For R P Sahu, a cancer patient from Ghaziabad, surviving the last few days of his life was as painful as it was expensive. The doctors and relatives knew the end was coming but they still could not fulfil his wish of spending the final days in the comfort of home. For, as long as he was alive, he had to be kept in the Intensive Care Unit (ICU) with the life-support system. There was no way an ICU could be set up at home.
This is going to change soon. HealthCare at Home India (HCAH), a joint venture of the Burman family, promoters of Dabur, the consumer goods major, and Gareth and Charles Walsh, founders of the UK-based Healthcare at Home, says it can set up an ICU at home. The company seeks to offer health care in oncology and post-operative and palliative care at home. The Burman family owns 65 per cent stake in the firm and Gareth and Charles Walsh the rest. "We are not in the business of prescribing treatment. We are in the business of ensuring the right kind of treatment is executed to perfection in the close confines of a home. In that sense, we are not competing with hospitals or clinics. What we are doing is complementing the work done by doctors in hospitals or clinics," says Vivek Srivastava, chief executive, HCAH.
Spearheading this new venture is Gaurav Burman, scion of the Burman family. He has a little more than 15 years' experience in the private equity space and is in charge of the family's non-core investments. HealthCare at Home India is not the only new venture he has put his hand on. He has recently invested in StoreMore, which claims to be the country's first storage service provider for households and businesses. Gaurav is also managing partner of Elephant Capital and founding partner at Promethean Investments.
He says: "I believe, over and above investing in innovative ideas and novel concepts, our single most important determining factor when we make an investment is the quality and history of our partners, and the management team."
About his health care venture, he says: "There are many medical conditions far more suited to delivery at home. I believe, having seen the level of knowledge, investment and experience our partners - Charles, Gareth and the team - have, there is no better solution for the India consumer than the one we are already offering in Delhi and Chandigarh, and will shortly be offering nationally."
HCAH's 100-member team claims to have the twin advantage of a sophisticated technology platform and affordable medical care at home. The technology platform has been developed in association with the UK-based Healthcare at Home. All the nursing and support staff are given a (computer) tablet each, which can store critical data on patients and transmit these to the company's back-end team and the treating doctors. "This helps doctors monitor the progress of patients on a real-time basis and make course correction in the treatment if needed," says Srivastava. A nurse associated with the company says, "Beside the nursing training, we have also been trained to operate the technology to key in all important data related to the patient. We send the data to our back-end team, which is reviewed by unit heads and passed on to the treating doctors."
What attracts the patients to HealthCare at Home India, claim company executives, is the cost advantage. A day's ICU stay in a good hospital costs Rs 20,000-50,000. HCAH boasts of setting up an identical facility at half the cost. In the case of chemotherapy, the cost is identical but patients can make substantial saving in time and money - they do not have to travel long distances to reach hospital and stand in long queues. The physiotherapy package, available elsewhere in the range of Rs 150-5,000 a day, starts at Rs 7,000 for a week.
The company claims to set up an ICU arrangement within 24-36 hours. Other non-critical care services can be availed within two hours. Nearly 70 per cent of its business comes from ICU at home, chemotherapy, physiotherapy and post-operative care at home.
As in the UK
Although there is no estimate of the size of India's home care market, HCAH executives expect the business to grow manifold. "Homecare is a $2-billion market in the UK and growing at 20 per cent per annum. I see a big future for this business here as well," says Srivastava.
At the moment, the company operates only in the National Capital Region and Chandigarh. It expects to cover all the major cities in the country within two years. The plan is to invest Rs 200 crore over the next three to five years. Along with the geographical expansion, the company wants to add services such as maternity care, chronic care and home dialysis to its portfolio. The company expects Rs 500 crore revenue in five years and hopes to break even in two years.
Hospital alliance not easy
Selling this idea to patients and doctors is not the only challenge facing the management. There are many other issues which need to be addressed. For instance, what will be the response time in case of medical emergency? How will multiple diagnostic tests be conducted at home? More important, who will take responsibility in case something goes wrong? Experts also say forging of alliances with hospitals is not going to be easy. However, Kanwaljit Singh, facility director at Fortis Rajan Dhall Hospital, New Delhi, says "home services are friendly, especially for chronically ill patients who would find lengthy hospital stay only for basic care expensive. Such an arrangement allows a happier, well-monitored, flexible and less expensive recovery option for patients and also makes them contributory partners in their recovery."
HCAH wants to ride on the goodwill it claims it has earned by successfully rendering services to nearly 1,000 patients so far.
LEAVE IT WITH THEM: HIRE A STORE TO HOLD STUFF
A couple had to renovate their three-storeyed building near South Extension in Delhi. Storing the household stuff was a bit of a headache. They chanced upon a leaflet that promised to store their belongings. Then a salaried employee with a big company had to relocate from Kolkata to Delhi. Finding a suitable house was not the only problem; he had to find one big enough to accommodate 200-odd paintings of his mother. The help in both cases came from StoreMore, a Noida-based company that provides records' management and storage services. It is co-promoted by the Burman family. The company's chief executive officer, Amit Wilson, an IIM-Bangalore alumnus, says: "StoreMore is not just a business. It is a relationship. If you take a look at the kind of stuff that is safely stored in our warehouses, you will realise why I say so." The company has two warehouses, one at Noida and another at Manesar, near Gurgaon. Company director Pooja Kothari says, "One family has kept its 100-year-old piano. One person has kept boxes full of school projects of his daughter. All stuff with emotional value attached but cannot be kept at home are gradually making their way to our warehouses."
The journey began in 2010, with the company offering record-keeping services. It boasts of 57 clients for these services - Punjab and Sind Bank, Nestle, Ficci and Paras Hospital, among others. For its storage services, the company has managed nearly 150 customers. "Our business will grow manifold once storing stuff in safe warehouses becomes part of lifestyle," observes company director Nitin Dhawan.
Storage service in eight big cities is estimated to be a Rs 500-crore opportunity in the country. In the US, it is estimated to be a $24-billion market, where one in 10 people use storage services.
At the moment, the company operates only the National Capital Region. It has plans to offer services in all the metros by the end of 2014. Says co-promoter Gaurav Burman: "StoreMore is an exciting business, where we happened upon a management team that are totally committed and working their guts out to build India's first and best self-storage, document storage, high-value storage business."
Providing non-critical care services such as nursing, physiotherapy and post-operative care at home is fine. But what about critical care that needs constant vigil of doctors and other technicians? In hospitals, expert advice is close in an emergency. In case a medicine does not work or is counter-productive, doctors can make corrections immediately. But is that possible at home? In emergency diagnostic tests, reports for patients at home might be obtained with a lag, unlike in hospitals where complicated tests can also be done at short notice. Often, periodic tests are needed and doctors need to monitor patients in real time. Can homecare providers do that? Today, when cases involving medical care are on the rise, you need to fix the responsibility of the service providers. Given the way things are, hospitals may not be too willing to tie up with ventures in which they hardly have any control. Why would hospitals want to take the risk of leaving patients outside of their controlled environment? Who would take responsibility if something were to go wrong? Laws do not permit transfer of patients to third parties.
My view is those offering medical services at home should only concentrate on non-critical care and include rehabilitation where there is a big gap.
Anil K Maini is senior advisor (business development) at Medanta - The Medicity