Detroit, Michigan, has the highest concentrations of poverty of any large American city and surrounding area. That means that the Henry Ford Health System, one of Detroit’s major hospital groups, has had to work hard to find ways to deliver high-quality healthcare to all who need it, like launching the Henry Ford Innovation Institute in 2012 to explore and develop ways to achieve this goal. And that, in turn, is why a healthcare group in India has sought to form an ambitious partnership with Henry Ford that aims to build a new network of multi-specialty, advanced-care hospitals in an area of southern India that has never had one.
The agreement, announced in 2016, is between the six-hospital Henry Ford, and Pearl Human Care Private Limited in the Indian city of Vellore. It’s a collaboration intended to provide significant benefits to the area’s patient population, but also to both healthcare systems, including substantial revenue streams. “This is a low-risk, potentially high-reward approach,” says Mark Coticchia, vice president and chief innovation officer for Henry Ford.
Under the agreement, Henry Ford will license its medical and technical know-how, including workflow, policies and procedures, to Pearl, which is building a network of hospitals. The first, the multi-specialty, 400-bed Naruvi Hospital, is expected to open in 2019. This hospital will be followed by a similar facility at Chennai and two smaller units at Pondicherry and Salem. “Henry Ford’s strategy and our requirements were a perfect match,” said G.V. Sampath, chairman and managing director of Pearl Human Care, in an email interview. “It was a simple choice for both of us.”
The agreement follows a 2010 partnership between Henry Ford and Aldara Medical and Hospital Center, soon to culminate in the opening of a large hospital, 192 clinics, eight operating units and a state-of-the-art hospital in Riyadh, Saudi Arabia, modeled after Henry Ford’s West Bloomfield Hospital. Coticchia says these arrangements — he doesn’t like to use the term “partnerships” because of potential legal connotations — are carefully designed to make good use of Henry Ford’s know-how without the entanglement of direct treatment to patients. “Our physicians don’t deliver any care, and that’s a very important point,” he says. “Rather, we are advising. We are providing expertise. We let others do the implementing and executing.”
Johns Hopkins, the Cleveland Clinic, and Partners Healthcare are among those U.S. healthcare delivery organizations that have taken over management of hospitals outside the U.S. or entered into healthcare-delivery joint ventures abroad — deeper partnerships that carry more risk than Henry Ford currently plans to take on, given volatile international events or markets, Coticchia adds. On the other hand, most other partnerships between U.S. and international hospitals and medical schools are currently limited to expanding education and research opportunities. That approach poses the least risk but also the least reward, he says.
Henry Ford’s approach is intended to leverage its recognition as a teaching and research hospital by licensing its specific protocols, procedures, technology and other intellectual property to other healthcare entities. According to Coticchia, the Detroit hospital is assembling core teams of physicians, nurses and administrators who will work collaboratively with “mirror” teams in the India and Saudi hospitals. Together, the teams will identify local needs and ways that Henry Ford’s processes can be translated into the local culture, environment, marketplace and regulatory atmosphere.
For example, Henry Ford will offer internally produced training modules for hospital executives in areas such as corporate compliance, reimbursement, electronic health records, marketing and promotions. On a clinical level, Henry Ford will offer modules on specific topics such as rheumatology or emergency preparedness.
Coticchia compares the process to a major hospital building an offsite clinic. “We’re not managing the hospital,” he says. “The hospital has its own management team and physicians. We work hand in hand to translate the delivery of medicine that is accepted by the local culture.” For example, Saudi culture requires strict separation of men and women outside the home. “The way you design the waiting rooms and the examining rooms are different than the way you design them in the U.S.,” he says.
According to Pearl’s Sampath, Aldara is being built as a multi-specialty facility, and is likely to develop areas of excellence based on the expertise of physicians they recruit. Naruvi will offer specialization in cardiology, neurology, orthopedics, and internal and surgical medicine — all high-performing specialities at Henry Ford. “Our association goes well beyond mere areas of specialization,” said Sampath. “The entire hospital design, processes, medical protocols, systems and practices, training methodology, and doctor-exchange programs ensure a deep relationship.”
Henry Ford’s relationship with Aldara began as a limited consulting engagement, grown out of connections established by Henry Ford physicians who were from the Middle East or who had connections there. Coticchia, who oversees global business development at the Innovation Institute, began exploring a more formal, institutional-level relationship with Aldara in 2010. “Before we started down this path in the international marketplace, I actually did a lot of research into other institutions, other missions and other models and how they came about,” he says. “And they all started with personal relationships.”
Naruvi Hospital, on the other hand, had been searching for a partner to help the hospital reach international standards, but management was cautious about giving up autonomy to an external agency. The ideal partner, Sampath described, would provide long-term technical and operational support without infringing on the operating freedom of the local administrators and medical staff running the hospital. Henry Ford turned out to be that partner. “The chemistry between Naruvi executives and the Henry Ford senior leadership team worked well in terms of our ethos, ethical practices, and approach to patient care,” said Sampath.
Henry Ford will also help its international collaborators with training of physicians and nurses and developing of medical programs through ongoing online and in-person education sessions. The contract calls for Henry Ford physicians to provide training at Vellore and for Indian physicians to come to Michigan for training courses. Coticchia sees this opportunity to provide U.S. physicians with international experience as a huge advantage. “This provides our professionals with growth opportunities,” he says. “That is important when you’re trying to attract, recruit and retain physicians of great talent.”
Henry Ford and Vellore, meanwhile, have found ways to collaborate on a common problem: obesity and diet-linked diseases. According to a release by Henry Ford, a study found obesity rates among urban children in New Delhi has increased 50 percent in the last ten years. As part of a health and wellness initiative in its U.S. hospitals, Henry Ford has revamped its hospital food to cut down on sugar, salt, saturated fat and other ingredients associated with obesity and heart disease, while also working to make the food more appealing. These new recipes will be licensed to the Vellore hospital and modified to reflect Indian cuisine. More than 500 of Henry Ford’s modified recipes have already been licensed for sale in corporate food courts in India’s New Delhi National Capital Region, and the hospital plans to expand and license their food for sale at other venues such as schools and home delivery services.
The Detroit hospital system employs a “hub-and-spoke model,” in which a central facility provides both core and specialty services and satellite branches offer primary care in more rural or underserved communities, says Coticchia. Vellore Hospital is also interested in the hub-and-spoke model, which in theory can inexpensively scale to a large population spread over a wide geographic region. “Henry Ford is known for the way we employ an industrial engineering approach to delivering care,” he says.
While Henry Ford serves a low-income population, its hospitals also treat middle-class and wealthy families in the Detroit area. This range of patient populations makes Henry Ford’s processes attractive to both the Saudi and Indian hospitals, which serve a growing middle-class and low-income populations as well as an elite sector. “Our model works in all the patient populations,” says Coticchia. “It’s quality care at a cost-effective price.” At this point, the agreements do not include clinical or research studies; that may happen in the future. “This is a beach head,” he says. “This is a beginning.”
But Coticchia has some words of caution for other institutions considering global ventures. Brand recognition, he says, is key in attracting global attention — large hospitals like Henry Ford have a national reputation; smaller hospitals likely do not. Sampath, as well, stressed the power of the Henry Ford brand, saying the name will be employed “along with the Naruvi brand for greater impact in the Indian market.”
Coticchia says that Henry Ford is looking to identify other international opportunities, but will probably remain focused on India for the time being rather than moving further into Asia, where there are more substantial challenges with language barriers and a lack of recognition of intellectual property rights. He adds that the organization is particularly interested in deals that are likely to produce long-term revenues. “We want to be able to share in the success of the project,” he says.
Sampath, too, emphasized that India holds promise for American medical institutions looking to partner. “Modern hospitals are a recent phenomenon here,” he said. “The market offers huge opportunities for the creation of world-class medical centers.”
— Stephanie Schorow
Stephanie Schorow is a freelance writer based in Medford, Massachusetts.