Timely, relevant, and actionable investment perspective, best practices, and planning insights for institutional and wealth management clients from CAPTRUST's Consulting Research Group.

Advanced Filter

In Good Company


by Jennifer Brookland

The word “skeptic” comes from Greek roots that mean inquiry and observation— not doubt. So Dr. Franklin “Lin” Church has no problem admitting he was skeptical when he first heard about a business plan to send Americans overseas for surgery.

Actually, when Rajesh Rao sat at Church’s kitchen table over mugs of coffee and pitched the idea that would become IndUShealth, Church thought, “He’s a great guy, but he’s way out on a limb.”

Church had spent three decades as a family doctor in Raleigh, North Carolina, and, even though he’d stopped practicing several years prior, his drive to help people had never gone away. People still called or emailed—even stopped him in the grocery store—every day to ask for his medical opinion. To him, that kind of respect and trust was a currency all its own.

So before he traded any of that for a harebrained idea, Church needed Rao to convince him that the medicine was solid.

In fact, Rao was still overcoming his own skepticism about the idea. But the challenge of tackling the immense healthcare burden borne by American employers called to him. It was, as he says, a tough nut to crack. And Rao had always been drawn to just that kind of task.

A problem solver at heart, Rao had spent three decades working in the U.S. in positions ranging from an engineering job at IBM to C-suite roles in retail automation and e-learning software companies he helped found. “To me, the opportunity to evaluate a problem … and make customers really happy with a solution is just an exciting thing to be able to do,” he says.

Rao loved that, in the U.S., even little companies have the ability to nimbly and creatively make change—even for big customers. But it was time for a personal change. “For me, what I recognized midcareer when I made the switch is that I could continue doing some of the same things and solving the problems I knew how to solve, or I could switch careers and do something completely different,” he said.

The opportunity to crack that new, tough nut presented itself to Rao when Tom Keesling approached him through the Carolinas chapter of a global entrepreneurship group.

Keesling is a former hospital executive who had also worked in aviation and with technology start-ups. His experience in the American healthcare system left him feeling that he was contributing to an ever more broken system. It was a cognitive dissonance he eventually couldn’t ignore.

Could it really be possible for a software engineer and a hospital executive to change the way Americans accessed surgical care? He was skeptical, but he was in.

“I got very good at making a lot of money for hospitals,” Keesling says. “And unfortunately, when all the hospitals get very good at making money, what happens is the prices begin to go up. You find out the impact that all this is having on individuals. It stuck in the back of my head.”

Keesling thought the U.S. system was likely beyond meaningful reform. But he had another idea to give patients access to the expensive surgical treatments they needed. Why not offer them an option to travel to a country like India, where surgery was just as safe and effective but nowhere near as expensive?

When Rao heard Keesling’s thoughts, he couldn’t help but think of the India he had grown up in—chaotic India that was poor, top-down, and unevolved technologically. “My eyes were shut to imagining that things had gotten any better since I had left,” Rao says.

He was intrigued by Keesling’s healthcare background and interested in doing something different. “But he was suggesting something so out there and unique!” Rao says. “I was in disbelief at first.”

Then again, Rao’s intellectual curiosity was piqued. Could it really be possible for a software engineer and a hospital executive to change the way Americans access surgical care? He was skeptical, but he was in. Now Keesling and Rao needed a physician who could smooth the way for a blessing from the medical community.

So it wasn’t a great sign when Church took a sip of his coffee and said, “I don’t think this sounds doable.”

Twelve years later, IndUShealth has agreements in place covering more than 170,000 people across more than 40 companies with over 100 worksites across the country.

That first trip to India was enough to convince Church, who saw the gleaming, state-of-the art hospitals and internationally trained surgeons, reviewed the data on outcomes and recovery times, and marveled at costs that were less than half of what the same procedures would cost at home.

Patients from rural America, especially, get an opportunity to have top-notch surgery at high-volume centers, something not always guaranteed where they live and work, where competition between hospital systems is often minimal.

“When I came back from India after that first visit, I had fear and trepidation that the medical profession was going to be really negative about what we were doing,” Church says. But at a presentation when he asked how many doctors in the room had patients who couldn’t afford the co-pays on their surgeries, every single one of them raised their hands.

“Very few people can afford $5,000 for a knee replacement,” Church says. “I saw the opportunity to send people to India and get the same hardware at a fraction of the cost.”

 These days, most patients travel to closer countries, like Costa Rica and the Cayman Islands, that have caught up in their expertise and technology. IndUShealth offers orthopedic procedures like hip and shoulder replacements and neurosurgical procedures, including cervical disc replacement, as well as hernia repairs and weight-loss surgeries.

By sending their workers overseas, employers save thousands of dollars.

“There’s so much talk about the need to keep jobs in the U.S., but so much of the export of jobs is connected to the high cost of health care for the workforce,” explains Rao. “So we are right there, helping to do more than just lip service to keep their jobs here. We are actually reducing the cost of care to where these jobs can really be saved. And that’s exciting to me.”

And faced with an aging workforce whose output is declining as its healthcare costs escalate, Church is proud that IndUShealth’s “medical tourism” options take non-productive people and make them productive again.

People like Gary and Kay Harwell of Hickory, North Carolina, who have had a combined five surgeries in Costa Rica at no out-of-pocket cost thanks to the option offered by their former employer, manufacturer HSM Solutions, to use IndUShealth’s global healthcare option. Kay Harwell had lower back surgery and is doing wonderfully, according to her husband. For his part, 69-year-old Gary Harwell most recently had a knee replacement. 

Each time they traveled to Costa Rica—patients may travel with a companion at no cost—the Harwells stayed in a resort bursting with orchids, violets, and other native flowers and vegetation.

IndUShealth and the caseworker assigned to Gary Harwell made all the plans and approved them through his insurer, provided passports and purchased plane tickets, made their reservations, and scheduled doctor and hospital visits. IndUShealth even provided the Harwells with calling cards to make sure they could stay in touch with family back in Hickory.

“Everything was turnkey,” Harwell says. “I didn’t have to worry about a thing.”

The medical care seemed more personal compared to what Harwell had experienced in American hospitals. In Costa Rica, “they looked after my needs and took care of me, and if I had any problems, I had a phone, and I could just call them up and say ‘Help me out,’ and they would be there in 30 minutes,” he remembers. “Surgery in the U.S. was less personal. Needs were met, but it was different.”

That level of care and attention from IndUShealth made a world of difference to the Harwells, who had never traveled outside the U.S. before.

“They were truly sincere about helping the patient,” Harwell says. “They’re just good folks, as us Southerners would say.”

For Rao, Keesling, and Church, the thank-yous from grateful employees like the Harwells is reason enough to keep pushing to find creative ways to change health care.

“I went from a situation where I tried to share the misery as widely as possible,” says Keesling of his time trying to turn around rural hospitals’ economic woes. “And I just got back from the Ashley Furniture (an IndUShealth client) picnic where people lined up to say thank you. It’s a nice transition.”

For his part, Rao is relishing the ability to keep problem solving. He had worried at the start about giving it all up. But now, he’s hooked on the fun of challenging himself and continuously learning more.

“It’s easy to become an expert if you immerse yourself and learn everything you can learn,” Rao says. Church says admiringly that his software engineering colleague has practically taught himself medicine; he brings Rao copies of the New England Journal of Medicine to peruse when the three get together each week in Raleigh.

To Rao, IndUShealth’s success is “a good affirmation that we can be not only good at what we do, but be leaders. And we are,” he points out. The company is the exclusive provider of this service to large companies, and within two years of its founding, Rao was testifying before Congress about the approach.

“In retrospect, it was the type of challenge I was looking for,” Rao says, even though at the start it was tough to come up against so many disbelievers.