IndiaMedToday Oct 2018 by IndiaMedToday

OCTOBER 2018, VOLUME 2 ISSUE 10 `200 INDIA MED TODAY

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Innovation in Healthcare

Are we on the right track? SPECIAL FEATURE

HOW TO DISRUPT STATUS QUO RAMESH KANNAN, PARTNER, SOMERSET INDUS HEALTHCARE FUND

SPECIAL FEATURE

HEALTHCARE INNOVATION: WHERE IS IT GOING SUNIL THAKUR, MANAGING DIRECTOR, QUADRIA CAPITAL ADVISORS

IMPACT OCTOBER 2018

HOW SWITZERLAND IS LEADING INNOVATION GOING FORWARD

EDIT NOTE www.indiamedtoday.com

OCTOBER 2018 EDITORIAL

BOARD OF ADVISORS

Editor Neelam Kachhap editorial@ indiamedtoday.com

Dr Dr Dr Dr Dr

Alexander Thomas Girdhar Gyani Prem Kumar Nair Bhabatosh Biswas Alok Roy

ART & PRODUCTION

CONSULTING EDITOR

5Th eLLemenT sTudio Prasshant

Dr Libert Anil Gomes Dr Salil Choudhary

Innovations to impact healthcare delivery and health markets

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HEALTHCARE DELIVERY in India stands at the precipice of a new age. With the roll out of Pradhan Mantri Jan Arogya Yojana a new playing field has been created for innovators to expand access to effective and affordable health services, especially for the poor. India has made sizeable impact on the medical innovation landscape with a number of thinkers coming forward with brilliant concepts and ideas and yet, very few innovations have had a substantial impact at scale. Our current issue looks at innovation in a different light. In this issue, we have tried to bring together people who have been involved in the design and implementation of healthcare innovations, which have the potential to be taken to scale and impact healthcare delivery. We aim to recognize and encourage healthcare innovators and serve as platform for thought leaders to explore the potential for new partnerships.

We aim to recognize and encourage healthcare innovators and serve as platform for thought leaders to explore the potential for new partnerships We have sought insights from experts on how to leverage the potential of these ideas and accelerate progress towards achieving healthcare goals. Our experts outline the challenges, particularly policy and regulation impacting the life-cycle of start-ups. This issue has perspectives from innovators both in the start-up space and indigenous established companies. This annual issue is a space where leaders from best-in-class organizations can share cross-industry solutions for the everyday challenges and inspire new ideas. We also have two renowned venture capitalists sharing their insights on working in the healthcare innovation space. Besides this read about three engaging healthcare events. IndiaMedToday, was the media partner for these events. As always, if you have any comment on the magazine or are interested in contributing, please contact editorial@indiamedtoday.com

and published at 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084.

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OCTOBER 2018

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CONTENTS

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How Switzerland is leading Innovation going forward DRIVE

Healthcare inInnovation in Healthcare: novations – An Are we on the right track? Entrepreneur’s Perspective COVER STORY

Ashim Roy, CEO, Cardiotrack

How to Disrupt Status Quo Ramesh Kannan, Partner, Somerset Indus Healthcare Fund

Sunil Thakur, Managing Director, Quadria Capital Advisors

OPINION

October 2018

SrinivasThirumalai, Finance Expert, Healthcare Industry, Chennai

SHOWCASE

Precision Medicine with Unique Approach DiponEdBioIntelligence

Innovation in Diagnostics to Drive Healthcare

EVENT REPORT

Healthcare Innovation: Where is it Going

Innovative Financing of Healthcare

J.Mitra & Co. Pvt Ltd

SPECIAL FEATURE

03 Editorial 05 Letters 06 News roundup 42 Event Report APPROACH

IMPACT

SPECIAL FEATURE

UPFRONT

Leading In-vitro Diagnostics with Innovation

ANBAI Teachers Day Awards 2018 CAHOTECH 2018 Healthcare Innovation Pitch Day WWW.INDIAMEDTODAY.COM

CHECK IT OUT ONLINE

LETTERS

BER 2018,

E 2 ISSUE

VOLUM

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SEPTEM

INDIA

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apacity building is a key element of any healthcare eco-system and it becomes significantly important in a country like India because of the need-supply gap and size of the market. The issue highlights this important need and how we can try and resolve it.

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LTH BODHI HEAAGE TECH N USING NEW UPGRADATIO FOR SKILL

Sunil Thakur, MD, Quadria Capital Advisors Private Limited

S ON THE FOOTPRINT OF TIMEASUNDARAM SANDS SHAN MUG PROF TK SEPTEMB ER 2018

The announcement of the Ayushman Bharat - PradhanMantri Jan AarogyaYojana (AB-PMJAY) is huge for the country, especially the less privileged sections of the country. The world might not have seen a program that covers such a large number of people on the planet. However, this kind of program will need great leadership and management capabilities of people at various levels of government, quasi-government and nongovernment organizations for effective implementation and for it to truly benefit ever last citizen in this country. And, this is the big challenge.

extent to raise awareness. Governments and Ministries of Health must accurately understand the scale of the problem by investing in surveillance and monitoring of cardiovascular disease. By making just a few small changes to our lives, we can reduce our risk of heart disease and stroke, as well as improving our quality of life and setting a good example for the next generation. There is no-shortcut to a healthy heart. We should spread the word that a healthy lifestyle is the key to a healthy heart.

Ravi Sreedharan

Dr. Sanjay Bhat

Founder and Director, Indian School of Development

Consultant - Interventional Cardiology, Aster CMI Hospital

Management (ISDM)

Itâ&#x20AC;&#x2122;s an inspired proposal by IRDA which is presently at conversation stage, if the insurance companies are permitted to test products in a particular geography or among a set of few policyholders before they are officially launched in the marketplace, then, we believe that this will encourage insurers to create more comprehensive, innovative, personalized, and affordable suite of healthcare solutions benefiting the end consumers. Product testing in a particular geography is a progressive step to unleash innovation, ensure the acceptability of products by end-consumers, and lastly to help create pull market in health insurance. Itâ&#x20AC;&#x2122;s a serious concern that insurance penetration in the country is substantially much lower against global average, nevertheless, with innovation driving newer affordable insurance products, the penetration level in the country can be expected to increase considerably going forward. Prasun Sikdar Health Insurance

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Taking a comprehensive approach to address the cardiovascular disease burden is the need of the hour. It is also very important to advocate life-saving techniques to prevent heart failure like CPR for revival after a sudden cardiac arrest. Conducting CVD awareness programmes and counselling sessions are also required to a greater VOLUM

Dr. C. K. Ponde

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Managing Director & Chief Executive Officer at Cigna TTK

APRIL 2018,

India is going through an epidemic of heart disease and unfortunately the growing incidents are seen in people under 40 who are suffering from coronary artery diseases 20% more than what we saw 5 years back. This can be attributed to a variety of reasons like stress, lack of exercise, increase in consumption of junk food, family history, etc. Adopting simple lifestyle changes every day like having low sugar and low-fat diet combined with a high fibers intake, regular exercising and along with the determination to quit smoking will drive in preventing heart disease. Few major risk factors for CVD are diabetes, blood pressure, cholesterol and smoking. Therefore, people who fall under these risk factors should opt for timely treatment to control them.

October 2018

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ALL HOW A SM L HOSPITA MADE IN RAIPUR S HUGE GAIN IN CHD

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NEWS ROUNDUP SUPRAFLEX STENT CLINICALLY AT PAR WITH GLOBAL STANDARDS Supraflex, a cardiac drug eluting stent designed and manufactured in India has been confirmed to be at par with Abbott’s Xience through an investigators-driven study called ‘TALENT’ – Thin strut sirolimus-eluting stent in allcomers population vseverolimus eluting stent. Supraflex is made by Sahajanand Medical Technologies (SMT), Indian medical devices manufacturer specializing in the provision of life-changing vascular solutions. The findings of the TALENT trial were presented at the ‘late breaking trial session’ at Transcatheter Cardiovascular Therapeutics 2018 (TCT), the largest global conference of cardiologist currently underway in San Diego. This study was conducted in 7 countries – United Kingdom, Netherlands, Poland, Spain, Italy, Hungary and Bulgaria – across 23

renowned centres with a sample size of 1435 patients. Xience is regarded as global standard in safety and efficacy for drug eluting stents. Renowned cardiologist, Dr. Patrick Serruys was the chair for the TALENT trial. Prof. R. de Winter, MD, AcademischMedisch Centrum, Amsterdam, The Netherlands; and A. Zaman, MD, Cardiac Catheter Laboratories, Royal Freeman, Newcastle, UK, were the Principal Investigators for the TALENT trial.

INDIAN SYRINGES & NEEDLE MANUFACTURERS SEEK PRICE CAP & INCLUSION IN NLEM

Indian Syringes & Needle Manufacturers have urged the government to impose a price cap to stop the exploitation of patients by hospitals. The price limit on needle and syringe would curb unethical practices in the medical field and overcharge of these products by hospitals.

“We want a level-playing field. Hospitals need not sell at the MRP and are free to sell under the Max Retail Price but Doctors have been blaming us (manufacturers) for labeling products with high MRP. With Price Caps or Cap on Trade Margins ,our endeavor is to make the hospitals focus on making the procurement decision on the quality of the Medical Devices and their buying price for cost minimization rather than current skewed market where hospitals focus on Margins to be made on Higher MRPs and tend to seek profit maximisation . This has taken away the motivation of hospitals to be cost competitive and patients feel exploited leading to a trust deficit” said Rajiv Nath, President, All India Syringes and Needles Manufacturers Association (AiSNMA). or the purpose of self-regulation and as responsible manufacturing, the Domestic Syringe Manufacturers had earlier set a path breaking self regulatory precedent by deciding

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NEWS ROUNDUP

he 19thConvocation of National Board of Examinations (NBE), an autonomous body of Ministry of Health and Family Welfare was held recently in Delhi. At the convocation ceremony, 306 doctors received the Gold Medal in their respective specialty and 61 medical teachers we rehonored for their exemplary work in the field of modern medicine. NBE also conferred degrees to 20,534 Post Graduates doctors. Dr. Alexander Thomas, Founder-Member and President of the Association of Healthcare Providers of India (AHPI), Founder-Member and President of the Association of National Board Accredited Institutions (ANBAI),received the NBE Emeritus Teacher Award from the Vice President of India, Shri. Venkaiah Naidu, in the presence of the Minister of State, Health and Family Welfare, Smt. Anupriya Patel , Shri Ashwini Kumar Choubey, Dr.Ahijat Sheth, President,NBE and Hon.Executive Director Dr.Rashmikanth Dave, NBE and other dignitaries at the event. Dr Thomas is the Founder-President (20122017) and Patron of the Consortium of Accredited Healthcare Organizations (CAHO), former Director (CEO) of Bangalore Baptist Hospital (BBH); and has served the healthcare sector for over 30 years. Dr. Thomas has been honored with the Lifetime Achievement Award by CAHO (2018). He

Dr Alexander Thomas Receiving the Award from the Vice President of India, Shri. Venkaiah Naidu

was recognized as an Icon of Quality and Patient Safety in Healthcare by the Society for Emergency Medicine in India (2017), received the Distinguished Service Award by the IMA(2016), and was awarded the Meritorious Service Award

to voluntarily cap trade margins to maximum 75% over their discounted net Ex-Factory prices (including GST) and to implement this latest by Republic Day, 26thJanuary, 2018 as a contribution to Citizens of India, for the benefit of Patients. This covers all categories of Syringes & Needles – Disposable / Auto Disable / Reuse Prevention / Needle Stick Prevention / Insulin Pen Needle, etc. But four companies – Lifelong Meditech along with MNC Manufacturers / Importers – Becton Dickinson, B Braun Medical and Nipro Medical were opposed to this self regulatory advisory.

NETMEDS ACQUIRES JUSTDOC.COM TO STRENGTHEN DOCTOR NETWORK

Netmeds.com, an online pharmacy announced that the company has bolstered its expertise in the online healthcare space by acquiring telemedicine portal JustDoc.com in a cash and stock transaction. Founded in 2015, JustDoc.com is a robust

October 2018

by the Christian Medical College,Vellore, for 25 years of service (2013). Dr Thomas is also a member of our Advisory Board and has helped guide IMT to excel in healthcare reporting. Our heartiest Congratulations on the honor bestowed on you.

online consulting portal, which connects patients with reputed doctors via their technology platform. JustDoc has served thousands of patients throughout India through their website and app. Speaking about the acquisition, Founder & CEO of Netmeds, Pradeep Dadha said, “In addition to prescription medicine and OTC products, we also offer customers ‘The Vault’, our proprietary Electronic Health Records storage app. The acquisition of JustDoc brings an extensive and experienced physicians’ network, which will be the perfect addition to our present range of products and services at this stage in our growth plan.” Netmeds.com provides prescription medicine and healthcare products to more than 3,000,000 patients across India, serving over 19,000+ pin codes. The company has seen double-digit growth rates month-onmonth since inception. Dadha sees this acquisition as an extension of the company’s quest to provide a robust panoply of health-related products and services.

“Netmeds will continue to expand the scope of its offerings to include diagnostics, lifestylerelated consulting and a patient ‘peer-to-peer’ social network channel. Adding end-to-end video consultation workflows can make the whole process of providing high quality and affordable healthcare services far more efficient.”

SSNMC-BRAINS NEUROSCIENCES CENTER OF EXCELLENCE LAUNCHED AT BANGALORE On the ocassion of World Alzheimers’ Day 2018 (Sep 21st 2018), BR Life SSNMC Super Speciality Hospital, Bengaluru, launches the SSNMC-BRAINS Neurosciences Center of Excellence (CoE) at its superspecialty hospital located in Ideal Homes Layout, Rajarajeshwari Nagar, Bengaluru. The SSNMC BRAINS Neurosciences CoE is a joint collaboration between BR Life

SSNMC Hospital and BRAINS Neuro Spine Center, founded by Dr BC Roy Awardee and one of India’s foremost Neurosurgeon, Dr Venkataramana NK, which has led to the launch of the state-of-the-art Center of Excellence. The centre is managed by a highly trained and specialized team of Neurosciences Specialists (Doctors, Nurses, Technicians and Paramedics) and offers a most modern, integrated and comprehensive diagonistics, treatment, rehabilitation services in the field of Neurosciences specifically targetted to brain and spine related problems. Speaking on the occasion of World Alzheimer’s Day, Dr Venkataramana NK says “The loss of ones memories and capability to perform routine functions is devastating. Early diagnosis, prevention of the condition and identification of treatable dementias as a therapy goal can help provide effective treatment and improve the living conditions of the patient. The aim of SSNMC-Brains Neurosicience Center of Excellence is to provide individualistic and holistic treatment to each person walking in through our doors.”

diagnosed in left side of the liver,” he said at a press conference. With further investigation (CD99+, FLI1+) including biopsy and IHC test, cancer was confirmed. The patient was given chemotherapy and after that the left part of his liver (Left Hepatectony) was removed. Liver surgery which in itself is extremely complicated process and the young age of the patient made it far more challenging for Dr. ShashikantSaini. Fortunately, the surgical procedure was successful and currently patient is undergoing the remaining sessions

Markets said: “India is an important market for Cigna and we are pleased to welcome Manipal Group on board, a pioneer in healthcare delivery ecosystems, as our new health insurance joint venture partner. The joint venture is well-aligned with our mission to improve the health, well-being and sense of security of our customers.” Dr Ranjan Pai, Chairman, Manipal Education & Medical Group (MEMG) said: “The two organisations are a good cultural fit. The combination of Cigna‘s global expertise in health and wellness, its ability to offer

of chemotherapy in supervision of Dr Pawan Agarwal, Medical Oncologist at BMCHRC. Yukinori Ozaki, Medical Oncologist and team from Japan reported the 4th case of Ewing Sarcoma of Liver, in 2015. Ewing sarcoma is a rare tumor that occurs commonly in the long bones of children or adolescents that can also arise in soft tissues including the extremities, retroperitoneum, chest wall, and rarely in the liver as primary sites. In 2015, 15 cases of Mesothelioma, a rare cancer, were also reported from Rajesthan in workers exposed to asbestos fibers.

customized solutions for the Indian market, and Manipal Group’s integrated healthcare expertise with multi-specialty hospital networks will create a true differentiation for healthcare in India.” Manipal Group has diversified and established business models to serve the needs of its customers. This includes building worldclass hospitals, fostering preventive healthcare processes, and nurturing best medical faculties through education institutions.

YOUNGEST PATIENT WITH MANIPAL GROUP BUYS RARE CANCER (EWING STRATEGIC STAKE IN SARCOMA OF LIVER) REPORTED FROM JAIPUR CIGNA TTK HEALTH BhagwanMahaveer Cancer Hospital and INSURANCE Research Center, Jaipur reported a rare form of cancer called Ewing Sarcoma of Liver in a 4-year-old boy. The child has undergone chemotherapy and liver surgery and is now continuing with the remaining treatment at the hospital. Till date only four cases of Ewing Sarcoma Liver Cancer have been recorded across the globe and in all of those patients’ age was around 20 years. This one at the age of 4-years is considered to be very rare. The surgery was conducted by Dr ShashikantSaini, Surgical Oncologist, BhagwanMahaveer Cancer Hospital and Research Center. “No such case has been witnessed till date, for such a young age of 4 years. The patient got registered at the hospital on June 2018, CT Scan was conducted and a 11 cm tumor was

Cigna TTK Health Insurance Company Limited (Cigna TTK) has received necessary regulatory approvals, from the Insurance Regulatory and Development Authority of India (IRDAI) to partner with Manipal Group, a leader in the field of healthcare delivery and higher education. As per the new structure, Cigna Corporation (NYSE: CI) will continue to hold its 49 percent stake in the Indian health insurance venture, while Manipal Group and TTK Group will jointly hold 51 percent stake in the joint venture. The new partnership will help Cigna TTK bridge the gap between healthcare delivery and healthcare financing, enabling the company to provide customers with a more comprehensive, innovative, personalized, and affordable suite of healthcare solutions. Jason Sadler, President, Cigna International

DIGITAL PATHOLOGY GETS A BOOST WITH MICROSOFT, SRL DIAGNOSTICS PARTNERSHIP Microsoft India and SRL Diagnostics announced their partnership to expand the AI Network for Healthcare to pathology. This collaboration will help improve the quality of digital pathology for population screening by bringing together Microsoft’s Azure and AI innovations along with SRL’s world-class expertise in the study of cells and tissues (histology). With this addition, Microsoft’s AI Network for Healthcare has now expanded to include pathology along with eyecare and cardiology, thus representing the continued efforts made by the organisation to democratize healthcare. Growing prevalence of chronic diseases such as cancer is one of the key factors for the need for pathology to transform. Digital pathology is increasingly being preferred as it has helped bring improvement in service delivery, patient

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NEWS ROUNDUP which seeks to replace the body with a new commission is passed by Parliament.The ordinance notification said that ‘MCI shall stand superseded and the president, vice president and other members of the Council shall vacate their offices.”A bill to replace MCI with National Medical Commission is pending in Parliament. All the existing top governing body members of MCI have been replaced and in their place, the Centre, has appointed Board of Governors comprising senior doctors from various organisations who will now exercise the powers of MCI.The Board of Governors who would run MCI include NitiAayog member Dr V K Paul, AIIMS Director RandeepGuleria and Nikhil Tandon.

SBI CARD AND APOLLO HOSPITALS GROUP LAUNCH APOLLO-SBI CARD

safety and communications while reducing errors and lowering costs. Histopathology is a specialized form of pathology for analyzing tissue biopsies (mounted on glass slides) and is used for detecting numerous diseases. Histopathologists require highly efficient tools to assist in diagnosis, thus augmenting the demand for automated and innovative implementation of cloud and AI. Commenting on the partnership Anil Bhansali, Managing Director, Microsoft India (R&D) Private Limited, said, “Microsoft is committed to empower both the healthcare industry and patients by using AI to democratize healthcare for all. Our partnership with SRL Diagnostics will assist pathologists by equipping them with technology that will augment their capability. This is the third area where we have expanded our AI Network for Healthcare after eyecare and cardiology. We will continue to look for other areas where we can deploy technology to make healthcare more accessible.” Commenting on the partnership ArindamHaldar, Chief Executive Officer, SRL Diagnostics said, “In line with SRL’s vision to

October 2018

help people on their path to better health, we are delighted to be partnering with Microsoft to co-create solutions and generate both social and business value. Diagnosis is the first step to disease management, as without accurate identification of the cause there is no possibility of a precise treatment. With the growing number of samples of cancer, as well as of other diseases, there’s a need to quickly and accurately analyze the samples to help doctors arrive at a diagnosis faster. The AI platform that Microsoft will build in collaboration with SRL is expected to create a software environment infused with millions of data points and knowledge gained from SRL’s expert laboratory professionals.”

PRESIDENT OF INDIA SIGNS ORDINANCE TO SET UP COMMITTEE TO RUN MCI President of India Ram NathKovind signed an ordinance to set up committee to run the Medical Council of India (MCI) till a bill

SBI Card, the country`s second largest credit card issuer, and Apollo Hospitals Group, India`s leading integrated healthcare services provider announced their partnership to launch the Apollo SBI Card – a first of its kind co-branded credit card in the healthcare segment.Designed to meet the complete healthcare needs of the family, the Apollo SBI Card is a pioneering product that offers an unmatched value proposition to consumers in the health and wellness space. Indian healthcare and wellness market is growing rapidly with increasing demand for affordable healthcare and wellness services and products. Growing health consciousness across age groups together with penetration of healthcare into untapped markets are contributing to increased demand for healthcare. The Apollo SBI card is a first of its kind card that offers exclusive benefits and exceptional value to the wellness conscious consumer on all healthcare spends. Through this partnership, card holders will be able to access services from the extensive Apollo Healthcare ecosystem, which includes the Apollo Hospitals, Apollo Clinics, Apollo Pharmacy, Apollo Diagnostics, Apollo Cradle, Apollo Sugar, Apollo White Dental, Apollo Spectra, Apollo Life Studio, Apollo Telehealth

Services (ATHS) and Apollo Homecare. The Apollo SBI Card will comprehensively cover all the health and wellness needs of family members at different stages of the healthcare journey. Apollo SBI cardholders receive complimentary OneApollo membership through which they can enjoy exclusive discounts and savings of upto 10% on health check-ups, diagnostic services, pharmacy products, physiotherapy etc. Through this membership cardholders can avail complimentary services such as consultations, dental screening, home sample collection, counselling with diabetic educator and dedicated relationship manager at Apollo Cradle etc. Cardholders can avail savings and benefits of up to Rs 40,000 through the One Apollo membership. In addition to this, Apollo SBI Card offers cardholders the strongest savings proposition on their healthcare spends through an accelerated reward point structure. Cardholders earn 3 Reward Points per Rs 100 spent at any Apollo entity while spends on lifestyle categories such as dining and entertainment earn the cardholder 2 Reward Points for every Rs 100 spent. Cardholders can avail instant redemption of reward points at Point of Sale at any Apollo Healthcare centre and also redeem reward points for Apollo gift vouchers, thereby enjoying savings on their health and wellness spends at Apollo.

Speaking at the launch, Mr. Rajnish Kumar, Chairman, SBI said, “SBI Card has been on a consistent growth path over last few years. Its customer centric business approach and focus on delivering innovative, market leading products have ensured rapid growth and made it one of the largest card issuers in India. The tie up with Apollo will enable us to bring a unique value proposition to customers in the country`s expanding healthcare and wellness segment. SBI and Apollo are both leading brands trusted by millions of consumers and this association will help drive growth for SBI Card while offering Indian consumers an exceptional payment product to maximise value on health and wellness spends” Commenting on the launch, Mr. Hardayal Prasad, MD & CEO, SBI Card said, “We are delighted to partner with Apollo to introduce the Apollo SBI Card, the country`s first cobrand credit card in healthcare segment. Increasing health consciousness and focus on overall wellness is a growing trend among Indian consumers across ages, making Health and Wellness one the fastest growing segments at present. Consumer spends on health and wellness are on the rise. In our portfolio, we have observed health and wellness spends have been growing 30% YOY over last few years. India has one of the youngest populations in the world today. As this population ages, demand for healthcare is set to rise further.

With the launch of Apollo SBI Card, we are pleased to bring our consumers a powerful, comprehensive product that takes care of their healthcare needs at all stages of their lifecycle. Apollo SBI Card is designed to bring consumers accelerated savings and maximum value on their health spends. Consumers earn accelerated rewards on health spends in the Apollo ecosystem, which can be instantly redeemed at Apollo health centres. Cardholders also enjoy complimentary OneApollo membership which brings benefits such as exclusive savings, discounts and complimentary services across various Apollo offerings. We are confident that the unique value proposition combined with the unmatched excellence in quality, customer centricity, trust and transparency that SBI Card brings, will make this a very successful product. We look forward to significantly increase customer acquisition in the health segment, with the Apollo SBI Card.” Ms. ShobanaKamineni, Executive Vice Chairperson, Apollo Hospitals Enterprise Limited said, “The Apollo SBI Card will offer the most comprehensive health and wellness services to its users. Through this unique offering the country’s most extensive health network will be available to its users. We believe that this card will help provide access to a range of health services which no other institution or product is offering. Apollo SBI Card holders enjoy complimentary OneApollo Membership which offers a bundle of exclusive healthcare benefits and privileges at any Apollo Health Centre. OneApollo program is a healthcare companion which accompanies the member in one’s entire journey across Apollo Ecosystem with healthcare privileges and exclusive rewards. We are happy to partner with SBI as we move forward with our aim to make available world class health services to all Indians”

MANIPAL HOSPITAL DWARKA INAUGURATED Manipal Hospitals, part of Manipal Education and Medical Group, one of India’s leading healthcare provider launched its state-of-theart digitally enabled 380-bed multi super-

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NEWS ROUNDUP specialty ‘Manipal Hospital Dwarka’. Aimed at providing specialised tertiary and quaternary care, the hospital is spread over 5,60,000 square feet and houses 7 centres - cardiac sciences, medical and surgical gastroenterology, neuro sciences, oncology services, orthopaedics& joint replacements, renal sciences, gynaecology and paediatrics - with cutting edge technology, equipment and advanced support services for enhanced patient outcomes. The facility was inaugurated by cricketer and former India captain Rahul Dravid in the presence of dignitaries RP Upadhyaya, IPS, special commissioner (law & order), south, Delhi Police, Dr. SudarshanBallal, chairman Manipal Hospitals and PramodAlagharu, CEOManipal Hospitals DwarkaPvt Ltd. The group operates a chain of multispecialty hospitals with over 5200 beds and has footprints across Bengaluru, Manipal, Mangalore, Vijayawada, Salem, Goa and Jaipur. Manipal Hospital Dwarka is the group’s first hospital in the capital and tenth in the country. The group also operates a facility in Klang, Malaysia. Announcing the launch Dr. H Sudarshan Ballal, chairman Manipal Hospitals said, “It is a proud moment for Manipal to foray into the capital after being in the industry for close to 60 years. The launch of this hospital is in line with the group’s vision to strengthen presence across the country. Featuring experienced medical professionals and latest in medical infrastructure, the hospital symbolisesManipal’s commitment to providing world-class clinical services in an ethical and patient centric manner.” With a complete WIFI premises and HIS system, the hospital is equipped with wireless point-of-care (POC) devices such as computers on wheels (COWs) and mobile clinical devices.

significant rise in Vector Borne Diseases (VBDs) such as Malaria, Dengue, Chikungunya, Filariasis, Japanese Encephalitis and Visceral Leishmaniasis. All these VBDs are preventable, what’s needed is effective and innovative vector control solutions and community education to spread awareness about disease prevention. To mobilize public-private collaboration on safeguarding public health and to pool industry know-how and resources, Bayer partnered with ASSOCHAM to organize a national dialogue on ‘Protecting Communities: Vector Control in Action’ at New Delhi today. The event was supported by the NitiAayog; the National Vector Borne Disease Control Programme(NVBDCP), Ministry of Health and Family Welfare, Government of India and the New Delhi Municipal Council. Nearly 150 participants from key stakeholders such as the National Institute of Malaria Research (NIMR); the Indian Council for Medical Research (ICMR); World Health Organization (WHO), the Bill & Melinda Gates Foundation, Pest Control Operators, NGOs and local government officials attended the event. The common perception is that VBDs are diseases of marginalized communities, since they are endemic in low-income groups or in areas where the vicious cycle of diseases and

poverty exists. However, with growth in Aedes borne diseases like Dengue and Chikungunya, nearly everyone is at risk irrespective of their income group. In addition to high mortality, VBDs put an economic burden on society through direct medical costs and indirect costs such as loss of productivity. In April 2018, Bayer signed ‘Zero by 40’, a global declaration that aims to eradicate Malaria by 2040 through the research, development and supply of innovative Vector Control solutions. In India, Bayer’s Environmental Science unit works closely with Public Health authorities, government organizations and industry associations to implement solutions for preventing VBDs. Bayer is also committed to support the Government of India’s national target for Malaria eradication by 2030 as part of the National Health Mission under the National Vector Borne Disease Control Programme(NVBDCP). At the event, Bayer also introduced one of its new products for Vector Control: Aqua K-Othrine, which is soon to be launched in India. Aqua K-Othrine is India’s first waterbased insecticide concentrate for application as a space spray adulticide in the management of mosquitoes. Aqua K-Othrine can be used in thermal fogging machines, ultra-low volume (ULV) sprayers and cold fogger machines.

BAYER INITIATES PUBLIC DIALOGUE ON TACKLING VECTOR BORNE DISEASES IN INDIA

Rapid urbanization in India has led to a

October 2018

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OPINION

Transforming IVD with Innovation

Suresh Vazirani, Chairman & Managing Director, Transasia Bio-Medicals Ltd.

THE HEALTHCARE industry in India has shown progressive growth and continues to do so. From USD 160 bn in 2017 it is projected to touch USD 372 bn by 2022 at a CAGR of 16 per cent. (https://www.ibef.org/industry/ healthcare-india.aspx). So, while it’s a good indicator for industry players, it also implies the growing healthcare concerns of 1.3 bn Indians and the need for better patient outcomes. Factors driving innovation According to the US National Library of Medicine, we are entering an era in which we can detect disease and predict its susceptibility with greater accuracy (and at an earlier stage), as well as predetermine an individual’s response to the drugs.This is where In-vitro Diagnostics (IVD) plays an important role, as it draws attention to the need to provide innovative solutions that simplify lab workflow and ultimately make the tests accessible to patients. The test results too are available quickly,

with turnaround times becoming increasingly shorter. A chain reaction takes place here, creating a further benefit for the healthcare system as a whole: diseases that are treated in their early stages tend to be less expensive in the long run. They also place a smaller burden on healthcare resources. Though IVDs represent two per cent of healthcare costs, they account for about 70 per cent of healthcare decisions. The WHO, too, is attempting to draw attention to the importance of investment in diagnostic testing with it’s first-ever, recently published ‘Essential Diagnostic List (EDL).’ In all, 113 testing products are included, with 58 cited for the ‘detection and diagnosis’ of common conditions, such as, type 2 diabetes and 55 designated for the ‘detection, diagnosis and monitoring of ‘priority’ diseases’—namely HIV, TB, malaria, hepatitis B and C, human papillomavirus and syphilis. The good news is India has taken the lead, in initiating its own model EDL.

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OPINION

Novel technologies Investments in clinical diagnostics have risen to record levels in the past few years. From a product development perspective, one of the driving factors has been importance of matching products to local needs. With recent technological advances, devices are now becoming less expensive and easier to use and interpret. Transasia has been focusing its research to develop affordable products catering to Indiaâ&#x20AC;&#x2122;s need for essential diagnostics. Take the example of Transasiaâ&#x20AC;&#x2122;s ErbaQik rapid test kit for malaria and dengue. The use of unique black gold particles, gives the kit a dual colour advantage, aiding in distinct differentiation of the test and control bands. Similarly, in the case of Hepatitis C, most of the detection kits are imported. Years of research, has resulted in Transasia being the first and only Indian company and one of the very few globally, to design and develop the 4th Generation Hepatitis C Virus (HCV) Ag + Ab kit. It aids in early and accurate detection of HCV and at a cost which is 50 per cent lesser than the imported products in India. New technologies are also bringing in ef-

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ficiencies and filling the gaps. Transasia has been improvising its clinical chemistry systems for greater operational efficiency and cost effectiveness, based on the expectations set forth by the pathologists. The use of permanent hard glass cuvettes in its fully automated systems, for example,has helped make the systems environmentally sustainable and cost effective. Lab automation is yet another example of the answer to skill gap. Internet of Things (IoT),refers to the network of devices embedded with software, sensors and connectivity that enables them to collect and exchange data. IOT aids in providing remote access for predictive maintenance, thereby reducing downtimes and enhancing service effectiveness. Reaching far and wide Other innovations are rooted in finding novel ways of making diagnostics accessible to people in remote areas. Transasia has taken the lead in the industry by introducing Transasia on the Move, a mobile van to bring our technologies closer to our customers, especially in Tier III and IV cities.

According to the US National Library of Medicine, we are entering an era in which we can detect disease and predict its susceptibility with greater accuracy (and at an earlier stage), as well as predetermine an individualâ&#x20AC;&#x2122;s response to the drugs

COVER STORY

Innovation in Healthcare

Are we on the right track? IMT Team

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COVER STORY

ealthcare industry in India is on the brink of a massive change as the government rolls out the national health protection scheme to benefit 50Cr people across the country. Today, the healthcare providers face unprecedented challenges to improve quality, improve access, increase efficiency, eliminate waste, and lower costs. In this scenario, innovation is becoming the major force. Incidentally, over the last few decades, there has been an explosion of innovations focused on improved life expectancy and better quality of life. Indian Healthcare’s pace of growth is a platform to create substantial market disruptions in healthcare providing waves of opportunities for both larger organisations and start-ups alike. But all this momentum has not translated into enhance product or service development and furthering India’s position as a hub of medtech. Just doing our bit is not enough. Why is it that India is not a major force in medtech yet? What can be done to rescue this situation? Let us hear from experts.

Rajiv Nath Forum Coordinator, Association of Indian Medical Device Industry (AiMeD)

nnovate in India can vary from incremental improvement to a breakthrough medical technology to a juggaad or frugal innovation. Established manufacturers may innovate in India with an incremental improvement over a copy of an existing medical device, to initiating a breakthrough medical technology, to a juggaad or frugal innovation of a manufacturing process to make the process more efficient or productive. Medical Device manufacturers may allocate anything from Zero percentage to two percent of their sales turnover to R&D expense but with a difference. In India medical devices being engineering products are different than drugs or the research involved in drugs. In India it is more related to design & engineering or design & development. In India and globally, most breakthrough improvements originate not from large corporations but from small organisations or individuals or teams of engineers , doctors or developers. They struggle to manufacture and sell the product and it’s not uncommon that a larger player or MNC will buy out the company or the idea or sub-license the proprietary or patented innovative idea or product. Consider the case of Deepak, a doctor intern who faces some limitations while using an instrument in OT and discusses the problem with Ajay an IIT engineer friend who applies his mind

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and after a few weeks reverts with a rudimentary prototype as a solution which excites Deepak with its simplicity and improved performance and he gives some further suggestions. Ajay and Deepak work on improving the prototype and make further improved samples and then take their final version to Dr Aggarwal a senior surgeon who gets impressed but is unwilling to try it on a live patient in absence of regulatory approval. Ajay & Deepak check on the Internet and inquire. They are surprised to know that the product is not regulated and the original product they had copied and improved upon can be imported freely without any import license or regulatory approval so they go back to Dr. Aggarwal and request him to evaluate but once again Dr Aggarwal refuses and states that the instrument must get US FDA or European CE approval before he can use it clinically. This second challenge flummoxes the pair and the innovation dies a death until they come to know of ICMED certification by QCI. ICMED is the Indian Certification for medical devices and is a voluntary Quality assurance certification granted by an NABCB accredited certification bodies like UL , TUV , Intertek etc. But this needs resources (their 3rd challenge) and a manufacturing plant (4th challenge)so they seek loan from a bank and partnership with an angel investor friend Sunil who runs a factory. They take a room on rent from Sunil and make the product under controlled conditions with help of Sunil’s production team. They get production quality samples tested at a NABL testing lab but this doesn’t have all

the instruments and tests so they are challenged again (5th challenge) to find a national lab of good repute who can do all the tests. They are informed to contact ShriChitra Institute in Trivandrum and IIT Mumbai. Between these threelabs , they get all tests done and find shortcomings so they improve upon design and raw material grade and after few retests their product qualifies . Next they get their production plant audited to seek ICMED certification and having achieved certification get the clinical evaluation done by Dr Aggarwal, who gives a green signal but is meanwhile transferred. Ajay faces the next challenge (6th) of marketing the product . He fixes a price half of the original imported product he copied and tries to get an order from the hospital but fails even after many attempts. Ajay invites Sanjiv the hospital procurement officer for dinner. Over a few drinks Sanjivtells Ajay the

reason for not buying the product. It is priced too low and the MRP also is very low so the hospital would makemargin of only Rs20 while on the imported product they make Rs 50 and even though the imported product was being bought at Rs20 more than Ajay’s product they were unwilling to try. The solution Sanjiv suggested was to match the MRP of imported product so that he could convince his Boss to use Ajay’s superior designed product. He leaves Ajay with an ethical dilemma (7th challenge) to keep trying to sell at a price attractive to poor patients , affordable and useful to Deepak and his colleagues or raise the price to satisfy the purchase department but still be un-affordable to poor patients? This is a hypothetical incident but most of the Indian innovators face a similar situation. Untill these challenges are addressed India will not be able to break into the medtech innovator’s highway.

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COVER STORY

Muthu Singaram CEO, IIT Madras HTIC Incubator

s India on the right tract for healthcare innovation? Yes, in my opinion we are working towards the right direction maybe a little slow but surely and we are working hard towards building the healthcare innovation in India. Though the ecosystem has evolved over the last few years there are some stumbling blocks that need to be addressed. The gestation period of a healthcare product is long as it involves clinical trials & validation, regulatory compliances and quality & risk management, hence only a few have ventured in this area. In addition, lack of specific guidance, skill sets, and efficient management of product development cycle has reduced the innovatorâ&#x20AC;&#x2122;s feat in the healthcare space. Also, the dynamics of the healthcare market in India is quite different from the other western countries which make it critical for the innovator to understand the market requirements and study the customer behavior for

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successful commercialisation of the innovation. Most start-ups require considerable amount of nurturing and support to be able to accelerate and even more in the case of healthcare, considering the nascent state of the healthcare industry. In such a situation, the incubator acts as an anchor and helps the start-ups fill the missing gaps. The technical support, business services support, expert mentoring, validation, network and peer support provided by the incubator creates a conducive environment for startupâ&#x20AC;&#x2122;s rapid growth. Incubators attached to public academic institutions are more focused on building a strong entrepreneurial ecosystem. They have access to faculty, engineering facility, student talent, alumni network and seed grants forincubates. Most institutions also have the infrastructure set-up which reduces the burden of operational overheads unlike the private incubators. The innovators need to be driven with passion along with patience to be able to accomplish their vision.

Kalyan Shiva CEO, 5C Network

ealthcare is a vast field, and innovations are abound in every facet of it. In India, I think Healthcare innovation is about going wider rather than deeper. Let me explain; because India offers unprecedented scale, people are trying to innovate to bring in high quality (even if basic) healthcare to the masses. In radiology, OEMs are working on low-cost high resolution machines. While we will keep hearing about the latest Da-Vinci robotic surgery machines and the amazing work in genomics, healthcare innovation in India will be a combination of technology and business innovation in order to reach the masses. Telediagnostics will play a huge part in this.

By my definition of innovation given above, I would say yes start-ups are synonymous with innovation. There are huge problems in healthcare, but in this field, in which the phrase ‘this is a matter of life and death’ can be taken literally, the problems are being addressed in some way. It may not be the most efficient way or the most productive way or the most cost effective way, but the problem is being addressed. A hospital that doesn’t have the ability to do a procedure would refer a patient to a larger hospital and maybe get a referral fee; hospitals that do not have EHR systems would have some sort of bookkeeping force that manages everything. If you’re a startup that is able to make a stakeholder in the healthcare system use your product and change the way they were doing something (by either doing it for far less cost or providing much greater value for the same or more cost), I’d say that’s innovation.

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SPECIAL FEATURE

How to Disrupt Status Quo Ramesh Kannan, Partner, Somerset Indus Healthcare Fund

INNOVATION IS crucial to the continuing success of any organization, Healthcare is no exception. Right from the Lab to the Last mile, there is a constant endeavour to innovate some with profit as the core, many with patient wellbeing as the core. Right from pre-birth screening, neo natal screening, early detection to predict, pre-empt and prevent,easy to use /self-use/non clinician use of point of care devices, connected health, wearables, remote monitoring, mobility, harnessing power of smart phones,portability, data mining, supply chaindisruption,artificial intelligence solutions, digital health platforms, mental health, support forums, advocacy, opex model for devices and equipments, subscription/ pay per use models, patient-provider management,genomics, precision medicine, robotics, data on cloud, 3D printing.The list is endless in terms of where Healthcare innovation is heading Where is Innovation heading But the key question is how many of these will be available, accessible and affordable and more importantly accountable to the vast populace of patients who clearly have to be the ultimate beneficiary in one form or other. While Innovation in itself is a great initiative, the larger question whether all of the noble intent and disruption intended has achieved its cause and purpose. While each of the innovator has taken upon small and yet challenging task/s and succeeded at that, the question is whether they have seen the light of the day to make a meaningful difference to the world at large on a greater scale and size In the Indian context, innovators have made an impact in cancer screening, ai in ra-

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diology, ai in pathology, tele-ecg, tele-icu, teleophthalmology, supply chain logistics, telehealth, patient-provider connect, data on cloud, maternal, new born and child health, non-invasive diagnostics, robotics, genetics, portable testing and monitoring devices. Start-up Story Who are these innovators, well, mostly start up’s. Start Up’s have the agility, alacrity and appetite for audacious attempts to disrupt status quo Supported by a huge eco system consisting of hackathons, challenges, industry and research grants, incubation, acceleration, seed capital, angel capital, venture capital, mentoring by industry veterans, strategic support from large healthcare companies, the youngstan of India are going all out with a contrarian agenda to question, challenge and disrupt conventional thoughts While frugality, boot strapping and intense passion has led many a start up to try innovation, their ability to survive, sustain and succeed has always been fascinating to watch. Whether they fold up, sell out, merge, get acquired, raise next rounds of funds, not just get the product or solution right, but also the business model, commercialization, monetization, market access, management bandwidth to be enterprise –wise, create IP, Patent, product certifications, strategic alliances etc is there to see as the story plays out. Start up’s are best suited and poised for innovation considering that there is no bias, pre-set thoughts, legacy ideas and baggage to carry, the spirit of freedom to act without fear of failure makes them the best bet for innovation.The inherent DNA of dream, dare, defy and deliver something the large companies woefully lack.

How do they do it? The large companies instead of doing it inside, try to leverage from outside by working with these start up’s providing them with access to their labs, technology, people, domain, money, market access, commercialization programs etc to go beyond their walls, take a leap of faith, rely on such relationships and take these offerings faster to the market, the underlying core being that the humility that has set into them that somethings can be done better by others outside of their system. So essentially a grand collaboration of David and Goliath seems to be a nice way to make innovation happen, like a relay race, the startup sets the tempo, runs the lap with gusto and abandon, beats the clock and hands over the baton of sorts to the larger company to carry it forward in the best interest of the ultimate beneficiary, the patient. Capital is Key In all these pursuits of dream, capital is key and a mix of many forms of capital, be it grants, angel , seed, venture, growth, strategic etc greatly impact the start up’s. It is just not about capital, but value the funding partner brings in terms of domain, expertise, knowledge and wisdom and the ability to open up networks to collaborate and co-create, not to mention being an able coach, guide and mentor to the budding innovator Venture Capitalists in the Innovation space are- “been there, done that “executives with a halo and brand equity that makes them attractive for the innovators to rely on for capital and more. Venture capital, though institutional in nature, but with sum total of individual brilliances make a huge difference to innovators. The individuals who constitute the venture capital firm thanks to their wealth of experience, failures and successes, learnings and mishaps on one side and on the other with their vast network that can add value and accentuate the start up’s efforts are key to success . Gone are the days of arm chair advisory, board meeting gyaan and networking parties to bask in. Today the venture capitalists work

equally hard as that of the innovator in making sure that money and value is put to best use Choosing Right Partner Today, across the globe, abundant money is chasing relatively scarce innovative ideas that can change the Healthscape, hence startup’ s have to equally careful in choosing their venture capital partner right. Start Up’s require sound advice and counselling if their intended offering ultimately will be acceptable to the market in its true sense i.e. It is used and paid for at prices that the profitable to all stakeholders, in addition to of course creating impact and value To get there, start up’s require test sites for piloting their offerings, commercialization support, market access, business model that works, monetization of their offerings, robust model to grow to size and scale, collaboration for optimization, co-creation to enhance, management bandwidth that goes beyond two entrepreneurs wearing the technology hat and no one to don the financial, commercial and the business hats. True venture capitalist can catalyze these to help innovation win.

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SPECIAL FEATURE

Healthcare Innovation: Where is it Going Sunil Thakur, Managing Director, Quadria Capital Advisors

INNOVATION IS rapidly driving the new phase of global healthcare. As we have seen in the past, healthcare undergoes revolutionary change after every 50 years. We possibly may be at the cusp of that very next change. The statusquo is being challenged at all levels and there is no sight of how, when and where the new norm will settle. Much of the reason for all these changes is the rising cost of healthcare and the need to provide access to quality healthcare. Developed markets are focusing on cost whereas emerging and underdeveloped markets are focusing on access and affordability (read financing). There is a consensus among all the stakeholders regarding the dire need for innovating new models of care both from a product and services perspective. Further, most of the innovations are helping the market to penetrate deeper (access), change clinical pathway (move out of hospitals), accelerate the speed of intervention and recuperation (advance surgeries) and allow customer to participate in the care and wellness program. How Innovation is moving Since innovation has multidimensional and multi-faceted flavours, the most simplified way to assess its role and performance at all stages of clinical pathway. Its got to do with how innovation is playing out in different stages right from screening to diagnostics to clinical interventions to recuperation and finally closing the circle with monitoring. If I talk about the developed market,

October 2018

which is driven by cost and clinical novelties and is dominated or influenced by strong payer system, the innovation is inclined towards alternate care models, efficient intervention technologies, precision medicine, rare disease therapy and preventive and monitoring models. Alternate care models are being used to create need based cost-effective interventions. Models such as telemedicine, home healthcare, digital therapy etc for good example of such care. Efficient intervention technologies are being worked upon for quicker and efficient diagnosis and then faster surgical turnaround and more importantly quicker recoveries. Precision medicine caters to the big need for the right treatment protocol inorder to avoid ineffective or wrong medication. Joining Forces The future seems more exciting and revolutionary. Non-traditional players are bringing in different approaches, drawing experience from their own industry, to healthcare solution. For example Verily, a google (Alphabet) company, is working on glucose sensing smart lenses, bio-electronic solutions to several chronic problems, IoMT (Internet of Medical Things) for surgical procedures, disease detecting nanoparticle platform etc. Amazon is working on disrupting the entire supply chain and clinical pathway through significant technology intervention and interface. Besides this some of the other advancement will be seen on the personalised medicine side include the path to get to the medication. This would include work on genomics, microbiomes, gene therapy, immunotherapy etc.

Emerging Market Needs Coming to the emerging or developing markets, the market needs is very different. These markets are still grappling with issues of access, affordability and quality. A substantial chunk of the population in emerging markets does not have access to basic healthcare and therefore the need is more towards innovation that can fulfil this gap. Therefore most home grown innovation especially on the product side are targeted towards this gap. Right from telemedicine, to screening devices to primary intervention products. Having said that there is a great deal of innovation happening on the urban centric/ need based models aswell, including new care models such as home healthcare, telemedicine, digital therapy, e-pharmacy, health monitoring tools etc. Innovation in India Within emerging market if I talk about India, there is a great deal of work happening in the early stage of the clinical pathway, which is mainly screening and diagnosis. Quite a few of these are home grown innovations that address local needs. But not many have succeeded to scale up given the lack of the right commercial support and the right eco-system to propagate and drive the usage. The area where we are seeing huge traction, even though it may not be solving a population wide need, is the client engagement and dis-intermediation models. Client engagement models such as doctor and procedure discovery, e-pharmacies, aggregators are a big draw with the urban population. At an institutional level, technology is helping in improving adherence and strong patient engagement programs. However, the big question is the level or type of innovation sufficient to fill the healthcare needs of the population. The answer is, we are convoluted miles away from where we should be. India not only needs innovation in medical products or services, it needs innovation in the way we approach our healthcare system. The healthcare infrastructure and policies were built around an acute care and communicable disease model whereas now maximum number of deaths are accounted for reasons related non-communicable disease.

How do we do it? If we are to make a paradigm shift towards solving this, our approach towards healthcare should take into account all forms of diseases. Thereafter a big apportionment of resources should be towards preventing the population reaching the stage of medical intervention. Here, while the health industry will be at the centre of the activities, the big support has to come from allied industries that have an indirect impact of healthcare. It could be the food and beverages industry, auto industry, education, telecom etc etc. How do we innovate a plan that gets the allied eco-system to sync with the needs of the healthcare industry. Thereafter, we should look at how prevention and wellness models can be delivered to the last mile. This may not necessarily require an innovative product but an idea of service that delivers the impact to the last mile. The other big underlying area to be solved is how to educate and bring health workers in the last mile ecosystem. Models of incentivization and teleeducation and medicine would be a great stepping stone. Moving to the intervention side, we ought to create products that can help bring down the

cost of servicing patients, create affordability and high velocity (treatment of more number of patients with the same resources). Products that have frugal features and easy to use are the ones that will make the most impact. The question is how may such ideas have seen the light of the day, the ones that have, what is their success rate. We have come across many such startups, that have great ideas, even though some may qualify as incremental, but lack of sustained funding and commercialization support has stunted their progress. There are many venture capital funds that are now out in the market to back the ideas, but what is needed is a much bigger and wider pool of capital to support the start-up ecosystem. They too will look at government to support their investee companies especially for product trials and procurement/ commercialization through public hospitals. While the VC funding in the last few years has not been very encouraging, we feel with the advent of specialised healthcare funds like Healthquad, Asian Healthcare Fund, Invascentetc will bring the required funding and more importantly the right expertise to back such innovation.

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IMPACT

HOW SWITZERLAND IS LEADING INNOVATION GOING FORWARD Sebastien Hug, CEO & Consul General, Swissnex India

Maitree Dasgupta, Head of University Partnerships, Swissnex India

Alexandra Allet, Project Manager, University Partnerships, Swissnex India

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SWITZERLAND HAS a long and proven track record as a leader in the field of healthcare technologies. Emerged originally out of the industrial revolution, the pharmaceutical industry has evolved since the mid-20th century to become a central pillar of Switzerland’s economy and as a world leading hub for innovation of pharmaceutical products and processes. Not surprisingly, the pharma sector is one of the biggest R&D spenders and contributes significantly to the fact that Switzerland is among the countries with the highest R&D expenses as a percentage of the GDP, that is, 3.4 per cent versus a OECD average of 2.4 per cent. Proven Track Record But big pharma is not the only piece of Switzerland’s healthtech landscape puzzle. Numerous Small and Medium Enterprises (SMEs) drive innovation especially in the Medtech and Biotech sector, and create a vibrant and tightly-knit eco-system. In fact, Switzerland is home to around 1,350 medical technology companies and thereby has the highest concentration of Medtech enterprises in Europe. With respect to Biotech, Switzerland in fact gave birth to one of the world’s first biotech company, Biogen in 1978. Nonetheless, it was only since the mid-1990s that the healthcare biotechnology sector has taken off in Europe. But Switzerland has caught up since and its biotech companies have become highly sought after assets. Last year, for example, Johnson & Johnson acquired Actelion for USD 30

billion, the largest transaction in 2017 in the life sciences sector. Another indicator of its maturity is its quantity and quality of the field biotech-related patents. While there has been a strong growth from 2000 to 2010, the number of patents have been increasing only slightly, especially in comparison to a strong growth in China and South Korea. At the same time, however, the quality of the patents has become much stronger. Half of all Swiss biotech patents are qualified as world-class, which is defined as the top percent of all patent families by business value. Several reasons contribute to explaining Switzerland’s leading role in innovating healthcare. For one, it is one of the highest spenders on healthcare per capita in the world. But more importantly, healthcare companies choose to conduct R&D in Switzerland because of its highly-skilled workforce, the high labour productivity, the proximity to world-class research institutions and the stable as well as liberal economic environment. In spite of its past successes, Switzerland cannot rest on its laurels. Its healthtech industry is facing many challenges: Decreasing R&D productivity, the looming patent cliff, demands for lowered priced yet high-quality healthcare solutions, among others. Without doubt, the global pharma and biotech R&D landscape is going through a major restructuring. And Switzerland is no exception. While no comprehensive review can be given here, we would like to briefly explore how some of the major trends shape the Swiss eco-system, that is: personalized, translational and digital.

Reshaping Healthcare Innovation With patents running out and conventional R&D approaches yielding low returns on investment, the two large Swiss pharma companies Novartis and Roche are readjusting their portfolios to align themselves with their personalized medicine strategies. Non-core assets and primary care offers are being divested, while R&D efforts are focused on developing breakthrough, highly innovative products, such as cell- and gene therapies, which also impacts operations in Switzerland. Only very recently, Novartis announced to cut a substantial amount of jobs in its manufacturing facilities and business service units, while at the same time investing into creating new positions in the development and production of cell and gene therapies. Collaborative Effort Given the emphasis on highly innovative diagnostic and therapeutic approaches,

healthcare industry players seek external collaborations and rely even more on strong R&D eco-system with world-class basic research. With its excellent universities and research institutions, Switzerland is well suited to support breakthrough discoveries through translational research and lead the trends in personalized and precision medicine. As a case in point, Switzerlandâ&#x20AC;&#x2122;s first genome center opened its doors in 2017, located in Geneva at the Campus Biotech. The Federal Institute of Technology in Lausanne (EPFL), the University of Geneva (UniGE) and the Geneva University Hospital (HUG) have joined forces, aiming to create Switzerlandâ&#x20AC;&#x2122;s first highthroughput DNA sequencing platform, with the ambition to become Europeâ&#x20AC;&#x2122;s largest. Similarly, at the University Hospital of Bern, the Swiss Institute for Translational and Entrepreneurial Medicine is currently being established offering specialist R&D labs for joint use by industry and academia, among other things.

Switzerland is among the countries with the highest R&D expenses as a percentage of the GDP, that is, 3.4 per cent versus a OECD average of 2.4 per cent

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IMPACT Another example is the establishment of the Wyss Zurich R&D center. Thanks to a donation of USD 120 mn by Synthes founder and entrepreneur Hansjörg Wyss, the University of Zurich and ETH Zurich launched the joint center to drive translational research in the fields of regenerative medicine and robotics. National Data Infrastructure At the core of these developments is an ever rapidly growing amount of data that is being produced and ought to be analyzed. To ensure the quality, exchange and interoperability of health data (i.e. clinical, molecular, laboratory and imaging data), a well-functioning collaboration among relevant institutions, especially in a small country like Switzerland, is absolutely paramount. Hence, the Swiss government has launched in 2017 the “Swiss Personalized Health Network” (SPHN) initiative and dedicated USD 70mn to build a national coordinated data infrastructure for research hospitals, universities, and other research institutions. Instead of creating a centralized data-base, the SPHN will “build a dynamic network of existing data sources and fund the efforts needed in order to make data nationwide interoperable and sharable for research”. Part of the SPHN was initiated by the Swiss Institute of Bioinformatics (SIB). Founded twenty years ago, today it represents the largest national bioinformatics network in Europe and is a key player in enabling Switzerland’s transition towards personalized medicine. Data Driven Innovation From IoT-enabled medical devices to mobile health solutions, data-driven innovations have also become pivotal to many Swiss startups and spinoffs from Universities. Take Ava, currently one of the hottest Swiss start-ups with offices in Zurich and San Francisco. Ava is a wearable wrist device which predicts the fertile window in a woman’s cycle in real-time, facilitating family planning through datadriven, clinically-proven technology. Developed in partnership with Neuchâtel-based research institute CSEM and the University Hospital Zurich as clinical partner, Ava’s data-driven

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solution is proven to be far more reliable than other traditional methods. In May, Ava has just closed a series B funding round raising USD 30 mn. Another example of a MedTech startup deploying the latest advances in medical imaging analysis and machine learning is RetinAI, a spinoff of the Universities of Bern and Lausanne. RetinAI automatically identifies pathological biomarkers by learning from its data, and thereby supports the health care professionals in their diagnosis of eyes-related illnesses. Investing in Education Yet,to lead innovation in healthcare, investments in new infrastructures and collaborative initiatives are not enough to unleash the full potential of the digital revolution in healthcare. At the beginning of all innovation is the human mind and its ability to imagine

the future. Deprived of any natural resources, Switzerland has no other choice than to invest in its brains, that is, its education system. To be highlighted is the important role of its VET (vocational and educational training), dualtrack system. Two-thirds of Swiss teenagers choose to do an internship, which generally combines three-day real-world learning in a company, and two days in a school-setting. In this respect, of great importance is the close partnership between the state, industry associations and educational institutions to develop apprenticeship programs and curricula that reflect the latest developments and needs of the industry. Equally noteworthy are the increasingly large number of continuing education courses offered by higher education institutions. Supporting the necessity of lifelong learning in a fast-changing world, these sought after courses are addressed to professionals, combine theory with real-world application and ensure continuous up-skilling on topics such as “Digital Food Competencies”, “Digital Basics for Life Sciences” and “Advanced Clinical Trial Management”. Embracing Synergies Alas, the latest developments medical and life sciences landscapes illustrate that a vibrant interplay between all players – including established companies, start-ups, research and educational institutions as well as policymakers and politicians – is absolutely crucial for a small country such as Switzerland. It is therefore not about just investing more into education and R&D, but doing so smartly: harnessing synergiesby entering a new age of collaboration across industries and sectors; embracing the digital revolution by completely reimagining the way we solve problems in the healthcare industry; and enable thriving innovation ecosystems by ensuring favourable economic, political, and social framework conditions. Lastly, especially as a small country, openness and international outreach to collaborate and exchange with peers abroad is equally important for future success. To this end, the Swiss government has initiated the swissnex network, in 2000,to support Switzerland’s education, research and innovation players.

Value in Collaborating Located in world-leading innovation hubs, the five swissnex offices support the outreach and active engagement of their partners in the international exchange of knowledge, ideas and talent. Established in Bangalore in 2010, swissnex India creates value for its partner by providing context, connecting people and ideas, catalyzing collaborations by curating conversations, and creating visibility. As such, we collaborate with universities, start-ups, innovative companies, and policymakers to bring Switzerland and India closer in education, research and innovation. Life Sciences and Healthtech is one of four focus areas where we see much potential and opportunities for more intensified exchange and partnerships. Switzerland and India: Partners in Innovation While India has become one of the leading generic drug manufacturer in the world, and is a valuable partner in custom synthesis and contract manufacturing; it can find potential partners in Switzerland in drug discovery& development. A recent collaboration between Novartis subsidiary Sandoz with Biocon to develop biosimilars for use in immunology and oncology is a move in that very direction. Over

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IMPACT The Swiss government has launched in 2017 the “Swiss Personalized Health Network” (SPHN) initiative and dedicated USD 70mn to build a national coordinated data infrastructure for research hospitals, universities, and other research institutions

October 2018

the last one decade, India has made progress in building an ecosystem which is more favorable toentrepreneurship in life sciences and gave rise to biotech parks and clusters. Govt of India through its grants via. Department of Biotechnology (DBT) and the Department of Science & Technology (DST), boosted the startup companies in these sectors by creating bioincubators and building academia industry connections. Now a similar thrust is given to develop the medtech sector in the country by setting-up medtech zones and supporting industry infrastructure. India’s focus on low-cost but high-quality medical devices and Switzerland’s strength in translational medical technologies (lab to market) is definitely a high potential area. We see a lot of early or mid-stage startups in both countries working on IoT enabled medical devices, where collaborative ventures can be explored for the world market. For example, Smart Cardia, an EPFL spin-off is tackling prevalent cardiac disease through a wearable cloud-based monitoring solution that notifies dangers in heartbeat like arrhythmia to doctors. In 2016, Swissnex India helped Smartcardia to launch trials with Manipal Hospitals in India. As well, this year, we have partnered up with Robert Bosch India Engineering (RBIE) to identify Swiss start-ups, amongst others, in the healthcare sector.

Academia-Industry Training Camp Moreover, at swissnex India we believe that fostering exchange among students, young researchers and entrepreneurs lays the foundation for future collaboration. Therefore, swissnex India has been running the AcademiaIndustry Training Camp together with SINE, IIT Bombay, for the past three years. Co-funded by the Department of Science and Technology (DST) and the Swiss State Secretariat for Education, Research & Innovation (SERI), the mission of AIT is to help researchers, take the plunge into entrepreneurship, by building a bridge from academia to industry, through a 1-week intense training camp in India, followed by another week in Switzerland. Lastly, in September we have launched the new ThinkSwiss Research Scholarship Program, which provides grants to Indian undergraduate and graduate students for a summer long (3 months) research internship at a Swiss University. Life Sciences & healthtech is and will remain one of swissnex India’s focus areas because we believe bringing leading healthcare innovators from Switzerland and India together will not only drive growth and gain new technology knowhow for stakeholders, but also advance high-quality healthcare at optimized cost globally.

SHOWCASE

Precision Medicine with Unique Approach Dr. Kaushik D. Deb, Founder & CEO, DiponEdBioIntelligenc

THE COUNTRY’S health care ecosystem is moving from sick care to healthcare and needs support from different providers to decrease disease burden, costs, and enhance quality of life. Precision and personalized medicine is therefore becoming central to the efforts of care providers. DiponEdan R&D driven company was founded in 2011 by Dr Kaushik Deb with a vision to bring in cure through precise treatment. The company is an upcoming leader in precision medicine with a unique P4M approach. DiponEd has taken up a way to integrate predictive, preventive, participatory and personalized medicine - P4M philosophy to achieve it’s mission as a company offering precision medicine. DiponEd believes that data collected over a period of time, over all the four P’s, will give the much needed intelligence to cure patients. The company’s core strengths are cellular biologics, in-vitro biology, formulations, metabolomics, genomics, proteomics, point-ofcare medical devices, and clinical research. DiponEd is developing genomic panels and molecular tests to Predict and Prevent noncommunicable diseases and health conditions like diabetes, cardiovascular conditions, drug responses, cancer, sports muscle endurance, hair and skin aging problems, metabolic problems and obesity, etc. The company is also working on a number of non-surgical preventive options using neutigenomics approach that are being worked out to prevent diseases like breast cancer, autoimmune conditions, arthritis, lung diseases, male and female infertility and neuro-cognitive decline. Under Merisis therapeutics, DiponEd’s in

house brand, we have developed more than 10 biologics and ortho-biologic devices for low cost treatment of joint pain, lower back pain joints, arthritis, AVN- hips, Diabetic foot ulcers, non-healing wounds, burns, non-union fractures, sports injuries, 3D printed orthotics, bioprinting etc. We also developed in-house molecular tests for telomere length assays, liquid biopsy for cancer detection, and developing affordable point-of-care rapid test for detecting sickle cell anemia etc. Diponed is continuously working to take up new challenges in health care and we keep evolving through developing new solutions. Some globally pressing needs and challenges that we are working on are related to antimicrobial resistance drug formulations, for treatment of MDR TB, and ICU and hospital borne infections. We are also developing regenerative approached to work on degenerative diseases through tissue engineering, 3D bio-printing, stem cells etc. Diponed has won a number of awards for its innovations in new devices and therapeutics, and was also selected as an Elevate 100 awardee by Ministry of IT BT ,Govt of Karnataka, for its Mesenchyme stem cell API (Merisis MS6) drug for treating GVDH in Bone marrow and Organ Transplants. DiponEd is working closely with R&D institutions, bio pharma R&D divisions in formulations, toxicity, discovery, safety and efficacy of modern drugs, transdermal drug and insulin delivery systems, all over the world and with Indian doctors with great therapeutic ideas to help them work on their innovations in advanced therapies. We also assist medical and dental colleges and universities in their research projects related to new therapies.

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SHOWCASE

Innovation in Diagnostics to Drive Healthcare Jatin Mahajan, Managing Director, J.Mitra & Co. Pvt Ltd

October 2018

INNOVATION IS pivotal for the healthcare segment. Society and diseases are ever transforming, and it is critical that innovation in healthcare remains the only constant, in keeping with the age-old adage change is the only constant.The medical industry is witness to innumerable innovations that have transformed lives. Some of them are: Innovation in Devices– Artificial heart, robotic catheter, handheld medical scanner, bone injection drill, spectacles, hypodermic needles, thermometers, dialysis machine, lens implant, prosthetics & implants, etc,. Technological Innovations – ECG, X-ray, Nano healing, MRI, ultrasound, mammography, etc,. Innovative Drugs – Penicillin, Insulin, aspirin, oral contraceptives, vaccinations, statins, smart pills, Viagra, etc,. Surgical Innovations – Organ transplant, laser surgery, awake craniotomy and awake cardiac surgery, etc,. For us innovation forms the backbone of our existence. Our innovations and research capabilities make us the trend-setters in the IVD industry in India. And this is the reason why we have more than 55 patents – the highest in the industry. This has earned us both recognition and respect. In August, we launched iQuant with 8 parameters (diagnostics), a unique product based on FIA technology that will transform diseases detection in the rural and semi-rural areas. Launched in collaboration with IIT Madras’ HTIC (Healthcare Technology Innovation Centre), this portable equipment is a state-of-theart Fluorescence Immunoassay Analyzer for quantitative and qualitative determination of

blood test parameter – that includes TSH (Thyroid Stimulating Hormone), T3 (Tri-iodothyronine), T4 (Thyroxin), Vitamin D, Dengue NS1 Antigen, Dengue IgM, Dengue IgG and HbA1c test. With this launch, various highly-active and sought-after diagnostic solutions will be available across the country and in the remotest of locations at the fraction of a cost. And we will be exporting the same to more than 45 countries across the globe. iQuant, HbA1c Quanti card, Dengue NS1 Ag Quanti card, Dengue IgMQuanti card are all innovative products that do not have a parallel in the industry. These help us stand out in the segment. And it is the outcome of these research and innovations that not only are we India’s leading in-vitro diagnostics company but also the preferred solutions in over 45 countries across all continents. For J Mitra, the two key important thoughts that drive innovation are – accessibility & affordability. We research and innovate around economical, newer and faster diagnostic solutions. And we try to ensure that our products and solutions reach the remotest corners. For this, all our diagnostic solutions mustbe costeffective and portable. As the biggest researchers and innovators in our segment, we continue to come out with better and better solutions. J Mitra is helping mankind in early and potent diagnostic of ailments, leading to effective treatment and recovery. This not only reduces treatment cost and discomfort, but also goes towards creating a healthier society. Early and effective diagnostics will ensure that the overall productivity of the civilization increases and there is higher quality of life index.

APPROACH

Innovative Financing of Healthcare Srinivas Thirumalai, Finance Expert, Healthcare Industry, Chennai

INNOVATIVE FINANCING refers to an approach of funding enterprises, interventions and value chains that create positive impact. It is recognized as a solution to overcome funding deficits.Innovative finance uses available tools (Philanthropic&Commercial) to implement solutions, and also create new ones if required. Innovative finance has the potential to transform the way healthcare is financed, managed and delivered. It leverages private sector enterprise to tackle development problems. Innovative Finance for Health Systems covers various finance mechanisms for SME financing, trade finance, credit guarantees, corporate and third party investment funds. These help to strengthen local capacity and to deliver healthcare services and address challenges.

Hybrid Public Private Partnership would also be needed, where Government may let market players provide care and take on stewardship role, paying for results either directly or through insurance system. There is a need for innovative financing and business models. Government funding with private income flows could facilitate sustainable models. Investor as Partner The World Bank uses the term innovative financing for development to refer to non-traditional applications of official development assistance or joint public private or public mechanisms, that tap new resources and engage investors as partners in development and to deliver financial solutions.

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APPROACH

Another aspect of innovative financing is impact investments. These are Investments made by companies, organizations and funds with the intention of generating social or environmental impact alongside a financial return. The growth in Impact Investing reflects greater awareness among institutional and individual investors to align investment portfolios with social and developmental goals while also generating financial returns. Most discussions on innovative finance for access to healthcare have been based on government or developmental institutions. However there are significant opportunities for business in enhancing access to healthcare for underserved communities to achieve social goals and also profits. Innovative finance can be used to address challenges along the value chain by shifting incentives and reducing investment risks of catalyzing and scaling costly solutions. Value Chain approach to innovative finance is important because companies implementing inclusive business models face multiple challenges. It is necessary to target all the activities in the

October 2018

health systems, including people and organisations that have a role in delivery of healthcare products and services and find solutions to overcome the challenges, such as weak delivery networks , provider and workforce constraints, Inadequate infrastructure and facilities and weak information systems. There are various investment funds which are either venture capital or private equity funds to be used in development of markets and improving health facilities and infrastructure. Impact bonds could also be used to train frontline workers. Companies also have opportunity to tap programs focused on scaling innovation in technology. Companies are also investing in local innovators who can develop innovation for local markets especially in resource constrained settings. Innovative Finance for Patients Innovative finance for patients includes mechanism such as micro saving, micro credit and insurance services that aim to stimulate demand and affordability of Health Services. There are a growing number of opportunities for health-

Innovative finance has the potential to transform the way healthcare is financed, managed and delivered. It leverages private sector enterprise to tackle development problems

care companies to partner with microfinance and insurance. Access to healthcare requires patients or consumers who are willing and able to seek care. Many people do not seek healthcare because they are unaware of health risks. Poor education and literacy levels have a significant effect on health seeking behavior. There are major gaps in financial services particularly in insurance for low income individuals. Even when National Insurance Schemes are available, people end up paying out of pocket for products and healthcare not covered by the scheme. Innovative Finance Trends Demand Stimulation and Aggregation: This involves promotion of health education and awareness to stimulate health care seeking behavior and health system utilization. This can improve financial viability of inclusive business ventures and impact investments in low income areas. Companies can target philanthropic or commercial investments either directly or together with financing partners to focus on interventions that increase feasibility and viability. Financial Inclusion: This includes a wide range of products such as health savings account, insurance, loans etc. Micro Insurance requires different process and technology as it is designed to operate at scale. It can also provide life coverage in addition to health insurance. It also helps clients monitor their health through regular reminders etc. Companies can also introduce a health component to traditional micro finance or lending schemes given the importance of health for loan repayment and success of small business. This one stop shop approach is a sustainable way to provide healthservices and strengthen financial inclusion. There is a need for partnership between health care and micro finance sector that links insurance or health products with access to health services. This will help to improve participation in health insurance. In healthcare, innovative finance can change the way societyâ&#x20AC;&#x2122;s health challenges are solved. Innovative finances impact investing in their early stages. It represents an opportunity to amplify the social impact of strategic philanthropy and market access investments.

Technology can transform access to primary healthcare services and lower cost of medical transportation Rwanda Case Study As technologies transform the way people access healthcare, there are number of ways to use innovative finance to make services more accessible. Technology can transform access to primary healthcare services and lower cost of medical transportation. Rwanda best illustrates as to how technological developments can enable access to healthcare for its citizens. Rwandans in remote villages use AI enabled algorithms on their mobile phones to get diagnosis for health problems. Doctors consult through telemedicine, blood is delivered by Ziplineâ&#x20AC;&#x2122;s medical drones. A central electronic health records system collects data about health activities.Rwanda is a pioneer in innovative digital healthcare in Africa. Rwandan Government has increased expenditure on healthcare and also initiated major healthcare reforms, starting with mandatory health insurance. In line with rapid technological development around the globe, Rwanda has embraced digital technology at every level. The Government has invested in building a fiber network infrastructure. This has also lead to increased mobile phone penetration. The Government is playing a decisive role in transforming the country towards a digital society and shifting the entire healthcare system towards digital health. They have partnered with inter governmental organizations for introducing Electronic Health Records and expanded it to manage financial aspects registration, consultation, clinical records etc. Collaborations have also played a part in shaping the healthcare system. It also involves collaborations with companies like Zipline, a medical drone manufacturing company to deliver medical supplies. Countries from around the world are interested in understanding the best practices in digital health in Rwanda and on how to implement similar solutions in their countries.

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DRIVE

Healthcare innovations An Entrepreneurâ&#x20AC;&#x2122;s Perspective Ashim Roy, CEO, Cardiotrack

INNOVATION IS all around us and innovative solutions are being introduced in every aspect of our lives. Healthcare is no exception. However, there are two aspects of innovation in healthcare delivery that are worth noting. Healthcare innovations have accelerated significantly over the past three years and secondly, have started to reach remote and underserved communities. When an industry goes through rapid innovation cycle, solutions are likely to yield full spectrum of results from non-functional to av-

erage to mind boggling. Are we on the right track? There is incredible amount of innovation taking place in healthcare. From wellness apps to diagnostics technologies to intervention, many startups and large companies are in a race to deliverinnovative solutions to the market. Healthcare is a vibrant market and this can be easily seen by taking a quick look at the stats from a recent market report on healthcare app economics in Table 1 below.

HEALTHCARE APP MARKET ECONOMICS

October 2018

Healthcare App Attribute

Quantitative Data

Health apps available in 2017

325,000

New health apps added to major app stores in the past one year

78,000

Health app publishers releasing

84,000

Android Vs iOS for healthcare apps

Android

investment into digital health start-ups

$5.4bn

Digital healthcare apps download in 2017

3.6bn

Percentage of digital health practitioners expect health insurances to be future distribution channel

53%

pure digital market players in the digital health industry (% of App developers)

28%

Leading therapies using healthcare app

1. 2. 3. 4. 5.

Diabetes Obesity Depression Hypertension Heart Disease

Healthcare app market could well be the bellwether of innovation in healthcare delivery. Because of the effort required to bring innovation to market for diagnostics and intervention solution, the numbers are significantly lower, however, innovation trend follows the same trajectory as healthcare apps. Innovation in healthcare is clearly directed towards addressing three fundamental gaps that exist in most countries: ď&#x192;&#x152; Supply (number of patients) and demand (medical professional) mismatch a. Automation solutions to address this problem include diagnostics and intervention solutions that improve operational efficiency, reduce time needed to perform diagnosis, use of AI/ML to reduce data interpretation, and use of robotics to perform routine intervention procedures. b. Over the next decade, these technological innovations will reduce the supplydemand gap by an order of magnitude. Cardiotrack, Niramai and others are examples of application of AI to automated data interpretation and reduce the amount of time taken by a specialist.

Distance or travel time to nearest healthcare provider c. Tele-health solutions are beginning to address the need of patients and reduce and some cases eliminate time to travel. d. As the median age of the population increases, the larger percentage of the population will benefit from telehealth services enabled by medical IoT devices and high bandwidth data connection. AyuLynk digital stethoscope allows remote patient diagnosis and enables a doctor at a faraway place to diagnose a patient in a remote area. ď&#x192;&#x152; Cost of healthcare service (diagnostics or intervention) e. Integration of IT into healthcare delivery will bring cost savings that have been possible because of declining computation cost. These base technologies will drive the next level of innovation to drive cost of healthcare services. EHR/ EMR solutions are good examď&#x192;&#x152;

ples of brining IT into healthcare to reduce cost. So, where is healthcare innovation heading? It is certainly improving healthcare delivery. Also, there is convergence of wellness, diagnostics and intervention solutions. In many remote communities and rural parts of India, innovative solutions are making healthcare more accessible and saving lives. In Hubli, a small town 420 km from Bangalore, life of Hazaresab was saved because of a portable ECG equipment deployment. Solutions that facilitate early diagnostics based on IoT and AI are helping to democratize healthcare delivery for underserved communities. Early diagnosis is an essential ingredient of preventive care and basic foundation for making Ayushman Bharat successful. This is an area that will see significant activity and deliver innovation to underserved communities. For patients, healthcare providers and insurance companies, AI analytics will work like an advance warning system. These analytics solutions will save lives and reduce cost of healthcare because they will enable low cost intervention in the early stages of disease onset.

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DRIVE

There is incredible amount of innovation taking place in healthcare. From wellness apps to diagnostics technologies to intervention, many startups and large companies are in a race to deliver innovative solutions to the market

October 2018

Are we looking at innovation in the right light? Entrepreneur who are committed to improve healthcare have started their activities based on their understanding of the market need, opportunity and how they can bring value. However, not all innovation will reach their full potential due to funding, execution, market timing, user experience, competition, bureaucratic red tape and other factors. The speed at which innovative solutions are being introduced is reflection of market need and high entrepreneurial interest. However, there are challenges in ability of healthcare innovators to deliver the “right” solution. Some of these challenges faced by entrepreneurs and innovators are shown in table below. CHALLENGES FACED BY HEALTHCARE APP DEVELOPERS Healthcare App Attribute

Quantitative Data

Gap of demand and supply widening with high number of developersnot developing health apps due to uncertain regulations Low downloads growth rates Number of downloads Less than 5,000 – Median value Monthly active users – Median value

Less than 1,000

What is needed from healthcare innovation? Is healthcare innovation heading delivering the right outcomes? How do we decide what innovation is “right”? In a country like India, where there are huge unmet needs, it is fair to say that healthcare innovation should solve BIG problems. In my view, innovative solutions should be designed to solve the most pressing problems in healthcare for billions of people living across the geographies, across socio-economic strata. Solutions such as Lasik have revolutionizedophthalmologic surgeries and have helped millions of people in urban and rural areas in developed as well as developing economies. On the other hand, a calendar app that set up appoints help to

create efficiencies, is not really solving a very BIG problem that will positively impact lives on hundreds of millions of people. There is an alternate view point that we should not ignore – ability of healthcare innovators to attract investment. It is important to recognize the ability of the VCs toidentify high ROI opportunities and invest accordingly. An innovation may help millions of people, however, if it is not properly funded, it will not scale up and will eventually cease to exist. India with a billion-plus population, relatively few regulatory restrictions and a vibrant startup culture is a perfect crucible for healthcare innovation. Healthcare innovation requires patient capital, long gestation period, safety and clinical trials and lot of market experimentations, before the solution can deliver desirable outcomes for the beneficiaries. We need to evaluate healthcare innovation keeping in mind these diverse viewpoints. Ayushman Bharat will help 500 million people with their hospitalization cost. Can this be considered innovation? The simple answer is that Ayushman Bharat in itself is not an innovation, it is a policy. However, it can become the biggest healthcare innovation platform anywhere in the world, if the makers of Ayushman Bharat want. Are start-ups geared for innovation? Any healthcare startup that is bringing innovative healthcare solutions to the market should consider India as one of the key test grounds. If one can deploy their solution in India and scale up to some degree, the entrepreneur will see several benefits:  A cost-effective solution in India will definitely be cost effective anywhere in the world  The data that can be collected from Indian deployment can help create new analytics models In fact, if the unit economics can be proven in the Indian context, the solution (after necessary regulatory approvals) would be able to achieve disruptive price points in the developed economies. In the present healthcare scenario (post Ayushman Bharat launch), a lot of en-

trepreneurs will push their solution to be part ofAyushman Bharat, which could become an excellent proving ground for new innovation. The challenge in any innovation in healthcare is that at some point in time, the innovator must deal with the public health infrastructure and seek help from public health officials. This is the innovator’s dilemma – when and how to deal with public health system. Startups are poised for innovation and good ideas (and many bad ideas) will succeed. Hike app does not deserve billion-dollar valuation that it currently boasts. Every bad idea that sucks up investment funding, starves 100 good ideas. Every ill-conceived Government initiative to help startups will do the opposite. “Make in India”, if implemented properly should have spawned 1,000 entrepreneurs to start manufacturing in India. Not only it failed to do that, in fact, there are entrepreneurs who joined the “Make in India” bandwagon in 2015-16 are making a beeline to move the manufacturing to Malaysia, China and other countries. And, one cannot blame them. The cost of imported source material is 25-40 per cent higher in India. This leaves Indian manufacturers at a significant disadvantage compared to their Chinese counterpart. In absence of “Buy in India”, there is zero incentive for Indian entrepreneurs to “Make in India”. Entrepreneurs innovating on new healthcare solutions do not have the DNA to deal with rampant red tape and corruption in public procurement process. A different type of innovation is required for technology innovations to take roots in the public healthcare system. Roadblocks There are many challenges faced by healthcare startups. A short list is provided in Table 3. Adaptive startups will “work around the system” and really innovative startups will “work the system”. Challenges faced by healthcare innovators are lot more than other sectors. This is because one has to be extremely cautious about issues of safety, data security, clinic testing and other aspects before the solution can be deployed. Road travelled by startup entrepreneurs is littered with failed startup initiatives. Many of these failed attempts have to do with Government policies and implementations.

CHALLENGES FACED BY HEALTHCARE STARTUPS Healthcare App Attribute

Quantitative Data

Design Talent

AI talent pool is shrinking due to aggressive recruitment by Google, Amazon and other MNCs

R & D Infrastructure

Computing resources required to development of innovative analytics algorithm are very expensive

Source Material Cost

Cost of imported source material is 25-40% higher compared to International markets

Make in India

A huge disappointment for every manufacturing startup. Until manufacturing companies get incentives to manufacture in India (ex. lower cost of source material, world class testing facilities, priority on public procurement, help to export etc.), it is unlikely that startups will Make in India.

Healthcare policy implementations

Policies such as price cap on stents have not helped patients or providers in any meaningful way. It has created concern among healthcare providers and stopped healthcare infrastructure investment. This has created problems for startups who eagerly want to sell to various healthcare providers.

National Health Stack (NHS)

Yet another techno-policy document, which is incomplete and does not provide any guidance to startups for designing the next generation of innovative products that would be compliant to NHS.

NASSCOM, FICCI and EPC

There are many such initiatives from the Government to help startups. However, these initiatives have not delivered measurable outcomes that would help startups to scale up in India or increase export or raise funds.

Conclusions Even though there are challenges in successfully scaling up a healthcare startup, there is excellent news. Healthcare entrepreneurs in India cannot be held back because of lack of support from the Government. The spirit of Indian en-

trepreneurs to succeed in spite of the Government. Every time an entrepreneur saves life of just one person, it is a great positive outcome. In my view, for an entrepreneur, saving lives of people through their innovation is better than receiving a Nobel Prize.

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EVENT REPORT

ANBAI Teachers Day Awards 2018 THE ASSOCIATION of National Board Accredited Institutions (ANBAI) along with the National Board of Examination (NBE) organized the Teachers Day programe to honor eminent and distinguished medical teachers and hospitals who have contributed immensely towards the cause of furthering medical education in India. The awards ceremony was held on Saturday September 22, 2018 at the J N Tata Auditorium,

Inauguration ceremony

October 2018

National Science Seminar Complex, Indian Institute of Science, Bengaluru. The event was attended by 500 delegates including eminent healthcare leaders, hospital promoters clinicians, academicians and leaders from different walks of life. The chief guest of the event was Shri. Vajubhai Vala, Honourable Governor of Karnataka, who bestow the awards in the presence of other distinguished guests

including Dr. Jayshree Mehta, President Medical Council of India; Dr. Abhijat Sheth, President- NBE and Dr. Rashmikant Dave, Executive Director- NBE, Dr. Alexander Thomas, President – ANBAI, Dr. S Rajasekaran, President Elect – ANBAI. Dr. Avinash Nivritti Supe and Dr Rakesh Kumar Tandon received the Emeritus Teacher Award. Prof. Vikram Kate, Dr Muralidhar Kanchi and Dr Ravindra Bhalchandra Sabnis received the distinguished DNB teacher of excellence award. Dr K Bhanu and Dr Atul Kakar received the eminent NBE alumnus award. The scroll of honor was awarded to Kerala Institute of Medical Science (KIMS) Trivandrum. Two NBE accredited Hospitals received the excellence in teaching for DNB programme award. These were Saifee Hospital Mumbai and Narayana Nethralaya, Bnagalore. The life time achievement award was given to Dr Prathap C Reddy, Founder Chairman Apollo Hospitals Group. In a recorded message Dr Reddy accepting the award thanked ANBAI and NBE for conferring the prestigious award and reaffirmed Apollo Hospitals’ commitment towards excellence in higher medical education. The awardees were selected by a jury headed by the former Chief Justice of Jharkhand and Himachal Pradesh, Justice V K Gupta. The other highlight of the ANBAI Teachers Day event was the panel discussion on the topic “Medical Education – The need to look beyond”. The panelists were Dr. Abhijat Sheth, President- NBE, Dr. Reena Nayyar Additional Secretary – MCI, Prof. VenkatRao, Vice Chancellor – NLSIU, Prof. Raghunath, Professor Corporate Strategy and Policy – IIM Bangalore; Prof. Biman Bagchi, Dean, Faculty of Science – IISc, Bangalore, Shri K Raghu, Past President – ICMAI, Dr. Fr. George Edayadiyil, Chancellor – Christ University and the discussion was moderated by Dr Rajasekaran. The proceedings of the panel discussion will be formulated into a white paper on, “ The way towards the future of Medical Education in India”, to be submitted to the Government. Dr Sudarshan Ballal, Chairman, Manipal Hospitals was the organising chairman of the event and the event was supported by the efforts of Dr. Alex Thomas, President ANBAI.

Panel discussion in progress

The awardees with Shri.Vajubhai Vala,Governor of Karnataka

The Organising Committee

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EVENT REPORT

CAHOTECH 2018 Concludes Successfully CAHOTECH 2018, the 3rd International Healthcare Technology Conference of Consortium of Accredited Healthcare Organizations was held on 29th September, 2018 at Bangalore. The event was focused around the theme â&#x20AC;&#x2DC;Adaptable future technologies for Indian hospitalsâ&#x20AC;&#x2122;. The event aimed to introduce newer and better technology solutions to hospitals and was hugely popular with more than 500 participants from across India.

Inauguration

October 2018

CAHOTECH is a platform for healthcare organizations and technology industry to share and utilize combined experience, to guide themselves continuously towards more efficient practices utilizing technological development. The next event CAHOTECH 2019 is scheduled to be held in Chennai. It is a full day event, highly focused to understand future healthcare technologies for clinicians, hospital managers and

administrators, biomedical engineers, scientists, researchers and other stakeholders of healthcare industry interested in promoting change through innovation and advancement in healthcare. The conference seeks to highlight technological innovations in the areas of process efficiency, optimum utilisation, enhancing clinical and patient care. It is a forum for sharing of experience towards technological innovations already functional in some partnering hospitals. The event also serves as a platform for assessment of newer technology and showcasing of promising startups. Dr. Nagendra Swamy, Advisor, Manipal Health Enterprises was the Organizing Chairman and Dr. Narendranath V, Chief Administrator, Ramaiah Medical College Hospital, was the Organizing Secretary of the event. The event started on an enthusiastic note with Dr Devi Shetty, Founder & Chairman Narayana Health, as the chief guest. He spoke about different aspects of technology that impacts hospital and doctors alike. He spoke of the future where largest healthcare service providers will not have any beds but it will be technology that will be used by doctors to provide accessible affordable healthcare. Dr. Dakshayani B P Group Director Flight Dynamics Group, ISRO Satellite Center and the woman behind India’s acclaimed Mars Orbiter Mission was the guest of honor. The event had riveting talks by industry leaders. Shashank N D, Founder-CEO of Practo Technologies spoke about how digital technology is taking healthcare delivery to a new dimension. Dr Rajini J,VP-Corporate Development, Skanray Technologies Pvt. Ltd spoke very well on health technology under the make in India banner. She also outlined Skanray’s journey in transforming healthcare delivery through their innovative products and services. Sumit Puri, CIO, Max Hospital spoke about smart hospitals and what does it take, to be one. Post-lunch sessions focused on Start-ups. There were around 12 start-up presentations. Some of the interesting presentations were made by Dr Saravana Kumar, Chief Medical Officer, Health Sensei; Aravind, Head LRNR; Vikram Goel, Founder, Incredible Devices and

Organising Committee

Audience

Dr. Nandhini Mundkur, Paediatrician. The day ended with a fiery panel discussion moderated by Sameer Mehta, Mehta’s Hospital and a valedictory ceremony.Cahotech 2018 ensured an enthralling experience to the attendees.

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EVENT REPORT

Healthcare Innovation Pitch Day

Healthpod team with the start-ups

HEALTHCARE INNOVATION Pitch Day, organized by Healthpod Business Incubator in association with MS Ramaiah Medical College, Bengaluru was held on September 8 2018 at the medical college campus, Bengaluru. Around 120 healthcare professionals, from across the country participated in this event. More than 30 innovators working in the healthcare domain applied for the pitch day event. Out of these 20 were selected to present their ideas at the pitch day. The Pitch Day event saw an elite audience comprised of government organisations, investors and mentors along with hospital owners and practicing doctors who lauded and encouraged the participants.Pitch Day finalist teams delivered 10-minute pitches followed by a question and answer session with the judges. Some of the Judges were, Dr Mudit Saxena, Partner, MD & CEO, Ovum Hospitals; KingshukPodhar, CEO, AIM-AMTZ, Medi Valley Incubation Council; M S Patil, Swarup, CanBank Ventures; Raghvendra, IDFC Bank; Dr Balachandran, VIT; PrashantPansare, Eagle 10 Ventures, Dr Veena P, MSRMC,

October 2018

Dr Deepak Sparsh Hospital, NeerajLal, Cluster Head & VPBangalore, Rainbow Children Hospital; Dr Sarvana Kumar, Head ,Clinical Operations & Accident and Emergency Medicine department, Dr Mehta Hospitals, Chennai. Dr SalilChaudhary, Director, Healthpod and the brain behind the event said, “Healthpod focus specifically on healthcare start-ups from the seed stage onards. We believe that mentorship is mostly required when the idea needs a validation and that is precisely what Healthpod provides. This pitch day event is an extension of our efforts to build a new healthy India.” Dr. AniruddhaChimote, Director, Hosconnn Consulting Services said, “ The startup who presented ideas at The Healthcare innovation Pitch day have immense potential and hopefully their innovative ideas will play a key role in solving a few critical healthcare issues.” Judges select Pitch Day winners to receive an award, ranging f rom Rs 1.5 Lakhto Rs 10 Lakh. The event concluded on a high note with the organisers announcing another event to be held by the end of the year.

P4M

Targeting Cure…

   

Predictive Preventive Participatory & Personalized Medicine

PRECISION MEDICINE

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Looking for Hospitals, Clinics & Health care Partners We provide - One stop integrated solutions for Genomics, Tissue engineering, 3D bio printing, modeling, drug drug interactions, drug overloads , Molecular diagnostics, Neutrigenomics, BM Stem cell processing devices, PRP, PRFM, Anti-aging, Liquid biopsy kits, devices etc, plus all your health care research and development projects

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