Like many academic medical centers, UCLA Health devotes considerable time and energy to honing its international strategy, both in treating patients from abroad and forging partnerships to deliver care to foreign patients closer to home. Not surprisingly, China and Southeast Asia have been key topics of discussion.

Mike Burke, director of international services at UCLA Health, has spent time in China exploring opportunities to provide consulting, education, training and management services for Chinese health care providers.

Framing the Issue

  • Many parts of the world, particularly Asia and the Middle East, view U.S. health care in the highest regard.
  • Overseas patients are coming to the U.S. in increasing numbers for treatment at American facilities.
  • There is a high demand among foreign health care systems to partner with U.S. providers.
  • The type of partnerships vary, from consulting services to helping to build and operate hospitals.
  • Those who have undertaken any kind of international venture caution that it is a long and complex process. 
  • In all cases, experts warn, it is critical to understand exactly what you are getting into and to protect your brand.

“We’re starting to structure a [partnership] with an existing consulting firm that has a lot of experience in international health care. We are designing an exclusive model that will give us a strategic and operational edge without having to hire an army of consultants in house,” Burke says. The partnership would allow UCLA’s Center for World Health to respond to requests such as writing business plans to build hospitals and potentially managing service agreements in China, as well as projects in Vietnam, Singapore and other areas, including the Middle East.

UCLA Health and other U.S. health systems focusing on building their international capabilities know they face a long, complicated and often resource-intensive journey, but they see this work as aligning well with their mission, helping to leverage their intellectual capital and as a means to supplement business development for years to come.

Protecting the brand

Brett Spencer, M.D., partner and managing director of the Boston Consulting Group’s health care business, says the objectives vary widely among U.S. hospitals with aspirations to grow their brand internationally. And while there are many international suitors looking to align with U.S. providers, Spencer says America’s health systems so far, generally and wisely, have been selective about lending their name to international joint ventures.

“There are a lot of suitors for a relatively few number of [organizations] in the U.S., and the ability to create value without destroying the brand in international markets is difficult,” Spencer cautions. “It’s OK to share information, but when you don’t have a brand tied to it, it makes it difficult to find ways to get adequately compensated for the brand risk and the necessary investments to make everyone comfortable that your name [is going] above that door.”

Indeed, relatively few U.S. health systems to date have lent their names to overseas partnerships; some that have include Johns Hopkins Medicine, Cleveland Clinic Foundation, Mayo Clinic and UPMC. Yet, many other health systems, including Stanford University Medical Center and Ochsner Health System, have begun establishing the infrastructure to promote international consulting services. Meanwhile, Houston Methodist opened an office in Dubai about eight years ago and launched an office in Saudi Arabia’s capital Riyadh in July. And in August, Ascension, the nation’s largest nonprofit health system, created a unit to extend its ministry and mission globally in support of its call to lead the transformation of health care and strengthen the Catholic health ministry internationally.

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“We’re setting up, for the first time, offshore consulting offices in Asia and the Middle East as our initial staging point for working overseas, because we understand that we need to be there with a value proposition and working those relationships that we have,” says Barbara Ralston, vice president of international medical services at Stanford University Medical Center.

This decision didn’t come quickly. Ralston says her organization spent a decade studying these markets and building relationships. The consulting offices, she notes, will have people on the ground to evaluate strategic initiatives from a legal and financial risk-management standpoint.

“We have lots of faculty members from China and both physicians and business people in Silicon Valley and India as well. But when somebody says, ‘Can you help us manage a hospital?’ we’ve got to know a lot about that project. To date, we have not participated in anything like that and we are very conservative about giving our brand to anybody,” Ralston says.

Members of Ochsner Health’s international team recently were in Saudi Arabia consulting as that nation steps up efforts to privatize areas of the national health system. Ochsner Health also has helped to facilitate discussions on a medical city being built in Saudi Arabia and a university that’s being set up there, says Ana Hands, M.D., Ochsner Health’s vice president for international health and transplant services.

“We helped them with their medical school curriculum and construction of a university hospital. We had our facilities team look at the blueprints and worked with them on the best way to build the hospital,” Hands says, adding that Ochsner also provided infection control and prevention consulting in the Middle East a couple of years ago when some providers there had difficulty stemming a large number of cases of methicillin-resistant Staphylococcus aureus.

Summer Dajani, vice president, global services, education and training for Houston Methodist, says her organization has a consulting advisory management group that works primarily with partners in Latin America and the Middle East.

“We have an office in Dubai that manages all of our projects in the Middle East, North Africa and Eastern Europe. We have finite consulting jobs all the way to longer-term relationships with multiple consulting jobs in the contract,” Dajani says, adding that the Houston Methodist board plays a strong governance role in this area.

“The board is involved and they get feedback on how we’re doing from a volume perspective, finances, what we are doing in other countries and how we are sharing best practices. Their interest is, if we’re a global company, it’s great that we serve patients, but what are we doing in those countries to showcase and share our best practices?” Dajani says.

U.S. health care in demand

The Boston Consulting Group’s Spencer says demand for U.S. health care expertise is strong and growing in many regions of the world, particularly the Middle East.

“The U.S. health care system gets criticized a lot, but we are by far the people others go to to ask for help. … The Middle East has always been interested [in U.S. health care]. In Southeast Asia and China, I think it has to do with the significant rise in the upper middle class. They aren’t wealthy enough to fly to the U.S. for care, but they want more than they can get from the public health service,” Spencer says.

Whether other international consulting services offered by U.S. health care providers can ever rival the likes of those built by larger and more-established programs remains to be seen, but clearly it won’t be easy.

Johns Hopkins Medicine International, for instance, employs about 400 people, with staff members representing 60 nationalities, says Pamela Paulk, president of JHI. Launched in 1998 to facilitate global expansion of the Johns Hopkins Medicine mission, JHI actively collaborates with nearly 20 leading hospitals, health providers, governments and educational institutions on five continents. The organization provides consultation services, including shared medical, quality and operational knowledge, so affiliates can expand and improve the health care they provide within their communities.

“Some of our projects are fairly short-term and smaller in scope,” Paulk says. “At the other end of the spectrum are joint ventures where we have an ownership stake, such as Johns Hopkins Aramco Healthcare, our first-of-its kind agreement in Saudi Arabia. With all affiliations, we strategically choose international endeavors that will improve health on a universal scale.”

UPMC, meanwhile, has projects or facilities in more than a dozen countries, including a pathology consulting and health care collaboration in China, a cancer center in Ireland, and transplantation and clinical management services in Singapore, to name a few. In late July, UPMC’s longtime partner Fundación Cardiovascular de Colombia opened the Oncology Institute, part of an 870-bed hospital in Colombia. The 200-bed Oncology Institute will provide state-of-the-art medical and radiation oncology treatments to patients who previously traveled hundreds of miles to receive such care in other regions.

Chuck Bogosta, president of UPMC International, says the complexity of international business development makes it difficult for many U.S. health systems to compete. But for those that successfully build long-term business, clinical, governmental and other relations abroad, the rewards can be significant.

“It both generates an alternate revenue source and it has been very important for our reputation,” Bogosta says, adding that UPMC has learned important lessons from its international activities.

“The GDP associated with health care in the U.S. is 17 to 18 percent. In developed countries outside the U.S., it’s in the 7 to 11 percent range and in the emerging markets it’s much lower — 3 [percent] to 4 percent. They’ve figured out how to provide care in a lower-cost way and we’ve learned quite a bit about how to be more efficient and still develop a high-quality program in a more efficient manner,” Bogosta says. — Bob Kehoe is a senior editor with H&HN.