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© 2022 Redseer Consulting confidential and proprietary information
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Solve. New
The Dire Need and Rise of Digital
Chronic Disease Management in India
June 2022
Report Summary

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Preface
Source(s): Redseer Approach
India’s healthcare suffers from a substandard infrastructure and limited insurance coverage, leading to inferior healthcare quality in the
country, as confirmed from multiple global indicators (ranked 145 out of 195 countries on healthcare access & quality, as per the
Lancet study in 2016; ranked 66 out of 195 countries on healthcare security, as per Global Health Security Index 2021). The poor
condition of India’s healthcare system was recently exposed as the system collapsed during the COVID-19 pandemic (especially the
period of second COVID-19 wave). This has created a huge growth opportunity, given India currently spends only 5.4% of its GDP on
healthcare, which is only half of the global average of ~10%. Moreover, the opportunity is largely price inelastic (and hence mostly
independent of the inflationary trends), as healthcare is considered as a truly essential expenditure, which takes priorities over most
other categories.
The disease burden in India is led by chronic conditions (diabetes, hypertension and cardio-vascular) that last for at least an year and up
to a person’s lifetime and account for ~65% of the total deaths in the country, putting 400-450 million chronically ill people at a huge risk.
The risk became evident during the pandemic, when the population with existing chronic conditions, was considered prone to the
COVID-19 infection and the associated complexities. Moreover, India’s infrastructural gaps make the chronic treatment journey
cumbersome and expensive, establishing a dire need for convenient and affordable solutions to manage the chronic conditions. New-age
players are leveraging the power of technology to address this large and pressing need.
The Government of India has also realised the gravity of the desperate healthcare situation in India and has prioritised the execution of
healthcare reforms via its commitment to increase the government expenditure on healthcare to 2.5% of GDP by 2025 (up from 1.2% of
GDP in the 2018-2019 period). Similar to the new-age players, the government is also relying on technology to improve the condition of
healthcare in India, as demonstrated by the Ayushman Bharat Digital Mission, under which the government plans to develop the
backbone necessary to support the integrated digital health infrastructure of the country.
Preface of the Report
Descriptive

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India has one of the highest population of chronic patients…
430-450
150-200
20-30
70-90 60-80
31% 48% 34% 10% 30%
Penetration>>
Penetration in India is lower driven by
lower disease awareness specially
among the semi-rural and rural
population. Even if patients are aware,
they often don’t opt for a treatment.
Absolute population and penetration for chronic diseases - Global Benchmarks
In Mn, %, 2021
Source(s) : Redseer Analysis, Secondary Research
High chronic disease penetration in the
US is driven by inclusion of Obesity as a
chronic disease

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…wherein hypertension, diabetes and cardiovascular are the three largest chronic
conditions, in terms of prevalence among population
242
75
67
30
28
7
Hypertension
Arthritis
Diabetes
COPD
Asthama
Cardiovascular
Hypertension
It is a common condition in which the long-term
force of the blood against the artery walls is high
enough to cause health problems
Hypertension can be of two kinds, primary and
secondary hypertension and usually impacts adults
aged above 30
Diabetes
It is a metabolic disease that causes high blood
sugar. It affects how body turns food into energy.
Body either does not make enough Insulin or can’t
use it.
There are two main types of diabetes- Type 1 and
Type 2. Over 90% of patients are diagnosed with
Type 2.
Cardiovascular disease (CVD)
These are a group of diseases that involve the heart
or blood vessels. It includes coronary heart disease,
cerebrovascular disease, rheumatic heart disease
and other conditions. It is the leading cause of
deaths globally.
Hypertension, diabetes, and cardiovascular
diseases are the three biggest chronic
diseases in India by patient population
Chronic disease split of overall population
In Mn, 2021
Source(s) : Redseer Analysis, Secondary Research

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Genetics, lifestyle changes, rapid urbanization, and stress have led to this huge
prevalence of chronic diseases in India
Indian genetics
Genetic vulnerabilities of
Indians is one of the cause for
rising cases of chronic illness.
According to an international
study led by IIT Madras a gene
protein variation among 15%
Indians and other South Asians
increases the risk of diabetes,
heart attacks and hypertension.
Further, another study found
out that Indian babies have
higher insulin and lower
adiponectin which is
suggestive of higher risk of
diabetes in future
Lifestyle
According to WHO, there are 4
major risk factors related
unhealthy lifestyle -- alcohol,
tobacco, poor diet and limited
physical activity. CVD diseases
are the result of exposure to a
combination of such risk
factors over a period time
according to an article in Ergo-
Plus. The lifestyle is further
deteriorating due to rapid
urbanization within India in the
past few decades
Rapid urbanization
India is having a demographic
switch to chronic diseases
where rapid urbanization is
also taking place. Urban
settings is associated with
more sedentary, stressful
lifestyles and consumption of
less nutritious food. Urban
environment also have effects
on health. Severity of chronic
diseases is higher in urban
areas e.g.- 60% of diabetic
cases in India come from urban
cities
Key drivers of high chronic disease count in India
Descriptive
Stress
Prevalence of declining mental
health (more than 35% Indians
suffer from mental health
issues) and increasing stress
levels in India (above global
average) are key drivers of
chronic diseases in India. This
exposure to chronic stress is
one the most significant drivers
associated with increased risk
of diseases especially chronic
conditions like high blood
pressure, heart diseases,
asthma and diabetes.
Source(s) : Secondary Research, Expert Discussions

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A chronic patient needs to interact with multiple care touchpoints during his / her
lifetime and regularly consult the doctor to monitor the outcome of the treatments
Chronic disease – typical treatment journey
Descriptive
Curative treatment
Preventive treatment
Doctor
Device provider
Pharmacy
Nursing home
Hospital
Chronic
patient
Gym/Yoga
Nutritionist
Diagnostic lab
Monitoring device
Medicines
Lab test
Injectables
Inpatient care
Diet control
Regular fitness
Regular consultation with doctor on the
outcome of the treatments
Regular track of
patient’s health
to provide
timely and
accurate advice
Diagnosis of the
condition
Multiple touchpoints for the
patient to manage the
health condition – spanning
multiple years
Treatment
recommendation
by doctor
A B
Source(s): Consumer in-depth discussions, Doctor in-depth discussions, Redseer Analysis

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This results in pressing challenges for the chronic patients, which are
unaddressed by traditional providers...
48%
47%
47%
45%
43%
22%
Too much hassle
in the process
Delays in guidance from
doctor
High combined
expenditure
Lack of adherence
to recommendation
Difficulty in continuous
record keeping
Limited availability
of products
6% NPS
with Traditional
(Offline) Healthcare
Solutions
Need for an
affordable
digital
ecosystem,
integrated
across all
touchpoints
“I need to buy medicines / strips, get
tests done, take insulin and visit my
doctor regularly, which makes
things really cumbersome for me
and my family – worst part, this will
go on for my lifetime.”
“There have been times when my
sugar level used to change
frequently but I was not able to
regularly contact my doctor”
“I am a type-1 diabetic and for me
the costs of various steps in my
treatment was too expensive to
bear”
Patients Speak
1
2
3
1 2 3
Source(s): Consumer Surveys and In-depth Discussions, Redseer Analysis
Challenges faced by Chronic Patients with Traditional Healthcare System
Q. What challenges did you face before using the digital platform?
N=449, % of respondents Chronic
diseases
account for
~65% of
deaths per year
and hence any
delays in
receiving care
could be very
risky.

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…owing to the siloed and sub-par health infrastructure in India
Providers
Consumers
Doctor
Pharmacy
Diagnostics provider
Medical insurance
Key Challenges
• Limited presence of integrated providers in the offline
OPD space, pushing chronic patients to coordinate
across different stakeholders for different services.
• Fill rates of unorganized retailers that account for ~70%
of Indian pharma, is 60-65%, leading to considerable
inconvenience for chronic patients
• Presence of multiple touchpoints in the offline OPD
space results in lack of standardized services for chronic
patients who have a multi year treatment journey
• India has still not achieved the ideal patient to doctor
ratio of 1 doctor:1000 patients suggested by WHO, thus
there is a disproportionate workload across doctors,
further exemplified for specialists
• Timely access to care is dependent on doctor presence in
the local catchment area, which otherwise leads to
delays (and the associated risks).
• Only ~27% Indian population is medically insured as
opposed to 91% in US and over 95% in China, leading to
high out-of-pocket costs in India.
• Lack of price/discount parity for end users as no
standard pricing protocol is followed by unorganized
players
Hassle Timely guidance Affordability
Challenge Type:
Challenges faced by Chronic Patients with Traditional Healthcare System
Descriptive
1 3
2
1
1
1
2
2
3
3
Source(s): Consumer In-depth Discussions, Secondary Research, Redseer Analysis

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Health-tech platforms have come to their rescue, by providing an affordable digital
ecosystem covering all the interaction touch-points
Source(s): Expert Discusions, Secondary Research, Redseer Analysis
Category Services part of the Digital Ecosystem Leading Players (Selected Examples)
1. Doctor Consultation
A. Real-time doctor interaction
B. Online doctor consultation
2. Health Monitoring
A. Regular Vital Tracking
B. Monitoring Device Integration (e.g. glucometer, BP monitor)
C. Activity Trackers
D. Treatment / test reminders
3. E-commerce
A. Medicines and injectables
B. Health products
4. Diagnostics A. Online lab test booking
5. Preventive Care
A. Health tips
B. Health Coach
C. Insurance Coverage
Health-tech Ecosystem addressing the Chronic Patient Pain-points
Descriptive

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Health-tech platforms are also enabling doctors to provide timely & accurate
guidance to the chronic patients, thereby improving the quality of outcomes
Doctor pain-points with chronic-patients
1. Inability to track or manage patient health records
2. Lack of regular supervision
3. Patient attrition led by limited adherence to the prescribed treatment
4. Patient base confined to local geography
Digital Patient Management
solution with :
✓ Health record tracking
✓ Real-time patient
supervision
✓ Remote consultation
Leading Players:
(Selected Examples)
“Missing an important health record could severely impact the choice & outcome of my
patients' treatment”
-- Diabetologist
“I have usually seen that once the patient goes out of my clinic the adherence drops
sharply, which in turn impacts their overall health”
-- Endocrinologist
“A lot of my patients’ face a severe case of diabetes because they did not adhere to the
given treatment as there was no supervision to guide them”
-- Diabetologist
“Multiple patients, whom I used to treat for years had to move because of COVID-19
pandemic and post that there was no way except for call for us to be in touch”
-- Cardiologist
Source(s): Doctor In-depth Discussions,, Redseer Analysis
Challenges faced by Doctors (who treat chronic patients)
Descriptive
Pro

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Thereby playing a crucial role in reducing the severe burden of chronic diseases in
the country
65%
25%
10%
Chronic
Acute
Injuries
Chronic diseases
exert more severe
disease burden in
India as they
account for ~65%
of deaths per year
India fatality split by type of diseases
Percentage of deaths, as of 2019 Key Highlights
• Chronic diseases have the highest fatality count in India
across all the diseases, with top 3 diseases leading to
fatalities belonging to the chronic diseases category
• Heart diseases are the biggest contributor (16.17% share)
to the fatality count followed by COPD at 9.57% share and
stroke at 7.44% share
• Diarrhea (6.73%), Neonatal disorders (4.67%), and Lower
respiratory infections (4.62%) are the three biggest fatality
causes within acute diseases
• In case of Injuries, falls and road injuries being the largest
contributors within injuries
Source(s) : Healthdata.org

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These elements provide chronic-first health-tech platforms access to a large ~$40
Bn TAM
Further growing on account of rising prevalence, preventive-care focus and inflation
Increasing prevalence
The number of chronic patients has been rapidly
increasing for the past few years and is
expected to increase further going forward
driven by Indian genetics, lifestyle, rapid
urbanization, and stress
High medical inflation
Medical inflation is also rapidly increasing at
around 7% per annum and this trend is expected
to continue going forward. Inflation is relatively
lower for pharmaceuticals
Increasing adoption of preventive services
People are getting more aware of their health
issues and the dangers of chronic diseases.
This coupled with increasing supply and
availability of preventive treatments has led to
an increase in their adoption
20%
35%
17%
29%-36%
28%
2021
25%-31%
Others2
18%-24%
20%
2026P
Diabetes
Hypertension
CVD
39
57-110
+8% to +23%
23% 20%-38%
Penetration in the
overall healthcare
Chronic care market size, 1
USD Bn, 2021-26
Key growth drivers
Source(s): Redseer Sizing Model
Note(s) : 1. Calculation assumes that Diabetes, Hypertension and CVD make 80% of the chronic care market 2. Others constitutes of spend on chronic diseases such as asthma,
arthritis, COPD, etc.

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More than 50% of the chronic care TAM is concentrated among the 20-50 yr.
population and is dominated by the urban segment
Source(s) : RedSeer sizing model, LASI
29% 19% 51%
60+
1%
India Chronic-care
Market Split by Age
<20
50-60
USD 39 Bn
20-50
Chronic care market size split by age1
USD Bn, %, 2021
Chronic care market size split by location2
USD Bn, %, 2021
45% 55%
Urban
India Chronic-care
Market Split by Location
Rural
USD 39 Bn
Key Highlights
• Significant number of people between
the ages 20-50 suffer from diabetes,
with some patients being in the <20
age bracket as well driven by type-1
diabetes which is genetic in nature
• Further, for hypertension as well 20-50
is the largest age bracket with limited
number of patients in the <20 age
bracket
• The burden for CVD is skewed
towards the 60+ age bracket as these
diseases are usually the consequence
of hypertension and diabetes
• Across the three diseases, prevalence
is slightly higher in urban areas
compared to rural areas
Note(s) : 1. Calculation for chronic care market size split by age is done based only on the overall volume of patients in each age bracket and does not incorporate for variances
in spend pattern that may exist across age groups; 2. Calculation for chronic care market size by location is done only based on volume of patients present in each area and
does not incorporate spend variances across urban or rural

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~$13 Bn of the opportunity is currently serviceable by health-tech platforms and
these platforms cover less than <1% of it, indicating a large growth potential ahead
Source(s): Redseer Sizing Model, Redseer IP
Chronic Health-tech Models’ Addressable Market in India
USD Bn, 2021
USD 167 Bn
India healthcare market size
USD 39 Bn
India chronic care market size
(TAM)
USD 17 Bn
India urban chronic care OPD
market size
USD 13 Bn
India urban chronic care
OPD market for
smartphone users (SAM)
<1% of SAM
Currently penetrated by
chronic-first health-tech
models, indicating a large
headroom for growth

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Going ahead, chronic-first health-tech platforms can strengthen their position via
tapping into the adjacent market segments and upgrading their stakeholders’
experience
Pre and Post in-
patient care
Data Monetization
Additional Disease
Coverage
Full stack ePharma
Extensive and
engaging health
tips
Adjacent Opportunities Stakeholder Experience Upgrades
Doctor information
protection
Patient side:
Inclusion of verified
health tips
Doctor side:
The Way Forward for Chronic-first Health-tech Platforms
Descriptive
Cover the pre and post IPD portion of
care specially for chronic patients like
stroke rehab
Utilize the huge database of chronic
patient’s activity and monetize it via
health enterprise partnerships
Extend the existing chronic disease
ecosystem to other chronic diseases
such as nephro, arthritis based on the
disease demand
Transition from a call based to
an app-based ordering system
Enrich the health tips section and
customize as per audience
Doctor vetting of health tips to
ensure consistency with
treatment
Restricted access to doctor
personal info to ensure their
privacy
Source(s): Consumer and Doctor research, Expert Discussions, Redseer Analysis

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Source(s) : RedSeer Research, UN Human Development Report, Economic Survey of India
Note(s): 1. BRCS- Brazil, Russia, China, South Africa
0%
5%
10%
15%
20%
5.4%
16.8%
5.9%
10.2%
In this manner, health-tech platforms are empowering India to prioritize its
spending towards health, which is quite behind the global standards
World Average
9.85%
BRCS1
Healthcare Spend (Government + Private) as a % of GDP- Global Benchmarks
%, India- 2021, Others- 2019
Significant need and
headroom for prioritization
of healthcare expenses in
India, which are quite behind
the global standards

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