Ep 65 – Developing Human-Centered Health Systems in Low and Middle Income Countries, with Dr. Chintan Maru

Historically, health systems in low- and middle-income countries (LMICs) have taken a volume-based approach to health rather than a value-based one. The public sector has focused on coverage rates or access, and the private sector profits when it drives quantity of expensive, hospital-based care. Adhering to this path will create long-lasting structural flaws that increase costs without delivering desired results, similar to what we see in the US and many other developed economies.

Our guest this week is Dr. Chintan Maru, founder and executive director of Leapfrog to Value, a health initiative to advance value-based care in lower- and middle-income countries. Dr. Maru is a medical doctor and public health expert who has dedicated his career to maximizing the value of health systems. The race to value is not limited to fixing health care in the US – lessons learned and shared internationally will have world-wide impact, and will help lower- and middle-income countries leapfrog past hurdles and accelerate their own race-to-value. Join us as we learn from Dr. Maru about his efforts to leapfrog to value in Ghana, South Africa, Kenya and India!

Episode Bookmarks:

01:45 Low- and middle- income countries (LMICs) are at-risk of replicating system flaws from higher-income countries

02:10 The Leapfrog to Value strategy: Building a robust ecosystem for VBC experimentation

04:00 How Dr. Maru’s father dealing with Parkinson’s Disease provided a personal perspective on the work he does in value-based care

06:00 “In low- and middle-incomes countries now, quality has eclipsed access as a prime driver of outcomes.”

08:30 “There is a big focus in low- and middle-incomes countries on primary care and community-based health delivery, often via community health workers.”

09:15 How Value-Based Care differs In LMICs: focus on how to spend more on health to achieve universal health coverage!

09:45 “Instead of volume versus value, you are trying to get both volume and value.”

11:00 Ensuring localization by directing donor-funded programs for health system development with local stakeholders

13:15 Dr. Maru explains how the definition for “value” differs in LMICs when implementing universal healthcare

14:00 “The phrase ‘value-based care’ hasn’t really shaped the dialogue for universal health coverage for places like India or Kenya yet. It’s just coming into the conversation.”

14:15 How can payment models in LMICs prioritize health over healthcare?

15:15 Feasibility versus point of path feasibility in creating value-based care systems

16:30 “There is a ‘leapfrog to value’ opportunity in low- and middle-income countries to build a value-based health care system somewhere between the point of feasibility and  the point of path dependency.”

17:00 Building new national health insurance models in Kenya, India, South Africa, and Ghana to experiment in value-based care

18:45 Dr. Maru cites mobile banking penetration in Nairobi as an example of how we can learn from the ingenuity of others when there isn’t already an entrenched ecosystem

20:15 Partnering with USAID Center for Innovation, the Gates Foundation, and the Rockefeller Foundation on the Leapfrog to Value flagship report

21:45 Getting buy-in from local stakeholders in LIMCs for value-based care experimentation and innovation

23:00 “Value-based care is partnership-driven.”

24:00 The role of global health donors in providing risk capital to cover the costs of value-based care pilots in LMICs.

25:00 Comparing climate change and the need for environmental sustainability to the value-based care movement

26:30 Determining appropriate hospital bed capacity in places like Mumbai, India, Lagos, and Nigeria

27:30 Sensitizing healthcare investors to take a bit of a civic-spirited point of view–perhaps even before any value-based payments really shape the market

28:45 Creating the right incentives for patients to be responsible for personal health outcomes when the health system is predominantly funded by the public sector

29:45 Implementing direct-to-consumer options in publicly-funded health systems

30:45 “The tip-of-the-spear opportunity might actually be a vertically-integrated system because the payer-provider context allows for value-based care.”

31:15 The example of Thailand as an exemplar country that pursued both value-based care and universal coverage

32:45 Finding homegrown, local examples of ingenuity in LMICs like India (e.g. eye care and cardiac surgery)

34:15 Developing a human-centered model for tuberculosis care in India

38:00 The role of technology in making the leapfrog to a value-based system

39:30 “Many of these countries are articulating their own national digital health roadmaps.”

40:00 How COVID-19 has demonstrated the potential for technology to enhance care delivery

42:00 Dr. Maru discusses the use of Patient Reported Outcome Measures (PROMs), e.g. HIV treatment

45:45 Dr. Maru discusses the elements of workforce development that are needed to make a shift towards value.

48:00 How COVID-19 has affected the movement to value-based care in countries like India where the pandemic is uncontrolled.

49:00 “Social determinants of health are the highest value levers.”

51:00 Dr. Maru makes a book recommendation: Reverse Innovation in Healthcare: How to Make Value-Based Delivery Work

52:00 “What motivates me most is this idea that health systems are really about human flourishing.”