karan singh

1

Healthcare IT Controlling Non Communicable Diseases

Karan Singh, Bain & Company

2

NCDs account for 53% of all deaths in India

NCDs estimate to cost India $6.2T by 2030

A 10% rise in chronic disease will result in 0.5% lower rates of annual economic growth

3

0

20

40

60

80

100%

2030

Africa

America

Europe

Middle East

Asia

52

2030

Africa

America

Middle East

Europe

Asia

900

Quarter of global productivity loss by 2030 will be borne by India

Source: WHO, Bain Analysis

NCD deaths(M)

DALYs lost(M)

India share 17% 24%

0

5

10

15

20M

Years of life lost due to CVD in population

aged 35-64 years, in 2030

India

18

China

11

Russia

3

USA

2

South

Africa

0.4

11.5 7.8 3.3 1.7 0.32010E

4

Rapid urbanization in India expected to add to disease burden

Growing urbanization

High prevalence of risk factors

Resulting high NCD burden

0

100

200

300

400

500

1991

217

2011

377

2021e

496

Urban population (M)

26% 31% 36%Urban (%)

Prevalence Rural Urban

Central obesity 55% (M) 72% (M)

Work related sedentariness 39% 64%

Prevalence Rural Urban

Hypertension 10% 25%

Ischemic Heart Disease 2.5% 6.4%

Source: Planning Commission document on NCDs

5

India has narrow window to reverse NCD epidemic

Source: Planning Commission

•Major proportion of NCDs are preventable by tackling modifiable risk factors

•Potential to prevent ~75% of stroke, heart, diabetes and 40% of cancer

0.02

0.05

0.1

0.2

0.5

1

2

5

10

0.5 1 2 5 10 20 50 100

USA

Brazil

Australia

Nominal GDP per capita

( 2010, $K )

Healthcare expenditure

per capita (2010, US$K )

Philippines

Vietnam

United Arab Emirates

United Kingdom

Thailand

South Africa

Singapore

Saudi Arabia

Qatar

Pakistan

Oman

Malaysia

Kuwait

Indonesia

India

Hong Kong

Egypt

China

Cambodia

Bahrain

R² = 0.90

India

6

Need fundamental change in health system to tackle NCDs

Prevention Diagnosis TreatmentFollow

upPrevention

EarlyDiagnosis

PromptTreatment

Follow up

•Proactive, care seeking behavior (prevent vs treat)

•Public health focus, incl. mass screening

•Primary care focus, early intervention focus

•Protocolized care delivery

•Care support & follow up to increase adherence

“Sickness focus”

“Wellness focus”

7

Learnings in tackling NCDs from developed markets

Note: CVD data includes men and women 25 to 84 years old, Diabetes data includes men and women >30 years old, MI-Myocardial infarctionSource: Explaining the decrease in U.S. Deaths from Coronary Disease, 1980-2000, Ford et al, N Engl J Med 2007, American Society of Nutritional Sciences, American Heart Association, Explaining the Decline in Coronary Heart Disease Mortality in England and Wales Between 1981 and 2000, Unal, Critchley Et Al, British Heart Foundation, Action on Smoking and Health, National Screening Committee website, Explaining the Decline in Early Mortality in Men and Women With Type 2 Diabetes, Charlton Et Al; New England Journal, Cancer Prevention and Early Detection Facts and Figures 2013,American Cancer Society, National Cancer Institute ,US, The growth of Palliative Care Programs in US Hospitals, 2005, Morrison et.al, Journal of Palliative Medicine, Secondary research

50% DECLINE IN CHD MORTALITY

35% DECLINE IN DIABETES’ MORTALITY

20% DECLINE IN CANCER MORTALITY

0

200

400

600

800

1,000

CHD mortality per

1L male/ female population

1980

Men

Wom

en

2000 1981 2000

0

10

20

30

40

50

Men

48

25

Women

37

28

Age-standardized mortality

(per 1,000 person-years)

within 24 months of diagnosis

0

100

200

300

1991

215

2010

172

Cancer mortality per

1L population

8

Significant portion of reduction from prevention & early diagnosis

Source: Explaining the decrease in U.S. Deaths from Coronary Disease, 1980-2000, Ford et al, N Engl J Med 2007, American Society of Nutritional Sciences, American Heart Association, Explaining the Decline in Coronary Heart Disease Mortality in England and Wales Between 1981 and 2000, Unal, Critchley Et Al, British Heart Foundation, Action on Smoking and Health, National Screening Committee website, Explaining the Decline in Early Mortality in Men and Women With Type 2 Diabetes, Charlton Et Al; New England Journal, Cancer Prevention and Early Detection Facts and Figures 2013,American Cancer Society, National Cancer Institute ,US, The growth of Palliative Care Programs in US Hospitals, 2005, Morrison et.al, Journal of Palliative Medicine, Secondary research

Prevention Diagnosis Treatment

Diagnosis & Treatment

• Large scale awareness campaigns

• Medications for co-morbidities/ risk factors (hypertension, tobacco)

• Multiple screening programs

• Secondary prevention (Aspirin, β-blockers)

• Formulation and use of evidence based therapies

• Increased use of advanced treatments

• Lifestyle interventions • Increased access to advanced drugs

• Large outlay for R&D

• Increased use of advanced drugs

Prevention

45-60% 10% 30-45%

60% 40%

Cardiovascular disease

Diabetes

9

Early intervention can lower cost & improve outcomes

-100

-80

-60

-40

-20

0%

Cervical Cancer

-40%

HIV

-60%

Chronic Kidney Disease

-75%

Chronic Artery

Disease

-85%

% decrease in cost of treatment by early diagnosis

Note: Cervical Cancer, CKD and CAD data is for US; HIV data is for UK and Canada; Late Stage implies Stage III/IV of cervical cancer, AIDS stage for HIV and ESRD stage for CKD; For CAD – comparison is across stable angina (early stage) and acute myocardial infarction (late stage)Source: Bain Analysis; PubMed, US National Library of Medicine and National Institutes of Health; UK Department of Health; Litholink; Health Protection Agency, UK; Nature; Aidsmap

2x 10x 8x 2xIncrease in survival rates by early diagnosis

10

Where are IT/technology points of intervention to improve outcomes?

Note: USA estimates at an overall level including ruralSource: Diabetes International Foundation; WHO; primary interviews; National Diabetes factsheet, secondary research

38M 21M 9M 2.5M

USA 20M 14M 10.5M 4M

0

20

40

60

80

100%

Number of Diabetes Patients (2011)

Urban India

diabetics (estimate)

Diagnosed diabetics

Patients on oral tablet

Patients on insulin

Patients receiving approprate care

mgmt

USA benchmark

Prevention Diagnosis Treatment Follow up

1

23

11

Opportunities for IT/technology

• Improve access via telemedicine, etc

• Improve treatment – via integrated care and better capture/sharing of information, use of protocols

• Improve adherence – via lower cost IT enabled disease management programs & remote monitoring

1

2

3

12

Improving access is a must for early diagnosis

0

20

40

60

80

100%

Population

1.2B

Hospitals

17K

Doctors

0.7M

Hospital beds

Rural

Urban

1.8M

Percent of total

Source: Bain Analysis

0.0

1.0

2.0

3.0

4.0

5.0

Spain

4.7

3.8

Denmark

3.53.3

UK

2.2

1.7

Brazil

1.3

China

1.1

South Africa

0.6

India

0.6

Doctors per 1000 population

Germany USTurkey

1

13 0

20

40

60

80

100 %

2007

20

2012

69

79

Mobile phone penetration in India (%)

20170

5

10

15

20 %

2007

4

2012

12

2017

17

Internet penetration in India

0

20

40

60

80%

2010

3%

2012

9%

2017

66%

Smartphone penetration in India

MOBILE PENETRATION IS RISING @ ~30%

INTERNET ADOPTION IS RISING @ 25%

SMARTPHONE USAGE IS RISING AT ~80%

Source: TRAI

Connectivity can help us leapfrog access

1

14

What do you expect companies to do to better promote healthy living? Importance

Offer healthier food options

Develop programs that reward people for healthy lifestyles

Promote healthy lifestyles via digital media & social online platforms

Offer stress management programs

Aim to generate broad community movement supporting healthy lifestyles

Invest more in awareness campaigns on healthy lifestyles

Offer online doctor or lifestyle counseling services

Develop new technologies that help to monitor and manage health

Offer novel, consumer friendly diagnostics

Indians sees technology as important means to achieving healthy living

1 5

Note: Importance rating indicates % of respondents who selected a certain option as one of their top 5 choices. None of the above chosen by NY: 9%, Munich 6%, New Delhi 1%Source: Healthy Living Survey, Bain & Company, 2013 (Munich, New Delhi, New York; n=1,200)

MunichNew YorkNew Delhi

HighLow

1

15

Tele services need to be scaled up

Source: Bain Analysis

MOBILE TELEMEDICINE

E-ICU

TELE - RADIOLOGY

1

16

How to improve treatment effectiveness?

• Lack of (& underuse of) guidelines, protocols

• Integrated care

• Sub optimal IT systems/infrastructure to collect, share information

• Inadequate MD-patient communication

2

17

What is potential for “integrated care” in select diseases?

AdherenceTreatment

complications

Source: Secondary research, Expert interviews

Unorganized fitness centers

Optimal information/communicationUse of tools to capture, share and track progress

RoutineTreatment

Diagnosis Prevention

2

18

Successful integrated care models to consider

Note: *Includes rehabsSource: Bain case studies

Wellness services

DiagnosticDelivery

Insurance EducationDoctors; Hospitals*

0

500

1,000

1,500

2,000

Clinical acute patient bed days

per 1,000 patients

Medicare FFS

1,706

Kaiser

1,057

0

20

40

60

80

100

Coomparison of key

health costs stats (US avg indexed to 100)

100

83

100

64

US a

vg.

100

Geie

inger

73

Medical spend

per person

ALOS # Doctor

visits

IT/ Analytics

2

19

Significant unmet needs in IT identified by institutions

•Cost effective- Segment specific needs, capex to opex based- Cloud based

•Integrated, scalable- Piecemeal/disparate offerings, obsolescence

•“Right spec”- Customized, easier user interface, etc

•Reliable service & support- 24x7 support, quality of response

2

20

Opportunity for adopting disease mgmt, remote monitoring solutions

• Enrolment: >90%;

• Clinical: 30-60% reduction in severe complications in diabetics

• Economic: ~10% decrease in Diabetes’ treatment costs

• Govt-sponsored SMS alerts & callbacks to TB patients in Thailand raised medication compliance rates to ~90%

• China: Patients to input data (BP, glucose, weight, etc.), sends to provider via phone

• Provider send back customized treatment plans remotely to patient

• Govt. offering ‘call-back’ service to give counsel on HIV testing; Global Health shares educational videos via mobiles

3

21

In summary

•NCDs need to be top global & national priority

•Need a paradigm shift: from sickness to wellness

•IT/technology can play a critical role in- Improving Access – via telemedicine- Improving Treatment Effectiveness – Guidelines/protocols & IT

tools/systems to capture, sharing of medical information- Improving Adherence – via IT enabled disease mgmt and remote

monitoring