BY: Kannan Ramesh - Partner - Somerset Indus healthcare fund - 28 Aug-2021

A quick synopsis of issues and areas entrepreneurs and organizations need to keep in mind to prosper in the new, tech-enabled terrain of healthcare. 

Healthcare has transformed itself post-Covid. Technology has come to the fore. Remote care, wearables and digital accessories are the new norm. TeleHealth is becoming common. Home care is growing. Awareness on nutrition, wellness has enhanced. The question all this begs is: Are these technological innovations sustainable? And if not, then how must we connect the various dots and variables to optimize the chances of success?

Technology cannot succeed if it exists to serve its own cause. It will only work if it works for the greatest common good – and benefits provider, payee and patient equally. Success is often determined by access. The key is your ability to reach all nooks and corners through innovative partnerships. Even more key is clearly defining who will pay for the products or service and whether the same is profitable to all stake holders. 

In the Indian context the differentiator between OPD and IPD, self-pay and third party pay, package and non-package care and so on determines the easiness or complexity of the payment process. Every entrepreneur is trying to get technology to play, which becomes a serious problem because when we try to please everyone, we end up pleasing no one. So it’s important to draw the line somewhere, and pick one’s strengths, niche and market meticulously. 

The right technology with a well-thought out value proposition and a viable commercial model stands a better chance to succeed.  The price-sensitive gaps between Tier 1 and Tier 2 / 3 cities is where the hidden opportunities lie, making the chances of succeeding is greater. Expansion and growth will automatically open up new options for the provider to choose from.  Opportunities exist in tele -health (tele- medicine, tele- cardiology, tele pathology, tele- radiology, tele- audiology, tele- nephrology, tele-ICU etc.) mental health, EMR (speech recognition technology which eliminates writing by doctors) GPO - General Purchase Organisation (more hospitals are consolidated and the purchases aggregated thereby bringing down the cost of material leading to increased earning to the provider). The possibilities implicit in connecting specialists sitting in Tier 1 cities and patients in Tier 2 and 3 cities - with the power and reach of technology – is truly ground breaking. 

Managing and monitoring chronic diseases is becoming extremely important: Ailments like diabetes and blood pressure, for instance, require constant monitoring. This involves both devices and technology at play.  A simple ECG read by a cardiologist sitting miles away and determining the danger or otherwise to the patient is truly remarkable. Ditto with a radiologist or a pathologist who contributes to the wellbeing sitting miles away. 

SAAS models are understandably becoming extremely popular since they combine robust service with easy payments. It’s a win-win for all parties. The model is allowing commercialization on a simple and quick scale – and is leading to better acceptability. Providers enabling remote, local doctors to use equipment & devices located in faraway hospital is a big boon to the patient. 

Tele-ICU is an amazing development that’s fast-maturing - wherein the patient is monitored and managed by a panel of Intensivists sitting in the distant, big cities. This can significantly bring down the cost and time in treating patients, and is certainly turning out to be the next future. 

Coming to access : Access alone cannot guarantee success, Access has to be coupled with bundling of technology thereby enabling products and services to be offered to the provider by a single channel using technology instead of multiple channel.  This contributes significantly to convenience and comfort in use. 

Neuro sciences - particularly managing Vertigo, Dizziness, Balance disorder, Migraine, Motion sickness, Fall, Dementia, Alzheimer and others - presents a huge opportunity. Technology is coupled with models where the setting-up and running/operations remains with a technology partner, while patient-flow and services rest with the provider. This works on a SAAS model where the provider and the technology partner share the income. 

Specialities like oncology and NICU mother & child require strategic interventions in technology to reach the end customer faster, better and at an affordable cost. Innovations in these areas - in screening and preventive medicine – is greatly helping providers to detect earlier and treat better. Technology has made both the device and the software very easy to use. In a country with a lot of cancer patients, there is a huge upside in getting all the providers to use these products and services in the best interest of the patients. 

One other significant change is converting the capex model into OPEX model, this way the provider pays for the equipment only when it is put to use. There is no capex and everything works on OPEX - this change can bring about a significant change in the way providers access product and services. 

Ultimately the challenge faced by the technology provider and the healthcare provider is whether they should pursue B2B2C model or B2C model. In the case of B2C model - establishing loyalty and continuity is a big challenge. In a B2B2C model - the provider plays an important role and ensures usage of the facility. 

Insurance is catching up as more and more technology enabled platforms are connecting to MSMEs, corporates and leveraging on partnerships, collaborations, scale and size - and thereby offering value to the end customer. In the short to medium term this could be a segment which can grow significantly. 

The growth of E-commerce has significantly contributed to products and services (on a B2C model) gaining ground. While web stores and close-loop systems have encouraged B2B platforms, there is an increased emphasis on reducing cost of transfer of products and services in the most optimal fashion possible. 

The purpose of technology is to interrupt and engage early and thereby save/change lives. Changing habit by tech enabled screening and prevention on one side - and access and affordability on the other – lets both provider and payee emerge winners. 

A lot of entrepreneurs and ventures spend time on technology (rightfully so) - but fail to invest in ‘Go-To-Market’. Improvements and innovations is a constant exercise and obviously one cannot do everything on day one. Hence you have to start with a basic minimum and then grow. In the process it calls for a dedicated effort to create a market more homogeneously and then branch out to other parts of the country. The nature of your foray teaches you a lot and so it is very important for startups to focus on commercialisation and creating its own market - as much as it is important developing the technology. 

Unit level economics plays a very important role and activity should be feasible, viable and profitable. While efforts are undertaken to take advantage of surplus capacity like Operating theatre’s doctor time, etc., the key is the cost of acquiring the patient and the cost of operation has to be economical and profitable. Building large enterprises with lots of money, expanding and growing constantly getting in to a newer areas etc., will not hold water for long.  It is important to establish the credentials of the business from an economic sense, and then grow. 

While a lot can be said about the tenacity and resilience of the Indian entrepreneur - the real key is to build a very strong commercial model which enables the products or service to be bundled and used by a majority - leading to scale, size, revenue and profits. India is a great country blessed with amazing opportunities and a dynamic entrepreneur pool. It has to be carefully cultivated to enable the winning proposition.

*This story is published by VOH team*

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