Healthcare-IT Business Strategy

Friday, June 14, 2019

Healthcare Wallet will Emerge!

 




Healthcare Wallet will Emerge!

India is poised for 10 fold increase in digital payments. Will become 4th largest in the world after Singapore, Sweden and USA. This will have a profound impact on Digital Health. Will become a major driver in adoption of Digital Health across payer and provider systems.

Consider This:

Health Insurance coverage has gone up from 3% of Indias population to over 40% with Ayushman Bharat.

90% of Health Insurance claims is reimbursement of out of pocket out patient expenses related to the inpatients episode.

Insurance is more comfortable reimbursing a Digital expense because it reduces the chances of fraud and abuse. From a Actuarial perspective the risk comes down because of full traceability.

Patients will gravitate toward clinics and hospitals that provide Referrals, Prescriptions, Reports in Standards based electronic format. Because Insurance companies will clear the standard eClaims format faster.

About 8% of out patient gets converted to inpatient procedures for any hospital OPD. Any reduction in out patient foot fall will negatively impact the inpatient load and hence the top line.

A Fintech based rating engine will appear to rate the clinics and hospitals. This rating engine will be far more pervasive than the Practo rating engine because money in the pocket is always a more powerful driver.

A whole new sand box gets created for the digital health startups, software vendors and fintech companies to play. Someone will fill the vacuum. For lack of a better word a Paytm or Jio Wallet for Healthcare expenses and reimbursements is on the anvil.

India will be the next battleground for Global Retail and Healthcare! After USA, India has the largest user base for the Internet Giants like FB and Google. Amazon is in India. Walmart is picking up majority stake in Flipkart. All the Internet and Retail giants have expressed interest in Healthcare.

Can you extrapolate the Dots? I can see the Trend! Fintech fueled transformations are underway.

The real innovation in mobile payments in India began a few months prior to the cash ban. It’s called a unified payment interface, or UPI.

With more than 140 Indian banks sharing the interface, and Alphabet Inc.’s Google and Facebook Inc.’s WhatsApp offering instantaneous payment services on it, UPI has become a keenly watched experiment. By the looks of it, things are going well: From nothing to 800 million monthly transactions in less than three years, India’s UPI has taken off. Growing smartphone use and crashing data costs have helped immensely.

Google and WhatsApp will fight for market share. So will PhonePe, now owned by Walmart Inc. as well as new entrant Amazon Pay, which hasn’t made much of a dent globally into PayPal’s dominance of e-commerce. Indian banks that run their own UPI services. Indian tycoon Mukesh Ambani’s Jio with its 300 million subscribers will push JioMoney. Masayoshi Son and Warren Buffett will keep an eye on their Paytm stakes.

Now RBI has removed charges on RTGS/NEFT transactions; and asked banks to pass on benefits.

Cities Perspective:

Tier 1 cities: Pune, Bengaluru, Chennai are leading the wave in UPI transactions. Pune topped the city list, with the highest average digital spend — per person per month — of ₹16,513. Followed by Chennai at ₹14,208 and Bengaluru at ₹14,000.

Tier II and III Cities: Razorpay says by 2020, 40 per cent of digital payment transactions in the country will be driven by businesses and consumers in Tier-II and -III cities, and 50 per cent of internet users will be using digital payments. Whereas Paytem says - We have been witnessing a tremendous increase in adoption of digital payments in tier II & tier III cities that constitute 50% of our total user base. Surat, Durgapur, Rajkot, Meerut, Imphal, Rohtak, Panipat, Mangalore, Ranchi, Puducherry, Rajamundri, Warangal, Jodhpur, Thrissur, Karnal, Madurai and Jamnagar are among the fastest adopters and are leading the wave of digital payments adoption.

Users of wallets are not updating their KYC (know your customer) details. Instead, they are using UPI (Unified Payment Interface) to make digital payments. Anyhow total payments via digital instruments are expected to be between $400-500 billion in 2020, up from $50 billion in 2017.

Hold your breath guys! Fintech is the digital health roller coasters.

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Thursday, February 4, 2016

New Healthcare Aggregators: SMAC and IoT



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See Dr Pankaj Gupta @ Healthscape IDE 2017 Panel Discussion Video 2: https://youtu.be/7RgY-5lp1qQ. Why are hospitals not moving to cloud computing?
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The old paradigm of business as a linear value chain is now facing extinction. Businesses are now ecologies and not merely producers and sellers ! That requires a change in thinking. Customer Relationship Management (CRM) needs to be a mission at every step of the process. This is hard to overemphasize! The internet is clearly the medium that allows such integration across time and space. It is time to take a more accepting look at Cloud and Social Media technologies. This offers the only universal layer of engagement across stakeholders. The investment in IT hardware as we knew it in the past has been greatly optimized by mobile. It has brought a tactile feel to life and work for all of us. Mobile mirrors the nature of Healthcare in terms of immediacy and continuity so well. Healthcare needs to embrace it wholeheartedly. Healthcare can only profit from it.
There is a huge Vacuum in Indian Healthcare-IT space. Large Healthcare-IT vendors have exited the market. Either they lost interest and exited or got bought out e.g. TrakHealth, iSoft. Also many traditional HIS/EHR are losing market share as the market is moving from client-server to cloud and from Capex to Opex models e.g. Wipro HIS, TCS Med Mantra, HealthFore. Many of these players like Wipro, TCS, CSC are suffering in their primary market [USA] due to shifts in US Govt policy and Automation and hence lack the Executive confidence to invest in product upgrades for the Indian market. On the other hand many incumbent players are not able to shift out to cloud because of their long term negotiated contracts in client-server model e.g Napier, Akhil, Srishti. New cloud based players like Dwise, UBQ, SRIT, ICT, Attune are small in size and yet to reach size and scale. Whereas Practo is trying to solve a problem that doesn't exist! Someone was stupid to assume that Appointments and Scheduling will sell whereas we Doctors want to see long waiting line of patients outside our clinics. Also the patients like to see waiting queues - in Doc sahib ki chalti hai.
Effect of Demonetization -- many hospitals are going to be sold off to PE that can invest in FDI e.g. Fortis is on the chopping block. The new management is going to hit on the bottom-line, optimize processes, re-skill staff and invest in growing the topline. All this is obviously a compelling case for Digital! So the time is now when full conversion of Client-Server Enterprise class to Digital [SMAC, IoT, CRM, AI] will happen. Now Healthcare CIOs have a choice to make - keep eyes closed and risk losing their jobs or tighten the belt and ride the Digital wave. Welcome to the Future!
The Government push towards MDDS/EHR Standards is not helping the old horses. PM Modi has put the focus of his Digital India on Healthcare, Education and Jobs [see http://economictimes.indiatimes.com/topic/Digital-India]. Whereas Healthcare is a State Subject and District Health Officers are wondering how do we benefit from Digital! Hard for many to imagine SMAC is a unifying force across enterprises and IoT breaks the silos. PM Modi's Digital India can be quite a game changer!
The era of hierarchical command and control is over. Now is the time for horizontal networking across Communities of Practice [CoP]. Whatever gets the maximum likes becomes the In Thing. Whatever is the In Thing gets used the maximum. Students are learning more from the online networking than from the formal classroom and professors. Research will reach the point of use as soon as it gets published. Primary care Providers in semi-urban and rural areas will have access to latest therapeutic recommendations. The old Adage that 'Knowledge is the only form of power that is not expendable but grows when shared' has become true.
The movie Avatar has beautifully depicted the concept of Small data ^ = Big Data where small knowledge base of each living being [App] is contributing towards the collective consciousness [Big Data] of Eywa. Now the question is will the future of SMAC/IoT be driven by technology or biotechnology?
Anyways for now - The time has come when you don't need big monolithic HIS software to run hospitals. Now you can do everything with small mobile based Apps for every function. Though I am already seeing many of these Apps in the market but what is lacking is a unified platform on which the Apps should be built such that the data can be seamlessly collated. Also it gives the provider the flexibility to select from a bouquet of Apps.
IoT integration platforms are emerging that will integrate at the App level, Data level and Semantic level. Anyone in the ecosystem can slice, dice, run reports on the collated data.
Successful Cloud models have dug the grave for the Enterprise Hardware. Capex has got converted to Opex. Now you can pay for the software on the cloud like you pay your monthly electricity bill.
SMAC coupled with IoT has a potential to bring the Aggregator Business model to Healthcare. Soon the unorganised and fragmented primary care, secondary care and supporting care market will begin to get Aggregated. I see these Aggregators becoming larger than established capital intensive Enterprise market similar to what happened in the Automobile market. It will be in the interest of Insurance, Pharma and Govt to go all out and support this emerging SMAC/IoT driven Healthcare Market Aggregation.
What happened in the FinTech space will now happen to HealthTech too. Just as the FinTech became a game changer to the Financial sector, a Digital Healthcare Ecosystem is taking shape. So many times bosses mocked new technology and got it wrong! Healthcare Businesses that are still in a denial mode will have huge re-skill challenges and risk shut shop.
References:
Why Healthcare must Re-imagine itself - and how
https://www.linkedin.com/pulse/why-healthcare-must-re-imagine-itself-how-arun-kumbhat
Why All Indian Hospitals IT is in Bad Shape
http://healthcareitstrategy.blogspot.in/2014/04/why-all-indian-hospitals-it-is-in-bad.html
Global HIS/EMR vendor nightmare outside US
http://healthcareitstrategy.blogspot.in/2012/08/global-hisemr-vendor-nightmare-outside.html
Thick client vs Thin client
http://healthcareitstrategy.blogspot.in/2008/08/thick-client-vs-thin-client.html
There is no Market for EMR in India
http://healthcareitstrategy.blogspot.in/2012/10/there-is-no-market-for-emr-in-india.html
Size of Healthcare-IT Market in India
http://healthcareitstrategy.blogspot.in/2012/06/size-of-healthcare-it-market-in-india.html

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