Health biz insight november 2019 edition

3Health Biz Insight November 2019
Welcome to the November edition of Health Biz Insight
This time on Center Stage we have covered India’s most-watched healthcare plan –
Ayushman Bharat. A recent addition to it is the government’s innovation that has
the capacity to elevate the quality levels of Indian hospitals – both public & private
– the fast track certifications of Gold, Silver & Bronze. The intention is to take
quality consciousness to the deepest levels of Indian hospitals. While the work is on
at full throttle, will such a move really change the playing field?
In Game Changers this month, we have written about how ISB’s Healthcare
Management Programme is breaking new grounds. It is a programme that’s
delivered through a blended learning format and targeted mainly towards senior
level executives.
Strategy section talks about a scientific study on costing of medical procedures across public and private
hospitals. While Industry Trends explains how a well-informed expert team is what a successful cardiac
surgery needs. The Insight features an interview with woman leader Shubhra Thakur, Head – Health
Economics and Government Affairs, Boston Scientific India.
Special Feature is an article on the need of scaling up screening for cervical cancer, which requires a future
with innovative breakthroughs. Moving on, Health Beyond Fitness tells you about the best exercises for a
stronger back that you can do at home. This month, under Leisure – Travel, give river rafting a try. Visit
Kolad in Maharashtra, which is also famous for its natural beauty & pristine nature.
Do not forget to check out our regulars too. Current Affairs – we bring to you news that impacts the
industry in ways more than one. Every month, we fish out and bring to you the top news from among the
lot of numerous news that streams in. Conference Alerts - a listing of upcoming national and international
healthcare events.
Happy Reading!
Jayata Sharma
EDITOR
FROMTHE

4 Health Biz Insight November 2019
Dr. Poonam Khetrapal Singh, WHO Regional Director for South-East Asia
Diabetes is a significant threat to public health across the WHO South-East Asia Region. An
estimated 91 million people in the region suffer from diabetes. Around 49 million – more
than half – are unaware they have it. Undiagnosed or poorly controlled type 1 or type 2
diabetes can lead to heart, kidney, nerve or eye damage. It can also lead to premature death,
which in the region accounts for just under 50% of all deaths caused by noncommunicable
diseases (NCDs). Preventing and controlling NCDs is one of the region’s eight flagship
priorities.
As part of the region’s primary healthcare approach to tackling diabetes, families must
be empowered to act. Families have an important role in creating awareness of the risks of diabetes, including
overweight and obesity. They can also instill healthy habits such as physical activity that help prevent diabetes,
including its early onset, which in the region is high. In addition, family members are often the first to identify
diabetes’ signs, symptoms, risks and complications. When complemented by access to quality primary health care,
families are an important asset in the battle against diabetes.
The region’s member states are taking decisive action. All countries have developed national multisectoral NCD
action plans. Each plan contains specific interventions to tackle diabetes. Their roll-out has occurred alongside
member state efforts to strengthen primary-level NCD services, which will also help the region achieve its flagship
priority on universal health coverage. Several opportunities exist for the region to sustain and accelerate its progress
and achieve the ‘25x25’ and Sustainable Development Goal targets. Each of them should be grasped.
First, all families should have access to educational resources on diabetes. This can be done via social and
behavioural change campaigns that highlight the family unit’s role as a first line of defense. Campaigns should also
outline how families can work together to develop healthy habits. This is particularly important given most diabetes
cases are type 2, meaning they can be avoided by healthy eating and adequate physical activity.
Second, access to healthy environments should be increased. The creation of green spaces and outdoor gyms will
facilitate exercise and the weight management it brings. So too will efforts to reformulate unhealthy food and drinks
and enhance people’s ability to make healthy choices. Though these measures go beyond the health sector, health
authorities should act as nodal agencies, working across sectors to find high-impact solutions that also reduce health
care costs.
Third, all families should have access to quality primary health care. Primary-level services must be equipped to
detect diabetes, including the high and rising incidence of pre-diabetes. A reliable supply of quality medicines and
medical products that can help manage cases should be on hand. Each of the interventions outlined in the Colombo
Declaration on accelerating the delivery of NCD services at the primary level, which the region adopted in 2016,
must be fully implemented.
The region’s efforts to halt the rise of diabetes by 2025 and beyond must continue. It must also be scaled up.
On World Diabetes Day, WHO reiterates its commitment to supporting member states tackle diabetes via a
multisectoral, primary health care approach that empowers families. Together we must fight diabetes. Together
we can win.
OPINION
‘To tackle diabetes, strengthen primary healthcare
and empower families’
WHO’s South-East Asia Region comprises the following 11 Member States:
Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia,
Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste.

Content November 2019 Vol 9 Issue 8
Front of the Book
Top News------------------------------------------------07
News that impacts the industry in ways more than one. Every
month, we fish out and bring to you the top news from among
the lot of numerous news that streams in
Current Affairs----------------------------------------34
Latest takeovers & mergers, new launches, new technologies, and
updates of the industry
CenterStage-----------------------------------------------------------------------------12
A government innovation that has the capacity to elevate the quality levels of Indian hospitals -
both public & private – are the fast track certifications of Gold, Silver & Bronze. The intention
is to take quality consciousness to the deepest levels of Indian hospitals. While the work is on at
full throttle, will such a move really prove a game changer?
Content
Editor
Jayata Sharma-Sand
Special Correspondent
Neelam Jhangiani
Art & Design
Sharmila Revankar
Cover Design
Sharmila Revankar
Disclaimer: Health Biz Insight is an online mag-
azine only. We do not deal in any other service/
product under this name. Views and opinions
expressed in this magazine are not necessarily
those of Health Biz Insight, its Publisher and/or
Editors. We, at Health Biz Insight do our best to
verify the information published but do not take
any responsibility for the absolute accuracy of the
information.
Health Biz Insight does not take the responsi-
bility for any investment or decision taken by
readers based on the information provided in the
magazine. No part of this magazine can be repro-
duced without prior written permission of the
Publisher. Health Biz Insight reserves the right to
use the information published in the magazine in
any manner whatsoever.
Printed by Vijay Dhingra and Published by Jayata
Sharma-Sand on behalf of Health Biz Insight.
Printed at 1752, Street No. 10, Rajgarh Colony,
Krishna Niger, New Delhi 110051; and Published
at C-1/701, Neelpadamkunj, Sector 1, Vaishali,
Ghaziabad 201010

Content November 2019 Vol 9 Issue 8
Features
Game Changers---------------------------------------21
ISB’s Healthcare Management Programme is Breaking New
Grounds. It is delivered through a blended learning format
and targeted mainly towards senior level executives
Strategy--------------------------------------------------25
A scientific study on costing of medical procedures across public
and private hospitals
Industry Trends----------------------------------------27
A well-informed expert team is what a successful cardiac
surgery needs
Special Feature----------------------------------------29
Scaling up screening for cervical cancer requires a future with
innovative breakthroughs
The Insight ---------------------------------------------31
An interview with woman leader Shubhra Thakur, Head – Health
Economics and Government Affairs, Boston Scientific India
Health Beyond Fitness-----------------------------36
The best exercises for a stronger back that you can do at home
www.healthbizinsight.com
Back of the Book
Leisure Travel------------------------------------------33
River rafting being the major attraction here, Kolad is also famous
for its natural beauty & pristine nature
Conference Alerts-----------------------------------38
A listing of upcoming national and international healthcare
events

Current Affairs
Ekincare raises $3.6 million funding
Sheikh Shakhbout Medical City Opens in Abu Dhabi
Abu Dhabi: The Sheikh
Shakhbout Medical City
(SSMC), one of the 10
largest hospitals in the
United Arab Emirates (UAE),
opened its doors recently,
marking the completion of a
10-year, 3.2-million square
foot project.
Leading global design firm
Stantec led the master
planning, architectural,
interior, and landscape
design of this flagship
institution for the Abu
Dhabi Health Services
Company (SEHA).
The hospital is the first of
its kind in the UAE to
provide advanced burn
treatment and expand access
to specialty care services like
orthopaedic and thoracic
surgery. The new facility
replaces the existing Al
Mafraq Hospital, which
opened in 1983 and had
reached its operational
capacity.
As part of its project role,
Stantec also provided
mechanical, electrical,
structural, and infrastructure
engineering services.
Additionally, the firm
provided construction
administration oversight
for the duration of the
construction period.
“SSMC was developed as
part of SEHA’s vision to
provide the best healthcare
services in line with the
directives of the Government
of Abu Dhabi,” said Eng.
Mohammed Al Zaabi,
Chief of Facilities at
SEHA. “SEHA is a leading
healthcare provider and
SSMC is a significant
addition to the services
provided adopting cutting-
edge technologies and
providing a high-class
environment to both patients
and users.”
The SSMC’s design is
distinguished by four towers,
situated along thoughtfully
planned landscaping, with
patient rooms that each offer
views of the campus and
access to rooftop gardens for
respite. Designated floors
cater to patients looking
for additional privacy
and attention, with two
presidential suites and 36
VIP suites. The hospital
has space for 732 beds,
distributed across three
wards as post-surgical
inpatient beds, maternal
and child health beds
(including 12 VIP),
medical intensive care unit
(MICU) beds, cardiac ICU
beds, surgical ICU beds,
burn unit beds, and
neonatal ICU beds.
An initial staff of 3,000
medical professionals will
provide care for patients of
all ages.
Hyderabad: Ekincare, an
artificial intelligence-based
healthcare start-up, has
raised $3.6 million (Rs 25.81
crore at current exchange
rates) in a Series A funding
round led by a new investor.
The latest funding takes
the total capital that
ekincare, operated by Aayuv
Technologies Pvt. Ltd, has
raised so far to $5.6 million.
It didn’t disclose the name of
the new investor.
Other investors that
participated in the funding
round include existing
investors such as venture
capital firm Venture East,
Eight Roads Ventures
and Hyderabad-based
Touchstone Equities.
The start-up says it helps
companies efficiently
administer benefits,
optimise their healthcare
spends and show health
outcomes using its AI-based
assistant.
The company said it will use
the latest fund infusion to
strengthen its technological
platform, business
development and marketing.
It will also expand its
portfolio of offerings for the
corporate health benefits
market.
Co-founder and chief
executive officer Kiran
Kalakuntla said ekincare’s
platform recognises patterns
across different health
datasets and makes out
differences between
different consumer
segments to serve customers
better.
TOP NEWS

Current Affairs
Delhi: Global medical
travel provider Lyfboat has
been awarded the highest
certification for quality patient
care and safety in India – from
the National Accreditation
Board for Hospitals &
Healthcare Providers
(NABH).
Achieving the NABH
accreditation highlights that
Lyfboat, whose services
enable treatment in India for
international patients, has
been recognised for quality in
a range of different operations,
including training, facilities
available, infrastructure,
travel related services such
as visa assistance and local
transportation, and website
requirements.
“The accreditation from
NABH is a major milestone
for our company as it
recognises Lyfboat’s
endeavours and
commitment to patients
around the world,” said the
Lyfboat management team,
headed by Dr Surbhi Suden,
Chief Medical Officer, and
Anuj Gupta, CEO. “Our
dedicated approach towards
specialised healthcare has
helped us in achieving
remarkable success and
this accreditation further
reinforces our commitment
to meet patient expectations
for quality treatment and
services.”
Lyfboat achieves NABH accreditation
VPS Healthcare signs patient deal with Etihad Airways
Saudi Arabia: Healthcare
service provider VPS
Healthcare has signed a deal
with Etihad Airways which
makes the airline its preferred
air transport provider for
patients travelling from Saudi
Arabia to Abu Dhabi for
medical treatment.
Etihad will provide VPS
Healthcare with special
rates on air fares on its
flights from Riyadh, Jeddah
and Dammam. In July last
year, Etihad Airways launched
two specialised services for air
travellers with pre-existing
medical conditions.
The service was the first in
the region to be offered by an
airline and is carried out by
members of the Etihad medical
team who are qualified
in aviation and transport
medicine.
The first service allows guests,
who require medical clearance
prior to travel, the opportunity
to request an Etihad aviation
doctor to visit them and
conduct an evaluation in
consultation with their
attending physician.
All medical forms and
assessments will be completed
by the Etihad doctor on-site,
leading to a recommendation
about their fit-to-fly status
within one day.
The second service is an
in-flight nurse who can
accompany guests during
their trip and provide medical
support from all the Etihad
destinations.
“Abu Dhabi’s location makes
it an ideal setting for a hub
for medical tourism,” said
Shamsheer Vayalil, CMD
of VPS Healthcare.
VPS Healthcare is a healthcare
service provider currently
operating 20 hospitals and
more than 125 medical centres
across the Middle East,
Europe and India.

Current Affairs
Max Hospital launches oncology tower in Uttar Pradesh
Ghaziabad: Max Super
Speciality Hospital, Vaishali
recently inaugurated a
new Oncology Tower. The
building (MICC Tower II)
was inaugurated by General
V K Singh, MOS for Road
Transport and Highways and
MP Ghaziabad, in the presence
of other dignitaries.
Abhay Soi, Chairman,
Max Healthcare; Dr. Harit
Chaturvedi, Chairman, Max
Institute of Cancer Care,
senior oncologists, members
from Max senior leadership
and representatives from
Ghaziabad administration
were part of the inauguration.
Commenting on the launch
Abhay Soi said, “In Vaishali
alone, we have over 50 cancer
specialists providing the
most specialised treatment
in a very comprehensive
manner. We have introduced
the Disease Management
Groups as well as invested
in advanced technologies for
comprehensive treatment of
cancer patients.”
Dr. Harit Chaturvedi
commented, “Our DMG based
tumour boards are already
adding a healthy dimension
to the level of planning for
each treatment. Also, the
dedicated wing for women will
offer specialised care, quick
diagnosis and staging, and,
personalised service to females
of all age and backgrounds.
We have ensured that close
to 95% hospital staff on this
floor is women.”
As per Indian Council of
Medical Research data, India
will have over 17.3 lakh cancer
cases by 2020 -- a doubling of
cases in 25 years. It may see
over 8.8 lakh deaths due to
the disease, with only 12.5 per
cent of the patients receiving
treatment in early stages.
Breast cancer, cervical cancer,
oral cancer, and lung cancer
together constitute 41 per cent
of cancer burden in India.
In India, there are 450,000
follow-up patients every year
and the annual registration
of new patients in India is
50,000, with limited oncology
specialists.
Google’s health care plans to include patient data
Global: Google announced a
partnership with a large US
health care system aimed at
modernising its information
system and providing new
tools for doctors, in the tech
giant’s latest foray into the
health industry.
Announcement of its
arrangement with the
Catholic health care system
Ascension followed a
Wall Street Journal report
that Google had access to
thousands of patient health
records without doctors’
knowledge.
Both companies stressed
that their deal is compliant
with federal health privacy
law. Unlike most of the
data Google collects on
individuals, health data is
strictly regulated by the
federal government.
Google is providing cloud
computing services to
Ascension, which operates
health centres in 21 states,
mostly across the South and
Midwest. It is also testing the
use of artificial intelligence to
examine health records and
find patterns that Google says
might help doctors and other
providers.
Health care providers are
increasingly interested in
using data to help manage
care and keep patients
healthy. That might mean
relatively simple things like
tracking whether someone
refills a prescription or
something more complex like
spotting a worsening medical
condition and addressing it
before the patient winds up in
the hospital.
Health care systems are
allowed to share patient
information with business
partners so long as the
partners agree to safeguard
the information and use
it only in the way it was
intended.
“To be clear: under this
arrangement, Ascension’s
data cannot be used for
any other purpose than for
providing these services we’re
offering under the agreement,
and patient data cannot and
will not be combined with
any Google consumer data,”
Google cloud executive Tariq
Shaukat wrote in a blog post.

Bengaluru: Aster DM
Healthcare has taken on
lease a hospital in Bengaluru
that is being vacated by
Narayana Hrudayalaya,
and will start operating the
facility in one and a half
years, Aster’s chairman and
managing director Azad
Moopen said.
“This hospital was earlier
occupied by NH (Narayana
Hrudayalaya), and they had
earlier vacated, and we have
gone into an agreement to
take that as well as agreed
with the lessor to have
additional beds there so that
it becomes a much larger
facility,” Moopen told.
Aster DM Healthcare has
already started upgrading
the facility at Whitefield in
Bengaluru and will increase
the number of beds to 350
from the 91-bed facility
operated by Narayana
Hrudayalaya earlier.
There are two new
buildings coming up next
to the existing hospital,
which will lead to increase
in the number of beds, chief
financial officer Sreenath
Reddy said.
Devi Shetty-led Narayana
Hrudayalaya had last week
announced closure of the
hospital at Whitefield
effective 31 December,
citing its inability to scale
up the facility due to
various reasons, including
failure of the lessor
to provide additional
infrastructure that is
compliant with
regulatory norms.
While Narayana
Hrudayalaya positioned
the Whitefield hospital
for the upmarket segment
and did not have oncology
as a specialty, Aster DM
Healthcare will be adding
the oncology segment and
target the middle to upper
income segment.
When Narayana was
operating the hospital for
its upmarket segment, the
91-bed facility generated
Rs. 65 crore in the previous
financial year, according
to information in the
company’s exchange filing.
Aster DM leases Bengaluru empty hospital
Mumbai: BeYouPlus, a
start-up which is aiming to
standardise beauty treatments
by partnering with local
clinics, has raised $3 million
(approximately Rs 21.20
crore at current exchange
rates) in a Series A funding
round led by the Mumbai-
based IvyCap Ventures.
Other investors that
participated in the round
include Madison Capital and
Singapore Angel Network, the
Gurugram-based company said
in a statement.
BeYouPlus, which is operated
by Dermacy Healthcare Pvt.
Ltd, will use the funds to
enhance its technological
infrastructure and expand its
products and services to new
markets, it added.
Ankit Khurana, founder
and chief executive officer
at BeYouPlus, said the firm
was committed to providing
globally-recognised medical
procedures to domestic masses
at an economical price point.
“It is our firm belief that
the answer to India’s lack of
healthcare infrastructure rests
with a standardised distributed
model for day care and elective
medical procedures,” he said.
BeYouPlus’ operating model
improves private practitioners’
BeYouPlus secures $3 million funding
Current Affairs

Current Affairs
Rare Congenital Heart Disease treated at Columbia Asia Hospital
India’s medical tourism market to reach $9 bn by 2020
Bengaluru: Baby Aryan, a
seven-month old kid, was
suffering from a congenital
heart disease, a complex
developmental anomaly of the
heart, where the partitioning
of the heart was incomplete.
The valves that regulated the
flow of blood within the heart
was incomplete resulting in
a common valve instead of 2
separate valves. These valves
were not competent resulting
in a poor forward flow of
blood and very high pressure
in the lung’s blood vessels.
Baby Aryan underwent a
complex heart surgery where
in the heart was partitioned
into 4 chambers with 2
separate valves between them
that were competent.
This is among the most
complicated heart operations
done, especially at such a
tender age with high risk of
post-surgery infections and
also the risk of his little body
succumbing to it.
After the surgery, Baby Aryan
recovered well.
Many such infant patients
suffering from similar types
of heart disease often die
because they are not diagnosed
correctly at the right time.
Also, they do not have
access to facilities and skilled
teams that perform complex
congenital heart surgeries.
In India only a dozen centers
are capable of doing this kind
of heart operation, while the
number of children affected
with congenital heart disease
are approximately 8 out of
1000 live births.
“Every child needs to live a
free, healthy life, without the
constraints of any complicated
disease which burdens the
family with the fear of death
and restrict their growth and
development.
Recovering an infant life from
such a complicated disease
has an indelible effect on
the parents. More parental
counselling and charitable
gatherings should be organized
where parents of such infants
are supported and guided
to move ahead in the right
direction, says Dr. Joseph
Xavier, Consultant – Cardio
Thoracic Vascular Surgery,
Columbia Asia Hospital
Sarjapur Road.
National: India’s market
for medical tourism is expected
to touch the $9 billion
mark by 2020, according
to a report released by the
Federation of Indian
Chambers of Commerce and
Industry (FICCI) and Ernst &
Young.
As per the report titled ‘India:
Building Best Practices in
Healthcare Services Globally
2019’, the rising costs of
health care in developed
countries such as the US
and the UK will make India
an affordable alternative in
the coming years. The report
also noted that the country
is one of the preferred
destinations for Medical Value
Travel (MVT) as it occupies
the fifth position among
41 major medical tourism
destinations, as per Medical
Tourism Index Overall
ranking, 2016.
Delhi, Mumbai, Chennai,
Bangalore, Hyderabad and
Kolkata are the preferred
destination cities for medical
tourists arriving in India.
Nearly 27% of India’s
medical tourists head to
Maharashtra, out of which
80% go to Mumbai. Chennai
attracts nearly 15% of the
incoming foreign patients
while Kerala handles
around 5-7%. HBI
efficiency while at the same
time providing consumers with
quality and reliable healthcare,
he added.
As part of its investment,
IvyCap founder and managing
partner Vikram Gupta will join
BeYouPlus’ board of directors.
Separately, Gupta said IvyCap
was confident in its investment
because of the start-up’s focus
on accessibility, transparency
and standardisation in
healthcare treatments.
BeYouPlus says it has developed
a model wherein it can offer
highly specialised doctors with
a procedural solution to add to
their outpatient department
(OPD) practice.

With the launch of Ayushman Bharat, the landscape of Indian healthcare has seen a shift. The govern-
ment is leaving no stone unturned to make this scheme a success. In fact, we may also say that the
government is working on this in an almost ‘corporatised’ way. Professionalism & innovations, plus
timelines and digitalisation are being given huge importance. Most of the ideas and innovations are also
mainly taking place keeping PM-JAY in mind.
One such innovation that has the capacity to elevate the quality levels of Indian hospitals – both public &
private – are the fast track certifications of Gold, Silver & Bronze.
The intention is to take quality consciousness to the deepest levels of Indian hospitals. While the work is
on at full throttle, will such a move really prove a game changer? Let us try and find out.
Ayushman Bharat’s Fast-Track
Quality Certifications
Will they prove to be a Game Changer?
Center Stage

Center Stage
By: Jayata Sharma
S
o, how did it all start?
The Quality Council of
India (QCI) had already
started with revamping
the NABH Entry-Level
Certification for Healthcare
Organization (HCO) and
Small Healthcare Organization
(SHCO). QCI was preparing a
new web portal called HOPE
- Healthcare Organizations
Platform for Entry Level
Certification.
At the same time, the office
of PM-JAY expressed
their interest of launching
certifications for entry-
level facilities, which had
the capacity to seep into
the deepest corners of the
healthcare system.
Their ideas matched & thus
the AB PMJAY Quality
Certification technology
portal was prepared & the
Ayushman Bharat fast Track
Certifications were launched,
by merging QCI’s already-in-
motion activity on the same
lines.
3 levels of certifications
The certification system
consists of three levels –
Gold, Silver and Bronze. As
the name suggests, the Gold
Quality Certification is the
highest level of certification.
Those hospitals with Joint
Commission International
(JCI) Gold Standard
Certification or the National
Accreditation Board for
Hospitals and Healthcare
Providers (NABH) Full
Certification, can apply for
Gold Certification. There is
no extra cost for this level of
certification, under the above
circumstances.
The Silver Quality
Certification is the second
level of certification where
those hospitals with National
Quality Assurance Standards
(NQAS) and NABH Entry -
Level certification (HOPE) can
directly apply. Again, there is
no extra cost for this level of
certification, under the above
circumstances.
The final level of Certification
is the Bronze level of
Certification, which the
hospitals with no prior
certification can choose and
apply for. The fee for this
level varies from bed size of
the hospital – starting from
INR 12,500 to INR 30,000
(excluding the 18% GST).
The certification programme
is a three-tier system to ensure
step-by-step upgradation
of empanelled hospitals to
improve their quality of
services. This certification
programme will not only cater
the government hospitals
empanelled under the
Ayushman Bharat Scheme,
but will also focus on
motivating the smallest
of empanelled healthcare
providers with no certification
to come forward and apply
for the Bronze Quality
Certification, which is specially
designed keeping in mind these
healthcare providers.
There is no cap on locations
or type of facilities, hospitals
in every location in India can
apply for these certifications.
A fully digital initiative
It seems the days when
‘sarkari’ works in India
used to dread us, may be

Center Stage
left behind soon. With the
Digital India initiative, plus an
overall revamp of our working
systems, India is becoming
more and more technology-
enabled. Taking cue from this,
the certification process has
also been made completely
digitised. End to end. With
minimal manual intervention
required. This has also ensured
transparency in the certification
process.
The whole process of quality
assessment is carried out
on a technology platform
consisting of a Web Portal
and an Assessor Mobile App.
All the standards developed
are objectively presented
as questions for
hospitals to answer
online.
The assessment
is done in two
phases – (i) Desktop
Assessment, where
hospitals’ self-
attested documents
are verified online and upon
successfully completing it, (ii)
an Onsite Assessment takes
place. Here, an Assessor visits
the hospital and collects the
required information through a
mobile app developed for this
purpose.
You apply digitally, pay
digitally, you get assessed
digitally. Desktop assessment
happens digitally, even the
certificate is given digitally.
When hospitals request for
hard copy of the certification,
QCI provides that.
The only component which
is missing is when the
accreditation committee
shows the entire format and
the report, although over a
platform, but they are still not
able to do it remotely. The
target is that over a period
of time, every accreditation
member sitting at their own
place can take a decision and
submit their decision on the
portal itself.
So, how did the government
build a robust IT system for
this? Initially, the government
did all the experimentation
with various projects in
the PPID structure, which
was Project Planning and
Implementation Division,
when the Swachha Bharat
campaign was ongoing.
Once it succeeded, they
started expanding to reports.
Initially, their pilot was in the
Swachha programs, since it
succeeded, QCI did it in
NABL, National Accreditation
Board for Certification
Bodies (NABCB) and now
it is being done in
NABH.
The certification process has also
been made completely digitised.
End to end. With minimal manual inter-
vention required. This has also ensured
total transparency

Center Stage
You are the brainchild
behind these certifications.
What was the idea?
One of the major criticisms
that we used to get is that
accreditation takes a lot of
time. So, firstly, we wanted
to address this. The new
certifications will take about
25-35 days, as opposed
to 6-8 months for normal
accreditations.
Secondly, the initial thinking
has been that accreditations
are a voluntary system and
the government has not really
mandated it. Hence, the idea
was also to handhold these
people so that they can go on a
quality journey. Plus, we have
attached incentives to these
certifications; so, more people
have started applying.
Thirdly, things have changed
recently with the Insurance
Regulatory and Development
Authority of India’s (IRDAI)
proposal that for any cashless
transaction in a hospital,
they will have to get NABH
certification. This is when
National Health Authority
(NHA) came up with these
fast-track certifications.
One important thing to
highlight is the transparency
level here. Any kind of
assessment that QCI runs,
is totally transparent and
we don’t give power to the
assessors. The inspector raj
that was prevalent in India
was because there was lot
of power in the hands of the
assessor. Now, we have a
changed scenario. We have
technically-competent people
going for assessment and they
only collect evidences, the final
decision takes place at the
backend.
Your target is to certify
7000 hospitals. Work is
going as per plan?
We have the capacity to certify
about 200 hospitals every day.
So, the speed and systems on
our end is not the issue. What
is hampering the speed is the
readiness of the hospital to go
through this process, which
will and is taking time. Our
capacity is much higher than
what the funnel is. So, when
the funnel is totally populated,
then we would be able to do
more, turnaround time will be
much faster.
In fact, we are working with
the hospitals to improve their
readiness quotient & move it
faster.
What are the other
challenges?
The biggest problem that we
are facing is that there are lot
of statutory compliances. Most
of the hospitals are not able
to complete these statutory
compliances because many
regulators are also involved,
like fire safety, biomedical
waste, and more. All these are
needed to get the certification.
And for obvious reasons, we
cannot undermine or move
past without these regulations
in place, it will jeopardise
the safety of patients and the
hospital.
Dr. RP Singh
In a chat with Dr. RP Singh, Secretary General, QCI,
we find out more on this initiative
‘We have the capacity to certify about 200
hospitals every day’
The biggest issue is that most hospi-
tals are not able to complete statu-
tory compliances like fire safety, bio-
medical waste management, adequate
manpower for services & more. All
these are needed to get the certification
Dr. Sangita Reddy, Joint Managing Director, Apollo Hospitals Enterprise Ltd.
The National Health Authority’s initiative to certify PM-JAY empanelled hospitals based on quality standards is
indeed a laudatory step to ensure high quality of care and patient safety. This step of the government will serve
to improve patient confidence in the care provided at hospitals that are part of the Ayushman Bharat network.
Very often quality does come at a price. However, if one looks at the overall health and wellness status of an
individual, high quality care ends up being cheaper in the long run because it will have minimal side effects.
The move will also motivate empanelled hospitals to focus on continuous improvement in quality of care
provided as well as facilities and infrastructure. With over 18000 hospitals empanelled to date, the certification
will allow segmenting of hospitals based on the quality of healthcare, and increase transparency for the patients.

Center Stage
Doctors are also generally not
very technology savvy, so it
has been a major challenge to
make them understand and
bring a change in their mindset
to adopt technology and speed
things up.
In the public sector hospitals,
one big problem is of human
resources; nursing staff for
example. In the ICU, there is a
requirement of suppose
2-3 nurses per bed, with
just 8 hours of duty for each.
Now, most of the hospitals
do not have this compliance.
So, they apply with the
vision that they would be
able to complete the process
of recruiting people till the
certification happens, but
they are not able to do so.
Therefore, in the public sector
there are only about 10% of
hospitals, which have been
accredited, whereas other
90% is from the private sector.
How did you achieve
time reduction on overall
accreditations?
We have removed the pre-
assessment, which directly
reduces about 6 months.
Pre-assessment was required
earlier, when people were
not familiar with the
concepts of certifications and
accreditations. However,
now you usually have quality
managers or similar people
in your own hospital system
who have worked earlier on
accreditations and can guide
internally.
Plus, the desktop review can
also be done by the hospital’s
own office staff. That is how
we have squeezed the time
limit. Plus, we have strict
deadlines for our own selves,
to give the certification within
45 days. So, 45 days is what
we aim for as far as entry level
certification is concerned, 90
days is what we aim for full
accreditation. This has been
replicated in the fast-track
certifications too.
Once you reduce the man day
efforts, the cost of accreditation
on the hospital automatically
comes down.
Do you foresee the fees
getting increased in the
future?
We don’t have to increase
the fees; all this innovation
is taking place to decrease
the fees while ensuring
quality.
The certification
process has
also been made
completely digitised.
End to end. With
minimal manual
intervention required.
This has also ensured
total transparency
The Kayakalp Initiative
It is a scheme launched by Union Ministry of Health and Family Welfare to encourage and
incentivise health facilities in the country to keep the facilities clean and hygienic. The purpose of
this initiative is to appreciate and recognise the healthcare organisations’ effort in creating a healthy
environment. It promotes cleanliness, hygiene and infection control, creates and share sustainable
practices related to improved cleanliness in health care facilities linked to positive health outcomes.
Performance parameters to be assessed
Hospital/Facility Upkeep
Sanitation and Hygiene
Waste Management
Infection Control
Support Services
Hygiene Promotion
Interested HCO/SHCOs can apply for Kayakalp while registering themselves on HOPE portal.
A certificate will be issued by Ministry of Health and Family Welfare to all the compliant health
care facilities.

Center Stage
Dr. Arun Gupta
What was the philosophy
behind launching
Ayushman Bharat’s fast-
track certifications?
NABH has been in existence
since almost a decade and
we have not even touched a
4-figure number in accredited
hospitals. Entry-level NABH
certifications are also just
around 3,000.
Now, when we launched
Ayushman Bharat, we
defined the packages, the
service providers, the patient
categories. The next logical
step was to define quality.
One parameter is to check
outcomes, but that is a
lengthier process. So, we
decided to have defined quality
inputs. Which can be achieved
by accreditations; the current
numbers of which, are low.
We have about 18,000
hospitals empanelled with
us right now in PM-JAY.
In a best-case scenario too,
if we assume all accredited
hospitals have come under
our umbrella, we still only
have 16% certified hospitals.
Hence, we wanted to diffuse
the mystery on accreditations
and bring a simplified
version of it. This is when we
approached QCI, which was
making the HOPE portal at
that time, which matched with
our thought process and thus
we joined hands on it.
What are the direct
benefits to hospitals?
Better patient safety, good
outcomes, goodwill, patient
trust, more footfalls. On
an instant basis, we will
provide 10% more on base
rates to Silver category
hospitals and 15% above the
base rate to Gold accredited
hospitals.
So, if a hospital bills us for
1 crore, they will directly get
10-15 lakh additional by us.
How was the process
simplified?
We sat together with the
people who have worked on
the field, on the floor level.
After which we formulated
simple processes with even
more simplified language. So
that people feel emboldened
to go for it. We have also
uploaded the entire guideline
on the website.
Especially for the Bronze
category, we have made the
guidelines even simpler. Once
they get Bronze, then they may
be encouraged to achieved
Silver & Gold too.
After feedbacks from the
sector, some changes
in the Health Benefit
Packages were made.
How was it done?
Health benefit package
(HBP) was designed and
given to NHA to fuse it
with Ayushman Bharat
and roll it out. Immediately
feedbacks started coming in
– mainly highlighting that the
terminology is not consistent,
rates are not favourable, etc.
There was a dissatisfaction
among the industry & people
were taking it as a reason to
not empanel with PM-JAY.
So, that is when we started
Dr. Arun Gupta, Executive Director, National
Health Authority (NHA), in a conversation on
Ayushman Bharat’s Fast-Track certifications
& changes made
‘We will provide 10% more on base rates
to Silver category hospitals and 15%
above the base rate to Gold accredited
hospitals’
The new accreditations will only
take 25-35 days for the entire
process to be completed; as op-
posed to 6-8 months for full scale
NABH accreditations

Center Stage
working on removing the
aberrations. For instance, in
some cases, the cost of the
implant itself was more than
the package for the whole
procedure.
We wanted to create a
workflow for this. That’s
when we approached the
Department of Health
Research, which has been
undertaking a study on
Costing in Health since 2017.
They already had the data of
public hospitals, which we
acquired. It was a speciality-
wise costing data.
We also did many meetings
with various specialist
committees, wherein we
showed them comparative data
and rates of various schemes
like CGHS or any state scheme
as compared to Ayushman
Bharat. There were reasons
asked, some changes suggested,
which we incorporated and
finally a costing method could
be derived.
Oncology is also a huge issue
in India. For which, we looked
at 4 major sets – paediatric
cancer, surgical oncology,
medical oncology & radiation
oncology. Tata Memorial
Hospital was the best facility
for data on this & thus we
signed an MoU with them to
undertake costing for these.
They worked on it with the
help of the National Cancer
Grid.
After all this, we were able
to cover costing for more
than 1000 packages out of
1352. We also met individual
specialists to do more work on
the costs.
Additionally, we arranged a
national-level meeting with all
states, after sending them the
revised costing. After which
the review committee okayed
and finally the governing
board passed it, which is
finally the HBP 2.0 that is
currently in practice.
Shobha Mishra Ghosh, Asst.
Secretary General, FICCI
Ayushman Bharat is set to
transform India’s healthcare
landscape by moving closer
to target of Universal Health
Coverage and SDG3. The
government has fast-tracked
various initiatives aimed
at achieving these targets
including enhancing the
quality of services through
standardisation and
accreditation. Over 18,000
hospitals empanelled under
PMJAY include several
hospitals that have no
accreditation. NHA has made
a significant stride by framing
bronze, silver and gold
accreditation ratings with
QCI. This will help ensure
a minimum level of quality,
ability to stratify providers
and empower beneficiaries
to gauge the level of facilities
available in different
empanelled hospitals.
Further, ratings should
be coupled with optimal
payment models and viable
reimbursement rates to
incentivise quality, efficiency
and clinical outcomes.

Center Stage
Dr. JL MeenaHow have the quality
standards improved in
Indian healthcare?
I have been working in
quality since 2002, when I
was in Gujarat. We did it on
a very small scale, with the
Reproductive & Child Health
(RCH) quality standards. Then
in 2007, NABH came in and
Gujarat was the 1st state to
adopt NABH.
Earlier, there used to be a huge
scare about these standards.
However, slowly, as public
and private, both hospitals
started getting accreditations,
the industry started adopting
quality in a much better way.
Then there was no stopping.
We started NQA certification,
NABH entry-level certification,
nursing assessments. We took
in medical colleges too (though
could not take them directly
in NABH), so we started
accrediting their blood banks,
their labs under NABL. Even
separate certifications were
started for radiology set-ups.
We also designed certifications
for PHCs, for which QCI
framed a different set of
standards.
Tell us about your role in
Ayushman Bharat’s fast-
track certifications.
The initiatives we had
implemented in Gujarat, we
had to sort of replicate them
under Ayushman Bharat.
Though with few key areas -
like the PM-JAY certifications
had to be strictly time-bound,
with focus on self-assessment,
and stress on cultivating a
culture of quality.
Plus, we wanted to formulate
a certification process with
no language barrier or extra
complications. Because, we had
seen that the implementation
team at hospitals also comprise
of lower level staff, which is
usually not adept in English or
complicated communication.
Also, evidence-based process
with pictures and data was
key. We have kept the entire
process extremely simple and I
had also uploaded the process
video on You Tube, which has
been viewed by 171 countries
till date.
How important is
inculcating quality as a
culture in any organisation?
Very important. Quality has
to always be imbibed in the
culture and has to come from
the heart. In my earlier works
in Gujarat, we had created
a system of monthly quality
assessment (from 3rd parties)
for hospitals, by creating a
set of 20 questions. Now, we
did doubt if the answers of
all these questions have been
filled in accurately or not.
However, this exercise at least
ensured that people have in
mind that a quality assessment
is to happen. Then slowly,
this forms the culture of an
organisation.
The next step is appreciation.
Punishment will rarely result
in pure quality. For this, we
started giving appreciation
certificates to accredited
hospitals at national level
workshops conducted by QCI
& NABH. Then we realised
that not many people are
able to achieved NABH. So,
we also starting appreciating
people at the Kayakalp
initiative level (check inside
article for Kayakalp).
We also started giving out
appreciation certificates on
the occasions of 15th
August
& 26th
January, which ensured
maximum visibility to the
accredited hospital/organisation,
which further helped improve
numbers of certified facilities
plus morally boosted the
already-certified ones.
An insight into the quality focus of Ayushman Bharat’s
fast-track certifications with Dr. JL Meena, General
Manger, Hospital Networking & Quality Assurance,
National Health Authority (NHA), Ayushman Bharat -
Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)
‘We had done the 1st
Gold certification
desktop assessment in front of the media’
Managing timelines are very vital for
us. For Gold certifications, we had
targeted 15 days’ time, but we have been
able to do it in about 7 days. Everything is
automated, which boosts the system

Center Stage
6 hospitals have been AB PMJAY Gold Quality certified
Apollo Hospitals International Ltd, Gujarat
U. N. Mehta Institute of Cardiology Research Centre, Gujarat
Cygnus Superspeciality Hospital, Haryana
Government CLSC Spine Institute Physiotherapy, Gujarat
Sanjiv Bansal Cygnus Hospital, Haryana
Kashyap Memorial Eye Hospital, Jharkhand
VK Neurocare and Trauma Research Hospital, Haryana
2 hospitals have been AB PMJAY Silver Quality certified
MGM Hospital and Research Centre, Madhya Pradesh
SKR Hospitals & Trauma Centre Pvt. Ltd.
Few hospitals have applied for AB PMJAY Bronze Quality Certification, but not yet certified.
AB-PMJAY Quality Certified Hospitals as on 14th
November, 2019
In case of any support or issues, hospitals can raise the ticket on https://support.pmjay.gov.in/ or mail the issue on support.
pmjay@qcin.org. They can also call on NHA’s toll free number 14555/1800111565
There is an increased
focus on self-assessment
of quality.
Yes. I think self-assessment
is the best kind there is. As
you know your strength and
weaknesses, you can do a
SWOT analysis yourself in the
best way for improvement.
Are you also planning
any surprise checks on
hospitals?
Yes. Though our first focus
is that industry gets sensitised
on this. Post which, we do
plan surprise checks. Having
said that, our process has
been made very robust, and
mostly any such surveillance
may not be needed. However,
we will undertake such checks
if we find anything amiss or
someone raises a concern.
In fact, recently at one
hospital, we did send our
team to cross-check a certain
flagged issue.
What are you doing to
increase awareness?
We have already conducted
more than 20 awareness
workshops across India. Plus,
we are planning regional
workshops with hospitals.
Along with this, we are also
targeting and tying-up with
organisations like FICCI, CII,
FOGSI, consultancy firms,
and more. We have plans
to reach through various
industry events as well.
How has been the
response to this initiative?
We have seen more positive
response than we had
anticipated. When the first
Gold certificate was given,
the entire national and many
international media covered
it. In fact, to show the
transparency levels, we had
done the 1st Gold certification
desktop assessment in front
of the media.
Additionally, our core
implementation team has
been very prompt and, on
their toes, which helped us
a lot.
The core implementation
team members: Ankita
Garg, Project Manager,
QCI; Ridhima Madaan,
Project Manager, QCI;
Sukhdeep Kaur,
Consultant, NHA; and
Aman Kaher, Product
Manager, NHA.
Dr. Suganthi Iyer, Dy. Director,
PD Hinduja Hospital & Research
Centre, Sr. Medico Legal
Consultant & NABH Assessor
It will help in the journey
towards quality, attainment
of a level of good healthcare
delivery to patients, ensure
safety of patients and maintain
perseverance of quality
healthcare. In addition, citizens
have a fundamental right
to good health, AB PM-JAY
is helping to deliver good
healthcare to all in smaller
towns and peripheral areas too,
which was difficult earlier.
Even small healthcare
organisations can start journey
towards quality healthcare
delivery with this initiative.
Summing it up
India is advancing, and healthcare advances at double the speed. In this day and age, it is vital to
not compromise on quality of a service, which is the lifeline of any nation. The new-age certifications
are surely targeting high quality healthcare services with reduced timelines, and such an initiative,
if implemented well, can definitely be a game changer in India’s healthcare sector. HBI

Game Changers
ISB’s Healthcare
Management Programme
is Breaking New Grounds
Delivered through a blended learning format and targeted mainly
towards senior level executives, it is a rigorous and challenging
programme that minimises disruption at work and personal
pursuits
By: Neelam Jhangiani
T
he need for leaders
with a sound
understanding of the
developing economies and
a global perspective in the
rapidly changing business
landscape was recognised
early by the Indian School of
Business (ISB). Over the years,
the institute has strived to
create such leaders through
its innovative programmes,
outstanding faculty and
thought leadership.
ISB’s Advanced Management
Programme for Healthcare
(AMPH) is a step in this
direction. The programme
aims to create future leaders,
especially for the healthcare
industry. AMPH, since
its inception in 2016, has
had a unique positioning
of delivering high-quality
management education to mid
and senior executives from the
healthcare delivery industry.
Delivered through a blended
learning format and targeted
mainly towards senior level
executives, it is a rigorous and
challenging programme that
minimises disruption at work
and personal pursuits.
Prof. Sarang Deo, Associate
Professor of Operations
Management at the ISB, takes
us through the journey of
the AMPH programme so
far. Prof. Deo has extensive
experience in the field of
management education
and prior to joining ISB, he
was an Assistant Professor
at the Kellogg School of
Management. He frequently
collaborates with international
agencies such as the Clinton
Health Access Initiative and
the Bill and Melinda Gates
Foundation. He is also
undertaking a research, which
has been funded by the US
National Science Foundation
and Grand Challenges Canada.

Game Changers
Let us see what he has to tell
us more on the programme &
ISB. Excerpts…
How is AMPH’s position
unique as compared to
other courses available in
India?
AMPH is an ISB program
run by the Max Institute of
Healthcare Management
within ISB. The programme
was started in the year 2015
and till date it has received
exceptional response by the
healthcare community and
the engagement is extremely
encouraging.
The main distinguishing
factor for AMPH is that we
have deliberately designed
it to not focus on day-to-
day hospital administration,
which many other courses
and programs in India do.
The focus of the program is to
develop a long-term strategic
view and to build top leaders
for the healthcare sector,
which means the nature of
the courses that are offered,
faculty who teach in the
program are very different.
Most of them have a
healthcare expertise and
exposure but some of them
also come from outside
healthcare, they can be faculty
in marketing or strategy but
have extensive experience
and bring in the best practices
from those industries to
healthcare and are able to
talk the language that CXO’s
of large organisations can
understand.
Why is your focus more
on upskilling of already
existing executives?
As these people are already
at senior positions in a
growing organisation, it is
very timely and urgent that
we re-orient the perspective of
these people. We do need to
build leaders from ground up,
but what to do with people
who are already heading a
100-crore organisation but
have no formal training in
management. Many of these
people have grown from
within the organisation maybe
at junior positions and only
learnt how one organisation
works, which is not going to
be enough going forward.
How often are the inputs
and consultations taken
from industry leaders on
the Programme?
This is an issue that we take
very seriously at ISB, we
want the curriculum and
programme structure to be
industry relevant. AMPH
curriculum has been designed
in consultation with leaders
from the healthcare industry.
The curriculum ensures
that the learnings at the
programme are relevant to the
current needs of the industry.
Consistent with ISB’s
philosophy of delivering high
quality, industry relevant
management programmes,
the School undertook a
curriculum review in its
second year itself and changes
were made to the programme,
industry trends were also
changing and we needed to
capture those too. For e.g.,
the growing importance of
health technology and change
in policy environment. Some
structural changes were made
in the programme accordingly.
Other than that, on an
ongoing basis we get together
both policy makers and
industry leaders through
round table and events that
we organise. Some of our
alums from the programmes
themselves are in senior
positions, either head of
department, CEO of hospitals;
so, they also are a channel of
constant feedback.
Kindly share the kind of
changes that were brought
in after the 2nd year
review.
When we first designed the
programme, it was deliberately
focused on healthcare delivery
services, which it still is,
but we felt it needs to be
complimented with some
understanding of healthcare
product based, which is
both biopharmaceuticals
and medical devices so we
introduced a course on that.
We realised that there is a lot
of entrepreneurship coming
in the sector so we introduced
one course on business model
innovation, that we have
now strengthened further to
introduce entrepreneurship, so
it covers both new businesses
that people want to start &
also changing the business
model of existing businesses.
Third thing we have
introduced is a webinar series
on health systems and this is
keeping in mind the changing
regulatory regime and the
financial regime of India
where government is emerging
as a big player, unlike earlier.
We also want our participants
We have a
component called
applied learning
where students
form teams and
they have to
implement ideas
and concepts that
they have learnt in
their courses in a
real organisation
and it is typically
one of the
organisations that
they come from

Game Changers
We realised that
there is a lot of
entrepreneurship
coming in the sector
so we introduced one
course on business
model innovation
to get a bird’s eye view of how
are health systems structured
in other countries – how does
financing work, how much
of it is finance by taxes or
individual patients from out of
pocket expenses? Also, what
is the role of private insurance
in other countries? These are
some of the main changes we
have brought about in our
program.
How do you ensure quality
of the faculty members?
An eclectic and accomplished
team of faculty teach at the
ISB. Our faculty are chosen
on the basis of their research
excellence and teaching
acumen. They have a deep
understanding of the health
sector and are in tune with the
latest trends and issues in the
Indian healthcare industry.
Our faculty have to be either
subject matter experts in
the healthcare domain or
they have to be top notch
faculty. They may not have
a healthcare background,
but they should be top notch
faculty for management at ISB.
Many of our faculty teach in
the flagship PGP programme
so they are all experts in their
domain, be it a functional
domain like finance,
marketing or strategy.
We also get some experts to
periodically teach or co-
teach if there is no relevant
experience from within the
functional domain. Let’s say
if you take a course for cost
accounting for health services,
we may not be able to find
someone from the accounting
area within ISB to teach a
course, because it is such a
specialised subject. Then we
go out and see are if there are
people who are practicing this
in the industry for a long time;
these are right people to teach
such a senior class. Thus, we
have a very careful choice
of faculty both from within
ISB and visiting faculty and
at the same time both from
academic community and the
practitioner community.
One-year MBA is the flagship
program at ISB and we want
a reasonable amount of
integration of the AMPH with
the main stream academic
program, so if a marketing
faculty teaches in the MBA
program and has expertise
in healthcare, we will try our
best to get that faculty to come
and teach in AMPH. Faculty
body is not separated, which
ensures quality because these
faculty who teach in the MBA
program obviously know
management in and out and
have taught for several years.
How is the pedagogy
participant-centric and
experiential in nature?
This is something very natural
in the ISB environment, lot of
faculty members teach in the
MBA program as well they
rely predominantly on the
case methodology with very
few lectures where required.
Even concepts that require
a bit of lecturing is usually
interactive with the students,
there are discussions within
the class so that’s one aspect
for pedagogy. Second is we
have a component called
applied learning where
students form teams and
they have to implement ideas
and concepts that they have
learnt in their courses in a real
organisation and it is typically
one of the organisations that
they come from. So, it is not
only theoretical but they can
see it on the ground. These are
two main reasons by which
we make it experiential and
participant centric.
Kindly share with us a few
examples of the business
strategy formation /
real-life problem-solving
exercises that are
conducted during the
Programme.
I can give you my own
example; I am mentoring two
teams from the current class.
One of the team is trying to
understand how to build low
cost hospitals in tier 2, tier 3
cities to be able to cater the
demand of Ayushman
Bharat. For this, they are
comparing cost structures of
three different hospitals and
three different tier 2 cities
where they work. Based on
the insights that they will get
and by comparing these cost
structures, they will be able to
propose something new. This
is a very timely and pertinent
topic because government
wants to push Ayushman
Bharat and believe that access
to healthcare can increase in
smaller towns. At the same
time, industry people are
saying that the rates offered
by Ayushman Bharat are very
low, so the question is – can
you innovate something in the

Game Changers
business model to be able to
deliver good quality healthcare
at these low rates.
Now, the set of projects that
our students take up have to
do with process improvement
and operational improvement
within hospitals. Thus, how
do you prove the conversion
of outpatient visit to
inpatient procedure to make
it financially viable? How
do you reduce the discharge
delays that patients face in
hospitals because that is a
major driver for customer
satisfaction and repeat
business? Some other type
of projects involve learning
social media marketing; let
us say there is an individual
practitioner say a doctor,
how can they use Facebook
to market their services so
that they don’t have to spend
a lot of money on traditional
marketing.
How have the learning
objectives for the
programme been
developed on the AACSB
International model?
AACSB requires that each
program must have an
Assurance of Learning, which
includes setting learning goals,
measuring them consistently
and regularly. At ISB, this is
instituted for PGP suite of
programs. We have taken
a proactive approach and
introduced similar learning
goals for AMPH.
We feel we are breaking new
grounds; others have not
done it yet. Again, taking
a leaf from our one-year
MBA programme, we believe
having clear learning goals for
AMPH is important because
it sets the tone for what
sort of courses to include in
the program, what sort of
pedagogy to go after. Hence,
again in consultation with
industry leaders we articulated
and crystallised four learning
objectives. It was also based
on typical state of participants;
when they come in lot of our
participants do not have a
clear understanding of what’s
the distinction between sales
function and marketing
function or where does exactly
HR and operations interface
each other or where does
costing stop and financing
start.
The course inculcates business
acumen and a functional
outlook among participants,
and from there the journey
starts. Culmination of this is
how to do integrative decision
making when decisions cannot
be made only from marketing,
finance or operations angle.
There are also learning goals
associated with responsible
leadership, ethical dilemmas
where we need to take into
account various stakeholders
not just shareholders or
investors but patients, larger
society, government. We
want to make sure several
courses are able to touch up
on this aspect. There is also a
specific course on responsible
leadership but across the
course duration, participant
should get exposed to such
multi-objective decision
making so on and so
forth.
How many executives do
you train annually?
It’s a selective program, we
run one cohort of participants
typically around 15, because
we believe the intensity of the
course is such that it is not
easy to scale. As mentioned
earlier, the priority is to train
top management because
if they are convinced that
management thinking is
important and relevant, they
will be able to transmit some
of that down the line in their
organisation.
Tell us about your partners
- in India and worldwide.
ISB has several partnerships
or MOU’s with many leading
universities in the world. Our
founding affiliate schools are
Kellogg School of Management
at Northwestern University
and The Wharton School at the
University of Pennsylvania; the
Associate Schools are London
Business School (LBS), MIT
Sloan School of Management
and The Fletcher School of
Law and Diplomacy, Tufts
University.
So initially, when the program
was designed, we got inputs
from those people. Our
visiting faculty comes from a
range of international schools
and universities. We are also
a part of an organisation
called Business Alliance for
Healthcare Management
(BAHM),
it’s a select group of business
schools with healthcare as a
focus area.
So that helps to exchange ideas
on cutting-edge curriculum
and pedagogy within healthcare
management. HBI
It’s a selective
program, we
run one cohort
of participants
typically around 15,
because we believe
the intensity of the
course is such that
it is not easy
to scale

Strategy
An extract from a report by: FICCI
D
eveloping and
maintaining hospitals
is a capital-intensive
affair and therefore, managing
costs, achieving profitability
and justifiable growth are very
important for any hospital
venture to be successful.
Hospitals face number of
challenges as they are exposed
to greater risk as compared
to other industries, owing
to complexity of operations,
ensuring appropriate quality
of care and humanitarian and
ethical issues in providing
healthcare.
The operational and financial
risks in hospital sector and
various challenges faced in this
sector also emanate from the
growing competition, which
puts hospitals under pressure to
provide cost effective services
along with ensuring good
quality of care.
Two critical aspects being:
• Appropriate pricing of
services
• Optimal capacity utilisation
Further, due to continuous
technological advancement
in diagnosis and treatment,
hospitals
need to invest heavily on
acquiring the most appropriate
technology to deliver quality
care to the patients. Hospital
pricing policy has to ensure
the recovery of the capital
costs of these equipment and
technologies.
Apart from physical resources,
hospitals also face the challenge
of ensuring that they retain
qualified professionals. A
FICCI-Kantar IMRB pan India
patient satisfaction survey of
5,000
healthcare consumers
conducted in 2017, revealed
that reputed doctors associated
with a hospital was the third
most compelling reason for
people to choose a particular
hospital for treatment.
While volume-based costs
may appear to be a reasonable
Demystifying Healthcare
Costs
A scientific study on costing of medical procedures across
public and private hospitals
Not all costs in
healthcare are
proportionate to
changes in volume,
except the cost
of machinery and
materials. Better
patient outcomes and
quality of care, which
are powerful
drivers of value in
healthcare, also have
implications on cost

Strategy
method of costing in several
industries, it cannot provide
accurate costs in the healthcare
industry. Delivery of healthcare
being very complex in nature,
accurate measurement of costs
is difficult. Not all costs in
healthcare are proportionate
to changes in volume, except
the cost of machinery and
materials. Better patient
outcomes and quality of care,
which are powerful drivers of
value in healthcare, also have
implications on cost.
Costing is a challenge
Ascertaining types and units
of resources consumed and
apportioning cost of such
resources for each service
delivered in a hospital
have been challenging for
providers. Therefore, it is
important to move away from
the conventional method
of measuring costs to a
scientifically designed method,
which is able to capture the
utilisation of resources for
various processes within a
hospital.
Time Driven Activity Based
Costing (TDABC)
This revised and simplified
Activity Based Costing (ABC),
has been internationally
recognised as an effective
methodology for estimating
costs of processes used in
patient care. TDABC assigns
resource costs to patients based
on the amount of time resources
are used in patient encounters,
while other costing approaches
rely on arbitrary allocations to
some extent. TDABC directly
measures the clinical and
non-clinical resources for every
activity involved in delivery
of a service. This helps in not
only understanding the actual
cost but also the utilisation of
resources according to their
available capacity.
Volumes make an impact
Lower volumes led to higher
costs, as the cost of delivery of
care in case of less than 100-bed
small hospitals was found to
be higher than that of the cost
incurred by more than 100-bed
hospitals. This observation
is irrespective of whether the
hospital was located in a metro
or a non-metro city. Small
hospitals face challenges in
investment in manpower and
equipment, and hence engage
with clinical teams on fee-for-
services basis (as consultants)
and in some cases small
hospitals rent equipment even
for the routine surgeries.
Volumes impact different
components of cost in different
manner. Higher volumes do
lead to savings in machinery
and materials (consumables).
However, increase in volumes
does not always lead to lower
costs, as the utilisation of
infrastructure is constrained
by capacity utilisation of the
clinical manpower.
Any significant rise in volume
can lead to new break-even
points/levels, as additional
investment will be required for:
• engaging additional clinical
manpower
• adding capacity, in case
major volume of general
ward patients is added as
this capacity is usually full in
established hospitals
Large public hospitals like
AIIMS command price
advantage in procurement
of machinery and materials
(consumables). Balancing
between cost and accessibility
is complex.
While real estate cost
continues to be a challenge
for the hospitals in metro
cities, hospitals in non-metros
have higher cost of clinical
manpower in terms of their
remuneration and fringe
benefits. Due to limited public
infrastructure beyond metro
cities, hospitals also invest in
creating a support system for
the doctors and their families.
Summarising it
Globally, there is a gradual shift
with decreasing usage of Fee-
for-service model and increasing
adoption of the capitation
model for out-patient care and
diagnose-related-groups
(DRG) model for in-patient
care. Most countries are
moving towards a hybrid
model (fixed + variable
incentive), which incentivises
efficiency of resources/inputs
and achievement of clinical
outcomes by moving away from
indicators linked directly to
revenue generation via fee-for-
service arrangements.
Challenges for
Indian Hospitals
• Cash flow and working
capital management
• Achieving operating profit-
ability on a sustainable
basis
• Optimising resources and
processes and thereby
reducing overall cost
• Improving overall margin
• Deriving financial per-
formance indicators for
different departments or
service lines
• Managing employee cost
without affecting the staff
turnover ratio
• Analysing and optimising
workforce and benefits
• Managing receivables
below 90 days
• Improving and maintaining
credit rating of the hos-
pital by ensuring healthy
financial ratios
• Generating and retaining
funds for future capitalisa-
tion, modernisation and
expansion
• Cash embezzlement,
wastage, fraud and leak-
ages

Industry Trends
The Importance of
TeamworkA well-informed expert team is what a successful cardiac surgery
needs
By: Dr. Mohan Kumar HN
T
he heart is the most
sensitive and crucial
organ of a human
body that facilitates life.
However, the general lifestyle
these days has led to affecting
this organ in ways more than
one, leading to many diseases
and health concerns related
to the heart. It has now
become highly essential to get
appropriate treatment from
trusted experts.
The whole team has a role
There have been various
instances when the treatment
and care provided to the
patient along with the
doctors’ expertise have paved
the way for the patient’s
further course of life. Hence,
it is important that the team
treating the patient is well-
informed and has adequate
knowledge and experience to
help the patient recover well
in cardiac surgeries, especially
due to the complications these
surgeries involve.
Ensuring a successful cardiac
surgery starts from a proper
diagnosis. It is important to
know that while one reaches
out to a hospital in case of a
cardiac treatment, they keep
in mind various factors, and
you should ensure that they
can rely on the hospital. This
is crucial because a cardiac
surgery is not just about a
good heart surgeon, but the
entire team that is involved.
Below are some factors, which
a hospital must fulfill to
assure proper cardiac surgery
and recovery of a patient:
• The work initiates with
a good diagnosis, so
the hospital must have
good clinicians who can
diagnose the clinical
conditions like coronary
There are specially-
trained cardiac
anesthetists who
must check-in before,
while and after the
surgery about how
the heart is beating
and constantly keep
a tab on what is
happening to the
heart

Industry Trends
artery disease, vascular
abnormalities, congenital
abnormalities at the right
time so that the patient
reaches the surgeon on
time.
• As diagnosis is a crucial
step in deciding the
surgery or the further
treatment required
and in understanding
the complexity of the
problem, the quality,
and presence of
diagnostic tools like an
electrocardiogram (ECG),
MRI or CT scan machines,
etc. become of utmost
important to gather the
correct information. So,
does the hospital have the
right instrumentation? Is
an essential and crucial
question that must be
addressed.
• The next important
factor in these surgeries
is the expertise that the
clinicians possess to carry
the procedures with grand
old ways or the newer
techniques. While every
technique has a different
way, so does every surgery
and hence appropriate
knowledge is necessary
about all the procedures
and instruments or
machines.
• Further in line is the care
that the patients will be
provided. There must be
good nurses who have
been trained well for
particular care that is
involved with respective
cardiac surgeries; and in
some cases, care is also
based on the age of the
patient.
• An anesthetist is an
equally important part
of the team. There are
specially-trained cardiac
anesthetists who must
check-in before, while and
after the surgery about
how the heart is beating
and constantly keep a tab
on what is happening to
the heart.
• Having a thorough
understanding of the
complications that can
accompany cardiac
surgery is also very
important. For instance,
the patient can suffer from
a brain stroke, which
is a rare complication
with heart surgery and
so requires a good
neurological team readily
available. Hence, it is
critical to have specialists
who are experienced and
skilled to cover problems
ranging from neurological
or intestinal or kidney-
related, etc.
• A team to know the
post-care necessities of
the patient who has gone
through a particular
surgery is also a very
important part to ensure
complete recovery of the
patient.
Hospitals like Columbia Asia
have an entire spectrum of
cardiac sciences that caters to
everyone from newborn to an
adult as they understand that
successfully cardiac surgery
can be performed only with
a good support team who
understands the procedures
as well the complications that
could arise.
All of this involves the ability
of the entire team to explore
many complex procedures
smoothly and hence an overall
team that has the adequate
knowledge and is well trained
and experienced is a must
while selecting a cardiac
hospital. HBI
About the author
Dr. Mohan Kumar
HN is a Consultant –
Interventional Cardiology,
Columbia Asia Hospital,
Sarjapur Road, Bengaluru

Health Biz Insight November 2019
Special Feature
29
Scaling up Screening for Cervical Cancer
A Future with Innovative
Breakthroughs
By: Dr. Nalini Gupta
E
very eight minutes, a
woman dies of cervical
cancer in India, reveals
the National Institute of Cancer
Prevention and Research. Come
2020, an additional 148,624
new cases of cervical cancer will
be added to the existing disease
burden, each year. Primarily
caused by sexually acquired
infection (Human Papilloma
Virus or HPV), cancer begins
with precancerous cellular
abnormalities in the cervix.
It can be years before a woman
advances to the later stage of
cancer and fully registers the
disease.
Therefore, being cognizant
of the precancerous stage
become extremely important
to manage a highly preventable
cancer. With advanced
screening mechanisms such as
liquid-based cytology (LBC)
test, a patient can be correctly
diagnosed for the presence
of even the minutest cellular
abnormalities as well. Because
it is a highly preventable form
of cancer, it’s imperative to
raise awareness on the need for
timely screening procedures.
Failing to address precancerous
lesions in the initial stages can
stall the case for reducing the
burden of cervical cancer.
A similar situation is witnessed
in India wherein the lack of
awareness around advanced
screening procedures, is the
reason behind the galloping rise
in patient numbers. As per the
current estimates, every year
96,922 women are diagnosed
with cervical cancer and 60,078
lose their battle to the disease.
Moving beyond the common
myth that cervical cancer
affects only postmenopausal
women, the government should
establish regular screening
programmes for women of all
groups and socio-economic
background. But before opting
for a clinical examination,
women must understand the
disease profile carefully.
Understanding cervical cancer:
the disease profile and possible
screening options
• Cancer first develops as
treatable precancerous
cellular abnormalities in
the lower part of the uterus
that connects to the vagina.
• Scientists believe that HPV,
a group of viruses, out of
these, type 16 and 18 are
directly responsible for
around 70% of cervical
cancer cases globally.
• The HPV virus can sustain
in a patient for years,
causing cervical cells to
become cancer cells.
• Typical symptoms of
With advanced
screening
mechanisms such
as liquid-based
cytology (LBC) test,
a patient can be
correctly diagnosed
for the presence of
even the minutest
cellular abnormalities
as well

Health Biz Insight November 2019
Special Feature
30
cervical cancer include
vaginal bleeding after
intercourse, between
periods or after menopause,
watery or bloody vaginal
discharge that may have
a foul odour, pain in
the pelvic region during
intercourse, etc.
• As a progressive disease,
cervical cancer requires
multiple screenings
at regular intervals of
2-3 years to check its
development. In such
times, we need to action a
two-pronged approach i.e.
self-analysis and consulting
a specialist.
• According to experts in
oncology, timely screening
of cervical cancer leads to a
93% survival rate.
• Women of all groups,
starting from puberty
onwards, must prioritise
their reproductive health to
lead a better quality of life.
Since early-stage cervical
cancer generally shows no
signs or symptoms, it is
recommended to opt for
advanced screening procedures
at regular intervals.
A case in point: the
Scandinavian countries
invested heavily in building
a medical environment that
encourages women to regularly
screen their bodies. The result
is, the disease burden came
down to the level of a rare
disease i.e. 1 to 2 patients per
100,000 population.
In the Indian scenario, the lack
of awareness about the disease
profile and possible diagnostic
solutions has reduced the
median age from 50 years
to 38 years. The findings are
startling. Hence, it’s time we
encourage women to take
extra care of their health.
Emerging technologies to fight
cervical cancer
With innovative
breakthroughs in the field of
oncology, detection of even
asymptomatic cervical lesions
has become extremely feasible.
Conventional screening
procedures such as a ‘Pap
smear test’, which requires
several samples for detecting
multiple subsets of cancer
has now been substituted
by much more sophisticated
technology. Take, for instance,
the LBC test. LBC allows
clear visualisation of even the
minutest cellular abnormalities.
This, in turn, allows a doctor
to use the same residual sample
to conduct future tests to
confirm presence of high-risk
HPV in the sample. LBC,
therefore, allows screening for
important additional follow-
up tests without the need for
repeat sampling.
Furthermore, the new test
allows storing the sample for
up to 6 months, facilitating
the detection of high-risk
HPV. A leap from pap smear
tests, wherein the sample was
collected with a spatula and
resulted in a meagre 30%
recovery by the time it reached
the slide for observation.
With LBC, the sample can
be collected through a brush,
which allows complete recovery
of the sample. Because 95% of
women who develop cervical
cancer test positive for HPV,
assessing pilot sites for the HPV
is possible with LBC.
The subtleness of early
symptoms such as abnormal
menstrual bleeding and
vaginal pain usually become
the reason for overlooking
these symptoms as potential
triggers of cervical cancer. In
my career, I have observed that
women who voluntarily opt for
screening have fewer chances of
suffering from cervical cancer.
There is also a general fear that
by screening younger women,
we expose them to unnecessary
follow-up procedures with no
real benefit.
What we must understand is
that cervical cancer develops
over years of undetected
precancerous abnormalities.
Hence, screening for cervical
cancer at regular intervals
is the plausible solution to
controlling the disease burden
as well as saving millions of
future patients. HBI
About the author
Dr. Nalini Gupta is
a Professor at the
Department of Cytology
and Gynae Oncology - PGI
Chandigarh.
She has 19 years of
experience with interests
in cytopathology,
gynecologic & lung
oncopathology, liquid-
based cytology. She
has more than 225
publications in various
peer-reviewed indexed
journals of international
and national repute. She
is a life member of IAPM,
NAMS, ISSLC and IAC.
She is also a member
of editorial board of
Cytopathology journal.
She was awarded an ICMR
International Fellowship
and she worked with
Dr Mina Desai in
Manchester Cytology
Centre, Manchester
and with Dr John Smith
in Royal Hallamshire
Hospital, Sheffield, U.K.

The Insight
‘Have confidence & conviction in
yourself’
An interview with woman leader Shubhra Thakur, Head – Health
Economics and Government Affairs, Boston Scientific India
By: Jayata Sharma
What do you think about a
man vs. a woman in a work
set-up?
I am not a believer of the
division based on gender.
There should not be disparity
based on how a man
would approach a certain
situation vis-à-vis a woman.
Professionals who work
together effectively regardless
of gender differences make the
best teams.
Women professionals need
to be head strong just as men
would be in bringing their
views, ideas and expertise to
the table.
Which are the three
toughest challenges
that you have faced and
overcome?
I have taken up very diverse
roles in my career to challenge
myself. Moving from one role
to another often came with a
lot friction and its own set of
challenges. With perseverance
and focus, one can fight any
odds.
For a large part of my career,
when I had to make tough
decisions at work, I wish I had
a mentor earlier enough. Not
being able to find guidance
and astuteness at the right
time was an issue.
Women are many times
looked at with a subjective
lens and breaking stereotypes
is another level of challenge.
Clarity about which situations
to put your energy into
and which ones to avoid
completely is very useful.
How important is the
company’s outlook in all
of this?
It is extremely important. In
the corporate world, there is
good understanding about
the value women can add to
an assignment the same way
the opposite gender would.
Recognizing that merit and
competencies alone define
an individual’s growth is
reassuring.
3 things as per you that
women colleagues should
do for each other.
As a woman, the first thing
I would like to shout out
is for women to have the
confidence and conviction in
themselves and their dreams;
and leave no stone unturned
in going out and realising
them against all odds. This

The Insight
goes out not only to women
who are my colleagues, but
every girl and woman who
may not have the means and
direction to make it possible.
Positive reinforcements that
one can give to fellow women
colleagues is vital.
Supporting women colleagues
to realise their true potential
and excelling at work is also
extremely crucial. For we
spend a significant amount
of time at work and with
colleagues, being open to
conversations – whether nice
or tough, is very basic to
recognizing their principles,
aspirations and challenges.
This is the first step in
beginning to support.
Most importantly, never
undermine the power of one.
The change one woman could
bring in another’s life is huge.
If we take the onus to support,
guide and mentor at least one
other woman, if not more, it
could be immense help in their
growth.
I also think that one doesn’t
need the tag of a guide or
mentor to do that. The kind
of support women colleagues
could provide each other
through sharing knowledge,
training, imparting skills,
cultivating an environment of
trust and healthy competition,
or even emotional support and
sharing the load sometimes
at work, works wonders and
brings a lot of positivity.
It may not be as easy as it
sounds as oftentimes, we fail
to keep our own inhibitions
and shortcomings aside.
How can we change the
‘abla naari’ perspective of
our own selves?
In this day and age of
change and more and more
women being empowered
and reaching great heights,
the “abla naari” is fast
diminishing, if not completely
absent. I say it is vanishing
because we have several
examples of women from
different walks of life who
are doing brilliantly well and
inspiring others, however hard
their circumstances may have
been. Nevertheless, there are
many women who face grave
challenges being marginalised,
which brings us more
responsibility to be the catalyst
of positive change in their
lives. Instead of bearing an
“abla nari” mindset, courage
to overcome obstacles should
be the belief of an “able nari”.
Are we still in a man’s
world, trying to fit in? How
can we break this cycle?
Women in leadership
positions are fewer than men
in leadership. In many parts
of our country, the gender
ratio is still heavily skewed.
We still have to cover a lot
of ground to come to an
equal representation and
opportunities. However,
instead of making it a man
v/s woman arena, men and
women need to co-exist
harmoniously powering each
other’s engines of ambition.
There are tasks at which
women are best performers
while men can perhaps handle
certain roles better. It is
realising and accepting these
differences that will take away
the need to fit in and be like a
man. The frame of reference
should not be the qualities of
a man.
Your top 3 suggestions
to fellow women
professionals.
Find your calling- ‘something’
that we are effortlessly able
to do and follow through day
in and day out. I have seen
many people choosing their
professions and hobbies due to
its popularity or what I call as
the “herd syndrome”.
Also, integrity and self-
confidence will help you stay
grounded and be a better
professional.
Knowledge is power. It can
help differentiate your own
brand as well as point in the
direction of higher pursuits
in your career. One must
continually keep learning and
improving and vice versa.
Afterall, there is something
to learn from everything and
every person.
The mantra that keeps
you going.
You are what you make you
of yourself. My pursuit to
constantly learn and grow in
life keeps me going.
What is your secret to a
work life balance?
Even though I am a
workaholic, I ensure to spend
good time with family and
take time off once in a while.
Spending time with friends
even in a simple setting gives
me a lot of energy.
Since I enjoy being in the
profession I am, work life
balance is natural and not
something to seek. Efficient
time management is the key.
How do you unwind and
relax?
I believe in introspection and
spending time with myself as a
means to relax. Having made
TV programs and films at
some point in my career, I love
the art of cinema and music
that helps me unwind. HBI
Instead of bearing
an “abla nari”
mindset, courage to
overcome obstacles
should be the belief
of an “able nari”
Views expressed are personal.

Leisure Travel
The Adventure
Destination of West
River rafting being the major attraction here, Kolad is also famous
for its natural beauty & pristine nature
By: HBI Desk
Kolad is a village in Raigad
district, Maharashtra State,
India. It is 117 kms from
Mumbai on the National
Highway no 17 (Mumbai-
Goa). It lies on the banks
of River Kundalika. Kolad
has a varied climate; spring
(March to May) is hot and
sultry, while the monsoon
season (June to September)
is accompanied by heavy
rainfalls. Winters are during
November and February and
are characterised by a medium
level of humidity and cool
weather.
White water river rafting is a
popular adventure water sport
for people travelling here. The
Kundalika River in Kolad
is the best option for white
water rafting in Maharashtra.
The huge amount of water
released from a local dam
each morning creates good
opportunities for rafting.
Below are some activities that
can be undertaken in this
tourist spot.
Kolad river rafting
Kolad is an instance of
paradise for adventure
enthusiasts. Kundalika river’s
14 kilometer stretch of
exciting rapids provide one
and a half hours of white-
water rafting. The monsoon
season tends to be the best for
the adventure sport, though
at times rafting pauses due to
weather conditions.
Nestled in the lap of Sahyadri
Ranges, the small village
called Kolad is known
for attracting people with
adventurous streak. Offering
a nerve pumping rafting
expedition on Kundalika
River, the activity takes place
across two dams covering an
approximate stretch of 12
kms. Bundled with raw beauty
of nature, the activity is a
perfect opportunity to let your
fear fly off. The adventure

Leisure Travel
Kundalika river’s 14
kilometer stretch
of exciting rapids
provide one and a
half hours of white-
water rafting
over the easy flowing and
abundant water is not only
about fun but about a passion.
Manoeuvre your rafts and get
ready for an adventurous ride
on Kundalika River invading
through a tiny and rustic
hamlet of Kolad adding punch
to the ride.
Tamhini Ghat waterfalls
The most popular attraction
of Tamhini Ghat is the
enchanting Tamhini
Waterfalls. Also known as the
Valse, these waterfalls
cascade down a significant
height and form a pool at the
base. Other than trekking,
sightseeing and picnicking,
tourists also enjoy swimming
in the water or simply an
occasional dip.
Ghosala Fort
Standing between the
Revdanda and the Salav
Creeks, is a fort known for its
architecture and design. There
are two temples and a dargarh
in the fort complex as well.
Prisons, parapets, stores and
chambers can be seen inside
the fort.
Sutarwadi Lake
This pristine lake with
beautiful surroundings
and a quaint atmosphere is
a perfect destination for
bird watchers. Watching
the sun get reflected on
the calm waters is a
beautiful sight to behold
while here.
Plus Valley
Tamhini Falls

Leisure Travel
Plus Valley trek
The Plus Valley is such a
unique place that nobody
can resist the call to explore
and enjoy it. Exactly like the
name of the place, the valley
is in the shape of a plus sign,
which adds to the intrigue and
excitement of this amazing
destination. Challenging
terrains, exotic fauna, and
awe-inspiring scenery will
keep you coming back for
more.
Bhira Dam
Also known as the Tata Power
house Dam, it was built by
Tata Power Company in
the year 1927. The water
of this dam is used for
irrigational purposes and
power generation. It is the
major source of water for the
Kundalika River, which is
popular for water rafting.
Tala Fort
Situated 1000 feet above the
sea level, this fort primarily
acts as a view point. Built in
the 4th Century, this fort is set
in the midst of lush greenery
on hilly terrains. The River
Rajpuri can be viewed from
here.
Kuda Mandad Caves
These caves are a part of
the Janjira Hills. A group
of 13 Buddhist caves, many
sculptures, paintings and
inscriptions can be found here.
Stupas of the Lord can also be
seen.
Gaimukh
Literally translated as ‘the
mouth of the cow’, it houses
a temple dedicated to Lord
Shiva which comes in the
limelight every Mahashivratri
- the festival of Shiva. During
the festival, a 15 days
Gaimukh Mela is organised
in the village. Along with this
temple, there is also a cave
temple (a unique experience in
itself) dedicated to Kuramvars.
There are a couple of other
temples in and around this
village as well
Devkund Waterfalls Trek
Located in Bhira, Devkund
Waterfalls are a popular
tourist attraction and a
beautiful picnic spot. The
Devkund waterfalls in fact
lie at the confluence of three
waterfalls and it is believed
that they originate from the
river Kundalika. Enveloped
by a forest of the same name,
‘Devkund’, you can reach the
peak by taking a three-hour
long trek from the base village
of Bhira. HBI
Kuda Mandad Caves
Bhira Dam

Health Beyond Fitness
That you can do at home
The Best Exercises for a
Stronger Back
If back exercises aren’t
currently part of your
fitness routine, start with
the beginner circuit. When
you’re ready for more of a
challenge, move on to the
intermediate and advanced
circuits.
For whichever circuit you
choose, we recommend
completing three rounds of
each of the three exercises,
following a pattern of 30
seconds of work, then 30
seconds of rest. Do that
twice a week, and as you
get stronger, aim for three
times a week.
You’ll need a pair of heavy
weights (or heavy books that
are approximately the same
weight) and a pair of light
or medium weights (or
canned goods).
Beginner Circuit
1. Hip Hinge Hold
Stand with feet hip- to
shoulder-width apart,
arms at your sides. Keep
knees slightly bent (rather
than locked), and keep
shoulders pulled down
(rather than tensed up
toward your ears).
Keeping your lower back
naturally arched, push your
hips back as far as possible
and lower your torso by
hinging at the hips. Lower
until your torso forms a
45-degree angle with the
floor (or as close to it as
you can get). Hold for
30 seconds, then reverse
to return to start.
2. Hollow Hold
Lie faceup on the floor
with legs long and arms
extended over your head.
(Increase the intensity by
holding one of your weights
in your hands.) Press your
lower back into the floor
as you lift your arms and
legs so your body forms a
C (your shoulders and feet
should be hovering several
inches above the floor).
Squeeze abs and butt
muscles and hold for
one minute.
Strong back
muscles support
good posture and
can help keep
chronic problems,
like lower back
pain, at bay

Health Beyond Fitness
3. Dumbbell Deadlift
Stand with your feet hip-
width apart and hold a light-
or heavyweight dumbbell in
each hand in front of your
hips, with your palms facing
your thighs. Squeeze your
shoulders together, then
hinge at the hips to bend
over, lowering dumbbells
along the fronts of your legs
until your torso is parallel
to the ground. Return
to standing, focusing on
shifting your body weight
down through the midfoot
as you do. Repeat for 30
seconds, paying careful
attention to form and not
rushing any part of the
movement.
Intermediate Circuit
1. Dumbbell Bent Over Row
Stand with your feet hip-
width apart and hold a
light- or medium-weight
dumbbell in each hand at
your sides. Hinge forward
at the hips until your torso
forms a 45-degree angle with
the floor (or as close to it as
you can get), allowing the
dumbbells to hang below
your shoulders, wrists facing
in. Pull the dumbbells up
next to your ribs, drawing
your elbows straight back
and keeping your arms in
tight to your sides. Slowly
lower the weights back to
starting position. Repeat for
30 seconds.
2. Dumbbell Reverse Fly
Stand with feet hip-width
apart and hold a light- or
medium-weight dumbbell
in each hand by your sides.
Hinge forward at the hips
until your torso forms a
45-degree angle with the
floor (or as close to it as
you can get), allowing the
dumbbells to hang below
your shoulders, wrists facing
in. Keeping a slight bend in
the elbows, lift dumbbells up
laterally and out to the side
until they reach shoulder
height. Slowly lower weights
back to starting position.
Repeat for 30 seconds.
Increase the intensity
by using your heaviest
dumbbells.
3. Dumbbell Farmer Carry
distance or less apart and
heavy dumbbells on the
floor beside each foot. Bend
to pick up the dumbbells,
driving through your heels
to lift the weights. Stand
tall, shoulders back and core
engaged with the weights
hanging next to your thighs,
and take short, quick steps
to move forward at least
50 feet. Turn around and
continue walking for a total
of 30 seconds.
Advanced Circuit
1. Single-Arm Suitcase
Deadlift
apart, a heavy dumbbell
on the floor by your right
foot. Bend to pick up the
dumbbell, focusing on
driving your body weight
down through your heels to
lift the weight up until your
torso is back in an upright,
standing position. Slowly
lower the weight back to
the ground. Continue for 30
seconds, then repeat on the
opposite side.
2. Dumbbell Swing
apart and hold a heavy
dumbbell with both hands,
gripping from the top.
Push your hips back, knees
slightly bent, and lower your
chest to bring the dumbbell
between your legs. Push
your hips forward to slowly
swing the dumbbell up to
shoulder height. Reverse the
movement, slowly swinging
the weight back between
your legs. Continue for 30
seconds.
3. Dumbbell Plank Lateral
Drag
Place a light or heavyweight
dumbbell on the left side
of your body. Start at the
top of a push up position
by placing palms on the
ground, directly below your
shoulders, and walking your
feet back until your body
forms a straight line from
shoulders to heels above the
ground. (If you can’t support
your weight, drop down
to your knees, so that your
body is in a straight line
from your shoulders to your
knees.) Reach your right
hand under and through
the left side of your body
to grasp the edge of the
weight, then slowly drag it
and place it on the right side
of your body. Return your
right palm to floor, grab the
weight with your left hand,
and slowly drag it back to
the left side of your body.
Continue alternating for
30 seconds. HBI
Originally published on:
www.everydayhealth.com
Some major back
muscles you want to
keep in good working
order for posture,
range of motion, and
mobility include the
trapezius, latissimus
dorsi, rhomboids,
erector spinae,
levator scapulae, and
several deeper-lying
muscles that run
parallel to the spine

Health biz insight november 2019 edition

Health biz insight november 2019 edition

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