The case, which is set in the period 2014-21, provides an overview of Karma Primary Healthcare's origin and growth story. It also explores the unfolding growth opportunities, some of which emerged as a consequence of the COVID-19 pandemic. Karma was founded by Jagdeep Gambhir to deliver quality healthcare to communities in rural India. As of 2021, Karma clinics were present at 25 locations in semi-urban and rural India. Nurses at these clinics used a teleconsultation-based care model to connect the patient with doctors located remotely. The case suggests that Karma has been reasonably successful in progressing toward its original mandate of delivering care to rural communities. However, opportunities for further growth opened up. The case presents the prospects for growing the organization's nascent B2B business, given the broad acceptance of, and high demand for, tele-consultation-based care models across India during and after COVID-19. Further, the case discusses in detail the opportunity for Karma to utilize its experience and capabilities to enter urban India, and touches upon the critical factors that would determine the decision whether or not to enter this market.

Narayana Health (NH) had been successfully delivering affordable high quality tertiary care to the masses in India through its chain of hospitals for over a decade. To encourage the adoption of the NH affordable care delivery model worldwide, Dr. Shetty, Chairman of NH, was keen to establish a hospital in the western hemisphere and believed that it was important to demonstrate the model to the US. Thus when the Cayman Islands Government was interested in developing the island as a medical tourism hub during 2008-09, Dr. Shetty agreed to develop the Health City Cayman Islands (HCCI), a 2,000 bed conglomeration of multiple super-specialty hospitals within a single campus located on the Grand Cayman Island. The first phase of HCCI, a 104 bed hospital focused on cardiac care and orthopedics, was developed jointly by NH and Ascension, the largest non-profit hospital system in US. The hospital was inaugurated in February, 2014 but there were open questions related to pricing of the procedures and the related target patient segment and volumes. Also, HCCI senior management realized the need to adapt the NH model developed in and for India to fit the new environment at Cayman and was open to experimentation in coming months.