Driven by consumer awareness and a technology revolution, Indian healthcare industry is witnessing a paradigm shift. The advent of miniaturization of medical devices is now driving the concept of home healthcare not just for the sick elderly patients in the age group of 60 plus, but also for a large section of disabled and accident trauma cases in any age-group.
The concept of home healthcare is in vogue for the providers of ayurveda. Kottakal Arya Vaidya Sala among others have trained staff to attend patients at home for physiotherapy among other services.
Home healthcare provides the convenience of treating sick patients where frequent hospitalization is a challenge. The services include geriatric, chronic and post-operative care to patients with home visits from doctors, nurses, physiotherapists, nutritionists, counselors and trained attendants.
Understanding the unmet needs of growing ageing population which is the biggest driver of home healthcare, private equity players and venture capitalists are eager to invest in start-up ventures in India. The investors are confident that the affordability of the services and the compassion for the aged in their homes would lead to success of this business model. There is a huge nursing team supported by paramedics which would make the service a hit, according to a section of junior doctors from Victoria Hospital.
The segment of 60 plus population is reported to have arthritis, osteoarthritis, paralysis, cardiac disorders, diabetes, Parkinson Disease which require creation of healthcare setting at home, they pointed out adding that there could be several experienced medical practitioners entering the fray.
According to United Nations Population Fund report, the number of over-60s will increase from around 100 million in 2014 to more than 300 million by 2050. Ageing is a challenge and a healthcare problem. This is where three home healthcare majors in the country like Portea Medical, Medwell and India Home Healthcare are gearing up to tap the share of the market which has a growing ageing population and double income homes.
Portea Medical has pioneered the US Home Healthcare model in India offering home visits from high-quality MBBS-level doctors, nurses, physiotherapists, nutritionists, counsellors and trained attendants. It recently unveiled the ‘360° Wellness Home Care Plan’ to tackle the age-related illnesses for the elderly community and those suffering from chronic ailments ?.
Medwell Ventures was founded early this year by acquiring the 19 year-old Bengaluru-based Nightingales Home Health Services which provides annually 53,000 patients bedside nursing, 24,000 medical services and over 5,000 families subscribing to its annual care plans.
The acquisition of Nightingales Home Health Services was big advantage of infrastructure and services for Medwell which focused on congestive cardiac failure(CCF), chronic obstructive pulmonary disease(COPD), neurological disorders like Alzheimer’s and Parkinson, arthritis, orthopedic rehabilitation, post operative surgical site management and metabolic diseases for geriatric and other age-groups.
Indian Home Healthcare(IHHC) is one of the leading providers of certified medical and non-medical home healthcare services in India. In 2009, it was started to provide quality care to patients in their own homes. Headquartered in Chennai, it also has a branch in Bengaluru. Recently, the company inked a strategic partnership with NationWide Primary Healthcare Services, which is a chain of general practitioner (GP) and paediatric clinics to offer specialized home healthcare services. It has partnered with several major hospital groups and doctors for 24X7 elderly/geriatric care, long term medical care for any medical conditions, NRI health care (care for elders/family members of non-residential Indians), post surgical care, palliative care and New-born and mother care.
Fund infusion
Portea Medical received a capital infusion from Qualcomm Ventures to scale up its network and services in July 2914. Now Portea is gearing up to invest in advanced technology to implement efficient and dependable high quality home care.
At the same time , Medwell is in its initial round of funding from the promoters of the group which include Cytespace Research Private Ltd, which will invest US$15-20 million or around Rs.120 crore over the next three to five years.
The company expects to establish a hub & spoke model and a network in Bengaluru and 10 metro clusters in the country to serve millions of families over the next three to five years. This will be supported by cloud-based technology platforms and protocol-driven services in specialised therapeutic areas.
Medwell is co-promoted by Vishal Bali former chief executive officer, Fortis Healthcare and Dr. Ferzaan Engineer chairman, Cytespace Research and former, chief executive officer, Quintiles India.
Reducing hospital stay
“The current key objective for healthcare providers is to decrease the average hospital stay allowing patients an early return-to-work. Clinicians want clinical effectiveness and this is where continuity of care is required. Patients are looking at affordability and prefer to stay away from re-admissions. This is where, we could chip in the specialized home healthcare services and provide continuity of care in a home, stated Bali.
According to Medwell in India, 4.5 million succumb to chronic disease and 25 per cent patients are under 60 years. Many of them require constant medical attention and physiotherapy or oxygen. The challenge of growing geriatric population and hospital bed shortage has created the need for quality continuity care. The readmission for chronic obstructive pulmonary disease (COPD) is 23 per cent and congestive cardiac failure (CCF) is 17 per cent.
“While large and medium hospitals would go in for home health as an extended care, Medwell is also talking to nursing homes which could be a part of the home healthcare space. In addition, we are also in conversation with medical insurance companies to rope in this sector for reimbursements. It is envisaged that medical insurance players would soon cover this segment,” added Bali.
Factors like convenience of healthcare at home for any age-groups have now created the right platform for home healthcare, said Dr. Engineer.
Home healthcare providers are witnessing a growing demand from Parkinson’s disease patients necessitating constant nursing support. In the case of Portea currently, 10 per cent of its long-term care patients are from the category of Parkinson’s disease, according to Portea Medical.
The company is now facing a huge demand from Parkinson’s disease patients to access its services. Unfortunately a significant number of elderly patients with early Parkinson's symptoms assume its traits as normal aging and fail to seek medical intervention. In the early stages, it is important to have a physiotherapist visit periodically, to assess the progress of medication and exercise. As the disease progresses, patients need physical and emotional support which mandates presence of a nursing attendant along with family support in addition to medications, said Dr Udaya Kumar Maiya, medical director, Portea Medical.
Although the company accounts for highest demand for geriatric care, Parkinson patients are being enrolled each week. “There is no specific training imparted to the nursing and physiotherapy team specifically for Parkinson’s disease, but they are well equipped and qualified in elder care which encompass various conditions,” said Dr. Maiya.
The growing Indian healthcare industry
In India, healthcare has emerged as one of the largest service sectors with estimated revenue of around $ 30 billion constituting around five per cent of GDP and offering employment to around four million people. By 2025, Indian population is expected to reach 1.4 billion with about 45 per cent constituting urban adult (15 years plus).
To cater to this demographic change, the healthcare sector will have to be about $100 billion in size contributing nearly eight to 10 per cent of the then GDP, according to Confederation of Indian Industry. India has 6,00,000 lakh doctors with around 12,000 hospitals.
The future of Indian healthcare revenues are from medical tourism because of the country’s capability in providing world class treatment and benefits at almost 1/10th cost of western world. Medical tourism market is valued to be worth over $310 million with foreign patients coming by 100,000 every year in 2014.
International patients are accessing Indian medical centres for cancer care driven by the positive outcome from oncologists expertise followed by dependable access to technology at a reasonable cost.
From HCG to Apollo Hospital Group, Fortis, Medanta-The Medicity, Max Healthcare Artemis Hospital, Tata Memorial Cancer Centre, Mazumdar-Shaw Cancer Centre, to name a few are a hot spots for international patients to access treatment for cancer, besides related complicated and chronic conditions. These hospitals are accredited by international agencies and recognized by patients and are offering world-class care.
According to Dr B S Ajaikumar, founder, chairman, HCG Enterprise, the expertise of Indian oncologists at the hospitals in the US and UK have lured the foreign patients to travel to India for treatment. In fact, the patient care for cancer in India is on par with developed nations and can be accessed at one-tenth of the cost.
Every hospital in the country is now well equipped with qualified doctors with global exposure, English speaking staff covering nursing and paramedics. This enables India to receive maximum of its international medical tourists from USA, UK, UAE, Nepal, Sri-Lanka, Bangladesh, Maldives and Mauritius, said Dr Devi Prasad Shetty, founder and chairman, Narayana Health.
Another driver is the diagnostics and pathology services in the country. There is extensive outsourcing of laboratory tests by foreign hospital chains because of cost differential in India. This has helped Lal Path Lab and Metropolis Healthcare Ltd tap a share of the global pie.
Metropolis has recently introduced India’s first single test for seven diseases which cause fever. The Multiplex PCR test helps diagnose seven common diseases causing fever covering malaria, dengue, typhoid, leptospirosis, chikungunya, West Nile fever and Rickettsia, thus saving cost and providing respite to people in a healthcare system that is getting more expensive and less inclusive by the day.
Another area of growth is Telemedicine which is seen to significantly improve the productivity of medical personnel and help to extend patient care to remote, far flung inaccessible regions.
The future of Indian healthcare is to ensure prevention and wellness. The high prevalence of non communicable diseases has led companies like Vidal Healthcare to empanel 900 general practitioners across the country to spur its business model designed to stall life style disorders and ensure early detection of diseases. The country already accounts for 61 million diabetics and a large number of cardiac cases.
Vidal Healthcare has also developed a comprehensive suite of services: Healthex and Zindagi Plus which help individuals comprehend their health risks, set goals and make behavioural changes to achieve wellbeing. Healthex is a four-step programme to enabling clinical assessment, lab measurement, physician and nutritionist counselling. Zindagi Plus combines energy audit with nutritionist counselling to reduce disease-disorder risks.
“Our objective is to bring a sea change in healthcare by shifting from the conventional ‘disease’ model of medicine, with a focus on alleviating symptoms, to a model that adds value through all round wellness to improve the overall quality of life. We have a high-tech high-touch approach that will eventually result in societal well-being by equipping individuals with the good health”, said Aparajithan Srivathsan chief executive officer, primary health services,” Vidal Healthcare.