You want an appointment with a doctor but don’t know which specialist you should see? You have an ailment and need medical advice sitting at home? Fret not, for help is at hand — at the click of a mouse. Buoyed by the fact that India has one of the lowest doctor-patient ratios in the world- —one physician for every 1,700 patients — on par with sub-Saharan nations and well below the WHO-prescribed limit of one physician for every 1,000 patients, several start-ups have forayed into the online medical consultation and appointments arena.
And they have their work cut out for them — the Centre for Medicare and Medicaid Services has developed a lengthy set of guidelines for both medical practitioners and healthcare providers. Of these, some key concepts that have emerged are the need to correctly use electronic health record technology and advanced clinical processes for improving the quality of healthcare, maintaining the privacy and security of patient health records and better clinical outcomes. Now, a clutch of online start-ups, among them Bengaluru-based Practo and New Delhi-based HelpingDoc and iClinic Healthcare, are taking up the challenge of achieving these objectives.
These companies are bringing doctors and patients together on a common platform by booking appointments for patients and listing doctors on their websites. On these sites, you can pick the doctor, the date and time when you want to meet him or her in and then confirm the appointment at the click of a button.
Or, if you pay an average convenience fee of ₹150, you can even consult a doctor online. The process is simple — all you have to do is write about your problem and furnish any reports you have; a doctor from a carefully vetted list will review the matter and offer his or her prescription.
Practo.com, founded by Shashank MD and Abhinav Lal in 2013 as a platform to connect doctors and patients, has its sales team looking for doctors street by street, city by city; doctors are listed only after their qualifications, specialisation and medical licence are verified. Patients can run a search on the website or the app by doctor specialisation or name, after which Practo’s ‘relevance algorithm’ lists the most suitable options. The patient can go through this list, check the respective doctor’s calendar and book a slot.
iClinic conducts exhaustive background checks on GPs and specialists and receives regular feedback from patients about the quality of care. If a patient registers a complaint against a doctor, the doctor may even deregistered from its site. Though most such companies make negligible revenues, they’re not exactly tiny in terms of their operations. Practo lists over 150,000 doctors, representing 200 specialties such as dentistry, dermatology, gynaecology, paediatrics, ENT, homoeopathy, ayurveda, cardiology and neurology.
It claims that the number of doctors on its site is growing by 30% every quarter and will double to 300,000 in 16 months, while the number of patients, too, is growing by 30-50% every quarter. It has a total employee strength of 1,200 and this is set to double by March next year. Doctors don’t pay the company to be listed on its portal and neither do patients pay it to get matched up with doctors. In line with its core philosophy of putting patients first, that is, taking all its decisions based on what is best for patients, the company doesn’t charge for consultation. However, the patient does have to pay a fee to the doctors or institutions for availing their services.
Bridging the gap
The services offered by online healthcare providers to bring doctors and patients on a common platform
While the online portal is not making any money, Practo Technologies, which was set up in 2008, is making the most of Practo Ray and Practo Reach. In 2013, the duo set up and founded Practo Ray, a cloud-based software that helps doctors digitise and manage their practices. “Traditionally, it was felt that doctors put up tremendous resistance when it came to adopting new technology. This was because technology was not specifically designed keeping their requirements in mind. For example, in 2009, I was shocked to find that my doctor could not email me a copy of my medical report because his software didn’t even have the facility. So, we decided to launch Practo Ray,” says Shashank.
While successful in India, Practo Ray was also deployed in Manila, Philippines and Singapore. Feedback was taken about the problems doctors faced while managing their practice, IT, hardware and software updates and data back-ups. The ensuing insights allowed the doctor to focus on the practice while IT was taken care of by Practo. Today, the programme manages millions of patients and healthcare records every month and has over 90% market share among doctors using software to manage their practices. The company also makes money from Practo Reach, which allows clinics and institutions to showcase hyper-contextual information cards next to search results based on user queries for a fee.
Practo recently launched a diagnostic lab search, which helps users to access nearly 4,000 labs across eight cities, search for tests instead of lab names, check lab accreditation, filter results by location and compare test prices. In April 2015, the company acquired another firm FitHo, which will help it get into the preventive healthcare and fitness consultation business. Practo is present in 35 Indian cities and follows the same revenue model overseas as in India — that is, Practo search remains free and Practo Ray brings home the bacon. Though the company has not launched Practo Reach in Manila, Philippines or Singapore, Practo Ray is extremely popular in the latter two, with the company being number one in terms of market share in both the markets. Next on its agenda are south-east Asia, west Asia, Latin America and eastern Europe. The company received two rounds of funding: $4 million series A from Sequoia Capital and $30 million from Sequoia Capital and Matrix Partners. “We have been very lucky to have worked with investors who understand our goals and mission. Both Sequoia and Matrix have given us the opportunity to grow,” he adds.
iClinic Healthcare was started with a slightly different mission by Sanjoy Mukerji, former chief commercial officer of Vodafone India and three others in October 2013, with a seed capital of ₹4 crore. The company enables doctors and patients in small hospitals and towns to remotely connect and share health information with specialists to allow diagnosis and treatment. It also has a 24x7 online doctor booking appointment service for both the public and companies. It offers a video service using which users can call specialists, besides offering written medical advice through a web platform.
For corporate employees, a general physician visits designated offices at predetermined times and is also available for home visits. iClinic also provides a 24x7 web or video chat with a GP, as well as a health risk assessment on various parameters such as weight, exercise and personal habits. In addition, online patients may seek medical advice through written consultations and upload reports for a second opinion. Based on this information, the doctor then files his or her own report, which the patient can check by logging in to his or her account.
iClinic predominantly has a presence in 40 cities and towns across north and northeast India. It has 250 specialist doctors registered online and adds specialists as and when new town hubs are added — the next few town hubs planned are Mumbai, Nashik and Jaipur. iClinic consultations are priced at ₹1,000 per consultant, which is split between the specialist, the attending GP and the company. It charges corporate clients a fixed monthly fee, for which it provides unlimited free consultations.
Mukerji also happens to be the CEO and MD of a diagnostics company Diagno Labs, which was set up in 2012. Diagno Labs and iClinic are now part of the RJ Corp group headed by former Pepsi executive Ravi Jaipuria, a colleague and friend of Mukerji from his stint at Pepsi. Indeed, Diagno Labs has been funding the current expansion of iClinic.
Learning from the pain
At least one of the online healthcare companies was set up after the founder’s own personal experiences. “I was an entrepreneur by accident, not design. I faced issues in finding good healthcare for my two-year-old daughter while on a trip to India. This — coupled with the unstructured and fragmented nature of healthcare delivery services in India — triggered the creation of the company,” explains Amit Bansal, who founded HelpingDoc in April 2012 with three advisors —Hemant Singhal, Srinavas Gattamneni and Julian Hall.
Bansal completed his MBA from the London Business School and was a consultant to financial, telecom and public-sector organisations in Europe. He formed HelpingDoc with an initial seed capital of ₹1.5 crore. His company has three basic service offerings — doctor bookings online that is free for both doctors and patients, an annual subscription and cloud-based software for doctors to manage their schedules, patient notes and medical reports and online health consultations, for which patients pay a fee.
It has 40,000 doctors registered on its site, 25,000 patient appointments booked every month and does 1 million page views per month with a staff of 100 employees. Asked what differentiates it from the rest of the pack, Bansal says, “We are the only major player that provides appointments and consultations online. We also have a call centre that assists patients in case of any last-minute cancellations and schedules changes from the doctor’s clinic.”
In 2014, HelpingDoc raised ₹10 crore in series A funding from Singapore-based Central Marketing Systems and is looking to further raise series B funding in 2015 to aggressively expand to all tier 1 and 2 cities in India. Bansal claims to be setting a scorching pace of growth. “We are currently growing our revenue by 100% quarter-on-quarter and expect business to grow by 400-500% a year for the next two to three years,” he declares.
For all the hoopla, these companies haven’t broken even as yet. Practo certainly hasn’t and Shashank is cagey about providing financial figures. But he says, “If you look at our Indian business, we are moving towards profitability. We are the largest healthcare platform in Asia and we’re still growing 50-100% a quarter.” Practo Ray and Practo Reach are its primary revenue generators and both are quite popular. The company has an asset-light business model, which, coupled with its SaaS software, gives it healthy margins. Shashank points to the company’s recent raising of series C investments as testament that investors believe in this company’s business model and that it can become profitable.
Mukerji expects his company to break even five years hence; the focus is not on profitability right now as the company is on its expansionary phase, but on ensuring adequate margins per consultation. In early 2015, iClinic had 25 iClinic Consult Care Centres for assisted remote consultations. It has added 25 more over the past five months, thanks to funds coming in after the merger with Diagno Labs.
“In the next one year, we intend to open up 200 centres across India, expand into west India by tying up with hospital chains there and expand very aggressively in the diagnostics space. We will also create complete synergy between diagnostic and clinical products and services, as that will be a unique strength in the market,” says Mukerji. The expansion will require ₹10 crore over the next three years, to be funded entirely by RJ Corp. The business is growing at 40% quarter-on-quarter and Mukerji expects it to grow five-fold in the next two years. “There are 600 district headquarters in India and we want to be present in each of these in the next five years and become the preferred specialist consulting platform in the entire country,” he says. A vaulting ambition for sure.