Even as the pandemic unfolds, we are witnessing new trends in consumer behaviour and healthcare delivery systems alike. Conventional paradigms have shifted—paving way for a hybrid model of treating patients. With a spike in digital consultations enabling doctors to go beyond their local patients, healthcare service providers seek to deliver a more equitable and accessible healthcare experience. Monika Sood, Co-founder and Partner, and leader of the healthcare advisory practice at Areté Advisors LLP, reflects upon the post-COVID future of healthcare, as both practitioners and stakeholders rejig their priorities to meet the changed market need.
The pandemic has undoubtedly accelerated digital adoption in every industry, and healthcare is no exception. Tech interventions in the field of medicine have been hailed upon by many and have had manifold benefits. Alongside medical practitioners, healthcare providers have been looking at adopting tech and leveraging AI as part of their growth plans with the aim of delivering superior healthcare. COVID-19 clearly necessitated and accelerated some of those plans, fostering a data-driven and interconnected healthcare ecosystem.
When the first wave of COVID-19 hit us, there was an immediate upsurge in telemedicine. Most players improvised quickly, creating innovative tech platforms to facilitate these interactions, or providing ad hoc solutions to patients via WhatsApp messaging or other messengers, simultaneously creating payment gateways for a smooth experience. Patients could now reach their preferred doctor over a call at their preferred time, without having to expose themselves to the virus. Old ways made way for the new and as online consultations replaced physical patient examinations, both patients and doctors were forced to adapt and become comfortable with technology. With a reduction in COVID cases, while teleconsultations saw a sharp decline, they were significantly higher (5-10x) than in the pre-COVID era. Given the benefits to patients and doctors, telemedicine is here to stay.
The second wave of COVID-19 led to a tsunami of cases that exposed the cracks in the Indian healthcare system and brought to the fore issues of limited hospital bed capacity, dwindling oxygen supply for critical patients, shortage of testing provisions, medical staff and equipment at hospitals. This wave made private and public players join hands to effectively combat the disaster and come up with innovative solutions.
Healthcare providers witnessed a significant decline in financial performance in the first half of FY21 due to a multitude of reasons. As per an industry report, the private healthcare sector witnessed an 80% fall in patient visits and test volumes with revenue drop of 50-70% end March. Hospital occupancy levels fell to 30-40% by late-March vis-à-vis pre-COVID-19 occupancy levels of ~65-70%. Patients delayed elective procedures due to lockdowns resulting in limited movement from upcountry towns to hospitals in metro cities. They demonstrated digital agility and gravitated towards doctors with higher ratings and sound testimonials. Despite moving to teleconsultations, hospitals faced revenue loss of other associated services like diagnostics, imaging, and pharmacy. Most players innovated rapidly to offer these services online and competed with established e-pharmacy and online aggregators.
With restrictions all across on travel and flights, medical tourism got severely affected and hospitals lost international patients. As per the Ministry of Tourism, the number of international tourist arrivals had gone up to 495,000 by 2017 and India’s medical tourism industry was pegged to grow by 200% by 2020, hitting US$ 9 billion (around ₹68,000 crore). However, estimated loss in the first two quarters of 2020 alone ranged at about US$ 1 billion.
Meanwhile, the providers had to bear the increased cost of Personal Protective Equipment (PPEs) and introduce new safety protocols. The focus was on investments in technology platforms, as patients increasingly expected a seamless experience—be it the ease of use of these apps, making payments or ensuring availability of doctors at the designated time.
Based on our experience of advising leading healthcare providers in the country, hospitals are keen to leverage technology to improve healthcare outcomes, increase efficiency, and enhance customer satisfaction. A few focus areas that could deliver attractive returns are as follows:
Building patient loyalty: As more data becomes available, hospitals could look at building robust Customer Relationship Management (CRM) solutions, to build and nurture customer loyalty. Services being offered could include appointment reminders, scheduling tests, cross-selling and upselling products based on patient history etc.
Home care evolution: With physical distances becoming safety protocols, hospitals need to be closer to their patients than ever before. Aside from platforms facilitating outpatient consults, Home care is fast becoming a crucial element of service delivery where hospitals are reaching out to patients and delivering services at home leveraging remote monitoring devices. Today, Home care companies are delivering even complex services like chemotherapy and ICU services, at home. In terms of home-health opportunities, industry leaders are also seeing opportunities in home labs and infusions.
Prioritising safety protocols: With safety being the utmost priority, it is an area of focus for healthcare providers. Hospitals are taking multiple initiatives to ensure that patients feel safe and comfortable when they visit the hospital. A few interventions such as changes to facility configuration and layout, minimising contact for admission where formalities can be completed online and the patient is taken directly to the room, could take them one step closer to enhancing customer satisfaction levels. Customised offerings for senior citizens are already on the rise.
Evolution of telemedicine: Hospitals are investing in robust technology solutions to improve the teleconsultation process for patients. Most believe that the future is likely to be hybrid with patients preferring to use tele consults for non-acute and follow-up cases. For patients visiting hospitals from outside the city, it is likely to become the medium of choice for the consultation. These solutions include additional functionality home sample collection, pharmacy fulfillment etc. to ensure a seamless experience for patients.
India, as a country sees a lot of patient movement from tier-II and tier-III cities to the metros. These are characterised by specialised surgeries and follow-up trips. Technology can be leveraged to make this process efficient and cut down unnecessary expenses on trips. All paperwork and follow-up formalities can happen digitally, and the patient may travel just once for the surgical procedure. Hospitals could set up remote monitoring centres in upcountry towns with the requisite equipment that can measure basic parameters and relay that info to the main hospital and manage patients easily.
Leveraging digital marketing in a changed market: With both consumers and practitioners online, hospitals need to leverage the wave of digitalisation—by making informed use of digital marketing and analytics tools. Hospitals are reaching out directly to patients for products and services offered by them. One of our clients was able to improve revenue by 10-12% in a six-month period by effectively using digital campaigns to target their potential customers. Through optimal usage of centralised data analytics, insights into outpatients and inpatients could prove valuable in extending services.
Improving medical outcomes using technology: Healthcare providers today offer predictive and personalised healthcare services using genomic sequencing. For example, one of our clients recently launched a genetic test that assesses the risk of a patient developing heart disease based on their genetic makeup. Hospitals are increasingly offering robotic surgeries for better outcomes.
AI and Machine Learning as game changers: As hospitals look at improving efficiency, AI has become an important cog in the wheel. For example, artificial intelligence algorithms are being used for medical imaging (CT, MRI, X-rays) with high accuracy levels. This will lead to more efficient use of skilled radiologists. Teleradiology solutions are also being widely used to ensure better reading of scans especially in geographic areas which have limited radiologist availability. AI-based interpretation of chest X-ray images has been used to support COVID-19 detection in under-resourced areas. Decision Support Systems are being set up as hospitals collect more electronic treatment data, and the tech around robotics and neuro navigation systems is being used to improve the quality of surgeries. Such strategic tech tools will help practitioners and healthcare service providers improve their efficiency in leaps and bounds and deliver better medical outcomes. A lot of well-established players are, therefore, looking to include technological advances in a massive way in their service offerings.
Supply chain diversification: Entire supply chain dynamics are changing as hospitals are relying on aggregators for medical supplies at significant discounts, as opposed to traditionally buying from one distributor. The aim is to ensure the availability of critical medical supplies at lower costs and offer durable solutions while maintaining profitability.
As geographical boundaries blur and technology becomes centre stage, it becomes important for hospitals to reflect upon their positioning and showcase what differentiates them from others. The bar has been raised for hospitals, with the flexibility of tele consults—second opinions getting simpler, shorter or no wait times etc. so they will need to engage and communicate with their consumers in a more meaningful way. In my view, despite the ease of using these modes, the criticality of human interactions and doctor-patient relationships will ensure strong outpatient departments in the hospitals. However, certain formats will become more important and effective, like Home care, remote ICU services and patient management, with a stabilisation of tele consult volumes as face-to-face visits resume.
Service providers need to be mindful of the fact that even as widespread adoption of technology is on the cards, processes need to change to make them more relevant and simpler with the times. Any transformation is dependent on people’s ability to adapt. The element of educating different stakeholders also gains significance as the willingness to change and adapt is often lacking despite the clear solutions in sight. Hospitals today are embarking on the journey of digital learning, training various stakeholders to leverage the benefits and instilling confidence in the world of tech. A closely linked hurdle to this is also striking a balance between using technology and maintaining sensitivity towards the patients.
Healthcare has been a very traditional space, built on the foundation of trust and familiarity. All the digital reinforcements that service providers and hospital chains are trying to rope in, are fairly new in this context. Therefore, bridging the skill gap with well-trained individuals will be crucial to avail the benefits of technology.
In terms of expertise and skill set, domain specialists will remain critical for specialised care as all medicine will need to be delivered by them. At the same time, practitioners would need to be comfortable with using tech interfaces to interact with their patients, as opposed to age-old methods of using prescription pads, meet and treat scenarios. The managerial heads, be it the CEOs or unit heads will need to extend their expertise beyond managing patients, physicians and hospital staff and ‘understand’ technology to improve their operational and financial performance. Identifying innovative patient acquisition and retention strategies, using digital marketing tools and online reviews are the areas of expertise that traditional operators will need to build. Those who understand these better would perhaps be better positioned for success than others.
As business models are being disrupted and transformed, it is important for the healthcare space to reorganise, reimagine and enact. Large technology firms like Google and Amazon are looking at investing into healthcare, basing their firm belief in technology solutions in healthcare delivery. The next 10-15 years appear fascinating in terms of the businesses that will evolve and the advances we make via technology. From the hospital provider perspective, we have a long way to go before we bridge the skill gap, so it will remain critical for people to upskill and keep up with the tech.
Healthcare, at the end of the day, is a very human interface and not everything is solvable by technology. While technology is going to support and facilitate, the healthcare space will always retain the human element at its core.
 Movdawalla, K. (April 2020). Impact of COVID-19: Private healthcare sector calls for urgent financial stimulus. Retrieved from https://www.ey.com/en_in/life-sciences/impact-of-covid-19-private-healthcare-sector-calls-for-urgent-financial-stimulus
 Chandna, H. (August 2020). Only one attendant, no sightseeing, no shopping — how India could reopen medical tourism. Retrieved from https://theprint.in/india/only-one-attendant-no-sightseeing-no-shopping-how-india-could-reopen-medical-tourism/480037/
 Coronary Artery Disease
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Healthcare delivery, healthcare providers, accessible, affordable, teleconsultations, healthtech, hospitals, homecare, safety, COVID-19
Monika Sood, Co-founder and Partner, Areté Advisors LLP