclusion and mass healthcare, aspire to deliver true care with a focus on primary care, wellness and health outcomes and build