Selected commentary from the PHM Emerging Markets Healthcare Monitor is largely embargoed for a time per publication policies.  Other commentary by date.

Beyond Tomorrow: Private Healthcare in Emerging Markets

IFC 4th International Private Healthcare Conference
May 2011
(This is a pdf download.)

Qatar - Free Kidney Transplant for Patients from Abroad

February 2011

Disease Management May Pose Problem for Indian Hospitals

January 2011

USA Worksite Wellness Negative

Disease Management May Pose Problem for Indian Hospitals

January, 2011

Fortis Healthcare Ltd. announced its venture into Specialty Medical Centers focused on the management of diabetes, metabolic diseases and endocrinology.

The centers will provide comprehensive care catering to Renal, Ophthalmic, Neurological, Cardiac, and Metabolic ailments emanating from Diabetes. 

One report estimated 51 million people are battling diabetes in the country today and India is likely to be home to about 80 million diabetics by 2030. 

Other reports have placed the total diabetic count in India at approximately 91 million today. 50 million? 90 million? The numbers are disturbing. 

What will be most important to watch over the next decade or so is the reimbursement mechanism that gains favor with the payers, that is, the insurance companies. And companies that target chronic diseases like diabetes will be at risk. 

Chronic disease fits very well with capitated forms of reimbursement for insurance companies. But, should the rate of diabetes increase faster than projections, then clinical resources will be negatively impacted. Expect to see hospitals and clinics facing significant financial losses due to these patients, e.g. diabetics.  

With patients’ vision loss, renal and liver failure, amputations, and all the other associated costs of chronic diseases like diabetes, we know a serious financial drain on medical service providers will occur if they have not carefully negotiated their reimbursement schedules. Even companies like Fortis Healthcare.


Qatar - Free Kidney Transplant for Patients from Abroad

Kidney patients, outside Qatar, awaiting transplants can avail Qatar’s state-of-the-art kidney transplant facilities. Qatar is set to become a hub for renal transplants with an increasing number of procedures being done here.

Meanwhile, Arab News reports 6,000 Saudis await organ transplants.

Clearly this is a sensitive subject, particularly when it involves private healthcare, for-profit or not. Too often we see organizations, associations, and others step into the sensitive area of transplantation services without fully understanding the ramifications.

A few years ago one industry association even got involved with organ transplants as a service of medical tourism.

It would be very easy for a hospital to be black listed for not following international treaties in organ transplants.  Investors, owners, and their boards must assure their management is following the guidelines to the most exacting detail.

Organ transplant horrors are not confined to war zones like Kosovo.


USA Worksite Wellness Companies Negative

With the 2011 onset of prevention and wellness provisions in the Patient Protection and Affordable Care Act of 2010 (the Act), I now take a negative position on the worksite wellness model, including independent disease management providers.

The reasoning for this position will be challenged by the many, many worksite wellness providers, a sector that has not been able to scale up in any serious manner. In short, I envision a future where the majority of worksite wellness and disease management activities will be provided by local hospitals and in turn, Accountable Care Organizations or ACOs.

Hospitals and ACOs will attempt to “vacuum” revenue sources contained within the Act, and they will do this on several fronts. To begin, certain preventative requirements within the Act have already started (2011) and Medicare providers are well situated to gather the data, an integral component to the Act.

This will be follow by local hospitals taking their community based expertise gained from the required wellness services and then work to capture the financial incentives provided to employers contained in the Act.

The question then becomes, what type of provider is best suited to capture those employer based wellness incentives?

The medical loss ratio (MLR) targets will be an onerous goal for many insurance companies and managed care organizations. While there will certainly be provisions to include wellness within the allowable expenses that make up the MLR, we believe companies will attempt to eliminate every negligible amount.

And when the insurance sector examines the many marginal contracts they administer with wellness and disease management providers, we see the likelihood of eliminating these expenses. At the very least, the insurance sector will turn to the national hospital players like Community Health Systems, PHC, Inc., and others that can provide scale and minimize procurement efforts.

Another reason for turning negative on worksite wellness and disease management is the Act capitalizes on the classic, local delivery model of healthcare. This focus on community based resources, along with heavy data capture requirements, and the mandated preventative services to a sizeable senior population, all combine to illustrate the redundancy of the worksite wellness standard