Week 1: Introduction to Case Method

Coursework > Week 1: Introduction to Case Method > Introduction to Case Method

• I think it’s opened my eyes into the world of medical management and how you integrate innovation, business with medicine.
• So I guess should we start off just with what the discussion is defined as and what the objectives are? Really, it’s an opportunity to generate knowledge and to construct meanings from evidence, and there’s uncertainties in business decisions and cases and all meetings, and to draw from each other for that experience.
• I mean, I think that was very much my experience in the case method.
• I think coming from medicine, which is much more didactic, into the case discussion approach was a little bit challenging because we’re used to just receiving information and remembering it, but I think what I found really fertile about this is that you can take different bits of knowledge and aggregate them towards answering a practical question.
• You learn through conversing with your peers, which I think is very valuable.
• Really just come in having an opinion because I think that helps to not force the discussion but have a discussion about something.
• UCH IWEALA: Someone can say, did you think about it like this or did you notice this in the financial statement? TRISHAN PANCH: And I really found that was really helpful training for doing this in real life where you have some kind of idea and you have to convince some people that it’s a good idea based on facts, and not everyone’s going to agree with you.
• Actually, it probably is the case that you should be thinking a little bit ahead, so people are always going to find it a little bit challenging.
• I think that’s one psychological preparation going into it, that you’re not going to know everything, and whatever position you take, someone is going to know more than you in some part of it and be able to take it apart, but everyone’s got something to offer.
• If you can take the position of focusing growth in India, and Trishan, could you take the position of focusing growth internationally? TRISHAN PANCH: Overseas, OK. BETSY VERRIL BULLOCK: And then we’ll at the end discuss what we really think.
• Uch, what do you think about their business model? Can you kick it off for us? UCH IWEALA: Yeah, definitely.
• So I think that Fortis actually has a very attractive business model.
• You said “high quality care,” and I think one of the things, as I was reading the case, that was something that I questioned the quality of their care.
• So it’s higher quality compared to the rest of the Indian or international medical services? UCH IWEALA: I think actually, their health care quality can be comparable, at least in their institutions within India, to what you would receive in the West.
• I think from the case, what I noticed is that when they expanded, they had the first eICU system, and so they had some high level technology and services that I think would be comparable to developed nations.
• So I think they’re wonderful at recognizing opportunity and they’ve replicated that to some extent throughout India.
• BETSY VERRIL BULLOCK: So you think they should focus on India.
• UCH IWEALA: I personally think they should focus on India.
• I think there’s certainly credibility in that argument.
• I’m not sure I necessarily agree, but I think if we all take a step back, we can see that Asia in general is undergoing a profound economic and demographic shift, and it’s going from infectious disease being the main burden of disease and demand for health care being somewhat unpredictable, and therefore the system having to be reactive and very local, to the science of providing care being much more mature and the processes being much more established and health care being much more predictable as people live for longer with more chronic diseases.
• Those seem to be three very big differences that you have to combat, so what are some things that Fortis is doing well? TRISHAN PANCH: Well, I think Fortis, probably appropriately, and I think is instructive, actually, in terms of question of should they focus on India or overseas.
• I mean, I think that’s one of the things we always said about health care.
• So I’m all for seeking opportunity, but I think that we have a counter example in Apollo, which did expand but did it more in a moderate fashion, which allows them to ensure that every asset that they add is leveraged and utilized appropriately.
• BETSY VERRIL BULLOCK: Should we all talk what we really think, because we’re forced into a couple different perspectives here.
• UCH IWEALA: I really think about India as their growth strategy, and the reason why also is if you look at exhibit 9- BETSY VERRIL BULLOCK: What page is that on? TRISHAN PANCH: It’s a different page.
• BETSY VERRIL BULLOCK: I guess reading the case, I think the growth is attractive.
• I think, as you mentioned, there’s a tendency to, oh, this is the land grab.
• I think there’s so much opportunity and need for improvement.
• They’re not as financially sound as Apollo, their key competitor, who has had a much more focused strategy, and with Fortis trying to expand both service line and geographic, I think that’s just too much for them.
• When it takes over a year to integrate, I don’t think they’re doing it well.
• Then if you do want to capitalize on a trend, say the medical tourism industry, then think about how to best do that instead of expanding just in every direction you can and spreading yourself too thin.
• UCH IWEALA: I actually wanted to touch on that medical tourism because I think that is also something that we hear about more and more.
• I think again, in exhibit 6, this is where they have a model of when do they break even on certain goals based on the- TRISHAN PANCH: Based on occupancy.
• I think I was just going back to you mentioned exhibit 9 and the GDP per capita increase and demographic shifts.
• I think I would argue, coming from this case, with respect to the India operation side of things, that a lot of that increase probably is asymmetrically distributed, i.e. there’s a massive growing middle class in India, and it seems like Fortis have gone for the upper middle class, basically people who are not quite as rich as the people who just get on a jet and go to M.D. Anderson or wherever it is for their care, but looking for care domestically or paying cash.
• I think an insurance based market, and basically pricing, because you know the demand is somewhat predictable across the population.
• I TRISHAN PANCH: I think we all agreed he was in a somewhat vulnerable position.
• UCH IWEALA: So I’m generally a positive guy, so I appreciated how you started off the discussion and put me on the spot in terms of what do you think their business model is, and take a position, which is what we introduced the case discussion as.
• BETSY VERRIL BULLOCK: I think one thing we maybe could have done more is challenged each other, obviously in a respectful way, but push each other on the numbers and the facts, and does the argument really hold together, just to think on your feet.
• In all seriousness, I think we got to a point where we weighed out the pros and cons of different approaches and settled on something which sounds like it’s very similar to where the actual board and management team have taken it.