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biomedical engineering, India, internship, johns hopkins, medical, medicine, Medium, Saathealth, senior, Theodore A. Lee

So proud of my son Theodore Andrew Lee who spent his January term doing an unpaid internship in India at Saathealth. He is a senior in Biomedical Engineering at Johns Hopkins University. Read his interesting reflection upon his experience. I am reposting it from his original post on Medium.com.

Securing a healthy future for the next generation of children

The view from my apartment overlooking Hiranandi Gardens and the Powai Lake

Reflections on Saathealth

by Theodore Andrew Lee

Introduction

Before college, I had every intention of going to medical school. Practicing medicine was one of the most direct ways I could impact the lives of others and I was drawn to the noble and intimate profession. However, I had this inescapable curiosity for technology and business, and was drawn to the deep gratification that comes with designing and building things to impact many people. At Hopkins, I discovered various ways to change healthcare from outside of traditional medicine. MedHacks, Blue Cross Blue Shield, and A-Level Capital were vehicles that enabled me to explore my desire to create a lasting impact in healthcare technology.

These experiences have led me to a fundamental question. What does meaningful value really mean in healthcare? To better answer this question, I realized that I need a framework to better understand the market, its stakeholders, and an overarching strategy to eventually deliver and create value. Exposure to the inverted incentive structure of stakeholders and vast bureaucracy in the US healthcare system has led me to believe radical healthcare innovation will begin at the fringes, with the people who need it the most. That is, the millions of uninsured people in the US or the hundreds of millions of people in developing countries without access to basic healthcare.

This is ultimately the reason why I decided to intern at Saathealth in India this January, a mobile health start-up seeking to improve the health of low-resource/income families; the recent widespread adoption of smartphones in one of the world’s most fragmented patient populations is a perfect forcing function to realize new healthcare technology and innovative business models.

Background

Saathealth aims to empower families in low-resource/income settings to achieve better health through targeted education. During my three weeks at Saathealth, I worked closely with Aakash, the CEO, and Srini, the Head of Product, to identify new opportunities for growth. We focused specifically on investigating alternative business models and new markets. This involved developing an understanding of Saathealth’s product-market-fit challenges within the complex market dynamics of the Indian healthcare ecosystem. I investigated these challenges by speaking with Saathealth team members, conducting my own research, and interviewing Saathealth users living in the slums surrounding Mumbai.

Healthcare in India

From the conversations I shared with my team members, I learned the impending challenges and opportunities within the Indian healthcare system. In 2018, India launched a national health program, Ayushman Bharat, to achieve universal health coverage. It provided coverage to 500 million people and in its first year of implementation the program reached 3.9 million Indians, however household healthcare expenditure still remains largely out of pocket. There remain significant challenges in growing the program: a shortage in healthcare infrastructure, a gap between rural and urban populations, a scarcity of skilled workers, and a lack of public funding. However, with the widespread adoption of mobile phones in India, digital health emerges as a solution for last-mile care delivery, bridging the continuum of care, and most importantly incentivizing healthier lifestyles.

My own research unveiled a global health problem recently introduced as the Double Burden of Malnutrition (DBM). DBM is the coexistence of undernutrition and over-nutrition in a population, household, or individual. DBM within a single individual, commonly occurring as early undernutrition and subsequent over-nutrition, is the most important factor to the risk of developing non-communicable diseases (NCDs) in adults. To make matters worse, NCDs are now responsible for the majority of deaths worldwide, and are disproportionately high in low and middle income countries (LMICs), where nearly 80% of all NCD deaths occur. Severe levels of DBM have recently shifted to countries in the poorest income quartile, India being one of the largest countries with DBM. Efforts to reduce undernutrition have unintentionally increased rates of overweight/obesity, thus proving a need for solutions that simultaneously prevent the risk of both nutritional deficiencies and surplus.

From my visits to the slums surrounding Mumbai, I witnessed first-hand the prevalence of DBM in many individuals (countless adults were shockingly obese) and I investigated the circuitous nature of patient journeys. The average patient first seeks help at a local pharmacy where they receive prescriptions directly from pharmacists — a low-cost and short-term remedy that is also illegal. If the prescriptions are ineffective, the patient will go to their local quack, an unlicensed community healthcare provider. These quacks produce cheap and accessible ‘care’ that is backed by years of experience rather than a regulated education, often compromising patient safety. If the quack’s care is futile, the patient will finally visit a GP, where care is expensive and visits can take a full day, further causing a day’s loss of wages.

Saathealth

The existing Saathealth platform educates its users on hyper-localized health information that many developed countries take for granted (boiling water before drinking, not sharing mothers for breastfeeding, etc.) Users are incentivized to consume health information and engage in quizzes on the platform through a point system that is publicized on community leader boards.

Saathealth started in 2018 and is validating product-market fit through a series of experiments.

One of these experiments, enabled users to redeem their points for discounted health and nutrition products at local kirana (convenience) stores to build healthy purchasing patterns and lifestyles. This trial ran for 3 months and confirmed Saathealth’s initial thesis that their app could drive behavior change and healthy purchasing patterns, as they experienced explosive growth. This model feeds on network effects and requires front-loading significant capital to scale and still remains one of the models that Saathealth continues to pursue.

Another on-going experiment involves working directly with health food companies and promoting a line of nutrition and health products to Saathealth users, with the option of directly owning some of these assets.

While running these experiments, the Saathealth team has built a set of assets: a massive cohort of engaged users, a direct-to-consumer trusted brand, a supply chain network, a digital infrastructure that links demand and supply side players, and a large pool of original behavior change content.

My work

With these existing assets in mind, I collaborated with Aakash and Srini to synthesize a business model that leverages these assets and simultaneously targets DBM. This new strategy constructs a marketplace that aligns the incentives of low-income families, health and nutrition product companies, and local kirana store owners.

Users on the Saathealth platform are motivated to improve their own health and the health of their children. As they consume health and DBM focused content, they are incentivized towards healthier purchasing patterns and lifestyles through discounted health and nutrition products at local kirana stores. This was proven to work in the 3-month pilot, and by doing so, the Saathealth platform aggregates the demand for nutritious food and health products from a highly fragmented user base.

By aggregating the demand of consumers, Saathealth enables partner stores to realize increased traffic in their stores. Furthermore, these stores are heavily reliant on building a loyal customer base by building relationships with the surrounding community. Partner stores can build more meaningful relationships through the Saathealth app: they can take an active role in the decision making process of purchasing products and can be trained to measure a user’s height, weight, and other indicators to monitor development in the Saathealth app.

Lastly, as Saathealth builds out product promotion capabilities, they can form partnerships with large health and nutrition companies. This enables partner companies to access a new customer acquisition channel that taps into a large and fragmented group of users. Saathealth users are nudged to consume affordable nutritious foods to counter the aggressive marketing tactics of large processed food companies. This will offset the large capital requirements associated with scaling the marketplace between users and kirana stores; Saathealth will generate revenue from their own high-margin products and from advertising/revenue-share-agreements of partner products.

Conclusion

As healthcare becomes increasingly inaccessible and the burden of disease shifts from infectious to chronic, this new business model shifts the traditional care delivery models to meet the patient where they already are. Kirana stores are already an active part in sustaining the daily lifestyles of individuals and this proposed business model leverages these stores to shift care delivery up-stream and foster more frequent and personalized care.

Through this entire process, from investigating Saathealth and the Indian healthcare ecosystem, to building a comprehensive business case, I learned an incredible amount to better answer my initial question of meaningful value in healthcare. Even more importantly, I underwent immense personal development — I learned that I grow more quickly in fast-paced environments when presented with a dynamic set of responsibilities that cut across different work streams. The scrappy nature of an early venture was invigorating and validated my goals of one-day building a high-impact healthtech venture as a physician-innovator.

Saathealth offered a front-row seat and a backstage pass to tackle some of the most critical and costly issues in healthcare in developing economies. My experience in India is a testament to my growing thesis that radical healthcare innovation will start at the fringes, with populations that need healthcare the most.

I am incredibly thankful for the opportunity to spend my last undergraduate winter holiday in an amazing country filled with welcoming people, delicious food, and a rich culture. The future of Saathealth presents an exciting opportunity to better the lives of India’s coming generations, availing innovations in digital health that will broadly impact the entire global healthcare system.