IVEy Publishing 9B20A028 GETTREATED. A DIGITAL MEDICAL TOURISM CONCIERGE SERVICE IN ARMENIA Dr. Anahit Armenakyan and Raffi Elliott wrote this case...
Question Get Answer

i need answers of these five questions. <br/>- Start by identifying

the problem, or in other words what you think needs to be solved and discuss it in relevant detail.
 
2- List and discuss relevant facts from the case that are directly associated with the identified problem.
 
3- Discuss relevant marketing concepts, that may be applied in this situation and elaborate their relevance in this case.
 
4- Recommendation: After identifying the problem, and discussing the applicable marketing concepts, make two to three recommendations (or in other words the best course of action to deal with the problem).
 
5. Finish the discussion by choosing one course of action and explain why this is the best choice.

1.jpg
IVEy Publishing
9B20A028
GETTREATED.CO: A DIGITAL MEDICAL TOURISM CONCIERGE
SERVICE IN ARMENIA
Dr. Anahit Armenakyan and Raffi Elliott wrote this case solely to provide material for class discussion. The authors do not intend to
illustrate either effective or ineffective handling of a managerial situation. The authors may have disguised certain names and other
identifying information to protect confidentiality.
This publication may not be transmitted, photocopied, digitized, or otherwise reproduced in any form or by any means without the
permission of the copyright holder. Reproduction of this material is not covered under authorization by any reproduction rights
organization. To order copies or request permission to reproduce materials, contact Ivey Publishing, Ivey Business School, Western
University, London, Ontario, Canada, N6G ON1; (t) 519.661.3208; (e) [email protected]; www.iveycases.com. Our goal is to publish
materials of the highest quality; submit any errata to [email protected]
Copyright @ 2020, Ivey Business School Foundation
Version: 2020-04-06
It was a bright sunny morning on January 23, 2019, in Yerevan. Raffi Elliott, the chief executive officer (CEO)
and founder of GetTreated CJSC (GT), was enjoying the cool air at his desk in Impact Hub Yerevan- a local
chapter of the world's largest network focused on building entrepreneurial communities for impact at scale. As
the floor began to fill up with working buzz, many interesting ideas were circulating in this place that invited
entrepreneurs and business innovators from all over the world to Armenia. Taking a brief glance at the looks
of sheer enthusiasm on the faces of his peers, Elliott recovered the sense of optimism that had generated his
business idea in the first place. His working concept consisted of a digital medical tourism concierge service
that would help people find affordable and safe medical treatments abroad. The business he built on this
model-GT-was growing steadily with about a 5 per cent customer base growth rate; but he knew there was
potential for higher growth: tourists from all over the world were coming to the &quot;new&quot; post-Velvet Revolution
Armenia, while the Armenian medical sector grew in accordance, gaining increasing recognition in the world.
It was a time to strategize and think of a better way to capture the momentum.
MEDICAL TOURISM
Worldwide
The Medical Tourism Association defined medical tourism as a phenomenon whereby &quot;people who live in
one country travel to another country to receive medical, dental and surgical care while at the same time
receiving equal to or greater care than they would have in their own country, and are traveling for medical
care because of affordability, better access to care or a higher level of quality of care.&quot; Once associated
with cheap cosmetic surgery and fringe medical therapies, medical tourism was beginning to gain traction
in many countries as a solution to rising health care costs.* Medical tourism was also being viewed as a
form of niche tourism, where people travelled overseas to obtain medical, dental, and surgical care while
simultaneously being on holiday.' A direct result of the globalization of health care, medical tourism was
gaining momentum and catering to over 3 million patients, growing at a rate of 20 to 30 per cent annually.
Rising health care costs in industrialized countries, coupled with the availability of high-quality medical
services at significantly lower prices in developing countries, were the strongest drivers of medical tourism.
Another factor contributing to the increase in the numbers of medical tourists was inadequate coverage of
some medical procedures (e.g., dental or cosmetic) by home country health insurance.' While this was
Page 2
9B20A028
particularly true for countries with no widespread national coverage, like the United States, medical tourism
was attractive even in countries with national health coverage, like the United Kingdom and Canada, but
with long waiting lists and growing aging populations. According to the Fraser Institute, in 2016, an
10.jpg
1:43
LTE
D
X
9B20A028_pcs (1).pdf
Page 10
9B20A028
EXHIBIT 2. PRICES FOR SELECTED MEDICAL PROCEDURES ACROSS THE GLOBE IN 2019 (USD)
Medical
Costa
procedure
Armenia
USA
Canada
Rica
Colombia India
Israel
Malaysia
Turkey
Dental implant
$600
$2,500
$2,500
$800
$1,200
$900
$1,200
$1,500
$1, 100
Breast implants
$4,000
$6,400 $10,000 $3,500
$2,500 $3,000
$3,800
$3,800
$4,500
Rhinoplasty
$1,300
$6,500
$6,500
$3,800
$4,500 $2,400
$4,600
$2,200
$3,800 $11,000 $10,000
$4,500
$4,000 $3,500
$3,550
$3, 100
Face lift
$6,800
$6,700
Liposuction
$1,500
$5,500
$3,000
$2,800
$2,500 $2,800
$2,500
$2,500
$3,000
Tummy tuck
$3,500
$8,000
$8,000
$5,000
$3,500 $3,500 $10,900
$3,900
$4,000
LASIK (both eyes)
$850
$4,000
$4,000
$2,400
$2,400 $1,000
$3,800
$3,450
$1,700
Note: Prices are approximate and do not include airfare travel or lodging costs for a patient and companion. Prices vary based
upon many factors, including hospital, doctor's experience, accreditation, and currency exchange rates.
Source: &quot;International Medical Treatment Prices,&quot; Medical Tourism Association, n.d., accessed March 20, 2020,
https://medicaltourism.com/Forms/price-comparison.aspx.
EXHIBIT 3. PRICELIST COMPARISON FOR SELECTED DENTAL AND LASIK PROCEDURES
Procedures (a selected list of services
GetTreated.co
Comparative prices for procedures
provided by GetTreated.co)
in Ontario (Canada), in CAD
Dental Dental consultation,
50,000 AMD
Child exam - $67
Treatments planning
Adult exam - $133
Implant
250,000 AMD
Initial/final $1,600/$4,000 for each
implant (per tooth
Inlay
150,000 AMD
N/A
Crown
160,000 AMD
$1,425 (gold),
(zirconium)
or $1,625 (porcelain)
Veneer
150,000 AMD
$1,750
Complete denture
150,000 AMD
$1,000-$3,000
Removable partial denture
250,000 AMD
$700-$3,500
Gum formation
30,000 AMD
Root canal filing
18,000 AMD
Small tooth filling: $80 (silver filling) or
$200 (white filling)
Large tooth filling: $325
Tooth extraction
10,000-35,000 AMD
Starting at $136
Wisdom tooth removal
50.000 AMD
N/A
Teeth whitening
250,000 AMD
$650
LASIK LASIK consultation
15,000 AMD
$500
Laser operation/ LASIK/ 2 eyes
400,000 AMD
$4,000
Laser operation/ LASIK/ 1 eye
200,000 AMD
$2,000
Note: N/A = not available. AMD = Armenian Dram, 1 AMD = CA$0.0028 on January 23, 2019.
Sources: Robert A. Milner, &quot;Dental Bridges: The Cost of Bridging the Gap,&quot; Consumer Guide to Dentistry, April 18, 2019,
accessed March 20, 2020; &quot;Laser Eye Surgery Costs in Canada,&quot; Olympia Benefits Inc., March 7, 2014, accessed March 20,
2020, www.olympiabenefits.com/blog/laser-eye-surgery-cost-in-canada.
Page 11
9B20A028
EXHIBIT 4. BREAKDOWN OF CUSTOMERS BY YEAR, COUNTRY OF ORIGIN, TYPE OF SERVICE,
AND GENDER
11.jpg
1:44
. LTE
D
X
9B20A028_pcs (1).pdf
Page 11
9B20A028
EXHIBIT 4. BREAKDOWN OF CUSTOMERS BY YEAR, COUNTRY OF ORIGIN, TYPE OF SERVICE,
AND GENDER
Year
2014
2015
2016
Month NN
COO
Service Gender NN
COO
Service Gender NN
COO
Service Gender
Jan
Slovakia
Dental
Feb
12
France
Dental MF
2
USA
Dental
FM
Italy
Dental/ FM/
Mar
Canada
Dental
F
Canada
Dental F
5
Philippines LASIK FFF
Australial
LASIK/ FFM/
Apr
Armenia
Dental
F
2
Austria
Dental MF
6
USA
Plastic FFM
UAE
Dental/
Canada/
MM/
May
Canada
Dental M
13
Canada
Plastic MF/M
3
Germany
Dental M
Armenial
Jun
12
UK
Dental MF
3
Croatia
Dental MF/F
Canada
Ju
2
USA
Dental M/F
3
Canada
Dental FMM
2
Canada
Plastic FM
Canada/ Dental/
Aug
2
JSA
Plastic M/F
2
Argentina Plastic MM
2
Czechia
LASIK
FF
Russial
USA
MFM/M/
Sept
Canada
Dental
F
5
Argentina
Dental
Oct
USA
Dental F
3
Germany LASIK FFM
Nov
1
France
Dental
F
3
Canada
Dental FMM
3
Qatar/UAE Dental MF/F
Dec
3
Canada Dental FFF
Canada
Dental F
Year
2017
2018
Month
NN
COO
Service
Gender NN
COO
Service
Gender
Jan
2
Canada
Denta
MM
3
Canada
Denta
FMM
Ireland/Germany
Dental/
Feb
3
Austria
Dental/Plastic
M/M/F
2
Russia
Dental
MM
Mar
2
Canada
Dental
FM
Canada
Dental
FFM
Canada/USA/
Apr
4
Armenia
Dental
F/F/2F
Ukraine/UAE
Dental
M/F
May
3
Spain/Canada
Plastic/Dental
F/MM
France/Czechia
Denta
FF/F
Poland/USA
Canada/France/
MM/M/
Jun
4
Canada
Dental
F/FM/M
14
Lithuania
Dental
F
Jul
15
Russia/USA
Dental
FFM/FF
3
France/Canada
Dental
MM/F
Uruguay/
Canada/Armenia/ Dental/Dental/
MMM/
Argentina/UK/
Dental/LASIK/ MF/MF/
Aug
6
France/USA
Plastic/LASIK
M/F/F
R
Ireland
Dental/Dental F/FFF
Philippines/
LASIK/
Sept
4
Armenia/Georgia
Dental/Dental
FF/M/M
4
Canada/USA
Dental
MMF/F
Canada/France/
Japan/Finland/
LASIK/Dental/ FF/M/
Oct
3
USA
Dental
M/F/M
6
Spain
Dental
MMF
Nov
13
Israel/Greece
Dental
FF /F
IN
Canada
|Dental
MF
Dec
Canada
Dental
M
3
Estonia
Dental
FFF
Note: F = female; M = male; NN = numbers; COO=country of origin.
Source: Raffi Elliott, personal interview with authors, January 23, 2019.
Page 12
9B20A028
2.png
Page 2 SBZOAOZS particularly true for countries with no widespread national coverage, like the United States, medical tourism
was attractive even in countries with national health coverage, like the United Kingdom and Canada, but
with long waiting lists and growing aging populations. According to the Fraser Institute, in 2016, an
estimated 63,459 Canadians travelled abroad for medical treatment due to long waiting times. Other drivers
of the medical tourism industry were highly sought privacy and confidentiality as well as improved
communication technology and globalization? A 2008 McKinsey report, generated from an analysis of the top 20 medical tourism destinations, revealed
five discrete segments among the global medical tourist.” One segment consisted of those who wanted the most advanced technologies and who paid little attention to
the proximity of the potential destination (about 40 per cent); these patients came mostly from Latin America,
the Middle East, Europe, and Canada, and they tended to seek health services in the United States.11 Another segment consisted of those who sought better quality care for necessary procedures because they
could not find it in their own countries (abOut 32 per cent); these patients often came from the developing
world and were usually concerned with costs, distance, and unfamiliar cultures. ‘2 A third segment sought quicker access for medically necessary procedures and wanted to avoid long wait
times at home for procedures Such as orthopaedics, general surgery, or cardiology (about 15 per cent); the
number of these tourists was largely dependent on health investments and policies in their home countries. 13 Another segment sought lower costs for medically necessary procedures (about 9 per cent); with increasing
bills for health services in most developed countries, this segment had the highest potential for growth, with
the largest numbers of patients coming from North America.” The final segment (about 4 per cent) sought lower costs for discretionary procedures (e.g., breast
augmentation/reduction, rhinoplasty); similar to the preceding segment, these patients came mostly from
developed countries and preferred going to smaller specialized providers than to large multispecialty hospitals.15 In Armenia Armenia was slowly becoming a viable player in the world medical tourism industry due to its highly
qualified medical professionals and rapidly increasing numbers of medical clinics with advanced world-
class technology. It was an attractive destination with a rich and ancient culture and beautiful landscapes.
According to a report by the World Travel &amp; Tourism Council (WTTC), the country was experiencing a
steady growth in the number of tourists choosing Armenia as a destination, with the tourism sector’s
contribution reaching 4.4 per cent of the national gross domestic product in 2017 with a predicted per annual
growth of 4.2 per cent from 2018 to 2028.16 The WTTC ranked Armenia 5th out of 185 countries in tourism
growth. However, while a 2017 KPMG report indicated that only 8.5 per cent of incoming tourists to
Armenia came for health treatment,” this figure might not have been fully representative of the size of the
market because many treatments went unreported. The number of clinics catering to medical tourists, as
well as the new offerings (e.g., well-being tours and health treatments) from the regular tourist agencies,
continued to grow.18 According to Armenia Travel, the country was an attractive destination for both
domestic and international tourists, with its healing resorts, where courses on speleotherapy were offered
to people with respiratory and lung diseases in unique microclimates of the underground caves; its spa
resorts with hot springs; its clinics for dental and plastic surgeries; and its well-being eco-retreats.19 Authorized tor use only by Hemang Patel in BUSI 2063 at Yorkville University from Apr 20, 2020 to Jul 07, 2020.
Use outside these parameters is a copyright violation.
3.png
Page 3 9B20A028 GETTREATED CJSC The Company GT was a platform that provided all-inclusive services for inbound medical tourists to Armenia. The
company was based in Yerevan, the vibrant capital of the Republic of Armenia. The idea of the company
was seeded in 2014, when Elliott (a Canadian of Armenian and Irish heritage) made his final decision to
relocate to Armenia from Canada to establish a new life. Rectifying the results of an unsatisfactory medical
procedure in Canada and positively surprised by the quality and affordable cost of the medical treatment in
Armenia, Elliott came up with the idea of opening a medical tourism company. After conducting extensive
research on the medical tourism industry and weighing the risks and potentials, he concluded that Armenia,
with its world-class doctors and welcoming image for tourism, had a lot to offer to international tourists
seeking affordable treatments overseas. Elliott initially thought of an “Expedia-like&quot; booking platform for
medical tourism. However, after four years of testing different strategic directions and making a number of
modifications, Elliott adopted the current model of a digital medical concierge-style service with a focused
patient-centric approach. His business was based on four pillars, or value propositions: ease of use,
convenience, affordability, and safety. As medical tourists wanted the ability to easily see and compare prices for medical treatments abroad in a
transparent and honest way, Elliott put a lot of effort into developing GT’s website ’s user interface to reduce
as much friction as possflale between the client and the treatment. The whole process of arranging for a
medical service through GT was straightforward. Anybody interested in medical treatment needed to
complete the “Get Started&quot; form detailing the type of medical procedure required (e.g., dental), a preferred
doctor’s name from the available list of doctors, the specific procedure (e.g., general consultation,
zirconium crown), and the estimated time of travel (e.g., within the month of April 2019). Upon receipt of
the completed form, GT would contact the client to arrange the best time for treatment, book the doctors,
and make accommodations. Once the client was committed and had booked a flight, a GT representative
would be arranged to meet the client at Zvarmots International Airport and take them to the hotel. On arrival
at the hotel, the client would take some time to rest and would then be taken by the GT representative to
the chosen doctor for the first appointment and in-person consultation. In some cases (e.g., plastic
treatment), the first consultation was done online prior to the patient’s arrival. Multilingual GT staff
members andfor contractors also worked as translators whenever necessary. GT would take care of every step of the client’s journey, fi-om flights to hotel accommodation to
translations. To make the stay as convenient as possible, clients would be given an Armphone—a
smartphone designed and assembled in Armenia with preinstalled made-in-Armenia apps (see Exhibit 1)—
which they would return once they had received and finished their treatment. Safety in medical tourism had a twofold meaning: the safety of the service and the safety of the destination.
GT’s clients were guaranteed a world-class quality service based on the understanding that trust was of
paramount importance. Doctors and clinics partnering with GT were carefully and rigorously vetted for
quality in accordance with the Armenian Medical International Committee’s (AMIC) guidelines.20
Although GT could not guarantee the safety of the destination, the company made efforts to mitigate any
risks of the service by working “on the side” of the client. Treatments on GT’s platform were usually one-half to one-third the price of the same treatments in the patients’
home cauntries. Affordable treatment was one of the strongest points of differentiation for medical travel to
Armenia, and GT made sure to place a strong emphasis on price in its marketing communications message. As
Elliott put it, people “canget asuperior treatment to what theycan get in, say, Canada for athird ofthe price. In
other words, instead of getting the same crown or implant in Canada, one can get a crown or an implant that they
can never afford in Canada here for less than a basic one in Canada” (see Exhibit 2). Authorized for use only by Hemang Patel in BUSI 2063 at Yorkville Universitytrom Apr 20, 2020 to Jul 07, 2020. Use outside these parameters is a copyright violation.
4.png
Page 4 QBZOAOZS People GT was a small company with one full-time and two part-time employees. Elliott, the founder and CEO,
was the only full-time member of the company. Although born in Montreal (Quebec, Canada), he always
had strong connections with Armenia, visiting the country numerous times throughout his studies in
political science at the University of Ottawa, from which he graduated with an honours degree in 201 1. The
idea to move to Armenia was always in the back of his mind, but it was his experience working as a research
fellow at the European Friends of Armenia that helped him to finalize the decision that same year.21 Elliott
went on to earn his master’s degree in political economy from the American University of Armenia in 2015.
Having an entrepreneurial spirit, he seized the opportunity to enter the ever-growing information
technology (IT) sector of Armenia in 2012 via the first “Start-Up Cup” competition, with an innovative
start-up company called NEST Innovations. The company recruited yOung talent and offered a quality
service in up to six languages to provide a one-stop-shop of IT services for small and medium-sized
companies around the world, which combined web development with maintenance and upgrade services.
As margins became low and the competition for similar services from India got tougher, Elliott started
looking for more innovative ideas and decided to reorient his attention toward a start-up that would provide
affordable quality health care to people like him. GT was originally conceived as a tech company rather than a service provider. For this reason, Elliott hired
graphic designers, database managers, and full stack developers. As the company’s focus shified toward
pmviding a more individual approach for clients, it became apparent that in-house tech work was redundant
and distracted from the core business. As website maintenance and other services were later outsourced to
an independent web developer, Elliott took on a more direct role in developing the business and working
in the client-facing side of the business. The company employed two people on a contract basis. The
contractors were in charge of the in-country care for incoming patients (e.g., airport pickup, transfers to
hotels or clinics, and translation services). These contractors also acted as personal concierges for the
patients, advising them on where to eat or what to see, and were paid on an hourly basis. Elliott also hired
a part-time customer service representative to take on some of the additional seasonal incoming customer
volume and relied on freelancers for some of the additional workload. Additionally, GT subcontracted local
tourism expeditions to a small tourism agency called Arevakar Travel that specialized in gastronomic 5-to-
6-day tours of Armenia, during which the tourists experienced food adventures and had a chance to taste
the best Armenian wines and national dishes. The agency also provided sightseeing tours to medieval
temples and churches for GT’s clients. The Services GT initially offered dental services and slowly added new types of services—plastic surgery and LASIK (or
laser eye surgery)—to its service lines. Partnering with a number of local clinics equipped with cutting-edge
technologies and highly qualified professionals ensured that the provided services were of the highest quality.
In the initial contact“Get Started” inquiry form, the clients were asked to choose theirpreferred clinic and doctor.
On average, eight to ten clients received treatments in Armenia through GT’s services each month. To provide dental services to the medical tourists, GT partnered with a number of dental clinics located in
Yerevan that provided services in endodontics (e.g., root canal treatment, root filling, and extraction), dental
implantation, aesthetic dental restoration (e.g., teeth whitening, dental crowns, and bridges), and dental
prosthodontics (e.g., gum treatment and cosmetic veneers) (see Exhibit 3). Usually, the dental procedures
were significantly more affordable in Armenia for the same or higher quality procedures compared to the
prices of GT’s patients’ home c0untries. GT only promoted procedures that could be done in one or two trips;
hence, dental implants were popular, while braces (which require regular orthodontist visits) were not. Authorized for use only by Hemeng Patel in BUSI 2063 at Yorkyille Universitytrom Apr 20, 2020 to Jul 07, 2020.
Use outside these parameters is a copyright violation.
5.png
Page 5 SBZOAOZS GT’s plastic surgery services ranged fi'om cosmetic (e.g., rhinoplasty or nose surgery) to reconstructive
(e.g., septoplasty or the correction of a deviated septum) procedures. Given the sensitive nature of this type
of procedure, GT would typically arrange for an online, fully confidential consultation with one of its
partner-doctors to determine the eligibility of the treatment. At this stage, GT had secured collaborations
with three plastic surgery centres and was under contract with another institution on an as-needed basis. To
make it worthwhile for GT’s patients, GT agreed with the collaborating clinics to only offer treatments that
required a 10-day recovery time and no additional visits. GT’s LASlK surgery included the laser eye correction or laser vision correction types of services that treat
myopia (i.e., nearsightedness), hyperopia (i.e., farsightedness), and astigmatism (i.e., distorted or blurred
vision due to uneven eye focus on the retina). The company partnered with the pioneer of laser eye
correction in Armenia, the Malayan Eye-Care Center, which had a long history of eye treatment dating back
to the first eye department founded at the Yerevan State Medical University in 1928. The centre was
established in 1978 by then—chief ophthalmologist of Armenia Sergey Malayan, MD, whose name the clinic
was holding, and it was the largest ophthalmologic centre in Armenia.22 Apart from the obvious sight
benefits of the LASIK procedure, it was characterized as painless and required only a 24-hour recovery
periodB—something that was of high value to GT’s clients. Customers GT customers came from three main regions of the world: North America (i.e., the United States and
Canada), Western Europe, and the Gulf countries. The largest segment of GT customers (about 40 per cent)
comprised ethnic Armenians from the widespread diaspora. The rest were composed of French— and Anglo-
Canadians (50 per cent), Americans, French, and Filipinos from the Gulf countries (about 10 per cent) (see
Exhibit 4). A typical GT customer could be described as a mature 50- to 70-year-old person near the end
of their professional career or already retired. Usually, GT customers were relatively affluent and had time
on their hands. With life expectancies having risen in the Western world to 30 to 90 years of age,24 GT felt
that its main customer group had developed a feeling that they had to invest in their health. At the same
time, a large number of these customers were starting to experience or were expecting a reduction in cash
flows due to retirement plans and were thus more restricted in their finances. Therefore, they would rather
combine pleasure with health benefits, and save money while having a vacation in an attractive destination
than spend three times the amount on the same treatment in their countries of residence. In the high season, during the months of May to late September, the number of customers reached up to 15
per month. These were typically customers who had already planned a vacation in Armenia. The great
majority of these customers were ethnic Armenians from the diaspora or foreign tourists looking to combine
the pleasure of travelling and visiting their friends or families with the benefit of receiving medical
treatment for their issues. Meanwhile, in the low season, GT welcomed only three to four customers per
month. These were typically customers who came for treatments on any day, at any time of the year.
Usually, because it was during the low season, these customers would receive a more personalized service.
Overall, on average, GT would have eight to ten customers per month, bringing in US$10,00025 to $30,000
of annual gross revenues. Competition According to Elliott, GT had four categories of competitors. The main competition came from the doctors
and hospitals of clients’ home countries, which discouraged them from going abroad. The competition was
strongest from countries that provided state insurance (e.g., Canada) with provincialfterritorial health cards Authorized for use only by Hemang Patel in BUSI 2053 at Yorkville University from Apr 20, 2020 to Jul 07, 2020.
Use rmts-zide these nnrnmetera is: a rnnvrinht vinlntinn.
6.png
Page 6 SBZOAOZB not covering overseas treatments. The Canadian government, for example, issued special recommendations for
travellers to acquire special comprehensive health insurance that could potentially cover special medical
procedures.26 Nevertheless, the number of Canadian medical tourists was steadily growing as health spending in
Canada was growing and was projected to reach CA$7,078 per capita in 2019, which was 3.5 per cent higher
than in 2018. This trend was particularly true for people looking for plastic surgery treatments.” Similar trends
were traceable in other countries of interest to GT. Although these were quite strong competitors, Elliott felt that
he was at an advantage: “Usually people cometo me after they have experienced treatment in their local hospitals
andfor clinics and are either not satisfied with the quality, just like I was not, or with the waiting or price.&quot; The next type of competition came from traditional medical tourism agencies that existed around the world
and targeted the same global medical tourism market. These agencies had contracts with foreign hospitals
with a focus on international tourists. While these agencies posed a threat to GT’s market share, Elliott still
thought that GT had an advantage Over them. Typically, these agencies would have an established network
of hospitals and doctors and were incentivized to send their clients to the members of the network. While
GT had established close relations with a number of clinics, compared to these agencies, GT did not receive
financial incentives to suggest certain clinics over others and, hence, it could give impartial assessments of
its partner-clinics to incoming patients. The third group of competitors comprised similar concierge-type large-scale medical tourism tech start-ups
like Medigocom.28 These highly connected international networks of medical experts were growing rapidly
in size and coverage. These companies were appealing in that they offered affordability, quality care, and
shorter waiting times along with transparency and privacy. To compete with these players, Elliott offered
personalized treatment, which his clients valued. Elliott also believed that the customers felt comfortable
talking to him and could relate to him because of his Canadian origin. Cultural proximity with his clientele
played a strong role in the early days of GT and continued to carry a strong positive value over time. Finally, and closer to home, competition came from the traditional tourism agencies in Armenia, which
added medical tourism to their list of services, and from the local clinics that developed packages to appeal
directly to medical tourists. These were typically unorganized and small-scale, and Elliott was confident
that they posed no real threat to his company since they largely lacked the personal appeal to the types of
clients GT was serving. Promotion In its early days, Elliott relied heavily on his personal connections to acquire customers for the company. Elliott,
whose extended family was located in Canada and Europe, was acutely aware of the power of personal
relationships, and, hence, during each of his annual trips to Canada, he organized meetings with local Armenians
to present GT’s services. Being able to present the services personally and answer questions allowed for a more
personal approach and thus enhanced the sense of trust amongst potential customers. Up until then, Elliott had
introduced GT to Armenian community centres in Ottawa and Montreal. However, as a member of
RepatArmenia.org,29 Elliott connected with other repatriates and Armenians around the world to present
business opportunities in Armenia and to promote GT. In his presentations at the Imagine Armenia forums in
Toronto and Montreal in April 2018, Elliott delivered talks on starting an innovative business in Armenia using
the example of GT. In the beginning, Elliott made appearances at various trade shows in Armenia and the United Arab Emirates
(UAE), as well as in Canada when visiting family. The last two shows (in total, $1,850 in costs) only led to
three new clients, which led Elliott to re-evaluate the effectiveness of these appearances since these events
were mostly attended by other medical tourism firms and rarely by potential clients. Authorized tor use only by Hemang Patel in BUSI 2053 at Yorkville University from Apr 20, 2020 to Jul 07, 2020.
Use outside these parameters is acopyright violation.
7.jpg
were mostly attended by other medical tourism firms and rarely by potential blients. Page 7 BBZOAOZB While personal connections were the strongest recruitment channel, Elliott also invested in using Google
Ads, which was strongly recommended by GT’s early-day angel investor. An investment of $13,000 in a
massive Google Ads campaign in 2014 generated over 200 click-throughs and resulted in 21 clients. Despite
the high cost per acquisition (CPA) of about $600, the campaign was successful in generating, on average,
about $1,780 profit per client. However, the Google Ads campaign was inconsistent, with a monthly budget
of around $912 in 2015 through 2017, resulting in a range of 7,640 to 12,760 impressions per month, a 4.5
per cent click-through rate (CTR), and only a 1 per cent rate of conversion. Nevertheless, Google Ads
generated about 59 per cent of GT‘s clients between 2014 and 2018. GT then pivoted its entire promotion strategy to the web and word of mouth (WOM). The company had a
relatively small digital advertising budget of $1 ,000 per month (with about 80 per cent for maintenance of a
Facebook page and 20 per cent for Google Ads), but it was expected to double in the following year through
reinvestment of the profit into more targeted ad campaigns. From 2016, GT started paying more attention to
social media advertising through its own pages on Facebook, Twitter, Instagram, YouTube, and Linkedln.
Elliott thought that since more and more Generation X and Baby Boomers were signing up on F acebook, the
platform would be most appropriate for targeting his “idea &quot; customer. The platform allowed for more specific
targeted and short-term campaigns tailored for specific audiences (e.g., reaching out to clients in Gulf
countries at the Muslim holiday of Bid). At the same time, Instagram and Snapchat presented more
opportunities to reach out to Millennials and Generation Z, as Elliott believed that these customers considered
these platforms more “sincere and authentic.&quot; Elliott also wondered whether it would have made more sense
to revise the use of Twitter and Linkedln, as the numbers of followers and likes were stagnant. On average,
the acquisition cost per customer was about $200, but Elliott was looking for ways to reduce it. Between 2014
and 2018, 23 per cent of GT’s clients came from social media advertising (Facebook, Instagram, and Twitter). As customer retention was quite high due to the quality of the service received by customers and positive
WOM (see Exhibit 5), the main emphasis was placed on customer acquisition efforts (see Exhibit 6). The
acquisition effort was dictated by the very nature of the business, as the services received were “durable,” and
the same customer would not usually need the same procedures for the next 10 to 15 years. There were,
however, a few customers who had experienced one type of service and chose to come for another one. GT also engaged in “free advertising,” which included webinars, blogging, and cross-promotion with other
services (particularly tourism agencies and hotels). Through his blog entries, Elliott presented the
advantages of medical tourism in Armenia and shared his experiences of presenting the company in
different countries and events (e.g., “5 Reasons to Visit a Dentist in Armenia This Summer,” “5 Medical
Innovations You Didn’t Know Were Armenian,” “GetTreated Takes 2nd Place at UpStart,&quot; and
“GetTreated Hits Dubai“). Elliott also appeared in a number of local Armenian newspaper and television
stories, which were quite popular among the Armenian diaspora. As per Elliott’s records, walk-ins and trade
fairs generated about 17 per cent and 2 per cent of GT’s clients in 2014 and 2018, respectively. ARMENIAFTHE DESTINATION Despite the ongoing tension between Armenia and Azerbaijan“), Armenia enjoyed a steady increase in its
number of tourists. According to a 2017 report from the State Tourism Conunittee, the predicted number
of incoming tourists in Armenia would reach 2.5 million in 2020, which was about the same number as the
whole population of the country.“ The majority of tourists came to visit their friends and relatives (51.2
per cent), while others came for business (12.2 per cent), holiday and leisure (14.4 per cent), health
treatments (8.5 per cent), and other purposes (13.7 per cent). The biggest group of tourists came from Russia
and other Commonwealth of Independent States countries (25.7 per cent), followed by Europe (26 per cent), Page 8 QBZOAOZB East Asia (182 per cent), Iran (17 per cent), the United States (10 per cent), and Georgia (3.3 per cent).
Meanwhile, the UAE, India, and the Philippines were rapidly becoming the new sources of the incoming
tourists to Armenia. Particular interest was shown by Gulf-based Filipino tourists, Whose numbers increased
from 674 in 2014 to 22,000 in Zwed interest was a requirement to renew vim: fnr mmatriate wnrkpre arlrmlprl hv a nnmhr-r nffinlf r-mmtrir-c 32
8.png
Page 8 BBZDAOZB East Asia (18.2 per cent), Iran (17 per cent), the United States (10 per cent), and Georgia (3.3 per cent).
Meanwhile, the UAE, India, and the Philippines were rapidly becoming the new sources of the incoming
tourists to Armenia. Particular interest was shown by Gulf-based Filipino tourists, whose numbers increased
fi'om 6'74 in 2014 to 22,000 in 2017. One of the reasons for Such an increased interest was a requirement to
renew visas for expatriate workers adopted by a number of Gulf countries.32 The country was ranked as the 10th-fastest growing tourism destination in Europe, with 18.65 per cent year-
on-year growth.33 A VISA-flee regime for citizens of more than 50 countries (e.g., Russia, Iran, Argentina,
the UAE, and the United Kingdom could stay up to 180 days per year) and an upon arrival VISA for citizens
of about 140 countries (e .g., Canada, Israel, and India with $31 for up to 120 days and $6 for up to 21 days)
made it easy to travel to Armenia.34 The country had a long and rich history going back thousands of years before Christianity, and its capital—
Yerevan—elaiming to be 2,801 in 2019. Armenians prided themselves as the first nation to accept Christianity
in 301 AD and, having been preached to by two apostles, Bartholomew and Thaddeus, in the 1st century,
called their church an Apostolic Armenian Church. Beautiful monasteries and churches were found in every
corner of the country—each in a picturesque natural setting.35 Many of GT’s clients chose to combine day
trips to these monasteries while waiting for their procedures or even after the procedures. A large number of
Gulf-based expatriate workers, who increasingly took an interest in GT’s services, would take the opportunity
to comply with the legal requirements of the country of residence with a leiSure travel to a close-by country
with a rich Christian history and beautiful landmarks. Many of GT’ s clients were looking forward to a “white
Christmas” with the hope of enjoying the snowy slopes of the Tsakhkadzor ski resort But most importantly, located 1,000 to 2,500 metres above sea level, Armenia attracted tourists with its dry
continental climate of warm summers and moderately cold winters. These conditions were ideal for the
recuperation and healing of GT’s clients. The unique geolocation of Armenia contributed to the diverse
flora and fauna of the country, with many of its species being endemic and included in the Red Book of
Armenia.“ Thus, one of the most sought-after tourist packages included easy hiking trails, eco-tours,
cycling, bird-watching, and many other nature-exploring tours. Armenia was also finding a place on the food and drink travel maps by attracting food and drink experts
and lovers from all over the world. In 2015, Jack Maxwell shared his favourite moments in an episode of
“Top 5: Armenia” on the Travel Channel’s Booze Traveler series.&quot; In May 2018, Anthony Bourdain aired
an episode on Armenian cuisine as part of his Parts Unknown television show.38 Wine tours were becoming
another attraction in the country with its old wine history that was experiencing a rebirth, with a number of
expats establishing new wineries and bringing Armenia back into the wine world.39 WHAT NEXT? Elliott was going through the company’s records. The numbers were good—there was clearly a steady
growth in the number of clients. The reviews were great and positive. He was pleased—some of his
clients had not only come for other treatments, but they had also brought their friends and family
members. However, he was concerned with growing competition and was certain there was more
potential out there. Something had to be done to attract more clients. He needed more innovative ways to
attract new customers and beat the competition.
9.png
Page 9
9B204028
EXHIBIT 1. TOOLS USED BY GETTREATED CJSC
GetTreated (GT) used Armenian apps to help the company offer a unique and personalized medical travel
experience to patients from around the world. The company was highly motivated to promote Armenian-
made products and apps along the way. While in Armenia for treatment, and after the first few days, the
clients used the Armphone and the preinstalled apps to order, for example, a taxi to explore Yerevan and
surrounding provinces on their own or to make a food order via menu.am (an online food service). Once
they were done with their treatment, the clients returned the Armphone. However, as some of the
preinstalled apps started showing signs of decline-Zangi messenger, in particular, seemed to be losing
the momentum it had gained in 2017-Elliott was rethinking his use of the apps and even the Armphone.
Armphone
This smartphone, designed and assembled locally in Yerevan, was both affordably priced and powerful
enough to run all the applications patients needed during their stay with GT. Patients were issued this
device upon arrival at the airport, and they could use the preinstalled apps to navigate the city, find places
to eat, or contact GT representatives at any time. (Note: The first Armphones were produced and introduced
to the market in January 2016. However, in 2017, only 1,430 phones were produced-15 per cent less than
in 2016-and there were no statistics from 2018.)
GG app-Taxi services
GG was a local ride-hailing service with reliable drivers and clean and spacious cars. Yerevan was a
compact city where most distances were quite easily walkable. The simple-to-use GG app meant that a
reliable driver was always available at the touch of a button. GT patients' Armphones came pre-equipped
with the GG app, which allowed them to hail a car at a moment's notice to safely and conveniently reach a
destination of their choice and pay online via credit card.
Menu.am-Online food service
Menu.am was a 24/7 online food delivery system that took orders to obtain and deliver dishes from over
500 restaurants and cafes in Yerevan at the touch of a button. The app, which patients could find on their
Armphone, offered a selection of meals from Yerevan's best restaurants. Orders were typically delivered
within 40 minutes. The app also let users order other things, such as groceries and medication.
BeSafe-Secure file-sharing
A cloud-based medical wallet allowed a secure sharing of sensitive medical information with physicians in
full compliance with the US Health Insurance Portability and Accountability Act (HIPAA).
Zangi-Low-bandwidth calling
Zangi was a free low-bandwidth calling app based on voice over Internet protocol (VoIP) technology with
full end-to-end encryption technology for quick and confidential calls from anywhere. Travellers were
Authorized for use only by Hemang Patel in BUSI 2063 at Yorkville University from Apr 20, 2020 to Jul 07, 2020.
Use outside these parameters is a copyright violation.
encouraged to download the Zangi messenger app onto their phones before their trip. The app, which
boasted full end-to-end encryption technology, allowed patients to quickly and confidentially contact GT
representatives for any reason. Zangi's low-bandwidth VolP technology meant that GT patients could
receive calls from anywhere.
Source: Rafi Elliott, &quot;5 tools that help us treat you in Armenia,&quot; GetTreated (blog post), July 24, 2017, accessed March 20,
2020, https://gettreated.co/5-tools-that-help-us-treat-you-in-armenia/.
page 12.jpg
page 13.jpg
Page 13
9B204028
EXHIBIT 6. GETTREATED.CO COST BREAKDOWN (IN USD) PER PROMOTIONAL ACTIVITY 2014-2018
2018
Google
2017
....
Facebook
.........
Trade Fairs
2016
2015
2014
$0
$2,000
$4,000
$6,000
$8,000
$10,000 $12,000 $14,000 $16,000
Source: Raffi Elliott, personal interview with authors, January 23, 2019.
Page 14
9B20A028
Endnotes
1 &quot;About Us,&quot; Impact Hub Yerevan, n.d., accessed March 2, 2020, https://yerevan.impacthub.net/about-us/.
In spring 2018, a series of anti-government protests across the country, led by then-Member of Parliament Nikol Pashinyan, led to
the peaceful change of the Republican Party-controlled government. This peaceful revolution was coined the &quot;Velvet Revolution.&quot;
3 &quot;Medical Tourism FAQs,&quot; Medical Tour
dical-tourism-fag-s.html.
www.medicaltourismassociation.com/en/m

Why Join Course Hero?

Course Hero has all the homework and study help you need to succeed! We’ve got course-specific notes, study guides, and practice tests along with expert tutors.

  • -

    Study Documents

    Find the best study resources around, tagged to your specific courses. Share your own to gain free Course Hero access.

    Browse Documents
  • -

    Question & Answers

    Get one-on-one homework help from our expert tutors—available online 24/7. Ask your own questions or browse existing Q&A threads. Satisfaction guaranteed!

    Ask a Question
Let our 24/7 Marketing tutors help you get unstuck! Ask your first question.
A+ icon
Ask Expert Tutors You can ask You can ask You can ask (will expire )
Answers in as fast as 15 minutes