karan singh

1. 1
Healthcare IT Controlling
Non Communicable Diseases
Karan Singh, Bain & Company

2. NCDs account for 53% of all deaths in India
2
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. 3
Quarter of global productivity loss by
2030 will be borne by India
NCD
deaths(M)
Source: WHO, Bain Analysis
DALYs
lost(M)
India share 17% 24%

4. 4
Rapid urbanization in India expected
to add to disease burden
Growing urbanization
High prevalence of risk factors
Prevalence Rural Urban
Central obesity 55% (M) 72% (M)
Work related
sedentariness
39% 64%
Resulting high NCD burden
Prevalence Rural Urban
Hypertension 10% 25%
Ischemic Heart
Disease
2.5% 6.4%
Source: Planning Commission document on NCDs

5. 5
India has narrow window to reverse
NCD epidemic
•Major proportion of NCDs
are preventable by tackling
modifiable risk factors
•Potential to prevent ~75%
of stroke, heart, diabetes
and 40% of cancer
Source: Planning Commission
India

6. 6
Need fundamental change in health
system to tackle NCDs
“Sickness focus” “Wellness focus”
Prevention Diagnosis Treatment
Follow
up
Prevention
Early
Diagnosis
Prompt
Treatment
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

7. 7
Learnings in tackling NCDs from
developed markets
50% DECLINE IN
CHD MORTALITY
35% DECLINE IN
DIABETES’ MORTALITY
20% DECLINE IN
CANCER MORTALITY
Note: CVD data includes men and women 25 to 84 years old, Diabetes data includes men and women >30 years old, MI-Myocardial infarction
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

8. 8
Significant portion of reduction from
prevention & early diagnosis
45-60% 10% 30-45%
Prevention Diagnosis Treatment
• Formulation and use
of evidence based
therapies
• Increased use of
advanced treatments
60% 40%
Diagnosis & Treatment
• Large scale awareness
campaigns
• Medications for co-morbidities/
risk factors (hypertension,
tobacco)
• Multiple
screening
programs
• Secondary
prevention
(Aspirin, β-
blockers)
Prevention
• Lifestyle interventions • Increased access to
advanced drugs
• Large outlay for R&D
• Increased use of
advanced drugs
Cardiovascular
disease
Diabetes
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

9. 9
Early intervention can lower cost &
improve outcomes
Increase in survival rates by
early diagnosis
2x 10x 8x 2x 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

10. 10
Where are IT/technology points of
intervention to improve outcomes?
Prevention Diagnosis Treatment Follow up
1
2
38M 21M 9M 2.5M
USA 20M 14M 10.5M 4M
USA benchmark
3
Note: USA estimates at an overall level including rural
Source: Diabetes International Foundation; WHO; primary interviews; National Diabetes factsheet, secondary research

11. 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. 12
Improving access is a must for early
diagnosis
Source: Bain Analysis
1

13. MOBILE PENETRATION
13
IS RISING @ ~30%
INTERNET ADOPTION IS
RISING @ 25%
SMARTPHONE USAGE
IS RISING AT ~80%
Source: TRAI
Connectivity can help us leapfrog
access
1

14. Indians sees technology as important
means to achieving healthy living
New Delhi New York Munich
What do you expect companies to do to better promote healthy living? Importance
14
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
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)
Low High
1

15. TELEMEDICINE
15
Tele services need to be scaled up
MOBILE
E-ICU
Source: Bain Analysis
TELE
- RADIOLOGY
1

16. 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. 17
What is potential for “integrated care”
in select diseases?
Adherence
Treatment
complications
Unorganized fitness
centers
Optimal information/communication
Use of tools to capture, share and track progress
Source: Secondary research, Expert interviews
Routine
Treatment
Prevention Diagnosis
2

18. 18
Successful integrated care models
to consider
Wellness
services
Note: *Includes rehabs
Source: Bain case studies
Diagnostic
Delivery
Insurance Education
Doctors; Hospitals*
IT/
2
Analytics

19. 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. 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
• China: Patients to input data (BP,
glucose, weight, etc.), sends to provider
via phone
• Provider send back customized
treatment plans remotely to patient
• Govt-sponsored SMS alerts &
callbacks to TB patients in Thailand
raised medication compliance
rates to ~90%
• Govt. offering ‘call-back’ service to
give counsel on HIV testing; Global
Health shares educational videos via
mobiles
3

21. 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