“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.
There are currently more than 260,000 mHealth apps on the market, according to data from Research2guidance. Whereas this may be exciting news, the sheer number may also be overwhelming for patients and doctors. How can you know what is useful and what is not? One way hospitals are solving the app reliability challenge is by building in-house innovation incubators.
He are 5 reasons why in-house innovation incubators are good news.
1. Accelerating change
Innovation arms in hospitals are exciting because they help introduce novelties into the rigid healthcare systems.
2. Providing reliability
New solutions are designed by high profile specialists in hospitals. Consequently, solutions are tested inside the hospitals and perfected before they are put on the market.
“I would never give or prescribe medicine to any of my patients that has not been approved in some formal capacity. Why should I prescribe an app?” says gastroenterologist Ashish Atreja, MD, MPH. If you’re a startup, he might take a look at your solution. Why?
One of his jobs as the CTO of Sinai AppLab is onboarding new technologies built by startups outside Mount Sinai. After all, he emphasizes, “it’s impossible for one incubator to do and know everything.”
3. Ease of recommendation
It is easier for doctors to recommend in-house solutions, because they have better access and understanding of the innovation process and reliability of an app compared to the flood of other mhealth digital health offerings on the market.
As Ashish Atreja explains, Mount Sinai even build a platform which allows physicians to prescribe evidence based apps. “We curate the best apps based on the evidence, security and safety. There’s a whole team of people rating the best apps, looking at the published evidence and bringing them to the market place.”
4. Financial benefit
Innovation arms generate new revenue streams for hospitals.
5. Encouraging innovation
When a support environment for creativity is in place, doctors who want to innovate can test and develop their ideas. They also get all the entrepreneurial support in scaling and improving their ideas, so they can reach patients faster.
In 2012, Cleveland Clinic experts designed the Medical Innovation Playbook – a detailed report on the diverse and rapidly evolving technology commercialisation programs of the USA’s top medical centres. It includes an overview of nearly 10,000 invention disclosures, 6,400 patent applications and almost 2,000 issued patents.