Virtual Care – Key success factors for Indian healthcare participants

(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)

After trying to predict the post-Covid era for Indian healthcare in my earlier post, it did emerge that “virtual care” may be a major focus area going forward. In this post, we will try to understand, how “at scale” and “comprehensive” virtual care works and what would be key success factors for key Indian healthcare participants?

In my quest for finding the right definition of “virtual care”, the post on “intouchhealth” website seemed to be most helpful. It defines virtual care as “a broad term that encompasses all the ways healthcare providers remotely interact with their patients. In addition to treating patients via tele-medicine, providers may use live video, audio, and instant messaging to communicate with their patients remotely. This may include checking in after an in-person visit, monitoring vitals after surgery, or responding to any questions about their diagnosis, condition or treatment plan”
Let us now try to visualize, how “at scale” and “comprehensive” virtual care looks like. I have leveraged data from US based Teladoc (investor briefs, interviews etc.) as it is the only major listed company in virtual care and Amwell (one of the largest setups though privately held).

Business model:

• Insurers and employers buy subscriptions for their members (may have co-pay)
• White labelling digital care infrastructure for providers
• Direct to consumer i.e. consumer pays for each visit e.g. mental health

Following data points further outline that the above offering is “comprehensive” and working “at scale”:

• Between Teladoc and Amwell, they cover more than 100 mn US citizens
• Teladoc saw 2 mn visits during the Jan to Mar’20 quarter
• Waiting time < 10 mins (did spike temporarily to 8 hrs) with care provided 24*7
• Net Promoter Score for Teladoc > 54 (much better than healthcare in general)
• 92% visitors didn’t require follow-up visits (As per Teladoc 2019 interview)
• 100+ use cases across primary care, urgent care, pre-op, post-op and so on
• Significant uptake within untapped age group – 18 to 30 years (Jan to Mar’20, Teladoc)

Key specialties gaining significant traction includes primary care, mental health, dermatology, nutrition, sexual wellness with tele-stroke also getting launched during Covid. In fact, a peek into Teladoc’s road-map shows that virtual care may be pervasive in near future except for few complicated surgical interventions or specialized diagnosis / treatment across orthopedics, oncology, cardio or neurology.

With above data points, it is fair to say that the proof of concept for “virtual care” exists. It was further mentioned that virtual care may provide care at 1/3rd cost of physical care. This may further make it attractive for “price sensitive” Indian ecosystem.

Given the startup ecosystem and software capabilities existing in India, I feel, we would be able to solve for the underlying technology sooner or later. So, the key question is how can key healthcare stakeholders help “virtual care” become a reality in India?

Following are few key success factors and specific recommendations:

“Virtual care” ready practitioners: With doctors being at the forefront, their readiness would need to be expedited through following measures:

• Soft-skill training given that the “tele-patient” is likely to be more anxious and won’t have access to “placebo of touch and feel”. Social determinants like age, gender, income can further impact patient experience.
• Awareness of Dos and Don’ts including privacy as well as reimbursement norms
• Awareness and training in productivity tools e.g. decision support, patient analytics, voice recognition tools to enable smoother transition
• Identifying virtual care “promoters” and “advocates” to further create awareness among patients, practitioners and engage with policy makers

Hospitals designing virtual care use cases: With proven expertise and meaningful scale, hospitals chains and large setups are well placed to drive virtual care uptake and expand “expertise bandwidth” through initiatives like:

• Identification and prioritization of specialties for “virtualization” – based on feasibility (tech as well as clinical) as well as need for “less contact” e.g. mental health, stroke management, dermatology etc.
• Redesigning current protocols for focus specialties to include “virtual care” use cases – engage with device players, innovators, pharma players
• Training of practitioners – within setup as well as across referral network to provide integrated experience to patients
• Incubate startups and enable distribution of virtual care offerings – “take bets” and “try and learn”

Pharma providing specialized inputs: As virtual care starts gaining specialty-specific color, pharma can play a key role as an enabler:

• Leveraging prescriber reach as well as para-medic connect to create awareness around virtual care through targeted CMEs and training initiatives
• Internal training of workforce e.g. reps, MSLs etc., in order to cater to requirements of “virtual care customers”
• Collaboration with providers and technology players to develop uses cases as well as productivity tools e.g. patient profiling tool for new specialty drug
• Launch “scalable” patient support initiatives that promotes “self-care” and provides timely counseling

Internet of Medical Things (IoMT) facilitated by med-tech players: Along with software, virtual care would require medical grade devices to improve uptake. Med-tech players can play a major role through:

• Leveraging their startup collaborations to define “virtual care themes” for accelerated innovation
• India-specific designs and business models, keeping in view price-sensitivity and limited resource settings
• Collaborative initiatives with providers and pharma to develop integrated solutions

Encouragement from insurers and employers: Indian payers and employers, too can enable “virtual care” ecosystem:

• Payers can start reimbursing virtual care treatment options or further incentivize “virtual” preventive or promotive measures
• Employee wellness program can be a key platform for creating awareness as well as addressing myths around virtual care
• With self-care driven initiatives (Omada, Livongo) enabling US employers to lower healthcare bills, it is time for Indian employers to at least start piloting them

Conducive and scientific environment facilitated through regulations and accreditation: Tech driven “virtual care” would have fair share of “modern day snake oil salesman” so task is cut out for regulators and accreditation agencies. Focus areas for them may include:

• Proactive definition of rules and regulations around privacy, data management and reimbursement
• Efficient monitoring and approval mechanism focused on “virtual care” – “medical grade” hardware and software
• Accreditation programs for practitioners, providers and other care givers to ensure consistent patient / consumer experience and enable reimbursement

As Julie Sweet (CEO, Accenture), in a recent interview with Satya Nadella (CEO, Microsoft), said that leaders across industries are saying to her that “we are not going to go back”. Same may apply for “virtual care” adoption within healthcare i.e. there would be a new normal post-Covid even if rate of change comes down. I am a firm believer that Indian healthcare ecosystem will ride this wave to reinvent itself. What is your take on the Indian “virtual care” landscape?