Dr Vaibhav Agrawal, Dr Soumik Kalita and Dr Devashish Saini, Founders, PrimaClinics

PrimaClinics, healthcare with entrepreneurial spirit

In the age of specialized medical care the age old family doctor has slowly been edged out. The safety and comfort levels one enjoyed with a family doctor has become a thing of the past or has it? Three doctors turned entrepreneurs have used the “family doctor” concept at the heart of their business idea to bring an old school value back to life. Dr Vaibhav Agrawal, Dr Soumik Kalita and Dr Devashish Saini are the founders of PrimaClinics a health care venture that promises to be more than just a medical solution.

We spoke to the young doctor entrepreneur Dr Devashish Saini who took some time out of his packed schedule to answer our questions on entrepreneurship and the PrimaClinics business idea…

How would you describe the health care services that the PrimaClinics business idea offers?

Prima Clinics is a chain of every-day care clinics providing quality health care services - consultation, dispensary, laboratory, diagnostics, vaccinations and minor procedures - all under one roof, at a price affordable to urban Indians. We proactively share information and knowledge with our patients, and develop care plans in close consultation with them, providing personal attention and care for the whole family. Our clinics run on established protocols, we pay close attention to detail and strictly adhere to standards of quality, with a vision to create an enduring institution delivering primary health care services with more than 100 clinics across India by 2014.

How is PrimaClinics not like other 'other healthcare institutions'?

At the core of our business model, we provide our patients the kind of care and service they used to get with their family doctor: A doctor who knows them and their whole family, gives them time, has their complete trust and shares their concerns and dreams. In each Prima Clinic, our patients get the same kind of service and even better quality care, at a price affordable for everyone.

We are going to focus on rapid expansion throughout India, executing standardized practices and protocols in each clinic. This allows the creation of a unique Continuum of Care - where a patient can walk into any Prima Clinic anywhere in India, and receive the exact same

standard of care and service!

We are going to revolutionize healthcare in India in several ways: our patients are empowered by the information we share with them, and become responsible towards improving and maintaining their own health; our doctors and nurses are empowered through expansion of their role to cover more and more clinical and administrative roles; we are going to be the only entity in India providing affordable care for chronic health diseases like high blood pressure and diabetes, which are going to be the biggest killers of Indians in the decades to come, with India poised to become the diabetic capital of the world.

Following are some of the specific ways we are going to differentiate ourselves, and maintain our differentiation from competition:

- Expansion of the doctor's scope of practice by creating treatment protocols for all common   healthcare problems

- Expanding the nurse's role as Care Coordinator on the lines of the Nurse Practitioner in the West

- Introducing easy-to-use, high-end, Stage 4 Electronic Medical Record for easy storage & retrieval of clinical information, clinical decision support, efficient billing, scheduling & reporting

- Conducting health awareness campaigns through camps and banners with evidence-updates

- Identification of urban areas for expansion where Prima Clinics will be the 1st primary health provider

- Creating career-advancement models for our staff, incl. ownership of their own Prima Clinic over time

How was the business idea for PrimaClinics chalked out?

The idea for Prima Clinics was independently envisaged by the founders. Over the last several years working in different setups ranging from a rural primary health care centre to CMC Vellore and AIIMS, we were acutely aware that urban India faces the significant challenge of large scale immigration coupled with the lack of a formal health delivery mechanism like PHCs in rural India. In addition, specialization of health care has gradually eroded the role of the "Family Doctor" who was responsible for the overall health of the urban Indian family thus making healthcare prohibitively expensive with the lack of one stop clinics for the family. A major reason for doctors opting for specialist courses rather than practice as generalists is the lack of career pathways and peer pressures pushing doctors into pursuing specialized courses. Also, most of existing GPs are not trained in updating their knowledge thus depriving the populace of evidence informed health care (EIHC).

As a result of this amalgam of accessibility, affordability, quality and information problems that middle-income India faces, chronic diseases like hypertension and diabetes mellitus, as well as acute infectious diseases are inappropriately treated, and often go untreated.

While Devashish was attracted to the great opportunity offered by the absence of quality healthcare services in India, Soumik had always wanted to do something actionable about the pathetic condition of India's healthcare scenario. We met each other and Vaibhav, and the idea clicked with all three. We decided to pilot the idea with our own funds and incorporated the company in April 2010.

We spent the initial three months brainstorming about what services to offer, hunting for the right location, and searching for reliable backend suppliers. We were helped in this by several advisors and three interns from IIT-Delhi, TISS Mumbai and Delhi University. After hunting for suitable staff for more than a month, we serendipitously found Dr Gurpreet Kaur for the role of Family Physician, and Perry as our Care Coordinator. (Later Vivek joined as Office Executive).. We opened the first clinic on June 12, 2010, kick starting it with a hawan and a blood donation camp.

Since then we have been working continuously to strengthen our processes, constantly improve the quality of care we deliver, spread awareness in the surrounding communities, and increase the breadth of services we offer. We have conducted 4 health camps, distributed pamphlets in newspapers and door-to-door, sent SMSes, placed ads on local cable TV, etc etc. But increasingly more and more of our clientele is coming in through word of mouth of our existing

customers. This has been the greatest validation of our service quality and model!

Most recently, we have introduced vaccines for children and adults, as well as health checkup packages in our clinics.

Please tell us more about the people behind PrimaClinics

Prima has been founded by 3 doctors with diverse experience and training:

Dr Vaibhav Agrawal

Vaibhav pursued his MBBS at T.N.Medical College and BYL Nair Ch. Hospital in Mumbai. He has been working at Sir Ganga Ram Hospital, New Delhi for the last one year. In addition, he has extensive clinical experience in the United States in a variety of clinical settings including Cornell University, New York and Northwestern University, Chicago.

Dr Devashish Saini

Devashish pursued his MBBS from AIIMS, New Delhi followed by Master of Science in Health Informatics at the University of Alabama at Birmingham. While in the US he also completed a year-long surgical internship at the University of Missouri-Columbia. He returned to India in 2008, studied entrepreneurship at the SP Jain Institute of Management and Research, Mumbai and joined Swasth India Services wherein he helped design and build low-cost low-overhead health systems for the Indian poor.

Dr Soumik Kalita

Soumik works as a Senior Researcher in GlaxoSmithKline Beecham. Apart from his degree in medicine he has been trained in critical care medicine, hospital administration and was a Legacy Heritage scholar for the Masters of Public Health programme at the Hebrew University of

Jerusalem. He has also been trained in cardiovascular epidemiology and community oriented primary care. In his more than 12years of experience, he has worked in several positions ranging from a medical officer in a primary health centre in rural India, to a research scientist, to head of strategy development and epidemiology.

Does Prima Clinics have any tie ups and recognition that adds to its credibility?

Bhaichung Bhutia Football Schools is a one-of-its-kind initiative by Bhaichung Bhutia, the dynamic Indian football skipper in association with Football By Carlos Queiroz, the internationally acclaimed Portuguese football academy. BBFS promises a truly world class coaching experience with exposure to international training methodologies under the guidance of senior coaches from Portugal. Prima Clinics are the official healthcare partners of BBFS covering the regular training sessions, tournaments and all other activities of BBFS.

We have had consistently positive feedback from patients. 100% of our patients are satisfied with the care they received at Prima, the staff's professional behaviour and the minimal waiting time. The best evidence of acceptance is when they come back with their family members and recommend their friends to visit us.

What are the goals and projections for PrimaClinics in the coming years?

Healthcare in India is going to get more and more expensive due to indiscriminate use of insurance and lack of government focus on urban health care. India is poised to become the diabetes capital of the world, and without appropriate lifestyle changes, the average urban Indian is going to face significant risk of heart disease. Appropriate primary care and continuity of care for chronic diseases like diabetes and high blood pressure are going to become major challenges. The current trend of investment in the healthcare industry is focused on building more and more corporate hospital chains, which are not going to solve the above problems, being too expensive for the average Indian.

Prima Clinics plans to grow and create presence all over India, in all metropolitan areas and Tier-II cities of India by 2015. We will have opened 400 Prima Clinics, all providing standardized quality service and care. We will have served 1 crore unique Indians. In addition, Prima will have contributed significantly to research in the field; answering questions about clinical care, as well as identifying best practices in health care management.

How have you positively monetized the PrimaClinics business idea?

Each Clinic has four major sources of revenue:

1. Consultation Fee, comparable to other GPs in the area; no charge for follow-up upto 7 days

2. Dispensing of common medications

3. Lab Services - Collecting samples and outsourcing to a quality lab

4. Minor Procedures - including vaccinations, injections, nebulizations, stitches, dressings etc.

We have created a financially lean model of clinic setup and operations. Each clinic becomes cash neutral within 6 months and we plan to recover all invested cost within 1 yr of operations.

Additional revenue is anticipated from corporate tie-ups and membership plans.

What makes you happiest about your entrepreneurial journey and what challenges you?

We love the fact that we are doing something uniquely innovative, and at the same time working to solve one of our country's biggest problems. We derive energy from the fact that Prima is doing something that the government in India has tried to do for 60 years and failed.

There are learnings each and every day, ranging from profoundly personal ("Wow! I can do this too!!") to professional ("Now I know all that is there to know about Unilateral Renal Agenesis!") to managerial ("We now have a better stock management system!"). Our skills are complementary and we take care of separate verticals of the business, which allows us to further hone and develop our specialized skills.

The biggest challenge is to find the right people and the right service providers. At all low points, our greatest comfort is that there are two more of us working on the same shared vision!

What is the man power set up like for a PrimaClinics team?

Each clinic has a family physician (MBBS doctor) and one or two ancillary staff (nurses by training).The core management team consists of the 3 founders. In addition, we have 3 advisors:

- Praneet Gupta, B-Tech (IIT-Bombay), MBA (Kellogg), ex-BCG, currently working in Booz & Co.

- Dr Jogesh Ahuja, ex-Navy, IIM-Ahmedabad, who has worked in a variety of settings ranging from Industry, field research, primary care as

well as secondary hospitals.

- Dr Priyank Jain, MBBS from AIIMS, post-grad training in Internal Medicine from US, currently working in Boston as a physician

We are hiring physicians and nurses for our current and future expansion plans.

What are the current expansion plans that PrimaClinics has set about to accomplish?

Prima is currently expanding in Gurgaon. We plan to have 10 clinics in NCR region by end of 2011. After that we are envisaging a period of exponential growth, within NCR region as well as all metropolitan areas and Tier II cities of India, reaching 100 clinics some time in

2014 and 400 clinics in 2015.

Over time we plan to backwards integrate into laboratory and diagnostic services. We plan to buy medications and consumables directly from manufacturing companies to ensure the best quality at lower cost. We will establish formal research wings to improve clinical quality as well as establish best practices in management.

What are the average figures on the services and people that PrimaClinics has provided for?

We have provided care to 1000 unique patients so far. They have included people from all walks of life (lawyers, engineers, construction workers, teachers), all age groups (2 mth - 80 yrs) and

all kinds of complaints (healthy people for vaccination, cough, cold, fever, high blood pressure, diabetes, conjunctivitis, asthma, pneumonia etc etc). We have provided home-based care to several local residents, immunized several children and adults.

Initially, most patients walked in after seeing our display board. We got several referrals from helpful doctors and chemists in the area. But more and more, we are seeing patients who have been referred by friends or family members who have been to Prima before.

While all other consumer-facing businesses see a spike in sales around Diwali, healthcare is the one big exception. In the bonhomie of the festive season, people postpone, downplay or downright ignore their health problems! We learned this the hard way on our first Diwali this

year!

We wish the good doctors trio of Dr Vaibhav Agrawal, Dr Soumik Kalita and Dr Devashish Saini, many happy entrepreneurial years of care and service at PrimaClinics. To learn more on their hands on personal approach to medical care visit their website at www.primaclinics.com

Keep watching this space for regular updates on PrimaClinics.