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COVID-19 has helped people to seamlessly switch to home healthcareNew Delhi: Rajiv Mathur, Founder & Executive Chairman, Critical Care Unified shares with ETHealthWorld’s Prabhat Prakash on the importance of home healthcare, how patients are now choosing to be treated at home rather than being admitted in a healthcare centre and how home healthcare will boost the healthcare sector.

How big is the home healthcare industry in India (current scenario)?

Home healthcare is becoming increasingly popular around the world. By 2026-2027, the global home healthcare industry is expected to reach $390 billion while the Indian home healthcare market which is currently approximately worth $5.2 billion is expected to touch $13.5 billion. This expansion will be aided by digital technology which will open up new markets and allow more healthcare services to be consumed at home. The tremendous growth of the home healthcare market is expected to generate three million new jobs by 2025.

Worldwide, countries are continuing to implement integrated care delivery systems within home healthcare, with attendant benefits of enhanced capacity, efficiency and lower cost of care. India has shortages in terms of the ratio of clinicians and installed capacity at hospitals to the size of its population. Home healthcare has started to play an important role in bridging this gap.

In the last few years, Indian home healthcare has matured from providing basic nursing care to comprehensive and intensive care at home. From being a largely unorganised sector, home healthcare is fast emerging into a structured and professional industry delivering quality care with the adoption of internationally accepted protocols.

What is the role of technology in the home healthcare space? What are your views on this?

By definition, home healthcare is remote. Therefore, from a monitoring and support perspective, technology plays a significant role in the provision and delivery of services. Innovation in digital orientated healthcare delivery systems is allowing real-time monitoring of patients’ vital parameters thus enabling a proactive approach to treatment review and modification.

Telemedicine is gaining increased adoption which ultimately will allow better management within the healthcare continuum, including self-care. The scope and role of tech-driven healthcare offerings were evident during the waves of the pandemic when a range of services was delivered remotely and virtually. Smart use of technology has the potential to capture critical data across various ailments and demographics allowing scaling and affecting outcomes.

What difference has the COVID-19 pandemic brought into the home healthcare space?

The pandemic’s arrival in 2020 exposed severe inadequacies of India’s healthcare infrastructure at all levels, including the lack of ICU beds, oxygen supplies, and healthcare staff across the country. With the healthcare ecosystem collapsing under the pandemic, not only was there a major scarcity of beds at hospitals but also the fear of patients getting exposed to the virus. This led to the inevitable shift from hospitals to hospital-grade care at home, which introduced many families to the multiple benefits of this option such as safety, convenience, and also cost-effectiveness. While many households may have reluctantly resorted to home healthcare as their last option during the past two years, it has now become the first preference for many, who see great value in it. Though it would have been difficult to imagine a full-fledged ICU set-up being recreated at one’s home just a few years ago, COVID-19 has helped people to seamlessly switch to home healthcare. This has been one of the major effects of the pandemic on this sector.

How has the organisation transformed since its inception? What are the learnings from the patient side and as a provider from the pandemic?

Over the past five years, CCU has had a sharp focus on unit economics and its operations have been consistently profitable; a great break from the traditional EBITDA negative model in the startup sector and amongst its peers.

Leading hospitals and clinicians across India are supporting our ‘ICU at home/critical care services at home offers. We are the preferred partner for these hospitals for providing critical care services at home. Our service has crossed over 10,000 critical care patients in the last five years. There is a long list of success stories including patients with severe multi-organ illnesses, debilitating COVID-19 side-effects, immuno-compromised patients, and also patients getting critical care in their homes in small Tier 3/4 towns.

We have fine-tuned the model of delivering critical care services in small towns with remote monitoring and support. Underpinned with technology, this model will enable scaling up to about 30 cities in a 2/3 year time frame.

In addition, developed robust SOPs and clinical pathways to deliver critical care services across various specialities including, neurology, oncology, pulmonology, cardiology and organ transplant care. With emerging centres of excellence (COEs) in these specialities, we endeavour to raise the level of critical care at home to an unprecedented level of quality.

What are the challenges faced while setting up units for home-based care in urban and semi-urban areas?

With home healthcare becoming an important component in the continuum of healthcare delivery, several challenges are being faced in enabling a rapid scaling up of offerings and penetration within the country.

Currently, the lack of availability of comprehensive insurance plans limits the scope of consumption of these services in the home. With long term chronic illnesses and high costs of care in private institutional settings, financial resources are depleted to an extent that patients or patients’ families start compromising on both composition and quality of care required. Availability of insurance plans can be a game-changer also enabling the lower cost of care via home healthcare offerings.

Inadequate supply of adequately trained healthcare staff poses another challenge. A significant amount of resources are required to train staff in delivering services in a home setting – both clinical as well as soft skills.

In addition, the role of the family is important during the healing process. Advantages of care and healing at home get negated if cooperation and support of the family are lacking. They need to be counselled in terms of supporting the caregiving staff and educated on some key protocols in the delivery of healthcare services in the home.

Out of all the specialities, which service is most sought after (stats)?

We specialise in providing comprehensive critical care at home. Therefore, in most cases, while there may be a primary ailment, co-morbidities exist. In several cases, our institutes coordinate with a multi-disciplinary team of doctors that drive the treatment.

Setting up an ICU service at home is the most sought after offering. Not only is it 50 per cent or lower in cost, but it also reduces significantly the risk of contracting an infection in an ICU of a hospital which can be fatalistic given the already compromised condition of the patient.

However, nearly 40 per cent of the cases that we treat are from the neurology segment requiring post craniotomy or stroke care. This is followed by pulmonology, oncology, cardiology and nephrology forming another 50 per cent with 10 per cent under the category of general ADL care.

What are your expansion plans? How do you think the market will shape up for you in the post-pandemic scenario?

A tech-driven and robust expansion plan for the next five years include the extension of critical care services to 25/30 cities across India, underpinned with solid technology and propelled by the distinctive hub and spoke model. Given CCU’s expertise in addressing diverse global markets, expansion into chosen international regions where a dire need exists is imminent. Expansion of our services in the future include wound debridement and other critical care services such as chemotherapy at home, as well as a range of diagnostic services like ECG, X-Ray and ABG. We also want to establish a technology blueprint that will use analytics, AI, and IoT to enable effect on outcomes.

With only one lakh ICU beds out of a total of 20 lakh hospital beds in the country, the need and growth potential for our services is exponential. Coupled with the groundswell in the adoption of home care services and technology-based offerings, consumption of home healthcare services is at an inflexion point.



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