Startup Meddo to organise doctors' clinics - against all odds

Can neighbourhood clinics be organised under a single brand? That’s what healthcare services company Meddo—promoted by Dr Naveen Nishchal, Founder, Cygnus Hospitals, (since sold to Amar Ujala) and Saurabh Kocchar, former CEO, Foodpanda India—is attempting to do by creating a partnership model with doctors.

Max Healthcare attempted to create a branded primary healthcare experience in 2004. The idea was primary healthcare clinics would feed patients into secondary and tertiary hospitals of Max Healthcare. The model has undergone many changes. Apollo too has primary care clinics.

However, what Meddo is attempting is a reverse franchise into its brand.

In primary healthcare, the patient has a strong relationship with the doctor, the neighbourhood clinic or a general practitioner (GP). With 5-6 lakh neighbourhood clinics, an estimated 30% are GP’s, the rest being orthopaedists, cardiologists, urologists, endocrinologists with speciality clinics. Around 90% of ailments do not need hospitalisation.

The founders are looking to organise the fragmented primary clinics. Meddo’s plan was to bring technology in primary care through Electronic Health Records (EHR), an old idea, but hard to crack. While both patients and doctors realise the merits of EHR, no one actually does it. As Meddo entered the market, the business plan changed to looking at the needs of GP’s.

Meddo approached doctors with full digitisation through an electronic clinic management solution and offered a trained clinic manager (on Meddo’s rolls) for the doctor. “My clinic manager is my administrator, a phlebotomist, handles patient management and the pharmacy.” says Dr Ankita Wangcho, a Palam Vihar-based gynaecologist.

The doctor relies completely on the clinic manager. She ensures the clinic runs smoothly, manages patient appointments and updates patient details in the EHR. In return Dr Wangcho’s clinic has been branded a Meddo Clinic. Doctors are good with clinical care practice but not good at operational, supply chain and administration. “We come in and pad the practice with peri-clinical perspectives. OPD lags in technology. We smoothen everything outside the doctors’ chamber,” says Kocchar.

“With medicine dispensing and pathology tests at the clinic, I no longer have patients calling me for alternate medicine while seeing other patients. I have offered Meddo space for pharmacy and pathology counters and I get a clinic manager and a little revenue share,” says Dr Somendra Shukla, pediatrician, and neonatologist.

One key cornerstone to this upgrade is the technology layer. The clinic management software includes the clinical digital support system (CDSS), which is administered to a patient to prepare case sheets so that no obvious vitals are missed. “We have 5-6 EHR digitisation methodologies which we make available to clinics. There are multiple methods—tap and type solution, pen and paper solution, pen and camera solution and an Apple pencil solution. We are working on a scanner, which when you enter the clinic will check eight vitals without manual intervention.” says Kocchar. The doctor gets the details in the profile to read.

Technological support that Meddo provides is with sophisticated software, DOXPER, a distributed hospital information system, with a nerve centre that takes in all information from clinics. It is a simple revenue share model that works for both. Meddo has standardised branding, supply chain, training, technology and training of personnel. The only exception is radiology and appointments are booked for patients by the clinic in nearby areas.

The investment in branding the clinic is about ₹1.5 lakh. There are over 300 Meddo branded Clinics, mostly in NCR with over 4,000+ doctor partners (domestic and international).

“We work on supply chain disintermediation, hence reducing the number of participants in the supply chain thereby generating enough margins.” says Kocchar. Buying required medicine to supply to clinics and offering pathology services allows Meddo to make money without having to pay margin to intermediaries. The other revenue stream is offering proprietary digitization technology solution Doxper to major hospitals like Nanavati Max Super Speciality, BLK-Max Super Speciality Hospital, Manipal Hospitals as well.

The next step is to bring in Insurance, though it is tough in OPD. Says a senior Max Bupa executive, “The Indian OPD market is extremely fragmented and no meaningful product can be introduced. There is not enough data on the OPD market to create a viable insurance product."

There is no homogeneous treatment in OPD as almost all insurance products are based on inpatient treatment. Outpatient visits are frequent, cyclical, unexpected and considered unpredictable episodes. Secondly, healthcare may be exempt from OPD but insurance pays 18% GST. Most importantly, OPD consultation in India is very cheap.

Kocchar feels that the loyalty metric is high because neighbourhood clinics typically keep patients out of hospital care. However, the company is dabbling with the idea of launching subscription to create comprehensive care plans for Meddo clinics. With over a crore plus patients in the network, it will be another revenue stream. With Series A funding of $6 million by Healthcare fund AlKemi Capital, SRI Capital, and Picus Capital, Meddo will be rolling out branded OPD clinics in Bangalore next.