Speaker: Dr KK Kalra, Director HCFI & Former CEO NABH

18^th November, 2021; 11am-12noon

Key points of HCFI Expert Round Table

• With more than 30 million cases since the Covid-19 pandemic began and more than 400,000 deaths, India was one of the worst-hit countries. This has led to an alarming collapse of the healthcare system, particularly during the deadly second wave. The supply chain mismanagement was quite evident. There was shortage of essential resources like oxygen supplies, medicines and even hospital beds, which left people struggling to fight for the survival of their loved ones.
• Globally, the pandemic has had a great impact on the social, political, economic and healthcare aspects in many countries.
• The heavy toll of this pandemic on human lives and suffering, psychosocial impact and economic slowdown are strong reasons to translate experiences into actionable lessons. This is important not just to prevent similar future crises, but rather to improve the whole spectrum of population health and healthcare delivery.
• Covid-19 has had a significant effect on the Indian healthcare sector too. It practically collapsed initially.
• The pandemic has disrupted the provision of routine care, forcing providers and patients to postpone many services and adopt virtual and non-contact strategies. These changes are an unprecedented opportunity to re-evaluate the necessity of services our health system provides by embracing the ones that are of most value and reducing or eliminating those that provide little or no benefit.
• During the pandemic, the public and private sector worked in tandem.
• The pandemic can be a useful window of opportunity to undertake public healthcare reforms that are long due.
• There have been several digital innovations during the pandemic and the society has been forced to digitalize not only in India but also globally.
• According to a report published by the US Department of Health and Human Services in July 2020, 43.5% of Medicare primary visits were provided via telehealth in April vs 0.1% before the pandemic in February.
• India too has adopted telehealth and mobile technologies. At the FICCI health conference, Apollo Hospitals share that their Coronavirus Risk Scan App was downloaded 13.5 million times in just one week. Practo has seen five-fold rise in telemedicine consultations between March and mid-May.
• In the post-Covid world, telehealth will be further institutionalised with the Ayushman Bharat Health and Wellness Center program.
• A key change is that now digital healthcare systems are now taken more seriously in both medical education and practice.
• The pandemic has strengthened the healthcare infrastructure in India. It has also altered the way care is delivered – from acute to community setting, from person-focused to patient-centered care.
• But this pandemic has highlighted a key missing link in our preparedness, which is the need for updated and near realtime availability of trusted information.
• The healthcare industry, along with the central and state governments, undertook a robust response plan to tackle the pandemic by setting up of dedicated COVID-19 hospitals, isolation centres and tech-enabled mapping of resources. 
• The Aarogya Setu mobile app has been widely used for syndromic mapping, contact tracing and self-assessment throughout the country. It is also being used to schedule vaccination and to download vaccination certificate. 
• Such technology platforms were used to supplement the response management, which included delivery of essential items in containment zones, tele-consultations with patients, bed management and real-time monitoring and review by the authorities.
• Covid-19 has been an incredible catalyst to the changing trends in three distinct ways. Firstly, the knowledge doubling time in medicine has shrunk from 73 days to just 20 days in relation to Covid. Based on Elsevier’s Scopus database, over the past six months, more than 50,000 articles with the key phrase “COVID-19” have been published across the world. 
• The translation of research findings into practice has accelerated too. Traditionally, the diffusion of knowledge into clinical practice takes an average of 17 years, but with COVID, this has now come down to days, and sometimes even hours. The Covid-19 vaccine was developed in just one year, whereas an average vaccine takes around 7.4 years. Over the past six months, there had been more than 130 million downloads of COVID-19 related research articles on Elsevier’s ScienceDirect platform. 
• The healthcare system in India managed to withstand the pandemic. India has become a global leader by way of its efforts in manufacturing of medical equipment, disposables, drugs and vaccines. India not only fulfilled its domestic requirements, but also supported other countries.
• Healthcare sector therefore is a promising investment opportunity.
• Make in India: PPE, diagnostic kits, vaccines, medical devices including ventilators, oxygen concentrators
• Preparedness for infrastructure: makeshift beds, ICU beds, PPE, drugs etc. including in tier II and Tier III cities and some rural areas has also begun.
• Health insurance awareness
• Use of technology and AI, IoT has increased.
• Pre-pandemic Government schemes like Ayushman Bharat and National Digital Health Mission have sped up exponentially. These efforts to make healthcare affordable and accessible for the entire population also offer scope for private players to widen their reach and presence. 
• There is improved emphasis on surveillance systems and data analysis for containment strategies.
• Mobile enabled technologies can now be deployed en masse to monitor quarantined individuals and to trace exposed individuals in a timely and accurate manner. The Arogya Setu App has been very useful in this regard.
• There has been integration of government and private lab services for data collection and analysis.
• Enhanced public health literacy regarding vaccination and Covid-appropriate behavior.
• Patient care is shifting to remote care (telemedicine). Telehealth services have been used in the screening of patients prior to their visit and triage assessment, routine monitoring of patients at home, remote clinical encounters or supervising patient care by off-site experts.
• A significant portion of such services will probably remain telehealth-based even in post-Covid period because of increased convenience and better patient-centered care.
• The Indian health-tech industry valued at USD 1.9 Billion in 2020 is expected to reach USD 5 billion by 2023.
• Use of healthcare technology has already increased in the country such as Aarogya Setu app, telemedicine, virtual check-ups, online bookings, patient mapping, online clinical support etc.
• The National Health Mission was announced in August 21 as an indication of India’s commitment to rapidly integrate digital solutions and technology and build a strong and efficient healthcare infrastructure.
• Projects like Ayushman Bharat and National Digital Health Mission are a promising start towards enhancing India’s healthcare system and more such initiatives are foreseen on both the private and public front.
• The Ayushman Bharat Digital Mission (ABDM) aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. It will bridge the existing gap amongst different stakeholders of Healthcare ecosystem through digital highways.
• India has among the largest vaccination drives in the world. Under this, every individual is required to register through the CoWin App to get access to vaccines. While the registration process is digitised, we do not have a digital vaccination card for the entire population linked to their birth certificates or other identification cards such as Aadhar for easy reference in the future.
• Under the ABDM, all stakeholders of the healthcare ecosystem will work together to bring about required reform in the healthcare sector.
• There has been greater synergy between stakeholders resulting in collaborative efforts between lifesciences companies and between industry and regulatory authorities.
• A robust healthcare trajectory for the future can only be built through collaboration, engagement, partnerships, knowledge exchange and skill sharing.
• The government must bring in increased investments and resources into healthcare, enhance access, quality of health services and improve emergency preparedness.
• This is an opportunity not only for the private sector in India to collaborate with the government, but also for inviting global expertise to invest in India. 
• There is a need for a resilient governance by private sector engagement, integrated national data systems, intersectoral service delivery and proactive cooperation by private sector, civil society and large-scale community mobilization for prevention. 
• The future of the Indian healthcare system is promising.
• With the National Digital Health Mission, India has the unique opportunity to galvanise the movement towards the universal adoption of Digital health, accelerate health information exchange and availability of a minimum clinical data set, that is relevant not only for continuity of care but also for machine learning. 
• The six pillars of the 2021 Union budget begin with health and well-being, followed by infrastructure, inclusive development, human capital, innovation/R&D and good governance. This is the most opportune time to engage, deliberate and collaborate.
• As a first step, providers and health systems should prioritise the safety of patients and healthcare workers alike by triaging treatment for high-need patients helping them avoid the emergency department whenever possible.
• Leveraging alternative care pathways and care sites, such as telehealth, home care and community-based care, can also help keep patients out of the ED and provide alternatives to low value and wasteful care.
• Ayushman Bharat was designed with the objective that it would give certain minimum benefits. 
• The General Insurance Council of India looks into policies on how to improve insurance cover in the country, which is very low at present.
• We now have to move towards the level of assured delivery and strengthen the primary health care.
• The Health & Wellness centres are the backbone of Ayushman Bharat and are a modified version of primary health care.
• Healthcare providers in the private sector and/or medical colleges should adopt at least one Health & Wellness centre on a PPP model to showcase the parameters, which the government has defined and help set up a standard of care and improve quality of care.
• The insurance sector is not very effective in India. Because the insurance pays for day-to-day small management, there are often unethical practices. In the western model, there are deductibles, which take care of smaller management aspects.
• A drastic improvement in governance in insurance sector is needed. Reimbursements must be given within a stipulated period of time. Failure to do so would make insurance companies liable to pay an extra amount as penalty for delay.
• TPAs are there to facilitate policy holders, not to become a barrier for them.
• We have to adopt best practices in the world, but make it India centric.
• Many conditions are not covered by insurance. This list of conditions needs to be updated.
• The services need to be feasible as survival of companies is also important.
• We need to bring in good practices in insurance sector so that the insurance coverage increases in our country.
• There is a lack of transparency in the process, which needs to be addressed.

Participants

Dr KK Kalra

Dr Ashok Gupta

Dr Arun Jamkar

Prof Bejon Misra

Dr DR Rai

Dr B Kapoor

Dr S Sharma

Moderator 

Mr Saurabh Aggarwal