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‘We plan to make the Wellspring healthcare model work by not being greedy’

Dr Gautam Sen and Kaushik Sen, co-founders of Wellspring Healthcare, believe that they can make a difference to the healthcare system through their community centres which aim to offer basic facilities under one roof

Today there is a lack of proper primary healthcare facilities in the country. In fact, our medical system is churning out more and more specialists with fewer and fewer students seeking to become family doctors. Wellspring Healthcare aims to fill this gap by offering basic facilities through its community centres. Investors like NR Narayana Murthy's venture capital firm Catamaran, Anil Ambani Group's Reliance Venture Asset Management and some foreign entities have shown confidence in this mission, by investing substantial amounts in the venture recently. In an interview to Moneylife, Dr Gautam Sen and his son Kaushik Sen explained more. Excerpts:

Moneylife (ML): Why did you start Wellspring Healthcare?
Kaushik Sen (KS):
We started this venture in October 2009 and formally launched the company in April 2010. The idea behind the venture is our personal belief that a lot of things in the healthcare system need to be improved.

There used to be a family doctor that you went to and that person was there for you and your parents, a larger than life figure. Some people are lucky enough to have a person even now. Many people from that generation are retired, or some of them have passed away and what has come in their place is typically a population of general practitioners.

There is a big vacuum in terms of what consumers need. They need someone to take care of themselves, someone to treat them fairly, some one to give them good consistent care, with basic facilities under one roof, and for higher level things they don't need on a routine basis to send them to someone who will treat them well. You can think of us as a modern family doctor with a well-supported infrastructure.

Dr Gautam Sen (GS): Most of the times they self medicate, thinking 'why go to the doctor and spend time and energy. After all he is going to give you some pills and doesn't explain what it is for'. Also, the pre-hospital service is so disorganised that people don't want to go to a doctor if they can avoid it and when they are really serious they run to a specialist.

Then, since you have not gone through the stages, the specialist has his way of treating, or you land up in a hospital for a small illness. Though the hospital is quite capable of taking care of you, 80% of the cases they are treating are overcrowding the hospital.

The public hospital is so overburdened with routine cases that specialised cases get neglected. And in corporate hospitals they are welcome, because more cases means good money. It's a very short-term vision. We realised that the pre-hospital sector is badly neglected.

ML: What prompted you to leave your job and start this venture?
We have taken a lot of risk. He (Dr Gautam) has given up his practice and positions to focus on this. I have given up a good career in the corporate world. I think our perspective was to do this because there is a big vacuum in terms of how healthcare needs to be and we felt that we would be in a position to make a difference.

ML: What is the reason for selecting the brand name Healthspring Community Medical Centres? Why the emphasis on community?
One of my father's passions is work on the needs of the community. A community needs high-quality medical care, at the right place at the right time. The way we have designed these medical centres, we will do everything consumers need on a regular basis, but not what they don't need. It is very local, meant to cater to a specific geographic area, that is, a locality.
GS: The moment people look at the community medical centres as another dispensary, they will feel we are approachable. We are proud to say that we are a healthcare delivery system at home.

ML: What will be the typical structure of a centre?
Under one roof, the centre will have an area of 1,500 sq ft. We will have four highly qualified doctors. If a patient requires a specialist, for example an orthopaedic surgeon, we will have a specialist on our panel. They are not hired by us, but they have been carefully screened by us. The specialists we have picked are the most ethical in the city and you have a choice from our list.

For things that we feel you need a higher level consultation we will advise you to one of the people on our panel. You can, of course, also go to someone else. We also have tie-ups with hospitals that you can go to since you are a member of Healthspring. You will get certain benefits that you will not get otherwise.

It is an end-to-end system, so if you get an operation done, we will take care of you again after the operation. We do the follow-up and post-operative rehabilitation. We will monitor you through the process. We do not financially benefit from this process and the doctor who sends you to a specialist doesn't have an incentive to send you. In fact, the incentive is to keep you healthy. So they give you a completely unbiased perspective.

ML: What is the procedure to select the team of doctors?
The doctors have a few characteristics. First, they have to be medically very sound. Second, is to have a patient-friendly perspective. There are many doctors who think that they are doing the patient a favour. They don't want to answer questions, don't want to entertain patients, or even discuss the options. We are also looking for people who share this philosophy with us that the patient deserves to be a part of that process and deserves your respect.
GS: We know that it's not easy to get such doctors. The working of our medical education is such that everyone wants to be a specialist and becoming a family doctor is the last priority. The other thing is the hospital you are attached to. The more hospitals you are attached to the more glamorous you are.

Those who could not score good marks, or belong to a caste because of reservation policy, ultimately take up the practice very reluctantly. So, family medicine has become a speciality which very few people realised in the developing countries. But in the UK a family doctor gets paid more than a specialist. His working hours are better than a specialist. So is the case in the US. There, every doctor is an MD, there is no hierarchy. In India there is a hierarchy. If you have a foreign degree, nothing like it, and the more degrees the better.

We are trying to bring in a lot of respect, regard, importance to a primary care physician. He is the builder of good healthcare in the country. Our foundation is gradually getting shaky. We want to bring in good doctors who can communicate; today all knowledge and skills are available which can be acquired by anyone, but communication, empathy, attitude to understand patients behaviour is important. We tell the doctor inside stories that we don't tell anyone. This is a sacred relationship and to maintain this relationship we need the highest standard of ethics.

ML: With real estate prices going up and inflation so high, equipment becoming expensive and keeping staff salaries and profit in mind, how will Wellspring help in keeping the prices low?
What we can do as an organisation is to scale our systems across things. We have taken some conscious decisions; we will not over-invest on capital expenditure. Whatever money we can spend we will put into people and processes; we will make sure that the doctors who are a part of our centres are paid well so that they don't have to give in to temptation. We will make sure that we invest in the right processes, right training and protocol to ensure that we are giving good, consistent healthcare.

Healthcare is one of those businesses where you plan it right and have a long term mindset then what is good for customers is good for you. If I treat a patient very well and fairly, I win the patients trust and maintain it, over time he will keep coming back to me, and over time even though on an individual transaction I may have not made a lot of money your value to me over a lifetime is much higher. But If I squeeze you in the one time that you come to me, you won't come back. This is a very frequent occurrence in our medical system. We plan to make this model work by not being greedy.

ML: In your first round of funding, how did you manage to get money from Reliance Venture Asset Management, US-based BlueCross BlueShield, and Narayan Murthy's Catamaran?
This is very interesting. The typical investment in our country in the healthcare sector has been in hospitals. It is not like a consumer brand where seeing the product people will come to us. The way we are looking at things is to do the right things for the patient and the brand will be created over time because our patients will come to us.

We are focussed on prevention and transformational healthcare. Since we have a long-term perspective, we ended up having a few choices. It is very difficult to get/raise money at the growth stage. We are fortunate that Catamaran liked the model and the combination of talents. Very few people are ready to take risks at the initial stage. We are one of the early stage companies that got this funding. People liked the model we came up with.

ML: Will there be packages available for patients?
We have a set of packages like corporate packages, family packages, etc. We also have packages for people wanting to buy comprehensive healthcare for their parents where all the visits for their parents are free.
GS: We will not only send a doctor home for free check-ups every month, but any amount of consultation will also be free. Supposing you are not in town and there is an emergency, we will make sure that the patient is taken care of, stabilise him/her and inform you.

We will have arrangements for your credit card payment. Today there is no system to provide this. People are ready to pay, but there is no one to help. Our concentration is on developing a system and processes, and not on equipment. People spend on buying the best equipment, but what is the use when the basic requirement of a patient is not taken care of? So, we have consciously decided to not invest, but to take care of the larger community needs, 80% of which are simple needs. We'd rather spend on getting the right software and guidelines from NICE (National Institute for Health and Clinical Excellence).

ML: Who will remind the patients about their follow-up visits?
The broader thing is chronic disease management. Patients know about the medicines to be taken and the tests to be done but they don't do this. The front-office staff will remind you about your tests. If you have questions, a doctor will be available.
GS: People feel it is good to hear, but they do not follow. It is an engagement. Our members will engage you to take care of your health and help you be aware of what can go wrong. If they are engaged with us, within months they will start noticing the graph of their illness. Investigation and X-ray are not treatment. Very few people show you your improvement. We will do that.

ML: For a venture like this what are the potential risks?
We have to give consistent good care from day one. The other risk that is important to us is that people should trust us. This trust is earned with good behaviour over time. It's also earned by delivering whatever we promise you.
GS: It is an idealistic concept, but firmly based on the reality that I am very confident about and we have a very passionate team who are helping us with business, professional and technical assistance. We have doctors who have the vision, but don't have the managerial skills. They are glad they now have a platform to put this forward.


Share prices directionless: Thursday Closing Report

Nifty hit the suggested resistance of 5,650 today. A close below 5520 below would signal a downtrend

Yesterday we mentioned that the Nifty may rally up to 5,650, which it did. The Nifty hit an intra-day high of 5,654, before crashing and closing at 5,600, up 14 points. The market is now moving in an indecisive area. Tomorrow's move will help us decide the further direction.

The market overcame initial weakness to trade in the green for most part of the noon session, but a sharp sell-off in late trading led the market to a flat close. Headline inflation data for June and weekly food inflation figures for the week ended 2nd July were the economic indicators that were announced by the government today.

The market opened lower this morning on nervousness among investors following the triple bombings in Mumbai last evening. Also, a mixed opening on the Asian bourses, after Moody's Investor Services threatened to downgrade the credit rating of the US, kept investors on the sidelines. The Nifty opened at 5,569, down 16 points, and the Sensex resumed trade 32 points lower at 18,564. The indices touched their intra-day lows in the first 30 minutes, as the Nifty dipped to 5,542 and the Sensex slipped back to 18,449.

Selective buying pushed the indices gradually upwards around noon, but choppiness saw the indices popping in an out of the red a couple of times. Comments from Planning Commission deputy chairman Montek Singh Ahluwalia stating that acts of terror should not impact market sentiment, gave a firm push to the market in noon trade.

The indices touched their intra-day highs a little past 2.30pm, when the Nifty touched 5,654, up 112 points from the day's low, and the Sensex climbed to 18,803, a gain of 354 points from the low point of the day. However, the gains were short-lived, as massive selling took over and dragged the indices into the red in late trading. Nevertheless, the Nifty closed in the green up 14 points at 5,600 and the Sensex added 22 points from its previous close to end at 18,618.

The advance-decline ratio on the National Stock Exchange (NSE) was a positive 1025:673.

Among the broader indices, the BSE Mid-cap index gained 0.38% and the BSE Small-cap index rose 0.18%.

BSE Realty (up 2.26%), BSE Bankex (up 1.04%), BSE Healthcare (up 0.80%), BSE Metal (up 0.69%) and BSE Capital Goods (up 0.40%) were major sectoral gainers. BSE IT (down 1.47%), BSE TECk (down 1.01%) and BSE Fast Moving Consumer Goods (down 0.27%) dragged the index lower in trade.

DLF (up 3.15%), Tata Motors (up 1.95%), Cipla (up 1.84%), ICICI Bank (up 1.40%) and State Bank of India (up 1.39%) were the top performers on the Sensex. On the other hand, TCS (down 2.23%), Infosys (down 1.55%), Reliance Communications (down 1.42%), Bajaj Auto (down 1.25%) and ONGC (down 1.18%) settled at the bottom of the index.

The top Nifty gainers were IDFC (up 3.53%), Ambuja Cements (up 2.96%), Sesa Goa (up 2.93%), ACC (up 2.73%) and DLF (up 2.55%). The main losers on the index were TCS (down 2.60%), RCom (down 2.09%), GAIL (down 1.85%), Siemens (down 1.82%) and Power Grid (down 1.72%).

Markets in Asia settled mixed on a warning by Moody's that it plans to review the US' credit rating, which saw some caution in the export-driven economies of the region.

The Shanghai Composite added 0.03%, the Hang Seng was up 0.06%, the Jakarta Composite rose 0.42%, the Straits Times was up 0.01% and the Seoul Composite rose 0.02%. On the other hand, KLSE Composite declined 0.05%, the Nikkei 225 fell by 0.27% and the Taiwan Weighted lost 0.08%.

Back home, foreign institutional investors were net buyers of stocks worth Rs315.95 crore on Wednesday, while domestic institutional investors were net sellers of stocks worth Rs368.91 crore.

Repro India has acquired the India printing operations of Macmillan Publishers India (MPIL), the subsidiary of well-known UK-based publisher. The deal also entails servicing the print requirements of MPIL in India. Under the arrangement, MPIL will outsource the printing of its education books to Repro, translating into a business of over Rs250 crore over the next five years for Repro in this period. The acquisition of this printing operation in Chennai would strengthen Repro's foothold in the south India market, bringing it closer to its clientele. Repro India rose 9.49% to close at Rs161 on the NSE today.

Tech Mahindra, a global systems integrator and business transformation consulting organisation, has entered into a global partnership agreement with Redknee, a leading provider of business-critical billing and charging software and solutions for communications service providers, to jointly deliver software and services to the communications service providers market.

The partnership aims to deliver benefits for both the entities through a wider scope of business opportunities and greater depth of solutions delivered for service providers globally. The stock rose 1.43% to close at Rs751 on the NSE.

Zicom Electronic Security Systems is launching a new innovative business called Zicom SaaS. The company plans to invest about Rs80 crore in the project in the next two years. The objective of the new initiative is to provide a holistic security package to the customer, taking care of all his requirements based on security assessment and to give him the complete package of hardware, software, monitoring. The Zicom stock surged 7.42% to Rs42 on the NSE today.


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