Latest / Becker’s Healthcare Podcast / Building Global Healthcare Institutions Through AI, Innovation and Strategic Investment with Dr. Zain Kenderian

Transcript

Building Global Healthcare Institutions Through AI, Innovation and Strategic Investment with Dr. Zain Kenderian · Becker’s Healthcare Podcast

• 0:02
  - The strategic agenda facing hospital and health system
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  - leaders right now is not a short list.
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  - Growth in a consolidating market, sustainable margins in
• 0:09
  - a reimbursement environment that rarely moves in your
• 0:12
  - favor,
• 0:12
  - a tech investment cycle that demands both urgency
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  - and discipline,
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  - and a workforce story that is still being
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  - written.
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  - Eker's fourteenth annual CEO CFO roundtable brings together
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  - more than 1,500 executive level attendees and nearly
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  - 400 speakers across four days of sessions that
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  - are designed to help c suite leaders benchmark,
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  - pressure test, and sharpen their priorities.
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  - Not in the abstract, but against the real
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  - decisions they'll face heading into the next year.
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  - It's the kind of event you leave with
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  - a clear sense of where you stand and
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  - what comes next.
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  - So join us November second through the fifth
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  - at the Hyatt Regency in Chicago,
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  - and come ready to do the hard thinking.
• 0:50
  - Register on our events page at beckershospitalreview.com
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  - by clicking on the events tab in the
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  - upper right.
• 0:58
  - This is Laura Dirda with the Becker's Healthcare
• 1:00
  - podcast. I'm thrilled today to be joined by
• 1:02
  - doctor Zainen Kundarian,
• 1:03
  - chief executive officer of Bascom Palmer Eye Institute
• 1:06
  - Abu Dhabi. Doctor Kundarian, it's a pleasure to
• 1:08
  - have you on the podcast today. Thank you,
• 1:10
  - Laura. It's a pleasure, to be here.
• 1:13
  - Absolutely. Now I'm excited for our conversation. I
• 1:14
  - know we're gonna talk a lot about the
• 1:16
  - Eye Institute, its first international location that you're
• 1:19
  - heading up and how you're thinking about the
• 1:21
  - future. But before we dive in, can you
• 1:23
  - briefly introduce yourself and just tell us a
• 1:24
  - little about your background?
• 1:26
  - Absolutely.
• 1:27
  - It's a pleasure.
• 1:28
  - I'm Zain Kandarian.
• 1:30
  - I'm a physician by training. I, grew up
• 1:32
  - in Iraq, earned my medical degree in Baghdad.
• 1:36
  - And over time, my career moved, from the
• 1:39
  - bedside,
• 1:40
  - towards building the institutions that deliver care.
• 1:45
  - That took me to Kellogg Business School, for
• 1:47
  - an executive MBA
• 1:49
  - because access,
• 1:51
  - quality,
• 1:53
  - sustainability
• 1:54
  - are as much about how we organize and
• 1:56
  - finance care as about clinical medicine.
• 2:00
  - Today,
• 2:01
  - I'm the the, as you mentioned, the the
• 2:03
  - CEO of Bascom Palmer Eye Institute Abu Dhabi,
• 2:05
  - which is the first international location of Baskin
• 2:08
  - Palmer,
• 2:09
  - which The US news has ranked us as
• 2:11
  - the number one eye institute,
• 2:13
  - eye hospital,
• 2:14
  - in The US,
• 2:15
  - 25 times.
• 2:17
  - We opened our doors in Abu Dhabi,
• 2:20
  - back in November,
• 2:21
  - last year 2025.
• 2:23
  - Also, my work as group,
• 2:25
  - executive vice president and COO at Soze Group
• 2:29
  - in August Medical, which is a private equity
• 2:31
  - group.
• 2:32
  - We mainly invest in in health care and
• 2:35
  - education,
• 2:36
  - about 80% health care, 20% education,
• 2:39
  - gave me the,
• 2:40
  - investors' view of what it takes to build
• 2:44
  - institutions
• 2:45
  - that last.
• 2:46
  - Also, humanitarian work,
• 2:49
  - has been a big part of my of
• 2:51
  - my life.
• 2:52
  - It continues to shape how I think about
• 2:54
  - access to care.
• 2:56
  - So so
• 2:57
  - in brief, if if there is a common
• 2:59
  - theme
• 3:00
  - is that I sit
• 3:02
  - where medicine,
• 3:04
  - capital, and execution meet.
• 3:07
  - Well, that makes a lot of sense. You
• 3:08
  - know? And it's a really great background to
• 3:09
  - have and a place to be, especially in
• 3:11
  - today's health care environment. So could you tell
• 3:13
  - us a little bit about the deal you
• 3:14
  - negotiated with to bring Bascom Palmer
• 3:17
  - High Institute's first international location to Abu Dhabi?
• 3:20
  - What made that expansion model work? Yeah. Absolutely.
• 3:23
  - The short version,
• 3:25
  - it took a long time, and it worked,
• 3:28
  - because every party got something it needed.
• 3:32
  - So my role was to negotiate and structure
• 3:34
  - the partnership with the University of Miami and
• 3:37
  - Bascom Palmer and align it with the Department
• 3:39
  - of Health in Abu Dhabi.
• 3:42
  - This is not a franchise. It's, it's not
• 3:44
  - a branch office.
• 3:46
  - Local capital,
• 3:48
  - carries the investment.
• 3:50
  - Miami brings the standard, the faculty, and the
• 3:52
  - governance.
• 3:54
  - Our,
• 3:55
  - CMO, chief medical officer, doctor David Sears, Bascom
• 3:58
  - Palmer faculty,
• 3:59
  - and most of our physicians
• 4:01
  - are recruited through the university
• 4:04
  - and seconded to Abu Dhabi. Now
• 4:07
  - it worked for three main reasons in in
• 4:09
  - my opinion.
• 4:11
  - First,
• 4:12
  - a government
• 4:14
  - that wanted it. Abu Dhabi government has a
• 4:17
  - very clear strategy
• 4:18
  - to keep complex care in the country. So
• 4:21
  - the regulator,
• 4:23
  - was a part... Partner from the get go,
• 4:26
  - from day one,
• 4:27
  - rather than a hurdle.
• 4:29
  - Second,
• 4:31
  - protecting the brand instead of diluting it. So,
• 4:35
  - for an institution like Bascom Palmer that's ranked,
• 4:39
  - number one for a quarter of a century,
• 4:42
  - the biggest risk is reputational.
• 4:45
  - We built everything around quality.
• 4:48
  - Miami,
• 4:49
  - protocols adapted to local population shared governance and
• 4:53
  - and and real time collaboration.
• 4:56
  - Our principle,
• 4:58
  - is that we move,
• 5:00
  - expertise
• 5:01
  - before we move the patient, which is very
• 5:03
  - important.
• 5:05
  - Every patient,
• 5:06
  - is evaluated in Abu Dhabi first.
• 5:09
  - If we can do it locally, we bring
• 5:11
  - Miami expertise,
• 5:13
  - to Abu Dhabi. And only then, if it
• 5:16
  - didn't work, we send patients to Miami.
• 5:18
  - And the third element that made it work
• 5:20
  - was building an institution, really, not a clinic.
• 5:24
  - We're doing academic medicine.
• 5:26
  - Our mission is really to to bring the
• 5:28
  - the the full Bascom Palmer model,
• 5:31
  - to the region, clinical care, research, and education.
• 5:36
  - For example, we've partnered with with, Abu Dhabi
• 5:39
  - Biobank,
• 5:40
  - to establish the first operational
• 5:43
  - iBank in the region.
• 5:45
  - Also, The Emirates the Emirates Society of Ophthalmology
• 5:48
  - named us first ever
• 5:50
  - strategic partner,
• 5:52
  - and we're planning to establish the first
• 5:55
  - fellowship program in The UAE so that we
• 5:57
  - can train the next generation of ophthalmologist
• 6:00
  - up to the standards of Bascom Palmer.
• 6:03
  - That's what makes it durable,
• 6:05
  - Laura, because
• 6:08
  - it wouldn't become durable, wouldn't become sustainable.
• 6:11
  - That's what makes the economics,
• 6:13
  - defensible
• 6:14
  - because the value is really...
• 6:16
  - Isn't the visit. It's the capability,
• 6:19
  - here. So if I wanna give,
• 6:22
  - a...
• 6:23
  - What I've learned from this experience, a lesson
• 6:26
  - maybe to other,
• 6:28
  - US systems,
• 6:30
  - who would want to go globally,
• 6:32
  - I would say
• 6:33
  - try to export
• 6:34
  - the culture and the institution
• 6:37
  - rather than you export the logo that's been
• 6:39
  - done before and failed.
• 6:41
  - Also, very, very important is to find a
• 6:44
  - local partner and a government whose ambition match,
• 6:49
  - yours.
• 6:51
  - That's some great advice and definitely so important
• 6:53
  - when you think about, you know, these types
• 6:55
  - of deals. I can imagine,
• 6:57
  - so many organizations,
• 6:58
  - health systems, and and groups are looking to
• 7:01
  - expand
• 7:01
  - in The United States, but also, abroad and
• 7:04
  - having that kind of footprint and ability to
• 7:06
  - understand the local governments and policies makes a
• 7:09
  - big difference.
• 7:10
  - Absolutely. Yeah.
• 7:12
  - I know Bascom Palmer Abu Dhabi integrates some
• 7:14
  - of the AI driven diagnostics and telemedicine from
• 7:17
  - day one, which is
• 7:18
  - incredibly,
• 7:19
  - fascinating to think about that advanced technology. So
• 7:22
  - what have you learned, and where is the
• 7:24
  - technology headed?
• 7:26
  - Yes. Absolutely. This is this is our strength.
• 7:28
  - So so
• 7:30
  - let me start with the biggest lesson learned
• 7:32
  - here.
• 7:33
  - You know, the the biggest lesson I learned
• 7:35
  - is that the technology
• 7:36
  - is rarely the bottleneck. The bottleneck is everything
• 7:39
  - around it. Right? So it's the workflow. It's
• 7:42
  - the,
• 7:43
  - data regulation
• 7:45
  - and and how how care gets paid for.
• 7:49
  - On the diagnostic side,
• 7:51
  - ophthalmology,
• 7:53
  - specifically is arguably is the most
• 7:55
  - AI ready specialty in medicine because,
• 7:59
  - so much of what we do is imaging.
• 8:01
  - Right? So,
• 8:02
  - and we all know that that AI,
• 8:05
  - thrives on data.
• 8:07
  - The first,
• 8:08
  - autonomous AI diagnostics
• 8:11
  - that the FDA authorized in 2018
• 8:13
  - was for diabetic retinopathy.
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  - And in The UAE, which is one of
• 8:18
  - the highest diabetes
• 8:19
  - rates in the world,
• 8:21
  - that matters enormously.
• 8:23
  - And I'll give you a concrete example of
• 8:25
  - this. In Abu Dhabi, we use something called
• 8:27
  - HERO, which is a... An integrated AI driven
• 8:32
  - diagnostic device,
• 8:33
  - which was born at Bascom Palmer in Miami.
• 8:37
  - Basically, it's a it's a headset,
• 8:40
  - automates the majority of the tests in a
• 8:43
  - comprehensive eye exam,
• 8:45
  - back... Backed by more than 70 patents.
• 8:49
  - So
• 8:50
  - in short, it does,
• 8:52
  - about 12 or 13,
• 8:54
  - comprehensive eye exams,
• 8:56
  - in about three minutes,
• 8:59
  - where if you go today to any,
• 9:01
  - eye hospital, it takes you about four to
• 9:04
  - six hours to do those, and it involves
• 9:06
  - many technologists and optometrists to do those.
• 9:11
  - So what we have learned is that AI
• 9:13
  - is a force multiplier, really. It it tells
• 9:15
  - us who needs a subspecialist
• 9:18
  - and how fast. It does not
• 9:20
  - replace a... Replace a subspecialist.
• 9:23
  - Laura, I get this question all the time
• 9:25
  - that
• 9:26
  - will AI replace,
• 9:28
  - doctors? Will AI replace ophthalmologist? And and the
• 9:31
  - answer is no.
• 9:33
  - The the better question, will ophthalmologist who use
• 9:36
  - AI
• 9:37
  - outperform those who don't? The answer is is
• 9:40
  - yes, decisively.
• 9:42
  - AI becomes a copilot. Right? That that extends,
• 9:46
  - what a skilled clinician,
• 9:49
  - can see and know.
• 9:50
  - On the telemedicine
• 9:52
  - front,
• 9:54
  - the the real value is cross border, and
• 9:56
  - this works really well for for us. A
• 9:59
  - complex case in Abu Dhabi
• 10:01
  - can be reviewed with our colleagues from Miami
• 10:03
  - without
• 10:04
  - the patient getting on a very long fifteen
• 10:07
  - hour flight,
• 10:09
  - which is massive.
• 10:11
  - That's how we put the... Move the expertise,
• 10:14
  - not the patient into practice.
• 10:17
  - The the the hard part isn't the video,
• 10:20
  - really. It's it's the licensure,
• 10:23
  - the liability,
• 10:25
  - the data protection again... Against two
• 10:28
  - completely different
• 10:29
  - jurisdictions,
• 10:30
  - and how the teleconsul get,
• 10:33
  - valued and paid.
• 10:35
  - But but that
• 10:37
  - has to be designed into the into the,
• 10:40
  - contract from from the start. And that's the
• 10:43
  - only way you could make it successful.
• 10:45
  - And where it's headed,
• 10:47
  - you know, I see, like, a a lot
• 10:48
  - of places, but I'll I'll shed light on
• 10:50
  - the three.
• 10:51
  - One in ophthalmology, specifically, the eye,
• 10:55
  - as the window of the whole body,
• 10:57
  - I believe retinal images predicting cardiovascular,
• 11:01
  - kidney, and neurodegenerative
• 11:03
  - disease.
• 11:04
  - That's one. Two, I think, care,
• 11:07
  - will be moving into home, meaning
• 11:09
  - patients
• 11:10
  - will come in
• 11:12
  - when they need treatment,
• 11:14
  - not,
• 11:15
  - on a fixed calendar, you know, follow-up.
• 11:18
  - And then also
• 11:19
  - something,
• 11:21
  - very important is gonna change,
• 11:23
  - the the field,
• 11:25
  - of medicine is AI plus genomics. So
• 11:30
  - Abu Dhabi has one of the of the
• 11:31
  - world's most ambitious population genome programs called Emirati
• 11:35
  - genomes.
• 11:37
  - That wealth of data paired with
• 11:40
  - Bascom Palmer strength, in gene therapy,
• 11:44
  - we will be able to diagnose inherited retinal
• 11:46
  - disease earlier and match patients
• 11:49
  - to trials and treatments that
• 11:51
  - were,
• 11:52
  - not available before.
• 11:54
  - So so the the winners,
• 11:56
  - when we use AI and and that technology
• 11:59
  - won't be those who has the best,
• 12:03
  - algorithm. There'll be those who build the workflow,
• 12:06
  - the data, and the trans... The trust to
• 12:08
  - use it.
• 12:10
  - I love that. And I think, you know,
• 12:11
  - being ahead of the curve is so important
• 12:13
  - these days and and doesn't take much, but
• 12:15
  - that kind of mindset and then a willingness
• 12:17
  - to invest in the technology and figure out
• 12:19
  - to your point how you can get your
• 12:20
  - data,
• 12:21
  - in place,
• 12:22
  - and build those workflows.
• 12:24
  - Now I'd love to learn more about your
• 12:25
  - perspective on private equity and investments in health
• 12:27
  - care as well. What's driving capital investments right
• 12:30
  - now, and where do you see some of
• 12:31
  - the biggest gaps that are still unaddressed?
• 12:33
  - Yeah. I'll answer,
• 12:35
  - as someone who who sits on on both
• 12:37
  - sides of the table. Right? So I run,
• 12:40
  - an operating institution
• 12:42
  - and and through Soza Group, I invest in
• 12:44
  - and advise health care companies.
• 12:46
  - So
• 12:47
  - what drives the capital,
• 12:50
  - I believe,
• 12:51
  - three things,
• 12:53
  - do drive the capital today. One,
• 12:56
  - demand that doesn't go away,
• 13:00
  - aging population,
• 13:01
  - chronic disease, and and care moving into outpatient
• 13:04
  - settings. Ophthalmology, obviously, is a is a textbook
• 13:07
  - case.
• 13:10
  - To, a shift in where the return comes
• 13:12
  - from.
• 13:13
  - So,
• 13:14
  - the old playbook,
• 13:16
  - was to roll up practices,
• 13:18
  - add leverage, and sell at higher multiple.
• 13:21
  - Higher rates today and closer scrutiny
• 13:25
  - took out that arbitrage. With with plenty of
• 13:27
  - dry powder and investors wanting capital back,
• 13:31
  - returns now have to come from operating better.
• 13:36
  - And and third,
• 13:38
  - sovereign and and regional capital. In The Gulf,
• 13:41
  - health is national strategy
• 13:44
  - and and a pillar of economic diversification.
• 13:47
  - And governments,
• 13:49
  - are deliberately
• 13:51
  - opening doors to private operators and and PPP,
• 13:54
  - public private
• 13:55
  - partnerships.
• 13:57
  - I see there are some gaps, in there.
• 14:00
  - First,
• 14:02
  - which is very obvious these days, capital is
• 14:05
  - abundant,
• 14:06
  - but capability is scarce.
• 14:08
  - There is a lot of money for building
• 14:10
  - and and equipment,
• 14:13
  - but far less for talent,
• 14:15
  - clinical governance, and, and training.
• 14:19
  - You can buy
• 14:20
  - a a machine in a month or two.
• 14:22
  - Right? But it takes a decade,
• 14:25
  - or sometimes more to build a team
• 14:29
  - that knows what to do with it.
• 14:31
  - Also,
• 14:33
  - I can I can tell you that almost
• 14:35
  - every business plan today
• 14:38
  - assumes doctors and nurses
• 14:40
  - who don't exist yet,
• 14:42
  - whether that's in The Gulf or even here
• 14:44
  - in The US? So that's that's one gap
• 14:47
  - that's quite obvious.
• 14:49
  - Second gap I see is that
• 14:51
  - to... Today, nobody has figured out how to
• 14:54
  - finance excellence.
• 14:56
  - So,
• 14:57
  - academic medicine, meaning research, education, clinical,
• 15:00
  - care
• 15:01
  - does not fit a,
• 15:03
  - quote, unquote,
• 15:05
  - five year halt.
• 15:07
  - Payers
• 15:08
  - can price procedures, but excellence is the expert
• 15:11
  - who is there when the rare case walks
• 15:14
  - in.
• 15:15
  - The the third gap, I would say,
• 15:20
  - the people with the greatest need.
• 15:22
  - Refugees,
• 15:24
  - displaced populations, the lower wage workers
• 15:27
  - are where the capital almost never
• 15:30
  - flows. And that's a problem. But that takes
• 15:33
  - philanthropy,
• 15:34
  - government, blended finance alongside investors
• 15:37
  - to solve that that problem, that gap.
• 15:41
  - It makes a lot of sense. You know,
• 15:42
  - it is really helpful to point out. I
• 15:44
  - think, it's just interesting to see how private
• 15:46
  - equity has evolved and for sure where it's
• 15:49
  - headed and some of the big opportunities,
• 15:51
  - that are untapped as of now. I'm curious
• 15:54
  - before we wrap up here, where do you
• 15:55
  - see health care ventures and private equity investment
• 15:57
  - headed in the next two to three years
• 15:58
  - or so?
• 16:00
  - Yeah. That's a very interesting
• 16:02
  - question.
• 16:03
  - My short answer is that,
• 16:05
  - I see fewer deals,
• 16:07
  - better deals, and maybe more accountability
• 16:10
  - for
• 16:11
  - whether the investment actually,
• 16:14
  - made care better.
• 16:16
  - First from financial engineering
• 16:19
  - to operating excellence.
• 16:21
  - So the the the roll up era is
• 16:23
  - giving way to fewer higher quality deals. Ophthalmology
• 16:27
  - shows it. Fewer than 100 groups transacted in
• 16:30
  - 2025
• 16:32
  - versus
• 16:33
  - more than 300 in 2021.
• 16:36
  - Second,
• 16:37
  - strategic buyers
• 16:39
  - are stepping in.
• 16:40
  - Drug distributors such as McKesson,
• 16:43
  - Syncora are already acquiring ophthalmology and retinal platforms.
• 16:48
  - So expect,
• 16:50
  - more of that vertical integration
• 16:53
  - where, specialty care delivery meets the drug and
• 16:56
  - supply chain.
• 16:58
  - It changes how physicians and investors should think
• 17:01
  - about exits.
• 17:03
  - And third,
• 17:05
  - I'd say,
• 17:06
  - maybe more scrutiny,
• 17:08
  - and that's not all bad.
• 17:10
  - Your own reporting has tracked it, I believe,
• 17:15
  - what I would say 25 states have proposed
• 17:18
  - or enacted laws
• 17:19
  - on private equity in health care and physician
• 17:22
  - practice management deals
• 17:24
  - are, I believe, on a... On pace to
• 17:26
  - fall by probably 50% this year. So investors
• 17:30
  - who treat physicians as partners and can show
• 17:33
  - better outcomes will be fine,
• 17:35
  - but I believe those who relying on leverage
• 17:37
  - and opacity
• 17:39
  - won't.
• 17:40
  - Fourth, I would say,
• 17:43
  - AI
• 17:44
  - moves from pilot to core operations and get
• 17:46
  - valued more carefully. So,
• 17:49
  - the way I see it is that money
• 17:51
  - will flow,
• 17:53
  - proprietary
• 17:54
  - data... Will will follow proprietary
• 17:56
  - proprietary data and and real clinical integration,
• 18:00
  - not thin layers on someone
• 18:03
  - else's model.
• 18:04
  - And and and the one I'm closest to
• 18:06
  - is the capital and and expertise crossing borders.
• 18:10
  - So
• 18:11
  - the way I see it is that the
• 18:13
  - The Gulf will be one of the of
• 18:15
  - the most important health care investment markets in
• 18:17
  - the world, and The US academic
• 18:20
  - medicine
• 18:21
  - is one of America's greatest exports. So I
• 18:23
  - expect
• 18:25
  - more,
• 18:26
  - US institutions
• 18:27
  - to follow our path
• 18:29
  - and more Gulf capital to flow into US
• 18:33
  - health care innovation.
• 18:35
  - That makes a ton of sense. I love
• 18:37
  - it. Doctor Kenderian, thank you so much for
• 18:38
  - joining us on the podcast today. This has
• 18:40
  - been such an insightful conversation, and I look
• 18:42
  - forward to connecting with you again soon. Thank
• 18:44
  - you so much. It was a pleasure to
• 18:46
  - join you. Thank you for having me on.