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HEALTHCURSOR CONSULTING GROUP

“Inclusive Innovation and Growth:-” Dr. Ruchi

Dass

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Table of Contents

1 Background

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3

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Innovation- As we define it in Healthcare

Turning Point- Opportunities & Market Readiness

Policy- FRAMEWORK for Inclusive growth

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The Indian Healthcare Divide

• India has 17% of the world's population

• Poorest healthcare infrastructure among growing

economies

• Healthcare accounts for only ~5% of GDP

• Healthcare Delivery Market in India ~ US$ 60 billion in 2010

• Healthcare market expected to grow at CAGR of 15%

• Accessible, reliable and affordable healthcare continues to

be a challenge

• Significant supply deficit

• Growing middle class with rising income levels , health

awareness

1.3 0.71.5

1.9

0.9

1.8

3.6

1.9

3.7

0

2

4

6

8

Bed Doctors Nurses

Existing Required (2010) Required (2020)

Indian Healthcare Capacity Shortfall (in mn)

15% CAGR

Indian Healthcare Market Growth

Source: Public Research

Source: Public Sources, Technopak Analysis

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Ageing Population and Chronic Care management

No. of Years Chronic Care

Disease Patients

Social Class Less than 7

Years

More than 7

years

Total

High 24 12 36

Middle 18 11 29

Low 7 13 20

Very Low 12 12 24

TOTAL 61 48 109

Percentage (56%) (44%)

Source: Health services utilisation in urban India: a study By C. A. K. Yesudian

Out of pocket expenditure is more than 80%

Rising demand for medical services and timely medical intervention

Need for measures to provide health specialists’ access anytime anywhere

and not only at the point of care

Health Services Utilization

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5

Ageing Population and Chronic Care management

Resource Constraints

Call a Doctor/ Second OpinionPatient education and Health

TipsHome health and Remote

monitoringTele-Diagnosis and e-

prescription

Supply Problems

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•There is 1 doctor per 1000 people in India.

•Most of India’s estimated 1.2 billion people have to payfor medical treatment out of their own pockets (That ismore than 80% of the total health expenditure as per2011 stats).

•Less than 15% of the population in India today has anykind of health-care cover, be it community insurance,employers’ expenditure, social insurance etc.

•Over 72% (that would be over 620 million) of India’spopulation lives in its 638,588 villages.

•It is hard to believe but in India, a common man is mostindebted to healthcare after dowry.

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Ageing Population and Chronic Care management

Resource Constraints Patient Empowerment

With increasing Internet and mobilebroadband access, available in-depthinformation on medical conditionsand their treatment has enhancedpatients’ knowledge, generating anincreasingly consumerist attitudetoward medicine and higherexpectations regarding treatment.

Empowerment

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Ageing Population and Chronic Care management

Resource Constraints Patient Empowerment Integrated Care

• In the face of the enormous challenges of managing chronic diseases, delivery innovations appear to have the most impact whenmultiple parties (e.g., physicians, nurses, payors) interact seamlessly to provide the best possible patient care over an extendedperiod of time.

• Such integrated models have the potential to reduce costs dramatically, while increasing patient satisfaction and clinical quality.

Integrated care

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Health Innovation ecosystem in INDIA

Operators/Distributors Solution Providers

Healthcare Providers

Government /Regulators

... p

rovi

de a

cces

s to

...

... are regulated and funded by ...

… provide platform to and partner with …

.. fund and regulate ...

Implemented remote monitoring solution

Medical data management

Remote monitoring solution

Digitization of health records

..several others….

Sharing of medical images

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Opportunities

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Technology Vs Usability Innovation

Source: PSFK

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Episodic care Vs Continuum of care

Source: PSFK

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Healthcare & surveillance

Source: PSFK

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Table of Contents

1 Background

2

3

4

Innovation- As we define it in Healthcare

Turning Point- Opportunities & Market Readiness

Policy- FRAMEWORK for Inclusive growth

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Innovation Strategy

Platform Inclusion Ecosystem Drivers Discourse

Innovation Strategy- From the Books

Innovation Strategy- From the Ground

Creation Protection Exploitation

Innovation Defined- For a Country like India

Meaningful= Design Driven

Disruptive = Technology

driven

Incremental= User Centric = Market driven

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Design Driven Innovation

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Design Driven Innovation

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Innovation Budgets

Innovation budgets of the main government departments and agencies

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Innovation brings economic growth

“India is an entrepreneurial country, but itsentrepreneurs have had to struggle to create andgrow their business ventures. There is, however, agrowing group of first-generation Indianentrepreneurs – the founders of companies such asHCL, Cognizant, Infosys, Bharti and others that havegenerated large scale employment and significantwealth. They and others such as IndiaBulls,Makemytrip and Naukri have also demonstratedvalue creation through a public listing. Thesesuccesses have encouraged a new breed ofentrepreneurs especially in the internet and e-commerce space.

India has the potential to build about 2,500 highlyscalable businesses in the next 10 years – and giventhe probability of entrepreneurial success that means10,000 start-ups will need to be spawned to get to2,500 large-scale businesses. These businessescould generate revenues of Rs10 lakh crore ($200billion)”

Moreover, entrepreneurship tends to be innovation-driven and will also help generate solutions to India’s myriad social problems including high-quality education, affordab le health care, clean energy and waste management, and financial inclusion. Entrepreneurship-led economic growth is also more inclusive and typically does not involve exploitation of natural resources.

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Table of Contents

1 Background

2

3

4

Innovation- As we define it in Healthcare

Turning Point- Opportunities & Market Readiness

Policy- FRAMEWORK for Inclusive growth

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Application of usable innovation

Health Awareness and Education- Existing health content could be aggregated, filtered and indexed, under the guidance of global domain experts and made available on IVR, mobile devices

and tablets like “Aakash”.

Said innovation will help achieve &:

1. Assist India with meeting the MDGs by providing support to the social sectors; WHO says thatIndia will fail to achieve some of the most important Millennium Development Goal (MDG)targets like reduction in maternal and child deaths, and increase in child immunization rates by2015.

2. Solve the economic implications related to the burden of NCDs in the country- In 2004, 4.8million (59.4 percent) of the estimated 8.1 million Indian deaths were due to NCDs. A 2011study shows that about 25% of families with a member with CVD and 50% with cancerexperience catastrophic expenditure and 10% and 25%, respectively, are driven to poverty.

3. Help ASHA/ Aanganbadi workers stay connected to useful resources at the time of need.- Theinformation challenges facing health workers include lack of routine systems for seeking andsharing information, lack of high-quality and current health information, and lack of locallyrelevant materials and tools. Without such basic information, the provision of quality servicesby health workers, the effective management of programs, and the use of evidence toformulate health policy all suffer. This information deficit contributes to poor health outcomes,including increased morbidity and mortality.

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Case Study 1: Health Awareness and Education- Existing health content could be aggregated, filtered and indexed, under the guidance of global domain experts and made available on IVR, mobile devices and tablets like “Aakash”

Mediphone Process

Technology Providers

Solution Provider

HealthcareProviders

Regulators1

2

3

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Medical Organizations

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Success Factors

� Mediphone has the capability to scale up on several platforms and can work seamlessly on Landline, Mobile and Internet. The service can be provided in regional languages as well.

� Mediphone can also be supplemented with a health classifieds service that will further enhance the call flow. � Mediphone will also act as a platform to browse and buy Health related packages from several providers.� Currently Mediphone is handling more than 1500 calls per day and will soon start Hospitals referrals, Appointment

scheduling and emergency management 24X7.

MobileIVR

System

Patient Profile

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8

Decision support Tele-Triagesystem

Airtel Subscribers

Patients

• Call helpline

•Ask questions on

health-related

problems

•Describe an ailment

Community workers

•Visit families

periodically

•Are on call for serious

ailments

•Connect villagers with

call center

•Promote awareness

•Educate

•Deliver medications

Call center agents

Receive incoming

calls and

triage to

– Physicians

– Nurses

– Educators

– Field workers

Place outgoing calls

to

– Follow up on

patients

– Monitor

community worker

performance

Physicians in call

centers

•Speak with patients

•Conduct interviews;

use images and videos

if required

•Make a diagnosis

•Recommend

treatment including

medications,

educational advice

•Refer to agent to

coordinate medication

delivery and follow-up

Case Study- INDIA

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Application of usable Innovation

Crowd-sourcing Healthcare- provide an opportunity for scientists, doctors, technocrats, students

and others with diverse expertise to work for a common cause.

Said innovation will help achieve &:

1. Drug Discovery- Crowd-sourcing will help assist India with controlling morbidity of Tropicaldiseases by providing a global platform where the best minds can collaborate & collectivelyendeavour to solve the complex problems associated with discovering novel therapies forneglected tropical diseases like Malaria, Tuberculosis, Leshmaniasis, etc. Drug discovery can bemade successful by pulling together informaticians, wet lab scientists, contract researchorganizations, clinicians, hospitals and others who are willing to adhere to the affordablehealthcare philosophy.

2. Best Practices- Sharing best practices in solving some of the most complex issues around NCDsand related complications in the country. Take an example of Multiple sclerosis- It is verydifficult to prognosticate effectively for MS patients. Some individuals have a very benigncourse and/or respond well to treatment, whereas others become rapidly disabled withinseveral years of diagnosis. Sharing of best practices related to treatment, prognosis and followup can hence lead to success.

3. Clinical Trials- Governments and public funded institutions in the countries with high burden ofdisease has a responsibility to contribute to the drug development. The cost of trials cantherefore be brought down considerably on a platform which is crowd-sourced and open.

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Case Study 2: The Webicina- "Webicina," a site where medicine combines with social media to allow physicians within the country as well as across the world to communicate their findings easily, quickly and effectively.

Webicina Components

Medical Resources

System

HealthcareProviders

Social Media1

2

3

45

Medical Organizations

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Success Factors

� Webicina has the capability to scale up on several platforms and can work seamlessly on KPO/IVR, Landline, Mobile and Internet. The service can be provided in regional languages as well.

Integrated Platform-

Mobile App/ Web 2.0

Patient Profile

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Personalized SearchDrug DiscoverySecond Opinion

Empowered Patients and providers

Case Study- Hungary

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Major Players

Players ExamplesDefinition

Regulators Medical regulatory authorities such as FDA, HIPAA etc

HealthcareProviders

Individuals or institution s providing health car e services

Fitness Providers General fitness providers and diet clinics

Application Developers

Independent medical / mobile Software developers

Data Management Medical information providers

Health Device Manufactures

Manufacturers of sensors that interface with application on mobile phones

Medical Organizations

Medical education & research institutions, publishers, pharmaceutical companies and pharmacies

Network Providers Wireless data network providers

MobileManufacturers Smartphone and feature phone manufacturers

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Table of Contents

1 Background

2

3

4

Innovation- As we define it in Healthcare

Turning Point- Opportunities & Market Readiness

Policy- FRAMEWORK for Inclusive growth

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Areas of Policy making

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Innovation

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Digital Health Efforts- Collaboration areas

Health Information systems-

CHIS- India will also put in place a Citizen Health Information System (CHIS) - a biometric based health

information system which will constantly update health record of every citizen-family. The system will

incorporate registration of births, deaths and cause of death.

Surveillance- Maternal and infant death reviews, nutrition surveillance, particularly among under-six

children and women, service delivery in the public health system, hospital information service besides

improving access of public to their own health information and medical records would be the primary

function of this effort. Placed on a GIS platform, it can identify geographic concentration of disease.

Medical Records- The system will also provide hospital information service to improve the quality of

care to patients through electronic medical records, to lower response time in emergency and improve

hospital administration. It will support emergency response systems and referral transport

arrangements, the organ retrieval and transplantation programme.

Resource Mobilisation- The system will also support financial management -- from resource allocation,

resource transfers, accounting and utilization to financial services like making of payments to facilities,

providers and beneficiaries. It will provide a platform for continuing medical education and support

regulatory functions of the state by creating a nation-wide registration of clinical establishments,

manufacturing units, drug testing laboratories, licensing of drugs, approval of clinical trials

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Approach and Innovation

The major part of public investment in information technology in health care

would go to institutional capacity building for understanding and use of

information.

Incurring large expenditures on hardware and software without making a

matching input in capacity development and institutionalization can be an error.

Every state should have the skilled human resources needed at state and district

level. This would require a mix of those with IT skills and public health informatics

skills.

State centres for health information, either standalone, or embedded in existing

institutions would be essential and district teams of three to five persons for

managing information flows and interpreting information would also be essential.

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Lessons learned

•The future of Healthcare innovation requires accessing and managing distributed

networks of knowledge providers.

•Health/Biomedical research infrastructures need to be accessible, high quality and

sustainably financed.

•The intellectual property landscape should evolve to better leverage strategic intangible

assets.

•New research and business models are needed to meet economic and public health

objectives.

•Intellectual Asset Valuation could facilitate trade in the under –exploited knowledge assets

of the Healthcare/Biomedical sector.

•Regulatory evolution, in consultation with industry, is critical to ensure the development

and diffusion of breakthrough biomedical technologies and the innovative use of existing

technologies.

•End users of new biomedical technologies have an increasingly strong impact on

innovators and public policy.

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Challenges

There remain a number of outstanding questions

with reference to the development, delivery, and

uptake of health innovations where further

research might be pursued in order to help

inform policymaking.

The thematic areas for possible future work

include:

1. Progress in governance and the regulatory

system.

2. Open innovation models in health.

3. Commercialisation of innovation derived

from research and health infrastructures.

4. Financing models for health innovation.

5. Intellectual asset management.

6. Patient needs and demands.

7. Metrics and indicators of health innovation.

8. Policy challenges of disruptive technologies.

Development

Delivery

Uptake

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