What will the future of healthcare in Asia look like? To find out what might be, Dr. Snehal Patel, Co-Founder and CEO at MyDoc and Co-Founder and Director of Galen Growth, Asia, led a conversation with Jeff Chen, Chief Innovation Officer at Fullerton Healthcare Group and former Chief Strategy Officer at Tencent-backed WeDoctor, and Dr. Lee Hong Huei, former CEO of Southeast Asia at Parkway Pantai, the region’s largest private healthcare provider. Below are a few select excerpts from the broader discussion.
Patel: We often talk about telemedicine, chronic disease management, and new apps in the market. Generally speaking, are these a fad or a trend?
Lee: Digitalization in healthcare is bound to happen, although healthcare appears to be adapting to these changes slowly. There are many reasons for this, including the fragmentation of the stakeholders, e.g., doctors who are running their own practices and facilities with conflicting priorities. Specific ecosystem and regulatory characteristics of each country add an additional layer of complexiy. While digitalization is happening at different speeds in different contexts, what COVID did was basically force the issue. In a sense, COVID has given digitization a push. The question is, how do we build on this momentum?
We don’t have a crystal ball for this, but we can be certain of a few things in healthcare: accessibility, quality, and cost will always be seen as conflicting priorities. Trade-offs are anticipated. Where digitization has made a lot of impact is in “accessibility.” I am sure it will slowly begin to impact cost and quality as well. This is a space we need to watch. I don’t think it’s a fad. It’s a trend. But, how will this trend evolve? What final form will it take?
Patel: Jeff, is this clamor for digitization hype or a trend? Are these things really addressing structural bottlenecks?
Chen: Take China as an example. WeDoctor started in 2010 doing digital appointments. There was a lot of traffic, but no monetization. Hospitals wouldn’t pay for it and if they tried to charge users, they’d be branded scalpers. In 2015, when WeDoctor got the first Chinese internal hospital license, people were still not paying for it. There were two main reasons. First, most healthcare services in China are paid for by National Health Insurance, which didn’t include online healthcare services. Second, even today, healthcare predominantly still happens offline. How much of a person’s problem can be solved just through seeing doctors online without them taking their key vitals? People didn’t want to pay because it wasn’t solving their problems. That led to some of the players that WeDoctor signed to do a more integrated online-to-offline type of service.
What we’re going through right now is a game changer. As Dr. Lee mentioned, user adoption is faster than doctor adoption, but it still isn’t as fast as e-commerce. But this wave of the pandemic definitely increased user adoption. The shape that we’re seeing will be quite different from all the other disrupted industries. Healthcare can’t be purely digital. It’ll be an integrated model.
Patel: Hong Huei, your experience is working with one of the largest healthcare groups in the market. During your tenure, some of these vertically integrated models started to appear. What are your thoughts now? It’s true that patient needs cannot be addressed online. An overarching theme in healthcare that we all hate is patient data siloization. What do you think about the verticalization and how that’s moving with regards to this current new wave?
Lee: There are two dominant models in the market. One is represented by operations such as Raffles Medical Group, where they own and operate the entire ecosystem. Then there’s the other models where specialists are essentially independent. Some may form small group practices. Integration in this latter model is challenging. Any proposal will be evaluated through certain lenses. The first set of lenses will be in relation to patient care. (“Do my patients need it? Do I need this for delivering patient care? Does it give me an edge? Does it help me serve my patient better?”) The second set of lenses is monetary. (“Does it make sense for me to expend X dollars to enable this?”) Adoption of telehealth is still patchy due to inherent limitations, e.g., the ability to assess patients fully.
Patel: To summarize, vertical integration does make sense. But the reality is we have to deal with doctors. That’s probably why, in some sense, there’s been a mismatch in terms of adoption. Digital health as a category has probably gone much faster than the actual adoption on the clinical side, because of these soft factors. But what about horizontal integration? In the U.S. there’s blockbuster news with Teladoc, one of the biggest telemedicine providers in the world, merging with Livongo, a chronic disease site. That’s an interesting model, because until then both were siloed. What’s your perspective?
Chen: It’s [WeDoctor’s service] very sticky. Out of the whole population that we cover, a significant portion use self-service in a year. But what if I can horizontally add services, and deliver them online? Content may not be monetizable, but it increases stickiness. Then, we can move forward into a more wellness and preventive focus. I don’t see the whole vertical linkage opening up anytime soon. There’s the same problem in China. WeDoctor is connected to all these tier-three Grade A public hospitals, so we see digital appointment data, what doctor patients see and at what time, who’s the user, their ID, and their membership, but I don’t see the rest. Is that helpful enough? Between hospital A and B, they will never share data or consultation notes. If we’re talking about data being integrated, that’s tough. But horizontally, what we’ve seen with Teladoc and Livongo is an interesting direction to go in.
Patel: What’s amazing about Southeast Asia in general, Singapore in particular, is a phenomenal healthcare system, but it’s also more geared toward 20th-century types of problems. The needs and requirements of a large facility and the community-level health has lagged, and that’s where digitalization can work. Lots of the folks in hospitals are not embracing the provider side of the wave. Are they taking specific defensive measures? Or are they slowly but surely starting to open up?
Lee: I think everyone is still trying to find their way. Facility operators and healthcare practitioners both realize that digitalization is something they can’t avoid. Question is, in what shape and form?
I don’t think it is a deliberate “defensive strategy” per se. It is quite challenging to bring tertiary care online. A radiation oncologist who could do remote planning and deliver remote care still needs the machine on the other side. Horizontal integration is a great idea. Cognitively, I think we can get everyone to agree conceptually that data interoperability is beneficial for the patients. However, once we come down to the granular details, that’s when difficulties start. Some form of legislation needs to be in place to create the impetus for this. Otherwise, it is entirely natural for business owners to think along the lines of “barriers of entry” and “competitive advantages,” i.e., “information is power.”
There must be a very clear distinction between custodian vs. ownership role(s) for healthcare data. Patients should always own the data. When they go to the hospital and have scans, lab tests, and so on, the data is still theirs. For this to work, we need a well-thought-out patient rights and responsibility framework where the patient can and should be able to authorize data custodians to enable data exchanges. On the technical side, data interoperability is seldom a problem. There are existing data standards. As long as entities comply with certain data standards, the information can be interchangeable. The problem is clarity on the governance framework for custodian vs. ownership roles. Without regulatory support, it is unlikely that anyone will willingly participate in data exchanges.
About Lee Hong Huei
Dr. Hong Huei Lee is an independent healthcare executive consultant based in Singapore. Prior to this, he spent 18 years helming various portfolios in one of the largest integrated healthcare service providers in the region. These included Chief Executive portfolios across the entire spectrum of healthcare (primary care network, third-party administration, insurance, hospitals, laboratories,ctraining, and education). His last portfolio was the Head of Southeast Asia at Parkway Pantai Limited, one of Asia’s largest integrated private healthcare providers, operating in Singapore, Malaysia, India, China, Brunei, and United Arab Emirates.
About Snehal Patel
Snehal Patel is the Co-Founder & CEO of MyDoc Pte. Ltd. In addition to his full-time role with MyDoc, Snehal is also Co-Founder and Director at Galen Growth Asia | The Asia HealthTech Connector. He is also currently employed at Proof & Company, since June 2012, holding the title of Co-Founder & Non-Executive Director. Snehal is also currently employed at Saena Partners, holding the title of Managing Director. He also works for Arete Holdings Inc. as Director. Snehal received an MD in 2003 from Columbia University College of Physicians and Surgeons. He also earned a BA (honors) in political science from Rice University in 1997.
About Jeff Chen
Jeff Chen currently serves as the Chief Innovation Officer/Head of Capital Markets at Fullerton Healthcare Group. Fullerton Health is an integrated enterprise healthcare service provider founded in 2011 in Singapore. Previously, Jeff served as the Chief Strategy Officer at WeDoctor Holdings Limited. WeDoctor is China’s leading technology-enabled healthcare solutions platform, providing seamless online and offline healthcare services as well as integration of general practitioner and specialist doctors. Before joining WeDoctor, Jeff held the position of Head of Technology Investment Banking, Asia Pacific at HSBC. Before that, Jeff was the Director, TMT Investment Banking at Credit Suisse Hong Kong for five years.
This APAC healthcare industry article is adapted from the October 28, 2020, GLG panel discussion “Asia’s Healthcare Revolution.” If you would like access to this video panel or would like to speak with APAC healthcare industry experts Lee Hong Huei, Snehal Patel, Jeff Chen, or any of our more than 700,000 industry experts, contact us.