ViOS: A Premium Telemedicine Platform — investment portfolio
By: Dr. Ismail Sayeed
Tags: Investors, Startup, Health, Investment, Portfolio

In urban settings, most of us are accustomed to various options of transportation, consumer habits, availability of cheap fast food and luxurious habits. However such luxuries come at a heavy price, throughout all social classes people are under more stress and are exposed to harmful environmental toxins.

Survival against fatal infectious diseases of the past (communicable diseases) also comes at a cost; increased life spans have also increased our chances of lifestyle diseases, also known as non-communicable diseases (NCD) such as heart disease, diabetes, cancer, mental health illnesses and other long-term debilitating illnesses.

Chronic diseases used to affect the older generations due to degenerative processes of a stressful life, however due to the accumulation of negative health behaviours (bad diet, smoking, stress etc) such diseases are occuring in greater severity at younger ages.

Chronic disease management is very difficult, expensive and a serious burden to the population, resources, and healthcare skills development and various issues that may negatively impact a country’s health system.

The ongoing pandemic crisis has exposed faults in healthcare management, even in developed nations. Due to re-allocation of resources and personnel, it seems that interest in effective disease management (not related to coronavirus infections) Has severely affected the much-needed management of patients with chronic illnesses.

The global lockdown has greatly affected the way patients can reach specialised healthcare services, and the way providers can help far off communities as well.

Therefore much interest has been shown on the potential of Telemedicine, and Telehealth as a whole, to provide support of services in these times.

A process that allows safe, quick and affordable communication is an obvious advantage even before the global COVID-19 outbreak. It is an interesting phenomenon that patient empowerment by digital health (or mhealth) as a sustainable option for home treatments, is now getting a great deal of interest.

In this publication we will discuss the capability of telemedicine services to help patients with chronic illnesses, to better manage their treatments with patient-centered ownership and self monitoring.

Chronic illnesses, such as asthma, COPD, diabetes, heart failure and hypertension represent a significant burden of disease. Burden of disease is measured in Disability-Adjusted Life Years (DALYs), which reflect years of life lost from premature death and years of life lived in less than full health.

In high-income countries, asthma, COPD and diabetes represent 11.1 million DALYs or 7% of the total DALYs. As well as their significance from the perspective of those affected, chronic diseases also impose huge costs on the health care systems responsible for managing them. In the US, the direct health care costs for patients with asthma, diabetes, heart disease and hypertension were $52.1 billion in 1996. Lack of appropriate caregiver support is another issue that is often ignored.

PROBLEM STATEMENT

Due to nationwide lockdown procedures and societal apprehension about coronavirus exposure, there have been some severe challenges in maintaining an effective health system.

Patients are unable or unwilling to venture out unnecessarily in fear of being infected and suffering adverse complications. Patients with chronic illnesses are in added disadvantage due to disruption in regular follow and treatments. It is highly probable that acute exacerbations of their illnesses may pose a life-threatening outcome, without regular specialised care.

Healthcare professionals are also in dire situations due to occupational exposure risks and overwork. Various supply chain challenges and budgetary constraints are impacting their workflows as well.

Healthcare specialists not directly related to acute management of the pandemic, are facing logistic issues with seeing their patients, while maintaining safe social distancing and adequate personal protection. As a result of this severe decrease in patient flow, hospitals are unable to carry out their main revenue generating activities i.e. elective procedures and prescription sales.

As a result, provider reimbursements have taken a massive hit.

In response to this vocational crisis, many providers have adopted digital health solutions in record numbers. The initial hesitancy in healthcare technology has been brushed aside since their livelihoods are now at stake.

Telemedicine has been a boon for both providers and patients, remote digital communication allows patients to connect via audio-video to seek counselling, remote second opinions and general healthcare consultation (the need for physical examinations, diagnostic needs and prescriptions assessed by the connected provider). Providers have now seen an alternate and convenient process to maintain their services without added hurdles in these difficult times.

Additional players in the health sector have taken note of the potential of telemedicine (and telehealth) to augment the health system. Medical insurers are considering innovative business models to maintain their operations and regulators are now becoming more lenient to expand coverage beyond their ‘host’ states.

However, telemedicine ventures in various countries (public or private) have yet to maintain a truly robust presence in their respective health systems. If clear benefits to various key resources are being documented, why has there not been a watershed moment of adequate financial break even or sustainability models for the digital health entities?

As the hype over cutting-edge advances in digital health via AI, VR and even machine-learning processes in mobile diagnosis has settled, an operational challenge has been identified.

Through intensive digital marketing, the public is well aware of various telemedicine software and their unique selling propositions. Although the health outcomes of telehealth is still underway, many satisfied patients have greatly appreciated the affordability and convenience of digital health.

But what about the providers?

Delayed reimbursements by insurers, inadequate remuneration packages by telemedicine companies or perhaps issues with the business model (appointment no-shows can be costly) may make it unattractive for providers to remain in their system. A critical spiral may occur (or is occurring) where providers start leaving, if there are no doctors available then patients will not use the telemedicine app anymore.

So how do you incentivise the provider network to stay with you? Will it be profitable?

SOLUTION

Whether telemedicine services were adopted by a healthcare facility or an individual practice, the investment in the technology was under scrutiny by their respective accounts departments (or persons). In the initial phases of the lockdown, large scale demand for digital health and a progressive reimbursement scheme by insurers was a primary boost to adding telehealth services. In countries with mostly out-of-pocket healthcare payments, many patients were eager to purchase telemedicine appointments with digital payment technologies.

The connection with a video chat functionality, digital payment and real-time scheduling forms the basis of a generic telemedicine platform. In many countries, such systems are widely known and often used to various extents.

To motivate the provider network to remain in their platforms, digital health businesses have provided certain reimbursement models, such as:

Regular salary payments in lieu of low patient turnover in the hospital setting, provided regular telehealth shifts are accepted on site (the hospital charges a fixed amount for the appointment).

A revenue sharing model where the telemedicine provider charges a consultation fee, the patient is the payer

The telemedicine session is free, income is generated from diagnostic charges and prescription commissions

Some healthcare NGOs and public health entities have a ‘telemedicine hotline’ for covid-related or general health — providers’ salaries originate from taxes (for public sector providers) or from donors.

The above mentioned examples are the common business models for most digital health companies. Each has their own specific patient user characteristic, often based around the essential question —

‘who will pay for telemedicine?’

CRITICAL FAULT LINES

Inadequate provider reimbursement is a critical bottleneck to scalable and sustainable digital health business, regardless of patient/user segmentation. Mainstream telemedicine companies may cater to several patients of various health issues in a seamless and innovative technological manner, but high provider turnover can be a crucial rate-limiting step to sustainability.

As the pandemic has progressed, so to as the global market behaviour in digital health solutions. Customer feedback analysis has identified some salient user experience issues that may or may not be relevant for all telemedicine providers.

The following list highlights key constraints of a ‘patient-centered’ and also ‘pro-provider’ solution:

Poor provider reimbursement — either inadequate amount or delay in payouts (can be applicable to insurance coverage and out-of-pocket model

Inflexible telemedicine shifts — major health centers may insist on fixed daily shifts whereas private entities have to negotiate with each and every provider for their ‘preferred’ duty times and correlate with appointment schedules in their saas platforms.

Issues with digital payments transactions

Strict national regulations on digital health operations (including local prescriptions)

Lack of transparency in provider skills capacity

Appointment ‘no-shows’ by either party — leading to costly refunds or missed economic activities

Lack of provider quality control and standard operating procedures (including HIPAA, CODA and GDPR)

THE ViOS VALUE SOLUTION

The ViOS platform is a direct-to-customer service marketplace with video-based digital communication, that provides on demand healthcare consultation with certified and qualified specialists.

The ViOS Doctor app and ViOS Patient app are separate android applications that connect both parties in real-time for quick transparent review of provider capacity and availability with affordable digital payment gateways.

We solve the critical issues of provider retention by:

Allowing specialists to easily create their virtual clinic in our platform, by digitally submitting their professional licenses and certifications (with diligent verification)

2. Choosing their own customizable consultation fees

3. Choosing their own individual online availability at their own convenient timings — anytime and anywhere

4. Fast weekly payouts to bank accounts of their choosing

The patient population will benefit from this high value network of specialised (and internationally-recognised) professionals — who are motivated to their concierge care management, without the need for confusing appointment schedules, with the verified skills and capacity of an expert panel of providers.

TECHNOLOGY

The underlying technology infrastructure is built on shared proprietary services of Twilio Programmable Video Api, Stripe Online Payment Api and a robust backend dashboard that aggregates uploaded documents (pertaining to copies of professional licences, degrees and other documents) for real-time review and profile activation.

The ViOS platform allows for various tracking modalities such as:

Number of provider applications

Databank of every applicant details

Online activity duration from either app

Number of sessions requested from each doctor, or each patient

Duration of video call

Location of video requests

Financial statements

Leaderboards

Activity metrics on each provider (no. of patients/per day/week/month or income/week etc)

CYBERSECURITY

User privacy is an essential tenet to our operations. We take concepts of patient confidentiality and minors protection very seriously.

The Twilio chat api, Stripe gateway and the ViOS Database is based on a 256-bit encryption with ISO-27001, ISO 27017, ISO 27018, Cloud security alliance, SOC 2 Type II, GDPR, HIPAA, PCI frameworks and other regularly updated security protocols

As part of our initial onboarding process, we will not collect private health data from the patient population using the ViOS Patient App. Emails are used for providing invoices and marketing communications only.

BUSINESS MODEL

The ViOS business model is based on a transactional model, for services rendered to both parties (hosting a virtual clinic, marketing, branding, server hosting, security, api subscriptions, tech support, customer support and other operations related activities)

Users of the ViOS Patient App will purchase a 20-minute on demand video call session with their chosen provider, using their debit/credit cards.

Each provider on the ViOS Doctor App will be prompted to choose their consultation fee between the range of USD $70-$110 per session — in the amount of their choosing, upon registration. This range is based on market research on perceived ‘ability to pay’ and ‘value-based remuneration’ policy of ViOS, Inc.

ViOS, Inc will levy a flat 20% commission for every video session.

UNIQUE SELLING PROPOSITION

The ViOS Platform shares many similarities with many telemedicine startups available in most health systems around the world. However we are differentiated for greater market value in the following ways:

Primary descriptor as a software development and distribution

Many healthcare-related ventures have to contend with local policies governed by health ministries and other regulatory bodies. We are primarily designed for direct peer-to-peer cross-platform messaging and VOIP software development. Hence we occupy a unique IT infrastructure that is associated with 1–1 or 1-many real time synchronous video communication. Such an identifier may provide the necessary ‘path of least resistance’ in terms of cross-border market penetration.

Industry expertise

One of the many reasons for low investor demand (and trust) in healthtech enterprises is due to the lack of founder expertise in the health sector. Inability to understand and leverage the nuances of the health industry and its complex value structures, highlights the need for an authority in the market. Therefore ViOS can confidently proclaim a majority shareholder status and leadership by an experienced physician entrepreneur with documented knowledge of health care entrepreneurship.

Low operational expenses

Relatively low overhead burn rate from a lean approach to bootstrapping, is a strong point to consider for strategic scaling and functional development i.e. ability to pivot with minimal sunk costs.

Delaware C Corporation

A strong appreciation of the mature economic contribution by the US Market (B2C and B2B) highlights the need to incorporate as a business entity within the US territory. A robust financial transaction path with minimal hassles and ‘transaction failures’ with US-based banking is a strong value component to a seamless user experience — for payers and providers. C Corp status is also a major plus point for progressive and impactful investment opportunities (eg. equity financing) with a strong opportunity for large player acquisition (perhaps IPO) in the foreseeable future.

Cloud based operations

With a strong reliance on remote teams, IT enabled processes related to remote communication and other cloud-based operations, there was no need to invest in fixed geographic locations for the development team (no office space required).

The pro-enterprise position by the US trade bodies with regards to foreign shareholders operating US businesses, has also allowed a diverse team to carry out various pre-launch activities with ease and affordability eg. cloud accounting, digital marketing, freelance contract graphic design, saas audits, social media recruitment campaigns and other online activities

High investment in automation and transparency

In continuation of the above-mentioned reliance on cloud technologies, we at ViOS are committed to digitally automate as many of the operational processes of the ViOS platform as possible. We aim to integrate seamless user registration (with appropriate social login api), on demand service procurement (connection only when both parties are online), secure and user friendly payment gateway and notification system for future communications.

This investment in technology and business automation will further enhance the efficiency and profitability of subsequent user acquisition and paid activations. I.e. with optimal levels of automation, high value user interactions can occur such as customer engagement and provider skills training.

Pro-Provider policy to enhance high net worth retention and activities

Where our competitors have an eschewed interest in satisfying the market needs of the patient population, we are committed to nurture our high value provider network, with prospective value creation and policies aimed at high retention. It is believed that high provider retention and activity in the platform (online more often) will lead to a critical mass of high number of paying patients.

To summarize our pro-provider activities, we have:

User friendly registration process (easy process for less tech savvy providers)

Fast and concise verification and approval process

User generated pricing (ability to choose the fees based on a high value premium setting)

Fast payouts (based on bank locations)

Premium value based pricing

We believe our provider reimbursement (and incentivisation) system is our strongest value point compared to our existing competitors. By ensuring a competitive and fast reimbursement to our providers, we can leverage greater interest from high net worth peers to join, further enhancing the premium value proposition of an exclusive concierge health and wellness consultation experience, for our equally high net worth patient groups.

GO TO MARKET STRATEGY

Using the concept of the ‘pre-launch’ and ‘pre-selling’ market demand for quality convenient healthcare consultations, approximately 4300+ registered users have been onboarded in our mailing lists.

This was made possible by leveraging:

An existing customer base in the previous ViOS platform iteration (pre-covid)

Adaptive SEO with high quality onsite blog backlinks

Social media branding in high interest groups

Educating the value of telemedicine in social media marketing activities

Network effects from professional social circles

Professional Linkedin recruitment sourcing campaigns

Our future strategy (as of publication of this document) is to partner with established provider networks, containing high value professional profiles, to allow for peer-generated onboarding and user activation.

A paid acquisition campaign with social media marketing will be utilised to invite select user segments into the appropriate value funnel.

The potential for user-generated content marketing is possible given the immediate value creation that is built into the platform i.e. patient success due to a convenient and effective video chat with a chosen specialist provider, who was able to alleviate a particular health need, and an influential provider who is able to promote our platform services in providing high value with low effort.

PROJECTION

With a strong pre-launch market demand and low cost operational expenses, we envision a sustained user growth potential with high return on market activation costs.

Where our high volume low cost competitors may provide their own value proposition to their customer segment, the ViOS platform will incentivise only high demand transactions, based on premium value-centered pricing strategies.

Therefore our provider network may only contain a lesser number of providers, we can efficiently incentivise for greater collaboration and activities with higher fees per session metric. Additionally we do not plan to have a high number of infrequent patient interactions i.e. one time sessions, therefore our market strategy is based on ‘upselling’ or repeat customer interactions (less patient numbers but higher transactions per patient in the platform)

From the date of publication, we are in the final design and beta testing of both of our apps, with penetration testing of our backend database as well. There is active onboarding and recruitment of high interest high value providers in our exclusive Linkedin group (only for specialists) and increasing patient user mailing lists.

WHAT WE NEED FOR SUCCESS

The most crucial element towards an impactful market penetration, is to have the right authority in the industry. With an experienced guidance to demand generation and strategic leverage of other key players, we at ViOS, Inc are confident of a ‘moonshot’ trajectory towards enterprise success.

Financial support without the proper leadership guidance, by an influential panel of senior advisors may not yield a structured and sustained growth metric.

A bootstrapped method to launch is an efficient process to proof of concept (and influence early adopters), additionally a cautious budgetary structure can help generate impactful data for the next campaign (in the same locale or in adjacent markets)

The purpose of this introductory publication is to: