About few years ago, a British citizen of Indian origin Dr. Shashi Baliyan, came on vacation to his hometown in Haryana, India, to spend some quality Diwali time with his parents. This holiday inspired him to take a new turn after he attended a medical symposium there with a friend. Moved by the insight he gained during that event, he launched an initiative that provides some score plus hospitals across the country with the latest in medical equipment to make cancer treatment accessible and affordable. Not merely that, he has subsequently migrated back to India, to spearhead and take up myriad ventures that are aimed at innovating healthcare in India. NRI Achievers profiles him and his work in this feature for our readers, to take inspiration from and consider participating like him in the resurgent India growth story and the phenomenon of reverse brain drain …
Dr. Shashi Baliyan is a doctor of medicine who also holds a Master’s Degree in Hospital Management. With a proven track record of over 12 years advising and restructuring various NHS, private sector and some blue-chip company-run hospitals and healthcare services in the United Kingdom and elsewhere, he brings to the table a wealth of experience in managing healthcare systems to India’s medicare sector. After having worked with globally renowned management and consulting groups of the likes of Accenture, et al., while in India on a holiday late 2009, he stumbled across the stark fact that Haryana did not have even a single piece of quality high-tech Radiotherapy equipment to help treat cancer patients in any of its hospitals.
This insight led him to attempt estimating the need for specialised medical devices across the country. After some footwork, he along with friends and colleagues in his peer group mobilised their resources to kickstart an initiative which saw the birth of ClearMedi Healthcare in January 2010, which forged JVs between Medipass Srl Italy, KOS SpA Italy. “I realized that people had to travel far to access cancer treatment in India. Even then most hospitals in smaller towns were not equipped with the right equipment to treat them. I went back to Britain and brainstormed it with a few friends, after which I started shunting between London and Delhi to do something concrete about this,” Shashi says.
Since launch of its operations in September 2011, this company of whom Dr. Shashi is the MD has provided a range of core technologies for cancer treatment to hospitals across the country. “Although in percentage terms the cancer incidence in India has been as much as half that in Western countries, but there is hardly any penetration of Oncology services in smaller towns here,” he reasons. Dr. Shashi has also had keen focus in exploring possibilities from Tier 1 and Tier 2 cities like Gwalior, Vadodara, Patna, Madurai, Mysore, Coimbatore, Nagpur and Meerut to name just a few. And this commercial intervention by ClearMedi has helped Patients treatment cut costs by 50 percent or more. “Among equipment we partner with Hospital for full Oncology departments, Nuclear Medicine (PET CT and Gamma Camera) and Radiology department. We focussed on cancer as its incidence in the country is high and there is a latent demand for cancer treatment. Young people are getting affected by it and you cannot imagine the number of queries I get,” says Dr. Shashi. The equipment is maintained by ClearMedi on contracts that run 15-20 years until the machines themselves outlive their lifecycle or become obsolete, says Dr. Shashi, who lives today with his wife and two children in Gurgaon, Haryana.
In Jamia Hamdard’s Imaging Centre at Delhi, ClearMedi has installed equipment for MRIs, CT scans, Mammography and Digital X-Rays, while the Ashwin Hospital in the Coimbatore city of Tamil Nadu has been equipped with a Linac (linear particle accelerator used for radiation therapy). “Other than accessibility to diagnosis and treatment, our initiative has also cut costs for patients by 50 percent or even more as compared to any diagnostic centre. An MRI scan costs Rs.8,000 in a diagnostic centre, of which half goes to the doctor. We remove those frills and charge the basic cost,” he said. “In Delhi, the cost is half. In Hisar, the cost is one-third. The patient pays the hospital directly, not to us. So, there is no discrepancy.” A CT scan in a ClearMedi aided hospital costs ₹ 1,600. Elsewhere, it ranges between ₹ 4,000 and ₹ 5,000. Dr. Shashi also claims not to be led by medical equipment suppliers, into whose trap many hospitals have admittedly fallen into, resulting in large scale procurement of non-upgradeable machinery. “We have a clear focus – of accessible and affordable medical care to people mostly in tier-II towns, and are doing our best towards that endeavour. ”
While the scope is indeed enormous, there are still some viability pitfalls for this sector. Consider this forecast from early last year by Grant Thornton India, “… the Indian medical device and equipment market is expected to grow to around US$ 5.8 billion by 2014 and US$ 7.8 billion by 2016, growing at a CAGR of 15.5 percent”. Consider also this analysis by Qmed of late 2013, that posits the potential in India for medical devices manufacturers: “Since a significant part of India’s population does not have access to adequate public healthcare, the potential market for innovative medical device manufacturers is huge. If they can find effective ways to leverage low-cost, high-value medical devices, India could prove a very profitable market.” Fact however remains that there aren’t enough domestic manufacturers catering to gaps in healthcare.
Despite humongous scope and estimates, medical entrepreneurs like Dr. Shashi Baliyan do have to tread very prudently in the current climate and milieu prevalent in the Indian healthcare segment. “We’ve worked at making the equipment affordable, we buy in bulk from other geographies. In fact, we’ve reduced costs by a third or even halved them.” Dr. Shashi Baliyan adds that funding is another challenge. “With the joint venture, the scalability of the model is massive. But our projects are very capital-intensive. Banks want too much collateral, and I had to begin with my own money,” he shares. For the entrepreneur in him, it’s all about persistence in the face of great odds. But for now, let us just listen in to him in his own words his journey, and what else he has in store for us for the present and in the future …
“My whole journey began in 2009, when I had come home to spend Diwali with my parents in Haryana. While there I had met up with my friend, a cancer specialist. At that time Haryana state (outside NCR) did not have a single Linear accelerator facility for treating cancer in the whole state. I was aghast. That set a thought going in my mind that became an obsession. Upon my return to London, I ultimately decided to return to India to do work toward bettering healthcare in our country. Decision made, I began doing footwork on identifying real-world gaps that need to be plugged. Recognising that the task will be a huge if not insurmountable one, I wanted to limit parameters so that we could at least make a difference on one aspect to start with. Thus began my shuttling between London and Delhi for my research, which took me the better part of about six months or so. Once I had a Plan A and Plan B outlined in my mind, I reached out to my peer-group, all senior professionals based out of UK, US, Switzerland etc., and got them on-board to create a start-up company: ClearView Healthcare India came into being.
“It was indeed gratifying in a way with my coming back to the very hospital where I had started from. So we picked up this one contract, and after a short while we sort of realised… not that we did not have an inkling of this so it was not like a bolt out of the blue… that the whole market scenario is simply too big for us… and it would take too long to capture or to go to the interior of India without upscaling dramatically and fast. To be able to do this even reasonably, we first of all needed strategic partners. So looking across the globe seeking enterprises we could partner with, we zeroed in upon Medipass, a company doing similar business in the UK and in Italy and roped them in.
“I permanently moved back along with my family to India in 2012, and have so far been able to forge 16 cancer treatment & diagnostic centres across India that are all fully live and functional. Today we are probably one of the fastest growing healthcare companies in India. We are sited at many Tier 2 locations like Madurai (Tamil Nadu), Nanded (Maharashtra), Mysore (Karnataka), Patna (Bihar), Gwalior (MP), to name a few. We are present in the NCR too, in Delhi & Gurgaon. In Paras hospital Gurgaon we operate their radiology department. Besides lot of other firsts we also have the distinction of putting up the first PET CT for the whole state of Bihar in Paras HMRI hospital Patna.
Our current plans are to create at least 50 more sites over the next few years. Not merely through organic growth but also via inorganic means. This is the Clearmedi story so far. Apropos, as a family we are now branching off into more related service areas for healthcare as well. Let me tell you about this other eureka moment I had while on the job at some of our partner sites… an insight that sparked another train of thought about providing hospitals a service that is as much direly needed as our cancer-care initiative. We have called it “Shubhram.” Shubhram is being managed by my elder brother Dr Shashi Bhushan Balain who has moved back from UK along with his neonatologist wife Dr Munisha. Dr Seema Baliyan my wife who is a qualified GP from UK is one of the directors in Shubhram along with my brother. So now it is the whole family who is working round the clock to make it a success.
Being both a Doctor and Hospital Manager, I was able to identify some key areas with scope for innovation in Indian hospitals. Linen is something we all take for granted, it is a low key item in our country, and consequently is also low priority for most hospitals. But in my view it is a very very critical area, as it is mostly the major bane that is the source of hospital acquired infections. So we have launched Shubhram, designed to provide one of the most state-of-the-art laundry and Linen management solutions for Indian hospitals. The need is very much there – as the only facilities available are mostly in-house ones.
“Hospital acquired infections are a major source of morbidity and mortality in our hospitals. Infections are often transferred via used items of clothing, linen and the environments in which they are laundered or stored. Therefore effective laundry management is vital to prevent cross-infection between patients and to protect para-staff that transport and handle used linen. Good hygiene and cleanliness is a basic prerequisite for well-being, and this becomes all the more important in a hospital setting. Patients expect a clean and hygienic experience in a safe environment of care when they visit a hospital, for which a high level of compliance with policies of cleaning, disinfection, and sterilization is needed.
“Our experience and audits showed that while in general these policies are rigorously followed for medical equipment and environmental surfaces, the same standards are either overlooked or are inconsistently followed for laundry and linen services. Though a few off-site laundry services do exist, they are largely either small sector or unorganised sector, the kind of quality they provide being far from good. One probable reason is that socially this work is considered ‘dirty.’ After lot of research across India we found out that no hospital was happy with laundry services whether in-house or outsourced. Ergo, I smelled another opportunity and started hunting for an appropriate strategic partnership. We found another Italian company, Servizi Italia, a large player and specialist in the field, serving European and Latin America economies and tied up with them. Outsourcing is cost effective, and completely disinfected linen can be provided to hospital users. Given the fact that high levels of dependence on antibiotics in our country have given birth to so called ‘super-bugs’ here, it is all the more important that hospitals pay heed to their laundry and linen cycles to combat hospital required infections.
“Indeed there are really no standards extant in our country for hospital linen, so we took it upon ourselves to adopt worldwide best-practices to follow Risk Analysis Bio-contamination norms (RABC) norms, to set up our first one-of-its-kind state-of-the-art facility in Delhi NCR, at Sonepat. For us, cleanliness is more than just what meets the eye, so our expertise and processes ensure that linen not only appears clean and smells hygienic, but is also thoroughly disinfected. Our Sonepat plant maintains a clean, infection free cycle from the time dirty linen is taken off hospital beds till it returns as fully disinfected linen. Our plant has capacity to process 60 tonnes of linen everyday.
“To put that into proper scale and perspective, a leading public hospital in Delhi with a bed capacity of around 2500 washes some 4 tonnes of linen every day. So Shubhram Sonepat can process linen for say, for more than 30,000 beds every day. . On costs, again taking the leading public hospital as an example, we will be able to save them a ballpark ₹ 3 Crore every year if we process their linen and what’s more, consider the enormous space this would release, they could easily put up lot more beds in that freed up space. Another point on how we operate – we generally buy and stock 6 times the linen inventory of any hospital we serve so that they for one need not invest in linen at all as they perforce have to do now. And our inventory is managed in such a way that smooth flow to-and-fro of the linen to the hospital is facilitated.
“A case in point is another trust Hospital, whom we serve. In one stroke by taking their laundry out, they now have access to all the water needed for their new buildings, and permissions will now be easier. They will also now be able to utilize all that freed-up space as well to maybe have a cancer centre and a centralised pharmacy, and put in a few score beds as well. This will mean fund inflow rather than the fund outgo the laundry implied. So we have taken out that function and put it elsewhere at practically no cost to them & freed up their space as well. Apart from all these cost and space saving advantages, there is of course the entire pollution angle that is done away with, making the place a lot more clean-healthy. We have great expectations that this venture will do well, and so far responses are very encouraging indeed.
So much about my doings, now let me tell you something about myself and my background.
“As far as medicine as a career was concerned, that was already cut-out for me, probably before I was born… my dad had made up his mind that I ought to become a doctor. Though I did complete my medicine from PGIMS (formerly Govt. Medical College) Rohtak, a premier Institute of India providing excellent medical education and patient care services, I did not practice medicine very long. Because no sooner had I entered medical college, my inclinations veered to entrepreneurship rather than doing surgeries. My father was not too happy about it. I started looking for options. When I was in my 2nd year I made up my mind to get into hospital management, a very new field in India. So I did manage to go abroad in 2000 on completing MBBS, and did my hospital management course from Nuffield Institute of Health Sciences in Leeds, UK. I then worked with the NHS for few years, before founding my own consulting company. I was reasonably successful, and made reasonable amounts of money that formed the corpus of what I had all along wished to actually come back and invest into India. And even when I started ClearMedi it was not as if I had oodles of money, but it was like you take a step and then things just start falling into place and that’s how it is even now.
“The vision is that you have to bring true world class services in India … so it was my thinking we should rather make it something big and so, we did it that way. That’s why I created the JVs. That’s why we are now planning to create structures not merely in Delhi NCR but in four different parts of India. Looking at Bombay Pune Expressway, Bangalore, Chennai, Hyderabad and Kolkata. There is so much to do, as almost this entire country of ours is lacking in world class healthcare support services. We do not have anything comparable now.