2. National Conference on Social Entrepreneurship and Sustainable
Development- 2014, TISS-CS
E
08 / Jan / 2014- 10/Jan/ 201
4
Primary Care Initiatives --
Primary Healthcare Entrepreneurship Models in
India- Executing Family Clinic Chains and Physician Networks.
Primary Healthcare
Stay Healthy. Stay Confident
Dr. Sachin Ganorka
r
3. Clinics – The Product
Community Health Care
Preventive
Additional services :
Diagnostics, Pharmacy
Professional
Clean
&
Hygienic
International
Protocols
Better service
Affordable
Chain of clinics
offering ‘quality’ GP
Consultation services
catering to the primary
health care needs of
individual
s
and families
4. Agenda and Take away, Time for presentation- 45 min
• Primary clinic, Your Family clinic, your family Doctor
• The Service offerings
• Process Flow to launch the clinics , Average Cost and Timelines per Clinic Unit
• The clinic Footprint in Hyderabad, Andhra Pradesh example
• The Work Flow and the Framework at the clinic chain- Patient Experience
• Clinical Quality at the clinics
• Evidence Based Medicine, Clinical Protocols and Clinical Audits
• Standardization of clinical treatment through IT integrated Clinical protocols and pathways
• Evolution of the clinic business model- Diagram
• Tariff Sheet Snapshot- Transparency in Pricing
• Revenue Data Example Snapshot
• Net Promoter Score/ Customer Satisfaction- Example of a clinic score
• Patients seen and Outcomes of the Clinic Network
• Family Physician- Managing Diabetes and Geriatric Healthcare
• Generic Medicines and Rational Prescribing , In-House Pharmacy
• Quality Labs and Ethical Evidence based testing
• Trusted Referral Partners and Tertiary Ecosystem
• Outcomes and Good Practices for a Family Physician as an example
• Patient’ Charter for the Clinic Chain
• Conclusions and Recommendations
5. Problem Statement and Objectives
Problem statement –
The importance of family medicine is yet to be fully recognized by the health planners in India.
Family medicine practitioner is a multi- competent generalist who not only provides the point of
first contact but also provides the continuum of care.
More than 90% of the illnesses affecting the population can be effectively managed by properly
trained family physicians. A World Bank study done in 2000 to study healthcare expenditure
highlighted that expenses over healthcare payable to private sector bring financial misery to the
people.
Objectives-
•Understanding execution of family clinic and family physician networks in India as primary care
entrepreneurship models.
•Drawing from the Conclusions and Recommendation to propel the primary clinic models ahead.
6. Solution -Evidence Creating Care, Cost Effective Care, Family
Physician
Evidence creating care where a doctor uses latest scientific evidence to support his/her
practice and clinical decision making. He /She prescribes rationally and adheres to
essential investigations.
Principles of cost effective care for a Physician
Take the necessary time in history taking and physical examination.
Write only essential investigations.
Whenever possible, adheres to rational evidence based approach to prescribing.
A “wait and see” approach to new symptoms.
Avoid heroic procedures in terminal care, refers for alarm features.
A good family physician is one who is
A personal primary care physician.
Gives personal care from cradle to grave
Skilled clinician
Makes early diagnosis at an undifferentiated stage of the illness.
Accessible
7. Abstract
Healthcare lies in the context of social, political and economic inequities. There is a need
for a first point of contact where quality primary healthcare could be accessed, is low
cost, effective and patient centric. There is a need for physicians to act as agents of social
change and engage in capacity building and community participation.
The family physician is best placed in the community to act as a gatekeeper and be first
point of contact in delivering primary care and an early diagnosis. A family physician
could anchor care and be the bridge between different providers and help the patient
chalk out an appropriate plan of care.
The family physician could help the patient navigate through the complexities of the
healthcare system and reduce the mortality and morbidity by showing the right care
pathway.
Sustainable primary care models lead by family physicians can disrupt complexities and
high cost healthcare by helping patients’ access care especially in chronic conditions like
Diabetes and Geriatric care. They can resolve 90% of conditions at the first point of
contact and refer what is only necessary to be seen by the secondary and tertiary level.
They could be vital change agents for preventive care, screening, patient advocacy and be
community ambassadors for health promotion and use appropriate technology which is
culturally relevant.
8. Abstract
.
This paper pertains to model executed for the Primary Urban Healthcare for tier 1, tier 2
and tier 3 cities in Andhra Pradesh, Karnataka and National Capital Region. It discusses
the work done and approaches to achieve sustainable primary healthcare in urban poor
settings and its evolution to a universal urban setting.
It involved setting up low cost units housed by family physician, qualified nurse and
pharmacist delivering primary care, quality lab tests and generic medicines. Evidence
based Quality care was delivered using International protocols and cloud based electronic
medical records. It involved coordination, offering concierge and home based care. The
economics and outcomes will be discussed which can help similar models assimilate
lessons and propel primary care entrepreneurship models in the country forward.
Key Words - Primary Care, Family Physician, Early diagnosis, Gatekeeper, Chronic
Conditions, resolve, generic medicines, protocols, concierge.
12. Quality Management Systems at clinics
Leadership commitment and
resources
re
Continuous Quality
Improvement
Organizational
Excellence and growth
Clinical processes and
Outcomes
Work efficiency/
Career growth
Continuous Professional
Development/ Employee
satisfaction
Training and Development
Excellent patient
outcomes
Effective process
management
Patient safety goals,
Patient
Satisfaction
Net promoter scores,
increased patient
satisfaction
Patient centred
Care
Operational Efficiency
Standardized policies and
processes
Evidence based medicine /
Clinical Protocols/Best
practices
15. www.razi.com
Clinical Quality- Training, Recruitment and
Manpower Development- Physicians, Nurses and
Pharmacists Examples
Physician Programs-
Pain Management for Family Physicians
Communication skills for Family Physicians
Palliative care for Family Physicians
Hypertension and Diabetes Management for Family Physicians
HIV and Tuberculosis Management for Family Physicians
Nursing Programs-
Sterilization for Infection control and Razi Nursing protocols
Communication and Computer skills
Clinical Skills Update
Pharmacist Programs -
Inventory Management
Pharmacy Management
Reporting
Pharmacy Management Systems Training
16. Clinical Protocols
Clinic’s broad objective is to standardize and optimize quality of clinical
care for the common conditions seen at outpatient clinics by their
physicians. Compliance with evidence based protocols; pathways and
appropriate patient advice are some of the methods commonly adopted
by clinics to achieve this objective.
30. www.razi.com
Checklists Examples- Operations
coordination and Clinical Audits
Microsoft Office
Excel 97-2003 Worksheet Microsoft Office
Excel 97-2003 Worksheet
Microsoft Office
Excel 97-2003 Worksheet
Microsoft Office
Excel 97-2003 Worksheet
•Pharmacist skill assessment checklist
•Nursing Skill assessment checklist
•Sterilization checklist
•Lab Grading checklist
31. www.razi.com
Health programs coordination , Products
and Referral Frameworks
1. Vaccination- Hepatitis B and Rabies , Healthy women, Diabetes
check, Healthy Heart , Active Ageing Program, Health checks and
Screenings
2. Medical Devices – ECG machines, Point of Care testing
3. Lab Tie ups
4. Referral linkages for physician to other providers and institutions
33. Advantage
• Family Clinic
• Advantage Vs. GP: Quality of Service, Reliability
Advantage Vs. Corporate Hospitals: Affordability, Accessibility, Convenience
• One Stop Clinic: Physician’s Consultation, In-house Pharmacy and
Diagnostics
• International Clinical Protocols
• Professional Management Team;
• Electronic Medical Records (EMRs)
• Tie-up for Cloud Computing
•Well Trained and Qualified Staff
34. Clinic Offerings
•Consultation Services
• GP
• Specialist consultations.
•Diagnostic services
•Blood pressure check
•Body mass index calculation and inference
•Injection services
•IV fluids infusion services
•Glucometer – fasting/ post prandial sugar/random blood sugar check
•Dressings- minor /major
•Vitals – temperature, pulse, respiration, pain, blood pressure
•Wound management and suturing
•Vaccines - Rabies , child immunization schedules
•Nebulization
•Lung Function Tests- Breathometer
•Point of care Diagnostic Tests- For e.g. Urine Analysis, Malaria tests, pregnancy tests
•Minor surgical procedures like abscess drainage, wound suturing
•Medical, fitness certificates
•Ante natal checks
•Lab reports- SMS alert and email
•Home Health Services/ In-Home care
•Disease Management Programs – Hypertension, Diabetes Management, Pain Management
•International Clinical Protocols
43. www.razi.com
Conclusions and Recommendations
• The family care models are evolving across the country and the world in terms of
services and programs rendered.
•
• There is a need to cover these models with a pre-paid insurance /Out- patient
department Insurance scheme so that preventive care becomes the focus. The Fee for
service system needs to be combined with a value based bundled payment system
which emphasizes on the outcomes of care delivery. This would help patients access
care at the primary level and reduce the burden on the secondary and tertiary care
systems for primary care problems.
44. Conclusions and Recommendations
• The primary care system needs to get linked in with a trusted secondary
and tertiary ecosystem for continuity and coordination of care. There are
cracks in the public health care system which primary care can address
being at the first point of contact and coordination of care.
• The primary care models need to focus on specific requirements and
needs like geriatrics and diabetes. The chronic care segment which
requires extensive follow up will immensely benefit from family
physician networks and continuous monitoring.
• Primary care providers are gatekeepers of the health care systems and
can help the patient traverse the healthcare journey in a safe
manner. There is need to focus on good generics, quality lab services
and medical products which can help the patients lead a better quality
of life and access services at a single point of care
45. Conclusions and Recommendations
• The family care models can focus on social equity and can help people from all walks
of life get to accessible, affordable and quality healthcare at the first point of contact.
• Primary care models can offer sustainable concierge services for diabetes and
geriatric care in future. Evidence based care for the above segment can help improve
quality and reduce costs of delivery in long term. A team based approach can improve
the holistic health of the individual concerned with the family physician being in the
centre of the concierge.
46. Conclusions and Recommendations
• Physicians can act as agents of social change through primary care and lead in
transforming the healthcare landscape in the country.
• There is a need to create a trained cadre of family physicians who can deliver primary
care through standardized systems and be the community leaders in their respective
geographies.
• The aspects of patient experience, design and Information technology services need
to address the pain points in the primary care work flow and make it user friendly.
• The family physicians can hence cause disruption in delivery of care by providing an
early diagnosis and being cost effective which will reduce the complexities, mortality
and morbidity in the healthcare system.
49. Viva Sehat
Viva Healthcare is one the fastest-growing community healthcare providers for the mid-market
in Asia. We are headquartered in Singapore and currently operate across Asia, Africa and the
Middle East. Our community focused multi-specialty primary healthcare centers offer high
quality patient consultations, preventative care and diagnostics.
In India Viva Sehat, as part of the Viva Healthcare Group, offers conveniently located primary
healthcare solutions for the average family in the form of a ‘one stop clinic’. We believe that
family medicine can address the majority of the preventable health issues experienced by
communities in India. Comprehensive patient-centred care to all, irrespective of economic status
or location, is the essence of our service offering.
Our vision is to be among the three most trusted healthcare brands in the Indian mid-market.
50. Gated Community Clinic
A gated community clinic is a primary healthcare facility conveniently located within
the community. We follow internationally recognised evidence-based clinical protocols
and efficient practices, which helps in offering cost effective, quality healthcare.
51. Services & Offering
Family Doctor Consultations
Injections & IV Fluid Infusions
Nebulisation
Suturing, Dressing & other minor procedures
Day Care/Ambulatory Care
Diagnostic Tests (Pathology – Blood, Urine)
Home Visits – Doctor & Lab
Specialist Consultations
Service is available six days a week, nine hours per day
52. Requirements
300 to 500 square feet existing property
Access to basic amenities – electricity, water supply and toilet
57. Existing Clinic
Aparna Sarovar has a population of over 4000 residents in 1100 apartments.
We have treated over 500 patients in the first 50 days.
We have a special focus on senior citizens and geriatric care and have also introduced a
wheelchair service
We offer home visits and lab sample collection to help the bed ridden and immobile
residents.
61. TISS International Conference on Social Entrepreneurship and Sustainable Development 2015
Mumbai, 4th Feb, 2015-7th Feb, 2015
Rural Health Initiative for Primary
Centres and Eye Care Centres in
East India
62. Rural Health Initiative for Primary Centres and Eye Care Centres in East India
Objectives
• Duration of Presentation – 20 Min
• Alchemist Health and Eye Centers- Footprint in East India-
Healthcare for the Rural Poor
• Alchemist Model -Rural Health Initiative for Primary Centres
and Eye Care Centres in East India
• Snaps
63. Alchemist Model -The Clinic Footprint in East India
Population being served – 27 crores
64. Alchemist Model –Snap Shot
Healthcare for the Rural Poor in East India
Hybrid Model - Primary and Eye Care hospitals structure, Stand alone PHCs
Services - General Care, Lab, Pharmacy, Refraction, Eye Surgeries, Outreach
camps, spectacles , Optical shop
Space - 3500-5000 Sq. feet space in Rural / Semi urban Areas of West Bengal,
Bihar, Jharkhand, Odisha
12 centers - Habra, Uluberia, Naihati ( West Bengal), Jharsuguda( Odisha),
Arrah, Chapra, Munger( Bihar), Hazaribagh, Chatra, Ramgarh,
Phusroo( Jharkhand)
81. Thank you and Questions
Dr. Sachin Ganorkar, GM, Alchemist Rural Health Initiative ,
East India,
www.alchemistclinics.com
Sachinganorkar19@gmail.com
9322670885
Twitter Handle -@sachinganorkar
