VOL.10 NO.2 PAGES 64
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CONTENTS Vol 10. No 2, FEBRUARY 2016
Chairman of the Board Viveck Goenka
UNION BUDGET2016-17: ROADMAPFOR HEALTHCARE
MARKET
Sr Vice President-BPD
Neil Viegas Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das
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EXPRESS HEALTHCARE TO HOST FIRST EDITION OF HEALTHCARE SABHA AT HYDERABAD
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FIT INSULIN INJECTION DAY OBSERVED IN MUMBAI
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EVENT BRIEF
Bengaluru Assistant Editor Neelam M Kachhap DESIGN National Art Director Bivash Barua Asst. Art Director Pravin Temble Senior Graphic Designer Rushikesh Konka Artists Vivek Chitrakar, Rakesh Sharma Photo Editor Sandeep Patil
Healthcare industry stakeholders share their hopes and aspirations for the sector from the Union Budget 2016-17| P12
STRATEGY
MARKETING Regional Heads Prabhas Jha - North
INTERVIEWS
Dr Raghu Pillai - South Harit Mohanty - East & West Marketing Team Douglas Menezes
P20: BIPIN PENDYALA Founder and MD, SuVitas
Ambuj Kumar E.Mujahid Arun J Debnarayan Dutta Ajanta Sengupta PRODUCTION
P22: MIKE MAY Scientific American Worldview
IT@HEALTHCARE
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PATIENT EXPERIENCE MANAGEMENT: KEY TO PROGRESS
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STRATEGIES TO FORAY INTO HEALTHCARE IT
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LIVING LONGER, BETTER, HEALTHIER—THANKS TO TECHNOLOGY
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‘THE HEALTH INSURANCE SECTOR WILL GROW AT 20 PER CENT YOY GOING FORWARD’
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LESSONS FROM HUMANITARIAN EMERGENCIES
General Manager B R Tipnis Manager Bhadresh Valia Scheduling & Coordination
PROF MEIR PUGATCH
IPKM Chair, University of Maastricht
Ashish Anchan CIRCULATION
PROF FRANK LICHTENBERG
Circulation Team
Columbia University
Mohan Varadkar
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Express Healthcare® Regd.with RNI no. MAHENG/2007/22045,Postal Regd. No. MCS/162/2016 – 18,Printed for the proprietors, The Indian Express (P) Ltd. by Ms. Vaidehi Thakar at The Indian Express Press, Plot No. EL-208, TTC Industrial Area, Mahape, Navi Mumbai - 400710 and Published from Express Towers, 2nd Floor, Nariman Point, Mumbai - 400021. (Editorial & Administrative Offices: Express Towers, 1st Floor, Nariman Point, Mumbai - 400021) *Responsible for selection of newsunder the PRB Act.Copyright © 2016 The Indian Express (P) Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.
EDITOR’S NOTE
2016-17: A year for healthcare?
A
s the number of confirmed cases of Zika virus infection crossed the 20,000 mark in Columbia, the World Health Organization (WHO), called an emergency meeting on February 1. The WHO is expected to classify the Zika outbreak, which has already been detected in 25 countries and territories, as a "public health emergency of international concern" which will hopefully spur more funds into the search for a vaccine against the infection. 2116 pregnant women are among the 20,297 confirmed cases of the disease in Colombia itself and with the current outbreak being linked to microcephaly, in which infants are born with smaller than normal heads and under-developed brains, the fallout is bound to be both heart-rending as well as a public health nightmare. Public health authorities in India are closely monitoring the spread of the Zika virus, as Aedes aegypti, the mosquito which transmits Zika, is the same one that transmits dengue. Given that India spends just around four per cent of GDP on healthcare, with public health accounting for just a little over one per cent of this total, it is a foregone conclusion that a Zika outbreak in India will be catastrophic. Its only saving grace so far is that Indian samples have last showed traces of this virus way back in 1952-53 and there are hopes that there might be some kind of passive immunity to the infection. But, viruses are wily creatures and the strain causing this outbreak could be a very different one from the one last seen in India. It is against this backdrop that the healthcare sector prepares for yet another budget presentation from Finance Minister Arun Jaitley. Last year's allocation of Rs 33,150 crores for the healthcare sector was similar to the previous year's. This was a major disappointment as it did not up the health spend to the anticipated two per cent, even though this was the expectation, given the intentions spelled out in the National Healthcare Policy. Will Budget 2016-17 be a let down again? Industry body NATHEALTH has proposed that the healthcare sector should be exempted from the impending GST regime at least for a decade, in effect continuing the service tax exemption the sector currently enjoys. In fact Anjan Bose, Secretary General and Sushobhan Dasgupta, President, NATHEALTH recommend that government withdraw service tax on health insurance premiums as well. It also makes a case for setting up a healthcare infrastructure fund and a medical innovation fund in order to create a long term ecosystem for the sector to thrive. The medical devices sector has been clamouring
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Given that India spends just around four per cent of GDPon healthcare, with public health accounting for just a little over one per cent of this total,it is a foregone conclusion that a Zika outbreak in India will be catastrophic
for a separate ministry so that policy making can be tailored to the specific needs of this segment making the point that this is very important for the sector to be part of the 'Make in India' programme. While the recently released policy for start-ups will definitely encourage healthcare start-ups, the fact is that this sector has a social goal as well as a longer than usual gestation period. Thus special incentives will be required to see true benefit reach the masses. The government needs to incentivise efforts in the preventive and primary healthcare stage, as these will reduce healthcare spend in the long run. With India's burden of non-communicable diseases (NCDs) like diabetes only increasing by the day, corporate hospital chains have a business strategy to tap into this patient pool. Apollo Sugar Clinics is just one such example but can the government leverage their expertise to detect diabetes among India's rural poor? Early diagnosis prevents early onset and could also put a brake on disease progression. Diagnosis will be a key link in reducing disease burden and thus it was not surprise that the Dr Lal Path Labs IPO was a resounding success. As the first NSE-listed diagnostics company, the company could set the trends for its peers to follow suit. Read more about the company's aggressive expansion plans in our cover story. (Ushering a new era, pages 28-32) Most of the industry leaders who have put forth their recommendations to the FM in the pre budget section in this issue stress the urgency of the need for a more benign gaze on this sector. (Union Budget 2016-17: Roadmap for healthcare, pages 12-19). A healthy population is crucial for a nation's progress. According to a 2011 World Bank Health, Nutrition and Population Discussion Paper on the Chronic Emergency: Why NCDs Matter," NCDs are set to steadily increase the number of healthy years (or disability-adjusted life years—DALYs) lost in middle-income countries, but the loss will increase very quickly in low-income countries. By 2030, low-income countries will have eight times more deaths attributed to NCDs than high-income countries. How do we arrest this slide? By lobbying for more forward looking health policies. Getting the government to crack down on corporations in the business of unhealthy food options. Such consumer-driven activism has succeeded in burger chains and other fast food conglomerates launching healthier options. Likewise, cola giants have reduced the sugar content in their flagship products. But the battle is very nascent in India. We need to move on all fronts if we want to secure the health of future generations. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com
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HEAD OFFICE Express Healthcare® MUMBAI Douglas Menezes The Indian Express (P) Ltd. Business Publication Division 2nd Floor, Express Tower, Nariman Point Mumbai- 400 021 Board line: 022- 67440000 Ext. 502 Mobile: +91 9821580403 Email Id: douglas.menezes@expressindia.com Branch Offices NEW DELHI Ambuj Kumar The Indian Express (P) Ltd. Business Publication Division Express Building, B-1/B Sector 10 Noida 201 301 Dist.Gautam Budh nagar (U.P.) India. Board line: 0120-6651500. Mobile: +91 9999070900 Fax: 0120-4367933 Email id: ambuj.kumar@expressindia.com Our Associate: Dinesh Sharma Mobile: 09810264368 E-mail: 4pdesigno@gmail.com
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J P NADDA
MANEKA GANDHI
Union Minister for Health and Family Welfare
Women and Child Development Minister
(Speaking during an emergency meeting on the Zika Virus)
(Speaking during a session at All India Regional Editors’ Conference in Jaipur)
“We are closely monitoring the situation and all necessary steps have been initiated to ensure that India is well prepared in case of any eventuality”
“New National Nutrition is on the anvil which will strive to provide nutritious, balanced and healthy food to children across the country”
CHENNAI Arun J The Indian Express (P) Ltd. Business Publication Division 8th Floor, East Wing, Sreyas Chamiers Towers New No 37/26 (Old No.23 & 24/26) Chamiers Road, Teynampet Chennai - 600 018 Telephone (Board): +91 44 24313031/32/34 Fax: +91 44 24313035 Mob: +91 9940058412 Email id: arun.j@expressindia.com BENGALURU Dr Raghu Pillai The Indian Express (P) Ltd. Business Publication Division 502, 5th Floor, Devatha Plaza, Residency road, Bangalore- 560025 Board line: 080- 49681100 Fax: 080- 22231925 Email id: raghu.pillai@expressindia.com HYDERABAD E.Mujahid The Indian Express (P) Ltd. Business Publication Division 6-3-885/7/B, Ground Floor, VV Mansion, Somaji Guda, Hyderabad – 500 082
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MARKET
Healthcare industry stakeholders share their hopes and aspirations for the sector from the Union Budget 2016-17, with Express Healthcare
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AMIT MISRA
VARUN GERA
Head – Consulting,North India,IMS Consulting Group
CEO,HealthAssure
‘The earlier the government brings clarityin price regulation,the easier it will be for the device and equipment companies to firm up their India strategy’
‘To address the issue of affordability, the budget should move towards Universal Health Coverage’
M
016’s budget should be an appropriate time to announce concrete measures that will propel this nation towards better health, covering issues of affordability, access and some policy level changes to accelerate the rate of change. ◗ Affordability: To address the issue of affordability, the budget should move towards Universal Health Coverage through measures like: ■ Tax incentives for private insurance players to increase health insurance penetration, and increased government spend to subsidise/cover non-insurable or below-poverty-line (BPL) population ■ Encourage small and mid-sized businesses which employ a sizeable population to buy group health insurance for their employees by providing them tax incentives ■ Withdrawal of service tax on health insurance premium to make it more affordable ■ Tax exemption for primary care expenses and other non-insurable health spends through programmes like health savings account, etc. ◗ Access: Increased government spend from the current one per cent of the GDP to augment healthcare access to population viz. primary, secondary and tertiary services to rural areas.
edical devices and equipment industry plays a critical role in healthcare delivery. What sets this industry apart, unlike the other components of the healthcare value chain (viz. pharmaceuticals and services) is India’s high dependence on imports (~70-80 per cent). Theoretically, given the large unmet healthcare need and the current thrust of the Indian government, this sector naturally lends itself as a priority for ‘Make in India’. Local manufacturing is expected to ensure product quality and price control making healthcare more accessible and more affordable. However, the import trend does not seem to be changing anytime soon. A closer look at the current industry dynamics points towards certain policy imperatives that may be necessary to stem the tide. ◗ Creation of a robust regulatory framework relevant to medical devices and equipment: The current Drugs and Cosmetics Act treats devices at par with pharma products. This implies that the Act is not sensitive to certain nuances specific to devices and equipment. The amended Drug & Cosmetics Act proposed recently covers theses points. However, the proposed amendments
have been awaiting the nod from the parliament for more than a year. The government has also hinted at creation of a separate Department of Medical Devices. An amended Act with a separate ministry will be the right step in creating clear ownership within the Government to push the medical devices agenda. ◗ Clarity on the price regulations on devices: The Government has been hinting at price control in certain devices in line with drugs. Obviously, such an Act may impact profits and hence, in turn, also the investment decisions of the companies. The earlier the Government brings clarity in this matter, the easier it will be for the device and equipment companies to firm up their India strategy. ◗ Propose fiscal incentives specific to the industry: The current ‘Make in India’ programme can be specifically customised for a strategically important industry like medical devices. Features such as ‘medical device parks’ which provide tax holidays to tenants and preferential pricing for locally manufactured products can be considered. Further, rationalisation of the duty structure of imports needs to be done. ◗ Develop and sustain the manufacturing eco-
system: Skills such as biomedical engineering are in short supply in India. The supply gaps need to be plugged to make the initiative sustainable in the long term. Also, indigenous product and technology development capability needs to be nurtured to ensure truly ‘Make in India’ products in the future. These concerns pertaining to the medical devices industry in India have always been there and were raised many a times in the past without any modifications seen yet. However, this time we can witness a change with the Government’s actions and the will it demonstrates to address the import dependence through its ‘Make in India’ initiative.
The ‘Make in India’ programme can be specifically customised for a strategically important industry like medical devices
2
◗ Awareness: Drive awareness campaigns on health, safety, sanitation, etc. Educating and promoting the benefits of health finance to citizens ◗ Others: Improve efficiencies within the industry by allowing for uniformity in data exchange across various healthcare verticals ■ There is also a need to address few special groups such as senior citizens and differently-abled persons which are vulnerable, through special focus groups and dedicated financing arrangements. ■ It is definitely encouraging to see the recent reforms introduced to help the burgeoning start-up ecosystem in India. However, this move will need to be backed by specific initiatives within sectors that are expected to grow rapidly over the next few years. And healthcare is definitely tops that list. Last year alone, we have seen the beginning of the pro care/preventative approach, and a movement away from a cure-based one, with many players in the start-up ecosystem identifying the gaps in primary care services and leveraging technology solutions to make healthcare easily accessible. However, these steps need to move to the next level with a greater thrust from the government.
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MARKET
GAGAN BHALLA CEO, Apollo Sugar Clinics
‘The government must start to prioritise significant,long-term investment commitments’
T
he government must prioritise significant, long-term investment commitments in some critical areas of healthcare to make it more effective and efficient. ◗ Increase investment in healthcare delivery, especially primary care and outpatient settings: To illustrate how NCDs need a fundamentally different approach to healthcare delivery infrastructure, let’s look at diabetes care. On an average, the number of outpatient visits for each in-patient admission in urban India is 10, compared with approximately 50 – 70 across developed countries. Indian diabetics typically visit a care facility when they are much further into unmanaged diabetes and related complications, and treatment costs could be as much as 10-25 times higher than with earlystage detection. With early detection screening and basic management at primary health centres (PHCs), cost and quality of healthcare for Indian diabetics will be much better. Today, state-run PHCs, which primarily serve rural areas, are critically short on staff – they typically have a 50 per cent shortfall in supporting staff and 10-20 per cent shortage of doctors. The next two decades will see a massive disease burden increase of the rural Indian diabetic. ◗ Shift to technology based solutions to manage public health disease burden: Today,
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Aadhar card reaches the length and breadth of the country – latest estimates show that it reaches 68 per cent of adult Indian citizens. This infrastructure can be combined with mobiles to administer healthcare benefits to the urban or rural poor, and urban or rural senior citizens – these should include universal insurance cover, large scale chronic care screening and disease management programmes administered both remotely via call centres/mobile apps or SMS, combined with improved physical infrastructure at PHCs. Done correctly, this technology-led transformation of our public healthcare infrastructure will be more effective than the Medicaid/ Medicare infrastructure of the US. It would help serve our most affected populations at a much lower cost. ◗ PPP initiatives: The private corporate companies have developed India-specific healthcare expertise, especially in tertiary care. They are now innovating new models in chronic care to provide integrated care models of care to our citizens. If the government starts investing significantly in healthcare delivery to manage the oncoming NCD burden over next two decades, a public-private partnership-based approach will be mutually synergistic and will provide faster, more effective, higher quality and lower cost solutions. This can lend a whole new meaning to Make in India.
T
he Union Budget 2016-17 should look at the following things:
SANDIP KHOSLA
Encourage start-ups The government's start-up policy released a few days ago is aimed at stimulating growth and development of the economy by encouraging more entrepreneurs to commence manufacturing goods/providing services from India itself. Barrier to entry have been diluted, a large corpus of seed funds have been earmarked, tax benefits have been extended and regulatory requirements have been significantly done away with. So, a large part of what was required to provide an adrenalin boost to this initiative has already been covered in this policy itself. There is no specific mention for healthcare though which implies that the Government has not focused on any infrastructure or priority sector in this policy; instead, it aims to use this to further its ‘Make in India’ initiative. For start-ups engaged in manufacturing goods in the priority sector of healthcare, the budget should provide a longer tax holiday than the three years just announced – a period of five years would be ideal. There should be higher investment by the government directly and through the PPP mode to increase the human resources required at all levels in the healthcare sector. Encouragement should be provided in various forms (financial and otherwise) to the Indian medical professionals engaged in the healthcare sectors overseas, to return to India. Healthcare should be exempt from the forthcoming GST – until this new law is rolled-out, healthcare should be allowed full credit for indirect taxes
Group CFO,Paras Hospitals
‘Healthcare should be exempt from the forthcoming GST’ Essential medicines and implants should be charged VAT/GST at zero per cent to reduce cost of treatment
(Service Tax, VAT) paid on its inputs. Essential medicines and implants should be charged VAT/GST at zero per cent to reduce cost of treatment. Input credit should be made available on VAT paid on medical equipment used in hospitals – alternatively, these should be exempt from taxes altogether. There should be higher incentives for start-ups wanting to invest in education, infrastructure, healthcare, environment and renewable (alternate) energy. Budget should also focus on increasing the talent pool in healthcare, an issue that is restricting the growth of this industry. Government-funded medical colleges in tier II and
III cities following a centrally-designed curriculum, cheaper study-loans for those hailing from humble backgrounds, wanting to pursue healthcare as a career are a few suggestions.
Increase GDP spending Consumer-level spending will increase when money in tax-payers’ pockets increase. This can be achieved by creating a rationalised tax structure in which the cascading effects of taxes is eliminated and final goods and services are made available to consumers at optimum prices. Implementation of GST, which subsumes a host of indirect taxes currently imposed on goods and services, will go a long way in achieving this objective. At the government-level, spending can increase only if its revenue from collections of direct and indirect taxes increase due to higher realisation of taxes, better compliance and increasing the tax base itself. Government spending will spur job creation and employment which will then result in more disposal incomes, which in turn will encourage spending. This circle will continue and result in growth of the economy. Government spending has to be judiciously planned. Infrastructure investments
in education, healthcare, power, renewable energy, roads and highways should form priority sectors for government investments.
Reforms for medical devices On Jan 19, 2016, the government has already initiated steps to stimulate production of devices within India by increasing basic custom duty on imported devices by 2.5 per cent, removing Special Additional Duty (SAD) exemption of four per cent for imported devices and reducing import duty on raw materials, accessories and components required by Indian manufacturers by 2.5 per cent. This is a significant step to stimulate domestic manufacture and reduce dependence on imports. Recently unveiled “Start-up Policy� should provide further incentives to entrepreneurs to enter this sector. Reducing dependence on imported devices by substituting these with equivalent-quality, lowerpriced Indian goods will eventually bring down the cost of healthcare for the common man.
Measures to protect Indian healthcare and pharma trade from market volatility Market volatility is a function of many factors, a large number of which are outside the control of individual organisations. However one key parameter that affects share price movements is the financial performance (earnings). Generally speaking, in healthcare, there exists a big mismatch between the number of beds available for providing the core service itself to an exponentially large volume of customers. An organisation that provides this service at an acceptable price-point and follows good standards of corporate governance, transparency and reporting, will
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be profitable and remain so over time. The rate of growth of profit slows down with the passage of time as economies and benefits of
scale are reached. At the EBITDA-level, organisations generally deliver anywhere between 20-30 per cent, depending on their size, scale
and product offering. Share price of these organisations is insulated from market swings since its fundamental financial parameters are healthy
and continue to remain slow. So , the ability of an organisation to improve/ protect its profitability will insulate it from market volatility.
MARKET DR KAUSHIK MURALI President- Medical Administration, Quality& Education,Sankara Eye Foundation India
‘Focus investments on India-specific solutions’
G
DP spending would need to increase in line with the proposed increase to 2.5 per cent by 2020. The government would need to be clear about its healthcare agenda. Policies would need to be tailored for India in terms of programmes, insurance or trained and qualified human resources. While alternative stream doctors are being considered to provide healthcare and the allied health sector sticks to rigid norms for nursing staff, we need to ensure that well trained staff is available and recognised by accrediting agencies. ◗ Enable a paradigm shift to proactive rather than reactive healthcare through healthy living, with a focus on prevention and primary care through greater public spending on prevention, individual incentives for healthy living and
broader engagement with multiple stakeholders (for example: using technology, incentivising food and beverage companies for health(y) food, promoting healthy lifestyles through media and schools). ◗ Institutionalise standards for minimum quality of delivery across products and services, and initiate tracking of outcomes. Minimise sensationalisation of success and infections. ◗ Use technology and IT in healthcare to overcome access barriers in remote areas and engage patients. Focus investments on India-specific solutions. ◗ Inculcate a culture of personal responsibility for health through education, awareness, schooling, public mandates and incentives— for example, through health savings accounts and co-payments. ◗ Active Pharma Ingredients
AMEERA SHAH MD,Metropolis
‘Government needs to bring in policy changes that can provide a boost to the growth of health services sector’ 16
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(APIs) should be manufactured as it is a large part of generics in India. With adequate focus, it can provide high quality and affordable drugs and would contribute to the India pharma market. ‘Make in India’, through reforms and subsidies focussed on the generics manufacture, could help increase the quality of products available and also make them compete with the branded market. ◗ Bio-technology parks needs to be established and strengthened to support existing and new entities. With adequate research personnel and equipment, technology could be developed and thereafter licensed out to manufacturers. While reverse engineering is an approach and could be a start point, we would need innovation and invention to be competitive and also to develop products relevant to India. ◗ Integrated manufacturing hubs could be created to collocate complementary and ancillary manufacturing companies. No company today is self-sufficient in making all parts that go into an equipment. Often LCD panels and specialised switches are sourced from East Asia for convenience and cost advantages. If we want to truly Make in India, manufacturing ecosystem would need to be nurtured with technology, capital and skilled resources.
◗ Reduce the customs duties on spares. Currently the entire device, if imported, attracts a duty of 11 per cent, however if a printer (thermal) or power cable needs to be brought in, it is considered a generic device and attracts a duty of 30 per cent. This indirectly pushes up the cost of healthcare as the incremental costs are borne by the enduser (patient). ◗ Reduce cost of capital for the trade through reduced interest on borrowing would allow them better cash flow and help make them more competitive in the international markets. There is a need to ensure that the intent of reforms is percolated down. While the leadership at the centre, and in most departments, is extremely proactive, there is a disconnect with the staff on the ground, who seem anchored to the earlier systems. ◗ There is an urgent need to establish a Central Directorate for Medical Devices. Currently, the DGCI looks at around 10 devices that have been notified, and the Proposed Amendment to the Drug and Cosmetics Act, looks at adding two members as experts to the DGCI. Considering the volume of the industry, it is not clear whether this would be feasible in the long term. The directorate would have many advantages.
◗ Allow certification of Indian manufactured products by a central body (DGCI or QCI) and makes them eligible for public procurement. Currently, devices with FDA and CE certification are preferred. Getting them is laborious and often superfluous for companies not looking at export. By having our own certification body quality could be ensured and would also help promote local cost effective options. ◗ Need to have a control in place to ensure that technology imported is vetted and evaluated to register these devices. Today imported devices without any quality check can be brought into our country and used without approval. ◗ Leverage the new diplomacy initiatives to open large markets such as China and remove protectionist regimes. We also need to ensure that Indian manufacturers are allowed to sell in China. Currently, clearance with the local FDA would take two to three years. ◗ Pharma market, across the world, is consolidating through M&A. It may happen in India as well. Further focus on enhancing quality of products made by Indian companies, India is likely to be a self-contained market and insulated from international volatility. ◗ Improved cold chains would ensure that vaccines and critical medicines are not spoilt by the climate fluctuations.
It is high time that we realise the significance of healthcare as an economic development opportunity at national as well as state levels
H
ealthcare is traditionally seen as a social sector in India, with less government focus and low budget allocation. India currently spends cumulatively 4.2 per cent of its GDP
on healthcare, with just one per cent being contributed by the public sector, which is amongst the lowest globally. India’s public healthcare system is patchy, with underfunded and overcrowded hos-
pitals and clinics, and inadequate rural coverage. It is high time that we realise the significance of healthcare as an economic development opportunity at national as well as state levels. The Indian
A paradigm shift in terms of our healthcare policy as well as our approach towards the sector is needed for India’s economic growth
healthcare market is growing at a CAGR of ~16 per cent and is expected to reach $280 billion by 2020. A paradigm shift in terms of our healthcare policy as well as our approach towards the sector is needed for India’s economic growth. The government needs to bring in requisite policy changes that can provide boost to the growth of health services sector in reaching out to the masses.
Reforms for medical devices sector focusing on 'Make in India' From a diagnostic industry perspective, our business is hit very badly due to rupee depreciation because 30 per cent of our P&L goes in chemicals to conduct tests. These chemicals are imported and are heavily taxed. We pay almost 25-30 per cent of tax on these imported chemicals. Today, the problem is that as the rupee fluctuates, our cost of importing these chemicals goes up and we can’t pass on the cost burden to our patients. The other problem is that we don’t have good indigenous chemical manufacturers in India from whom we can buy these chemicals and reagents. So, if the industry is encouraged to produce these chemicals in India, it will not only benefit these manufacturers but also the entire diagnostic industry and off course patients at large as this will even help in reducing
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the cost of diagnostic tests. Therefore, the ‘Make in India’ campaign should not only focus on equipment but also diagnostic chemical and
reagents. Also ‘Make in India’ is being looked at as manufacture in India while ideally it should be innovate in India. Today, even in the medical
devices sector, we are procuring devices from other nations and these devices have not been built for our population. The technology first needs to
be calibrated to the Indian market and population. This can be avoided if we innovate for the Indian population and ‘Make in India’.
MARKET
DR ANURUPA ROY Founder,WHO AM I
‘There must be a budget allocation for R&D of lowcost drugs,preventive vaccines and personalised medicines’
on travelling to distant places for treatment etc. Moreover, there is almost negligible attention towards mental health in India. We need to improve focus in this area as well. All these measures would aid in reducing healthcare expenditure. The growth in ageing population, which is the most vulnerable to disabilities, diseases, terminal illness and dementia, also calls for economic reforms without delay. Also, with the current available resources, there is a need to increase the use of technology. Only having five AIIMS is not going to resolve accessibility, quality and affordability issues in Indian healthcare.
incorporate policies covering complete/partial cost of diagnostic tests and consultations. Giving benefits and subsidies, tax exemption to those availing the services will encourage people to get an insurance plan and avoid huge out-of-pocket healthcare expense. Indians currently spend about $120 per capita (PPP) on healthcare each year, of which only a quarter comes from the government. Mexico, whose Seguro Popular universal insurance scheme is regarded as a model for upper middle class income countries, spends nearly $1,000 per capita, with half coming from the government.
Medical education, R&D
I
t is important to have a clear roadmap as we frame the forthcoming budget. India is set to lose $4.8 trillion between 2012 – 2030 due to non-communicable diseases. Correct distribution of funds, improving infrastructure and skilled resources and preventing loss of money in unused/misused resources is key while allocating the budget for India’s complex and vast healthcare system.
Improvement in GDP spending One of the major needs is to focus on increasing the GDP spend on healthcare, mainly public health which stands at one per cent, to improve services. With heavy privatisation in urban sectors and the associated increase in
out-of-pocket expense, it is important for the government to improve healthcare infrastructure in both rural and urban areas. It’s time to get rid of old issues like insufficient doctors, including specialists, and less facilities and poor infrastructure to support the treatment process. There is also a need to equip hospitals with modern medical devices and techniques as well as increase bed capacity in a few hospitals. Rural areas too need better infrastructure along with improved availability of specialists and skilled auxiliary workers. Together, they would help reduce the number of advanced stage diseases, promote early detection and prevention of diseases, decrease spending
Information technology and connected healthcare IT should be deployed effectively to enhance healthcare. It would help in simplifying healthcare delivery and improving its effectiveness. It would also aid if reducing a significant number of problems being faced by millions daily. Hence, all hospitals should get a budget allocation for its IT infrastructure.
Health insurance Apart from health insurance premium benefits that we witnessed in the last budget, there is a need to introduce measures for prevention and early detection of diseases. This will reduce healthcare costs to a great extent by making insurance companies
It is important to prevent brain drain to tier-I cities
and other countries in pursuit of specialised education after post-graduation and careers opportunities in nursing, pharma, physiotherapy, paramedical sciences by increasing budget allocation to modernised medical education, exchange programmes with international colleges, scholarship for participation in conferences with a definite outcome, increase in the salaries of doctors practising at government hospitals etc. There must be a budget allocation for research and development of low cost drugs, preventive vaccines and personalised medicines. Tax sops for units focusing on R&D and an improvement in patent laws would also be welcome.
Health education
Correct distribution of funds, improving infrastructure and skilled resources, as well as preventing loss of money in unused/ misused resources is key while allocating the budget
Like many countries, it is important to keep a part of spending on incorporating health education classes for students in schools.
Social entrepreneurship In a densely populated country like India, it is important to seek support from notfor-profit organisations to improve healthcare delivery. There should be a special authority to help these organisations utilise their funds and a minimum CSR funding allocation for organisations working towards health and education. An accurate yearly report should also be submitted to ensure the effectiveness of the initiatives undertaken.
‘Government should allocate funds to promote holistic and alternative medicine’ SAGAR SAMBRANI Independent Financial Analyst
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I
n its strides towards the haloed developed country status, India faces major challenges in the field of healthcare. A burgeoning population, poor health infrastructure and paucity of funds allotted in the budget have
hindered the country’s progress. At one per cent of GDP, our public healthcare expenditure is the least among BRICS countries. This year, we expect more focus on reducing patients’ out-ofpocket expenditure (currently
at over 60 per cent) through initiatives focused on health insurance, setting up of more affordable quality medical institutions. The government can also focus on promoting India as a medical tourism destination. I believe that the
Focus on providing tax benefits to medical device manufacturers in India, along with promoting FDI in the sector with an aim to developing a more robust local medical manufacturing industry
following should be areas of focus in the government's annual health budget: Develop a roadmap for strategic health initiatives such as telemedicine, digital health record adoption etc. These initiatives will help compensate for the inadequate number of doctors and the lack of connected healthcare platforms. Special tax breaks for startups in this sector or public-private partnerships (PPP) with them could lead to a faster development of these technologies. Focus on providing tax benefits to medical device manufacturers in India, along with promoting FDI in the sector with an aim to developing a more robust local medical manufacturing industry. Currently, we import over 70 per cent of all medical apparatus used in the country. To reduce out-of-pocket expenditure, the Rashtriya Swasthya Bima Yojana was launched in 2008 for BPL families. Having received appreciation by the UN, World Bank and the ILO as one of the world's best health insurance schemes, it fell short in that it only benefitted patients through cashless hospitalisation facility but could not provide assistance in the case of
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OPD patients. The National Health Assurance mission which was expected to be launched last year, could go a long way in providing universal healthcare for Indian citizens.
With India extending its Visa on arrival scheme, more tourists may prefer India for their medical treatment. The government should allocate funds for promoting holistic
and alternative medicine to foreigners, and tax earnings from medical tourism could be used to subsidise healthcare for the underprivileged in India. Telemedicine facilities
also contribute to providing more support to prospective or recovering patients, thus increasing India's attractiveness as an affordable healthcare destination.
MARKET I N T E R V I E W
‘SuVitas is doing well and is progressing to achieve breakeven in < 12 months’ The 58-bed startup transition care facility called Suvitas.com in Hyderabad offers a stroke programme for neurology, orthopaedic, oncology and cardiology patients in need of specialised rehabilitation support. Raelene Kambli interacts with Bipin Pendyala, Founder and MD, SuVitas to understand his business model and strategy for sustainability Tell us about your start-up SuVitas. What does your business comprise? SuVitas is India’s first transition care company dedicated to provide accelerated and effective posthospitalisation care with patient significance. We serve patients recovering from neuro/ neuro surgery, major road accidents, orthopaedic, cardiac surgery and early stage oncology health incidents. ◗ Need: When individuals are recovering from neuro surgery, neurology problem, spinalcord surgery, major road accidents, hip replacement/ fracture, etc., the recovery period after hospital discharge is long drawn and requires intense medical care along with specialist equipment. The family too is devastated and not equipped to deal with the recovery process ◗ Strategy: SuVitas blue ocean strategy is protocol oriented personalised care plan, homelike relaxing environment, empathetic approach, and collaborative care from physicians, therapists (physio, occupation, speech, respiratory), nursing, dieticians and emotional counsellors. Patients are called ‘residents’ as they stay for a period of two to 16 weeks at SuVitas, as required for their recovery ◗ Therapy services: Physiotherapy, occupation therapy, speech therapy,
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cognitive therapy, respiratory therapy (BiPAP, CPAP management) ◗ Nursing services: Tracheotomy, Ryles tube/ PEG tube feeding, catheter management, oxygen requirement, vitals monitoring and medication, wound care and positioning, bladder and bowel care as well as personal grooming ◗ Nutrition services: Advice and counselling, personalised diet delivery ◗ Awareness/ education and engagement services: Education to resident/ family member about the health incident, current and future requirements; education on necessary lifestyle changes, meditation, music and art therapy, festival and birthday celebrations for residents How old is your business? We launched our services in late May 2015, hence eight months old now. How did you start your business and how did you manage to scale it? We are familiar with the maturity of post-hospitalisation transition care segment in the US and UK. We have also witnessed first hand challenges of recovery for the individual and supporting family when one goes through a major health incident. Further, given the growing healthcare investment scenario in India
(patients are called residents at SuVitas as spend long time with us while recouping). We are now operating at 60 per cent occupancy within our 50bed capacity. We have built the business based on trusted relationship with physicians/ surgeons and marketing efforts and media. Scaling up business will be a result of building strong brand recall in the general population as well sustaining the trusted relationship with physician/ surgeon community in the locations we operate.
Over the past eight months we have moved from concept stage to serving 100 residents
and the changing dynamics of society in the metro’s made us believe that our plan to start a transition care business in India is very viable and also that the time is appropriate. Over the past eight months we have moved from concept stage to serving 100 residents
Are there any entry barriers that you face? If yes, how did you overcome it? SuVitas is the first transition care company in India and hence is the category pioneer. The initial challenges were evangelising and concept selling. Awareness and education of general population at large is a huge task for a start-up and requires tremendous efforts. For this,we leverage print and television media extensively to spread the awareness among general population. What are the other challenges you faced? As transition care is a novel concept in our country, we had to hire the right people and more importantly ensure proper orientation of the team members for delivering services..
Tell us about your investors? Are they VCs, angel investors, crowd funded or anything else? We have not yet raised external funding. SuVitas is bootstrapped by the three promoters. We will now look to raise funds for expansion. What is your opinion on choosing the VCs over angel or crowd funding? Which medium gives a better deal? VCs vs angel funding is largely a derivative of the size of investment required. Angel funding is usually in the range of $20,000 to $500,000 whereas VC funding is typically upwards of $1000000. Approaching angel funding is relatively simpler as there are about 10 angel networks in the country and since each network is a large group of individuals from diverse background, there is likely to be interest for almost all sectors. Approaching VCs require additional homework to identify the funds that are investing in the specific sector and understanding the fund’s investment philosophy and then seeking an opportunity to pitch. What is the current size of your business? How much money have you raised so far? Currently, we are doing a run rate of Rs four crore and progressing towards target of Continued on page 23
MARKET I N T E R V I E W
‘India has a great potential to become a major player in the bio-pharma innovation process’ Recently, Professor Meir Pugatch, IPKM Chair University of Maastricht, Professor Frank Lichtenberg from Columbia University and Mike May from Scientific American Worldview presented their empirical studies at the USIBC Convenes Conference. Raelene Kambli speaks to Professor Pugatch, Lichtenberg and May, on how India can become a global leader in the R&D and biopharmaceutical sector while also expanding healthcare access in country
What scope do you see for the Indian life sciences and biopharmaceutical sector on the global front? Professor Meir Perez Pugatch – India holds an outstanding potential to become a regional leader in the field of life-sciences and biopharma innovation, especially given the greater government support for biomedical investment and innovation under the Modi administration. The future success of government initiatives such as the 'National Biotechnology Development Strategy' could boost India’s capabilities to compete in new fields of biopharmal innovation. Yet at the same time significant gaps, which have historically represented a major challenge to innovators seeking to operate in India, should be addressed. For example, looking at the findings of recent Pugatch Consilium research, these gaps and challenges exist in several areas such as India’s IP regime, its clinical research policy environment and regulatory framework. The Modi administration has already shifted its attention to some of these issues. By addressing these aspects and bringing them to the acceptable level of global international standards, India stands to meet its aforementioned potential and benefit greatly from it.
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You say that India can become a global top-10 competitor in the life sciences and bio-pharma sector. Can you explain how? Professor Meir Perez Pugatch – India has a great potential to become a major player in the global pharma arena, not only in the generic front but also in the biopharma innovation process. Indeed, the recent Biopharmaceutical Investment & Competitiveness (BCI) Survey of 2015, which gauges these ecosystems in a sample of countries, shows that India currently performs well in several areas, not least with regards to its infrastructure and scientific level of research. Yet at the same time the BCI survey also identified four areas of weakness which India should address: 1) regulatory deficiencies and bottlenecks in the approval and review process on innovative products; 2) limited coverage of medicines even with costs driven down; 3) a relatively weak biopharma IP protection, and 4) insufficient collaboration and outputs between public research bodies and private enterprises. I believe that once India addresses these gaps it will become a much more attractive hub for investment and innovation in 10 years’ time. How can innovation in the
Certain regulatory barriers can also negatively affect access to healthcare
While global markets ‘ slow-down’ slight decrease FDI inflows may take place
bio-pharma sector help in increasing healthcare access in India? Mike May - In some cases, innovative medicines require less complicated storage methods and easier delivery methods, such as pills versus injections, and this could take healthcare to more remote areas.
Professor Meir Perez Pugatch – One such prominent way is through clinical research. Pugatch Consilium’s Scaling Global Clinical Trial Activity of 2014 finds that clinical trials provide patients with access to innovative drugs, which may literally revolutionise existing treatments, and often continue
beyond the duration of the trial. Clinical trials also provide physicians with experience in cutting-edge and skills, and often involve improvements to infrastructure and health technologies in local communities. Additionally, with costs of the drug itself and associated tests often being borne by the study’s sponsor, clinical trials may lead to savings for healthcare systems, in some cases, the sponsor may continue to provide the treatment at a preferential price. Conversely, certain regulatory barriers in terms of innovation can also negatively affect access to healthcare. For example, the lack of Regulatory Data Protection for submitted clinical test data, excessive patentability requirements and gaps in predictability and transparency in the criteria and processes governing clinical research outlined in the Drugs and Cosmetics Act all play some part in India’s currently extremely low clinical trial activity and total number of new drug launches. Tell us about the Scientific American Worldview's seven years of meta-analysis finds? Mike May - From 2012-2013, India's data produced stable outcomes, and then it improved slightly from 2014 to 2015. All BRIC countries, however, need to improve considerably to
MARKET compete with the current world leaders in innovative biotechnology. According to your study what's in store for India? Professor Frank Lichtenberg – India has made impressive strides in the past 50 years. In 1960, life expectancy at birth in India was 30 years lower than it was in the US (40 vs. 70). Today, it is about 13 years lower (66 vs. 79). Thus, India has closed more than half of the life expectancy gap between it and the US.. Much of the progress was probably due to the implementation of basic public health measures: better sanitation, environmental regulation, increased childhood vaccination rates, etc. The evidence suggests that to make further substantial progress in population health, the quality of healthcare goods and services must continue to improve. My research has demonstrated that use of new medicines can play an important role in improving the quality of health care, because the quality and efficacy of new medicines tend to be significantly higher than that of older medicines. Indian policymakers should therefore focus their efforts on ensuring that the Indian people have access to recently developed drugs, medical devices, and procedures. Professor Meir Perez Pugatch – One of our recent researches: Quantifying the
Economic Gains of Strengthening India’s Clinical Research Policy Environment has found that by improving its clinical research policy environment to roughly the median level of international best practices, India could increase the number of new clinical trials per year to above 800 and add over Rs 600 million in direct monetary transfers and indirect economic gains, with more than 50 per cent of which directed at hospitals, related services and patients. This may be regarded as a conservative estimate. It is possible India could experience even higher levels of investment and economic gains. What kind of investment is required by India to foster innovation in life sciences? Professor Meir Perez Pugatch – Essentially, the life sciences and biopharma sector relies equally on public and private investments. India, under the Modi administration, has pushed several government initiatives and policy reforms focused on the life sciences sector which may prove very useful in improving its output. Looking at the analysis of India’s biopharma ecosystem in the Biopharmaceutical Investment & Competitiveness (BCI) Survey of 2015, the major areas of investment, crucial to foster innovation in India, are its IP regime which suffers
Indian policymakers should ensure that the people have access to recently developed drugs, medical devices, and procedures
from overall ineffectiveness. . With the global markets slowing down currently, do you think that this
phenomenon would negatively impact research related to life sciences and the bio-pharmaceutical sector globally? Mike May - Data in Scientific American Worldview indicate an increase in market capitalisation for public biotechnology companies in many countries over the past two years, and that should actually drive more research. Professor Meir Perez Pugatch – Naturally, some impact as a ripple-effect can be expected, though to minimal extent. The life sciences and biopharma sector is of the most innovative sectors across all industries, with some 15 per cent of revenues invested in future R&D according to some estimates. While global markets ‘slow-down’ slight decrease FDI inflows and some shifting and reordering of strategies may take place, history suggests that this sector is less sensitive and vulnerable to market trends. Give us five trends that the world should look for in 2016 where life sciences and the bio-pharma sector is concerned? Professor Meir Perez Pugatch Biosimilars: With the impending patent loss of a growing number of biological drugs, the need to address the many issues of biosimilars – e.g. naming, interchange ability,
quality assurance and many more – become more pressing. Of equal importance is generic manufacturers’ ability to manufacture biosimilars while maintaining all their properties, a requirement which necessitate much more stringent requirements and modern equipment. Potential shift in the P&R schemes : The high cost of some innovative treatments had elevated discussions regarding the current pricing and reimbursement schemes, and the potential of new directions which are based on risk-sharing and pay-foroutcome schemes. Strengthened dialogue between industry and regulators : There is a growing recognition within drug manufacturers and drug regulators alike of the benefits in engaging in collaborative discussions, which may develop into a new, more productive ‘partnership’ between drug regulators and drug manufacturers which maintain international standards. Healthy ageing : Innovative treatments targeting elderlyspecific diseases such as Alzheimer and dementia have long been in the pipeline, yet failure rate was high. As around the world population is rapidly ageing, more effort is directed toward this field, with some result possible in the near future. raelene.kambli@expressindia.com
Continued from page 20
SuVitas is doing well and... Rs six crore by the end of this FY. We have not raised any external funding till now but will be looking forward to doing so for our growth in the coming months. Our plan is to expand to 2000-bed capacity across the country in the coming four to five years. Most start-ups in India are only meeting top lines. How would you differentiate your start-up from the rest? In the early stage, every startup struggles with topline and bottomline projections
and meeting the same. It is natural for a start-up to focus more on topline during the early stages to gain momentum and then seek profitability. Typically healthcare delivery organisations take 1824 months to get to breakeven. SuVitas is doing well and is progressing to achieve breakeven in < 12 months.
while dormant is very large. We estimate the potential size to be approximately $ four billion given the consistent increase in medical tourism, stroke and cardiac problems in the current population demographics. With regard to environmental sustainability, our business has very little carbon footprint.
What is your plan for sustainability? Business sustainability is not a critical challenge as the demand for transition care
Are you equipped for an uncertainty in the business environment? As a young startup it is important for us to be prepared
for and plan for uncertainty. Promoter team is well experienced and are certain of weathering any challenges that come along. What are your expectations from the new start-up policy by the government? It is very encouraging to see the initiatives of the current government and the PM. One initiative that will further enhance entrepreneurial ecosystem (in addition to the current proposals) is to give tax exemption when promoters
invest into starting a new company. Instead of investing post-tax money if promoters are given the option to invest pre-tax money (essentially tax exemption/ break), it will further improve the money flow into startups and encourage individuals to become entrepreneurs. It is also important to give tax exemptions to capital gains from own startup similar to capital gains from listed companies/ MFs. raelene.kambli@expressindia.com
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MARKET PRE EVENT
Express Healthcare to host first edition of Healthcare Sabha at Hyderabad Central and state-level policymakers would congregate at the event to deliberate on cohesive, unified and innovative ways to achieve the vision of the National Health Mission IN KEEPING with the objectives of the National Health Mission pertaining to ‘Universal Access to Equitable, Affordable and Quality Healthcare Services’, The Indian Express Group and Express Healthcare are organising Healthcare Sabha 2016 – The National Thought Leadership Forum on Public Healthcare. The first edition of Healthcare Sabha will be held from March 4-6, 2016 at Hyderabad Marriott Hotel and Convention Center. The forum will deliberate on cohesive, unified and innovative ways to achieve the vision of the National Health Mission. Key subjects at the forum would include ◗ Models of financing public healthcare to aid the masses ◗ Usage of ICT in the public healthcare delivery model ◗ The role of frugal innovations in medical technology ◗ Skill enhancement programmes to bridge the workforce deficit ◗ The expanding role of NGOs’, Foundations’ and corporate hospitals’ outreach programmes The event will also host the Express Public Health Awards honouring the visionaries, innovators, and game changers from public healthcare. Public Health Foundation of India (PHFI) will be the Knowledge Partner to the Awards. Dr K Srinath Reddy, Founder and President, PHFI, is the Chairperson of the jury. The categories for the Express
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Health Innovation in increasing affordable access to medicines, vaccines, medical products and technology ■ Innovations in health information systems for population health assessment/quality improvement/increasing transparency and accountability ■ Innovations in human resource for health ■ Excellence in leadership, stewardship and governance at the state level
differently abled people
■
◗ Express Public Health Award to the Most Effective Public Private Partnership in: This award celebrates state governments which have managed successful, sustained partnerships with the private sector ■ Healthcare infrastructure ■ Diagnostics ■ Human resource for health
Public Health Awards 2016 will be as follows: ◗ Express Public Health Award to the Most Efficient State/Institution in management of: This category aims to recognise and acknowledge state governments which have been the most proactive and efficient in initiating public health programmes and utilising public funds to meet the population’s health needs. The jury would take into account the scope and impact of the
project in terms of size of population covered, etc., defined measurable outcomes. The subcategories in this segment are: ■ Infectious diseases ■ Non-communicable diseases ■ Reproductive, Maternal, Neonatal, Child and Adolescent Health ■ Excellence in Public Health Service Delivery (in terms of covering greater population and increased range of services through the health system) ■ Innovation in Financing for
◗ Express Public Health Award to the Most Effective Healthcare NGO: This category aims to recognise and celebrate the work of registered NGOs which have contributed to identifying and solving healthcare challenges on a local, regional or national level for a minimum of five years. Nominations will be evaluated on the outcomes and scope of their work. The sub categories will comprise: ■ Healthcare for rural poor/urban poor/migrant population ■ Tribal health issues ■ Social empowerment models ■ Women and Child Health ■ Healthcare for elderly and
◗ Express Public Health Award for Most Effective Health Technology Systems: This category aims to recognise and celebrate the work of states and institutions which have deployed technology to improve efficiency and access to quality, affordable healthcare services The sub-categories in this segment are: ■ Health Information Management and Systems (HIMS) ■ Telemedicine/teleradiology ■ Health helpline ■ Affordable lifesaving technology ■ Wearable health devices ◗ Lifetime Achievement Award for Contribution in Public Health: It would recognise and celebrate yeoman service in public health, either through their NGOs or through their efforts to support public health causes. Nominations for this category can be made by individuals other than the nominee. ◗ Express Public Health Award for Contribution by a Private Healthcare Practitioner towards Public Health: This award aims to recognise and appreciate outstanding contribution of a private healthcare practitioner towards public health causes and initiatives, bridging the private-public divide. For more information on the event log on to www.healthcaresabha.in
MARKET POST EVENTS
FIT Insulin Injection Day observed in Mumbai Healthcare professionals to adopt green insulin injection technique, propagate the message of ‘Go Green to Stay Fit’ FIT INSULIN Injection Day was observed in Mumbai and other parts of the country, with the adoption of FIT2.0 India recommendations. Amongst other best practices, the recommendations emphasise safe disposal of insulin syringes and pen needles as a means to reduce environmental impact of modern diabetes management. On this occasion, the advisory board members of Forum for Injection Technique (FIT) India propagated the message of 'Go Green Stay Fit' in line with the article on Green Diabetology published in Indian Journal of Endocrinology and Metabolism (IJEM) emphasising the urgent need for proper disposal of insulin delivery sharp devices.
“While modern insulin technique guidelines address the need for appropriate disposal of needles and syringes, safe disposal of insulin delivery sharps is seldom practiced in clinic and home care environment,” said Dr Sanjay Kalra, FIT advisory broad member and lead author of the IJEM ‘Green Diabetology’ article. Apart from environmental contamination, unsafe disposal is having an adverse impact on healthcare worker safety. As per CDC, every day more than 1000 healthcare workers in hospital setting are injured with a needle or other sharp device. This especially happens during insulin syringe/pen needle re-capping, intended for re-use. The WHO in
Every day more than 1000 healthcare workers in hospital setting are injured with a needle or other sharp device the Policy Guidance released in February 2015, has identified the issue of reuse of syringes, accidental needle stick injury, unsafe
sharps waste management. As per the FIT recommendations, biomedical diabetes carerelated wastes need to recycled, not reused. This can not only prevent the spread of infections among waste handlers and endusers but also promote conservation and efficiency, and help in revenue generation for waste disposal sites. In an effort to address safe and environmentfriendly insulin disposal, healthcare professionals will initiate a nation-wide movement for green diabetology 'Go Green Stay Fit', which shall aim towards safe disposal of insulin. The programme will also sensitise diabetes care professionals to their responsibility toward the physical environment,
while reinforcing the need for interdisciplinary cooperation between all stakeholders. “Under the Green Diabetology programme, we will be propagating safe disposal of insulin syringes and pen needles, prevention of reuse and education against re-capping insulin injecting devices to prevent accidental needle-stick injury. We will encourage adoption of simple practices that will facilitate optimal recycling and usage of insulin-related waste material while providing a source for revenue generation as well,” said Dr Hemraj B Chandalia, Director, Department. of Endocrinology, Diabetes and Metabolism, Jaslok Hospital & Research Centre, Mumbai.
JPNadda felicitates 43 scientists for contribution to biomedical research Science should reach to all those places and people who need it the most: Nadda JP NADDA, Union Minister for Health and Family Welfare felicitated 43 scientists for their work in communicable and non-communicable diseases, maternal and child health and various other medical and biomedical fields in New Delhi, recently. At the ceremony he stated, “Our PM has a vision that the fruits of science should reach the poorest, the vulnerable and to the remotest areas of the country and we must ensure science
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reaches to all those places and people who need it the most.” He further added, “I find health research an invaluable ally in governance and development.” Nadda also asked ICMR to list out at least 10 major pressing challenges in the field of healthcare in India and find out local solutions for those challenges. These suggestions will enable healthcare to become holistic and truly meaningful, he said. Highlighting the importance of such awards, the Health Minis-
ter said, “The awards will boost the morale of the recipients and inspire other scientists to consistently work towards making innovations more affordable.” Announcing collaboration with AYUSH Ministry in biomedical research, Nadda said, “We have a vast traditional knowledge and this needs to be incorporated in a holistic manner.” He stated that as opposed to working in silos, Ministries should collaborate and work together. He also urged ICMR to
go for cutting edge research and attract the best talent in the country which would be dedicated to research. He added that research should focus in increasing access to healthcare and in making innovations affordable to those who need them the most. Nadda stated that researchers are ‘silent workers’ who go into the depth of the matter with utmost patience. He congratulated the recipients in various fields. Speaking at the occasion, Dr
Soumya Swaminathan, DG, ICMR and Secretary, Dept of Health Research stated that ICMR will now work with AYUSH Ministry to harness the rich knowledge of traditional medicine systems. The collaboration of allopathy and traditional medicine systems will be vastly beneficial to people, she said. Also present on the occasion were Ajit Sharan, Secretary AYUSH, Lt Gen BK Chopra, Dr MC Mishra, Director AIIMS, New Delhi.
EVENT BRIEF MARCH 2016 04
HEALTHCARE SABHA 2016
HEALTHCARE SABHA 2016 Date: March 4-6, 2016 Venue: Marriott Hotel and Convention Center, Hyderabad Summary: In keeping with the objectives of the National Health Mission pertaining to ‘Universal Access to Equitable, Affordable and Quality Healthcare Services’, the Indian Express Group and Express Healthcare are organising Healthcare Sabha 2016 – The National Thought
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MEDICAL FAIR INDIA 2016
Leadership Forum on Public Healthcare. The Forum will deliberate on cohesive, unified and innovative ways to achieve the vision of the National Health Mission. The event will also host the Express Public Health Awards honouring the visionaries, innovators, and game changers from public healthcare. Contact For Healthcare Sabha 2016 registrations: Shilpa Chaurasia
The Indian Express (P) Ltd 1st Floor, Express Towers, Nariman Point, Mumbai 400 021 Ph: 08879137185 Email: shilpaindianexpress@gmail.com Website: www.healthcaresabha.in For Express Public Health Awards nominations : Raelene Kambli The Indian Express (P) Ltd 1st Floor, Express Towers, Nariman Point, Mumbai 400 021
Ph: 09819614430 Email: raelene.kambli@expressindia.com Website: www.healthcaresabha.in
MEDICAL FAIR INDIA 2016 Date: March 11-13, 2016 Venue: Bombay Convention & Exhibition Centre (BCEC), Mumbai Summary: MEDICAL FAIR INDIA seeks to serve as a
perfect platform and offers a plethora of business opportunities for healthcare professionals to meet, engage and network with participating companies, delegates and speakers. Organiser: Messe Düsseldorf GmbH Contact Messe Düsseldorf GmbH Ph: +91 (0) 11 4855 0061 E-mail: BhardwajL@mdindia.com Website: www.messe-duesseldorf.com
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cover )
Dr Lal Pathlabs is determined to reach where no diagnostic service provider has ever been BY M NEELAM KACHHAP
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(
T
he mood is upbeat at Dr Lal PathLabs Private Limited (LPL) new lab at Bangalore. Dr Om Prakash Manchanda, Director and CEO, Dr Lal PathLabs is jubilant. He has every reason to be since, Dr Lal PathLab ended 2015 on a high note, raising Rs 6.3 billion in a successful IPO on the National Stock Exchange. It also gained the distinction of being the first diagnostic service provider to be listed at the NSE, leading the way for other healthcare companies to dream big. The Delhi-based LPL was established in 1949 by the late Dr (Major) SK Lal. His son, Dr Arvind Lal, the present Chairman and MD took over the business in 1977. Today, the group has 172 laboratories, 1554 sample collection centres (patient service centres) and 7000 sample pick-up points spread across India. "We as a company grew out of Delhi. Then slowly and steadily we grew in the northern markets,"
says Manchanda who is associated with the company for the past 10 years. LPL has mastered the business model where specimens are collected across multiple locations within a region for delivery to a predesignated clinical laboratory for centralised diagnostic testing. Diagnostic services providers play a crucial role
WE OFFER OVER 3,495 DIAGNOSTIC AND RELATED HEALTHCARE TESTS AND SERVICES
FOCUS:LEADERSHIP
as information intermediaries, providing useful information for correct diagnosis and treatment of patientsâ&#x20AC;&#x2122; diseases. The industry can be classified into imaging diagnostics and pathology testing services. LPL mainly deals in pathology testing services. Their diagnostic and related healthcare tests as well as services include; routine clinical laboratory tests such as blood chemistry analyses and blood cell counts; specialised testing services such as histopathology analyses; genetic marker-based tests, viral and bacterial cultures and infectious disease tests; and preventive testing services like screenings for hypertension, heart disease and diabetes. "With over 3,495 diagnostic as well as related healthcare tests and services offered, we believe we are capable of performing all of the diagnostic healthcare tests and services currently prescribed by physicians in India," confides Manchanda.
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A trusted brand LPL's customers include individual patients, hospitals and other healthcare providers as well as corporate customers. "In the fiscal year 2015 and the six-month period ended September 30, 2015, we collected and processed approximately 21.8 million samples and 13.4 million samples from approximately 9.9 million and 6.2 million patients, respectively," informs Manchanda. At present, the company has one National Reference Laboratory in New Delhi, 171
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other clinical laboratories, 1,554 patient service centres and over 7,000 pickup points.
Abundant opportunities LPL is one of the leading players in Indiaâ&#x20AC;&#x2122;s mostly fragmented diagnostic services industry. "The size of the diagnostics industry was estimated at around Rs 377 billion in 2014-2015," informs Manchanda. This represents both pathology and radiology markets. Of the pathology market, only 15 per cent is in the hands of organised players like
Thyrocare, Dr Lal PathLabs, SRL Diagnostics and Metropolis, among others. Another 48 per cent of the market, which is highly fragmented, is dotted with independent labs, and growing at a rate of 15-16 per cent p.a. The overall market for wellness and preventive diagnostics, was six to eight per cent of the total diagnostic services market in 2014-2015. "As per industry reports, the diagnostics industry will continue to grow by a CAGR of 16-17 per cent over the next three years to over Rs 600 billion by
2017-2018," says Manchanda. Consolidating the fragmented market would provide additional growth opportunities for the larger players as well as the smaller, standalone laboratories and centres which are opting to join larger diagnostic healthcare services chains as franchisees or as attractive acquisition targets.
Attractive financial performance The diagnostic chain has seen positive growth throughout but has also seen rapid growth after
corporatisation. "In the last couple of years, we have grown rapidly, almost 20-30 per cent y-oy," informs Manchanda. According to its Red Hearing Prospectus for the period of 2013-2015 the company's total revenue grew from Rs 4,544.77 million to Rs 6,625.24 million, representing a CAGR of 20.7 per cent; and its EBITDA grew from Rs 1,004.71 million to Rs 1,588.87 million, representing a CAGR of 25.8 per cent. The company's profit for the same period grew from Rs 556.47 million to Rs 949.97 million, at
(
FOCUS:LEADERSHIP
LPL : ATAGLANCE ESTABLISHED IN
1949
172 1554 7000 laboratories
CAGR of 30.7 per cent; and their consolidated net worth increased from Rs 1,620.54 million to Rs 3,410.82 million. "In the six-month period ended September 30, 2015, our total revenue was Rs 4,077.14 million, our EBITDA was Rs 882.10 million, our profit for the period was Rs 374.65 million and our consolidated net worth was Rs 4,091.28 million," shares Manchanda.
Building blocks of growth The company intends to strengthen its presence in the core markets of North India as well as Central and Eastern India. "Our first focus is organic growth in the entire North East and Central India as we are well placed to take business to the next level here," says Manchanda. "In North India, we intend to further strengthen our position by opening new, franchised
patient service centres across this region in order to expand our network’s reach," he adds. The growth in Central and Eastern India is planned through the construction of regional reference laboratories, combined with the opening of additional smaller clinical laboratories and several new, complementary patient service centres. "We are opening two reference labs, one in Kolkata and one in Lucknow," discloses Manchanda. "The Kolkata lab is almost complete and will be operational soon. The Lucknow lab will take some time," he adds. The company also wants to target expansion in Southern and Western India by opening additional clinical laboratories and patient service centres. "We are also going after certain select cities where we want to build consumer facing business like we have built in the North. These cities are
sample collection centres (patient service centres)
Bengaluru, Pune and Mumbai," says Manchanda. "At present, the company has 18 service centres in Bengaluru and a regional laboratory. We are building a lab in Pune on similar lines," shares Manchanda. So, the organic growth will be in two layers, first is the consumer-facing business which will be North, East and Central focused and the second is the high-end specialised business which will be all-India focused.
Second building block The second area of growth for LPL is on-site lab management or hospital lab management. The company plans to increase the number of hospital-based clinical laboratories that it manages by leveraging the scale and efficiency of its network to perform diagnostic healthcare testing services of these hospitals and other clinical laborato-
sample pick-up points spread across India
ries. "We have some experience in this area and at present, we have 14 labs with hospitals," says Manchanda. "We see great opportunity here and I want to drive this aggressively," he adds. The company may also seek similar opportunities with ‘polyclinics’ – which generally are consolidated partnerships of physicians, consisting of general practitioners and specialists. "Polyclinics generally have limited resources, thus presenting an opportunity for us to provide them both, laboratory management and specialised laboratory testing services," states Manchanda.
Strategic acquisitions The third building block of growth for LPL is strategic acquisition. The company will continue to seek strategic partnerships with key franchisees and hospitals for its
future growth. "We continue to explore expansion opportunities in select cities in India through strategic acquisitions of regional diagnostic healthcare service providers who possess brand recognition among an existing patient base and healthcare providers," reveals Manchanda. Previously, the company had undertaken strategic acquisitions in India of smaller-scale diagnostic healthcare service providers that increased its patient base, customer reach and economies of scale. "We believe future acquisitions and partnerships will provide us operating synergies and a basis for organic growth in these new regions, through the introduction of diagnostic healthcare services such as specialised testing that are in addition to those already offered by the acquired companies," shares Manchanda. The company also believes
WE CONTINUE TO EXPLORE EXPANSION OPPORTUNITIES IN SELECT CITIES IN INDIA THROUGH STRATEGIC ACQUISITIONS OF REGIONAL DIAGNOSTIC HEALTHCARE SERVICE PROVIDERS WHO POSSESS BRAND RECOGNITION AMONG AN EXISTING PATIENT BASE AND HEALTHCARE PROVIDERS EXPRESS HEALTHCARE
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cover ) WE AS A COMPANY GREW OUT OF DELHI. THEN SLOWLY AND STEADILY WE GREW IN NORTHERN MARKETS,LPL HAS MASTERED THE BUSINESS MODEL WHERE SPECIMENS ARE COLLECTED ACROSS MULTIPLE LOCATIONS WITHIN A REGION FOR DELIVERY TO A PREDESIGNATED CLINICAL LABORATORY FOR CENTRALISED DIAGNOSTIC TESTING that strategic acquisitions and partnerships will provide it with additional purchasing power with suppliers and increased economies of scale. "We are looking at consumer-facing diagnostic labs where sharp focus on quality and standards are in line with our lab," says Manchanda. "We don’t want to do too many of them but we are looking at some platform deals where we see scope for growth. These targets would be city-based players and we want to grow them in their respective ecosystems. We would be interested in cities like Hyderabad, Chennai and Bengaluru," informs Manchanda.
Quality is the main differentiator The quality and reliability of diagnostic and related healthcare tests and services are essential to the success of LPL. "Our commitment to the quality and reliability of our diagnostic healthcare services is fundamental to our corporate brand and strategy," says Manchanda. “We will continue to respond to the needs of individual customers and the healthcare industry by maintaining the quality of our diagnostic healthcare services and improving our turnaround times for testing results,” he adds. In addition, LPL will continue to upgrade diagnostic equipment and technology in order to increase the efficiency
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of its processing capacity. "We believe we gain access from our suppliers to advanced diagnostic technologies and equipment, which further enhance the quality and reliability of our diagnostic healthcare services. We will also continue to enhance the customer experience by further developing our online initiatives and leveraging our potential data analytic capabilities," Manchanda concludes. mneelam.kachhap@expressindia.com
STRATEGY I N T E R V I E W
How has healthcare insurance evolved over the years and what are the trends in 2016? Healthcare insurance has a history of almost 30 years in this country and it has evolved in a very big way. Especially in the last seven to eight years, there have been substantial improvements in the health insurance sector. Today, health insurance is very important to people. I think with increasing life spans, increasing medical advances and increasing cost of medical treatment, today, health insurance has become absolutely mandatory for every individual and every family, and people understand that. I would say that today the most popular and voluntarily sought after insurance is health insurance. Hence, this sector will continue to grow. In the last decade, it has grown by about 20 per cent on a year-to-year (y-o-y) basis. I expect the same trend to continue in the coming years. What is the breakage of the health insurance sector in India? If you look at the health insurance premium of this country, last year it was about Rs 21000 crores approximately. In terms of value, half of it is corporate or group health where the companies cover their employees through group policies, around 40 per cent comprise individuals taking polices and 10 per cent is the government health schemes. But, if you look at the number of people covered, I would say about that around 25 per cent of the people in this country have some form of health insurance or another and a large part of it comes through government health schemes such as the Rashtriya Swasthya Bima Yojana, and health schemes adopted by
‘The health insurance sector will grow at 20 per cent YoY going forward’
states like Tamil Nadu, Maharashtra, and now Rajasthan. So, in these cases, the government itself funds the premium and people are covered, especially those below the poverty line. So, out of the 25 per cent of the populace covered under health insurance, about 16-17 per cent of them are covered by the government health insurance schemes where people don’t really pay much, about four per cent would be corporate insurance where the employers pay, and only about five per cent of individuals buy health insurance policies. Today, with people having higher purchasing power and as I said, health today is the most important requirement in term of insurance, it is more important than life insurance, so that will also grow. So, the sector will grow at 20 per cent going forward and it will be one of the largest segments in the general insurance space. How important is health as a sector for New India Assurance? It is a very important segment for us. We are the market leaders in health insurance. About 28 per cent of our business comes from health insurance. It is also growing at about 20 per cent each year. Thus, it is a key portfolio for us. So, what are the plans for this segment in 2016? We would like to keep up the growth in line with what is happening in the market. Basically, as I said, there are
three segments, the government health insurance, corporate insurance and individual insurance. We are active in the government health segment, we have recently been selected by the Rajasthan government to provide health insurance cover for the whole state. We have also been an active player in the Rashtriya Swasthya Bima Yojana in various states such as Himachal Pradesh, Chhattisgarh, Karnataka, Meghalaya, Arunachal Pradesh etc. We will continue to be active in the government health insurance space. In the case of corporate health, New India has a historical advantage because most of the major corporates in the country are our customers. So, many of the major group insurance policies are with us. In the retail health space, we have a large segment but that is where we want to grow. It is where a large segment of people are not covered. 75 per cent of people do not have health insurance in this country. So, this segment offers the biggest potential for growth, so we will focus on it by using technology, product innovation and distribution. In terms of product innovation, we had come up with a floater health insurance policy last year. We also introduced Asha Kiran health insurance policy for people who have only girl children at reduced premium rates, and we also launched a top-up health insurance product. Currently, we are working on two-three new
Health insurance has emerged as a significant financing mechanism for healthcare. G SRINIVASAN, Chairman and MD, The New India Assurance, speaks about the evolution of this sector, upcoming trends, his company’s role in improving health insurance penetration, the way forward for the sector in India and more, in an exclusive interview with LAKSHMIPRIYA NAIR EXPRESS HEALTHCARE
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kind of health insurance products as well. So, product innovation is a major focus area for us. Distribution is done mainly through the agents, because we reach out to individuals through them. We have around 70,000 agents, we train and motivate them to sell insurance. Ultimately, the way health insurance should really happen is that every family should take a policy for themselves. That is the ideal form of health insurance. How has technology helped revolutionise health insurance? What are the technologies that NIA has adopted? I was speaking of technology adoption on the distribution side. We have several
be used to make it easier. So, has NIA used any technology to do so? Basically, we use the third party administrators (TPAs) for settlement of claims. Currently, we use around 10 TPAs. Through the TPAs, we use a lot of technology. If someone goes to the hospital, he immediately contacts the TPA and within half an hour or an hour he gets a preauthorisation and he gets admitted and we provide a cash-less facility to them. So, all this is now taken care of through technology. And it also helps in maintaining transparency in the whole process. So, today everything is technologically-driven and there is lot of information available. A lot of analytics can be done through the
immediate authorisation to go ahead. The other area is managing claims, if you don’t manage claims, the claims cost can go up which will ultimately cause the premium costs to go up. You are a partner in the government’s Rashtriya Swasthya Bima Yojana. How does it work and what is your role in it? It is an interesting scheme that the government has been operating for the last eight years. Basically, people below the poverty line are enrolled for this scheme.There is a smart card which is given to the customers. So, if the person or his family members have and to go to the hospital, then this smart card is swiped at the hospital and then they
IRDA has allowed health insurers to tie-up with banks, how does this help in increasing health insurance coverage? Are you in any such tie-ups? Yes, we have bank-insurance tie-ups with Union Bank of India, Corporation Bank and many co-operative banks. We have been in these tie-ups for many years. Now stand-alone health insurance companies have also been allowed to tieup with these banks as per a new regulation which has come into effect from from April 1, 2015. The banks can tie-up with three general insurance companies. Thus, now IRDA has opened up the banking architecture. Today, banks can tie-up with multiple insurance companies and viceversa. Then the products of
We are the market leaders in health insurance. About 28 per cent of our business comes from health insurance. It is also growing at about 20 per cent each year customer portals so somebody can take a policy through the Internet. They don’t have to come to our office, they can go to the site and take a policy. Then we have empowered our intermediaries, so agents can issue policies, brokers can issue policies, our own marketing people can also issue policies. Somebody can use a mobile app to take a policy. So, by using technology, people can take policies in a hassle-free manner. Even in the case of settling claims, a lot of technology can
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information derived such as you can understand which kind of diseases are driving the claims and are there any problems in certain areas and so on. So, all that can be done through analytics and that is the only way to control health insurance claims because health insurance is a tough sector when it comes to claims settlement which has two aspects. One is claims service, we have to give immediate service to the customers because nobody can go to a hospital and wait for an hour. They have to be given
are admitted and given treatment as per the packages they have been enrolled for. When the card is swiped, we are intimated about the person’s details, the reason he is being treated for and the package he has opted for etc. The government has already finalised the packages and made arrangements with various hospitals to give treatment as per these packages. As per the scheme, the patient is discharged after treatment without paying anything and the hospital is paid by us.
the companies will be available for sale at these bank branches. When the customer goes to the bank, he can see which insurance company’s product is better and he can take that. Thus, it has a very positive impact for the customer. Despite significant growth, only 25 per cent of India’s population is getting covered under health insurance. So, what are the major challenges that are hindering the growth of this sector? How can they be mitigated?
Spreading health insurance is an absolute necessity, 100 per cent of people should be covered under health insurance. But it is not happening because: one there is lack of awareness, people don’t know that there is a product available that take care of their health needs, secondly, some of them clearly cannot afford to take health insurance, thirdly, there is a question of accessibility too. People want someone to come to their home, explain the benefits of health insurance. So, these are some of the reasons why health insurance has not achieved higher penetration. But, compared to other forms of insurance, health insurance has made a much deeper penetration in India. However, this has to continue, so as insurers we have to make sure that there are more intermediaries available, more foot soldiers who can reach out to customers and make our products more simple and affordable. Then I think that the penetration levels will go up. On the other hand, there are a lot of challenges on the claims side. In fact, India is probably one of those countries where there is absolutely no regulation of hospitals. The providers’ field is completely unregulated and there are lot of variations in the charges that are levied by the hospitals in the country. There is also high medical inflation in the country, every year the rates go up by 12-15 per cent. Probably, health is also one area where technology increases the cost. Newer methods and technologies actually means higher costs, in most of the other fields, technology means lower costs. So, what is happening is that medical costs are going up and this is driving premium costs further, making health insurance even more
STRATEGY
unaffordable. These are some of the challenges that we face. If we successfully manage these challenges then we can definitely make health insurance more widespread in this country. What are the steps that the policymakers can take to tackle these challenges? First, they have to take some concrete steps to bring medical costs under control. In order to do this, there has to be some transparency, some kind of uniformity in the medical charges across the country. There must also be standardisation of the formats used by various hospitals and technology should be used in a very big way to implement it. If there is a standard format then it is very easy to settle claims and it also helps people to easily understand them. Treatment protocols should be put into place and strictly adhered to, accreditation must also be encouraged. These are some of the steps that the policymakers should focus on. As per a recent newspaper article, NITI Aayog wants more insurance models to come up in the public health arena. Whatâ&#x20AC;&#x2122;s your take on it?
Ultimately, the way health insurance should really happen is that every family should take a policy for themselves. That is the ideal form of health insurance There has always been a debate in the country on how the government should spend money on health. One is the traditional model where the government bills hospitals and provides free or subsidised treatment to people. The
other model, which we have been following for atleast a decade, is instead of spending all the money on building hospitals, you provide health insurance to people. In this way, when people take treatment, the insurance
policies help pay the bills and the money goes to the private sector who, in turn, builds the infrastructure. The advantage in the second method, where the insurers are involved, is that we bring in efficiency. When the government spends directly, there is often no control and we do not know whether the funds are being deployed efficiently. When the insurance companies are involved, we make sure that the medical costs are controlled and falls within the premium that is being charged. Hence, there is a lot of scrutiny of the claims, it brings in transparency, efficiency and better documentation. I believe this is the reason why NITI Aayog feels that insurance models are the way to improve public health. What are the three big changes that have occurred in the health insurance sector in the last three years? One would be the way the claims are being settled. We didnâ&#x20AC;&#x2122;t have the cashless model before. In the last fifteen years, the cash-less model has been introduced. Today, people go to the hospital and show their insurance policies to take their treatment
without paying any money upfront. Earlier people had to spend money and claim reimbursement from the insurance companies. This is a major change. The second thing is product innovation. Earlier, there were very limited products in the market. Today, around 200250 products in health insurance are available. So, a lot of new products which are suitable for different segments of the society have evolved over the last fifteen years. Third is the increasing use of technology. Today, technology is used in a big way in every space of health insurance, be it procuring health insurance, managing it or claims settlement. What are your expectations from the budget this year? As insurers we expect reduction in taxes so that health costs can come down. We also recommend that service tax should not be not charged from health insurance policies, so that health insurance premium costs can come down, third is that the exemption limit in Section 80 D be reduced so that a large number of people can opt for health insurance. lakshmipriya.nair@expressindia.com
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STRATEGY INSIGHT
Lessons from humanitarian emergencies Edmond Fernandes, CEO, Center for Health and Development (CHD) and Homolata Borah, Research Scholar, Jawaharlal Nehru University elucidate on the the lessons to be learnt from humanitarian emergencies to reduce the impact of such disasters in future
D
Post MBBS, the Ministry of Health should evolve expertise in the field of disaster health. This workforce should be the single focal point that interfaces with NDRF and SDRF to advance conversations in disaster health. There should be a one-year field based fellowship in disaster health and it should be open to MD â&#x20AC;&#x201C; Community Medicine Physicians as a priority upwards. Alternatively, Ministry of Health should also provide opportunity for PhD scholars and MPH Professionals to take up Disaster Health Fellowships.
Goodwill and chance
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HOMOLATA BORAH Research Scholar, Jawaharlal Nehru University
Considering Fellowships in Disaster Health
isasters not only destroy the very fabric on which the nation gets built but also hijack growth and affect the lives of multitudes who are struggling for existence. Natural disasters affecting India is not something new. We have had man-made disasters too like the Bhopal Gas tragedy, but whether we have learnt our lessons from them remains an open question.
India has been relying on the goodwill of the private sector organisations and registered humanitarian organisations to manage mass casualties, provide medical relief and establish rehabilitation wherever needed during any disaster. Often so, disasters bring out the best of human intentions to reach out to those in need, but on the other hand disasters also push to its very limits, the struggle for survival. The human mind goes beserk and chaos sets in, bordering on desperation. In such situations, public anguish is understandable. Disasters also activate alternative human behaviour and mobs often resort to robbery and loot. Women are subjected to molestations, many others become vulnerable to rape, children are trafficked and abused and the elderly are beaten up and often neglected. Much depends on the magnitude of the disaster and the time gap before any help reaches the affected populace. A well-known publication,
EDMOND FERNANDES CEO, Center for Health and Development
A dismal scene of an area affected by floods in Chennai
in its August 2015 edition, carried an investigation into the rising flesh trade after the Nepal earthquake. The report said that traffickers use several strategies to defraud and lure girls into the sex trade. On an average, Rs 60,000-75,000 is what they earn by selling a girl to a brothel. The onus lies on the government to increase security checks to halt such practices anywhere during humanitarian emergencies. The government remains the single most powerful machinery that can address this menace.
Security for aid workers and agencies Providing security to workers who give relief to the victims is imperative because many of them are new to the local turf. Female aid workers need to be
given extra care because of obvious reasons. It is important that aid agencies inform the local police of their presence and ask for security if it is feasible. During major relief camps and distribution of relief goods, it is extremely important for the military and police personnel to be present, failing which the aid workers sometimes get beaten up, are misinterpreted and untoward incidences occur.
Disaster readiness Disaster readiness calls for engagement of communities in creating resilience. Readiness of doctors, social workers and corporates to support such emergencies is a consciousness that is in evolution. The district administration should map and identify areas to be converted into field hospitals during disasters and
for emergency relief and rehabilitation. Disaster readiness must originate from school curriculums and must be enforced at higher education levels as a compulsory practice.
Need for a basic law of national resilience Repeated floods year after year and other natural calamities like earthquakes, droughts, the time has arrived to push for a basic law of national resilience which should be an Act of Parliament. This law should direct the district authorities to have defined, workable targets towards disaster resilience and mitigation. Regular training programmes in capacity building should be enforced. We need to move beyond our usual reactionary approach and view disasters through the prism of a national priority.
Discouraging disaster tourism Disaster spots require specific skills and unless the individuals are well equipped and have the experience of working in disasters, it behoves them to not venture into disaster tourism. More mess is created than good by circulating messages without authenticity and confirmation. Even journalists who have not reported in disasters before should be briefed before they begin reporting on the event. It would be wise for newcomers to work with seasoned organisations and learn the art of disaster risk reduction and the approach towards humanitarian emergencies. In India, apart from the Disaster Management Act 2005, it remains a science in evolution. Little has been done, and there is much more left to do.
IT@HEALTHCARE INSIGHT
Patient experience management: Key to progress Sreejit Menon, Analytics Practice Head - IT Services, Happiest Minds Technologies emphasises on the growing importance of patient experience management and elaborates on leveraging technology to ensure it
E
xperience management is key to any industry. Understanding and managing 'experience' could be for external as well as internal stakeholders, but to a large extent experience management is focused primarily on the end consumer and more so in a B2C context. To elaborate further, in the telecom industry, customer experience management (CEM) is the second most critical focus area after revenue assurance. in the hospitality industry, experience management, more popularly known as guest experience management, is the single most critical area and is mapped to the guest cycle (pre-arrival, arrival, occupancy, departure and now post departure as well). In the travel industry, it becomes passenger experience management which is directly associated to top-line as well as bottom-line growth apart from operational efficiency like fleet management and optimisation, asset management and predictive maintenance, etc. Similarly, in the healthcare industry, patient experience is key to customer acquisition, delight and retention. The core principles of experience management are more or less the same for most industries, though the life-cycle, processes and data would be specific to the respective industries. Understanding the experience is not just a topdown approach mapped to the customer journey (across various consumer touch points) but also a bottom-up approach
personalised for every customer across the customer life-cycle (per-acquisition, new, mature /growing /engaged and loyal). In the healthcare industry, patient experience management is not just about the in-hospital experience, but research says that two-third of an individual's interaction with a healthcare provider is as a customer, pre and post treatment. Only a third of their experience is as a patient during treatment and during the hospital stay. External data like brand reputation, sentiments, etc. would play an important role as much as the knowledge of the customer from the internal patient demography, patient treatment progress notes, billing information, etc. Experience of internal stakeholders like physicians, nurses and other supporting staff is also critical since it is directly correlated to patient experience. While the in-hospital experience like waiting time, nursing care, choice of food, cleanliness and even parking, etc. is core to the patient experience, the provider selection is subject to awareness (diagnosis, doctors as key opinion leaders), access (choice of healthcare provider based on vicinity, insurance coverage, channels of reach, knowledge of availability of referenced doctors, treatment etc.) and transitions (communication with referring physician, follow-up visits, call backs for assistance, wellness services, etc.) are critical elements apart from online recommendations, buzz and sentiments that pro-
SREEJIT MENON Analytics Practice Head - IT Services, Happiest Minds Technologies
vide good reference during online search. People often choose their care providers after a lot of due diligence and influence by various stakeholders including referrals from professional as well as personal circles. While the hospitals endeavour to optimise the length of stay (LoS) for every patient, they are also striving to provide custom and personalised experience. Some of them have already embarked on digital transformation journey including real-time patient health monitoring and measuring patient experience including waiting period monitoring using wearables like RFID wristbands, introductions of kiosks and mobile apps for self-service including doctor appointment booking, billing (optimised using simulation), choices in cuisines based of personalised diet recommendations and allergies, etc. As an example of a PEM initiative, a major hospital in Texas, US, developed custom hardware (custom remote control, pillow speakers, etc.) and software, integrated the same with customer mobile phones as well as in-room wall-mounted television sets to provide a seamless and person-
alised experience (including media experience) to the patients. The patients could view their individual schedule, order food, read messages, make calls, view media content specific to their diagnosis, review progress, provide real-time pain indication and notification to nurses who monitor the same on a dashboard among other services from either one of the input devices â&#x20AC;&#x201C; custom remotes or mobile app. At the backend, multiple service providers were integrated to provide a seamless unified experience. One of the ways of implementing a patient experience analytics platform to enable a PEM solution would be to create a data lake on a Big Data platform that would not only include standard information coming from traditional source systems like patient demographics including socio-economic state and health condition (including electronic health records), coverage (care programme, insurance, etc.), referral information (both external and internal), provider and practice details, department and staff details, facilities and rates, diagnosis and treatment facts, tests/cultures details and facts, etc., but also operational information about location and time spent by patients, feedback and survey inputs from patients/visitors from traditional as well as social media and key websites, enquiry and appointment details, etc. This is apart from data coming from various sensors including medical instruments and wearable devices
including patches that can track sensor enabled pills apart from recording patient rest and activity patterns. Various patient experience views can then be created based on existing KPIs like patient foot fall/admissions, outpatient/inpatient ratio, admission turn over rate, net and average patient revenue, average length of stay/patient days, bed occupancy rate, average procedure/ surgery count and length, etc. or newly suggested or defined experience management KPIs to provide a view of the micro as well as macro level customer experience â&#x20AC;&#x201C; both at an individual as well as an aggregate level. For example, aggregate views like patient history, patient journey, etc. could be created to give a holistic view and personalised recommendations can be provided to individual customers based on their health status. Analytics models can then help to not only understand and suggest where changes need to be made to improve patient experience but they can also be built to predict key performance indicator (KPIs) like bed utilisation in coming weeks, months as well as to improve business efficiency by optimising assets and resources. Cloud-based Big Data analytics platforms, enabling patient experience analytics and management, can help providers better understand the actual patient experience, the key driving factors for enriching the same Continued on page on 40
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Strategies to foray into healthcare IT
JP PATTANAIK Sr Business Analyst United Health Group
JP Pattanaik, Sr Business Analyst and Akanksha Rajeev, Business Consultant, United Health Group, in this article, provide an insight to various strategic options for Indian IT product-centered organisations to consider foraying into healthcare industry
Picture used for representational purpose only
T
he lucrativeness offered by the healthcare IT industry has brought significant attention worldwide. Healthcare industry is considered ever green and healthcare IT has attracted the attention of global players for investments.
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There are a section of players who are pioneers in the industry and have recorded significant growth. At the same time there are laggards who want to build such capabilities and tap the untapped market following the recent industry trends and success stories. Healthcare IT
organisations have to cope with transforming business model while adhering to strict regulatory demands of the industry. They need to carefully adopt strategies based on the organisational maturity, capital and the time they have for go-to-market. In pursuit of
quick success, often organisations commit mistakes choosing the right approach while building potential health IT product capabilities. This article highlights different strategic options for Indian IT product-centered organisations thinking of foraying into the healthcare industry.
AKANKSHA RAJEEV Business Consultant, United Health Group
Region
Spending as a per cent of GDP
North America
16.5 per cent
Western Europe 10.5 per cent Latin America
7.5 per cent
Asia/Australia
6.5 per cent
Global healthcare and healthcare IT spending trends
Middle East/Africa
6.1 per cent
According to industry estimates, the global healthcare spending is expected to grow at an average of 5.2 per cent year on year during 2014 – 2018 to a total of $9.3 trillion. In spite of its vastness, both developed and emerging nations are dealing with issues like ageing population, rising incidences of chronic diseases, rapidly increasing cost of healthcare, disparity in quality of care, infrastructural challenges, workforce shortage, non-uniform distribution of healthcare facilities across the community locations etc. The burden faced globally today has never been so challenging than ever it was. An estimate by the Economist Intelligence Unit (EIU) the regional healthcare spending during the year 2015 is expected to be as given in the table. Globally, most nations have been challenged to improve quality of care while reducing the cost of healthcare by
Eastern Europe 5.8 per cent
means of inventing cost effective methods for an optimal outcome. The challenges described above have led to adoption of healthcare IT solutions such as Electronic Medical Records (EMR)/Electronic Health Records (EHR) for safe storage of healthcare information and to make more informed decision. According to an estimate by MarketsandMarkets, a leading research organisation, the global healthcare IT market is estimated to reach $56.7 billion by 2017 — up from $40.4 billion in 2012 — due to the demand for clinical information technology, administrative solutions and services. Among the various healthcare IT solutions offered, EMR/EHR segment dominates the sector. Gartner estimates healthcare providers in India are likely to spend $1.2 billion on healthcare IT products and
Evaluation Parameters
MODIFY
CREATE
ACQUIRE
Total Cost of Ownership
Low
High
High
Effort
Low
High
Low
Time to Market
Low
High
Medium
Market Acceptability Risk
Low
High
Low
Customisability
Low
High
Medium
Scalability
Low
High
Medium
Skilled Resource Availability
Low
High
Medium
Legal/IP Risk
High
Low
Low
Security Risk
High
Low
Low
Potential Revenue
Medium
High
High
Highly Favourable Figure 1: Strategic approaches for health IT product capabilities
services in 2015, a seven per cent growth over 2014. Software spending is likely to grow 6.2 per cent to reach $103 million in 2015, up from $97 million in 2014, led by growth in vertical specific software. An estimate by Frost & Sullivan, healthcare information technology market in India is expected to reach $1.45 billion in 2018 mainly due to fast adoption of technology by stakeholders. India being a developing nation, the health IT spending is still much less than that of the developed nations. The rest of the paper discusses various drivers for healthcare IT initiatives, its attractiveness and approaches for Indian health IT organisations for an effective go-tomarket strategy.
Drivers of healthcare IT in India Some of the major factors contributing to the growth of healthcare IT globally are listed below: ◗ The continuously growing pressure to cut healthcare costs ◗ Need for care coordination and management demanding integrated healthcare systems ◗ High rate of return on investment in healthcare systems ◗ Financial support and incentives from the government ◗ Growth of medical tourism ◗ Government initiatives, conducive policies for the sector ◗ The rise in the ageing population ◗ Growing demand of health IT products to reduce medication errors ◗ Rise in incidences of chronic and lifestyle disorders
◗ More informed and engaged patients.
Why do more and more Indian IT organisations want to venture into healthcare industry? Healthcare has a huge addressable market. India as a country has witnessed a rather steep growth trajectory only in the last decade with the advent of the private sector. The influence of technology has been an important growth driver, with healthcare models based on IT intervention now becoming a reality. The accessibility of healthcare today is more than it ever was, consequently increasing the opportunity for new players. Emergence of new delivery models which are
Not-Favourable
Moderately Favourable
Figure 2: Evaluation of the approaches
scalable, less capital intensive and yet promise better earnings is one of the major reasons the healthcare sector has lured the investors. Diagnostic chains, single speciality clinics, wellness centres, primary care set-ups etc. are all emerging models of healthcare and it is still evolving. In a nutshell, healthcare industry provides array of opportunities for new experiments at a promising return on investments. The penetration of healthcare IT is still in its infancy providing ample opportunities to all competent healthcare IT solution providers. With increased importance to healthcare needs, the adoption of modern healthcare IT systems is bound to grow.
Approaches for go-to-market In order to tap the business opportunity presented by the IT enablement of healthcare institutions, the IT organisation should evaluate options and consider one that suits the best. A single approach may not fit all. In pursuit of quick success, often IT organisations opt for suboptimal options, which may not meet their long term objectives. Following are the three strategic options to realise the business opportunity presented by healthcare IT market: ◗ Approach 1: MODIFY Enhancing an open source software ◗ Approach 2: CREATE
Building a greenfield system ◗ Approach 3: ACQUIRE Acquiring a licensed product The table below provides the advantages and disadvantages associated with each of the approaches. An organisation should evaluate the functional, technical and business capabilities while prioritising a strategic approach. Each of the approaches can be evaluated based on the following parameters:
Cost and effort Total cost of ownership (TCO): Total cost of ownership refers to the cost to the organisation for sustaining a product line. This includes the license fee for the product and cost of the application maintenance
PROS AND CONS WITH DIFFERENT APPROACHES Approaches
Advantages ■ No licensing fee ■ Internationally adopted and operated.
MODIFY (Enhance an Open Source Software)
■ Quicker go-to market time ■ Can be enhanced and used privately. ■ Low effort and investment.
Disadvantages ■ Overlaying IP issues ■ Runs the risk of selecting not the best suited
system. ■ Risk of unknowns around open source
technology ■ Dedicated IT support
needed
■ Limited ability to customise ■ Ability to create a Greenfield system. ■ Can be a stand-alone or a complementary
CREATE (Building a System from Scratch)
product. ■ High level of ownership, customisation and flexibility. ■ Compare the leading products and develop a better one.
■ High upfront investment for building the system ■ High cost of ownership. ■ High cost of licenses, system maintenance and
updates ■ High risk as market reaction unknown. ■ Longer go-to market time. ■ Dependence on technical and functional
expertise for development and maintenance. ■ Can involve huge investment. ■ High cost of ownership.
■ Internationally adopted and operated.
ACQUIRE (Acquiring a Licensed Product)
■ Reduces overall effort and go-to market time.
■ High cost of licenses, system maintenance and
updates, even with a limited customer pool.
■ Scalable systems.
■ Dedicated IT support.
■ Leverage brand image of the acquired product.
■ Runs the risk of selecting not the best suited
system. ■Runs the risk of over-valuation.
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IT@HEALTHCARE and support. Effort: This is the effort that needs to be put in by the organisation to meet the desired product criteria driven by Customer/Market needs. Potential Revenue: This refers to the revenue that would be generated by the organisation on entering the market with the stated product.
Market factors Time to market: This is the time taken to launch the product in the market for customers. Market acceptability risk: The risk that the product launched into the market is not accepted by the clients. This is particularly high for a new product launch.
System related factors Customisability: The capability of a system to be easily customised for desired features. Creation of a greenfield system offers the highest amount of flexibility as it can be designed keeping product expansion in mind. Scalability: The capability of a system to be easily scalable for larger implementations. While a greenfield system can be designed to be scalable an open source or acquired product may have limitations. Skilled resource availability: The major constraint of a system is the technology stack that it is built on. Having technically sound resources trained exclusively on the same platform is one of the major factors for system selection.
Gartner estimates healthcare providers in India are likely to spend $1.2 billion on healthcare IT products and services in 2015, a seven per cent growth over 2014 Legal/IP Risk: Enhancing and commercialising existing open source systems would give rise to potential legal risks. Some systems are covered under various public licenses which prohibit the commercial use for profit. Security risk: With the ever growing population that is being catered through the IT enabled system, security of the healthcare data plays a vital role in the evaluation of a system. Many laws of the land mandate patient privacy and prohibit the transfer or usage of the healthcare data and thus require utmost authorisation and protection for the same. Any shortcomings in the system that compromises patient data security would pose a security risk. The evaluation of each of the approaches based on the above mentioned parameters are summarised in Figure 2.
Key considerations A greenfield system though requires investments, is a safer approach as it minimises some the risks demonstrated in other two approaches. However, all organisations may not be in a position to have proprietary systems to exploit the immediate market
opportunities presented. The pioneers always have the advantage to exploit the market opportunities with less competition. New players should carefully choose the market segment they want to make an entry. When an organisation lacks significant market presence and experience, it may be recommended that the organisation should take baby steps and stay profitable yet. A big bang approach may not support the ultimate objectives of the organisation. In this context it may be recommended to health IT vendors that the Approach –‘MODIFY’ can be considered as a short term strategy with an objective of learnings, small scale implementations and R&D. Approaches – ‘CREATE’ and ‘ACQUIRE’ can be considered as long term strategies with an objective of achieving the vision of the organisation. Approach - CREATE demands investment in terms of time and ensuring the product exceeds expectations than a competing product while approach – ACQUIRE enables the organisation a quicker go-to-market for realising the opportunities. However, the risks associated with the
approach must be given due consideration.
Conclusion The lucrativeness of the healthcare IT market has received significant attention. It is an obvious choice to exploit the opportunities presented. The pioneers and the laggards are equally keen to make the best of the opportunities. An approach that works best for a pioneer may not be of same value to a beginner. In pursuit of quick success, organisations should not commit the mistakes of engaging in a wrong approach to make a foray in hurry. It has been rightly said, “There is no shortcut to success.” Organisations need to carry out a risk and return tradeoff before formulating and executing any strategies for the best possible outcome.
References i. 2015 Global Healthcare Outlook. Common Goals and Competing Priorities By Deloitte, Whitepaper, 2015. (https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-HealthCare/gx-lshc-2015-health-care-ou tlook-global.pdf) ii. Global healthcare IT market estimated to reach $56.7B by
2017 By Ashley Gold, News Article, FierceHealth IT, May 10, 2013. (http://www.fiercehealthit.com/st ory/global-healthcare-it-marketestimated-reach-567b-2017/201305-10 iii. 2014 Global health care outlook: Shared challenges, shared opportunities By Deloitte, Whitepaper, 2014. (https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-HealthCare/dttl-lshc-2014-global-health -care-sector-report.pdf) iv. Overview of International EMR/EHR Markets: Results from a Survey of Leading Health Care Companies By Accenture, Whitepaper, August 2010. (http://www.accenture.com/Site CollectionDocuments/PDF/Accenture_EMR_Markets_Whitepa per_vfinal.pdf) v. Healthcare IT market in India may touch $1,454 million: Study (http://timesofindia.indiatimes.co m/tech/tech-news/Healthcare-ITmarket-in-India-may-touch-1454million-Study/articleshow/24142487.cms) vi. IT spending by Indian healthcare providers may rise 7 per cent in 2015, Gartner says (http://timesofindia.indiatimes.co m/business/india-business/ITspending-by-Indian-healthcareproviders-may-rise-7-in-2015Gartner-says/articleshow/472957 10.cms)
Disclaimer The ideas and opinions shared in this article are personal views of the authors and have no bearing or impact on the official policy or position of United Health Group or its entities
Continued from page on 37
Patient experience management... and enable custom offerings and campaigns to the target patient groups for optimal reach and response with the overall aim to enhance the patient experience and satisfaction, at a fraction of a cost of in-house development. There are quite a few digital
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healthcare companies which have already created and are offering solutions around wearable insights and patient monitoring, connected care, genomic and clinical data integration, telemedicine, content analytics (medical/health records) and predictive personalised health
analytics to name a few. With progress being made in the healthcare industry towards enabling services like targeted treatment via integration of genomic and clinical data using big data, stem cell therapy and regeneration, 3D printing of body parts and or-
gans, and successful robotic surgeries managed remotely (more of a reality than a concept that was being brainstormed a few decades ago) it is just a matter of time that artificial intelligence powered healthcare self service solutions and applications would
evolve to enable and enrich patient experience management and drive even larger causes like helping fight and control any disease outbreak on a mass scale and perhaps go on to become the corner stone for humankind's progress towards immortality!
IT@HEALTHCARE INSIGHT
Living longer, better, healthier—thanks to technology Steve Lucas, President, SAP Platform Solutions Group elaborates on the role of technology in enhancing access and effectiveness of healthcare delivery
W
hat do diabetes, cancer and the Notre Dame Soccer team have in common? Well I'm about to tell you! Some of the scariest words a person can hear from their physician are the words cancer or diabetes. In the case of diabetes, I can almost guarantee that every person reading this either has a family member with diabetes or knows someone who does. I am one of those people with type-1 diabetes, (the rarer form of diabetes) which along with type-2 diabetes affects almost 30 million Americans. While I have had this immune disorder for nearly 20 years, for the past five years I have been able to automatically measure my blood sugar every 1-5 minutes, which has radically improved how I manage my diabetes. How? Through the Internet of Things! I wear a sensor on my body that constantly monitors my blood sugar and warns me if my levels are too high or too low—this can literally make the difference between living and dying. I can even share the blood sugar data from my sensor with my doctor and family over the Internet, through my cell phone. This past year alone, I have received more than 5,000 high or low alerts and collected more than half a million rows of data about my blood sugar. Coincidentally, I will have to take around 3,000 insulin injections this year to adjust my blood sugar accordingly - but knowledge is power and I am able to control my diabetes at
STEVE LUCAS President, SAP Platform Solutions Group
The wearables market is growing quickly. By 2021, it’s predicted to hit $14.9 billion – quadrupling from where it is today near normal, non-diabetic levels thanks to this technology. I am absolutely amazed by how technology is continually changing and improving the way we treat, and in some cases prevent, diseases based on the analysis of personal and aggregated medical data collected on a global scale. I like to tell people that "I am
the Internet of Things!" Imagine what we could achieve if we were to combine my blood sugar readings with anonymised data from the other 30 million people in the US dealing with diabetes, then analyse it using sophisticated analysis and data mining technology (like SAP HANA!) to identify patterns,
trends, and even root causes that could be used to better tailor treatment plans to the patient. Healthcare professionals could use this information to not just treat symptoms of the disorder, but address the problem head on. It is incredibly powerful to know that someone on the other side of the world could
benefit from me sharing my personal medical data in order to live a longer and healthier life. With this in mind, I want to share another story of a truly inspiring individual. My SAP colleague, Franz Deitering, has been battling cancer since 2008 when doctors discovered a walnut-sized tumour in his intestine. Franz feels okay now, but he wants to take steps to make sure he has defeated cancer for good and there will be no recurrence. Last November, he read about an SAP-sponsored programme called Corporate Oncology Programme for Employees (COPE), and seized the opportunity to enroll, after discussing it with his doctor, Professor Dirk Jaeger from the National Center for Tumor Diseases (NCT) in Heidelberg. The COPE programme was developed in conjunction with partner MolecularHealth and enables doctors to make better treatment choices based on individual genetic data. Until now, cancer treatment has been based on purely empirical data, which means there is a fixed therapy for colon tumours or breast
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February 2016
IT@HEALTHCARE cancer at a certain stage. This new approach is different. Since each instance of cancer is unique and the treatment that may save one patient might not work for another, it is imperative to be as precise and data-driven as possible. By processing genetic sequencing data powered by SAP HANA, MolecularHealth rapidly analyses a tumour’s precise characteristics. The analysis includes information about drugs and side effects. Doctors can then use this intelligence to develop a personalised treatment plan for a particular patient. Not only are physicians able to make better-informed, safer treatment decisions. They can treat patients more efficiently and effectively. As an added bonus, the patient should experience significantly reduced medicationprovoked side effects. Franz received his results from the COPE programme at the beginning of spring. To participate, his doctor had to send in Franz’s blood and tissue samples. Even though the results have not required any changes in his treatment so far, Franz says he feels well prepared should the cancer
The stakes in healthcare are enormous. But thanks to IT, healthcare is becoming personal, predictive, and preventative – perhaps not surprising when you consider that this sector alone generates 30 per cent of the world’s data. In fact, we will never stop generating data. Every heartbeat, every commute, every purchase, every interaction adds to the growing sea of information return. But, since we ultimately want to prevent disease rather than just treat it, let’s talk about preventative healthcare. Staying healthy is critical to an athlete’s performance and Notre Dame's Director of Sports Science, Matt Howley, was tasked with keeping his athletes at the top of their game when he started working with the men’s soccer team three years ago. As a result, he introduced the team to a new athlete monitoring technology by Catapult. The small GPS device is worn by the players
in all games and practices and uses satellite technology to measure how far or fast a player runs, how many times they sprint in a game, and various body movements. The data Howley has been able to collect has transformed the team and revitalised their fitness programme, helping his players stay on the field and away from injury. The wearables market is growing quickly. By 2021, it’s predicted to hit $14.9 billion – quadrupling from where it is today. Can you imagine the amount of data that will be generated as a result?
Sports is a digital business. Hyper-connectivity, supercomputing, cloud computing, smart devices and cyber security are five mega trends driving digital transformation in sports. The teams that digitize will be the ones that gain a competitive advantage. At SAP, we’ve created what we call the Digital Athlete Framework based on SAP HANA. With the power of HANA, teams can now leverage big data from sensors, video and social and bring all data signals together across massive historical data sets, enabling the perfect predic-
tion and recommendation for player fitness and performance. It’s a powerful weapon for the $100 billion global sports industry. So what links the diabetic, the cancer patient and the athlete? Data – mountains of it. Consider this: during one hour of soccer training, 77.7 million data points are captured and processed. The stakes in healthcare are enormous. But thanks to IT, healthcare is becoming personal, predictive, and preventative – perhaps not surprising when you consider that this sector alone generates 30 per cent of the world’s data. In fact, we will never stop generating data. Every heartbeat, every commute, every purchase, every interaction adds to the growing sea of information. As a diabetic working in high tech, I'm excited that we’ve developed the tools to reach into that immense amount of noise generated by data, isolate the information we can use, and then share the resulting learnings with the whole world making everyone's lives better and more full.
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Dr Pradeep Chowbey honoured byJapanese Society of Endoscopic Surgeons He was recognised for his contributions in the field of minimal access and bariatric surgery DR PRADEEP Chowbey, Chairman of Max Institute of Minimal Access, Metabolic and Bariatric Surgery and Executive Vice-Chairman, Max Healthcare, was recently felicitated with the honorary membership from the renowned Japanese Society of Endoscopic Surgeons in Osaka, Japan. The Japanese Society of Endoscopic Surgeons is a body working to-
wards the development of endoscopic surgery globally. Dr Chowbey was recognised for his contributions in the field of minimal access and bariatric surgery.
Commenting on the prestigious recognition, Dr Chowbey said “I feel honoured to receive this felicitation and I am deeply thankful to the Japanese Society of Endoscopic Surgeons. It
is a proud moment to receive the recognition for my work from a widely respected association. These memberships and awards further strengthen my resolve to continue to do revolu-
tionary work in the field of laparoscopic and bariatric surgery.” Dr Chowbey was one of the first surgeons to recognise the increasing prevalence of obesity in India and looks at bariatric surgery as a mainstream medical solution to treat this problem, if the said issue cannot be resolved through lifestyle changes, healthy eating and other medical intervention. The Max Institute of MAMBS was accredited as the Founder International Centre of Excellence for Bariatric Surgery by the Surgical Review Corporation (SRC), USA (2010) and Centre of Excellence in Endohernia by the Asia Pacific Hernia Society. The institute is the first centre to receive these accreditations in India under the leadership of Dr Chowbey.
Medtronic announces Dr Nagendra Swamy joins retirement of Milind Shah - Manipal Hospitals as Group VP India Subcontinent MedicalDirector MEDTRONIC PLC, recently announced that Milind Shah, Vice President, India Subcontinent (ISC) and MD, India Medtronic, will retire on January 15, 2016. The company’s senior management is conducting a full internal and external search for Shah’s replacement. “We deeply appreciate the significant contributions Milind has made to Medtronic. He has been instrumental in achieving market growth, regaining share and demonstrating thought leadership through a cadence of successful product launches and business model innovations,” said Bob White, Senior Vice President and President, Asia Pacific. “Milind has led by example,
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guided by the Medtronic Mission to alleviate pain, restore health, and extend life”, he adds. "I made the decision to join Medtronic motivated by the potential of medical technology and the power of our Mission,” said Shah. The breadth of the Medtronic portfolio and the depth of the company’s reach are supported by a talented team who are committed to ensure that patients have access to our innovative therapies. I am confident that Medtronic will be able to provide value to the Indian healthcare system with strong partnerships for continued growth and success. Shah joined Medtronic as MD in 2004.
In his new role, Dr Swamy will represent the interests of clinicians and the clinical activities of the organisation. MANIPAL HOSPITALS has announced the appointment of Dr Nagendra Swamy as the Group Medical Director of Manipal Hospitals. In his new role, Dr Swamy will represent the interests of clinicians and the clinical activities of the organisation. He will facilitate and identify clinical specialities to be introduced and emphasised in each unit in discussion and consultation with the COO/regional heads; devise and implement strategies to attract and retain clinical talent; initiate
standardisation of clinicalprotocols/audit/outcomes/clinical indicators/medical ethics and institutionalise processes to measure adherence. In addition to this new role, Dr Swamy will continue to be responsible as Chairman of the Quality Council, Management of teaching hospitals, Nursing Operations, President for Private Hospitals and Nursing Homes Association (PHANA). He will continue to lead the ‘Build Manipal Way’(BMW) Project and will chair the Med-
ical Advisory Board. Dr Swamy is a member Accreditation Board for Healthcare Sector Skill Council –India, PresidentPrivate Hospitals and Nursing Home Association (PHANA) and CoChairman, Tourism & Wellness Expert Committee of the BCIC. He is also a recipient of various coveted awards including the Doctor’s Day Award conferred by Government of Karnataka and also awarded as distinguished alumni by Manipal University.
TRADE & TRENDS
Halyard Health's surgical masks addresses today's healthcare needs The mask packaging is clearly labelled with the level of protection according to the ASTM International Standard WEARING A face mask that does not have a fluid-resistance rating may leave one inadequately protected whilst performing procedures that generate splashes or sprays of blood, body fluids, secretions or excretions. Concentration of viruses circulated in the blood can reach up to 10,000 viruses/ml for HIV, 1 million/ml for Hepatitis C, and up to 10 trillion/ml for Hepatitis B?1 What is particularly worrisome is that a clinical trial confirms that these potentially contaminated blood drops strike the head and neck of operating theatre staff more than 25 per cent of the time during surgery2. Further, a clinical study confirms that more than 90 per cent of the time, surgeons, who are focused on their patients, are unaware that they have been struck by contaminated fluids3. This fact alone underscores the importance of surgeons having access to the right mask to protect themselves.
How can one be sure about getting the protection one needs? To make it easier to select the right level of mask protection, the American Society for Testing and Materials (ASTM) International and the US Food and Drug Administration (FDA) developed mask labelling based on test performance criteria. Within the ASTM International Standard, there are three categories of protection, with Level 1 representing the lowest level of protection and Level 3 representing the highest level. For fluid resistance, masks are
required to withstand a pressure of 80 mmHg in order to meet the Level 1 criteria, 120 mmHg to meet the Level 2 criteria and 160 mmHg to achieve a Level 3 rating. The ASTM International Standard requires that face mask packaging has a graphic display that clearly states the mask’s performance level. Masks that do not have this graphic display cannot be assumed to be fluid-resistant.
focused on preventing infection, eliminating pain and speeding recovery. Formerly known as Kimberly-Clark
Put safety first Halyard Health (formerly Kimberly-Clark Health Care) makes it easy to put safety first. Halyard has a full range of fluid-resistant procedure and surgical masks that meet and in some cases exceed the ASTM International Standard. All Halyard’s mask packaging are clearly labelled with the level of protection (Level 1, 2 or 3) according to the ASTM International Standard. This simplifies the process of mask selection and will help make sure that one is appropriately protected for the fluid risk that may be present.
References 1. Bennet BT 1994 American College of Surgeons 178 (2): 49 2. AORN 2011 Perioperative Standards and Recommended Practices; Romney Surgical face masks in the operating theatre: re-examining the evidence 2000; 254 3. Hosogly, Salih et al. Transmission of hepatitis C by blood splash into conjunctiva in a nurse 2003;503 About Halyard Health Halyard Health is a global medical technology company
Health Care, Halyard became an independent company on November 1, 2014. Halyard has 12,000+ employees globally and market products in more than 100 countries worldwide. Halyard’s solutions are designed to address some of today's most important healthcare needs, such as preventing infection and reducing the use of narcotics, while helping pa-
tients recover faster. Halyard is focussed on improving lives with its diverse portfolio of surgical and infection prevention products as well as pain management, digestive and respiratory health medical devices. Halyard offers innovative healthcare solutions supported by dedicated customer support, clinical research and accredited education pro-
grammes in the following clinical areas: ◗ Infection prevention ◗ Surgical solutions ◗ Respiratory health ◗ Digestive health ◗ Pain management Contact Halyard Health India World Trade Centre, Tower 1, Unit 308, Opp. Eon IT Park, Kharadi, Pune - 411014
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Organ donation at KMCH Coimbatore gives fresh lease of life to six people KMCH, Coimbatore emerges as the only multi organ transplant centre in Tamilnadu ORGAN DONATION in India is still at a nascent stage. But there are many noble minds who take brave and sensible decision when it matters the most. A recent incident at KMCH Coimbatore highlighted the importance of taking a timely decision to do-
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nate organs which in turn can save several other lives. S Thangavelu, the father of a deceased five and half-yearold child, T Janasruthi, voluntarily came forward and donated his child’s organs. On the fateful day on January 2, 2016, Janasruthi was on her way to attend school (she was a student of first standard of Govt Middle School, Thanthonimalai). She was travelling in a two wheeler along with her mother and sister. An accident took place near Thanthonimalai in Karur district of Tamil Nadu where Janasruthi suffered from severe head injury. She was administered first aid at a
hospital near the accident spot, from where she was brought to a private hospital for treatment in Coimbatore. After a couple of days, the situation worsened and the child was shifted to KMCH for better treatment. On January 5, 2016, after a visit by a team of doctors from Coimbatore Govt Medical College Hospital, she was declared brain dead. Thangavelu approached the doctors at KMCH and wanted to know whether the child’s organs can be donated. Subsequently, Janasruthi’s organs were harvested at KMCH. One kidney was sent to Fortis, Chennai, another
was given to KMCH, Coimbatore, one heart valve was sent to Madras Medical Mission, Chennai, the liver was sent to Apollo, Chennai and the eyes were donated to Arvind Eye Hospital. Thangavelu’s timely decision made his daughter’s organ reach six different people and made them smile forever. Dr Arun Palaniswami, Director – Quality Systems, KMCH, Coimbatore expressed
his gratitude and was all praise for Thangavelu and his family for their timely action in extending the consent. He also made a note that with an increasing awareness on organ donation, KMCH, Coimbatore is completely equipped with its infrastructure to donate/receive/transplant organs 24/7 and 365 days a year. It has emerged as the only multi organ transplant centre in Tamil Nadu.
TRADE & TRENDS
Tolexo eliminates structural inefficiencies in healthcare eco-system Tolexo has been striving to bring in quality as well as quantity, by enriching the sub segments in medical supplies IF THE recently concluded Indian Medical Expo 2016 is anything to go by, the medical electronics industry, presently, is expanding at the rate of 17 per cent CAGR. This expansion, it attributes to the increasing aged population with easy availability of up to date healthcare solutions and most importantly the increasing disposable income. Down pinning this growth is the fact that medical sector still has infrastructural, technological and production deficiencies. “Contemplating the market sentiment, there is an urgent need of a makeover, waiting to happen for a long time now,” said Navneet Rai, Co-founder, Tolexo, a leading market place for business and industrial goods. Going by the facts stated above, medical supplies has
seen an uptick in demand but not in supply. Worth mentioning is the growth in the last couple of months, for Tolexo, as it introduced a complete new horizontal of medical supplies. In the not so distant past, this sector was reeling with supply side restraints (quality as well as quantity) but with a glut in demand. Tolexo’s operations in the medical supplies vertical has brought in much required assistance by solving the supply restraints with the widest assortment, competitive prices with convenient delivery services to even the most untapped markets in India. It caters some prominent sectors like Indian Army, hospitals like Metro Hospital, Mumbai; Rajeev Gandhi Hospital etc. Tolexo’s buyers also include big giants like Mahindra and
Tolexo is eyeing a huge potential in technology and internet penetration to fill up supply side deficiencies in the medical sector Mahindra, and institutes like Jawaharlal Nehru University. Certainly another trailing factor that marred the medical sector is the slackness entailing
technological advancement. Taking a note, Tolexo has on board the best brands which have contributed to technology upgradation and provide reliable healthcare solutions. Domestic demand is surging and hence, the emerging requirements for refinement, to fill the gap. As a big industrial giant, Tolexo has been striving to bring in quality as well as quantity, by enriching the sub segments in medical supplies. From diagnostic instruments to medical consumables, hospital equipment to hospital furniture, and also offering orthopedic products, it has a wide variety on offer. Product management has gained a lot of prominence as quantity shortage gives way to structural hassles. “We are stressing on the
fact that delivering the product is necessary, but product availability is the utmost urgency. Following this, we are already equipped to provide turnkey solutions to segments like pathology labs, blood banks, etc, to begin with, with more segments to be added in the near future”, expressed MK Singh, GM – Category Management, Tolexo. Tolexo’s market outreach is quite impressive as is in the case of its parent company, IndiaMart with various selling platforms which include Tolexo’s mobile app, website, telesales and direct sales team. Taking a cue from the soon to happen Express Technology Sabha, Tolexo is eyeing a huge potential in the technology and internet penetration to fill up supply side deficiencies in the medical sector.
Airox wins awards at World Entrepreneurship Summit- 2015 It was only equipment company in the event who got these awards AIROX, A Aurangabad based company, a market leader in oxygen generator business in India, achieved a great mile stone at World Entrepreneurship Summit- 2015 - "Leaders who Inspire Healthcare" which was held on December 26, 2015 at The Leela Ambience Delhi, India.
Airox received three awards at the event: ◗ Best Healthcare Enterprise of the Year 2015 ◗ Best Medical Equipment Company of the Year 2015
◗ Best Healthcare Entrepreneur of the Year 2015 (Sanjay Jaiswal) The awards were given by the following dignitaries: ◗ Satyendra Jain, Health Minister, New Delhi ◗ Dr Kirit Solanki, Member of Parliament) ◗ Dr BK Chopra , Indian ARMY Medical Services - Director General ◗ Major HP Ahluwalia (Padma Bhushan, Padma Shri and Arjuna Award winner) Airox was only equipment company in the event who got
In 2014 Airox received the ‘Fastest Growing Indian Company’ award at the International Achievers Conference these awards. The jury had 11 members. Airox has been chosen amongst various companies in the Indian healthcare equip-
ment segment. Airox has a head office in Aurangabad and branch offices at New Delhi, Kolkata and Vapi,
Gujarat. It has installed its systems in all states of India, the company has 100 employees and 15 distributors across the India. In 2014 Airox received the ‘Fastest Growing Indian Company’ award at the international achievers conference. This Aurangabad-based company is doing great work on the national level and Sanjay Jaiswal, MD, Airox technologies has been complimented for this great success. For more details, visit www.airoxtechnologies.com
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Expressions Electric Bed Warmers cut electricity bills by over 90 per cent It comes with one year warranty against manufacturing defects EXPRESSIONS ELECTRIC Bed Warmers are simple to use, extremely safe and very cost-effective compared to other heating solutions. It is easy to buy-use-maintain product which has revolutionised the concept of in-house heating. One needs to simply spread the Expressions Electric Bed Warmer under the bed sheet and over the mattress and warm the bed. The bed warmer’s comfort controls provide two warming settings to provide exact personalised comfort. This dual comfort control allows to customise and control the heating of the part of the bed. So two people sleeping on a double bed warmer
can adjust the heat levels on their side of the bed as per their choice. The company offers dual controls on the full sizes and single controls on single bed sizes. The bed warmers are 100 per cent safe to use and resistive to electrical shocks, excessive power supply and overheating. The temperature is thermostatically controlled and maintained to provide the user a night of restful sleep. In case Expressions Electric Bed Warmers are used in an unsafe manner like --bending or over heating of a wire, the system automatically turns off to prevent damage or injury. Each Expressions Electric Bed Warmer is made from two sheets of fine weave, preshrunk polyester and polar fleece cloth quilted together with bonded polyester fill in between, similar to a high quality mattress pad. The closely quilted seams form tunnels that hold the heating element wires inside for uniform heat distribution. It is durable, of
high quality and backed by direct factory service, if ever needed. Each product is covered by a full one year warranty against manufacturing defects. Expressions Electrical Bed Warmers cut electricity bills by
over 90 per cent as opposed to the use of traditional room heaters. They come in a range of sizes and colours, with costs ranging between Rs 2,199 and Rs 4,999. Bed warmers are recommended by doctors for the pa-
tients having joint pains, back pains etc. This is because one can get constant heat throughout the night and this decreases joint pains. Contact http://www.expbedwarmers.com/
Carestream’s earns 61 US patents in 2015 Gets 64 additional patents in other countries CARESTREAM HEALTH was awarded 61 new patents from the US Patent and Trademark Office in 2015 for innovations in radiography, cone beam CT imaging, healthcare IT, dental imaging and other areas. The company also received 64 additional patents in European and Asian countries last year. “These patents demonstrate Carestream’s continued success in developing and protecting advanced technologies across our global businesses,” said Susan Parulski, Chief
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Patent Counsel for Carestream. “We are committed to delivering new products and technologies that are reliable, easy to use, and enable our customers to improve the quality and value of their services,” she added. New patents earned by the company include:◗ New image capture technologies related to the development of cone beam computed tomography (CT) systems designed for orthopedic extremity imaging. ◗ Enhancements to Care-
In 2014, Carestream was awarded 66 patents from the US Patent and Trademark Office
stream’s proven portfolio of healthcare IT systems that manage, store and share patient data and medical imaging exams. ◗ Continued technology advances in Carestream’s portfolio of radiology systems that can enhance medical image quality for a wide range of healthcare providers. ◗ New technology and features for dental imaging, dental image processing and software and dental restoration systems. ◗ Continued developments in Carestream imagers and media
that provide affordable printing of digital X-ray exams onto medical film and paper. ◗ New product features for Carestream Advanced Materials in the area of transparent conductive films for use in flexible touch panel displays for such products as digital wrist devices, smart phones, digital tablets, laptops and electronic displays. In 2014, Carestream was awarded 66 patents from the US Patent and Trademark Office as well as 34 patents in countries outside of the US.
REGD. WITH RNI NO. MAHENG/2007/22045, POSTAL REGD. NO. MCS/162/2016 – 18, PUBLISHED ON 8TH EVERY MONTH, POSTED ON 9TH, 10TH, 11TH EVERY MONTH, POSTED AT MUMBAI PATRIKA CHANNEL SORTING OFFICE, MUMBAI – 400001