At a time when most hospitals have struggled to keep pace with the changing times and when the cost of medical care has gone through the roof for many, Apollo Hospitals in Navi Mumbai always kept patient at the forefront. Providing quality care remained its key motto throughout the pandemic and continues to be followed with alarming aggression. Newer concepts have been devised and newer strategies have been implemented. In an exclusive interview with THE WEEK, Santosh Marathe, Western Zone CEO, Apollo Navi Mumbai discusses medical care, tech driven care and more.
What as per you are the most important lessons that emerged from the pandemic?
I think post pandemic one thing which emerged very strongly is the acknowledgment of the value of life. Unfortunately the pandemic exposed multiple holes in the systems and the lack of readiness of healthcare providers to handle high volume activities. We are seeing post Covid compromised presentations of lung and heart cases while also an increased incidence in cardiac disease among the young population of the age bracket of 20 and 30 years. The sedentary lifestyle has definitely taken a toll and now people have started introspecting their lives post Covid. Non Communicable Diseases was always a focus area from Apollo Hospitals & we are seeing enhanced awareness on the general citizens on annual health checks & vaccination. People are now more alert. So that was really an eye opener for all of us and we thank the public health authorities for initiating the Public Private Partnership initiatives. Herein Apollo Hospitals did provide the access of best of technology and clinician skill sets to both the Covid and non-Covid healthcare needs. Post pandemic, the manner in how healthcare is provided and how healthcare is availed, both have changed significantly. Pandemic times showed the highest adoption of digital & virtual solutions with enhanced adoption by all care providers, patients & their family members. During the early days of the pandemic, the healthcare providers were also scared and the general citizens were reluctant to come to the hospital. That is where we came up with multiple contactless solutions . The Apollo 24x 7 App was strengthened during the pandemic times to provide all healthcare solutions on a fingertip and that has been a big advantage. One advantage with Apollo Hospital is that with 77 hospitals, we had a lot of knowledge sharing that we undertook in those early days. In Covid inoculation of the general citizens, Apollo took the lead in mobilising vaccine supplies pan India and ensuring the safety of general public and healthcare providers.
Did your hospital face challenges in terms of an overwhelming number of patients on the one hand and an acute shortage of staff on the other, with many of them testing positive?
Definitely. During the early pandemic times when commuting was a challenge, we had to host most of our staff in the hospital or in a nearby nursing hostel while providing commuting facilities who stayed at their respective residences. For the first time in such challenging times, occupational health condition of the healthcare workers became a discussion point as equally important as the health condition of patients and their family members. And we made sure that both the physical and mental health and well-being of our healthcare providers and their families were taken care of. Uncertainty of the situation, adoption of stringent clinical pathways, socialising restrictions and working in PPE outfits for extended hours of work had been overwhelming, leading to burn out of staff and families at periodic intervals. But despite this hardships all the frontline workers at Apollo did a brilliant job. In the early days of the pandemic, Apollo Hospitals Navi Mumbai was earmarked for taking care of the regular healthcare needs of the society, but within a very short period of time, there was a dire need to provide healthcare environment which will have optimising designs that support and maximise infection control. This was coupled with acute shortage of ventilated beds, oxygen supplies, pharmacy and PPE shortages. Despite multiple staff and consultants indispensed from work, we mobilised additional staff and created a separate cohort for facilitating Covid and non-Covid care within the same environment, but with demarcated areas, designated staff and controlled negative pressure circulations . Most of the Apollo Hospitals are designed and built with Joint Commission International (JCI) and NABH standards, wherein such cohorts can be created seamlessly and within a very short period of time can be modulated to enhance or restrict operational bed capabilities. With every recurrence of the subsequent Covid waves, the system became more and more efficient providing the healthcare professional the much desired confidence and skill sets required for the care pathways. Also within Apollo Group we evolved a Red Book”, which was a dossier of 360 degree insight on clinical pathways and the book has undergone several revisions in the past 2 years. This reference document ensured standardisation across all units of Apollo while assuring best clinical outcomes. We also created additional room capacity for quarantined patients under “Project Isolation” by partnering with Hotels across the country. Overall it has been a great learning experience.
Post pandemic what are you doing differently and what can patients expect in the coming months?
Apollo did significant structural and technology adaptive changes in providing care. A significant unmet healthcare need of the society was evident in the past 2+ years. We have created multiple focussed clinical programs under the Flu Clinic and Recover clinics which captured the periodic review of the patients getting affected by Covid and post Covid presentations. We created separate pathways for more vulnerable segment of the society, the senior citizens, paediatrics, cancer patients and the expectant moms. We have provided a hybrid access model of care, wherein patients and relatives can choose between a virtual review vis a vis physical reviews. We have encouraged and assured Covid vaccinations (Including booster dose) and focussed on adult vaccinations with a greater focus on screening programs by way of health checks. The attender and visitors restrictions are monitored and relaxed and strengthened, on the basis of pandemic situation dynamics. Patients and relatives are coming back to the healthcare environment for their elective work activities. We do get significant patients from the remote districts of Maharashtra and from other adjoining states. Almost 10 per cent of the our patient volumes are from international segments. With more liberal commuting guidelines, we are seeing patients reaching out and accessing their routine healthcare needs at Apollo. Despite the pandemic times, Apollo Hospitals continued to do high end complex works in Transplants, Ped Cardiology, Structural heart & Cancer care.
What does Apollo offer in terms of mental healthcare?
The uncertainty, fear and prolonged work hours had a significant impact on the mental health of our care providers, patients and their relatives. We have invested significantly in mental health. Periodic counselling sessions both in groups as well as for individual therapies were initiated during the pandemic times and continue as on date as a standard part of care continuum. The Red Book guidelines and periodic upgrades gave the awareness of a few of the best practices for adoption to the care providers. At Apollo Hospitals, we recasted the work rotas to provide adequate resting times to all our consultants and staff. The respective families of all the care providers were also sensitised on the infection control regimes. We strengthened our facilities by getting mental health consultants on board including counsellors, psychologists, sociologists and others. As a routine, all our admitted patients went through consultations with our fulltime psychologists during Covid-19. Quite a few of the care providers had been forthcoming in terms of the counselling help while we also undertook sessions for corporate and housing society members in the neighbourhood. Our senior consultants undertook multiple social media sessions to instill the sense of confidence in the community while providing the access and guidance of “Do’s & Don’t” in the pandemic environment.
What have been the trends in terms of organ transplant and donations this year?
Apollo Hospitals Navi Mumbai has done some significant work in the transplants including liver, kidney, heart and cornea. We will be doing our first lung transplant soon. There is a significant effort put in for creating awareness on organ donation in the community. The hospital has helped in cross subsidising costs for the needy patients by way of crowd funding avenue. Live donor program has also progressed well at the hospital with excellent clinical outcomes achieved for both the donors and the recipients. It is such a noble gesture from the patients and their family members. Almost 25 per cent of the cases undertaken by Apollo Hospitals Navi Mumbai are contributed through cadaver donations. Such noble initiatives of organ donation from one deceased patient has led to providing a new lease of life to multiple ailing patients by way of liver, kidney, cornea and heart. The organ donation volumes did encounter a drop during the Covid pandemic.
In today’s rapidly evolving business and the race among corporatized hospitals, how do you ensure Apollo remains ahead?
Our Chairman Dr Prathap Reddy always envisions healthcare initiatives a decade ahead of all of us. The kind of passion and energy that he contributes towards the societal cause is immense. With 4 decades of presence, Apollo Hospitals has done significant activities for accreditation, when competition was not around. All of the bigger Apollo Hospital setups in metro cities are Joint Commission International (JCI) Accredited, which is a US based certification agency, while most of the rest are NABH accredited. Apart from the quality accreditation, technology leadership is another forte of the Apollo group, which has kept the clinical progression and access to care growing exponentially. The cost of providing care at Apollo Hospitals is different from others, because of multiple influencing factors - JCI accredited hospital, infrastructure, clinical pathways orientation, credentialing of the consultants and clinical staff and usage of only FDA approved or CE approved products. Apollo provides Value for Money (VFM) and we have our internal benchmarks between comparable hospitals. This provides a forum to share best practices, clinical pathways and cross utilise resources. At Apollo Hospitals Navi Mumabi, almost 30-35 per cent of our footfalls come in from internal medicine, pediatrics and Obs & Gyneac cases. The hospital has created a “Go To” destination place for the local community for their day to day healthcare needs while also providing the best in class treatment for high end work. The outcome based approach keeps Apollo ahead of the rest of the service providers in the region.
India’s Drug Pricing Authority recently allowed a price hike for 10.7 per cent for scheduled drugs which are under price control. What does this mean for hospitals and patients? How are you navigating this to ensure the hike is not transferred on to the patient?
The recent hike in the scheduled NPPA pharmacy items is a welcome gesture, though the cost escalations are much more than what is provided. Apollo Hospitals manages the supply chain logistics in pharmacy very efficiently, Very recently Apollo Hospitals opened up its 5,000th Pharmacy unit. Apollo Hospitals was the only lead private player who proactively invested in Covid vaccination and ensured that the same reached out to maximum citizens through the joint efforts with public health authorities. There are quite a significant measures undertaken in standardizing costs but India also needs to focus on standardizing care pathways. Apollo Pharmacy vertical focussed on registered brands and with an assurance of maintaining potency of the drugs throughout the supply chain logistics including robust storing facilities.
Tell us about your patients who come from diverse countries. How do you offer care?
From a medical tourism point of view, almost 10 per cent of our cases come from international segments. Though the international patients access care at a particular unit, they get access to best of the clinicians and technology within the Apollo Group. For example, patients coming to Apollo Hospitals Navi Mumbai get their cases reviewed through the National Tumour Board while also get an access to treatment modalities under Apollo Proton Therapy centre at Chennai. Medical tourism works in dual mode for Apollo Hospitals. While we get patients mobilised directly through the ministry of health of the respective countries, we also undertake significant medical activities by way of on-site activities. This includes multiple teaching proctorship programs, screening of patients, and providing observership programs for young doctors. In one of our recent partnership with a hospital at Lagos Nigeria, we are working on an interesting concept of “Reverse medical tourism” with our partners Duchess Hospital. Unfortunately when international patients travel across borders, there is a substantial non-medical spend as well incurred by the sponsoring authorities. We provide an end-to-end care continuum to the International patients and their families. We are mindful of the cultural and lifestyle requirements of the patients and their families and likewise we have invested in infrastructure and resources to fulfil this unique needs of the international patients. At periodic intervals, we do get around 10-15 junior doctors undergoing observership at Apollo Hospitals Navi Mumbai. Having Tele Medicine connect also helps in virtually connecting with patients especially for post-operative care of the cases operated in India. We also conduct “Clinical Grant Rounds” wherein we encourage all our clinicians to present interesting cases and present papers. This forum is made accessible to our partnered hospitals and clinicians including international designates. During Covid pandemic, Apollo Hospitals Navi Mumbai treated almost 325+ patients from Mauritius and few other countries..
What is the road ahead? How do you plan to grow and expand?
Apollo Hospitals is a 400 bedded JCI Accredited, quaternary care facility dealing with all key Centres of Excellence of Cardiology, Oncology and Neuro Surgery. In each COE, we do very complex work activities like structural heart disease in cardiology and disease management group activities under sub-specialisation in oncology. We have Da Vinci Robotic suite which can be used in most specialty precision works. We have recently invested and strengthened our rehab services. There are quite exciting activities and progress happening in specialised areas of genomics and geriatrics. Apollo Hospitals runs the emergency medicine faculty in collaboration with the Royal College of London and has ambulances with a unique emergency helpline “1066”. These are fully equipped ambulances with a doctor on board. These ambulances are as good as ICU on wheels. We also have a very extensive 110 bedded Intensive Care Unit (ICU) setup catering to cardiac, transplant, neuro and medical management cases. Apollo Hospitals Navi Mumbai is rolling out “enhanced connected care” and many more homecare initiatives. As a leading healthcare provider in the region, we also take it as an obligation to elevate the standard of overall care provided by secondary care setups. We adopt nursing homes from the region and partner with them for care continuum activities. Apollo Hospitals has always focused on Non Communicable Diseases (NCD) by promoting health checks and now the same is backed by AI tools which gives progressive risk profile for individuals over a three year time horizon through “Prohealth”. The AI tools also populates the data set for individual corporates, wherein we can create a health scorecard for the corporate and work on medical management program for their employees.
Apart from our presence in Navi Mumbai, in the coming years, we will making some inroads for building capacity in South Mumbai and Pune. The Western Region cluster for Apollo Hospitals is integrated with Apollo Hospitals Navi Mumbai, Apollo Hospitals Nasik and Apollo Hospitals Ahmedabad.
