Index

Abraaj Group, 38, 45

Accenture, 89

access to care, 5

disparities of in the US, 149–151

in Mississippi, 126–128

for the uninsured, 147–168

US, 6–7

Adcock, Michael, 131, 132, 133, 137, 139, 142, 143

Advisory Board Company, 174

Affordable Care Act of 2010, 6–7, 20–21, 156–157

Africa, 91–92

Ahmed, Faheem, 23

AIG, 75

Ajaikumar, B. S., 44, 54

Alliance for Connected Care, 142–143

Almeida, Alwin, 102

Amazon, 5, 203

American Diabetes Association, 140

American Telemedicine Association, 143

Anderson, Rhonda, 154, 157

anemia tests, 60

angioplasty costs, India versus US, 14

Apple iPads, 88

Apple Tree Partners, 200–201

Aravind Eye Care System, 12–13, 91

cataract surgery at, 32

community opthalmology training by, 38

complication rates, 22, 54

costs at, 209, 210

doctorpreneur behind, 43

education and research at, 220–221

eye camps, 47, 53

as focused factory, 53–54

locally manufactured supplies for, 57–59

process innovations at, 63, 64

profitability of, 22–23, 215

purpose at, 46

quality at, 211, 213, 214

subsidized care at, 22

task-shifting at, 61–62

ultra-cost-consciousness at, 66

variable costs at, 67

volume at, 56

Ascension Health, 26, 28–29, 34, 96, 97–98, 147–168

cost innovations at, 154–156

equipment maintenance at, 156

HCCI and, 107–108, 112, 158–160

history of, 147–148, 149–151

lessons from, 166–168

pilot programs at, 151–154

purpose at, 107–108, 148–149

serving the poor and uninsured at, 156–157, 163–166

value-based care at, 160–162

Ascension Holdings, 162

Ascension Ministry Service Center, 155

Ascension Ventures, 161–162

Asia Heart Foundation (AHF), 76, 86

Atigeo, 162

AT&T, 130, 132

Aurolab, 57–59

Avera Health, 31

Bangalore Institute of Oncology (BIO), 44

Barnard, Christiaan, 75

“beating-heart” surgical technique, 18, 84–85

bedsores, 152–153

Berkshire Hathaway, 5, 203

Berwick, Donald, 19, 33

best practices, 149, 151–154, 160–162

B.M. Birla Heart Research Institute, 76

B.M. Birla Hospital, 71

bottom-up change, 18–19, 21, 60, 190–205, 222

Bower Foundation, 131–132

Bradley, David, 175–176

Brewer, T.J., 123–125

British Journal of Opthalmology, 214

Bryant, Phil, 139, 140

build-and-brand model, 136–137

bundled pricing, 66, 120–121, 198–199

at Ascension, 161

cost consciousness and, 25

at HCCI, 115, 117

Medicare and, 92, 198–199

at Narayana, 77–78

at Surgery Center of Oklahoma, 31

in value-based care, 20, 21

Bush, McKeeva, 106, 109

business models, 39–70

build-and-brand, 136–137

central principles behind, 39–40

change opportunities and, 204–205

culture of ultra-cost-consciousness and, 65–68

disruptive, 35

hub-and-spoke design, 49–56

at Narayana, 72–75

purpose and, 46–49

task-shifting in, 61–65

technology leveraging and, 56–61

for the US, 93–99

Caldwell, Scott, 155

Callahan, Sharon, 169–170, 180

cancer, rates of, 41

cancer care

doctorpreneurs in, 44

smoking cessation and, 47

task-shifting in, 62–63

wellness programs, 53

cancer treatment

costs of in India versus US, 13, 14

innovations in, 18

cannibalization

hub-and-spoke configuration and, 135, 145, 196

of income, health-care costs and, 6

UMMC and, 135, 145, 196

“Can Reverse Innovation Catalyse Better Value Health Care?” (Ahmed), 23

capital expenditures, 67–68

change opportunities in, 200–201

at HCCI, 111–113

at Narayana, 82–83

capitalization, 22–23, 49

at Narayana, 73

at UMMC, 131–132

capitation, 176–178, 189–190

cardiac care

“beating-heart” surgical technique, 18

coronary bypass surgery, 18

doctorpreneurs in, 45

focused factory model for, 30–31

frugality in, 84–85

at HCCI, 27

outreach camps, 86

protocols for, 55

See also Narayana Health

Care Hospitals, 13, 14

bought by Abraaj Group, 38, 45

doctorpreneur behind, 45

education and research at, 221

expansion of to other countries, 91–92

protocols at, 55

quality at, 212

stents developed by, 59

ultra-cost-consciousness at, 65–66

unnecessary procedures at, 66

valuation of, 22

CareMore Health, 31

Carnival Cruises, 118

cataract surgery, 13

costs of in India versus US, 14

Dr. V and, 43

equipment for, 52

in Finland, 32

innovations in, 18

locally manufactured supplies for, 57–59

process innovations in, 63–64

in the UK, 33

Cayman Airways, 110

Center for Telehealth, 134, 143

Centers for Medicare & Medicaid Services, 21, 198–199

centers of excellence

HCG, 53

LV Prasad, 51, 52

telehealth, 124–125

centralization, 154–156

certificate-of-need laws, 42

Chandi, Harry, 106–107

Chang, David F., 211, 214

The Checklist Manifesto (Gawande), 65

Children’s Hospital of Philadelphia (CHOP), 30, 200

China, health-care statistics on, 208

Chirp, 183, 185

choice, 19

Christensen, Clay, 19

chronic conditions

home care for, 57, 139–143

in India, 41

at Iowa, 169–172

primary care and, 170–172

UMMC and, 139–143

See also kidney dialysis

chronic obstructive pulmonary disease (COPD), 169–170

Cigna, 97

Cisco, 87, 89

Cleveland Clinic, 30

cost structure of, 219, 220

profit margin at, 74

volume at, 56

commitment, 45. See also purpose

Commonwealth Fund, 6–7, 127

Companion Global Healthcare, 101–103

competition, 19

regulated, 194, 216

value-based, 19

consumers, value-consciousness of, 199–200

continuous improvement, 19, 25

contracts

long-term, 83

per-use, 83

corneal slicing, 18

coronary artery bypass surgery (CABG), 84–85

costs of in India versus US, 14

cost effectiveness, 66

costs

at Ascension, 149, 154

bundled pricing and, 66

capital expenditures and, 67–68

consciousness of, culture of, 25, 65–68

consciousness of, in India, 41

culture of consciousness of, 25

focusing doctors’ attention on, 68

focus on reducing, 15

at HCCI, 115–116

hub-and-spoke design and, 50–54, 53–54

in India, 208–215

India versus US, 14, 15

at Iora, 176–178, 187–188

labor, 16, 17–18, 217–219

of medicines and supplies, 82–83

needless waste and, 65–66

overutilization and, 29

patients’ nonmedical, 47, 165

profitability and, 48–49

projections of potential US reductions in, 35–36

sliding payment scales and, 29

supplies, 57–59

telehealth and, 56–57

transparency in, 193

ultra-cost-consciousness, 25, 40, 65–68, 81–85, 111–113

unnecessary procedures and, 66

US versus India, 3–5

variable, 67

Crisp, Nigel, 23, 33

critical care

at Narayana, 89

at UMMC, 123–124

Crossing the Quality Chasm (Institute of Medicine), 149–150

C Spire, 130, 132, 140

culture, 17

at Ascension, 148–149

changing the entrenched medical, 195–196

diagnostics on, 229–230

at Narayana, 78, 81–85

of ultra-cost-consciousness, 25, 65–68, 81–85

UMMC and, 136–139

curiosity, 9

CyberKnife, 15, 52

Dartmouth-Hitchcock Medical Center, 185

Dartmouth Master of Health Care Delivery Science program, 63–64, 68

data mining, 184

data sharing, 60–61

at UMMC, 137

Daughters of Charity National Health System, 148

Daych, Diane, 200–201

Deccan Hospital, 13, 14, 15

home care at, 57, 58–59

quality at, 211, 212

decision-support software, 89, 159

deductibles, 157

“Delivering World-Class Health Care, Affordably” (Govindarajan & Ramamurti), 10, 15

demand, turning need into, 47

demographics, 6

India, 41

diabetes, 41

UMMC and, 139–143

Diabetes Telehealth Program, 140–143

diagnostics, health-care innovation, 38, 223–230

dialysis. See kidney dialysis

Digicel, 117–118

disease prediction, 90

disease prevention, 89–91

Disney Cruises, 118

doctorpreneurs, 42–45, 99

at Iora, 170–172

purpose of, 46, 132–136

at UMMC, 124, 136–139

Donohue, Liam, 176, 181, 184

Doyle, John, 108, 150–151, 154

on cost structure, 156

on organizational thinking, 195–196

on pilot programs, 152

on quality, 153

Shetty and, 158–160

on venture capital, 162

ECG machines, portable, 87–88

economies of scale, 81–82. See also scale

economies of scope, 81–82

education, health

at Narayana, 80

of patients about medical conditions, 47

at UMMC, 141

education, medical, 16

costs of, 219–221

at HCCI, 112–113

in hospitals, 18

hub-and-spoke configuration and, 54

India, 17

eHealth centers, 90

e-ICU systems, 31

electronic medical records (EMRs), 60–61

at Iora, 183–185

at Narayana, 88–89

emotional intelligence, 179–181

employers, health insurance and, 202–203

EMRs. See electronic medical records (EMRs)

end-stage renal disease, 58–59

energy costs, 115

entrepreneurs, 99, 204–205

in India, 42, 45

at UMMC, 124

equipment

at Ascension, 155–156

at HCCI, 115–116

hub-and-spoke design and, 50, 52, 54

maintenance and repair of, 83, 155–156

reusing, 82–83

shortages of, 47

ultra-cost-consciousness and, 65–66

utilization rates, 53–54, 56, 79, 200

See also resources

execution, 49

experimentation, 49

expertise, centralization of, 53

extensivists, 31

family members

at Iora, 182

at Narayana, 79–80

task-shifting to, 64–65

Farmer, Paul, 19, 173

Federal Communications Commission, 132

FedEx, 194

fee-for-service system

as barrier to innovation, 42

capitation versus, 177–178, 189–190

experimentation with, 198–199

hospitals and, 200–201

overutilization in, 29

regulated competition and, 216–217

value-based care versus, 19

Fernandopulle, Rushika, 34, 98, 169, 170, 192

background of, 172–174

casino workers and, 175–176, 194–195

on health coaches, 179–181

on hospital systems, 185–187

on medical decision making, 182

opportunities for change and, 194–195

on primary care, 170–172

on regulation, 187–188

fixed cost per unit, 48–49

focused factory model, 30–32, 53–54, 200

France, 5

Friedland, Richard, 33

funding, 184–185. See also capitalization

G2L, 33

Galli, Robert, 129–130

Gawande, Atul, 65

General Electric, 9, 99

global mindset, 9

group purchasing, 154–156

Hall, Greg, 130

Harman International, 9–10, 99

Harvard Business Review, 9

Have a Heart Foundation, 117–118

HCCI. See Health City Cayman Islands (HCCI)

HCG. See Health Care Global (HCG) Oncology

health care

adoption of, 138

consumer responsibility in, 200

context of US versus Indian, 216

disease prevention in, 89–91

disparities in, 149–151, 162

as human right, 22, 76

inertia in, 117

per capita spending on, 41

primary care in, 170–172

purpose in, 24, 39, 46–49

reform, obstacles to, 195–196

self-service in, 64–65

shortages of doctors and facilities, 41, 42

social context of, 182–183

universal, 165–166

US spending on, 151

value-based, 19–25

Health Care Global (HCG) Oncology, 13, 14, 15

creating demand at, 47

doctorpreneur behind, 44

education and research at, 221

EMRs at, 60

expansion of to other countries, 92

hub-and-spoke design at, 50, 52, 53

purpose at, 46

quality at, 211, 212

specialization at, 55

subsidized care at, 22

task-shifting at, 62–63

telemedicine at, 56–57

valuation of, 22

voice prosthesis by, 59–60

health-care reforms, 7

bottom-up and top-down, 21

value-based, 19–25

Health City Cayman Islands (HCCI), 26, 27, 91, 96, 97, 101–121

accreditation of, 104–105

Ascension and, 29, 149, 158–160

challenges at, 114–116

as disruptor, 103–105

getting people into, 116–119

lessons from, 119–121

marketing at, 113, 116–117

regulations and, 109–110

scaling at, 34

staffing at, 114

ultra-cost-consciousness at, 111–113

Health City complex, Bangalore, 81–82

health coaches, 34, 98, 179–181

Health Dialog, 176

health insurance

Ascension, 107–108, 147–168, 156–157

as barrier to innovation, 42

change opportunities and, 202–203

employers and, 202–203

for farmers in India, 74, 86–87

HCCI and, 113, 118–119

Iora and, 175–176

opportunities for change and, 202

self-insured casino workers and, 175–176, 194–195

serving the uninsured and, 156–157, 163–166

telehealth payments and, 132–133, 135, 138–139

US, access to, 6–7

US, cost of, 6

Health Resources and Services Administration (HRSA), 124–125, 144

heart care. See cardiac care

Hemingway, Ernest, 191

Henderson, Kristi, 28, 97, 192

on adoption rates, 138

on diabetes care program, 140–142

on disparity of care, 127–128

entrepreneurship by, 136–139

on financial results, 142

obstacles overcome by, 196–197

on policy, 142–143

purpose of, 125–126

skepticism and pushback toward, 130–132

on technology, 123

technology leveraging by, 128–130

vision of, 132–134

See also University of Mississippi Medical Center (UMMC)

Hermann, Matt, 162

Herzlinger, Regina, 19

Hewlett-Packard, 87, 90

Home, 118

home-based care

Deccan, 57, 58–59

UMMC, 133, 139–143

Home Depot, 113

hospital readmission rates, 6

hospitals

applicability of reverse innovation to US, 215–222

Ascension, 150–151, 154–156

build-and-brand model of, 136–137

capital expenditures by, 67–68

change opportunities in, 200–201

consolidation of, 92

construction of, 84

cost-consciousness in, 67–68, 84

cost innovations in, 154–156

costs in India, 210–211

education and research in, 18, 219–221

in Mississippi, 127–128

primary care and, 185–187

profitability of Indian, 21–22

telehealth and, 28, 134–136 (See also University of Mississippi Medical Center [UMMC])

ultra-cost-conscious, 111–113

US, 68

US versus HCCI, 111–113

hub-and-spoke configuration, 24, 39–40, 49–56, 69

cannibalization of services and, 135, 145, 196

costs and, 50–54

diagnostics on, 225–226

at Iora, 185–187

at Narayana, 85–87

at Pacific Vision, 164

protocol development and, 55

quality and, 54–56

technology leveraging and, 56–61

at UMMC, 28, 123–146

iKare, 60, 89, 159

Immelt, Jeff, 9

India

business models of exemplars in, 39–70

core principles of value-based care in, 24–25

costs of care in US versus, 14, 15

demographics in, 41

dissociating health care from affluence in, 105–106

doctorpreneurs in, 42–45

exemplars in health care, 10, 13–16, 39–70

health-care spending in, 76

health-care statistics on, 208

health metrics on, 41

innovation drivers in, 193–194

land/building leasing in, 67–68

serving the uninsured in, 163

skepticism about innovations from, 16, 17–19, 207–222

value-based health care in, 19–25

Western use of practices from, 26–34

Indian Space Research Organization, 87

infant mortality rates, 41

Ingawale, Myshkin, 60

innovation

at Ascension, 149

barriers to US, 42

bottom-up, 69, 190–205, 222

diagnostic tool kit on, 38, 223–230

by doctorpreneurs, 42–45

drivers of, 193–194

for emerging markets, 9–12

exemplars of health-care, 10, 13–16

global mindset about, 9

loose bricks for, 98–99, 193–197

obstacles to, 195–197

opportunities for, 194–195, 197–205

in processes, 40

profitability and, 48

purpose and, 46

regulation and, 221

scaling and replicating, 34–35

skepticism toward Indian, 214–215

in supplies, 57–59

top-down, 174, 191

value-added technological, 59–60

value-based care and, 20

visionary leadership in, 192–193

Western uses of Indian-style, 26–34

See also reverse innovation

Institute for Healthcare Improvement, 33, 152

Institute of Medicine, 7, 149–150

integrated practice units, 20

Intel, 203

Intel-GE Care Innovations, 140

Interfaculty Program for Health Systems Improvement at Harvard, 174

International Confederation of Catholic Health Care Institutions, 162

International Conference on Global Health Disparities, 162

intraocular lenses (IOLs), 57–59

Iora Health, 26, 29, 34, 96, 98, 169–190

cost savings and capitation at, 176–178

disruption by, 187–188

growth of, 172

hub-and-spoke configuration at, 185–187

IT at, 172

lessons from, 188–190

payment system at, 172, 177–178

primary care at, 181–183

purpose at, 172–174, 178

results at, 184

risk tolerance at, 186, 187

scaling at, 34

self-insured casino workers and, 175–176, 194–195

task-shifting at, 34, 98, 170, 172, 179–183

technology leveraging at, 172, 183–185

ISTO Technologies, 161

IT systems, 60–61, 190

at Iora, 183–185

Ivey International Centre for Health Innovation, 33

John Deere, 9–10

Johns Hopkins, 195

Joint Commission International (JCI), 17, 21–22, 27, 82, 83, 97, 104–105, 211

Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 152

Journal of the American Medical Association, 56

J.P. Morgan, 75, 203

JPMorgan Chase, 5

Kaiser Family Foundation, 157

Kaplan, Gary, 30, 195–196, 197, 200

Kelly, Ryan, 136

kidney dialysis

costs of in India versus US, 14, 15

home-based, 57, 58–59

Kim, Jim, 19, 173

knee/hip replacements, 101–103

costs of in India versus US, 13, 14

knowledge transfer, 8–9

labor costs, 16, 17–18, 217–219

The Lancet, 23

leadership, 98–99

at Ascension, 148–149

global mindset in, 9

visionary, 192–193

LifeSpring Hospitals, 13, 14

capital expenditures at, 67

costs at, 210, 211

purpose at, 46

quality at, 211, 212

task-shifting at, 64

ultra-cost-consciousness at, 66

Lions Clubs, 86

Lowe’s, 113

LV Prasad Eye Institute, 91

center of excellence, 51

doctorpreneur behind, 43–44

education and research at, 221

hub-and-spoke design at, 50, 51–52

profitability of, 215

purpose at, 46

pyramid model at, 50, 51–52

quality at, 212

results at, 52

specialization at, 55

subsidized care at, 22

task-shifting at, 62, 63

technology innovation at, 60

vision guardians, 44, 51

Mackey, Jim, 5

Manipal Heart Hospital, 76

market creation, 85–86

marketing, at HCCI, 113

Maryland, Patricia, 160

Massachusetts General Hospital, 195

Massachusetts Institute of Technology, 60

maternity care

bundled pricing for, 66

costs of in India versus US, 13, 14, 15

Mayo Clinic, 30–31

focused factory in, 200

organization thinking at, 195

profit margin at, 74

task-shifting at, 65

volume at, 56

McKown, Chris, 176

medical devices, 5

medical records. See electronic medical records (EMRs)

medical tourism, 97, 106–107

at HCCI, 118

Medicare Access and CHIP Reauthorization Act of 2015, 21, 199

medication adherence, 141, 142

Mikola, Anssi, 32

Mississippi Rural Health Association, 136

Mother Teresa, 71–72, 76

MRSA, 102

Multispecialty Hospital, Mysore, 81–82, 84

Narayana Health, 4, 13

Ascension and, 29, 149, 158–160

buying power of, 112

capital expenditures at, 67, 68

cost-consciousness at, 82–83

costs at, 210

cost structure of, 219, 220

culture at, 81–85

disease prevention at, 89–91

doctorpreneur behind, 43

education and research at, 221

employee costs at, 79

EMRs and IT systems at, 60–61

expansion of to other countries, 91, 92

hub-and-spoke model at, 85–87

IPO of, 22

key facts on, 73

labor costs, 218

microinsurance plan, 74, 86–87

mission statement of, 77

mortality rates, 22

Mother Teresa and, 71–72

Nairobi hospital, 38

pricing model at, 77–78

quality at, 212

results at, 72–74, 75

reverse innovation from, 158–160

rich and poor patients at, 48

specialization at, 55

subsidized care at, 22

surgical gowns and drapes, 83–85

task-shifting at, 63, 64

technology at, 87–91

ultra-cost-consciousness at, 65–66, 68

value-based competition at, 71–99

volume at, 56

See also Health City Cayman Islands (HCCI)

National Accreditation Board for Hospitals & Healthcare Providers (NABH), 17, 22, 211

National Health Service (NHS), UK, 5, 22

cataract surgery, 33, 43

complication rates, 54

Nature, 11–12

Naturella, 10

Nayak, K. S., 58

need, turning into demand, 47

NEJM Catalyst, 23

net promoter scores (NPS), 184

Neurolutions, 161–162

nurse intensivists, 63

onconurses, 62–63

operating capital, 47

Oracle, 87

organizational thinking, 195–196

outsourcing, 112, 121

overutilization, 29

in the US, 170–171

Pacific Vision Foundation, 98, 163–165

Partners in Health, 173

Pearl, Robert, 105, 119, 204–205

PepsiCo, 9

peritoneal dialysis, 58–59

Permanente Medical Group, 105, 119, 204–205

Perry County Hospital, 123–124

per-use contracts, 83

pharmaceutical companies, 5

as barrier to innovation, 42

physicians

attracting, 54

cost-consciousness and, 66, 68

density of, 41

as doctorpreneurs, 42–45

at HCCI, 112–113

labor costs and, 217–219

in Mississippi, 127–128

at Narayana, 78

opportunities for change and, 201–202

reimbursement of, 66, 78

shortage of in India, 42

shortage of in Mississippi, 127–128

shortage of in Texas, 143–144

shortages of in the US, 127–128, 143–144

specialization of, 54, 55

policy, 36

universal health care and, 165–166

US, 6–7

Porter, Michael, 19–20

poverty, 41

Ascension and, 149, 156–157

dissociating health care from affluence and, 105–106

Indian exemplars and, 214

as motivator for innovation, 42, 45

Narayana and, 72–73

nonmedical expenses and, 47

paying patients and, 47, 48

technology and, 88

UMMC and, 139–140

preventable injuries, 152–155

primary care, 170–172, 181–183

prisons, UMMC in, 139

process innovations, 40, 63–64

at Ascension, 160–162

diagnostics on, 228–229

at Narayana, 78–81

self-service, 64–65

Procter & Gamble, 9, 10

productivity, 73

profitability, 15

of Indian exemplars, 215

at Iora, 176, 184–185

as means to an end, 47, 48–49

at Narayana, 74–75

purpose and, 46

at UMMC, 133, 142–143

universal health care and, 165–166

protocols, 55, 65

at Ascension, 149

for home-based care, 59

quality and, 66

Pryor, David, 152, 153–154

purpose, 24, 39, 46–49

at Ascension, 107–108, 148–149

at Care Hospitals, 45

diagnostics on, 224–225

at Iora, 172–174, 178

leadership and, 192–193

at LV Prasad, 52

at Narayana, 75–78

profitability and, 48–49

targeting rich and poor in, 47, 48

turning need into demand and, 47

at UMMC, 125–126, 132–136

universal health care and, 165–166

pyramid model, 50

quality, 169–190

at Aravind, 43

at Ascension, 151–154

as cost driver, 154

data sharing and, 60–61

disparities in care, 149–151, 161

frugality and, 85

HCCI and, 118–119

hub-and-spoke configuration and, 54–56

of Indian exemplars, 15, 17, 21–22, 211–214

at Iora, 182–183

in Mississippi, 126–127

at Narayana, 73

protocols and, 66

task-shifting and, 80

at UMMC, 143

US, 6–7

value-based care and, 20

volume and, 48

Rabindranath Tagore Institute of Cardiac Sciences, 76

Raghuvanshi, Ashutosh, 75, 80, 81

on cost-consciousness, 82–83

on HCCI, 111, 117, 118–119

HCCI and, 107, 114–115

on iKare, 89

on quality, 85

on resource utilization, 82

on task-shifting, 90

Raju, B. Soma, 45

Rao, Gullapalli N., 43–44, 52

voice prosthesis by, 59–60

Red Cross, 117–118

Reddy, Krishna, 55

regulated competition, 194, 216

regulation, 11, 99

as barrier to innovation, 42

bottom-up change and, 18–19

change opportunities and, 198–199

HCCI and, 109–110

in India, 16, 42, 45, 221

innovation and, 221

Iora and, 187–188

task-shifting and, 69, 194

UMMC and, 138–139

US versus India, 221

Renaissance Health, 175–176

Renault, 9, 10

research, 15

hospitals, 18, 219–221

Resource Group, 155

resources

doctor shortages, 41, 42, 47

expertise, centralization of, 53

hub-and-spoke design and, 50–54

process innovations and, 63–64

profitability and, 48–49

shortages of, 47

utilization of, 29, 56, 79, 200

reverse innovation, 7–12

Ascension and, 158–160

consumers and, 199–200

definition of, 7, 8

opportunities for, 197–205

promise of, 91–92

promoters of, 33

promoting, 191–205

research on, 10–11

Reverse Innovation: Create Far From Home, Win Everywhere (Govindarajan & Trimble), 11

risk tolerance, 186, 187

Robert Wood Johnson Foundation, 163–165

Rotary Clubs, 86

Royal Caribbean, 118

rural health care, 28, 123–146

Rural Health Care Program, 132

Saint Agnes Hospital, 157

scale, 34–35, 39–40

charity and, 77, 176

at Narayana, 81–82

at UMMC, 137

Schiller, 87–88

schools, UMMC in, 139

Sculley, John, 32

Shetty, Devi, 43, 192

Ascension and, 158–160

background of, 75–76

on cost-consciousness, 82–83

on dissociating health care from affluence, 105–106

Fernandopulle and, 173

HCCI and, 103–104, 108–110

hub-and-spoke model and, 85–87

Mother Teresa and, 71–72

pricing model of, 77–78

process innovation by, 78–81

on purpose, 78

on regulations, 101

on staffing, 114

technology and, 87–91

ultra-cost-consciousness of, 65–66

value creation by, 72–75

vision of health care of, 87

on Walmartization of health care, 77

See also Narayana Health

Shetty, Viren, 106, 112, 113

Shouldice Hernia Hospital, 32

Sisters of Charity, 147–148

Sisters of St. Joseph Health System, 148

skepticism

about India, 16, 17–19, 207–222

at UMMC, 130–132

Skype, 87

smoking cessation, 47

social justice, 149, 157

Southwest Airlines, 63

special interests, 7

as barrier to innovation, 42

Iora and, 187

specialization, 54, 55, 134–136

at Iora, 185–187

Speranzo, Tony, 162

Spivey, Bruce, 163

Srinivasan, Aravind, 91, 173

staffing

costs, at Narayana, 79

creating new job categories and, 61–63

at HCCI, 114

at Iora, 177

labor costs and, 217–219

at LV Prasad, 51–52

in Mississippi, 127–128

See also physicians; resources; task-shifting

standardization, 154–156, 160–162

Stanford Hospital, 89

Stanford Medical School, 31

Steward Health Care, 31

St. John Providence Hospital, 157

St. Vincent’s Medical Center, 153

subsidized care, 47, 48, 165

at Narayana, 73

at Pacific Vision, 165

profitability and, 48

suppliers, change opportunities and, 203

supplies, 57–59

at Ascension, 155–156

at HCCI, 115

manufacturing, 83–85

at Narayana, 83–85

reusing, 82–83

US versus India costs of, 219

Surgery Center of Oklahoma, 31

Swasthya Slate, 60

task-shifting, 25, 40, 61–65, 69

creating new job categories and, 61–63

diagnostics on, 228–229

down-shifting, 182

examples of places using, 31

to family members, 64–65, 79–80

at HCCI, 116

at Iora, 29, 98, 170, 172, 179–183

at LV Prasad, 44, 51

at Narayana, 78–81, 90

process innovations and, 63–64

regulation and, 194

share-shifting, 182

at UMMC, 141

in the US, 92

technology, 24–25

change opportunities and, 204–205

cost-consciousness and, 68

diagnostics on leveraging, 226–227

EMRs and IT systems, 60–61

in home care, 57, 58–59

human side of, 145–146

at Iora, 172, 183–185

leveraging, 40, 56–61, 128–132

at Narayana, 87–91

per-use contracts for, 83

at UMMC, 123–124, 128–132, 137

value-added innovation using, 59–60

Teisberg, Elizabeth, 20

telehealth, 28

data sharing in, 137

future of, 143–144

insurance reimbursement for, 132–133, 135, 138–139

in intensive care, 31

at Iora, 184

at Narayana, 90–91

regulation and, 69

scaling, 34

technology leveraging and, 56–57

at UMMC, 97

Telemedicine magazine, 134

TelEmergency, 131–132, 134. See also University of Mississippi Medical Center (UMMC)

Temasek, 185

Tersigni, Anthony, 108, 147, 148–149

HCCI and, 158–160

on pilot programs, 152

purpose of, 161

vision of, 150

See also Ascension Health

Thompson, Gene, 106

3nethra, 60

Toyota Production System, 68, 78, 195–196

transparency, 31, 193

Trimble, Chris, 11

TriMedx, 67, 83, 108, 156, 159

TripleCare, 32

Trump, Donald, 161

Tufts Medical Center, 137

turnaround times, 63–64, 79

Turning the World Upside Down (Crisp), 23

Uber, 194

UMass Memorial Medical Center, 31

UMMC. See University of Mississippi Medical Center (UMMC)

United Health Foundation, 127

United Kingdom

cataract surgery in, 33, 43

complication rates in, 54

National Health Service, 5, 22, 33, 43, 54

Netcare Group, 33

United States

applicability of reverse innovation to, 215–222

core health-care problems in, 95

cost-consciousness in, 68

costs in, 3–4, 6

costs of care in India versus, 14, 15

disparities in quality of care in, 149–151

equipment utilization in, 54, 82

health-care delivery, 12

health-care statistics on, 208

hub-and-spoke system in, 55–56, 92

Indian-style innovations in, 18–19

influence of on global health care, 103–105

innovation drivers in, 193–194

knee/hip replacements in, 101–103

potential cost reductions in, 35–36

protocols in, 65

renal care in, 58–59

serving the uninsured in, 163–166

state of health care in, 5–7

task-shifting in, 65

technology leveraging in, 61

universal health care in, 165–166

unsustainability of health care in, 92

value-based care in, 20

volume in, 92

See also Health City Cayman Islands (HCCI)

United States Department of Agriculture (USDA), 132

University of Michigan, 195

University of Mississippi Medical Center (UMMC), 26, 27–28, 34, 96, 97, 123–146

access to care and, 126–128

adoption at, 138

diabetes care, 140–143

expansion of, 134–136, 139

future of, 143–144

home-based care in, 139–143

hub-and-spoke model at, 125–126

insurance reimbursement at, 132–133, 135, 138–139

lessons from, 144–146

quality at, 124–125, 143

results at, 141–143

skepticism and pushback toward, 130–132

specialist care in, 134–136

technology leveraging at, 128–132

University of Texas Southwestern Medical Center, 3–4

unnecessary procedures, 66

value

at Ascension, 160–162

innovations maximizing, 8

at UMMC, 141–143

value-based care, 19–25

at Ascension, 160–162

consumers and, 199–200

core principles of, 23–25

drivers behind in India, 40–45

examples of, 30–33

promoting, 191–205

at UMMC, 133–134

value-based competition, 71–99

key actors in US, 198

variable costs, 49

controlling, 67

Venkataswamy, Govindappa, 43, 163

job categories created by, 61–62

venture capital, 161–162

Virginia Mason Medical Center, 30, 195–196, 197, 200

Virtual Care Center, 31

virtuous cycles, 39

visionary leadership, 192–193

vision care

at Pacific Vision, 163–165

task-shifting in, 61–62, 63

technology innovation in, 60

See also cataract surgery; LV Prasad Eye Institute

volume

at Aravind, 91

focused factory model and, 53–54

at HCCI, 115–116

hub-and-spoke design and, 50, 55–56

at Narayana, 73

profitability and, 48–49

specialization and, 54

targeting rich and poor and, 48

US, 55–56

in the US, 92

US versus India, 219

Wadsworth, Eric, 63–64, 68, 177–178, 188

Walmart, 9, 10, 113, 118, 199

wellness programs, 53

worry scores, 180

Wound, Ostomy and Continence Nurses Society, 152–153

Wright, Wayne, 101–103, 118

Yeshasvini, 86–87

Zane, Ellen, 137, 194

Zocdoc, 32