Chronic

Care
Healthcare Innovations
Full Spectrum of Care
What is Chronic Disease?
• Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or
limit activities of daily living or both.
• Chronic care refers to medical care which addresses pre-existing or long-term illness, as opposed to acute care which is
concerned with short-term or severe illness of brief duration. Surgery Care whereas deals with the branch of medical
care which is mostly related to in and during the process of Surgery.
• Chronic care management includes any care provided by medical professionals to patients who have chronic diseases
and conditions. A disease or condition is chronic when it lasts a year or more, requires ongoing medical attention, or
limits the activities of daily life. It includes physical conditions like diabetes or mental conditions, like depression.
• Examples of Chronic Disease are as follows:
• Asthma, Alzheimer’s Disease and Related Dementia, Arthritis, Atrial Fibrillation, Autism Spectrum Disorders,
Cancer(Breast, Colorectal, Lung, and Prostate), Chronic Kidney Disease, Depression, Diabetes, Drug, and Alcohol Abuse,
Heart Failure, Hepatitis, HIV/AIDS, Hyperlipidaemia (High Cholesterol), Hypertension (High Blood Pressure), Ischemic
Heart Disease, Osteoporosis, Schizophrenia, and Other Psychotic Disorders, Stroke, Diabetes, Cardiovascular Diseases,
etc.
 Technological Changes
Technology components that can help better organize chronic care management remotely include:
• Devices and Sensors: Medical devices and sensors help a physician measure the vitals and other patient parameters. For
example, as a patient walks into the clinic, a physician notices his gait. The technology equivalent to this can be gait
recognition sensors using mobile accelerometers. Similarly, sensors for measuring blood pressure, temperature,
glucometers, pulse oximeters, and respiratory rate sensors, all integrated with mobile applications, can be used to
monitor patients remotely. Many healthcare facilities and smaller clinics offer remote monitoring devices or kits, as per a
patient’s need.
• Platforms: Platforms are required to aggregate data and facilitate communication between patients, physicians, and
caregivers. These platforms are HIPAA compliant and offer integration with devices and EMRs.
• Integration with EMR: While EMRs are part of the technology infrastructure in any health system, integrating wearable
data from devices into the EMR can help physicians maintain data continuity with the initial in-person visit recorded in
the EMR. Facilities and providers can choose to reduce the noise created by large volumes of data from personal devices
by requesting data at specified intervals only. With EMRs offering healthcare-standard APIs (such as FHIR) for integration,
patients need to select devices with integration capabilities using healthcare standards.
• Data analytics for risk stratification and decision support: Devices and sensors can generate vast amounts of data stored
in big data repositories. Algorithms on top of this data can help in risk stratification, prediction, and improving outreach.
AI techniques like machine learning, cognitive computing, and deep learning can play a critical role in identifying chronic
diseases using predictive modeling techniques.
 Future Upgradations
• The ability to engage patients: Often, chronic diseases are due to health risk behaviors such as physical inactivity,
incorrect nutrition, tobacco use, and excess alcohol consumption. Engaging patients throughout their healthcare journey
can help achieve desired outcomes in chronic disease management. "Tell me and I forget, teach me and I may remember,
involve me and I learn" (Benjamin Franklin). Improvement in behavior patterns can ensure continuous reminders, alerts,
and engaging patients to track behavior patterns, diet, and lifestyle goals to improve health. A two-way communication
flow from the patient to the care provider team and vice versa should be a necessary feature.
• The ability to integrate remote patient monitoring devices: IoT devices and wearables integrated with the EMR workflows
can allow caregivers to provide advice at the point of care. Vital data points captured with wearables, smartphone apps,
and home monitoring devices are used in between follow-up visits to provide interim care and advice in chronic disease
management. The ability to aggregate data from other hospital information systems: These could be data aggregated from
multiple sources, including labs, pharmacies, sensors, and valuable clinical-decision support (CDS) to track patient
information to manage chronic diseases proactively.
• Artificial intelligence (AI) can provide intelligent suggestions by analyzing a patient’s physiological data from wearable
devices for the diagnosis and treatment of diseases.
• Integrating AI, blockchain, and wearable technology could optimize the existing chronic disease management models,
with a shift from a hospital-centered model to a patient-centered one.
• By learning about new cases that have happened in the past, many AI algorithms are capable of catching related
knowledge to enhance themselves. The AI-powered individualized treatment provides clinicians with an opportunity to
specifically tailor early interventions to each patient with chronic diseases.
Chronic Care vs Surgical Care
Chronic health conditions such as cardiovascular diseases, diabetes, chronic respiratory diseases, bone diseases, and
cancers, as well as their risk factors.

The nine chronic conditions included hypertension (HT) or high blood pressure, diabetes or high blood sugar, cancer or a
malignant tumour, chronic lung disease, chronic heart diseases, stroke, bone/joint disease, neurological/psychiatric
diseases, and high cholesterol.

Surgery includes Proctology, Laparoscopy, Gynaecology, ENT, Urology, Vascular, Aesthetic, Orthopaedics, Ophthalmology,
Fertility etc.
What would the
characteristics of
successful chronic
care companies be?

https://www.kalaari.com/wp-content/uploads/2021/09/chronic-care_compressed.pdf
• Holistic ecosystem approach: The platform will have to integrate various stakeholders in the healthcare journey of the
consumer, acting as a one-stop platform, counseling on lifestyle aspects, offering information, and as an EMR center.

• Building global products from the onset: India is a low ARPU market. Thus, startups need to think about scaling globally
from Day one. There is an increasing incidence of lifestyle diseases in MENA, and SEA regions that can be capitalized on given
similar characteristics to the Indian market.

• Monetization strategy: To start off, startups need to choose chronic care diseases offering high AOV and CLTV such as cancer,
kidney diseases, or diabetes. Healthcare delivery via providers has high-value accretion. Over time, the platform has to
evolve to solve multiple chronic care diseases as they cannot be evaluated in isolation. 89% of diabetic patients have at least
2 comorbid conditions such as hypertension, obesity, kidney, or cardiovascular diseases. Having multiple providers on the
platform can help improve customer stickiness and retention.

• Insurance Linkage: Only 40% of Indians are currently insured and <10% have private insurance. At sufficient scale and data
access, startups can explore insurance linkage. While most healthcare players are subscale for insurers’ interests today, we
expect that to change over the coming years.

• Integrate health and wellness: The nature of chronic diseases requires a comprehensive approach to treatment and
management that spans various lifestyle choices such as dietary habits, exercise, mental wellness, and tracking along with
clinical solutions. Health and wellness are not distinct categories. Sometimes, startups focus on either health through
diagnostics, or wellness through lifestyle interventions. The former provides a higher AOV, while the latter helps create
higher engagement. At the intersection of both, is where models like Livongo thrive and succeed.
Market Analysis

• The Global Chronic Care Management Solution Market is expected to grow from USD 8,109.60 Million in 2019 to USD
19,062.09 Million by the end of 2025 at a Compound Annual Growth Rate (CAGR) of 15.30%.
• The global market for chronic disease management therapeutics and device technologies should grow from $391.8
billion in 2021 to $553.0 billion by 2026, at a compound annual growth rate (CAGR) of 7.1% for the period of 2021-
2026.
• Data Bridge Market Research analyses that the chronic disease management market was valued at USD 6.17 billion in
2021 and is expected to reach USD 20.64 billion by 2029, registering a CAGR of 16.3% during the forecast period of
2022 to 2029.
• The number of persons aged 60 and up has consistently increased over time as a result of rising life expectancy. The
worldwide geriatric population will grow from 727 million in 2020 to 1.5 billion by 2050, according to the United
Nations Database on World Population Ageing 2020.
• The long-term care market size is estimated at US$ 1047.85 billion in 2021 and is predicted to be worth around US$
1,720.20 billion by 2029. It is registered at a CAGR of 6.4% from 2021 to 2030.
• According to the United Nations, the geriatric population across the globe is estimated to reach 2 billion by 2050.
Over 20% of the country’s population suffers from at least one of the non-communicable diseases (NCDs),
which are estimated to cost India $6.2 trillion during the period 2012-2030, according to a report released
on Tuesday. As per the World Health Organisation (WHO), non-communicable diseases or chronic diseases,
such as cancer, heart ailments, respiratory diseases and diabetes, kill 38 million people globally every year.

https://www.livemint.com/Politics/qXjSfkDp3RDnpjsFpTCkkM/Over-20--of-Indians-suffer-from-chronic-diseases-report.html

About 75 million people above 60 in India suffer from some chronic disease shows the first part (2017-18) of
the world’s largest study on the aged- the longitudinal aging study in India(LASI) released by the health
ministry on Wednesday.

https://timesofindia.indiatimes.com/india/75m-indians-above-60-suffer-from-chronic-disease-survey/articleshow/80143113.cms
 The prevalence of chronic non-communicable diseases (NCDs) is increasing worldwide. In 2016, NCDs are estimated to
account for 71% of 57 million global deaths, with cardiovascular diseases (CVDs) contributing to 31% (NCD Countdown 2030
collaborators, 2018).

Studies show that India’s burden of non-communicable diseases (NCDs) is escalating (Arokiasamy, 2018). In India, NCDs
account for 63% of all deaths; deaths from CVDs, chronic respiratory diseases, cancers, and other NCDs account for 27%,
11%, 9%, and 13%, respectively (WHO, 2018a). Also, while NCDs typically occur in individuals aged 55 years or older in many
developed countries, their onset occurs a decade earlier in India and is quite prevalent in the ages 45-55 years.

https://www.iipsindia.ac.in/sites/default/files/LASI_India_Report_2020_compressed.pdf
Overall, more than three quarters of older adults age 45 and above are currently taking treatment for their diagnosed
diseases of hypertension (72%), chronic heart diseases (73%), and diabetes mellitus (82%), whereas only 58% of older
adults diagnosed with stroke are on treatment and bone/joint diseases (56%); whereas the treatment rate for
neurological & psychiatric diseases among the elderly is the lowest (41%).

Treatment rates are higher among elderly age 60 and above than older adults age 45-59.

Multi-Morbidity
Multi-morbidity is defined as the simultaneous presence of two or more chronic health conditions in an individual.
Information on nine chronic health conditions is included in the measure of multi-morbidity: hypertension, chronic heart
diseases, stroke, any chronic lung disease, diabetes, cancer or malignant tumor, any bone/joint disease, any
neurological/psychiatric disease, and high cholesterol.
https://www.iipsindia.ac.in/sites/default/files/LASI_India_Report_2020_compressed.pdf
Cardiovascular Disease
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They include hypertension, stroke,
and chronic heart diseases such as rheumatic heart disease, congenital/structural disorder, conduction disorder/cardiac
arrhythmias, congestive heart failure, and coronary heart disease/ blockage.

Hypertension
Hypertension is a long-term medical condition in which the blood pressure in the arteries is persistently elevated.
Hypertension is estimated to account for 10.8% of all deaths and 4.6% of DALYs in India (MoHFW, 2018)

The self-reported prevalence of diagnosed hypertension among older adults age 45 and above is 26%; the prevalence rate is
higher for elderly age 60 and above (32%) than older adults age 45-59 (21%). Among elderly age 60 and above, self-
reported diagnosed hypertension is more prevalent among women (36%) than men (27%) and among those residing in
urban areas (47%) than those in rural areas (26%).
Diabetes Mellitus

The number of persons with diabetes in India has increased from 26 million in 1990 to 65 million in 2016, and diabetes is
the third major contributor to the burden of NCD mortality and morbidity in India (Tandon et al., 2018).

The self-reported prevalence of diagnosed diabetes by background characteristics. The self-reported prevalence of
diagnosed diabetes mellitus in India is 12%, with the prevalence being higher among elderly age 60 and above (14%)
than among older adults age 45-59 (9%). Among elderly age 60 and above, the prevalence of diagnosed diabetes is
three times higher in those living in urban areas (26%) than those living in rural areas (9%) and slightly higher among
men (15%) than among women (14%). T
Chronic Heart Disease
The self-reported prevalence of diagnosed chronic heart diseases in India among older adults age 45 and above is 3.6%.
The prevalence rate is more than two times higher among elderly age 60 and above (5.2%) than among older adults age
45-59 (2.2%) (Table 7.3).
The rural-urban difference is more pronounced among elderly age 60 or above, with 9% residing in urban areas having
been diagnosed with chronic heart diseases compared with only 4% in rural areas.

Stroke

The self-reported prevalence of stroke by background characteristics in India. Overall, the self-reported prevalence of
diagnosed stroke among older adults age 45 and above is 2%. The prevalence rate of stroke is higher among elderly age 60
and above (2.7%) compared to older adults aged 45-59 (1.0%). Among the elderly age 60 years and above, the prevalence
of self-reported stroke is slightly higher among men (3.3%) than women (2.2%) and among those in urban areas (3.1%)
than those in rural areas (2.5%).
Diabetes Care Market

Diabetes care market in India is ~$17 Bn in size as of FY21, expected to grow 3X+ to ~$59 Bn by FY31.
MIS includes any surgical procedure that is performed through tiny incisions instead of a large opening. Most
common MIS surgeries include Laparoscopy (appendicitis, hernia and gallstone), Gynecology (Hysterectomy, Vaginal
cyst removal), Urology (Kidney stones & Prostrate) and Ophthalmology (Cataract & LASIK).
https://redseer.com/newsletters/a-80-billion-market-minimally-invasive-surgery/
 Home HealthCare Market

Lifestyle diseases contribute to about 50% of expenditure on in-patient beds in urban India and also require
frequent hospital visits creating hassle for patients.

Consumer pain points with hospital services in India

1. Access & Availability

Hospital infrastructure is overstretched with only 0.71 beds and 1.52 nurses per 1000 population.
2. Risk of getting other infections
1 in 4 patients has a risk of developing a Hospital Acquired Infection (HAI).
3. Costs & Hassle associated with lifestyle disease treatments
Lifestyle diseases contribute to about 50% of expenditure on in-patient beds in urban India and also require
frequent hospital visits creating hassle for patients.
4. Lack of personal Care
Hospital services do not provide personalized care to the patients which leads to low health outcomes post the
critical situation is overcome (especially in the case of elderly patients).
5. High hospitalization expenses
A patient admitted to ICU in a hospital pays between INR 35k to 50k per day.

https://redseer.com/newsletters/healthcare-at-home/
We are witnessing a number of players in this emerging market. And what makes home healthcare a preferable
choice is that it is 40% less costly as compared to hospitals.
Driven by multiple
favorable factors:

1.Increasing consumer
receptiveness towards
Home Healthcare

2. Rising Doctor’s
acceptance of Home
HealthCare

3. Improved Insurer’s
willingness to cover
Home HC expenses
Company X Landscape Analysis

Full Stack Solutions (Diabetic, Oncology,

Diabetic Care Oncology Care Cardiovascular, hypertension etc.)

Women Health Care Platform Physical Home Care

Surgery Solutions & Care
Reports and Links
https://youtu.be/t8FF6OESqVQ
https://www.youtube.com/watch?v=RshYNrftKwo
https://www.kalaari.com/wp-content/uploads/2021/09/chronic-care_compressed.pdf
https://www.downtoearth.org.in/news/health/almost-70-senior-citizens-in-india-have-a-chronic-illness-74944
https://www.livemint.com/
https://www.iipsindia.ac.in/sites/default/files/LASI_India_Report_2020_compressed.pdf
https://www.iipsindia.ac.in/content/lasi-publications
indiadiabetesmarketreport-220119124023.pdf
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-0854-8
https://link.springer.com/content/pdf/10.1007/s11596-021-2485-0.pdf
https://www.paho.org/hq/dmdocuments/2013/PAHO-Innovate-Care-2013-Eng.pdf
https://www2.deloitte.com/content/dam/Deloitte/cz/Documents/life-sciences-health-care/2020-global-health-care-
outlook.pdf
https://www.paho.org/hq/dmdocuments/2012/PAHO-improving-chronic-ill-2012-en1.pdf