Healthcare: The right prescription

Ranjan Pai, chairman of Manipal Education and Medical Group (MEMG), had a simple brief for his team during a brainstorming session sometime in early 2018: He wanted to connect with patients after they left the premises of his hospitals. The reason: to come up with ideas that could be potential business opportunities. “We realised that people don’t want to travel long hours for every medical need to big hospitals unless it is necessary or for specialised treatment and doctor consultations,” Pai tells Fortune India.

People in Bengaluru, also known as the Silicon Valley of India, on average spend at least an hour each day commuting because of the city’s dreadful traffic snarls. “Is there a way people can travel to our hospitals only when there is a need while they can sort out most of their healthcare requirements digitally, through an app,” Pai thinks aloud.

Not just Pai, other big names in the industry like Devi Prasad Shetty of Narayana Health, and Suneeta Reddy of Apollo Hospitals are also thinking of new ways to take the sector forward. Some of the questions they are asking: What lies ahead; how do you adapt to new challenges such as the rise of chronic diseases due to change in lifestyle and climate and, how do you cater to rising demand with the population explosion?

Experts and industry players like Pai, Shetty, and Reddy feel technology could provide answers to most of these questions. Advancement in technology is creating new opportunities to generate and use data to improve health outcomes, with artificial intelligence (AI), blockchain, and data analytics leading the way. A recent report by EY, ‘Life Sciences 4.0: transforming healthcare in India’ points out that there has been a radical shift in consumer expectations for convenient and personalised care with growing awareness.

India has a population of 1.3 billion, the second largest after China, according to the latest data from the United Nations. Keeping a physical record of these many people is a Herculean task and also economically not viable. Electronic health records and cloud storage allow quick access to an individual’s data, enabling streamlined collaboration between different stakeholders in the ecosystem, while consumer-facing mobile apps empower patients to be in charge of their own health, says the EY report.

Hospital chains across the country are seriously considering it as a more natural way of engaging with patients, going forward. Pai is working on a similar narrative. He has already laid the groundwork for his new venture that will focus on digital healthcare, with technology at the heart of the project. “It will only work if you have a dedicated team who understands healthcare and more importantly technology,” says the 45-year-old entrepreneur.

Manipal Health Enterprises Pvt. Ltd (MHEPL), which is part of MEMG, is sitting on a goldmine of data from across its network of 11 hospitals in India, one in Malaysia, and a clinic in Nigeria. The Bengaluru-based billionaire physician by training now plans to monetise the data. “Since it will be all data-driven, it is important the data is owned by the hospital, because people are sensitive about their healthcare records. We want to mine the data that we possess and with the help of AI tools we can get more predictable results,” says Pai.

Every year, through its chain of hospitals, Manipal provides healthcare services to 2.5 million-3 million patients a year. While the business plan is still a work in progress, Pai says it will be broadly a personalised digital healthcare platform maintaining medical records and providing services such as doctors’ appointments, teleconsultations, diagnostic reports, prescription, and others. He is looking to roll out the service during the April-June quarter of FY20 as a pilot run within the Manipal hospitals network. The initial investment will be about $10 million to set up the venture. He is clear that there won’t be any revenue targets for the first two-three years. Initially, a team of about 15 members with a resident entrepreneur will run it as a separate entity. “We want to go beyond the regular hospital service. We want to use digital healthcare as an extension of the hospital,” he says.

The idea is not new and is quite similar to what some other large hospital chains in the country are offering. Take Chennai-based Apollo Hospitals Enterprise, for instance. The country’s largest hospital chain operator is working on several areas within the digital domain. Its integrated patient engagement healthcare platform encompasses the whole Apollo Hospitals ecosystem: from pharmacy to hospitals, and clinics where people can seek and exchange information, book doctors’ appointments, schedule lab and diagnostics tests if required, purchase medication, store medical records, and also book for home-care service.

Here, too, data mining plays a key role in understanding patients’ needs. “Besides booking doctors’ appointments, the portal offers tele-consult options with specialists. Going forward, this platform will also integrate optimised treatment plans—the type of treatment that would be required. This feature is especially useful in our PPP [public-private partnership] telemedicine projects, where we link up with small towns and provide opinions on medical treatment— which provides them guidance and a plan without needing to travel to the cities,” says Reddy, managing director, Apollo Hospitals Enterprise.

Apollo currently works with the Andhra Pradesh government across several primary healthcare centres, and has also deployed the technology in several other states. Today, the group has 70 hospitals with a presence across the country and in Muscat and Dhaka.

Over the years, the hospital industry has grown exponentially from primary healthcare centres to multi-speciality private hospitals. But India’s public health expenditure continues to be one of the lowest in the world—only 1.02% of its gross domestic product (GDP), compared to low-income countries such as Sri Lanka’s 1.6% and Bhutan’s 2.5%, according to data from the National Health Profile, 2018.

Analysts feel with the government rolling out its ambitious health insurance scheme, Ayushman Bharat (National Health Protection Scheme), the healthcare sector is likely to reap the benefits. The project is said to be the world’s largest health insurance scheme funded by the government. It aims to offer insurance of ₹5 lakh per family per year for secondary and tertiary care hospitalisation. Considering India’s demand-supply gap (more patients, fewer hospitals and doctors), it will be a tough task for the government. Tech innovations in healthcare delivery could be one of the ways to address that gap. However, the extent of digital growth across the healthcare spectrum also hinges on mobile and Internet penetration in tier 2 and tier 3 markets and the country’s interiors, not just big cities. The success will also depend on the scaleability of various digital initiatives by the hospitals. Exponential growth in mobile and Internet penetration in the past few years has been a major growth driver for digital offerings.

Last year, India outpaced the U.S. to become the second-largest smartphone market in the world after China. Smartphone shipments to India stood at 40.4 million units during the September 2018 quarter compared to 100.6 million units to China, according to a report by research firm Canalys. Not just that, smartphone adoption in India is expected to touch 60% (890 million users) of the total mobile users by 2022, says the EY healthcare report.

“Globally healthcare is moving from a treatment and fee-based approach to a preventive and wellness and a value-based one, where data will be paramount,” says Anil Bhansali, managing director in charge of research and development, Microsoft India. “We are capturing all the signals from all kinds of sources, not just hospital and pathological data, but also ambient data, putting it in storage, running it through AI and machine learning to provide the best input data for diagnosis and treatment. The more data that we have, the better will be the treatment.”

The healthcare industry in India mainly comprises hospitals, diagnostics, medical equipment, pharmaceuticals, telemedicine, and health insurance. Over the years, the industry has grown rapidly, backed by increasing demand for new-age healthcare facilities, tech innovations, growing awareness about diseases, higher per capita income, and changing lifestyle.

India Brand Equity Foundation, a resource centre under the commerce ministry, expects the healthcare industry in the country to increase to $372 billion by 2022 from an estimated $160 billion in 2017, while the hospital industry is expected to grow at a compound annual growth rate of 16-17% to touch $133 billion by FY22 from $62 billion in FY17. Hospital operators are bullish about the next stage of growth.

Shetty, founder, chairman, and senior consultant cardiac surgeon at Narayana Health, feels the entire foundation of the healthcare industry is based on data and future changes in healthcare delivery will be led by compulsion. He cites the example of how India has just 600 diabetologists (diabetes specialists) for 70 million diabetes patients. “There is a mismatch in demand and supply. Each diabetologist has to see a diabetic patient personally every month or every three months. It is not possible,” says Shetty. “In that case, we have to change the way we provide diabetic care where in the diabetologist sees the patient once a year but the patient gets a detailed evaluation done and all his or her medical records and checkup details are fed in through a database.”

In this case, the medical record happens to be the patient’s mobile phone—whenever there is a fluctuation in sugar levels, the patient can send a message to the diabetic counsellor and the counsellor connects with the diabetologist who can advise a change in medication.

Narayana Health—which has 23 hospitals, seven heart centres, 19 primary care facilities across India, and an international hospital in the Cayman Islands—today has dedicated teams working on tech solutions. A San Francisco-based startup called Cura (partly owned by Narayana Health) has designed the diabetic app. “We have over 3,000 patients now who are on online diabetic care. We started this about threefour months ago. We have about 55,000 diabetic patients who are being treated in our group. All these patients can technically be treated online because we have the database. It wasn’t possible earlier,” Shetty says.

The cardiologist points out that tech giant Microsoft has launched an application called Kaizala, a mobile chat app that enables people to connect different stakeholders.

“It is like WhatsApp but it is Health Insurance Portability and Accountability Act-compliant. It is important because we are sharing data. But the data stays in our private cloud,” says Shetty.

Kaizala was modified “to suit our requirement”, he says. “Our team of doctors worked with Microsoft to customise Kaizala. It has a folder that can store all your medical records.” Shetty points out that the advantage of having it in the folder is that at the click of a button, it can be sent to the doctor. Kaizala also has a video conference application. Launched eight months ago, currently the app is in the pilot stage.

While hospital operators are working towards streamlining data, a large amount of scattered data among many stakeholders and the prevalence of legacy systems has been a barrier for the healthcare industry in terms of new technology adoption. Experts say it could be a daunting task to introduce new technologies, considering the scale and the complex nature of the sector.

However, global technology companies are working with large hospital chains to find a solution. Apollo Hospitals, for example, is working with IBM Watson, the Armonk, New York-based tech giant’s flagship data and analytics platform, to optimise treatment protocols in oncology.

Sandeep Makhijani, Watson health leader, Asia Pacific, IBM, explains: “While using the platform, the clinician has to input all relevant information, for instance, that it is a male patient, 50-year-old, the cancer type, the clinical parameters that have been observed, and the tests that have been done. Once that data is available to Watson, it will run it through its A.I. tool and provide a treatment recommendation.” In partnership with Microsoft, Apollo Hospitals has also built a cardiac risk assessment and predictive model, the first of its kind tailored for the Indian demographic. “Through this, we can early identify those who are prone to heart disease and put them on a preventive and reversal regimen. We are the only Indian provider doing that,” says Reddy.

Apollo Hospitals has partnered with search giant Google for its symptom search service. Anyone searching for medical information on a specific symptom on Google will be directed to clinical content validated by Apollo Hospitals. But Makhijani feels that the healthcare industry has to start appreciating the fact that technology is going to be an integral part of its growth story.

“The industry has been fairly slow in the adoption of technology. When you look at a healthcare provider, their investments are primarily in building the infrastructure. Unfortunately, they don’t think about digital technology, in the beginning; it comes much later.

Technology will help them deliver quality care at an affordable cost.” “Technology is here to stay,” Makhijani signs off.

The story was originally published in the April issue of the magazine.