Telemedicine Players Need To Remodel For Sustaining Long-term Operations

In existence since 2001 when the Indian Space Research Organisation (ISRO) connected a rural hospital in Aragonda to Apollo Hospital in Chennai - telemedicine has really exploded only in the last four to five years with a special boon provided by the pandemic where teleconsultation platforms consulted patients over a call with patients wary of catching the Covid 19 virus inside the hospitals.

But the post-Covid 19 era is transitioning fast with some experts from the industry highlighting that footfalls on telemedicine platforms have fallen considerably compared with the highs of the pandemic. Some of the popular companies in the teleconsultation business in India are Practo, MeddiBuddy, MFine and Lybrate among many others.

According to a 2023 report by Technology, Information Forecasting and Assessment Council (TIFAC) the telemedicine market in India is expected to grow at a compound annual growth rate (CAGR) of 31 per cent for the period 2020–25 and reach USD 5.5 billion. The increasing demand for teleconsultation, telepathology, teleradiology, and e–pharmacy are acting as the levers for this growth, the report says.

Although Industry insiders tell a different tale, they believe that the growth for independent players providing teleconsultation services is stabilising now versus what the scenario was during the pandemic. Experts also say that the post-pandemic fallout has gone in favour of large healthcare providers who have benefited more in the telemedicine space.

“Overall, directionally when you look at it from a provider perspective, pretty much most of the large, organized healthcare providers have seen a positive trend with respect to growth in telemedicine through the pandemic and in the post-pandemic period as well. These groups have started tracking their digitally sourced leads or revenues and that is significantly north of what it used to be earlier,” says Kaustav Ganguli, MD, Alvarez & Marsal India.

He says while there was a frenzy of remote consultation platforms coming up in the pandemic with an uptick in consultations, the growth has now stabilised for these independent teleconsultation companies and they have not had a unidirectional positive traction.

“This year we spoke to 25 hospitals in India and we found that telemedicine consultations as a percentage of consultations at the hospital are roughly around 10 to 25 per cent, not more than that, 25 being the highest in certain hospitals and 4 per cent being the lowest but the average is around 10 per cent. So the numbers have kind of plateaued, they have not really grown beyond it,” states Dr Vikram Venkateswaran, Partner, Deloitte India.

Telemedicine Needs To Go Beyond Consultation

Industry critics believe that telemedicine needs to reinvent itself in order to sustain and scale going forward as presently there has not been much success in their business models. Providing arguments in support, experts say that patients look for a physical touch by their physicians and the teleconsultation applications do not provide an integrated care mechanism which adds significant value to the patients.

Siddharth Srinivasan, CEO, Lupin Digital Health says that telemedicine needs to go beyond being a call between the doctor and the patient and that there has to be some value addition to patients who can actually measure their vitals sitting at home and the doctor is able to see that in real time.

“If you're able to add that value, where patients are being monitored remotely. They can be diagnosed through algorithms, which then the clinician is able to validate but a lot of that heavy lifting is being done by technology, then having a virtual connection helps, and I think fundamentally it is going to be a hybrid model,” Srinivasan says.

He further says that patients will for emotional reasons want to sit in the doctor's chamber for the first time. A heart failure patient for instance wants to get assurance from the doctor, he wants his pulse to be checked and have that confidence, Srinivasan opines.

“But would one want to go to a doctor every time he is having some oedema in the foot? Absolutely not. All the doctor needs to do in that case is prescribe some medicines,” he adds.

Teleconsultation platforms are actively looking to diversify their business adding more services to their standalone business models. According to Ganguli, independent teleconsultation platforms branching into other service areas or solutions is not surprising as banking only on consultation-driven revenue models to scale up is probably not a very wise idea. “There is significant fragmentation in this area as well. Besides, healthcare providers are now coming up with their own digital solutions, with different solutions for different intervention areas across the value chain of patient engagement,” he says.

Dr K Ganapathy, Director, Apollo Telemedicine Networking Foundation and Apollo Tele Health however believes that it is quite possible that the footfalls when compared to the height of the pandemic probably have come down in some hospitals and some regions of India. “But compared to the pre-pandemic era, I am absolutely certain that the deployment of telehealth has considerably increased,” Dr Ganapathy says.

Telemedicine Can Add Value To Hospitals

Experts from the industry believe that hospitals are actively sourcing their patients from their digital platforms, creating unique profiles with patient data and giving personalised services to the patients. Telemedicine, although a small part of their business today can rein in returns in the long term.

Dr Venkateswaran says that the only organisation providing a care continuum is a hospital today and that there is nobody else looking at the care continuum, especially in preoperative, operative and post-operative care. He adds that while telemedicine providers have been able to provide online consultations, they are not really an integral part of their care.

Ganguli said that hospitals are not relying on a single patient application to engage with the patient. Instead, they are using a host of physical interactions, digital outreach, website content, call centres, WhatsApp bots and artificial intelligence (AI) led outreach to ensure that the patient is engaged in the digital funnel and is being advanced through that funnel.

“I do believe that overall out-of-hospital patient engagement, consultation and home care will continue to grow for providers as they can keep building on this integrated ecosystem of solutions that will enable both digital patient outreach as well as continued engagement through the patient life cycle,” Ganguli concurs.

Dr Ganapathy further suggests that in India there is a serious dearth of specialist and super-specialist doctors unevenly distributed in urban and rural areas.

“In a study which we carried out five years ago, we showed that 970 million Indians lived in areas where there was not a single neurosurgeon, and therefore it is absolutely essential that the only way we can provide specialist and super-specialist health care is through using information and communication technology,” Dr Ganapathy delineates.

Hot In Healthtech

With an ongoing funding winter which has hit healthtech more than other sectors, things are moving slowly but steadily in the industry. According to a 2023 report by Tracxn funding in healthtech dipped by 55 per cent in 2022 to USD 1.4 billion versus USD 3.2 billion in 2021.

On being asked about the exciting ventures which will gauge the traction of investors and patients alike, experts from the healthcare industry contended that startups solving greater problems of diagnosing high-burden diseases in India with the help of Artificial Intelligence (AI) and other evolving technologies will continue to attract eyes.

Some experts also highlighted another trend in the distributor's sector of pharmaceuticals and medical devices where a technology-enabled consolidation is playing out. Big distributors are providing technology-enabled platforms offering much better services with respect to procurement, inventory management, faster turnaround time and much greater fulfilment rates when it comes to fulfilling the requirements of both independent pharmacies as well as small clinics and hospitals. This is enabling significant scaling and consolidation in the distribution segment, industry voices contended.

The original article was published in BW Healthcare World.com on 18^th October 2023.