Scaling up Indian Tele-consult Platforms – “7S” success Framework for Virtual Care

(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)

In my earlier post, I focused on key success factors for driving “virtual care” uptake in India. This article would focus on framework that entrepreneurs / startups / strategists can leverage to build an “at scale” and “comprehensive” virtual care company.

Given that we are looking at “SaaS” based business models, it may be prudent to explore success factors for scaling up such an enterprise. Following are select pearls of wisdom captured from an excellent talk, titled “Scaling from $1MM to $500MM ARR”, delivered by Karen Peacock (COO, Intercom) at annual 2019 Saastr conference:

• Expand your customer base by focusing on NOT what they want but what they need e.g. they may ask for budgeting tool, but cash management software better serves their needs
• Watch what your customers do NOT what they say e.g. they may say quality is my top selection criteria but in actual practice, always goes for cheapest option
• Your strategy is as much about what you DON’T do e.g. few short-term gains are worth a miss
• Add-on purchases happen upfront - nail your purchase experience and “show” rather than “tell”
• Keep reinventing – find the market fit again and again
• Fall in love with the problem NOT the solution
• Focus on active use and DO NOT fall for vanity metrics like visits, downloads etc.
• Decide your platform play – focus on delivering value to customers, partners and then yourself (yes, in that order)

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”

Healthcare cost: How much is too much?

My uncle, after undergoing a successful removal of tumor a few years ago, was recently diagnosed with abnormal growth of cancerous cells. It was a case of metastasis i.e. spread of a cancer from one organ or part to another non-adjacent organ or part. Thankfully the disease was manageable due to timely detection and availability of a suitable drug. As we move ahead I must clarify that in this blog, I am not focusing on the disease or its treatment rather the focus would be the cost of availing such healthcare services. Before I decided to write this blog post, I had a lengthy and animated discussion with one of my friend who has been working in the pharmaceutical industry for quite a few years. 

How Anna moved the nation?

It’s ironical but true. It took a 74 year-old to mobilize one of the youngest nations (in terms of demography) in the world that too using the methodology of satyagraha which till the recent past was touted as being out of sync with modern India. In fact many felt “Gandhigiri” was more the "in thing". A nation that saw cricketers and movie-stars being identified as “youth icons” certainly was suddenly enamored by a Gandhian.  The Sydney Herald calls him “The New Gandhi”, The Times quoted, “Anna Hazare: How One Activist Brought the World's Largest Democracy to Its Knees” and so on. After all it was unthinkable that a metro centric- mobilization would reach such humongous proportions. So, how did Anna manage to strike the chord? 

Entrance exams: Are they asking the right questions?

The last decade has been a decade of changes and reforms. You can also include the entrance or competitive examinations to that fold. In this post I’ll discuss some changes as well as existing gaps in various competitive examinations.

There was an era when three posts were considered to be the most prestigious in the Indian set up. They were the PM (prime minister), the CM (chief minister) and the DM (district magistrate). When it comes to competitive examinations, three of them stand out for their rigor. They are IIT-JEE (for entry into the IITs), CAT (for entry into the IIMs) and civil services exams conducted by the UPSC. Let’s consider the changes in the formats of respective examinations one by one and consider the likely fallouts.

IIT & IIM: Do we really need to expand?

As India looks to outpace other countries in terms of economic growth - higher education, because of its criticality, is in the limelight (better late than never). With the focus being on higher education, two of the best known Indian Institutes, IIT & IIM find a mention in our day-to-day discussions. As efforts are being made to increase the number of IITs & IIMs , questions are being raised whether that's leveraging the brand or diluting it?

We do know that India needs more quality educational institutes. With the claim to fame of many IITs & IIMs being “one of the toughest institutes to get into”, it’s more a commentary on the paucity of seats rather than intellectual rigor. So doing nothing is not an option.

Before I start putting down my views, I would bring to your attention a group that opposes expansion of IITs & IIMs even if brown-field i.e. increasing capacity of existing institutes. They argue that it might commoditize the brand (make no mistake quality is not their concern). Such arguments make no sense as IITs & IIMs are not Guccis & Armanis. IITs/IIMs stand for quality not exclusivity. 

Let us now look at some pressing concerns that justify the “need to expand”.

“During 1955 to 1975, the growth rate was high (10.5%) as the IITs were being set up and establishing the UG programme. In the next twenty years, there was a slight increase in the output (less than 1% per year). Since 1995 the growth rate increased to 4.2% per year mainly due to the addition of IIT Guwahati and IIT Roorkee.”

Source: ENGINEERING EDUCATION IN INDIA (2007)

The above data clearly shows that we need Greenfield investments i.e. open new IITs & IIMs as they mainly power the growth in intake. In fact IITs that accounted for 5-8 % of total output of engineers in 1980s now account for less than 1%. 

Many feel that expansion might lead to quality of education being compromised with. It’s a valid concern and needs attention (I will try to come up with remedial steps in the later part of the blog) but do you feel that the quality of new colleges will be worse that the existing private set up where students are forced to join if they can’t make it to the sought after colleges. I don’t think so as the “quality gap” is so enormous that we would certainly find the new ones, in terms of quality, somewhere in-between.

Even though IITs & IIMs might be under funded by global standards but they are still much better off than their Indian counterparts. So the question is whether we would be better off opening new colleges under new names rather than using the umbrella of IITs & IIMs? My answer would be that the name provides them greater attention and care which a new institute desperately needs. NITs have been greatly benefitted by the tag.

We all have great faith in the brand name of IITs & IIMs. Are these brands that weak that expansion would dilute them to the extent that it threatens their existence? That’s not the way, great brands operate. In fact, if properly carried out, expansion would only strengthen them. Greater student & alumni base would mean greater reach, influence and impact. Mind you, it would come in handy when we face the onslaught of foreign universities. By the way these are the outputs of some well known international engineering institutions: Urbana-Champaign 1950 degrees, Purdue 1840 degrees, Georgia Tech 2300 degrees, Tokyo University 3000 degrees, Tsinghua university about 4000. (Source: ENGINEERING EDUCATION IN INDIA, 2007)

Let’s now look at some of the methods that can expedite quality enhancements at the new colleges:

• With increased intake, we must aim at increasing the bandwidth of well known professors i.e. number of students that s/he can address at a given time. This can be facilitated by ICT based live or recorded lectures. Technological intervention would also help in facilitating better educational aids or resources. The Masters as well as Fellowship programmes need to be strengthened as well.
• We have buddy system in place where an old IIT/IIM mentors the new IIT/IIM but that doesn’t include student set-up. Peer learning and mentoring by seniors can help students at new IIT/IIM catch up faster. We should provide online platform to facilitate such exchange of information. Student exchange programmes can also be incorporated to facilitate co-operation. 
• At least for the first few years, mentor IIT/IIM should help out their new members with their placements. It might seem unthinkable given the sort of competition but modalities can be worked out as new IITs/IIMs have relatively fewer intake.
• Private sector, both India and abroad, have been the biggest beneficiary of the outputs of IITs/IIMs. PPP model for faculty development where industry provides visiting faculties or funding can be looked into. The academic exposure would benefit the employees as it could be a welcome break or “going back to basics” for them. It would be a win-win situation for both as private sector stands to gain through quality output and colleges through quality faculty.

Some reach out only for the riches whereas some reach out to help each other out. So if alumni and students of established IITs/IIMs reach out to their newer counterparts, they can certainly consider themselves better IITians if not prouder. Else a caste system in the intellectual and educational set up is in the making as there is a very thin line between being elite and being elitist. Please avoid it.

QE II and the recovery story: Is it time for austerity?

(The article was adjudged the best entry at Consilium – The Policy Design Competition at IIM Lucknow)

Quantitative Easing II better known as QE II has been globally the most  discussed phenomenon in the recent times. Through this mechanism the US Federal Reserve will buyback 600 bn US$ worth  of bonds, at about 75 bn US$ a month, and infuse newly created money in the system. The buyback follows the QE I that saw an infusion of 2 trn US$.

The step can lead to lowering of interest rates or yields in the US thus incentivizing investors to look for greener pastures abroad that provided greater returns. Considering the deflationary concerns in the US and the unusually high unemployment rate, “doing nothing” was not an option for the regulators. With Chinese not allowing Yuan to appreciate to the levels acceptable to the US, Fed through QE has taken it upon itself to undo the “trade imbalance”.  QE through lowering of interest rates aims at spurring demand as well as consumption. This will generate jobs as well as lead to appreciation of asset prices which have touched new lows thus leading to foreclosures and defaults. As far as global economy is concerned, even they can benefit through FII inflows.

The Decoupling Theory

One term that has been doing the round nowadays on the web, on biz news channels or newspapers is “Decoupling”. The decoupling theory holds that Emerging economies have broadened and deepened to the point that they no longer depend on the United States or Europe for growth. Emerging markets (EMs) are nations with social or business activity in the process of rapid growth and industrialization. So let’s start our exploration of the decoupling theory (DT) now.

Decoupling as we all know is separating or detaching. But what’s the reason that we hear so much about DT? The two likely reasons are shaky recovery of the developed economies with V shaped likely to make way for a U or even worse W shaped recovery and the robust performances of the emerging economies like China & India.  So what does DT entail for the world economy? One, it signifies the growing strength of the developing countries as well as weaning strength of the countries like US & UK. Add to that it also tells that emerging countries are gaining self sufficiency i.e. consuming what they are producing within themselves.

A peep into "Peepli-Live"

"सरकार मरने का पैसा देती है!” This line pretty much forms the basis of the storyline of Aamir Khan produced film: Peepli Live. In other words, "a farmer in need of money would prefer to commit suicide if the government gives him muaawzaa (compensation)". You all might be wondering if I am trying to do a movie-review in this blog. Well my answer would be a Yes as well as a No. Yes because I will discuss the different realms touched by this movie and a No because this blog is not a commentary on the quality of filmmaking or acting or for that matter the music of this movie.

The Past, The Present & The Future of Asia.

We all love keenly contested battles. Isn’t it? Such contests can take place on the sports ground, in the academic setup, on the battlefield etc. The one such battle that I am going to talk about, is taking place on the global scale. It’s the battle to become the next economic superpower of Asia. In this blog I’ll discuss the three countries that look set to stake their claim for the Numero Uno tag. The great thing about this contest is that we could have three different leaders at three commonly classified points of time i.e. the Past, the Present & the future. So, let me break the suspense on the trinity (if there was ever one). They are Japan, China & India. Let’s us analyze their strengths, weaknesses and the possible road ahead.

The Need for Indian Case Studies

After a hiatus of almost three weeks due to the academic projects, exams and the launch of The Money Manager-the pan-IIM finance magazine, Saketvaani is back with you to ignite the discussion. This time the focus would be “the case for Indian case studies”. Though all of us may not be familiar with case studies but you can use words like journals, research papers etc. interchangeably for cases. First let me tell you the reason behind choosing this topic.

I have finished almost 70% of my MBA education in an Indian B-school and most if not all the cases that I have come across are prepared by foreign B-school (read Harvard Business School: HBS). Should it really be a cause of concern as haven’t we been brought up mainly on books by foreign author? So why complain now, that too in a B-school clamouring for global recognition?

Is regulation the only way to create sustainable cities?

There has been too much emphasis off late on regulations being the only way to create sustainable cities. Through this blog, I would like to express my opinion on the above mentioned topic. 

I think we can play with the question a bit i.e. we can aim at creating self-sustaining cities rather a sustaining one. This is because one of the prerequisites for sustenance is the participation of the stakeholders and in this case it is residents of the city. For it to thrive, the actions of the dwellers will have to be in sync with the requirements of sustainability i.e. taking care of the environmental concerns, politically acceptable and economically beneficial. I know this balance is hard to achieve but so is the concept of “sustainable cities”.

Base Rate System : A change for the real ?

(My heartfelt thanks to Mr. G. C. Nath, Senior V.P., CCIL for his invaluable insights on this topic)

There hardly is an adult nowadays who hasn't felt the need or has gone ahead to avail a loan. You can blame it on the increasing consumerism or the inflationary forces. Anyways, I am not going to discuss the rate of inflation or conspicuous consumption rather I will focus on the rate of interest on these loans. These rates were affected by a major change that took place on the 1st of July, 2010. This happening was; "coming into effect of Base Rate System".This blog is on Base Rate System and its likely impacts. 

Family creates value

The idea of writing this blog came to my mind when I was in Ahmadabad for my summer internship.Apart from the Gujarati splendor what I witnessed was a quite different type of business lingo. The bosses and the sirs were replaced by bhaiyaa, bhai or even pappa. Even though the firm that I worked for happened to be a B-School but things were no different over there either. In fact this lingo was more common when the discussion was among the higher-ups in the firm.So what was so different about the businesses in Ahmadabad or rather the Gujarati style of functioning? It was the style or type of ownership. They were the Family owned businesses (FoB).

Too Big To Fail

I have always wondered, why things are so hard to change even when we are at a consensus that they must. Take the case of corruption, inefficient bureaucracy, casteism, communalism... the list is endless. The reason is that they have become "too big to fail (TBTF)". Take the case of government office saddled with corruption. Though a lot of people are at a receiving end due this menace but they are mostly the external stakeholders of this system. On the other hand, those benefiting from it, the peon, the kirani babu and the bada saheb can directly affect this system and most importantly, they are a sizable lot characterized by greed. In order to satiate their insatiable desire, they go out of their way to guard their territory.

ICT based distance learning programme - IV

In this fourth and last blog of this series, I will share the framework that I have developed for a model distance learning institute. 

The learner centric model for a Distance Learning institute

Note: C&A:Curriculum & Assessment, LR:Learning Resources, Infra:Infrastructure (Technical and Physical)

ICT based distance learning programme - III

In the third part of this series,I will present the consolidated findings of some of the breakthrough research done in this field.Please refer the First part for Introduction and Second part for the Importance of ICT.

ICT based distance learning programme - II

After introducing ICTs and some common terms associated with it in my last blog, in this part I will enumerate, why ICTs are assuming greater importance in the field of education.

ICTs are a potentially powerful tool for extending educational opportunities, both formal and non-formal, to previously underserved constituencies—scattered and rural populations, groups traditionally excluded from education due to cultural or social reasons such as ethnic minorities, girls and women, persons with disabilities, and the elderly, as well as all others who for reasons of cost or because of time constraints are unable to enroll on campus. With advancement in technology, not only the robustness has increased but so has the cost involved in its deployment.

ICT based distance learning programme - I

(This is the first of the series of posts that I am devoting towards creating awareness about the distance learning programmes which,if implemented effectively,could play a crucial role in democratizing education. The Second Post will be on the importance of ICT in distance education and the Third will be on the findings of breakthrough researches in this field. In the fourth and the last one, we'll develop a framework for a Distance learning programme.  Looking forward to your comments.)

Distance education, or distance learning, is a field of education that focuses on the pedagogy, technology, and instructional system designs that aim to deliver education to students who are not physically "on site" in a traditional classroom or campus. It has been described as "a process to create and provide access to learning when the source of information and the learners are separated by time and distance, or both." The University of London was the first university to offer distance-learning degree in 1858. Almost all the countries have at least a distance teaching university and many countries such as UK, Australia, Canada,USA and India even offer DE programmes within on-campus universities.

Union Budget 2010

(This article was originally written for the CNN-IBN blog)

Burgeoning fiscal deficit, inflation breathing down your neck and the promise to keep the growth story intact, not the best time to be the Finance Minister. Pranab Babu had his task cut out. How does his respond? Does he come up with a populist budget (the WB election issues are there) or he buckles down the pressure exerted by the India Inc.

Let’s try to analyse it under different heads:

 

Tax: 

The new income tax regime ensures that the salaried middle class ends up paying less and the upper middle class lesser. We were just discussing fiscal deficit by the way and the deficit will now go up by 26000 cr. Tax savings by an additional amount of Rs 20,000 for investments in long-term infrastructure bonds are now allowed but is it enough considering the major portion of the savings still finds its way to the savings bank account. I think the FM has missed out here. The excise duty inches up 2% (on car and SUVs) and the oil prices shoot up not because revolutionary deregulation has become a reality but basic duty on petroleum products has been enhanced. So FMCG companies gain as the middle class spends more but who loses out, it’s him again, the ‘aam aadmi’, who doesn’t earn enough to be taxable but still relies on kerosene. Though there was a relief from the service tax front as it stay put at 10%. Raising the rate of Minimum Alternate Tax (MAT) from 15 per cent to 18 per cent of book profits could be the cause of complaint for the infrastructure firms. 

Reforms: 

GST, the tax reforms aimed at uniformity, transparency, widening the tax net and that has found favour in more than 100 nations still seems to be in the dock as no concrete roadmap was announced. Labour reforms, oil deregulation, fertilizer subsidies, the most hotly debated topics considering the existing scenario didn’t get the due attention. So, it seems the structural deficiencies causing deficit are here to stay.

 

Agriculture: 

Nutrient based fertilizer subsidy is a step in the right direction but unless followed up with more radical steps so that the benefits directly reach the farmer, it could be the case of too little too late. Providing project import status with a concessional import duty and full exemption from service tax to installation and commissioning of mechanised handling systems, pallet-racking systems, cold storage, cold room and processing units in mandis and warehouses will reduce the wastages during handling and storage. It’s high time we looked at agriculture as a source of revenue by taxing the rich farmers and passing on the benefits to the marginal and landless farmers. 

Infrastructure: 

It was noteworthy that forty-six percent of plan allocations in 2010-11 will be for infrastructure development. It goes to show that the FM has realised that for the sustainability of the Indian growth story, infrastructure has to be robust. Tax breaks on investments in long-term infrastructure bonds is a welcome step. The major concern would be proper execution of such projects. 

Social Sector: 

Increased allocation to rural development initiatives like National Rural Employment Scheme, Bharat Nirman, Rajiv Awas Yojana for slum dwellers etc shows that Bharat will no longer be neglected vis-à-vis India but the major cause of concern with such schemes have been corruption and leakages in the system. Unless these issues are properly dealt with, they would be a burden on the exchequer. The NREGS too needs to go beyond funding temporary activities like digging up wells, check dams etc. It could be used to develop permanent assets for irrigation. Provision for further capital for regional rural banks will help in credit penetration as well as stop fund leakages as targeted beneficiaries can be directly paid through bank accounts. National Social Security Fund has been created for workers in unorganised sector. This is modest beginning but a much needed initiative nevertheless. 

Other Initiatives: 

Clean energy cess on coal produced in India, concessional duty on solar power rickshaw developed by Council of Scientific and Industrial Research, increased allocation for new and renewable energy are a proof of the progressive thinking of the government but it needs to be sustained to be effective. The higher education was neglected by the FM that too considering the immense possibilities of PPP in this sector. The continuing shortage of skilled workforce should have rung a bell or two by now. 

All in all a budget that will yield positive results if the initiatives are effectively implemented. Else it could be the classic case of, ‘Too much boast, little toast”.