Strategist | December'20 | Healthcare Sector

ConQuest The Consulting & Strategy Club of IIM Shillong

presents

STRATEGIST The Future of Healthcare

DECEMBER 2020 |VOLUME 6| ISSUE 2

ConQuest, the Consulting & Strategy Club of IIM Shillong was founded in 2008 with a vision of delivering sustainable solutions to society by acting as a forum between the industry and students passionate about strategy and consulting. It strives to equip the students with the domain knowledge and skills by facilitating consulting assignments, expert talks, online newsletters, and competitions.

MEMBERS: Dhruv Anand, Summit Gupta, Yash Jain, Ankita Mittal, Raksha Shetty, Kanika Gupta, Asawari Joshi, Aditya Agarwal, Anurag Kumar Thankur, Avni Dhingra, Sanyam Jain, Satyam Goyal, Saurabh Aggarwal, Suraj Agarwal and Vidhi Mundhra

STRATEGIST CONTENTS O3 O5

Editor’s Desk Covid 19, Health Insurance industry’s white knight??

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How can Tech infrastructure create new opportunities for the healthcare industry?

Impact of E-Pharmacies Is Telehealth the future?

In Conversation with...

ConsultINsights

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EDITOR’S DESK In this edition of Strategist, we take a look at the Healthcare Sector, the backbone of any prosperous and flourishing country. Being at the front of the ongoing pandemic, this sector has gathered special attention all around the world. The Covid-19 pandemic has tested the industry up to its limits. It has brought to fore various shortcomings of the healthcare system as well as its courage to stand in the face of a crisis and come through it strong with the management and devotion of the people involved. Many established hospitals improvised by providing online video consultation as the movement of people got restricted, and hospitals had to operate with limited capacity to cater to the needs of COVID-19 patients.

With the improvement in technology and new age consumer trends, more and more innovations are hitting the sector. E-pharmacies are the talk of the moment, with their business model attracting huge investment and the way they are developing as a force that can disrupt the healthcare sector and revolutionize the way we get our medicine. The combined market for e-pharmacies is expected to rise to $2.7 billion in 2023 from $360 million in 2019. The key growth drivers are the increased internet penetration and the ease of ordering the medicine online. The circumstances during the pandemic made established e-commerce companies like Amazon to turn their attention towards integrating drug delivery services on its platform.

quently the claims book. The health cautiousness is also acting as a stimulus for ayurvedic medicines, as more and more people are looking for natural ways to boost their immunity.

In addition to looking broadly at the healthcare sector, the current issue also focuses on these narrow segments as well.

As people got more and more cautious towards their health, the healthcare side of insurance sector also saw the effects of the pandemic as there was a 30-40% uptake in the health insurance adoption across industry players. The insurance sector is also grappling with the uncertainty surrounding the treatment expenses for Covid-19 and conseStrategist

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COVID 19, Health Insurance industry’s white knight??

SUBHASISH DAS - IIM SHILLONG

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Rakesh M K IIM Shillong

What is insurance? Wikipedia defines insurance as a financial product that offers a means of protection from financial loss arising due to uncertainties and risks which cannot be controlled.

So, the definition extends inherently to all kinds of risks and uncertainties. Insurance can be of many types. Life, health, property insurance are a few types of insurance. Insurance as a financial instrument touches all parts of a human’s life from birth to death. This says how versatile the product is.

Is insurance important for a person? Absolutely yes. But is it widely used? Has it reached the common man? Maybe not to the expected mark. We as a country are slowly realizing the importance of insuring. COVID 19 as a pandemic has brought in heightened awareness in the society about people’s lives and overall being of the society.

But why was such a great product called health insurance ignored by the common man for so long? Reasons for this are pretty simple. Unaffordable, incomplete information with certain preconceived notions, lax interest by the govt in ensuring the wellness of the common man were some of the issues plaguing the industry. But this situation is changing quickly. Common man today has become aware of the importance of health and risks associated with black swan events hurting financial prudence. COVID certainly has fastened the process. Health insurance industry has been forecast to grow at 19% CAGR during 201924 by Mordor Intelligence.

Insurance and COVID, relation?

Recent releases by IRDAI point to this fact. The following table shows the growth of monthly health insurance premium collection between June and August of 2019 and 2020. Growth has picked up and YoY has been at over 46%

Standalone

2020

2019

Monthly

Jun - Aug

Jun- Aug

Premium

INR 4,348.19

INR 2,968.22

YoY Growth

46.49%

Collections

Is this rate sustainable? Recent forecasts say yes.

Consumer sentiment survey conducted by BCG between March and May shows increased consumer willingness towards higher spending on tailored insurance products and medicines across all income categories and geographical parameters. % net increas in spends across geographies & based on household income during the next 6 months Large Towns

Small Towns

Rural

18%

10%

3%

Affluent

Aspirer

Struggler

26%

18%

7%

(Source:http://image.bcg-email.com/lib/fe5815707c62037d7c13/ m/1/76a59555-7df7-42f5-8625-3d6bc3b5ba9e.pdf)

Affluent household (HH) income: >10 LPA Aspirer HH income: 5-10 LPA Struggler HH income: <5 LPA The following table reflects monthly health insurance premium collection to be in an upper trend with consistent shifting of base from around 1000 crores in Aug-2019 to 1450 crores as of Aug-2020.

Dotted line below shows the increasing trend and almost 45% increase in collections in the 12 months which is indicating that COVID has indeed acted as a white knight and savior for the industry under tough conditions.

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Note:

re-engineering their operating models to include safety protocols and thereby giving a positive sigDue to nationwide lockdowns in April and May 2020, nal to the customer. Field visits and inspections premium collection data is unavailable for those months are being automated and industry is maturing Source: IRDAI website and is trusting the customer more than ever which But what is driving this change and how insur- in turn is driving a positive sentiment across the ance as an industry and product is evolving to aisle and eliminating stereotypes. We also need changing customer choices, needs and preferenc- to remember here that insurance as an industry is es? Insurers are reaching the customer proactively not just adding new customers regularly but also rather than the customer searching for products retaining customers bigtime. cluelessly. Broadly speaking, three themes driv- So, what is the effect of all these changes? Redeing this change at the industry level are increasing fining customer value proposition and mutual customer trust, accelerating digital transformation dependence and fostering relationships between and prudent management of available resources. customers and insurers. In addition to all of this Examples being insurance companies building competition is get fiercer which is many choices customized offerings and going fully digital and to choose from. Private players are competing agcreating awareness which in turn is having a rip- gressively for market share and dome time going ple effect across all insurance categories and add- further rapid consolidation in terms of number of ing value to society at large. players is expected. Number of channels of distribution are increasing consistently with bank backed insurance offerings gaining popularity Thereâ&#x20AC;&#x2122;s a tectonic shift in the way insurance com- due to easy after services, greater branch footpanies are operating at the offline and physical print, trusted customer base and ease of services level. Employees and salesforce are being driven all around with more value additional products towards value addition products and not just leading to banks becoming one stop destinations black and white life insurance policies. They are for every financial product in the market from asset management to forex to insurance. It is also expected public transport resumption completely Is the change visible?

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across the country would propel monthly premium collection to new highs. In addition to all of the other players, LIC being such a large enterprise continues to innovate and thrive with superior customer reach and trusted agent network which has been nurtured over decades. This agent network of LIC is an invaluable asset during these times and this is the reason why LIC still continues to be a partner of choice for the common man and remains a strong force to be reckoned with.

Technology, innovation and disruption is here to stay POSE So, what does future hold for insurance industry as a whole and health insurance in particular? Innovation is here to stay in terms of offerings and channels. Micro insurance with very low premiums and crop insurance for traditional and commercial crops are the things industry is gearing for due to a large market size of the industry. Making insurance affordable and accessible to every Indian is the objective the industry is working with and it seems well within reach in the next decade.

Data collection and analysis continues to be a pain point for the industry leading to inefficient utilization of funds. This is changing gradually. Already ICICI Prudential, SBI Life are building a consortium of other insurers are partnering with blockchain solution companies for answers to such critical problems. This proposal is on anvil and is waiting for regulatory approval which is expected soon. Smart homes and property insurance, wearables for monitoring medical conditions, telematics for vehicles, blockchain enabled smart contracts will be the themes going ahead changing the face of the industry as we know it today.

Whatâ&#x20AC;&#x2122;s next? Where do we go from here?

The market size of Indian health industry in 2018 was about 370 billion INR and is projected to surpass 2 trillion INR by 2030. The industry has been consistently growing at a rapid pace in double

digits. With the advent of COVID 19, this growth will further pickup. With the complete implementation of Ayushman Bharat scheme by Govt. of India and higher product offerings and innovation by insurers this number is surely possible by 2030.

COVID has disrupted the plans for mergers and acquisitions by many companies and thrown the whole economy into a tailspin. But insurance industry, especially health insurance segment has shown its resilience and is recovering at a quicker rate than previously expected. COVID has accel-

erated the whole process and insurance will soon get back to firing on all cylinders. But problems remain in the short term due to strained customer finances and intense competition for higher market share. Once the pandemic is out of the away, all of these short-term issues will fade away. But how long will the pandemic be here is a million-dollar question which only time can answer. Amid all this, the silver lining is that society is improving at granular level of resilience and restraint of individuals. This will benefit the overall ecosystem of the country in the longer term. So, it is just a matter of time for the industry to get back and serve the customers to the best of its abilities not just in terms of products offerings but also be relevant in the adoption of newer technologies and innovation and cope with many COVID like pandemics to come going ahead.

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How can Tech infrastructure create new opportunities for the healthcare industry?

Harshita Arora IIM Ahemdabad

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Nobel Prize Laureate in Economics, Amartya Sen propagated the theory of ‘Capability Approach’ in welfare economics, which states that the freedom to achieve well-being is to be understood in terms of an individual’s capabilities, which are prominently determined by the healthcare services that he/she receives. Such individuals constitute the workforce of a nation which ultimately determines the productivity and consequent growth trajectory the nation will set itself on. Therefore, the indispensability of healthcare industry is unquestionable. In India, the Out-of-Pocket (OOP) expenditure stands at an exorbitant level of 64%, as compared to the world average of 32%. Merely 3.6% of India’s GDP is dedicated to healthcare, whereas the average for OECD countries stands at 8.8%. Suffering from a lack of resources and the prevailing dismal state of affairs, only the introduction of compelling and meaningful technology can entail increasing returns on the front of healthcare indicators. Taking cognizance of technological developments in core and adjacent industries is a key starting point in the journey to outline opportunities in the healthcare industry.

b)The scalability of ‘The Symptom Checker’, not just for COVID but for other diseases/ ailments as well, would lead to provision of primary healthcare to millions of Indians who have been left out of the basic safety net on account of high OOP. Such effective democratization of healthcare through technology would enable the masses to access effective healthcare solutions, which would improve the Indian performance on healthcare indicators as well.

Amazon a) has also ventured into the healthcare sector with pharmaceutical distribution and health insurance.

This will further strengthen its existing ecosystem. It has partnered with JP Morgan and Berkshire Hathaway to launch ‘Haven’ in the USA, for providing low-cost health insurance services to its employees. It has also acquired a mail-order pharmacy distribution company called ‘PillPack’.

I. How can/is Amazon leveraging its existing assets to enter into healthcare?

II. The company has a direct distribution advantage to over 300M active customers, 100M Prime Reliance Industries Limited (RIL) Members, and approximately 5M sellers on the a) RIL launched ‘The Symptom Checker’, an end- site. By teaming up with JPMorgan and Berkshire to-end COVID-19 platform to manage the health- Hathaway, Amazon now has an additional pool care and well-being of employees and family of more than 1.2M diverse set of employees to test members, facilitates the daily self-monitoring of its products before releasing it in the market. symptoms and also triggers emergency medical III. Amazon is a company with huge cash which it response for immediate attention, if required. is making from its other profitable businesses like Prime and AWS. It can reinvest this money for its healthcare venture.

IV. It has existing distribution channels, fulfillment centers, and a good logistics infrastructure (Amazon Logistics) to distribute healthcare goods and services quickly. b) Amazon could bring significant cost savings to

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consumers across the entire supply chain of pharmaceutical distribution from manufacturers to patients. Amazon has acquired the wholesale pharmacy license and other important licenses from the PillPack acquisition. It needs a few more licenses to be able to deliver across the entire pharma supply chain. Currently, the entire supply chain has several intermediaries and negotiators which increases the costs for end-users.

Reliance has completed acquisition of Netmeds for a deal worth $80-100 million. NetMeds and PharmEasy have also been in talks to merge. Amazon is the newest player in the space. Evidently, with a fleet of delivery personnel, relevant technological backbone and consumer trust, Amazon’s adjacencies have widened beyond imagination, especially in the current context of social distancing & recurrent lockdowns.

c) With 5G, and leveraging Wavelength, AI medicine as a field is being looked into thoroughly by Amazon. Usages explored till now include realtime detection of abnormalities during a colonoscopy. By acquiring controlling a majority stake in Deliveroo, it can even track the eating habits of people and recommend the next steps in both the health and shopping world.

Cure.fit a) Cure.fit has been successful in identifying the pain points of the customers and develop a curated offering to provide a one-stop solution to wellness and fitness.

b) While thinking about the present course of action, cure.fit was successful in its analysis of the changed consumer behaviour in terms of the perception of health and fitness. The shift is from a E-Pharmacy curative/ reactive approach to a preventive/proactive one. This opportunity was being tapped by a) It is very well established by now that start-ups cure.fit and they saw it as something which might such as those in ed-tech & online consultancy secbe even more beneficial in the longer-term. tors have experienced phenomenal growth with the onset of lockdowns imposed on account of Co- c) The company aims to conquer the world of health vid restrictions. For instance, Practo Technologies, and wellness with the help of technology. Cure.fit an E-health platform, registered a 600% growth takes a holistic approach towards health and fitwith 70% being driven by new users & 45% repre- ness by bringing together all aspects of a healthy senting growth from smaller cities. lifestyle on a single platform. The company is promoting preventive healthcare solutions through b) A white paper released by FICCI states, “The both online and offline channels. Currently, they need for a future-ready digital health system has are working on four verticals to ensure holistic become even more urgent with the COVID-19 panwell-being of their users demic. A strong health system must have a strong and resilient digital backbone. E-Pharmacy pro- • Cult.fit: for physical well-being; Offline Channel vides a building block for such a digital health eco- fitness centres, but enhanced engagement through system to ensure efficient and affordable universal health coverage”. c) Currently, the e-health space comprises of- NetMeds, 1mg, PharmEasy and Medlife. The industry structure is undergoing several changes with acquisitions and mergers characterising the space.

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through online pre-bookings and customized fitness sessions. It enhances alternative fitness methods such as HIIT, Boxing, Dance Fitness, etc. Customers participate in collective activities usually taken up by a trained and certified instructor.

Conclusion

It is noteworthy at this point that in India, just as financial services began to develop around UPI, one can expect the healthcare services to be developed with the ‘Aarogya Setu’ app as the foundational • Eat.fit: for healthy eating; Online food delivery ground. The app could serve as ‘one-stop-solution’ service using complex prediction models and data for all healthcare related needs which would furto suggest healthy meals to customers. Eat.fit fo- ther reduce the dependence on doctors and fill the cuses on providing healthy alternatives for Indian gap that exists between the stark figures of number food items while applying informative labels that of doctors per thousand patients. Learnings from describe the nutritional values of each item. Re- the innovations in the examples provided above cently, Eat.fit has also partnered with other online shall serve as key benchmarks that characterise food delivery start-ups to deliver its dishes. the opportunities in healthcare created through technological developments. The future of Indian • Mind.fit: for mental well-being, both online and healthcare sector would look bright if we were to offline available providing meditation and calmembrace the technological advancements that mark ness classes. the developments in core and adjacent industries.

• Care.fit: to provide personalized healthcare solu- The benefits of such a democratization would be tions through fitness advice and medicine delivery. manifold and would directly benefit the poor, instead of benefitting through the trickle-down approach.

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Impact of E-Pharmacies

Waji Arshad- IIM Amritsar

Mr. Joseph, on permanent medication, living alone in the suburbs of Mumbai finds himself running short on medicines, and given the current pandemic, it would not be wise for a man in his 50s to venture out. This kind of a scenario would have been a perfect recipe for disaster; an old man caught between a life-threatening fast spreading disease and residential health issues requiring constant augmentation to immune system.

in India in 2015 with the advent of two popular online pharmacies such as Netmeds and 1mg and have made good inroads thanks to the exponential increase in the digital footprint of Indian population.

Rules governing E-Pharmacies in India:

At present, there is a vacuum when it comes to laws enacted by the Union Government concerning online sales of prescription-based medicines But thanks to a plethora of startups in the field of in India. However, there exist an association of delivering medicines to home, Mr. Joseph now online pharmacies formed in 2015, IIPA (Indian can have access to critical medicines without havInternet Pharmacy Association) comprising of 11 ing to venture out.

E-Pharmacies with Mr. Prashant Tandon (foundThis idea of E-pharmacy started gaining traction er of 1mg as president). IIPA enacted ethical set

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of rules in compliance with the country’s legal framework to be applicable to all the members. It received good support from the Union Government as E-Pharmacies were in line with government’s digital India initiative.

well. But beyond customer acquisition, there are other critical benefits of E-Pharmacies enumerated below:

• Control over drugs sold without prescription: In India, majority of front-end sales personnel Some of the other laws that E-Pharmacies in In- employed in pharmacies engage in sales of drugs dia adheres to are: Drugs and Cosmetics Act 1940, without soliciting prescription. One can even Drugs and Cosmetic Rules 1945, Pharmacy Act get highly regulated drugs without prescription, 1948, Indian Medical Act 1956 and Information if there is some acquaintance or the is willing to Technology Act, 2000 governing online sales of splurge a bit more. This practice is put to rest in medicines. online pharmacies where drugs are dispatched only after due diligence of the uploaded prescripModel: E-Pharmacies in India are currently worktion. ing on two models, viz, Inventory model and Market Place model. As the name suggests, the for- • Central repository: All drugs sold through Emer is online selling of inventory of a single entity Pharmacies are accounted for and can be traced while the latter is a market place for various regis- back from the customer to the supplier. This sort tered pharmacies to sell their drugs. of arrangement is not possible in scattered offline pharmacies. A central repository can help a nation Growth Engine: Exponential growth in the digital in many ways, most premier and evident being an landscape of India has been the biggest contribuaid in constructing the national health policy. tor to burgeoning growth of E-Pharmacies.

• Reducing the information asymmetry: For years, Indian consumers have been in the dark with respect to most aspects of medicines. With the advent of E-Pharmacies, consumers can now get a lot more information about the medicine, its contents, various sizes, read reviews, and select the right brand for themselves.

Positives of E-Pharmacies: This example of Mr. Joseph itself evinces the power of intervention these E-Pharmacies possess in critical times like these, but beyond that E-Pharmacies have started deep penetration assuaging the customer apprehension towards online medicine purchase by doling out steep discounts. This discount strategy borrowed from other e-commerce platforms worked as desired for E-Pharmacies as

• Availability: There is a limit to what offline pharmacies can store and hence a ceiling on brands and assortments, but with E-Pharmacies, there is no such issue as they usually have a central warehouse or multiple sellers giving huge array of brands at customers disposal.

Limitations: • E-Pharmacies still don’t have express deliveries hence offline retailers are still the preferred choice when it comes to ad-hoc medication requirements.

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• Trust deficit when it comes to old generation - ries related to consumers. main consumers of the drugs.

• Leveraging the data generated by consumers, • In normal times, relationship, trust and instant and predict consumption requirements, and sendfulfillment from nearby offline pharmacy is yet ing reminders to be matched, as offline sellers are marching to• Working closely with medical practitioners to wards discount parity. leverage the benefits of data generated for both Threats: the consumers and the experts.

In 2018 All India Organization of Chemists and Druggists (AIOCD) observed a day long strike prompting Indian government to draft laws prohibiting online sales of medicines through an E-Pharmacy unless registered. This was governments reaction to the protest, what other rules may come up in future is yet to be seen.

E-Pharmacies in the post Covid-19 world: There are few in this world who can claim that Covid-19 has been a boon for them, but its E-Pharmacies definitely has to be one of them. It has been a heaven-sent opportunity for them. Covid-19 has helped E-Pharmacies eliminate the biggest impediment in their quest towards moving to the next level- making consumers like Mr. Joseph develop the habit of purchasing medicines online.

But to make sure this change is purchasing pattern in irreversible; E-Pharmacies need to come up with innovative solutions to solve consumer needs. Their value proposition hitherto, is being diminished as offline players have started matching the discounts and home delivery. Offline players though still hold the aces up their sleeves when it comes to instant delivery fulfilment for ad-hoc purchases.

E-Pharmacies can adopt some of the below-enumerated ways to come up with a meaningful value preposition: • Offering monthly subscriptions to consumers on permanent medication • Expert advice and one touch solutions to que14

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E-pharmacies gained traction because of increase in digital footprint of Indian population and achieved over 3500 Crores in revenue by 2018.

Covid-19 has provided another positive intervention, this time in changing the consumer buying behavior. This change if handled well, can act as stepping stone to unlock the potential of E-Pharmacies in over US$ 20 billion Indian drug market.

Is Telehealth the future?

Vidhi Mundhra- Conquest Team

tinues to change how physicians deliver care. An analyst firm Frost & Sullivan predicts a 64.3% naTelehealth is the delivery and facilitation of health tionwide uptick in demand for Telehealth this year care, health education, and health information due to the health crisis. COVID-19 pandemic has services via remote technologies. brought in immense opportunities for telehealth Live video conferencing, mobile health apps, solutions as social distancing was being practiced. “store and forward” electronic transmission, and So, Telehealth is an attractive, effective, and afremote patient monitoring (RPM) are examples of fordable option. For example, Teledoc Health Inc. technologies used in Telehealth. had a 60% increase in its number of virtual conHealthcare is a $2 trillion industry lately, which is sultations, which touched 2 million in just three undergoing a lot of evolution. It is bound with ad- months from January to March 2020 when comherent cost, red tape, and progression in uncured pared to the Q4 in 2019. diseases.

With a huge commitment of resources focused on What is Telehealth?

To outweigh these realities, the industry is looking for ways to improve in nearly every imaginable way, and no wonder it found it’s solace in digital.

dealing with the pandemic, this brings attention to the changing dynamics of the industry and what it shows about the allocation of resources

Effect to due pandemic

Market effects

Nearly 50% of doctors are now using Telehealth to treat patients as the COVID-19 pandemic con-

Growing investments in Telehealth and the recent pandemic are directing the industry on a higher Strategist

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growth trajectory. Prior to the pandemic, Telehealth was viewed as generally suitable for most populations, but now it is considered a more viable option given the greater safety and cost-savings it provides.

According to fortune business insights, the telemarket size was valued at $61.4 billion in 2019 and is expected to reach $559.52 billion by 2027, showcasing a CAGR of 25.2% in the forecasted period. The adoption of Telehealth is increasing in the field of behavioral health, cardiology, radiology, and online consultation.

With healthcare companies having specific telehealth subsidiaries, such as Bonum Health, and telehealth brand for meeting the increased need of the industry, these companies are increasing their capability and handling thousands of virtual visits in a day to meet the growing need, thus making room for more growth in the market.

and healthcare affordability People have resistance towards accepting newer and unconventional practices. They refuse to use telemedicine and telehealth services, maybe due to unfamiliarity with technology.

4.Opportunity – AI and Analytics The analytics used for Big Data can be used to process the data collected from the telehealth industry, which includes both subjective and objective data, which helps in risk prediction and management. There is a huge potential in analytics, AI, and machine learning to streamline the process of od care delivery as well as regulate the industry.

Digital divide For individuals who don’t use or have access to

email, smartphone, or computer, might be left behind and won’t be able to reap the benefits of Telehealth. They might face significant challenges These affect the top key players in the market in coordinating and access care. These situations such as Allscripts Healthcare Solutions Inc, AMD reflect the digital divide, one that crosses all deGlobal Telemedicine, American Well, BioTelem- mographic groups. etry, Cisco Systems, Honeywell International Inc, Koninklijke Philips N.V., etc Dynamics in the Telehealth market 1.Driver - Technology Adoption due to pandemic In the wake of the pandemic, the demand for healthcare services and technologies reached an all-time high. Chatbots and robots are being deployed to collect information, treat patients, and make diagnoses. Players present in Telehealth are focusing on providing innovative solutions to hospitals and support providers.

2.Restraint – Healthcare Fraud There are multiple ways in which patients can be victimized, such as using fake licenses or receiving payments on an account that belongs to someone else, False claims being raised, etc.

3.Challenge – behavioral barriers, lack of awareness, 16

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In Conversation with...

1.What’s new in Healthcare Tech?

In recent times healthcare sector has been witnessing major changes. Application of technology in the form of artificial intelligence is making things real ‘Smart’. Now we have smart wrist watch that can keep an eye on heart rate, body temperature, blood pressure, ECG, oxygen saturation in blood and can warn early if any of the parameters is abnormal. Real advantage of this technology is early diagnosis and treatment within the ‘Golden Hour’ (period of time during which there is the highest likelihood that prompt medical and surgical treatment will prevent death), thereby reducing chances of death, complications etc. Many more devices based on AI are in pipeline. In near future we may see ultra-sonography being done using mobile phones. Other novelties include robotic surgeries, artificial organs, nano technology. Application of technology in medical fraternity is changing the face of healthcare industry.

health set up the doctor cannot perform any of the clinical tests. Hence it is better, if a patient can personally visit the doctor at least at the first time and then uses Telehealth for the follow up visits. However in India, Telehealth will need some more time to get general acceptance due to one other reason – mind set of patients. Many patients feel relaxed or get psychological support when they personally meet the doctor. Hence, Telemedicine will be more popular as and when the patients will come out of the mind set and can see practical benefits of Telehealth. But Telehealth setups cannot completely replace clinics and OPDs.

In India, Telehealth system can be a boon to strengthen rural healthcare system. As number of specialists and super specialist doctors is limited and these experts are mainly saturated in big cities and metros, patients living in small cities and rural areas are deprived of their expertise. This can be overcome by connecting doctors practicing in rural areas and their patients with specialists in 2.As a person knowledgeable with India’s cities through Telehealth. So doctor and the pahealthcare infrastructure is it possible to distrib- tient in a small town can take opinion from speute any Covid-19 vaccine (eg: Pfizer, Serum Insti- cialist practicing in any part of the world. On Field tute etc) on a national scale? What would be the doctor can perform clinical tests, investigations as major hurdles in your opinion? suggested by the specialist and can also carry out COVID 19 vaccine is something that the world is the treatment. This system can have positive imwaiting for. Considering population of our coun- pact on healthcare status in rural parts. try it is a herculean task to make the vaccine avail- 4.We have been facing new strains of diseases able across the country in sufficient quantity. Ma- over the past decade. Allopathy has been the jor hurdle in the distribution of vaccine will be most agile stream of medical profession to remaintaining the cold chain. Vaccine developed spond to the new diseases. Do you think that in

by Pfizer, which will be available in near future, future, allopathy might make other disciplines needs to be stored below – 70C. Even in developed such as homeopathy or ayurveda redundant? countries it is difficult to have such storage facilities in all hospitals, health centers with sufficient Ayurveda, Yoga, Unani, Siddha and Homepathy capacity. Transporting vaccine from one place to (AYUSH) system of medicine was the mainstream another while maintaining the cold chain is also medicine before the emergence of modern medidifficult. The Government will need to build lo- cine and according to WHO, 65 to 80% people gistic support and storage facilities in very short still use traditional medicine. Advances in sciperiod of time across the country. But I am hope- ence have undoubtedly made modern medicine ful that necessary arrangements will be made by as mainstream in healthcare system, but it canthe Government. not make AYUSH system redundant. Currently no healthcare system is complete to cater all the 3.What is the scope for Telehealth in India? aspects of human health. While modern medicine Telehealth/ telemedicine is witnessing boom af- has no alternative in treatment of emergency conter the world is hit by COVID 19 pandemic. Dur- ditions, infections, in long term management of ing lockdown patients who were suffering from diseases such as Diabetes, Hypertension, arthritis conditions other than COVID 19 were extensively etc. there is scope for AYUSH system due to side dependant on it. However, we need to understand effects of modern medicines. Advantage of AYthe importance of visiting a doctor as well. When- USH system is use of predominantly herbal (non ever a doctor treats a patient, before treating the chemical) medicines which don’t have side effects. doctor talks to the patient, sees medical reports AYUSH is time tested healthcare system based on and also conducts clinical examinations which oriental ways of scientific thinking. If these orienare very important to reach to a diagnosis. In tele- tal principles in AYUSH system are blended with Strategist

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modern research tools our country can give one of the best integrated healthcare system to the world.

Hence integrated healthcare system is the need of the day and AYUSH systems have major role to play in it.

the WHO recommendation of 1:1000. The Government has set up premier institutes like All India Institute of Medical Sciences (AIIMS) in different parts of country. Private education institutes/ universities are planning to set up medical or AYUSH colleges. So number of seats for medical edu5. During Covid-19, we saw a surge in demand cation will surely increase and also the number of for traditional immunity boosting medicines students opting for it. and tonics. Were these products as helpful as they were being marketed to be?

Medical education includes postings in hospital wards which are very important to gain practiIn a chaotic situation of COVID 19 pandemic, cal knowledge and acquire different skills. As initially there was no clue for treatment or pre- colleges suspended in campus activities during vention of Corona virus. Hence in initial days all the pandemic, medical students were deprived healthcare systems had to treat the patients based of the practical knowledge. Especially final year on their experiences in treating similar diseases in students who have at least one ward posting a past. With multiple research projects, clinical ex- day are at considerable loss. Some colleges/ uniperiences some line of treatment is decided and is versities postponed examinations. But it will have being followed. Similar thing happened for tradi- short term impact and students will have to find tional immune boosters. Hence, there was demand ways to compensate the loss of knowledge. for medicines which are known to have positive effect on immunity, such as Giloy, Haldi, Chyavanprash. These medicines are already researched extensively for their immunity boosting effect and the data is also available in form of scientific publications. In current COVID 19 pandemic, central and state Governments, pharmaceutical companies, NGOs have conducted/ sponsored many research projects to quantify the effects of these medicines in boosting immunity. The reports of these studies are getting published in scientific journals and claim to have beneficial effects. Metaanalysis of these research articles will help in finding precisely which immune booster medicines have helped in the current pandemic. Ministry of AYUSH, Govt of India has also launched a mobile app â&#x20AC;&#x201C; AYUSH Sanjivani, to collect data about Dr. Shaliesh V. Deshpande use of AYUSH medicines in COVID 19 and its effect. Results of the data collected through app are M.D Ayuveda awaited.

At Parul University, Vadodara, Gujarat we have conducted two projects to see preventive effect of Ayurvedic medicines. A major multi-centric study among these was to see preventive effect of famous Ayurvedic medicine Chyavanprash in preventing COVID 19. Initial analysis is showing promising results. Another study was to see effect of a combination of Ayurvedic medicines in preventing COVID 19 and respiratory infections in security guards. It has also shown promising results and participants consuming these medicines were not infected with COVID 19. Results of these studies will soon be published.

6.Do you expect Covid-19 to have a significant impact on medical education in India, and why?

The pandemic of COVID 19 has highlighted importance of adequate number of doctors per population The Economic Survey 2019-20 says that the doctor-population ratio in India is 1:1456 against 18

Strategist

Professor, Department of Ayurvedic Medicine

In Conversation with...

1.Whatâ&#x20AC;&#x2122;s new in Healthcare Tech?

Healthcare has been witnessing a lot of innovations and technological advancements. Telemedicine and Robotic surgeries. Robotic surgeries help doctors perform complex procedures with more flexibility, precision and control what is possible with the conventional techniques present. It is usually associated with minimally invasive surgery which is procedures performed through tiny incisions.

2.Which company do you think is making a name for itself recently in pharma/health industry and why so?

over the past decade. Allopathy has been the most agile stream of medical profession to respond to the new diseases. Do you think that in future, allopathy might make other disciplines such as homeopathy or ayurveda redundant?

Allopathy is most advanced stream in medical science but Ayurveda/ Homeopathy are our heritage science. To make the optimum use of medical knowledge and innovation, there science should also be utilized in therapy along with allopathy in the constructive way for benefit of humanity 7.Do you expect Covid-19 to have a significant impact on medical education in India, and why?

Due to the outbreak of COVID 19, the companies We have lost many colleagues in the pandemic. which are in news in pharmaceutical industry are This has also opened our eyes for the need of more majorly related to the vaccine. Pfizer, BioNTech, healthcare infrastructure and personnel.

Zydus Cadila.

8.Can we expect some Ayurvedic medicine as 3.As a person knowledgeable with Indiaâ&#x20AC;&#x2122;s well for Covid-19? What would be the major difhealthcare infrastructure is it possible to distrib- ferences between cure finding procedures under ute any Covid-19 vaccine (eg: Pfizer, Serum Insti- different medical disciplines? tute etc) on a national scale? What would be the Yes, we can expect but the acceptability and stanmajor hurdles in your opinion? dardization of the product is a big query in our In my opinion it is possible to distribute Covid-19 country. Major difference in the cure finding provaccine utilizing the current healthcare systems cedure is the scientific approach of different mediand the new additions which are being made to cal disciplines. the distribution channels will in turn make is feasible for widespread distribution. Major hurdles in this would bea. Maintaining cold chain b. Avoiding black marketing c. Arranging professionals d. Rate control and standardization e. Matching demand and supply 4.What is the scope for Telehealth in India?

Telehealth is boon to the country like India. It is still very difficult to avail good health advice at village levels and with the rapid penetration of internet, Telehealth can be a way to reach people residing in remote areas. It can be cost effective, time saving and very handy. Having said that it canâ&#x20AC;&#x2122;t be a perfect substitute for a hospital.

5.Major changes that you have seen in patient behavior due to covid.

Major change observed in patient behaviour is acceptability to telemedicine, online consultation and health awareness.

6.We have been facing new strains of diseases

Dr. Saurabh Rathi Diplomate of National Board of Examinations MD Intensivist & Consultant Physician Strategist

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ConsultINsights

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Strategist

Blue Ocean Strategy When Ford introduced Model T in 1908, it was a strategic move that challenged the conventions of the automotive industry in the United States.

It made the automobile accessible to the mass of the market. Until that time, America’s 500+ automakers built custom-made novelty automobiles.

Despite the plethora of automakers, the industry was small and unattractive with cars unreliable and expensive, costing close to $1,500, twice the average annual family income. But Ford changed that all with the Model T.

contrast, Blue Ocean Strategy originates from a study that took place over 10 years and analyzed company successes and failures in over 30 industries. It is based on proven data rather than unproven ideas.

As is evident from the Ford story, Blue Ocean Strategy argues that consumers don’t have to choose between affordability and value. If a company can successfully identify what consumers currently value and then rethink how to provide that value, then low cost and differentiation can Called the car ‘for the great multitude, construct- both be achieved. This is termed ‘value innovaed of the best materials.’ Although it only came tion.’ in one color and one model, the Model T was durable, reliable, and easy to fix. It was priced so that it was affordable to the majority of Americans. In 1908 the first Model T cost $850, half the price of existing automobiles. In 1909 it dropped to $609, by 1924 it was down to $240. Ford’s assembly lines revolutionized production and replaced skilled craftsmen with ordinary laborers who worked one small task faster and more efficiently, reducing the labor hours by 60 percent. Sales of the Model T boomed. Ford’s market share increased from 9 percent in 1908 to 61 percent in 1921. Such was the impact that Ford changed the primary means of transport in the United States.

A Blue Ocean approach means your goal isn’t to outperform the competition or be the benchmark The story of Model T is a classic example of Blue in the industry. Instead, the aim is to redraw indusOcean Strategy, a departure from the typical mantry boundaries to operate within that new space, agement exercises which focus on number crunchmaking the competition irrelevant. There are a ing and competitive benchmarking. Instead of few caveats in this though, ignoring a significant attempting to gain more share in an already satucompetition might result in being eaten. Entering rated market, Blue Ocean Strategy is about creatany new market requires a detailed study of all ing demand in a growing and uncontested market the factors that might come into play and any misto capture uncontested space. judgement might be catastrophic. A lot of innoBased on an eponymously titled book by W. Chan vation depends on anticipating the ever evolving Kim, this strategy argues that ‘cutthroat competi- needs of customers some ideas might sound like tion results in nothing but a bloody red ocean of to be a game changer but they must not be too difrivals fighting over a shrinking profit pool.’ This ferent to what the current environment supports. takes centerstage in today’s innovation driven Some innovations resulting in a blue ocean entry market space, where all the companies are look- might be too early to be commercially viable. Thus ing for new market space and ways to reinvent it is very important to take the innovation as a part the industry i.e. to find and develop ‘blue oceans’ of present ecosystem and its evolution in near fu(uncontested & growing markets) and avoid ‘red ture rather than a standalone entity. oceans’ (overdeveloped & saturated markets). In short, avoid head-to-head competition and focus on innovation in order to have more success, fewer risks, and increased profits in a blue ocean market.

The major advantage of Blue Ocean Strategy lies in its practical applicability. Some strategic planning models are based on theories that don’t quite pan out well during go-to-market executions. In Strategist

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