A healthy dose of digital for Apollo Hospitals

Every year on February 5, Apollo Hospitals Enterprise celebrates its Founder’s Day to mark the birthday of its founder and chairman, Prathap C. Reddy. The occasion was slightly more special for the Chennai-based company in 2020 because that was when it also launched its digital healthcare app, Apollo 24/7. The aim is lofty: to build something akin to a healthcare super-app, offering e-consultations, diagnostics, e-pharmacy, preventive health, and other services on one platform.

Apollo’s timing was also, unintentionally, prescient because around the same time, the Coronavirus breached Indian shores and led to a months-long lockdown by the end of March. Cooped up indoors as the virus raged nationwide, Indians had little choice but to pick up their phones to consult doctors at the slightest signs of any symptoms, or manage existing conditions, or even order medicines. Digihealth, telehealth, e-healthcare, call it what you will, was booming. And Apollo 24/7 rode the wave.

“It is a natural progression. If we don’t do it, no one else can,” says Shobana Kamineni, executive vice chairperson, and one of Reddy’s four daughters who co-manage Apollo. It is hard to argue against her claim considering Apollo’s reach: it operates 71 hospitals, making it India’s largest hospital chain, and also owns more than 4,000 pharmacies across 24 states. Still, even that’s insufficient for India’s population. “We can’t build enough hospitals to service every Indian, but most of India will have digital access in the future. And if you have digital access, the healthcare platform that you should be on is Apollo,” says Kamineni. Apollo has already done more than a million teleconsultations and is delivering almost 40,000 medicine orders every day, she says. The aim is to serve 100 million Indians in the next four years, with personalised health services, diagnostic video consults, digital therapeutics, condition management, and more.

Their digital ambitions, though, pit the 38-yearold company against health startups like Practo and PharmEasy, which curate health products and services ranging from consultation and diagnostics to medicines. These apps boast a loyal user base and have the financial heft to expand, considering they are backed by marquee investors ranging from American venture capital firm Sequoia Capital to Singapore’s Temasek. Moreover, Amazon has also started its e-pharmacy in some cities, while legacy companies are also entering the fray. Tata Digital recently bought a majority stake in online healthcare marketplace 1mg, and Reliance Industries acquired a 60% stake in online pharmacy Netmeds last year. However, Apollo 24/7 isn’t doing too badly, all considered, going by downloads on the Google Play Store. The app has 5 million-plus downloads, as do Practo and Netmeds, while PharmEasy and 1mg have over 10 million.

But, this is just the start of the race for supremacy in India’s digital healthcare market, which Credit Suisse estimates will be worth $7 billion by 2025. And the Covid-19 pandemic has been the perfect catalyst for that growth. The number of online consultations tripled in India last year, according to a report by Practo and the Telemedicine Society of India. More pertinently, online consultations surged sevenfold in non-metros, and fivefold among those above the age of 50. Digital healthcare saw a spike in other countries as well. Ping An Good Doctor, a telemedicine service started by Chinese insurance giant Ping An Insurance, saw a 27% rise in medical consultations to an average of 831,000 every day in the first half of 2020.

So, what makes Apollo so confident about its plans for digital prowess? Managing director Suneeta Reddy believes what sets them apart is that they are the only major Indian healthcare player with a significant online and offline presence. The digital ecosystem, she says, “brings every part of Apollo together. We are the largest integrated healthcare player in Asia today with the different verticals that we’ve created. It is a huge advantage because it’s good for the patient, and it’s good for us.” The second differentiator, according to Kamineni, is the trust the Apollo brand has built by treating millions of patients across its wide network over the years. “When you want a doctor to consult, why do you want the choice of 100,000 doctors? It makes no sense. You want a doctor you can trust,” she says.

It’s not just trust. Kamineni believes there is no other player in “this part of the world” which has the knowledge and data sets that Apollo does. Who then is Apollo learning from? Kamineni points to China’s Ping An, U.K.-based Babylon, and U.S.-based Livongo, which was recently bought by telemedicine and virtual healthcare company Teladoc, as examples of companies that have done well in the digital healthcare space. Apollo, though, she adds, is capable of ranking amongst the top five players in the world.

E-health ready

But Apollo cannot conquer the market on its own, especially considering the competition. To build out the non-healthcare aspects of the 24/7 app, Apollo is striking partnerships with financial, telecom, e-commerce, and other players. “The most like-minded and marquee partners in the country will be part of this,” says Kamineni. Apollo has roped in State Bank of India and HDFC Bank as its banking partners, while Airtel is its telecom partner. It will soon name more e-commerce and technology partners. There are others too. “Almost 600 corporates in India already work with us. When we offer this 360-degree experience, we will leverage the deep partnerships and relationships we have all around India, with doctors, with ecosystem players, with everyone,” Kamineni adds.

Apollo is also parallelly scouting for healthtech startups through HealthXCapital, its Singapore-based venture capital fund. “We’ve invested into what we believe will be companies that will aid healthcare in the future,” says Suneeta Reddy. One of the companies Apollo funds is THB, which Reddy says is one of India’s largest healthcare data analytics firms. “We are using these companies to improve the way we engage with customers,” she says, adding HealthXCapital will soon have an India office.

However, Apollo’s digital bet could be both advantageous and disadvantageous, believe some industry experts, who declined to be named. The advantage, they say, is that the consumer-facing app is supported by a supplier. For example, if a patient decides on surgery after an online consultation, they can approach an Apollo hospital, which will already have their case history. But that very intertwining, these experts argue, could be a disadvantage as the app may not be perceived as “independent” as those of its rivals’, which give consumers the option to choose from various hospitals or pharmacies.

Nonetheless, other hospital chains too have realised the advantages and are keen to cash in. The likes of Fortis Healthcare, Aster DM Healthcare, and Narayana Health are all getting their digital act together. They had to since “hospitals traditionally have focussed on acute episodic care, which necessitates inpatient admission,” says Rana Mehta, healthcare industry leader and partner, PwC India. “The larger continuum of care including diagnostics, outpatient consultation, preventive care, home delivery of medicines, and home health saw an exponential growth in the pandemic.” Hospital chains are now ramping up their digital capability to offer these services, he adds.

The question that arises next is whether people will continue to access digital healthcare once the pandemic is over, and whether the opportunity is as big as it seems. They will and it is, believes Milan Narendra, partner, government and public sector, EY India, adding the pandemic was a game changer. “Telemedicine has been in India for a while, but there is more acceptability of remote care after the pandemic. Another interesting trend is the continuum of care, that is, a patient can be in touch with the doctor all the time and the doctor can keep track of the patients, resulting in a stronger patient-doctor relationship,” he says.

Forget the continuum of care, earlier just arranging a consultation could take forever. That wasn’t surprising considering India has one doctor for every 1,511 people, well shy of the World Health Organization’s (WHO) prescribed ratio of 1:1,000. With time becoming the new currency, patients expect access to quality healthcare with the least amount of time required as an investment, something digital healthcare can provide. However, Narendra says healthcare will be more of a blend between physical and digital services once the pandemic subsides, but he cautions that the various cogs of industry “need to be geared up for the quantum leap.”

“From an organisation perspective, the private sector and the government need to plan for a blended mode of existence,” says Narendra. “During the pandemic, there was capacity available for digital services as there was a slide in hospital footfall. However, organisations can’t continue with existing capacities. A doctor sitting in the OPD (out-patient department), for example, cannot do online consultations simultaneously.”

Indeed, a lack of proper infrastructure is the primary reason many experts believe India may have missed the bus when it comes to leveraging digital health during the pandemic. Secondly, the rules for telemedicine were only notified in March 2020, and initiatives like eSanjeevani, India’s national telemedicine service, were rushed through during the pandemic. Still, the high demand for these services—the eSanjeevani app crossed 3 million e-consultations this March—bodes well for the future of digital health. And Apollo 24/7.

Prevention and cure

Apollo also has the early-mover advantage. Their telehealth initiative started 20 years ago when they used V-SAT (a satellite communications system) in a rural hospital in Aragonda, a small village in the Chittoor district of Andhra Pradesh where Prathap C. Reddy was born. They have been delivering services like tele-radiology, tele-cardiology, tele-condition management, and tele-ICU for a while now.

Joint managing director Sangita Reddy says telehealth was one of the things that did well during the Covid-19 pandemic. Apollo TeleHealth provided teleconsultation and counselling services to over 2,200 Covid-19 patients and over 40,000 suspected cases through its “Doc on Call” service during the pandemic. The company wants to share its telehealth expertise with the government and others in the sector. It is already collaborating with various state governments and has more than 700 public healthcare centres in public-private partnerships across the country.

Apollo believes it can be instrumental in helping solve India’s long-standing issue of healthcare access outside the metros. Suneeta Reddy believes the pandemic has settled the argument about healthcare localisation. “Covid-19 has made companies realise that people cannot always travel to bigger cities to access healthcare,” she says. And they don’t often have to, adds Sangita Reddy. She says their experience in Aragonda shows telehealth can handle 80%-90% of intensive care cases. “We strongly believe in propagating [telehealth] for the government and for the country today, so that rural India gets the type of care that it needs,” she says.

That cause will also be helped along by the continued proliferation of smartphones in the country—expected to top 800 million by next year. Still, Suneeta Reddy says Apollo will expand both its physical and digital presence deeper into tier 2 cities and smaller towns, and that the company is actively looking at acquisitions to do so. She declined to share details.

Meanwhile, the hospital chain is also focussed on introducing the latest in health technology to India. Something that Preetha Reddy, executive vice chairperson, says the sisters imbibed from their father. Take the Apollo Proton Cancer Centre in Chennai, for example. Opened in 2019, it is the first proton therapy centre for cancer care in South Asia, but Reddy says it took her father three meetings to convince Apollo’s board to make the `1,300-crore investment. Now, they expect the centre to add to Apollo’s financials this year, despite fewer patient visits over the past year.

Clearly Prathap C. Reddy, at 88 years old, is still enthusiastic about bringing the latest health technologies—artificial intelligence (A.I.), automation, robotics, 3D printing—to India. “Robotics will make a very significant impact,” says the cardiologist by training. “Apollo today has about 10 robots. I’m looking at the day when we have 100-300 robots in the country. It will make a very significant impact because it not only gives the doctor additional help to do the surgery with perfection, with minimal side effects, but also a better view of the procedure.”

That’s on the prescriptive side; there is also preventive healthcare.

Going by the obsession over immunity boosters during the pandemic, and the fact that those with comorbidities were at greater risk, the focus on preventive health is here to stay. Apollo realises that. “We are definitely seeing people’s interest in their health and their bodies is much more now,” says Sangita Reddy. “Covid-19 has really taken a toll on people’s bodies. A lot of things are happening to the human body, which we don’t know and we don’t understand. For that group of people, preventive health becomes important.”

Apollo’s focus on preventive healthcare predates Covid-19, to September 2019, when it launched ProHealth. The personalised, three-year-long programme brings together diagnostics, predictive tools, and personalised care. “It’s a combination of artificial intelligence (A.I.), clinical insights, automation, and customer convenience. You can do your risk profiling, customised health checks, and have the technician come home and take your samples,” says Sangita Reddy. ProHealth was made part of Apollo’s 24/7 app in December last year.

There are more interesting initiatives under ProHealth, like the one with Microsoft, for example.

Apollo and the tech firm together have developed a cardiac risk score, an A.I.-powered programme to better predict cardiac diseases for the Indian population. Besides ProHealth, a few years ago Apollo started working with Google on an India-specific initiative called a symptom search feature, which gives users information on commonly searched symptoms.

As is clear, Apollo is converging all its various initiatives into its digital healthcare efforts, the face of which is the 24/7 app. “All of this comes together as part of our effort to keep people healthy… and it’s good for our financials,” says Suneeta Reddy. The ultimate aim, she says, is for Apollo to eventually become something of a concierge programme for patients to look after their health throughout their lives.

And how will Apollo realise they have been successful? Sangita Reddy has an answer: “The day telemedicine is not a separate department or a division, the day it is embedded in mainstream medicine, that’s the day we will have achieved what we wanted to.”

(The story originally appeared in Fortune India's July 2021 issue).