Is the timing just right to press the paddle for acceleration on digital health?

Rahul Bhargava, Managing Partner, PurpleCrest explains that what demonetisation did for digital payments by massive change in old habits, COVID-19 is doing for digital health. This is why now is the right time to press the paddle for acceleration on digital health

Early in August, Teladoc – a telemedicine provider, and Livongo – a digital diabetes coaching company, merged for $18.5 billion in the largest digital health deal in history. The result is a combined entity worth $38 billion – first true digital health giant. The deal is being seen as a sign for the rise of digital-first healthcare globally. The pandemic has been instrumental in accelerating the adoption of virtual care, and also this deal.

With 150 million plus downloads, India’s Aarogya Setu became the most downloaded COVID-19 contract-tracing app in the world. This resulted in operationalisation of the Swasth Alliance – coming together of 100+ players across the healthcare ecosystem, to offer free teleconsultations for patients with COVID-19 symptoms through the Swasth app. The app itself was soft-launched as Aarogya Setu Mitr earlier, and is targeting 1-2 million consultations per day. And the latest is the big announcement of National Digital Health Mission (NDHM) on August 15, which eventually aims to make the entire ~1.4 billion population and healthcare ecosystem go digital!

These developments are indicative of the times we are living in – frequent public health turbulences (e.g., SARS, Ebola, COVID-19) and digital innovations. Technology is being put, or being ‘made to put’ by these pandemics, to make healthcare massively better for every human being – in terms of cost of delivery, quality of delivery and access to delivery. That perhaps is how digital health is defined!

If we look at the current pandemic, technology adoption in the overall healthcare ecosystem became the need of the hour. Digital transformation of the sector at scale would have taken at least a few years to become reality, especially in developing nations like India. But the coronavirus outbreak hastened the entire process, as new habits got created in the last 3-4 months – both on the demand and supply side of healthcare, which in a normal scenario would have taken 4-5 years or even a decade in some cases. When was the last time billions of people with smartphones and the internet were confined to their homes for months?

Patient-behavior shift

Consumer and patient behaviors have shifted towards digital methods across the care continuum – fitness and preventive health, to find answers to health related-queries, doctor consultations, doorstep diagnostic, and medicine purchases.

As per press articles, the digital health platform Healthifyme witnessed a 50 per cent growth in organic signups and retention in May 2020, achieved its highest lifetime revenues of $1 million and launched HealthifyStudio for online group fitness sessions. This is not the only example. Curefit, Disney+, Hotstar and multiple other content platforms entered the online fitness industry as a result of shift of offline consumers of these services to online/digital as well as entry of new consumers driven by fear and anxiety due to the pandemic.

On the curative side, procedures and consultations that were essential – such as pediatric consultations, non-elective surgeries – increased their use of digital tools where possible. However, the big patient shift came due to COVID-19 itself. As per recent press articles, 1mg – a healthcare app, witnessed a 450 per cent increase in fever related doctor consultations. Practo experienced similar growth of 500 per cent in such consultations. Figures in the country are similar to the rest of the world and Asia Pacific, where companies such as Ping An Good Doctor (China), MyDoc (Singapore), HaloDoc (Indonesia) all saw an increase of 2-7x in online consultations over the last few months. This clearly is a step change in acceptance of telemedicine by patients, governments, providers and insurance. But telemedicine in itself is not the solution. Telemedicine is likely to help triage patients better and connect the healthcare system more effectively.

Provider adoption shift

The demand curve for digital health from patients had a steep slope even before the onset of COVID-19. One can argue that this was due to earlier phases of the digital revolution brought by smartphone firms, Reliance Jio, Flipkart, Amazon, Google, Facebook, WhatsApp etc. What really created a deep impact over the last few months has been the adoption of digital on the care delivery side – physicians, wellness experts, hospitals, clinics, yoga studios, pharmacists, labs – everyone started seeing this as a necessity instead of as an option. This is turning out to be the missing puzzle piece for Digital Health’s acceleration. What demonetisation did for digital payments by massive change in old habits, COVID-19 is doing for digital health.

It was really helpful when MOHFW, in consultation with NITI Aayog and Board of Governors MCI, released the long pending guidelines for teleconsultation in March 2020. That resulted in major adoption of telemedicine by every institution possible – government itself, hospitals, e-pharmacies, small clinics and even multiple employers. Platforms such as Practo witnessed 50-60 per cent jump in physician registration after that. Growth figures for integrated platforms like Docprime, Lybrate, mFine as well as for non-consumer facing telemedicine and EHR software providers were similar.

Further, on Independence Day 2020, PM Modi announced the National Digital Health Mission (NDHM) to create a digitised interoperable healthcare ecosystem. With its six key building blocks – Health ID, DigiDoctor, Health Facility Registry, Personal Health Records, e-Pharmacy and Telemedicine – the initiative aims to improve patient’s access to care anywhere, and also enable existing stakeholders to build their own products on top. Digital health startups and organisations with advanced capabilities in digital health are likely to benefit, and so would the patients, from a massive digital transformation of such a scale. When executed fully, it will be a game changer for sure.

Opportunity and timing

So for a healthcare business leader, is the timing right to press the paddle for acceleration in digital health? Healthcare leaders at our firm’s client organisations and experts we have been interacting with, are developing their approach by asking various strategic questions. At one level, these questions can be classified in five broad categories and can help leaders, healthcare management professionals and the 11.57 lakh registered allopathic doctors – many of whom run their own practice – navigate their approach towards Digital Health investments.

1. Business continuity/growth: Is there a significant risk of losing existing patients to competition (including the new age disruptors, non-healthcare giants entering healthcare)? Are there opportunities to capture new sources of revenue digitally e.g., outside India, digital therapeutics) ? Could profitability (or cash flows) be higher with rapid adoption of digital technologies – faster than pre-COVID-19?
2. Patient-centricity: Can patients be significantly served better across the care continuum – awareness (digital channels), diagnosis (digital screening), treatment (digital therapeutics), compliance (digital coaching and tools) – through selective use of digital technologies? The answer would vary by therapy or health condition (think mental health vs. a surgery), specific problem that requires attention (e.g., access vs. affordability) and so would intensity of acceleration
3. Ecosystem collaboration: As Swasth alliance is demonstrating, is there a case for peer learning and/or stronger collaboration among relevant stakeholders in the healthcare ecosystem – providers, diagnostic labs, pharmacies, pharmaceutical organisations, insurance, regulators, employers – for growth, with digital technologies as an enabler? If facilitated well, this could particularly benefit mid-market organisations where resources (talent, capital) are always scarce. Our firm, for instance, had enabled peer learning among hundreds of physicians and independent practitioners since the onset of COVID-19 for immunity focused holistic programmes.
4. Operations improvement: Digital health is also about improving the workflow and operations of healthcare businesses. Could acceleration be brought in operational workflows and business processes (e.g., hiring or payments, for faster outcomes, lower costs and better quality) ? Once again, relevant for most providers, yet highest ROI in resource constraint operations (mid-size and smaller centres)
5. Learning and development: It can be argued that the limit to derive full benefit from digital and analytics for any healthcare organisation would be tied to the talent and their capabilities. If that is true, then should the paddle for acceleration be first pressed in learning and capability building – focused on digital health? With lockdown and footfall reductions resulting in extra time, and digital learning making access possible, multiple healthcare organisations have been ‘upgrading’ their leadership and staff.

These are not exhaustive, and merely reflect a synthesis of our discussions with leaders in our network. The pandemic has made the question on digital health relevant by exposing the gaps that exist in the healthcare system, led by massive fragmentation. In other sectors and countries, digital technologies have successfully demonstrated their ability to improve connectivity and solve for fragmentation. And that – solving for fragmentation through digital transformation of the healthcare value chain – could be the last argument in favour of digital health investments.