You think you have better outcomes but you have to prove that with robust data (many different indicators) to convince the government that in the end if they contract your organization they will actually save money since you give them better outcomes and less complication rates, for example. Data is crucial for decision-making and proof of concept otherwise things remain too abstract.
Apart from the many interesting ideas and thoughts above, maybe one solution to the former adopted model would be to equally distribute different procedures among the doctors. First thing to do would be to estimate how many photodynamic therapies and mole excisions happen in a month, for example (make an average per month over the last year data). Then, these procedures would be equally scheduled and distributed among each dermatologist on a one month-period – this would avoid some doctors picking the most lucrative ones. Of course there could be some specific procedures that some doctors could be better than others (and this would be evaluated by quality measures and outcomes) and, in this case, specific incentives could be implemented. Limits for consultation times should also be implemented to avoid long waiting and doctors should be responsible for not allowing delays to happen.
People frequently are resistant to any sort of changes and this is always a challenge. I recognize benchmarking other institution´s successful programs is always a good way to start – this helps not feeling so lost with a new program creation. Benchmark clinical data is also very valuable, since if you show the healthcare team that their outcomes are poor or not so good as in other institutions in the region or country, this could be a major driver and stimulus for change (people might feel ashamed of their results). This proved to be very successful in the Cystic Fibrosis program at Cincinnati Children’s Hospital we have studied in the second module of MHCD, for example. Lastly, shared earnings (win-win) in this Medicaid program between the healthcare team and the government by reaching better health outcomes and cost reduction could be another incentive for program implementation.
Building your culture to other organizations that have very different thoughts and behaviours has always been a big challenge. M&A strategy should ideally look for companies with similar cultures and attitudes, since this makes the transition much soft and easier and less “traumatic”. Although this kind of buying strategy is not always possible, I think implementing your organizations’ culture into the new one is just a matter of time and patience – people and organizations are frequently very resistant to changes, but after a while (months or even years) they will find that this is inevitable and if people wish to stay where they are, they will have to change the posture and behaviour.
Since you have had great success with your initial private healthcare enterprise with children and public services have poor quality and satisfaction in your country, I definitely think your new enterprise has great chance to thrive if well designed and developed. In the scenario described, I also think there is great potential for the adult population as well. In developing countries like the BRICS, many people are underserved by good quality services and giving it to this population frequently brings trust and fidelity. There is no lack of money, since people are travelling abroad to search for healthcare.
However, I find more prudent to start small, with outpatient clinics and low-medium complexity procedures, such as clinical analysis lab tests, ultrassound, mammograms and bone densitometry. This means that a lower initial investment would be needed and and management would also be more simple. Good physician selection is obviously an important cornerstone of the business. If the initial enterprise goes well and thrives, this could be a good scenario to attract other investors such as private equity funds, that could then scale it and make it bigger (with more complex diagnostics and medical procedures as you have mentioned).
I recommend you benchmark healthcare enterprises in Brazil that were developed to serve the lower and medium class, which are underserved by poor public services, such as “Dr. Consulta”. I will leave you two links that I found below:
Wish you very good luck!