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RETAILInsight




                                      Healthcare Retail:
                                      Picking up pace
                      Kapil Khandelwal says that healthcare retail emerged as a
                      concept around two years ago. However, its convergence
                         with cross-domain sectors like retail, education and
                             manufacturing is a very recent development




     O
           Over the last few years, the Indian retail, healthcare and   Organised retailing
           information communications and technology (ICT)              In urban India, it is estimated that over 200 retail stores
           sectors have undergone rapid growth and transition to        and malls are in the pipeline, with over 200 million
           meet the western standards of quality and service            square feet of space. Under the current circumstances,
           delivery. However, the current economic slowdown is          with the lowering of rental yields and higher cost of
           forcing each of these sectors to rethink their business      finance, it is imperative to innovate newer retail models.
           and operating models and innovate.
                                                                        Healthcare retailing and care delivery
           Current trends and challenges ahead                          With approximately 4-5 percent of the overall organised
           The current economic scenario has created several            retail space in urban India dedicated to healthcare and
           systemic shifts in the way retail, healthcare and ICT        allied products and services, there is potential to grow
           players can leverage the emerging consumer trends            and be at par with our western counterparts.
           and challenges.
                                                                        ICT services
                                                                        ICT players and solution providers in India have
                                                                        introduced new low-cost solutions that can serve a
                                                                        potential population base of over 70 million in urban and
                                                                        semi-urban India. The role of ICT services is expected to
                                                                        grow the distribution of healthcare delivery outside the
                                                                        traditional setting of the doctors clinic. With the kick-off
                                                                        of national ID initiative announced in the recent budget,
                                                                        a unique ID would serve in enabling a portable
                                                                        healthcare record system in a seamless health
                                                                        information system linked to the unique ID by the
                                                                        healthcare and ICT solution providers.

                                                                        Consumer needs and preferences
                                                                        There are potentially over 40 million households in
                                                                        urban and semi urban areas, predominantly in the
                                                                        northern, western and southern Indian states that have a
                                                                        high risk of chronic diseases, given the genetic
                                                                        disposition. With consumerism in healthcare,
                                                                        households in SEC segments A and B have identified
                                                                        issues to access and price their wellness, preventive,
                                                                        curative and chronic healthcare, pharmacy and
                                                                        support services.
                                                                            With the current economic slowdown, there have
                                                                        been increased preferences to switch and delay wellness
                                                                        and preventative care products and services. Consumers
                                                                        also prefer providers who can give appointments the
                                                                        same day, consult over the phone, or extended hours and

      24   RETAIL BIZ JULY 2009
RETAILInsight



on weekends or holidays in the same shopping vicinity,
avoiding long trips. Clearly, price and proximity matters
as consumers are altering their shopping patterns for
price, availability and access. Some of the above
emerging trends in the sectors are enabling a
convergence and a paradigm shift towards health retail
2.0. that leverages on the convergence of retail and
healthcare delivery integrated with ICT solutions.

Healthcare retail 2.0: Conceptual framework
Healthcare retail 2.0 emerged as a concept around two
years ago. However, its convergence with cross-domain
sectors like retail, education, manufacturing, etc is a very
recent development. There are several key characteristics
that emerged as a result of this:
    A new location or a way of connectivity between
patients, and patients with their care provider
    The sharing and transparency of information about
care, health and providers, and the support in choice and
delivery of healthcare care in a retail format
    The self-management and access to health
information of individual patients in any health status,
whether healthy or chronically sick
    Interoperability of health information, which benefits
the sharing and access to this information leveraging ICT
technologies from one service provider or location              quick consultation and turnaround for the whole
to another                                                      spectrum of healthcare, right from wellness to chronic
    The empowerment of patients through widespread              disease management. Such clinics would have specialist
and richness of information to make choice on the               physicians available for consultation virtually, for referral.
location of his care and its setting
    The open conversation about and innovation of health        Emerging retail formats
care through consultation of all stakeholders and               Some of the newer formats that would emerge out of
application of a new business model based on multiple           health retail 2.0 convergence would be ones that create
value creation                                                  new innovative and disruptive delivery models of
    Growing role and importance of various players and          healthcare in India. These would include:
intermediaries, who enable the conversation between                 In store clinics:
patient and caregiver, at the same time contributing to it      These clinics would look like urgent care clinics that
                                                                would be located in retail/pharmacy chains with a space
     The branded healthcare clinic chains have been in          of 100 to 200 sq feet. The nurse/general practitioner
India for a few years with well established names such as       would have access to specialists for referral to the hospital
Apollo, Manipal, Fortis, Kaya, Ayush, VLCC etc. to name         chain to which it is affiliated. These clinics would be
a few. Newer ICT-enabled models such as EMRI, HMRI,             operated seven days a week with extended hours.
Healthcare Magic, etc have also emerged as a                        Medical spas:
complement to delivering healthcare consultation and            These would potentially be offering lifestyle oriented
response remotely. Initiatives in rural India are already       consultations within salons and spas. They would address
ongoing to ensure that the village entrepreneur who is          areas from nutrition, exercise to massage, cosmetic
operating the Information Kiosks can also enable                surgery etc. These outlets would be affiliated to beauty
ICT-enabled healthcare delivery. Diagram 1 in this article      and cosmetic counters.
provides a contextual frame of reference for healthcare             Express health and diagnostic clinics:
retail 2.0 operating model.                                     Typically staffed by a nurse or a general practitioner, these
     With potential retail space available in metros, urban     are walk-in clinics to facilitate quick diagnostic and check
and semi urban at lower rentals, there is potential for a       up for non-emergency care for preventative and chronic
business model of conveniently providing standardised,          care.
fast, limited services at transparent prices by retail chains       Health and wealth counselling:
in partnership with pharmacy or healthcare clinic chains.       These clinics would provide specialist counselling
These clinics would be enabled by technology to facilitate      sessions that would involve both a health assessment and

                                                                                                         RETAIL BIZ JULY 2009    25
RETAILInsight



           insurance/wealth management advise including product               Cost:
           solicitation. The formats here could be single brand           While consumerism is forcing transparent low-cost
           or multi-brand.                                                models to emerge, successful models would be the ones
               Specialist clinics:                                        that can clearly provide value at lower operating costs. A
           Linked with particular brands and products, these clinics      transparent menu card pricing approach for the services
           would offer scope for augmentation through specialist          would drive traffic. While costs and time are critical
           consultations with dermatologists, dietician, dentists etc.    elements of this model, retailing of healthcare would need
               Call center-based disease/case management with
                            b                                             to create an ambience which is in line with these.
           community clinics:                                                 Standardisation of services:
           This model emerged in the US where case managers are           Care delivery models that would have standarised process
           assigned to the patient who is chronically ill. In case of     would have the biggest impact on the cost and value
           any consultation or walk-ins required, the patient walks       delivered. These could be stretched further to include
           into the in-store clinics in their community.                  quality measures to improve on the services and the care
               Kids health and wellness:                                  outcomes.
           These clinics are within children stores that can provide          Time and place convenience:
           easy diagnosis for common ailments and also                    One of the critical riders of success of such models is the
           vaccinations and inoculations that are due.                    ability to provide seamless 24x7 anytime, anywhere
                                                                          service. ICT technologies coupled with location of
           Key success factors for healthcare retail 2.0                  such clinics would augment the value of the
           While the jury is still out there to evaluate the emerging     services delivered.
           shifts in healthcare delivery innovation in India, some of         Branding:
           the critical success factors to this emerging model for care   Services co-branding with healthcare products/services
           delivery include:                                              provider would definitely positively associate with such
               Integration with hospital provider:                        services and also enable additional foot falls into the retail
           Consumer confidence to such disruptive innovation in           outlets.
           healthcare delivery would be instilled if there is a               Information technology:
           branded hospital provider supporting the seamless              Affordable, compact diagnostic devices that are
           delivery of care.                                              connected with healthcare ICT systems and evidence-


                   Diagram 1


                                               Wellness               Health Status             Disease Treatment
                                             & Prevention            (CDC Adapted)               & Management


                                             Heally       Vulnerable        Affected          Sick (Acute)      Sick (Chronic)


                         Virtual

                         Home
              location




                         Work                                              Employee clinics

                         Outpatient clinic                                Healthcare retail 2.0


                         Emerging                                   Urgent care clinics (After hours)


                         Hospital

                         Long-term care



      26   RETAIL BIZ JULY 2009
RETAILInsight




based health information systems are the key to success     in India, these clinics would be low-cost access points for
for any retail-based healthcare delivery model.             customers and opportunity to augment their service
    Continuity of care:                                     offerings.
As the retail models of healthcare delivery would evolve        Venture funding and investors:
over time to become mainstream, the need for continuity     The key driver for growth of such innovative models for
of care for conditions is important. Linkages through       healthcare delivery would be funding for such outlets.
hospital tie-ups and information systems is an important    There is potential for PE and VC firms to explore such
aspect here.                                                models for entrepreneurial investments in healthcare
                                                            that provide quicker break even and exits in less than
Key stakeholder perspectives                                three to four years timeframe.
The win-win from various stakeholders in the emerging           Quality accreditation agencies:
healthcare retail models would have to be analysed to       Agencies like NABH, JCIA etc would have to evolve
ensure that tweaks are made appropriately for long-term     approaches to ensure that these models are accredited to
success:                                                    provide consumer confidence.
    Retailer/mall host:                                         Consumers:
The retail player gains through participation in the        The healthcare retail models offer consumers to decide
model by ensuring increased foot falls and private label    how, when, where to seek healthcare services from a
sales. Apart from lease rentals and/or profit sharing,      wide range of options and formats. Most conventional
other incremental revenue streams that would accrue         healthcare providers may disagree about what the
from this model include shelf slotting fees, co-promotion   patients think and require. However, the innovation life
and sponsorship.                                            cycle in retail takes three to five years to mature as
    Healthcare retail operator:                             compared to over 15 years in healthcare and hence this
While the economics for the healthcare retail operator      could lead to breakthroughs in meeting consumer
are challenging, the operating costs have to be managed     requirements.
tightly. The pricing strategy would have to ensure that         With the successful emergence of various
there are adequate number of customers averaging four       healthcare retail formats and transparency of
to five per hour.                                           information about care, health and providers, and the
    Healthcare insurance providers:                         support in choice and delivery of healthcare care in a
While outpatient visits are currently not covered by many   retail format, there is nothing can that stop healthcare
of the health insurance providers in India. These models    retailing in India from moving forward and achieving
could enable newer products that would cover outpatient     an 'at par' status with its western counterparts in the
health insurance as well as tie-ups for health-wealth       years to come.
counselling setting to solicit health insurance coverage.
   Disease management providers:                            The author is one of India’s leading experts in healthcare and
As new models of chronic disease management emerge          life sciences IT in Asia Pacific and emerging markets.


                                                                                                        RETAIL BIZ JULY 2009   27

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Paradigm Shifts In Healthcare Retailing Biz Models

  • 1. RETAILInsight Healthcare Retail: Picking up pace Kapil Khandelwal says that healthcare retail emerged as a concept around two years ago. However, its convergence with cross-domain sectors like retail, education and manufacturing is a very recent development O Over the last few years, the Indian retail, healthcare and Organised retailing information communications and technology (ICT) In urban India, it is estimated that over 200 retail stores sectors have undergone rapid growth and transition to and malls are in the pipeline, with over 200 million meet the western standards of quality and service square feet of space. Under the current circumstances, delivery. However, the current economic slowdown is with the lowering of rental yields and higher cost of forcing each of these sectors to rethink their business finance, it is imperative to innovate newer retail models. and operating models and innovate. Healthcare retailing and care delivery Current trends and challenges ahead With approximately 4-5 percent of the overall organised The current economic scenario has created several retail space in urban India dedicated to healthcare and systemic shifts in the way retail, healthcare and ICT allied products and services, there is potential to grow players can leverage the emerging consumer trends and be at par with our western counterparts. and challenges. ICT services ICT players and solution providers in India have introduced new low-cost solutions that can serve a potential population base of over 70 million in urban and semi-urban India. The role of ICT services is expected to grow the distribution of healthcare delivery outside the traditional setting of the doctors clinic. With the kick-off of national ID initiative announced in the recent budget, a unique ID would serve in enabling a portable healthcare record system in a seamless health information system linked to the unique ID by the healthcare and ICT solution providers. Consumer needs and preferences There are potentially over 40 million households in urban and semi urban areas, predominantly in the northern, western and southern Indian states that have a high risk of chronic diseases, given the genetic disposition. With consumerism in healthcare, households in SEC segments A and B have identified issues to access and price their wellness, preventive, curative and chronic healthcare, pharmacy and support services. With the current economic slowdown, there have been increased preferences to switch and delay wellness and preventative care products and services. Consumers also prefer providers who can give appointments the same day, consult over the phone, or extended hours and 24 RETAIL BIZ JULY 2009
  • 2. RETAILInsight on weekends or holidays in the same shopping vicinity, avoiding long trips. Clearly, price and proximity matters as consumers are altering their shopping patterns for price, availability and access. Some of the above emerging trends in the sectors are enabling a convergence and a paradigm shift towards health retail 2.0. that leverages on the convergence of retail and healthcare delivery integrated with ICT solutions. Healthcare retail 2.0: Conceptual framework Healthcare retail 2.0 emerged as a concept around two years ago. However, its convergence with cross-domain sectors like retail, education, manufacturing, etc is a very recent development. There are several key characteristics that emerged as a result of this: A new location or a way of connectivity between patients, and patients with their care provider The sharing and transparency of information about care, health and providers, and the support in choice and delivery of healthcare care in a retail format The self-management and access to health information of individual patients in any health status, whether healthy or chronically sick Interoperability of health information, which benefits the sharing and access to this information leveraging ICT technologies from one service provider or location quick consultation and turnaround for the whole to another spectrum of healthcare, right from wellness to chronic The empowerment of patients through widespread disease management. Such clinics would have specialist and richness of information to make choice on the physicians available for consultation virtually, for referral. location of his care and its setting The open conversation about and innovation of health Emerging retail formats care through consultation of all stakeholders and Some of the newer formats that would emerge out of application of a new business model based on multiple health retail 2.0 convergence would be ones that create value creation new innovative and disruptive delivery models of Growing role and importance of various players and healthcare in India. These would include: intermediaries, who enable the conversation between In store clinics: patient and caregiver, at the same time contributing to it These clinics would look like urgent care clinics that would be located in retail/pharmacy chains with a space The branded healthcare clinic chains have been in of 100 to 200 sq feet. The nurse/general practitioner India for a few years with well established names such as would have access to specialists for referral to the hospital Apollo, Manipal, Fortis, Kaya, Ayush, VLCC etc. to name chain to which it is affiliated. These clinics would be a few. Newer ICT-enabled models such as EMRI, HMRI, operated seven days a week with extended hours. Healthcare Magic, etc have also emerged as a Medical spas: complement to delivering healthcare consultation and These would potentially be offering lifestyle oriented response remotely. Initiatives in rural India are already consultations within salons and spas. They would address ongoing to ensure that the village entrepreneur who is areas from nutrition, exercise to massage, cosmetic operating the Information Kiosks can also enable surgery etc. These outlets would be affiliated to beauty ICT-enabled healthcare delivery. Diagram 1 in this article and cosmetic counters. provides a contextual frame of reference for healthcare Express health and diagnostic clinics: retail 2.0 operating model. Typically staffed by a nurse or a general practitioner, these With potential retail space available in metros, urban are walk-in clinics to facilitate quick diagnostic and check and semi urban at lower rentals, there is potential for a up for non-emergency care for preventative and chronic business model of conveniently providing standardised, care. fast, limited services at transparent prices by retail chains Health and wealth counselling: in partnership with pharmacy or healthcare clinic chains. These clinics would provide specialist counselling These clinics would be enabled by technology to facilitate sessions that would involve both a health assessment and RETAIL BIZ JULY 2009 25
  • 3. RETAILInsight insurance/wealth management advise including product Cost: solicitation. The formats here could be single brand While consumerism is forcing transparent low-cost or multi-brand. models to emerge, successful models would be the ones Specialist clinics: that can clearly provide value at lower operating costs. A Linked with particular brands and products, these clinics transparent menu card pricing approach for the services would offer scope for augmentation through specialist would drive traffic. While costs and time are critical consultations with dermatologists, dietician, dentists etc. elements of this model, retailing of healthcare would need Call center-based disease/case management with b to create an ambience which is in line with these. community clinics: Standardisation of services: This model emerged in the US where case managers are Care delivery models that would have standarised process assigned to the patient who is chronically ill. In case of would have the biggest impact on the cost and value any consultation or walk-ins required, the patient walks delivered. These could be stretched further to include into the in-store clinics in their community. quality measures to improve on the services and the care Kids health and wellness: outcomes. These clinics are within children stores that can provide Time and place convenience: easy diagnosis for common ailments and also One of the critical riders of success of such models is the vaccinations and inoculations that are due. ability to provide seamless 24x7 anytime, anywhere service. ICT technologies coupled with location of Key success factors for healthcare retail 2.0 such clinics would augment the value of the While the jury is still out there to evaluate the emerging services delivered. shifts in healthcare delivery innovation in India, some of Branding: the critical success factors to this emerging model for care Services co-branding with healthcare products/services delivery include: provider would definitely positively associate with such Integration with hospital provider: services and also enable additional foot falls into the retail Consumer confidence to such disruptive innovation in outlets. healthcare delivery would be instilled if there is a Information technology: branded hospital provider supporting the seamless Affordable, compact diagnostic devices that are delivery of care. connected with healthcare ICT systems and evidence- Diagram 1 Wellness Health Status Disease Treatment & Prevention (CDC Adapted) & Management Heally Vulnerable Affected Sick (Acute) Sick (Chronic) Virtual Home location Work Employee clinics Outpatient clinic Healthcare retail 2.0 Emerging Urgent care clinics (After hours) Hospital Long-term care 26 RETAIL BIZ JULY 2009
  • 4. RETAILInsight based health information systems are the key to success in India, these clinics would be low-cost access points for for any retail-based healthcare delivery model. customers and opportunity to augment their service Continuity of care: offerings. As the retail models of healthcare delivery would evolve Venture funding and investors: over time to become mainstream, the need for continuity The key driver for growth of such innovative models for of care for conditions is important. Linkages through healthcare delivery would be funding for such outlets. hospital tie-ups and information systems is an important There is potential for PE and VC firms to explore such aspect here. models for entrepreneurial investments in healthcare that provide quicker break even and exits in less than Key stakeholder perspectives three to four years timeframe. The win-win from various stakeholders in the emerging Quality accreditation agencies: healthcare retail models would have to be analysed to Agencies like NABH, JCIA etc would have to evolve ensure that tweaks are made appropriately for long-term approaches to ensure that these models are accredited to success: provide consumer confidence. Retailer/mall host: Consumers: The retail player gains through participation in the The healthcare retail models offer consumers to decide model by ensuring increased foot falls and private label how, when, where to seek healthcare services from a sales. Apart from lease rentals and/or profit sharing, wide range of options and formats. Most conventional other incremental revenue streams that would accrue healthcare providers may disagree about what the from this model include shelf slotting fees, co-promotion patients think and require. However, the innovation life and sponsorship. cycle in retail takes three to five years to mature as Healthcare retail operator: compared to over 15 years in healthcare and hence this While the economics for the healthcare retail operator could lead to breakthroughs in meeting consumer are challenging, the operating costs have to be managed requirements. tightly. The pricing strategy would have to ensure that With the successful emergence of various there are adequate number of customers averaging four healthcare retail formats and transparency of to five per hour. information about care, health and providers, and the Healthcare insurance providers: support in choice and delivery of healthcare care in a While outpatient visits are currently not covered by many retail format, there is nothing can that stop healthcare of the health insurance providers in India. These models retailing in India from moving forward and achieving could enable newer products that would cover outpatient an 'at par' status with its western counterparts in the health insurance as well as tie-ups for health-wealth years to come. counselling setting to solicit health insurance coverage. Disease management providers: The author is one of India’s leading experts in healthcare and As new models of chronic disease management emerge life sciences IT in Asia Pacific and emerging markets. RETAIL BIZ JULY 2009 27