A finger on India's pulse

The year 1997 is etched in Kanchan Naikawadi’s mind. Going through her first pregnancy at the time, she remembers being elated, excited and a little confused. The confusion stemmed from watching her father look drained and ill, though she couldn’t put her finger on what could be wrong with him. What he and the family hadn’t told her was that he had been diagnosed with advanced stage cancer. So while the then-25-year-old Kanchan focused on the new arrival, her father received regular chemotherapy sessions and kept his distance from her, for fear of radiation affecting the unborn child. A month after her baby’s birth, he passed away. 

What made it worse were glib comments by visitors at condolence meets. “Many would say, ‘How did you not know it was cancer, how did you not catch it early?’ First-stage cancer is not always symptomatic, and by the time the first signs showed up, the cancer had already advanced. After reading more about the topic, we understood there were ways to figure out and anticipate these things; there were diagnostics available,” says Kanchan. That’s when she and her husband, Amol, decided to come up with a way to make early disease detection commonly available.

“We have a finance, not medical, background. But the concept of preventive healthcare struck us as an interesting business idea. It makes better sense to detect a disease early on rather than waste time and money on tests and treatment. So, we started looking into how we could get people interested in preventive screening.” The couple went on to start Indus Health Plus where Kanchan is now designated as managing director.

The couple studied WHO statistics and global trends to zero in on the diseases they wanted to target. Doctors in their network guided them on the diagnostic tests they would need. In 2000, the Naikawadis convinced the same group of doctors to partner with them for their maiden run. The doctors set up and started running a diagnostic centre at Model Colony, Pune, while the duo helped with back-end support. “We set up Indus Health Plus in the office right above that centre, pooling in Rs 50 lakh from personal savings, family and friends. And that split between their diagnostics process and our back-end services became the model we based our business on,” says Amol, joint managing director of the firm. 

 Healing touch

That business idea has now grown into nearly 82 outlets across major Indian cities and towns. So, what does Indus Health do? In a nutshell, it acts as a single point of consultation when you need to know how healthy you are but don’t know where to start. Through its partners, the firm puts together a range of diagnostic procedures at close to half the market price, without itself investing anything more than back-end support and clerical assistance. While this delivers a constant flow of business to bigger hospitals and market recognition for smaller centres, customers reap the benefit of a high-quality, customised diagnostic experience at rock-bottom prices. 

Indus Health Plus- element

Though most hospital and medical chains have in-house laboratories, they often outsource the diagnostic function or struggle to monetise this component of their services. This is where Indus Health comes in. It negotiates with hospitals to understand their costs and agrees upon a mark-up for the partner hospital. Once the deal is finalised, Indus Health adds its own mark-up (around 10%) before selling the package to clients at a price lower than market rates. Hospitals agree because of assured volumes. “They don’t lose money or have to invest in this relationship. Instead, they have customers delivered to them on a platter,” says Amol. Since 2000, Indus has reached out to nearly 420,000 customers and had a turnover of #96 crore in FY13. The company has tie-ups in 38 cities — a major chunk of which are tier 2 and 3 towns — where its centres run close to 250 check-ups a day.

And how exactly does Indus Health work? On signing up, customers can choose from a range of diagnostic test packages based on their age, pre-existing conditions and requirements. One of the big draws of the firm is that people can gift packages to their friends and family as well. Once all the details are submitted, Indus Health’s 400-strong workforce, 40% of whom are women, takes over. First, representatives from the firm’s call centre in Pune contact the customer and guide them to the closest Indus Health partner clinic or hospital, where the firm’s employees aid them through the diagnostic process. Irrespective of the package, all the tests are conducted and results delivered on the same day. Before they leave, customers are also counselled by partner doctors about disease management and other precautions. The call centre follows up with clients, who get significant discounts on both future tests (up to a year) as well as on related treatments at the partner centres.

In towns where medical infrastructure is a problem, Indus Health provides its clients a list of packages at the nearest medical centre. For instance, if the firm’s sales team signs up customers in, say, Jalgaon, they travel to Aurangabad for the tests at an Indus Health centre. Having covered nine states so far, the company has set its sights on enlarging its India presence and aims to expand operations to the subcontinent, West Asia and Africa in the near future.

 In good health

Is Indus Health then an aggregator of services such as Makemytrip for travel? No, because based on disease trends, it groups together different tests as comprehensive packages — ranging from Rs 2,000 to Rs 17,000. The company currently counts Apollo, Sterling, NM, Wockhardt, SRL and Sahyadri hospitals among its partners. While its partner centres could be anything from trust hospitals to a standalone unit, preference is given to hospital chains that are present at multiple locations within the same city, provided they have the requisite infrastructure at these locations. Prince Surana, director of the Surana Sethia Hospital & Research Centre in Mumbai, recalls Indus Health approaching him in 2007-2008. “We were a bit sceptical initially. However, we are now very happy with the partnership as the Indus Health association has increased credibility of our diagnostics centre,” he says. The hospital has “an understanding” with Indus Health based on the number of check-ups and footfalls. “But more than the sharing ratio, we gain through branding and exposure. Moreover, there is scope for growth in the industry, as only 5-8% of the preventive healthcare segment has been tapped so far,” Surana adds.

This is evident in Indus Health’s financial success. A majority of its profits come from its core market of tier 2 and 3 towns. “At first, we thought that this was an urban product. Thankfully, we were proved wrong; the service is very popular in smaller towns, with youngsters living in the cities gifting diagnostic packages to their parents back home,” Amol says. 

Forward march

Though the company is growing at a fast clip, it faces significant competition from the in-house diagnostic arms of most major hospital chains and the countless small medical centres that have mushroomed across the metros and offer aggressive rates.  

And, unlike hospitals that can get captive customers for their preventive check-ups through corporate tie-ups etc, Indus Health needs to dig deeper into the country to get its clientele, investing more time and effort per customer. About half of its business comes from retail clients acquired by its agents, 30% from existing clients and their referrals while the rest is from corporate clients. The last includes FMCG companies providing check-ups for their retailers and credit card companies offering special packages to cardholders. “Apart from a significant amount of advertising, we carry out community outreach programmes at housing societies, corporate firms, etc. At least 20% of revenue is devoted to customer acquisition,” says Amol. 

There’s also competition from chains such as Thyrocare, which have disrupted the space with rock-bottom prices for test packages. Amol, though, doesn’t consider Thyrocare (incidentally, an erstwhile partner) direct competition, since he says it provides only lab tests compared with Indus Health, which includes lab, diagnostics, radiology, counselling etc. “We may not be able to stop competing laboratories from dropping their prices drastically, but we definitely can maintain our stream of customers,” he says. “Most other labs depend on referrals from general practitioners for business, whereas we aggressively target only the preventive healthcare market.” 

Industry analysts are also bullish on growth prospects. Amit Mookim, healthcare industry head at KPMG, points out that the global wellness and preventive care market is much more evolved due to a competent insurance model, where corporates and insurance companies incentivise preventive health checkups through rewards and discounts. In India, however, the insurance sector is nascent and there are several regulatory concerns. So, there is very low awareness about preventive healthcare and not much scope or infrastructure for such services. “Despite these challenges, Indus Health has succeeded and is very popular among corporate clients. Now is the right time for such services to take off in India,” says Mookim.   

Insurance firms in India, too, are moving towards preventive screening. Abhijeet Ghosh, head, health analytics and networking, Bajaj Allianz General Insurance, says of every 100 policies sold, the frequency of claims is sometimes as low as 10-15%, which means nearly 85-90% health policyholders don’t file for a claim. “So, we now offer customers preventive screenings as value-added services. We give them health and wellness cards that they can use at diagnostic centres, hospital chains, opticians, etc. that we have tied up with and get discounts on diagnostics and medication,” he adds. 

It is this potential for growth that has investors reaching out to the Naikawadis, although the couple hasn’t opted for external funding yet. “Ours is an asset-light model, so we do get a lot of investor attention,” says Amol. A big hurdle, though, is that Indus Health still struggles to find the right partners and maintain the same quality across centres. Thanks to a fragmented provider network and low awareness about preventive healthcare, it will be challenging for the company to sustain its growth rate. 

"As long as it makes the diagnostic process for customers easier, the firm will grow" - Amit Mookim, healthcare industry head, KPMG

But, as KPMG’s Mookim points out, globally, the drop-off rate for preventive healthcare packages is quite high, with only 40-50% of customers renewing their contracts; in India, this number is a measly 10-20%. Adds Mookim, “As long as the firm drives a good bargain on packages and makes the diagnostic process easier for the customer, it should stay on the growth path.”