Tuesday 20 October 2015

Investor red flags- always logical?

A few of my interns recently did a brain-storming session with me. They were all enthusiastic to do something of their own and had many questions. Many of them I met at several accelerator competitions and hackathons.

I am not an authority or a VC. So far, I have invested in 9 companies globally- all in healthcare or education. One thing that I have come across in almost every transaction is when seed funded companies go for Series A- Investor raise red-flags about

1. Recurring revenue
2. Team
3. Valuation

One such situation came in today when I was asked How do you anticipate growth of 15%-20% YOY when in a force of 200 employees you have only 5 sales guys and 2 marketing people. What are you relying on? Most start-ups find it hard to answer such a question.

When you cannot rely on sales and marketing to be your driver of growth, you rely on your customer to be your driver of growth. Hence when the service and the product keep evolving imparting better and sustained value- one needs to rely less on marketing. I think it actually builds a much deeper foundation when you don’t rely on a very large sales and marketing team to get your brand out.

This MIT guy asked me- How would you measure the value of a company? Especially, a company that you started a month ago – how do you determine start-up valuation?

My answer was simple Valuation need not show the true value of the company. Actually what it defines is about investor share in the company.  At the time of investment, valuation is the core determinant of return for investors. In other words, the return to investors is based on the increase in the valuation of shares they receive in exchange for their capital. Understanding valuation is critical to successful investing. Unfortunately, valuation is the most misunderstood part of the investment process and often leads to contentious negotiations that get the entrepreneur investor relationship off on the wrong foot.Valuation depends on how much money you need to say run 3 pilots and have 8-12 months of runway. As an Investor, I expect growth in 18 months.

Valuation matters to entrepreneurs because it determines the share of the company they have to give away to an investor in exchange for money.  At the early stage the value of the company is close to zero, but the valuation has to be a lot higher than that. Why? Let’s say you are looking for a seed investment of around $100, 000 in exchange for about 10% of your company. Typical deal. Your pre-money valuation will be $ 1 million. This however, does not mean that your company is worth $1 million now. You probably could not sell it for that amount. Valuation at the early stages is a lot about the growth potential, as opposed to the present value.

The biggest determinant of your startup’s value are the market forces of the industry & sector in which it plays, which include the balance (or imbalance) between demand and supply of money, the recency and size of recent exits, the willingness for an investor to pay a premium to get into a deal, and the level of desperation of the entrepreneur looking for money.

The follow-up questions was- Does valuation also depend on who you are taking money from? - I laughed it out. The answer to that is a big "YES" - we all know that.

We have an acquisition offer from a large hospital chain- Tim said- they are interested in Acqui-Hire- Should we take it? How to decide between getting acquired and acqui-hire.

Well. It depends on how your company is doing? Acqui-Hire is offered when you have a great team together but product isn't going anywhere. Acquisition is the best move when we realise that the product has traction, but the company does not generate enough revenue to qualify for an IPO.

And last but not least- What does an Angel like me look for returns?

Some angels target 5x to 10x ROI (cash-on-cash return on their investment) in four to eight years, which yields an internal rate of return of between 25 and 75 percent. (In the accompanying table, the target numbers assume that divergence of between 3x and 5x times is factored in.) Other angels simply target 30x ROI without divergence. The two approaches are effectively equivalent:

If you assume 4x divergence (the midpoint between the expected range of 3x to 5x) and multiply that by a return of 7.5x (midway between the 5x and 10x range), then you get 30x, which factors in divergence. These rules of thumb are not sacrosanct; they reflect two common approaches.

Divergence is the difference between the growth rate of the company’s valuation and the
valuation of the shares investors receive due to dilution by subsequent investors and other factors. Even in successful ventures, divergence, in fact, tends to be between 3x and 5x.
A simple example may help make the point: An investor funds at a $4-million post-money valuation and receives shares valued at $2 each. The company is sold in five years for $60 million, which is a 15x increase in company valuation. Due to dilution, however, the value of the investor’s shares will almost certainly not have increased 15x to $30 per share. They might instead have increased only 3x to $6 per share. In this example, the increased valuation of 15x divided by the increase in the investor’s share value of 3x demonstrates a 5x divergence.

A startup company’s value, as I mentioned earlier, is largely dictated by the market forces in the industry in which it operates. Specifically, the current value is dictated by the market forces in play TODAY and TODAY’S perception of what the future will bring.

Effectively this means, on the downside, that if your company is operating in a space where the market for your industry is depressed and the outlook for the future isn’t any good either (regardless of what you are doing), then clearly what an investor is willing to pay for the company’s equity is going to be substantially reduced in spite of whatever successes the company is currently having (or will have) unless the investor is either privy to information about a potential market shift in the future, or is just willing to take the risk that the company will be able to shift the market.

Therefore, when an early stage investor is trying to determine whether to make an investment in a company (and as a result what the appropriate valuation should be), what he basically does is gauge what the likely exit size will be for a company of your type and within the industry in which it plays, and then judges how much equity his fund should have in the company to reach his return on investment goal, relative to the amount of money he put into the company throughout the company’s lifetime.

Comments welcome.

Ewing Marion Kauffman F Foundation

Monday 5 October 2015

Dr. Ruchi Dass, Enlightiks on Analytics in Healthcare

Quick Snapshot of our work at @Enlightiks- shot at the Healthcare IT Summit, Mumbai, India. What do we do there with Predictive analytics tools- serious work!!

Predictive analytics (PA) uses technology and statistical methods to search through massive amounts of information, analyzing it to predict outcomes for individual patients. That information can include data from past treatment outcomes as well as the latest medical research published in peer-reviewed journals and databases.

In medicine, predictions can range from responses to medications to hospital readmission rates. Examples are predicting infections from methods of suturing; understanding Patient’s patterns,  bias and compliance;  determining the likelihood of disease, helping a physician with a diagnosis, and even predicting future wellness.

The statistical methods are called learning models because they can grow in precision with additional cases. There are two major ways in which PA differs from traditional statistics (and from evidence-based medicine):

First, predictions are made for individuals and not for groups
Second PA does not rely upon a normal (bell-shaped) curve.

Prediction modelling uses techniques such as artificial intelligence to create a prediction profile (algorithm) from past individuals. The model is then "deployed" so that a new individual can get a prediction instantly for whatever the need is, whether a bank loan or an accurate diagnosis.

1. Help increase the accuracy of diagnoses.

Physicians can use predictive algorithms to help them make more accurate diagnoses. For example, when patients come to the ER with chest pain, it is often difficult to know whether the patient should be hospitalized. If the doctors were able to answers questions about the patient and his condition into a system with a tested and accurate predictive algorithm that would assess the likelihood that the patient could be sent home safely, then their own clinical judgments would be aided. The prediction would not replace their judgments but rather would assist.

2. Helps preventive medicine and public health.

With early intervention, many diseases can be prevented or ameliorated. Predictive analytics, particularly within the realm of genomics, will allow primary care physicians to identify at-risk patients within their practice. With that knowledge, patients can make lifestyle changes to avoid. As lifestyles change, population disease patterns may dramatically change with resulting savings in medical costs. With Predictive Analytics, our future medications would be more personalised because predictive analytics methods will be able to sort out what works for people with "similar subtypes and molecular pathways."

3. Provides Physicians with intuitive insights planning treatment methodology for individual patients.

Evidence-based medicine (EBM) is a step in the right direction and provides more help than simple hunches for physicians. However, what works best for the middle of a normal distribution of people may not work best for an individual patient seeking treatment. PA can help doctors decide the exact treatments for those individuals. It is wasteful and potentially dangerous to give treatments that are not needed or that won't work specifically for an individual. Better diagnoses and more targeted treatments will naturally lead to increases in good outcomes and fewer resources used, including the doctor's time.

4. Provide employers and providers with predictions concerning insurance product costs.

Employers providing healthcare benefits for employees can input characteristics of their workforce into a predictive analytic algorithm to obtain predictions of future medical costs. Predictions can be based upon the company's own data or the company may work with insurance providers who also have their own databases in order to generate the prediction algorithms. Companies and hospitals, working with insurance providers, can synchronize databases and actuarial tables to build models and subsequent health plans. Employers might also use predictive analytics to determine which providers may give them the most effective products for their particular needs. Built into the models would be the specific business characteristics. For example, if it is discovered that the average employee visits a primary care physician six times a year, those metrics can be included in the model.

5. Helps researchers develop with even lesser data that can become more accurate over time.

In huge population studies, even very small differences can be "statistically significant." Researchers understand that randomly assigned case control studies are superior to observational studies, but often it is simply not feasible to carry out such a design. From huge observational studies, the small but statistically significant differences are often not clinically significant.
For example, small to moderate alcohol consumption by women can result in higher levels of certain cancers. Many news programs and newspapers loudly and erroneously warned women not to drink even one alcoholic drink per day.

In contrast with predictive analytics, initial models in can be generated with smaller numbers of cases and then the accuracy of such may be improved over time with increased cases.

6. Helps Pharmaceutical companies to plan and best meet the needs of medications for the masses.

There will be incentives for the pharmaceutical industry to develop medications for ever smaller groups. Old medications, dropped because they were not used by the masses, may be brought back because drug companies will find it economically feasible to do so. In other words, previous big bulk medications are certain to be used less if they are found not to help many of those who were prescribed them. Less used medications will be economically lucrative to revive and develop as research is able to predict those who might benefit from them. For example, if 25,000 people need to be treated with a medication "shotgun-style" in order to save 10 people, then much waste has occurred. All medications have unwanted side effects. The shotgun-style delivery method can expose patients to those risks unnecessarily if the medication is not needed for them.

7. Leads to better Patient outcomes.

There will be many benefits in quality of life to patients as the use of predictive analytics increase. Potentially individuals will receive treatments that will work for them, be prescribed medications that work for them and not be given unnecessary medications just because that medication works for the majority of people. The patient role will change as patients become more informed consumers who work with their physicians collaboratively to achieve better outcomes. Patients will become aware of possible personal health risks sooner due to alerts from their genome analysis, from predictive models relayed by their physicians, from the increasing use of apps and medical devices (i.e., wearable devices and monitoring systems), and due to better accuracy of what information is needed for accurate predictions.

Tuesday 8 September 2015

Driving Innovation the GE way- GETech Mela Coverage

‘Reverse innovation,’ a principle well established in the business world, describes the flow of ideas from emerging to more developed economies. Reverse innovation refers to the process of first identifying and/or fostering a successful innovation in a LIC that addresses an unmet need in a HIC, then adapting and spreading the innovation from the LIC to the HIC. It is, in a nutshell, learning from and investing in poorer settings as one way to tackle problems in wealthier settings that require out-of-the-box solutions.

The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low- and middle-income countries. 

At GE Tech Mela, I came across GE's Stripped-down, portable ECG machine- GE Healthcare's MAC i is an ultra-portable, battery-operated electrocardiogram machine, designed for use in rural clinics in India, where mains electricity is either intermittent or non-existent. The cost is only 25,000 rupees (£320). It is a boon for the Indian market where electricity and primary healthcare access is a big problem.

The concept of Reverse Innovation and Glocalisation (Global- Local) is not new to GE. In 2010, I came across a dual-slice computed tomography imaging system called HiSpeed Dual with GE. It was the first CT system that the health care arm of U.S. conglomerate General Electric had made in India, and the first high-end CT imaging system that anyone had made in the country. GE Healthcare had previously imported the system for Indian customers. By manufacturing it in Bangalore, GE Healthcare cut the price by 10% and  reduced an 8- to 10-week waiting period as well.

Mr Shyam Rajan, CTO, GE Healthcare has contributed significantly over the last two decades towards the development of Maternal and Infant Care products such as infant warmers, incubators, and phototherapy equipment. He is a firm believer that “low cost” does not translate to “low technology”, and that the opposite can often be true.

I was at the Healthcare Pavilion called "Odyssey Hospital" that showcased GE Heathcare's key capabilities and solutions in an integrated manner. A mini hospital prototype enacting GE touch points at every level.

I thoroughly enjoyed my conversation with him as I have used most of the portable devices on the ground especially while I was involved with WHO’s PMNCH program on Mother and child health. We hit off a banter when I realised how value packed their offerings are keeping in mind insights they derived from the ground and real life challenges.

I also interacted with Mr. Munesh Makhija, Managing Director, GE India Technology Centre Chief Technology Officer, GE South Asia.

Munesh and myself talked at length about GE Superheroes, the concept of organizing Tech Mela every year, GE's vision and how they celebrate everything they do.

It was a power-packed day and definitely a weekend well spent. You can catch up on more moments at #TechMela on Twitter handle @GE_ITC or take a look at this infograph that reiterates the vision- “Design and Make in India”.

Tuesday 21 October 2014

Healthcare On Mobiles: Women Achievers in Information technology 2014

Healthcare On Mobiles: Women Achievers in Information technology 2014: I feel proud when my name is included with the leading ladies in India today- Facebook, Walmart, Amazon and others. I however feel equally concerned about the future of IT in India.

While I represented as the only lady to represent the healthcare industry, it is indeed a truth and a realization that we need much more of IT across industries. At INTEROP, I had the privilege to meet with Prof F. C Kohli. "Those were the days when we were provided with Russian computers. These computers used to heat up after every 4-5 hours and then we had to shut them down and let them cool off before we can use them again", said Mr F. C Kohli recalling his initail days toying with these machines called Personal computers then.

Friday 12 September 2014

Women Achievers in Information technology 2014

I feel proud when my name is included with the leading ladies in India today- Facebook, Walmart, Amazon and others. I however feel equally concerned about the future of IT in India. While I represented as the only lady to represent the healthcare industry, it is indeed a truth and a realization that we need much more of IT across industries.

At INTEROP, I had the privilege to meet with Prof F. C Kohli"Those were the days when we were provided with Russian computers. These computers used to heat up after every 4-5 hours and then we had to shut them down and let them cool off before we can use them again", said Mr F. C Kohli recalling his initail days toying with these machines called Personal computers then.

Those who have never heard his name- Well! Prof. F. C . Kohli is frequently referred to as the Father of the Indian Software Industry due to his significant contribution in Indian IT industry. Padma Bhushan, Faqir Chand Kohli completed 90, on March 19, 2014. It was a day to celebrate for many Indians whose life he has touched directly or indirectly. A workaholic, who scoffs at the concept of retirement and fading into the sunset and is deeply engaged in using technology and systems approach to solving societal problems at 90!

Mr Kohli continues to be proactive, focusing his energies on education. His current efforts are around using computer aided sounds and images to impart basic literacy, particularly to illiterate adults, in a matter of months.

I clicked a Selfie and Yes, I was lucky! It was "Teacher's Day" and I got this opportunity to be blessed by him as a "Woman Achiever in IT". Information Technology isn't that old in the country. I still remember my First Personal computer- Bulky with Cassette and Floppy drives!

The 1980s liberalization of the Indian informatics industry took place in the context of continued high levels of state involvement, but there was evidence that the character of that involvement was changing.In 1991 the Department of Electronics broke this impasse, creating a corporation called Software Technology Parks of India (STPI) that, being owned by the government, could provide VSAT communications without breaching its monopoly. STPI set up software technology parks in different cities, each of which provided satellite links to be used by firms; the local link was a wireless radio link. In 1993 the government began to allow individual companies their own dedicated links, which allowed work done in India to be transmitted abroad directly. Indian firms soon convinced their American customers that a satellite link was as reliable as a team of programmers working in the clients’ office. Today, advancements in IT has been of benefit in creating more jobs in India but the real revolution is yet to begin.

Those were the days. Quotes from Mr F.C Kohli:

"When we started, the Indian software industry was primarily focused on exports and 40 years later, it still continues to be so. The domestic market accounts for only 15% of the software industry's $100 billion annual turnover. The country has too few computers. This is because there are no computers in Indian languages. China has computers in mandarin, but India, for historical reasons, has stuck with English. The computer is but a tool and Indians should be able to use this tool in their own language. You express your ideas best that way. Innovative thinking comes in your own language. After all these years of speaking in English, I still dream in my own language.

Most people in India seem to have been carried away by the spectacular success in IT services ($ 70 billion exports in 2012-13 according to RBI). A decade ago, some politicians even started calling India, quite prematurely, an 'IT Superpower', in their own inimitable style. However the man who started it all is far removed from such pompous statements. He has been painstakingly advocating that India cannot be a significant player on the global technology map without a developed hardware industry.

He said, "Right now, India does not have a hardware industry. But we will have to develop one, once the computer reaches the masses. Using technology, I can go and make the small shopkeeper more efficient that a supermarket mall. A computer can handle a shop's supply chain management, from purchases to inventory control. It can bring down costs and collect customer data. In the USA, local shops don't necessarily close if WalMart comes to town. We need both."

Ignoring your own produce- There is a huge talent that we produce in India. Number of graduates- three million a year, about 450,000 are engineers; 600,000 and more are commerce graduates and 1.1 million from humanities. We have 95 agricultural colleges and 15 agricultural engineering colleges, where do they go? They are not in villages; they are not in agriculture, it means we are not interested in what we have produced.
Practically Illogical Industry- ‘What computer has done for the country? Almost all the software is exported, we have about $50-60 billion out of exports and $10 billion revenues from the indigenous market, out of that again half the software is from Microsoft, Oracle and others, which we import and sell. So if we really see, hardly any software (made and sold) within the country.
If we are depending on IT, Do we have computer literacy? Everybody is making profit by exporting software and who wants to dirty their hands and focus on India? It is not easy to develop software for India, we have 22 languages, China has 2, Saudi Arabia has only one i.e. Arabic, and so software finally has to be made in local languages like European do. Our states are bigger than the many European countries, so you can’t even say that everybody should learn one language, we also wants to keep the diversity because it is an asset.
Skewed Numbers- The limit is your imagination.- If 900 million people of India becomes computer literate, than you need many more PCs than now, every year now, 6 million PCs are sold in India, which are imported or locally assembled. Then we need 25 million PCs a year, for that kind of number, we need indigenous hardware industries. We also need micro-electronics engineers for hardware industries, India is producing less 200 engineers and small country like Israel produces more than 1000 a year, when we will we be to produce 3000 to 5000 micro-electronic engineers?? Intel is having its design centre in Bangalore they are designing their 6 core chips here and not in the US.
The Indian IT industry is still young and the growth process is not going to stop anytime soon. It will certainly become more sophisticated. There will be new players, niche players, specializing in different applications. We are still doing a lot of lowend work for the global market, though we are also into some high-level development. The domestic market will also throw up low-end work. If you can't find growth avenues despite all this, it is a managerial problem.
Interop Mumbai, debate and Keynote
ET- Interview with Dr Kohli

Wednesday 11 June 2014

No Big data in Healthcare?

The big data revolution is here, on an aggressive growth path, and the patient might truly be the biggest beneficiary of next wave. But hey! Where is that data?

1. More than 65% of data across the globe stay non-digitized.
2. 68% of digitized data isn't integrated with channels or inter-operable systems.
3. 99% problem in delivering effective healthcare is in bad data, old data and No data.

The health care system is filled with dreamers, from compassionate nurses and doctors to technology experts, researchers in the lab to people like us- mHealth experts. After careful evaluation of facts, we have arrived at this hypothesis:

The need to fully engage patients as a member of the care team is fundamentally about encouraging individuals to become more involved with their healthcare, so they will be motivated to make behavioural changes that can positively impact their health status. Today we do it in 3 ways:

1. Public health programs- where we don't spend much on pervasive technologies but paper, photocopies, fuel, per diem (per day) of health workers and volunteers.

2. Disease management/Wellness programs- where a patient buys self-help health check-ups like "a dress from fashionandyou.com" based on prize and tests that he has heard off or just go for a master health check-up .

Or a Hospital that puts a Diabetes patient on to a DM program which means 3 visits/month on to a clinic for repeat diagnostic tests, doctor consultation, Diet plan and exercise regimen. 90% patients show non-compliance here and the churn is more than 70%. All the data of-course will stay with the hospital and they will never share it with other Doctor or hospital.

3. By downloading an app, signing on to a health portal or designing a regular and timely healthcare plan and stick to it. (Surprisingly 23% people do manage their health like this). The problem is that it is very hard to track, monitor or quantify success or deterioration in the absence of proper matrices and without a Doctor's help at the other end.

If my healthcare data doesn't reside in a cloud, what will BIG Data analytics do for me?

I am unlike Retail, Banking, Advertising or any other vertical where there is loads of digital data. In Healthcare, there is very little data.

Any phase in the evolution of patient care cannot take place without sharing secure data with a wider group of constituents in the healthcare continuum. The need of the hour hence is:

1. Data Collection: There is a need to up the public health game by efficient data collection. Episurveyor--->;Magpi (DataDyne), Commcare, Formville, Cellife are some examples of such applications that exist today. Using a cell-phone to complete questions allows for information to be analysed in real time, built in skip logic, and the capturing of other media not possible on a paper form.

2. Provider + Government + Health Insurance Push- Obviously you can’t do much about 60% population of India where either there is no computer or no literacy. The need of the hour is to build healthcare models on ubiquitous technologies be it mobile phones, radio, community broadband centres, Zila panchayats, Schools, UID Kendra or areas where there can be a patient dashboard available. In the USA, with strong meaningful use process, organizations are required to offer patients online access to their electronic medical information.

To meet the MU2 requirements in the US, a provider must notify at least 50% of its patients of online access to medical records. In addition, the provider must have more than 5% of its patients view, download or transmit their health information as well as another 5% of patients send a secure electronic message to the provider organization. They do this via an online Patient Portal. Not only is the Patient Portal functionality a requirement for meeting MU2, but it extends a tremendous number of additional opportunities for the patient and provider.

With support of the provider, patients can use a computer or mobile device to schedule their own appointments, pre-register, select payment plans, share lab results, and of course, view their medical information. Each of these functions helps the patient become more involved in their care while eliminating costs associated with scheduling, sharing results and records, eligibility verification, collections and prescription renewal functions.

3. Attaching Data to Channels and Analytics- As per CHMI data every year we run more than 100+ technology driven healthcare programs in India (50+ of them are mHealth programs). Most of them show success and impact but fail to scale as funding or Government support run out. The data as well as the effort goes waste.

There is a need to connect redundant systems with appropriate channels, knowledge blocks and derive influence out of these. While the availability of Mobile apps, patient portals and digitisation of health records does not necessarily translate into active provider or patient use, the technology is emerging as the key platform for various efforts around patient engagement such as access to medical records, communication with providers, education, wellness tracking and e-visits.

We need a system that will incorporate registration of births, deaths and cause of death. Maternal and infant death reviews, nutrition surveillance, particularly among under-six children and women, service delivery in the public and private health system, hospital information services besides improving access of public to their own health information and medical records.

Big Data analytics can clearly provide---;Great Insights (i.e. trends, impact, markers and analysis)------; A clear Business objective-----------;Change management------;Good project management----;Desired quality and results? (this one is debatable!)

The Big Data Success story (Prospective):
In the United States, the independent Blue Cross and Blue Shield were planning to provide healthcare financing for almost one in three citizens. But accurate research data is critical to providing effective treatment, improving outcomes and helping reduce spiralling costs.

Blue Cross and Blue Shield faced the challenge of creating the world's largest healthcare informatics data warehouse to enhance benchmarking capabilities and enable advanced predictive analytics.

Blue Health Intelligence
A renowned IT company designed, developed and implemented a system, dubbed Blue Health Intelligence that would integrate data from up to 40 member companies. They built an overall architectural design incorporating "continuous certification," providing the most comprehensive source of accurate healthcare research data to be found anywhere.This company is CSC.

Warehouse Is Key
The data warehouse is key to the Blue Health Intelligence's overall 10-year strategic plan. No other consortia-based analysis tool exists at this scale: The warehouse is capable of processing medical and other types of claims for 90 to 100 million people, while providing the client with huge competitive advantage. Recognized by both BHI and industry as a one-of-a-kind solution, the BHI data warehouse will lead to greater healthcare transparency by delivering unmatched detail about trends and best practices.

This certainly sounds good! Big data analytics help have a direct dialogue with consumers, provide tailored healthcare, perform surveillance and risk analysis, reduce maintenance costs, offer population wise and enterprise- wise insights and customize offerings in real-time.

IBM is teaming up with the New York Genome Center to develop Watson so that it can help tailor treatments to specific terminal cancer cases, using what IBM calls "cognitive computing."

Comments welcome.

Health Information Security and Privacy Collaboration (HISPC). http://healthit.hhs.gov/
Meaningful use american recovery and reinvestment act, hrsa.gov
Privacy and security guide, Healthit.gov, The Office of the National coordinator for Health Information technology
CSC corporation, Blue shield, Blue Cross, Predixion software, Logicworks.net
DataDyne presentation by Joel Selanikio; Dan Stoke, Vice President of Client Sales and Service, Intellect Resources
A Health Care Provider’s Guide to the HIPAA Privacy Rule: Communicating with a Patient’s Family, Friends, or Others involved in the Patient’s Care.
Andrew Gill, UK retailer Waitrose takes a different approach to in-store loyalty cards & big data

Saturday 1 March 2014

Healthcare On Mobiles: Featured post- mHealth fighting malnutrition

Malnutrition is a byword in the forested hills of the Melghat region inhabited mostly by Korku Adivasis. Every year 400-500 children between the ages of 0 and 6 die in the region, comprising Chikhaldhara and Dharni taluks, according to official figures from 2005.

The Problem: Thousands of kids die every year in the tribal area of Melghat (Maharashtra, India) due to lack of medical attention and nutritional support. Increased incidence and rapid spread of infectious diseases such as pneumonia, typhoid, and dysentery are primary cause of high child mortality. Situation worsens during monsoon when the food supplies are low and the communicable diseases are at their peak.

Melghat is also a place known for high infant mortality rate. Some reasons for the health crisis in Melghat include lack of infrastructure, under-equipped and under-staffed public health and ICDS centres, the tradition of early marriages and early motherhood, lack of sanitation and clean drinking water facilities and the tribals' blind faith in bhumkas (quacks).

Failed Operations of the past: When the Maharashtra government first recorded the figures of child deaths due to endemic malnutrition in the remote villages of Melghat, shocking numbers were revealed.Almost two decades later, even though the government figures show a substantial drop in the number of malnutrition deaths, social activists and health-coordinators working in the impoverished area say that the authorities pass off such deaths as still-births.

The reality continues to bite with the data recorded just before monsoon this year, indicating 509 malnutrition induced deaths during past year, until March 2011. Every year, hundreds of children of Korku tribe in the tehsils of Melghat in the Satpura ranges fall prey to starvation and malnutrition. While the government records indicate figures ranging from 400-525 in the last five years, health activists working among the tribals tell a different story.

Thursday 19 December 2013

Top 10 Tech Leaders- Perspectives by Information week

Mobility poised to play a significant role in healthcare’: Dr. Ruchi Dass, Founder & CEO, HealthCursor Consulting Group

An mHealth Evangelist, and Founder & CEO, HealthCursor Consulting Group Dr. Ruchi Dass, has been involved in specific healthcare IT, e-learning and ICT projects for the public/private sector in India.

In an exclusive interview with InformationWeek, she discusses how mobile phones have transformed the entire healthcare landscape and shares how mobile technology is propelling innovation in healthcare.

According to you, how is mobile phone penetration transforming healthcare landscape in India?  
While the Government is building more and more hospitals, the gap between the patient-doctor ratio is huge. For the next 20 years, the infrastructure will not be able to match the growing population of India. Hence, the next step is to create a model where one hospital supplies its service to 10 -15 nearby villages through the use of technology. Technology facilitates remote patient monitoring, enables safe data collection and dissemination, while reducing service costs.  To give a data point, every citizen in rural area has to travel a distance of 20 kilometers to avail healthcare facility. The need is to decrease the travel time, decrease the cost and make it more affordable and convenient. For this, the government started disseminating information and awareness through mobile phones. It also started educating rural citizens about the various free campaigns being conducted in their district.  Also, today the mobile phones worth only Rs 5,000-6,000 have smartphone capabilities. One can run apps that tell us if a person has got flu or not. This has empowered the rural population too. 

Saturday 14 September 2013

10 Influential Women in Health IT -By Dan Bowman

From government officials to hospitals administrators to patient advocates, women are making an impact in health IT by leading innovation and change in all facets of healthcare. We asked our readers to nominate the most influential women in health IT for our second annual list.

And boy, did they respond--it was tough to keep the list to 10. We received nominations for women who are changing the face of personal health data and patient engagement, advancing nurse informatics, promoting mHealth and tele-medicine, using technology to improve global healthcare, developing healthcare apps and more. 

Read more: 10 (More) Influential Women in Health IT - FierceHealthIT http://www.fiercehealthit.com/slideshows/10-influential-women-health-it#ixzz2es3FJS1D
Subscribe at FierceHealthIT

Sunday 18 August 2013

mHealth India- Insurance and technology

Inspite of low penetration of Health Insurance in India, inclination towards Prevention and wellness products and services is on the rise. Penetration of private healthcare insurance policies is less than 0.5% in India (Health insurance penetration in India is as low as 5%). If you live in the U.S, you would have come across this tagline many a times "Health Insurance companies investing in Wellness products to reduce claims and cut consumer costs". In India, it is Flipped!!!

As there is not enough health cover, more than 70% expenditure on health is out of pocket. Hence the consumer is now becoming more aware of his/her wellness and is taking initiative to invest in prevention and health checks himself. No wonder, there are a million wellness companies that have mushroomed up in the last 3 years and most of them are making money on a B2C/Retail approach for obvious reasons. We are starting to look at some Technology driven wellness companies including mhealth based ones and I thought it would be worthwhile to know more about the stakeholders, current trends and market dynamics in detail.

There are several reasons because of which the healthcare insurance penetration in India continues to be low over years in India. It is a shocking fact that some of the most poverty stricken countries have better insurance coverage than India. In some of the African countries, Insurance has joined hands with telecom companies to provide coverage, access and telephony as well. While most of the insurance companies wish to expand their access through every distribution channel, it is imperative that we learn from some of the new age models to dispense health insurance in India too.

Existing examples:

Simplee- A Palo Alto, Calif., startup unveiled Simplee, a free mobile app that enables you to carry your medical bills, outstanding claims and health insurance data on your Apple device when you visit the doctor, as well as pay your bill from your smartphone.

HealthCoach- Companies such as Healthrageous, Keas and ShapeUp are busy selling the idea of mobile health coaching to U.S. companies desperate to cut both their health insurance costs and losses due to absenteeism.

Bluebutton-The feds offer their own version of a mobile "medical wallet" called Blue Button, which enables Medicare recipients and U.S. veterans to access, download and store up to three years' worth of personal health records onto their computer, tablet, smartphone and other mobile devices.

An ideal mHealth framework may require the use of mobile technology for:
1. Awareness building
2. Policy comparisons
3. Market research
4. Marketing
5. Risk Modelling
6. Sales/Purchases
7. Policy administration
8. Billing
9. Claims settlement
10. Customer service

Inspiring trends:

Distribution and Marketing- Mobile network operators in Africa have identified the growing demand for financial services and micro insurance . Airtel Africa has partnered with MicroEnsure for Mobile Micro Insurance. The range of Airtel-branded insurance products includes life, accident, health, agriculture, and other forms of cover. 

Connecting intermediaries, customers and surveyors- ICICI Lombard India's mobile initiative started simply enough, with a set of basic applications that gave customers a consolidated view of all their policies, a reminder service to renew a policy, and a way to track the status of a claim. But as they matured with the mobile platform, they re-visited the paradigm and devised new ways to provide customers with more value-added and user-friendly features. This is however restricted to Auto insurance only.

 Encryption, Transactions and handling customer grievance- Public sector general insurance company United India Insurance launched a mobile-based real-time fund transfer facility for payment of premium. M-Power enables customers to renew their policies and also remit the premium for approved proposals. To use this facility, one has to get an MMID (an identification number called - mobile money identifier) from his/her bank and enable one’s mobile with the application given by the bank. However, there are only 10 banks on board with this platform. This initiative follows the launch of its Internet-based sales, customer grievance portal and information-cum-sales kiosks.

Sales, awareness and providing access- Bima, a young Swedish microinsurance company, is using mobile phones to sell as many as three billion new insurance policies to the global poor. Bima, that has begun to access this untapped market, is now one of the largest mobile insurance platforms in the world. In just three years, Bima has acquired 4 million clients in Africa and Asia and is adding 400,000 new subscribers per month. Bima has been tackling many of the obstacles—education, pricing, premium collection—that prevent poor people from obtaining such benefits. For instance, Bima products such as life, accident and health insurance cost "as little as $0.20 to $6.00 a month. Last month, Leapfrog invested $4.25 million in Bima, which will allow the company to expand even further within Africa and Asia as well as reach into new markets in Latin America.

                                                                                                                                To be contd..

Interesting read:
CareFirst BlueCross BlueShield taps Cognizant to support its mobile technology initiatives.
RelianceLife eyes expansion in health insurance space


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