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Reverse Innovation in Health Care: How to Make Value-Based Delivery Work, by Vijay Govindarajan Ravi Ramamurti
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Review
Advance Praise for Reverse Innovation in Health Care:Kenneth L. Davis, MD, President and CEO, Mount Sinai Health System, New York City--"A provocative volume of ideas."Robert Pearl, MD, professor, Stanford University School of Medicine; author, Mistreated: Why We Think We're Getting Good Health Care--and Why We're Usually Wrong--". . . a must-read for both health-care leaders and policy experts."Donald M. Berwick, MD, President Emeritus, Institute for Healthcare Improvement; former Administrator, Centers for Medicare & Medicaid Services--"If American health-care leaders . . . do not take this astounding book seriously, shame on them."Mary Ackenhusen, President and CEO, Vancouver Coastal Health, Canada--"Reverse Innovation in Health Care offers inspirational and practical insights. It will be required reading for my leadership team."Judd A. Gregg, former US Senator--". . . should be part of any consideration of how we improve America's health-care system."Tawfig Al Rabiah, Minister of Health, Saudi Arabia--"Reverse Innovation in Health Care is a great and well-rounded approach to tackling many of the current health-care issues."John Cochran, MD, former Executive Director, Kaiser Permanente Federation--"This book is timely and very important for American physicians, health-care executives, and legislators to read. Many of these case studies are very portable."Toby Cosgrove, MD, former President and CEO, Cleveland Clinic--". . . a rich new source of cost-saving medical innovation that deserves our most serious attention."
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About the Author
Vijay Govindarajan is one of the world's leading experts on strategy and innovation and is the Coxe Distinguished Professor at Dartmouth's Tuck School of Business and a former Marvin Bower Fellow at Harvard Business School. He is the author of a number of influential books, including the New York Times and Wall Street Journal bestselling Reverse Innovation.Ravi Ramamurti, a top scholar in international business, is the University Distinguished Professor of International Business & Strategy and Director of the Center for Emerging Markets at Northeastern University in Boston. His research and consulting work focuses on strategy and innovation by firms operating in, or from, emerging economies. He is the author or editor of seven books, including Understanding Multinationals from Emerging Markets.
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Product details
Hardcover: 288 pages
Publisher: Harvard Business Review Press; 1 edition (July 10, 2018)
Language: English
ISBN-10: 163369366X
ISBN-13: 978-1633693661
Product Dimensions:
6 x 0.8 x 9 inches
Shipping Weight: 1 pounds (View shipping rates and policies)
Average Customer Review:
4.5 out of 5 stars
15 customer reviews
Amazon Best Sellers Rank:
#161,101 in Books (See Top 100 in Books)
While the authors’ attempt to introduce “best practices†in India is commendable, the ideas are impractical if not impossible in the US health care system. Some of the ideas are downright scary – “reuse of single purpose surgical supplies.†It’s difficult to pinpoint all the differences between India and US in a complex topic as health care, but two immediate factors come to mind. First, there are entrenched reasons for the cost differences between the US and the rest of the world. For one, the US has an extremely litigious penchant towards health care providers, and a daunting level of checks and balances such as FDA clearance (and inspections) over pharmaceuticals and medical devices. One reason why the $1 voice prosthesis in India costs $700 in the US. Related to this, the US is one of the few markets where medical procedures and medication charges are not capped by the government; most nations even the most democratic and developed ones run health care as a utility. As a result, the US being a high-margin market subsidizes the high cost to develop “innovations†for the rest of the world. Second, the US medical networks have the “hub-and-spoke†model the authors recommend – it’s just isolated within a network. To gain the scale efficiencies in the book, individual networks would need to build a consortium to pool resources. Even if the networks are willing to work together, the efficiencies will still be difficult to gain based on the demographic and geographic profile of the US. Yes, the authors present us with 4 working cases in the Americas, but these institutions serve outliers of the general US population (e.g., Cayman Islands), and cannot be a foundation for the current health care needs of Americans. “Reverse innovation†may be a great concept in commodity industries, but for US health care, this book should be stored at the unreachable, top of the bookshelf [of ambulance chasing attorneys].
Many have tried to address the skyrocketing costs of American healthcare. Many have written about the astonishing results by hospitals in India such as Narayana Hrudalaya in Bangalore and Aravind EyeCare in Chennai. But Govindarajann and Ramamurti draw a straight line from one to the other and suggest some radical solutions for American healthcare from unexpected places. They back their hypothesis with real world American examples such as Ascension, the largest Catholic hospital system in the world, Iora Health serving Boston, Nevada and New York and the U Miss hospital center deep in the American south. The book should be required reading for any healthcare executive in government, in the corporate world and in the non profit arena.
The authors highlight lessons from healthcare innovators in India and how the lessons from India can be applied to US health care challenges. They highlight key issues of cost, access, quality and how these innovators have tackled these challenges. Other challenges in American health care such as healthcare disparities between social and ethnic groups are largely unaddressed , perhaps because these challenges also persist in India. I visited one of these hospitals during my executive MBA at Oxford university and found there care models quite impressive. The book is well researched and I commend the authors for a job well done. I recommend the book to CFOs, physician executives and administrators.
This book is very inspiring and made me rethink my role in the community. Social innovators, keep on innovating :) !
Must read for anyone who is involved in healthcare
In Reverse Innovation (2012), Vijay Govindarajan and Chris Trimble explain a process by which business leaders can identify the significant differences between rich-country and poor-country needs. "Reverse innovation does not begin with inventing, but with forgetting. You must let go of what you've learned, what you've seen, and what has brought you your greatest successes. You must let go of the dominant logic that has served you well in rich countries. If you want to use today's science and technology to address unmet needs in the developing world, then you must start with humility and curiosity." That is to say, reverse innovation can help to reverse the negative trends and tendencies that can weaken an organization.What are the core principles of value-based health care as practiced in India? According to Vijay Govindarajan and Ravi Ramamurti, there are five:1. A driving purpose: care for all2. A hub-and-spoke configuration3. An enthusiastic use of technology4. Task-shifting and continuous process improvement5. A culture of ultra-cost-consciousnessGovindarajan and Ramamurti note several correlations between these core principles and principles of value-based competition offered by Michael Porter and Elizabeth Olmstead Teisberg in Redefining Health Care: Creating Value-Based Competition on Results (2006):o Players should focus on creating value fort patients, not just lowering costs.o Competition should center on medical conditions over the full cycle of care.o High quality care should be less costlyo Value should be driven by provider experience, scale, and learning at the medical-condition level.o Innovation that increases value should be strongly rewarded.Most of those who are thinking about purchasing this book are probablky curious to know what happens when a health care organization attempts to replace its status quo with value-based health care as practiced in India. Govindarajan and Ramamurti include several lessons to be learned from each of these four organizations:Health City Caman Islands (HCCI) Pages 119-121Sample Lesson: Be frugal in capital expenditures and in variable costs.University of Mississippi Medical Center (UMMC) (144-146)Sample Lesson: Create a demand-driven network shaped by grassroots speed.Ascension Health (166-168)Sample Lesson: Use scale not just for market power but also to dramatically lower costs.Iora Health (188-190)Sample Lesson: Have a "social heart" but couple it with a "business brain."It is worthy of note that years ago, after days of negotiation facilitated by then President Jimmy Carter at Camp David, President Anwar Sadat of Egypt and Prime Minister Menachem Begin reached several agreements. At a press conference later, they were asked how, after centuries of savage bloodshed, they could reach these peace accords. Begin replied, "We did what all wise men do. We began at the end." That in essence is what reverse engineering is all about.Govindarajan and Ramamurti are well aware that no two health care service areas are exactly the same in terms of need, capacity, demographics, and resources. And the same is true of health care organizations within those areas. They fully recognize and understand cultural values and sensitivities that must be taken into full account. They also realize that the competitive marketplace is more volatile, more uncertain, more complex, and more ambiguous than ever before. All that said, the fact remains that world class health really care can be delivered affordably.I highly recommend this book to directors and administrators of all health care organizations as well as to all federal, state, county, and municipal officials who are involved in oversight and/or funding of those organizations. The process is reverse innovation and in this book Vijay Govindarajan and Ravi Ramamurti explain HOW. I'm certain that the material they provide in this book will help to save thousands of lives as well as billions of dollars all over the world.Bravo!
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