Predicting "post-Covid" era for Indian healthcare

(Standard disclaimer: Views, thoughts, and opinions expressed in the post are my own, and do not reflect the view of my current or past employers. I may not have copyright to any images in the post)

Developments over the past few weeks have been unprecedented and with “health” at centre of Covid crisis, experiences are personal in nature. Given the constantly evolving landscape, I thought it may be meaningful to imagine how post-Covid era will look like for Indian healthcare participants. I have leveraged the “C-O-R-O-N-A” framework to structure my thoughts. The objective is to catch big trends and at the same time brainstorm with readers like you. So, let us begin.

C: “C” of the framework stands for “Contact”. “Touch and feel” has acted  as a placebo for patients given the health seeking behavior in India. Few years ago, I do recall that business models build around tele consultation provided at fraction of a dollar was struggling to find takers. Even western world leveraged it mostly for emergency support. Doctors too, had their share of reservations e.g. sub-optimal diagnosis, potential loss of business and so on.

I do think that “post-Covid” healthcare setting will have “virtual care” as one of the focus areas. Just a glance at a recent presentation by Teladoc (one of the largest virtual care platforms in US) shows that offerings now transcend across acuity i.e. critical care, chronic or every day care as well as care sites i.e. right from home care to ER. So, my prediction regarding Indian providers would be that “top players” would have departments / areas rated based on “infection risk” and “ability to leverage virtual care”. The rating would further lead to redesigned workflows (e.g. minimum distance between healthcare worker and patient may vary specialty-wise) and workforce deployment. Remember, healthcare workers have arguably been the worst affected by Covid, both in terms of mortality and morbidity. “Minimize” contact and “maximize” outcomes.

In pharma, on the other, “In-person interaction” has witnessed an interesting trend. As per one of the recent con-calls of a major industry cloud (life sciences) player, unlike popular perception, the “in-person” interaction hasn’t decreased over a period of time as “more and more” specialized launches have necessitated the need for more reps as well as deeper relationship between reps and doctors. So, my prediction for pharma will be - “contact” i.e. in-clinic meetings may come down but “connect” would remain important.     

O: “O” stands for Openness, with the trend being greater tendency to share healthcare information by individuals. Some of you may be following pre-Covid discussions around sharing of patient data within the US. Post-Covid, need for “contact tracing” has meant that data sharing is either mandatory or default opt-in. Multiple research papers have concluded that default opt-ins have been used by policy makers to nudge citizens towards say organ donation, inculcating savings mindset and so on. Many would argue that loss of healthcare data is more damaging as it doesn’t change over time.

My prediction would be that “openness” will lead to four key outcomes:

• India as a country will be richer in terms of insights from the data especially around social determinants of healthcare
• Platform providers – be it tele-consultation or remote detailing, would require less “selling effort” but would need to “deliver outcomes”. Providers will have new ways to evaluate their doctors and same would be true for medical reps
• Regulations in India around patient data would evolve though it will be a bumpy ride as there would be some missteps in the “open” post-Covid world
• Technological offerings may emerge that would command premium or increased acceptance in-lieu of greater privacy or security e.g. iOS equivalent of mobile world or “duck-duck go” for internet search, may have market in India as well

R: “Risk” would be third leg of framework. Even a relatively “risk averse” healthcare industry given IP issues, medico legal concerns, regulations, patient privacy etc., has been disrupted like anything. Supply chain issues especially for global pharma and medical equipment, elective procedures coming to a standstill (account for ~70% of volumes for few leading chains and much more in terms of bottom lines), new launches - major growth driver in pharma, have taken a backseat and so on. As the sector moves towards greater technological adoption, risks would emanate from cyber space as well.

My prediction would have a veiled recommendation to business leaders (hard to contain the consultant inside me). India has been a traditional growth driven market so the focus has been on finding opportunity areas and putting might behind it. Any remaining mind space has been taken up by uncertainties, given evolving regulations and disruptive changes.

In my opinion, post-Covid winners across different segments within healthcare i.e. leaders who would deftly navigate their organization will have one tyhing in common i.e. ability to manage risk. Their internal strategic reviews would allocate more time for discussions around risk – what do we face, what if, how do we mitigate it? In fact, every third review can start with outlining risk on the opening slide and then brainstorming over it. Though, one does need to differentiate between “risk” and “uncertainty” as former is measurable. Our focus during reviews will be on “risks”, uncertainties can be topics for upcoming conferences.  

O: “Orientation” or some would say “re-orientation” which would result in new ways of doing business. Over the years, product managers within healthcare have been of the view (and rightly so) that doctors typically do not appreciate change in workflows which may be attributed to “risk aversion”, “do no harm approach” or “long years of training”. Thus, unlearning is not easy and new product introduction requires interventions at multiple levels e.g. KOLs, regulators etc.

My prediction is that post-Covid world will have a new normal. “This time it’s different” – a much hated quote in investing world, may hold true in healthcare. This will change the way healthcare is delivered in India. “Ordering coffee online” is different from ordering in a “physical coffee shop”. Similarly, “in-clinic” consultation will be different from online consultation. Following may characterize effective post-Covid virtual care in India:

• Focus on “online access” i.e. leading platforms would be able to handle phone, video as well as SMS based interactions
• Product managers leading the change will be able to reimagine healthcare delivery and leverage learning from other industries. They will develop or leverage medical grade productivity tools e.g. speech recognition, IoT, patient profiles that aid prescription
• New KPIs and USPs will emerge – Patient satisfaction score at end of consultation, on-demand consultation, call centre to mobile app transition, contextualized decision support etc.

N: “Nimble” will mean greater speed whether it comes to adoption, approval or implementation. Given during-Covid adoption of virtual care in developed markets, it seems unthinkable that HIPA Act focused on patient data came way back in way back 1996 in US. AmWell (one of the leading tele-medicine players in US) was founded in 2006. However, “during-Covid” trends are already showing that even if few developments may be knee-jerk reactions, rate of change is likely to remain high in near future. Cleveland clinic estimated 17 times increase in tele-health visits (3,400 / month to 60,000 in March’20). Back home, Fortis has already handled 8,000 consultations since roll out (exact time period not known).

With technology at the forefront, following areas are likely to witness increased agility:

• Approval as well as accreditation of “medical grade” digital tools by Indian regulators so that end users can adopt it with more confidence
• Faster review and approval time of drugs or devices, given the agility shown in approving diagnostic tests as some process improvements may be sticky in nature   
• “More technology will lead to more data” which will mean greater frequency of analysis and review
• “Plan and implement” will make way for “Try and learn” or “Fail fast but fail cheap” which will mean more pilots or small projects being undertaken   

A: A stands for alliances and collaborations. With technology driving or facilitating major share of the “post-Covid” changes, my prediction would be that Indian companies be it pharma, hospitals or medical devices, will deliver increased value through “incubators”. This will have following benefits:

• Proactive assessment of existing as well as emerging solutions and offerings, and subsequent mapping with opportunities and risks
• Strategic engagement with startups thereby shaping outcomes – involvement from design to commercialization phase
• Fail fast and fail cheap – very important as all ideas do not scale up even if promising (as do innovative drugs)
• Rub-off effect resulting in improved culture of innovation (trust me it works) as well as greater brand equity (much needed to attract top talent to healthcare)

I will end this post with one of my favorite quotes from Jack Ma - “Today is hard, tomorrow will be worse, but the day after tomorrow will be sunshine”. Let us hope that the post-Covid world has positives that we all can look forward to.

Thank you for your time and do let me know for your “C-O-R-O-N-A” predictions.