“Just creating an app does not mean you have a company. The key key question is: are you solving a problem?” These were the opening words of Pradeep K. Jaisingh, Founder of HealthStart India, at the VC Panel at #FTR4H program at MEDICAL FAIR India in New Delhi. Panel was organised by HealthStart. The main aim was to highlight VC perspective on the digital health startups scene in India.
As said by Mr. Jaisingh, the basic background of technology needs to be that it improves the outcome. A solution needs to solve a problem and be sustainable. From the macro perspective, potential for disruptive innovation in India is big, said Mr. Jaisingh. Especially in terms of diagnostics, treatment and management of chronic diseases.
The doctor’s expectations in the near future are high. Artificial intelligence can be utilized to effectively synthesize patient information before his visit in the hospital or a doctor’s office.
What do the doctors need?
Private Equity Professional Mayur Sirdesai, Director at Somerset Indus Capital Partners, warned, the key issue in digital health technology and innovation is probability of adoption. “When a doctor has a line of patients in the waiting room, he can’t be bothered by entering data in the computer,” he mentioned. The second challenge is payment for digital solutions. Revenue model of a startup is crucial to implementation of a solution in practice. In India, most payments are still out of pocket which might change with the development of the insurance market.
From the perspective of Shuchin Bajaj, Founder Director at Cygnus Medicare, a big potential in India is in putting more effort into medical education of other specialists and healthcare providers, apart from doctors. “We are to doctor-centric. I am a big fan of personalized medicine and “ayurveda” in that sense. These sciences look at the patient as an individual while medicine takes the patient as a dataset. Ayurveda does not treat the disease,” he said.
Needs and payments
Partha Dey, Healthcare Leader and SME at IBM India mentioned the need for more collaboration:“It is clear and we agree we need to walk together and collaborate. Technology can work as a platform and our idea is to use it to solve real life problems. We are working on longterm solutions. The first issue is always the business case. What do users need? What are they prepared to pay for? A lot of startups have ideas, but struggle with translation and implementation in practice.”
Vikram Gupta, Founder and Managing Partner at IvyCap Ventures Advisors described India as a unique market because of the payment system. “In the developed world insurance takes care of healthcare. Our environment drives behaviour. Hence healthcare consumption is different compared to the rest of the world. The opportunities here are of different nature than in other countries. One thing to look at is infrastructure. Ratio of hospitals does not match population needs.” Huge opportunities lay in financial assistance for healthcare, concluded Vikram Gupta.
FTR4H is in full preparations for MEDICAL FAIR INDIA 2017. Before arrival, we talked to Incubators, Companies, Start-ups, Experts… Here’s what you might find useful if you’re thinking about doing business in India.
1. Make good market research
India ranked at 130 out of 189 economies in 2015 according to the World bank. 4% of the GDP go to healthcare; around 60% of expenses for healthcare are out of pocket, according to OECD. Almost a third of the population is supposed to own a smartphone by 2019, claims GSMA report. All this goes in favour to digital health or at least mHealth solutions, but keep in mind plenty of good startups on the ground are busy tackling everyday issues.
The country is extensively working on using all the advantages of digital solutions to improve people’s lives and health. Heard of Aadhar? It’s unique-identity number issued to all Indian residents based on their biometric and demographic data such as eyes and finger prints. Nishal Arvind Singh, Founder NASS & Associates IPR Boutique law firm and Legal policy advisor to Honourable Health Minister Satyendra Jain of the Delhi Government explains the plan behind the project: “All payments will be linked with aadhar, to avoid duplicity, promote increase in online payments and disbursement to beneficiaries under many governmental schemes for education, pension etc. This will enable direct transactions into beneficiaries bank account, which will prevent corruption,” says Arvind, adding that in time, it will be connected with healthcare. The unique identification number of a person will prevent duplication and confusion in data management and insurance claimes with others with the same name.
2. Do you have enough time for business here?
According to a World bank report from 2006, it takes 56 procedures and approximately four years for a simple commercial contract in India. As explained by Prabhu Guptara, a distinguished Professor of Global Business, Management & Public Policy at William Carey University, India, a Member of Boards of different companies in the UK, Germany and Switzerland, the problem is the bureaucratic system. It takes years for the legal claims to be processed, let alone enforced. It is a slow system, so brace yourself with energy and patience to conquer it.
3. Know that India has very good medical doctors
Top class. World renowned. There’s a reason medical tourism flourishes here. However, as Sachin Gaur warns, 80% of people live in rural areas and only 20% of facillites are there. There are different initiatives to improve access, such as the the mohalla (neighbourhood) clinics. As explained by the hindustantimes, they were started with the aim of taking diagnostics and treatment of simple ailments to people’s doorstep and reduce the footfall in tertiary care hospitals.
4. Can you make a subscription plan under a dollar a month?
India has 1.3 billion people, the majority is poor. “2/3 of the population can’t be your target market. 30% of the population lives on less than 2.5 dollars/day, another third 5 dollars/day. Which still leaves you with 400 million people you could address,” says Prabhu Guptara. However, given the number of people, if you can design a subscription model for around 20 cents, than you might address the poorer population, says Sachin Gaur, Director Operation at InnovatioCuris. Taking into account the volume you could reach, it can turn out to be a viable business model.
“If you can design a subscription model for around 20 cents, than you might address the poorer population,” says Sachin Gaur, Director of Operations at InnovatioCuris.
5. Ask, connect to people on the ground
Have you heard of HealthCode.io? It’s a platform for healthcare professionals where you can find people interested in co-creation, consulting, commercialisation, fundraising, mentoring, investing, validation. The app, as the founders claim, already has members from 52 countries, so you might find useful connections even outside India!
Be sure to check the two episodes of Medicine Today on Digital Health! Praphu Guptara speaks about differences in the healthcare systems in India, Switzerland or England. Sachin Gaur talks about the innovative solutions in India and problems of digital solutions and cyber security. You can find it on iTunes or Soundcloud.
India has more than 5 million qualified professionals working in the healthcare industry. There are around 1 million doctors and 2.5 million nurses. This workforce is growing at a rate of more than 10% per annum.
If India is a puzzle to you, this short interview with Mayank Sharma, one of the owners ofMedhoop – a platform for healthcare professionals and industry in India, will give you a nice introduction into the current state of the trends in the digital health startup community in India. And why it is a good investment to take part in events such asMedical Fair India 2017, held from 6-8 April in New Delhi.
“We aim to create an ecosystem in the healthcare industry for all the industry stakeholders. Everyone, from medical students, colleges and teaching institutes, healthcare providers, Health-tech, medical devices and consumables industry, thought leaders and startups, can connect seamlessly and grow together,” This is Sharma’s brief description of Medhoop. The size of the country is keeping the healthcare industry in India fragmented. The disconnect is making the industry inefficient and uncompetitive. For this reason, digital health development is so much more promising here.
Let’s start with the basics. What are the three digital health trends to watch out for in India?
The Indian healthcare industry is now growing 360 degrees. Healthcare providers are not only focusing on developing world class healthcare physical infrastructure, but also on integrating technology. All this aims at making treatment and information closer to patients. Among major trends I would highlight mobile health (mHealth), on-demand healthcare, EHR/EMR solutions, healthcare aggregators and telemedicine.
How developed are these segments?
The mHealth space is probably the hottest in the segment. It is being further augmented by wearable gadgets that monitor health statics on a real-time basis. There are startups integrating existing technologies with concepts like telemedicine, doctor on call and remote monitoring of patients. On-demand healthcare is fit for an urban population which seeks everything instantly. If possible, they want it available on their smartphones. Startups understand this need. EHR industry is on the rise, looking to capture all the information they can. Not only to provide better health care for patients, but also for system improvements. From cutting treatment costs, research purposes, giving patients access to their health records online, to changes in regulatory environment.
What does the startup community in India look like?
“Today India is among the top countries in terms of growth of startups. It is exciting, buzzing with innovation, passion and energy.”
India has been a country of startups for a long time. But the real recognition is happening now – with the rise of Startups Unicorns. We have Flipkart, Snapleal, Taxi aggregator Uber (prime competitor to Uber in India), online payment solution Paytm. Social media and growing internet penetration has opened an altogether new growth avenue for startups.
What about the digital health community specifically?
The digital healthcare community in India is growing at a very rapid pace. From hospital/doctor appointment booking solutions, EHRs, diagnostic lab aggregators, mobile health devices – innovation and new ideas all around. Today we see a lot more entrepreneurs in the digital health and healthcare space compared to 5-8 years ago.
What contributed to this acceleration?
At first, the healthcare community has been hostile to new technologies and experiments due to the inherent nature of its business. But slowly, the awareness levels and aspirations of doing things faster and better is positively affecting healthcare innovations and digital health technology. Companies like Practo have already made it big and are serving international markets already.
Which cities are leading in terms of accelerating innovation? How does Delhi rank in this community?
Bangalore leads the list, closely followed by Delhi, Gurgaon, Mumbai, Hyderabad and Chennai. Not surprisingly, we also have beautiful healthcare and health-tech ideas coming out from comparatively smaller cities like Jaipur and Ahmedabad. I myself come from Hathras, a very small town, and now residing in Delhi, so let’s say innovation has no boundaries.
What were the digital health biggest investments in 2016?
There is significant development and a number of startups working on services like pharmacy or lab services aggregators, remote monitoring healthcare devices and online doctor or hospital discovery. Startups which attracted major investments in 2016 were majorly from the SaaS segment. Practo, Healthkart, 1mg, and Goqii were among the front runners in a list of healthcare investments by investors.
“There is significant development and a number of startups working on services like pharmacy or lab services aggregators, remote monitoring healthcare devices and online doctor or hospital discovery.”
Which are your Top 3, 7 or 10 startups for 2017?
This is a tough question for such an exciting space like digital healthcare in India. But if I divide the digital healthcare space into segments, I would say the following: In-Doctor Networkspace: the two companies clearly standing out are DocPlexus and Curofy. Both of them are fulfilling the need of doctors to be able to consult cases online right from their mobile phones and build their own professional network. It would be interesting to see what route they take next.
In-Doctor Discoverysegment: booking platform Practo had disrupted the industry before anyone could even think of an idea such as online booking of appointments. Lybrate (online doctor database gives you access to over 90,000 highly trained medical experts) has been able to stick it out in 2016 and will, it seems, continue to do so. Then there is CrediHealth, with the tagline ‘Your Medical Assistance’ doing exactly the same. Within its services, it offers second opinions, doctor selection and surgery planning to an altogether other level. I am sure these companies will be further innovating and disrupting this space.
Where can Startups present their solution to the wider public? Are there many events such Medical Fair India?
There are multiple events on medical equipment, lab equipment, medical specialty-specific devices and pharma in India.
You are a partner of Medical Fair India. Where do you see the benefit of this collaboration?
It matches with our belief that as a healthcare ecosystem partner, we have a responsibility to represent all the healthcare stakeholders and engage with them. This year Medical Fair India combines equal opportunities for healthcare companies as well as medical and healthcare technology startups, which is an encouraging trend.
What can startups expect from Medical Fair India?
The most important part of such expositions and fairs is networking with various industry stakeholders. Participation offers understanding of new dimensions of the industry, understanding the demands, meeting customers, buyers and a lot more. This season Medical Fair India integrates FTR4H (Future For Health) platform where healthcare technology startups can participate. Medhoop also plays a critical role of bringing these startups to forefront, connecting them with industry, prospective customers, investors and a lot more. Among other things, we are organising mentorship hours for startups. So there is a lot for startups to gain.