Description
Group practice and to suggest a sustainable & scalable business plan along with marketing plan for Group practice setting. A Healthcare provider institution requires a balancing act. Provider institutions must balance pressures from the supply side (demographics, pattern of diseases, public expectations), the supply side (technology/clinical knowledge & work force) and the wider societal level (globalization, financial pressures). This leaves many of the providers wondering how to react. In a country like India which has largely Private healthcare provision, individual practitioners constitute an important part of the healthcare delivery.
To carry out a detailed analysis of Group practice and to suggest a sustainable & scalable business plan along with marketing plan for Group practice setting.
COE Marketing
Live Project
MBA program Batch 2008-2010 Semester IV
Name of student
Dr. Harsh Chopra
Roll no.
2008A49
COE Marketing ACKNOWLEDGEMENTS:
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I made a distinct choice of pursuing a career involving Healthcare and Health policy, and I have not regretted it since. During the course of MBA I have been lucky enough to work on a couple of projects involving healthcare functionality and to study all marketing subjects with Healthcare marketing point of view. At the first instance I would like to express my gratitude to Prof. Prathima Sheorey COE Marketing, for her inspiration and insights into the interesting subject of marketing. Her teaching made us realize the genius that goes into every research and how academics lay foundation of strong business sense. My heartfelt thanks to her, for giving us the freedom to decide our fie ld of interest for carrying out the winter project I would also thank Ms Anita Gupta Asst. Prof marketing for her timely guidance, for her kind co operation and for being always approachable. My research would be incomplete if it was not for the doctors who spared their time from busy schedules to have a discussion with me and give me certain wonderful insights. The patients and the hospital staff with whom I interacted have definitely helped me look at all the angles of stakeholder perspective And last but not the least I would like to acknowledge the intelligent tools SPSS and Microsoft Excel which helped me analyze the research in a better way. This being the last project at MBA, I am happy for I am looking towards the future and it is bright. So in the words of Calvin and Hobbes, I’d like to close by saying ?It’s a magical world.. its full of smiles!?
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COE Marketing TABLE OF CONTENTS:
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Table of Contents
Executive Summary............................................................................................................................ 4 Secondary Research/Literature Review .............................................................................................. 7 Objective of Research ...................................................................................................................... 11 Research Approach .......................................................................................................................... 12 Business Objective ........................................................................................................................... 13 Need Gap Analysis/Primary research................................................................................................ 18 Marketing plan ................................................................................................................................ 23 Financial Projections ........................................................................................................................ 33 Assumptions and Limitations............................................................................................................ 36 Conclusions and Implications............................................................................................................ 37 References....................................................................................................................................... 38 Exhibits............................................................................................................................................ 40
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COE Marketing EXECUTIVE SUMMARY:
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A Healthcare provider institution requires a balancing act. Provider institutions must balance pressures from the supply side (demographics, pattern of diseases, public expectations), the supply side (technology/clinical knowledge & work force) and the wider societal level (globalization, financial pressures). This leaves many of the providers wondering how to react. In a country like India which has largely Private healthcare provision, individual practitioners constitute an important part of the healthcare delivery. Private practitioners function independently and deal with all these pressures on their own not being able to cope with all of them at the same time, also independent functioning is not cost effective at most times and hence there is gradual d eterioration in the delivery standards, consequently the payer and the patient suffer due to poor delivery of services. The concept of Hospitals and clinics has taken place in the past two centuries and has been majorly driven by technology. But unfortunately in India most of the Healthcare delivery development has taken place with little focus on value creation and very little thought has gone into the development of service line strategies. In this research I have tried to establish what possibilities for change exist for the current day Indian private practitioner. Literature review has been done and discussion and interviews have been conducted with doctors with the underlying question of all this was ?will the individual clinic based model change, and will it progress to a sustainable Group practice model?? The Business model structure value proposition, market segment, strategic position, value chain, competitive strategy and cost structure/revenue potential provided the framework for identifying various key factors which were used in the creation of Strategy canvas variables. Also the model has been kept in mind to identify its applicability as a relevant theory to build various strategies for Group Practice. The interviews were conducted on MBBS and MD doctors of Pune. The outcomes of interview have been to identify the satisfiers/dissatisfiers with current form of private practice, Patient load of various doctors, Referral and diagnostic referral practices of specialists.
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COE Marketing
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Land and equipment cost were identified as the major criteria for consideration of new practice set up. These findings helped identify the importance of cost sharing and enhanced technology deployment at group practice. The notion of value is at the core of a business model: Value as Input and Value as Output. The current problem of healthcare delivery is aptly summed by Porter & Teisberg (2006) 19 as a zero sum competition; no value is created, competition is about shifting costs. Keeping these points of strategic decision making along with the target consumer’s needs a comprehensive business plan for a sustainable and scalable model of group practice setting has been created. The group practice setting has been named SATORI. Vision and mission of practice setting have been decided. Platform setting includes making nurses and doctors as our core strength and then extending to partnerships with Medical tourism agencies, advanced medical centers and insurance companies. The practice setting will be functional in two phases. The Polyclinic will start with initially 4 specialties: Pediatrics, Cardiology, Endocrinology and Urology. In first phase Addition of Cosmetology- Dermatology, Orthopedics and Gastroenterology followed by subsequent development of surgical facilities and addition of indoor beds will take place in the second phase. Marketing and communication objectives defined, SATORI will carry out marketing through a combination of: ? ? ? ? ? ? PR & publicity Within facility promotion Campaigns Tie Ups Advertisements CSR & community initiatives
Evaluation parameters have to be decided for the judgment of marketing campaigns.
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The financial success of business plan is judged at the end by devising a comprehensive expense and expected revenue analysis. Also taken into account is the yea r on year incremental revenue.
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COE Marketing SECONDARY RESEARCH/ LITERATURE REVIEW
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Modern medical care has become a complex service requiring the coordinated efforts of many physicians and other auxiliary talents. According to Havlicek PL,A medical group is defined as three or more physicians formally organized as a legal entity in which business, clinical and administrative facilities are shared 1 Many benefits have been stated in favor of group practice to improve quality, efficiency, physician life style and income. Evolution of Group practice: It was evident that they improved the quality of health care, decreased costs and provide a professionally desirable working environment for medical practitioners. Medical care has become increasingly complex and expensive. Awareness of medical errors has grown and the possibility for using organized processes to improve quality has been well studied. In this context, the role of group practice seems more relevant today. Moser M tells that, Large multispecialty groups like the Mayo clinic, Palo Alto Medical Clinic, Scripps Clinic and Permanente Medical group were formed following the report of the Chicago co mmittee in 1932 in the US 2 Pros & cons of Group Practice: Cited advantages of group practice include potential to increase physicians’ leverage with negotiating health plans, operational efficiency, improve quality and containing medical care costs. A prospective Community Tracking Study done by Casalino et al3 among physician groups, health planners and hospital administrators identified six important benefits and seven barriers Leverage with health plans and negotiating with health insurance schemes are useful indicators of group practice and were identified as the most frequently cited benefits in this study. As per Singh JC, It was also observed that gaining leverage with hospitals was the most frequently cited benefit. Improvement in the quality of life of the specialists, including lesser duties and more vacations was the other advantage. 4 Distribution of surplus money may be a contentious area. If the bonuses are not properly accounted for, it might result in judicial interference.
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COE Marketing Ope rational proble ms in a Group practice setting:
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Modern group practice involves a large number of people acting in different roles towards the achievement of a high standard of primary medical care. As well as medical, nursing, social and administrative roles it is essential to realize that all the families whose personal and corporate health are embodied within the practice are themselves an integral part of the organization and that operational considerations must include the patient group as a functioning and dynamic integer of the whole organization. 5 There is no doubt in any doctor's mind about his responsibility for these functions in the management of the illness situation. On the other hand, in the wider context of the management of the organization there are certain deterrents which prevent doctors from accepting their contribution. The traditional hierarchy of authority in general practice. The existence of a polarity in general practitioner attitudes and role perceptions was observed but not quantified by Fry and McKenzie
6
Line and staff relationships at the hospital level: The classic study of Isabel Menzies2 on the factors underlying wastage among nursing trainees in a large general hospital began a fundamental re-examination of the training and role of the nurse which is still evolving. 7 This report argues cogently for the need for management training for nurses at three levels of responsibility The management of people: The observations of Fry and McKenzie now become extremely important. The sociological role of the general practitioner can be at least partly described by attributing to him a 'maturation' function in respect of the families and individuals in his care. HEALTHCARE SETUP IN INDIA: ? ? ? ? Total healthcare expenditure is about 6% of GDP of which private expenditure is >75% about 2/3 rd of this expenditure is to meet the primary level treatment. 8 Bhatt RR researched that, Private healthcare expenditure has increased in India at the rate of 12.5% p.a since the year 1960-61 9 80% of qualified Allopathic doctors are working in private setups 10 In order to strengthen the private sector it is important to identify the areas of intervention to make it more responsive to problems of its growth.
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COE Marketing ?
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The most dominant system of payment in India is the fee-for–service. According to Bhat RR in 1999 11 70% of the providers charge on a fee-for-service basis
According to Technopak Healthcare outlook report 2007 the drivers of growth in Indian healthcare are: ? ? ? ? ? Better Health Insurance penetration Newer Treatments Lifestyle Diseases - Obesity, Diabetes, Cardiovascular Rising Income Levels Population of 1.2 billion by 2015
Health insurance: Less than 10% of India’s population has some form of health insurance cover 13 The sector is projected to grow to US$ 5.75 billion by 2010, according to a study by the New Delhi-based PHD Chamber of Commerce and Industry A growing number of hospitals in India are turning to accreditation agencies worldwide to both standardize their protocols and project their international quality of health care delivery. The health infrastructure across Indian states is projected to grow by an average of 5.8 percent per annum between 2009-2013, taking the total expenditure in 2013 to USD 14.2 billion In comparison to all 32 states, Maharashtra forecasted to maintain its dominance as the state with highest cumulative healthcare infrastructure expenditure, with spend of $ 7.3 billion between 2009 - 201cture challenges and opportunities
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COE Marketing The new Healthcare customer in India: ? ? ? ? ? ? ? ? Has better access to medical Information Focuses on quality and convenience Benchmarks across industry Is more able to afford the best Wants to be part of the decision making process Demands transparency Measures outcomes
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Pune Healthcare Landscape: Put the hospital and beds in exhibit ? ? ? The healthcare of pune is largely private. Exhibit No 1. Lifestyle Diseases are increasing >40% population in the lifestyle disease age bracket
Amongst chief patient load drivers are : ? ? ? ? Cardiology ailments Orthopedic& Trauma Diabetes & Endocrinology Routine Medical Problems
33 lacs(2009 1.8 10,000(WHO recommendation 3 per 1000 population) 6000(APPROX) 4000
Total Population( PUNE) Bed ratio (present) Total Beds Required Beds Available Bed Deficit
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COE Marketing OBJECTIVES OF THE STUDY:
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1. To understand the dynamics of a group practice set up and understand the factors governing its functioning. 2. To perform the feasibility of starting a Group practice in Pune 3. To plan the Marketing of Group practice set up 4. To prepare an estimate of budget requirements of the project
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COE Marketing RESEARCH APPROACH: Study Methods:
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For Primary research: 33 doctors practicing in Pune city were approached for interview. A sample of 70 doctors was selected using random selection from a list of doctors available with the registrar of medical education at BJ Medical college. 4 doctors were found to have stopped practicing at the mentioned address. A total of 21 doctors were finally interviewed in out of the 53 responsive doctors. These doctors included MBBS and MD doctors. The two pronged approach of questionnaire and Interview was used so as to obtain certain qualitative information on various aspects. The findings presented in Primary research are the responses to questionnaire however the insights provided during interview have been extremely helpful. Many views were subjective in nature and attempt was made to corroborate responses. However the findings are subject to non-response bias and subjective assessment, a limitation that is common to all such studies. Exploratory Research: Exploratory research was done through open ended questionnaire & focused group discussion. The parameters and variables obtained from exploratory research were converted into questions which were used for Primary Research. Estimated Value of Information: The value of information obtained from this exercise is suited for academic as well as business point of view. Considering the changes in Indian healthcare set up Group Practice offers a lot both in terms of Health policy related academics as well as business opportunity. Data collection method: Secondary data was collected from Journal research and web search. The library services of PGIMER (post graduate Institute of medical education and research Chandigarh) were utilised for journal referencing. The knowledge obtained from this data as well as discussion with Doctors during exploratory research was converted into a questionnaire. The questionnaire was
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COE Marketing
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personally administered (intercept) while doing the consumer survey so as to avoid confusion among respondents which may lead to item non response. Questionnaire Design: Structured Direct Personal questionnaires have been used to procure data from the Sample Attitude measurement scale: The following aids have been used for the data collection process: ? ? ? 5 point Likert Scale Open ended questions Multiple choice question
Sampling Process: ? ? Sample consisted of those physicians who are running Private practice The sample unit consists of people from Pune city
Stratified, convenience sampling has been used for the research. Research carried out to determine the various inputs for business plan: Observational research at important hospitals and personal interview of Health Administrators/supply managers of major hospitals in Pune Data reduction and Analysis techniques used: Business Model Approach Business model is a comprehensive approach to building strategy. It is a ?conceptual tool that contains a set of elements and their relationships and allows expression of the business logic of a specific firm? (Osterwalder, Pigneur, & Tucci, 2005) 14 .The key concepts of what a business model is all evolves around value: value creation, value realization and value appropriation How do we define value creation for hospitals in a way that informs future strategic planning? This research focuses on building a value-creating strategy for hospitals in a comprehensive and coherent way. Using strategy as a model, gives heads and tails to the
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COE Marketing
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question of what to analyze. It enables us to deal with complexities - which may, in many cases, actually result from the absence of a strategy (Kiewik, 2007) 15 . Different Literatures propose different role of business model: ? ? ? ? ? ? Analyzing, implementing and communicating strategic choices Shafer, H. J. Smith, & Linder, 2005 Telling a good story Magretta (2002) 16 Linking strategy and operations Mäkinen & Seppänen, 2007 17 Linking of strategic management and entrepreneurship theories of value creation Amit & Zott (2001) Focusing device that mediates between technology development and economic value creation Chesbrough & Rosenbloom (2002) Planning Magretta (2002)
The flow of idea in Business model tool STRATEGIC CANVAS TOOL: Strategy canvases allow a graphical representation of an organization’s strategic profile (Kim & Mauborgne, 2002, p. 78)18 How does the strategy canvas tool work: 1. Start with a blank strategy canvas per theme for each of the five business model themes (value proposition, market segment, strategic position, organizational structure and cost structure/revenue potential).
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COE Marketing
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2. Score the elements per theme for the proposed organization on a scale -- low, medium, high 3. Quantify each variable Merge all scores per theme 4. Merge all themes (this differentiate the most and the least; discuss lowest and highest scoring elements). The strategy canvas tool has been utilised in the strategy formulation for Group practice model discussed subsequently. The model summary is given in Exhibit No. 2
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COE Marketing
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A BUSINESS MODEL COMPLETE WITH MARKETING AND COMMUNICATION PLAN FOR A GROUP PRACTICE SETTING IN PUNE SATORI GROUP PRACTICE- Caring for you…with a difference! Mission To serve and enrich the quality of life of patients suffering from diseases, through the efficient deployment of technology and human expertise, in a caring and nurturing environment with the greatest respect for human dignity and life Vision SATORI group practice will strive with excellence to fulfil the needs of the Physician and patient community in its chosen field of medical treatment and grow to be the most respected name in quality healthcare business. Clinical profiles& facilities The Polyclinic will start with initially 4 specialties: Pediatrics, Cardiology, Endocrinology and Urology. In first phase Addition of Cosmetology- Dermatology, Orthopedics and Gastroenterology followed by subsequent development of surgical facilities and addition of indoor beds Business and marketing objectives: ? To achieve a 40 % awareness amongst the target audience by the first six months, 60 % by the end of one year. ? To achieve a conversion rate of at least 10 % from awareness to actual ordering of services. BACKGROUND: The Market, the need-gap, the market trends and industry analysis
?
Healthcare industry is the world's largest industry with total revenues of nearly USD 2.9 trillion. India's high population makes it an important player in the Healthcare Industry.
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COE Marketing
?
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Indian healthcare is expected to grow from a currently valued 37.5 billion USD industry to that worth 75 billion USD in the next 5 years itself. With a projected compounded annual growth rate of 15%, the industry is projected to grow close to 10 times its current size in the year 2022.
Growth Projections for the IHC
12000
12000 10000 8000 INR '000 million 6000 4000 2000 0 FY 2007 FY 2012 FY 2017 1500 6000
3000
FY 2022
FY 2007
FY 2012
FY 2017
FY 2022
Strategy Canvas Model summary:
STRATEGY CANVAS Value proposition Market Segment Strategic Position Value chain Cost Structure/ revenue 88.98246 89.57895 95.05 86.03922 93.29688
Model calculation shows that strategic position that we choose for the new enterprise i.e the position we chose to communicate to our internal and external stakeholders is of prime importance to Satori Group practice.
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COE Marketing Need Gap Analysis: Carried out by means of primary and secondary research. According to the primary research: No. of patients seen on a normal working day
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Range No patients 1 to 5 6 to 15 16 to 25 26 to 50 Above 50 Total
Minimum 8 40 19 12 16 5 100
Maximum 0 4 30 16 27 23 100
As per the survey, carried out amongst the doctors of Pune. Most private practitioners normally see anywhere between 10 to 50 patients a day. This shows that when different specialties come together a good patient load can be expected.
Practices of Patient referral
Frequency Never Occasionally Frequently Most often In all cases
Recommending for Specialists % Diagnostics % 17 50 23 6 4 2 42 45 8 2
Information sought by patients about
Diagnostic centre
3 37 30 27 4
Since most of the practitioners function independently i.e. runs their individual clinic they routinely refer patients for specialist and diagnostic purposes. This shows presence of a symbiotic relationship amongst the doctors and if the related specialties function under one roof
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the lost customers can be easily tapped also it would be more convenient both for the doctor and patient. Factors Affecting the establishment cost of a private practice player
Factors Location Equipment/technology Manpower maintenance Infrastructure rqmnts 5 51 42 4 1 1 4 17 36 16 19 7 3 8 12 26 34 10 2 6 4 19 29 17 1 3 1 15 3 37
Average Score 4.26 4.2 2.69 2.84 1.86
The biggest factor affecting the establishment of a new private practice set up is location followed by investment in technology and equipment. Thus if doctors are offered infrastructure facilities under one roof and also provided latest equipment and technology it will be a big motivator for them to join a group practice, it would lead to sharing of costs, better technology and consequently better services to the patient. The advantages as per discussion with doctors, for the two biggest interest groups would be:
Most important point that came out of discussion with doctors is Ancillary income, the group must get at least 30% of its income from ancillary service, it becomes difficult to sustain it as a group in absence of this income from ancillary services as specialists will find it advantageous to function independently
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COE Marketing Based on the above we can define the target customer as:
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Nature of the Group Practice facility: SATORI will be a high end Group Practice with the following characteristics: 50 bedded acute care tertiary healthcare facility with specialty and super specialty services ? Full outpatient department, inpatient department and primary care services ? It will have a state of the art radiology imaging centre ? It will be fully digitized and paperless with all clinicians and departments using an Electronic Patient Record system at all times ? It will provide an intimate, friendly and caring environment ? Its design and processes will be patient?focused ? High staff to patient ratios for personalized care ? Providing the highest standards of cleanliness, comfort, safety and convenience ? State of the art medical equipment and evidence based protocols It will be staffed by selected, highly?qualified healthcare professionals to ensure highest q uality practices Diagnostic services Radiology: CT scan, MRI, bone mineral densitometry, mammography, ultrasound, x?ray ? ?
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Laboratory: biochemistry, haematology, serology, microbiology, clinical pathology, histopathology Other support services Endoscopy, blood bank and blood components, dialysis, non?invasive cardiology such as echo, stress testing, holter, and ECG IT Driven tools and service ? ? ? ? ? ? USP ? ? ? ? ? ? Quality healthcare services with state of the art medical facilities under one roof Well qualified staff Excellent customer patients services Easily accessible and competitively priced. Customized designs to suit the varying needs of different customers (patients) Constant interaction with the patients and strong bonding with them Hospital management system Billing Inventory Accounts management Records management Decision support system that improves diagnosis and treatment
JCI Accreditation: ? ? ? ? To stay competitive in the market According to Ernst & young report quality is the most preferred attribute for patients to choose a particular hospital To increase customer satisfaction To cater foreign patients.
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COE Marketing Floor Wise Design: Basement:? ? 10 OPD’s Diagnostics, Lab
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Ground Floor:? ? ? ? ? ? ? ? ? ? Lord Ganesh Temple Reception, ADT department Billing Department Blood Bank Cafeteria Children Play Area Emergency Department Admin Department ATM machine
First Floor:? ? ? ? ? OT SICU Labour Room NICU PICU
Second Floor:? ? ? ? General Ward Twin Sharing Semi -Deluxe Rooms Library
Third Floor:? ? ? ? Tele-Medicine Department Conference Hall Yoga Area Ayurvedic Department
Estimate of man power provided in Exhibit No 3 B
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COE Marketing Governance plan: Management: Chairman and Director Chairman (1): ? ? Overall in charge of the whole institution.
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Owner of SATORI, responsible for financing and overall administration of the institution.
Director (1): ? Administrative In charge of the Institution,
Physicians in respective departments, to ease the issues of physician leadership crisis we shall have revenue sharing arrangement amongst the doctors.
Marketing Plan for SATORI Group Practice: MARKETING OBJECTIVES: ? ? To establish itself as a provider of excellent Medical care amongst the patients, insurance groups and organizations To establish itself as a top choice healthcare facility amongst the concerned specialists
POSITIONING: For The External customerA World class Integrated Healthcare facility with Specialty Focus For the Internal CustomerA Hassle Free Integrated Healthcare facility with World class technology & resources
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COE Marketing BRANDING THE GROUP PRACTICE Logo:
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An oyster with a pearl in it. The oyster is the symbol of the hospital, for whom the
patient is as precious as a pearl. Tagline: Caring for you…with a difference! Color: Light Blue and Yellow; Blue is a corporate color and it symbolizes tranquility, Yellow stands for honesty Brand Powe r: To provide the best in advanced super-specialty in healthcare; IT is given special importance COMMUNICATION OBJECTIVE: • To build Brand Aware ness of SATORI Group Practice Pune as a Excellent medical destination which also provides integrated diagnostic and therapeutic service • To portray SATORI Group Practice as having JCI accreditation, advanced capabilities and well trained medical staff among employers, health providers, medical planners, insurers • To create online& offline properties which are informative, interactive and give SATORI Pune a human face
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COE Marketing Platform Setting:
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Patients ( Phase 2 )
Experts and Early Adopters
( Phase 1 )
Peers and Partners
( Platform Setting ) Doctors and Nurses
( Core Strength )
Doctors and paramedical staff of the hospital shall form the core strength of the Group practice, hence initial focus would lay completely on them. Then as the core strength is established we move to setting partnerships, meanwhile targeting the experts and early adopters.
To establish the credibility of the brand as well as to attract good medical talent and patient clientage, partnership has to be looked into with: ? Medical tourism bodies
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COE Marketing ? ? ? ? Accreditation agencies Healthcare provider agencies Health Insurance agencies Advanced medical centres
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Looking beyond the 4Ps to get an overview of the Group facility:
PROMOTION: The various methods that will be used for promotion of group facility are as follows: ? ? ? ? ? ? PR & publicity Within facility promotion Campaigns Tie Ups Advertisements CSR & community initiatives
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COE Marketing The underlying theme of promotion will be based on-
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PR and Publicity: Touch points of Publicity campaign: • • • • • • • Newspaper Magazines: Health, general, Lifestyle Hoardings across various places in cities Advertisements in local television shows Sponsoring school events Organising awareness camps and visiting schools Mobile marketing
MEDIA COVERAGE Wide media coverage in both the vernacular and English press for local newspapers should be ensured: ? ? Whenever a pioneering work is done by our doctor, a rare case is diagnosed, award received by doctor Stories of dedication by Nursing& support staff
Proper care should be taken to highlight:
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COE Marketing • • • • • Information Touch points Patient Testimonials Excellent Customer Service End to end services Ancillary services
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PR would constitute one of the major brand building exercise since word of mouth constitutes the biggest and single largest motivator for patients to turn to a hospital. CAMPAIGNS:
Special Weeks targeted at specific TG: • Healthy Heart Week • Diabetes week • Know your kidneys week
Special OPDs on specific days of month: consultants charge Rs 100 for consultation
SATORI evening clinic 5 to 9 for 9 to 5 office goers
School camps
Camps in nearby suburbs & Diagnostic camps within city
These campaigns should be promoted through direct mailers, hoardings & press ads These campaigns should be backed by advertisements to be promoted on special days according to campaign: Women’s day special package for preventive health check up (Exhibit No. 4 A ) Educating women about Heart attack (Exhibit no. 4 B) Family membership programs/ Healthy neighborhood Exhibit No 4 C)
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COE Marketing Special promotions for doctors (Exhibit No 4 D ) TIE UPS: •
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Corporate Tie Ups: Pune being essentially corporate hub, specific tie ups with corporate houses, government bodies
• •
Tie Ups with Insurance providers A large no. of educational Institutions present: Specific packages for educational institutes
WITHIN FACILITY PROMOTION: For Internal Customers: • • • Inviting Expert faculty & CMEs in tie up with academic medical centre: AFMC BJMC Video conferencing with Advanced medical centre in US once a month Paramedical staff training regularly
For External Customers: • • Educational Posters Interactive screens which contain educational and Informative material in addition to facilities’ description • Feed back system
CSR AND COMMUNITY INITIATIVES: • • • Organize an annual marathon Be a part of special days: Anti Diabetes day, World Health day, Doctors’ day To be a part of rescue team in any natural calamity, epidemic in city
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COE Marketing •
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Involve SHGs in nearby villages: Specific campaigns for rura l household- Rs.300 annual membership which guarantees them free consultation for a five member family and discount of 10% on diagnostics and 5% on pharmacy
ONLINE MARKETING: Online marketing would play an increasingly bigger role for the establishment of Group practice brand. The website is a very important part of the branding exercise of entire marketing for SATORI• Homepage features a flash banner. The rotating images—evocative pictures of facilities and happy patient-doctor interactions—will help create a sense of sincere concern and personal care on behalf of staff and doctors • The homepage’s YouTube link will lead visitors to a portal filled with patient testimonies regarding their experiences and treatment • A blinking emergency contact icon on the top of the page for anyone interested in learning more about emergency • • • The virtual patient section Employing Search Engine Optimization Creating an Administrative Console to allow for personalization, simplify co ntent management on provider’s end, and enable Customer Relationship Management (CRM)
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COE Marketing
SATORI virtual patient section
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Other digital ideas: ? ? ? ? ? ? ? Media Facebook Twitter Orkut Flicker Youtube Mouth shut Blogger Metrics
? ? Digital ? ?
Increase in hits on website Engagement on social media Conversations around SATORI on blogs and discussion boards Contact information left for further enquiries
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COE Marketing ? ?
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Traffic directed via google ad words and flash banners bought New members registered on to SATORI website
?
No. of new associations with health providers and insurers post PR activity
PR & Publicity
?
Views of the Youtube videos about patients and their SATORI experience
?
No. of references of SATORI in media –Magazines, Newspapers & industrial journals
? Tie-Ups ? CRM ?
No. of new corporate/ Educational institutes/SHGs availing customized Health programmes No. of discount vouchers used for treatment Database of all the people who expressed interest in SATORI
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COE Marketing Financial Projection and estimation: Expenses Estimation:
Amount (Rs.) 1. Land cost 7000 Sq.Ft / *4000 2. Equipment planning
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Rs 28000000
Echo – Colour Doppler Ventilator: 3 Cardiac Monitor (NIBP) 30 Defibrillator: 5 TMT-2 Central Line Oxygen ECG Machine : 4 Pulse Oxymetre : 2 Centralized Monitor Infusion Pump : 4 Pace Maker : 02 Computerized System X-Ray :3 Cardiac Fowler Bed IITV USG : 2 Pathology Equipments Other material & Medicines CT scan MRI CSSD Lab
Ambulance@ Rs.500000/*2 Communication System@ Rs.2000000/1 IT system
Total
3. Hospital Furniture
Civil Cost Plumbing Cost Electrical Cost Air conditioning Cost Miscellaneous Cost Total
Miscellaneous Total
Rs. 18, 00,000 Rs. 24, 00,000 Rs. 30, 00,000 Rs. 10, 00,000 Rs. 03, 00,000 Rs. 02, 00,000 Rs. 40,000 Rs. 20,000 Rs. 01, 00,000 Rs. 120,000 Rs. 100,000 Rs. 02,00,000 Rs. 09,00,000 Rs. 07,50,000 Rs. 08,00,000 Rs. 8,00,000 Rs. 15,00,000 Rs. 02,00,000 Rs. 1,00,00,000 Rs. 1,50,00,000 Rs. 1,50,00,000 Rs. 2,00,00,000 Rs. 10,00,000 Rs. 20,00,000 Rs. 1,00,00,000 Rs. 115230,000 Rs. 75,00,000 Rs. 2,00,00,000 Rs. 30,00,000 Rs. 30,00,000 Rs. 24,00,000 Rs. 14,00,000 Rs. 37300,000 Rs. 10,00,000 Rs. 153530,000
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Budget Amount budgeted(Monthly) (Rs.) 1. Salaries NURSES @ Rs. 7000/ *20 Pharmacist @ 12000/* 4 Maintenance staff @ 6000/* 12 Security staff- outsourced Technicians @ 7000/*3 Housekeeping -outsourced dietary services @ 3000/ * 6 Administrative Heads @ 50000 /* 2 Med.Supr. CEO Admin Others @ 6000 /*6 RMO @ 15000/*8 Special Services @ 12000/*3 total Annual 140000 Rs. 48,000 Rs. 72,000 Rs. 20,000 21000 Rs. 10,000 18000 100000 Rs. 50,000 Rs. 1,00,000 36000 120000 Rs. 36,000 Rs. 771000 Rs 9252000 Rs 162782000 Amount expenditure(Yearly) (Rs.)
marketing budget
Rs. 30,00,000
Other expenses TOTAL
Rs. 6,00,000
Rs. 72,00,000 Rs. 172982000
Revenue estimation(year 2009-10) sr particulars no OPD patients(30 patients* 30 days * 1 8 OPD ) 2 IPD patients( 4 patients * 30 days ) 4 Pharmacy( OPD) 5 Pharmacy( IPD) 6 USG( 6usg * 30 days ) 7 Xray(10 Xrays * 30 days ) 8 CT (50 CT per month ) 9 lab tests( 50 OPD tests * 30 days) 10 lab tests( 25 IPD tests * 30 days) 11 ECG ( 30 ECG * 30 days ) 12 MRI (50 MRI per Month) TOTAL
Charges Rs. 500 Rs. 50,000 Rs. 700 Rs. 400 Rs. 2,200 Rs. 500 Rs. 800 Rs. 200 Rs. 4000
revenue per month 3600000 6000000 1000000 600000 126000 120000 110000 750000 600000 180000 200000 13286000
revenue per annum 43200000 72000000 12000000 7200000 1512000 1440000 1320000 9000000 7200000 2160000 2400000 159432000
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Financial Projection:
YEAR INCREA REVENUE SE IN REVENU E*(perc entage to original) 0% 159432000 15% 175375200 30% 45% 60% 75% 210450240 273585312 383019436.8 574529155.2 INCREASE IN EXPENDIT URE#(perc entage to original) 0% 10% 20% 30% 40% 50% EXPENDITURE PBIT## NET PROFIT(ASSU MED)
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
172982000 21397200 25676640 33379632 46731484.8 70097227.2
-13550000 153978000 184773600 240205680 336287952 504431928
93926580 112711896 146525464.8 205135650.7 307703476.1
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COE Marketing Limitations of the study and proposal:
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1. Respondents selected from amongst the private practitioners of Pune do not represent the actual market situation with respect to consumer segments, usage and perception about Healthcare brands within each segment attributes of importance, decision influencing factors, service evaluating attributes etc. 2. Apart from the various expenses considered for the financial planning there might be certain other unforeseen expenses which might exceed the miscellaneous expenses 3. Assumption has been made that an administrative model which is under the control of management shall be acceptable to doctors, this has been done to minimize the effects of physician leadership problems 4. The pricing of equipment and the remuneration to paramedical staff has been done keeping in mind the industry trends which might change at the time of implementation 5. The year on year increase in revenue has been forecasted keeping in mind favourable response to marketing campaigns and in sync with market growth rate 6. Since currently there are no operations of this kinds, the assumptions have been made keeping in mind the clinic and hospital model, certain situations peculiar to Group practice may arise which may call for a relook at strategy 7. The strategy canvas tool which has been used here, is assumed will be helpful for future strategy formulation as well and also to compare the competitors
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COE Marketing Conclusions and Implications of study and proposal:
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Though it has been undertaken as a academic project. This project bears importance both for the Health policy related academia and business idea in healthcare. The initial part of the project has analysed the Group practice as a concept, reviewing the existing literature in light of current healthcare scenario in India. The later part of project has implemented the understanding obtained through the analysis of literature and primary research into a feasible and sustainable business plan. The important implications of the study are: The Indian healthcare scenario is changing and the rising healthcare costs both for the patient and provider make it imperative to figure a cost efficient and technology employing method for providing healthcare support to patients In the initial setting up of practice land and equipment pose a major challenge, hence initial focus should be laid upon the Medical/non surgical facilities Ancillary services development shall be a major concern area for any Group facility development The business model of any healthcare agency should be focused at Value creation Understanding for the business model of any healthcare agency should arise at the customer level
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COE Marketing REFERENCES:
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(1) Havlicek PL. Medical group practices in the US. American Medical Association: Chicago III; 1999 (2) Moser M. The growth of Multispecialty Medical Groups 1982 1989. J Ambul Care Manage 1991;14:9-13. (4) Singh JC. Are we ready for subspecialization and group practice in India?. Indian J Urol 2006;22:23-6 (5) Reedy BLEC. operational problems in group practice. Journal of public health 2003; 4-7 (6) Fry, J. and McKenzie H. (1968). Journal of the Royal College of General Practitioners. 16, 437. (7) National Nursing Staff Committee. Management development ofsenior nursing staff in the hospital service. (1968). Department of Health and Social Security. London: Her Majesty's Stationery Office. (8) Health Report of Developing nations World bank 2006. (9) Bhat RR IIMA journal of management 1996 (10) Jassani Journal of community medicine 1989 (11) Bhat RR, journal of Healthcare policy and health 1999 pg 28-37 (12) Technopak Health outlook 2007 (13) Health Insurance – A Horizontal Study; Ministry of Finance;Eleventh Report, Committee on Public Undertakings (2005 - 2006); Fourteenth Lok Sabha) (14) Osterwalder, A., Pigneur, Y., & Tucci, C. L. (2005). Clarifying Business Models: Origins, present and Future (15) Kiewik nisatie' - Strategische keuze of angsthazerij , M. (2007, February). De gemeentelijke 'regieorga University of Twente.
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(16) Magretta, J. (2002). Why business models matter. Harvard business review, 80(5), 86-92 (17) Mäkinen, S., & Seppänen, M. (2007). Assessing business model concepts with taxonomical research criteria. Management Research News, 30(10), 735-748. (18) Kim, W. C., & Mauborgne, R. (2002). Charting: Your company's future. Harvard business review, 80(6), 76-83. (19) Porter, M. E., & Teisberg, E. O. (2006). Redefining Health Care: Creating Value based Competition on Results. Harvard Business School Press.
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COE Marketing EXHIBITS: Exhibit No 1: Pune’s healthcare landscape
HOSPITAL
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BEDS
Aditya Birla Budhrani Cantonment BVP Dr. Ambedkar Hsp. Deen Dayal Gadikhana (Clinic) Hardikar Hospital Inlaks & Budhrani & M.N.B.Cancer Jahangir Nursing Home Joshi Hospital K.E.M. Kamala Nehru Kotbagi Krishna Gen. Hospital (Stree Clinic) Leprosy Lokmanya Hsp Mental Hsp. N.M.Wadia Cardiology Naidu Poona Hosp. & Research Center Ratna Memorial Ruby Hall Nursing Home Deena Nath Manageshkar Sasoon
500 200 350 700 100 200 150 200 780 300 100 550 350 350 150 200 250 500 60 28 250 150 550 450 1200
Exhibit 1 B: Pune’s population break up:
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– Prostate Exhibit 1 C common ailments in Pune
Common Ailments encountered in Pune
• General Medicine:
– Respiratory Diseases – Heart Diseases – Neurology – Road Traffic Accidents
• Obstetrics & Gynecology
– Fibroid – Ruptured Uterus – Hysterectomy – Laproctomy – Cyst & Tumours – Infertility –LSCS
:
• Neurology
– Cerebrospinal strokes – Aneurysm
• Neurosurgery :
– Brain & pine Tumours – Spinal Degenerative Diseases – Head & spine Injuries
•
General Surgery:
– Appendicitis – Pancreatitis – Gall Bladder Infections – Cellulitis – GI Surgery – Traumatic Ulcers
• Opthal :
– Cataract – Glaucoma – Corneal Transplant – Refractory errors
• Plastic Surgery :
– Congenital Deformities – Post traumatic – Cosmetic Surgery – Burns
• Orthopedics :
– Total Knee Replacement – Osteoporosis – Fractures – Rheumatoid Arthritis – Joint Pains – Backache
• Cardiology :
– Myocardial Infarction – Arteriosclerosis – Pediatrics cardiology – Congenital Anomalies
• Nephrology
– Renal stones
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COE Marketing Exhibit No 2: Strategic Canvas: Model summary
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VALUE PROPOSITION 1.1 1.2 1.3 1.4 1.5 1.6 1.7
Diversity in Medical treatment Complexity of medical tretament Treatment volume Service Level Coordination of Care Non Medical services Research
Medium High High High High Medium Low
0.67 1 1 1 1 0.67 0.5
MAX SCORE 6 8 9 11 11 10 2
RELATIV E SCORE 4.02 8 9 11 11 6.7 1
MARKET SEGMENT 2.1 2.2 2.3 2.4 2.5 Patient Organization Helathy people Sick People Geographic Scope High High Medium High Medium 1 1 0.67 1 0.67 8 9 7 9 5 8 9 4.69 9 3.35
STRATEGIC POSITION 3.1 3.2 3.3 3.4 3.5
Cooperation: Support process Growth innovation transparency Supply chain Integration
High Medium High High High
1 0.67 1 1 1
8 6 7 10 9
8 4.02 7 10 9
VALUE CHAIN 4.1 4.2 4.3 4.4 4.5 4.6 Process optimization Physician In lead Management in lead capital intensive Standardization of care outsourcing High Medium High Medium High Low 1 0.67 1 0.67 1 0.5 10 7 11 7 11 5 10 4.69 11 4.69 11 2.5
COST STRUCTURE/REVENUE 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8
Cost reduction Profit Value based Payment Cost Based payment Insurance Income From Non core activities Income from Pvt payment Negotiable prices (the less the better)
Medium High High Medium High High High low
0.67 1 1 0.67 1 1 1 1
7 8 9 6 8 10 8 8
4.69 8 9 4.02 8 10 8 8
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COE Marketing Exhibit No. 3A: Questionnaire
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Dear Doctor, This is a questionnaire to assess the Indian Private practice scenario. The objective of the survey is research based and academic. Kindly spare a few minutes to answer the following questions. Doctor what is the number of patients that you see on an average per day? No patients 1 to 5 6 to 15 16 to 25 26 to 50 Above 50 Minimum Maximum
Doctor how often do you refer patients for Specialist services? Never Occasionally Frequently Most often In all cases
Doctor how often do you refer patients for Diagnostic services? Never Occasionally Frequently Most often In all cases
Doctor how often do your patients seek information on Diagnostic and specialist services? Never Occasionally Frequently Most often In all cases
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Doctor out of the following give score to the different factors that affect setting up a new practice as per the cost that you incur on them, where 5 being highest score and 1 being the lowest
Factors 5 Location Equip ment/technology Manpower maintenance Infrastructure rqmnts 4 3 2 1
Name: Qualification Hospital: Ph No: Interviewer: Date:
____________________ ____________________ ___________________ ____________________ ___________________ ___________________
Thanks a lot for your time and co-operation
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Exhibit 3 B: ESTIMATED MANPOWER
Nurses in the Hospital Nurses in I.C.U Nurses in S.C.C.U Nurses in I.C.C.U Nurses in N.I.C.U Nurses in Special ward Nurses in Deluxe ward Nurses in Double ward Nurses in Single ward Nurses in General ward Nurses in Day care Nurses in Operation Theatre Nurses in OPD Nurses in Casualty ward Nurses in Labour Room Total Nurses in the Hospital(Including 30% of Physiotherapy Department Relie ve rs) Physiotherapists Physiotherapists Aide/Junior Senior Physiotherapists Trainee Total Physiothe rapists Pharmacy De partment Pharmacists for Indoor Issues Pharmacists for OPD Issues Junior Pharmacists Senior Pharmacist Pharmcy Aide Chief Pharmacist Total Staff in Pharmacy General Maintainence Manpower required Relievers Total Staff in General Maintanence Security De partment Security guards (Including Relievers gateways & Special areas) Security Supervisor Total Staff in Se curity De partment Ste rile Supply Department Technician required including Supervisor Relievers shift Total Staff in Ste rile De partment Laundary De partment Laundry Opeartor Laundry Orderly / Assistant Laundry Staff Relievers Total Laundry Staff Shift Supervisor / shift
12 9 0 7 12 4 7 19 8 4 5 7 7 1 90 1 0 0 1 1 2 0 0 0 1 4 9 3 12 5 2 5 12 3 1 4 5 2 7 2 9 1
Department of Laboratory Medicine Section Head 1 Number of Technicians for fairly 6 Number of lab 9 automated Senoir Technicians 1 Technicians manual/fairly Total Technicians 10 automated lab Relievers 3 Attendants for Automated Lab 6 Relievers for Attendants 0 Reception cum Clerk 1 Relievers for Clerks 0 Department of Imaging Sciences Section Head Number of Technicians for routine Special X-rays, procedures like barium investigations, HSG etc. myelography Relievers Department of Ultra Sound Number of Technicians Attendants for Ultra Sound Releivers 1 2 4 1 2 4 1
Department of ECG & 2D ECHO Technicians with Echo 5 Relievers 2 Special Services Blood Bank Health Check Up X-Ray Infection Control Nurse Nurse Clinical Specialist Total staff - special services Food Service Department Dietician Cook Cook Helper Dishwasher/Attendant Storekeeper Total Staff in Food Service 0 1 0 1 1 3
1 3 3 3 1 11
Back
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COE Marketing Exhibit No 4 a : Advertisement for Women’s Day: preventive health package
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Exhibit No 4b: Advertisement for women’s heart check up
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COE Marketing Exhibit No. 4 c: Healthy neighbourhood/Family membership
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Exhibit No. 4 d: Advertisement for doctors on doctors’ day
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doc_843445448.pdf
Group practice and to suggest a sustainable & scalable business plan along with marketing plan for Group practice setting. A Healthcare provider institution requires a balancing act. Provider institutions must balance pressures from the supply side (demographics, pattern of diseases, public expectations), the supply side (technology/clinical knowledge & work force) and the wider societal level (globalization, financial pressures). This leaves many of the providers wondering how to react. In a country like India which has largely Private healthcare provision, individual practitioners constitute an important part of the healthcare delivery.
To carry out a detailed analysis of Group practice and to suggest a sustainable & scalable business plan along with marketing plan for Group practice setting.
COE Marketing
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MBA program Batch 2008-2010 Semester IV
Name of student
Dr. Harsh Chopra
Roll no.
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COE Marketing ACKNOWLEDGEMENTS:
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I made a distinct choice of pursuing a career involving Healthcare and Health policy, and I have not regretted it since. During the course of MBA I have been lucky enough to work on a couple of projects involving healthcare functionality and to study all marketing subjects with Healthcare marketing point of view. At the first instance I would like to express my gratitude to Prof. Prathima Sheorey COE Marketing, for her inspiration and insights into the interesting subject of marketing. Her teaching made us realize the genius that goes into every research and how academics lay foundation of strong business sense. My heartfelt thanks to her, for giving us the freedom to decide our fie ld of interest for carrying out the winter project I would also thank Ms Anita Gupta Asst. Prof marketing for her timely guidance, for her kind co operation and for being always approachable. My research would be incomplete if it was not for the doctors who spared their time from busy schedules to have a discussion with me and give me certain wonderful insights. The patients and the hospital staff with whom I interacted have definitely helped me look at all the angles of stakeholder perspective And last but not the least I would like to acknowledge the intelligent tools SPSS and Microsoft Excel which helped me analyze the research in a better way. This being the last project at MBA, I am happy for I am looking towards the future and it is bright. So in the words of Calvin and Hobbes, I’d like to close by saying ?It’s a magical world.. its full of smiles!?
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COE Marketing TABLE OF CONTENTS:
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Table of Contents
Executive Summary............................................................................................................................ 4 Secondary Research/Literature Review .............................................................................................. 7 Objective of Research ...................................................................................................................... 11 Research Approach .......................................................................................................................... 12 Business Objective ........................................................................................................................... 13 Need Gap Analysis/Primary research................................................................................................ 18 Marketing plan ................................................................................................................................ 23 Financial Projections ........................................................................................................................ 33 Assumptions and Limitations............................................................................................................ 36 Conclusions and Implications............................................................................................................ 37 References....................................................................................................................................... 38 Exhibits............................................................................................................................................ 40
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COE Marketing EXECUTIVE SUMMARY:
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A Healthcare provider institution requires a balancing act. Provider institutions must balance pressures from the supply side (demographics, pattern of diseases, public expectations), the supply side (technology/clinical knowledge & work force) and the wider societal level (globalization, financial pressures). This leaves many of the providers wondering how to react. In a country like India which has largely Private healthcare provision, individual practitioners constitute an important part of the healthcare delivery. Private practitioners function independently and deal with all these pressures on their own not being able to cope with all of them at the same time, also independent functioning is not cost effective at most times and hence there is gradual d eterioration in the delivery standards, consequently the payer and the patient suffer due to poor delivery of services. The concept of Hospitals and clinics has taken place in the past two centuries and has been majorly driven by technology. But unfortunately in India most of the Healthcare delivery development has taken place with little focus on value creation and very little thought has gone into the development of service line strategies. In this research I have tried to establish what possibilities for change exist for the current day Indian private practitioner. Literature review has been done and discussion and interviews have been conducted with doctors with the underlying question of all this was ?will the individual clinic based model change, and will it progress to a sustainable Group practice model?? The Business model structure value proposition, market segment, strategic position, value chain, competitive strategy and cost structure/revenue potential provided the framework for identifying various key factors which were used in the creation of Strategy canvas variables. Also the model has been kept in mind to identify its applicability as a relevant theory to build various strategies for Group Practice. The interviews were conducted on MBBS and MD doctors of Pune. The outcomes of interview have been to identify the satisfiers/dissatisfiers with current form of private practice, Patient load of various doctors, Referral and diagnostic referral practices of specialists.
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Land and equipment cost were identified as the major criteria for consideration of new practice set up. These findings helped identify the importance of cost sharing and enhanced technology deployment at group practice. The notion of value is at the core of a business model: Value as Input and Value as Output. The current problem of healthcare delivery is aptly summed by Porter & Teisberg (2006) 19 as a zero sum competition; no value is created, competition is about shifting costs. Keeping these points of strategic decision making along with the target consumer’s needs a comprehensive business plan for a sustainable and scalable model of group practice setting has been created. The group practice setting has been named SATORI. Vision and mission of practice setting have been decided. Platform setting includes making nurses and doctors as our core strength and then extending to partnerships with Medical tourism agencies, advanced medical centers and insurance companies. The practice setting will be functional in two phases. The Polyclinic will start with initially 4 specialties: Pediatrics, Cardiology, Endocrinology and Urology. In first phase Addition of Cosmetology- Dermatology, Orthopedics and Gastroenterology followed by subsequent development of surgical facilities and addition of indoor beds will take place in the second phase. Marketing and communication objectives defined, SATORI will carry out marketing through a combination of: ? ? ? ? ? ? PR & publicity Within facility promotion Campaigns Tie Ups Advertisements CSR & community initiatives
Evaluation parameters have to be decided for the judgment of marketing campaigns.
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The financial success of business plan is judged at the end by devising a comprehensive expense and expected revenue analysis. Also taken into account is the yea r on year incremental revenue.
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COE Marketing SECONDARY RESEARCH/ LITERATURE REVIEW
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Modern medical care has become a complex service requiring the coordinated efforts of many physicians and other auxiliary talents. According to Havlicek PL,A medical group is defined as three or more physicians formally organized as a legal entity in which business, clinical and administrative facilities are shared 1 Many benefits have been stated in favor of group practice to improve quality, efficiency, physician life style and income. Evolution of Group practice: It was evident that they improved the quality of health care, decreased costs and provide a professionally desirable working environment for medical practitioners. Medical care has become increasingly complex and expensive. Awareness of medical errors has grown and the possibility for using organized processes to improve quality has been well studied. In this context, the role of group practice seems more relevant today. Moser M tells that, Large multispecialty groups like the Mayo clinic, Palo Alto Medical Clinic, Scripps Clinic and Permanente Medical group were formed following the report of the Chicago co mmittee in 1932 in the US 2 Pros & cons of Group Practice: Cited advantages of group practice include potential to increase physicians’ leverage with negotiating health plans, operational efficiency, improve quality and containing medical care costs. A prospective Community Tracking Study done by Casalino et al3 among physician groups, health planners and hospital administrators identified six important benefits and seven barriers Leverage with health plans and negotiating with health insurance schemes are useful indicators of group practice and were identified as the most frequently cited benefits in this study. As per Singh JC, It was also observed that gaining leverage with hospitals was the most frequently cited benefit. Improvement in the quality of life of the specialists, including lesser duties and more vacations was the other advantage. 4 Distribution of surplus money may be a contentious area. If the bonuses are not properly accounted for, it might result in judicial interference.
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COE Marketing Ope rational proble ms in a Group practice setting:
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Modern group practice involves a large number of people acting in different roles towards the achievement of a high standard of primary medical care. As well as medical, nursing, social and administrative roles it is essential to realize that all the families whose personal and corporate health are embodied within the practice are themselves an integral part of the organization and that operational considerations must include the patient group as a functioning and dynamic integer of the whole organization. 5 There is no doubt in any doctor's mind about his responsibility for these functions in the management of the illness situation. On the other hand, in the wider context of the management of the organization there are certain deterrents which prevent doctors from accepting their contribution. The traditional hierarchy of authority in general practice. The existence of a polarity in general practitioner attitudes and role perceptions was observed but not quantified by Fry and McKenzie
6
Line and staff relationships at the hospital level: The classic study of Isabel Menzies2 on the factors underlying wastage among nursing trainees in a large general hospital began a fundamental re-examination of the training and role of the nurse which is still evolving. 7 This report argues cogently for the need for management training for nurses at three levels of responsibility The management of people: The observations of Fry and McKenzie now become extremely important. The sociological role of the general practitioner can be at least partly described by attributing to him a 'maturation' function in respect of the families and individuals in his care. HEALTHCARE SETUP IN INDIA: ? ? ? ? Total healthcare expenditure is about 6% of GDP of which private expenditure is >75% about 2/3 rd of this expenditure is to meet the primary level treatment. 8 Bhatt RR researched that, Private healthcare expenditure has increased in India at the rate of 12.5% p.a since the year 1960-61 9 80% of qualified Allopathic doctors are working in private setups 10 In order to strengthen the private sector it is important to identify the areas of intervention to make it more responsive to problems of its growth.
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COE Marketing ?
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The most dominant system of payment in India is the fee-for–service. According to Bhat RR in 1999 11 70% of the providers charge on a fee-for-service basis
According to Technopak Healthcare outlook report 2007 the drivers of growth in Indian healthcare are: ? ? ? ? ? Better Health Insurance penetration Newer Treatments Lifestyle Diseases - Obesity, Diabetes, Cardiovascular Rising Income Levels Population of 1.2 billion by 2015
Health insurance: Less than 10% of India’s population has some form of health insurance cover 13 The sector is projected to grow to US$ 5.75 billion by 2010, according to a study by the New Delhi-based PHD Chamber of Commerce and Industry A growing number of hospitals in India are turning to accreditation agencies worldwide to both standardize their protocols and project their international quality of health care delivery. The health infrastructure across Indian states is projected to grow by an average of 5.8 percent per annum between 2009-2013, taking the total expenditure in 2013 to USD 14.2 billion In comparison to all 32 states, Maharashtra forecasted to maintain its dominance as the state with highest cumulative healthcare infrastructure expenditure, with spend of $ 7.3 billion between 2009 - 201cture challenges and opportunities
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COE Marketing The new Healthcare customer in India: ? ? ? ? ? ? ? ? Has better access to medical Information Focuses on quality and convenience Benchmarks across industry Is more able to afford the best Wants to be part of the decision making process Demands transparency Measures outcomes
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Pune Healthcare Landscape: Put the hospital and beds in exhibit ? ? ? The healthcare of pune is largely private. Exhibit No 1. Lifestyle Diseases are increasing >40% population in the lifestyle disease age bracket
Amongst chief patient load drivers are : ? ? ? ? Cardiology ailments Orthopedic& Trauma Diabetes & Endocrinology Routine Medical Problems
33 lacs(2009 1.8 10,000(WHO recommendation 3 per 1000 population) 6000(APPROX) 4000
Total Population( PUNE) Bed ratio (present) Total Beds Required Beds Available Bed Deficit
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COE Marketing OBJECTIVES OF THE STUDY:
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1. To understand the dynamics of a group practice set up and understand the factors governing its functioning. 2. To perform the feasibility of starting a Group practice in Pune 3. To plan the Marketing of Group practice set up 4. To prepare an estimate of budget requirements of the project
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COE Marketing RESEARCH APPROACH: Study Methods:
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For Primary research: 33 doctors practicing in Pune city were approached for interview. A sample of 70 doctors was selected using random selection from a list of doctors available with the registrar of medical education at BJ Medical college. 4 doctors were found to have stopped practicing at the mentioned address. A total of 21 doctors were finally interviewed in out of the 53 responsive doctors. These doctors included MBBS and MD doctors. The two pronged approach of questionnaire and Interview was used so as to obtain certain qualitative information on various aspects. The findings presented in Primary research are the responses to questionnaire however the insights provided during interview have been extremely helpful. Many views were subjective in nature and attempt was made to corroborate responses. However the findings are subject to non-response bias and subjective assessment, a limitation that is common to all such studies. Exploratory Research: Exploratory research was done through open ended questionnaire & focused group discussion. The parameters and variables obtained from exploratory research were converted into questions which were used for Primary Research. Estimated Value of Information: The value of information obtained from this exercise is suited for academic as well as business point of view. Considering the changes in Indian healthcare set up Group Practice offers a lot both in terms of Health policy related academics as well as business opportunity. Data collection method: Secondary data was collected from Journal research and web search. The library services of PGIMER (post graduate Institute of medical education and research Chandigarh) were utilised for journal referencing. The knowledge obtained from this data as well as discussion with Doctors during exploratory research was converted into a questionnaire. The questionnaire was
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personally administered (intercept) while doing the consumer survey so as to avoid confusion among respondents which may lead to item non response. Questionnaire Design: Structured Direct Personal questionnaires have been used to procure data from the Sample Attitude measurement scale: The following aids have been used for the data collection process: ? ? ? 5 point Likert Scale Open ended questions Multiple choice question
Sampling Process: ? ? Sample consisted of those physicians who are running Private practice The sample unit consists of people from Pune city
Stratified, convenience sampling has been used for the research. Research carried out to determine the various inputs for business plan: Observational research at important hospitals and personal interview of Health Administrators/supply managers of major hospitals in Pune Data reduction and Analysis techniques used: Business Model Approach Business model is a comprehensive approach to building strategy. It is a ?conceptual tool that contains a set of elements and their relationships and allows expression of the business logic of a specific firm? (Osterwalder, Pigneur, & Tucci, 2005) 14 .The key concepts of what a business model is all evolves around value: value creation, value realization and value appropriation How do we define value creation for hospitals in a way that informs future strategic planning? This research focuses on building a value-creating strategy for hospitals in a comprehensive and coherent way. Using strategy as a model, gives heads and tails to the
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question of what to analyze. It enables us to deal with complexities - which may, in many cases, actually result from the absence of a strategy (Kiewik, 2007) 15 . Different Literatures propose different role of business model: ? ? ? ? ? ? Analyzing, implementing and communicating strategic choices Shafer, H. J. Smith, & Linder, 2005 Telling a good story Magretta (2002) 16 Linking strategy and operations Mäkinen & Seppänen, 2007 17 Linking of strategic management and entrepreneurship theories of value creation Amit & Zott (2001) Focusing device that mediates between technology development and economic value creation Chesbrough & Rosenbloom (2002) Planning Magretta (2002)
The flow of idea in Business model tool STRATEGIC CANVAS TOOL: Strategy canvases allow a graphical representation of an organization’s strategic profile (Kim & Mauborgne, 2002, p. 78)18 How does the strategy canvas tool work: 1. Start with a blank strategy canvas per theme for each of the five business model themes (value proposition, market segment, strategic position, organizational structure and cost structure/revenue potential).
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2. Score the elements per theme for the proposed organization on a scale -- low, medium, high 3. Quantify each variable Merge all scores per theme 4. Merge all themes (this differentiate the most and the least; discuss lowest and highest scoring elements). The strategy canvas tool has been utilised in the strategy formulation for Group practice model discussed subsequently. The model summary is given in Exhibit No. 2
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A BUSINESS MODEL COMPLETE WITH MARKETING AND COMMUNICATION PLAN FOR A GROUP PRACTICE SETTING IN PUNE SATORI GROUP PRACTICE- Caring for you…with a difference! Mission To serve and enrich the quality of life of patients suffering from diseases, through the efficient deployment of technology and human expertise, in a caring and nurturing environment with the greatest respect for human dignity and life Vision SATORI group practice will strive with excellence to fulfil the needs of the Physician and patient community in its chosen field of medical treatment and grow to be the most respected name in quality healthcare business. Clinical profiles& facilities The Polyclinic will start with initially 4 specialties: Pediatrics, Cardiology, Endocrinology and Urology. In first phase Addition of Cosmetology- Dermatology, Orthopedics and Gastroenterology followed by subsequent development of surgical facilities and addition of indoor beds Business and marketing objectives: ? To achieve a 40 % awareness amongst the target audience by the first six months, 60 % by the end of one year. ? To achieve a conversion rate of at least 10 % from awareness to actual ordering of services. BACKGROUND: The Market, the need-gap, the market trends and industry analysis
?
Healthcare industry is the world's largest industry with total revenues of nearly USD 2.9 trillion. India's high population makes it an important player in the Healthcare Industry.
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COE Marketing
?
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Indian healthcare is expected to grow from a currently valued 37.5 billion USD industry to that worth 75 billion USD in the next 5 years itself. With a projected compounded annual growth rate of 15%, the industry is projected to grow close to 10 times its current size in the year 2022.
Growth Projections for the IHC
12000
12000 10000 8000 INR '000 million 6000 4000 2000 0 FY 2007 FY 2012 FY 2017 1500 6000
3000
FY 2022
FY 2007
FY 2012
FY 2017
FY 2022
Strategy Canvas Model summary:
STRATEGY CANVAS Value proposition Market Segment Strategic Position Value chain Cost Structure/ revenue 88.98246 89.57895 95.05 86.03922 93.29688
Model calculation shows that strategic position that we choose for the new enterprise i.e the position we chose to communicate to our internal and external stakeholders is of prime importance to Satori Group practice.
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COE Marketing Need Gap Analysis: Carried out by means of primary and secondary research. According to the primary research: No. of patients seen on a normal working day
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Range No patients 1 to 5 6 to 15 16 to 25 26 to 50 Above 50 Total
Minimum 8 40 19 12 16 5 100
Maximum 0 4 30 16 27 23 100
As per the survey, carried out amongst the doctors of Pune. Most private practitioners normally see anywhere between 10 to 50 patients a day. This shows that when different specialties come together a good patient load can be expected.
Practices of Patient referral
Frequency Never Occasionally Frequently Most often In all cases
Recommending for Specialists % Diagnostics % 17 50 23 6 4 2 42 45 8 2
Information sought by patients about
Diagnostic centre
3 37 30 27 4
Since most of the practitioners function independently i.e. runs their individual clinic they routinely refer patients for specialist and diagnostic purposes. This shows presence of a symbiotic relationship amongst the doctors and if the related specialties function under one roof
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COE Marketing
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the lost customers can be easily tapped also it would be more convenient both for the doctor and patient. Factors Affecting the establishment cost of a private practice player
Factors Location Equipment/technology Manpower maintenance Infrastructure rqmnts 5 51 42 4 1 1 4 17 36 16 19 7 3 8 12 26 34 10 2 6 4 19 29 17 1 3 1 15 3 37
Average Score 4.26 4.2 2.69 2.84 1.86
The biggest factor affecting the establishment of a new private practice set up is location followed by investment in technology and equipment. Thus if doctors are offered infrastructure facilities under one roof and also provided latest equipment and technology it will be a big motivator for them to join a group practice, it would lead to sharing of costs, better technology and consequently better services to the patient. The advantages as per discussion with doctors, for the two biggest interest groups would be:
Most important point that came out of discussion with doctors is Ancillary income, the group must get at least 30% of its income from ancillary service, it becomes difficult to sustain it as a group in absence of this income from ancillary services as specialists will find it advantageous to function independently
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COE Marketing Based on the above we can define the target customer as:
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Nature of the Group Practice facility: SATORI will be a high end Group Practice with the following characteristics: 50 bedded acute care tertiary healthcare facility with specialty and super specialty services ? Full outpatient department, inpatient department and primary care services ? It will have a state of the art radiology imaging centre ? It will be fully digitized and paperless with all clinicians and departments using an Electronic Patient Record system at all times ? It will provide an intimate, friendly and caring environment ? Its design and processes will be patient?focused ? High staff to patient ratios for personalized care ? Providing the highest standards of cleanliness, comfort, safety and convenience ? State of the art medical equipment and evidence based protocols It will be staffed by selected, highly?qualified healthcare professionals to ensure highest q uality practices Diagnostic services Radiology: CT scan, MRI, bone mineral densitometry, mammography, ultrasound, x?ray ? ?
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COE Marketing
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Laboratory: biochemistry, haematology, serology, microbiology, clinical pathology, histopathology Other support services Endoscopy, blood bank and blood components, dialysis, non?invasive cardiology such as echo, stress testing, holter, and ECG IT Driven tools and service ? ? ? ? ? ? USP ? ? ? ? ? ? Quality healthcare services with state of the art medical facilities under one roof Well qualified staff Excellent customer patients services Easily accessible and competitively priced. Customized designs to suit the varying needs of different customers (patients) Constant interaction with the patients and strong bonding with them Hospital management system Billing Inventory Accounts management Records management Decision support system that improves diagnosis and treatment
JCI Accreditation: ? ? ? ? To stay competitive in the market According to Ernst & young report quality is the most preferred attribute for patients to choose a particular hospital To increase customer satisfaction To cater foreign patients.
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COE Marketing Floor Wise Design: Basement:? ? 10 OPD’s Diagnostics, Lab
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Ground Floor:? ? ? ? ? ? ? ? ? ? Lord Ganesh Temple Reception, ADT department Billing Department Blood Bank Cafeteria Children Play Area Emergency Department Admin Department ATM machine
First Floor:? ? ? ? ? OT SICU Labour Room NICU PICU
Second Floor:? ? ? ? General Ward Twin Sharing Semi -Deluxe Rooms Library
Third Floor:? ? ? ? Tele-Medicine Department Conference Hall Yoga Area Ayurvedic Department
Estimate of man power provided in Exhibit No 3 B
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COE Marketing Governance plan: Management: Chairman and Director Chairman (1): ? ? Overall in charge of the whole institution.
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Owner of SATORI, responsible for financing and overall administration of the institution.
Director (1): ? Administrative In charge of the Institution,
Physicians in respective departments, to ease the issues of physician leadership crisis we shall have revenue sharing arrangement amongst the doctors.
Marketing Plan for SATORI Group Practice: MARKETING OBJECTIVES: ? ? To establish itself as a provider of excellent Medical care amongst the patients, insurance groups and organizations To establish itself as a top choice healthcare facility amongst the concerned specialists
POSITIONING: For The External customerA World class Integrated Healthcare facility with Specialty Focus For the Internal CustomerA Hassle Free Integrated Healthcare facility with World class technology & resources
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COE Marketing BRANDING THE GROUP PRACTICE Logo:
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An oyster with a pearl in it. The oyster is the symbol of the hospital, for whom the
patient is as precious as a pearl. Tagline: Caring for you…with a difference! Color: Light Blue and Yellow; Blue is a corporate color and it symbolizes tranquility, Yellow stands for honesty Brand Powe r: To provide the best in advanced super-specialty in healthcare; IT is given special importance COMMUNICATION OBJECTIVE: • To build Brand Aware ness of SATORI Group Practice Pune as a Excellent medical destination which also provides integrated diagnostic and therapeutic service • To portray SATORI Group Practice as having JCI accreditation, advanced capabilities and well trained medical staff among employers, health providers, medical planners, insurers • To create online& offline properties which are informative, interactive and give SATORI Pune a human face
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COE Marketing Platform Setting:
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Patients ( Phase 2 )
Experts and Early Adopters
( Phase 1 )
Peers and Partners
( Platform Setting ) Doctors and Nurses
( Core Strength )
Doctors and paramedical staff of the hospital shall form the core strength of the Group practice, hence initial focus would lay completely on them. Then as the core strength is established we move to setting partnerships, meanwhile targeting the experts and early adopters.
To establish the credibility of the brand as well as to attract good medical talent and patient clientage, partnership has to be looked into with: ? Medical tourism bodies
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COE Marketing ? ? ? ? Accreditation agencies Healthcare provider agencies Health Insurance agencies Advanced medical centres
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Looking beyond the 4Ps to get an overview of the Group facility:
PROMOTION: The various methods that will be used for promotion of group facility are as follows: ? ? ? ? ? ? PR & publicity Within facility promotion Campaigns Tie Ups Advertisements CSR & community initiatives
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COE Marketing The underlying theme of promotion will be based on-
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PR and Publicity: Touch points of Publicity campaign: • • • • • • • Newspaper Magazines: Health, general, Lifestyle Hoardings across various places in cities Advertisements in local television shows Sponsoring school events Organising awareness camps and visiting schools Mobile marketing
MEDIA COVERAGE Wide media coverage in both the vernacular and English press for local newspapers should be ensured: ? ? Whenever a pioneering work is done by our doctor, a rare case is diagnosed, award received by doctor Stories of dedication by Nursing& support staff
Proper care should be taken to highlight:
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COE Marketing • • • • • Information Touch points Patient Testimonials Excellent Customer Service End to end services Ancillary services
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PR would constitute one of the major brand building exercise since word of mouth constitutes the biggest and single largest motivator for patients to turn to a hospital. CAMPAIGNS:
Special Weeks targeted at specific TG: • Healthy Heart Week • Diabetes week • Know your kidneys week
Special OPDs on specific days of month: consultants charge Rs 100 for consultation
SATORI evening clinic 5 to 9 for 9 to 5 office goers
School camps
Camps in nearby suburbs & Diagnostic camps within city
These campaigns should be promoted through direct mailers, hoardings & press ads These campaigns should be backed by advertisements to be promoted on special days according to campaign: Women’s day special package for preventive health check up (Exhibit No. 4 A ) Educating women about Heart attack (Exhibit no. 4 B) Family membership programs/ Healthy neighborhood Exhibit No 4 C)
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COE Marketing Special promotions for doctors (Exhibit No 4 D ) TIE UPS: •
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Corporate Tie Ups: Pune being essentially corporate hub, specific tie ups with corporate houses, government bodies
• •
Tie Ups with Insurance providers A large no. of educational Institutions present: Specific packages for educational institutes
WITHIN FACILITY PROMOTION: For Internal Customers: • • • Inviting Expert faculty & CMEs in tie up with academic medical centre: AFMC BJMC Video conferencing with Advanced medical centre in US once a month Paramedical staff training regularly
For External Customers: • • Educational Posters Interactive screens which contain educational and Informative material in addition to facilities’ description • Feed back system
CSR AND COMMUNITY INITIATIVES: • • • Organize an annual marathon Be a part of special days: Anti Diabetes day, World Health day, Doctors’ day To be a part of rescue team in any natural calamity, epidemic in city
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COE Marketing •
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Involve SHGs in nearby villages: Specific campaigns for rura l household- Rs.300 annual membership which guarantees them free consultation for a five member family and discount of 10% on diagnostics and 5% on pharmacy
ONLINE MARKETING: Online marketing would play an increasingly bigger role for the establishment of Group practice brand. The website is a very important part of the branding exercise of entire marketing for SATORI• Homepage features a flash banner. The rotating images—evocative pictures of facilities and happy patient-doctor interactions—will help create a sense of sincere concern and personal care on behalf of staff and doctors • The homepage’s YouTube link will lead visitors to a portal filled with patient testimonies regarding their experiences and treatment • A blinking emergency contact icon on the top of the page for anyone interested in learning more about emergency • • • The virtual patient section Employing Search Engine Optimization Creating an Administrative Console to allow for personalization, simplify co ntent management on provider’s end, and enable Customer Relationship Management (CRM)
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COE Marketing
SATORI virtual patient section
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Other digital ideas: ? ? ? ? ? ? ? Media Facebook Twitter Orkut Flicker Youtube Mouth shut Blogger Metrics
? ? Digital ? ?
Increase in hits on website Engagement on social media Conversations around SATORI on blogs and discussion boards Contact information left for further enquiries
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COE Marketing ? ?
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Traffic directed via google ad words and flash banners bought New members registered on to SATORI website
?
No. of new associations with health providers and insurers post PR activity
PR & Publicity
?
Views of the Youtube videos about patients and their SATORI experience
?
No. of references of SATORI in media –Magazines, Newspapers & industrial journals
? Tie-Ups ? CRM ?
No. of new corporate/ Educational institutes/SHGs availing customized Health programmes No. of discount vouchers used for treatment Database of all the people who expressed interest in SATORI
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COE Marketing Financial Projection and estimation: Expenses Estimation:
Amount (Rs.) 1. Land cost 7000 Sq.Ft / *4000 2. Equipment planning
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Rs 28000000
Echo – Colour Doppler Ventilator: 3 Cardiac Monitor (NIBP) 30 Defibrillator: 5 TMT-2 Central Line Oxygen ECG Machine : 4 Pulse Oxymetre : 2 Centralized Monitor Infusion Pump : 4 Pace Maker : 02 Computerized System X-Ray :3 Cardiac Fowler Bed IITV USG : 2 Pathology Equipments Other material & Medicines CT scan MRI CSSD Lab
Ambulance@ Rs.500000/*2 Communication System@ Rs.2000000/1 IT system
Total
3. Hospital Furniture
Civil Cost Plumbing Cost Electrical Cost Air conditioning Cost Miscellaneous Cost Total
Miscellaneous Total
Rs. 18, 00,000 Rs. 24, 00,000 Rs. 30, 00,000 Rs. 10, 00,000 Rs. 03, 00,000 Rs. 02, 00,000 Rs. 40,000 Rs. 20,000 Rs. 01, 00,000 Rs. 120,000 Rs. 100,000 Rs. 02,00,000 Rs. 09,00,000 Rs. 07,50,000 Rs. 08,00,000 Rs. 8,00,000 Rs. 15,00,000 Rs. 02,00,000 Rs. 1,00,00,000 Rs. 1,50,00,000 Rs. 1,50,00,000 Rs. 2,00,00,000 Rs. 10,00,000 Rs. 20,00,000 Rs. 1,00,00,000 Rs. 115230,000 Rs. 75,00,000 Rs. 2,00,00,000 Rs. 30,00,000 Rs. 30,00,000 Rs. 24,00,000 Rs. 14,00,000 Rs. 37300,000 Rs. 10,00,000 Rs. 153530,000
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Budget Amount budgeted(Monthly) (Rs.) 1. Salaries NURSES @ Rs. 7000/ *20 Pharmacist @ 12000/* 4 Maintenance staff @ 6000/* 12 Security staff- outsourced Technicians @ 7000/*3 Housekeeping -outsourced dietary services @ 3000/ * 6 Administrative Heads @ 50000 /* 2 Med.Supr. CEO Admin Others @ 6000 /*6 RMO @ 15000/*8 Special Services @ 12000/*3 total Annual 140000 Rs. 48,000 Rs. 72,000 Rs. 20,000 21000 Rs. 10,000 18000 100000 Rs. 50,000 Rs. 1,00,000 36000 120000 Rs. 36,000 Rs. 771000 Rs 9252000 Rs 162782000 Amount expenditure(Yearly) (Rs.)
marketing budget
Rs. 30,00,000
Other expenses TOTAL
Rs. 6,00,000
Rs. 72,00,000 Rs. 172982000
Revenue estimation(year 2009-10) sr particulars no OPD patients(30 patients* 30 days * 1 8 OPD ) 2 IPD patients( 4 patients * 30 days ) 4 Pharmacy( OPD) 5 Pharmacy( IPD) 6 USG( 6usg * 30 days ) 7 Xray(10 Xrays * 30 days ) 8 CT (50 CT per month ) 9 lab tests( 50 OPD tests * 30 days) 10 lab tests( 25 IPD tests * 30 days) 11 ECG ( 30 ECG * 30 days ) 12 MRI (50 MRI per Month) TOTAL
Charges Rs. 500 Rs. 50,000 Rs. 700 Rs. 400 Rs. 2,200 Rs. 500 Rs. 800 Rs. 200 Rs. 4000
revenue per month 3600000 6000000 1000000 600000 126000 120000 110000 750000 600000 180000 200000 13286000
revenue per annum 43200000 72000000 12000000 7200000 1512000 1440000 1320000 9000000 7200000 2160000 2400000 159432000
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Financial Projection:
YEAR INCREA REVENUE SE IN REVENU E*(perc entage to original) 0% 159432000 15% 175375200 30% 45% 60% 75% 210450240 273585312 383019436.8 574529155.2 INCREASE IN EXPENDIT URE#(perc entage to original) 0% 10% 20% 30% 40% 50% EXPENDITURE PBIT## NET PROFIT(ASSU MED)
2009-10 2010-11 2011-12 2012-13 2013-14 2014-15
172982000 21397200 25676640 33379632 46731484.8 70097227.2
-13550000 153978000 184773600 240205680 336287952 504431928
93926580 112711896 146525464.8 205135650.7 307703476.1
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COE Marketing Limitations of the study and proposal:
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1. Respondents selected from amongst the private practitioners of Pune do not represent the actual market situation with respect to consumer segments, usage and perception about Healthcare brands within each segment attributes of importance, decision influencing factors, service evaluating attributes etc. 2. Apart from the various expenses considered for the financial planning there might be certain other unforeseen expenses which might exceed the miscellaneous expenses 3. Assumption has been made that an administrative model which is under the control of management shall be acceptable to doctors, this has been done to minimize the effects of physician leadership problems 4. The pricing of equipment and the remuneration to paramedical staff has been done keeping in mind the industry trends which might change at the time of implementation 5. The year on year increase in revenue has been forecasted keeping in mind favourable response to marketing campaigns and in sync with market growth rate 6. Since currently there are no operations of this kinds, the assumptions have been made keeping in mind the clinic and hospital model, certain situations peculiar to Group practice may arise which may call for a relook at strategy 7. The strategy canvas tool which has been used here, is assumed will be helpful for future strategy formulation as well and also to compare the competitors
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COE Marketing Conclusions and Implications of study and proposal:
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Though it has been undertaken as a academic project. This project bears importance both for the Health policy related academia and business idea in healthcare. The initial part of the project has analysed the Group practice as a concept, reviewing the existing literature in light of current healthcare scenario in India. The later part of project has implemented the understanding obtained through the analysis of literature and primary research into a feasible and sustainable business plan. The important implications of the study are: The Indian healthcare scenario is changing and the rising healthcare costs both for the patient and provider make it imperative to figure a cost efficient and technology employing method for providing healthcare support to patients In the initial setting up of practice land and equipment pose a major challenge, hence initial focus should be laid upon the Medical/non surgical facilities Ancillary services development shall be a major concern area for any Group facility development The business model of any healthcare agency should be focused at Value creation Understanding for the business model of any healthcare agency should arise at the customer level
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COE Marketing REFERENCES:
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(1) Havlicek PL. Medical group practices in the US. American Medical Association: Chicago III; 1999 (2) Moser M. The growth of Multispecialty Medical Groups 1982 1989. J Ambul Care Manage 1991;14:9-13. (4) Singh JC. Are we ready for subspecialization and group practice in India?. Indian J Urol 2006;22:23-6 (5) Reedy BLEC. operational problems in group practice. Journal of public health 2003; 4-7 (6) Fry, J. and McKenzie H. (1968). Journal of the Royal College of General Practitioners. 16, 437. (7) National Nursing Staff Committee. Management development ofsenior nursing staff in the hospital service. (1968). Department of Health and Social Security. London: Her Majesty's Stationery Office. (8) Health Report of Developing nations World bank 2006. (9) Bhat RR IIMA journal of management 1996 (10) Jassani Journal of community medicine 1989 (11) Bhat RR, journal of Healthcare policy and health 1999 pg 28-37 (12) Technopak Health outlook 2007 (13) Health Insurance – A Horizontal Study; Ministry of Finance;Eleventh Report, Committee on Public Undertakings (2005 - 2006); Fourteenth Lok Sabha) (14) Osterwalder, A., Pigneur, Y., & Tucci, C. L. (2005). Clarifying Business Models: Origins, present and Future (15) Kiewik nisatie' - Strategische keuze of angsthazerij , M. (2007, February). De gemeentelijke 'regieorga University of Twente.
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(16) Magretta, J. (2002). Why business models matter. Harvard business review, 80(5), 86-92 (17) Mäkinen, S., & Seppänen, M. (2007). Assessing business model concepts with taxonomical research criteria. Management Research News, 30(10), 735-748. (18) Kim, W. C., & Mauborgne, R. (2002). Charting: Your company's future. Harvard business review, 80(6), 76-83. (19) Porter, M. E., & Teisberg, E. O. (2006). Redefining Health Care: Creating Value based Competition on Results. Harvard Business School Press.
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COE Marketing EXHIBITS: Exhibit No 1: Pune’s healthcare landscape
HOSPITAL
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BEDS
Aditya Birla Budhrani Cantonment BVP Dr. Ambedkar Hsp. Deen Dayal Gadikhana (Clinic) Hardikar Hospital Inlaks & Budhrani & M.N.B.Cancer Jahangir Nursing Home Joshi Hospital K.E.M. Kamala Nehru Kotbagi Krishna Gen. Hospital (Stree Clinic) Leprosy Lokmanya Hsp Mental Hsp. N.M.Wadia Cardiology Naidu Poona Hosp. & Research Center Ratna Memorial Ruby Hall Nursing Home Deena Nath Manageshkar Sasoon
500 200 350 700 100 200 150 200 780 300 100 550 350 350 150 200 250 500 60 28 250 150 550 450 1200
Exhibit 1 B: Pune’s population break up:
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COE Marketing
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– Prostate Exhibit 1 C common ailments in Pune
Common Ailments encountered in Pune
• General Medicine:
– Respiratory Diseases – Heart Diseases – Neurology – Road Traffic Accidents
• Obstetrics & Gynecology
– Fibroid – Ruptured Uterus – Hysterectomy – Laproctomy – Cyst & Tumours – Infertility –LSCS
:
• Neurology
– Cerebrospinal strokes – Aneurysm
• Neurosurgery :
– Brain & pine Tumours – Spinal Degenerative Diseases – Head & spine Injuries
•
General Surgery:
– Appendicitis – Pancreatitis – Gall Bladder Infections – Cellulitis – GI Surgery – Traumatic Ulcers
• Opthal :
– Cataract – Glaucoma – Corneal Transplant – Refractory errors
• Plastic Surgery :
– Congenital Deformities – Post traumatic – Cosmetic Surgery – Burns
• Orthopedics :
– Total Knee Replacement – Osteoporosis – Fractures – Rheumatoid Arthritis – Joint Pains – Backache
• Cardiology :
– Myocardial Infarction – Arteriosclerosis – Pediatrics cardiology – Congenital Anomalies
• Nephrology
– Renal stones
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COE Marketing Exhibit No 2: Strategic Canvas: Model summary
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VALUE PROPOSITION 1.1 1.2 1.3 1.4 1.5 1.6 1.7
Diversity in Medical treatment Complexity of medical tretament Treatment volume Service Level Coordination of Care Non Medical services Research
Medium High High High High Medium Low
0.67 1 1 1 1 0.67 0.5
MAX SCORE 6 8 9 11 11 10 2
RELATIV E SCORE 4.02 8 9 11 11 6.7 1
MARKET SEGMENT 2.1 2.2 2.3 2.4 2.5 Patient Organization Helathy people Sick People Geographic Scope High High Medium High Medium 1 1 0.67 1 0.67 8 9 7 9 5 8 9 4.69 9 3.35
STRATEGIC POSITION 3.1 3.2 3.3 3.4 3.5
Cooperation: Support process Growth innovation transparency Supply chain Integration
High Medium High High High
1 0.67 1 1 1
8 6 7 10 9
8 4.02 7 10 9
VALUE CHAIN 4.1 4.2 4.3 4.4 4.5 4.6 Process optimization Physician In lead Management in lead capital intensive Standardization of care outsourcing High Medium High Medium High Low 1 0.67 1 0.67 1 0.5 10 7 11 7 11 5 10 4.69 11 4.69 11 2.5
COST STRUCTURE/REVENUE 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8
Cost reduction Profit Value based Payment Cost Based payment Insurance Income From Non core activities Income from Pvt payment Negotiable prices (the less the better)
Medium High High Medium High High High low
0.67 1 1 0.67 1 1 1 1
7 8 9 6 8 10 8 8
4.69 8 9 4.02 8 10 8 8
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COE Marketing Exhibit No. 3A: Questionnaire
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Dear Doctor, This is a questionnaire to assess the Indian Private practice scenario. The objective of the survey is research based and academic. Kindly spare a few minutes to answer the following questions. Doctor what is the number of patients that you see on an average per day? No patients 1 to 5 6 to 15 16 to 25 26 to 50 Above 50 Minimum Maximum
Doctor how often do you refer patients for Specialist services? Never Occasionally Frequently Most often In all cases
Doctor how often do you refer patients for Diagnostic services? Never Occasionally Frequently Most often In all cases
Doctor how often do your patients seek information on Diagnostic and specialist services? Never Occasionally Frequently Most often In all cases
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Doctor out of the following give score to the different factors that affect setting up a new practice as per the cost that you incur on them, where 5 being highest score and 1 being the lowest
Factors 5 Location Equip ment/technology Manpower maintenance Infrastructure rqmnts 4 3 2 1
Name: Qualification Hospital: Ph No: Interviewer: Date:
____________________ ____________________ ___________________ ____________________ ___________________ ___________________
Thanks a lot for your time and co-operation
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COE Marketing
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Exhibit 3 B: ESTIMATED MANPOWER
Nurses in the Hospital Nurses in I.C.U Nurses in S.C.C.U Nurses in I.C.C.U Nurses in N.I.C.U Nurses in Special ward Nurses in Deluxe ward Nurses in Double ward Nurses in Single ward Nurses in General ward Nurses in Day care Nurses in Operation Theatre Nurses in OPD Nurses in Casualty ward Nurses in Labour Room Total Nurses in the Hospital(Including 30% of Physiotherapy Department Relie ve rs) Physiotherapists Physiotherapists Aide/Junior Senior Physiotherapists Trainee Total Physiothe rapists Pharmacy De partment Pharmacists for Indoor Issues Pharmacists for OPD Issues Junior Pharmacists Senior Pharmacist Pharmcy Aide Chief Pharmacist Total Staff in Pharmacy General Maintainence Manpower required Relievers Total Staff in General Maintanence Security De partment Security guards (Including Relievers gateways & Special areas) Security Supervisor Total Staff in Se curity De partment Ste rile Supply Department Technician required including Supervisor Relievers shift Total Staff in Ste rile De partment Laundary De partment Laundry Opeartor Laundry Orderly / Assistant Laundry Staff Relievers Total Laundry Staff Shift Supervisor / shift
12 9 0 7 12 4 7 19 8 4 5 7 7 1 90 1 0 0 1 1 2 0 0 0 1 4 9 3 12 5 2 5 12 3 1 4 5 2 7 2 9 1
Department of Laboratory Medicine Section Head 1 Number of Technicians for fairly 6 Number of lab 9 automated Senoir Technicians 1 Technicians manual/fairly Total Technicians 10 automated lab Relievers 3 Attendants for Automated Lab 6 Relievers for Attendants 0 Reception cum Clerk 1 Relievers for Clerks 0 Department of Imaging Sciences Section Head Number of Technicians for routine Special X-rays, procedures like barium investigations, HSG etc. myelography Relievers Department of Ultra Sound Number of Technicians Attendants for Ultra Sound Releivers 1 2 4 1 2 4 1
Department of ECG & 2D ECHO Technicians with Echo 5 Relievers 2 Special Services Blood Bank Health Check Up X-Ray Infection Control Nurse Nurse Clinical Specialist Total staff - special services Food Service Department Dietician Cook Cook Helper Dishwasher/Attendant Storekeeper Total Staff in Food Service 0 1 0 1 1 3
1 3 3 3 1 11
Back
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COE Marketing Exhibit No 4 a : Advertisement for Women’s Day: preventive health package
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Exhibit No 4b: Advertisement for women’s heart check up
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COE Marketing Exhibit No. 4 c: Healthy neighbourhood/Family membership
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Exhibit No. 4 d: Advertisement for doctors on doctors’ day
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