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Launch of Jile Health, Part-2: Subjectivity of information is the biggest problem

Hi everyone,

This is the Part-2 of the Jile Health launch, and if you have not read part 1, I will advise you to read part 1 first before reading part 2 to have the proper context

However, to have proper context - I have listed all titles in part 2.

  1. Formation of a new S-curve on top of the old S-curve - indications of a paradigm shift

  2. 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 would 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)

  3. Is the integration of technology inflating healthcare prices - based on US data points?

  4. Why do I approach problem-solving by keeping people in the centre rather than technology?

  5. 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! :) .

  6. How should you proceed with the rest of the essay?

  7. 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

  8. 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 the ecosystem (Till here: Part-1 - attach the essay link)

In this essay, we will go through the below key topics:

  1. Why does the Healthcare for 1.2 Billion demand a different thought process?

  2. Complicated Bharat’s Healthcare - 90% of healthcare delivery has 30+ stakeholders (I am not kidding)

  3. Why this is the best time to solve this problem. :)

  4. Why is healthcare unaffordable in the first place? Apart from the problem highlighted in the story.

  5. Why should we start appreciating invisible hands?

  6. How EMR 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.

  7. 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!)

  8. Components of EHR for Acute visits

  9. Components of EHR for Chronic care visits (Follow-ups)

  10. Example of India’s largest telemedicine startup’s Electronic Prescription and why that is not enough

  11. 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.

We ended Part 1 with these lines - 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… (Continuation of Part 2)

If you read my essay on “Decoding Pricing models for Bharat”, I highlighted the term “Life Changing Value”. And I explained this term with a story. For our customer base - 1.2 billion Bhartiya - the structuring of Life Changing Value is supercritical. And initially, we were in Paradox because offering a Life-Changing Value at an affordable price means building a net negative contribution margin business. However, if we take a different route: a combination of tangible: short-term (immediate) and long-term - we can offer a Life-Changing Value at an affordable price for 1.2 billion Bhartiya. And this can unlock a trillion-dollar value (How?). This answer I would like to keep to myself for the next few years. :) You will have some sense of the potential solution if you read the complete essay! I would be happy to answer your queries.

I hope you got a sense: why Healthcare for 1.2 billion Bhartiya demands different thought processes. And now you also know - it is all about making Healthcare affordable for 1.2 billion Bhartiya - people will pay by default!

Before we move to the next part of this essay, let me quickly add: In the past four months, I had a single goal in my mind - make healthcare affordable for 1.2 billion Bhartiya. I remember talking to myself so many times: Suman, you wanted to solve a hard/complex problem, no - solve it (It usually brings a smile to my face)! Because this is indeed a hard and complex problem to solve, but at the same time, it is so beautiful to see users who use our Jile Health tool get benefits and before living rate us 5 stars or 1 star, sometimes (lol). I would like to allocate all atoms and molecules of my body - I can’t tell you every single time I think of this, I get this massive sensation in my body…And I would like to have this sensation my entire life.

Okay, I wanted to remind you that I am the best person to solve this problem. Let’s get back to the meat of the solution. Not gonna write I used the First Principle (which I applied :)) but even before that - I mapped stakeholders end-to-end, including TPA (Third Party Authorities). And let me tell you, India's 90% of the healthcare market has 30+ stakeholders (Directly and Indirectly), the highest compared to any other industry. This was good and bad both.

Note: If someone could have told me to solve this problem - make healthcare affordable for 1.2 billion Bhartiya - just 6 or 8 months earlier, my default answer would have been a big NO. But today, we are at the intersection of multiple forces: making it possible to solve this problem.

To understand why, today, it is possible to make healthcare affordable to 1.2 billion Bhartiya. We need to understand why it is unaffordable in the first place.

Can you recall my above-raised questions - with so much technological development, why the USA’s Healthcare per capita is super high and my admission of the fact that “ABDM has the potential to solve this problem”? We are going to understand those aspects in detail.

Before we go into the details, you need to understand the importance of EMR and EHR (Electronic Healthcare Record) in the Healthcare infrastructure, otherwise, you will keep wondering and put too much cognitive load to connect the dots - that we don’t want. We want to encode this into our DNA - offering our products and services at Zero Cognitive Load!

I promise this is going to be a fun read - even after reading this you are not having fun, please forgive me! (pray) - I will try harder the next time.

But before we start, we need to appreciate, acknowledge, and thank some of the folks who work behind the curtains. These folks are invisible to us, don’t give interviews in public, getting paid like normal employees - but they have been doing some extraordinary work for many years. Let me explain why. In 2016, Sunil Kumar Srivastava published a paper titled “Adoption of Electronic Health Records: A Roadmap for India” that summarises the EHR implementation in developed countries. And advised GOI to consider these points in implementing EHR to make healthcare affordable for every Indian, not just the top-5% of the population. And it is amazing to see, authorities read Mr Sunil’s paper and implemented almost everything in just 4 to 5 years, after multiple iterations under ABDM. It will be almost impossible to talk about everything under ABDM because it is so brilliantly thought out and getting implemented. But one small component of ABDM is EHR, and this will give us a fair understanding of India’s current Healthcare infrastructure.

In simple language, EHR is a Patients’ record of Health information. What I mean by this is that when you visit an HSP (Health Service Providers - Hospitals, Labs, Clinics etc) and HP (Health Professions - Doctors, Nurses, Paramedics etc.) after going through the process - there are defined steps, not difficult to understand for sure - these HSP and HP give you a Note, that contains necessary health information (I have explained this in detail). If you have to keep one line in your mind, please remember this: When you are paying money to HSP and HP, you are not only paying money for the immediate treatment (present), you are also paying for the future. Ultimately, the present treatment should make your future better. This means the value of your payment to HSP or HP is getting divided into two - Present and Future. And the EMR and EHR are that future value (WoW) - I bet you were not knowing this, same for me before writing this :).

And therefore, EMR and EHR can be considered the spine of Healthcare. This is one of the reasons, almost all the developed countries including China - implemented EHR a decade back and most of these countries have achieved deep penetration of EHR. Here is a table for your reference

CountryEHR implementation Year Latest Adoption

Now you might be re-asking this question, hey even with the USA having 95% adoption of EHR, why does the Healthcare per capita so high?

Apart from the above problem that I highlighted in the research paper. Since Healthcare is a relatively complex industry - mainly because of the high number of stakeholders. They missed one key aspect of data digitization - the exchange of data from one stakeholder to another stakeholder. To get a sense of how this data exchange is inflating healthcare prices - we need to go through a few examples.

Okay, to understand the full scope of the problem we must take two examples.

  • Acute Care visit (Branch of secondary health care where a patient receives active but short-term treatment. For example, a patient has mild cold for the past nine days, and he/she ignored by taking it likely but on the 10th day, the situation is super bad)

  • Follow-up Chronic Care Visit: Long-term illness - asthma, diabetes, emphysema etc.

One more thing, there is a difference between EMR (Electronic Medical Record) and EHR (Electronic Health Record) - EHR is sharable. In another word, a combination of multiple EMRs can be called EHR - if there is consent to share those EMRs. We will talk about EHR because healthcare is a multi-stakeholder industry. And almost always a treatment involves - Multiple Doctors, Lab tests, reports etc. And hence we will only talk about EHR in this essay.

The last thing, you already know EHR is a patient health information database. However, the decision on types of information and extent both are controlled and moderated by Health Authority. In 2016, GOI’s Ministry of Health and Family Welfare released Standards of EHR - and some large HSPs indeed follow these standards. However, we are considering the most optimized EHR information system - we are counting the days on our fingers tips.

Example-1: We will start with an Acute Care visit

When we were thinking about how can we not repeat the mistake committed by the US - creating a net negative for HSP and HP by implementing EHR (this is just one of the problems) - thanks to the ABDM building blocks, we were surprised, shocked, excited, and emotional. Because with the help of ABDM building blocks dataflow among multiple stakeholders is just one click away, the standardization of electronics prescriptions is possible and verified HSP/HP would eliminate the massive trust deficit. And these factors will make healthcare affordable for 1.2 billion Bhartiya. This means, in the absence of ABDM, it would have demanded us to invest hundreds of millions of dollars and half of the decades of building even with everything the outcome could have been uncertain. But now it is not!

Okay, any picture formation in your mind after looking at the above table? I know you are not a doctor, and so I am (lol). Cool, let me stop teasing you and highlight key points.

  • Subjective information sucks, according to reports subjective information has been the reason for clinical mistakes, information overload, diagnosis prolongation etc. But thanks to ABDM’s ABHA now 75% of the subjectivity can be removed and made available directly to HSP and HP. (WoW). This interoperable protocol is available at zero cost.

  • Subjective information also doesn’t demand physical visits - seriously, yes. This means if a user has an ABHA number with one click through the Jile Health app, he/she can give permission to HSP/HP for review. Incredible!

  • Even in the case of Objective information, patients' physical presence near HSP/HP is not necessary this means all the necessary information that an EHR contains demands only one physical visit. Unfortunately, in the absence of solutions - it takes days to complete.

  • If you do the math, you will realise - with just a few tools, and an ABHA id we can create a minimum of 3X of net positive for HSP/HP and convert 3 to 4 visits to just one. Amazing no, just a few tools? :)

  • This table also gives us a fundamental understanding: of why simply saying “Telemedicine” is a potential solution to everything is lazy thinking.

Before we go to the next example. I know what are you thinking, we are building EHR for HSP and HP. Without creating any suspense, let me tell you the answer is a big NO. Because even a super-efficient (which is not available) creates a net negative for 95% of Indians' HSP and HP. If we build and offer EHR, except for the top 5% of HSP/HP rest would not pay us. And our target audience excludes the top 10% (lol). We believe revenue/Free Cash Flow is not good to have business components, it is a must-have component. And Please remember we must generate $5.2 billion yearly revenue, not even one unit less than that. :)

It is a good time to have a look at example-2.

Beautiful! Because Chronic disease is a long-term disease and demands treatment for multi months or years. And hence demand patients' multi visits. However, using ABHA and a few tools, it can be reduced to a few visits. Also, data additional data points on the EHR would deflate healthcare prices.

Now let me give you an example of one of India’s largest Healthtech companies - an example of electronic prescription (provisional treatment).

Two prescriptions for the same disease on the same platform - but can you see there is no exchange of information? In fact, the data points and process were the same as above (EHR) - HPI, PMH, Medication, treatment etc. and I had to search and recall everything.

When I will use the app the next time for the same follow-up treatment, I have to share information by combining these two. Because the entire Healthcare stakeholder ignores the fact that, any payment made in present is a combination of present and future. God, every single time I think about the potential of ABDM it is multiplied by multifold.

Note-1: The treatment was effective, and those medications fixed my problem.

Note-2: You might be wondering how come I grow two years in just 5 months after the first treatment. Frankly, the doctor was younger, so I lied to her and told her I was 25 instead of 26 (lol) - just human nature!

When I visited my village for the Chhat festival. I remember suggesting Practo to my neighbour, and she came back to me after 10 minutes - ye to sirf English ka hi option de raha he (It has only English as a language option). Imagine, it was not the problem of affordability or reachability - it was a problem of availability (the solution was not available in the consumer’s preferred language)

Today, we are at the intersection of multiple forces - AGI, ABDM, 80% digital penetration, trained healthcare stakeholders etc. And this is the best time to make healthcare affordable for 1.2 billion Bhartiya…

I would be happy to answer all your questions! :)


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