Post on 11-Jan-2016
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Business Model Innovation at Medtronic Capturing the Growth Opportunity
Global Innovation Fellows, 2013Call number: 1-702-894-2305 or domestic at 1-866-794-1439 Conf Code: 9410201709Leader PIN (Katie): 498308
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Discussion Topics
1.2.3.
Unlocking new sources of growth with BMI
BMI at Medtronic with Healthy Heart For All
What is BMI?
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Evolution of Medtronic Strategy(VP Meeting May 2013)
Tighter op. mechanisms & alignmentExe
cuti
on
Gro
wth
S
trat
egie
s
Po
rtfo
lio
Syn
erg
ies
Stabilize Align Transform
Dec 2011 Today
Consistent growth and performance
Working capital
Convert to revenueEconomic Value
Globalization
CVG RTG Diabetes
Customer groupings
$$
Product cost & delivery
f ( )=
Services/ solutions
Value segment
New Therapies
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1Revenue Growth on a constant currency basis Emerging Market Revenue includes revenues from Asia Pacific (except Australia, Japan, Korea, and New Zealand), Central and Eastern Europe, Greater China, Latin America, the Middle East and Africa, and South Asia.
1.0 billion
Real GDP growth2010 – 2030
The world's center of economic gravity is shifting east and south…Developing versus emerging countries: the match !
Population growth 2010 – 2030
Developed countriesDeveloping/emerging countries1
Population
MDT FY13 Revenue
MDT FY13 Revenue Growth1
5.4 billion
30%70%
5%95%
$1.9 billion $14.7 billion
+17% +5%
Total: +USD 95 trillion
Total: +1.4 billion people
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Moving BMI from a mysterious art to more of a disciplined scienceHow to create, deliver and capture value?
Channels
Value Proposition
Partnerships
Profit Model …
Customer Experience
BMI can be built up systematically!What is BMI?
Discover top opportunities
for BMI
Blueprint solutions to seize identified
opportunities
Test and refine solutions to improve the odds of success
Scale the business and capture value
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Example of Business Model Innovation…
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Situations where Business Model Innovation is applicable
Situation
1. Non-consumption is a big barrier
2. Low end attacker
3. Technology alone does not offer the solution
Examples of BMI at MDTExamples from other industries
Expand Diabetes Therapy with a “Emerging Market Injection port”
Pacemakers & defibrillators, online.
Making high quality cardiac care available to all members of society
Making high quality cardiac care available to all members of society
Converting patients to pump therapy in all territories
ELR
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A change of Business Model at Medtronic?
New Value Proposition:•Should we go into hospital economics area… •Medtronic have to accelerate intra-business collaboration to achieve sustainable growth in this high competitive market•Transform MDT from simple device delivery to value-enhancing partner (more value-added services)
New Products Portfolio:•Many new products in coming 5-10 years -> enter into the new attractive fields. •Sell pharmaceutical products ?•Sell more capital products ?
New Channels:•Web order for breakthrough technologies•Dealer consolidation or no dealer•Fewer sales reps and less direct case planning?
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Applying for a job at IKEA
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BMI Process
Discover top opportunities for business model innovation:
•Identify priority jobs-to-be-done
•Understand consumption barriers
Blueprint solutions to seize identified opportunities:
•Develop customer value propositions to address priority jobs
•Identify profit formula, key resources and processes required to deliver customer value proposition
Test and refine solutions to improve the odds of success:
•De-risk business model by testing key assumptions
Scale the business and capture value:
•Design a sustainable business model
•Acquire resources to scale
1 2 3 4
Proof of Concept
EVDefined Tested Delivered
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Samsung's new Galaxy Tablet$599$799
Slate 500 tablet device of HP
$499 - $829 $120
Creating BMI is a dynamic process
Ipad of Apple Iped (made in China)
It's Not A Motto, It's A Mindset
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BMI Toolbox for Market Discovery New Toolkit
Process Manual
The BMI ToolboxCross pollinate with other management processes
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Business Model Canvas (BMC)Key Partners
•Who are our Key Partners?•Who are our Key suppliers?•Which Key Resources are we acquiring from partners?•Which Key Activities do partners perform?
Key Activities
•What are our core business activities?•What are our Key Activities to serve our current buyer segments?
•What value do we deliver to the customer?•Which one of our customer’s problems are we helping to solve?•What bundles of products and services are we offering to each Customer Segment?•Which customer needs are we satisfying?
Customer relationship•What kind of activities and initiatives do we have to do in order to establish and maintain our relationship with customers?•How are they integrated with the rest of our business model?
Buyer Segments
•For who are we creating value?•Who are our most important customers?
Core Capabilities & Resources
•What are our Key Resources, Assets and Capabilities to deliver our Value Proposition?•What are the core strenghts of our organisation?
Channels•What are the channels/ means that we use to reach our customers? How are we reaching them now?•How are these Channels integrated?
Cost Structure
•What are the most important costs inherent in our business model?
•Which Key Resources are most expensive?•Which Key Activities are most expensive?
Revenue Streams
•What are our direct and indirect revenue streams ?
•How much does each Revenue Stream contribute to overall revenues?
Value Proposition
ProfitProposition
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What is Yahoo?Listen Yahoo is a great company that is very, very strong in content for its users, uses amazing technology to serve up what increasingly we think is going to be the web of one. For instance, on our today module in the front page, every 5 minutes we have 32,000 different variations of that module. So you don’t even know what I’m saying! In fact we serve a million different front page modules a day and that’s just through content optimization. And that’s just the beginning…Customized because we know the things you’re interested in. Maybe you don’t like light entertainment maybe you like a certain sports team, etc., etc. And our click through rate went up twice. So the point is, people come to us to find out what is going on with the world in a very nice quick fashion to do their communications, email, messenger, check-in on their teens. We all know about Yahoo finance. It’s a places where you can just get it together. It’s collated for you, it’s all the things as you’re moving, you can even get your social information there. Everybody moves through many websites in a day, Yahoo is one they always stop at.
What is AOL?AOL is planning on being the largest high quality content producer for digital media.
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Simple and powerful tagline
Customer Value Proposition
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Business Model of NayamedKey Partners Key Activities Customer
RelationshipBuyer Segments
Core Capabilities & Resources
Channels
Cost Structure Revenue Streams
Value Proposition
ProfitProposition
12
3
4
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Beta version of the BMI Knowledge Exchange Platformbmi.medtronic.com
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Active ManagementSponsorshipCommitment
Distinct but Linked
Organizations
Focus on learning
milestones
Differently Disciplined
Startup Funding
Guiding Principles for BMI Success
Active senior management
sponsorship, staying power and long term
commitment
Clear statement of key hypotheses and
focus on learning milestones
Smartly leverage core assets from BU’s without distracting the core or
constraining BMI efforts
Processes, decision criteria, and incentives are aligned to
rapidly getting to proof of concept with test-and-learn
iterative approach to fail fast and fail cheap
Dedicated start up funding for
experimentation and testing new ideas
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Revectoring the model through pilots and follow an emergent strategy in the face of uncertainty, is critical to BMI success
Flawed Strategy
Successful Strategy
Diamond Model
Hub Model
CityModel
Rental Program for GDM
Try Before You Buy T1/T2
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Discussion Topics
1.2.3.
Unlocking new sources of growth with BMI
BMI at Medtronic with Healthy Heart For All
What is BMI?
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22 | MDT Confidential and Proprietary; Do Not Copy or Distribute
Diagnose the system
Define the Priority Job-to-be-done
Uncover population needs, unmet needs and pain points
Define potential solutions
Size the market opportunity
Next Map: Piloting & Prototyping
Create an Opportunity Map/ Needs Filtering
The BMI journeyIterative & dynamic process to uncover market opportunities
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Example of mapping of forces involved in obesity…
Source: Systems Innovation, Nesta, 2013
Diagnose the system
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Key stakeholders in the decision-making system (DMS) indeveloped countries differ from those in emerging countries
In India, the decision-making system is strongly influenced by patients and their families…
In Europe, MDT’s “customer” is defined as a multi-stakeholder, “decision-making system”…
Europe DMS
Implanter Technician
Purchaser Administrator
Dept. head Pharmacy
India DMS
PatientReferring
cardiologist
Patient’s family
Implanting cardiologist
Patient’s PCP
…with a broad set of clinical and economic jobs such as:
• Minimize time/expense of procurement process
• Benchmark clinical/financial performance vs. other centers
• Educate me on new products and procedures
…with new jobs-to-be-done influencing decisions such as:
• Understand costs and treatment options available to me
• Obtain an accurate diagnosis
• Know that my physician is credible and I can trust him
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Clinical need: I want a better way to perform ambulatory ECG monitoring for cardiovascular patients at risk of silent ischemia in order to improve its diagnosis and management.
Background -Ischemia often causes chest pain/discomfort -In silent ischemia – don’t feel pain -Therefore, suffer heart attack without warning -High-risk – previous heart attack -Multi-lead ECG signals can pick up silent ischemia
Problem -Holter monitor detects ischemia -But has some gaps (duration, leads, retrospective …) -Under-detection of silent ischemia prevalence
Market -Prevalence - ~785,000 first heart attack in 2009 (USA) -Incidence – total of ~200,000 silent ischemia/year (USA)
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Never assume you know anything... Always look
for patterns , themes and insights.
Go beyond customer’s expectation and focus on the "hole" rather than the
"drill“ to identify the underlying needs
Trust Action Over
Statements
Avoid the ‘Curse of Knowledg
e’
Get As
Close to
Context As
Possible
Focus on the
circumstances over
the demograph
icsFocus on the Jobs-to-be-done and get at the
root cause that is driving their needs
Don’t outsource your eyes…
Here are few tips that will help you make the most out of your fieldwork activities…
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How would you describe your health condition?
I am taking Zocor and supplements
Why do you describe as “moderate”?
I asked my doctor to prescribe it to me
I just found that my cholesterol is a little high
What are you doing about it?
Moderately healthy, could be better
Where did you get this product?
How did you know about this medicine?
My colleague recommended me to take this product
5 Wives and 1 Husband: Insight Generation technique
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Exubera was supposed to revolutionize diabetes care. Turns out patients aren't interested—it'll cost Pfizer $2.8 billion
• Massive miscalculation about how patients with diabetes manage their disease
• Exubera is about the size of a can of tennis balls (not something that can be used discreetly at a restaurant or party)
• Its dosage can't be adjusted as easily as injected insulin can
• It carries the risk of lung problems..• It’s at least 30% more expensive!• Etc.
“Perhaps next time Pfizer will do a little more homework to determine whether an innovative idea truly has a market.” Bloomberg Businessweek
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People don't want to buy a quarter-inch drill. They want a
quarter-inch hole.
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BMI focuses on unsatisfied and important jobs-to-be-done for successful, predictable and repeatable innovation
“Help me to deliver care to my patients”
“Help me to expand my knowledge”
“Help me to manage by finances”
“Help me update my
EMR system”
“Help me to train my
staff”
Example from the Physicians’ perspective
Understand and prioritize our clinical and non-clinical stakeholders’ needs
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[Customer] wants to [solve a problem] in [this context]
Five questions to ask are:•What kind of problem is the customer trying to solve, in a specific circumstance? •What (social, emotional, societal, etc.) criteria will the customers use to assess solutions? •What (functional or other) limitations take some solutions off the table? •How is the customer getting the job done now? •Is there an important job to be done that lacks an adequate solution?
It’s past pediatrician office hours and a parent suspects their child has strep
[Parent] wants to [have child tested for strep] [outside of physician office hours]
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CustomerValue
Proposition
What are the “JOBS” that we are trying to solve for our stakeholders?
Products &
Therapies
Jobs-to-be-done
TranslateImmediate
Results(needs)
End Results
(underlying needs)
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1. Reduce the amount of money I have to spend on healthcare2. Know that I will not be a financial burden on my family when paying for healthcare3. Obtain an accurate diagnosis4. Understand all the treatment options (and associated costs) available to me5. Know when I am at risk for a life threatening condition6. Maintain the same lifestyle I've had in the past while living with a device7. Save me time by having medical procedures done close to home8. Provide for my family while I'm being treated/recovering/living with a device9. Minimize my recovery time / get me back to work or my family as soon as possible10. Eliminate the need for follow up care11. Eliminate any worries that I have about my heart / live carefree12. Get the device that best fits my / my parent's needs, so I do not pay for features I do not need13. Know that my physician is credible and I can trust him14. Eliminate the need for me to see multiple doctors when I am being treated15. Know that the device I have received has been implanted properly16. Allow me, not my family (e.g. son or daughter) to pay for any major surgeries/devices I need17. Allow me, not my family (e.g. son or daughter) to make the decisions about my healthcare18. Help me get insurance coverage
Score*100%88%87%85%85%84%83%82%80%80%75%74%61%58%52%49%34%75%
Cost is barrier throughoutthe process and it extends
beyond devices:Consultation, diagnosis,procedure & travel costs
(individual & family).
RMPs are typically the first line of defense &
diagnostic capabilities areimportant; despite the
RMP’s lack of diagnosticskill, RMPs are usuallytrusted by the patient.
Many rural poor have the“fear of travel” barrier in
addition to travel costconcerns; many do not
want to receive anoperation and recuperateaway from home (>30km).
The “healthy worker”phenomenon exists withthe rural poor. RMPs &
patients believe that theyare healthier than urban
counterparts because theydo physical labor.K
ey F
ind
ing
s
Note: *Score is the JOBS opportunity score, which measures the gap between importance and satisfaction for a specific job. The jobs are ranked relatively to the first job score. Data is directional given small samples sizes (n < 30). Source: JOBS Survey, India Market Research, August, 2009
Identify Market-Opportunities using the Jobs-to-be-doneHHFA Jobs-to-be-Done: Rural & Can’t Afford
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Key Jobs-to-be-DoneI would like/ I wish ….
Indonesia Malaysia
Treated Patients
Untreated Patients
Treated Patients
Untreated Patients
To be able to afford the procedure 5.57 6.00 5.75 7.60
To reduce the waiting time for procedure 4.50 5.60 5.92 7.00
To have an easier/simpler system to apply for a welfare grant 4.79 5.00 5.42 7.00
To better understand the treatment options 4.79 4.70 5.67 6.80
To better understand the disease and procedure 5.14 5.30 5.83 6.60
To learn more about the procedure from other patients 4.29 5.90 4.08 5.80
To trust that my physician is offering all possible treatment options 4.93 4.90 5.92 6.40
To reduce the time to receive a diagnosis 4.71 5.30 5.25 6.60
To have different payment options 4.43 5.10 5.17 6.60
To remove my fear and anxiety surrounding the procedure NA 5.50 NA 6.60
My family and friends to better understand and accept my disease and condition 5.00 5.20 4.83 5.80
Average 4.8 5.3 5.4 6.6Variance 0.14 0.16 0.34 0.27
Identify Market-Opportunities using the Jobs-to-be-done
Opportunity Score: High opportunity Solid opportunity
Quantitative research undertaken with 17 Patients in Malaysia and 24 Patients in Indonesia to understand the patient pathway, from cardiac symptoms to implantation
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Target Stakeholders:
Target Demographics (e.g. Income level, age, health status, etc.) Size of target segment (e.g. # of target patients)
Key Barriers & frustrations Existing options/ Current Alternatives
Priority Jobs-to-be-done
Proposed Offering / Customer Value Proposition
Your value proposition is the way in which you articulate your offering to the target audience(s) – ‘the solution to their needs and barriers’
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• A large majority of diabetes patients have several concerns pertaining injecting insulin with primary being ensuring correct dose, pain, and selection of site
• 50% have fears related to insulin delivery• Only little over 1/3 discuss their fears with the provider
Insights
Problem Statement
Priority job-to-be-done
Potential Solution
How to develop new treatment option to reduce “fear of pricks” and fear of multiple injections?
I would like painless injections of insulin and a more comfortable experience
• Improved Adhesion for Hot Humid Climates• Soft Cannula Reduces Fear • Improved Breathability for Comfort• Accepts Longer & Larger Needles
InCite(New Injection Port )
Expand Diabetes Therapy with a “Emerging Market Injection port”
Turning conversations into insights, and insights into solutions!
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Nintendo Game cube
XBox Playstation
The Video Games Industry
Who are the dominant customers of the videogame industry?
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Jack, 10 years old
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The 3 tiers of noncustomers
Your Market
“Soon-to-be” noncustomers
First Tier
Second Tier
Third Tier
“Refusing” noncustomers
“Unexplored” noncustomers
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Who are the noncustomers?
1st Tier
(soon-to-be)
2nd Tier
(refusing)
3rd Tier
(unexplored)
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Discussion Topics
1.2.3.
Unlocking new sources of growth with BMI
BMI at Medtronic with Healthy Heart For All
What is BMI?
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44 | MDT Confidential and Proprietary; Do Not Copy or Distribute
How does a poor 45-year-old widow living in rural India obtain a high-end medical device?
• 45 year old widow and mother
• 3+ month history of daily black-outs and heart palpitations
• Son is family’s sole bread-winner and earns approximately $55 per month
• Unable to afford cost of an entry-level pacemaker at full price
If they manage to save $10 every month, it will take them 7 years to be able to afford a single chamber pacemaker
(US$800 – without the surgery)
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45
A mix of physicians, patients & other players were interviewed to gain a holistic view of the Indian healthcare system - 100+ interviews across 21 locations
Mangalore
Kolkata
Jaipur
Bhopal
Mumbai
Chennai
Delhi
LucknowKanpur
Pota GaonMurad NagarMoti Nagar
Nivadi Gaon
Nilla
KhanugaonArjupur
Durgapur
Bangalore
NashikLasalgaon
Maduari
30 Patients
9 “Other” Players
• Jaipur Foot• Aravind & Aurolab• Microfinance• Telemedicine• Medical Students
• Single/ Dual Chamber• Premium Pacing• Low cost Pacing• Stents• No Device
64 Physicians
• Eps & IVCs• MD Cardiologists• GPs• RMPs• Alternative Medicine
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Rural & Can’t Afford: Care pathway and barriers
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Patient population Patient referred to
Cardiologist in the hospitalAdoption of therapy
by the patient
Patient visits General Physician
• Lack of awareness amongst patients
• Disengaged patients
• Lack of physician knowledge
• Lack of diagnostic tools• Economics unfavorable
for referral physician
• Affordability/liquidity issues
• Anxiety of going through a procedure
30%75%60%
Why patients drop out of Care Pathway?
x% Dropout percentage
In the current care pathway patients drop out at each stage due to multiple barriers
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Patient population
Patient referred to Cardiologist in the
hospital
Adoption of therapy by the
patient
Patient visits General Physician
Therapy Educator Patient CounselorPatient Outreach
AssociateHHFA team
How HHFA addresses
barriers
1. Patient awareness2. Physician education
and diagnostic tools
3. Patient outreach through screening camps
4. Patient counseling5. Low interest loans6. Tiered-service for
poor patients
HHFA addresses these barriers simultaneously through 6 key offerings
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HHFA FY13 Launch Plan
Manpower (Total 37)
HHFA Partnered hospitals (Total 88)
Partner hospital characteristics•Cardiologist owned with few stakeholders•Low-medium utilization of cathlab capacity•Medium implanter skills•20-50 implants per month
9 11
CLUSTER 2Gujarat
Mumbai (HO)
CLUSTER 3Coimbatore
Kerala
37
88
4 15
CLUSTER 4HyderabadBangaloreChennai
6 27
CLUSTER 5Kolkata
Durgapur
7 9
CLUSTER 1Delhi
Punjab
11 26
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HHFA Economic Benefits
Nber of footfalls and reduction in patient dropout
Total avoidable cost for
the patient
Diagnosticrevenue
Overall Revenue
Nber of footfalls in the hospital
Procedures due to financing and tiered services
Overall Revenue
Cost of irrelevant diagnostics,
consultations and emergency
Lost in productivity due
to persistent symptoms
+7.5% +0.5% +8%
Stakeholders’ PerspectiveMDT’s Perspective
HHFA performance FY13-FY17Cumulative revenue: $110 Mn
EBITRevenue
+7% +10% +15%
$500 $800 $1300
# Hospitals
# Hospitals$ Mn
HHFA Cumulative FY13-FY17
# Hospitals: 530 Revenue ($ Mn): 110
# Cities: 53 EBIT: 32
HHFA creates a Unique Economic Value Proposition by Customer Type
Physicians
Providers
Patients
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“If it wasn't for this program I would not be alive today. Thank you so much!”
First Patient: A.K., 35
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HHFA Replication ModelApplying HHFA Modules to resolve barriers for other therapies across markets
Across GeographiesAcross Medical Conditions
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Four walls and a room full of experts
Stakeholders engagement model with
extensive fieldwork
Standalone solutions & best-in-class products
Integrated solutionswith a new Ecosystem
Creating a Unique Economic Value
Proposition by Customer Type
Before
Implanting physician as primary customer, strong
physician relationship
After
Changing mindset, behaviors and mechanisms are required to unlock new sources of growth…
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What’s next? Exploration…
1. Understand and prioritize our clinical and non-clinical stakeholders’ needs2. Re-shape our offering and designing new solutions and services3. Formulate market entry strategies
“if a solution is not affordable, then it is not a solution…”
Dr Devi Shetty, Narayana Hrudayalaya Group of Hospitals
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