It was rather strange for Pavan, a Senior Financial Analyst in Bangalore, when he started getting severe coughs during a conference call with his client. It was 2 pm and immediately after wrapping the call, he discussed with his family and decided that he should go in for testing for the Novel Coronavirus.
But there was fear of going to a hospital and risk of contracting Covid-19. After a brief discussion with friends, he registered with healthcare app mfine and booked an appointment with a Senior Doctor.
The Doctor went through the process of understanding Pavan’s symptoms and upon further detailed assessments, prescribed a couple of allergy medicines and advised to hold-off testing for Covid-19.
“It was my first time to consult a Senior Doctor over a phone and it was sort of unnerving,” said Pavan. “Even after a week I have doubts whether I was diagnosed accurately and if I am safe with allergy medicines. The cough though has reduced, but my mind is not settling through this kind of diagnosis,” says Pavan.
Winning over people like Pavan and scores of other fence sitters, is a challenge in the Indian ecosystem and there are numerous players who are actively engaging with all stakeholders to bring in normalcy to telehealth.
“It is a myth that a physical examination is a must, while it is needed for many situations, there’s a slew of other conditions that don’t need physical diagnosis. What we require is correct history and clear communication from the person seeking a diagnosis,” said Dr Sanjay Gowda, a Senior General Practitioner who consults with multiple hospitals in Bangalore.
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The onslaught of Covid-19 has accelerated the adoption of healthcare delivery through digital channels and also is serving as a means for legacy chains to accept the new normal.
Dr Gowda is among the many Doctors who are seamlessly straddling the offline and online modes of healthcare delivery and pretty much satisfied with the progress done by multiple healthcare digital delivery platforms.
“Our attempt is to make diagnoses that are effective with evidence-based guidelines, for cases that can be handled with virtual care. We are not claiming that through tele-consultation we can solve emergency situations and life-saving medical care. There’s no ambiguity in the fact that not all cases can be treated with virtual care,” clarifies Gowda.
The onslaught of Covid-19 has accelerated the adoption of healthcare delivery through digital channels and also is serving as a means for legacy chains to accept the new normal.
“In my discussions with multiple hospital chains, I understand that a good 64% of surgeons have witnessed reduction in their outpatient services and 37% of them have stopped outpatient services totally. More than 50% of Doctors like me have adopted online consultations,” explained Dr Gowda.
According to Dr Niranjan Patil, who runs S G Healthcare, elective surgical work has dropped more than 90%. He asserted, “We are also witnessing a significant decrease of close to 50% in emergency services. We are going through the throes of immense financial impact over our as how to stabilise the centre. Small and standalone hospitals like us are struggling to carry on as patients have restricted their visits owing to the fear of Covid infection.”
Cost optimization and how to be a lean and mean machine are the aspects which Doctors like Patil are increasingly looking towards and the new age platforms offer a possible solution for this conundrum.
“The administrations of hospitals are realizing that the implementation of a streamlined cost optimization plan is important as it enables the hospitals to sail through difficult times. As these healthcare organizations continue adapting to the new normal, many new players in the digital delivery of health care are aligning closely with legacy hospital chains and both are twinning the benefits,” said Dr Gowda.
This paradigm shift in approach from multiple stakeholders was accentuated and investors led a 50% surge in investments in the Indian healthcare sector during the first half of 2020.
Practo, the Bangalore-headquartered healthcare firm which was the pioneer in innovating in delivery of healthcare through digital channels, said that in-person visits to doctors fell by 67% during the April-June 2020 due to Covid-19.
“Telehealth has multiple applications, optimal care and virtual care is possible and extremely helpful in a pandemic scenario like Covid-19. It uses high-definition transmission and clarity to provide rapid, accurate and real time consultation from professionals with expertise. Healthcare professionals can evaluate, diagnose and treat in a seamless environment. Patients are proactively using healthcare to manage their health and telehealth is a great alternative and has the potential to reach exponential levels”, says Dr C M A Belliappa, General Physician based in Bangalore.
Shashank N D, Founder & CEO, Practo says that doctors, patients, authorities are all slowly accepting this new form of healthcare delivery, which has shown a lot of promise. “Masses beyond metropolitan areas are increasingly getting used to consulting specialists online. A reality that will take years of trust and infrastructure building to get down to the last mile but will prove to be one of the best investments in future proofing healthcare for a billion + Indians,” he added.
Practo, mfine are among the players who are pulling away from the crowded market to establish themselves and expected to lead further consolidation. Together these two platforms have reported to have handled more than 500,000 cases during the past three months.
There are at least more than two dozen notable players in this space who are trying to establish, and this is ensuring the pie is getting larger.
Consultants at PwC indicate that players operating in the digital healthcare market experience stiff competition from each other. The market comprises various players including start-ups and established global companies, aiming to expand their footprint in India. The presence of numerous players leads to a fragmented market. The relatively untapped market offers high potential and thus attracts significant investment opportunities.
In terms of revenue, the digital healthcare market in India was valued at Rs 116.61 Bn in 2018 and is estimated to reach Rs 485.43 Bn by 2024, expanding at a compound annual growth rate CAGR of 27.41% during the 2019-2024 period.
The digital platforms are carving various niches to address specific gaps in the healthcare system and emerging consumer needs. Prior to Covid-19, the health tech industry catered mainly towards developing diagnostics and medicine delivery solutions, building wearable gadgets, treating lifestyle-related issues like stress and anxiety disorders through remote therapy, enabling early diagnosis of genetic disorders, and the alleviation of pain after painful procedures.
“With India at the epicentre of Covid-19, key segments where new opportunities will emerge include the development of tools to facilitate emergency care and improvements to medical infrastructure through technology-based optimization. This includes expanding the scope of wearable devices to track health conditions, developing patient-facing mobile health apps, and the greater integration of artificial intelligence (AI), robots, and blockchain technologies for example, surgical robots, robotic carriers, electronic records and monitoring systems, sensors, remote diagnostics,” said advisors at Dezan Shira & Associates, who specialize in advising global investors on where to invest in India.
Contactless healthcare tools and systems, immunity-boosting nutrition, and safety and hygiene are some of the most viable segments for investors going forward as Covid-19 has brought about a paradigmatic shift in our consumption priorities and social behaviour.
Although the digital healthcare sector offers ample opportunities, significant barriers are slowing down the adoption of digitization in the Indian healthcare sector. The lack of digitized data regarding patients’ info and prescription hampers the adoption. Factors like inferior technology infrastructure and lack of structured regulations pose as challenges to the digital healthcare market. Furthermore, the high cost of customer acquisition, along with a complex and multi-layered ecosystem leads to difficulties in value proposition.
Dr Devi Shetty, the celebrated cardiac surgeon and Founder of Narayana Healthcare notes that the disruption caused by Airbnb and Uber is nothing compared to how technology will disrupt the healthcare industry. He affirms, “People talk about the use of data analytics and artificial intelligence (AI). But all these technologies need data. Now, how do you get the data when 95% of the hospitals in India don’t have electronic medical records. If you don’t have EMR, you are looking at manually typing in the data, which will not be 100% accurate. So, the big game of data analytics making a big difference in healthcare will only happen if every hospital is using EMR, and every patient has his own personal health record in a digital format.”
The mHealth segment is estimated to dominate the market, with close to 41% of revenue share in 2024, followed by the telehealth segment. Enhanced accessibility and convenience encourage patients to embrace mHealth services and solutions, including healthcare apps and wearable devices.
“The digital healthcare platforms are sharpening their strategies to provide on-demand access to quality healthcare to millions of Indians while ensuring medico-legal safety to its partners on the platform. Collectively, these players have been able to make a larger impact on the way primary healthcare is being delivered,” said Dr Patil.
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In addition to health check-ups and follow-on discussions, Indians are facing multiple lifestyle-oriented challenges and many of them are going in for aggressive preventive healthcare solutions.
In addition to health check-ups and follow-on discussions, Indians are facing multiple lifestyle-oriented challenges and many of them are going in for aggressive preventive healthcare solutions. The digital system of healthcare delivery is extremely conducive in such situations both for doctors and for citizens seeking guidance and support.
“The wellness healthcare is estimated to be around $170 billion by 2025 and this is the biggest focus which all the new age healthcare platforms are working on. Changes in diet and lifestyle are among the top aspects which are seeing traction and it will play a differentiated role in how these platforms expand further,” says Dr Patil. According to Dr Gowda, all the digital platforms have close alignments with the hospital chains and as and when there is need for upstream care in a hospital, the patients are referred in for further care.
“There is absolutely heightened competition between the players but parallelly there is strong collaboration. The consumers will benefit as this industry consolidates and global and Indian investors are burning the midnight oil to make this happen,” consultants at PwC. To put this in perspective, a good $3 billion has been invested across some 200 plus health tech firms in India over the past couple of years.
Dr Jacob Kuruvilla, Advisor with Practo says that as we prepare to step into the “new normal” where cities are now easing restrictions and citizens are preparing to step back into a different world, healthcare is going to be seen through a different lens. “How we deliver accessible, affordable and convenient healthcare to the remotest parts of India is the next big focus. Telemedicine along with other healthcare technologies like online appointment booking, to avoid crowding, will play a huge role going forward,” Dr Kuruvilla feels.
While many of the private equity and venture capital funded digital platforms are trying to find their niches in Tier-1 cities, the Government of India is rolling out expansive measures to reach adequate healthcare to the rural masses.
“The poor to non-existent coverage of rural healthcare services will result in greater public healthcare spending and the government’s interest in the participation of private stakeholders using technology and R&D for improving ease of access and ensuring quality of care,” said advisors at Dezan & Shira Associates.
While the low cost of medical services in India has attracted considerable medical tourism in recent years, the country is also increasingly focused on developing its R&D capabilities given the relatively lower cost of clinical research.
The challenges here would be the expansion of India’s hospital and medical education infrastructure, which is currently unable to provide sufficient coverage in the country. Expansion of educational institutions and medical facilities to tier 2 and tier 3 cities will be key to the growth of the healthcare sector.
Here telemedicine will have a crucial role to play in terms of providing low-cost consultations and extending diagnosis facilities in remote and rural areas; this of course is dependent on the reliable availability of high-speed internet connectivity and telecommunication.
Foreign investors will thus find multifaceted opportunities when looking to enter India’s healthcare market, the hospital industry, medical electronics and devices, the medical supply chain, home healthcare, telehealth systems, and healthcare-focused software as a service (SaaS) platform.
The legacy hospital chains, which still form the backbone of healthcare delivery systems are parallelly scrambling their acts to have a strong foot in this sector which is expected to see a further sharper hockey stick growth. From Manipal Group to Apollo Hospitals, traditional healthcare operators who rode the investor interest wave till 2019 are digging in their heels to stave off competition.
“All the established hospital chains are adopting aggressive technology implementation plans in an effort to create a connection with patients directly,” said Dr Gowda.
Even as these moves by traditional and new age healthcare firms play out in the marketplace, Pavan’s cough is now under control and he has booked an annual subscription at a digital health platform for preventive care not only for himself but for his family of four. And he is actively advocating the same to his friends.
