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#7 Healthcare leapfrog – but where is the problem?

When was the last time you skipped a movie for a workout, or chose a salad over a pizza? Or, actually got your annual tests done – annually? Or, visited a doctor without seeking a second opinion? Or, took your pills without constant reminders?
These are problems even for someone who can afford the time and access to read blogs online. Now let’s move on to Bharat (i.e., all Indians except the affluent ~30 million families). 

Remember the Gorakhpur hospital deaths last year? Or, the recent Bihar encephalitis crisis? Here are some more boring stats – more than half the doctors in the country practise without any medical qualification, less than 20% of our population has access to secondary and tertiary care, more than 7% get pushed into poverty because of expenditure on healthcare every year. Be it tuberculosis, diabetes, anaemia or cancer – India shares one of the highest, if not the leading, burden of disease globally.

So, where is the problem? It’s everywhere! 

Let’s step back a little. There are constraints, and then there are problems. Problems are those that can and should be addressed. Constraints, however, are things that are almost impossible to change. For example, there just aren’t enough qualified doctors in the country. Or, a single-payer and provider system (i.e., our public health system) simply cannot address all the healthcare needs of the country. It is impossible to create a large pool of doctors in a short amount of time. Similarly, we are bound to have multiple payers and providers, each of whom has fundamentally misaligned incentives. These constraints are inherent in the system.

The question is – can problems be solved while operating under these constraints?

If we were to look at the problems, they would broadly be classified as the following:

  1. Supply (quality, affordability and accessibility): Improving quality, affordability and accessibility is indeed a necessary first step. While it is important to strengthen the existing infrastructure, certain initiatives and technologies can help accelerate this process. For example, the Ayushman Bharat Yojana is already addressing affordability at secondary and tertiary care levels for the vast majority of the population. Similarly, the combined use of low-cost screening and diagnostic devices, telemedicine and clinical decision support systems can enable even minimally trained professionals to deliver care, especially at the primary care level – making it good, affordable and accessible.

  2. Demand (health-seeking behaviour for preventive care and adherence): Even an excellent care delivery system would fail if people didn’t avail the services or didn’t stick to the recommendations offered as part of these services. This is precisely the problem in healthcare. Very few people actually engage in preventive care or adhere to the recommendations or treatment plan prescribed by a caregiver. It would require a very savvy use of point-of-care devices (that enable convenient at-home/doorstep testing, monitoring and instant diagnosis at affordable prices) and behavioural economics hacks (nudges) to bring about this behavioural change.

  3. Misaligned incentives (between provider-provider and payer-provider): An eye-care provider that I spoke to explained this to me. Even though this provider focused on cataract surgeries, it often ended up carrying out screening camps and post-op follow-up care for its patients. This was because of a lack of referrals – even if small providers/ general practitioners detected disease in the patient, they would not refer the patient upward for fear of losing to another provider. In other words, upward referrals don’t happen because downward referrals don’t happen. Similarly, the fundamentally misaligned incentives between payer and provider (which we talked about at length in this post) result in issues like procedure inflation and delayed intervention. How can this be addressed?

What’s missing?

As mentioned in one of our previous posts, we think the answer might lie in the concept of care intermediaries. As the name suggests, these will be new types of independent entities that are different from payers and providers. They will act as agents of the patient and aid in decision making. Specifically, they will play the following roles: (a) aggregation, (b) nudges, (c) referrals, (d) audits. With care intermediaries in the picture, let us understand what the new normal would be:

  1. The care intermediary predicts preventive care-seeking behaviour, disease incidence and adherence patterns. It uses this intelligence to distribute appropriate gamifier policies to customers. As an aggregate buyer of these policies, it is able to provide them at reasonable costs to the end consumers while also providing for its own sustenance.
  2. Every person who has a gamifier policy is now nudged by the care intermediary to seek preventive care. The care intermediary also carries out appropriate screening and diagnostic tests for its consumers.
  3. For the consumers identified with a need, the care intermediary then becomes a part of the referral workflow, and makes recommendations to the patient for both procedure and provider selection. 
  4. Lastly, the care intermediary facilitates downward referrals and nudges the patients to adhere to the prescribed post-treatment care plans. 

There could be many manifestations of the care intermediary – for example, it may partner with local community health workers to carry out screening and adherence management. Or, it could partner with primary caregivers for providing the actual referral recommendation to a patient. In other cases, such as seeking a major tertiary care treatment like surgery, the patient may directly consult the CI for recommendations.

What’s next?

What will the business model of a care intermediary be? How will it make credible recommendations?  Who will it partner with? What are the checks and balances required? What is needed from a privacy perspective?

The idea of a care intermediary is new, and a lot still needs to be worked out!
If you would like to share feedback or volunteer with us to help with this effort, please reach out to me at [email protected].

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Some reflections on the fireside chat with Vinod Khosla and Nandan Nilekani

On a cloudy Bangalore evening on August 2nd, the otherwise quiet campus of a medical college in the ‘startup saturated hub of Koramangala’ was bustling with energy. That night the campus was hosting a fireside chat with Vinod Khosla (renowned Venture Capitalist and Co-Founder of Sun Microsystems) and Nandan Nilekani (Co-Founder of Infosys), with Sharad Sharma (Co-founder of iSPIRT) acting as moderator.

Sitting in the midst of many young entrepreneurs, Sharad remarked how energetic Vinod and Nandan are at their respective ages.

Vinod responded “I have this fear that you can grow old when you retire, not retire when you grow old. So, I hope I never retire. As long as you have interesting problems to work on, there’s nothing more exciting to do than work on that.”

Sharad commented that even after all of his accomplishments, it seems that Vinod sees himself as the David in a ‘David vs Goliath’-styled battle and wondered whether that was a fair assumption.

Vinod replied “You want to be the underdog. You want problems to be hard. If they were easy to solve, somebody would have solved them. The problems are very large when you look at them initially. If you apply exponential learning to that, you can catch up with any problem very quickly. If you get on the right path to exponential solutions, they’re not as hard as they seem. Just starting to solve the whole problem in one step is like trying to climb Mount Everest in one step and go straight to the top without going to base camp 1, base camp 2 along the way.”

Turning to Nandan, Sharad asked “I think India does not have a David vs Goliath mindset. Does it?”

Nandan replied “India didn’t get Independence without thinking big. India’s first elections is another example of thinking big. I think it’s all there. Now, we are applying it in new ways. We shouldn’t be daunted by the size of the problem. Whether you’re solving a small problem or a large problem, it requires the same amount of thinking. So, you might as well solve the large problem. There’s much more value for your time and money. Today, you’ve, on one side, an extraordinary array of things that need to be fixed. And, you have an extraordinary array of tools & technology that can fix those problems. You’ve access to enormous amounts of capital & great talent. There’s no better time than this”

Sharad brought the conversation back to Vinod, asking what it takes for entrepreneurs to step up to big problems, to unlearn, to position themselves to be breakthrough entrepreneurs.

Vinod expressed that, in his view, “most people, most of the time, are limited by what they think they can do, not what they can actually do. Most people limit themselves. It’s a surprising thing to say, but I almost always find it to be true.”

He elaborated that entrepreneurs must have the courage to take one little step at a time on this exponential climb. They do not have to figure out the whole journey in order to start the journey. They will determine the right paths to follow along the way. They just have to be creative in figuring them out.

He mentioned that he doesn’t mind failing and that his “willingness to fail gives [him] the ability to succeed. Most people fail to try, instead of trying and failing.”

He went on to share an observation with the audience. He said “I look back 40 years and I can’t find one major innovation that came from a large company. Not one. General Motors and Volkswagen couldn’t design an electric car. Boeing & Airbus couldn’t do space as SpaceX could. None of the media companies did media as Twitter and Facebook did. None of the Pharma companies did Biotechnology as Genentech did.”

It’s important to note that he mentions ‘large innovation’ and not ‘incremental innovation’. Also, he refers to innovations that turned out to be large in their impact on markets that they were meant for.

While there are many examples to support this claim, let’s take examples from the period of the early days of Sun Microsystems, about four decades ago.

Xerox’s PARC lab had a treasure trove of innovation that would have never seen the light of day, had it not been for Apple.

IBM at their research lab in mid-1970s, pulled together some of the smartest people in the field to create a functioning relational database system based on Ted Codd’s theory (Codd was an English computer scientist who, while working for IBM, invented the relational model for database management, which served as the theoretical basis for relational database management systems).

They succeeded and developed a functional language called SEQUEL (Structured English Query Language), later changed to SQL. In any sense imaginable, it was a breakthrough, but it wouldn’t have revolutionized the software industry had it not been for Larry Ellison’s Oracle.

Vinod mentioned that “when the path is not clear and you are inventing something new, almost certainly it would be a startup, despite how hard it may sound!”

He mentioned that when people in the energy sector looked to GE and Siemens to innovate, they didn’t.

In the current market dynamics with large tech monopolies, we see, at times, that an incumbent does well at copying what a startup does, but they rarely outdo the hunger and agility of a fast-growing startup. Google had trouble with the social network, and there are numerous examples to this effect. However, given the large distribution that few of the monopolies have with nearly zero marginal cost to acquire new customers, even if the product is not the best to be found in the market, some other inherent advantages can make a me-too product of a large incumbent thrive. For example, Microsoft, despite Slack’s rise and successful IPO, is doing well with Teams because it is leveraging its corporate-ubiquitous Office 365 suite. (Ending Q2 2019, Teams had 13 million DAUs as compared to Slack’s 10 million DAUs.)

These occurrences should in no way deter the entrepreneur, but he or she does need to immerse him or herself in systems thinking and order effects of multiple degrees when looking at how dynamics in the market that he or she is trying to disrupt, will evolve.

Following up on this point, Sharad pointed out that usually there is something working in the background enabling the entrepreneurs to carry out the change. The wind in their sails such as a technological shift, market change, and public goods.

He cited examples of GPS, India Stack and Solaris, (a UNIX operating system developed by Sun Microsystems) which came about as a result of AT&T and Bell Labs opening up UNIX standard to the world.

Nandan agreed and said “So far entrepreneurs’ successes have been built on huge investments in public infrastructure by governments like the Internet, GPS etc. We need to invest in long term digital infrastructure. Only governments can afford it or have that vision. Then open it for private innovation.”

He further mentioned that “It’s a philosophy that we have adopted in India. Just as the US invested in the internet, GPS etc, we will invest in identity, payment infra, etc. and API-fy them, thus allowing innovation to happen on top of that.”

Vinod chimed in saying that “almost all entrepreneurs build on things that are already there. In fact, how much you orient that infra towards entrepreneurial ventures makes a huge difference. There are lots of startups in the US-based on government funding in science and technology in US universities.”

Nandan added that the advantage that we have now, is that the technology has been democratized. “We have all kinds of open source stuff. We have a cloud. It’s all there and it’s all free. And it’s for entrepreneurs to take that and mix & match. That’s where we can do a lot of work.”

Sharad summarized this exchange aptly by saying that “solving hard societal problems needs ‘jugalbandi’ between public infrastructure and private innovation on top of it.”

Taking an another IBM example of how this ‘jugalbandi’ manifests, while IBM was working on SEQUEL, a group of professors at the University of California, Berkeley, were also working on a relational database as part of a project called ‘Project Ingres’, funded by the US Government. Oracle used both as a foundation to spear through the market.

It was ultimately the speed of execution that saw Oracle making headway, utilizing the nudge given to it (IBM introduced a commercial product in February 1982, despite having a relational database up and running in 1977. They also were invested in hierarchical database system called IMS and were not fast enough to cannibalize their product)

In India, if the BHIM app was a B2C reference implementation of UPI, PhonePe utilized the opportunity to build a massive business on top of the same UPI stack.

Shifting gears, Sharad recalled his interaction with Jeff Bezos where he said Jeff takes just 10 minutes to determine whether a new hire is a good fit or not and one of the key things he looks for while assessing, is resilience. Entrepreneurs need loads of it as a ‘David’

Sharad asks Vinod about what he looks for in an entrepreneur when he is deciding whether to fund a start-up.

Khosla said “There’s no one formula. As a tech investor, you’re looking for a unique solution where one can create an advantage over time. It’s as simple as that. The biggest ingredient is the quality of the team you assemble. If it’s a great team, we will fund it, whether it has an interesting business plan or not. Team matters the most. And then how clever you are, how differentiated your technology is, how far ahead are you of others in thinking through how you want to build it.

“An important characteristic when evaluating somebody who has failed is what’s their rate of learning. That’s probably the most important way you evaluate an entrepreneur. When they move from job to job, do their teams follow? What books do they read? Do they spend their time learning new things? There are half a dozen things like that, that I personally use in evaluating people. But it’s still the hardest thing you do.”

He further added that he also has a strong belief that people with expertise in the area apply old rules and old biases while noting that experience is one of the largest biases there is!

Taking his Fintech investments as examples, he explains how the founders of Square, Stripe and Affirm never had worked in Fintech. Not knowing the space proved to be a massive advantage, and the entrepreneurs tried to solve problems with great empathy towards the customer, iterating while operating with first principles thinking.

He added by giving the example of Elon Musk’s never having worked in the auto industry prior to founding Tesla. Automakers laughed at the Silicon Valley startup with no experience in auto-making. He made lots of mistakes but fixed them quickly while figuring out a better way to proceed than those decided through conventional wisdom.

For those looking to innovate in their existing field of expertise, Sharad echoed that unlearning is more important than learning.

Sharad posed a nuanced question for Vinod by asking whether a healthcare start-up hiring a VP of Sales should hire one from the healthcare sector or not. Sticking to his view, Vinod remarked that he would rather hire an athlete who would be innovative and learn quickly instead of someone with bias from experience!

Talking about the quantum of funding and the excess in Silicon Valley, Vinod said, “nobody can say what’s the right level of money. It feels like a lot of money is floating around in Silicon Valley. But that’s because there’s been a lot of really good ideas. When new platforms emerge, new applications become possible. Then great entrepreneurs build them.”

He continued, “if you look at your mobile phone, and the touch interface, there really hasn’t been a huge startup in the US in the last five years. If you look at Uber, Lyft, Airbnb, Pinterest, they are all done. We have to see where are new platforms coming along.”

When prodded on what these new platforms can be, he elaborated “I do think AI is a new platform and offers lots and lots of opportunity. Fortunately, other than ads, it offers opportunity in lots of societal impactful areas. Medicine is my favourite. 3D printing is another new platform that people aren’t using enough. One of my favourite startups right now is trying to 3D print whole houses. What’s the advantage of that? Much, much lower cost, 24 hours to print a house, but more importantly, it’s environmental footprint is much better.”

He also wanted to highlight for entrepreneurs that large problems to be solved are not confined to the domain of software, but are present in many other fields as well, such as food, construction, healthcare, transportation, etc., which are all open to radical innovation.

He said that when one merges biotechnology solutions, such as CRISPR, with AI, all kinds of disease solutions are possible. He also believes that startups will dominate drug discovery using AI, far more than the big pharmaceutical companies will.

He brought up the example of Impossible Foods and recalls everyone asking him why he was investing in a hamburger company.

Giving the rationale behind the investment, he said that “about 30% to 40% of the planet’s land surface area is used for animal husbandry of one sort or another. I think about 90% of it could be freed up if the same meat was produced using the techniques like Impossible Burger. Plant proteins are the best way to save the planet. It’s healthier than meat proteins for humans because they come with cholesterol and other negative things. So it’s a beautiful solution.”

Talking more about the funding and its quantum, he argued that “the more money you raise initially, the less likely you are to succeed. There’s some beauty & elegance in very small amounts of money because it forces you to think about your problem much harder…you’re much more creative with your solution.”

While speaking about the need for creativity, Sharad mentioned that when entrepreneurs hit an obstacle during the process, they need to re-imagine and rejig, however, there are certain components that ought not to be rejigged, such as the core set of company values.

He gave examples of Infosys and Wipro being built on that value-based culture while noting that Bangalore’s vibrant ecosystem today is definitely a beneficiary of that culture.

Nandan agreed and said “values are very important if we want to build companies to last. If we want to build companies that sustain themselves over decades and really have an impact on society and the world, they have to be anchored in a core set of values.”

Vinod concurred, reflecting that “if you don’t have values, the first time you run into a problem, people scatter. If you have values & you have a mission, people stick together & double their efforts as a team. Values play a big role during bad times”

Following this topic, the chat naturally steered towards how entrepreneurs evaluate risk and what can be the right framework for evaluation and mitigation.

Vinod said that there is no one set of rules and that everyone has their own way of looking at it.

He added, “most investors reduce risk to the point where the probability of success is high, but its consequences of success are inconsequential. It’s a good way to get a predictable rate of return. I personally find it much more exciting, where the probability of success is low, but consequences of success are consequential.”

He gives the example of Larry and Sergey, founders of Google, saying that they had no interest in making a billion dollars when Yahoo offered to acquire them. They wanted to be consequential and change the world.

While this statement is accurate, it is important for us to study the different risk scenarios that entrepreneurs face, as well as how they frame and mitigate them. The reason is that while the Google founders rejected a billion-dollar offer, they also badly wanted to sell ‘PageRank’ to AltaVista and Yahoo for 1 Million Dollars to go back and resume their studies at Stanford (from The Google Story by David A.Vise).

So then, the question that arises is that how do the founders have different outlook towards acquisition at different points in time? What changes in-between, what transitions entrepreneurs go through, and what indicators should they rely on? One can dive into ‘Prospect theory’ and other frameworks for decision analysis under risk, but we also need to consider the passion and hunger of entrepreneurs, the unquenchable fire that powers them through the risk. That will have to be another iSPIRT blog altogether!

Speaking about the risk entrepreneurs face, Nandan added “You need a social fabric which delinks failure from the person; which recognizes that failure is a tremendous experience which is likely to increase the probability of success the next time around. Here failure, person & institutions are entwined.”

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Talking about AI, Vinod said “There will be enough jobs for humans after ‘Artificial General Intelligence. We don’t have enough humans for all the elder care we need and all the childcare. We could deploy ten times as many people and raise better children and look after elders much better. Those are just two examples. I think relationships are the inherent human tendency that will not go away and meaning will come from relationships.”

Nandan added that “the assumption that AI will automate everything and there will be no jobs left and therefore we need UBI and a way to keep them occupied is wrong. The way I think about it, AI amplifies human capability. The combination of human and AI is going to be very strong.”

As the chat drew to a close, it became more apparent than ever that for the Indian ecosystem to thrive and for us to build massive companies, we need a new entrepreneur archetype – the kind that can zoom out and look at macro-trends, applies ‘systems and first principles’ thinking, platform over product thinking, have big audacious goals while being extremely empathetic to their customers.

There used to be a long gestation period from the founding of a company until it faced foreign competition on Indian soil. From early days of MakeMyTrip, Naukri to Ola, Quikr a few years back, it has reduced drastically such that companies like PhonePe have to ward off heavyweights like Facebook, Google and Amazon within a year of starting up! Indian entrepreneurs will need to buckle up as the platform wars on Indian Playground with digital public goods will only intensify, unleashing massive opportunities and growth for the country.

Please write into [email protected] for a deep dive and information on upcoming iSPIRT events where we will discuss this new entrepreneur archetype as part of what we call ‘Athletic Gavaskar Project’, and to learn more about our volunteer model.

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A Day at Startup Bridge – Crafting Strategic Partnerships

For our most recent Startup Bridge Salon on May 9th, we had planned for sixty 1-1 strategic partnership meetings between 11 B2B startups and 35+ US corporates. In the weeks leading up to the event and the week post-event, we clocked 115 meetings. Read more to learn about the event & program, and how you can participate or get involved. 

 I got 10 meetings with decision makers through StartupBridge which is worth 1000 business cards at a trade show. (Raviteja, CEO @Moengage, May 2019)

I made 18 connects out of which 11 are of extremely high value. (Aditya, CEO @FirstHive, May 2019)

History of StartupBridge, M&A/PSP Connect

In 2013-14 the M&A Connect (and Business Exchange BEX) program was established as part of iSPIRT’s Market Catalyst pillar to help solve the problem of extremely low “exits” to “investment” ratio for startups in India. Strong “exits” are healthy markers of a mature startup ecosystem, closing the cycle of capital flows. The program consisted of developing a strong match between the global corporates interested in acquisitions (buy-side) and Indian startups (sell-side). 

The initial problem was a discovery issue where Indian startups were not on the radar of these potential acquirers. The M&A connect program activated the India radar, by engaging the buy-side to collect deep virtual mandates, and use it to match and make warm connects with the sell-side, at times hand-holding the connect process to several favorable outcomes. 

In this program, we found that our startups were not effective at pitching their story to a potential acquirer. This resulted in a few aborted connections. Additionally, it became clear that the path to an effective M&A lay in facilitating potential strategic partnerships (PSP), which if nurtured has the potential to blossom into investments or acquisitions. Strategic partnerships can surface in the form of technology or GTM/distribution level enfgagement between startups and larger corporates. It can open several doors instantly, making distribution easier, revenue growth faster and gives the startup multiple options.

The M&A Connect program morphed into PSP Connect (Dec 2016 onwards) and the program goals moved from pure M&A to building strategic partnerships. iSPIRT partnered with TiE leaders in Silicon Valley to create the Startup Bridge India initiative (SBI), where many buy-side companies were invited to meet and explore strategic level engagement with highly curated sell-side startups. 

The Startup Bridge Approach

Over the last 3 years, the SB team, iSPIRT volunteers and TiE partners, have helped B2B SaaS/enterprise startups refine their air-game, and engage in partnership discussions with high conversion outcomes. 

We have connected 45 startups to Fortune 1000 corporations and in the process catalyzed $200M+ of value in terms of PSP (potential strategic partnership), customers and M&A. (Manu Rekhi, Inventus Capital & Startup Bridge)

The key value proposition is to help startups scale revenue by 10x in 2 years through meaningful PSP connects with decision-makers at global Fortune 1000. In turn, these corporations leverage SB to engage with highly curated startups to get access to technology and product gaps. 

We are effectively the bridge over the chasm that most startups struggle with, and the potential disruption that many corporates are worried about.

Startup Selection

Did you know that ~50% of Unicorn enterprise startups in the Silicon Valley have an Indian founder or co-founder and had origins or back-offices in India? 

Our stringent startup selection process is essential for matching the “Who in India” with the “Who in USA”. Data from the program over the years have shown that the startups which stood to leverage the program effectively and benefited the most were in the ARR range of $500K to $5M. Hence SB’s high-level criteria for inducting B2B enterprise/SaaS startups into the program focus on a) having a global product-market fit, preferably in the US, with b) a strong footprint & revenue (~$1M ARR), and c) bringing deep technology, high revenue potential and/or a high growth momentum. 

PSP Wishlist

Karthik & Vinod discuss their key partnerships approach

On the buy-side, it is critical to engage corporates who can enable the 10x growth for these startups. Most startups see partnerships as tactical like with a reseller, system integrator (SI), channel/OEM partner… A strategic partner goes beyond tactical value. A startup can explore and collaborate with a PSP to accelerate its strategy in the emerging focus area. In return, the PSP provides a rocket boost to the startup’s customer acquisition, distribution, branding, and/or a holistic product strategy. Having such a partner can also significantly impact startup valuation.

As a startup, you need to think about a PSP early in the game at the ‘Flop’ and not at the ‘Turn’. You need time to develop a PSP and you need to start early. (Vijay Rayapati, Nutanix, Jul 2018)

If you think of the value chain of your customers, their vendors, integrators, solution & platform providers, a strategic partner may lie above you and your peers, and a level or two above your target customer. Often high growth customers can transform into strategic partners. We help the startups think through their PSP wishlist and make relevant recommendations.

Startup Air Game

Pitching to a PSP company is very different from the pitching to a customer or to an investor. A well-articulated pitch can make a difference between a yawn and a wow! A great startup pitch highlights their Mission, problem statement, their solution & approach, the product/platform overview, key metrics & traction, unit economics of growth & acquisition, testimonials, market size & drivers, and finally their ask. 

I thought I knew my pitch and had the details at my fingertips. But then I started getting really valuable, thought-out feedback…I had to focus on pitching to partners, not customers. (Pallav Nadhani, FusionCharts, Dec 2016)

Mentor feedback sessions during the boot camp

It takes 100 hours per startup to articulate their value proposition into a pitch deck of only 10 crisp slides. The initial hours creating & refining their pitch deck with assigned mentors. It is followed by a day-long boot camp before the event where they are grilled through their pitches by the SB team, startup & corporate mentors from the industry, and successful entrepreneurs.The multiple rounds of feedback not only cover their proposition, but also helps weave in the founders’ story, and develop their stage presence, and tonality. Post boot camp they work on the critical feedback with their individual mentors, sometimes even redefining their models & assumptions, and final dry runs with the SB team. The results at every SB event have been astounding 7-min founder pitches amazing every attending corporate and industry leader. 

Tapesh and his amazing 7-minute “technicolor” pitch deck

PSP Virtual Mandates & Exclusive Connects

Vamshi 1-1 connects over the roundtable.

We have found that startups require 2 points of support for effective partnership outcomes. First, crafting warm connects based on virtual mandates. Second, prime focus on shepherding the startup-partner conversations on a rolling basis. The unmet need is to have 1-1 connects with the right person on common ground.

I went from first discussion into pricing in one week with a Fortune 10 company.  Getting in front of the decision maker is all the difference. As a founder/CEO I can close the sale without the long drawn out sales process. (Sanjoe Jose,  CEO @Talview, May 2019)

Bringing PSP companies into our network, we connect with key profiles within the company on their build-buy-partner outlook. This helps in surfacing several latent areas of focus for partnerships, investments or acquisitions. Constructing the virtual mandate out of these relations is key to recommending a high-potential match between the startups and corporates. 

All startup bridge sessions and introductions are curated and by invite-only. 

Exclusivity made the quality of event and connections even more important. I attended because of an impressive amount of my peers from other Fortune 1000 companies. (Rahul Kamath, VP Oracle, May 2019)

Impact to Date

The stringent startup curation criteria ensure high potential innovation & growth partnerships for corporates. The intense boot camp and mentoring hours help startups develop highly effective positioning in the market. The latent virtual mandates enable effective match-making resulting in extremely relevant growth opportunities for the startups.

If I had to do this on my own each of these connections would have taken 8-12 weeks of effort.

Though these events get significant attention & traction, the goal of the SB program is to deliver these connections on a rolling basis. Here are some stats and anecdotes across the years:

  • 19 out of the 45 startups in the SB cohorts have grown 10x in the past 2 years.  
  • 749 connections to decision-makers have been made to-date with >$200M of value creation in terms of partnerships, customer purchases, and M&A. 
  • 121 PSP connections from the May 9th event and beyond.  
  • 3 exits and 1 more on the way.
  • Focus on quality and value creation has resulted in consistent high NPS 56-81. This focus on quality is the core principle of this community lead effort and the hallmark of success so far. 

What can you do?

Shifting from its pro-bono, volunteer-run orbit, Startup Bridge is transforming into a mature, scalable global program. By broadening the corporate network reach beyond Silicon Valley, and expanding support to startups of Indian origin regardless of domicile, the program is poised to benefit startups and corporates at scale. Upcoming SBDays are being planned for New York, Bay Area, Japan. Startup Bridge continues to be mission-driven, helping fill a critical gap in strategic partnership building for Indian origin startups. 

If you are a startup or would like to refer a startup to be part of the SB program please fill the partnership application form. Alternately you could email us at [email protected]. 

If you are a corporate exec and/or can help us with decision-makers (CXOs, EVP/SVP, GM), or key influencers (VP/Director of Partnerships, Corporate Development) please email us at [email protected]. 

[This post could not have been possible without inputs from the SB Team & iSPIRT volunteers, Dipty Desai, Jibin Jose, Manu Rekhi, Raju Reddy, Sharad Sharma, Sijo George, Rajan Thiyagarajan, Vrushali Malpekar, and volunteers from the previous Startup Bridge/PSP Connect program.  Also, personal thanks to all the volunteers, mentors, and the participating startups for making the SB Salon on May 9th successful.]

Some more photos from the salon

Whatfix pitch by Khadim
Vivek pitching iZooto
Predera’s pitch by Vamshi
Vishal on Seclore
Side 1-1 with Flex
Hitachi giving feedback on Startup Bridge
Workday commenting on Startup Bridge
Ashish with Israeli Panel
Side 1-1 with Salesforce
Peer networking
Corporate Attendees
Corporate Attendees
Nimesa at boot camp – pitch feedback
Moengage at boot camp – stage presence feedback
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Fireside Chat: Vinod Khosla and Nandan Nilekani in Conversation with Sharad Sharma

Join us for a conversation with Vinod Khosla and Nandan Nilekani. Together with Sharad Sharma, our fireside chat host, they will talk about what it means to be an entrepreneur in India today and how these entrepreneurs can solve the hardest problems of India.

Vinod Khosla and Nandan Nilekani are arguably two of the most influential thinkers and innovators of our time when it comes to transformation, entrepreneurship, and large scale impact. Born within 6 months of each other, both graduated for IITs, created iconic companies, become billionaires in the in aprocess and continue to innovate and transform the world.

What better opportunity than to hear these icons of industry at a fireside chat discussing the most intriguing aspects of startups, entrepreneurship, digital transformation and India’s growth towards a multi trillion dollar economy.

About Mr. Vinod Khosla

Vinod Khosla is the founder of Khosla Ventures, a premier Silicon Valley venture capital firm, and a member of the 2018 Midas List. His firm, Khosla Ventures, invests in a wide variety of startups ranging from Healthcare, Sustainable Energy, Food/Agriculture to Space, AI and Robotics. He co-founded Sun Microsystems in 1982 after which he spent 18 years at venture capital firm Kleiner Perkins Caufield & Byers before launching his own fund.

About Mr. Nandan Nilekani

Nandan Nilekani is the co-founder of tech giant Infosys and currently back as a non-executive chairman affecting a remarkable turnaround. In 2009, he was made a Cabinet Minister and Chairman of UIDAI – India’s mammoth National ID project – Aadhaar.  After Aadhaar, Nandan has actively supported India’s digital transformation through the IndiaStack initiatives in payments, digital locker, eSignature and other services. Nandan has also backed startups in the India ecosystem.

About Mr. Sharad Sharma

Sharad Sharma is the co-founder of iSPIRT and has worn many hats as CEO of Yahoo India R&D, Chair of NASSCOM Product Forum and as intrapreneur at AT&T. He is a passionate evangelist and an active investor in the software product ecosystem in India.

When?

2nd of August, 2019 from 18:00 – 19:30 hrs.
Venue to be disclosed. 

How to participate?

You can be a part of this Fireside Chat by registering here. Confirmed participants will be intimated by the 28th of July via email. 

Please note, due to limited seating at the venue we will not be able to accommodate everyone who applies.

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Data Empowerment and Protection Architecture Explained – Video

More commonly known as the ‘Consent Layer of the India Stack’, Data Empowerment and Protection Architecture (DEPA) is a new approach, a paradigm shift in personal data management and processing that transforms the currently prevalent organization-centric system to a human-centric system. By giving people the power to decide how their data can be used, DEPA enables the collection and use of personal data in ways that empower people to access better financial, healthcare, and other socio-economically important services in a safe, secure, and privacy-preserving manner.

It gives every Indian control over their data, democratizes access and enables the portability of trusted data between service providers. This architecture will help Indians in accessing better financial services, healthcare services, and other socio-economically important services.The rollout of DEPA for financial data and telecom data is already taking place through Account Aggregators that are licensed by RBI. It covers all asset data, liabilities data, and telecom data.

We, at iSPIRT, organised a learning session on the 18th of May, to give relevant and interested stakeholders a detailed primer on DEPA. We had 60-odd very animated and engaging people in the audience. The purpose of the session was to understand the technological, institutional, market and regulatory architecture of DEPA, it impacts on existing data consuming businesses and how people could contribute to this new data sharing infrastructure that’s being built in India.

The session was anchored by Siddarth Shetty, Data Empowerment And Protection Architecture Lead & Fellow, iSPIRT Foundation (Email – sid@ispirt.in). Please feel free to reach out to him for any queries regarding DEPA.

For other queries, please write to [email protected].

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#6 Healthstack session at LetsIgnite

We had the chance to conduct a discussion on the National Health Stack during the LetsIgnite event organized by the LetsVenture team on 15th June at the Leela Palace. The audience comprised of early stage healthcare startups along with angel investors and venture capitalists having keen interest in healthcare investments. Some notable attendees included Dr. Ramesh (senior cardiologist, MD Endiya Partners) and Mr. Mohan Kumar (Partners, Norwest Venture Partners).

Sharad Sharma (co-founder, iSPIRT), Dr. Santanu Chatterjee (Founder, Nationwide Primary Care), Dr. Ajay Bakshi (Founder Buddhimed Technologies, ex-India CEO Parkway Pantai) and Arun Prabhu (Partner, Cyril Amarchand Mangaldas) had been invited to lead the session, which was moderated by Anukriti Chaudhari and Priya Karnik, both core volunteers at iSPIRT championing the health stack initiative.

The context was set by an interactive talk by Sharad who began by giving a glimpse of the underlying philosophy of the iSPIRT Foundation – the idea of building public goods as digital technology stacks which can be leveraged by private players to serve Bharat. . Sharad described societal change in India being a Jugalbandi between digital public infrastructure, market participants and policy makers to achieve the same. He mentioned how the India Stack was changing the face of fintech in India and that the Health Stack could do the same for healthcare. The audience was more than startled to hear that a day prior to the session, the number of UPI transaction in India were already one-sixth of what MasterCard had done worldwide. ( UPI has only been around for 33 months! ). Sharad then went on to explain the different layers of the Health Stack comprising National Registries, standardised health information flows, an insurance claims management software built upon a standard Policy Markup Language and a gamifier policy engine. He didn’t miss reminding the audience that the Health Stack was being built to solve for the healthcare needs of ‘Bharat’and not the privileged 30 million Indian families already being well-served by the healthcare conglomerates in urban areas.

With the context in place, Anukriti took over to give a background of the healthcare landscape in India. India struggles with a 1:1600 doctor to patient ratio with more than 60% of doctors and hospitals concentrated in urban regions. To add to that, the public expenditure for healthcare is just 3.9% of our annual GDP (compared to 18% in the US) and it’s not surprising that most deaths in public healthcare facilities happen because of poor quality of care. Health insurance penetration barely touches 20% with OOP expenditure dominating the healthcare spending in India. With a huge underserved population, the need of the hour is to leap-frog to scalable solutions that can reach the masses instead of incremental linear growth solutions to address the Indian healthcare challenges. The different layers of Health Stack make it much easier for innovators (both public and private) to develop radical solutions.. While funding in healthcare startups has increased over the last 5 years, it still significantly lags behind areas like fintech, e-commerce, ed-tech, etc. Moreover, the bulk of healthtech investments have been focused on the consumer tech sector. Anukriti ended her views with a futuristic optimism regarding the innovations that Health Stack could open, to make healthcare truly affordable, accessible and high quality.

We were fortunate to have Dr. Santanu and Dr. Bakshi give insights about the Health Stack with their on-ground experiences in healthcare spanning over decades. Dr. Santanu mentioned that for primary care, the national registry of care providers was very fundamental to ascertain ‘which stakeholder provides what’ given that almost every provider is somewhere involved in primary care. On top of that, he stressed about the need for Artificial Intelligence backed clinical support systems that seamlessly integrate with the doctor’s workflow. This is of particular relevance for rural healthcare settings wherein, despite various efforts, there aren’t enough doctors to setup shops in villages . A standardized health information layer, along with data transfer mechanisms, could be the driving force for this. He was, however, wary of how well standard insurance schemes would work for primary care as the insurance business model falls apart given that almost everyone needs access to primary care at some point or the other. Priya resonated with his views and further suggested that for ‘Bharat’, micro insurance policies could be the key mechanism to drive insurance adoption at the consumer level. Such a system could potentially be facilitated by a claims engine platform build upon a standard policy markup language to ‘almost-automate’ (auto-adjudicate) the claims addressal process.

Dr. Bakshi contended that for a stable society, healthcare and education are a must, as the former secures our ‘today’ while the latter secures our ‘tomorrow’. Having worked as the CEO of three major hospital chains in India, he accepted (without an iota of political correctness) that as a nation, we have failed miserably in providing either. Healthcare is a social good and nowhere in the world has it been solved by private players alone (given the way private incentives are aligned). The public sector in India hasn’t stepped up which is the reason that private players dominate the quality healthcare delivery which could lead us (or is perhaps already leading) to following the footsteps of the US. This is an alarming trend because in the short and medium term, India cannot afford to outsource the entire healthcare delivery to private players. Dr. Bakshi remarked that to set things on the correct track, the Health Stack is a very important initiative and congratulated the iSPIRT team for working ardently to make it happen. He however suggested all stakeholders to be privy of the fact that while fintech transactions are linear (involving the payer and the recipient), a healthcare ‘transaction’ involves multiple aspects like the doctor’s opinion, investigation, drugs, nurses, ward boys and many other layers. This underlying multidimensionality would make it difficult to replicate an India Stack kind of model for the healthcare setting. At the core of the healthcare transaction lies the ‘doctor-patient’ interaction and it is imperative to come but with some common accepted standards to translate the healthcare lingo into ‘ones and zeroes’. He lauded the health information flows  of the Health Stack for being a step in the right direction and mentioned that in his individual capacity, he is also trying to solve for the same via his newly launched startup Buddhimed Technologies.

With two stalwarts of healthcare sitting beside her, Anukriti grabbed the opportunity to put forth the controversial concept of ‘doctors being averse to technology’ which could possibly be a hindrance for Health Stack to take off. Dr. Santanu and Dr. Bakshi were quick to correct her with the simple example of doctors using highly technical machines in providing treatments. They coherently stated that doctors hated Information Technology as it was forced upon them and suggested that IT professionals could do a better job by understanding the workflows and practical issues of doctors and then develop technologies accordingly. This is an important takeaway – as various technologies are conceptualized and built, doctors should be made active participants in the co-creation process.

The idea of a common public infrastructure for healthcare definitely caught the attention of both investors and startup founders. But amidst the euphoria emerged expected murmurs over privacy issues. That was when Arun Prabhu, the lawyer-in-chief for the session, took the lead. He reiterated Dr. Bakshi’s point of the doctor-patient relationship being at the core of the healthcare transactions. Such a relationship is built upon an element of trust, with personal health data being a very sensitive information for an individual. Thus, whatever framework is built for collating and sharing health information, it needs to be breach proof. Arun cited the Justice Srikrishna report to invoke the idea of consent and fiduciaries – a system wherein individuals exercise their right to autonomy with respect to their personal data not by means of ownership (which in itself is an ambiguous term), nor by regimes of negligence or liability but by the concept of a coherent consent mechanism spread across different stakeholders of the healthcare value chain. Moreover, the consent system should be straight-forward and not expressed via lengthy fifty page documents which would make it meaningless, especially for the India 2 and India 3 population. Lastly, he mentioned that just like physical and tangible assets have certain boundaries, even data privacy can have certain realistic limitations. If an information point cannot be specifically identified or associated with a particular individual but can have various societal benefits, it should be made accessible to relevant and responsible stakeholders. Thus, while it is imperative to protect individual health data privacy, there should be a mechanism to access aggregated anonymized health data. There is tremendous value in aggregating large volumes of such data which can be used for purposes like regional analysis of disease outbreaks, development of artificial intelligence based algorithms or for clinical research. Priya added that such a system was inherent in the Health Stack via the Population Health Analytics Engine and the framework for democratisation of aggregate data.

Overall, the session amalgamated various schools of thought by bringing together practitioners, CEOs, CIOs, lawyers, startups and investors on one common discussion platform. This was perhaps an example of the much-needed Jugalbandi that Sharad had mentioned about. A public good is conceptually ‘by the stakeholders, for the stakeholders and of the stakeholders’. This necessitates its active co-creation instead of isolated development. Needless to say, multi-way dialogue is the DNA of such a process. Staying true to that philosophy, we look forward to conducting many such interactive sessions in the future.

Ravish Ratnam is part of the LetsVenture Team – a platform for angel investing and startup fundraising.

He can be reached on [email protected]

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Call for National Health Stack Session at LetsIgnite on 15th June

Health Stack

The National Health Stack aims to improve quality, access and affordability of healthcare, facilitate national health programmes, monitor insurance policies and claims, and boost medical research and health analysis. The stack is being designed to support existing and future health initiatives, both public and private.

NHS is a visionary digital framework usable by centre and state across public and private sectors. It represents a set of platforms that supports a multitude of health verticals and their disparate branches, and is capable of integrating future IT solutions for a sector that is poised for rapid, disruptive changes and unforeseen twists.

Various layers of the National Health Stack will seamlessly link to support national health electronic registries, a coverage and claims platform, a federated personal health records framework, a national health analytics platform as well as other horizontal components.

Health Stack @ LetsIgnite

LetsIgnite, an initiative by LetsVenture,  has been India’s premier Investor conference bringing together marquee investors to engage with early-stage Startups in the ecosystem as well as other prominent Investors.

One of the highly anticipated sessions at LetsIgnite will cover the introduction to the National Health Stack, feature a deep discussion among the various NHS stakeholders and address queries about NHS. Additionally, 5 shortlisted health-tech startups will be pitching to a highly curated audience consisting of Angel investors, HNIs and other relevant stakeholders.

Some of the confirmed speakers for the session include Sharad Sharma (iSPIRT), Dr. Santanu Chattopadhyay (Founder, Nationwide Primary Healthcare Services), Dr. Ajay Bakshi and awaiting a few more confirmations.

LetsIgnite events are built as a business conference for Investors to connect with relevant Startups in the form of several knowledge-based sessions, panel discussions, and one-on-one interactions. To know more about Lets Ignite and check out what else is happening, click here.

When

1:15 – 3:15 pm on the 15th of June, 2019

Where

The Leela Palace, Bangalore

Who should come for the session?

Calling out to healthtech entrepreneurs, various stakeholders of the health ecosystem, angel investors and enthusiasts who are looking to understand the impact of the National Health Stack to come attend this session. Please feel free to write to Ravish Ratnam ([email protected]) to participate.

For Healthtech startups looking to apply for the Pitching Session, please register on this link.

The deadline for Pitch session applications is the 25th of May, 2019.

NOTE – Please note that this is a highly curated track at LetsIgnite and they may not be able to accommodate everyone who applies for this session.

For general queries, please feel free to write to Ravish Ratnam ([email protected])

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Drones, Digital Sky, Roundtables & Public Goods

This is a guest post by Dewang Gala and Vishal Pardeshi (Pigeon Innovative).

Unmanned Aerial Vehicles(UAV’s)/ Drones have been making a buzz all over the world. Drones in the past have been looked at as a threat in various countries. The public perception towards drones has been very different in the past and has been changing over the past few years when people have been able to see the real benefits that this technology can offer. However, there is a need for a regulatory body to avoid the misuse of drones.

India is one of the key markets where the future growth of drone technologies is likely to emerge. India’s drone market expected to grow $885.7 mn and drones market in the world will reach $16.1 billion by 2021. Thus this market will create lots of employment opportunities and help our nation’s economy grow. Just like how the Information technology sector flourished in India increasing its contribution to the Indian GDP from 1.2% in 1998 to 7.7% in 2017, the Indian drone industry shows a similar promise.

How can drones contribute to the public good in India?

Previously, drones were an area of interest for defense sector only, but in past decade drones have been able to come into the public and commercial space where they have been able to take high definition photos, map a large area in a short time, calculate crop health, spray pesticides, inspect man-made structure which would be difficult or unsafe while doing it traditionally, play a crucial role during natural calamities to save lives, deliver goods and medicines.

Countries like Rwanda have allowed a full network of drones in their airspace which has helped save lives with the delivery of medical supplies. The company operating there initially had a huge challenge to convince people that the drones were meant for good and the company did not have the intention to spy on them. Once the people of Rwanda saw that these drones could save lives, a whole network of drones emerged across the country. Imagine the impact it would create across different industries in India if we accept and embrace this technology and have regulations in place for its safe usage. The upsurge of new drone-based innovative companies is a positive sign of India heading towards becoming a global leader in this field.

India is a high potential market, still entrepreneurs and businessman in this sector experience oblivion. This is because a few years back drones were completely banned in India as a perceived threat and now steps have been taken in Drone regulation 1.0 to get the industry moving forward. Though there are many roadblocks for the regulations to be in full force as it tries to bring together multiple agencies, the good part of it is that government understands that they lack the necessary skills set to create regulation and is willing to take help from the existing players to contribute in making the regulation more robust and user friendly.

What can be the public goods in the drone industry and why do we need them?

Paul A Samuelson is usually credited as the first economist to develop the theory of public goods. But what exactly is public goods?
A good which is:

  • Non-excludable – it is costly or impossible for one user to exclude others from using a good.
  • Non-rivalrous – when one person uses a good, it does not prevent others from using it.
  • Indivisible – one cannot divide public goods for personal use only.

Traffic lights, roads, street lights, etc. are examples of public goods. With the seamless possibilities that drones can offer, it makes sense to have public goods defined for this sector.

Imagine a future where airspace is accessible to everyone, where we have defined drone ports and air corridors which will allow smooth and safe operation of the drones. A lot of industries can benefit from it. Creating public goods will also allow more people to participate in the system thus increasing the size of the pie. If everybody in the system starts feeling comfortable with the operation of drones in the open skies then we could fundamentally transform the way we do things.

Who should be responsible for creating public goods?

Although classical economic theory suggests public goods will not be provided by a free market. But in a market like India, where the market is neither free nor regulatory, groups of individuals or organization can come together to voluntarily help government bodies to provide public goods in this market. For example, DigitalSky platform is a software initiative developed by the joint effort of iSPIRT and the government, working towards creating an online platform for registration of drones and obtaining permission for its operation, with a vision of making it paperless and presence-less.

There is tremendous scope for innovation and improvement in this sector. In the case of public goods, no firms will find it profitable to produce these goods because they can be enjoyed for free once they are provided and they cannot prevent this from happening. To provide these goods then, we either rely on governments or private organizations which volunteer to work on these issues.

The growth in India’s drone market would be primarily driven by the proactive initiative of existing players who will lay the foundation of this market in India. Thus DICE and iSPIRT have taken an initiative and are spreading awareness through round table sessions.

Round table sessions organized by DICE and iSPIRT serve as a platform where drone based entrepreneurs come together and think towards growing this industry by creating a model that benefits everyone in the system. The aim is to create a win-win situation in B2B and B2G.

The round table primarily serves two purposes:

  1. To enable strategic partnerships between companies and encouraging companies to contribute to public goods.
  2. Bridging the gap between the companies and the government.

Behavioral economics suggests that individuals can have motivations other than just money.

For example, People may volunteer to contribute to local flood defenses out of a sense of civic pride, peer pressure or genuine altruism.

Even if we have a narrow self-interest point of view we have to understand that voluntarily helping government bodies in tackling and solving the issues in drone rules and regulation will in turn help this market to flourish. And companies or individual contributors will have an underlying first mover advantage. So it’s important to act proactively to help the government to create regulation on your futuristic business model. It’s our job to demonstrate government that business can be done safely with a minimum amount of agreeable risk. Working together will not only accelerate the pace at which the regulations are implemented but also ensure that India takes away a big slice of the $100bn drone market. [5]

How does the future look like?

If you have ever seen the cartoon “The Jetsons” from the 1990’s you can already imagine what the future could look like. We are in an era where we can clearly automation and AI takes over mundane and laborious tasks at an exponential rate. The computers around us today are becoming powerful with each day. It can be witnessed that today it has become much easier to survive and it isn’t hard to survive as it used to be back in the days. We are not too far from the singularity where machine intelligence surpasses human intelligence. Thus we should have an environment where we can ensure that the technology is exploratory and exploitation is avoided.

Technology doesn’t happen on its own, people work together to make those imaginations/dreams a reality. We can already see Proof of concept (POC) of drone deliveries, drone taxis, and other futuristic applications. Who knows what else could we have with us in the next decade. Imagine a future where you would own your own personalised autonomous flying vehicle which takes you to your desired place with just the press of a button. You would have mid-air fueling stations which would enable you to drive without having ever to touch the land. Millions of smaller sized drones would be able to deliver products within minutes just like the internet today delivers information. Drones would become smaller and smaller and nanotechnology will enable us to overcome the limitations we see in drones today. Many other applications will rise up as we start working towards.

If you have any suggestions/solutions/ideas on how the system can be made better you can definitely become a part of iSPIRT / DICE India and write to us on [email protected] or [email protected] and also become a part of the round table.

 

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India’s new Software Products Policy marks a Watershed Moment in its Economic History – Can the nation make it count?

India is on the glide path of emerging as one of the economic powerhouses of the world – its economy is ranked sixth in size globally (and slated to climb to second by 2030); it has the fastest growing annual GDP growth rate amongst (major) countries; the country ranked in the world’s top 10 destinations for FDI in 2017-18. With a population of 1.3 billion and a large middle class of ~300 million+, it is one of the most attractive markets globally. Specifically in the digital economy – India has a huge $ 167 billion-sized IT industry; it boasts of a 55% market share in global IT services & outsourcing; 1140 global corporations run their tech R&D centres in India. In the tech startup space, India has attracted Private Equity (PE) & Venture Capital (VC) investments of $33 billion in 2018, and it has over a dozen unicorns (startups with over $1 billion valuations).

These data-points are truly impressive and would make any country proud, but they belie one of the glaring historical paradoxes of the Indian economic story – the sheer absence of world-beating products from India. Ask Indians to name three truly world class, globally loved Indian products or brands – chances are they’ll struggle to name even one. Check out the Global Innovation Index 2018 from the World Intellectual Property Organization (WIPO) – India doesn’t figure in the top 50 countries. Or the Interbrand 2018 Top 100 Global Brands Ranking – there’s no Indian name on that list. Leave aside brick & mortar industries, the Indian IT & Digital sector doesn’t fare any better on this count. IT services, which forms its lion’s share comprises largely of low end, commoditized services or cost arbitrage based outsourcing contracts. Most of the new age tech unicorns in India are based on ideas and business models that are copied from foreign innovators (with some local tweaks) – their outsized valuations are a result of them being the gatekeepers to the large Indian market, rather than from having created path-breaking products from first principles. So the overall trend is that India has a large domestic market, and it is a big supplier of technical brain power on the world stage, but when it comes to building innovative products, we come to a total cropper. This is best reflected in the Infosys Co-Founder, Narayan Murthy’s candid quote – “There has not been a single invention from India in the last 60 years that became a household name globally, nor any idea that led to the earth-shaking invention to delight global citizens”.



The launch of the National Software Products Policy (#NSPS):

It is in this light that the recently rolled out National Software Products Policy (#NSPS) by the Ministry of Electronics & IT (MeitY), Government of India marks a watershed moment. For the very first time, India has officially recognised the fact that software products (as a category) are distinct from software services and need separate treatment. So dominated was the Indian tech sector by outsourcing & IT services, that “products” never got the attention they deserve – as a result, that industry never blossomed and was relegated to a tertiary role. Remember that quote – “What can’t be measured, can’t be improved; And what can’t be defined, can’t be measured”. The software policy is in many ways a recognition of this gaping chasm and marks the state’s stated intent to correct the same by defining, measuring and improving the product ecosystem. Its rollout is the culmination of a long period of public discussions and deliberations where the government engaged with industry stakeholders, Indian companies, multinationals, startups, trade bodies etc to forge it out.

#NSPS will bring into focus the needs of the software product industry and become a catalyst in the formulation of projects, initiatives, policy measures etc aimed at Indian product companies. One of its starting points is the creation of a national products registry that’s based on a schematic classification system. Other early initiatives that will help in operationalizing the policy – setting up of a Software Products Mission at MeitY, dedicated incubators & accelerators for product startups, development of product-focused industrial clusters, preferential procurement by the government from product companies, programs for upskilling and talent development etc.

The Indian IT / Software Industry Landscape:

To understand the product ecosystem, one needs to explore the $ 167 billion-sized Indian IT / Software sector into its constituent buckets. The broad operative segments that emerge are –

1) IT Services & ITES: This is by far the largest bucket and dominates everything else. Think large, mid & small sized services companies throughout the country servicing both domestic & foreign markets. e.g. TCS, Infosys, Mindtree, IBM, Accenture, GE etc
2) Multinationals / Global Development Centers: These are foreign software companies serving Indian markets and/or using India as a global R&D development centre. e.g. Microsoft, Google, Netapps, McAfee, etc
3) Domestic Product Companies: This is a relatively small segment of Indian software product companies selling in domestic or overseas markets e.g. Quickheal, Tally etc.
4) Startups – E-commerce / Transactional services: This is the large, fast-growing segment of startups into direct (or aggregated) transactional businesses like e-commerce, local commerce, grocery shopping, food delivery, ride sharing, travel etc. e.g. BigBasket, Flipkart, Amazon, Grofers, Milkbasket, Swiggy, Dunzo, Uber, Ola, Yulu, Ixigo, MMT etc. You could also include the payment & fintech companies in this bucket – e.g. Paytm, Mobikwik, PhonePe, PolicyBazaar, Bankbazaar etc. This segment has absorbed the maximum PE & VC investments and is poised to become bigger with time.
5) Product Startups – Enterprise / CoreTech / Hardware: This is comprised of companies like InMobi, Zoho, Wingify, Freshdesk, Chargebee, Capillary, electric vehicle startups, drone startups etc. They could be serving Indian or foreign B2B markets.
6) Product Startups – Consumer Internet: This segment is composed of media/news companies, content companies, social & professional networking, entertainment, gaming etc. e.g. Dailyhunt, Inshorts, Sharechat, Gaana, Spotify, YouTube, video/photo sharing apps, Dream11 etc.

(N.B. Off course, this segmentation schema is not water-tight and there could be other ways to slice and/or label it)

Why India lags behind in Software Products?

The global software products industry has a size of $ 413 billion, and it is dominated by US & European companies. India’s share in that pie is minuscule – it is a net importer of $ 7 billion worth software products (India exports software products worth $ 2.3 billion, while it imports $ 10 billion). “Software is eating the world” – entire industry segments are being re-imagined and transformed using the latest developments in cloud computing, artificial intelligence, big data, machine learning etc. In this scenario, it is worth understanding why India seems to have missed the software products bus. The reasons are multifarious, cutting across cultural, economic, market, behavioural and societal factors –

a) The cultural aversion to Risk, Ambiguity & Failure: Indian society has traditionally valued conformity and prepares people not to fail. Our family and educational environments are geared for teaching us to eschew risk-taking and avoid ambiguity. But building products is all about managing risk and failure. When you take a product to market from scratch, you take on multiple types of risk – market risk, execution risk, product risk. For many people in India, this is in stark contrast to their social/attitudinal skills and expectancies they have built up over a lifetime.

b) “Arbitrage” offers the Path of Least Resistance: If you pour water down a heap of freshly dug mud, it will find the path of least resistance and flow along it. Human behaviour is similar – it is conditioned to look for the path of least resistance. And “arbitrage” offers that least resistance path in the IT industry – be it cost arbitrage, labour arbitrage, geographical arbitrage, concept arbitrage et al. The IT services industry leverages the cost arbitrage model via cheaper labour costs. Many of the transactional e-commerce startups in India have used geographical arbitrage to their advantage – once a successful product or model is created in another market, they bring it to India to capitalize on a local first mover advantage, build a large valuation and become the gatekeeper to the market before the (original) foreign innovators arrive in India many years later! But arbitrage means, that while you are taking on market & execution risk, you are not assuming the product risk. These dynamics played out at scale over the years has meant it is easier for a wannabe entrepreneur in India to go the arbitrage way and quickly build out a business using a readymade template than go down the software products path, which has a much longer gestation & higher risks associated with it.

IMHO, this “arbitrage” factor represents the single biggest reason why India has seen a virtual explosion in e-commerce startups, at the expense of product startups. Look around the startup ecosystem and you’ll see all kinds of transactional businesses involving activities like buying, selling, trading etc. Why… this almost reminds of that famous 17th-century quote by Napolean when he described Britain as a “nation of shopkeepers”🙂

c) Tech isn’t enough – you need design, marketing skills: To build great software products, you not only need strong technical abilities but also good design, marketing & branding skills to carve out a compelling product offering. Ask any startup in India – one of their most common problems is the inability to hire good designers and UX professionals. This puts Indian companies at a comparative disadvantage – even if they have the engineers to build the technology, their inability to translate that technology into an appealing user experience often means the difference between success and failure.

d) Lack of “patient” venture capital: This is a complaint you hear often from Indian product startups – the lack of venture capital that’s willing to be patient over the longer gestation cycles software products demand. While there is some truth to it, the more likely explanation is that software product companies present a “chicken & egg problem” for Indian startup investors. Investors are driven by financial returns – if they see returns from product companies, they’ll bet their monies on them. It just so happens, that Indian investors haven’t yet seen venture sized returns from software product companies. Hopefully, this dynamics will even out as the ecosystem grows.

e) Inadequate Domestic Market Potential: Many software products are monetized via subscription models, where the market’s ability (and propensity) to explicitly pay for the service is critical for success. Sometimes (SAAS/enterprise) companies try their model in India, only to discover there just aren’t enough paying customers. These startups may then be left with no choice but to either target foreign markets, or in extreme cases just move abroad for business continuity. Thus it has become imperative for the Indian domestic market to grow in size and scale to ensure the viability of product startups.

Platform companies from India are a non-starter: One aspect that needs calling out specifically is the sheer absence of any platform companies from India. Platforms are the next evolutionary step for scaled software product companies – if you get to the stage, where other industry stakeholders start building on top of the plumbing you’ve provided (thereby becoming totally dependent on you), that’s an immensely powerful position to be in e.g. AWS, Android, iOS etc. This factor assumes even greater importance given upcoming trends in AI, machine learning, deep learning, automation, robotics – the companies which emerge as platform providers may offer strategic advantages to the country of their origin. As depicted by the graphic below, India is as yet a non-starter on this count. This is deeply worrying – imagine a scenario 10-15 yrs out, when Indian software companies start dominating the domestic markets and also are a force to reckon with globally, but it’s all built on intellectual property (IP) & platforms created & owned by foreign companies!!

Some Suggested Action Areas for the National Software Policy:

MeitY in consultation with industry stakeholders is likely to create an implementation roadmap for #NSPS. Here are some specific action points I’d like to call out for inclusion in that roadmap:

Domestic Market Development: As explained earlier, the Indian domestic market needs curated development to reach a potential that makes product startups viable without having to depend on overseas markets. This calls for a series of steps, such as policy support from sectoral regulators, funding support via special go-to-market focused venture capital funds etc. The government could also help by announcing a preferential procurement policy from domestic software product companies. The Government e Marketplace (GeM) can help in institutionalizing these procurement norms.

Creating Early Awareness (Catch ‘em young): Fed by constant news in media about IT services, ITES, BPOs, outsourcing etc the average person in India is likely to be aware of IT services, but not necessarily software products. Many people may have friends and family members who work at TCS, Infosys, Wipro, IBM etc, but the same can’t be said about product companies. Given this scenario, it is important to create early awareness about products in schools, colleges, universities across metros, Tier 1, Tier 2 & 3 towns. Some of the world’s biggest product innovators like Bill Gates, Steve Jobs started writing software before they had reached high school – so if we can catch people young, we actually get a much longer runway to get them initiated into the product ecosystem. If they learn about products after they’ve started working in the industry, or when planning a mid-career shift from services to products, it might be quite late.

Reducing entry barriers for starting Software Product Companies: As shared earlier, one of the big problems in the Indian software product space is that there just aren’t enough entrepreneurs starting up product businesses. E-commerce & transactional services actually absorb (or suck in) a lot of entrepreneurial talent by virtue of having lower barriers to entry. To make a serious dent in products, you need a much larger number of product companies started off the ground. This can happen only by systematically bringing down the entry barriers – driving awareness, providing funding support, providing market development support etc. Advocacy and evangelism by software product industry role models also can help develop confidence and conviction in people to think products instead of services or e-commerce.

Building domestic Software Product Companies atop public goods: Silicon Valley has shown how you can build successful commercial applications on top of public goods (e.g. Uber built on top of GPS, Google maps & mobiles). In a similar way, public goods in India like IndiaStack, or HealthStack can be the base (or the plumbing) over which commercial applications get built for mass scalability. The good news is this trend has already been kickstarted, though its still early days.

This blog was first published at Webyantra.com

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#4 Reimagining Cancer Care

In the last few months, I have had the opportunity to work closely with the National Cancer Grid – a network of 150+ cancer centres in India – and in the process, better understand the workflows involved in different medical processes and the requirements of medical professionals. I have closely observed care delivery, interviewed cancer patients and oncologists, learnt about current challenges and about initiatives being undertaken by NCG and other organisations to tackle them.

This blog post is an evolved version of an earlier post, where I had talked about the use cases of health data and the implementation of a PHR (Personal Health Record). Of these, I believe that the biggest use of health data will be in improving the quality of care in complex medical cases (either acute like surgical procedures, or chronic like cancer). In this post, I will use cancer care to exemplify this.

Core idea
Let us visualise a specific application for cancer care, with oncologists as its primary users. There are only around 1000 trained oncologists in India, so let’s assume that all of them are users of this application. Let us also assume that clinical data of all patients treated by these oncologists is conveniently accessible through this application (with due privacy and security measures). What will these users do now?

Expert consultation
I attended a Virtual Tumour Board run by the National Cancer Grid – a weekly remote consultation program run on Saturday mornings where teams of doctors voluntarily join to discuss well-documented cases and their potential treatment plans. VTBs are run separately for each speciality (like head & neck tumour, gynaecology, neurology, etc.), which means that it takes up to 4-6 weeks for one’s turn. Doctors usually do not have the luxury of such long waiting periods, and therefore turn to individual consultations which are often not documented, depend on informal connects and are sometimes made with incomplete data. Formalising this process and making it asynchronous can be of huge benefit to all medical professionals.

Care team collaboration

Complex medical procedures often involve a team of doctors and other medical professionals, working responsibly for a given patient. A significant percentage of all deaths due to medical negligence is caused by lack of communication between the care team members. The communication process today is paper-based and unstructured, leading to accidents that can, in fact, be prevented – especially with the growing use of IoT devices and voice-based inputs. (I saw one such application at Narayana Health being used by their ICU teams).

Performance evaluation

Lack of organised data, changing patient care-providers and long feedback loops make it difficult for medical professionals to monitor their performance. Can we empower them with tools to do so? Doctors today lack visibility on the outcome of the treatment given and rely on intuition, experience or techniques tested in developed countries for care delivery. Such a tool would not only help doctors improve their performance, but also improve the trust equation with their patients.

User Experience
There are three crucial elements for enabling a good user experience:

Data input – Most EHR systems require text input to be typed in by doctors. This makes it difficult to use. Other input techniques for automated data transcription like touch, voice, or other innovative methods for data capture will need to be explored. Additionally, interoperability across all systems and devices will be key in enabling access to all data.

Data interpretation – Sorting through a patient’s health records takes up a substantial amount of time of a physician, especially when the data is unstructured. Developing intelligence to sort the relevant records as per the case in question will significantly enhance the user experience of the product.

Safety and Privacy– All solutions should ensure complete privacy of patients. This could mean access controls, electronic consent, digital signatures, digital logs, tools for data anonymisation, etc. it might also be important to perform basic verification of users of the platform.

Value Discovery
The value of the platform will increase as more and more physicians become a part of it. For example, an endocrinologist might need to consult a cardiologist in a case of disease progression, or an ENT specialist might need to consult an oncologist to confirm a diagnosis. More importantly, the platform will also drive innovation, i.e., other use cases can be developed on top of it. For example, the expert opinions mentioned above can also be used for consulting patient remotely, pre-authorising claims, forming medical peer review groups, etc. Similarly, working care groups can also simultaneously enrol staff for upskilling (as practised today in an offline setting), and information about treatment outcomes can help guide better research.

Next steps
We remain on a quest to find use-cases for PHR since we believe technology pilots alone would not be enough to drive its adoption. In that context, we are looking for partners to experiment with this in different healthcare domains. If you are interested, please reach out to me at [email protected]!

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#3 What does the Health Stack mean for you?

The National Health Stack is a set of foundational building blocks which will be built as shared digital infrastructure, usable by both public sector and private sector players. In our third post on the Health Stack (the first two can be found here and here), we explain how it can be leveraged to build solutions that benefit different stakeholders in the ecosystem.

Healthcare Providers

  • Faster settlement of claims: Especially in cases of social insurance schemes, delay in settlement of claims causes significant cash-flow issues for healthcare providers, impacting their day-to-day operations. The claims and coverage platform of the health stack is meant to alleviate this problem through better fraud detection and faster adjudication of claims by insurers.
  • Easier empanelment: The role of facility and provider registry is to act as verified sources of truth for different purposes. This means a convenient, one-step process for providers when empanelling for different insurance schemes or providers.
  • Quality of care: The use of personal health records can enable better clinical decision making, remote caregiving and second opinions for both patients and medical professionals.

Insurers

  • Faster and cheaper settlement of claims: claims and coverage platform, as described above
  • Easier empanelment of healthcare providers: registries, as described above
  • Diverse insurance policies: In addition to the above benefits, the policy engine of the healthstack also seeks to empower regulators with tools to experiment with different types of policies and identify the most optimum ones

Researchers and Policymakers

  • Epidemiology: the analytics engine of the healthstack can be helpful in identifying disease incidence, treatment outcomes as well as performance evaluation of medical professionals and facilities
  • Clinical trials: a combined use of analytics and PHR can help in identifying requirements and potential participants, and then carrying out randomised controlled trials

How can it be leveraged?

While the healthstack provides the underlying infrastructure, its vision can be achieved only if products benefitting the end consumer are built using the stack. This means building solutions like remote second opinions using health data from healthcare systems, as well as developing standard interfaces that allow existing systems to share this data. In the diagram below, we elaborate on potential components of both of these layers to explain where innovators can pitch in.

If you are building solutions using the health stack, please reach out to me at [email protected]!

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India powers up its ‘Software Product’ potential, Introduces National Policy on Software Products (NPSP)

This is an exciting occasion for our indigenous software industry as India’s National Policy on Software Products gets rolled out. This policy offers the perfect framework to bring together the industry, academia and the government to help realise the vision of India as a dominant player in the global software product market.

For ease of reference, let us summarise some of the major things that the policy focuses on

  • Single Window Platform to facilitate issues of the software companies
  • specific tax regime for software products by distinguishing  them from software services via HS code
  • enabling Indian software product companies to set off tax against R&D  credits on the accrual basis
  • creation of a Software Product Development fund of INR 5000 crores to invest in Indian software product companies
  • grant in aid of  INR 500 Crores to support research and innovation on software products
  • encouragement to innovation via 20 Grant Challenges focusing on Education, Healthcare & Agriculture thus further enabling software products to solve societal challenges
  • enabling participation of Indian software companies in the govt. e-marketplace to improve access to opportunities in the domestic market
  • developing a framework for Indian software product companies in government procurement.
  • special focus  on Indian software product companies in international trade development programmes
  • encouraging software product development across a wide set of industries by developing software product clusters around existing industry concentrations such as in automobile, manufacturing, textiles etc.
  • nurturing the software product start-up ecosystem
  • building a sustainable talent pipeline through skilling and training programmes
  • encouraging entrepreneurship and employment generation in tier II cities
  • creating governing bodies and raising funds to enable scaling of native software product companies.

There is good cause for cheer here. The policy offers to address many of the needs of the Software Product Ecosystem. For the first time, HS codes or Harmonised Codes will be assigned to Indian software product companies that will facilitate a clear distinction from ‘Software Services’ facilitating availing of any benefits accruing under the ‘Make in India’ programme. In addition, this will enable Indian software product companies to participate in govt contracts through registration on GeM (Govt. eMarketplace).

Considering that we remain a net importer of software products at present, steps such as the inclusion of Indian software products in foreign aid programmes, setting up of specialised software product incubators in other geographies and promoting our software product capabilities through international exhibitions definitely show intent in the right direction. With a commitment to develop 10000 software product start-ups, with 1000 of them in tier II cities, technology entrepreneurs building IP driven product companies can now look forward to infrastructural and funding support. The policy also aims to go beyond metro-centric development with a commitment to develop tech clusters around existing industry concentrations, enable skilling and drive employment in non-metros and tier II cities while actively encouraging Indian software companies to solve native problems.  

This policy could not have been possible without the vision of the Honourable Minister Shri Ravi Shankar Prasad, and continuous engagement and discussions with Shri Ajay Prakash Sawhney, Rajeev Kumar and Ajai Kumar Garg from MEITY and their team.

We have seen software companies solving native problems do exceptionally well, just look at what Paytm has been able to achieve while driving digital payments in India. There is now an understanding ‘Make in India’ can help us bridge the digital divide given that Indian entrepreneurs have a greater understanding of local issues and the challenges that are unique to us.

Setting up bodies such as the National Software Products Mission in a tripartite arrangement with the industry, academia and govt. to enable creation and monitoring of schemes beneficial to native software product companies is another much-needed step that will create a forum distinct to our software product companies and help give them a strong voice.

We would like to thank Lalitesh Katragadda, Vishnu Dusad, Sharad Sharma, Rishikesha T Krishnan, Bharat Goenka, T.V. Mohandas Pai, Arvind Gupta for their diligent efforts on the continuous dialogue and inputs for the policy.

While launching the policy is a great start, its implementation is what we all will have our eyes on. Now is the moment of action. We all look forward to fast-tracking of the various proposed measures under this policy for the benefits to start showing!

Website link to the official policy –  (https://meity.gov.in/writereaddata/files/national_policy_on_software_products-2019.pdf)

References

J​ANUARY​​ 15, 2019​ – ​https://tech.economictimes.indiatimes.com/news/internet/india-needs-to-win-the-software-products-race/67533374

DECEMBER 8, 2016​ – ​https://pn.ispirt.in/what-to-expect-from-draft-national-policy-on-software-products/

NOVEMBER 13, 2016​ – ​https://pn.ispirt.in/national-software-policy-2-0-needed/

MAY 10, 2016​ – ​https://pn.ispirt.in/taxation-and-digital-economy/

APRIL 29, 2016​ – ​https://pn.ispirt.in/saas-the-product-advantage-and-need/

JULY 16, 2014​ – ​https://pn.ispirt.in/government-recognizes-the-software-product-industry/

DECEMBER 11, 2013​ – ​https://pn.ispirt.in/three-waves-of-indian-software/

JULY 16, 2013​ – ​https://pn.ispirt.in/smbs-and-indian-software-product-industry-intertwined-fortunes/

JULY 4, 2013​ – ​https://pn.ispirt.in/8-truths-why-it-services-organizations-cannot-do-software-products/

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An Afternoon With Don Norman In Bengaluru

Are you building products for the everyday user? Is it becoming harder and harder to manage complexity while maintaining usability? How do you design a sustainable system for a complex multi-stakeholder environment? How do you teach a user to use your product with good design? How do you reinvent an established business model in light of rapidly evolving markets and technological possibilities? How do you design a product to be truly human-centric?

If any of these questions sound relevant to you, here’s an opportunity to seek answers on 22nd February in Bengaluru! 

About Don Norman

Dr Don Norman is a living legend of the design world having operated in the field for over 40 years. He has been Vice President of Apple in charge of the Advanced Technology Group and an executive at both Hewlett Packard and UNext (a distance education company). Business Week has listed him as one of the world’s 27 most influential designers. Dr Norman brings a unique mix of the social sciences and engineering to bear on everyday products. At the heart of his approach is human and activity-centred design, combining knowledge of cognitive science, engineering, and business with design.

Presently, he is Director of the recently established Design Lab at the University of California, San Diego where he is also professor emeritus of both psychology and cognitive science and a member of the Department of Electrical and Computer Engineering. He is also the co-founder of the Nielsen Norman Group, an executive consulting firm that helps companies produce human-centred products and services.

ProgrammeTalk

Don will share valuable insights about his interactions with Indian people, products and experiences.

Fireside Chat

An informal discussion with Don about his learnings and experiences spanning his long and illustrious career.

How to participate?

We’re inviting engineers, product managers, designers and everyone else who is building for large scale impact.

If you would like to further your understanding of human-centric design and hear straight from the horse’s mouth, please register here by 18th February. (An invite will be sent out to selected participants by 21st February)

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iSPIRT Presents Poster Session & Product Discussion With Don Norman

Don Norman, the pioneer of design in the 21st century, is visiting India. Presenting you with an opportunity to engage with the living legend in a closed-door interaction where you can discuss your solution/product and get unbiased feedback on 20th February 2019 in Bengaluru. 

We’re looking for solutions in the social space that are building for the next 500 million in India.

About Don Norman

Don Norman is Director of the recently established Design Lab at the University of California, San Diego where he is also professor emeritus of both psychology and cognitive science and a member of the Department of Electrical and Computer Engineering. He is the co-founder of the Nielsen Norman Group, an executive consulting firm that helps companies produce human-centered products and services. He is an honorary professor of Tongji University’s College of Design and Innovation (Shanghai). He serves as an advisor and board member of numerous companies and organizations. Norman has been Vice President of Apple in charge of the Advanced Technology Group and an executive at both Hewlett Packard and UNext (a distance education company).

Agenda

Poster session  – Show us what you’re working on and how your solution is better in a poster format.

Product Teardown – Engage with Don over your product and discuss what you’re doing well and what can be done better.

If you are interested or know someone who would be interested in growing through this experience, please do register or help them register here by 15th February 2019. Since this is a curated event and there are limited seats we would request you to kindly apply at the earliest. (An invite confirmation will be sent shortly after registration)

For further query, you can write to us at [email protected]