myCOL Aims to Simplify In-patient Healthcare Delivery Solutions in Urban India
The Company has received angel funding from Shishir Kapoor, Country Head, Opera Solutions. An MBA from IIM Ahmedabad, Shishir has served for several years in leadership positions at the Boston Consulting Group and co-founded Opera Solutions.
myCOL (my Circle of Life) was founded in April 2014 and was formally incorporated as a Company (Circle of Life Healthcare Pvt. Ltd.) in November 2014. Its founding team include Mudit Kapoor, Vaibhav Singh, Dinesh Tewari and Aarti Gupta.
What is myCOL and how does it work?
At the core of the myCOL idea lies a simple fact that hospitalization in India is an intimidating exercise even for educated and upwardly mobile people. Patients and caretakers alike report two major problems during hospitalization namely:
Where to go? and
What to do?
As regards the first question, the issue stems from the fact that:
1. There exists no exhaustive database of IPD facilities in the city/ region (NCR alone has 1300 IPD facilities)
2. There is no data on clinical expertise (ratings in the form of thumbs up and down from patients suffer from bias and are irrelevant)
3. There is no information on pricing
As for the second question, patients report 3 major problems:
1. Time taken to admit is very long (upto 3 hours)
2. Insurance inefficiencies, where applicable
3. Time taken to discharge is also very long (upto 6 hours)
myCOL is born out of deep research on the issues which plague the industry and attempts to resolve the same harnessing technology but with a distinct human touch involvement namely the FREE personal assistant or concierge who handles everything for the patient so that the caretaker can always be by his side rather than stand in lines and get bogged down by the administrative procedures at the hospital.
Professor (Dr.) Mudit Kapoor:
Mudit is an economist, thinker and a researcher. He is an academic with a purpose. In the last 10 years he has taught economics to more than 4000 MBA students at the Indian School of Business (ISB) and given several lectures to senior managers. He was a consultant with the World Bank and the Asian Development Bank.
Mudit is a PhD in Economics from the University of Maryland, College Park. He is a co-founder and a promoter of myCOL. Mudit works very closely with the founding team and the board members to develop and implement the strategic thought process. He brings vitality and purpose to the myCOL family. Through myCOL Mudit’s vision is (a) to democratize healthcare, (b) to simplify healthcare delivery, (c) to empower people to get the best and the most affordable healthcare.
Vaibhav has over 16 years of experience in private equity, investment management, consulting, M&A and advisory and has worked in more than 30 countries worldwide. Prior to conceptualizing and founding myCOL, Vaibhav held a leadership position in large size private equity fund managing assets in excess of 2 billion dollars in India which he joined from strategy and consulting major McKinsey & Co. A gold medalist in Commerce with honors from Delhi University, Vaibhav is also a Fellow Chartered Accountant and did MBA with specialization in Finance and Strategy from the Indian School of Business, Hyderabad.
As Co-founder and CEO of myCOL, Vaibhav works closely with the board of directors in managing the overall operations, product portfolio and growth at the start-up and has the vision of using the platform to transform the lives of millions of services starved patients in developing economies across the world, while creating the largest and most valuable healthcare startup from India.
Dinesh brings with him over 15 years of leadership experience in managing large teams under extreme duress and delivering despite all odds. In his 12 years as an army officer, Dinesh has lead teams in Counter-insurgency operations in the Northeast and Jammu and Kashmir, and in extreme inhospitable terrain of the Thar desert (Rajasthan).
Dinesh is a B.Tech (Telecom and IT) and a PGDM (MBA) from Indian Institute of Management, Ahmedabad specializing in General Management.
Dinesh’s primarily role involves creating a synergy of product and service through operations and product management, with the singular aim of making the platform the preferred choice for all healthcare consumers in emerging markets.
Aarti started her entrepreneurial journey in 2006 when she launched a first of its kind premium desserts only food enterprise at New Delhi.
Aarti completed her Bachelors in Commerce from SRCC and is a fellow Chartered Accountant. She started her professional career at KPMG in New Delhi and worked for more than 4 years in the assurance and tax divisions before following her heart that always belonged to the gastronomic world. At myCOL she is utilizing all her start-up experience in handcrafting marketing, operations and customer engagement & retention strategies.
Team BWDisrupt Interacts with Vaibhav Singh, Co-founder and CEO, myCOL And Spoke To Him
How did the idea came to start?
The Genesis of the business lies in the results of an in-depth research, which was done by Professor Kapoor and his team on the subject of access to and adoption of technology and its impact on health outcomes. It was also tempered by some personal experiences of both the founders whereby they had a close interaction with in-patient facilities in the recent past, which highlighted the obvious gaps, which a consumer faces in today’s healthcare delivery model in India.
The research was conducted through primary survey of patients (and their care takers) at some of the largest private hospitals in NCR using a simple questionnaire methodology. Three major issues emerged from the patient’s side:
(1) Lack of information regarding hospitals, doctors and facilities, put them at a severe disadvantage. Information was too costly to gather during stressful times so they are forced to make sub-optimal decisions.
(2) In-patient admission: the patients and the caretakers were not given appropriate advice on the procedures involved and so ended up wasting 3 to 4 hours during admission. This heightened the level of stress and simple tasks like filling forms became a struggle. There was no help with navigating the system. Even though the hospital had a straightforward system – the patients and their caretakers were ignorant of the process and it added to the delays.
(3) Billing and Insurance. In case of billing – the expectations and the actual did not meet. No one explained various parts of the bill (for example, doctors fees, procedure charges, consumables and medicines etc.) as a result led to mistrust and misgivings. Also led to delays at the time of discharge. In case of insurance it was difficult dealing with the TPAs, which led to massive delays, confusion, frustration adding to the stress. On an average upto 6 hours are wasted during discharge.
It’s interesting to note that there were minimal issues regarding medical care but most of the concerns/ complaints were centered around administrative issues.
For the doctors: the biggest issue centered around patient compliance – follow ups, timely and regular intake of prescribed medicines, bringing complete health records post procedures.
For the hospital:
a) Administrative challenges: regarding admission, billing, insurance and discharge are heightened due to the ignorance of the patient. myCOL’s personal assistant service will not only enhance patient experience but also improve efficiency and thereby increase their margins.
b) Reduction in Average Length of Stay (ALOS): Contrary to popular perception, hospitals actually want the patient to leave sooner than later as the money and margins are in the procedure (generally performed within the first 24 hours) and not in the convalescing period. Hence, even if the discharge time is reduced by 30 minutes, they stand to gain immensely from the reduction in ALOS thereby increasing the occupancy rates and margins for the hospital.
c) Inability to fill the beds due to asymmetry of information/ lack of information for the patients
It is commonly believed that there is shortage of beds in India but on the contrary even the best managed hospitals run average occupancy of no more than 70%. While some of this is attributable to the inefficiencies, but most of it is borne out of the market asymmetry of information. In the absence of an exhaustive compendium of IPD facilities available, the demand and supply do not converge efficiently, hence affecting the occupancy levels of the industry as a whole.
What are the special key features of the startup?
Circle of Life Healthcare Private Limited is a technology enabled healthcare startup, which aims to simplify in-patient healthcare delivery solutions in Urban India. At the core of the idea is the simple fact that securing in-patient hospital admission in India is an intimidating exercise even for the upwardly mobile and educated class. Be it the asymmetry of information regarding bed availability, a non-existent comprehensive database of specialists and hospitals or simply the administrative hassles in completing admission formalities, it appears that more than 31,500 man-hours are wasted daily in Delhi alone in securing in-patient hospital admissions.
Circle of Life Healthcare Private Limited aims to deliver a synergistic suite of services (all of which are completely free for the consumer) through its mobile application, myCOL (my Circle of Life), which retains the core human touch aspect of healthcare delivery. The primary service involves
a) Comprehensive database of medical facilities and practitioners available on a mobile platform in a user friendly map-based listing format
b) Resolving bed unavailability for patient convenience
c) Instantaneous assignment of a personalized assistant to each user requiring hospital admission. This assistant helps in all admission/administrative formalities to take the patient straight from the comfort of his home to the hospital room
d) Insurance coordination
e) Discharge & Post discharge assistance
f) Electronic Health Records (portable, available all the time)
g) Focus on Continuum of Care (Reminders, Medicine Delivery, OPD Appointments and Disease Management Centres)
In essence the services allow the patient's caretaker to focus singularly on the patient's well being rather than stress on procedural matters at the Hospital.
myCOL is designed to offer a unique set of solutions to the services starved patient through the following:
1. Exhaustive list of IPD facilities: Most of the players provide a list of OPD practitioners (with no claim to exhaustiveness). A couple of players provide a list for IPD but only such IPD facilities with whom they have a tie-up for securing commission for referral. The uniqueness of myCOL is:
a) Exhaustive list is provided for all IPD facilities, irrespective of size, whether public or private.
b) Map based listing for easy viewing
c) 46 attribute information list provided for each hospital, completely verified by our team of experts.
2. The biggest differentiator for myCOL is the personalized free ‘assistant’ service. On booking an assistant through myCOL, the Company immediately assigns an assistant for the patient and the caretaker to take care of all administrative formalities at the hospital of their choice. The formalities include filling registration forms, coordinating insurance, discharge formalities etc.
3. Electronic Health Records: Store your prescriptions, lab reports and bills on a cloud-based platform for easy retrieval. With a unique sharing facility, you can send these records to your practitioners and other family members with ease.
4. Set Reminders for your medication and appointments for yourself or anyone in your circle of family or friends. Link them with your records and ensure efficient follow-up of your treatment.
The Personal Assistant is at the core of the myCOL service and is required to maintain the human touch that is extremely essential in a successful healthcare delivery model. The role of the Assistant is designed to deliver the following services to the Patient/ Caretaker:
i) Establish contact with the Requesting User to kick-start the admission process. This alleviates the need for the Patient and the Caretaker to arrive at the Hospital much in advance of the readiness of the Hospital Bed, thereby allowing the Patient to move straight from the comfort of his home to the Hospital Bed
ii) Assist in coordinating with the Third Party Administrator/ Insurance Company
iii) Utilize the intensive contact hours with the Patient and the Caretaker to digitize the Healthcare Records of Patient/ Caretaker(s)
iv) Recommend health insurance plans to Patient/ Caretaker families
v) Upload medicine reminders into the Patient myCOL account before discharge
vi) Commence with discharge activities on behalf of Patient/ Caretaker thereby providing convenience to them and also effectively reducing the time taken for discharge (Assistant knows the system inside-out). Such service is also highly beneficial for the Hospitals as such reduction in ALOS (Average Length of Stay) can go a long way in improving overall occupancy levels at the Hospital.
In essence, the Assistant is expected to take over a majority of the administrative tasks which the Patient’s Caretaker would have otherwise been required to do, thereby allowing the Caretaker to wholly concentrate on being with and taking care of the Patient’s well-being rather than getting bogged down by mere administrative chores. It must also be pointed out that the Assistants are not intended to deliver any medical assistance/ advice.
The Company has received angel funding from Shishir Kapoor, Country Head, Opera Solutions. An MBA from IIM Ahmedabad, Shishir has served for several years in leadership positions at the Boston Consulting Group and co-founded Opera Solutions. He is an active investors and was one of the earliest investors in Housing.com and Chaayos. He is a member of the Powai Lake Ventures as well.
The Company is now in the processing of raising its first large external financing round of between $1-2 million and is getting excellent response from investors.
As mentioned earlier, myCOL is completely free for the users and the Company wants to promote myCOL as a the preferred choice of all patients and caretakers needing to visit a hospitals. Accordingly, the focus is on the following products and services:
2. Personal Assistant assistance
3. Reminder facilities for appointments and medications
4. Electronic Health Records
1. Drug Delivery at doorstep
2. Disease Management Centres
3. Assistance with Accommodation
4. Tie with pathologists/radiologist/ ambulance
1. Specialized Medical Tourism
thereby creating a platform that is so deep rooted that several elements within the same would provide appropriate monetization opportunities for the Company. In the near term, a nominal service fee is being charged to hospitals as ‘market development and service fee’ (MDSF) to cover the resource intensive assistance service being provided to patients to handle the administrative tasks at admission, insurance and discharge on their behalf.
Challenges Faced by myCOL
myCOL aims to revolutionize the way healthcare is consumed in India. One must appreciate that when someone is in medical distress, he or she finds it extremely difficult to think rationally. Therefore, while everyone keeps talking about how technology has to play an important role in healthcare (considering how large a sector healthcare is), one must appreciate that educating patients and caretakers about a healthcare technology initiative and then getting them to adopt it is not easy. This remains one of the biggest challenges for myCOL as well. How to go to market, let patients and caretakers know about you and then getting them to adopt. Even though myCOL offers a free personalized assistant to patients and caretakers in their hour of medical need, the problem is that it is a challenge to take this message to the people and then to drive adoption.
The other big challenge we face is to attract top quality talent. Inherent features of startups are that they are relatively unknown, cannot offer fancy packages and are fraught with hard work and risks. Add to that the disruption they are causing and challenging the incumbents. One definitely needs the right talent to execute a brilliant idea. This becomes a challenge as finding and incentivizing such quality of talent is difficult.
Market size and Market Opportunity
The Indian Healthcare Sector is currently at ~USD 150 billion and is poised to grow at a CAGR of 21% for the foreseeable future to become a USD 350 billion market by 2022 (recent McKinsey Report under the aegis of Dr. Naresh Trehan). India is a unique healthcare market since it is predominantly non-state sponsored and that more than 65% healthcare spend is out-of-pocket and only 35% is on in-patient (inside hospital) care. This is completely opposite to the rest of the world and as disposable incomes increase, lifestyle diseases become more prevalent, access improves and payer pools widen, the spend on in-patient (IPD) is bound to catch up with out of pocket (OPD).
Accordingly, it is estimated that the accretive IPD opportunity over the next few years is USD 100 billion market. However, there exist several inefficiencies which plague the sector proved none more so than by the fact that a burgeoning population faces regular ‘no bed’ issues while the Industry grapples with less than 70% occupancy. This is the very problem which myCOL attempts to resolve by harnessing the use of technology without losing the human touch critical in building trust without which any healthcare solution is bound to struggle.
Hence, the way to look at the opportunity in terms of size is as follows:
1. IPD opportunity in India itself is a $100 billion dollar industry
2. The number of hospital beds being filled up with new cases on a daily basis in NCR alone is close to 10,000 that means more than 3.5 million cases in a year. Even if 1 in 100 patients wants a free assistant at the hospital, myCOL can potentially serve more than 35,000 patients in one year in NCR alone which translates to 7 crores of MDSF revenue, additional medicine and insurance premium revenue plus 35,000 unique data points on non-clinical aspects all of which are extremely valuable in building the myCOL network.
3. Healthcare is the second largest contributor to the US GDP and at $1.8 trillion is larger than sectors like retail and technology. We believe that the myCOL proposition is not confined to India alone but to the entire world as it provides a new paradigm to the data starved healthcare sector.
Present Status and Future Plans
Since there is a distinct service involvement in the myCOL model, it was essential that the growth was not sudden and unmanageable. With this in mind, myCOL has not spent a single rupee on marketing till date and is only acquiring users through organic word of mouth and certain network based outreach initiatives. Therefore it would be imprudent to measure the success of myCOL on the number of downloads/ traffic. What is also important to understand is that myCOL has a clear business model with immediate high margin cash generation from the first patient served. Therefore, it is distinct from other start-ups that are generally dependent on virality and downloads to exhibit power of the network that could potentially deliver revenue and value (if at all) to all stakeholders.
The good part is that myCOL knows exactly who its user is and where to find such user. The user is most likely someone who requires a hospitalization in the foreseeable future and keeping this in mind, myCOL has designed a focused Go to Market strategy that includes:
Corporate Sign ups - 5000 students of founder being tapped for corporate tie-ups; Win-win as corporate saves on work hours of employees (rid him of administrative tasks and queues)
1. Contact doctors to recommend free service to patients; 60,000 doctors contacted via email; personal BD visits to follow; handouts to patients in OPD at large hospitals; tap into doctor networks (DocPlexus, Plexus MD & Curofy) by getting advisory board doctors to publish content therein
2. Alliance with Health Insurance Companies to offer service to policy holders; Win-win as insurance companies earn goodwill, better compliance & potentially lower claims & costs
3. Medicine bags with myCOL messaging to be provided to chemists; alliances with pathologists, radiologists, physiotherapists, home care specialists etc.
4. Alliance with large institutions (e.g. Gates Foundation) to reach source markets in tier2 and tier3 cities; 55% of beds in NCR are filled by out-of-towners; capture district hospitals
5. Co-branded health checks at school to gain access to target market young parent (potential caretaker) audience
As mentioned earlier, myCOL has gone live on 1 Jan 2016 and since that date, the following traction has already been achieved:
Number of enquiries for myCOL assistant
Number of patients served by myCOL
Patients served per day
Other enquiries for the period
Number of users/ downloads
It must be pointed out that the number of cases handled above has been done with only 5-7 assistants on the field (supply side constraint). The demand has been extremely encouraging and now with the proof of concept established, the Company is busy raising its first even external round of funding to immediately hire 50-60 assistants all of whom will be immediately deployed on the field to handle more and more cases.
What is also extremely important to note is that myCOL has two distinct customers or users:
1. Patients and caretakers – For them the service is completely free and that too at a time when they really need it (when in medical distress).
2. Hospitals – They would much rather focus on medical outcomes rather than administrative challenges faced by patients and caretakers.
As for the other customer for myCOL, namely Hospitals, the Company adopted a well thought out strategy that involved going to the biggest branded hospitals first. All the hospitals recognized that each patient has two facets, the patient side and the customer side. While hospitals are very good at managing patient centricity, they fail at customer centricity and hence, the need for a service such as this which not only helps provide information to patients but also improves their overall hospital experience. Having secured interest from the large branded hospitals, the task of getting the smaller hospitals is relatively simpler as the need of such a service to the smaller hospitals is more pertinent from improving occupancy levels and gaining market recognition and popularity.
What is also important to highlight is that myCOL has already entered into revenue agreements (MDSF) with ~50% of the private hospital beds in NCR even before the service went live. This is a great validation of the business and the real need of something like this and is a measure of the success of the organization and its vision.
As is evident from the above, the initial response received by myCOL has been overwhelming both from patients as well as hospitals. Over the next two years, our plans include:
a) Raise the first external financing round
b) Immediately deploy resources to hire more and more assistant to serve more and more patients
c) Create a sticky network based on trust achieved through personal touch of patients and caretakers who will then fulfill all their health related requirements including medicines, insurance, reminder and records on the myCOL platform
Accordingly, it is planned that over the next two years, myCOL should have expanded to:
a) Cover major urban health centres including Delhi NCR (current pilot), Chennai, Bengaluru, Hyderabad, Mumbai, Kolkata and Pune.
b) Provide direct employment to more than 1300 people serving as assistants
c) Directly provide assistance to more than 5 lac patients undergoing hospitalization over the next 2 years
d) Establish a large and trustworthy medical tourism business which provides completely automated technology solutions to the foreign patient
e) Help improve access to healthcare insurance by educating and offering insurance solutions to patients and caretakers served by myCOL assistants
f) Establish Disease Management Groups (several across each city) to help chronic patients better manage their health
g) Become a dominant participant in the online medicine market by catering to the needs to the several patients who have been served by myCOL and whose trust we have managed to gain.
Advice For New Players
While it seems to be very glamorous and exciting to run a startup venture, one must understand that it takes a lot of hard work and perseverance to make a successful Corporation. Our advice to new entrants is as follows:
1. Be Sure that you have what it takes to be constantly face new challenges each day
2. Be Ready to swallow your pride and do things/ jobs which may otherwise seem menial in terms of your experience and education
3. Be Aware that any level of theoretical analysis around product market fit it simply academic and the only validation would be when you are live
4. Be Cognizant of changes taking place in the external environment so that you are nimble enough to adapt quickly
5. Be Brave since there is a high probability that your startup may fail
As for specific advice for entrepreneurs entering the healthcare sector, our advice is that they should make sure that they create such a compelling use case that potential users recollect/ reach out to them when needed. The reason is that however useful the product they are trying to create might be, healthcare suffers from one basic problem. People just do not want to think about illness and health when they are healthy and this makes it very difficult for the start-up to deliver the message to its potential users exactly when they are unhealthy.
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