The Telemedicine Ecosystem in India



The onslaught of Covid-19 demanded an immediate stimulus from businesses across sectors in order to survive the unprecedented and prolonged dry spell. This led to the failure of various models but at the same time also to the creation of services and products which were aimed at making life simpler for consumers during this difficult period. E-commerce, healthcare, online media and content houses, technology providing companies are some of the business verticals which not only continued to seamlessly function but also saw major improvement in their numbers. 

Out of all, the healthcare sector has been immensely active, mainly owing to the nature of the situation at hand. In India, the healthcare sector includes hospitals, telemedicine, clinical trials, outsourcing, medical tourism, health insurance and medical equipment. Over the years, the sector as a whole has evolved into a highly advanced space for private players to introduce healthcare services to urban as well as rural India. The involvement of digital solutions has further added on to the increasing reach of the sector. While the state expenditure continues to be low as compared to global averages, new-age private players are taking it in their stride to make accessible and quality healthcare a ubiquity. 

Digitalisation of these services has immensely aided the commercial success of the sector today. The nation’s e-Health market is therefore expected to boom due to the rise in internet penetration and rapid digital transformation, also as a consequence of the pandemic, coupled with rising investor interest and gaining support from the recently introduced measures by the state. Telemedicine is an important part of the e-Health ecosystem being one of the largest contributors to this market. PitchBook estimates that revenue from the global telehealth market will hit $312.3 billion in 2026, up from $65.5 billion in 2019. 


What is Telemedicine?

Broadly speaking, telemedicine is the use of digital and technological infrastructure (eg. voice and video calls) by healthcare professionals which allows them to evaluate, diagnose and treat patients at a distance. The use of telecommunications tech aids in providing substantial medical and healthcare services to previously non-accessible regions. Earliest published records of telemedicine are in the first half of the 20th century when ECG was transmitted over telephone lines. From then, telemedicine has come a long way, with the help of the booming startup ecosystem, the delivery of these services has become much more efficient. In India, ISRO took the first steps creating a long lasting legacy for future commercial players in the field. In the States, the use of telemedicine was made by the University of Nebraska in 1959 and then later by NASA for disaster management in the 80s.

So what is telemedicine actually used for? The core of it, as mentioned, lies in the transfer of information digitally. To add on, a report by CB insights terms telemedicine as a collection of providers, platforms and marketplaces, teletherapy, coaching, care management, virtual care enablement, remote monitoring, diagnostic and telepharmacy. Large organisations and startups cater to consumers within these sub-areas with their products and services available on accessible and unified digital platforms.


Telemedicine in India


In November 2019, the Parliament revealed that India has one doctor for every 1,445 people, citing an existing burden in the already fragile healthcare system in India. Out of these, over half of them practice in metros, rendering the rural population helpless. There was and still is a need for a long term and trustworthy solution to solve this, the increasing use of telemedicine might be a start.

The telehealth mechanism was gaining popularity in India even before the outbreak of the pandemic.  In addition to this, the setting up of National Digital Health Authority of India (NDHAI) in 2017 further added confidence to the existing movement in the space. The policy operates with a macro vision to achieve high quality health services for all Indians through the cost-effective and secure use of technology in the field. Other initiatives such as the State Telemedicine Network (STN) are also on the cards, allowing telemedicine players to comfortably grow in Tier 2 and Tier 3 locations.

The pandemic evidently pushed the boundaries of these services, as remote consultation worked exceedingly well during nationwide lockdowns. In March 2020, telemedicine guidelines were issued which clarified the rules and regulations for startups and investors in this space. The Indian healthtech market is expected to reach $21.3 billion in 2025 and the e-Health market will continue to grow at a compound annual rate of 39.6%. Out of this all, telemedicine is expected to represent a total value of $5.4 billion in the same time period with a CAGR of 31%. 


Practo, Lybrate, Doc Prime, mFine and DocsApp are few of the Indian startups delivering telemedical services at large. These services most commonly are inclusive of teleconsultation, diagnosis and also cater as e-pharmacies. The technology used by these companies is easily applicable with the help of existing technological infrastructure like cellphones, cameras, wearable biosensors for clinical information and therefore, the spread of their use is at a much quicker pace. India is now home to more than 130 funded e-Health startups and over 5,500 healthtech startups. Practo, which is based in Bangalore, had a general physician typically ‘advise’ 25-30 patients a day, during the pandemic it witnessed up to 4x jump in the number of patients. Another Delhi based startup, myUpchaar, also saw a 3x jump in consultation requests.  The Centre’s telemedicine portal “eSanjeevani'' recorded ~7 million consultations across rural-urban geographies until July 2021.  Prior to this, the Indian telemedicine market operated in a grey area, the introduction of the previously mentioned policies cut out clear paths of these startups to ethically offer their services without any major threat looming over the business and its customers.


What are some of the Indian cos brewing?

To understand the true applicability of telemedicine as a permanent solution, let us have a look at what exactly some of India's booming healthtech companies have to contribute. 


Practo, founded in 2008,  provides a comprehensive medical directory with services like online appointment booking, online consultation, medicine delivery and even diagnostics. Practo has boarded over 100,000 doctor partners catering to over 30 crore patients in a year globally. 

1mg, a common name today owing to Tata’s purchase, emerged to be India’s leading digital consumer healthcare platform. 1mg’s services majorly include a robust e-pharmacy, diagnostics and digital consultation. 

myUpchar focuses on the vernacular limitations and thus provides services in 5 Indian languages along with English. This proves to be an efficient solution as most of the companies have their portals in all-English formats making it difficult for the population in the rural parts of India. 

Televital offers a B2B FDA approved and patented real time cloud-based solution that helps monitor vital signs. It has also developed various commercial models such as one time licensing, SaaS, PPP, patient centric and many more. Televital is currently investing to provide clinical decision support systems while working on intelligent medical devices to provide advanced solutions and to support and enhance patient investigations in rural areas.

Pristyn Care is involved in the surgery spectrum, giving patients access to over 100 full-time experienced surgeons and a well connected network of clinics. These services are enabled by their online interface which is inclusive of ancillary services like appointment scheduling, insurance handling, post surgery formalities, etc. 

SkinKraft taps AI driven technology to provide dermatologically approved and customised skincare solutions to customers with its direct-to-home model. The company’s key product  ‘SkinID’ – helps in customising individual kits and curating unique experiences for each user. 


What does the funding in the space look like?

In the first half of 2021, 53 deals were recorded in the healthtech sector amounting to $700 million. The rapid adoption of digital technology across geographies in India, increasing awareness of regular checkups triggered by the pandemic and competitive pricing of the services have given a comfortable space for the sector to grow, as mentioned previously. In addition to this there are still several gaps in the India healthcare system which have been strategically identified by entrepreneurs and thus resulted in an opportunity to build successful models, simultaneously providing investors a chance to back these viable solutions. 

Globally, the nascent telemedicine ecosystem is beginning to show signs of maturity. So far in 2021, early-stage deal share is tracking at a historical low — and late-stage share is at a high. There was a major increase in capital flow in the European as well the North American market as compared to Asia. The market driving forces outside of India mainly include the increasing emphasis on improving patient experience, pressure from long term telehealth regulatory reforms, focus on health inequity and of course digital transformation. Global telehealth investment rose for the fourth consecutive quarter, growing 17% QoQ and 169% YoY to reach a record high of $5 billion across 163 deals. During Q2’21 alone, 6 telehealth companies joined the unicorn club, bringing the count to 27 with an aggregate value of $55 billion.


100X.VC and Healthcare

Sensing the massive scope of opportunity and taking advantage of the open field that is available in India due limited tapping in the sector, 100X.VC identified a couple of game-changing ideas which are now on their path to contributing successfully to the healthtech and telemedicine ecosystem. 

MindPeers, a 100X.VC Class 02 company, is on its way to emerge as Asia’s first holistic behavioural healthcare platform. Though not originating completely from the traditional basis of telemedicine, Mindpeers is an all round mental health platform that connects users and businesses. It provides a personalised care plan inclusive of remote consultations and integrates mind well-being with physical healthcare to prevent non communicable diseases caused by stress and psychological issues. It combines technological empathy and human expertise to provide science backed interventions. 

DCode Care is a patient education and engagement platform. They help cancer patients find suitable care through research-driven online tools. Patients and caregivers can discover options of doctors and hospitals available to them, get guidance from past patients’ communities and seek assistance during their care process from DCode Patient Navigators.  A part of Class 03 of 100X.VC, DCode is leveraging their knowledge in cancer research and diagnostics combined with technology that helps users with customised expert recommendations for their specific cases.

My Ava is working towards solving problems regarding women's health and wellness. It is an application to help women with chronic conditions like PCOS with their deep-tech enabled programs. The portal helps women choose health plans, consult experts and book appointments according to the specialisation of the expert. In addition to this, Ava is striving to build a community of women on its platform to discuss matters related to wellness and health. 

Smiles.ai offers economical dental care from experts by leveraging technology. Patients can take up digital/video consultations or even in-clinic consultations with tech like Intra-Oral Scanners, 30 Second X-ray machines and 3D printers. They offer these services with the help of trusted doctors with specialisations and years of experience. 

Cora Health is a social commerce marketplace for health foods. Cora helps customers discover products suited to their health goals through the guidance and recommendation of a trusted online community. In addition to this, they also provide their users with upfront information from dietary preferences, diet choice match all the way to the last nutrients. 

The Renal Project is helping affected patients cope up with the dearth in easy availability of kidney care. They do this by setting up micro-dialysis centres and making temporary/emergency dialysis services available. Their mission is to revolutionise the availability and delivery of dialysis therapy to the ever-increasing population of kidney patients. 

We strongly believe that the telemedicine ecosystem, in the coming years, will provide a lucrative platform for entrepreneurs to showcase their innovations considering the increasing support from two very important stakeholders, the customers and the government.


Key Challenges

It would be imprudent to disregard the obstacles that stand in the way of the sector’s success even with a booming future as mentioned above. Apart from the unequal savviness of technology across regions in India, the core of telemedicine lies in exchange of information, more importantly, the exchange of sensitive information digitally. This itself poses a big concern owing to security and privacy issues. The handling of sensitive information is an integral part of their daily operations, a breach of any kind can prove to be disastrous for the company as well the nation’s healthcare system. Investors, too, are aware about this. 

Another big challenge is the fluctuating results with different technology tools which could lead to inconsistencies in health outcomes, and platform integration challenges for patients visiting multiple providers. There can be instances which lead to misinterpretations and ultimately result in wrong diagnosis. These kinds of situations are extremely difficult to handle, both in the sense of providing a service as well as from the point of view of running a business. Investors therefore approach these startups with caution and in-depth knowledge of the product and their mode of delivery. 


What can be done?


One cannot hope for the above challenges to magically subdue, specially in a country like ours. On a broader level, it is necessary to work towards protecting the public-spirit of healthcare without diluting it in the race for commercial success and agenda. Secondly, establishing tight knit governing policies should top the state’s priority list. Creating an ecosystem with smooth frameworks and procedures will result in boosting the investors’ confidence and at the same time drive the founders to polish their products even more. 

As the general public gets comfortable with the current pandemic stricken lifestyle, the need for telemedicine will undoubtedly continue to rise. India is currently in a prolonged transformative stage which is fueled by a series of experiments which will result in a product mix fit for the Indian society.  For the present digital penetration in the healthtech startup ecosystem to emerge as a success, active and equal participation from the private and public sector is mandatory. While the private side will try to fill in the gap with innovations and put talent to correct use, the state will be needed in order to protect the rights and privacy of the public at large. Obviously, the heavy use of this technology is not a fair comparison with in-person appointments with doctors; a hybrid model, however, will be an integral part of the revolutionary change that India’s health sector is witnessing today. 


Future of Telemedicine in India

These pocket-pleasing estimates for the sector  can be justified with the opportunities which are originating from the advanced technology being used by startups. The dynamic nature of the field demands the teams to be ever ready in order to come up with the best solutions. Today, in addition to the current telehealth solutions, ParaTelemedicine is gradually gaining popularity engaging with the pool of paramedics and emergency responders. Companies are also making use of AI to elevate customer experiences as an attempt to bring it as close to real experiences. Further on, the technology and networks developed by these startups will also hold immense value for already existing organisations. This seems to be a comfortable transition to the maturity phase, we have seen this with Tatas acquiring a majority stake in 1mg and the acquisition of Netmeds by Reliance. 


100X.VC is the first VC to invest in early stage startups using India SAFE Notes. We fund exceptional Indian founders. We deeply value our relationships with founders, co-investors, and corporations.

This article is by 100X.VC Research with contributions made by Misri Kothari, Analyst Trainee at 100X.VC

- 100X.VC Team

Published on: August 5, 2021