Small group of innovators in India finds ways to bring down medical bills

Not very long ago at M S Ramaiah Hospitals, a patient who came in with a minor cardiac issue developed bradycardia. While a healthy heart clocks between 60 and 100 beats a minute, his started beating below 30. “We could revive him because the resident doctor who was in another ward got an audio alert and shifted him to the ICU in time. A temporary pacemaker was installed,” says Anil Kumar, professor and head of medicine at the Bengaluru-based hospital.  

The audio alert was sent out through a cloud-based patient monitoring system by Stasis, a city-based start-up. Stasis monitors six vital signs, including heart rate and blood pressure. Doctors in 31 hospitals across India have been using Stasis since it became commercial in May 2017. Kumar says the remote monitoring system is specifically useful for tracking “semi-sick” patients — those who are otherwise stable but could develop complications (like bradycardia in dengue patients). 

Traditionally, even semi-sick patients are often placed in ICUs because they need constant monitoring. “While in about 99 per cent of cases nothing happens, it’s not a risk we can take,” says Kumar. But with a device like Stasis, doctors have been able to keep semi-sick patients out of critical care wards while also monitoring them more efficiently. Not only has this reduced the pressure on hospitals, but it has also eased the financial burden on patients. While a day in the ICU can drum up an average bill of Rs 5,000, Stasis has brought the cost down to $6 (about Rs 425) per day for the same purpose of monitoring vital signs.

Want of trained resources and crippling cost of treatment has for long plagued Indian health care. Healthtech start-ups like Stasis and a small group of innovative medical entrepreneurs are trying to change that by providing cost-effective and high-quality solutions to both patients and health care professionals.

Every year, about 60 million Indians — that’s close to 7,000 people per hour — slip into poverty because of exorbitant medical expenses, said Indu Bhushan, the CEO of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, at a conference in Goa earlier this month. Additionally, India has seen very low government health expenditure — in fact the lowest among BRICS countries (about 1.3 per cent of the GDP). The country’s famously skewed doctor-patient ratio hasn’t helped either. (While states such as Delhi, Karnataka, Kerala and Punjab have more than one doctor per 1,000 people, which is WHO’s prescribed ratio, researchers from think tank Pahle India Foundation put one doctor for every 6,000 people in Jharkhand, Haryana and Chhattisgarh.)

“While we are expecting Ayushman Bharat Yojana to create more opportunities, there’s already been an uptick in the interest shown by private investors in this sector,” says Rana Mehta, partner and leader (healthcare), PricewaterhouseCoopers. “But they are all looking for models that are replicable and scalable because accessibility to health care in India is often limited by its (lack of) affordability.”  

If the current scope of innovations is anything to go by, India is on the path to setting an example for the world.

Ingenious innovations like U S Vishal Rao’s Aum, a spindle-like voice prosthesis for cancer survivors, are evidence. 

Outside Rao’s room at HCG Hospital in Bengaluru, it is common to meet people who’ve travelled in general compartments of trains to see the surgical oncologist who they’ve heard can help them talk again. The available prosthetics in the market for those who’ve had laryngectomy (surgical removal of the larynx) has to be periodically replaced and it costs upwards of Rs 20,000. Rao’s Aum costs $1 (about Rs 70). It was Rs 50 when he introduced it in his hospital two years ago. 

While Aum is yet to hit the market, about 120 Indians are currently using it. In association with the Indian government and the Biotechnology Industry Research Assistance Council, Aum is in the process of being made available in 80 countries, says Rao. He has been getting enquiries from even Czechoslovakia, Israel, Pakistan and Bangladesh. “In some of these places there isn’t a single distributor of any kind of voice prosthetics,” says Rao. Often, he even couriers the prosthetic free of cost to surgeons who write to him.

Now even if Aum enters the industry as the product of a social venture, its cost is bound to go up as the innovation needs to be packed in a sterilised box along with a manual, a capsule and additional requirements. “Sometimes the stringent regulations in the medical industry can be an impediment to innovation,” says Rao.

Innovations such as these, which can compete with and even outlast their international competitors, are often met with disbelief. “We got relevant approvals from authorities in India in 2011. But to actually get some validation for our product, we had to wait till 2013 until we got approvals from Europe,” recalls Leo Mavely, the Bengaluru-based founder and CEO of Axio Biosolutions. This medtech start-up makes bandages for trauma care out of chitosan, a biomaterial obtained from treating shells of crustaceans. When this bandage, called Axiostat, is placed on a wound, it reacts with blood and effectively stops the bleeding in three to five minutes. Ordinarily, to stop excessive bleeding, one needs to manually put pressure on the wound for 30-45 minutes.

The start-up’s first client, five years ago, was a Border Security Force unit stationed in Chhattisgarh. They would regularly be injured in encounters with Naxals. The bandage comes especially handy in far-flung areas, where the delay in getting medical help can cause infection and even death due to heavy bleeding.

The bandage, which continues to find new uses, like in cardiac surgeries where patients are often on blood thinners or during dental procedures, is currently being used by 150 battalions across India. It was also used during the 2016 surgical strikes on terror launch pads in Pakistan-occupied Kashmir.

Less than a handful of companies in the world make haemostat products, two of which came out of research done by the US army. These American bandages sell in India for about Rs 7,500 per pack. Mavely’s homegrown product is priced at Rs 2,000.   

“The more you want to reach out in terms of preventive care, the greater is the need to be affordable,” says 

K Chandrasekhar, founder and CEO of Bengaluru-based Forus Health. The company has been at the forefront of indigenous innovations in ophthalmic care and its line of 3nethra retinal cameras is credited with leapfrogging the mission to eradicate preventable blindness in India. 

Around the time that Forus Health was conceptualised over eight years ago, there were only about 20,000 ophthalmologists in India. Forus has the distinction of inventing the world’s first low-cost retinal camera, 3nethra, that screens for conditions such as cataracts, diabetic retina, glaucoma and cornea issues. Its line of 3nethra Neo devices has especially come in handy to screen prematurely born babies for retinopathy of prematurity, a condition that results in permanent blindness. Its cameras, all of which can brave pothole-laden Indian roads as they sit encased in suitcases, are now available in 27 countries at a price that is one-third of the competitors. 

“Sachets became popular in India because people here aspired to buy a Head & Shoulders or a Colgate, and not a low-priced product. They went for sachets because they were getting quality products at affordable prices. We have to do the same with health care,” says Chandrasekhar. “We pride ourselves in selling the same kind of device to a state-of-the-art hospital in New York as to one in a remote part of, say, Odisha and Bihar.”

Forus has now tied up with Microsoft to make use of the tech giant’s artificial intelligence (AI) network to tackle the issue of the skewed ophthalmologist to patient ratio in developing countries. 

Healthtech is a dynamic space to be in today, especially given the advancements in AI and Internet of Things. The health care industry is also heavily reliant on early detection, which is where AI is playing a key role.

Since last year, for example, Bengaluru-based start-up Niramai has been using AI and machine learning to process, analyse and interpret thermal images and generate clinical parameters for early detection of breast cancer. This radiation-free process requires minimal human supervision and is a welcome early-detection measure since mammography works only for women over 40. 

Similarly, Microsoft has tied up with SRL Diagnostics, a Gurugram-headquartered chain of pathology labs, to study its repository of over one million samples of cancerous cells. Once the AI studies these data sets, it can be used to detect cancer and aid pathologists who currently need to study every potential scare manually.

Key to survival in this highly competitive market, however, is collaboration between companies, networks and people from medical and non-medical backgrounds. And this is where some start-ups have fizzled out. Innovations don’t happen in a vacuum. As Chandrasekhar puts it, “Your device won’t work in the market just because it is innovative. There needs to be a need.”

It is to bridge the gap between need and delivery of innovation that Bengaluru saw its second meet-up with the medical community mixing with everyone from entrepreneurs and engineers to toy-makers to discuss possible collaborations. The event was a part of an informal initiative called “Docs and Hackers” that aims to bring about a curriculum that focuses on medical innovation. The initiative will soon travel to other cities, too, says Rao. 

The initiative is necessary to ensure that start-ups in the health and wellness space are on the right track. In the case of a young company, which has received funding from the government, the research for creating the “perfect biopsy device” came from extensive readings of journals and papers. “There were two engineers and an entrepreneur who were running it. But none of them had ever spoken to a medical professional,” recalls Rao. “The day they finally went to a hospital with the device, the doctors refused to even try it because it was too dangerous.”

In this context of tried-and-tested innovations, Stasis, which has passed the scrutiny of medical professionals in India, is looking to expand to the US. “We will also be tying up with homecare agencies by the first quarter of next year,” says Roheet Rao, vice-president, sales and marketing, Stasis. Besides helping bring down medical costs, Stasis is patient-friendly in other ways, too. While traditional monitoring systems have graphs and waveforms that require a medical professional to translate the data, Stasis has colour-coded readings for the patient’s benefit. The readings get sent to a doctor’s smart device every five minutes, so there’s almost constant remote monitoring. 

Speculative and science fiction writer William Ford Gibson once said, “The future is already here — it’s just not evenly distributed.” In the space where health care currently floats, Gibson’s observation hits the mark. The future of a truly democratic health care industry today depends on the collaborative efforts of doctors, engineers and everyone who has a stake in it.