Hi everyone,
We were supposed to publish part one (Answers to top-8 questions), the launch of Jile Health, last weekend (28th Jan). But the Google Play store team took eight days to make our latest update live after creating some complications the first time. But here we are with the MVP version of Jile Health. The MVP version is just a tool for PMJAY (I have explained this in detail, below) users. Along with a data stream to create the future version of Health-based vertical AGI that could have the potential to perform all the Healthcare activities that don’t demand physical visits. I promise you will understand all these as you will go through this essay. :)
This essay is going to be a bit longer even after dividing the entire content into two parts. Therefore I have listed the key topics of the essay that you can use to jump from one section to another. However, it is advisable to read in the same rhythm! :)
Formation of a new S-curve on top of the old S-curve - indications of a paradigm shift
The Progress: Work of the past three and half months - Data room (Even though we have limited data, frankly if we wanted to have 10,000 users on the platform - we could have achieved that. However, scale is one of the tools that will allow us to make healthcare affordable for 1.2 billion Bhartiya means: we must convert a minimum of 45% of users into customers. There is a lot of work that needs to be done to make that possible. But our data points have surprised us)
Is the integration of technology inflating healthcare prices - based on US data points?
Why do I approach problem-solving by keeping people in the centre rather than technology?
The Origine store (It is amazing just a few months back - I was broken completely. And in the past three months, I have found myself alive. I literally see how in every what. The first time I got some sense of what motivates high-performing individuals - it is personal evolution. It is beautiful! Today, there is nothing in this world that gives me more satisfaction than doing the work that I believe has a purpose - except a few times! :) .
How should you proceed with the rest of this essay?
A Story: 95% of India’s healthcare treatment/diagnosis (Except primary treatment) demands consumers to travel 40 to 100 KM a minimum of 3 to 4 times in combination - an additional person with the patient. You can avoid this story, but I am sure this will give you a deep understanding of the problem
A framework: India’s motivation to pay: based on the short-term (immediate), long-term, tangible, and intangible. I think this framework can be helpful for our startup ecosystem (Till here: Part-1)
Why the Healthcare for 1.2 Billion demand a different thought process?
Complicated Bharat’s Healthcare - 90% of healthcare delivery has 30+ stakeholders (I am not kidding)
Why this is the best time to solve this problem. :)
Why is healthcare unaffordable in the first place? Apart from the problem highlighted in the story.
Why should we start appreciating invisible hands?
How EMRs and EHRs are future components of Healthcare services that we pay in the present - and avoiding that future components means patients lose 50% of the treatment cost.
Two examples of EHR samples from the data point system (No, we are not building EMR and EHR software. Who will pay us? I don’t think except for 5% of India’s HSP and HP anyone would even be inclined to use such software for free. Because from their context, it is creating a net negative, yes!)
Components of EHR for Acute visits
Components of EHR for Chronic care visits (Follow-ups)
Example of India’s largest telemedicine startup’s Electronic Prescription and why that is not enough
This is the best time to make healthcare affordable for 1.2 billion Bhartiya and create and generate value for everyone - customers, employees, investors, stakeholders etc.
If we answer all 19 topics, it would be a 7500+ words essay. I believe you would like to avoid that. So, in the first part - we are answering the top 8 questions!
But before we start the Jile Health part-1 essay, if you ever would like to get a sense of how I have evolved as a person. I have jotted down a small webpage: https://sumanjha.com (While coding, I was going through all sorts of complex emotions, damn it seems I just started yesterday even though it is more than seven years… :)
Okay, we must start now!
If we visualise: technological progress in the combination of S-curves; we have all the signals representing a new set of technology intersecting with the flattening part of the old S-curve. And I have two observations
The growth of the new S-curve is a minimum of 10X (Yes, it is scary) compared to all historical technological growth.
These new technologies indeed have the potential to surge the productivity of many industries and hence deflate the prices of some fundamental Humans need - food, healthcare, education etc. Good!
However, all my enthusiasm takes a setback when I keep our nation - India - in the centre, things are not very good, and therefore it is necessary to take this seriously. And there is a lot of building that we all need to do in terms of making it look very good! Do you remember - “Man ka ho to achha, na ho to or bhi achha” (For Non-Indians: If things are going to your plan good, if not going that is very good - now don’t change the structure of your face, kidding :) )? It seems things were on hold for good reasons. Please allow me to explain.
I am sure you all have heard a burning narrative in the USA about how the cost of even basic healthcare is super high. And many new-age startups including the new Healthtech startup of Mark Cuban have started building in the healthcare space. If we do simple math, things are indeed looking scary. In fact, according to a recent survey: Medical bills are reported to be the number one cause of U.S bankruptcies.
2019 data:
USA GDP = $21.38 trillion
Healthcare contribution to GDP = 16.77%
USA Population = 328 million
Healthcare per capita = ~$11,000 (WoW - around five times India’s GDP per capita)
You might be wondering, hey with almost 95% digital penetration, 85% EHR (Electronic Health Records) adoptions, access and advancement of all new technologies, ~50% of telemedicine penetration, 85% penetration of healthcare insurance (15% of the USA GDP is premium of Insurance, WoW), and still Healthcare per capita is super high (why?) Don’t you feel like technology is inflating the net price in this case rather than deflating it? Ideally, the introduction of technology should deflate the price of a product and services, no? (What are your thoughts? - talk to me! [lol])
The above picture sort of force us to ask this question: should we even integrate technology into India’s healthcare? Because, if the integration of technology is going to inflate the price - it would make Healthcare unaffordable square, no? Because quality healthcare is already unaffordable for 1.2 billion Bhartiya. When I was trying really hard to understand what was going on, I come across this informative research paper titled: “Determining Primary Care Physician Information Needs to Inform Ambulatory Visit Note Display” on the National Library of Medicine (the World's largest Medical Library operated by the federal government). If you go through this research paper, on the 3rd page there is a paragraph, it says: “Information chaos may occur when physicians cannot determine whether the information they receive is correct, false, or when they have to search multiple sources of information, which may increase workload and reduce the safety and quality of patient care” - after taking a pause, I covered and wrote ABDM has solved this problem. When I understood it, I was on my toe, I was walking in my room and saying to myself: Now it is possible, now it is possible (lol).
And there are hundreds of failures that have shaped, my, this type of thinking process. I have burnt my fingers so many times in past by keeping technology in the centre and not asking the basic questions
Is this technology inflating or deflating the final price of the product and services?
After integration of this technology, is the final price affordable for the end customers if yes, for how many? Here we also keep the future in our mind such as factors that could reduce the technology price which is costly right now - for example, computational cost reduction would ultimately make the cost of AGI much cheaper which seems costly right now.
Does the integration of technology is creating any sort of obstacles - demand unaffordable hardware, demand high-cognitive load in utilization, demand drastic behaviour changes etc?
Can the use of technology by one person in a family propagate the benefits to the entire family?
Are there any future technological developments in the pipeline that can bring exponential changes in consumer behaviours?
And so many other questions: we update this list as we discover more about the problems and interconnected components. In short, I started keeping our customers in the centre and formed the rest of the hypothesis. This is one of the reasons, I have been living among our customers - every single person I talk to is our potential customer! Okay, at this point I need to nudge you and remind you that there can’t be one reason behind this massive inflation of Healthcare costs in the USA, right?
You are right, there are so many factors behind this massive inflation of healthcare costs. Apart from Eroom’s Law: the observation that drug discovery is becoming slower and more expensive over time, despite improvements in technology. I am sure you will also have this question why? This is not a universal law like Gravitational forces or Entory this means it is solvable. I think the day we will decide to demolish this law - there would be a reverse of Eroom’s law. Many factors are influencing the Healthcare per capita of the USA, but out of many the one that has the real potential to keep the price under control was totally missed by the builders and stakeholders.
Before we go any further, let me list all the work that we (Me and Aviraj) have done in the past three and half months
Released Jile Health website (https://jilehealth.com)
Used that website to generate leads and created a WhatsApp group. The insights from that WhatsApp group have been the key thesis behind building blocks and pricing models.
Even though Aviraj was Part-time: We pushed a new update every alternative week, generated 100K live events, and released an MVP focused on one core action - PMJAY.
We created a database of 70,000 centres from across India where our users can go and create Ayushman Golden Cards (I have explained all these terms).
We created 25000 databases of Health and Wellness centres where our users can get all the information related to PMJAY and other health benefits.
We released features for two states - Bihar and UP - we have users from 18 states, and 127 Districts, submitting 100+ forms for scheme info etc.
We have 1500+ Installs, 600+ users, and according to our internal ratting our NPS is 90%+
Date room: (Click Here)
Note: I write these essays and read books doesn’t mean we like talking(lol). A. All of my writing is on weekends (except writing directly involves Jile Health work). B. I know this writing would save massive time for many years to come so we could focus on building…
Also, our Wiki page has 104 documents, and if we take printouts of all these documents they would be as large as scripts of James Cameron or SS Rajamouli’s movies. From that comparison, you can consider these two parts a teaser (See wordplay, :)).
Not just a few months ago, I had zero knowledge and understanding about healthcare, intelligent digital goods created by authorities, and healthcare being a tangible, immediate (short-term) (I have explained this framework in detail, below) category that has the highest motivation to pay by 1.4 billion Indians. No one suggested we should build in healthcare, in fact, it was a personal incident (Not inserting that story in this essay otherwise, it would be super long. You can read it here) that forced me to understand a few government initiatives and serendipitously I discover ABDM - NPCI of healthcare. And after three and half months of building, I have zero doubt about the market potential and opportunity to build a minimum of $50 billion business. (I can see you raising your eyebrows, however, if you patiently read this till the end along with the attached resources. You shall be only one step away from start believing)
Before we go ahead, here are a few points that you can consider that would be helpful for both of us.
Jile Health is not a social cause - we are talking about $5.2 billion yearly revenue. And we have no aspiration to generate, yearly revenue, of less than $5.2 billion. This means we are talking about the possibilities of building a $50 billion company
We would use technology to deflate prices at each step (In fact, we have defined this in terms of tools, and each tool will allow us to offer products and services at an affordable cost) but never shy away from getting our hands dirty if it demands. Because we believe revenue/Free Cash flow is as important as Great products and services, decent customer experience, uncompromisable customer-care service, Daily and Monthly active users etc.
It would be better if you allocate time, download the attached resources, and read with your original mind - the outcome would be better for both of us (Especially if you are a fund and have an interest in understanding Healthcare space and if you would like to know more)
Okay, now you have some context. We will start with a story :) - you were already knowing this, no?
This is a request to you - please read the story to get a sense of the problem. However, I understand we all have unstrachable limited time, so if you would like to avoid the story and directly want to read the summary of the story - you could jump. :)
I am in Patna, Bihar, India for the past 16 months. And one of the advantages of being near Dasaut (My village) is that I can visit my parents at almost all festivals. When I used to live in Bangalore, my travel route used to be: a flight from Bangalore to Patna and a cab from Patna to Dasaut (due to the absence of direct public transportation from the Airport). And for the initial 7 to 8 months of travelling from Patna to my village was the same - book a cab directly for my village, but it was costly). However, as things were not going well: I started slicing our costs which also includes my personal expenses. Out of many expenses: one was travel expenses. A cab generally costs INR 8000 up and down from Patna to Dasaut. On the other hand, a bus from the Patna bus stand would cost only INR 240 - I have to travel an 8KM in an auto from my Apartment. The only difference was the Bus takes the entire day and the Cab takes a few hours. At that point, I was money constraint, not time. :)
My return visit for the Chhath - you can read that essay here, I was advised to take the first bus from my village to Patna. Because a. from my village to Patna there are only two buses available that are also sharp in the morning - 5:30 and 6:10 AM and b. it might have fewer people, and hence I might get a seat. By surprise, the bus was packed ( at 5:30 AM), in fact, there was little space to stand. I wanted to get back to Patna as soon as possible, and therefore I had no other option apart from pushing myself onto the bus (It is a different experience, you should try someday, a significant percentage of the planet’s population travels this way :). I found a seat in Samastipur - 40 KM from Dasaut - because 30% of the passengers got down from the bus. I could see these were mostly in combination - husband, Wife with a kid, Woman with a teen, Woman with an adult, Senior Citizens with an adult etc. (Interesting). In the middle of the journey from Samastipur to Patna, I asked Conductor: Ye bus sab din yese hi bhadi aati he Subah Subah? (Is it the same every day - packed?). His answer: Ha Sir, in sabhi ko Doctor ke paas jana hota he (They all have appointments with Doctors). I nodded thinking this might be the story of just Bihar.
When the above personal incident forced me to build a tool (website) in healthcare: it was a clean slate - zero information (except PMJAY and ABDM). First thing, I subscribed to a few Podcasts related to Healthcare and created a playlist of Podcasts from Indian founders. This was one of the methods to have no biases in my thought processes. Among all the Podcasts one Podcast on Kalaari Podcast is named “Kallari Healthcare Roundtable: Scaling Healthtech in India. And in that Podcast Co-founder of Pristyn Care talk about how it requires 3 or 4 visits to Hyderabad from the nearest smaller cities for treatment and diagnosis. And using technology this can be reduced to one visit. It was more like a light bulb, I could associate quickly with the bus incident - travelling in combination - 40 to 100KM, in the sharp morning, 3 or 4 times for the same treatment. (God, now, my life feels like a luxury). I also quickly realised it was not only a problem of relatively poor healthcare infrastructure-based states like Bihar or UP. This travelling in combination (2 people) to 40 to 100KM in the sharp morning for the treatment is the story of every state. Today India 95% of healthcare treatment (except primary) demands 3 to 4 visits from tows/villages/smaller cities to State's capital for treatment. It was a good realization if we can solve for one state this will allow us to scale to the rest of the states. And hence our pitch is always: Making Healthcare affordable for 1.2 billion Bhartiya! (It’s not a random number we picked. (lol)
Do, you know what would be the permanent solution that would create a gigantic net positive - if we reduce 95% of India’s healthcare treatment travel from 4 to 1? You can do your math.
It was a long story, let me quickly summarise this
95% of India’s healthcare treatment/diagnosis demands consumers to travel 40 to 100 KM a minimum of 3 to 4 times in combination - an additional person with the patient.
This is currently happening in the offline world - money is being spent. In fact, a massive population is taking money on credit and spending on Healthcare because there is nothing in this world that is more tangible than human life. Sometimes, I wonder: a human with massive pain and with a very low probability of survival still wants to get well and live in this world. There is no amount of tangibility that can be bigger than human life. God, I love this Beauty of our (human) nature! <3
This is the story of all Indian states - 1.2 billion Bhartiya.
Great, we have 50% solution of the problem (why?) 50% solution of a problem is the identification of the right problem, no? I don’t think we have yet identified the right problem - I am trying to confuse you. (lol)
Okay, Can you remember - I used the term: Healthcare being a tangible, immediate (short-term) and therefore high motivation to pay. Let’s decode that framework.
Aviral's tweet inspired me to write this framework. If today, I am good with numbers - I think credit goes to his tweets. (Thanks, Aviral). Frankly, Aviral is a part of a VC firm otherwise, I would have chased him to be our angel investor! :)
When I first saw it, It was like a normal tweet. But when I was in my deep work (thinking: connecting random dots to solve a complex problem) about pricing structure - tangibles and intangibles flashed into my mind. I opened Twitter, searched Aviral's profile, scroll down his timeline, and cropped this tweet. :) I thought what if I plot all 4 in a 2X2 matrix? And here is what I drew on a page. It was beautiful because everything was coming nicely under four quadrants. ( I have also borrowed a few words from Kunal, thanks)
This exercise was super helpful. This allowed us to create a package and offer life-changing value at a price point that could be affordable for 1.2 billion Bhartiya (225 million families).
In fact, we can see there is motivation to pay for Tangible and Long-term categories as well. This is one of the reasons, we have recorded a relatively better number in the fintech - still in the nascent stage based on the size and scale of our nation. (We shouldn’t be celebrating anything because we are not even the 1% of our full capacity: can you imagine our full potential? I dream that every day, it is “Unknown, Unknown - no one can put a cap on the potential of our nation (lol)
Can you observe a nice pattern from the above framework? We can unlock massive potential if we
Make “Tangible-immediate” affordable (The success story of Physica Wala (PW) is largely based on making high-quality IIT Coaching affordable for almost everyone)
Make “Intangible-Long-Term” zero cognition load: Remove the cognitive load from fintech - investing, insurance, saving, landing etc. (God: Zerodha, Paytm, and other startups are not even 1% of their capacity)
Note: This framework can also be helpful for Brands and Marketers (How?) Plot your product using this framework and apply the Hierarchy of effects models (You can read my essay: here). This will give a fairly good idea of whether you should be activating users' thinking (cognitive) or feeling (emotion). Please avoid playing with emotions and fantasies (Two of the stupid Power law from the book: 48 laws of power). Please do what is good for your customers in the long term! (pray) I am not saying this it is said and institutionalized by Jeff Bezos, and Nithin Kamath).
If you find this framework helpful, you can thank Aviral and me also if you want! :)
But to make healthcare affordable for 1.2 billion Bhartiya non of the above models and frameworks are effective that can allow us to satisfy the need of 1.2 billion Bhartiya. But to know, what could be the potential solutions, you must wait for PART-2 because PART-1 is already 4000+ words.
See you all in Part-2!
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