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Darkness is nothing but the absence of …….?

I have found myself in my village, Dasaut, Bihar, these past few days. My parents are deeply spiritual, believing that the world is governed by their deity, and they devote at least an hour every morning, typically between 5:30 to 6:30 AM, to prayer. We have our flower plants, and for the last three days, I have been plucking these flowers early in the morning to help them. It's a unique time – around 5:00 AM, a moment when our part of the Earth is yet to be exposed to the sun's rays, casting our part of the state and country into complete darkness.


I picked up my mobile torch and walked to the place where Dad had planted these flower plants - we call it Bhraath. In the middle, I switched off my mobile torch and experienced complete darkness. I asked myself, "What is darkness?" Can you answer this? Till the time you are thinking about Darkness, let’s move ahead. Every time I think about our world and wonder what sets us, human beings, apart from the rest of the species on this Earth, it could be the conquest of darkness. Because our world wasn't the way it is today; in this unknown journey of curiosity for the past 10,000 years, we have continuously been eradicating darkness. However, in the context of our nation, we must eliminate numerous forms of darkness for billions of people.


Got any answer for the darkness? I have answered this question at the last of this essay, for now, let’s connect this essay with the problem that we are solving for India’s 8 quintile - Making Quality Healthcare affordable for 1.2 billion Indians. Let’s get started… :)


Yesterday, Gaurav Co-founder of BigOHealth shared an ImpactGuru link with a heartfelt note. His mother is battling Gall Bladder Cancer, and while approximately 10 lakhs have already been spent on her treatment, the doctors have recommended 6 cycles of immunotherapy, which comes at a staggering cost of 3 lakhs per month, totalling 36 lakhs annually. Sadly, 36 lakhs is beyond the means of 95% of Indians. They are trying to arrange some debts from family and friends however that debt would not be enough and hence he needs our help. The good news is that when I last checked, around 6% of the goal had been contributed by people like us. But the current amount is not enough.

Before we continue, let me make a humble request. While I've been writing essays primarily for personal consumption, I have never promoted it. If you find my essays useful, I kindly request that you consider making a contribution of any amount you can afford. Your contribution can be a ray of light eliminating potential darkness from Gaurav's life.

Returning to our essay, the issue of healthcare unaffordability is a significant darkness in the lives of our people. In Gaurav's case, it was a matter of 10 lakhs plus 36 lakhs, but the reality is that 90% of our population struggles to pay anything more than INR 2.5 lakhs in one go. This reality hit me after encountering a personal problem.


It's important to note that our journey with Jile Health didn't start with a mere business idea or opportunity. There was a 95% chance that my passion for entrepreneurship could have waned after the failure of ZILA SHOP. However, the combination of my personal experiences, the Ayushman Bharat Digital Mission (ABDM), and the Pradhan Mantri Jan Arogya Yojana (PMJAY) led to the creation of our first document on August 20, 2022.


Today when we reflect on our journey this equation can sum up beautifully: Clear problem statement + Being on the ground + Super clear about the product positioning and Target Audience + Target Audience’s motivation to Pay = A Status Quo challenging proposition.


For the first four to five months, we were navigating in the dark, struggling to explain - what we were building. But during that period, we gained valuable insights about the healthcare continuum. We recognized the lack of evenly distributed professionals and facilities across the 8 quintiles of India, and we aimed to build a technology-driven company independent of cumbersome operational components. Consequently, we focused on a single component that could improve healthcare for all stakeholders: patients, providers, and payers.


To understand, let me explain two slides from our pitch deck.

Healthcare Continuum

For healthcare to be affordable for 1.2 billion Indians, consumers must have access to all four components at an affordable price. While our target audience may not be willing to pay for preventive and diagnostic services, they are accustomed to paying for treatment. This is where health insurance plays a crucial role. Yet, the challenge lies in the absence of suitable and affordable health insurance for our target group, resulting in a lack of trust and low purchase rates. And the current experience is also broken.


A pivotal element connecting all four components is health indicators, comprising over 200+ health data points. In the care continuum, health indicators serve as the invisible and objective data that link patients, providers, and payers.


Today, thanks to ABDM, we can offer preventive and diagnostic solutions through smartphones at minimal cost. A suitable and affordable health insurance plan will address the issue of treatment. Our approach is to provide tech-driven solutions for preventive, diagnostic, and recovery services at almost zero cost, charging only for treatment through health insurance - the solution must be full stack.


A successful example of a similar approach can be seen in agritech startup Dehaat. They offer tech-driven advisory services through smartphones for free, using it as an acquisition channel to gain users' trust. This free advisory allows Dehaat to provide agricultural inputs at competitive prices and directly purchase outputs from farmers. Dehaat now competes not with other agritech startups but with established FMCG incumbents - after launching their own brands, holding the key to India's consumption. You can imagine the future potential.


Nevertheless, I believe that even companies like Dehaat can use technology more efficiently, considering their remarkable year-on-year growth of over 100%.


Returning to Gaurav's story, India is home to over 500 million chronic patients, with cancer being one of these ailments. The non-communicable nature of chronic diseases makes them silently propagate until they reach the treatment stage. Visible signs and symptoms alone are insufficient for early detection. Objective data points like health vitals, nutrients, and other indicators become crucial. While various methods can create comprehensive health indicators, the most viable one is longitudinal health records.


Longitudinal health records offer a cost-effective way to build comprehensive health indicators, vital for quality healthcare delivery, preventive care, risk assessment, personalized healthcare solutions, and cost reduction. With access to these records, healthcare insurance can become suitable and affordable for 1.2 billion Indians - the Health Insurance Premium can be brought down up to 60%.


Now, let’s delve into the creation of Longitudinal Health Records. According to the Sample Registration System (SRS), India recorded 5.8 billion OPD visits and 1.3 billion IPD visits in 2021. Additionally, according to the National Health Systems Resource Centre (NHSRC), India averaged 1 billion daycare visits per year. When we combine all of these figures, India had a total of 8 billion facilities and professional registered visits in 2021 by patients.


Now, in the case of OPD visits, professionals create just one health record. However, for daycare and IPD visits, professionals create more than one – let's say three health records each. This equates to the total number of health records created per year being 5.8 billion (OPD) + 6.9 billion (2.3 multiplied by 3 for daycare and IPD) = 12.7 billion.

Accessing and storing these health records for more than a year will result in the creation of longitudinal health records for 1.2 billion Indians. These records will serve as indicators for most medical conditions, enable preventive care, facilitate risk evaluation, provide personalized healthcare solutions, and significantly reduce the cost of healthcare delivery. This, in turn, will make health insurance more suitable and affordable for our target group.

Moreover, longitudinal health records generate a network effect and create a powerful flywheel. This flywheel optimizes other stakeholders, such as providers and payers, making quality healthcare accessible for 1.2 billion Indians.

Flywheel with Longitudinal Health Records


In the past week, we had a discussion with someone who possesses inside knowledge, working closely with ABDM and an insurance provider. If we build it, regulators are eager to allocate resources and implement it offering us GTM strategies at almost zero cost. It's essential to understand that while Gaurav was able to create an ImpactGuru campaign and is likely to raise the required amount, this is not a permanent solution. We have a once-in-a-lifetime opportunity to make quality healthcare accessible and affordable for 1.2 billion Indians and eradicate this darkness.


So, I don’t know your answer but for me: darkness is simply the absence of light. This light can take various forms, whether it's electricity generated and transmitted from a distant source, a mobile torch, or even fire. Darkness can be eliminated with light, whether through human-made sources (nurture) or natural sources (nature).


However, if you observe closely, even to receive natural light from the Sun, our Earth has to rotate on its axis, ensuring that every part of its surface is exposed to light. Similarly, if we aim to eliminate darkness from our society or the lives of our people, we need to take deliberate action. There are fundamental types of darkness in the lives of our people, whether due to the absence of light or the lack of access to quality healthcare at an affordable price, or even access to essential consumable products, among other things.


We have many darkness in our society but today it is possible to eliminate this Healthcare darkness - access to quality Healthcare at an affordable price. And elimination of this darkness will unlock one of the biggest tech companies in India.


I missed writing the last week hence in the mid-week essay. Thanks for reading, please make a contribution and share this essay or the campaign link in your network!


I shall see you all the next week :)


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