A subscription model fills gaps in healthcare

Government welfare schemes such as Ayushman Bharat offer free healthcare to the bottom of the pyramid—around 500 million people in India. The top 50 million have access to insurance and premium healthcare either directly or through their employers. That leaves around 600 million people who are the most vulnerable if they fall ill.

Take the case of an Ola driver or Amazon delivery person or a small kirana store owner who has to suddenly pay for hospitalization without insurance. Apart from wiping out savings, the quality of healthcare they receive for their money is often substandard as they have to wait in long queues in government hospitals or resort to quacks. India’s public health expenditure was just 1.29% of GDP in 2019-20 compared to 9.2% in a similar developing country, Brazil.

Bengaluru-based startup Clinikk is trying to reduce this gap with a subscription model combining telehealth, insurance and primary healthcare for those falling through the cracks. For a monthly subscription, averaging ₹300, a person gets access to tele-consultation with a doctor for any member of the family as well as an insurance cover for cashless hospitalization in an emergency. The app is available in 11 Indian languages.

EXPANSION MODE

Clinikk also has five primary care centres in Bengaluru, where subscribers get free consultation and discounts on medicines and tests. They cater to a small fraction of Clinikk’s 110,000 subscribers, but it plans to expand to more locations and cities with Series A funding that’s on the anvil. It has also empanelled 6,600 hospitals through its insurance partners for hospitalization.

“Essentially, Clinikk has created something like a monthly utility bill that takes care of multiple healthcare needs,” says co-founder Bhavjot Kaur. “People don’t understand the value of health insurance. But when you tell them they can also use the product for everyday ailments like common cold or minor injuries, it becomes much more relevant to them.”

Thus, the startup’s product innovation comes from combining services. “The idea is to create a consolidated experience for the customer. Whether it’s a small problem that could be solved over telemedicine or a major issue requiring hospitalization, the customer relies on a single entity,” explains Clinikk’s other co-founder, Suraj Baliga.

For example, back pain is common among Ola drivers. A health assistant initially interacts with the subscriber to get a sense of whether rest and medication can take care of it or if he requires consultation and possible surgery for a disc-related issue. So, a doctor is already primed with a case history by the time he gets involved.

Clinikk has put together protocols for triaging 85% of the health conditions it encounters, says Baliga, who was an orthopaedic surgeon at Manipal Hospitals before turning into an entrepreneur. “We built the protocols after taking inputs from sources like the Indian Council of Medical Research and the US Preventive Services Task Force,” he says. It also has protocols for diagnosis and treatment to ensure some amount of standardization.

What makes the Clinikk model attractive to insurers is its preventive aspect because a number of issues get sorted with early tele-consultation, reducing the need for hospital visits or admission.

For example, early treatment of an upper respiratory tract infection could prevent it from becoming more serious. This brings down the claims ratio for insurers.

“That’s how we are able to keep the insurance premium low,” says Kaur. “We don’t see the product in bits and pieces. It’s the closure of the loop that provides more value to all users of the product.”

Kaur admits it was hard to convince insurers at first to lower premiums for Clinikk’s target segment of people. Even after insurance companies came on board, new support systems were required. For example, there was no call centre for Kannada speakers and the forms were too long for people struggling to read and write.

BIG OPPORTUNITY

The biggest challenge for the four-year-old startup has been to persuade stakeholders that providing healthcare to this segment is a big opportunity, despite the challenges. It was a blue ocean, because services of this nature didn’t exist. “You should see the reaction when a subscriber walks into one of our care centres. They are unsure if it’s OK for them to sit on a chair. But that’s what we had in mind—no matter if the person is a Google executive or an Ola driver, they deserve the same quality of care,” says Kaur.

With more than 100,000 subscribers, and huge untapped potential yet, economies of scale are kicking in. One of the early challenges was collecting payments because of the predominantly cash-based economy in this segment. But the shift to digital payments, which got a further impetus post the covid pandemic, is helping Clinikk. “We got as many new subscribers in the last quarter as we did in the whole of 2019,” says Kaur.

Apart from reaching subscribers directly, Clinikk partners with organizations like Ola and Swiggy to provide services to their staff. The startup also worked with the Goa government to provide telehealth services post-covid across the state. Baliga believes the upcoming national health stack will help Clinikk scale up its services by bringing hospitals, clinics, pharmacies, labs, insurers, doctors and patients, along with consent-based access to their data, on one digital platform. “Integrating with these multiple entities will simply become a matter of integrating with the health stack,” he says.

While Baliga came to Clinikk from a medical background, Kaur was a geophysicist from IIT Roorkee working with energy major Shell. With experience of working on complex projects in multiple countries, she handles the business growth of Clinikk, while Baliga focuses on healthcare aspects.

Kaur’s awareness of the broken healthcare system arose from a personal tragedy. She comes from a small town in Assam that did not even have the primary care required to treat her father’s diabetes. The family shifted him to Chennai with much difficulty when he had renal failure.

“He spent eight months in Chennai and at the end of it, we were not even able to save him. He was the only earning member of the family and had no insurance,” Kaur says.

As for Baliga, his father had come out of destitute-level poverty to become a paediatrician and give him a good education. He met Kaur by chance during an election campaign when they were volunteering for two leading candidates in Bengaluru, both committed to driving a change in the government.

“Her story really inspired me. For me, it was about the impact that technology could make at scale. As a clinician, I was seeing 30-40 patients a day, but today we are reaching more than a lakh,” he says.

Initially, they created a telehealth service, but soon realized that by itself it could not make a dent if people didn’t get access to other services.

“Primary care coupled with financial risk protection was lacking for 600 million Indians. We had to close the loop,” says Kaur.