International Finance
Healthcare Magazine September-October 2019 Issue

Healthtech makes affordable healthcare a reality in Southeast Asia

In Indonesia, doctor consultation at a hospital costs IDR250,000 but on Halodoc, its just IDR40,000

Southeast Asia, where access to quality healthcare is patchy, healthtech solutions are realising affordable healthcare services at scale. According to a report by Galen Growth Asia (GGA), a healthtech research, analytics and advisory firm in Singapore, this region is striking out on its own path among other Asian regions in terms of healthcare investor interest. According to the recent HealthTech Investment Landscape report, healthtech companies in Southeast Asia raised a total of $189 million in the first half of 2019. This, it said, is three times of what was raised in the same period last year with some of the noteworthy deals being Halodoc, CXA, Biofourmis, Docquity and KaHa.

How is healthtech making healthcare affordable?

With regard to how healthtech is making healthcare more affordable and accessible, Julien De Salaberry, CEO at Galen Growth Asia, told International Finance, “A general rule of thumb, will be that digital health is lowering the cost of entry into healthcare for innovators and, therefore, facilitating the democratisation of healthcare as consumers or patients seek solutions online.” Citing the noteworthy deals as examples, he said that while, Halodoc was allowing for easier and cheaper access to medicines, Biofourmis was helping reduce the cost of drug clinical trials and CXA was providing seamless access to health insurance and its consumption.

Felicia Kawilarang, Halodoc’s VP marketing communications further told International Finance, that the Indonesian healthtech company, which connects patients with doctors, insurers, labs, and pharmacies through its mobile application, was making healthcare affordable by ensuring patients paid for just the doctors service fee in a way that they do not have to bear the operating costs of running a hospital or clinic. “A consultation with a doctor in the hospital will on an average cost about IDR250,000 but at Halodoc our doctors on average cost about IDR40,000 for a 30 minute consultation,” she explained.

Another example is Malaysia’s Naluri, which offers professional and confidential health coaching. Speaking more about the company, Azran Osman-Rani, Naluri’s CEO told International Finance, that it works with partner insurers, corporate employers, and healthcare providers to identify at-risk populations, meaning those who have elevated levels of blood sugar and blood pressure among others and offer them a fully-digital health coaching service.

In terms of how it was making healthcare affordable, Osman-Rani said while typically structured intervention programmes like a Diabetes Prevention Programme where patients receive counselling from a team of dieticians, nurses, and doctors, could cost between $1,000 and $2,000 per patient, for a four month programme, at Naluri, a similar programme which included, a before and after health screening, a mental health test and the provision of a bluetooth-connected weighing scale, would cost under $100, since all interactions were done online.

Osman-Rani further added that their solutions in traditional mental support were also more cost-effective when it came to group healthcare that is usually subscribed by corporate employers. While traditionally, in this area, support is in the form of an ‘employee assistance programme’ which comprises a telephone counselling hotline and face-to-face sessions, with Naluri, employers were assisted to identify the 20 to 30 percent of employees who are most at risk to enrol them in its digital coaching programme, where its monthly subscription rates came with unlimited chats with its psychologists and other healthcare professionals. This, he said, costs much lesser than a traditional single face-to-face hourly counselling session.

A Singapore example of a disruptive healthtech solution is mClinica. Operating across Indonesia, Philippines, Vietnam, Malaysia, Thailand, and Cambodia from its headquarters in Singapore, this startup is making healthcare affordable by connecting pharmacies across South East Asia to people, using mobile technology. Its CEO Farouk Meralli told International Finance that its mobile platform helps address several challenges at the pharmacy level including patient affordability and adherence.

He further explained that its platform helps pharmaceutical companies address the affordability of medications through targeted discounts while promoting long term adherence through customised health education and refill reminders. “Patients simply visit participating pharmacies and are registered in the programme by providing their mobile phone number. Through our platforms we have reduced the price of medicine by up to 37 percent and increased adherence by more than 30 percent making a tangible impact inpatient health,” he added.

Another Singapore example is of MyDoc. Dr. Snehal Patel, CEO and co-founder at this digital healthcare provider said healthtech enabled faster and more accurate collection and analysis of important real-time health and behavioural data, thereby reducing the need for costly treatment. In addition, he said, also enabled identifying and addressing inefficiencies and wastage in healthcare to further save on unnecessary costs.

Specifically, with regard to his company, which covers seven countries in Asia, Dr Patel said, they had a clear objective and business model to help the patient stay healthy and make healthcare more affordable by making them avoid expensive hospital treatment. And in cases where they do need to engage with healthcare professionals, MyDoc, he added, ensured they are seen quickly, by the right professionals, with costs tightly controlled and monitored.

Value addition: Healthtech simplifies data

Dr. Patel added that apart from saving costs, the company was also helping its customers in reducing confusions and duplications of key information related to their health which further saves time. “From the patient’s perspective the legacy model of healthcare is very often confusing, fragmented, disjointed, and opaque. They are passed from one place to another with little to no coordination, connectivity or cohesion.

Key information and data sit in disconnected silos and filing cabinets and do not follow the patient on their life-long journey in healthcare. This results in a great deal of duplication, unnecessary appointments, wasted time and gaps in healthcare data and can or do lead to undiagnosed health issues or, worse, misdiagnosis and very costly hospital treatment,” he said.

MyDoc, however, helped avoid the same by guiding the patient through their care journey, ensuring they are referred to the right provider and at the right time apart from ensuring the patient had their health record with them for life, which would help them ask questions, consult a doctor or pharmacist any time they need to , irrespective of where they go.

Naluri’s Osman-Rani, also said there were other healthtech benefits. One such benefit he said was making healthtech accessible to a larger population considering there is a shortage of medical specialists in the region. Citing Malaysia as an example, he said, considering there are about 13 million adults in his country who had mood disorders or chronic disease risks and that there were only about 200 practising psychologists and about 600 practising clinical dieticians, conventional sessions such as face-to-face therapy or counselling sessions would only help one million Malaysians and ignore the remaining 12 million who need help.

Apart from this, he added that healthtech solutions such as those being provided by Naluri were making it more convenient and less time-consuming for patients as they, unlike traditional healthcare programmes, do not require patients to make inconvenient transport arrangements to actually go and visit a doctor at a clinic or hospital.

With regards to Halodoc, Kawilarang said that her company’s other benefits too included making people’s lives more convenient and also helping them save time. “On average in Jakarta, Indonesia’s capital city, a patient’s journey to go to hospital and back home takes a total of 4 hours 30 minutes due to traffic and waiting conditions in hospitals, while with Halodoc it merely takes seconds to get connected to a doctor and get your medicine delivered to your home,” she explained.

Technology is at the core of healthtech

With regard to the technologies being used by healthtech companies, mClinica’s Meralli told that most of them were developing solutions using artificial intelligence and big data technologies. At mClinica in particular, Meralli said they employed an array of technologies including social networking technologies to connect pharmacies, machine learning to manage patient refills, and image recognition to digitise prescriptions at the pharmacy level.

Halodoc’s Kawilarang too said they use AI and machine learning based solutions. These, she said were rapidly productised and taken to production, to allow for efficiencies, cost savings and a distinct competitive edge.

Jaffry Mohammed, head of healthcare practice and senior VP, IT at UST Global, an American digital services company which has invested in MyDoc, told International Finance that there were a few patterns of technology adoption that they were seeing healthtech companies focus on. First, he said was the leveraging of data science and deep AI for propensity of disease, triage of medical conditions, prediction of diagnosis and personalisation of treatment. Second, he said was the integration of IoT into clinical practice.

In this regard, he explained that devices at home, work, and hospitals were all feeding continuous data streams that were being collected, interpreted, and converted to inputs for clinical interventions and personalisation of care plans. Third, he said was the use of augmented reality and continuous imaging in a clinical or surgical setting. And finally, he said was the use of AI and ML for non-invasive detection of disease such as skin scans, retina scans, and even voice samples. All these were new diagnosis methods that were being enabled using such latest technologies. “This is by no means a comprehensive list. The intersection of technology and medicine continues to inform many new disruptions in healthtech,” he said.

Constant evolution key to overcoming challenges

Like any industry, healthtech too faces a few challenges to grow. According to Dr. Patel the primary challenge was to get all the various stakeholders across the healthcare spectrum comfortable with using and relying on new technologies and new ways of doing things. Another challenge he said was to prove that healthtech is not only safe, secure and reliable but also more convenient, simpler, more cost-effective and, most importantly, results in improved healthcare outcomes. The final challenge, he said was convincing payers. This, he said, was very different to convincing patients as they are motivated by very different things and have very different pain points.

Meanwhile Naluri’s Osman-Rani said the challenge they were witnessing was healthcare providers being reserved in launching its programmes. This he said was understandable and was primarily because they wanted to see more clinical evidence before prescribing digital health coaching solutions to their patients. Halodoc’s Kawilarang opined that the biggest challenge that they faced was the lack of awareness for healthtech, apart from the low trust in using digital solutions for healthcare needs.

Halodoc’s Kawilarang however said these challenges would naturally subside with time and with more exposure. MyDoc’s Dr. Patel too said the challenges could be overcome but it could be a slow, iterative process that requires a lot of patience and understanding of the differing priorities and concerns of each key stakeholder. “It could not be further removed from the now infamous ‘move fast and break things’ motto of Silicon Valley. Healthcare is, arguably, the most guarded and sacrosanct industry of all.”

He further added that it was not a one-way street as well. Healthtech companies, he explained cannot force a seemingly robust technology solution upon stakeholders and had to instead also listen to learn from the many counterparties and stakeholders within the eco-system, and constantly evolve their models and offerings to adapt to the ever-shifting landscape that they are helping to shape and develop.

Southeast Asia healthtech industry moving form niche to mainstream

So considering healthtech faces a few challenges even as it uses the latest technologies to make healthcare more affordable to the common man, an important question is, what does the future hold for this space?

According to Dr. Patel there are many factors that indicate that the macro tailwinds for healthtech could not be more favourable. These factors, he said included large funding and investments in this sector coupled with a rapidly aging population, increased wealth, a burgeoning middle-class, heavy public and government support for technological innovation, high mobile internet penetration capable of reaching even the most remote areas and now even carrying out commercial drone deliveries.

He added that the industry was also in a transition phase, moving from niche to mainstream. This was because of governments, payers, which include organisations that take care of financial and operational aspects of providing healthcare to citizens, providers and patients rapidly adopting healthtech solutions due to their ability to solve various issues of accessibility, quality, and cost that the traditional healthcare models were ill-equipped to address. Going forward, the arrival of 5G would further boost this sector as the increased internet speeds will help overcome major barriers that are currently present in providing high-quality and affordable healthcare, Dr. Patel said.

The healthtech industry is currently highly fragmented, with many highly innovative companies, each focusing on addressing and improving different parts of the complex healthcare ecosystem. However, the next few years could make it inevitable for them to all come together and once this happens, they would be in a position, Dr. Patel said, to challenge and displace many of the large, deep-pocketed incumbent legacy players.

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