2023 India Healthcare and Lifesciences Investment Outlook

2023 India Healthcare and Lifesciences Investment Outlook

Since 2013 our algos have been accurately predicting the investment heatmap in the healthcare and life sciences in India which were predicting with 95% accuracy on the sectoral investment cycle in India till the end of 2019. Since the Covid Pandemic in 2020 we lowered levels of prediction accuracy like we started back in 2013. Covid-19 pandemic killed over 23 million people globally. 2022 has brought new headwinds, some we haven’t seen in over 40 years. Healthcare spending will fall in 2023 in real terms, given high inflation and slow economic growth, forcing difficult decisions on how to provide care. Digitalisation of the healthcare system will continue, but the use of health data will come under stricter regulation. A New world order under the current geo politics fragmentation and multilateral world is bringing India to the forefront. It’s vaccine diplomacy, effective and cost-effective therapeutic solutions is a game changer for India.   

2023: A Year of Newer Normal

Since the Great Chinese famine of 1959, for the first-time life expectancy as per UN, Covid-19 had been cut by 1.7 years off global life expectancy, reducing it to 71.1 years. While a recovery probably began in 2022, the UN calculates that 2023 will be the year when life expectancy first exceeds 2019 levels. The investment thesis with most of the investment managers in the current scenario is more of a long view on healthcare infra which are less tied to economic cycles and an imminent slow down globally. Some of the investment risks the healthcare and lifesciences sector faces include rising real interest rates, increasing price inflation for healthcare products and services in the face of weakening in consumer spending, reshoring the supply chains and the wars, both trade and terriotorial. Digital businesses are equally going to be impacted. ESG and impact funding is waiting for deployment.

2023 India Healthcare and Lifesciences Investment Outlook
2023 India Healthcare and Lifesciences Investment Outlook

Let’s relook at the board trends for 2023 in terms investment activity and trends.

Healthcare Financing

2021 was an all time-high for healthcare financing sector due to emergency and non-discretionary spend on healthcare. Health Tourism related funding is only going to take off in Q3 after the current wave tides down. Consolidation activity to slow down.

2023 Outlook: Moderate

  • What’s going wrong: right bite for the consumers, reach and penetration, higher debt financing costs, slower non-discretionary and elective healthcare spend, delaying of healthcare spend and health tourism, new wave restrictions, shortage of digital workforce
  • What’s going right: India stack digitisation, agetech, consumer borrowing to spend on electives

Medical Education

Skilled manpower shortages is the key driver for growth. All the students who have returned back from Ukraine need to be accommodate in our current system Regulatory reforms are urgently required to push digitization and newer business models for upskilling existing workforce. Churn in ownership of assets due to consolidation activity will continues at a faster pace.

2023 Outlook: Moderate

  • What’s going wrong: regulation, corruption, no vision, skill shortages, alignment to new age care, increasing debt burden
  • What’s going right: skill demand, digitisation, manpower-led business models creating their own content or tying up with larger established players, cross-border students coming to India, export of clinical manpower to the West     

Med Tech Innovation and Life Sciences Discovery and Clinical Development

India has proven to be the vaccine supplier to the world in 2022 with over forty percent of the world’s pre-qualified vaccine products are made in India. Capacity creation and new product development need to be accelerated particularly in infectious diseases and some niche segments. Reshoring and government policies for that need to be accelerated. Global investment and partnerships is on the rise in 2023. Patent expiry of some of the blockbusters in the US are a huge opportunity.

2023 Outlook: Moderate

  • What’s going wrong: Innovation pipeline, IP regulation, regulatory bottlenecks on clinical development, newer skill sets for research and acceleration, global collaboration and partnerships
  • What’s going right: Human capital, cost advantage, reshoring the supply chain, Make in India

Pharma and Therapeutic Solutions

Several players are going to go for the IPOs in 2023. Reshoring the supply chain is moving slowly. The Government production linked incentive is not moving as intended in the medtech, intermediates, APIs. The capital expenditure in creating world-class green infra is still to take off.

2023 Outlook: Hot

  • What’s going wrong: price controls, policy log jam, innovation and scale up, cost competitiveness, exit of PLI incentives, scale of capex, Margins pressure, IPO valuation
  • What’s going right: cost advantage, distribution infrastructure, Government incentive programs, blockbuster going off patent in the US, ESG funding entry

Healthcare Providers

2022 was a negative year for almost all the listed stocks. With higher interest rates, funding costs for have increased. Inputs such as steel, cement, etc, have also shot up increasing the capex per bed. Newer sources of funding green healthcare infra as a long-term bet which are less tied to economic cycles is emerging. Digitalisation will slow down even further as consumers go back to the old ways. Costs and profitability pressure will increase to maintain the investor interest. PE valuations will continue to get right adjusted to market valuation.  

2023 Outlook: Moderate

  • What’s going wrong: margin pressures, price controls, execution of programs on the ground, PPP in healthcare, supply and demand mismatch in micromarkets, debt financing costs, gun powder churn, operating cash runway, liquidity and working capital crunch
  • What’s going right: Asset-lite models, demographics

Healthcare Insurance

The IPOs in 2021 in the sector have created uncertainty in valuation and investor sentiment. The sector will continue to grow as it did in 2022. New products and customer segmentation is going to be the growth drivers

2023 Outlook: Hot

  • What’s going wrong: product fit to consumer needs, product approvals, loss ratios, operating cash runway, human capital reduction, consumer offtake and demand, IPOs pricing and valuation
  • What’s going right: Consumer demand, digitisation, new products

Health Retail

Spends on healthcare are slowing down and so is the discretionary spend. Falling service levels and consumer trusts is at an all-time high. Costs and margin pressures is going to be more acute. Only one major IPO expected in 2023. Many of the late stage start-up are going to scale down or not raise the capital at the expected valuations.

2023 Outlook: Moderate

  • What’s going wrong: regulation, consolidation, slower consumer spending, funding drying up, operating cash runway,
  • What’s going right: Consolidation, newer cross-vertical innovative business models, profitability focus and valuation being right adjusted

Wellness

Growth which tapered down in 2022 is still going to be sluggish in 2023 as consumers cut back their spends. Digital business model innovation is still lagging behind. Medical wellness tourism will be recover in Q3 of 2023. Corporate Wellness spends which also scale down even further. PE funding is going to slow down even further as valuations squeeze even downwards with margin pressure. Expect one major IPO here.

2023 Outlook: Hot

  • What’s going wrong: regulation, maturity to scale, down round valuations, slowing of wellness spends, manpower and cost pressures
  • What’s going right: newer cross-vertical innovative business models,

Alternative Therapies

Growth and new customer acquisition is the new mantra in 2023 as consumer spending decelerates further. New products and therapies that have accessed funding in 2021are going to find it difficult to raise at the expected valuation. Large MNCs are also entering in this space to fight for the consumer’s mindshare. Funding crunch is going affect growth. Expect an IPO. Some of the players may scale down or shut down due to funding. Consolidation activity will increase.

2023 Outlook: Hot

  • What’s going wrong: maturity to scale, consumer education and confidence, clinical research, new product development, growth, funding crunch,
  • What’s going right: discretionary consumer spending, newer cross-vertical innovative business models, mainstream complementary treatment.

Let’s wish that we focus on building trust in healthcare for the consumers in 2023 and there is peace across for the world to come out of recessionary trend that would boost the investor confidence across.

Happy investing and stay safe!

Also Listen:

 

Why I picked up playing Squash Now?

Why I picked up playing Squash Now?

The lockdown is over!

Over the lockdown, I was only doing my regular walks and diet control. This helped me reduce my weight and kept me fit physically and mentally. The result was that I reduced over 15 kilos in weight. However, I needed a full body workout and had to pick up a sport. I am not a gym person and needed to add some workouts for my upper body and endurance. Hence some racket sport would be a great addition. In the past, I had played table tennis in school and college at competitive level. Later, in college I played tennis till I gave up in 2011.

After 10 years, I wanted to take up a racket sport that is easy on my age and is all weather. The choice zeroed down to squash.

Research from Sports and Medicine Favouring Squash

According to Forbes Magazine, squash was rated as the  healthiest sports in the World. Forbes consulted with personal trainers, coaches and exercise physiologists, 10 sports were listed as being the ‘healthiest’ in terms of cardiorespiratory endurance, muscular strength, muscular endurance, flexibility, calories burned in 30 minutes, injury risk. Squash took first place!

According to Forbes, 30 minutes spent on the squash court gives you ‘an impressive cardio respiratory workout.’ Constant running and rallies build endurance and muscular strength in your lower body, and squash can even improve flexibility in your core and back, thanks to the twists, lunges and turns necessary to keep the ball on the go.

If you’re wondering what makes squash so healthy, here are the results from the Forbes survey:

forbes
Forbes Survey

Here is more, Recently the British Journal of Sports Medicine underwent a study which examined information on more than 80,000 adults across England and Scotland who took part in national health surveys between 1994 and 2008. The study found that risk of death from any cause was 47% lower among those who played racket sports. The study suggested that regularly playing squash could help stave off death the longest.

Scientists have narrowed down the sports and types of exercise that are linked to significantly lower odds of dying before those who do not do those activities. The research concluded that racket sports, swimming, aerobics and cycling seem to be the best for prolonging life, in that order.

Meanwhile, those who partake in racket sports such as squash, also have a lower risk of dying from cardiovascular diseases such as strokes. After taking into account influential factors, the authors of the paper identified which sport or exercise seemed to be the most beneficial.

Compared with the participants who said they had not done a given sport, they found that risk of death from any cause was 47% lower among those who played racket sports; 28% lower among swimmers; 27% lower among those who took part in aerobics classes; and 15% lower among cyclists. No such associations were seen for runners or joggers and those who played football or rugby. When the researchers looked at the risk of death from heart disease and stroke, they found that playing racket sports was associated with a 56% lower risk, swimmers had a 41% lower risk and aerobics participants had a 36% lower risk compared with those who did not participate in these sports.

The researchers did find a 43% reduced risk of death from all causes and a 45% reduced risk of cardiovascular disease among runners and joggers when compared with those who did not run or jog, but this advantage was not deemed significant when influential factors were taken into account. They cautioned that the impact of running and jogging might have been underestimated.

The study suggests that squash is ultimately the best sport to play to ensure a long life.

About Squash

Squash is played in a four-walled court with a small, hollow rubber ball. It is played between two i.e, singles and four i.e, doubles players. The game was first played in 1930 at Harrow School in London, England. The game is an excellent cardiovascular exercise and mostly played in the gyms. It’s not an Olympic sport yet but it features in Commonwealth games and Asian games since 1998.

Gregory Gaultier, Mohamed El Shorbagy, Ali Farag, Nour El Sherbini, Raneem El Weleily are leading the point table at the moment. Joshna Chinappa, Dipika Pallikal Karthik, Saurav Ghoshal and Ritwik Bhattacharya have made India proud in the sport.

Getting Started

Getting started on squash costs as low as ₹5,000. Please use the basic gear available on Decathlon, India website or visit their store. Search | Squash (decathlon.in)

What's in my squash bag?
What’s in my squash bag?

# Gear Make Remarks
1 Squash Racket Prince Thunder Sub Zero 200 – 175 grams Poor packing, bent while shipment and play, do not buy
2 Squash Racket Perfly SR 135 Latest product. Pro range. Loved it.  
3 Squash Ball Prince Rebel High quality Pro
4 Shoes Plaeto Unisex Squash Sneakers Loved it. Made in India and endorsed by Rahul Dravid
5 Short and T-Shirt Sweat Free from Reliance Trends and Decathlon Good fit
6 Bag Aurion Squash Zipper Kit Bag Great price and value
My Squash Starter Kit

I made the mistake of ordering Prince rackets on Amazon. The product is bad as the grip needs to be replaced. Also the Amazon packing and handling is poor. The rackets arrived damaged.  

Other Benefits of taking up Squash:

Even at this age

Squash as a game is age-friendly. At 50+, I was able to pick up the game in the first session. The rest is YouTube videos to brush up the 101 and techniques.

Easy to pick up

As I played tennis, squash was really easy to pick up and lean. I can play solo and brush up on my strokes and on court movement alone with a coach to guide me.

Improved cardiovascular fitness

As per my watch, my peak cardiovascular activity at the end of 45 minutes of constant play was 175 bpm. This was 30-35 bpm higher than my usual walk after 45 minutes.

Improved hand-eye coordination

One of the concerns that I had was, Will I be able to see the squash ball which is coming to me at high speed? Need less to say, I was able to affirm that I had not lost my hand-eye co-ordination even after taking up a racket sport after 12 years. I was able to hit the ball from the first shot.

I can play solo

I am able to play the game solo and do not need a team to be accumulated to play the game unlike in racket sport, you need a duo. Just start hitting the ball against the wall!

Increase strength

After a couple of days of playing squash, I see my upper body strength improving

Improved posture

Sitting in front of your laptop, leads to a couching posture. After a few days of playing squash, I could feel my shoulders and back straightening up to a better posture

Learn to run and move backwards

If you can run backwards, your brain is still sharp and focussed. Squash gets you moving forward and backward on court to hit the ball hard enough. So its like a brain tonic for me!

Can play it even during rains of Mumbai

Most of the outdoor sports become seasonal in nature and cannot be played all round the year. Not in the case of squash. All you need is a wall to hit the ball against!

Health benefits

While here are some of the other health benefits of playing squash. Stress reduction, strengthening muscles and joints, with proper elbow and knee guards it is not injury prone, improves mental strength, determination and routine

And lastly, I am having fun!

Budget 2022: When is Healthcare’s Amrit Kaal Coming?

Budget 2022

Preamble

On 1 February 2022, our Hon. Finance Minister presented her fourth budget in the Parliament and introduced the “Amrit Kaal” in Point 4 of her speech, “we are marking Azadi ka Amrit Mahotsav, and have entered into Amrit Kaal, the 25-year-long leadup to India@100. Hon’ble Prime Minister in his Independence Day address had set-out the vision for India@100.”

Point 5 of the Budget Speech outlined the vision for Amrit Kaal, “By achieving certain goals during the Amrit Kaal, the government aims to attain the vision. They are:

  • Complementing the macro-economic level growth focus with a micro-economic level all-inclusive welfare focus,
  • Promoting digital economy & fintech, technology enabled development, energy transition, and climate action, and
  • Relying on virtuous cycle starting from private investment with public capital investment helping to crowd-in private investment.

The Finance Minister has envisioned to develop ‘sunrise opportunities’ such as artificial intelligence, genomics, and pharmaceuticals to assist sustainable development and modernise the country. However, this is more on the supply side industrial development. But the core issue of healthcare infrastructure is not addressed. Envisioning the Indian population which we would like to be a healthy one by 2047 when we enter India@100. I believe that Budget 2022 missed out a huge opportunity in envisioning Healthcare 2047! Here are my reasons.

Current Undergoing Transformation in Healthcare

The country has undergone a tough time during the pandemic. The Government has played its enabling role in ensuring the supply chain disruptions with China does not lead into a health crisis of sorts. On the other hand, the funding of Covid-Vaccine and immunization has ensured that the country emerges quickly into an endemic phase of Covid pandemic. While this was going on, there was strengthening and upgrade of the digital health infrastructure. The pandemic has also taught lessons to the private healthcare delivery ecosystem to restructure their business models and ensure that there is a push toward lower costs healthcare delivery models. These transformations have demonstrated India’s resilience in its healthcare systems to face emergency situations like the current pandemic.  

India’s Amrit Kaal’s Population Demographics

As the chart below demonstrates that India’s population by 2047 will be shifting towards middle age bulge. Over 300 million (~19% of the total population) will be senior citizens by 2047. Our dependency ratio will be around 40%. These 40% will be in the tax paying bracket which will provide the then Finance Minister in 2047 the revenues to spend for different welfare programs including healthcare.

India's Population Pyramid Shifts to 2047
India’s Population Pyramid Shifts to 2047

Lessons from Elsewhere in the World

In early 2000, I was involved in restructuring the healthcare systems of Saudi Aramco. Being the largest oil producer in the world, the company had been underfunding the pension and healthcare benefits of their employees who were going to be retiring in the future. The financing of these healthcare benefits created a financial crisis of sorts which have to be funded.

USA has also being facing such challenges when its baby boomers have now become unproductive senior citizens and their total healthcare bill is currently 18% of their GDP.

Vision for India’s Amrit Kaal Healthcare Delivery to Avoid Maha Kaal

As per current estimates, our country requires USD 400 billion of investments in healthcare infrastructure on our current demography to meet the global norms. There are no allocation in the current National Infrastructure Pipeline (NIP) funding for healthcare. Therefore much of the investment will be private sector driven in the future for healthcare infrastructure.

Such experiences elsewhere in the world remind me that our Amrit Kaal in 2047 does not end up as Maha Kaal of our Amrit Kaal where we would have to look up to Indian Gods who were invoked to end the situation. There have been several demands in the last few budget to accord infrastructure status to the healthcare industry. The current budgetary allocations to healthcare all though increasing has not been sufficient to build capital formation for healthcare infrastructure in the country. From the current 2.5% of GDP, there needs to broaden the spend on healthcare. We need the real picture of the input and outputs in healthcare. With the current GST regime of zero tax on healthcare services, we are not able to gather the real value of healthcare in the country and healthcare should be under minimum GST slab so that there is pass through benefits of the inputs that are set off. This will lead to a lot of transparency and provide real hard estimates of healthcare spend of the country.

Assuming by 2047 our dependency ratio will be lower than today. Which means that the total taxpaying population in 2047 may be same as today or even lower. There needs to be a plan to ensure that current taxes from the current population who will become senior citizens by 2047 will be underfunded like in the examples that I have mentioned below, leading into a budgetary crisis.

In all earnest, given the current constraints the current budget 2022 could do so much for healthcare. But now that the Amrit Kaal is out of the bag, there needs adequate focus to healthcare to avoid healthcare Maha Kaal in 2047 when we enter India@100.

2022: Healthcare and Life Sciences Investment Outlook

2022: Healthcare and Life Sciences Investment Outlook

Since 2013 our algos have been accurately predicting the investment heatmap in the healthcare and life sciences in India which were predicting with 95% accuracy on the sectoral investment cycle in India till the end of 2019. Since the Covid Pandemic in 2020 we lowered levels of prediction accuracy like we started back in 2013. While we worked on the Heat Map for 2022, we realized that every new wave of Covid is like a black swan event and raises the uncertainty and reduces the accuracy of the predictions with a reset. For 2021, we released two sets of heat maps, one for the healthcare and life sciences sub sectors and another for the States. Since the Central Government took the mantle of immunization, the need for updating state-wise heat map for 2022 is not relevant and not much data is being updated except for the electioneering noise and promises by political parties and immunization achieved.

2022: A Year of Consolidation and Tempering Expectations

2021 was the record year since 2013 when we started tracking the healthcare and lifesciences investments. The investments across the board was the highest, with the maximum number of IPOs and M&A activity, with over USD 2.2 Bn in funding across all the sectors in 2021. Some of the investment activity we predicted for 2022 preponed to 2021 due to positive investor and market sentiments and uncertainty of the future waves of Covid. Therefore, 2022 is a year of consolidation and tempering the tempo of investments.  

2022 Outlook
2022 India Healthcare and Life Sciences Investment Heat Map

 Let’s relook at the board trends for 2022 in terms investment activity and trends.

Healthcare Financing

2021 was an all time-high for healthcare financing sector. However, recent clamp down of Chinese funded consumer financing fintechs is going to temper down the healthcare financing sector. Health Tourism related funding is only going to take off in Q3. Consolidation activity to slow down.

  • 2022 Outlook: Hot
  • What’s going wrong: regulation clamp down, right bite for the consumers, reach and penetration, higher debt financing costs, slower non-discretionary and elective healthcare spend, delaying of healthcare spend and health tourism, new wave restrictions, shortage of digital workforce
  • What’s going right: India stack digitisation, consumer borrowing to spend on non-electives, immediate gratification, reduced household savings supplemented by borrowings

Medical Education

Key shortages of healthcare frontline workers was very apparent during 2021 Covid Crisis. The need for regulatory regime to upskills is still being reworked. Healthcare could be the key job creator. Regulatory reforms are urgently required to push digitization and newer business models for upskilling existing workforce. Churn in ownership of assets due to consolidation activity will continue albeit at a slower pace.

  • 2022 Outlook: Hot
  • What’s going wrong: regulation, corruption, no vision, skill shortages, alignment to new age care, increasing debt burden, new age skills certification, funding dry up
  • What’s going right: skill demand, digitisation   

Med Tech Innovation and Life Sciences Discovery and Clinical Development

India has proven to be the vaccine supplier to the world in 2022. Capacity creation and new product development will continue. Dependence on Chinese supply chain will reduce further as alternatives are developed indigenously. Expect a few IPOs this year in this sector. Government grant funding will temper down.

  • 2022 Outlook: Hot
  • What’s going wrong: innovation pipeline, IP regulation, regulatory bottlenecks on clinical development, newer skill sets for research and acceleration, Government grants and funding slow down
  • What’s going right: Human capital, cost advantage, emerging social innovation models, lower dependence on Chinese supply chain

Pharma and Therapeutic Solutions

M&A and consolidation activity was at a record high since 2016. Shortage of digital workers will slow down the digital transformation activity. As China substitution and supply chain threats mitigate, the Government will temper down their PLI support as well

  • 2022 Outlook: Hot
  • What’s going wrong: price controls, policy log jam, wrong product portfolio, innovation and scale up, global or China-level cost competitiveness, exit of PLI incentives, shortage of skilled digital workforce
  • What’s going right: cost advantage, distribution infrastructure, digital business models, Government incentive programs

Healthcare Providers

Funding costs will zoom up and will make access to long-term capital dearer. Huge churn in asset ownership and consolidation activity will continue. Digital transformation activity will slow down due to skill shortages

  • 2022 Outlook: Moderate
  • What’s going wrong: margin pressures, price controls, GST slabs rationalization on inputs, execution of programs on the ground, PPP in healthcare, supply and demand mismatch in micromarkets, debt financing costs, gun powder churn, operating cash runway, liquidity and working capital crunch
  • What’s going right: Digital business models augmentation, asset-lite models

Healthcare Insurance

The IPOs in 2021 in the sector have created uncertainty in valuation and investor sentiment. The sector will continue to grow as it did in 2021. Digital push and intermediation will be the key to growth.

  • 2022 Outlook: Hot
  • What’s going wrong: product fit to consumer needs, product approvals, loss ratios, operating cash runway, human capital reduction, consumer offtake and demand, IPOs pricing and valuation
  • What’s going right: Consumer demand, digitisation 

Health Retail

The major consolidation of the health retail after hectic M&A activity of 2021 will slow down the decibel levels of consumer discounts and offers to focus on generating healthy bottom lines. Only one major IPO expected in 2022.

  • 2022 Outlook: Moderate
  • What’s going wrong: regulation, consolidation, slower consumer spending, excess funding for GMV and operating cash runway
  • What’s going right: Consolidation, newer cross-vertical innovative business models, profitability focus

Wellness

2021 was the highest growth year in the last 10 years on the back of discretionary consumer spending on wellness. Digital business model innovation is still lagging behind. Medical wellness tourism will be recover in Q3 of 2022. M&A activity and consolidation to continue in 2022 but at a slower pace. Corporate Wellness spends to continue to fuel growth in 2022

  • 2022 Outlook: Very hot
  • What’s going wrong: regulation, maturity to scale, new mass market business models
  • What’s going right: newer cross-vertical innovative business models, corporate wellness spending

Alternative Therapies

Newer products and therapies that have accessed funding in 2021 will continue to fuel growth and investments. Adoption of alternative therapies into mainstream allopathic as complementary treatment is going to accelerate. Newer product development and business models is the key to sustained growth and success in 2022

  • 2022 Outlook: Hot
  • What’s going wrong: maturity to scale, consumer education and confidence, clinical research, new product development, inflated valuation,  over capitalization and cash burn to gain market share
  • What’s going right: discretionary consumer spending, newer cross-vertical innovative business models, mainstream complementary treatment.

Let’s wish that there are no further variants and waves in 2022 for any black swarm events for affecting investor sentiments.

Happy investing and stay safe!

Kapil Khandelwal is Managing Partner of Toro Finserve LLP, India’s First Healthcare Infrastructure Fund and Director EquNev Capital Pvt Ltd.

Estranged 2020 : My Song, My Life, My Way

A Day in the Life of KK

Estranged 2020 : My Song, My Life, My Way

2020: Early Warnings of Devastation

I started 2020 with a very positive outlook. Our investment heatmaps were indicating upswing in investment activity, term sheets in progress for investments, strong investment flows on the back of Sino-US trade blockade. By 15 March, it was clear that some Chinese bug has hit Indian shores and I started out moving back our teams to their home bases, talking to the authorities on the situation. On my birthday, just a day before the first 14-hour lockdown, I was working late in office to mitigate the risk that may be arising out of the business disruption. Then there was the forced lockdown preventing me to work from office. The start of the Financial Year 2020-21 was clearing going to be a devastating one for all due to the Covid pandemic. In the first week of April 2020, all the financial and business outlook turned negative and also I suffered huge financial losses never anticipated in my life as a result. It was a very depressing personal situation for me which I had never faced in my life. It was clear I needed to bouceback. Suffering losses is a temporary situation, letting the frame of mind to continue with being mentally ‘broke’ was just not acceptable to me. Clearly there were four key issues that I observed in Q1

  1. the volatility and pace at which the situations changed
  2. all plans and predictions went for a toss
  3. there was utter chaos and no one had a clear head and view to handle the complexity and solutions to solve it
  4. with more bad news, there was no view when things will bottom out

That’s when I started my journey of My Song, My Life, My Mantra, My Way, My Avatar.

2020: My Song

During my long walks during the first week April, I would listen to Bon Jovi’s hit Estranged, the lyrics of which went like this and my responses (in brackets)…

When you’re talkin’ to yourself (about your situation)

And nobody’s home (although at home with family in the lockdown)

You can fool yourself (that All is Well)

You came in this world alone (I am all alone fending for myself)

So nobody ever told you baby (nobody had a clue)

How it was gonna be (the lockdown and beyond)

So what’ll happen to you baby (rather be strong than helpless)

Guess we’ll have to wait and see (no way)

One, two

The nine minutes song played out the remaining nine months of 2020 of my life.

2020: My Life, My Nine Mantra

There 9 minutes of the song inspired me to write my nine mantras to bounced back and come out a winner in 2020. These were:

1.    Love Thy Self: No Self Empathy

Every one in my circle of networks was very scared and required empathy. How would you empathise if you are yourself shallow and lack self-love? The toxic energy in the environment that was flowing around just was not doing good to me. I need not be a victim of this toxicity. That’s when I decided to manifest myself with a new energy and to fight the situation, I need to be stronger physically, mentally, spiritually. I started out with a healthy diet and high-end nutraceuticals, doubled up on my daily walks, increased my heart points by 3 times and started drawing on positive energy. As a result, I was over 10 kgs down in weight, much fitter and well energized positively to empathise with the people

https://www.linkedin.com/posts/kapilkhandelwal_festive-covid-lockdown-activity-6734056517827354624-rpJv

https://www.linkedin.com/posts/kapilkhandelwal_fitness-googlemaps-activity-6614182548820062209-J_Mn

2.    Renewed Vision for My Future Avatar

My mission in life has always been how to make healthcare cheaper, better, faster. Healthcare for All | Kapil Khandelwal (KK). With my interactions and calls with our investors, there was confidence in what we were doing. In fact, we raised even more funds during May-June 2020 for healthcare investments. The critical issue at hand was what investment strategies worked in the past would work in the post-Covid era. It was time to rework and restrategise the vision for my future avatar. With the positive energies, I set fearlessly out my renewed vision with Josh, Jonoon and Jigar. My best is yet to come!  

3.    Focus, Focus, Focus

With the my Avatar 2.0, it was time to focus. I clearly had 24-hours in a day and many unfinished business and agendas. It was with the renewed focus, that I cut down that was not required through a VED analysis of my work load. Clearly three key agendas for focus emerged out of this which I set forth in my work, declining, regretting and pre-closing many ongoing commitments as a result. This helped me put my time to get the maximum impact and the outcomes that my new Avatar was to emerge out.

4.    Build the Safety Net and Resilience

My primary responsibilities during the lockdown was to ensure that my people and their families are not adversely affected. To build confidence in my people, I build a safety net and emergency response for any eventuality due to Covid. At the cost of selling off my personal investments at a loss, I ensured that my people had food on their table and committed to my renewed vision with confidence.

5.    Create Impactful Behavior and Environment

To rebuild the economy and our healthcare systems for the future, it was clear that capital and investments would be with empathy and impact along with positive investor returns. One of the unfinished business was to ensure that there was a holistic and inclusive regulatory framework for the Social Stock Exchange (SSE) in India. I had been part of the journey with SEBI from its inception and worked with our team to produce a white paper with several recommendations which is now being on the table for the final regulation.

Social Stock Exchange | Kapil Khandelwal (KK)

6.    Network like never before

Other than the usual networking activity virtually during lockdown, being an investor allows you access to world politicians, thought leaders, think tanks, industry bodies, academia and opinion makers across the diaspora. My time was well spent speaking with them and gathering their take on various issues emerging out of this world crisis. Over the last 9 months, I had 1×1 with over 200 folks. I really thank them for taking their time to talk to me.

7.    Guides and Mentors

I renergised my circle of guides and mentors and opened up communications where we discussed may of my fears and issues heart to heart. This provided me the inspiration for being a better leader for the emerging new world order.

8.    Inspirational Leadership

With the current crisis, the model of leadership that I demonstrated is lead from the front and demonstrating everything is possible with less to do more. The constraints-based parochial leadership was passe for my people whether they were in front of me or virtually.

9.    Communication and Feedback with the World

In order to guide my peers and folks in the industry, I launched a podcast series QuoteUnQuote With KK which quickly emerged as India’s leading business podcast globally. QuoteUnquote with KK | Kapil Khandelwal (KK). This platform allowed me a means to communicate to the wider diaspora and also gain feedback from the world on what they were thinking on the issues.

2020: My Way, My Avatar

When I look back what I started alone in 2010 leaving Cisco as the top-200 Executive and compare what I have emerged out of 2020, I see that my way for the last 10 years could have only taken me so far. 2020 pandemic and situation, forced me to estrange my previous avatar and reincarnate into a new avatar that will be strong and durable for the 2020s decade.

The strong motive and motivations for my new avatar will drive me forward in the new normal for the world. I thank all those who have been part of this journey in 2020 to make it possible for me.

Here’s wishing you all a healthy, wealthy 2021!

How can Social Media be Socially and Inclusive in Healthcare in the New Normal?

Social Media in the New Normal

How can Social Media be Socially and Inclusive in Healthcare in the New Normal?

With the recent US Government action on Facebook and the pace at which fakenews have been spread during Covid and now on the Covid Vaccine, I am tempted to share my earlier article on this subject.

Background

India is world’s second largest growing online population in the world after Brazil. Over the last one year, India witnessed a YoY growth of 31% in people going on the internet, making it the world’s third largest population on the internet. More importantly, this growth has been fuelled people using tablets and smart mobile to go online. However when we look at in absolute terms, only 73.9 million people were on the internet (less than 10% of India’s mobile connected population) of this only 86% of the population (63.55 million) is using social media. While the use of healthcare online grew by 17% last year, it is still lower than retail sector’s growth of around 80% last year. It is fairly evident that several vertical online and social media options have sprung up in India, which has led to the heady growth in retail social media in India. Social media is not about page views, eyeballs or clicks (see box – What is Social Media?). Healthcare is no exception to this, as social media platforms radically changes the nature of business relationships. While over $ 750 million was invested in social and online retail business models last year, why has online and social healthcare business models and solutions remained a laggard in India?

What is Social Media?
Social Media is different from other communication platforms and channels in four ways:
Content is generated and governed to a varying degree by the users
Communities connect people with common life experiences, preferences and interests
Information can be developed quickly and distributed broadly
Open, interactive dialogue and information sharing among media users is encouraged    

Top – 10 Need-to-Knows about Social Networking and Where It’s Headed
Social networking is the most popular online activity worldwide
Social networking behavior both transcends and reflects regional differences around the world The importance of Facebook cannot be overstated
Short Content and Microblogging has emerged as a disruptive new force in social networking
Local social networks are making inroads globally
It’s not just young people using social networking anymore – it’s everyone
“Digital natives” suggest communications are going social
Social networking leads in online display advertising, but lags in share of dollars
The next disrupters have yet to be decided
Mobile devices are fueling the social addiction

The Social Media Landscape

Today there are over 450 social networking sites globally and they collectively serve over 6.5 billion registered users. Nearly 1 in 5 minutes online is spend online on social media, with Facebook getting a lion’s share of the time spent on social media. Healthcare consumers are now starting to leverage social media globally and in India. However, healthcare decisions or dis-engagement at any point in time with the decision making process is a very complicated process and there are many factors associated with this in the social media usage. Nor this is about hospitals putting up their Facebook pages, doctors in India putting up their profiles on Linkedin or some surgeon’s putting up their videos of their procedures on You Tube. This fragmentation has led to assessing not only beyond Facebook, Linkedin, Google+, Twitter, Instagram and You Tube.

Understanding the 4Es in Social Media Usage in Healthcare

Enhance

These are players who enhance and push content into the social community. By seeding conversations and then enhancing it, healthcare companies create and perpetuate an ongoing focus group that can help identify opportunities to create, enhance and modify products and services for consumers. These also include tools that enable the social media networking

Engage

The are platform that are used by healthcare providers, payers and employers to communicate and create a dynamic interaction with their community of patients, members and professional affiliates

 Educate

There are several platforms where user generated content and shared learning supports improved healthcare.

Enable

Enabling consumers to take a lead role in finding, sorting and acting on health information.

There are over 40 different micro-segments from the 4Es for social media features and services that can be offered by different social media platforms in healthcare. This is where there is opportunity for Indian social media platforms in healthcare to emerge and grow out globally. Analyzing the marketplace for vendors marketing social tools related to healthcare and I found a wide variety of business models and

strategic approaches. Of the numerous healthcare-centric solutions, many are geared toward consumer use, most are small and a scant few have “platform features” where broad social initiatives could be supported.

Slide3

4Es of Social Media in Healthcare Representative Companies in India and Globally
Enhance LiquidGrids, Listenlogic, Pharmawall, Semantelli, Welltok, NodeXL, Gephi
Engage Shapeup, ExtendMD, FairCareMD, HealthCrowd, QuantiaMD, RN Rounds, Sermo, Wellness Layers, Healthcaremagic,
Educate There are about 150 players here in India and abroad
Enable Snapdeal, Groupon, CarePages, eCareDiary, FitBit, Digifit, Endomondo, Gamercize, HealthCentral, LivingSocial, ZocDoc, 15 sites in India

Roadmap to Business Models for a Social and Inclusive Social Media in Healthcare in India

As you will notice from the table above, there are handful of social media business models or platforms in healthcare that have emerged out of India even though there is a huge potential to tap the huge mobile teledensity of close to 900 million. We have tapped less than 10% of this, even though healthcare is an important part of the way people live, work and communicate in India. How do we create a similar platform for rural areas, where Internet platforms are not usable due to literacy, access, and affordability challenges? Building on from my work at the Health and ICT Minister’s Panel for Africa in the last decade. The key takeaways from my work in the emerging market with respect to healthcare, ICT and social media is that these business models will be successful only when:

Transparency

The transparency of activities is a key feature in social media; health is a subject affects private provider companies, public administration as well as consumers

Rise of ubiquitous participatory communication model.

Newspapers, urban spaces and television will all be supplemented with interactive social media applications.

Reflexive empowerment.

Healthcare empowerment through social media is mostly reflexive, i.e. it is usually based on a specific issue and temporary coalitions that engage in dialogue on the topical issue.

Personalization/fragmentation versus mass effects/integration.

Practices and services in the web can be tailored and personalized to almost every detail with the help of portable profiles. Simultaneously, social media opens vast potential also for enormous mass effects and integration.

New relations between physical and virtual worlds

Practices induced by social media, e.g. communication, participation, co-creation, feedback and rating, get more common in daily environments and in urban spaces.

Key Drivers to Social Networking

There are 12 key drivers that need to be broadly analysed for developing social networking business models in (see box) in healthcare in India and that can then be exported to other emerging markets. Every business model in social networking in healthcare would pick 2-3 key drivers to disrupt the social networking landscape as described earlier.

Slide4

Creating a Framework for Transformative Business Models in Social Media in Healthcare

Countries like Finland, Singapore are experimenting these models of social media networking for healthcare. There are several analytical tools being used to analyse this networking effect. One such tool is illustrated in the box below:

Slide5

Charting out and exploring the social network relationships

As we are increasingly surrounded by a by a sea of tweets, e-mails, blogs, wiki pages, videos, wall posts and different apps that enable the social networking. It is important for any new business model to map out these relationships to understand where the gaps are in the overall social network landscape (4Es given earlier). 

Not all social media networks include people as nodes. Some include content of interest, such as videos, images, or wiki pages. Increasingly, data from social media sites such as tags, comments, purchasing patterns, and ratings can be used to link related content together into networks. Viewing content as a network can help learners make sense of how individual concepts or experiences fit into a larger whole. They can provide a view that provides perspective on an entire field of knowledge so that information that is most relevant can be identified. The goal is to provide an overview on surgery, many of which can be used to help educate medical students, professionals, and consumers. It may be useful in finding relevant content and its relationship. Companies or educational institutions interested in medical content may use such a map to inform their decisions about what videos to post and how to carve out a unique niche in the existing information landscape. Or they may decide that their solution has a poor selection of videos on the topic of interest

Social Network Map of Surgery on You Tube

Slide6

Case Study: Gram Vaani: Taking Social Media to the Masses

Gram Vaani is voice based social media network accessible from ANY phone (not a smart phone connected to a EDGE or 3G network). They have developed the novel concept of voice based social media, wherein they enable people to express themselves and share information in voice through ordinary phone calls. People can call into our toll-free number and leave messages or listen to messages left by other people (post moderation). It has captive user base of 35,000 families, over 2,000 impressions made per day. This enables

  • bottom-up information sharing where people ask questions and others from the same community help answer these questions, or share stories and experiences, and
  • accountability by giving reports on the performance of government schemes, demanding better performance from local and state social welfare providers, and policy inputs.

Their network in Jharkhand has seen several cases where reports filed by people led to redressal action by the government departments including healthcare, and the platform is also used regularly for information seeking on agriculture, livelihoods, health and education, and even cultural expression through folk songs and poetry. They have ability to run sponsored channels and programs and to incentivize local entrepreneur networks to conduct social marketing. 90% community sourced content which includes local news, interviews and informational services, opinion on topical issues, guided discussions and campaigns, grievances and feedback on government schemes, cultural artifacts including folk songs and poems. 98% of the users of this social media platform is educated class 12 and below. This platform is also very interesting for a vertical health through rural social media application.

Slide7

Summing Up

India is a typical to many other emerging markets where social media has only penetrated the urban and the educated sections of the society, while over a large majority 90% of the mobile population is still not seen the face of the Facebook. Healthcare is now emerging as investments in retail sector have penetrated deeper into India. We need business models that can become the next twitter or facebook in India. Folks like Graam Vaani have demonstrated in a small way that they can bring social media to the mobile connected populations of India and emerging markets. It is time to look at the 4Es of healthcare social media and start building vertical healthcare solutions on top Creating a Socially and Inclusive Social Media in Healthcare in India

Sustainability Heat Map of State-level Digital Health Initiatives in the New Normal in India

Preamble

The Covid Crisis has opened up many digital health initiatives by many State Governments as a crisis management initiative. Over 300 such initiatives were launched by various State Governments across India for management of Covid as part of their charter for health management. As we shift to the new normal, many of these efforts by the State Governments would either shut down or pivot into general health management initiatives. We caried out an exercise to create a sustainability index on whether they would continue or not.

Approach and Methodology

We carried out a nationwide survey on the Covid-based digital health initiatives. The information was collected through State Health Missions, State Health Department, their websites, doctors connect and various reports. Out of the 300 and more initiatives, we narrowed down to around 75 key initiatives across the States. An analysis of the functionality of these digital health initiatives by the State Governments can be categorized into eight broad categories. These are:

  1. Home Quarantine Tracking         
  2. Travel/Tracking
  3. Covid Chatbot  
  4. Covid Testing   
  5. Telemedicine   
  6. Drones/Robots/Surveillance/Tracking         
  7. Health Worker Management        
  8. Information/Fake News

These initiatives were accessed for their sustainability heat map on the following parameters:

  1. Digital applications
  2. Master data and architecture
  3. Pivotability
  4. New normal use cases
  5. Costs and capital for sustainability
  6. Management in the new normal
  7. Private sector partners
  8. Techno-commercial viability
  9. State regulatory issues
  10. Best practices for Covid management
  11. Others

State Covid Initiatives Sustainability Heat Map

Based on the analysis, we have drawn down a heat map as shown below:

image
Source: EquNev Capital Analysis

Our Conclusions

Based on our heat map, we see only 15% of the current applications that can sustain in the new normal. While we understand that these digital health initiatives were hastily drawn up in early-April 2020, the state health budgets and other issues to get these applications off the ground to create quick citizen impact, over the longer-term such digital health initiatives need to be thought through for a longer time frame as was discussed in my podcast The Promise of Digital Health: For Everyone, Everywhere. QuoteUnQuote with KK – Kapil Khandelwal (KK)

However, this time frame was a solid testing ground for how successful can digital health be in various states of India as healthcare is a state subject. Based on the information, Digital Health in India, holds promise.