Send the Word Over There, Nashville Healthcare Business Leaders are Coming

by Sharon H. Fitzgerald

Send the Word Over There, Nashville Healthcare Business Leaders are Coming

Ira Chilton
"The business of America is business," declared President Calvin Coolidge in 1925. Yet today, that business isn't just within America's borders, and leaders in Nashville's healthcare arena know that.

"Historically, Nashville companies have been so entrepreneurial and the U.S. market is so large that they've focused predominantly on U.S. opportunities and that's where they've deployed their capital. But we're hearing more and more from companies about the many good international opportunities that they're exploring," says Matt Gallivan, president of the Nashville Health Care Council.

Certainly the Council has contributed to the interest in overseas business, having led five international trade missions starting in 1999. Middle Tennessee healthcare leaders have visited Great Britain, Germany, France, Spain, Italy, the Netherlands and, most recently, Hungary and the Czech Republic. A 2006 mission to Poland and Austria is in the planning stages.

"What's occurring is that countries are increasingly realizing that they need to look for new ways to address the healthcare challenges that they face," Gallivan says. "Now more than ever, they are either reaching out, looking for new approaches, or they're more and more receptive to having our group come over and meet with them and talk about some of the opportunities for cooperation and two-way exchange and trade."

Ira Chilton, principal with the Nashville-based CFP Group, was a delegate on all five trade missions — and he has the business in Great Britain to prove it. In fact, during the 1999 mission to London, Chilton broke away from the meetings to close his first British deal, and there have been others since.

In partnership with a Swedish company, Capio Healthcare, the CFP Group is working on the design, construction or renovation, and equipping of 11 surgery centers to provide hip and knee replacements. "We ended up with about a third of what's going on over there," Chilton says. The surgery centers are guaranteed a certain amount of business from the National Health Service, the United Kingdom's government-owned healthcare system.

"While I know a nationalized healthcare system sounds good to a lot of people, they were having many problems, including a very heavy administrative burden and a lot of queue lines," Chilton says. Because orthopaedic trauma patients would take precedence over hip and knee replacements, patients in pain were waiting 18 months to two years for surgery, he explains.

By the end of the year, the first of the 11 facilities should open in York. Six of the surgery centers are new constructions, while five are renovations. "The National Health Service guarantees them 800 hips a year and 1,000 knees a year," Chilton says. "If the government only gives them 600 hips that year, they still pay them for the 800."

Chilton says qualifications for Round 2 bidding were recently released by the British government. He's in discussion with one company regarding bidding on diagnostic facilities and has been contacted by both Capio and another company about the possibility of bidding on additional surgical sites. Chilton adds that he has a separate British business opportunity independent of the government and another opportunity in Hungary. What's more, the Scottish government is putting together a bidding package patterned after Britain's, and "we'll possibly be involved there," he says.

Meanwhile, on the other side of the globe, Nashville-based Gresham Smith and Partners is exploring Asian markets, particularly China and South Korea. A design and engineering firm, Gresham Smith has also done some work in the past in South America, Mexico and even the Middle East.

Kevin Kim, a senior design principal with the firm, says China offers "an incredible market with so many opportunities. They're building things left and right." The work is basically designing government-owned hospitals, including campuses as large as 2,000 beds, yet the government is also encouraging privately owned medical facilities "focusing the new China's well-to-do class. Interestingly enough, some of these hospitals will target the overseas customer," Kim notes.

When competing for design jobs in China, Gresham Smith isn't up against local companies. "We are actually competing against other international companies, including a lot of companies from Europe — German, France, England and also other large firms in the United States," Kim says. "We've found ourselves competing at the highest levels."

And winning. Gresham Smith recently won a design competition for a Hong Kong hospital. The facility will be a unique joint venture between a U.S. firm, which will own 51 percent and provide management, and Chinese partners who will build the buildings and provide the capital.

Kim says Gresham Smith's work in China is "the idea part. That's really where they need our help. Once you go beyond the idea level, then you find yourself competing against the local firms, and they have much less expensive manpower."

Also in the idea business is the Vanderbilt Center for Evidence-Based Medicine, which hosted delegations from six different countries this spring. Foreign government health systems are looking to Vanderbilt experts to help tackle a host of challenges, from outmoded and underfunded facilities to technology needs and hindered access.

"We'll essentially pair a team of Vanderbilt researchers with a team of researchers from that country," Executive Director Paul Keckley says. After an in-depth analysis of six to eight months, senior government officials would receive a series of recommendations and help from Vanderbilt experts to make those recommendations reality.

Keckley explains: "We have some pretty important pieces of the puzzle. First, Vanderbilt has the analytic capability to evaluate how best to move from where those systems are to where they should focus their energies and resources. … The second is we would bring a considerable amount of expertise to infrastructure, especially in information systems — clinical information systems that can be used in outpatient, inpatient and private-practice settings have been our strength. We can bring informatics to those systems, which is now the focus of a lot of U.S. activity. We've developed our own electronic medical record, and we can easily export that to other systems. Third, we're 1,500 clinicians, four hospitals operating as a system. So we can look at a system view of care that organizations that only look at one piece can't see. … We actually operate a puzzle — the full range from preventive, chronic and acute. We have the infrastructure necessary to manage that puzzle, and we have the clinical tools and the operating models to operate each of the pieces of that puzzle. There's a difference in really managing the puzzle and managing individual pieces. So I think that's a considerable advantage."

There's an advantage for Vanderbilt as well. Clinicians, epidemiologists, information technology experts and even economists will be exposed to different deliveries of healthcare as a result of the university's partnerships with other countries. "I dip into people from other schools, not just the School of Medicine," Keckley notes.

He adds that "it's not foreign to us to deal with internationals," explaining that 10 doctoral students from Budapest are studying at Vanderbilt now and students from the Czech Republic will arrive this summer.

"Every health system of the world is somewhat different. Even the 25 European Union countries have nuances and differences among them. We can't simply take what works in the U.S. and export it without understanding that it's got to be politically and culturally a fit," Keckley explains.

Gallivan sees that educational aspect as a job of the Health Care Council as well, and participants in the trade missions are enmeshed in a country's social and political mores prior to arrival. He notes that the trade missions "have really taken on an added degree of importance because they're actually leading to more formalized discussions." For example, earlier this year Hungary health officials and the U.S. government signed a memorandum of understanding based in large measure on Hungarian interactions with Nashville healthcare companies.

Foreign governments are realizing that, when it comes to healthcare, they "can't go it alone," Gallivan says. "Thus, they're looking for more innovative approaches. Frankly, a lot of those approaches have been developed by Nashville-based companies."