2022

A BOLD VISION FORI N D I A’ S D I G I TA L H E A LT H
A digital revolution
driven by the Indian
consumer awaits

IN PARTNERSHIP WITH:

CONTENT
FOREWORD

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E XECUTIVE SUMMARY

41.

G L O B A L H E A LT H T E C H A D O P T I O N
T R E N D S & D E L I V E R Y I N N O VAT I O N S

2.

3.

G L O B A L T R E N D S I N D I G I TA L
H E A LT H & E N A B L E M E N T

10SELECT GLOBAL STUDIES

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4 . 	I N D I A N D I G I TA L H E A LT H L A N D S C A P E
5.

8

16

D I G I TA L H E A LT H O P P O R T U N I T I E S
IN INDIA

20

CONCLUSION26BARNIK CHITRAN MAITRAVIK AS KHARBANDAManaging Partner
India & South Asia
maitra.barnik@adlittle.com

Partner, Healthcare & Life Sciences
Middle East
kharbanda.vikas@adlittle.com

PRITHWEESH GHOSH

FABIAN SEMPF

Principal, Healthcare & Life Sciences
Middle East
ghosh.prithweesh@adlittle.com

Principal
India & South Asia
sempf.fabian@adlittle.com

DR. GAURAV SHARMASALONI MEHTAManager, Healthcare & Life Sciences
India & South Asia
sharma.gaurav@adlittle.com

Business Analyst
India & South Asia
mehta.saloni@adlittle.com

SIDDHARTHA BHATTACHARYA

DR. SHRAVAN SUBRAMANYAM

Secretary General, NATHEALTH

President, NATHEALTH
CEO, GE Healthcare

We would like to acknowledge all those who contributed in the review of this Report, especially:Dr. Harsh Mahajan, President Mahajan Imaging; Dr. Ashutosh Raghuvanshi, CEO & MD, Fortis Hospitals;
Ameera Shah, CEO & MD, Metropolis; and Sunil Thakur, Partner, Quadria Capital2

ARTHUR D. LITTLEFOREWORD
Across the healthcare spectrum, technological innovations continue to be
developed and made available to consumers at breakneck speed. Within thisevolving healthcare landscape, care is becoming more personal, more patient
centric, less episodic, more omnipresent, and fully embedded in the lifestylesof the population. Innovative use of digital technologies therefore creates
opportunities to enhance patient experience and at the same time optimize
care delivery to ensure affordable health access to all. Resulting changes in thefundamentals of healthcare delivery affect all components of the healthcare
value chain — from outpatient care enabled through telemedicine, to inpatientcare optimized through remote care and home health enabled throughdigitalization, Internet of Things (IoT), and other interventions.
The COVID-19 pandemic has catalyzed both technological and behavioral
change — on one hand, forcing people to embrace digital innovations in allareas of life and especially healthcare, and on the other, creating significant
pressure on health systems and exposing supply chain lacunae globally. Asa large and growing healthcare market and a hub for innovation and digital
entrepreneurship globally, India is poised to see a paradigm shift in digitallyenabled healthcare. In this context, this Report seeks to explore how global
trends and success stories in digital health will be relevant in the Indian
context, what opportunities could emerge in the near future, how readythe ecosystem is to adapt to the changing landscape, how recent policy
interventions have set the stage for accelerated adoption of digital health,as well as what specific challenges may need to be overcome and how thesetranslate into innovation opportunities for Indian healthcare players.

Barnik Chitran Maitra

Dr. Shravan Subramanyam

Managing Partner

President, NATHEALTHADL India & South Asia

CEO, GE Healthcare

Siddhartha Bhattacharya

Vikas Kharbanda

Secretary General, NATHEALTH

Partner, Healthcare & Life Sciences
ADL Middle East

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R E P O R T: A B O L D V I S I O N F O R I N D I A’ S D I G I TA L H E A LT H

EXECUTIVE SUMMARY
Digital technology has a transformative power that eclipses thecapacity of any other force behind earlier socioeconomic revolutions.
In healthcare, digital technology is creating a quantum shift, one that
could transform healthcare in India almost beyond imagination. India
could have 1 billion digital health users by 2030, enjoying an inclusive
health system where healthcare keeps expanding but costs keep falling— a system that efficiently prevents and treats diseases and responds
to individual lifestyles and disease profiles with tailored treatments,
all at an affordable price.
This is a future that the digitization of healthcare can achieve. But
only if the stakeholders involved step up to the challenge.
The demand already exists. India already has 400 million digital
health users, using available services such as telehealth, homehealth, home testing, e-pharmacies, and other digitally powered
offerings, even without much innovation by large healthcare providers.
A survey by Arthur D. Little (ADL) to identify what drives digitized
healthcare adoption in India showed up to 65% acceptance of digital
health solutions among customers who use e-commerce services.
Significantly higher adoption of digital health tools was reported bypatients who had long-term disorders such as cardiovascular disease,diabetes, and hypertension. The pandemic forced people to use digitalchannels for care needs. Having experienced the benefits of digitallyenabled healthcare delivery, consumers now consider them a necessity.
However, as too often in India, supply lags well behind demand.
The underpinnings are already there — India now has a sturdy digitalbackbone via Ayushman Bharat Digital Mission (ABDM). Aiming tocapture health data across physicians, providers, and patients, theplatform promises interoperability, flexibility, security, scalability,
and wide access.

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ARTHUR D. LITTLE

It is now up to healthcare providers, start-ups, technology providers,investors, and other stakeholders to develop digital health offerings
that meet and stimulate demand. Like nature, the economy abhors avacuum — those who tarry could find that others have already captured
the opportunities.

W H AT I N D I A N E E D S I S E F F E C T I V E ,ACCES SIBLE , AND HIGH - QUALIT Y
H E A LT H C A R E S O L U T I O N S

At the moment, opportunities abound. What India needs is effective,
accessible, and high-quality healthcare solutions that provide equitable
access and that can be rapidly deployed and scaled up. Conventional
healthcare capacity is highly unlikely to catch up with the demand andsupply gaps the country suffers now. Digital solutions are the answer,building on the deep penetration of smart devices and increases inconnectivity that the country has invested in over the past decades.
The pandemic catalyzed the adoption of telehealth, home health,home testing, e-pharmacies, and other digital offerings. But there is
still a lot of room for growth. Meanwhile, some solutions remain largely
unexplored, including e-diagnosis and tech-enabled home health andmore mature e-pharmacy solutions.
For conventional healthcare players, health technology start-ups,
and investors, this is the time to enter and build a hard-to-beatposition. How they could do so and the policy and regulatory support
they will need can be summarized as follows across 11 imperatives:

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R E P O R T: A B O L D V I S I O N F O R I N D I A’ S D I G I TA L H E A LT H

Provider imperatives
1. Develop “digital first” strategies instead of “digital as a bolt-on”
for conventional businesses.
2. Create digital health offerings that are integrated — from preventative
health to patient first contact to point-of-care delivery, onward to
post-care follow-up and then recuperative care.
3. Orchestrate partnerships and build-buy partner strategy.
4. Set a clear data strategy to use data to improve the health system.
Payer imperatives
1. Develop digital distribution strategies focusing on customer
ease and accessibility.
2. Build health claims platforms to improve efficiency and reducerisks and fraud.
Regulatory imperatives
1. Develop regulatory framework for policy that pushes legacy players
toward adopting digital health offerings while providing trust indigital solutions, data security, and consumer satisfaction.
2. Encourage start-ups through the right regulatory and policy
support.
Investor & funding imperatives
1. Develop an attractive, independent investment ecosystemfor digital-first healthcare plays as opposed to digital healthinvestments — with digital as a key parameter for investment
ideation, deal identification, transaction screening, and post-dealvalue creation.
2. Start targeting brick-and-mortar services from an integration
perspective where some momentum is already observed (notably
with large players like Practo and Pristyn Care).
3. Finance digital health innovations and platforms through greater
emphasis on healthtech and insurtech start-up ecosystems.

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ARTHUR D. LITTLE

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R E P O R T: A B O L D V I S I O N F O R I N D I A’ S D I G I TA L H E A LT H

1 . G L O B A L H E A LT H T E C H A D O P T I O N
T R E N D S & D E L I V E R Y I N N O VAT I O N S

KE Y T R EN D S I M PACT ING
HE A LT HCAR E SECTOR

As life expectancy increases globally, andThe future of healthcare is being shaped

significantly as well. In fact, the expectedby several trends. Fundamental shifts indemand and epidemiological characteristics,
demographic and access improvement inhealthcare, emphasis on supply chain resilience,changing consumer preferences and views
on healthcare, increasing automation,
standardization, and efficiency are driving theevolution of the healthcare sector as well as
digital health and health tech innovation.
Globally, noncommunicable diseases (NCDs)
are expected to drive a lion’s share of disease
burdens, according to the World HealthOrganization.1 NCDs are already the leading
cause of mortality and disease burdens globally,
contributing to over 70% of deaths globally
before the COVID-19 pandemic. The shift has
already permeated from developed countries
to developing countries and notably India as
well. As many as 77% of NCD deaths globallynow occur in developing countries like India.
Key ailments like cardiovascular diseases,
cancers, respiratory diseases, and metabolic
disorders drive a majority of the mortality
burden in India as well.
Notwithstanding the impact of COVID-19 in the
short term, comorbidities and risk factors such

especially so in developing markets, the needfor healthcare services is expected to increase
increase in the proportion of people above theage of 60 is set to grow 1.5 times over the next
20 years (14% in 2021 to 20% in 2040). 2 Accessto better healthcare must improve at the sametime to enable a healthy population to thriveand grow.
During this period, the elderly population(those people older than 80 years old) is likely
to grow from about 125 million globally to over
434 million by 2050, with sizable growth in thisdemographic being contributed to by large and(currently) developing markets like India. Publichealth agencies and experts also suggest thatthe incidence of long-term ailments and chronic
conditions such as dementia and Alzheimer’s
will continue to grow. Estimates point to anincrease of this incidence from 47 million in2015 to 75 million by 2030.
Demand for this demographic segment currently
has larger scale in developed countries witholder demographic bases. However, as the
populations in developing countries age further,
the younger population ages, and fertility
rates stabilize, developing economies can also
expect to see the elderly segment becoming
increasingly critical.

as diabetes, hypertension, and cardiovascularsusceptibility are well known to have driven
significantly higher mortality among vulnerable
patient groups during the pandemic as well.

12

8“Noncommunicable Diseases.” World Health Organization, 16 September 2022.
“2022 World Population by Country.” World Population Review, accessed October 2022.

ARTHUR D. LITTLE

HE A LT H C A RE D ELI V ERYPA RA DI G M SHI F T

The emerging paradigm will force care delivery

As the need profile evolves, the care delivery

healthcare more omnipresent with the healthmodels to go beyond just delivering care outside
the provider infrastructure and start to makeapproach to address the demand is also
evolving. All dimensions of the care delivery
paradigm are being impacted — from overalltargeted objectives and design criteria

consumer. Specifically in an Indian context,
care delivery models need to also evolveand create more equitable and democratic
access — servicing the marginalized andat-risk population groups more effectively.

for the healthcare ecosystem, to focus of

Tech-enabled business models in healthcare

treatment, service delivery approaches,novel care delivery settings for optimization,
shifting accountabilities of health outcomes

therefore likely need to be rethought to create
infrastructure and service offerings designed
for such delivery modalities.

from physicians to a collaborative approach
Figure1. Evolution in the care delivery paradigm
with patients, to funding of health systems
on activity basis to an outcomes/outputs
basis (see Figure 1).
Figure 1. Evolution in the care delivery paradigm
Care delivery paradigm changes
Today

Dimensions

Tomorrow

Treatment of patients/episodic care

Objective

Health of citizens

Facility-centric

Focus

Patient-centric

Episodic approach, curative

Service scope

Lifetime care, preventive

Hospital-based

Care setting

Decentralized, community based

Reliant on the doctor

Accountability

Patient actively managing own health

Financed for consumption

Financing

Financed for outcomes (not just activity)

Shift in focus from care management to health management
Source: Arthur D. Little

Source: Arthur D. Little

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R E P O R T: A B O L D V I S I O N F O R I N D I A’ S D I G I TA L H E A LT H

2 . G L O B A L T R E N D S I N D I G I TA L
H E A LT H & E N A B L E M E N T

Technology-enabled change in the healthcare

The diversity and lack of unified structure inspace has also seen significant acceleration incollected information represents challenges

recent years, especially from the perspectivethat can be addressed at scale. Connectingof development of new treatment modalities

collected data from patients and filteringand changes in clinical methods. Even

relevant information for clinical decision

traditional areas of technological adoption

making is critical for efficient and effective

have seen significant and rapid growth. New

care delivery. Additionally, the availability ofvaccine developments are a benchmark

standardized, curated, and accurate information

example of effective technological adoption

regarding patient demographics, health history,

in fundamental healthcare delivery. Complex

prior complications, comorbidity status, andvaccine development activities, typicallyseverity are all critical decision points that cantaking years or decades, have been accelerated

be integrated for clinical decision making.

to be completed in months due in large part totechnological advances in genomic sequencing,collaborative research with leading universities
and research programs, and rapid scale-up oftechnological offerings.

S H IF T F RO M I N FOR M ATION
D IG I TALI ZAT I ON TO DIGITALHE A LT H
Use cases of digital technologies in healthcare
target a shift in the way information is received
and processed in the healthcare system. The
emphasis of emerging, scale-based solutions
is to move away from pure digitalization of
information toward developing digital solutions

Scale-based clinical data collection andstandardization can then support healthinformation networks and exchanges thatenable research activities such as clinical trials,
payor optimization, and transfer of information
among different health information systems
that may be in large-scale use, in addition to
supporting treatment decisions by physicians.

RE MOTE H EALTH & VIRT UA L
CARE DELIVE RY BECOMING
MAINSTRE AM
With patient care moving away from facilitybased treatments to virtual models, ecosystems

in care delivery.

trending toward maximizing care access to

Health data, at the same time, is diverse andtelecommunications infrastructure, multiple

collected across a variety of platforms in aremote health and virtual care use cases arecomplex healthcare ecosystem. Systemic

gaining significant traction globally. Thesesources of information could be supplemented

include offerings across the entire spectrum

by data and interpretation of physical testing/of patient care — from telediagnosis anddiagnosis.

teleconsultation services, which are lower

all patient groups, and improving access tocomplexity in overall delivery, to electronic
ICUs (e-ICUs) and virtual hospital concepts.

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ARTHUR D. LITTLE

The e-ICU platform is a centralized model in which
nurses, doctors, and administrators are connected
to one or more satellite ICUs. The platform
combines audio/visual technology, predictive
analysis, data visualization, and advanced
reporting to overcome ICU capacity constraints
and extends critical care to patients regardlessof their location. Advanced clinical decision
support analytics enable providers to interveneat the earliest indication of patient deterioration.
Telemedicine, virtual hospitals, and e-ICU
concepts have already seen mainstream
traction, catalyzed by COVID-19-related travel
restrictions and infection issues. In addition,
the use cases for telemedicine concepts also
allow for lower-cost/higher-volume countries
like India to become referral centers for higherincome, lower-volume countries.

P OTE NTIALLY SCALABLE
CONSUMER USE CASE S
AI/ML-enhanced decision making
and automation

A broad set of offerings powered by artificial
intelligence (AI)/machine learning (ML)applications in healthcare are gaining traction
globally. First, tools that support clinical decision
making, diagnostics, laboratory, and other directcare delivery aspects are becoming increasingly
automated and diagnostics/lab reviews, decisionmaking support short of consultations, and othercare delivery automation activities are underconsideration. Second, AI/ML applications innontherapeutic interventions in mental healthand wellness are also undergoing exploration.
Third, AI/ML solutions that automate and enhanceroutine processes such as coding, logging,case tracking, and documentation activities

TELEMEDICINE,V I R T U A L H O S P I TA L S ,AND E-ICU CONCEPTS
H AV E A L R E A D Y S E E N
MAINSTRE AM TR AC TION

post procedure are also targeting efficiencyand physician-bandwidth-enhancement
opportunities. Natural language processing (NLP)
applications through chatbots also enable patient
information capture, supporting preliminary selfdiagnoses for pre-consultation reporting and prediagnosis/lab prep, and can enhance efficiency.
Health personalization

C OV I D-1 9 : CATALYST O F
C HA N G E I N D I G I TAL HEALT H
COVID-19 has had a significant impact on thegrowth of technology and digital solutions
across several use cases in healthcare globally.
Solutions, including digital tools such as
teleconsultations, virtual diagnosis, digitalized
mental health support, home testing andreport generation, and e-pharmacies have,as a result of the COVID pandemic, become
more personalized, cognitive, and integrated

With a shift away from episodic care toward
preventative care, personalization of healthis becoming a key focus area within the digital
health space. Consumers of health services
are also more aware than ever before that
personalization options for healthcare needs exist
in the market. Personalized health solutions cantherefore be a critical component of the overall
preventative care approach in the market, andgamification and rewards can further be used tohelp ensure that digital healthcare is embeddedin the lifestyles of patients.

within the lives of patients and providers.
ADL’s interviews with senior leaders indicatethat a large number of the beneficiaries/early
adopters of these programs have been patientswith chronic ailments with a need for periodic
follow-ups and patients who require significant
post-acute recuperative care as well as those invulnerable comorbidity groups.

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R E P O R T: A B O L D V I S I O N F O R I N D I A’ S D I G I TA L H E A LT H

Several technological developments, such as
miniaturization and acceptance of wearable
devices by the population, support adoptionof personalized healthcare. As technologicalmaturity remains lower than the levels required
to enable clinical interventions throughwearable tech, the segment is currently
restricted to higher-level health data metrics,
as other health sensor technologies become
mainstream. Consensus estimates of growthin the wearables segment point to 13%-15%
growth over the next five years, with the market
volumes set to grow three-fold over the next
four to five years, to close to 775 billion devices
every year. 3
AR/VR for training and care delivery
With COVID-19 creating significant travel
barriers since 2020 and increasing prevalenceof low-latency, high-speed network connectivity
worldwide, augmented reality (AR)/virtual reality(VR)-based applications are gaining significant
traction. AR/VR-based healthcare training forphysicians, specialized technicians, and otherclinical delivery staff are becoming increasingly
mainstream globally, especially in surgicaland other specialized therapy areas whereavailability of physical trainers may be limited.
Mixed reality offerings also can offer not justthe audiovisual experience but significant
components of tactile feel in several therapy
areas. In addition, patient-linked use cases for
AR/VR are also likely scalable and appropriate
for managing and enhancing functional
outcomes in patients with behavioral anddevelopmental disorders.
AI for detecting cardiac conditions
Some clinical conditions such as cardiac arrestsand stroke can be effectively prevented with

Home hospitals
Building hospitals entails high CAPEX
investments with a long breakeven period.
To reduce the CAPEX outflow and provide carenearer to patients, some health systems haveexperimented with home hospitals. These utilize
telemedicine, AI, clinical decision-making
software, and remote sensing to connect
patients and caregivers. The caregivers areprovided with real-time data on the conditionof patients and assistance on treatment
planning and interventions. Caregivers are also
alerted to move patients to a higher care facility
if needed. This provides a mix of continuous
patient monitoring at a lower cost of deliveryof treatment for patients.
Predictive modeling
The COVID-19 crisis illuminated capacity
planning and surge flow management
challenges at the healthcare system level.
As a result, facilities and policy makers now
capture large amounts of data — from clinicalindications to case progression, geospatial
data, and clinical and nonclinical demographic
data. Predictive modeling may allow multifactor
analysis and identification of growth andevolution patterns in epidemiology to assess
capacity requirements on a dynamic basis.
For example, electronic medical records arebeing used to detect patterns and estimate
the number of hospital visits, number ofpatients who would return to the hospital withina given number of hours, length of stay, andso on. Researchers at St. Michael’s Hospital in
Toronto, Canada, have developed an algorithm
that can predict the number of visitors to theemergency department with 95% accuracy,
depending on the day of the week, relationshipto major holidays, temperature, and climate.

early detection and intervention. AI can beused to analyze data sourced from multiple
sources such as wearables, patient checkups,
and patient vitals to effectively predict lifethreatening events such as cardiac arrests.
An AI system has been used in Copenhagen,Denmark, to analyze sounds during emergency
calls and alert dispatchers with 92% accuracy.

3

12“Medical Devices Market — Growth, Trends, COVID-19 Impact, and Forecast (2022-2027).” Mordor Intelligence, August 2022.

ARTHUR D. LITTLE

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R E P O R T: A B O L D V I S I O N F O R I N D I A’ S D I G I TA L H E A LT H

3. SELECT GLOBAL STUDIES

Digital health offerings are accelerating

Big data and tech-enabled use cases ininnovation and are deeply impacting

procurement thereby potentially enableprocurement functions in the healthcare

the adoption of value-based procurement

sector. Healthcare facilities tend to utilize aopportunities in the healthcare sector.

wide variety of consumables. In fact, a typical
healthcare facility may stock several thousandsof medical product types and SKUs within
their inventory and include tens to hundreds ofthousands of SKUs within their overall formulary

The Indian market has its unique share ofchallenges in this context, given the increased
need for cost-efficient solutions. Given thelower affordability of healthcare in the country

for procurement and usage.

and lower penetration of health insurance

These products are also widely varied inuse cases for supply chain management

their characteristics. For example, storage

remains a key area to improve accessibility.

requirements such as temperature, humidity,

Leading CTOs/CIOs in India’s healthcare spacelighting, and so on, may vary significantlyinterviewed by ADL make the case for data-and have a direct impact on quality of clinicaldriven and digitally enabled procurement.

outcomes. Clinical shelf life for products

They also highlight the criticality in six areas:

may vary from a few months to a few years.
Technological changes to products and delivery
mechanisms may change. Product recall andsafety management create complexity in supply
chain management. Products — from lowercost, basic medications to high-end, highvalued medical devices to legally controlled
substances — need to be procured, stored,
managed, and tracked through a unified

among the population base, viability of specific

1. Right usage of hard technology for productidentification and segregation based on theneed for and value of the product versus theinvestment required to collect information
on product stocks/usage.
2. Standardization of materials for procurement.
3. Effective governance around the supply chain

ecosystem by healthcare enterprises.

to ensure appropriate usage of materials.

Critically, from an enterprise-viability

4. Genuine integration with financial systems

perspective, procurement cost and pilferagerisks may be high or prohibitive as well,which healthcare organizations need tobalance. All these complexities necessitate a
responsive, effective, and adaptive supply chain
management solution for healthcare players.

and employing tech platforms at their core.
5. Transition planning from nondigital
approaches to digital approaches.
6. Multidisciplinary team engagement at thesolution design phase and training of theworkforce to ensure alignment with targeted
procurement outcomes.

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4 . I N D I A N D I G I TA L H E A LT HLANDSCAPEKE Y CON ST I T UEN TS OF
D IG I TAL HEALT H I N I NDIA

such as claims and payment management,

Most prominent and mature digital healthwith significant capacity, geographicalplatforms in India have historically targetedenhancement of front-end consumerfacing activities within the care pathways.
Penetration of services has largely centeredaround activities peripheral to core healthcaredelivery. Activities such as scheduling of visits
and appointments, physician/practitioner
identification, home diagnostics/sampling, andcase history management have seen traction in
the Indian marketplace.
Consumer-facing activities comprise four broad
categories of product suites (see Figure 2):
1. Integrated health provider applications —covering a wide variety of healthcare activities,
including physician selection, appointments,
labs and testing, medical records, and otherassociated core healthcare delivery services.
Additional activities in this category thatbilling, and so on. These applications aredeveloped primarily by large-scale players
outreach, and internal system maturity tosupport integration of offerings. The targetedvalue proposition for these applications isto ensure customer “stickiness,” patient
relationship management, and long-term
convenience for patients — especially forchronic care cases.
2. Service-specific health provider

applications — including a limited but
selective offering of specialized services suchas labs, diagnostics, dentistry, and so on, withkey services including scheduling, home pickupof samples, and report delivery. The targetedvalue proposition for these applications islargely to expand outreach and enable wider
patient capture on a shorter-term basis.

3. Integrated health aggregators — covering awide variety of services, including consultation
scheduling, teleconsultations, lab sampling,

diagnostics
Figure 2. Healthcare
categories inIndia selection, and so on, but withmay be provided application
also include allied services

no/limited support from brick-and-mortar

Figure 2. Healthcare application categories in India
Aggregator
Integrated health•Service-specific

•

•

•

No/limited direct
healthcare provision
Plays role to informcustomer and/or
provide interface
services

Source: Arthur D. Little

16

Source: Arthur D. Little••

Direct healthcare
provision
Augments
brick-and-mortar
care delivery
through digitalumbrella. The primary focus in this category
is to enable differentiation through better

Healthcare provider••

infrastructure under the provider’s own

Covers broader carepathway activities(e.g., consultation
scheduling, lab,
diagnostics, physician
reviews)
Largely developed as
in-house platforms/
solutions by scaleoriented groups
Limited services (e.g.,diagnostics, fitness,home sampling,e-pharmacy)
Servicing limited partof care pathway andlittle to no overall
linkage/outcomes

NON-EXHAUSTIVE

information sharing with patients and theirfamily members.
4. Service-specific health aggregators —including narrow/niche segments of caredelivery, operating as information-sharing
platforms with consumers and aggregation
within a limited service set.
From an operations standpoint, a variety of digitalofferings have been deployed by healthcare
providers in the country. These span information
management applications such as healthinformation system platforms, supply chain
management and vendor management platforms
to integrated financial and management
reporting systems.

Figure 3. Adoption of healthcare apps by e-commerce users

ARTHUR D. LITTLE

Figure 3. Adoption of healthcare apps by e-commerce users
64%

Key criteria defined to be high priority forcustomers in e-diagnosis as per focus group
discussions
42%
36%
26%

13%

Onlinepharmacies

Onlinephysicianconsultations

Fitness &wellness

Home health& recovery
management

E-diagnostics

Perceived quality of services & accuracy

1

Referral from physician & hesitance todeviate from such requests

2

Reputation, awareness level, and trustin the center

3

Turnaround time for reporting &scheduling concerns

4

Source: Arthur D. Little

DI GI TA L H E ALT H AD O PT I O N&ACCEPTA N CE AM ON G
Source:Arthur
D. Little
I N DI A N C O NS UM ER S
To understand the core drivers underpinningthe digital health consumer in India, ADL
commissioned a broad-based consumer survey
administered across the country. Longitudinal
data collected from prior surveys and focus
group discussions were also used to draw upon
and understand recent trends and validate
findings. Several key trends have been observedin the customer survey that bring to light the
behavioral trends observed among digital healthconsumers in India:
1. Deep penetration of digital healthsolutions, with significant room for growth.
ADL’s survey indicates significant traction
among consumers on the use of online
pharmacies, physician consultations, andfitness and wellness applications (see Figure3). All these applications observed between
35%-65% acceptance among customers who
utilize e-commerce services. This indicatesthat as many as 400 million Indians alreadyhave experience utilizing healthcare services.

In addition, a clear divide is visible among
the key age groups in the acceptance ofdigital health tools, with those over 40 being
about a third less likely to use digital tools
than younger consumers, largely becauseof familiarity and tool awareness among
the younger population (see Figure 4). The
opportunities do remain relevant for thissegment, however, as increases in routine
health examinations and lifestyle ailments
begin to emerge among the population in
the 41- to 50-year age bracket.
2. Larger, more evident value pools in Tier 2 and3 cities. Except for adoption of e-diagnostics

and online pharmacies, which vary somewhat,
all tiers of cities have a comparable degree of
adoption for digital services, indicating that thetechnology divide prevalent in the past is now
abating (see Figure 5). Tier 2 and 3 customers
are also becoming increasingly aware of the

Figure4.digital
Adoptionofindoctor
benefits oftechnologies
healthcareconsultation ap
and are demanding conveniences from digital
health offerings.
Figure 4. Adoption of doctor consultation appsby age group

Specifically in the case of online pharmacies,

49.0%

experiential similarity vis-à-vis e-shoppingand online retail have helped them to deeply

40.0%
Adoption of physician
applications observed to
decline in >41 age group —despite adequate penetrationof smart devices/networks
across age groups in India

penetrate in the telehealth space. The
survey found lower traction in e-diagnostics,
which is understood to be due to perceived
lower quality and accuracy of diagnoses,

14.3%

14.3%

41-50 years

51-60 years

patient desire not to interfere with physician
recommendations, and the facility operations(turnaround time, reputation, etc.).

20-30 years

31-40 years

Potential opportunity toenable and enhancetrust in digital offerings
within 41+ age segments

Source: Arthur D. Little

17

R E P O R T: A B O L D V I S I O N F O R I N D I A’ S D I G I TA L H E A LT H

3. Stickiness is high among patients using

While patients with chronic illnesses dodigital healthcare services. Patients

appear to have a higher degree of adoption

who had long-term disorders/ailmentsof digital health tools, COVID appears to havesuch as cardiovascular disease, diabetes,

catalyzed sustained use of digital healthcare

hypertension, or allied indications reported

tools in India (see Figure 7). Patients weresignificantly higher adoption of digital healthinitially compelled to utilize digital channels

tools (see Figure 6). These patients tendfor care needs due to movement restrictions

to use healthcare services more regularly

and infection risks. However, once theyand in a more organized manner. As theseexperienced the benefits of digitally

patients adopt digital healthcare solutions

enabled healthcare delivery, these are now

and appreciate their value, they will utilize

increasingly considered as necessities. It is

must therefore target greater usage of digitalaccustomed to using digital health services

tools and track the value of health information

indicated a preference to return to offline

communicated to the consumer pool.

modes for health.

platforms even more. Digital health solutions
no surprise that only ~14% of respondents
Figure 5. Adoptionof digital health offerings bycity tier

4. Seamless integration across the consumer

Figure 5. Adoption of digital health offerings by city tier70%

journey is critical for success. Key pain points
for consumers remain in the brick-and-mortar

67%

Tier 1

Tier 2components of health (see Figure 8). Many

Tier 3of these can potentially be resolved through

48%
34%

digital health offerings, but only if there is a

38% 38%
29%

34%
25%

deeper integration of tech solutions with brick-

25%

care
delivery. Physical interactions
Figure 6. Adoption of digital health tools byand-mortar
patient
type
23% 23%21%

13%

Online pharmacies

Online doctor
consultations

Fitness & wellness

Home health& recovery
management— if minimized either through implementation

8%of videoconferencing, telehealth, or remotehealthcare solutions, or through application-

E-diagnostics

based updating and support, or throughSource: Arthur D. Little

Figure 6. Adoption of digital health tools by patient type74%
Chronic patientsNon-chronic patients-47.3%

Source: Arthur D. Little

46%

39%

-43.5%

36%-27.8%
28%

Figure 7. Post-COVID-19 preferences in use of digital healthservices26%

26%-35.7%

18%

16%+220.0%5%

Online pharmacies

Online doctor
consultations

Fitness & wellness

Home health& recovery
management

E-diagnostics

Source: Arthur D. Little

Figure 7. Post-COVID-19 preferences in use of digital health services
56%

Source: Arthur D. Little

46%

46%

45%
38%

35%

32%

14%

Onlinemedicineordering

Onlineconsultation
schedulingSource: Arthur D. Little

18

Online video
consultationHome
samplecollection

Home test kits

Elderly
care athome

Connected
devices forreal-time
monitoring

Prefer to
return tooffline models

ARTHUR D. LITTLE

5. A preference for integrated applications that

operational transformation to ensure readyprovide the whole spectrum of healthcare

access to findings and medical supplies — canhelp in improved uptake and easier access toofferings. Consumers reported that applications

patients (see Figure 9).

that provide several healthcare services alongwith the option of storing health records are

In addition to the above pain points, several

preferred (see Figure 10).

experiential and non-transactional aspects

Figure8. Key pain points consumers faced with physicalof digital care delivery are important for
healthcare
services
customers.
Figure 8. Key pain points consumers faced with physical healthcare services
No. ofrespondents
Wait time at center

140

Need to visit many facilities

Solution to address key issues:
videoconferencing, telehealth &remote health offerings

106

Travel time for consultations

86

Pre-test requirement comm86

Price transparency

75

Long turnaround for reporting

72

Application-based notification, clear
information sharing & call center support

Figure 9. Customer reasons for remaining on digital
Operational optimization, supply chain
platforms
management & procurement excellence
Stockouts

52

Source: Arthur D. Little

Figure 9. Customer reasons for remaining on digital platforms
118

Source: Arthur D. Little 105

102

97

93

91

No. of respondents

101

80

79

14

Easy
payments
onlineHassle-free
appointments

Home careavailability

Physicianor facility
searchEase ofordering
medicine

Reducedwait time

Rewards/
cash backFitness tracking

Figure 10. Integrated application preferences

Medicalrecords
tracking

Prefer to
return tooffline models

Source: Arthur D. Little

Figure 10. Integrated application preferences services
Insights from focus group discussions
Tier 1
Source: Arthur D. Little
Type of app

Tier 2Tier 3Integrated healthcare app

Tier 1

AI/ML-based diagnostic
reports

Smart reports withtest interpretation

Subscription plans &loyalty benefits

E-pharmacy

Personalized diet tips
based on test results

Fitness tracker

Therapeutics

Genetic testing

Health advisor

Medication reminders

Self-testing kits

StrongTier 3At-home diagnostics

Health records
management

Very strong

Tier 2Moderate

Weak

Very weak

Source: Arthur D. Little

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R E P O R T: A B O L D V I S I O N F O R I N D I A’ S D I G I TA L H E A LT H

5 . D I G I TA L H E A LT H
OPPORTUNITIES IN INDIA

T HE CAS E FOR AT- SCALE
D IG I TAL AD OPT I O N I N INDIA

From a care delivery staff perspective as well,

The Indian healthcare system faces several

well as regional benchmarks. Plugging these

India is largely under-resourced to deliver care
to its citizens compared to international asgaps conventionally may require incrementally

structural and strategic challenges thattraining and developing thousands of physicians,

create opportunities for novel and innovative
healthcare solutions. India’s healthcare capacity— in terms of infrastructural capacity andnurses/midwives, and other clinical staff, likely
a herculean challenge given the time required
to educate, train, and nurture a high-performing

caregiver coverage — remains behind regional
and international benchmarks for both.

healthcare practitioner and the limitations that

For example, in terms of bed density, or thecountry.

exist in health education infrastructure in thenumber of beds per 1,000 people, India currently
ranks lower than international benchmarks aswell as most regional economies (see Figure 11).
This is compounded by the fact that in Tier 2

At the same time, from the perspective ofutility infrastructure (power and water access,etc.), telecommunications infrastructure
deployment, and information access, Indiaand 3 cities and beyond, healthcare systems

has made significant strides in the recent past

and access are significantly challenged and— creating an effective foundation for digital

undersupplied.

health platforms and solutions. In fact, India

Figure 11. Key healthcare metrics (India vs. others)
Figure 11. Key healthcare metrics (India vs. others)
Physician density

Bed density(physicians per 1,000 population, 2017)
India(beds per 1,000 population, latest available year)
0.78

Mid/low income

25%-40% lower than othercomparable low- to midincome markets

1.28

MENA (excluding high income)1.07

Pakistan

1.00

15%-20% lower than directcomparators/regional markets

Pakistan

0.93

Sri Lanka

South Africa

0.91South Africa
Bangalore

0.54

OECD

OECD

2.92

Nurse/midwife density(practitioners per 1,000 population, latest available year)
India

1.70

Mid/low income

2.50

MENA (excluding high income)Pakistan

2.00
0.70

Sri Lanka

OECD

Source: Arthur D. Little

Source: Arthur D. Little

Broadly within the same range
as regional/direct comparators
2.20

South Africa
Bangalore

15%-30% lower than othercomparable low- to midincome market averages

1.30
0.40
9.6

0.70
2.40

MENA (excluding high income)Sri Lanka

Bangalore

20

India
Mid/low income

50%-65% lower
than others

1.50
0.60

10%-80% lower
than others
3.60
2.80

0.80
3.70

ARTHUR D. LITTLE

now boasts the second-largest number of cell
phones anywhere in the world, and smart device- Provide an open protocol for various digital

health services, including a UHI Network, an

penetration stood at about 54% in 2020, up fromopen network of end-user applications (EUAs)

only 22% in 2016. With omnipresence of low-

and participating health service provider (HSP)

cost smart devices, penetration is expected toapplications.

4reach near full saturation by 2030-2035. India
also had among the highest data usage globally,at about 12 GB per month per user in 2020, a
number that is expected to double by 2025. 5 As
5G network access becomes accessible to urban
centers, the digital revolution in healthcare will
have an effective connectivity backbone.
Potential impact of ABDM deployment
In addition to infrastructure and connectivityrelated interventions that have progressed
rapidly in recent years, healthcare policy in India
has also been aimed at creating a foundation
for digital healthcare innovation through the
Ayushman Bharat Digital Mission (ABDM) program.
ABDM primarily aims to improve the quality andknowledge base of India’s healthcare sector in aconsistent, unified, and standardized manner.
The ABDM program is critically important toaffect a step change in digital health platforms.
With a primary objective to establish a health data
capture framework, the program can support the- Enable interoperable connections over anationwide decentralized, open, secure, andinclusive network, using ABDM registries thatkeep a list of the entities participating in the
network and utilize gateways that enablecommunication using standard protocols.

Ensuring safe storage and easy access of medical
records and access to accurate information on
healthcare providers will allow better decision
making by the Indian government. Geographyand demography-based monitoring and effective
evaluation of various programs and interventions
will enable the government to adjust dependingon patient outcomes.
The overall architecture of the program includes
a four-layered structure:
1. A unique identification database that includes
public digital goods such as the Aadhaar
unique identification number for patients,
facility registry for hospitals, and professionals
registry for practitioners.

eventual development of a “single source of truth”

2. The collection and maintenance of health datafor personal- and facility-level health data acrossat the patient, practitioner, and facility levels.

the entire population of India.
The core of the ABDM program is the UnifiedHealth Interface (UHI) framework. Reliable
sources of data and leveraging that data to

3. A unified health interface to enable consistentand secure access to relevant healthinformation.
4. User applications such as the COVID-19 tracker

analyze performance and drive improvement are

Aarogya Setu and other cases to deploy solutions

critical to supporting and sustaining an eventualthat accept information from the UHI layer.

insurance-covered healthcare model.
As information travels across the continuumof care, it becomes difficult to measure
healthcare quality and facility performance.
The UHI is targeted at providing a consistent data
foundation that delivers actionable information
to all health stakeholders and policy makers
from a consolidation of various data sources.
The UHI is envisioned to:- Streamline the digital health service experiencefor providers and patients by establishing andstandardizing the technology pathways thatenable such services to be given.
4
5

The program, upon full implementation, has
the potential to realize several benefits tostakeholders across the healthcare ecosystem.
For key participants, there may be several
opportunities:- Patients — a singular and consistent clinicalhistory will enable better diagnosis andcomorbidity management, easier case reviews
and second opinions, better availability ofhealth data resulting in diversified and lower
health premiums, reduced transaction timeand costs for health insurance, and systematic
tracking of health progress.

“Smartphone Penetration Rate in India from 2010 to 2020, with Estimates Until 2040.” Statista, accessed October 2022.
“Average Data Consumption per User per Month in India from 2015 to 2021.” Statista, accessed October 2022.

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R E P O R T: A B O L D V I S I O N F O R I N D I A’ S D I G I TA L H E A LT H

- Healthcare professionals — collecting

1. Digitally enabled home healthcare, chronic

standardized and unified health informationcare, and extended care. Home healthcare

will enable better clinical decision making,for chronic diseases and lifestyle ailments

greater data availability for patient treatment,

may offer potential for digital enhancement.

better and easier assessment of clinical risks,Patients and families of patients haveand easier and more streamlined clinicalhistorically relied on fragmented andprotocol monitoring.

unstructured recruitment of home healthcare- Healthcare providers — enabling community

partnerships, easier linkage with governmental
and social programs as they get deployed,
greater access to patient pools, better clinicalrisk monitoring, better morbidity management/
tracking, and enhancing competitiveness vis-à-practitioners through personal networks,
regional ads, and so on. Aging and life
expectancy increases have resulted in a rise inclinical care being provided in a home setting.
These services potentially can be aggregatedand provided in a bundled format at home.

vis other market participants. Effective data use
can also enable catchment expansion for highquality and efficient facilities as well as reduced
marketing and patient outreach costs, resulting
in increased visibility of the hospitals’ doctors.

- Health insurers — optimizing the insurance

lifecycle, as adopting the health ID as a patient
ID could enable consent-based access tolinked health records. Opportunities exist
as well in policy portability and information

T R A C K I N G PAT I E N T S
ON AN AC TIVE BASIS
A L L O W S PAT I E N T S
FREEDOM IN MOVEMENTWITHIN AND OUTSIDEFA C I L I T I E S

exchange, allowing patients to link a single
health ID to multiple provider and insurance
IDs for cross-insurer consistency checks
and fraud prevention. Policy premiums may
also be optimized for lower-risk/healthier
individuals, and more diversified and larger
risk pools may be enabled.

- Researchers — enabling clinical variations forenhancement in care pathways, new productdevelopment, clinical trials management andselection, and outcomes enhancement.

- Policy makers — effective capacity tracking

and monitoring, surge capacity management,
and redirection of policy initiatives toward
emerging areas of lacunae.

Opportunities for digital health acrosscare continuum

The opportunities that arise with ABDM havethe potential to make healthcare delivery inIndia much easier and faster by leveraging
information and communication technology.
Given the market gaps and digital accessenablement for external solutions, coverageand capability improvement measures may
represent significant growth opportunities in
the Indian marketplace. Use cases that likely
will gain traction in the market center around:22

Several use cases emerge in geriatric careand home healthcare involving the use of
IoT and wearable devices. For example, GPS
devices that track and monitor patients may
be affixed to a patient’s clothing or person
to assist caretakers in cases of patients withcognition challenges. Geofencing can also be
used to alert caregivers to patients who leaveor cross certain thresholds or boundaries.
Tracking patients on an active basis allows
patients freedom in movement within andoutside facilities while retaining the ability
for caregivers to find and assist in case ofan emergency.
Wireless home-monitoring technology
solutions are also becoming increasingly
mainstream as streaming video devices
become more miniaturized, energy efficient,and better networked even in markets withlower disposable incomes such as in India.
These technologies allow caregivers to
identify and monitor patient behavior andin-home appliance usage to minimize risks
associated with injuries, enabling greaterhousehold safety and speedier response incase of adverse events.

ARTHUR D. LITTLE

2. Preventative care enabled through IoT

devices. Wearable sensor technology to track- Insurance claims — improving theefficiency of medical insurance claims

routine activities such as walking patterns,

by revealing claim trends and streamlining

location and positioning, fall/injury detection,

claims processing.

emergency messaging/SOS, and heart rate
or vitals monitoring also enables caregivers
to provide and extend care to larger patient
pools while also providing more customized
care and monitoring of specific cases. IoT
devices are becoming increasingly affordable— particularly wearables — and are gaining
traction among the population, with wearables
alone registering growth of 93.8% by volume,
according to India Brand Equity Foundation(IBEF). Large market shares are being captured
by value segment players like Noise, boAt,
Realme, and other players launching productsin the affordable INR 3,500-6,000 range.
Collected data from sensors over a period— if collected in a platform approach — canbe used for preventative care rather thanresponsive care as well.
3. Electronic medical record (EMR) adoption
and diagnostic data integration. EMR

adoption is the next digital frontier in Indian
healthcare, primarily driven by the ABDM. The
next wave of growth in medical data generated
from health information systems is catalyzing
the next iteration of care delivery — utilizing
big data and evidence-based care and applying
these principles to enable:- Precision medicine — utilizing researchand centralized data to promote enhanced
diagnostics and personalized patient care.

- Safety practices — use of predictive analytics

collected from diagnostics can also allow
longitudinal tracking of key biomarkers.

4. Tech-enabled capacity augmentation.
Concepts such as e-ICUs and virtual hospitals(some of which are already under pilot
deployment with start-ups/large healthcare
groups) enable efficient deployment ofcritically scarce intensivists while alsoenabling asset-light operations in theconventional healthcare delivery approach.
e-ICUs and virtual hospitals may allow several
advantages over conventional facilities,
including lower headcounts (on a per patient
served basis) for highly trained and skilledintensivists, reduced risk of nosocomial
infections due to lower contact, reduced
hard CAPEX cost in real estate componentsof healthcare provisioning, and superior
distribution of super-specialty intensivists’capabilities across a wider group of
healthcare facilities or geographical centers.6
Consultations in India represent another digital
opportunity — both for primary care visits aswell as post-care follow-up discussions.
India is also a significant healthcare
destination from a Medical Value Travel(MVT, meaning travel in pursuit of healthcare)
perspective. Historically, India’s positioning
as an MVT destination has been largelyon account of the high quality and deep

to promote quality care and patient safety

experience of physicians practicing in the(e.g., infection risk monitoring).

marketplace, significantly cheaper cost

- Population health management — utilizing

analytics in epidemiology (e.g., linking EMRs
with GIS to identify healthcare trends in-- Consistency and standardization in data being

specific areas).
Readmission analytics — analyzing EMRs
to reveal trends that highlight patients
likely to need additional treatment toof care on a dollar-to-rupee basis, and thesoft-power presence of India as a nation,with the capacity to advance foreign policy
objectives and priorities through noncoercive
means. Opportunities exist for digital healthto provide pre- and post-procedure support
through digital offerings.

prevent readmission.

- Data security — securing medical records
by identifying changes in network traffic
or behavior that indicates a cyberattack.

6

Iyengar, Karthikeyan P., et al. “Electronic Intensive Care Unit: A Perspective Amid the COVID-19 Era — Need of the Day!” Lung India: Official Organ ofIndian Chest Society, Vol. 38, Supplement, 2021.

23

R E P O R T: A B O L D V I S I O N F O R I N D I A’ S D I G I TA L H E A LT H

5. Scalable supply chain and aggregated value-

integrated in the financial systems, such as

based procurement solutions. Healthcare

invoicing and digital payments. Integration

provider networks in India straddle a large

and automation of supplier reviews andspectrum of capability areas and sizes —consolidation of supply also supports thefrom single-facility family-owned healthcare

maintenance of relationships with vendorsorganizations to integrated and broad-based

and suppliers.

chains with dozens of hospitals operating
thousands of beds across multiple cities.
Smaller players represent opportunities toaggregate supply chain services under adata- and digitally enabled umbrella.

7. AR/VR-based training in specialized

care. AR/VR-based applications represent
opportunities for a variety of training andcapability development sessions. For lowcomplexity physician education programs bypharma and medical devices companies, pure

FOR L ARGES C A L E P L AY E R S ,S TA N D A R D I Z AT I O N
I S A C R I T I C A L FA C T O R
E N A B L E D B Y D I G I TA L
OFFERINGS

AR/VR solutions may suffice. However, formore technically complex medical devices/
implant-based training and development
activities, mixed-reality applications are also
emerging — reducing the training gap byenabling physicians and care givers to gain
tactile experience in addition to audiovisualexperiences.
8. Digitally enabled aggregation forstandalone facilities. A large majority ofIndia’s healthcare system is disaggregated

6. Predictive/prescriptive digital supply

and consists of standalone facilities. These

scale players, standardization is a criticalbenefits from digital health enhancements

chain management solutions. For largefactor enabled by digital offerings. Processes,
such as procurement of any materials, their
management, and tracking, need to be madeconsistent across network/s. A universal
approach leads to effective supply chain andvendor management as systems move to acentral procurement management modelacross the entire spectrum of supplies.
A digital health use case that may be
deployed at scale is predicting the nature
and amount of stock moving at a certain
point of time, based on historical demand/
supply data. Automating procurement
functions and configuring reorder levels,
inventory levels, reserves, and stock-out
levels can all be optimized through effective
use of digital offerings. Value-based
procurement can be enabled through use

even if they choose to invest. Capabilities toeffectively deploy effective and integrated
digital health solutions in these facilities
may also be a constraint in a large majorityof such facilities. Nor will it be easy for smaller
facilities to comply with or leverage theunified health information structures thatwill be rolled out under the ABDM program.
This represents a clear opportunity for healthtech enterprises to develop modular, scalable,
customizable, and easily implementable
solutions for such players.
Similar opportunities also exist in digitallyenabled supply chains and procurement
value creation initiatives. Standalone
facilities may have demand variabilities
and challenges in integrating digitally with
suppliers. These facilities may not have theof analytics and big data.

right capability set to push value-based

Such systems, if executed well, can alsointermediaries who can aggregate and canprovide necessary checks from a supply
chain governance perspective. In addition,systematic tracking to prevent pilferageand misuse of items can lead to significant
revenue losses. Systems should also be

24

facilities may not have the scale to reap

procurements concepts viably. However,digitally interface with both suppliers andconsumers can potentially facilitate theprocess, offering predictability, managing
economic order quantities, and enabling
efficiencies in procurement.

ARTHUR D. LITTLE

9. Medium- to long-term opportunities. In

These segments already have growing

addition, several other opportunities can bepenetration of smart devices and platforms

digitally enabled and made more effective.

to support digital health. With increasing

For example, digital loans, with funding

availability and critical mass, the fortune

linked to clearly defined digital readinessat the bottom of the healthcare pyramid inand easier financing access, can allow healthIndia can become digitally accessible as well.

organizations to invest in digital and improvetheir “digital internal rate of return.” However,this may require the digital health ecosystem
in India to become more formalized andfor digital health players to become more
standardized and segregated.
As digital penetration starts to hit criticalmass, the middle- and lower-income
segments in India will also start to become

Over the longer term, as the overall healthdelivery system matures, India may movetoward coordinated health, and eventually
toward a managed health network. However,this will require the entire ecosystem to beable to exchange information on a common
framework — something that will be enabledthrough digital health offerings.

viable from a service-delivery perspective.

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R E P O R T: A B O L D V I S I O N F O R I N D I A’ S D I G I TA L H E A LT H

CONCLUSION

1 1 IM PER AT I V ES FO R INDIAN
HE A LT HCAR E ECO SYSTEM
India presents a unique opportunity for an
existing digital health user community of 400
million people. With the further penetration ofsmartphones, 5G adoption, and service provider
innovation, by 2030 India could easily haveover 1 billion digital health users. This will help
catalyze a transformation in Indian healthcare,creating the platform to provide quality,
affordable care to all Indians. The government
has also created a scalable technology
architecture (through the ABDM) for healthcare
ecosystem players to drive technology-led
transformation of the sector. The healthcare
industry now needs to step up and breakthrough the digital divide. To realize the fullpotential of digital health, we propose thefollowing imperatives for the various industry
stakeholders.

1. Digital first. Providers face a risk of getting
disrupted by digital interventions, entrepreneurs,
and competitors unless they have a digital-firststrategic outlook. It is essential that they create
deeply integrated offerings to capture and retain
the consumer base over the long term. At thesame time, digital should not just be considered
as a front-end/patient interface activity andshould be cost effective and focused to capture
efficiency gains. At the same time, emphasisshould be on building digitally enabled supply
chains that are resilient, scalable, and efficient.
2. Platform offerings. Healthcare offerings havespecialized and moved beyond the confines of
hospitals. A variety of services and products
are home-based, hospice-based, or can beused anytime/anywhere. To improve customer
loyalty and stickiness, it is essential that
product and service availability be improved
through a platform approach. This would
require providers to partner with each other,payers, and other stakeholders to create

Provider imperatives
Providers remain the foremost point ofinteraction between end users and healthsystems. While COVID has accelerated thedigital uptake and improved accessibility, a
lot of providers look at digital to be anotherbusiness unit rather than a force multiplier.
Providers must ensure integration of digitalsystems within the provider space and otherstakeholders to enable meaningful digitalchanges and use of digital first as a strategic
advantage.

26

meaningful health service platforms.
3. Partnership strategy. The rising complexity
and scale-up challenges of digital productdevelopment make it imperative that providers
do not build everything and instead try to
reduce the risk of failure. Build-buy-develop
decisions and consequent actions are vital.
A provider must have a strategic need-solution
analysis framework and an ecosystem thathelps them to integrate multiple products
easily. This must also be reflected inoperations, strategy, human resources,
and advisory capabilities.

ARTHUR D. LITTLE

4. Data strategy. With the advent of digital
capabilities, providers are required to collect,manage, and store large amounts of data. Thisdata can provide intelligence to personalize
offerings and improve customer stickiness,but it requires a detailed digital data strategy
to ensure the organization uses the data
within the confines of regulations and privacy.
Providers may develop the data strategy alongwith offerings to comply with regulations while
utilizing the multiple benefits of healthcare data.
Payor imperatives
Healthcare payers have traditionally dealt witha fragmented ecosystem, which has resulted
in multiple redundant systems to distributeproducts, process claims, and reduce fraud.
Digital products can solve these redundancies
by reducing the cost of acquisition andimproving the efficiency and effectivenessof claims processing. The ecosystem needs
products that can solve for both the payor
and end customer while ensuring seamlessintegration with provider systems.
5. Digital insurance distribution. The
penetration of insurance products in India
is poor, and few start-ups and digital
disruptors have taken up the opportunity
to digitize distribution, posing serious
challenges to existing players. Payors must
identify the opportunity, develop digital
distribution platforms, and partner with
providers and other stakeholders to enable

Regulatory imperatives
While regulators and policy makers havetaken steps in the right direction, they will
also need to become the system’s conscience
as digital offerings are rolled out. The mostcritical imperative for policy makers will be toensure the program is governed effectively andappropriately. Data access, availability, andprivacy are concerns of global consequence
and, with greater consumer awareness, it will benecessary for regulators to be the custodians of
the health data that is generated:
7. Regulatory framework. Being an ombudsman
looking to balance compliance with theprescribed standards and commercial andpolicy support considerations.
8. Start-ups. Supporting new and incumbent
digital players to garner and secure fundingfor health tech start-ups.
Investor imperatives
Investors remain the key accelerating forcein every industry, and that is no different indigital uptake in healthcare. Investors havealways welcomed digital offerings and solutions
to improve efficiency and margins. However,investors must undertake systemic changes
to ensure digital products in healthcare areintegrated, drive enhancements in the healthsystem, and reach the end users for whom they
have been designed. These changes include:

digital transformation in their business. This

9. Targeted digital financing. As the start-up

would entail developing a strategic visionecosystem and linked investor base start toin developing the offering while ensuring

deploy resources aggressively in new productcustomer focus and ease.

and service line development and new ventures

6. Health claims platforms. Rising healthcarecomplexity — with instances of fraud,
misrepresentation, and increases in volume— exposes payors to financial and operationalrisks. This can be mitigated by integrated
health claims platforms with claim, disbursal,
fraud detection, and analytics with minimum
human effort and cost. Providers must have astrategy toward development and deploymentof the claim platform and integration with
providers, distribution, and regulators totargeting digital health opportunities, anattractive and independent ecosystem could
gradually emerge supporting digital-firstofferings. These will need to be nurtured andeffectively managed by the investor groupwhile ensuring digital ability is considered as
integral in deal flow and screening processes,
and not just an incremental differentiator.
In parallel, the start-up ecosystem must
integrate and penetrate brick-and-mortar
healthcare delivery to enable access to care.

ensure low risk and higher efficiency.

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R E P O R T: A B O L D V I S I O N F O R I N D I A’ S D I G I TA L H E A LT H

10. Driving true integration. A digital-firstinvestment/resource allocation approachshould not become a “digital only” approach
for investors and health tech start-ups. True
integration is only possible with both thedigital and brick-and-mortar realms being
seamlessly integrated. Ensuring investment/

D I G I TA L R E M A I N S T H E
MOST POTENT FORCEM U LT I P L I E R T O E N A B L E
A M AT U R E A N D E F F I C I E N T
H E A LT H S Y S T E M

M&A targets will need to be screened andscored with a quantitative approach. Allof these should be targeted at developing
an attractive, independent, and lucrative
investment ecosystem for investment inhealth, health tech, or digital health trends.
Digital health should also be considered byinvestment houses during the deal evaluation,
deal assessment, and, eventually, a value
creation plan.
11. Novel financing areas. Investors needto finance digital health innovations andplatforms through greater emphasis on healthtech and insurtech start-up ecosystems. This
would enable growth of the entire ecosystem
and add value to innovators and disruptors.

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India stands at the cusp of a revolution
in healthcare access, with several publichealthcare schemes as well as increased privateinterest in healthcare delivery. Digital remains
the most potent force multiplier to enable amature and efficient health system. These 11
imperatives are key to unlocking value whilemoving to a digital-first healthcare system andensuring that the system is integrated, efficient,and has participation from all stakeholders.

ARTHUR D. LITTLE

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