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EF: Can you elaborate on your background and how this contributes to your current role?

PC: I was trained as a dental surgeon and spent around 16 years in the public healthcare sector; I thought it would be of great value to have experience in the private sector too. I was fortunate to be given an opportunity with Mount Elizabeth Novena Hospital, which was at that time IHH Healthcare’s newest hospital in Singapore. The current success of the hospital is the result of the meticulous planning and strategic foresight of past and current CEOs and other leaders who laid the foundation. After a few years with the hospital, the COVID-19 pandemic hit, and I was grateful to be a part of the hospital during that challenging period for the healthcare industry. I feel incredibly privileged to have been a part of the hospital during this unique time, and now, as we move past the pandemic, we are planning for a new stage of growth for the hospital.

EF: Could you elaborate on the lessons learned from the pandemic from managing one of the most successful hospitals in Singapore?

PC: When I started my professional career in 2003, SARS hit and subsequently Singapore went through events like H1N1 in 2009, and now, COVID-19. Therefore, we have been preparing for disruptions and outbreaks in healthcare every few years. The lessons we learned from the preceding events were extremely useful in preparing us for the latter. However, every event was different, and we had to react in different ways. We had acquired experience through SARS on how to utilize and mobilize resources. Even the whole idea of triaging visitors to healthcare institutions proved to be very useful because we could assemble some of those and continue to evolve from there to learn, evaluate and change our strategies where necessary. We needed to keep an open mind, otherwise, we would have been blindsided. Interestingly, MNH was the first private hospital in Singapore to receive a COVID-19 patient. We received our first COVID-19 patient right at the beginning of the pandemic and thankfully we were alert, we made decisions on the go, and we adapted very quickly while keeping other patients safe. Those were the lessons learned at a hospital level. It was very important for us and that is the unique advantage that IHH SG has because we are a group of hospitals. It is very useful because you can count on the support of other hospitals to learn about the best practices. For example, we were able to allocate resources by assigning the most suitable hospital for the given task, especially for COVID-19 patients on a national level. It is crucial in times of crisis that different providers work together and support each other, both horizontally and vertically, to emerge from a crisis in a better condition. Another example that was very vivid for us was when we were involved in government contracts to provide border screening between Singapore and Malaysia. Right at the onset of the COVID-19 outbreak, there was a huge need to enhance and tighten border screening. This fell under our primary care division and our team went to the border and stayed overnight to help with screening at the Singapore-Malaysian causeway. In times of crisis, resources become scarce, so it is very important that all of us are willing to help one another in every way possible. There is no way any single provider or any single business can cope with that sudden surge of demand for resources

EF: In a post COVID-19 scenario, after making so many tactical decisions, what are the priorities for growth today?

PC: In Singapore, similar to many other economies, there remains a shortage of workforce across several sectors. To address this challenge, it is crucial to prioritize the recovery of our workforce capacity, particularly as it directly impacts healthcare. With two full years of COVID-19 behind us, there will inevitably be a surge in healthcare demands that cannot be fully addressed within a year. We are seeing patients not only from Singapore but also from other regions who require follow-up care that was deferred during the pandemic. This has resulted in more complex cases that take longer to stabilize. Additionally, healthcare providers are facing a new challenge: global inflationary pressures. Rising costs in healthcare were already on an upward trajectory, and this new pressure emphasizes the need for providers to find ways to deliver care more cost-effectively.

EF: How is Singapore addressing the issue of rising healthcare costs due to inflation and what measures are being taken to optimize resource utilization in the healthcare sector?

EF: The entire healthcare system in Singapore, including our group, is addressing this issue. The government has launched a "Healthier SG" campaign to improve the health of the population and control rising healthcare costs. Although we are in the private sector, we are closely aligned with the government's objectives to utilize healthcare resources in a more effective and cost-efficient manner to achieve better outcomes in healthcare.

EF: Can you describe the role you see for integrated healthcare and value-based care?

PC: The concept of value-based healthcare focuses on taking a longitudinal view of healthcare, rather than simply cutting costs at specific interventions. At IHH Healthcare Singapore, we are prioritizing value-driven outcomes that go beyond simply assessing the cost of care, and instead evaluate overall outcomes. We are also exploring how to make better use of big data and AI to enhance our interventions, both at the individual institution level and at the broader population level beyond hospital borders. This involves collaborating more effectively with primary care partners and sister units to improve integration. While it may be easy to determine the costs and outcomes of certain interventions, such as knee replacements, it is more challenging to understand the cost of managing chronic conditions and their associated outcomes.

EF: What is your opinion on the short to medium-term advancement and accessibility of digitalization and technology in Singapore, specifically in healthcare?

PC: There are two levels of consideration for using AI to improve healthcare. Firstly, AI can be used to improve the effectiveness of specific procedures, such as endoscopy by assisting clinicians in detecting issues like polyps. Many hospitals are already testing this, and it could reduce population-level misdiagnosis. Secondly, we need to aggregate data from multiple sources to improve the health outcomes of long-term patients. This means ensuring that long-term patients are healthy and implementing services that help them throughout different life stages. To achieve this, we need to leverage both AI and big data. By bringing together information from diverse sources, we can provide better healthcare outcomes.

EF: How is IHH SG working with the public sector to improve the healthcare landscape in Singapore? 

PC: The current focus of Singapore's public sector is to promote population health through empanelment with primary care physicians. Currently, only 20% of primary healthcare is provided in the public sector, with 80% being provided by individual general practitioners. The government is working to create networks that bring these individual primary care providers together to organize and care for the population. This is an important step towards providing longitudinal care and preventive services. In line with this, IHH SG has a primary care group of clinics and is working to build up its primary care sector to support the government's initiatives. Another goal is to understand healthcare costs in the hospital sector and find ways to reduce them, especially for patients requiring hospitalization. These initiatives are aligned with IHH SG's focus on value-driven outcomes.

EF: What is the unique position of private hospitals in Singapore?

PC: To better understand the healthcare setup in Singapore, it is important to consider the roles of private and public hospitals. Private hospitals in Singapore are primarily designed to address acute issues, with patients typically staying for around three days. However, this means that the disease burden and conditions treated in private hospitals may not be representative of the population, as those with chronic or geriatric conditions are more likely to seek treatment at public hospitals. This is due to government subsidies and incentives like the Pioneer Generation program, where some of the more elderly patients receive a high-level subsidy. Therefore, it is in their best interest, if they have a long-term ailment, to be treated in a public hospital. Private hospitals like those under IHH Healthcare Singapore are uniquely positioned to provide quick diagnosis, intervention, and short stays for patients with acute issues.

EF: You were appointed as the CEO of the hospital during a unique moment in modern history, what do you envision the future of healthcare to look like in five years? 

PC: The focus of Singapore’s healthcare is to achieve a healthier population through the "Healthier SG" movement initiated by the government. It is essential for IHH SG to contribute to this effort, as the responsibility of creating a healthy population cannot solely rest on the public sector. Our aim is to align with the public sector and measure our outcomes to ensure that we are producing healthcare outcomes in the most cost-effective manner. We are exploring innovative approaches to institutionalized care, such as developing an app-based platform called MyHealth360 for our patients, which will enable us to communicate with them continually and support them through their life stages and healthcare needs. As a large group, we have the privilege of investing in emerging technology and collaborating with companies that can help us improve our healthcare services. For instance, we have partnered with Lucene, which specializes in genetic testing, to deliver customized and high-precision medicine, and recently saw our first patient undergo proton therapy in our newly opened Proton Therapy Centre. Moreover, we are venturing into non-traditional areas of healthcare such as mental health programs by working with Intellect to implement post-natal depression trials at our sister hospital, Gleneagles Hospital. Our definition of healthcare is evolving to be more socialized, blurring the line between healthcare, social care, and education. We aspire to expand our horizons by looking at the most recent technology and investing in different companies with the sole purpose of improving our patients' health outcomes. By doing so, we hope to support the entire health population movement in Singapore.

N.B.: Dr Peter Chow has since become Acting Chief Executive Officer of IHH Healthcare Singapore

April 2023