MEENA GANESH LISTENS more than she speaks. People who know her say her defining trait is empathy, laced with occasional displays of dry wit. After a lengthy photo shoot with Fortune India last month, she told a colleague, “I can never be a fashion model.”
The other thing that strikes you is her self-deprecating style. When we met a couple of years ago, she conceded straight away that the name of her company—Health Vista India—smacked of a “complete lack of originality”. Yes, it is a health-care firm, and the ‘Vista’ came from TutorVista, an online education venture she and her husband Krishnan Ganesh had co-founded in 2005; in 2011 they sold a controlling stake in it to Pearson at a valuation of $213 million (Rs 1,345 crore at current rates).
She felt they had been hasty, maybe even lazy, in naming Health Vista. The haste could well have been a byproduct of the couple’s signature style: Build businesses before they are in vogue, scale at lightning speed, and exit at the sector’s prime. They sold their first company Customer Asset, a BPO, in 2003, within four years of its inception and at the peak of the outsourcing era, to the erstwhile ICICI OneSource (now Firstsource). The TutorVista exit too came just when online learning took off in the country. Between those two companies, Ganesh built global retailer Tesco’s India development centre, as CEO, from scratch to around 3,000 employees, in less than five years.
You would imagine Health Vista and its flagship in-home medical care brand Portea, where Ganesh is leading the charge as managing director and CEO, would call for a less hectic build-up, for it is in the delicate business of looking after the infirm and the ill. But Portea’s growth has been off the charts. In two years, it has raced to a user base of almost 100,000 patients and grossed 626,000 home visits, 65% of them from repeat customers. The visits range from handling post-surgery recuperation to physiotherapy, in addition to a small but growing practice that involves remote monitoring of patients. Bengaluru and the Delhi-National Capital Region account for nearly 60% of the business. Overall, Portea is now in 16 cities in India and four in Malaysia.
“Our business is delivery- and technology-intensive. Much of our investments and growth have been in these two areas,” says Ganesh. “It is also a very local business—you have to be present in Lucknow if you want to service patients there. It is not e-commerce.” Investors don’t seem to mind the inconvenience: Accel Partners, Ventureast, International Finance Corporation (IFC), and Qualcomm Ventures have pumped in more than $45 million in Portea, including $37.5 million in a Series B round in September.
Of course, the startup world is littered with prodigious successes that crash and burn just as fast. But Ganesh isn’t building Portea in their likeness. In fact quite the opposite: She wants Portea to embrace full accountability towards customers at a time when doing so is unfashionable.
Portea takes responsibility for every stage of health-care delivery, from attending to patient enquiry on its website or through its call centre, and creating the workflow for the visiting staff based on doctors’ recommendations, to delivering care at the patient’s home. Almost 85% of its services is owned and managed by a 3,000-strong in-house team of nurses, attendants, physiotherapists, phlebotomists, and doctors (freelancers do the rest). While the raison d’être of most startups is limited to connecting third-party vendors with customers, Portea has skin in the game all the way.
It is hard to play down the risk. A vast majority of India’s most disruptive tech ventures—the likes of redBus (bus booking), Pepperfry (furniture), Ola (cab aggregation), Oyo (hotel bookings), Grofers (groceries), and Practo (doctor aggregation)—have steered clear of the messy, resource-intensive business of service fulfilment, mirroring the hands-off, asset-light model of the Ubers and Airbnbs of the world.
But here’s the thing: Investors love that model; customers, not so much. An Ola investor estimates that its fulfilment rate is 75% of the claimed 750,000 daily rides its app activates. The rest includes rides that are refused by drivers, or cabs that simply don’t turn up, or customer cancellations. Ola doesn’t have to take responsibility for the dropout rate, even as it talks up the uptick in rides. Neither is redBus accountable when a bus operator asks a passenger to get off because a seat has been booked twice—offline and online—by two different people. Pepperfry can also blame the seller when a customer receives a faulty piece of furniture, or when the carpenter plays truant.
Those are just the symptoms. The real problem is that offline service delivery in India is maturing far slower compared with the rapid growth of online ventures. The Internet is a tool to create exponential demand, but fulfilling that demand calls for a tonne of spadework, especially in a country where last-mile connectivity is badly broken. It’s an existential dilemma for young, cash-guzzling companies that must grow faster and faster to stay ahead of competition, before they can apply their mind to solve the fulfilment puzzle. The upshot: ‘User experience’ has been reduced to the sexiness of an app and the ease with which it can link more and more buyers with sellers. Servicing the ever-growing hordes of customers, meanwhile, is always someone else’s problem.
It’s in this context that Ganesh—at 52 very much a senior citizen among yuppie entrepreneurs—is trying to ensure mass availability, access, and quality of health care, and retain control over the entire service experience. Given Portea’s pace of growth—it clocks 60,000 home visits a month, up from around 10,000 last year—balancing it all is going to be a stretch. If Ganesh pulls it off, Portea could become the beacon for a new kind of company. If not, it’d be another chapter in the Uberification of business.
ARUN MATHEW, 30, THE NEWEST MEMBER in Portea’s six-member board, has been with Accel Partners, the largest shareholder in the company, since 2009. He works in San Francisco Bay Area, and has managed investments in companies like Groupon there, as well as Freshdesk and BookMyShow in India. “Meena is very serious about owning the full patient experience,” Mathew tells me over phone from the Valley. “That’s the only way she can ensure quality, which is difficult to guarantee if you outsource the service.”
In e-commerce, if you use two different logistics vendors to deliver a package, the end consumer won’t notice the difference, he adds. “But if you use two different physicians—highly trained vs. poorly trained—the consumer will notice the difference. That difference affects a person’s health. What could be more important?”
To be sure, there are a few clear business benefits of building home health care end to end. It helps a company amass valuable patient data, which is crucial for streamlining operations and managing the same patients in future. Then—and this is what attracts investors—it can bag the full share of a medical transaction. “We need to build the brand and get to a critical mass—that’s the first priority,” says Bobba Venkatadri, a general partner with Ventureast who specialises in life sciences and pharma, and is also based in the Valley. Once those boxes are ticked, the opportunity is huge. “In India, 70% of hospital visits are unnecessary,” says Venkatadri. “For small problems, home health care costs patients far less than going to a hospital, consulting a doctor, and paying for needless, expensive tests.” He finds support in Pravan Malhotra, venture capital lead for IFC South and Southeast Asia. “The health-care industry will expand to include integrated care models, so that appropriate care is delivered at the right point of contact (i.e. not all in hospitals),” he argues.
Venkatadri says he was initially sceptical about Ganesh’s leadership, but has since been won over by her “transparency and style of management”. “She didn’t have the health-care background required to lead such a company,” he says. “But she compensates for that by listening to the experts—the doctors and nurses in the company—and by constantly engaging with customers.”
Riddhi Deb, a young manager who has worked with Mondelez and Ernst & Young, moved home from Mumbai to join Portea in Bengaluru in July 2014. The role—head of customer engagement—was unusual for a company barely a year into its operations. Typically, early-stage companies are in a hurry to broaden the customer base. “It takes them years to start focussing on customers’ holistic needs,” says Deb. “But Meena was clear from the start that we have to cater to all the needs of every patient.” Apart from ensuring repeat business and incremental revenue from each customer, deep engagement helps build network effects. “A large part of our new customers comes via references and recommendations,” says Deb.
Ganesh herself makes home visits to monitor quality. “She has the amazing ability to pick out insights from an ordinary interaction,” Deb says, citing an instance when a patient had trouble walking. Ganesh’s feedback: The patient probably needs a walker. The company looks at such situations as an opportunity to enhance service rather than push up the bill. “We don’t give sales targets to our staff,” Deb says. (Currently, phsyiotherapy and nursing make up nearly 70% of revenue.) A treatment plan is created after a first visit to the patient’s home, which can change based on the patient’s recovery. The focus is on compliance with the plan, not pricing based on number of visits.
GANESH'S BIG CHALLENGE is building awareness, given India has no history whatsoever of organised in-home health care. For patients, the benchmark is still the quality of care at a hospital. Similarly, caregivers like attendants and nurses could easily slacken the rigour that they are compelled to exercise in a hospital environment.
That’s why patient families aren’t entirely sold on the model. Based on my interactions with three families, and even my grandmother’s experience after a surgery, the concerns range from attendants not arriving on time to the roster changing which means familiarising with a new attendant. A friend, whose father is recovering from a string of surgeries, messages me on WhatsApp: “If you find any good alternatives to Portea and Nightingales, I’d love to hear about them.”
Nightingales’ home healthcare business was launched by Medwell Ventures last year. It is the brainchild of Vishal Bali, former CEO of Fortis Healthcare, Ferzaan Engineer, former CEO of biopharma services company Quintiles India, and health-care industry professionals Lalit Pai and Himanshu Shah. Nightingales focusses on chronic diseases and elderly care on a subscription model and has nearly 15,000 subscribers (a few services are available to non-subscribers too). “We focus on building long-term relationships,” Bali says, adding that Portea follows a more transactional model. The company has 525 employees, 80% of whom have a medical, paramedical, or nursing background. In June, it received $10 million from Fidelity Growth Partners. In sharp contrast to Portea’s blistering expansion, it operates in only two cities, Bengaluru and Hyderabad, with Mumbai on the cards. Also, unlike Portea, it’s not an Internet-enabled business.
Is Ganesh running too hard, and will this scupper quality? Mathew of Accel Partners says it’s one of the business’s inherent trade-offs. “You can have more control and high quality, but that makes the business much harder to scale.” This is the catch-22 all technology-enabled businesses must grapple with in their go-go years. Infosys and Wipro faced it when their teams soared from 25,000 to many multiples of that. E-commerce companies are facing the same bogey—think of Flipkart’s Big Billion Day fiasco last year, when its site collapsed under the strain of traffic, forcing a public apology.
The only way to prevent such a crisis is through technology and training. All Portea employees are given smartphones, and the company is developing a GPS-based mechanism to track their movement. It already has an interface to help staffers update vital patient information. “The reports reach my team of doctors and patients simultaneously by e-mail after the home visit,” says Dr. M. Udaya Kumar Maiya, medical director at Portea, adding that less than 10% of the patients need to be referred back to hospitals if complications show up. Patients have access to a portal where they can check their records. In October, Portea also launched an Android app, and will soon release the iOS version. “We want to make this the single point of contact for customers to get a doctor or information on specific problems, at any time,” says Ganesh says. Then there are online training modules for on-field staff.
More important, Ganesh drills into new employees that this isn’t e-commerce, where processes can be repeated mechanically. “The needs of every patient are so different that ensuring consistent customer satisfaction becomes all the more challenging,” says Kavita Chowkimane, Portea’s general manager, marketing, who has had managerial roles with online ventures like Simplilearn and TaxiForSure. For example, a 70-year-old male patient of a certain build can be handled only by a male nurse. “Figuring out availability and matching it with what each patient needs—all within a fixed time—is the toughest task,” she says.
There’s also the soft-skill aspect unique to health care: Portea’s staff often spend time counselling caregivers on the emotional needs of the families of terminally-ill patients. It’s just not the same as making small talk with passengers while ferrying them point to point, or plying customers for a higher satisfaction rating after delivering groceries.
PORTEA'S OFFICE has the chaotic vibe of every high-growth startup. Every day, zonal heads and their medical teams throw hundreds of problems at the Bengaluru HQ, and something that is important but not urgent can easily slip through the cracks. Also, even seemingly simple questions—how to decide pay for physiotherapists and nurses, or how to calculate travelling allowance and incentives—can require painful rounds of iteration: In many ways, Portea is building a whole industry ground up, and there’s simply no precedent to turn to.
That’s where Ganesh comes in. Vaibhav Tewari, Portea’s chief operating officer, says she has the ability to quickly break down complex problems and conceptualise solutions—but then you expect that of someone who is into her third innings as an entrepreneur, and has spent years besides opening up uncharted frontiers, including an Internet and application development unit for Microsoft when the Internet was in its infancy in India (1995 to 2000). Her real strength as a leader, says Tewari, is “treating everyone with dignity and fairness”. At brainstorming sessions, she stays calm and listens to everyone before offering an opinion. Her inputs are to-the-point, and there’s no ‘I am saying it, so just do it’ attitude. That has helped set a nimble culture where people are not afraid to make mistakes. “We take decisions fast, test them out, and course-correct if necessary,” Tewari adds.
Venkatadri of Ventureast feels Ganesh’s people skills are a key reason for investor faith in Portea. “The team loves her. Even during board meetings, she opens up access to two or three management levels below. She invites them to speak, there are open disagreements. It is exceptional in the typical Indian setting, and a pleasant surprise to me.”
Ganesh’s key aides have stayed with her across companies. Shridhar N. Upadhye, Portea’s vice president - operations, previously headed customer support operations and customer relations, implementation, and tech support across India for TutorVista’s Edurite business. Then there’s Arun Kumar, another TutorVista colleague, who was part of Portea’s founding team. This March, Kumar moved on to start up on his own, with support from Growth Story, an incubator funded by the Ganeshes. (There’s of course husband Krishnan Ganesh, who, as Portea’s chairman, helps raise money, manage investor relations, and scout for potential acquisitions, some of which Portea will soon announce.)
Ganesh’s ability to take everyone along will be even more crucial as Portea expands its network across the health-care ecosystem, tying up with insurance companies, medical device manufacturers, equipment-leasing companies, and pharmacies. Ganesh points out that insurers, for instance, can cut costs because of the quality of patient records at Portea’s disposal. Hospitals can discharge patients early—they tend to stay on to claim insurance—because “[we tell them] the home is a less infectious environment to recover in”.
Similarly, primary care is generally not covered under insurance, so people wait until they get really sick and need to be hospitalised. This pushes up expenses and insurance claims. A plan to partner insurance companies to help them disburse primary care insurance has been in the works for over a year, though Ganesh won’t reveal details. Meanwhile, Portea has signed up close to 50 hospitals in 12 cities—that’s almost 18,000 beds—to provide home care. “We work with clinicians, specialists, and other hospital staff so they can recommend us,” says Tewari. “It has been operationally challenging,” but accounts for over 30% of Portea’s patient portfolio.
Portea’s ultimate vision is to deliver all-encompassing primary care—physician visits, health checkups, diagnostics, physiotherapy, short- and long-term nursing care, post-discharge care, geriatric care, disease management, and remote monitoring—says Mahendran Balachandran, health-care lead for Accel Partners, and board member at Portea. “Primary care is the first and most critical touch point for consumers of health care. Portea has the ability to be India’s largest consumer health-care brand.” Will it continue to retain 85% control of ops when it gets there? “The success of any business finally depends on unit economics, not on whether it’s a marketplace or owns the entire value chain,” says Balachandran. “To me, what will make Portea successful is Meena’s ownership over every aspect of the business.”
That’s if she isn’t called away by the next big thing.