Gaurav Malhotra, MD Medicover Fertility, ex CEO & MD Bourn Hall Clinic India has more than 10 years of experience in the IVF Market. He says that:
The World Health Organisation (WHO) has estimated that 13-19 million couples are infertile in India, and this can be a reason for the rampant increase in IVF clinics across the country. Most of these IVF clinics take advantage of the deep-rooted stigma associated with infertility and hence have been seen flouting ICMR (Indian Council of Medical Research) guidelines on ART (Assisted Reproductive Techniques). Moreover, some of the clinics lack proper equipment, an advanced IVF lab and there is an absence of skilled doctors and embryologists.
So, while choosing a fertility clinic for your treatment, you need to consider some important points. The truth is that people are often confused while choosing a fertility clinic. This is quite normal as they are not expected to know, which will be the right clinic for them. People usually go by recommendations from family/friends or book an appointment with the first clinic they hear about. But remember, the choice of a fertility clinic is an essential aspect when it comes to fertility treatment. Because the success rate of the treatment may depend on some factors related to the overall functionality of the fertility clinic.
So, what are the factors that impact a patient’s decision making?
Many factors will form part of a patient’s decision-making – the final decision will most likely be related to confidence and trust on the doctor, treatment protocol and the care provided by the clinic. Many patients go by reliable sources or referrals to IVF clinics that come from their General Physician or their Gynaecologist. But it is important to do your research as well. Some of the important factors while making decision are as follows:
Expertise of Doctors & Embryologists
Yes, the expertise of the doctors and the embryologists must always be considered before deciding on the IVF clinic. And a patient must always ask for the details of the treating clinicians and the embryologists before finalizing the clinic. Check for clinician qualification, years of experience, embryologist’s qualification, years of experience, lab infrastructure.
A clinician must have good academic background and skilled hands, so that good medical history and investigations reports can be analysed properly so that appropriate personalised treatment plan can be made. It is important to pick up exact cause of problem and clear action plan should be made.
Depending on the medical history, a patient may be recommended some advanced additional procedures like ICSI in lab so that it can increase the success rate of IVF. A doctor who is experienced will be able to guide about these procedures without any difficulty. Embryologist who work in lab should be adequately trained and should have expertise to do procedures like ICSI, freezing and maintain optimal conditions in lab.
Types of Fertility Treatment provided by the Clinic
This is another aspect that a patient needs to consider before finalizing a fertility clinic. The clinic must do all the testing and procedures in house. So that the patient need not go anywhere else for the procedures. If you are dealing with a relatively simple case like blocked tubes, or if you have more complex infertility issues like recurrent IVF failure, azoospermia, the fertility clinic must be able to handle all level of infertility issues.
One stop fertility solution is another important thing, a clinic should have facility of all investigations and infrastructure like blood tests, scanning, right lab, operation theatre, day care facility.
The Reputation of the Fertility Clinic
What are people saying about the fertility clinic? Judging a fertility clinic by its reputation is a great way to start your research on the clinic. A reputation cannot be built by itself; it relies on what people say. People talk based on their experience, so, if a clinic has a good reputation, you can trust that the clinic is providing an excellent service too.
The Success Rate of the Fertility Clinic
There is no better way to judge the quality of the service than by assessing the success rate of the fertility clinic. If a clinic has a high success rate, they are doing something right. You can be sure that they know what they are doing to be able to prove themselves in such a manner. IVF success is an excellent way to find out what kind of treatment a fertility clinic is giving its patients. When patients are visiting a clinic for IVF treatment and are leaving with a baby – this sums up everything that words are inadequate to describe.
The Infrastructure of the Fertility Clinic
Infrastructure also plays an important part when deciding the fertility clinic. Is the fertility clinic equipped to provide the kind of service a patient is looking for? Do they have the required infrastructure, an advanced IVF lab with all the latest equipment to carry on all the procedures? If they do not have the basic setup, it is quite likely that a patient is going to get the quality of medical treatment that they have expected. It is important to choose a fertility clinic that has modern up to date infrastructure. Some clinics are particular about imbibing the latest technology, and this says a lot about the kind of service they provide.
In-house availability of Doctors & Embryologists
The availability of medical staff should be one of the factors while choosing a clinic. As some clinics and hospitals have visiting consultants who are associated with many hospitals and so are not committed to any one place and are usually on the move. So, might be in case of emergency the attending doctor may not be available. Some clinics have a team of in-house doctors & embryologists who are committed to the clinic and the happenings therein. They are always available in case the patient has an emergency or a need. It is better to select a fertility clinic that has a team of in-house staff.
Facilities provided by a Fertility Clinic
The facilities and services offered by a fertility clinic matters to the patient. Everyone wants to have their treatment at a clinic that provides good facilities irrespective of the cost of the treatment. A personalized and a holistic treatment approach, compassionate patient care and high-quality patient service. There should be no compromise zone. Good hospital facilities reflect the kind of overall service that patients will receive once they start treatment.
Transparency in Treatment
Transparency is the most important factor. When a clinic is transparent, you feel that you can trust them. When a fertility clinic wants to hide stuff and keep it confidential, then you know something is not quite right. Most good reputed fertility clinics follow a total transparency policy and keep the couple updated about each procedure and how the patient is responding, test results and complications if any. When decisions are to be made regarding which course of treatment to follow, the patient should also put in his viewpoints. It is important to be a part of the decision making based on the doctor’s suggestion because it is the patient who would be paying for the treatment cost.
Transparency in Cost
IVF can be an expensive treatment, but a clinic should be able to give a rough estimate of how much it will cost. Some clinics are vague about the total cost and keep surprising with huge bills as the treatment progresses. The patient should also ask whether the cost of IVF medicines are included or not. This can catch a patient unaware and set them financially off balance. Some clinics give a total package cost and inform the patient regarding other expenses that might come up, giving a rough estimate of what they should be prepared for.
- Regular audit, quality checks in lab and training of staff to keep up with the latest technology is another important factor contributing to high success rate and high-quality care.
- Registration with ICMR is a must which is given only if centre has adequately trained medical staff and lab infrastructure.
- PNDT licence for use of ultrasound.
- Biomedical waste licence
- Availability of trained Counsellors as IVF is an emotional roller coaster ride
- High risk pregnancy follows up referral
- Patient centric approach
- Clinic website or patient information leaflets or instruction sheets, written info
Many clinics are seen flouting ICMR guidelines. To this Fertility experts say that until the ART bill is introduced for stringent measures, nothing can be done with the ICMR guidelines. ICMR Director General Vishwa Mohan Katoch says that the association of ICMR is in forming guidelines on accreditation of IVF clinics. As ART is a growing sector, so if the demand is there, people will undoubtedly seek private care. Moreover, being in this sector i have noticed many clinics offering unethical practises. So, it becomes of extreme importance to know about the clinic you choose for your fertility treatment.
The Swedish firm company Medicover Healthcare is all set to invest in the IVF market with an initial investment of $100 million. It is a joint effort of some of the Private Equity backed IVF firms and a host of other companies operating together in a fragmented market.
Felipe Velasquez, Commercial Director: Medicover Healthcare said that the company would have around 50 green-field Medicover Fertility clinics in the coming three years. Moreover, of that 50 clinics, the company as of now will open four clinics: two in New Delhi and one each in Noida and Gurgaon respectively in the coming two months. The aim is to have ten clinics by the end of the year,
Medicover will expand its operations and is hence planning to open other clinics in Punjab, Haryana, Uttarakhand and Uttar Pradesh, and then enter Maharashtra and Rajasthan in the following years. The investment will come from the Medicover Group.
There is a vast opportunity in the IVF sector as the IVF market is expected to grow at a CAGR of 20 per cent that is from 100,000 cycles currently to 260,000 cycles by the year 2020, according to report published by EY in the year 2015.
Felipe Velasquez, commercial director of Medicover Healthcare, said there are approximately 30 million infertile couples in the country, but only 150,000 of them are seeking fertility treatment. There are many competitors in the market and hence there is a significant demand out there that needs to be fulfilled. India is a growing economy, and with changing lifestyles like women wanting to focus on their career before trying to get pregnant, the market is eventually going to rise. So Medicover Fertility will try to focus on the premium market.
The cost of IVF treatment depends on an individual’s medical history which usually ranges from Rs 150,000 to Rs 200,000 per IVF cycle in India when compared it is three to four times lower than in the United States. Though the cost is relatively lower still the treatment is unaffordable for at least 80 per cent of the population as the service providers target people who are in the higher income strata. The low cost of IVF treatment in India also makes the country an attractive place for medical tourism.
The IVF market is fragmented in the sense that there are both domestic and a handful of foreign companies that offers Assisted Reproductive services. Some of the names of the competitors are:
- Bourn Hall India, which is a part of the UK-based healthcare services firm Bourn Hall International. The Private equity firm TVM Capital MENA backs bourn Hall India.
- Nova IVI Fertility, which is a joint venture between Nova Medical Centres Pvt Ltd and Spanish IVF technology firm IVI is another competitor.
- Other than that, India’s multi-speciality hospital chains like Apollo Hospitals and Max Healthcare, also offer IVF services.
- Cloudnine Hospitals (an Indian Company) which is focused on birthing also offers ART services.
- Rainbow Hospitals also provides ART services along with primary paediatric services.
In a recent interaction with VC Circle, the co-founder and chairman of Cloudnine Hospitals, Kishore Kumar, said that they would expand their IVF business further.
Mr Gaurav Malhotra, Medicover Fertility, Managing Director said, as Cloudnine is a PE-funded company, so yes, after three or five years, the PE firm would want returns on its investment. Whereas Medicover Fertility is a family-owned business, so would stay for a long time in the market.
Mr Gaurav Malhotra, ex MD & CEO of Bourn Hall International India Private Ltd was also MD and CEO of Patni Healthcare Ltd, CEO of Medfort Hospital, Business Head – South Asia for Bausch & Lomb and the Business director for Johnson & Johnson Medical.
John Stubbington, CEO Of Medicover Group, said that Medicover, which is present in 15 countries including India and aims to invest revenues of $100 million in three years. He also said that Medicover Fertility in India would not enter other sections such as diagnostics and hospitals but only focus on the IVF market.
Says Mr Gaurav Malhotra, Medicover Fertility MD – A Single Speciality IVF Chain of Clinics.
The global health care sector is undergoing some major shifts. As suppliers, payers and investors across the globe are attempting to deliver effective, economical and equitable care, it’s leading to a system that’s opening new operative models.
Private equity and working capital have driven the expansion of the health care delivery sector in Asian countries. In the last decade, investors have raised over $3.4 billion to invest in infrastructure, medical technology and progressive clinical delivery, giving patients access to a globally bench marked personal health care delivery system.
This 1st wave of capital gave rise to several multi-speciality hospital networks that expanded across the country. It additionally led to the creation of huge standalone hospitals also where the capacity ranged from 300-500 beds with a mean demand of 850-900 sq. ft/bed.
Single speciality healthcare centres across the country are increasingly gaining importance and giving significant opportunities for emerging businesses and private equity investors, however, there are certain challenges that start-ups operating in the sector are facing.
Mr Gaurav Malhotra says that for healthcare start-ups, the cost of the capital is too high. Besides, the cost of rentals or land is high when compared to multi-speciality hospitals. As a start-up when it comes to procuring free land, it becomes difficult, but when you establish a multi-speciality hospital, you might often get the land for free from the government. Moreover, there are no tax benefits too that single-speciality hospitals, or day care centres typically get to avail.
Single-speciality hospitals or day-care centres as they are commonly known their main focus is on speciality care services in any one area of healthcare and it can be ophthalmology centres, dental care, fertility centres and oncology centres, to name a few. Almost all businesses in the single-speciality segment are lining up significant expansion plans.
There has been much said and written about single speciality chains and their expansion plans with patients increasingly coming to them, but there are certain points that may hinder the growth of the overall sector. When prices increase in setting up a clinic, they are typically passed on to the consumers, in this case, it’s the patients. Mr Gaurav Malhotra exclaims that even bank interest rates for healthcare start-ups are high. Since this is a social sector, benefits in interest rates would have certainly helped.
Conventionally, healthcare has always been an interesting area for investors and within the sector, single speciality is gaining the interest of the investors because of the nature of the business and the quick returns it guarantees. In fact, it is the possibility to offer a solution for a specific requirement by single speciality chains coupled with the specialized infrastructure that is driving the growth in the segment.
As per data from Grant Thornton, so Private Equity and Venture Capitalists firms invested $1,071 million, of which, $228 million went into primary healthcare or single speciality hospital, the total number of healthcare/pharma deals during the same period stood at 39. Interestingly, what excites the investor’s interest is that the rising number of mergers and acquisitions besides the growth prospect of the sector overall.
Furthermore, for investments in a single speciality, the incubation period for any project is low compared to multispecialty where the capital requirement is actually huge. The cost of a single bed in a multi-speciality set-up can go up to Rs 50-80 lakh. Moreover, there are issues concerning low-capital performance that make even the best hospitals to collapse operationally not before a year and a half and in about six on capital expenditure.
Healthcare has been a slightly confusing industry and it has made tremendous clinical advances with rapid advancements of treatments, medications and diagnostics.
These advancements require significant time to time investments and risk-taking capability by the companies and the clinicians. But from a management viewpoint, healthcare has been symbolised by risk-averse practices focused on avoiding errors rather than making advancements.
This risk aversion has been enabled by the comparatively mature and stable business of healthcare. This stability is being altered by significant changes which are creating great uncertainty. The two important types of uncertainty faced by most industries are technical and demand. It has been seen that Healthcare has had a relatively certain level of demand for decades while there have been moderately increased levels of technical uncertainty compared to other industries.
There is an increasing consumer expectation which is going to drastically increase the uncertainty of demand in the coming years, new sections of care are opening in various settings, for example, drug stores, fitness centres, and online with a push to meet consumer preferences for convenience and 24×7 access for non-urgent needs.
The aim is to basically transform preventive and ambulatory services which will in turn significantly decrease inpatient volumes. But the point is how and at what speed remains the questions to most of the health systems which have carefully transited to value-based care.
Previously Healthcare leaders who have succeeded in this environment have been able to do so because they were good planners who got things done on time and within budget, they had been careful and efficient and had tried to keep as many stakeholders happy as possible. With this kind of significant change initiated in healthcare and with high demand uncertainty, the key is to be careful and avoid mistakes, but the process can be riskier as we are not experimenting and taking chances.
There will always be a need for traditional management to manage some parts of the healthcare business that are relatively stable, however, new growth of innovative leaders will be needed to build parts of the organization that will become the new growth engines in a value-based healthcare world.
And this need for innovation will continue beyond the clinical aspects of healthcare also to include supply chain, revenue cycle, HR, facility planning, and design amongst others. Innovative approaches to support the rapidly changing clinical side of the business will be very much needed.
These innovators need to have a vision, get all the stakeholders on board, do thorough research and identify customer needs and new ways of working, prototyping, failing, learning, and again build new services and business models which are suited to the changing environment. The correct answers will address more than just the functional needs of patients, but it will also address their social and emotional needs.
The skills and knowledge at times that are needed for success may not currently exist in the organizations, but they must pull from payers, public sector, high tech, big pharma, start-ups, and other sectors. It is necessary to identify the necessary features, findings and recruiting the right people, and orienting them to the organization will be a challenge.
So, if you want to be successful in the value-based world, the leaders need to understand the various sources of data and conclude out ways how to integrate them for operational and analytic purposes so they can be appropriately leveraged. Currently, the data in sales and these innovators need to understand the different pieces and how to link them together.
Finally, the new innovative leaders need to understand their primary customer, that is the power shift from physicians as a hospital’s main customer to the patient and their family. This will require a consumer-minded approach that will only focus on the whole patient experience within the hospital and ahead. To build and maintain an engaged relationship with patients and their families will require new tools and technologies that are minimally used by the organizations today.
By Mr. Gaurav Malhotra, Medicover Fertility (Managing Director India)
Mr Gaurav Malhotra was attending a session with future leaders at Management Development Institute, Gurgaon, and during this session one of the female students asked him a very relevant question that does Glass Ceiling still exist for women leaders? This question made Mr Malhotra think and do some research and then he explained that:
That if see the number of Fortune 500 firms then we will find that companies with no female directors are down by 54%, but the progress is still slow. We are already in the 21st century and nearly 5% of Fortune 500 companies are still run by all men boards of directors. It is also important to note that 28% of the Fortune 500 firms listed just one female as the director. Studies have shown that it takes at least three women directors to improve performance and governance and achieve effective critical mass.
If we review this situation in India, then we will find that:
SEBI had asked companies to list at least one woman on their board of directors on the Indian stock markets. Moreover, the deadline for this exercise was listed for October 1, 2014, and was also extended till April 1, 2015, as India Inc had failed to find 966 women on their board of Directors to fill the seats and be at par with the new Companies Act 2013.
Why do we fail to understand that it is critical for Corporates to actively ensure Gender Diversity for long term sustainable success? They should not just comply with laws but encourage and ensure equal growth opportunities. These are few of the observations that were cited by Mr Gaurav Malhotra from his corporate experience of two decades.
The first observation was that if a corporate team is hiring for important leadership position then generally, they kind of reject female candidates in case they are married and are planning to have a baby soon or if they have young kids.
He even shared his own experience; when he was interviewing a female candidate for a finance director position and when he was about to make her the offer, she said that she wanted to tell that she was pregnant.
To this Mr Malhotra exclaimed that it is good news and should be celebrated; the candidate looked confused and confessed that this was the reason that she was asked to leave her last job where she was unnecessarily pressurised by her boss when he came to know about her pregnancy. As he was afraid that she would have to be given maternity leave.
But she was hired by Mr Gaurav Malhotra and she proved to be one of the best leaders. He said that a female leader does multitasking as she has to do many roles and balances her family and work requirements equally. Corporates need to be flexible and empathetic to ensure they can perform both these roles successfully. When these female leaders personally are given support then they can mould their personal and professional vision into reality which leads to superior business outcomes.
Also, we need to provide a safe working environment for all female employees. We cannot let the devil of "Sexual Harassment" at the workplace make us lose this battle of inclusion of women leaders. He also shared a very interesting incident from the past where one experienced Human Resource Head was himself the creator of rumours and juicy gossip about the female staff and one day the management had to let him go to send the right message to the entire organisation. All organisations need to have a Zero tolerance policy on sexual harassment, juicy gossip and casual comments at the workplace.
As a family/society we need to change our mindset and encourage women to work and succeed in their professional career. We should give them the required support system and not set them up for failure. Says Mr Gaurav Malhotra that his wife is working in the corporate for the last 18 years and there have been situations where both had to make required adjustments to ensure that both succeed. Women are still the ones who sacrifice their careers to handle work and family ties. The important point is to build an adequate support system which is critical for the sustainability of careers.
We need to provide women with a feeling of safety and security so that they can travel for their work even at late hours some time. This should be one of the priorities of our government too. We should overcome this obstacle as this remains one of the barriers; still, most of our public transport and even radio taxi is not considered safe.
He also reinforced the fact that we will not do anyone a favour by breaking this glass ceiling for all the women leaders; in-fact this will ensure greater sustainable success for community, companies and country. We need to keep these debates going to ensure that this gender bias decreases.
By Mr. Gaurav Malhotra, Medicover Fertility (Managing Director India)
- 30th October 2018: To announce the launch of Medicover Fertility in Hyderabad
- To reinforce Medicover’s position & intention to expand in India to become key player in Indian Healthcare domain
Mr Gaurav Malhotra, Managing Director Medicover Healthcare, said that: With the launch of the state-of-the-art IVF clinic in Hyderabad, we are pleased to offer a combination of best of advanced technology and medical expertise to childless couples in Telangana and adjoining states of South India. Medicover Fertility brings together its best European practises, trust, transparency and high-quality, compassionate patient care to the city of Hyderabad.
Medicover Fertility is located in the hi-tech city of Hyderabad and will be one of the largest Independent IVF clinic operating in the state of Telangana. Medicover Fertility, through its ethical and transparent services, provides complete peace of mind to the stressed couple. It ensures complete trust and transparency through its transparent labs. It is the first clinic in Telangana to offer affordable quality and ethical treatment to patients through zero percent interest and zero down payment in association with finance partner.
The clinic offers comprehensive Male and Female infertility treatment options including Intrauterine insemination (IUI), In vitro fertilization (IVF), IVF Donor programs (donor sperm / egg / embryo), surrogacy, fertility preservation (egg freezing/ sperm freezing / embryo freezing), Microsurgical Testicular Sperm Extraction (micro TESE), Percutaneous Epididymal sperm aspiration (PESA), Testicular Sperm Aspiration (TESA), Hysteroscopy & Laparoscopy amongst others.
Mr Gaurav Malhotra, MD Medicover Fertility, said that: There are more than 30 million infertile couples in India. It is an important opportunity for us to bring the best of European clinical practices, trust, transparency, high-quality service and leverage our experience of 23 years to serve the masses of Hyderabad and the state of Telangana. We want parents to take home a healthy baby, which is why we provide the parents with a DNA certification. We deliver superior pregnancy outcome and, every 3 hours, an IVF Medicover baby is born worldwide.
Fredrik Stenmo, Chairman of Medicover, said that our core mission in India is to deliver world-class healthcare services, which is deeply rooted in our core values and legacy. Medicover pledges a new level of care based on compassion, sophisticated clinical skills and advanced technology and equipment. Most significantly, every unit within the Medicover group of businesses is built on a genuine intent to help people improve and maintain their health. Commercial considerations do not replace our clinical objectives.
Mr Fredrik Ragmark, CEO Medicover said that: The labs in Medicover have the most advanced equipment & medical technology, and the same best practices are applied that are followed in our European centres. If we observe then we will see as per data in India, infertility affects approximately 10-15% of married couples who are really trying to have a baby. Medicover Fertility brings their European standard of operating protocols which have been designed and validated over 23 years in multiple European countries under the guidelines of ESHRE, an authority for infertility treatments in Europe.
John Stubbington, COO Medicover said that: With a presence in 14 countries and having dealt with patients from different geographies and culture, our team at Medicover is well equipped to understand the individual need. The skills and expertise of our doctors and embryologists, advanced technology and equipment, individualized treatment plans, compassionate patient care and our protocols have enabled us to achieve such high pregnancy success rates.
Medicover is a leading international Healthcare and Diagnostic Services company founded in 1995. Medicover operates a large number of ambulatory clinics, hospitals, speciality-care facilities and laboratories, and its largest markets are Poland and Germany. In 2018, Medicover had a revenue of EUR 672 million and 20,970 employees.