Prasad Kompalli , Co-founder and CEO mfine chats with Shripati Acharya , Managing Partner at Prime Venture Partners on evolving telemedicine industry in India.

Having been the CBO at Myntra and Senior VP at SAP Labs, Prasad Kompalli believes in leveraging technology for innovation and his strength lies in business strategy. He was one of the top 200 global leaders at SAP where he held strategy and general management roles. He studied at the European School of Management and Technology (Berlin), IMD Switzerland and INSEAD France to complete his post-graduation in business management, and holds 7 patents in data and mobile technology.

Time Stamps:

01:30 Transformation of telemedicine post-COVID

04:15 What led scale of telemedicine pre-COVID

10:33 Building a trust driven network

13:19 What are people using telemedicine for?

16:05 Role of AI in healthcare

21:24 Non-obvious insights on healthcare and patient-doctor interactions

26:36 What is health stack and why is it relevant?

Read the full transcript below

Shripati Acharya 01:03

Hi and welcome to Prime Venture Partners Podcast. This is Shripati Acharya, managing partner at Prime. Our guest today is Prasad Kompalli. Prasad is co-founder and CEO of mfine one of the leaders in telehealth in India. Before that he was Chief Revenue Officer and Head of Ecommerce platforms at Myntra. And prior to Myntra, Prasad spent several years in senior leadership roles in SAP in India and in Germany. Welcome, Prasad to Prime Podcast.

Prasad Kompalli 1:27

Thank you Shripati, thank you for having me today.

Shripati Acharya 1:30

So telehealth or telemedicine is an area of a lot of conversations these days. So wanted to get your opinion on what is happening in telemedicine post COVID and how big is this transformation?

Prasad Kompalli 1:44

Yeah, it’s pretty big considering that both in India and globally suddenly the interest has now I think have increased by orders of magnitude and not only interest actually translating into also usage both by doctors, providers and the consumers, focusing on India I think that the transformation is pretty big. I mean, until recently before COVID people wanted to use telemedicine, were using telemedicine, I mean, mfine started three years ago, we were actually one of the players building this out. But there was still ambivalence about, is this the right way to use telemedicine or government policies were also not fully clear there were some grey areas etc. what COVID has done definitely is that it has really shown the real use case of telemedicine clearly reinforced it that, you need to be able to deliver care even without physical proximity from a doctor’s and provider’s point of view. And from the consumer’s point of view, this has always been an issue in India where doctors are so less in number, going to a doctor has always been a huge problem and connecting to an expert doctor is a significant issue, all the users, many Indian users have connectivity, but the other end of the connectivity, the doctors were not available. So now most of the providers are moving there, to be able to deliver care and consumers wanting this all along, that is, basically push the accelerator button on that option.

And the government realised that India’s problem of no medicine access or healthcare access, telemedicine at least, is a significant part of the solution. It’s not the full solution, but it’s a significant part of the solution. It’s a kind of inevitable solution for India’s situation where there is only one specialist doctor for every 5000 people and, really highly qualified postgraduate specialists doctors are very, very far and few in number. I know some of the appalling statistics. There are only seven thousand cardiologists in this country. There are only 1700 neurologists in this country. There is a shortage of at least 200,000 paediatricians in this country. And they’re all distributed very, very unevenly only very much within the geographical proximity of 20-25% of the population. So that makes telemedicine an important component of whatever we want to do to improve access situation in India. And COVID just opened the entire Pandora box on this and said that, this is the only way and, and to the government’s credit, they reacted very fast. And that also constitutes the big change that I am seeing that the policies have been really clarified, the guidelines have been created.

Government even created a programme saying that every practising doctor of telemedicine should go through an authorised curriculum and get a certification and the moment it starts to get into academics and education and qualification, etc. you know that now every doctor is looking at telemedicine as one of the mainstream channels of delivery in his or her career, they have to come across this app to learn this or to make it a part of their practice. So that is what I’m seeing as the big change. There are 1.1 million allopathic doctors in this country tens of thousands of hospitals, every one of them would use this. Some may use 10%, some may use 50%, depending on their strategic point of view, and their ability to use this, but India will transform into a telemedicine first country very soon.

Shripati Acharya 4:15

That’s fascinating, I think today you cannot be a software engineer and not be aware or know exactly how to work remotely and use videoconferencing and what I hear you say is that that’s going to be a requirement for software jobs starting now basically. So let’s roll it back a little bit. And telemedicine has been around for a decade or more. It’s not something which is entirely new from an idea and initially implementations, and it didn’t scale that much until the last couple of years. So just keeping aside COVID, in a pre COVID era, what led to that scale, and what were some of the factors, which drove that?

Prasad Kompalli 5:33

Yeah. So we started three years ago, I mean, well ahead of COVID, and etc, which is a change in the ecosystem itself at large. So even when we started telemedicine was there, you’re right, it’s not a new term, it’s not a new technology, etc. But I think the fundamental problems that we noticed were that the deployment was somewhat not optimal in terms of the technology usage, the kind of solutions built and the business models were also not clear around it. What is it used for? First of all, if you look at telemedicine as just connecting two parties, doctor and the patient in a classic marketplace, kind of a model that doesn’t cut the deal in the healthcare sector. So that’s what we noticed that was our first insight that this is not a generic marketplace of commodities.

This is an expert driven, quality driven and most importantly, on the consumer side trust driven network, you need to really make sure that particularly the consumer is able to trust the provider. That’s an important insight. And secondly, because it is always seen as a commercial transaction or an episodic transaction between two parties, just as a consultation, and trust was not part of this, and expertise was not part of this or is limited to very simple cases, like, if I am lazy or if I don’t really have to go to the doctor, but I may actually choose to talk to somebody who is a little bit more qualified, like MBBS doctor or who studied in MBBS, etc. Then I would use telemedicine, but I always as a consumer if I wanted to really go to a doctor, I would actually go physically, taking out the trust was a big deterrent. So for people to use this, for anything meaningful or anything impactful. So the moment that happened, I think the scale did come really. So, number one and number two is that we have great hospitals in the country with a lot of good specialists, doctors, experts, etc. They never shifted to telemedicine in a more consumer friendly fashion, for them telemedicine was always one of the rooms in their office in their let’s say hospital building, wherein, they use it for screening, off and on for patients. And the end of the consultation is always that you have to come and visit physically to continue, so they never really saw it as a care delivery channel in itself. It’s more used as a connectivity channel, even from the hospital side, where trust was there but technology was not deployed correctly. So, that was the problem, at least we saw and when we started to address that, we saw the scale, first of all, we made the technology a lot more consumer friendly. That means telemedicine is not where you travel to a primary care centre, from there you connect over a video with a webcam to a doctor in the city or something.

Telemedicine is something that happens on your mobile phone or a smartphone, you get telemedicine, you can talk to any doctor you want across the country. So some of the early use cases of us were downright villagers or second tier town users etc. Everybody got empowered just by taking this technology into mobile. So that was a big scale factor for us. On the other side, the provider side, we brought in the experts we didn’t bring in the smaller use cases or simpler use cases for which healthcare can be easily delivered over phone we actually brought real experts orthopedicians, cardiologists, gastroenterologist, or endocrinologist, so they suddenly started looking at technology as something that enhances their practice.

They can actually do more effective care delivery with this technology more efficiently. That’s when the doctors came, the patients came, and the patients had the access in their mobiles for as democratised as a mobile phone access. That’s when we really saw the scale. But that hypothesis really worked out for us that we need to bring experts on one side and we need to make it extremely democratised in terms of ease of access for the users on the other side, that’s really opened up the entire scale for telemedicine for us.

Shripati Acharya 10:33

So you mentioned trust. You said you made it consumer friendly and you provided access to experts. But the patient here is not looking to connect to any doctor in the cloud. They’re looking to connect to somebody they trust. They’re not even looking for the best, cheapest price. They’re looking for what is best health advice, which they’re going to get. So how did you address the trust issue here?

Prasad Kompalli 10:57

Exactly. That’s one of the biggest insights we have got very early in the journey when I always talked about expertise and specialist care etc. Where are all these doctors? They are actually in the hospitals, they’re always in the organised sector, they’re always in the places where a comprehensive care from outpatient care, to inpatient care, to diagnostics everything can be done under one roof. So that significant number of good trusted brands and with deep expertise brought together as a hospital. So we clearly built our company around bringing all those experts from these hospitals. The hospital stood in the eyes of the consumer, stood for the trust, stood for the quality, stood for the comprehensive care etc. So contrast this with the other example that I talked about what was the problem earlier in telemedicine, so the telemedicine earlier was adopted with always the assumption that ‘it’s a small problem, I’ll talk to any doctor, I don’t really need to go to a doctor, but I’ll just take a qualified opinion, that’s a little bit better than my grandma’s opinion’ or something like this. That’s it. That was the one.

Now, and every time I have a bit more complicated issue, I would go to the hospital. Where do you go? I go to the hospital. Now, we brought the hospital online. That’s where we cross that trust barrier significantly or a lack of trust barriers significantly. So the moment, we have a sunshine hospital, and Dr. Guruva Reddy coming in, or doctors from Kings hospital Hyderabad coming in, or Sparsh hospital from Bangalore or, Sardar hospital from Delhi or Fortis hospital at the national level coming in on the platform, suddenly, the users realise that ‘okay, this is where I would have anyway gone. Now these guys are all in a virtual environment for me immediately accessible’. And that’s where we completely broke the barrier that until then was struggling to scale the entire category even, that was a big difference that we work with hospitals, we make a cloud extension of each of these hospitals.

So while we start building the unique kind of network effect, the more we build the network, the more consumers came, the more consumers converted on the platform, because the more we build a network, the more trusted the platform became itself.

Shripati Acharya 13:19

So Prasad, you mentioned that earlier, in telemedicine, folks are using it for minor ailments. And part of the reason was that they didn’t have trust on the other side because the doctor was anonymous. Now with mfine, they’re going to a hospital, which they know. A doctor in that hospital and that’s the person they’re talking to on the other side. So what kind of ailments are you seeing people use and find for at this point of time, which shouldn’t be something they would use say in a few years earlier.

Prasad Kompalli 13:48

Right now, if you see at an aggregate level we are solving 30 odd specialties, consultations across 30 odd specialities. More than 35% of our consultations are in the kind of deep speciality or superspeciality as we call it in India like cardiology or gastroenterology, etc. Let me give a couple of examples like, one of the patients was always coming with chest pain complaint and also, other symptoms etc thought she was having a heart attack or something like this, but we could first of all triage and the cardiologist actually could converse and look at the data like her hypertension etc, and other symptoms etc. and actually get her assured that, it is not a heart attack and then also treat and not only that, there is also chronic arrhythmia patients who got treated. This is a patient from Jammu and Kashmir very early when we launched cardiology. So he actually got treated for his chronic arrhythmia.

And another case of deeper thyroid issues, somebody from Punjab talking to a doctor in Bangalore and because the problem is getting better and better over a couple of consultations her health is getting better. She actually took a subscription of mfine and then stayed on for six more months to actually completely recover from her chronic issues. And things like this. There are many examples. Another example is from West Bengal 60 odd year old woman, her son created this case and talked to the doctor over a video call etc. for a neurological problem. With medication, it could be recovered. They all thought it’s a psychiatric issue, but it’s actually a neurological issue. So that was diagnosed fully by the neurologist from Hyderabad. And they are again happy, continuous users of mFine as well. So there are cases like this, which tell us that, first of all, the demand is there and second of all, they can be treated for deeper ailments than just always using telemedicine only for fever, cough, cold kind of things.

Shripati Acharya 16:05

We have heard about AI in healthcare for a long time and now it has been used a lot in healthcare as well. So what is your opinion on the role of AI in healthcare? How significant it is and how do we see it unfolding?

Prasad Kompalli 16:21

Generally speaking, healthcare has a lot of inferential intelligence built around based on data etc even a doctor goes through a lot of data and he has a certain kind of thinking and practice. Over a period of time, he or she has developed to understand what might be the ailment, what is the diagnosis, etc. I think the problem space is very amenable to applying machine learning over huge sets of data and solving many diagnostics or diagnosis related issues and making it more accurate, efficient, etc. for people or doctors. That’s the general application and there, a lot of people who have used this in very specific areas like for example, how to read x-rays and get certain deductions out of it or how to read ECG reports and certain deductions out of it very narrowly defined problems and solving deeply right for different ailments, we also saw AI in a bigger way, in a broader way rather, that if we can actually use AI in making the doctor’s life much more efficient, and in collecting the data in an accurate way, and building correlations and helping in the diagnosis process and treatment process for the doctor.

So, that will change the economics for the doctor itself and the industry as a whole. So this is very, very important for India, as I said we have very few doctors and even very few hospitals. I mean, all of us have only 24 hours in a day. So they are able to see only a certain number of patients today. If you can change that equation by three, four or five times more patients can be served by the same number of doctors that actually changes the economics of care delivery in India. So that’s the problem, we have applied AI to. We built an AI system that understands medical care delivery, diagnosis process, treatment options, differential diagnosis, how do we do investigations completely in an autonomous way without doctor having to go through a similar questionnaire for every patient in episodic everywhere, at the same time, create a very rich database and relationships across data so that the conclusions are accurate, conclusions are very easily made by the doctor as well. So that’s the part where we applied AI, making the diagnosis process extremely efficient for the doctor.

Shripati Acharya 18:52

I’m thinking that this might help the doctors in diagnosing ailments which are afflicting only a small percentage of the population so which might be a little bit more rare. So with AI systems I’m thinking it can assist a doctor in saying, Hey look, there’s actually a possibility of something which is occurring so rarely that the doctor themselves might not be as exposed to how that might look like?

Prasad Kompalli 19:20

Yes, I think there are multiple applications. I think one is the rare, fitting, rare kind of conditions etc. Even before that even identifying those rare conditions in a much more accurate way. So look at the busy doctors, typical busy doctors in Indian hospitals today, they can’t afford to spend so much time on the data and they can’t afford to process all that and build those correlations in their mind and then really, absolutely make sure that case is looked at in a thorough detailed way. I think there, the machine can complement human intuition, human expertise in a really effective way. That’s what we have seen.

Another example, so because we have longitudinal data of the patients, some of the doctors reported that they could actually see the trends in some of the vitals in a very clear way in a graph, like for example, I have a cholesterol issue, that’s my cholesterol values, and my entire lipid profile, etc, is presented as a graph of moving values over a long period of time for the patient, the doctor could easily identify correlation that at what point in time I did medication changes for some other symptom of the patient and what point in time other things are changing. So we could easily draw these correlations and show the doctor that’s really powerful, to be able to do it very repeatedly, for every single patient, whether it’s in front of you or remotely without getting fatigued without losing the data without having to go through reams of paper, I think that’s a great benefit for the doctors.

I think that’s where they both can identify rare conditions as well as treat them of course, but also the early detection and accurate detection of issues before they get complicated. These are the different use cases the doctors are reporting, while using the system.

Shripati Acharya 21:24

What I hear you say is that, changing the paradigm of treatment, which is one now you can look at the history of the patient for a continuous period of time instead of just a snapshot. You’re coming in giving all the information to the doctor and being able to crunch all that data is what AI is doing for the doctor being assisted in that fashion. So what are some of the non obvious insights that you have learnt about healthcare and patient doctor interactions in the three years that mFine has been around?

Prasad Kompalli 21:52

Yeah, many nuggets actually. And both bigger ones which lead to bigger changes in the system that we design or the smaller ones where we have done small product changes. What we saw was that mobile was becoming more of an examination tool for the doctor. So it’s not a connectivity tool. It’s not a video tool.

Shripati Acharya 22:14

That’s fascinating !

Prasad Kompalli 22:17

So, I think that’s also where telemedicine gets it, 1.0 , if I may call it, gets it wrong, if you have mobile and connectivity don’t just use it for video. It is not that. Doctors are looking for a lot more. Doctors used to initially, when in still early days some of the doctors used to post a picture. Like for example, somebody reported an abdominal pain and people used to post a picture and then say where exactly is that abdominal pain? Can you point to me on the picture which coordinate it is 1,2,3 which box so that basically led us to change the product paradigm in terms of changing the entire health. The keyboard itself is what the patient uses and the doctor uses so that we show up only relevant parts, we make an entire questioning and discussion to visual medium.

So today if you report a knee pain, we have some gifs moving and saying that you know which posture has you got more pain or which posture is actually relaxing you etc. The entire, making it extremely easy for the patient and the doctor to collect the information. It’s becoming more and more of an examination tool that’s the important point. Another thing, the same thing, over a period of time when we saw general physicians treating coughs. We said that actually we went back to the doctors and they said can I process this cough sound and understand what exactly is the cough coming from like a lower respiratory infection or higher upper respiratory infection? Doctors very much said yes, they referred to some papers etc to us and then they said yes, this can be done and we immediately launched that feature.

And now we have 70, 80 people everyday coughing into the phone recording their cough. And it is helping, it is actually helping to accurately diagnose. And how else the person is supposed to explain what kind of cough he or she has? So, of course, cameras are used extensively for dermatology situations or even tonsillitis kind of situations etc, by taking pictures etc. So one of the consumer, I remember very early days, doctor was asking how active is the baby and the consumer simply took a 30 second video of the baby and sent it. It’s very clear the baby’s very, very active. She’s not fully down with the fever. So, these are the things that we now make it part of the core product interaction paradigm itself. Those are the examples that have been.

One macro thing which we have changed, we have understood very early is that on the internet when you are connecting doctors and patients, the appointment system doesn’t work. So you have to have the internet paradigm the user comes to the internet for an immediate connection. The Internet is not giving you appointments for opening a page. I can open this page at 3 o’clock. So no, that’s a huge change. That’s where we designed the entire system to be on demand. So anybody could have built the system with a very obvious insight saying that okay doctor means appointment, so show his time somebody sets the time and he comes. And then that instead of physically, it’ll be video, no, this doesn’t work. Like that was pretty, initially very non obvious. But very early days, we got saying that when somebody opens your app on the internet looking at finding a doctor, they need to be able to talk to the doctor, now. That’s it. It’s a very on demand system. That’s how we build the entire system in mFine as well. And that seemed to be one of the biggest differentiators in the experience that people say because you can connect to the doctor in 60 seconds. That’s what we say. And that’s what people experience.

Shripati Acharya 25:55

Do you think that, as you mentioned earlier, that staggering number which is India has a shortage of 200,000 to two lakh paediatricians.

Prasad Kompalli 26:05

Yes.

Shripati Acharya 26:06

And if I just multiply by how many paediatricians by how many patients the paediatrician can see it is that many patients who do not have access to a paediatrician, it is really shocking and that is something which every mother needs access to for her child. So, India is developing something called a health stack, which is a digital public good that is being developed for health care. Could you tell us a little bit about what it is and why is it relevant?

Prasad Kompalli 26:36

Yea, this is actually a very good initiative, some of the planning organisations, part of the government and partly NGOs coming together and creating standards for information storage, sharing, access to healthcare services, etc. so that there is a level playing field for everybody. And there is also consumer rights protection across this technology access. So I think it’s a very big initiative and good initiative and it got a lot of momentum also post COVID. So, we are participating in that play in a deeper way. So that we also can help shape the entire industry’s standards that are being used. Also playing that level playing field for access, particularly for bringing quality providers, as well as I know making sure that the consumers rights and information is protected. So it is around, as I said, a standardisation of access protocols, it’s around data protection, it’s around data portability, so that your data as a consumer, you own it, and you don’t have to get your data locked up in one provider or the other there is a portability across the providers, etc.

There are many components of this, even telemedicine, what is the right way to provide a unified access across different service providers etc. So these things help really scale adoption now because they just make it simpler for providers to participate in this technology led care delivery at the same time, and protects consumer rights. And consumers get more and more choices. Something similar to what happened in the FinTech space in the financial sector, like payments have been standardised in India with UPI, and things like this something similar at a conceptual level. I think, of course, there are so many nuances to be solved in healthcare. But that is something that is evolving very fast and we are participating there and we are shaping those things. And we’ve got a lot of insights over the last three years building the solutions in mFine so teams are actually working together with this organisation across multiple startups and provider companies, etc. to shape what are the future standard software health stack.

Shripati Acharya 28:52

So do you really think that mfine can make a dent in something as significant as that and telemedicine or telehealth in general can make a difference there?

Prasad Kompalli 29:01

I think so and we aspire to do this. And I see the early signs of it. I have reason to believe that, I think we have the chance to influence this kind of disparity in terms of access in a significant way. On the other hand, let me answer also in another way, I mean, how else would we solve this? We added 600 cardiologists in the last two decades in this country, and there is an inevitability to this. And, of course, we need to find the right solution. And of course, we need to build the right model. I think we are on to something very big and something very substantially impactful across the country. So far, it looks like the model and assumptions we made is paying off. I think it’s going to be very transformational. As I said, I strongly believe India will have telemedicine as a huge component, just like India as a mobile first country. I strongly believe India can be a telemedicine first country as well. And has to be a telemedicine first country.

Shripati Acharya 30:02

Well, Thank you Prasad for this conversation. It was a privilege to have you on our podcast.

Prasad Kompalli 30:07

Thank you very much. It’s a pleasure. And thank you very much for having me.

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