Healthcare demands a caring persona and a deep understanding of problem solving. Businesses in this space must fulfill the needs of both patients and workers. Health tech is the new face of the healthcare industry which has seen enough disruption to last a lifetime. Nidhi Jain is a strong health tech leader with a praiseworthy womanpreneur story. 

Nidhi Jain, the woman behind KareXpert

Nidhi Jain is a womanpreneur who is leading India’s first-ever SaaS based integrated digital healthcare platform. She is also the brain behind India’s first company to offer a most exhaustive portfolio for hospitals. She has managed to differentiate her company in the industry which is now a unique competitor in the market. 

Health tech, a sector with huge potential

Nidhi’s vision for her start-up was to make healthcare accessible and affordable to Indian society and to digitally empower hospitals. She saw that the Indian healthcare IT is in its infancy stage, operating as a manual process with too many inefficiencies. However, it was predicted to touch 5% of $200 B with 30%+ CAGR (compound annual growth rate) within three years. Thus, she found a huge potential to tap into health tech. 

On the entrepreneurial front, Nidhi was inspired by entrepreneurs, and she connected the dots to her roots in healthcare. Since she comes from a family of healthcare professionals, she quickly identified the gap in the market for B2B and digital solutions. This motivated her to eventually launch her start-up. 

What KareXpert does 

KareXpert digitally connects different kinds of hospitals. It offers end-to-end digital empowerment to hospitals and healthcare providers through its comprehensive range of AI-enabled, cloud-based and mobile-ready solutions designed for coordinated patient care, optimising operational costs and increasing revenue. They have an advanced, secured and certified webscale software technology stack and their integrated solution has over 50 applications including Advanced HIMS (Hospital Information Management System), e-Claims, MIS (management information system) Reports, etc. 

How Nidhi drove the Business Model of KareXpert

When Nidhi started out her entrepreneurial journey, the concept of digital healthcare was a novelty with a lot of scepticism around its efficacy. There were hardly any players in the market and Nidhi entered the industry as a disruptor. She started out with providing doctor consultation solutions in health tech. Her previous product management experience enabled her to expertly pivot the business model towards the B2B market. Through KareXpert, Nidhi worked to fix the broken experience of patients in healthcare with respect to availing digital services. 

Everyday doctors and clinicians are overburdened. They have to sift through endless prescriptions, patient files and manually sign papers. Despite being a large industry, healthcare is still using outdated and manual methods and the technology adoption rate is still very poor in Tier II- cities. During a pandemic, this shortcoming is clearly realised. But the good news is that the health tech industry is rapidly increasing its footprint across the country, thus helping doctors and healthcare facilities get a technology upgrade. One such startup is Meddo.

Meddo: A Health Bank

Meddo is a Gurugram based Health Tech start-up that offers a 360-degree connected health platform for city-wise networks of OPD clinics, General Physicians, Specialist and Super Specialist Doctors. Its technology offerings work like a health bank for the patient and his family. Medicine reminders and follow-up reminders for appointment bookings are sent to patients through Meddo. 

How Meddo is digitally transforming OPD clinics

Meddo provides OPD clinics with their technology offerings like ERM systems, diagnostic support, medicine delivery services and support. Empowered by these technology heavy digital solutions, Meddo is transforming them into full-service medical centres. 

Current Market and Players in the Sector

The current market for Health tech start-ups offering technologically advanced digital solutions is seeing huge potential in Tier I cities like Bangalore. In these cities, target consumers like Clinics, Hospitals and Doctors are diverse, and large in number. 

Being tech natives and early adopters of technology, they can assimilate health tech solutions faster and easier. Existing and prominent players in this sector include Dozee, Medikabazaar, Doxper, Cardiac Design Labs and EasyAspataal.

How is Meddo different?

Meddo is different because they have connected with patient needs across their industry years. They have built their product and services around fulfilling clinical priorities and limitations. They aim to transform the highly unorganised ambulatory sector in India into an organised sector. As an omnichannel health tech start-up, they are providing ‘patient-oriented care’. 

Why are their solutions effective and different?

The start-up is bridging the gap between patients and clinics by strengthening the infrastructure and technology between the two. They are also offering administrative support throughout the clinician and patient’s journey. 

Despite India having more than eight lakh pharmacies, access to medication has been largely difficult for people. This became a challenge during the pandemic as timely availability of medicines proved to be an uphill task. As such, e-pharmacies that delivered medication to the doorstep turned out to be invaluable businesses. The biggest e-pharmacy start-up in India Pharmeasy became a unicorn in the year of the e-pharmacy industry, 2021. The company will soon be going public in an IPO listing planned for the Financial Year (2022-23). 

Who is Pharmeasy?

Pharmeasy, founded by Siddharth Shah, is a subsidiary of API Holdings. An e-pharmacy firm, Pharmeasy is an Internet company headquartered in Mumbai. Their online pharmacy and medical store in India is quite popular. Pharmeasy is a diagnostics brand that gets medicines home delivered. 

How did it become India’s largest pharmacy chain?

Pharmeasy became India’s largest online pharmacy chain after its acquisition of its peer, Medlife. After the acquisition, Pharmeasy covered every single pin code across the country and went on to serve over 2 million families per month. It also became the ‘largest healthcare delivery platform across the country by a distance’.

PharmEasy’s current valuation

PharmEasy is currently valued at $1.8 B and has entered the unicorn club of fast-growing start-ups. The current valuation occurred after venture capitalist ‘B Capital’ purchased a minority stake of $20 M in the firm. 

How is it planning to go public?

Pharmeasy is currently IPO bound and is targeting an IPO in the coming 12-18 months. It is ready to list on the public exchanges. The firm’s parent company API Holdings is aiming for a listing worth $1-1.2 B and is also looking to achieve a valuation of $4 B from this listing. Pharmeasy is hopeful of a blockbuster IPO in Financial Year 2022 and had earlier shortlisted Investment Banks Morgan Stanley and Kotak Mahindra Capital as advisers for the listing. 

Pharmeasy had also originally planned to file their DRHP (draft red herring prospectus) with SEBI (Securities and Exchange Board of India) in the August-September period this year and a possible launch in the January-March period next year. There are speculations that Pharmeasy was previously harbouring plans for a SPAC (Special Purpose Acquisition Vehicle) listing overseas but later settled for an India IPO.

Taking inspiration from the mythological character of Hanuman, the figure bringing sanjeevani for Lord Lakshman and saving his life, the startup Hanuman came into existence. It is a Patna-based healthcare startup working as a last-mile delivery service provider, offering immediate healthcare solutions to the people. Providing users with a world-class platform, Hanuman brings all kinds of emergency medical services at one place. Hanuman stands for help (H), accessibility (A), need (N), utility (U), and mankind (MAN).

Why was the Startup Started?

The pandemic outbreak made Dr. Niraj Jha think about the weak emergency care ecosystem of India. Lack of required healthcare infrastructure pushed Dr. Jha along with his friend Santosh Singh to launch Medicvisor Pvt. Ltd, famous by its brand name Hanuman in 2020.

The startup in its early stage launched a toll-free number to connect with ambulance service. It also came up with e-rickshaw ambulances equipped with oxygen cylinders to meet the growing need amidst the pandemic. The duo soon realised that not having a proper online portal or application is creating confusion for the service operators. The operators failed to understand which ambulance would be nearest to the patient. This challenge led to the launch of an online portal and mobile app for ambulances.

With more than 350 ambulances under its platform, Hanuman is providing services in districts of Bihar.

Its high time for the ‘entrepreneur suicide’ conversation

The world of business is glamorous but also dark. Disagreements among business partners can take a sour turn especially when there’s a lot of money involved. Every day we come across suicides in the entrepreneurial and business world and it’s the right time to start the conversation. Especially since more people are venturing into the start-up space, people with humble backgrounds who have no idea of the dangers lurking in business around cheating, extortion, financial devastation, debt and business rivalry.

Brilliant Minds – A great loss to the business world

The recent suicide of John McAfee, the software mogul who is named after his antivirus software which he sold prior to his tiff with the United States government around tax evasion has opened a can of worms once again. Brilliant minds like these are lost to suicide each year. Although McAfee’s suicide was due to his run from US authorities on fraud charges, there are numerous instances of business tycoons especially in India who have lost their lives due to circumstances around their professional lives and finances.

What leads a successful business owner to suicide?

The lifestyle led by entrepreneurs is a precarious one that often clashes with their personal, professional life, as well as the business and political environment around them. There are many reasons that lead to successful business owners committing suicide including extreme outliers of the profession, stress, failure, competition, time away from loved ones and family, less social life, less sleep, and more recently business crashes mostly recently due to the pandemic and lockdowns.

The first factor that determines whether setting up a business somewhere is healthy or not is how far the local governing bodies and state departments are willing to encourage investments and entrepreneurship.

There was a sudden mistrust and hostility regarding business ownership in India especially around Swiss Bank accounts, and income tax returns. A lot of business owners suffered from unnecessary raids, harassment and extortions from malicious entities who are in power. This affects the mental health of entrepreneurs since they are perceived as greedy or distrustful by their own employees and peers. If the business environment is not conducive in this manner, it can affect daily operations. In fact, the state of Kerala has seen a number of entrepreneur suicides in the last 3 years due to this very reason. It ranks on the 28^th spot in India’s investor friendly states out of 29 Indian states.

Entrepreneurs who lost their lives to suicide

CCD VG Siddhartha

VG Siddhartha established a coffee empire in the country at a time when a youth centric Starbucks style coffee shop cum cybercafé was a novelty. He paved the way for a modern hangout spot for Indian youth centred around delicious brews that were sourced from his own coffee plantations. But unknown to the public eye, Café Coffee Day’s V G Siddhartha was embroiled in a deep financial crisis, mounting debts, that led to an eventual downward spiral of the thriving entrepreneur. There are speculations that he was crushed under the intense stress and pressure coming from Private Equity investors and the tax departments.

Vineet Whig

Vineet Whig, the Chief Operating Officer of Encyclopaedia Britannica, a publisher of the online Encyclopaedia committed suicide in 2016 when he cited depression as the reason in a suicide note. His family said that he was an inspirational soul whose loss is irreparable in their lives.

Joy Arakkal

A more recent suicide is that of Joy Arakkal, a Dubai based businessman from Kerala who was the Managing Director of the ‘Innova Group of Companies’ in the UAE. He was a magnanimous person who involved himself in numerous charitable projects. However, Joy Arakkal embraced death to escape the financial woes that he faced in relation to his business.

Other notable entrepreneurs who died by suicide include Raj Travels’ owner Lalit Sheth, Ilya Zhitomirskiy, a Russian American entrepreneur and Mike Alfred, Founder and CEO of Cambrian Genomic.

Gender and caste-based violence doesn’t seem to be ebbing and Indians are showing their worst side during lockdowns by way of domestic violence and abuse. As such, there is a need to step up access to mental health especially in remote areas for vulnerable sections of society. Mental health start-ups are seeing huge demand, and many are disrupting a space which has unfortunately remained nascent for too long.

What is a mental health start-up?

A mental health start-up is a company that is incorporated for the sole purpose of raising awareness around mental health issues. It provides a platform or services that initiate the right conversations among the target consumers, mostly youth. But the main goal of a mental health start-up is to provide access to reliable information and support around the problem it’s trying to solve.

What problem does it solve?

Mental illnesses lie around a spectrum and have become commonplace due to the kind of lifestyles that are rampant in today’s world. A start-up may try to solve a range of issues, most commonly depression and anxiety. Access to professional help is a major problem to be solved in this space. Mental health challenges are widespread, and the scope of the problem is large.

The boom in mental health start-ups

The biggest challenge around access to mental health in India is the stigma around seeking professional help. A lot of people struggle in isolation due the lack of access, and inadequacy of mental health facilities in their vicinity. Our country is suffering due to the severe paucity of professionals. It’s still seen as a luxury availed by the upper class since the ratio of professionals vs. countrymen is 1 to 100,000.

Anonymity – A big factor in their success

People need a safe space to talk about issues that are affecting their mental health. An online, anonymous platform is the best way they can do this which has contributed to the stellar success of start-ups. There is a need for anonymous conversations with trained, empathetic listeners online and start-ups providing this service have seen a massive volume in their app downloads or website traffic.

How did the need arise – Were we always this crooked?

As per statistics, 1 in every 5 Indians are susceptible to depression, and 150 million Indians who need immediate interventions are unable to avail them. Whereas in the private sector, about 42-46% of employees suffer from general anxiety, depression, and extreme stress.

Even with the increased conversations around mental health, it was astonishing how the true face of India’s toxic environments were unleashed during the pandemic. Many people, especially women, suddenly felt imprisoned in hostile domestic environments. While gender-based and caste-based violence and abuse in the home front were already present, the intensity of abusive circumstances came to the fore during the pandemic. The need for start-ups was always present but the need for its urgent access was validated during this time. Due to the end of physical mental health forums, the demand for online services increased.

The onset of covid has made diagnostics a key component of the healthcare segment due to doctors and medical experts depending heavily on an accurate diagnosis of the disease based on which the treatment and medicine are prescribed, and monitor the mutating behaviour of the virus.

There are few diagnostic labs or centres in India which offer convenient diagnostics i.e., collecting patient’s samples from the comfort of their homes. Even though samples are collected from residence, the charge is on the higher side.  Realising the need for offering convenient and affordable diagnostics, Healthians – a B2C diagnostics startup launched in 2013 by Deepak Sahni and backed by Yuvraj Singh aspires to expand its business in 100 new cities in the next six months.

What Led Deepak Sahni to begin Healthians?

Deepak Sahni observed that the Indian’s behaviour of disease diagnosis is by large of a reactive one rather than being proactive. Preventive measures are taken only after a disease has been detected. The diagnostic space of the country follows a B2B approach to reach customers as till now it depends on a doctor’s recommendation to offer its diagnostic services to already ill customers. This can be well understood by this example – Individuals who are obese will check their lipid profile and cholesterol levels only after the body is reacting unusually. By the time, when a doctor advises them for a check-up, the body is already impacted.

The diagnostics industry in India also lacks standardization in the testing process and methods that result in an incorrect diagnosis. At times the samples collected might get lipemic (sample turning turbid due to accumulation of lipoprotein particles), which holds no value in testing. Healthians reject such samples however most labs continue testing with such samples as they will face losses in revenue.

These gaps made Deepak introduce a proactive healthcare system that birthed – Healthians. Healthians is B2C technology-driven diagnostic company that offers highly trained phlebotomists and precision-driven labs to ensure accuracy in tests. It offers a home collection of samples for testing.  In addition to diagnosis, it promotes wellness by offering free doctor and diet consultation with every diagnosis report at a better price and convenience.

CareStack, a dental care start-up with two headquarters – one in Florida, US and a domestic headquarter at Thiruvananthapuram, Kerala – recently facilitated an exit for 12 early-stage investors. 

Dental offices (individual clinics or dental health groups operating multiple clinics in different locations) have perpetually needed technology solutions to help them with end-to-end dental operations management right from appointment scheduling, clinical and patient services, insurance management, business analytics, reporting, and telephony integration. For far too long, dental offices have struggled with having to juggle between multiple, complex and fragmented solutions. 

The dental healthcare and wellness space has real needs in terms of maximising insurance reimbursements and patient payments. The dental services market has always relied on multiple software solutions shoddily connected to traditional dental software. It has largely proven to be unproductive for them. 

There is an urgent need for technology transformation and critical infrastructure like patient acquisition systems for dental clinics and dental groups. 

Technology challenges in the Dental sector

A big pile of systems

The dental world is still dependent on the traditional client-server practice management systems. To make up for their legacy software, dental clinics have come up with a makeshift dental software of sorts. They have connected multiple different systems to the traditional software. They are all loosely integrated with each other. 

There are a number of challenges that arise from using this makeshift system for everyday dental practice. It needs regular troubleshooting. Dental staff thus waste copious amounts of their practice time in troubleshooting issues. They also waste time in redundant data entry which takes away from their productivity throughout the day. 

Software solutions that do not communicate

It is sad that the dental care sector has to struggle with incompetent software systems that do not communicate with each other. 

Hampered dental care operations

Relying on dysfunctional technology systems hampers everyday operations in dental care offices. Some of the problems which they struggle with include:

• • Delay in responses
  • Missed appointment schedules
  • Patient dissatisfaction
  • Delayed patient fee and insurance payments

Understanding CareStack’s technology solution

CareStack offers an end-to-end modern, dental software solution which adapts to and fulfils the dental practise workflow. It’s a Dental SaaS platform which provides an intuitive user experience and is focused on one particular workflow, ‘revenue cycle management’. The workflow solutions are contactless which works well for social distancing practices at dental clinics. It’s a full-stack dental practice management software for clinical and business management. 

Katie, a resident of the United States of America, works 2 jobs and can barely afford healthcare in her country of residence. She has to undergo an urgent dental surgery but her insurance won’t cover the cost of treatment.

While looking for options to undergo the procedure outside the United States, she comes across Fortis Hospitals’ Maxillofacial Surgery marketing campaign online. The hospital is offering a visa, stay and treatment package which is 50% lower than the expenses she will incur in the United States. However, Katie will need to travel to India which she can also afford. The only problem is regarding the ongoing second wave of Covid-19 in India and she is a little concerned about her safety during her travel and stay in India. She contacts the hospital who assure her of safe travel and even offer her an upgrade so that she can be rest assured of being safe throughout her medical trip to India. 

What is Medical Tourism?

Medical Tourism is the travelling of residents from their home country abroad to undergo advanced treatments and procedures that are either unavailable or not cost effective in their home country. It’s an opportunity for travel and tourism activities where patients can take advantage of their visit to a different country for a supposed ‘medical getaway’ or holiday.

Healthcare institutions and hospitals specifically cater to the medical travellers by offering admission cum accommodation packages. Special in-house hotel rooms are provided to these medical travellers to give them an opportunity to explore their surroundings alongside their scheduled appointments. 

India’s key healthcare players are contributing to its growth 

Fortis Hospitals India is one of the top contenders on the list of Medical Tourism Manufacturers across the globe who will contribute to the growth. Fortis at Bannerghatta, Bengaluru got an international certification in 2016 for being the country’s go-to destination for Medical Tourism. 

Currently it’s the biggest healthcare player in the Indian medical Tourism sector alongside Apollo Hospitals, Manipal Hospitals, Narayana Health (famous for heart procedures). 

Apollo Hospitals at Hyderabad, Telangana recently received the JCI (Joint Commission International) Accreditation for Medical Tourism.

Popular Medical Tourism Treatments

Every year, scores of patients from across the globe flock to prime medical tourism locations especially in India to avail state-of-the-art expertise from top-notch facilities. Popular treatments include:

• Fertility Treatments
• Cosmetic Surgery like Hair Transplant and Breast Augmentation
• Dental Surgery
• Oncology Treatments 

Medical Tourism in India – Scope

Medical Travellers from countries like the USA prefer to travel to developing countries like India due to the low treatment cost for major surgeries like Hip and Knee Replacements. 

Asian countries are now the top destinations for medical tourism mainly because healthcare innovations have gotten very advanced and the costs are much lower compared to the US, Europe, etc. 

The scope for Medical Tourism in India is concentrated around Transplants, Orthopaedic, and Cardiac treatments. Due to the huge surge in patients, there is an option to avail a special visa category to make the process quicker and hassle-free under the Government of India’s ‘e-Tourism Visa Regime’. In India, the Asian Heart Institute is most sought-after for cardiac bypass surgery because medical tourists from most nationalities are welcome here and obtain access to top experts.

‘Breathe Well-Being’ is a Gurugram based Diabetes, health-tech start-up which recently raised $1 M in a Pre-Series A funding round backed by 3One4 Capital alongside Angel Investors Sandeep Singhal, Ashish Gupta, and ‘Stanford Angels and Entrepreneurs India’. A new entrant to the health tech industry, this start-up was founded in 2020 and is rapidly scaling up. 

Decoding the strategy

Breathe Well-Being’s strategy to reach out to 10 M Indians suffering from Type 2 Diabetes has been to follow a tech-abled healthcare delivery model since this approach has immense potential. 

Their technology platform, the ‘Breathe App’ runs on a clinically proven digital programme. This programme follows a personalised coach-driven, community-first approach through interactive gamification to help patients suffering from Type 2 Diabetes bring down their blood sugar levels, lose excess weight and to reach a point where they can easily wean off medication. 

Impact on the Industry

Breathe Well-Being’s D2C (Direct-to-Consumer) approach is unique in the healthcare sector. Their approach is also built on first principles and fundamentals which is strong and attractive to investors in healthcare. 

The current healthcare industry that caters to Diabetes is based on medications that cause long-term effects on a patient’s health. Breathe Well-Being is making a significant impact on the industry by addressing the problem from its root and by taking a lifestyle approach to treat the disease rather than a symptomatic approach. The results they’ve achieved are tremendous even with their holistic approach. 

How the start-up is a competition

The team behind ‘Breathe Well-Being’ has deep expertise in healthcare, community and lifestyle management. The start-up is a competition because it’s perfectly positioned to create a healthcare revolution in the digital delivery space. 

Why did the growth happen?

The company achieved a high growth rate due to strong ‘word-of-mouth’. The company reported 10000 success stories of pre-diabetic and diabetes patients losing weight and reducing their blood sugar levels. This tremendous achievement has surely accelerated their growth pace through good reviews and recommendations from users. 

The fact that the founders of ‘Breathe Well-being’, Rohan Verma and Aditya Kaicker are both second time founders in the healthcare industry has also contributed to a 30% M-O-M (month-on-month) growth with a 22x rise in their subscription base within 12 months.