You can think of us as a distributed hospital using the existing capacity in patient homes to take care of infrastructural gaps, immediately and cost effectively, says Vivek Srivastava, Co-Founder and CEO, HealthCare atHOME
How is Indian home healthcare growing?
According to estimates, the overall Indian healthcare market today is worth Rs 7 lakh+ crores and is expected to grow to Rs 18.7 lakh crores by 2020, a CAGR of 22.9 per cent. Globally, the segment of home healthcare comprises 3-6 per cent of the total healthcare pie, thus there is huge scope and potential in the Indian home healthcare market.
How is it going to address the shortage of few lakh hospitals beds?
We need over 6 lakh+ beds to cater to our population and home healthcare can help bridge this gap as it reduces the requirement of the hospitals beds, which can be provided to more needy patients. Since the shortage of beds are more in tier-II & III cities, the hospitals can extend their reach without building expensive infrastructure with a home healthcare partnership.
For example, patients residing in a tier III city at a distance of around 200 km from a tertiary care centre often discontinue their treatment in the middle due to rising costs and inconvenience. With home healthcare services, step-down care including complete ICU setup can be delivered right at their home at a fraction of cost.
How is HealthCare atHOME complementing the efforts of hospitals to provide quality healthcare delivery?
We work with the hospitals to widen their reach, by freeing the beds for new patients. You can think of us as a distributed hospital, we are using the existing capacity in patient homes to take care of infrastructural gaps, immediately and cost effectively. There are number of procedures where you do not need the hospital beds and these can be done at home. Then, our services reduce the average length of stay of patients at hospitals minimising the pressure on the hospital infrastructure, ensuring smooth transition from hospital to home, decreasing chances of re-admissions and offering personalised care and attention. We are focussing on services like critical care at home, cancer care, post-operative and rehabilitation care. We have successful tie-ups with leading corporate hospitals across the country in line with above business model. Second, we also improve patient satisfaction since personalised quality care is the key. Add to this, the main benefits of our services are improved safety and comfort for the patients and faster recovery because of familiar environment and proximity to near and dear ones.
Additionally, hospitals have long supported their communities, offering educational programs, health fairs and other such services. With HealthCare atHOME services, they can become more strategic in their community service enhancing footfalls by reaching out and offering community based services and specialised outreach programmes. Our programmes can improve patient satisfaction because the patients and the community starts realising that the hospital thinks about them even when they are not in hospital.
Can you elaborate on how you can increase capacity and what direct P&L advantages it can bring to hospitals?
The direct P&L advantages to hospitals are reduction in Average Length of Stay (ALOS) and Higher Average Revenue Per Operational Bed (ARPOB). Let me illustrate a case study of a critical care patient on prolonged ICU stay who has sepsis along with associated comorbidities. Such patients often have a prolonged recovery trajectory. Say he needs to stay in hospital ICU for 30 days, which will cost average Rs 70,000 per day for first 10 days, Rs 50,000 per day for subsequent 10 days and then Rs 30,000 per day for the rest of the days. The total monthly revenue comes out to be Rs 15 lakhs for the hospital but almost, 64 per cent of the revenue will come in the first 15 days of the stay.
However, when stable, the patient can opt for our ‘ICU atHOME’ service on 16th day, which will cost him Rs 15,000 per day for next seven days, followed by Rs 10,000 per day for next six days and Rs 6,000 for the remaining period. This entails for 15 days of hospital ICU stay and 15 days of ICU atHOME. The effective stay at hospital got reduced to 15 days which increases the number of such ICU patients admitted in hospital from one to two assuming 100 per cent capacity utilisation. This leads to an additional revenue of approx. Rs 4 lakhs leading to a monthly revenue of Rs 19 lakhs as compared to Rs 15 lakhs (27 per cent increase in revenue).
More importantly, the financial burden on such patients who choose homecare as part of their total treatment reduces significantly from Rs 15 lakhs to Rs 11.57 lakhs (23 per cent reduction).
What are the challenges you are facing? How do you plan to overcome these challenges?
The general perception about home healthcare services is having a nurse at home or an attendant at home. We attempt to break this myth by showing evidence and experiences of existing consumers. By far, we’ve done over 25,000+ oncology/ immunology procedures at-home, more than 20,000 ICU days at home and have looked after more than 4,00,000 patients across India and that too, with a high customer satisfaction rate (NPS >70 per cent) since 2012. Our success in reaching this goal is indicated with the fact that since our inception, revenues have grown by a multiple of 150x on a monthly basis. Additionally, now we are a 1200+ people organisation from five people when we started operations in 2012.
One of the major challenges that we face is the availability of trained clinical staff. There is a great need to ensure that clinical staff is effectively trained to be able to manage patient complication at home through an exhaustive induction programme, recurring on job trainings, refresher trainings and audits. We are putting a lot of investment and efforts in this direction to create a cadre of highly trained nurse-led multidisciplinary teams. We are also benchmarking our processes similar to CQC standards and JCI compliant setup.