Healthcare IT Controlling

Non Communicable Diseases

Karan Singh, Bain & Company

1
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

2
 Quarter of global productivity loss by
2030 will be borne by India
NCD DALYs Years of life lost due to CVD in population

deaths(M) lost(M)
aged 35-64 years, in 2030

52 900

100%

20M

18

India share 17% 24%

3
Source: WHO, Bain Analysis
80

Asia

15
Asia
 Rapid urbanization in India expected
to add to disease burden
High prevalence of risk factors
Prevalence Rural Urban

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

Growing urbanization

Work related
Urban population (M)

39% 64%
sedentariness

500

Resulting high NCD burden

Prevalence Rural Urban

377

400

Hypertension 10% 25%

Ischemic Heart
2.5% 6.4%
300

4 217 Disease
Source: Planning Commission document on NCDs

200
 India has narrow window to reverse
NCD epidemic
Healthcare

per capita

•Major proportion of NCDs

are preventable by tackling
modifiable risk factors
•Potential to prevent ~75% 10

of stroke, heart, diabetes

and 40% of cancer
India

5
Source: Planning Commission
 Need fundamental change in health
system to tackle NCDs
“Sickness focus” “Wellness focus”
Follow Early Prompt Follow
Prevention Diagnosis Treatment Prevention
up Diagnosis Treatment 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

6
 Learnings in tackling NCDs from
developed markets
50% DECLINE IN 35% DECLINE IN 20% DECLINE IN
CHD MORTALITY DIABETES’ MORTALITY
Age-standardized mortality
CANCER MORTALITY
Cancer mortality per

CHD mortality per

(per 1,000 person-years) 1L population

1L male/ female population

within 24 months of diagnosis

1,000 300

48

50

7 800

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 37
40
 Significant portion of reduction from
prevention & early diagnosis

45-60% 10% 30-45%

Prevention Diagnosis Treatment

• Large scale awareness • Multiple • Formulation and use

Cardiovascular campaigns screening of evidence based
disease • Medications for co-morbidities/ programs therapies
risk factors (hypertension, • Secondary • Increased use of
tobacco) prevention advanced treatments
(Aspirin, β-
blockers)

60% 40%
Prevention Diagnosis & Treatment

Diabetes • Lifestyle interventions • Increased access to

advanced drugs
• Large outlay for R&D
• Increased use of

8 advanced drugs
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
 Early intervention can lower cost &
improve outcomes

% decrease in cost of treatment

by early diagnosis
0%

-20

-40
-40%
-60
-60%
-80 -75%
-85%
-100
Cervical Cancer HIV Chronic Chronic
Kidney Artery
Disease Disease

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

9 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
 Where are IT/technology points of
intervention to improve outcomes?

Prevention Diagnosis Treatment Follow up

Number of Diabetes Patients (2011)
100%

80
USA benchmark

60
1
40
2
20
3
0
Urban Diagnosed Patients on Patients on Patients receiving
India diabetics oral tablet insulin approprate care
diabetics mgmt
(estimate)
38M 21M 9M 2.5M

USA 20M 14M 10.5M 4M

10 Note: USA estimates at an overall level including rural
Source: Diabetes International Foundation; WHO; primary interviews; National Diabetes factsheet, secondary research
 Opportunities for IT/technology

1• Improve access via telemedicine, etc

2• Improve treatment – via integrated care

and better capture/sharing of information,
use of protocols

3• Improve adherence – via lower cost IT

enabled disease management programs &
remote monitoring
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 Improving access is a must for early 1
diagnosis
Percent of total
Doctors per 1000
population
1.2B 17K 0.7M 1.8M
100%
5.0
4.7

80
4.0 3.8
3.5
3.3
60 Urban
3.0

2.2
2.0 40
1.7

1.3
1.1
1.0 20
0.6 0.6
Rural

0.0
Spain Denmark UK Turkey Brazil China South India 0
Population Hospitals Doctors Hospital
Germany US Africa
12 beds

Source: Bain Analysis

 Connectivity can help us leapfrog 1
access
MOBILE PENETRATION INTERNET ADOPTION IS SMARTPHONE USAGE
IS RISING @ ~30% RISING @ 25% IS RISING AT ~80%
Mobile phone Internet penetration Smartphone penetration
penetration in India (%) in India in India
100 % 20 % 80%

17
66%
80 79
15 60
69

12
60

10 40

40

5 20
20 4
20
9%
3%
13 0 0
2007 2012 2017
0
2010 2012 2017
2007 2012 2017

Source: TRAI
 Indians sees technology as important 1
means to achieving healthy living
New Delhi New York Munich

What do you expect companies to do to better promote healthy living? 1 Low Importance High 5

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

14 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)
 1
Tele services need to be scaled up

MOBILE TELE
TELEMEDICINE - RADIOLOGY

15 E-ICU
Source: Bain Analysis
 2
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

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 What is potential for “integrated care” 2
in select diseases?
Routine Treatment
Prevention Diagnosis Adherence
Treatment complications

Unorganized fitness
centers

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

17
Source: Secondary research, Expert interviews
 2
Successful integrated care models
to consider
Wellness
Wellness Delivery
Delivery IT/
IT/
Diagnostic
Diagnostic Insurance
Insurance Education
Education
services
services Doctors; Hospitals* Analytics
Analytics

Clinical acute patient bed days

per 1,000 patients

Coomparison of key

health costs stats (US avg indexed to 100)

2,000

18
Note: *Includes rehabs 100

Source: Bain case studies

1,706

100
 Significant unmet needs in IT 2
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

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 Opportunity for adopting disease 3
mgmt, remote monitoring solutions
• Govt. offering ‘call-back’ service to
give counsel on HIV testing; Global
Health shares educational videos via
mobiles

• China: Patients to input data (BP, • Enrolment: >90%;

glucose, weight, etc.), sends to provider
via phone • Clinical: 30-60% reduction in
severe complications in diabetics
• Provider send back customized
treatment plans remotely to patient • Economic: ~10% decrease in
Diabetes’ treatment costs
• Govt-sponsored SMS alerts &
callbacks to TB patients in Thailand
raised medication compliance
rates to ~90%

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 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
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