I remember reading some of this book in short form in Harvard Business Review a while ago. Dr. Govindarajan and Dr. Ramamurti focus on business management innovations in health care in India and they ask, not unreasonably, why these same ideas can't be adopted here. They use "reverse innovation" to describe the adoption process. My reaction to this consolidation and expansion into book form is about the same:

1. I don't think the term "reverse innovation" is a graceful one because to my literal mind it sounds like reversing innovation to go backward. However, it was coined by Dr. Govindarajan and colleagues for some of their earlier work and he certainly has naming rights. If he were older, though, he might have revived the more descriptive and philosophically aligned "appropriate technology".

2. The ideas in the book are important, but why haven't they caught on? Why is the USA such a health care, and health insurance mess when there are profitable business models we could be using for health insurance and health care?

In this book I was struck by the stories of Ascension Health and Iora Health, two of the US case studies that were not growing until they self-organized insurance programs, one by partnering with a private health insurance company, and the other by working out a fixed fee program. Another of the US case studies, the University of Mississippi Medical Center telemedicine program, was forced to devise a workaround of a state rule that prohibited payment for the telemedicine services it provides. Eventually that law was changed.

I am covered by an international policy that pays my hospitalization and outpatient fees around the world. It has been a joy to be free of the stupid choices between work and insurance. I have friends stuck in the US health insurance nightmare so I tend to see insurance as the big evil. This book is not about insurance, but it is the gorilla in the room.

I realize that Dr. Govindarajan and Dr. Ramamurti are working in the USA, but I wonder if they have approached Sweden, a country that builds cars and has a single payer health program. Or Switzerland, an advanced country that is not in the EU. Or Thailand, Malaysia and Singapore. It would seem to me that countries like these would be a better first adopters than the USA where these sincere men seem to be tilting at windmills.

I received a review copy of "Reverse Innovation in Health Care: How to Make Value-Based Delivery Work" by Vijay Govindarajan and Ravi Ramamurti (Harvard Business Review Press) through NetGalley.com.

The book is a compelling read with an universal appeal to layman, physician and health policy makers. It has a flowing narrative with original research and is not an exercise in "Blackboard Economics". It has a practical, bottoms-up approach to achieving healthcare cost savings without sacrificing quality or patient care outcomes.

The individual chapters reflect original research which are presented in a fresh optimistic way without sounding like " book reports ".The authors recognize that money is not a dirty word but an innovative driver of qualitative performance. The real solution is to spend it wisely- the book has many interesting ideas of doing it to achieve maybe 20 -30 percent healthcare cost savings including rewarding Primary care physicians for quality bundled care.

The phrase "Social heart and business brain" coined by the authors is the need of the hour. Soaring healthcare costs is one of the biggest problems of our times and will need such innovative ideas to resolve it.

As a practicing physician I recommend this book to everyone especially my colleagues and healthcare administrators. This book helps me sustain my optimism for the future of healthcare.

In Reverse Innovation (2012), Vijay Govindarajan and Chris Trimble explain a process by which business leaders can identify the significant differences between rich-country and poor-country needs. "Reverse innovation does not begin with inventing, but with forgetting. You must let go of what you've learned, what you've seen, and what has brought you your greatest successes. You must let go of the dominant logic that has served you well in rich countries. If you want to use today's science and technology to address unmet needs in the developing world, then you must start with humility and curiosity." That is to say, reverse innovation can help to reverse the negative trends and tendencies that can weaken an organization.

What are the core principles of value-based health care as practiced in India? According to Vijay Govindarajan and Ravi Ramamurti, there are five:

1. A driving purpose: care for all
2. A hub-and-spoke configuration
3. An enthusiastic use of technology
4. Task-shifting and continuous process improvement
5. A culture of ultra-cost-consciousness

Govindarajan and Ramamurti note several correlations between these core principles and principles of value-based competition offered by Michael Porter and Elizabeth Olmstead Teisberg in Redefining Health Care: Creating Value-Based Competition on Results (2006):

o Players should focus on creating value fort patients, not just lowering costs.
o Competition should center on medical conditions over the full cycle of care.
o High quality care should be less costly
o Value should be driven by provider experience, scale, and learning at the medical-condition level.
o Innovation that increases value should be strongly rewarded.

Most of those who are thinking about purchasing this book are probablky curious to know what happens when a health care organization attempts to replace its status quo with value-based health care as practiced in India. Govindarajan and Ramamurti include several lessons to be learned from each of these four organizations:

Health City Caman Islands (HCCI) Pages 119-121
Sample Lesson: Be frugal in capital expenditures and in variable costs.

University of Mississippi Medical Center (UMMC) (144-146)
Sample Lesson: Create a demand-driven network shaped by grassroots speed.

Ascension Health (166-168)
Sample Lesson: Use scale not just for market power but also to dramatically lower costs.

Iora Health (188-190)
Sample Lesson: Have a "social heart" but couple it with a "business brain."

It is worthy of note that years ago, after days of negotiation facilitated by then President Jimmy Carter at Camp David, President Anwar Sadat of Egypt and Prime Minister Menachem Begin reached several agreements. At a press conference later, they were asked how, after centuries of savage bloodshed, they could reach these peace accords. Begin replied, "We did what all wise men do. We began at the end." That in essence is what reverse engineering is all about.

Govindarajan and Ramamurti are well aware that no two health care service areas are exactly the same in terms of need, capacity, demographics, and resources. And the same is true of health care organizations within those areas. They fully recognize and understand cultural values and sensitivities that must be taken into full account. They also realize that the competitive marketplace is more volatile, more uncertain, more complex, and more ambiguous than ever before. All that said, the fact remains that world class health really care can be delivered affordably.

I highly recommend this book to directors and administrators of all health care organizations as well as to all federal, state, county, and municipal officials who are involved in oversight and/or funding of those organizations. The process is reverse innovation and in this book Vijay Govindarajan and Ravi Ramamurti explain HOW. I'm certain that the material they provide in this book will help to save thousands of lives as well as billions of dollars all over the world.

Bravo!

This book is very inspiring and made me rethink my role in the community. Social innovators, keep on innovating :) !

I have three core initiatives to a clinic I'm currently developing for launch. I've never seen any of them discussed in healthcare before. This book touches on all 3 in slightly different versions of my plans. All within the first 20 pages.

It is an easy read. It has real-world applications & companies it suggests for you to research. It has practical advice, and can become your guidebook to cost-effective, quality care. It also has advice for larger health systems.

None of the advances seen in India are incentivized directly in the US. But they are so impactful that if you were to realize their power, you'd be pursuing this over what you're currently doing.

Read this book. Then read it again. And recommend it to your friends who are trying to make a difference.