Nandita Dandekar – Founder, PinkTree Health LLP

COVID-19 had some good effects too. It brought tremendous focus on healthcare. Both the individual and the state suddenly their priorities altered and the impetus was on managing health of our citizens. The onset of COVID-19 triggered a structural change in the Indian healthcare system by encouraging people to use healthcare technologies.

Digital Health became a significant bridge between an individual and all healthcare providers including doctors. Numerous healthcare apps were introduced by the central and state governments to combat COVID-19. These apps were being used for digital contact tracing of confirmed and potential patients, ensuring compliance with quarantine guidelines, spreading awareness, providing updates about COVID-19 statistics, and issuing advisories.

The issuing of Telemedicine Practice Guidelines by the Indian government in March 2020 boosted the adoption of healthcare apps.

With the NDHB (National Digital Health Blueprint) and NDHM (National Digital Health Mission), the Government of India has taken a most critical step to initate and foster the digital ecosystem in the country. Healthcare start-up have started to create and build solutions that will help patients and specially who cannot physically move on their own or who are dependent on others to take their health in their own hands and helped their caregivers to provide them with necessary care.

COVID affected the lungs. Lung Health was anyways amongst a major health scare globally. It was significantly underdiagnosed and under treated. COVID added to the same.

Let’s look at some stats:

In India and also globally, the adherence rate of chronic therapy adherence to therapy rate is low. `e.g. Asthma affects 358 million people worldwide (34 million in India) and up to 70% of the patient population do not have the disease under control. Over 90% of asthma patients in India do not receive the right medication 1 . Also, adherence rates are generally lower for chronic disease vs. acute conditions as adherence decreases over time (WHO report). Current average non-compliance to therapy rate is 30-40% to therapy. As per reports, improved adherence rates with use of reminders can go up from 46% up to 73%. 2

INDIA OPPORTUNITY: Digital Health is the next big thing after UPI – India has all the components to be a global leader in this space too

Healthcare in India is big. Considering the population of the country, the paediatric and geriatric age group numbers, India has immense growth potential. Growing investments from public and private sectors in the digital healthcare space and the emergence of advanced technologies such as telehealth and telemedicine solutions are some of the factors that drive the market.

The healthcare apps market has both small and medium-sized start-ups that are trying to expand their reach further. Stakeholders in the Indian healthcare ecosystem are focusing on leveraging healthcare apps to make up for the shortcomings of traditional infrastructure. During the pandemic, the use of healthcare apps for online consultations, lab test bookings, and monitoring and tracking of patients’ vitals went up. An increasing focus on patient-centric care, emergence of advanced technologies, and changing business models have been crucial in driving the healthcare apps market in India. Wellness management and appointment scheduling apps have gained immense popularity. The demand for chronic disease management apps is expected to grow rapidly in the next few years.

DIGITAL HEALTH ECONOMICS: Digital Health is important in managing proactive healthcare which in turn helps in increasing productivity and thus helps the GDP growth

According to a report of the Indian Electronics and Information Technology Ministry, India can create over $1 trillion of economic value from the digital economy in 2025, with half the opportunity originating in new digital ecosystems that can spring up in diverse sectors including healthcare. Over $ 1 trillion economic value constitutes 18-23 percent of the country’s nominal GDP. There would be huge potential for global and local businesses, start-ups, and platform-based innovators. They will be investing more in emerging technologies such as artificial intelligence, blockchain, drones, and robotics) customised to India’s needs.

The Healthcare industry in India comprises of hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment. The industry is growing at a tremendous pace owing to its strengthening coverage, services and increasing expenditure by public as well as private players. Growing incidence of lifestyle diseases, rising demand for affordable healthcare delivery systems due to the increasing healthcare costs, technological advancements, the emergence of telemedicine, rapid health insurance penetration and government initiatives like e-health together with tax benefits and incentives are driving the healthcare market in India.

• The hospital industry in India was valued at $ 61.79 Bn in FY17 & is expected to reach $ 132 Bn by 2023, growing at a CAGR of 16%-17%.
• The Telemedicine market is the maximum potential eHealth segment in India, which is expected to touch $5.4 Bn by 2025, growing at a compound annual growth rate (CAGR) of 31%
• Over the next 10 years, National Digital Health Blueprint can unlock the incremental economic value of over $200 Bn for the healthcare industry in India.
• India has the world’s largest Health Insurance Scheme (Ayushman Bharat) supported by the government.
• India’s comprehensive investment in Medical Education: INR 17,691.08 Cr invested in 157 new approved Medical Colleges since 2014.
• The Preventive Healthcare market has also proven to have myriad growth potential. The preventive healthcare market is expected to reach $197 Bn by 2025, growing with a CAGR of 22% as compared to 15% for the curative healthcare market.

100 Mn: eSanjeevani telemedicine consultations

45.06%: Increase in the total investments in healthtech startups.

40%: Share in hospital beds (Pvt.)

150 k: Functional Ayushman Bharat Health & Wellness Centres

MARKET INFLUENCERS:

With the help of Government and digitalization, a lot of healthcare startups have come up with patient centric solutions. Be it online consultation, disease management or telemedicine, digital has revolutionised the healthcare industry.

However, the market has faced significant challenges due to lack of awareness, security issues, and unsatisfactory app performance. Moreover, for most consumers, fitness and wellness management are the areas of primary concern. They are unaware about the types of healthcare apps that are available for various health issues. Although digitization has disrupted the Indian healthcare landscape, a significant part of the population is still unaware about the benefits of healthcare apps.

SCIENTIFIC EVIDENCE:

There is enough scientific evidence to prove that personalised self-management and virtual assistance by health providers as a concept is here to stay and has benefits on patient outcomes and quality of life. As an example, Chronic obstructive pulmonary disease (COPD) is a major cause of mortality, morbidity, and disability. Patients with COPD report needing information and guidance on how to manage COPD. Many are unable to correctly use inhalers, manage breathlessness episodes, and recognize exacerbation signs. Recommendations to improve care for patients with COPD have included focusing on self-management and providing patient-centred support programs.

COPD self-management support (SMS) interventions have reduced acute care use and improved health-related quality of life. These interventions aim to help patients adopt desired behaviours, including medication adherence, smoking cessation, and physical activity. To help patients adopt desired behaviours, coordinated follow-up from well-trained healthcare professionals (HCPs) is needed, together with services to help patients overcome any met barriers. The Global Initiative for Chronic Obstructive Lung Disease recommends SMS.

THE NEED GAP:

Currently all stake holders in the chronic healthcare space operate in isolation. The doctor and the patient, in many cases, meet each other infrequently, maybe once or twice in a year, and have very little scope of interacting with each other with tangible and measurable mechanisms between these visits. 

This means that the doctor is unaware of the patient’s health status between these visits. 

The health application is focused on different airway disorders and will offer disease management solutions for the patient. The app will also provide to be a digital interface between patient, their doctor, and other relevant stakeholders.

BUILDING AN ECOSYSTEM OF CARE:

An ecosystem of care keeping the patient at the centre is critical. This care ecosystem can be designed via digital tools. Personalised Healthcare is important and more and more evidence reveals that the health outcomes of people and patients who share in the health decision-making process and take an active role in their own care lead to better health outcomes. This can be achieved if patients take full responsibility of their health, track their health records digitally and ensure they comply to therapy as prescribed by their doctor. 

FOCUS ON INNOVATION:

• Digital Health solution can focus on patient need gaps, like helping patients comply with their treatment regimens better and look after their health comprehensively. 

• The digital solution, in this case an mobile app, uses technology and machine learning to ensure that patients of airway disorders, like Asthma, Chronic Obstructive Pulmonary Disease, Tuberculosis and Obstructive Sleep Apnea stay in the course of treatment and overall management. 

• The application can use global scoring methodologies and formats to score and appraise the patients of their health scores. 

DIGITAL HEALTH APPLICATION:

The digital health application has benefits for the patients as well as healthcare providers like doctors. At a small per day cost, the solution can be made available to the masses. 

Benefits for the patient as a user:

1. Complete Disease management solution
2. Improvement in adherence to management and medication
3. Specialized digital care options in case of severe conditions / special needs.

Benefits for the doctor as a user:

1. Real time information to the doctor about the health status of the patient. 
2. Improved doctor patient relationship
3. Complete patient management on the tips

Digital Health in India is coming up quickly and is here to stay. The attempt is to ensure that more and more patients should use it, across different socioeconomic strata of the society. 

Patients with chronic diseases should use a digital health solution to manage their disease better between their two physical visits to the doctor and doctors should encourage their patients to do so!

Source: 

1. The Indian Express dated 3^rd May 2022) Article: Over 90% of asthma patients in India do not receive the right medication
2. Foster JM, et al. J Allergy Clin Immunol 2014; 134:1260−1268).
3. Research and Market Reports