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Providing hospital-quality healthcare at home

While there is potential for this relatively new concept, Portea will have to invest a lot in technology and training to succeed in the long term

Praveen Bose 

Radha Devi is in advanced stage of cancer. But she is not in hospital; she's at her home in trained hands, which know how to take care of cancer patients and are sensitive. Ramli Pradhan, her daughter, has engaged Portea Medical to look after her mother at home.

Portea Medical provides in-home healthcare, a new concept in India and a blessing for families. "For home visits, we provide doctors, nurses and physiotherapists who have passed our rigorous hiring standards and have had their backgrounds and medical knowledge verified by senior doctors," says the company. It also provides nurses for long durations and trained attendants for the old and sick who have difficulty moving around.

Earlier, Devi's daughter had availed the service of a home nurse, supplied by an agent. However, she was untrained. This unsuccessful experiment cost Pradhan Rs 23,000. In comparison, Portea's services, although a tad costlier at Rs 36,000 a month, have given Radha Devi's daughter the assurance that her mother is in safe hands. She is one of the many customers of Portea Medical, founded by Zachary Jones and Karan Aneja in 2012.

FACT BOX
  • Area of business: At-home healthcare services
  • Services: Physiotherapy, nursing, attendant, doctor visit
  • Funding: Rs 48 crore in series-A round from Accel Partners, VenturEast

Origin
Both Jones and Aneja grew up in the US. Jones went to Columbia University and later joined Copal Partners, while Aneja went to UC Berkeley and studied molecular and cell biology, with a certificate in entrepreneurship and technology; he went on to co-found Sidkar Technologies. After some time, both decided to come to India because of the opportunities here. It was in Delhi they first met through some common friends. The duo co-founded Portea in 2012. The company raised funds from the investor couple of TutorVista fame, Meena Ganesh and Ganesh Krishnan, who bought into the company in July 2013. Jones and Aneja continue as senior vice-presidents with Portea. In the first week of December 2013, Portea received Rs 48 crore in series-A funding from venture capital firms Accel Partners and VenturEast.

Portea works with hospitals, insurance and individuals. The company has five tier-I corporate hospitals as partners, a network of referring physicians and handles around 2,000 home visits a month. Portea's procedures were developed in consultation with professionals in the US.

Portea gets revenue from two streams - direct-to-consumer and business to business (B2B). In the former, it charges patients either for each visit or a flat annual fee. In the latter, mainly for geriatric and chronic patients, it charges an annual fee for customised services. "Typically, customers start with the per-visit model, but soon migrate to subscription," says a company official.

B2B partners comprise hospitals and insurers. Portea gets patients through them, provides the services on their behalf and the institutions pay for the services.

It provides post-surgery care and senior care using high-end technology. Among the healthcare packages is a Rs 9,999 scheme for individuals, including a visits by doctors and services including blood pressure, sugar checks and email consultations.

Notably, Portea does not outsource its services. All workers, including doctors, nurses, physiotherapists and support staff, are on company payroll. "To have full control on the brand and quality, we cannot outsource key and core functions," says Ganesh Krishnan.

Will it face competition from full-fledged hospitals? Unlikely, according to Ganesh Krishnan because hospitals are focused on in-patients. "Here, there are no operating beds and there's no real estate. It is about last-mile delivery. It's about remote patient care," adds Krishnan.

Opportunities

In-home healthcare is estimated to be a $3-billion opportunity in India, which has a bulging ageing population and many households with the wherewithal.

With the number of old people rising, the business can only grow and more players are looking to enter the segment, say experts. At the moment, in-home healthcare requirements are fulfilled by a highly unorganised and fragmented market. "We strongly believe the time is right for a national-level player to emerge," says Barath Shankar Subramanian, senior analyst at Accel Partners. His views are echoed by Venkatadri Bobba of VenturEast. According to Bobba, there is a lot of demand for post-surgery care, as it costs a lot in hospitals and the care could be inadequate at home. "If Portea can provide the same quality of service from the comfort of one's home, who wouldn't like it?" says Bobba. Bobba estimates the in-home health care sector to be growing at 25-30 per cent compounded annually. It will be a $100-billion market in 15-20 years, he says.

A new concept in India, in the US, it has been in practice for about 120 years.

What makes Portea different is its use of technology. "Portea will be able to provide its services at a lower cost using the technologies it has," says Bobba.

Portea's staff on duty at patients' homes are provided hand-held devices with GPS connectivity.

According to Ganesh Krishnan, there are three factors that ensure success. One, it needs large capital and it can't be a mom-and-pop shop. Two, it needs technology to provide service and scale. Finally, the company must be able to execute and monitor quality remotely. Portea needs a lot of technology to scale and, therefore, needs to invest a lot in training.

In India, quality healthcare is tertiary care in hospitals. "In the US, quality of healthcare delivery is high in primary, secondary, tertiary and home-based care. Entrepreneurship in healthcare in the US is more focused on deploying technology or cutting costs, while in India it's about creating a delivery infrastructure and establishing standards," says Jones.

The core requirements for the business include technology and people. "Until all these are in place, you can't pull it off," says Ganesh Krishnan.

How it works
The Portea platform sits on a geo-fencing network. This helps it divide every city into geographies to co-ordinate clinician visits. It has a complex back-end algorithm to identify clinicians. It takes into account the location of customer, preferable time slot, type of service request, clinician calendar and assigns the clinician. From a central location, it can view all patient requests, clinician locations and get real-time updates, if for any reason a clinician is running late.

Portea's clinicians have access to the Portea app, through which they can access the patient's medical history, check for instructions from the patient's consulting specialist and real-time update of the patient's vitals. Portea is now in the process of integrating its medical equipment with bluetooth capability so that data like blood pressure, temperature and sugar levels automatically get captured.

Portea's backend algorithms provide alerts if a patient's vitals cross internally-set thresholds and check for adverse drug reactions for anything suggested against the patient's older prescription.

Road ahead
Portea, currently in Bangalore, Chennai, the Delhi national capital region, Mumbai and Pune, will enter more cities while expanding its bouquet of services.

"As a company, we expect to break even in the third year. In each new city we open, we'll break even in two years. We look at both city-level and overall company-level metrics and profitability," says Ganesh Krishnan.

Portea will aggregate service providers and provide services on a pan-India basis. This requires training and technology.

Persuading patients to avail healthcare at home rather than going to hospitals would be a challenge. Portea has been trying to do this by emphasising on the value-proposition without compromising on quality of service, says Subramanian.




Rajah V Koppala
EXPERT TAKE

Portea Medical's strength is that the husband-wife team has a reputation for running and turning around numerous businesses. They typically invest in scaleable businesses and look for ways in which they can disrupt the existing model of delivery and create new standards. Health care is a secular field and home healthcare offers excellent prospects both in terms of scaleability and creating a disruption in the current healthcare delivery model. While most of the at-home healthcare providers work with rudimentary systems, with no technology back-up, their execution is very poor.

This model helps save a lot of time for patients, because they don't need to wait outside a clinic for a long period, sometimes spending half-a-day or maybe even a whole day at the hospital to service very basic healthcare needs.

Portea has provided hand-held devices to its people on the ground. They have hand-held devices with GPS connectivity all the time and the right person's device is activated to reach a patient. Hence, technology is their biggest strength.

One problem with the model is that the entry barriers are very low. And, it's not hard to imitate. Yet, technology can be the differentiator. Also, there is no payment system in India, unlike in the US where over 90 per cent of the payments are made by the government (medicare). Here, money will have to come from the pockets of people; so, it could take a while to gather steam. However, the market size is much bigger in India and Portea is sure to reach its projections.

Rajah V Koppala is a consultant interventional radiologist at Nova Speciality Surgery, Bangalore

First Published: Mon, January 13 2014. 00:47 IST
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