ACCESS Health hosted its seventh session in the virtual Fintech for Health Special Interest Group (SIG) series on May 19, 2022. The Fintech for Health team in India continues to engage fintech and healthtech players to share knowledge, dialogue with each other, and catalyze the creation of new partnerships and models to support health financing for low- and moderate-income populations. With support from MetLife Foundation, ACCESS Health created the Fintech for Health platform for innovative solutions that enable low- to moderate-income people in Asia to pay for and access high-quality care using digital financial services and a financial inclusion approach.

The seventh session of SIG witnessed the participation of thirty-two representatives from leading healthtech and fintech start-ups, payment banks, non-profit organizations, insurance companies, government officials, healthcare experts, and pharmaceutical companies. The session was aimed to create and foster knowledge sharing to enable health financing to the low- and middle-income segment affordably through subscription-based healthcare models. Patients are now being offered anytime, anywhere access to healthcare services by paying a fixed monthly, quarterly or annual fee; that way, the patients can get the services they need when they need them. A navigational shift away from transactional healthcare services to managed care started with these subscription-based models. These would also drastically improve the universal health coverage and connections between people, health, and well-being, resulting in improved health outcomes for the public, including the low- middle-income groups. On the occasion of World Family Doctor Day, ACCESS Health invited two pioneering healthtech start-ups working on subscription-based models – SevaMob and Clinikk.

SevaMob – AI-based diagnostics and hybrid primary care services for patients and businesses
SevaMob is a healthcare start-up that has developed an end-to-end healthcare delivery model with an Artificial Intelligence (AI) enabled healthcare platform with two components – AI-based point-of-care screening for blood, vision, diet, urine and sputum; and health outcome delivery through tele-health and asset-lite popup clinics. They have been able to deliver primary care at 50% lower costs by integrating these innovations. SevaMob’s subscription model extends to both patients and businesses/employers. SevaMob supports businesses by helping them create variable payment and coverage structures for their employees and payment options. SevaMob now works across 17+ states in India and has undertaken pilots in the United States and South Africa. SevaMob also monetizes its model by licensing the software to its B2B customers, including employers, NGOs, hospitals/clinics, pharma, health insurance, and local governments.

AI-based PoC screening is an accessible online application that can be used on slides manually prepared by technicians or automatically developed using their proprietary slide maker. The application can be used by any health facility staff, including a nurse practitioner, to learn the probability and chances of Tuberculosis, Malaria, COVID-19, and more in the diagnosed patient. The application also allows the patient to book a consultation on the application and is eventually delivered by SevaMob through telehealth or pop-up clinics. Their platform receives 50,000 consultations per month and has helped reduce malnutrition and vision issues in select groups by 15% and 25%, respectively.

The discussion touched upon the critical aspects of human resource deployment, pricing of products and services, incentives for providers, and measuring health outcomes. The group exchanged crucial information on the various process and product innovations in health that complement and improve the subscription-based model for the patients, care providers, and SevaMob themselves. The discussion highlighted the importance of outreach to increase patient footfall and to engage in strategic purchasing of kits and equipment in higher volumes for discounts. Outreach and purchasing go hand-in-hand to keep the prices low, especially in underserved areas with low-middle income populations. The need for innovations in telehealth that would allow the doctors and clinicians to manage their patient load in the clinic and online was highlighted. Orientation of subscription-based models as outcome-driven initiatives for the patients/consumers and their B2B customers are innovative. The discussion also highlighted the rise of outcome-based funders and risk funders for larger programs such as malnutrition and tuberculosis.

Clinikk Healthcare – Integrating patient care and health insurance to deliver primary healthcare and financial risk protection
Clinikk is an insurtech and healthtech start-up that is building a managed care model by integrating patient care and health insurance. They provide comprehensive family health insurance coverage and unlimited OPD coverage that can be delivered digitally and through state-of-the-art care centers at an affordable subscription. Clinkk is integrating healthcare delivery with health insurance to reduce the risk of in-patient treatment. Clinikk’s online application and care centers provide cashless primary, preventive, and promotive care to the subscribers, which helps them manage their care and reduce the risk of needing tertiary hospitalization. Their outpatient services include free medical consultations, procedures, medicines, lab tests, and imaging. Clinikk’s in-patient insurance provides a maximum of 55 lakh of coverage, a low waiting period, and a private room in tertiary facilities. Clinikk is also chartered to expand and scale in Hyderabad and Pune after Bangalore.

Clinikk also uses a protocol-based care at their care centers where the patients are diagnosed and recommended care as per the clinical protocols, mostly referred from ICMR, which results in affordable managed care for the patient and quality service delivery at the health hub. These interventions also contribute to reducing the premium for group insurance provided by their insurance partner to cover the inpatient costs along with other benefits in line with the traditional insurance plan. Patients with risk of chronic illnesses and noncommunicable diseases reach out to Clinikk earlier which allows the protocol-based care to provide quality primary healthcare and timely referrals to the patients.

The discussion involved questions and insights on the scale up of Clinikk in Pune and other cities in the country. The importance of low capital, resource optimized, and protocol-abiding state-of-the-art care centers which are not dependent on walk-ins and powered by a strong franchise-based model was highlighted. The critical pillars for success of Clinikk’s subscription-based models are strong technology backbone, AI-powered protocols of care where systems are able to learn from the practitioners, and lucrative incentives for the providers and care team. The SIG recommended referring the national guidelines developed by the health department which includes the most updated and comprehensive compendium of guidelines available. The group also suggested to support Ayushman Bharat Digital Health Mission to develop a compendium of guidelines at the national level and a constitution of appropriate mechanisms which allow for frequent updates and adaptation. The discussion on protocol-based care provided strong reasoning for their adherence at care centers by minimizing the risk of workflows being disturbed, leading to higher costs and processes due to lack of optimization. The growth of primary care models in the recent past was attributed to improved ecosystem enablers such as the fintech stack, ABDM sandbox, unified payment interface (UPI), eWallets, internet users, and bank accounts in India.

The healthcare industry today follows a traditional fee-for-service payment structure in most cases. In this case, for every visit the patient pays a fixed amount of charge for the services, usually consultation fee. However, the subscription model follows quite a different trajectory from the existing payment structures. Subscription model is also more affordable, accessible, convenient and transparent as compared to the traditional pay-per service model. Furthermore, it provides customers with flexible choices such as the opportunity to opt-in or opt-out of service anytime.

In the Indian healthcare industry, the subscription model is in the infant stage and their implementation is lined with certain hurdles. However, some of the critical factors such as the growth of telemedicine/remote monitoring, increase in the working young age population, data privacy, data security, smooth payment methods and availability of options, are likely to provide momentum to the growth of subscription models in healthcare in the coming years. Conclusively, witnessing how quickly the subscription-based healthcare models are emerging, organizations and companies looking to ride on the subscription wave have a lot of homework to do.

Some of the questions which still need attention to understand and scale the subscription-based models are as follows:

  • What are the incentives for the service providers such as doctors and clinics to join and promote subscription-based models vis-a-vis their private practice?
  • How customizable are the bundled services/treatment plans in the subscription models to accommodate the consumer needs?
  • How are subscription plans developed for patient care?
  • What are the drawbacks /limitations of subscription-based models?

Have more to add to the conversation? Read more about the Fintech for Health program here. If you have questions or would like to work with us, please email us here.

Authors: Sireesha Perabathina, Senior Consultant and Abhishek Sudke, Junior Consultant at ACCESS Health International. For more information contact [email protected] or [email protected].