Prasad Kompalli, Co-founder and CEO mfine chats with Shripati Acharya, Managing Partner at Prime Venture Partners on Health-Tech startup ecosystem in India.

In this conversation, they discuss top challenges in healthcare in India, why patient trust is the most important factor when it comes to health, the thesis behind mfine and a lot more.
 

Listen to the podcast to learn about

0:50 - Top challenges in healthcare in India today

2:28 - How has health-tech evolved in India in the last decade?

3:30 - How has tele consultation evolved in India?

7:25 - What was the thesis behind starting mFine?

8:45 - What is the experience for a patient on mFine?

13:20 - What role is AI playing in healthcare

16:25 - What are the new emerging areas in health-tech?

Read full podcast transcript below:

Shripati Acharya  0:22 
This is Shripati Acharya, managing partner at Prime Venture Partners. Welcome to the podcast series by Prime Ventures. Prime is an early stage VC fund investing in technology and product focused businesses. Today we have with us Prasad, Co-Founder and CEO of mfine, Welcome Prasad.

Prasad Kompalli  0:37
Hi Shripati. Thank you for having me here.

Shripati Acharya  0:39
So, let me just get right into it. Given your deep experience in healthcare, what are some of the top challenges in healthcare in India today?

Prasad Kompalli  0:50
I think most of the metrics people know of healthcare system in India if I have to describe it, very few doctors, one specialist doctor for 5000 people, 75% of the doctor actually are in the reach of 25% of the geography. If you look at these problems also number of doctors added are very-very small number, just 600 cardiologist added over the last two decades, for a people of 1.3 billion population in the country. So, the problem can be really summarized saying that, we just don’t have easy access to healthcare at all in the country. That’s a very broad problem statement for India here.

Shripati Acharya  1:28
Is this something which is unique to India? 600 cardiologists being added and I don’t even know how many are actually getting out of the system through retirement or whatever. So, that’s not even absolute number. So, is that something which is unique to India or it’s been a case in other places as well.

Prasad Kompalli  1:43
We have seen from a W.H.O. standards etc. we are far below, in terms of number of doctors needed. Hundreds of thousands and if not, bit over million doctors are needed over just next 5 years if you really go by developed countries. In that sense unique to India in terms of the population and the size and the diversity and the geographical spread of India. Similar problems exist in parts of China, parts of Southeast-Asia as well. But, with the sheer size of the problem, I think India is very-very unique and so far not really addressed yet.

Shripati Acharya  2:16
Clearly something which appears tech would be well positioned to address. So, how has the Health-Tech landscape evolved over the last 5-7 years in India?

Prasad Kompalli  2:29
Yeah, just a disclaimer, it’s just my point of view. I think, what I have seen from Health-Tech evolution in India is that, it’s somewhat driven by the similar approaches what probably drove e-Commerce in India or commerce in general in India over internet. It’s mostly people have limited themselves, even though they are Health-Tech companies they have limited themselves to peripheries of healthcare delivery. Peripheries I mean, you probably can book an appointment with a doctor but what happens between the doctor and the patient is not really solved. Or you can probably deliver a medicine just like an e-commerce package but whether that medicine is the right thing for the patient is not really addressed. So, the core of health care delivery is not yet addressed by tech which we have seen when we were starting mFine in some other countries already addressed. But in India, healthcare has been largely limited to peripheries of workflows, administrative workflows, or some commerce workflows, etc.

Shripati Acharya  3:30
And we have however, seen startups which have established companies trying to do tele-, what you’d call tele consult, and how has that evolved?

Prasad Kompalli  3:41
I think our learning was that when we studied the market, healthcare is a sector where it needs as a basis of every interaction huge amounts of trust from the patient side or from the consumer side in general speaking. Trust on the doctor, trust on the diagnosis process, even medicines when they’re delivered. Are they original? Are they good? etc, Do I have a cheaper alternative? Is there an exploitation going on, there’s a lot of doubt and anxiety on the patient side, whether you can do a video call between two people is not the problem statement for healthcare. It is basically who are those two people on the other side of this. This doctor has to be reputed as I can trust this doctor. If I can, if I need to, I can visit this doctor also in person. And the doctor also should have a trust that I can take care of this person over a long period of time, in general, for towards better health, not just episodic, somebody coming in and going I don’t even know whether I will see this person again, kind of situation. So I think telemedicine just solved as a marketplace problem of connecting suppliers and consumers or as a just a video tool between two people is not going to work or did not work. And more or less put all of that under kind of a 1.0 in a cliched way. That’s television 1.0. I think, the 2.0 has to be really more about built on top of existing trust relationships that are already existing, brand value of the providers etc. And it has to be way more local for people to be able to visit also in person. So, it has to be an omni care kind of a model. That’s atleast is our hypothesis what we have seen.

Shripati Acharya  5:16
Put it differently. It is not something where it is a commodity or where the cost is the high order consideration. What you’re saying is that the stakes are fairly high, when you’re looking after your own healthcare. And you really are looking first and foremost for competence and trust on the physician who’s actually providing you advice.

Prasad Kompalli  5:35
Absolutely. In fact, from a cost and ability to pay or willingness to pay is much higher when it comes to your health in people. Because it’s a very fundamental need of the people. It is not a impulse purchase, it is not something that’s nice to have. So, cost plays a very-very less important role here, but trust and quality play a very-very important role.

Shripati Acharya  6:01
How do patients think about trust in this case as it relates to healthcare?

Prasad Kompalli  6:05
You have seen in your own experience, right, you look for, for example, you’d ask your colleagues, you’d ask your community saying that know who’s a good pediatrician around, if you are new to city or something like this. Or, in a lot of places, still people are going to the same doctors who their parents went to. This is a very important insight that we all have probably overlook, when we are building solutions as technologies. But these are very-very important, you need to have that endorsement, not rating actually endorsement of people that you trust are telling you that this is a good doctor or this is a good institution to go to, and this is where you can deliver your baby if you are planning your baby. And this is where you can get out of your chronic diabetes. This doctor has a really good record of doing this. And I think that’s very-very important. That means it’s results based, It’s outcomes based. It’s also the skin in the game that the institutions have put in saying that, I’m here to deliver care over a long period of time as an institution. So, that brand value and that process maturity, that outcomes based approach to health care is what really drives the trust for patients.

Shripati Acharya  7:19
When you’re thinking about trust and looking at what has not worked. Let’s roll back to when you started MFine. So what was the thesis behind that?

Prasad Kompalli  7:26
Yeah, the thesis was definitely a problem to solve is the access. I think that was very-very clear to us. And the way to solve is that, it has to be a network based on trust that can instill trust in the people of longevity, of outcomes based treatments and accountability. In a general marketplace to establish accountability is extremely hard. What we have done is instead we said that, the hospitals in the country are growing and they’re putting in a lot of, let’s say maturity into processes, a lot of effort into building your brand value, lot of effort into solving real problems of people, in hundreds of thousands, if not millions of people, and building that kind of competence in a very institutionalized, professional way. So, I think we should leverage that was the first hypothesis. And so we went with the hospitals as our provider partners rather than going with individual doctors. That really was a fundamentally different approach. What we’ve seen in the market not for the heck of it but also for the point of view that, if trust is the real basis of healthcare transactions. This is the way to get the maximum trust. There are institutions of legacy, there are institutions of longevity, process maturity, and that’s what will drive the trust. That’s our hypothesis.

Shripati Acharya  8:45
So, just take us through an example perhaps to clarify, so what would be user experience on mfine, if I’m a patient, I want to actually get something look there?

Prasad Kompalli  8:53
Yeah, mfine for a patient is a virtual hospital. It’s a very large hospital on the cloud, if you like, so just like any other hospital, you get in, you always find a doctor waiting to see you. It’s an on demand system unlike any other appointment system kind of stuff. So, you get in and the kind of doctor that would be available for you immediately to consult with are all from reputed institutions. You can select depending on distance from your place, or depending on your own word of mouth that you would have heard about. The doctors would be all from names like Apollo, CLOUD NINE, RXDX, Sunshine, Kim’s in Hyderabad. These are the kind of hospitals from which these doctors are there. And as I said, they’re all available to see you. And right away you can tell about your symptoms and then start the consultation with the doctor.

Shripati Acharya  9:46
So, what have you found in the process in the last couple of years doing mfine which somewhat non obvious to the listener here.

Prasad Kompalli  9:56
First of all, when they look at the technology, they look at it as a toy and for a simple problems it can be solved. If I have a fever cold I can go, otherwise I really have to visit. First of all it’s not true. That’s any way the conviction we have and we built it. And second of all, when you take this general perception it will over a large population and which is actually having a steep access problem. You realize that this is not the real popular belief. The access problem is so steep, that they don’t worry about touch and feel and things like this, etc. at 8o’clock in the night, if you want to get to a doctor, you need to get a doctor. The only alternative is emergency room, where you get a resident doctor, but if you want to go to the top specialist doctor there is no option to say that or the luxury of saying that no I will wait, sometimes where for the touch and feel of the doctor etc. We still get a lot of questions how people can really talk to doctors over a video etc. But thousands of people are doing it every day on the platform. And this was very non-obvious initially, but now today, we also learned that across the spectrum of problems, when they have an access, they would use it and they would get benefit from it. We could not imagine or anybody could not imagine that we will do cardiology cases on the platform, we will do orthopedic cases on the platform itself.

Shripati Acharya  11:15
You said orthopedic, definetly expand on that and it definetly sound really interesting.

Prasad Kompalli  11:18
Absolutely. So, but I know there are people with chronic back pains, there are people with issues in the knees, issues in the young-old, they come and they use the video, they use the images, doctors are very creative, they send options of images to choose from, in terms of what kind of postures they have pain, etc. So, it’s a very powerful medium of communication and it simplifies access. So, everything else is taken care of both the patient and the doctor are getting creative, once the barrier of access is removed they are really using the platform to the hilt.

Shripati Acharya  11:48
So what happens if a doctor actually says that you need to come into the hospital, Because not all cases would probably get resolved entirely.

Prasad Kompalli  12:05
Right.

Shripati Acharya  12:06
Virtually.

Prasad Kompalli  12:06
Absolutely. So that’s also another advantage of having this hospital network and a very thought-through approach to what is the kind of choice we need to provide to the patient. So, doctor can say come and visit me after starting this treatment, or come with some X ray report or something like this. Usually, we always present the doctors available in the locality, in the order of the distance from you. So, the patient also chooses the nearby doctor that gives them the comfort and trust, so they can visit the same hospital, same doctor now in the physical OPD, or patient department. And then the care continues. Whether you start online, go to offline and start offline and go to online, the care continuum is there.

Shripati Acharya  12:47
With all the records and everything else.

Prasad Kompalli  12:49
All the records are there, all the data is there. We didn’t talk about the technology but a lot of technology work is going on behind to make it very easy for the doctor and the patient to have a deeper analysis of the problem and solve very quickly.

Shripati Acharya  13:02
Well, let’s talk about technology a bit then. So AI has been talked about a lot in healthcare. When you look at what’s going on across the globe, the role of AI and how it’s going to help or in some cases, replace some of the treatments which are otherwise happening offline. What is your view and where it is proceeding?

Prasad Kompalli  13:22
I think broadly, first big step which is not very far off is that we will have a very powerful, very knowledgeable, extremely capable machine, that can do diagnosis, that can understand history of the patient in a very detailed way. And completely do differential diagnosis, have treatment plans ready, can read X-ray reports or blood reports. And this is I think, in my view, short term, that is that next three to four years and most of the work the doctors do in terms of data collection and analysis, is going to be done by the machine and presented and today, I would say, to a large extent in some specialties and conditions, on mfine its already happening, for example, not to boast of mfine but I’m saying that this is just getting mainstream very fast. Regular cases basically, the machine can atleast diagnose and suggest that to the doctor. Healthcare in general, if you speak we still believe that model that even in the long term, it’s kind of an assistive technology, AI as an assistant is a way more effective way to combine accuracy, scalability of the machine, and intuition and creativity of the doctor. So that’s the evolution we’re also going towards.

Shripati Acharya  14:37
When you talk about trust is obviously there’s no way we’re going to trust the machine.

Prasad Kompalli  14:42
Absolutely. So, that’s also important that the machine is working in the background. And the interaction is always between the humans and when the person is giving symptoms. For example on mfine a person is giving his or her symptoms or uploading reports, etc. Machine is concluding a lot of things out of this, but telling all that as an assistant as a very reliable, accurate assistant to the doctor, the doctor is taking the final call in the end.

Shripati Acharya  15:08
You are trying to say that, the AI in this particular case, can help the doctor in both making more accurate diagnosis. And also probably increasing the speed of diagnosis perhaps.

Prasad Kompalli  15:22
Absolutely, the speed is incredibly high. And some of the very prolific doctors, who are very comfortable with technology, they are seeing 3-4 times more throughput or efficiency for them. And without loss of accuracy and quality, including if you see the satisfaction ratings, etc, of the customers, it’s pretty high. So, doctors love this only because the part of the job that is more administrative, documentation oriented, or, let’s say requiring more oversight of long history, long history of the patient etc. All of this is done by machine, way more accurately, way more effortlessly. And that’s where doctor is saving a lot of time for his thinking, for his communication, a lot of treatment is also counseling. The doctors can really focus on just connecting with the patients, talking to them. We always say at mfine that care is more than cure, you need to have also focus on the care, not just the cure of it, doctors are able to see that happening with the machinery.

Shripati Acharya  16:20
Let me ask you one final question. We are almost out of time. So, what are some of the more emerging areas of health tech? So there’s a new entrepreneur who’s passionate about health tech, what are some of the areas you would say are new interesting emerging areas?

Prasad Kompalli  16:34
I think multiple dimensions around data and technology, there are multiple opportunities as well. Things like, can we completely rethink or innovate around insurance models? For lack of a better word, I’m calling it still insurance. Would it still be called insurance if it’s a subscription? I think health can be a subscription service which people can get over the wire or at the center wherever it’s appropriate. And they can manage their health, rather than actually always, depending on, once you get sick, recovering, prevention, its management, that’s a big area, for the insurance kind of area. And the other thing is really, a lot of devices and wearables are coming in, which makes health more understandable for individuals more and more consumerized. Arrhythmia is not an esoteric thing which only doctors will understand. You can monitor this on your watch now, you can be very cognizant of what’s happening in, with your emotions to your heart rate, or you are exerting too much on yourself. And then your heart rate is changing things like this. So, it’s becoming more and more closer to the consumers. That’s another area of application like integrating with the devices and then creating some new ways of delivery of care. These are definitely some of the interesting areas that are coming up.

Shripati Acharya  17:57
Quantified health.

Prasad Kompalli  17:58
Yes, absolutely.

Shripati Acharya  18:00
Well, thank you Prasad for sharing your thoughts with us.

Prasad Kompalli  18:03
Thank you. Thank you very much.

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